Dr. James Lehmann’s Full Circle Journey with ORBIS
Dr. Lehmann is a Cataract and Cornea Specialist from San Antonio, Texas. He served as an ORBIS staff ophthalmologist on the Flying Eye Hospital in 2005 and returns to ORBIS as a volunteer faculty member. This interview was conducted during his latest program with ORBIS in Addis Ababa, Ethiopia in 2012.
Interview and photos by Geoff Oliver Bugbee
What makes ORBIS unique compared to other NGOs is that we don’t just try to come into a region and do as many cataract surgeries as we can - which is helpful to people, but you leave and they are not able to replicate what you’ve done. What ORBIS tries to do is take a kind of integrated approach. It’s not just about the delivery of surgery. The nurses teach nurses how to scrub, how to sterilize instruments, how to maintain sterile technique. The anesthesiologists teach the local doctors how to monitor patients correctly, how to choose patients for surgery. The biomedical engineers do hands-on with the local biomeds and learn how to fix machines that are broken and do routine maintenance. And that is truly unique about ORBIS - so when the Flying Eye Hospital comes to Addis Ababa and they’re at Menelik Hospital, when they leave they’re leaving the ability to continue what has been taught.
What is the fundamental difference between working as a staff member with ORBIS on the Flying Eye Hospital and being a volunteer faculty surgeon?
When I was here in Addis Ababa for the first time it was 7 years ago as a staff ophthalmologist on this DC-10 plane. At the time I had just finished my residency and had signed up to work as a staff doc for a year. And now, coming back as visiting faculty is nice because I can see what a good impact ORBIS has had on Menelik II Referral Hospital. Their eye bank is functioning. I looked on the board the other morning and saw that they had harvested 127 eyes this year which is fantastic. The operating room seems to have better equipment, is better maintained, and they’re doing a higher volume of surgery.
On a personal note, it’s special to me because I’m able to teach these local eye docs now and it’s kind of coming around full circle. When I was an ORBIS staff doctor, I was more of a “helper” - organizing and doing the heavy leg work to support the whole dynamic process - much like the current crew who do it impeccably well. But for me, it’s kind of special knowing that I put in the time doing that then and now to come back as a visiting faculty because I know how hard it is to be a staff member on this plane. Not only that, what an honor it is to be picked by ORBIS to be a volunteer surgeon on a program. They have a lot of eye doctors who want to do this, so the trust that they’ve put in me is not taken for granted.
I’ve been impressed with how engaged the trainees have been here in Addis and the audience participants here in the Flying Eye Hospital classroom. They’ve been copiously taking notes, asking questions - I think there’s a thirst for knowledge that they have and it’s encouraging to be a part of that process.
Our goal this week was to essentially teach cataract surgery to higher level trainees that are already doing some specialty work. We focused on a wet lab where we would simulate the cataract surgery before actually doing it on the patients. It gave them the chance to get a feel for the instruments, get a feel for how the surgery goes - and all of it on these little clay eye models. My two trainees are in their forties and they’re already practicing consultants here in Addis - one of them does glaucoma surgery and one does retina. It’s important for them to learn this modern cataract technique - Phaco emulsification. It allows them to do combined surgeries so they can take care of both the glaucoma and cataract at the same time. The small incision cataracts which work well here also make it more difficult to do glaucoma surgery or retina surgery after the fact.
What motivates you to do this work?
As a cornea specialist I always get to see the happy endings - that is, the patient who has been the recipient of the cornea transplant and is seeing better. But I had the opportunity a couple of months ago to attend what was called a ‘Donor Quilt Ceremony.’ These were people whose family members had donated a cornea after they had passed away. Their pictures were sewn into the quilt. The family of the donor would tell their intimate stories to the recipients in the room. This powerful experience allowed me to see the other side of the coin. I saw the people whose loved ones’ cornea had given sight to somebody else and that was big for me because I only see the happy side of the picture. And here I was able to see how tragedy can sometimes lead to something fortunate.