November 09, 2012

A Fairy Tale or Flying Eye Hospital?

Blog Post by Sarah Jacobs

Dr. Sarah Jacobs participated as an associate ophthalmologist during Week 1 of the ORBIS Flying Eye Hospital program in Addis Ababa, Ethiopia. She is a graduate of the Mayo Medical School in Rochester, MN.

This afternoon, at the end of a day of paperwork and eye drops and cleaning and more paperwork, there was a knock on the door of the plane (that phrase sounded a lot more normal until I actually wrote it out). A woman from the ORBIS Ethiopian office was standing outside on the stairs with a group of grade school children who had arrived for a tour. A lecture was underway in the front classroom, and a surgery was in progress in the back OR. We silenced the kids with stern hushing, then led them to the laser procedure room.

Sarah-Jacobs-Ethiopia-FEH small“Ugh. Think of all the equipment in here that they can wreak havoc on,” said my inner curmudgeon. “Ooh! Remember the first time you looked at an eye?" said my better self.

I took the kids to the slit lamp in pairs, with one child as the patient and one as the doctor. I turned on the lights and adjusted the beams and let them look at each other’s eyes. Every child came away with an expression of curiosity and discovery on his or her face, as if they had just seen something truly amazing. Have you ever had a moment when you perfectly, clearly, joyfully remember why you do what you do? This moment was one of mine.

I grew up on a dead-end dirt road called Poverty Flat, in a small, windy northern Arizona town. I was the youngest of 5 kids in a family living well below the poverty line – grimy faces, hand-me-down clothes, pinto beans for dinner, and a backyard well for water. For most of my childhood, the town lacked specialty healthcare. Even if it had been available, we wouldn’t have been able to afford it. My mom had her first stroke when I was 12, and the general sense in my family was to accept it as fate. When my dad had a retinal detachment, the nearest retinal specialist was 5 hours away. We were poor. Care was beyond reach. Nothing could be done to change it. I hated the feeling of helplessly surrendering. 

I studied hard, earned scholarships, and worked three jobs to put myself through college. I ploughed on through medical school, planning to pursue general family practice medicine. During my third year of medical school, I was on a service trip to the Dominican Republic where I worked with an ophthalmologist who changed my entire career trajectory. The people there had a local expression describing the blind: “Bocas sin manos,” meaning mouths without hands – people who must be fed but can’t do anything to contribute back to their families or the community. Think what an impact it can have on their productivity, quality of life, and sense of self-worth when their vision is restored.

Nearly 5 years ago, a South American woman told me a story about a gigantic airplane with an operating room inside that came to her city and made the blind people see again. Fairy tale. Or so I thought. This week, I found myself standing inside that airplane, volunteering as an associate ophthalmologist for ORBIS. I’ve been on medical service trips before – Dominican Republic, Ghana, Bolivia, Haiti, Chile, South Africa– but the ORBIS experience is distinct in several ways.  

On other trips, we would arrive with hundreds of pounds of medication and equipment in duffel bags, then screen and treat hundreds of people each day.  Every time, the same question haunted me:  “What happens after we’re gone?”  With ORBIS, an in-country doctor has been caring for the patients before we arrive, and continues to provide care after the plane flies away.

The purpose of and ORBIS Flying Eye Hospital program is not to perform as many cases as possible, but to teach new skills and stronger techniques to the local doctors and nurses so that they can continue the work for years to come.

For example, on Monday during the screening for children with strabismus (misaligned eyes), I met a local provider we’ll call Dr Z. He had been doing some straightforward strabismus surgeries, but was not comfortable with his ability to do more complicated cases. His eagerness to improve was striking. By Tuesday, he was sitting shoulder-to-shoulder with the ORBIS surgeon in the OR. By Thursday, he was operating confidently on complex cases. By Friday, he was planning when and how to arrange surgeries for his own patients. ORBIS treated 8 strabismic children during my week in Ethiopia. Dr. Z will hopefully treat thousands. 

November 30, 2011

Poverty, Cost-Effectiveness and Eye Care

Blog submitted by Barbara A. DeBuono, MD, MPH

Barbara A. DeBuono, MD, MPH is President and CEO of ORBIS

Cost-effective analysis is a measure that is discussed frequently in the context of healthcare in the United States. This process compares the costs and the benefits of a healthcare-related intervention. In the field of eye care it is clear that the benefits outweigh the cost.

On World Sight Day, I had the opportunity to attend a VISION 2020 congressional briefing in Washington DC with other eye care partners and government officials. The theme of the event was Cost Effectiveness of Blindness Prevention Activities. The event featured a presentation by Dr. Kevin Frick, professor at John Hopkins University Bloomberg School of Public Health and an expert in calculating cost-effectiveness of health care.

We all know that the cost of blindness and visual impairment in the United States is enormous. According to Dr. Frick, in the United States a blind individual aged 40 or older spends an extra $2587 on medical care every year. In 2008, the estimated United States societal medical cost of all blind individuals was $2.7 billion.1 Imagine what this would look like on a global scale.

When we apply these factors to the developing world, this cost goes beyond an economic and financial burden. Yet, we do not have strong data and research to support this assumption. What we do know is that blindness and visual impairment impact quality of life. In these communities, these conditions can hinder an individual’s ability to gain an education, gain employment and contribute to family financial stability. Ultimately, this can trap a family in a cycle of poverty. Studies have shown for example that individuals with cataract are more likely to be poor than those with normal vision.2

There has been little research to examine the correlation between blindness and poverty. ORBIS and partners in South Africa are currently working to help fill this gap. Using results of a household survey conducted by the South African War on Poverty Initiative, ORBIS and partners collected data regarding eye care in poor South African households. This will be followed by an analysis of the relationship between factors such as disability, access to healthcare and blindness. The results will be shared with the South African government for planning and advocacy purposes.  Examining blindness in the context of poverty can serve as a powerful advocacy tool for increased budget and attention to eye care services.

This is the data and information we need to put eye health on the global agenda. At ORBIS we hope to continue to work with global partners and use such data to advocate for increased eye care services and blindness prevention globally.

KZN launch21Oct11 (10)

Children perform at the opening celebration for the ORBIS supported Pediatric Eye Care Center in Durban, South Africa in partnership with the KwaZulu Natal (KZN) Department of Health. 

1. Frick, K. “Cost-Effectiveness of Blindness Prevention” Vision 2020 World Sight Day 2012 Congressional Briefing. Washington DC

2. International Center for Eye Health. (2009). Cataract Impact Study: Summary report. Retrieved from https://www.iceh.org.uk/display/WEB/Cataract+impact+study#