Calise, Alana

Salamanca, Omar

Soboka, Jibat G.

English

International Journal of Medical Students (IJMS)

 Experience    1 MD, Haramaya University, College of Health and Medical Science, Harar, Ethiopia. 2 MD, MSc, Orbis International New York, USA; Service of Ophthalmology, Grupo de Investigación Visión y Salud Ocular (VISOC), Universidad del Vall, Cali, Colombia. 3 MPH, Orbis International, New York, USA.  About the Author: Jibat Gemida Soboka is a new graduate of Ophthalmology from Addis Ababa University. I received the best resident research abstract of the 6th Congress of College of Ophthalmology for Eastern, Central and Southern Africa. Currently, I am waiting the International Council of Ophthalmology fellowship program.  Correspondence:  Jibat G. Soboka Address: Bati, Alem Maya, Ethiopia. Email: jibatgemida@gmail.com  Editor: Shawn Albers & Paul MacDaragh Ryan Student Editors: Nikoleta Tellios & Adnan Mujanovic Copyeditor: Andrew Stanton Kucey Proofreader: Adam Dinoff Layout Editor: Fatma Monib Submission: Nov 26, 2020Revisions required: Dec 20, 2020Received in revised form: Dec 25, 2020Acceptance: Dec 27, 2020Publication: Jan 11, 2021Process: Peer-reviewed Int J Med Students   •   2021  |  Jan-Apr  |  Vol  9  |  Issue 1                              DOI 10.5195/ijms.2021.848  |  ijms.info The International Journal of Medical Students 68 My Experience with Orbis International and the Flying Eye Hospital in Ethiopia Jibat G. Soboka,1 Omar Salamanca,2 Alana Calise.3  The Experience Approximately 80% of blindness in Ethiopia is avoidable. According to the national blindness, low vision and trachoma survey in Ethiopia, over 1.6% of the Ethiopian population is blind, and 3.7% live with low vision. This is higher than the world averages of 1.2% and 3.4%, respectively. The major causes of blindness and visual impairment are preventable or treatable, including cataract and trachoma.1, 2 Despite the huge burden, human resources available for eye health in Ethiopia are alarmingly low. There are approximately 140 ophthalmologists working to serve the millions of people who are blind and visually impaired, and more ophthalmologists are required to meet urgent eye care needs.3   The cataract surgical rate  in Ethiopia is 500 surgeries per million people, though the expected target is 2,000 surgeries per million.4, 5 This shows that eye care services need to be increased in Ethiopia to meet the burden of untreated eye disease.  Orbis International in Ethiopia Orbis is a global nonprofit that has been a pioneer in training eye care teams to prevent and treat blindness for nearly 40 years. Orbis began working in Ethiopia in 1998. Over the past 20 years, Orbis has achieved a lot in Ethiopia. One of the ways in which Orbis delivers training is through its Flying Eye Hospital, a state-of-the-art surgical teaching facility with an operating room (Figure 1), classroom, and recovery room, all onboard an airplane (Figure 2).6  The Flying Eye Hospital has visited Ethiopia five times, in 2003, 2005, 2006, 2012, and 2018, to provide additional training to address the burden of blindness and reduce the shortage of trained eye care professionals.7 The Flying Eye Hospital visits provided opportunities for Ethiopian eye care teams to develop their skills.8  My Experience I took part in a three-week Orbis project in Ethiopia from October 1-18, 2018, which provided ophthalmic training on the Flying Eye Hospital and at Menelik II Hospital (Menelik II), a teaching hospital in Ethiopia’s capital city, Addis Ababa. Eye care teams from other teaching hospitals and eye care centers across Ethiopia were trained as well. The project aimed to strengthen the capacity of eye health professionals by delivering subspecialized eye care services and residency training.  Patient Coordination As a chief resident, a key organizational role I held prior to and during the Flying Eye Hospital project was supporting case communication between Ethiopian ophthalmologists, visiting Orbis Volunteer Faculty (medical experts), and patients. I prepared case summaries and uploaded  the  data  to Orbis’s Cybersight telehealth platform, through Figure 1. Operating Room Within the Flying Eye Hospital    Figure 2. Patient Discharged After Treatment onboard the Flying Eye Hospital    which Volunteer Faculty could review the cases prior to arrival.9 Case types included newly diagnosed patients, known patients with complications or previously failed surgeries, and cases of academic importance. Patients were selected for treatment based on factors which included but were not limited to: suitability for teaching, having conditions affecting both eyes, blindness risk, age, and predicted surgical prognosis. However, treatment plans were discussed for all patients, whether or not they were selected for treatment. After online Experience   Soboka JG, et al.  My Experience with Orbis International and the Flying Eye Hospital in Ethiopia  Int J Med Students   •   2021  |  Jan-Apr  |  Vol  9  |  Issue 1                              DOI 10.5195/ijms.2021.848  |  ijms.info The International Journal of Medical Students 69 review by Volunteer Faculty, patients were selected for in-person screening, where the Ethiopian ophthalmologists and Volunteer Faculty worked together to determine a treatment plan. At the in-person patient screening, I was responsible for organizing the patient log books for the Ethiopian ophthalmologists and provided critical communication to patients about their treatment plan, logistics, and scheduling. In addition to patient organization, I was involved in a different training program each week.   Week One: Glaucoma Simulation Wet lab training included both lectures and simulated surgical training. As a chief resident, it was a great opportunity to simulate glaucoma surgery on high-fidelity model eyes. The wet lab training focused on trabeculectomy, a surgical technique to treat advanced glaucoma. I was able to practice every step of the surgery on the model eyes (Figure 3). The experience I was able to get using model eyes was less stressful as compared to real-time surgical training. At the end of the project, Orbis donated model eyes and wet lab equipment to Menelik II, so I have been able to continue to practice my surgical skills.  Figure 3. Simulated Surgery in the Menelik II Wet Lab    Week Two: Phacoemulsification Simulation This was my first experience using a virtual reality simulator for phacoemulsification surgery (Figure 4). Using the simulator onboard the Flying Eye Hospital, I was able to receive training and practice the steps required for a successful phacoemulsification case.  Live patient surgeries were broadcast from the plane’s operating room to its 46-seat classroom. Between simulation cases, I was able to watch live surgical cases, ask questions of the surgeons in real-time, and sit in on lectures. Through the simulation and live surgical case observation, world- renowned ophthalmic surgeons taught me about different surgeries to treat eye diseases. Figure 4. VR Magic Eyesi Surgical Simulator    Week Three: Hands-on Training in Medical Retina I was able to participate in a hands-on training, treating patients with retinal pathology. I was exposed to different methods and equipment used to diagnosis retinal disease, including indirect ophthalmoscopy, fundus photography, and optical coherence tomography (OCT). Most patients involved were diabetics with an eye complication called diabetic retinopathy. Diabetic retinopathy is one of the leading causes of blindness worldwide, and it is an emerging cause of blindness in Ethiopia.10 With guidance from Volunteer Faculty, I provided pan-retinal photocoagulation laser treatment for patients with diabetic retinopathy for the first time. At the three-month follow-up mark, the patients’ diabetic retinopathy was still under control.   Conclusion The opportunity to engage with and learn from world-class doctors was a great experience for me as a resident in Ethiopia. My experience with the Flying Eye Hospital was multi-faceted and fascinating. Orbis brought state-of-the-art services and education to Ethiopia, and the training was inspiring. I organized, observed, and trained both in simulation and with patients. The training improved my skills to provide quality eye care services in Ethiopia.  Through the Orbis training experience, the proverb “Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime!” will be a source of encouragement to serve and improve the future of eye care services in Ethiopia. The training I received will help me treat blindness now and in the future.          References 1. Berhane Y, Worku A, Bejiga AJAAFMoHoE. National survey on blindness, low vision and trachoma in Ethiopia. 2006. 2. Berhane Y, Worku A, Bejiga A, Adamu L, Alemayehu W, Bedri A, et al. Prevalence and causes of blindness and low vision in Ethiopia. Ethiopian Journal of Health Development. 2007; 21(3): 204-10. 3. Kletke SN, Soboka JG, Dimaras H, Sherief ST, Ali A. Development of a pediatric ophthalmology academic partnership between Canada and Ethiopia: a situational analysis. BMC Med Educ. 2020 Nov 16;20(1):438.  4. Palmer JJ, Chinanayi F, Gilbert A, Pillay D, Fox S, Jaggernath J, et al. Mapping human resources for eye health in 21 countries of sub-Saharan Africa: current progress towards VISION 2020. Hum Resour Health. 2014 Aug 15;12:44.  5. WHO. Cataract Surgical Rate.  2003; Available from: https://www.who.int/blindness/data_maps/cataract_surgery_rate/en/.  6. International O. Our work in africa. Available from: https://www.orbis.org/en/orbis-africa?geographicregion=www. Cited: December 18, 2020.  7. Hospital FE. What we are doing to tackle global blindness. Available from: https://www.orbis.org/en/what-we-do/flying-eye-hospital. Cited: December 18, 2020. 8. Szamocki SJIJoOP. Aboard the Flying Eye Hospital from London to Pampanga. International Journal of Ophthalmic Practice. 2014; 5(6): 237-40.  9. Cybersight. Online Training And Mentorship For Eye Health Professionals In Developing Countries. Available from: https://cybersight.org/online-learning/. Cited: December 18, 2020. 10. Azeze TK, Sisay MM, Zeleke EGJBrn. Incidence of diabetes retinopathy and determinants of time to diabetes retinopathy among diabetes patients at Tikur Anbessa Hospital, Ethiopia: a retrospective follow up study. BMC Res Notes. 2018 Aug 2;11(1):542.  Experience Soboka JG, et al. My Experience with Orbis International and the Flying Eye Hospital in Ethiopia  Int J Med Students   •   2021  |  Jan-Apr  |  Vol  9  |  Issue 1                              DOI 10.5195/ijms.2021.848  |  ijms.info The International Journal of Medical Students 70                                                Acknowledgments I would like to acknowledge Orbis International and the Senior Consultant Ophthalmologists from Addis Ababa University, Department of Ophthalmology. Conflict of Interest Statement & Funding The Authors have no funding, financial relationships or conflicts of interest to disclose. Author Contributions Conceptualization: JG & OS. Visualization: JG, OS & AC. Writing & Original Draft Preparation: JG & OS. Writing, Review & Editing: AC Cite as Soboka JG, Salamanca O, Calise A. My Experience with Orbis International and the Flying Eye Hospital in Ethiopia. Int J Med Students. 2021 Jan-Apr;9(1):68-70.  This work is licensed under a Creative Commons Attribution 4.0 International License ISSN 2076-6327 This journal is published by the University Library System, University of Pittsburgh as part of the  Digital Publishing Program and is co-sponsored by the University of Pittsburgh Press.  

My Experience with Orbis International and the Flying Eye Hospital in Ethiopia

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My Experience with Orbis International and the Flying Eye Hospital in Ethiopia

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