Vital Sings: Flying Eye Hospital

Premieres: June 22, 2020.

Sanjay Gupta: 00:03

It’s a Tuesday morning and this operating room is buzzing.

Dr. Tom Johnson: 00:07

Suction please. [inaudible 00:00:09] trauma.

Sanjay Gupta: 00:11

Dr. Tom Johnson is an oculoplastic surgeon and today he’s working with a team to fix a fracture around this man’s eye. Down the hall, another team led by Dr. Annette Giangiacomo is using a laser to treat a patient with glaucoma. It’s what you’d fine on any given day at ophthalmology clinics all over the world. There’s just one thing that might surprise you here, this is all taking place on an aeroplane. This is Vital Signs from Yaounde, Cameroon.

Sanjay Gupta: 00:53

Okay. Before you ask, no, it’s not actually flying. Operations only happen when the plane is on the ground, but that doesn’t make it any less impressive. It’s a massive logistical undertaking that began long before the first patients ever arrived. Last year, the shipping company Federal Express, more commonly known as FedEx, donated one of their cargo planes to Orbis, a nonprofit organisation that works to promote eye health around the world through awareness, treatment, and training. This is their third plane, affectionately known as the Flying Eye Hospital. That’s exactly what it is, a fully functioning, self contained hospital that just happens to have wings. It was retrofitted with at full surgical suite and recovery room.

Sanjay Gupta: 01:41

Because it’s a teaching hospital, there are also training simulators and a classroom section in the front of the plane where the local doctors can watch live operations in 3D as well as interact with surgeons in the operating room.

Dr. Giangiacomo: 01:53

Nine years.

Sanjay Gupta: 01:55 Dr.

Giangiacomo who was working in the laser room is an ophthalmologist based in Atlanta, Georgia. I caught up with her before the trip at Emory Healthcare.

Sanjay Gupta: 02:04

The eye is fascinating and obviously people take for granted, I think, a lot of times is this particular sense. When you’re a medical student doing this rotation, what is it about the eye and ophthalmology that interest you?

Dr. Giangiacomo: 02:17

I think the coolest thing for me was how much it can tell you about the body in general. It tells you so much about diabetes, problems with the brain, such as stroke, all types of neurological problems or primary care problems that you don’t expect to see as a medical student and how it all really is connected and can you tell you so much more than you might expect from two little eyeballs.

Sanjay Gupta: 02:39

Right. There’s various diseases in ophthalmology, various diseases of the eye. Are there ones that are of particular interest to you?

Dr. Giangiacomo: 02:48

I’m a glaucoma specialist. I treat both adults and children with glaucoma. It’s my passion and I really love the primary care aspect that glaucoma treatment does allow for me, but it gives a balance with some surgical and laser treatments that we’re able to provide as well.

Sanjay Gupta: 03:04

If a patient comes to your office and you’re about to tell them they have glaucoma, what is it that you’re telling them? How do you describe it?

Dr. Giangiacomo: 03:11

I describe it as a disease that often goes undetected because it really is considered the silent thief of vision. I tell them it’s problem with their eye that results in damage to the nerve of their eye and that the main risk factor for it is the pressure in their eye and so the way we treat it is to really lowering the pressure in their eye. I discuss with them the need to follow up with us, to assess it thoroughly because of the way that it can cause damage without them knowing.

Sanjay Gupta: 03:42

There’s nerves obviously in the eye, but also behind the eye. If the pressure builds up in the eye, it’s affecting their vision. It’s causing pressure on those nerves.

Dr. Giangiacomo: 03:53

Exactly.

Sanjay Gupta: 03:54

Dr. Giangiacomo took an Orbis trip to Ghana last year, but it was hospital based. This will be her first time operating on the Flying Eye Hospital.

Sanjay Gupta: 04:03

We hear about these big medical ships, ships like the Comfort, that go in and provide care. They’re these big ships. I’ve seen them. I’ve been on those types of ships. Why a Flying Eye Hospital? What’s the real benefit to that?

Dr. Giangiacomo: 04:19

Well, the benefit is that everything that’s needed is encased within this hospital and it can arrive to many different locations within a country, rather than an area of a country that borders water. The Flying Eye Hospital goes on many, many trips a year and in countries all over the world and they’re able to provide care wherever there’s an airstrip that they can land.

Sanjay Gupta: 04:43

They land, everything they need is on the plane. As a surgeon, everything you need to be able to take care of a patient is right there.

Dr. Giangiacomo: 04:51

This is what I hear. I have to tell you last year my trip to Ghana was the hospital based programme, so I’m super excited this year to be involved with the Flying Eye Hospital and see what it has to offer. I can’t imagine, but yes, everything is on that plane.

Sanjay Gupta: 05:05

According to the World Health Organisation, an estimated 253 million people have vision impairment. Here’s the thing, the WHO also says more than 80% of all vision impairments can be prevented or cured. The key is awareness and early detection, whether it’s cataracts, a clouding of the eye, or glaucoma, Dr. Giangiacomo’s specialty.

Sanjay Gupta: 05:28

Somebody had loss of peripheral vision, you’re saying that’s the type of vision loss they might have. At least initially, how soon do they get that vision back after this operation?

Dr. Giangiacomo: 05:39

That is the one thing that’s unfortunate with glaucoma is that you can’t regain the vision. Unlike other neurological problems, the nerve does not regenerate or repair itself. Our goal is prevent further vision loss, and so we’re aiming to treat eyes that have better visual potential to try to allow these people to have continued ability to maintain their jobs and contribute society.

Sanjay Gupta: 06:01

They really have to be caught early then to get the best benefit?

Dr. Giangiacomo: 06:04

The earlier the better, for sure.

Sanjay Gupta: 06:07

In Cameroon, the need for doctors trained in ophthalmology is huge. Cameroon has a population of roughly 24 million people and only 73 registered ophthalmologists, according to Orbis. That’s just one for 329,000 people. This is the third time Orbis will visit the country. Before any operations can begin, the first step is patient screening at Yaounde Central Hospital.

Dr. Giangiacomo: 06:32

Is the vision about like it was before surgery, approximately?

Sanjay Gupta: 06:36

Dr. Giangiacomo meets with several patients the first day, including Joseph.

Dr. Giangiacomo: 06:41

It looks like a very good [inaudible 00:06:42]. Look straight ahead. Look right at my eyes.

Sanjay Gupta: 06:45

He’s 74-years-old and has glaucoma. The doctors decide he’s a good candidate for an operation and schedule him for the next day.

Dr. Tom Johnson: 06:53

How long ago was his fracture?

Sanjay Gupta: 06:56

It’s the same for 40-year-old Serge. He’s in a consult with Dr. Tom Johnson, the oculoplastic surgeon. Serge had a motorbike accident in February of 2017 that fractured the orbital bones around his eye.

Dr. Tom Johnson: 07:09

These are pretty good size fracture here of the orbit. The orbital floor is very much depressed. Medial wall is fractured too.

Sanjay Gupta: 07:20

Serge will have surgery on the Flying Eye Hospital tomorrow. He’s anxious but excited. If it goes well, he’ll be on his way to getting his life back to normal. What’s it really like to perform surgery on an aeroplane? We’re going to the operating room next.

Sanjay Gupta: 07:41

Early morning in Cameroon’s capital city of Yaounde. This group of doctors and nurses from around the world, including the United States, India, and South Africa are spending a week here. Once they’re done, a new group of doctors will arrive. It continues for four weeks. At the moment, this group is headed to airport. They are boarding a plane, but they won’t be going anywhere. Instead, they will perform operations sitting on the tarmac in what’s called the Orbis Flying Eye Hospital.

Dr. Tom Johnson: 08:14

Sometimes, this is associated with …

Sanjay Gupta: 08:17

Dr. Tom Johnson first started volunteering with Orbis in the mid 1990s. He’s done more than a dozen of these trips since then and says the excitement never wears off. As an oculoplastic surgeon, he fixes issues relating to the eye, around the eye, like tumours or fractures.

Dr. Tom Johnson: 08:34

I like my specialty oculoplastic surgery because it’s a very diverse specialty. I do surgery on eyelids, on the tear ducts, on the orbit, reconstructed work, cosmetic work, tumour work, oncology. It combines everything in the ophthalmology with the rest of medicine.

Sanjay Gupta: 08:53

This particular plane is only a year old, so it’d be the first time he’s operating on it. It is state of the art, but there’s always an element of the unknown.

Dr. Tom Johnson: 09:02

To be part of the Orbis team, I think you need to be very flexible. You’re travelling to a different country, working with different people that you haven’t worked with before in different operating rooms with different equipment, so you have to be very flexible, be able to improvise.

Dr. Giangiacomo: 09:18

In general, blunt dissection is safer than sharp dissection.

Dr. Tom Johnson: 09:23

One of the main things that is important is to be a good teacher because the purpose of Orbis is to teach. You need to be very patient with your trainees, you need to be very informative, be able to pass on your knowledge to them because what we do here is not to try to do as many cases as we can leave as to try to leave behind our knowledge so the doctors that we train can continue using the skills we teach them to treat a lot more people. That’s how I think we make the biggest impact.

Sanjay Gupta: 09:59

Professor and doctor Epee Emilienne is one of the local doctors partnering on this mission to train and learn from the Orbis volunteers.

Dr. Tom Johnson: 10:07

You can see with the titanium I can actually bend it like this and it’s going to stay how like it.

Sanjay Gupta: 10:13

Dr. Epee was born and raised in Cameroon. She studied medicine in Germany.

Dr. Emilienne: 10:18

The most fascinating aspect of the eye is that [inaudible 00:10:23] somebody coming to life. When you saw children coming, they can’t see, then they’re given glasses and they start getting excited, looking left and right like now, I see, I see. When you don’t what is going on, you don’t understand and I really was, I’m very curious, so I decided ophthalmology was something that I could do. There’s a big need and from that day, we noticed the gap between the need and what we can do is big. I will say that when I first came, when I started working, we did the first campaign on glaucoma in 2002 for the [inaudible 00:11:01] and we had to discover a lot of glaucoma. We thought that cataract was the problem, but glaucoma was doing more because glaucoma was doing irreversible blindness.

Dr. Emilienne: 11:13

Everybody not even know. The majority of the people would not believe that something can be done for the eyes.

Sanjay Gupta: 11:19

Dr. Epee first started collaborating with Orbis several years ago, working the advanced teams who come to Yaounde ahead of these trips.

Dr. Emilienne: 11:27

The Flying Eye Hospital for me was a hope. I studied ophthalmology. I did up to a certain level and I came. I didn’t have somebody on top of me to correct what I was doing. As a student, you need to be mentored, even if you finish. What I learned was what I learned and that [inaudible 00:11:49], taking around all the mistakes. The Flying Eye Hospital coming with people [inaudible 00:11:55] go to internet and see who they are. I knew that I’m going to benefit, but you know where you could read it. You can even watch the video where somebody had to tell them this is where the problem is. This what you could change.

Sanjay Gupta: 12:10

Dr. Epee will learn a lot working with Dr. Johnson this week, but it goes both ways.

Dr. Tom Johnson: 12:16

It’s always kind of a give and take. I learned a lot from them as well and I think we form a partnership, a collaboration when we’re seeing these patients. They might not always agree with my treatment plan, and so we may discuss different options. The interesting thing about my specialty is there’s really no one right way to treat each problem. You can treat different problems in a variety of ways. Sometimes, we have our different preferences and so forth. It’s always good to learn from each other.

Sanjay Gupta: 12:50

Because the primary mission is to be a teaching hospital, it’s not about seeing as many patients as possible, but rather seeing the right patients. For a diverse specialty like oculoplastics, Dr. Johnson will do several different types of operations designed to teach a wide range of skills.

Dr. Tom Johnson: 13:08

We’re trying to show a variety of different techniques in a limited amount of time. I think that’s the most difficult part that we can’t really do surgery on every single patient. We pick out representative cases and patients that really need the surgery the most. Patients that have scarred eyelids that are endangering their vision because of exposure of the front of the eye, the cornea, patients that have tumours that maybe needs to be diagnosed to continue treatment. Again, that’s the difficult part is to choose the number of patients we have time to perform and have representative cases of the main disease processes that local doctors want to learn about.

Sanjay Gupta: 13:55

The goal is for the surgeons in Cameroon to then be able to operate on more types of patients once the Orbis team leaves. Serge is one of the selected patients who will have surgery this week on the plane. Patients are transferred by ambulance from the Central Hospital to the airport. This is the first time Serge has ever stepped foot on a plane.

Dr. Tom Johnson: 14:17

Well, he’s a young man who was involved in an accident in February, I believe. He had a large fracture of two of the walls of his orbit. The one on the floor, below his eye, and the one on the inside by his nose. What’s happened because of that is his eye has sunken back quite a bit.

Serge: 14:37

I was coming [inaudible 00:14:38] riding the motorbike, then the accident happened. I cannot tell you [inaudible 00:14:44] unconscious. I just recover four days after. I was not able to speak, to see so I cannot tell you the detail of the accident.

Speaker 6: 14:55

When was the last time you had something to eat or drink?

Sanjay Gupta: 14:58

Serge is a veterinary technician in a rural area outside of Yaounde. His job requires travelling on a motorbike, which he hasn’t been able to do since the accident.

Serge: 15:08

I cannot see backward, up, down, and even side. When I try to look up like that, I will see image double.

Dr. Tom Johnson: 15:19

It can be a challenging surgery, especially when it’s been many months since the trauma. Because as time goes on, patients develop more scar tissue and the scar tissue forms along the fractured bones and at times, you really have to very carefully peel that scar tissue off, avoiding damaging some of the muscles and nerves in the orbit so the patient can have normal function again. It can be kind of challenging.

Sanjay Gupta: 15:51

Surgeons feeling confident and hopeful. As trainees watch the operation on the television outside the operating room, Dr. Johnson and his team begin working to repair the fractured bones. A new implant will help lift the orbit floor, elevating Serge’s eye back to a more normal position. That should correct his double vision. Dr. Johnson also cleared out scar tissue that had prevented Serge’s eye from moving normally. After an hour and a half, the operation is over. There was one surprise, an old implant from a surgery right after Serge’s accident that he didn’t even know had been put into place.

Dr. Tom Johnson: 16:28

Surgery went very well. We were able to take out the old implant. I think the volume has been replaced very nicely. I think all the tissue that was caught in the fracture has been freed up, and so I’m hopeful he’s going to do very well.

Sanjay Gupta: 16:42

Dr. Giangiacomo prepares for her first operation on the Flying Eye Hospital. It’s Joseph’s turn next.

Sanjay Gupta: 16:51

From the outside, it looks like a standard aeroplane. Inside, it’s anything but ordinary.

Jonathan Lord: 16:59

Every time I come on this plane, I still actually get that buzz of excitement, after 11 years of working with Orbis, the previous plane and this plane, because now …

Sanjay Gupta: 17:06

Dr. Jonathan Lord is the Global Medical Director for Orbis.

Jonathan Lord: 17:10

I wasn’t amazed that you can actually put a fully functional hospital in a plane. We all come onto planes used to seeing multiple rows of seats. You forget how much room there is. This hospital meets all current US standards. It is fully accredited in the US as an ambulatory surgery unit. All we need is a runway we can land MD-10 aircraft on. That’s a prerequisite. We need aviation fuel and we need water. Other than that, we are entirely self contained.

Sanjay Gupta: 17:42

The plane has its own unit to sterilise instruments and equipment, can produce its own medical gases, runs on its own power generators, medical translators, in this case speaking French the official language of Cameroon, are brought in to help the doctors communicate with each other and with the patients.

Jonathan Lord: 17:59

The Flying Eye Hospital is sort of United Nations for us. We have at this point and time, I think on this programme, about 19 different nationalities. They speak between them over 25 different languages. Here in Cameroon, we’ve got a long term project with the Yaounde Central Hospital and Magrabi ICO Vision Institute and there are over 500,000 people here in Cameroon who are either blind or have low vision. 75% of it, 375,000 people here have treatable disease.

Sanjay Gupta: 18:36

To treat those diseases, Orbis team members are training local Cameroonian doctors on simulators throughout the plane. Dr. Tom Johnson just completed an operation on his patients Serge, who’s currently in recovery. Now, it’s Dr. Annette Giangiacomo’s turn. She scrubs in for surgery ready for a procedure to treat Joseph’s glaucoma.

Joseph: 18:36

[inaudible 00:19:00].

Translator: 19:00

After my retirement, I began to see poorly. I went to the hospital and spoke to Dr. Epee. She’s the one who gave me an exam and after that exam she saw that I had the beginnings of glaucoma. I really couldn’t tell because glaucoma is not painful. My eyes didn’t hurt. It was during that exam that we began to detect that I had glaucoma, in 2013 I believe.

Sanjay Gupta: 19:26

Joseph said he’s had eye exams before, but never any kind of operation.

Dr. Giangiacomo: 19:31

He’s a 74-year-old gentleman with advanced glaucoma and the pressure in his eye was running higher than ideal for the stage of disease. Also, he had trouble purchasing and maintaining the medication that he was on, so we decided to do surgery to try to lower the pressure in his eye and also achieve that long term with surgery rather than maintaining medications.

Sanjay Gupta: 19:58

Joseph’s treatment is a success. The next morning, all the patients who were treated on the Flying Eye Hospital are now back at Yaounde Central Hospital for their followup appointments, including Serge.

Dr. Tom Johnson: 20:10

Are you having much pain? Are you …

Serge: 20:12

No. No. No.

Dr. Tom Johnson: 20:12

No. It’s doing okay?

Serge: 20:13

Yeah. I’m okay now.

Dr. Tom Johnson: 20:14

Okay. Good. Serge, I going to take your patch off. It’s going to stick a little bit. He’s a little swollen here and here, but that looks good. He’s got very full movement.

Sanjay Gupta: 20:25

Dr. Johnson tells Serge he’ll have some swelling for a week, but the prognosis is positive. Hopefully, he’ll soon be back on his motorbike and back to work with his vision restored.

Dr. Tom Johnson: 20:36

Okay, Serge.

Serge: 20:37

Thank you, doctor.

Dr. Tom Johnson: 20:39

Thank you. Thank you. Thank you, sir.

Sanjay Gupta: 20:40

It’s looking good for Joseph, too.

Dr. Giangiacomo: 20:42

How does the eye feel today? Little scratchy? Okay. Now we talked yesterday, he had the [inaudible 00:20:48] component and he’s really nice and deep. It looks great.

Sanjay Gupta: 20:52

It will be a busy week for these volunteer doctors. After her followup with Joseph, Dr. Giangiacomo heads to the operating room at the Yaounde Hospital for another procedure. The room is full of observers.

Dr. Giangiacomo: 21:05

Take BSS.

Sanjay Gupta: 21:06

Dr. Giangiacomo wouldn’t want it any other way.

Dr. Giangiacomo: 21:09

If we can have a few x up here, Dr. [Xha 00:21:11] will need a few of these.

Dr. Giangiacomo: 21:13

It just reminds me that this is something that I want to keep going on in my career. It’s a great refresher of why I went into medicine in the first place is to teach people. We help patients on Orbis as well, but the goal really is to transfer knowledge and skills to the local doctors who really want to learn these things and do better. I just feel like it’s a wonderful opportunity that I’m very lucky to be a part of.

END