'The look on their faces is phenomenal to watch'

More than 600 people a year receive sight-saving surgery aboard the Orbis Flying Eye Hospital. Still, what the modified aeroplane leaves in its slipstream is much more powerful: some 2,100 local surgeons and eye care staff each year learn how to treat preventable eye diseases for countless others. Dr Ian Fleming, a volunteer anaesthetist, takes us through his day

I’ve always been aware of this enormous inequality in healthcare. Most of the healthcare needs are in the developing world. Most of the healthcare provision is not.

The Orbis Flying Eye Hospital is there to develop local services. We’ll do five to six eye operations a day, for two or three weeks, but the greater impact is that we teach the local surgeons. Orbis employs a small crew of some 20 doctors, ophthalmologists, theatre staff, nursing staff, flight technicians and biomedical engineers who travel with the plane. Then there are volunteers like me who join specific programmes; there might be 40 people in total, including two or three anaesthetists and around five surgeons.

I approached Orbis because I was looking for a development organisation. It took around 10 years to train to be a consultant anaesthetist and I commit around two weeks a year of my time, taken out of my annual leave.

They’re quite long days. The bus invariably leaves the hotel for the airport at about 7am and we don’t get back until 7pm. As soon as we reach the plane we can have the first patient on the operating table in 30 to 45 minutes.

The plane is totally self-sufficient, it has its own generators for heating, cooling and electricity that run off the plane’s own fuel. All the plane needs is steps up to it. Inside there is one operating theatre equipped with cameras and four recovery bays.

Programmes are divided into week-long chunks. The first week we’ll typically do surgery for cataracts and glaucoma, some of the most common causes of reduced vision and blindness. The second week covers different types of ophthalmic surgery, depending on each country’s need. I was in Kolkata last year helping develop glaucoma, cataract and paediatric services. Orbis has been extensively involved in India since 1988, and the Flying Eye Hospital has visited 15 times, four of those to Kolkata.

Mondays are screening days. Local ophthalmologists choose as many patients as they can find with a particular condition. My role is to assess the fitness and medical health of the patients they’ve chosen.

We’re looking for good teaching cases, those who have the most common eye diseases prevalent in the country. My job is to check the patients in and make sure they’ve obeyed all the instructions. For example, if someone is getting a general anaesthetic, I need their stomach empty to safely anaesthetise them. I use the World Health Organisation safety checklist: do we have the right patient, for the correct surgery and on the correct side?

It only takes five minutes to put in a local anaesthetic block – where the patient is awake but the eye is completely numb – and another five for it to work. If we’re giving a general anaesthetic it takes five to 10 minutes to get someone ready.

The look on their faces when the children realise mum or dad is no longer this blurred shape is utterly phenomenal to watchWe have hands-on trainees who are specifically attached to us for the week – they are primarily the ones we’re training. Because it’s a teaching programme, each surgery can take 90 minutes, even if it’s something that would take 20 to 30 minutes in the UK.

In a lot of developing countries anaesthetists are in short supply, so sometimes just one will train with me. At the start of the week I say, ‘Just assist and watch me’. It’s a pretty steep learning curve, but within a week or two they’re up and doing it. That’s when you know it’s going to work, if by the end of the programme they are doing the operation solo.

The plane really comes into its own in the teaching element. The front part of the plane has all the ordinary aeroplane seats – the classroom. It’s set up with audio-visual equipment for up to 50 ophthalmologists to observe the operating theatre on a plasma screen. The surgeon gives a running commentary, everyone sees the operation being done, and we can answer questions from the classroom, while doing the surgery. Surgeries go on right through the day. Patients wake up in our recovery bay and return to the hospital at the end of the day.

The most striking thing is helping young children with bilateral cataracts, who have had poor vision from birth. Quite often I don’t get to see them because I’m anaesthetising again the next day, but when I can be there to see the seals taken off for the first time, it is truly amazing. The look on their faces when they realise mum or dad is no longer this blurred shape – it’s utterly phenomenal to watch.

Typically we’re very well looked after by the local institution, which often wants to take us out for dinner as a thank you. By the end of the day I’m exhausted. But it’s very rewarding and inspiring, knowing that they will carry on the work and that there will be a ripple effect from our programme.

The most common frustration I have is the patients you see on screening day that we can’t help. Some of them will be patients with complex or advanced surgery that isn’t suitable for an Orbis programme, or their disease isn’t curable because it’s too far progressed. That’s very sad to see.

I’ve done 11 programmes with Orbis since 2005 in 10 countries, including Syria, Bangladesh, India and Nepal. One thing I really like about Orbis is that it recognises it’s not enough just to support the surgeon. I’m teaching the local anaesthetists, nursing staff are teaching the local nurses, theatre staff are teaching their counterparts – it’s this approach to supporting and developing the entire team that really makes the difference.