Global charity Orbis believes in a world where no one should be needlessly blind or visually impaired, and utilises a unique flying eye hospital to help achieve that goal. Charles Cunliffe visited it for GAR.

Orbis is an international charity with global headquarters in New York dedicated to fighting avoidable blindness. The organisation came about as a result of an alliance between the medical and aviation industries in the 1970s. The idea was fashioned due to the high costs of air travel at the time, making international travel for medical staff in developing countries prohibitive for participation in overseas training courses.

Even when doctors and nurses had the funds to train abroad, their ability to gain direct clinical experience was hindered due to strict licensing laws that often prevented them from performing surgical operations on patients. To combat this, a mobile teaching hospital was required.

Image © Charles Cunliffe

Image © Charles Cunliffe

In the 1970s, Albert Lee Ueltschi, one of the founders of Orbis along with business associate Fred Smith (founder of Federal Express) created a partnership. When Orbis was formed, Mr Smith helped Orbis with shipping supplies around the globe and subsequently provided maintenance when the organisation received their DC-10 in the early 1990s. This partnership is still going strong today.

The first Flying Eye Hospital took flight in 1982 following a grant from the U.S. Agency for International Development (USAID) and funds from a number of private donors which enabled the conversion of a Douglas DC-8 from passenger carrier to fully fledged teaching eye hospital.

The aircraft in question was a DC-8-21 registered N220RB; donated by United Airlines and the oldest DC-8 in their fleet at the time. N220RB was the 4th DC-8 off the production line at Long Beach as N8038D, taking its first flight on 02 Jan 1959. Entering service with United Airlines on 16 June 1960, the aircraft was converted to a DC-8-21 in May 1965 featuring more powerful Pratt & Whitney JT4A-3 engines making the originally fitted water injected JT3C-6 engines redundant. This allowed for a MTOW (maximum takeoff weight) increase, making the aircraft a perfect fit for a flying hospital. After conversion into a hospital, the aircraft flew its inaugural mission with Orbis to Panama in 1982. In its first two years of operation, the Orbis DC-8 visited 24 countries and hosted programs to support the hands-on transfer of surgical skills.

Image © Charles Cunliffe

Image © Charles Cunliffe

Through the introduction of more modern airliners in the late 80s, replacement parts and maintenance support became harder and more expensive to come by for the 30 year old DC-8 and it was clear that the aircraft would need to be replaced. This was achieved in November 1991 after generous donor support cleared the way for Orbis to purchase a DC-10-10 from Novair International. With the introduction of the new Flying Eye Hospital, N220RB (DC-8) was retired to the Datangshan Air Museum in Beijing in 1994, in recognition of where the aircraft flew its inaugural mission.

The DC-10 was re-registered N220AU from its British registration of G-GCAL and spent two years undergoing conversion, flying its first ever mission to Beijing in 1994. The DC-10, being a wide-bodied aircraft, offered many advantages over its predecessor, giving surgeons and trainees double the working space of the DC-8 and the flexibility to perform complex operations in a larger environment.

With the DC-10’s longer range, the Flying Eye Hospital could fly further to more countries, to aid with combating and preventing blindness.

Image © Charles Cunliffe

Image © Charles Cunliffe

To further expand their global operations, in 2011 Orbis announced the acquisition of an MD-10-30F as the organisation’s third generation Flying Eye Hospital. The DC-10 was not retired due to high hours or cycles but due to the on-board equipment becoming too old and costly to repair. The actual airframe did not have many hours to its name, but the avionics were outdated and lacked the sophistication of today’s airliners. The acquisition of the MD-10 allowed for a more flexible platform over its DC-10 predecessor.  It boasts an increased range over the DC-10 from 4,000 to 6,000 miles and requires only two flight crew instead of three.

The aircraft itself was donated by FedEx which crews and maintains the aircraft as if it is still flying scheduled services for the freight carrier. Currently, the flight crew is pooled of active duty FedEx pilots and also three retired FedEx pilots. The active duty pilots remain current on the type by flying MD-10/11 aircraft in mainline FedEx operations; the volunteer pilots also use their annual leave to fly Orbis missions. Typically three engineers fly with the aircraft – they are employed by Orbis and are also ex FedEx employees.

Because the aircraft was originally operated as a freighter (and is still certified as such today), the entire hospital is built as a series of customised modules and can be removed if necessary. The on-board hospital did not need to be specifically engineered or certified to fly on an aircraft, meaning costs could be kept down for the charity. Whilst in-flight, everything past the 46 seat classroom in the front section of the aircraft is de-powered and shut off but remains pressurised.

Image © Charles Cunliffe

Image © Charles Cunliffe

To power the hospital whilst deployed, the aircraft carries nine ground generators in the underbelly where cargo can be traditionally found on commercial airliners. These generators just power the hospital and operate completely separate from the MD-10’s own power systems, aside from using its fuel to power them. This setup allows the aircraft to operate in remote areas with limited infrastructure, allowing the aircraft to operate self-sufficiently.

Whilst already boasting a 46 seat training classroom where students can watch live 3D operations, the aircraft also has eight other rooms in addition to the cockpit. Throughout these rooms, the aircraft has 26 screens and monitors used to provide first class training through high-definition visuals.

To successfully create a fully-fledged flying hospital, 17.6 miles of cabling was required in order to provide power and redundancy measures. The aircraft can also carry 378 gallons of water and 40 tons of medical equipment.

Click below to tour the aircraft itself:

Typically the MD-10 flies less than 200 hours a year. In 2017, the aircraft has 33 sectors planned with an average flight time of around 4 hrs. To maximise efficiency, Orbis tends to group the programmes together to save flying over different continents to save fuel and time.

A Lasting Legacy:

Today the Flying Eye Hospital only accounts for one part of Orbis’s work, providing tailored, month-long training programmes alongside the organisation’s longer-term projects in-country. In 1999 Orbis set up its first full time programme in Ethiopia – with Bangladesh, China, India and Vietnam soon following, creating an initial five permanent countries for the organisation to work in. Always working in conjunction with the Ministries of Health, these programs were tailored to suit the needs of the individual ophthalmic communities and local eye care providers.

These initial five countries were chosen based on opportunities to train by judging local infrastructure and resources, urgency of need based on the magnitude of blindness in the local population and finally, the ability to operate safely in, and the stability of, the chosen country.

Image © Charles Cunliffe

Image © Charles Cunliffe

Today Orbis undertakes long term programmes in the following 18 countries:

Cameroon, Ethiopia, Ghana, Kenya, Malawi, Rwanda, South Africa, Tanzania, Uganda, Zambia.

Bangladesh, China, India, Indonesia, Mongolia, Nepal, and Vietnam.

South America:

These offices are run by local staff, who develop and implement projects in their local communities to improve eye care for the residents in urban and rural areas.

Orbis also operates fund raising offices in a further eight countries and since 1992, the Flying Eye Hospital has visited 81 countries and counting.

Image © Charles Cunliffe

Image © Charles Cunliffe

According to Orbis, there are 285 million visually impaired people worldwide, of which 39 million are blind – with a staggering 32 million of those cases being avoidable. Out of this total, 246 million have low vision, whether that be from cataracts, glaucoma or another cause of visual impairment. Orbis has stated that 80% of all blindness is treatable or preventable with 200 million cases being avoidable. In turn, around 90% of the world’s visually impaired people live in developing countries, hence why Orbis does so much work in these regions. Today, the top causes of blindness are: cataracts, glaucoma, and age-related macular-degeneration. This also ties in with the top causes of visual impairment. These being cataracts, glaucoma, and refractive errors.

As well as acting as a training facility, the Orbis Flying Eye Hospital also operates as an ambassador for global eye care health wherever it lands. This incredible aircraft, alongside the charity’s long term programmes, mean that Orbis is able to ensure a sustainable eye care legacy is left behind wherever it works.

GAR would like to thank Charles Cunliffe and Orbis, and also Geoffrey Holland (former Orbis CEO) and his son Charlie, for alerting us to the virtual tour.

For more information on the work of Orbis, visit