SIGHTLINES EPISODE 4: AVIATION FOR GOOD TRANSCRIPT

Hosted by Dr. Hunter Cherwek, with guests Bruce Johnson and Maurice Geary.

Dr. Hunter Cherwek: Welcome to Sightlines. I’m Dr. Hunter Cherwek, Vice President of Clinical Services for Orbis International. In this series, we’re looking at how the fight against global blindness has been affected by the COVID-19 pandemic; the innovations that are making it possible to safely deliver urgent sight-saving care in the midst of it all; and what that work might look like going forward as we prepare for the “new normal.”

Today we’ll be taking a closer look at the Flying Eye Hospital which, for many, is synonymous with Orbis. The Flying Eye Hospital is a fully accredited surgical eye hospital and teaching facility housed on board an MD-10 aircraft. It was supposed to be headed to Zambia this summer, and I was supposed to go with it, but of course that project had to be postponed due to COVID.

Today we’re looking at the plane itself. If you’re into aviation, technology, or just cool ideas, you’re in the right place. First up, Maurice Geary, the Director of the Flying Eye Hospital, will walk us through the plane room by room. Next, we’ll talk with Bruce Johnson, Director of Aircraft Operations and Maintenance, about the engineering of this one-of-a-kind aircraft, and what goes into flying and maintaining it. We’ll also talk about where the plane is now and what’s happening with it during the COVID lockdowns.

But first, here’s a crash course on what we’re talking about: Hundreds of millions of people around the world are blind or visually impaired, and most of them don’t have to be. 75% of cases could be treated or even entirely prevented. But the vast majority of these cases are in countries where the access to treatment is hard to come by. Orbis is working to change that, using strategic local partnerships, the time and talent of our volunteer experts from around the world, and innovative tools like Cybersight and the Flying Eye Hospital.

As you might imagine for an eye health organization, we had big plans for 2020. And, as you could probably guess, those plans had to change once COVID arrived. So we’re figuring it out, navigating this crisis and adapting for the “new normal.”

Some terms you’ll hear throughout the episode:

Cybersight – that’s our e-learning and telemedicine platform.

Volunteer Faculty – those are the expert ophthalmologists, nurses, and other medical professionals who donate their time and share their skills.

And now let’s get into it. Here are excerpts from my talk with Maurice Geary, Director of the Flying Eye Hospital, taking us room by room through the plane.

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Dr. Hunter Cherwek: Maurice, I'd like to talk with you a bit. You might have the most interesting office in the world. Maybe you can tell us a little bit about what is the Flying Eye Hospital? How does it work, not only in the air, but on the ground? Maybe you could tell us about your office and a typical day for you?

Maurice Geary: Sure, I'll try and tell you about the office. I'm not sure that there is a typical day on the Flying Eye Hospital, but I will try. So, the Flying Eye Hospital is a fully accredited hospital inside an MD-10 aircraft. So what we have is a hospital with a focus on training, so we have a training hospital inside a cargo plane. So the way, sort of the way it looks is at the front of the plane, we have what looks like a regular airplane seating area. We have 46 seats. So when we fly, some of our crew can actually fly on the plane in those passenger seats and then when we land and we convert the plane into a hospital that becomes our classroom.

So at the front of the room there in the classroom, we deliver lectures. Our volunteer faculty between their surgeries deliver lectures there. We also have a screen at the front of the classroom, which we have cameras in the microscope in our operating room on the plane that is connected to that screen, so we can watch live exactly what the surgeon is seeing in the operating room through his or her microscope.

The surgeon also then wears a microphone and whatever they're saying is broadcast in the classroom and we can ask questions from the classroom through a mic, which is broadcast in the operating room. So we have created a teaching hospital where we can see exactly what the surgeon is seeing through the microscope and we can also have a real time conversation. So, the surgeon will typically explain the procedure that they're doing step by step and, if the doctors who are in the classroom have questions, we can relay those questions to the surgeon.

We’ve got the classroom at the front of the plane. Behind that, we then get into our hospital. So to start off, we have a few very small offices for our support teams: logistics, finance, AV, IT. And then, behind that, we get into our patient care and laser treatment room closer to the center of the aircraft. In that room is where the patients and their family member come in the morning before their surgery and we register them and take all their details there on the plane. Also in that room, we have some equipment, where we can do laser procedures, if required.

We also have things like a slit lamp, which the ophthalmologists use to do an inspection of the eye, if needs be, and we have some of our simulators, so we can deliver training for simulated surgical techniques. Then, behind the patient care and laser treatment room, we have our operating room, so we have a one-bed operating room in the center of the aircraft. Our operating room is really the state-of-the-art and, behind the operating room, we have a sterilization unit. So we do a lot of really important training there on infection control on proper techniques for sterilizing equipment, so we have the ability to sterilize the equipment that comes from the operating room. We sterilize it right there on the Flying Eye Hospital and it's ready for use in sterile conditions. Behind that unit we have our recovery room. It’s also where the patients come after the surgery, so we monitor the patients while they're recovering from the surgery.

Dr. Hunter Cherwek: Also, people don't realize that, while the front of the plane has 46 seats, you have used the broadcast capabilities now where we can have the entire world watching the surgeries and lectures in that classroom. And we've had many instances where we have as many countries watching as we have seats in the classroom. So, that is just a huge advancement and a way of multiplying the teaching impact of the plane. You also talked about the laser room. I know that with the simulation you actually can turn that also into a simulation center. Maybe you can talk a little bit about how the plane is a platform for simulation as well.

Maurice Geary: Yeah, there are so many changes that we are bringing in in the last few years, and particularly with the growth of Cybersight. That’s given us so many advantages through the Flying Eye Hospital as well. We now have a platform where we can broadcast those surgeries from the Flying Eye Hospital live to an audience of medical professionals all over the world. Like you said, we can have 46 people in the classroom, but we can have 125 people watching from 60 different countries around the globe. It's really incredible.

In terms of the simulation center, that's, again, something new which we brought in the last few years is using that space of the hospital that we have and turning that entire space into a mobile simulation center. So, one of the things that we do during the Flying Eye Hospital project is when we do live surgical training, we always run two operating rooms. So, we run one operating room on the Flying Eye Hospital and we always run one operating room at the partner hospital as our host for the project. We then swap the teams that are working at those two locations throughout the project so that the doctors get exposure to our state-of-the-art hospital in the Flying Eye Hospital and then we also bring the training to their operating room in their hospital and work with them and the resources that they have available locally.

The same thing with the simulation center. We can bring this mobile state-of-the-art simulation center around the world and we can show by example what can be done with these new technologies. We also then work with our local partners to create WetLab or simulation center in their own hospital. And those simulation centers can take a huge range of technologies and resources – from artificial intelligence, very advanced RS surgical simulators, down to low tech solutions, teaching surgeons about refined control by peeling grapes using their surgical tools. And so you've got a huge range of what you can do and we always try and bring the state of the art, but also apply it to a local context.

Dr. Hunter Cherwek: You know, for me, one of the things that Maurice and I have talked about in the past is really that the Flying Eye Hospital is like the Flying United Nations. Maurice, maybe you can talk about the diversity of the team, not just the geography of the team, but also their backgrounds, their trainings, where they come from, academically and geographically?

Maurice Geary: It's one of the great joys of working on the Flying Eye Hospital is that we have a team that has such diversity. I have a team of 27 people on the plane. I think that the last count we were 16 different nationalities. You have people coming from medical backgrounds: ophthalmology, nursing, anesthesia. You have people coming from an aviation background, people coming from logistics, program management, finance, communications. So to get all those people together with the diverse international backgrounds, different professional backgrounds, and to bring all those together and see it gel is something really amazing.

One of my favorite days on the project is actually the day after we arrive in country. We spend one day converting the plane from an airplane into a hospital. It's one of the hardest days. It's hard physical work often outside in the sun and the heat and the humidity, but the whole team just comes together and everybody on that team just knows what they have to do, they know their job and everybody works incredibly hard for the whole day. At the end of the day, you've changed something from an airplane into a hospital and it's incredible to see it.

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Dr. Hunter Cherwek: That was Maurice Geary, Director of the Flying Eye Hospital, walking us through the plane. You can actually take an interactive virtual tour of the Flying Eye Hospital on our website at orbis.org if you’d like to see it for yourself. And now that you have a sense of what the Flying Eye Hospital looks like when it’s in hospital mode, let’s look at the flying part of it. To help us do that, I spoke with Bruce Johnson, Director of Aircraft Operations and Maintenance. We talked about how the plane was built, what’s happening with it during the pandemic, and what the future might hold. Here’s the interview.

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Dr. Hunter Cherwek: I'm very, very happy to have with us today, Bruce Johnson. Bruce is an incredible human being and one of the key people with the Flying Eye Hospital. Tell us how you got involved with Orbis and how Orbis got in your blood?

Bruce Johnson: Well, I’ve happened to be at FedEx in the DC-10 training program, so I was aware of Orbis. And then in 2005, my manager at FedEx asked if I would like to be a volunteer crew member on the DC-10 for Orbis, so that's where I sort of started. I knew about them before but started in 2005 to 2008 as a volunteer crew member and in 2008 became the Director of Aircraft Operations and Maintenance for Orbis.

Dr. Hunter Cherwek: Yes, and obviously, FedEx is critical to our ability to operate the Flying Eye Hospital. And you know FedEx and you were actually part of the FedEx family and company. Certainly we are incredibly appreciative not only that they donated the plane, but they continue to supply us with the parts, the pilots, the simulation training, all of those things that, you know, are critical to running an aircraft and the Flying Eye Hospital. For those who don't know, Orbis first took flight in 1982 with a DC-8 plane. In 1994, it was upgraded to a DC-10, a much larger plane allowed for much more space in the classroom. Then in 2016, we upgraded to the MD-10. So the 3rd generation plane that Bruce is now running and flying all over the world is the third plane that Orbis has operated. We only operate one plane at a time. The prior two planes are actually in museums; one is in China and the other is in the United States. Bruce, maybe you can tell us about the history of this specific plane, the third generation MD-10. Tell us when it was first built and the different functions and the different owners it's had throughout the years.

Bruce Johnson: Yes, this airplane came out of the factory, the Long Beach factory—I believe it was March of 1973. It was 1973 for sure; I can’t remember if it was March or April. But TransAmerica took possession of it and it came out as a combo aircraft, both a passenger and a freighter. In fact, I believe, it set one of the records at the time, the highest record for the amount of freight that would carry was one of the record setters when it came out. It then went from TransAmerica to FedEx in 1981. In 1981, it transferred into a pure freighter and it stayed at FedEx from 1981 until 2010 when it was donated to us. And then, it was put into modification in 2012 and then it's in its current form from 2016 to now.

Dr. Hunter Cherwek: Maybe you can talk about the engineering and how difficult it was to get a US accredited hospital inside of a plane and get it through all the regulations, all the engineering so that it's possible to do this, no matter where we are in the world.

Bruce Johnson: We started from the very beginning with all these people involved: FAA, FedEx, the aircraft engineering, the medical, the clinical team, and we put a concept paper together and we basically agreed to each step by step. Although the aircraft is considered a freighter, we had to apply for a special exemption to carry the number of people that we do aboard the airplane. Again, they are not passengers, but they’re our staff. We have 46 seats in the classroom area and then, of course, we have some flight attendant seats and the seats in the cockpit, so the airplane is capable of carrying 52 people, but, again, its main purpose is to be a hospital and we needed to figure out a way to protect that. So we had to take the rigid 9G barrier that used to be up close to the cockpit – which would protect the flight crew from the freight behind it – we had to slide that back to a position where the hospital would be behind it.

Our team that we were flying had to be before that, so that was our first big engineering feat was to move that. And we had to reinforce the aircraft to a point where that could be attached at that point and then we had to engineer an aircraft certified pallet that the hospital could be loaded on and then installed in the airplane with a cargo loading system, which nobody had a cargo loading system like that before, because we actually had the pallet go all the way across,

I think it's 217 inches across is the width of that pallet, that single pallet, and then of course it's, I think, 125 inches long and the reason for that size is to get through the cargo door and then we would match the hospital to that and then slide it back and join them within the airplane.

On the old aircraft, we would plug in the electrical power for the hospital into the plane. The plane would then convert it to the hospital needs, because aircraft use 400 cycle power for hospital equipment use 50 or 60 cycle power. So there's a lot of differences there on this model airplane. We had to separate that. So, none of the aircraft systems’ air conditioning, electrical, emergency lights, fire warning systems, none of the aircraft systems are in the hospital. The hospital has its own systems and are connected only on the ground, so none of the hospital is functional in flight. It's only on the ground. Then, we have to have a separate set of generators, air conditioning, that we set on the ground and run into the hospital, not part of the plane. So it was it was a pretty big engineering feat, needless to say. And then we had some issues, like, a hospital if it has an over pressure to oxygen generator for somebody that just blows it into the atmosphere. Well, you can't just blow 100% oxygen into the cabin of the airplane, so we had to find a way to take that oxygen from the hospital and get it out of the airplane. So there were some unique factors that we had to deal with during this modification.

Dr. Hunter Cherwek: Absolutely. I mean, there is no other Flying Eye Hospital in the world, I can tell you as the user of the hospital, it is an engineering masterpiece. For those who don't know, when we land at an airport and convert to the Flying Eye Hospital, the only thing we ask of our partners are stairs, patients who need our help, and doctors and nurses that want to work with us. Everything else, the airplane is completely self-sufficient. It has its own oxygen concentrator, electrical backup, water purification systems, and Bruce and his team found all these ways to make all of those critical hospital systems inside of a plane and allow us to go around the world and deliver the best training and the best clinical care possible.

One of the questions I have for you, obviously, right now, we're recording this during the COVID crisis. How has that impacted the Flying Eye Hospital? Where is it parked and what must you do to maintain it, even during the COVID crisis?

Bruce Johnson: So since we're not flying the airplane, those people that are not actively flying at FedEx on the MD-10 must have three take-offs and landings every 90 days so that training needs to continue. They have to have a proficiency check every six months, they have to have an instrument check every six months, so that training has continued regardless. Some of our team has had to travel to Memphis, which is where our training center is – that continues. The aircraft itself, we had two choices: we could have put the aircraft in long term storage and only done the storage requirements, but that would have been when you pulled it out of storage, you would have had a great deal of work to do to get it back in shape to be able to fly and, since we didn't know when we were going to fly again, we elected to keep the airplane in flight status.

So, we're doing all the maintenance. I was just doing this morning, I was just running through the task cards for the check we’ll do the end of July, first part of August. The airplane’s parked at the Alliance Airport at Fort Worth at the FedEx facility. Again, FedEx, one of our major supporters there, allows us to park it there at no additional cost to Orbis, which is good. And we also have access to engineering, parts, supplies, work stands, and stuff for us to be able to do that work. Phil and I are within driving distance of the aircraft, so we drive down periodically to taxi the aircraft, move it around, move the tires, do pre-flight service checks. Two weeks ago, we replaced all the filters in the hospital. Last week, we did all the engine runs and had a problem with one of the instruments and we replaced that. So we're keeping it in flight status. It's ready to go. If you were to call me up today and said, Hey Bruce, we got to go somewhere and you give us two, three days, and it would be ready to go. So that's what we elected to do is to keep it ready to go and be there to move whenever we need it.

Dr. Hunter Cherwek: I know we talked a little bit about FedEx and it's actually the FedEx employees who have donated the Orbis plane to Orbis to convert to the Flying Eye Hospital. Very few people know about all the engineering that goes into it and why certain pilots, why only certain pilots, can fly a MD-10. Maybe you can talk about how special the aircraft is for flight and why only certain pilots can operate or are certified to fly a MD-10 hospital?

Bruce Johnson: Because Orbis is its own operator, we actually have to have an FAA approved training syllabus that each pilot must go through. So needless to say, we just can't take any pilot and throw them in the seat of the MD-11 or MD-10, although there may be a lot of MD-11 aircraft out there. There are only Orbis, FedEx and one other company with one airplane that have them, and then if you add all the differences that we've added because of the modifications to this airplane, it would not make sense to take all these people, thousands of pilots that may be certified on MD-11, and fly it because FedEx is the only one that has MD-10s, other than us and one other company. And then Orbis, because of what we have to monitor as an aircraft operations team, we are responsible for all the training, tracking all of that. So we have a dedicated few people, 18 pilots from FedEx that are familiar with the Orbis process and the differences between even the MD-10 that FedEx flies and our MD-10. So we have a one of a kind airplane and, therefore, you just can't open that up to a whole group of people

Dr. Hunter Cherwek: I know that FedEx has a special program for the Orbis pilots with the simulation training and annual reviews and programs. It's amazing that in that cockpit, sometimes, you'll have 100 years of aviation experience flying that plane and it's amazing the similarities between aviation and medicine and how much we, the medical team, have learned from the aviation team, about simulation, surgical safety checklist so that when you say wings – check, wheels- check, we’re now saying Mrs. Jones – check, right eye- check, cataract surgery- check. So we've really learned a lot about the challenge-response system and how to do team training and team alignment drills as part of our clinical training. One of the things that I’d be very interested to hear as both a pilot and now someone running the Flying Eye Hospital, what has been your experience as a pilot and also with maintaining the certifications of our pilots using simulation?

Bruce Johnson: When I start to look at it, us in aviation, we used to practice a lot of our emergency drills in the aircraft themselves, whether it was engine inoperative or flight control problems. And over those years of practicing because we didn't have good simulators, certainly there was some risk involved in doing that – in some cases we lost people in crews, in aircraft, practicing. Simulators helped us eliminate that risk by, the better they got, they got more realistic they flew like the airplane did. You could take those high risk manoeuvres, you put them in a simulator. I watch now with the medical community, it’s the simulators are getting so good that the realism is getting close to – you know, I know it's not 100%, but it's getting up there – and now you can take some of that where the only way to practice before was on either a live human being or some kind of pig’s eye or something as a simulation tool, but now you can take these synthetic eyes that you guys have and allow people to do actual surgical type techniques without risking the person. So that's a parallel, really, it's removing risk by using simulation. So that's fantastic. It's interesting to watch.

Dr. Hunter Cherwek: One of the things I don't think people understand or recognize, the unsung heroes for the Flying Eye Hospital are the aircraft team. They're the first on the plane to get it all turned on and opened up in the morning, they're the last ones off and they are with that plane more days of the year, maintaining it and upgrading it, than any other team member. Maybe you can tell us a little bit about your team and what inspires them to do this work and how you've seen them grow as people because of the field work.

Bruce Johnson: There are many mechanics that have experience on the airframe itself, but not the modified airframe. We've got a lot of modifications, but the biggest modification is the hospital itself, so we're asking our mechanics, not only to be an aircraft mechanic, but they fix the generators, they repair the switching unit, all the stuff that runs the hospital. We have nine specific units that we have an air conditioning unit, we have two liquid cooling units, we have a power switching unit, the med gas palett, we have three generators. Those mechanics are not only taking care of the airplane for take-offs and landings and the maintenance checks, but during the program they're actually maintaining all the equipment that runs the hospital.

So we don't go anywhere without those two or three mechanics. Right now, we still have two mechanics: our lead is Valerie Suberg, who's our Senior Manager of Aircraft Maintenance, she's retired FedEx after 30 plus years. Phil Cooler is another one of our Aircraft Mechanics – again 30 plus years of work at FedEx as a mechanic. And they now work for us here at Orbis. It takes a lot of dedication, because they're gone much more than anybody else. They have to go to all the programs and then when the airplane has to do maintenance for two or three months, they have to go do that after the program. Even now during the COVID 19, the mechanics are still going to the airplane to maintain it. So, a dedicated group of people, and love what Orbis does and loves to be a part of saving sight worldwide.

Dr. Hunter Cherwek: You brought up a very important topic that I wanted to, you know, talk about. Obviously, you and I are not together because of the COVID crisis and we're not on the Flying Eye Hospital right now because of the COVID crisis. How do you see COVID and the recent events in 2020 affecting the programs from an aviation perspective going forward with the approvals, the clearances, landing processes. How do you see COVID affecting aviation for the Flying Eye Hospital in the months ahead of us?

Bruce Johnson: Well, we're sort of unique, if we were strictly a freight airplane probably wouldn't be a problem because there are systems involved for a, I guess a business that's hauling freight. Because we're more of a personal type airplane, we are in a little bit different category, so we have to wait until those locations that we need to go to open up for basically travel into those countries other than being essential, you know. Right now, a pilot for FedEx can go into just about any country. He or she may have to get quarantined or restricted to their hotel room before they fly. When we go in there, we're going to have to do it for two, three weeks, so we need until that stuff starts opening up to be able to do that. Do I think that's going to come? Certainly do. I think that should be opened up before the end of the year. How is it going to change us? I do think, like always, Orbis seems to be, as you mentioned before, the airplane used to be all of what we did but now it's like 20%. I think it's going to change how we do some of our programs. I think with technology has changed us greatly over just the last few years and I think it's going to continue. So I think those things that we're doing and switching some of our programs over to more to this virtual type of training. I think that training will be part of our portfolio now. So it'll probably change our programs. Will it change how we actually—do we still be able go to the places with the plane? I think we're still going to do that. But I think it certainly will change how we present our education to the people that we are trying to train. So I think good things come from difficult situations. So I think after COVID 19 is over with and where it's behind us, I think, through technology, through thinking out of the box, it'll actually improve things in certain areas.

Dr. Hunter Cherwek: No, absolutely. You know, I'm excited to get back on the plane, I'm sure you are as well, you know, get back in the field. Get back on the Flying Eye Hospital, get back to the patient care. What is it that continues to drive you to grow your career and your life with the Orbis mission?

Bruce Johnson: I think when I initially started, because I had just retired from the Air Force Reserve when I started with Orbis. I do think, originally, it was the excitement about flying because it would be similar to the type of military flying. And what I mean by that is, unlike other types of flying, Orbis goes into not necessarily, you know, the high-vis type of locations where you go on vacation type thing. We actually, certainly within all the rules, we operate this airplane into some pretty tough locations for that. So, it was exciting to do initially. But I guess what I was saying is, originally, it was about the flying. It shortly, very quickly, turned after you started to watch, location after location, the need for training in the ophthalmic community. It became heart warming to see that – and to be a part of that.

Dr. Hunter Cherwek: I obviously I've been with you all over the world, …

Bruce Johnson: …As you can see I get choked up when I start to talk about it, …

Dr. Hunter Cherwek: Yeah, I know, Bruce. I know, I know. And I know Seymour is the most famous teddy bear but you're definitely the biggest!

Bruce Johnson: Time after time watching the response from the individuals and the families of those being helped. Just the pure joy from being returned the gift of sight is pretty impressive. So, I think it's just patient after patient, seeing that same thing. A child seeing their mother for the first time, or we've had the grandfather to see the granddaughter for the first time, or whatever, it's just, it's just I don't think anybody can imagine what it's like to be able to have either lost the sight or never had it and then have it return. And I think that's what sticks out again.

When I was in the military, it’s interesting, you see the world in one point of view. I then became, now with Orbis, I'm seeing it in a different view. But I can tell you, just to a tee, we have been welcomed everywhere we go. Working with, whether it be the airport or customs or immigration, just really very little obstruction, work fantastic, always working around. People are just kind and that's, I think, is the probably the biggest thing. Again, one of those things I said earlier was, of all the things that we see on the news, is to actually work in this environment and to see the heart that’s out there on the people that want to help…

Dr. Hunter Cherwek: Yeah, I think that's, that's one of the things that I can just say is, I've seen the patch come off hundreds of times and it never gets old and the smile that they have is only surpassed by the one I catch myself having. I sometimes forget I'm smiling because it's so subconscious. You see that kid smile and all of a sudden you start smiling ear to ear.

Bruce Johnson: It is amazing. And it just, it just continues. I always tell my team. All of us, you know, at work all of us have a rough day. I always tell my team, you know, if you think you have a rough day, go watch a program. It'll revitalize you, get you ready to go again, you know, for sure.

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Dr. Hunter Cherwek: That was Bruce Johnson, Director of Aircraft Operations and Maintenance, who keeps the Flying Eye Hospital ready for flight. He is, as I said, the biggest teddy bear at Orbis.

You heard us mention FedEx several times. It was the employees of FedEx who donated the aircraft that houses the Flying Eye Hospital. Not only that, but FedEx pilots volunteer their time to fly it around the world. FedEx provides a ton of other support, too, so I want to give them a shout out.

Thank you for joining me for Sightlines today. I hope you’ll join us for the next episode and for the entire series. If you would like to learn more about Orbis and the Flying Eye Hospital, please visit us at orbis.org.

If you enjoyed this show, please subscribe to our YouTube channel to watch each episode and check out many other videos about our work around the globe. If you’re listening to the podcast version of the show, please hit subscribe so you don't miss a future episode. And if you're listening on Apple Podcast, please consider rating or reviewing the show. It really does help others to learn about us, about Orbis and our sight saving mission.

Until next time!

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