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Vital Signs with Dr. Sanjay Gupta

Ophthalmologists on Flying Eye Hospital Perform Eye Surgeries in Cameroon. Aired 2:30-3p ET

Aired December 23, 2017 - 14:30   ET


[14:30:45] DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: It's a Tuesday morning, and this operating room is buzzing. Dr. Tom Johnson is an ocular plastic 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 find 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 airplane.

This is "Vital Signs" from Yaounde, Cameroon.

OK, 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 non-profit organization 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 a full surgical suite and a recovery room. Because of the 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 who was working in the laser room, is an ophthalmologist based in Atlanta, Georgia. I caught up with her before the trip and Emory health care.

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

DR. ANNETTE GIANGIACOMO, OPHTHALMOLOGIST, EMORY EYE CENTER: I think the coolest thing for me is 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 type of neurological problems or primary care problems that you don't expect to see as a medical student. How it really is all connected and can tell you much more than you might expect from two little eyeballs. GUPTA: Right. And there's various diseases in ophthalmology, various

diseases of the eye. Are there ones that are of a particular interest to you?

GIANGIACOMO: I'm a glaucoma specialist. I describe it as a disease that often goes undetected because it really is considered the silent of vision. I tell them it's a problem with their eye that results in damage to 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 lower the pressure in their eye.

GUPTA: 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.

We hear about these big medical ships, like the Comfort, they 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?

GIANGIACOMO: Well, the benefit is that everything that's needed is encased within this hospital. It can arrive to many different locations within a country rather than an area of the country that borders water. So 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. They can land.

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

GIANGIACOMO: So this is what I hear. I have to tell you last year my trip to Ghana was a hospital based program, 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.

GUPTA: According to the World Health Organization, an estimated 253 million people have vision impairment. But here's the thing. The WHO also says more than 80 percent 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.

[14:35:07] Somebody has 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?

GIANGIACOMO: So that's the one thing unfortunate with glaucoma is you can't regain the vision. And like other neurological problems, the nerve does not regenerate or repair itself. So our goal is to 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 to society.

GUPTA: So they really have to be caught early to get the best benefit? GIANGIACOMO: The earlier the better for sure.

GUPTA: 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 is just one for every 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's central hospital. Dr. Giangiacomo meets with several patients the first day, including Joseph.

GIANGIACOMO: Look straight ahead. Look right at my eyes.

GUPTA: 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. THOMAS JOHNSON, OPHTHALMOLOGIST, ORBIS: How long ago was this fracture?

GUPTA: It's the same for 40-year-old Serge (ph). He's in a consult with the Dr. Tom Johnson, the ocular plastic surgeon. Serge (ph) had a motorbike accident in February of 2017 that fractured the orbital bones around his eye.

JOHNSON: This is a pretty good sized fracture here of the orbit. It's very much depressed.

GUPTA: Serge (ph) 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.

But what's it really like to perform surgery on an airplane? We're going to the operating room next.


[14:40:46] GUPTA: 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 the 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 the 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 hospital. Dr. Tom Johnson first started volunteering with Orbis in the mid-1990s. He's done nearly a dozen of these trips since then and says the excitement never wears off. As an ocular plastic surgeon he fixes issues relating to the eye, around the eye, like tumors or fractures.

DR. THOMAS JOHNSON, OPHTHALMOLOGIST, ORBIS: I like me specialty, ocular plastic surgery, because it's a very diverse specialty. I do surgery on eyelids, on the tear ducts, on the orbit, reconstructive work, cosmetic work, tumor work, oncology. And it kind of combines everything in ophthalmology with the rest of medicine. GUPTA: This particular plane is only a year old, so it will be the

first time he is operating at it. It is state-of-the-art, but there's always an element of the unknown.

JOHNSON: To be part of the Orbis team I think you need to be very flexible. You're traveling 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 and be able to improvise.

UNIDENTIFIED FEMALE: In general, blood dissection is safer than sharp dissection, OK?

JOHNSON: I think one of the main things that is important is to be a good teacher because the purpose of Orbis is to teach.

GUPTA: Professor and Dr. Epee Emilienne is one of the local doctors partnering on this mission to train and learn from the Orbis volunteers. Dr. Eppe was born and raised in Cameroon. She studied medicine in Germany.

DR. EPEE EMILIENNE, OPHTHALMOLOGIST AND PROFESSOR: The most fascinating aspect of the eye is that somebody coming to life. We've saw children coming to the country, then they're given glasses and they start getting excited, looking left and right, like now I see, I see. Well, you don't know what is going on, you don't understand how it really was. I'm very curious, so I decided ophthalmology was something that I could do.

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

EMILIENNE: The hospital for me was hope. I studied ophthalmology. When 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. So what I learned was what I learned, and that's what I applied, taking around all the mistakes. So with the hospital coming I will go and see who they are. I knew that I'm going to benefit. But you know where you good, you can even watch somebody and tell this is where the problem is. This is how to change.

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

JOHNSON: It's always kind of a give-and-take. I learn a lot from them as well. And I think we kind of form a partnership, a collaboration when we see these patients. And 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. And sometimes we have our different preferences and so forth, so it's always good to learn from each other.

GUPTA: 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 ocular plastics, Dr. Johnson will do several different types of operations designed to teach a wide range of skills.

[14:45:07] JOHNSON: We're trying to show a variety of different techniques in a limited amount of time. So I think that's the most difficult part, and 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 eyelids or are endangering their vision because of exposure of the front of the eye, the cornea, patients that have tumors that need to be diagnosed to continue treatment. So, 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.

GUPTA: The goal is for the surgeons in Cameroon to then be able to operate on patients once the Orbis team leaves. Serge (ph) 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 (ph) has ever stepped foot on a plane.

JOHNSON: He's a young man who was involved in an accident in February, I believe. And 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. So what's happened because of that is his eye has sunken back quite a bit.

UNIDENTIFIED MALE: I was back, riding the moter bike. And the accident happened and I was unconscious. I just recovered four days after, and I cannot tell you the details of the accident.

GUPTA: Serge (ph) is a veterinarian technician in a rural area outside of Yaounde. His job requires traveling on motor bike, which he hasn't been able to do since the accident.

UNIDENTIFIED MALE: I cannot see backward, up, down, or on the side. When I try to look up and down I will see images.

JOHNSON: 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 the nerves and the orbits so the patient can, you know, have normal function again. So it can be kind of challenging.

GUPTA: Serge (ph) is feeling confident and hopeful. As trainees watch the operation on a television outside the operate 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 (ph) eye back to a more normal position. That should correct his double vision. Dr. Johnson also cleared up scar tissue that had prevented Serge's (ph) 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.

JOHNSON: The surgery went very well. We were able to take out the old implant. I think the bottom 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.

GUPTA: Dr. Giangiacomo prepares for her first operation on the flying eye hospital. It's Joseph's turns next.


[14:52:06] GUPTA: From the outside it looks like a standard airplane. Inside it's anything but ordinary.

DR. JONATHAN MOORE, GLOBAL MEDICAL DIRECTOR, ORBIS: Every time I come on this plane I still actually get that burst of excitement after 11 years of working with all this they previous plane and this plane.

GUPTA: Dr. Jonathan Moore is the global medical director for Orbis.

MOORE: I was amazed that you could put a fully functional hospital in a plane. We'll come onto a plane and are used to seeing multiple rows of seats, you forget how much room there is. This hospital meets all current U.S. standards. It is fully accredited in the U.S. as an ambulatory surgery unit. All we need is a runway where we can land the aircraft on, that's a prerequisite. We need aviation fuel, and we need water. Other than that we are entirely self-contained.

GUPTA: The plane has its own unit to sterilize 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.

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

GUPTA: 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 patient Serge (ph), who is currently in recovery. So now it's Dr. Annette Giangiacomo's turn. She scrubs in for surgery ready for a procedure to treat Joseph's glaucoma.

JOSEPH FOUDA, PATIENT (through translator): After my retirement I began to see poorly. I went to the hospital and spoke to Dr. Eppe. She's the one who gave me an exam, and after the 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 I had glaucoma in 2013, I believe. GUPTA: Joseph said he's had eye exams before but never any kind of


GIANGIACOMO: He's a 74-year-old gentlemen 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.

[14:55:00] 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.

GUPTA: Joseph's treatment is a success. The next morning all the patients who are treated on the flying eye hospital are now back at Yaounde Central Hospital for their follow up appointments, including Serge (ph).

JOHNSON: Are you having less pain? No, doing OK? OK, good. Serge (ph), I'm going to take your patch off. It's going to stick a little bit. A little swollen here and here, but that looks good. He's got very full movement.

GUPTA: 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.

JOHNSON: Thank you, sir.

GUPTA: It's looking good for Joseph, too.

GIANGIACOMO: How does the eye feel today? A little scratchy? OK. We talked yesterday. He had the narrow angle component and he's really nice and deep. It looks great.

GUPTA: It will be a busy week for these volunteer doctors. After her follow up with joseph, Dr. Giangiacomo heads to the operating room at Yaounde hospital for another procedure. The room is full of observers. And Dr. Giangiacomo wouldn't want it any other way.

GIANGIACOMO: 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. It's 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. And I just feel like it's a wonderful opportunity I'm very lucky to be part of.