The BMJ Christmas appeal 2016-7: Orbis, the sight savers

David was just 4 months old when his mother, Moria, suspected that he was going blind. The boy, from Copperbelt province in Zambia, was taken to a traditional healer who made cuts near his eyes and put herbs in the wounds. It was only when Moria stood up to family pressure that her son, by then unable to play sport or write legibly, was diagnosed at the local clinic as having congenital bilateral cataract.

In 2012, David, then aged 10 years, was treated as an emergency referral at the paediatric unit in Kitwe Eye Annex, a facility supported by the charity Orbis. Today, David’s vision is restored, and he plays football at every opportunity. But nearly seven million people in Africa, and 39 million globally, are blind, and in 80% the cause is potentially treatable. For people who live in poorer countries blindness can lead to a vicious cycle of poverty.

Orbis was founded in 1982 through an alliance between the medical and aviation industries. Today it has more than 40 long term programmes in 18 countries in Africa, Asia, and Latin America, delivered by volunteer eye experts. Orbis also trains local healthcare workers and equips them with skills and materials that they, in turn, can pass on.

Training and treatment are provided in partnership with local hospitals and also aboard a plane that contains an operating room alongside simulator training machines, an audiovisual room, and a 46 seat classroom.

“The flying eye hospital’s programmes and hospital based programmes provide a unique educational and teaching environment for all aspects of sustainable eye care,” Larry Benjamin, a consultant ophthalmic surgeon at Stoke Mandeville Hospital and The Chiltern Hospital, and a volunteer for the charity, told The BMJ.

Last year alone, Orbis’s supporters helped fund 65 558 operations globally, including 24 177 on children, and 2.13 million screenings or examinations. The charity also trained 1414 doctors and nearly 29 000 other healthcare workers.

The charity’s takes a holistic approach and works hard to increase access to timely eye care.

“We know that up to 60% of patients in some of the countries we work in, including Zambia, can present to traditional healers before seeking a doctor’s advice or visiting a hospital,” says David Bennett, head of programme support, Orbis UK. This year the charity began working with traditional healers in Zambia and South Africa. “We are training traditional healers in the signs of eye disease and the implications of not treating children’s vision loss quickly,” he says.

“At last, the number of children who we are operating on within two months after the appearance of a cataract is on the increase,” says Chileshe Mboni, the ophthalmologist who treated David and whose training with Orbis began in 2012. “People now have confidence in the hospital and the service we provide,” he says.

Need for treatment

• About 246 million people worldwide have moderate or severe visual impairment

• In addition, 39 million people are blind

• 90% of blind people live in poorer countries

• But 80% of visual impairment is avoidable—that is, treatable or preventable

• Restoration of sight and blindness prevention strategies are cost effective