CASE STUDY

Donations, Volunteers and Technology Help the Visually Impaired Around the World

Global

Challenge
Exponentially increase the number of ophthalmic professionals in remote and underserved locations around the world by providing convenient access to training in a fully functional mobile teaching hospital on an aircraft, which supports operations and treatment of patients. The solution must be intuitive, easy to use and reliable.

Solution
Outfit a newly renovated MD-10 aircraft with state-of-the-art network AV and automation technology to stream high-definition, live audio and video feeds from the operating theater, laser treatment room and other key areas to a 46-seat classroom at the front of the aircraft as well as to local hospitals worldwide.

Crestron Stories: Orbis from Crestron Electronics, Inc. on Vimeo.

In September 2016, the Orbis Flying Eye Hospital®, the world’s only mobile and fully accredited ophthalmic teaching hospital on board an MD-10 aircraft, touched down in Shenyang, China. This event marked the 40th active care and teaching program conducted in China by nonprofit Orbis International since its inception in 1982. The MD-10 is the third-generation aircraft donated to Orbis by FedEx®, marking a 33-year partnership.

In 2015 alone, the Flying Eye Hospital and its partner institutions conducted more than 2 million eye screenings and exams, 30,000 trainings for doctors, nurses and other eye care specialists, and nearly 66,000 eye surgeries in remote and underserved areas of the world.

The state-of-the-art Flying Eye Hospital was unveiled to the public in June 2016 during a seven city U.S. tour, including a stop at the FedEx terminal at New Jersey’s Newark Liberty International Airport. The unveiling was particularly poignant for the team in attendance from the Rockleigh, New Jersey world headquarters of Crestron.

Crestron’s founder, the late George Feldstein, and his wife Lynda, both avid pilots and aviation enthusiasts, toured the second-generation Flying Eye Hospital at an airshow in Oshkosh, Wisconsin in 2012. “After taking a tour, and learning that Orbis had a new plane planned, he knew exactly what he needed to do, and he knew exactly how Crestron could help,” said Dan Feldstein, George’s son and Chairman and COO of Crestron. “He immediately went to work. Unfortunately, because he passed in 2014, he wasn’t able to see this come to fruition. But my parents instilled their passion for giving in me and my siblings. So we’re thrilled to be able to continue my father’s legacy and honour his memory by helping to complete the project that he started.”

In addition to Crestron, global support partners include Alcon Foundation, FedEx, Jebsen, L’Occitane®, and OMEGA®.

Stunning Facts
“There are 285 million blind or visually impaired people in the world,” said Bob Ranck, CEO of Orbis International. Sadly, eighty percent of them don’t have to be. Ninety percent of those impaired reside in the developing world. That’s where the Flying Eye Hospital operates.“

“As the proverb goes, ‘give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime,’” Ranck said. “This hospital is about teaching a man to fish. This is about our medical colleagues on the eye care team: nurses, doctors, anesthesiologists, surgeons, biomedical engineers —the whole team—and helping to upskill them to meet the challenges they face in the developing world.”

Orbis is the catalyst for a community of more than 400 medical volunteers, leading training endeavors around the world. “Cybersight® is our online telemedicine portal. It brings the medical training and consulting that we do on the ground to an online platform that ensures continuity of support and mentorship,” Ranck added.

“In 2016 alone, we engaged people from 129 countries for our Cybersight live teaching events,” said Dr. Danny Haddad, Chief of Program at Orbis. “This approach allows us to do more with the people we already have partnerships with—to increase the intensity and types of training we do with them. But, equally important, to also have an impact in places where we could never work in person for lack of resources, or the presence of political instability or conflict.”

A Global Platform
“The idea is to give people of low and middle-income countries access to an equivalent—or as near-to-equivalent—standard of residency training that you’d expect to see here in the U.S.,” said Dr. Jonathan Lord who currently serves as Global Medical Director at Orbis. Dr. Lord has been a Volunteer Faculty member at Orbis since 1997 and part of the Flying Eye Hospital team since 2010.  “The biggest single challenge is that no one has ever tried to do this with an aircraft before, but the advantages are what makes it so exciting,” he said.

As you enter the MD-10 aircraft, the learning experience begins in the 46-seat classroom, which looks and feels like the business class section in a typical commerical airplane. However, rather than passengers, the seats are filled with local doctors, nurses, biomedical engineers and other eye care specialists. They’re watching eye surgery or other procedures in real-time on a 50-inch, 3D-capable monitor, streamed live from one of the hospital rooms located behind the classroom. In addition to the operating theater, the hospital includes a laser treatment room, a sterilization room, a recovery room, an observation area, a small administration room and an AV/IT room.

“The microscope in the operating theater is linked to a 3D system so everyone in the classroom can get the same feeling—as though they’re sitting at the operating microscope,” said Lord. “The Crestron system is really helping advance what we do in the aircraft.” In addition to seeing a live procedure on the 50-inch monitor, two-way audio enables trainees to listen in on conversation between the surgeon and theater staff, and ask questions to make the most of training sessions. “In every room, you can control all the cameras placed around the aircraft. You can show what’s happening in any other room and we can enable two-way communication between those rooms. That enhances the training capacity,” he said.

Easy to Use
With 400-plus medical volunteers, the AV technology interface had to be easy-to-use. More than 20 Crestron touch screens, AV distribution systems, multimedia processors, cameras and high-definition displays create a fully integrated solution for each Flying Eye Hospital space. “Using the touch screens you can pull up anything that’s happening in other parts of the aircraft for people to see,” said Lord. “You can focus and move any of these cameras to make sure people see exactly what you want them to see.”

Integrated Solution
Occupying a compact space between the administration and laser treatment rooms is the AV/IT room. “The biggest challenge has been dealing with the space limitations on the plane,” said Brian Studwell, Director, Consultant Programs at Crestron. “Among the great things we were able to bring to the table were concealed cables for all distribution and the ability to power many of the transmitters and receivers remotely over a single cable.” All inputs and monitor outputs are connected using Crestron DigitalMedia™ technology so any camera feed can be routed to any display. In addition, a Crestron Sonnex® multi-room audio system and Crestron speakers provide audio throughout the airplane. “There’s a 32×32 DM® switcher, and a DigitaMedia Presentation System running the classroom,” said Studwell.

A large display in the AV/IT room shows feeds from all cameras located throughout the plane. “This is where you can switch screens, increase the volume of microphones, and change sources and destinations,” said Gangadhar Jalli, Audiovisual Support Manager for Orbis International.

The ability to live-stream from the aircraft is new to the third-generation hospital. “We can transmit content to and have live communication with students in a classroom at the local hospital. Or we can transmit it to students in other countries around the world.” Lord added. Live-streaming has eliminated distance limitations, enabling us to increase the potential audience. “The technology on this airplane significantly enhances our training capabilities, and advances our mission in the process,” he said.

One of the biggest advances Lord noted is that cell phone technology is now available most everywhere in the world. “Now, people can easily join the training and participate in the lectures just using a smartphone and a simple application.”

During programs, local hospitals are introduced to the Cybersight® online telemedicine portal. “It allows them to upload cases—details, pictures—to a forum in which they can consult with a mentor about it,” said Lord.

Upon completion of training aboard the flying hospital each participant is given a thumb drive or DVD that contains all training materials, and video recordings of all surgeries they saw and lectures and training sessions they attended,. “They can watch it again and again,” Lord noted. “Only by having the Crestron DigitalMedia technology in the aircraft are we able to provide this.”

Technology Increases Access
“Technology is really driving medical education forward,” Lord added. “It allows you to build that global community that improves the quality of education, drives standards forward, and makes it possible for the 285 million people in the world who are blind or have low vision to have access to quality eye care services. It’s about improving their lives and their communities’ lives.”

During 2017 the Orbis Flying Eye Hospital programs will be in Southeast Asia and Africa.

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Equipment List
2 – Crestron infiNET EX® & ER Wireless Gateway (CEN-GWEXER)
1 – Crestron iServer® Network Audio Server (CEN-ISERVER)
5 – Crestron Network Stream Player (CEN-NSP-1)
23 – Crestron DigitalMedia Graphics Engine (DM-DGE-200-C)
1 – Crestron 32X32 DigitalMedia Switcher (DM-MD32X32)
8 – Crestron DigitalMedia Receiver & Room Controller w/ Scaler (DM-RMC-4K-100-C)
12 – Crestron DigitalMedia Transmitter 201 (DM-TX-201-C)
5 – Crestron DigitalMedia Input Card with HDBaseT® connectivity for DM® Switchers (DMC-4K-C)
6 – Crestron 2-Channel 4K Scaling HDMI® Output Card for DM Switchers (DMC-4K-HDO)
1 – Crestron DigitalMedia Presentation System 300 (DMPS3-4K-300-C)
1 – Crestron High-Definition Digital Video Annotator (DVPHD)
1 – Crestron 3-Series Control System® (PRO3)
1 – Crestron Sonnex® Multiroom Audio System (SWAMP-24X8)
7 – Crestron 15.6-inch HD Touch Screen (TS-1542-C)
2 – Crestron 20-inch HD Touch Screen Display (TSD-2020)
2 – Crestron Handheld Touch Screen Remote (TSR-302)
2 – Crestron 8.7-inch Wireless Touch Screen (TST-902)
2 – Crestron 5.7-inch Wireless Touch Screen (TST-602)
8 – Crestron V-Panel 24-inch HD Touch Screen Display (V24R-C)

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SIDEBAR
Volunteers with Wings

There’s no doubt that without the help of hundreds of medical and support volunteers and corporate donations the Orbis Flying Eye Hospital wouldn’t be possible. Nor would it be possible to get this MD-10 hospital off the ground and to remote destinations around the world without a pilot.

Gary Dyson has been a captain with FedEx, flying worldwide for 30 years. It’s his day job. But for more than 15 years he has also been a volunteer pilot, flying between 25 and 30 programs for the Orbis Flying Eye Hospital.

“When I found out about Orbis around 1999, I called and said, ‘Hey, I’m a DC-10 captain. I would like to help you fly the airplane,’” said Dyson. A year later FedEx contacted Dyson to help train existing pilots. Today the programs are flown exclusively by FedEx pilots.

For more than 30 years, FedEx has played an indispensable role in helping Orbis achieve its vision of a world in which no one is needlessly blind. “Even before we started helping them fly the airplane we shipped supplies for them all over the world for free. So when we became involved as pilots it just made it all that much better,” Dyson added.

In addition to donating the MD-10 airframe to Orbis, FedEx manages the completion of routine and critical maintenance procedures, including the annual safety checks for the Orbis Flying Eye Hospital to ensure its airworthiness, and provides spare aircraft components as needed.

“For a pilot, it’s very special and a privilege to fly an airplane like this because it’s one-of-a-kind,” said Dyson. “And then getting to witness the life-changing event when people get their sight restored is amazing. It makes us as pilots want to come back and do it again and again. It’s my dream volunteer job.”

Dyson piloted the first program on the newly renovated MD-10 Orbis Flying Eye Hospital to Shenyang, China in September 2016.

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