1. 1 | ORBIS International ORBIS International ORBIS International in Haiti Joan McLeod Ismael Cordero Haiti Eye Care Symposium May 18-20, 2012 Port au Prince, Haiti

2. 2 | ORBIS International WHO Recent Global Estimates of Blindness and Visual Impairment  39 million people are blind, 245 million visually impaired  Up to 80% of blinding eye conditions are preventable or treatable  90% of avoidable blindness occurs in developing countries

3. 3 | ORBIS International ORBIS Multi-Platform Yet Integrated Sight- Saving Program Approach  Operate the world’s only Flying Eye Hospital DC10 plane which has worked in 78 countries  Provide hands-on training -skills & diagnostic to doctors, nurses and other eye care providers  One key focus is pediatric eye care  Offer doctors on-line consultations, e-learning, and medical education via Cyber-Sight- Telemedicine  Partner with leading eye surgeons and hospitals worldwide  Work to eradicate endemic tropical diseases, - Trachoma in Ethiopia program

4. 4 | ORBIS International ORBIS Partnership Globally shows Results for Year 2011  Enhanced training of over 2,200 doctors & 12,600 nurses & other eye care providers  Performed 2.3 million vision screenings & examinations on adults & children  Provided 3.4 million medical /optical treatments  Performed 76,000 surgeries

5. 5 | ORBIS International Haiti Socio-economic Background  Haiti is the 2 nd largest island in the Caribbean with a land area of 27,000 km²  One of the poorest and least developed countries in the world outside Africa literacy rate estimated at 65% ~70% of the population lives below the poverty line 70% of economically active population is unemployed  Population of approximately 10 million: 60% in urban areas and 40% rural (3 million in Port au Prince (PaP) area)  Health system includes public sector, private for profit sector, private nonprofit sector, traditional health systems

6. 6 | ORBIS International Haiti Human Development – UNDP Report 2011 Human Development Index (HDI) rank – 158/193 countries 36% population has access to clean drinking water 52% population has access to improved sanitation facilities 19% Population vulnerable to poverty 32% Population in severe poverty

7. 7 | ORBIS International Haiti Blindness Estimates Blindness estimates:  1% of the population is blind 50-60% due to cataract (50,000 cataract blind) 20-25% due to glaucoma 5% due to diabetic retinopathy  4% of blind are children  7% of children in schools have uncorrected refractive error Priority eye diseases are cataract, glaucoma and refractive error It is estimated that 50% of all blind individuals in the Caribbean live in Haiti

8. 8 | ORBIS International ORBIS in Haiti In 2010, ORBIS participated in a joint agency assessment to determine requirements post earthquake for local ophthalmic community Surveyed 19 facilities including government, NGOs, private, mixed Examined infrastructure, equipment, supplies, personnel, level of activity, services performed, number of cataract surgeries, etc. Results shared in a debriefing meeting of several NGOs and others “International Collaborating Group for the Reconstruction of Eye Care in Haiti”

9. 9 | ORBIS International Haiti Eye Care Infrastructure Prior to Earthquake Leadership and Governance Eye care not a big priority in MoH Cuban/Haiti eye care service functioning HUEH : University Government facility –trains, provides services Human Resources 50 ophthalmologists in Haiti: ~ 5 ophthalmologists per million people One residency training program (one resident per year); limitations in sub-specialty training –HUEH, No formally trained ophthalmic assistants, nurses/mid level eye care workers, eye care program managers

10. 10 | ORBIS International Haiti Economic and Eye care Infrastructure Prior to Earthquake Economic Environment 71% live below the poverty line No system of social insurance; 90% of health care payments paid out of pocket Problem in generating income for eye care Lack of financing for infrastructure development and new technology Infrastructure Technology Many clinics/hospitals do not have basic equipment to diagnose and treat eye conditions 80% of medical equipment donated by foreign agencies and no longer manufactured (thus difficult to maintain and procure spare parts) No central source of procurement resulting in practices buying equipment and supplies independently in small amounts at higher cost

11. 11 | ORBIS International Significant joint Assessment Findings At least 30% of ophthalmologists partially or totally lost offices, or their eye care facility was destroyed; none of the eye care facilities had insurance covering earthquake risk Few ophthalmologists were performing eye surgery since the earthquake Deteriorated equipment and facilities were further damaged Immediately after the earthquake the Government ordered state hospitals to provide free services to all patients; Many health personnel not being paid

12. 12 | ORBIS International ORBIS Project in Haiti: 2010-2011 Recovery and Rehabilitation of Eye Care in Post- Earthquake Haiti Working with the National Blindness Prevention Committee-Haiti (CNPC), ORBIS and CBM, supported an eye care stabilization project to provide services to displaced persons in ‘ tent camps’ Project ran from Dec 2010 – July 2011 –with a potential to extend Objectives were to provide: Eye care services (examination, treatment and surgery) to displaced persons living in tent cities throughout PaP Minimal financial support for ophthalmologists at risk of leaving Haiti (practices destroyed, government not paying salary, no patient fees) Capacity building and financial support to CNPC

13. 13 | ORBIS International Project Results reported to Jan-July 2011 8,692 persons screened, examined and treated as necessary for eye problems in ‘tent cities’ and at eye clinics in PaP 3,728 persons got eyeglasses 103 surgeries performed Trained one ophthalmologist in MSICS at Aravind Eye Hospital in India Supported training for 10 Eye care assistants / social workers for screening in “tent cities”

14. 14 | ORBIS International ORBIS External Review with IEF Project was reviewed in July 2011 by independent consultant from IEF Recommendations were for : Screening and patient outreach to continue –Importance of patient counseling (pre and post surgery) –Ensuring patient accompanied and transported to surgical centers to optimize surgery uptake minimize loss of follow-up Standardizing data management across surgical centers Including one additional surgery center for surgery referral - ORLO Improving patient flow practices within the hospital to ensure greater efficiency, and standard protocols for examination and follow-up

15. 15 | ORBIS International 15 Month Project Extension to January 2013 Direct Service Delivery Direct Service Delivery to 12,000 persons living in ‘tent camps’ in need of screening and basic eye care Estimated 6,600 persons from ‘tent camps’ and from PaP to receive examination and medical treatment at Eye Clinics Estimated 480 persons to receive eye surgery Additional 5 locations identified by CNPC Outreach to include 2 more sites

16. 16 | ORBIS International 15 Month Project Extension to January 2013 Health Care Institutions and Human Resource Development Eye Care Clinics/Hospitals will receive increased patients load, thus fees from consultations and surgeries, allowing further stability for employed ophthalmologists, and sustainability of the institution Will include additional surgical centers Strengthen CNPC staff : support study tours in Santo Domingo and/or Guatemala, and in data management Build surgical skills in Manual Small Incision Cataract Surgery (MSICS) Training for biomedical engineers/technicians thru new initiatives

17. 17 | ORBIS International FY2011 Achievements and FY2012 Targets Planned Target for surgery was under achieved - due to low uptake, cultural barriers, and preference for glasses and drops

18. 18 | ORBIS International ORBIS Eye Care Projects in Haiti MerciMerci