On average in Australia, we have approximately one optometrist to care for every 8,000 people. In East Timor there is just one optom for every 77,000. Many of these 77,000 live without power, running water and communications in remote areas. To make matters worse, a large number suffer from malnutrition, which has affected their eyesight from childhood.
mivision recently spoke to local eye nurses Lazaro Costa da Conceição and Nuno da Costa de Jesus, along with members of Optometry Giving Sight who support the men’s work in East Timor.
East Timor is a tiny country of one million people spread across 13 remote districts, each of which has a slightly different language. Over many years, volunteer groups from overseas have travelled to the country to provide much needed eye health services. While this has been life-changing for a lucky few, the nature of the voluntary service has meant that tens of thousands of severely vision-impaired people have been left untreated.
Fortunately, this is now changing thanks to funding from groups such as Optometry Giving Sight (OGS) who, through the ProVision Optometry Team (PVOT) progamme in East Timor, is working with the local East Timorese government to develop sustainable eye care services. The aim is to have a trained group of local eye care nurses and vision technicians, working from modern hospital facilities in each district and sourcing prescription eye wear from a local supplier.
These guys are the future of eye care in East Timor – through their work, this whole country will change, village by village the country will be better off
Already the country has 13 eye care nurses sourcing eye wear from a factory in Fanamanu. 11 vision technicians are undertaking training. A number of hospitals have been built, all of which have running water, limited power and equipment donated by charities, optometric suppliers and optometrists.
Locals making a difference
Nuno is one of the eye care nurses trained to provide refraction services and recognise eye diseases. He started off as a general nurse working in Baucau and managed ‘crowd control’ for the OGS funded teams when they set up clinic. Now he runs his own clinic where he takes care of more than ten patients a day from around Baucau. He saves the more difficult cases for the OGS funded visits, when an optometrist can provide the treatment. Then he pays close attention so that he can perform the procedure the next time a similar case arises.
Lazaro is an eye nurse in Oecusse, a district separated from East Timor geographically and accessible only by boat or plane. He was inspired to undertake training by the OGS funded volunteers he saw providing eye care to locals. “There was a problem in the village with eye sight and I wanted to help the people from my village to improve their eyes. There was nobody in Oecusse doing eye care before me – so now I look after 50-60,000 people,” he told mivision.
One of those patients has been Lazaro’s own grandfather who, at 64, hadn’t been able to see for ten years. “My grandfather could never see anything because he had cataracts. I gave him glasses and he can now see. It makes me very happy. He can now sew with a needle and read the newspaper.”
In this subsistence economy, vision is vital for survival – even for those who can’t read. With many husbands killed during the country’s struggle for independence, it’s often the women who are left as sole providers for the family. They rely on weaving ties in traditional East Timorese style, which they sell to make income. “I very often prescribe glasses for women – with glasses they can make an income, it makes a big difference to their families,” commented Lazaro.
Building a sustainable future
The problem for his patients is that Lazaro doesn’t have any glasses on hand to give out. Once he has done refraction testing, he sends the prescription to the FNTL, the optical lab in Dili to be filled. The lenses are made at a factory in Fana manu, which cuts, fits and grinds lenses to make custom spectacles as well as selling ready-made spectacles. More complex prescriptions are made up by Essilor in Sydney.
It takes two weeks to get the glasses to the patients – or in the case of patients in remote areas that require complex prescriptions, up to three months.
National president of the Optometrists Association Australia and OGS member Michael Knipe, says that rather than just provide Lazaro with the glasses he needs, the group has made a strategic decision to now ensure the supply lines become more sustainable. “In the past, Lazaro has been supplied with a stock of ready-made spectacles, but in an effort to make the programme sustainable and self-suficient, he is being encouragd to make the programme self-funding,” he said.
For those who can afford to pay, glasses are sold for the small amount of AUD$2 to $5. That’s enough to fund the purchase of more glasses.However there are many cases where people are unable to pay – and they’re given their glasses for free to ensure that no-one misses out.
When he’s not working at the new Oecusse hospital, Lazaro travels by motorcycle to provide outreach services to patients in remote villages.
These outreach services are partially funded and supported by Optometry Giving Sight (OGS).
“The Timorese Government has so much to fund – from housing, education, transport and infrastructure. They can’t afford to do it all, which is why we step in to fund outreach” said Andrew Koch, another Hobart based optometrist who has provided volunteer services in East Timor since 2002.
Eye care slowly improving
Mr. Koch says that it’s thanks to eye nurses like Lazaro and Nuno that the level of eye care is slowly improving in East Timor.
“These guys are the future of eye care in East Timor – through their work, this whole country will change, village by village the country will be better off,” he said.
“On my trips to the country I used to see 150 people a day. People would line up all day to have their eyes tested and I couldn’t get through them all. It was hard – I’d return to Australia knowing there were still plenty of people with eye health problems.
“Now that we have trained eye nurses on the ground to manage the basics, I go up there and my work is reduced to seeing 50 people – but all of those cases are challenging – they’re the ones the eye nurses are not yet equipped to treat.
“About one in 10 of the people we see is blind in one or two eyes.”
Malnutrition the problem
Mr. Koch says there is so much blindness because of the lack of health services and nutrition. “People have Vitamin A deficiency and their eyes dry out. When we find them early we give them a shot of Vitamin A and that saves their sight, but that’s only for one season. Often you get children who are blind in one or both eyes due to Vitamin A deficiency that’s gone too far – they’re blind forever. If they get a major infection, their immune system keeps them alive but it can’t save their sight… for every child that you see that’s blind, you know there are about ten that have died.”
“I’ve seen more pathology and trauma in one week in East Timor than in almost 20 years as an optometrist in Australia.”
A brighter future ahead
Despite the extraordinary level of eye disease in East Timor today, OGS can see a brighter future for the local population.
Soon East Timor’s 13 eye care nurses will be supported by 11 eye technicians currently under training. They’ll also have the benefit of a brand new national eye care centre, being constructed in Dili, a joint project between the Ministry of Health and the charity NZ Fred Hollows.
The new facility will bring all eye care services together whereas currently, outpatients’ services are separate from surgery. ProVision and OGS have already donated much of the equipment that will be used in the Centre and upon completion, they will contribute the equipment volunteer optometrists currently use when they’re working in the country.
“The equipment was always meant for the people of East Timor, so it makes sense to hand it over,” said Mr. Knipe. “We’ll use it when we’re up there but it is important that the equipment is used for the benefit of the East Timorese.”
| East Timor:
A Subsistence Economy
Despite being just 640km northwest of Darwin, this country of 15,410 km² suffers enormously from the after-effects of a decade long struggle for independence against Indonesia. East Timor became the first new sovereign state of the 21st century in May 2002. Continued internal violence necessitated intervention by the United Nations, which continue to maintain a presence on the streets.
As a result of its tumultuous history, the East Timorese standards of living, education and health are poor. According to the United Nations Human Development index, which measures life expectancy, literacy, education and standards of living for countries around the world, East Timor is ranked 123. That’s just behind India but ahead of Swaziland. Australia is ranked second on the list of 170 surveyed UN member
The staple diet in East Timor is rice. However weather patterns can play havoc on the country’s ability to produce all the rice it needs – and therefore on the nutritional health of the country’s population.