I’ve always wanted to see first-hand the work being done by eye care teams in remote communities. To see how the relationships work between the profession and people who are being helped. For some patients, the outcomes aren’t significant, but for others they are life changing.
I travelled into Australia’s Red Heart with the Brien Holden Vision Institute Foundation (formerly ICEE, the International Centre for Eyecare Education) to capture the work being done by the Regional Eye Health Program in three remote communities – Bonya (Ortippa Thurra), Harts Range (Atitjere) and Alcoota (Engawala).
On the plane to Alice Springs I pored over wads of paperwork and a Cultural Orientation Handbook that gave me pointers on how to conduct myself in remote communities – the Do’s and Don’ts, the rules and protocols.
Alice is beautiful in July. It’s the best time to do a trip like this. The weather is similar to Sydney or Melbourne – it’s cool but it’s also dry – and the pace is slow. Nothing happens quickly here nor does it need to.
From that point on the Do’s and Don’ts, rules and protocols all blurred into one word – respect. That was it…
I met the team when I arrived and we shopped for provisions for the week. The next day we loaded up the van with our food, bags, ready-mades, sunglasses, charts, and portable eye testing equipment and then headed off to our first community, Bonya, 250km east of Alice.
When you’re cramped up in a loaded car, rattling along endless dusty roads for hours with people you don’t know, it doesn’t take long before you know more about each-other than those you’ve shared the same piece of carpet with at work for years.
Heather Wilson, the Central Australian Aboriginal Congress (the Congress) Regional Eye Health Coordinator, coordinates the eye health team and is the pivotal connection between the Aboriginal communities and the optometrist. She’s lived in Alice for 26 years with her husband and four children and drove us to the locations as she knows the area well.
Heading to Bonya
The red dirt lifts like a cloud as we alight from our van.
The sign on the clinic door says: ‘Eye doctor visiting this afternoon. Come and have your eyes checked.’ It’s 1pm and there’s no-one around. After lunch, the head nurse Erin, opens up the clinic and we set up.
Erin has a heart for people and is passionate about making a difference. Because the accommodation in Bonya was unavailable when we visited, she opened up her home to us. She didn’t have to. For Erin, having the eye care team in her little community wasn’t about her, it was all about the people.
This was the theme of my trip: the people. Although, that said, for some who work in these areas, it’s about the money, but they either burn out or become very jaded and bitter.
The remote area nurse has a uniquely challenging role. They live away from family and friends for long stretches of time, and have no, or very limited access to things we now regard as essentials of life, like the internet and mobile phones.
Remote workers are told they’ll experience a honeymoon period of a few months, then they’ll either acclimatise and embrace their job or grow to tolerate it.
Some of the nurses I met struggle with the isolation, and because they’re physically confined to one area, were suffering from ‘Cabin Fever’. They felt claustrophobic, were bored and bitter.
Erin thrives in this environment. She’s lived in the Bonya community for three years and is still smiling.
The clinic at Bonya has a good vibe.
Breaking Cultural Barriers
Bonya has a population of 50 people but, today, we’re told most are still making their way back to the community from a festival in Alice – which was on two weeks ago!
The clinic door edged open and the first patient walked in.
Do’s and Don’ts were flooding my head and, before I could remember whether I shake or don’t shake a person’s hand, the patient, with one hand gripping a walking stick and toy plane, stuck her other hand out for me to shake and said “I’m Melanie”.
Melanie has cerebral palsy and can’t see an inch in front of her but, in her innocence; she broke down the cultural barriers for me.
From that point on the Do’s and Don’ts, rules and protocols all blurred into one word – respect. That was it. That’s all I needed. I just needed to be myself and respect people.
Heather sits with Melanie’s mum Georgina, chats with her and fills out paperwork, while Lien Trinh, the Vision Foundation’s locum optometrist, gives Melanie a complete eye check.
Lien has worked in remote locations since last year. She did a stint in Vietnam for a year before coming back to Australia where she worked in Arnhem Land and now Central Australia.
Lien completed training in low vision, paediatric vision and contact lenses at the University of Melbourne and post graduate studies in Ocular Therapeutics at the University of NSW. This year, she’s studying public health in her Masters of Optometry and doing remote work to get as much exposure to Aboriginal health
care as she can.
“I want to do one trip a month for the rest of the year. In Australia Aboriginal health is a huge part of health care. I’m really interested in getting into work in developing countries but this is my own backyard. We have no exposure to these sorts of health problems and eye care in the cities,” she said.
Melanie clutches her toy plane and tries to open her eyes. She has a lot of health issues including dense cataracts and advanced scarred Keratoconus. There’s not a lot Lien can do for her but she writes out a referral to the ophthalmologist who’ll visit the clinic in a couple of months.
Lien sees another 10 patients in the afternoon including Melanie’s mum who came in complaining of sore eyes. Patients amble in, and when they head out, most have a new pair of sunnies and either a pair of ready-mades or the promise to return to get their glasses in a few weeks or months.
Erin drives out to collect a few people from their homes. It’s busy but the pace is unhurried. Kids scrawl on colouring-in books with crayons then run around outside and mess with the dogs who have been waiting patiently for their masters. The one constant in the room is the life and times of Slim Dusty looping on the DVD player.
Each eye test takes about 30 minutes. This includes people with diabetes receiving drops to dilate their pupils.
The prescription glasses, supplied through a Low Cost Spectacle Scheme administered by the Fred Hollows Foundation, range from AUD$55 to AUD$180. It’s a huge amount for a person on Centrelink or Pensions, so Heather arranges manageable regular deductions from wage or Centrelink payments. Sometimes people borrow from friends or family. In some of the bigger communities the arts centre gives an advance.
The next morning Lien takes the nurses through an in-service training on Red Eyes before we head down the road to Harts Range, another couple of hours away.
Arriving in Harts Range
The tidy community of Harts Range is set against the East MacDonnell ranges. It has a school, shop, shire council, art centre, racetrack and the government-run health centre.
Word-of-mouth and a bit of diligent follow up by Heather will result in nearly 30 people (including all those with diabetes) having their eyes tested over the two days – that’s more than 10 per cent of the community’s population of 260.
Communication can be difficult. Tina is in her 20s and has diabetes. She’s asked whether she has “trouble with her eyes” and says “No”. She’s asked if she can see far away when she’s driving and she says “No”. Lien gives Tina a full check-up.
Louis and Cecilia are in their 70s and have three kids who live in Alice. They’ve lived in Harts most of their lives and remember when it was a cattle station. Louis didn’t go to school and worked with the stockmen, then on the railways for 24 years, before he retired. He’s had the same pair of tinted glasses for four years and takes pride in looking after them. Louis is diabetic but his vision is good and hasn’t deteriorated.
Cecilia, his wife, is an artist. She spends hours over her canvas painting with fine detailed brush strokes. Her vision is failing so Lien checks her eyes and provides her with a pair of ready-mades, which make
an enormous difference.
In the afternoon we head over to the arts centre to see Cecilia at work. A group of women are sitting around a long table dipping brushes into pots and chattering among themselves in their local dialect. Among them is Cecilia doing detailed work, painting witchetty grubs and other bush tucker. She’s not wearing her glasses and giggles awkwardly when we ask her where they are. She said her new glasses are in the car. She’s too embarrassed or “shamed” to wear them and is frightened she’ll be made fun of.
This is a common problem in the communities. Similar to the problem countless kids faced at school before Harry Potter came along. However, once an elder is seen wearing glasses, the stigma of wearing them is generally lifted.
Healthy School Age Kids Screening
The next morning a few kids, who have been earmarked for eye checks, drop into the clinic to have their eyes tested.
Over two days, the nurses ran the government’s Healthy School Age Kids program and took the kids through a series of skin, hair, teeth and eye checks like an “assembly line” says Jenny, the head nurse. “When we checked their visual acuity, there were five kids whose vision wasn’t up to speed for their age, so we booked them in to see the optometrist, to see if there was anything wrong.”
Unlike the adults, who are quieter and reserved, the kids bounce into clinic laughing, jumping around and rumbling each other. They have big broad toothy smiles and share jokes while they’re having their eyes checked. I don’t know what they were laughing at, but chances are, as they were looking at me before the punch lines were delivered, I was most likely the butt of a few of them.
While Lien checked their visual acuity I was trying to stop the others from whispering the answers. It was a rabble but fun.
The kids’ eyes were fine but the youngest, Shedrick, because of his age, was asked to come back next year.
The Impact You Have
It’s hard to gauge your impact on the local community when you’re there for such a short period of time but there is an unsaid acceptance and gratitude the community has for visiting health workers.
Many Aboriginal languages don’t have a word for “please” and “thank you” and find it odd that non-Aboriginal people say these things all the time. Aboriginal people are obliged by blood or marriage to share food and shelter without expecting any gratitude in response. We often interpret this behaviour as rude.
I had a chat with the elders and asked if I could take photos around the community. They gave me the nod, so in the afternoon before we packed up, I went for a walk. Some days you have to patiently wait it out for a photo opportunity, on others they walk in front of your lens. Today was that sort of day.
A group of Catholic nuns from Alice Springs were walking down the road towards me with some kids. I pointed to my camera, and they smiled, so I started shooting. As I did, two kids came running up to me. One of them was little Shedrick, who we’d seen at the clinic. He shouted, “that’s him. He’s one of them” and threw his arms around me. I’ll never forget it. I felt, at that moment, a level of acceptance that I didn’t expect we’d receive.
Our final stop was in Alcoota, a couple of hours down the Plenty Highway, where the team saw about 15 people. Anton, an Aboriginal nurse from South Australia, did a brilliant job in preparing the community for the eye care team’s visit. He was very well organised and picked up two to three people at a time to be seen by the team.
Having worked in the community for four years Anton knows the locals well and he’s very protective of their needs and rights to privacy.
They know him well now too – and they trust him. In fact, so much so that the local government has offered to provide him with a permanent home in the community. However Anton refuses. With just 22 homes in the community and some of them sleeping up to 15 people, he can see the local need is greater than his. Anton says until the over-crowding is sorted he’d prefer to keep his rented accommodation.
The week was long but extremely rewarding – so many extraordinary stories, so many wonderful people, so much potential and opportunity.
After I left, Heather and Lien headed off to Willowra, Stirling and Ti Tree where they saw another 53 people. Heather then went back home for a week before heading out again, while Lien trekked out to Tennant Creek, about five hours drive from Alice.
As to what’s next, who knows. Lien has made herself available to do remote work and the offers from agencies around the world are flooding in. “I’m just going with the flow,” she says. “Who knows where
I’ll end up? I just want to help people.”
Thank you to the Brien Holden Vision Institute Foundation and the Central Australian Aboriginal Congress for inviting me to join this outreach optometry trip in Central Australia. I owe a great deal of thanks to the many patients who agreed to have their photos taken; the elders in Bonya and Harts Range for allowing me to take photos in their communities as well as the generosity extended to me by the nurses and staff at the health centres in Bonya, Harts Range and Alcoota.
|Aboriginal Health Facts|
Aboriginal people make up about 2.5 per cent of the Australian population – or 517,000 people – yet they are one of the most researched groups in the world. There is a study being done on them every other minute, and while they continue to be studied, they continue to suffer from absolute poverty – lack of water, food and shelter. About 100,000 members of our Aboriginal population live in remote areas of Australia.
Aboriginal people are the most marginalised group in terms of health care and are the only people in the world living in a developed country who suffer from the scourge of trachoma, an infectious blindness, which is easily treatable. A form of conjunctivitis, trachoma spreads quickly through a community when people don’t wash their face and blow their nose.
Trachoma still exists in remote communities but we didn’t see any evidence of it in the communities we visited. What we saw were kids with strong teeth and shining clean faces – the result of years of health education by teams of dedicated health workers who had gone before us. The messages are getting through and are having an impact on the kids and their families.
Remote Eye Care Workers
Eye care workers need to be made of the right stuff to work in remote communities. They need to have a thick skin, be resilient, adaptable and able to work as part of a team under any conditions.
For the many eye care professionals I’ve spoken with, and seen at work in developing countries or remote communities over the years, I’ve noticed, that not only do the people and region they visit benefit but they benefit enormously as well. They love the work and they love the people.
If every optometrist was able to get out of their practice for one week a year and adopt a rural location that they visited every year, it would be beneficial for the community and the optometrist directly.
Outreach Optometry Services Central Australia
Outreach optometry services to many communities in the Central Australia region is a collaborative effort between the Brien Holden Vision Institute Foundation (formerly ICEE) and Central Australian Aboriginal Congress (CAAC), to help prevent avoidable blindness by providing access to optometric care.
CAAC, established in 1973, is one of the largest and oldest Aboriginal community controlled deliverers of health services in the Northern Territory. Brien Holden Vision Institute Foundation provides the optometry services while CAAC provides the service delivery to ensure its is most efficient, effective and appropriate.
The aim of the outreach optometry team is to provide essential eye care to people who live in remote communities. The priority is to check those diagnosed with diabetes every year; assess and refer people to an ophthalmologist if needed; and correct refractive error by providing low cost glasses.
This team visits 26 communities twice a year and more than 12,000 people over a 1.2 million km2 area. It is an enormous job. When you look at where these communities are you realise the sheer magnitude of the Regional Eye Health Coordinator’s position.