Small inexpensive steps could eliminate avoidable blindness from Australia’s Aboriginal community within just five years of implementation. There has been universal agreement of recommendations put forward in the recently released The Roadmap to Close the Gap for Vision. Now what’s needed is a comprehensive and co-ordinated effort across departments within the country’s state and federal governments to implement the necessary action. But will it happen?
Closing the Gap on Indigenous Eye Health
Australia’s Aboriginal and Torres Strait Island population suffers six times as much blindness as the country’s non Aboriginal. Quite disgracefully, 94 per cent of the vision loss is associated with preventable, treatable eye diseases. These staggering statistics, among others, were published in the 2009 National Indigenous Eye Health Survey (NIEHS), led by Melbourne Laureate Professor Hugh Taylor AC, from the University of Melbourne.
As a result of that survey, Professor Taylor, the Harold Mitchell Chair of Indigenous Eye Health; and Andrea Boudville and Mitchell Anjou of the Indigenous Eye Health Unit authored The Roadmap to Close the Gap for Vision. It was launched in late February by the Federal Minister for Indigenous Health, Hon. Warren Snowdon MP, and the Chair of National Aboriginal Community Controlled Health (NACCHO), Justin Mohamed.
The success we’re having with trachoma in the Northern Territory… is real validation that what we’re doing works
The Roadmap puts forward policy recommendations containing 42 interlinked strategies that could eliminate avoidable blindness from within our Aboriginal and Torres Strait Island communities. Many of the strategies contained in the Roadmap, as Professor Hugh Taylor told mivision, would be quick to implement, insignificant in cost and highly effective. “Unlike many other conditions, we have the solutions for the key eye care conditions and most vision loss can effectively be eliminated overnight,” he said.
“What is needed are additional resources to increase the availability of eye care, and good co-ordination and case management of the patient journey.”
Giving an example of the simple recommendations put forward, Professor Taylor said “we need to make sure no Aboriginal or Torres Strait Islander with diabetes goes for more than a year without having an eye examination”.
“So when a diabetic patient is getting their hemoglobin, blood or urine tested, his or her case manager would ensure they also have their vision checked.”
Additionally, he said, vision checks should be included as part of the standard Medicare funded health check and built into the health check procedure by the College of GPs. In doing this, Professor Taylor said, “we’ll build the eye health system from both ends”.
Professor Taylor said he and his team hope to have all of the recommendations in the Roadmap funded at Commonwealth and State level.
“We’re talking to the ministers of health, health departments and people within community health organisations, showing them the simple things that can be done to get them started now, without any significant funding.”
He said there has been bipartisan support for the recommendations put forward in the Roadmap and that even in the event of a change of government at federal level that support will continue.
“We’ve been talking to both sides of the political spectrum and think this will be well supported by both political parties. No one wants to spend any money on anything at all right now but the amount we’re talking about is relatively small – fully implemented it would cost less than AUD$20 million a year.”
Eliminating Trachoma
That may be the case but the question remains, once the funding is in place, will any serious measures be undertaken to close the gap? Back in 2009, as a result of the findings in Professor Taylor’s NIEHS, Australia’s then Prime Minister, Kevin Rudd made a clear commitment to eliminate trachoma. At that time, he committed a budget of almost AUD$16 million to eliminate the disease, which is responsible for nine per cent of blindness among our Aboriginal and Torres Strait Island population.
Once known as Sandy Blight, trachoma disappeared from mainstream Australia over 100 years ago. A type of conjunctivitis associated with poverty and poor living conditions, it’s a relatively easy disease to get under control. Yet disturbingly, Australia is one of 56 countries in the world that continue to battle this disease. Disgracefully, we’re the only developed nation to still find trachoma a problem.
Professor Taylor said with properly implemented programs, it would be possible to eradicate trachoma from Australia within five years or so. Yet despite having put the budget aside to do so in 2009, the country is far from reaching Mr. Rudd’s goal.
”Solid progress is only really being made in Northern Territory and Western Australia,” said Professor Taylor. In South Australia it’s happening at a slower pace and in Queensland and New South Wales it’s only just getting going. Trachoma is not a problem in Tasmania or Victoria,” said Professor Taylor.
“That’s frustrating because the success we’re having with trachoma in the Northern Territory for example is a real validation that what we’re doing works. The teams up there are making sure they examine all the kids for trachoma and antibiotics are distributed once a year to those who need them. They’re also checking for trichiasis in older people and there is the health promotion work.”
Educational Programs
He said a number of effective social marketing and educational programs have been implemented to help Aboriginal people improve and maintain their eye health. One of these is run by Milpa, a Goanna Mascot who visits communities and appears on television and radio programs to spread the word on ‘clean faces, strong eyes’ which is so important when it comes to managing trachoma.
Milpa means ‘eye’ in Walpiri language. Artist Lily McDonald developed the goanna character, which also features in The Trachoma Story kits, which were developed in 2010 by the Indigenous Eye Health Unit, in the Melbourne School of Population Health, in partnership with Katherine West Health Board and the Northern Territory Government’s Centre for Disease Control.
Social media and Youtube campaigns have also been used with high effect to spread the message… and then there is the Melbourne Football Club.
“The Melbourne Football Club visited the kids in Alice Springs and Darwin recently – the credibility of these people is enormous among Indigenous kids – their message has had significant impact,” said Professor Taylor.
Ahead of a game against Port Adelaide, players Max Gawn, Clint Bartram, Josh Tynan and Rory Taggart recently conducted community visits in the Territory where they ran clinics and visited hospitals and schools. In support of the Melbourne University’s Indigenous eye health program, the players took the opportunity to educate the children on how to maintain healthy eyes through regular cleaning.
National Consistency Essential
Professor Taylor said as well as offering regular eye care services and implementing educational campaigns, a nationally consistent, state-run distribution program for eyewear is essential.
“The price Indigenous people pay for their glasses differs across the States which is a problem – people need cost certainty and that cost needs to be reasonable.”
He said encouraging people within the Indigenous community to wear glasses can be a problem in itself, just as it is in the mainstream.
Additionally, he said, “like us, Aboriginal people tend to put their glasses down and forget where they are – and if you don’t have organised pockets, or you’re not working at a desk, or you don’t have a glove box in your BMW, they get lost… or they get chewed up by a dog or dropped in a fire”.
Understandably these different lifestyle related issues make affordability and reliable supply even more important to our Indigenous population.
Going Forward
For under AUD$20 million each year, Professor Taylor said there would be a “huge” increase in the efficiency of eye care delivery to Australia’s Aboriginal communities. “At the moment an Indigenous patient might see an optometrist then be referred to an ophthalmologist who recommends cataract surgery. The problem then becomes they wait for months and years for the surgery to occur – if it ever does. Similarly, they are tested for glasses and a prescription is written, but the glasses never arrive. So the entire procedure becomes a waste of money and effort and the patient is left with their vision impairment or to stay blind.”
Despite the problems in getting programs up and running across the country, Professor Taylor remains optimistic.
“Where the changes we’ve recommended are being done well we’re seeing significant improvements in Indigenous eye health. That’s validating our argument that a relatively small amount of money well spent will go a long way – we believe this is a really good buy for the government,” he said.
Minister Snowdon said the Government is committed to supporting the program. “The Australian Government is committed to promoting eye health and vision care and reducing the incidence of avoidable blindness. The National Framework for Action to Promote Eye Health and Prevent Avoidable Blindness and Vision Loss provides a blueprint for coordinated action by governments, health professionals, non-government organisations and industry to work in partnership on the prevention of avoidable blindness and vision loss. The Framework continues to guide the Government’s efforts to prevent avoidable blindness,” he said.
He said the Department of Health and Ageing is continuing to assess the recommendations contained in Professor Taylor’s report and the extent to which they can be incorporated by current programs.
