Corporate philanthropy today extends well beyond making simple donations to charity. It is now common to see large corporations establish not-for-profit organisations to deliver specific services. While it sounds admirable, in the complex instance of delivering eye care to culturally sensitive areas of remote Australia, is it the best way to support our first people?
The global report entitled Business’s Social Contract: capturing the corporate philanthropy opportunity,1 found that 84 per cent of corporate executives from 272 companies surveyed said they believe society expects businesses to be more actively involved in environmental, social and political issues than they were five years ago. Doing so, the executives said, is increasingly important as a business strategy.
In Australia, not-for-profit policy network, Catalyst Australia, recently concluded a comprehensive study on corporate community investment. It examined 12 major Australian companies and found that together they donate half a billion dollars to the community annually.
“Corporate community investing clearly helps make Australia a better place, and every dollar spent has an enormous potential to change lives,” said Jo-Anne Schofield, Executive Director at Catalyst.
…clear guidelines are needed to ensure a more sustainable system…
Indeed, the eye care community is very much committed to making Australia “a better place” with generous contributions made to under-serviced communities either through cash, work hours or the supply
of equipment.
However, despite this well-intentioned generosity, optometrists and ophthalmologists working on the ground in remote Australia believe there needs to be a more cohesive plan to deliver effective eye health services to remote areas of Australia.
Dr. Ian Reddie, Director of Ophthalmology at the Townsville Hospital, is the only Vitreoretinal Surgeon with a public hospital appointment based outside southeast Queensland. The hospital services a large area of northern Queensland, including Mt. Isa through to the Gulf of Carpentaria.
“We’re working with a two tiered medical system – the first tier is for those who are close to the services and the second tier is for those who are too far away, who must rely on church groups and corporates to support the government.
“If that’s the way we must work then every eye health provider must be very careful to understand the cultural complexities of the people we are working with.”
Duplication
Rowan Churchill, a privately funded optometrist working in North Queensland, has identified duplication and communication as two major problems in coordinating services with NGOs.
He said, in some instances, not-for-profit organisations are screening in areas that are already serviced, while other remote areas of Australia receive no eye care service at all.
Mr. Churchill has impressive credentials working with remote communities. Along with a team of ophthalmologists headed by Dr. Mark Loane, Mr. Churchill has set up and operated eye clinics in 26 Queensland communities over 18 years, funded primarily by Queensland Health.
Mr. Churchill’s model works like this: an optometrist travels to each community three times a year and is accompanied by an ophthalmologist on the mid-year trip. The ophthalmologist assesses referred patients and laser treatment is performed as required, as well as a pre-operative assessment.
A few months later, a surgical team visits the hospital at Weipa, the largest town on the Gulf of Carpentaria, and works with Queensland Health staff to perform 70–80 surgeries over five days. Most patients are back in their home community in just over 24 hours, having travelled as a group with “all care taken to meet their needs”.
He said visiting Aboriginal communities several times a year ensures that over time, everyone who needs to be seen, is seen.
“At any one time, people will be missing from the community. Trying to pull everyone together with a promotion or celebrities might attract the children, who generally don’t have vision problems, but it won’t get all of the adults together. So it’s important to keep returning”.
Mr. Churchill said return visits are also an invaluable way of building community connections and trust.
Communication Difficulties
Mr. Churchill says another crucial aspect of health service delivery is communication via patient records.
“The Queensland Government has put systems in place to manage remote eye health and it’s imperative that we work within those systems.
“Leaving records of screening results, as well as notes on referrals or bookings that have been made for surgery enables the local GP to follow up with the patient each week when they see him or her. If the patient is diabetic, it’s important to coordinate with the diabetic educators and leave appropriate notes on the Queensland Health patient file as well.”
One of the problems for NGOs working in this area is their inability to access these patient files.
OneSight, a global not-for-profit owned by OPSM, is one of the NGOs active in far-north Queensland. It ran its first clinic in Mount Isa in 2012. In August last year it held a two-day clinic in the Indigenous community of Doomadgee, on the Gulf of Carpentaria, with plans for another at nearby Mornington Island this year.
OneSight Foundation Director Julie Urquhart said Mount Isa was targeted because it was identified by Queensland Health as being ‘underserviced’. She said the clinic at Doomadgee and the proposed trip to Mornington Island were the result of community invitations.
Ms. Urquhart said as a not-for-profit, privacy laws prevent OneSight from accessing medical records for any members of the community. She said team members try to work around this, by asking patients about previous screenings and treatments.
She said OneSight does offer to leave its patient records in the community with the local health organisation. In the case of Doomadgee, the Aboriginal Health Clinic chose not to take the offer up. However, the school at Doomadgee accepted all records of children screened, along with duplicate copies, which were intended to be sent home to parents, Ms. Urquhart said.
Not Just a One Person Job
Melbourne University’s Professor Hugh Taylor is an expert in Indigenous eye care, and lead author of the report The Roadmap to Close the Gap for Vision, published in 2012.
Professor Taylor’s report found that communities that were able to “contribute to determining approaches for specialist services and care were more involved with supporting and achieving good patient outcomes”.
Too often, he said, the management of local health services in Australia’s remote communities relied on the work of a single committed person.
“A weakness of such a local system is the dependence on that individual as there was rarely a satisfactory backup, or contingency or succession planning… reliance on a single person… may limit the capacity of the local system to grow or adapt over time.
“Having an eye care professional in such a role has worked in the past, however for a national system to be responsive to local requirements there will need to be additional people to accept this type of responsibility.
“Local oversight and management needs to include the local Aboriginal Health Service, other primary care providers, and optometry, ophthalmology and hospital services. Within a region this may include a number of different locations and providers. There are some good examples of effective regional systems, but these are still the exception rather than the rule.”
Corporate Support Welcomed
Dr. Reddie said it was a case of “the more the merrier” when it came to corporate involvement in delivering eye care to remote areas of Australia.
“But services shouldn’t be competing and they shouldn’t be imposed on the local community,” Dr. Reddie said.
“They need to dovetail with what’s been done in the past – and learn from the past,” he said.
Dr. Reddie believes an effective way for not-for-profits and corporates to contribute to remote eye health could be to provide financial support to fund more full-time eye care coordinators operating in remote regions across Australia. He says funding from corporate Australia could assist cash-strapped governments to reach more people in the most remote areas of the country.
Dr. Tim Henderson, a medical eye specialist with the Alice Springs Hospital, agrees.
He runs a successful intensive surgery program, in part supported by the Fred Hollows Foundation, and similar to the model developed by Mr. Churchill. The ophthalmology department in Alice Springs also provides day to day outpatient consultations and surgery throughout the year.
“I think it is utterly misguided to ‘parachute in’ to (deliver eye health programs) with little or no reference to the existing services or understanding the circumstances of remote patients,” said Dr. Henderson.
“As an example, just because someone has a cataract that you or I would want surgery for does not justify making them have surgery if they don’t want to.”
He said it was necessary to “earn the right to the privilege” of operating on someone, by developing an ongoing relationship with them and their community.
“The stakes are high and there is no room for any sub-standard care. A poor outcome for a patient is not just ‘a complication’ for one patient – all health service interactions have long-term and wide-reaching consequences, because there is a corporate response to every single health event, which can result in suspicion and resistance years later and amongst family and friends far removed in other communities or states,” he said.
Fred Hollows: A Leading Example
Dr. Henderson said corporates wanting to enter remote Indigenous communities should look to the work of the Fred Hollows Foundation as a model.
“I think the Fred Hollows Foundation is showing the way for how to direct funds to support existing services for which public hospital funds will never be sufficient, but it is complicated and slow and perhaps accounts for why some well-meaning exercises plough ahead in isolation.”
Dr. Henderson said clear guidelines are needed to ensure a more sustainable system can be established.
“I would welcome clear mechanisms for as many individuals or groups or organisations to donate to specific events, items or components of existing services to enhance the whole that can be offered by the local services most familiar with the territory. This is much more effective than sporadic ad hoc and patchy contributions.
“The local services have the relevant experience, can ensure appropriate liaison, interpreters, transport and accommodation for supporting friends and relatives to provide peri-operative support. They are used to doing this every week and experienced at reducing the sense of dislocation and isolation many remote patients feel. More external resources simply allow us to do that better.”
Collaboration
Dr. Reddie said the way forward is to encourage collaboration.
“What needs to happen is that everyone should sit down at the table – the Health Department, eye health providers and anyone else who wants to come and provide these services. And we should at least try to engage with the people on the ground… there is no single answer to close the gap in Indigenous health… but we can’t be ham-fisted,” said Dr. Reddie.
The Optometry Association of Australia (OAA) says it has developed guidelines that strongly emphasis the need for collaboration and consultation.
OAA CEO Genevieve Quilty said the guidelines point to the need to minimise the overlap of opotometry services and work with the health infrastructure already in place.
Ms. Quilty said visiting services are important to support access to needed eye care for all Australians and to overcome geographical and cultural barriers to care.
“Generally speaking we believe care outcomes are optomised when care is integrated with local primary health care services, patients are supported to continue on the recommended clinical pathway and can access follow-up care in accordance with best practice for their presentation.
“We have encouraged all parties who are working or thinking of working in Aboriginal and Torres Strait Islander communities… to familiarise themselves with the position statement… the experience of those delivering and receiving services in remote, rural and indigenous settings is that continuity of care is a priority. This involves sustainable models of eye care that deliver consistent services over time and integrate with both primary and tertiary care,” she said.
As Dr. Reddie points out, all of the organisations involved are working with the one aim.
“No-one owns these people. We’re all just trying to get a much better outcome for those who have become horribly disadvantaged – and give them the same access to eye health services as those living in cities like Sydney and Melbourne receive.”
How They Help…and Why |
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mivision interviewed other members of the eye care community to find out how they contribute back to society and why. Here’s what we found… Johnson & Johnson Vision Care (J&JVC) J&JVC, which is a small division within the organisation, chooses its own direction, which, across the Asia Pacific region, is primarily focused on improving children’s vision. Luke Cahill, Professional Affairs Director at Johnson and Johnson Vision Care, said the division deliberately keeps its philanthropic work low key. “Sight for Kids is a regional JJVC initiative set up because we know that in many countries within the Asia Pacific, there are kids who don’t have access to eye care and vision services. Our division raises funds through a number of activities and those funds are matched by the J&J organisation.” Mr. Cahill said Sight for Kids funds Lions Club eye care specialists on the ground to perform sustainable eye care programs. “For a small group like J&JVC, it’s relatively expensive to send a group of eye specialists off to remote areas of the Asia Pacific to conduct eye clinics. “So instead, we pick off a specific area, like West Bengal, and fund eye care specialists who are working there locally and permanently to deliver sustainable services – screening for basic eye problems, and training.” Designs for VisionDesigns for Vision (DVF) donates products to the value of over AUD$100,000 to “a myriad” of charities in any one year. The company also facilitates the movement of quality second hand equipment from retiring doctors and optometrists to charity organisations. Additionally, Designs for Vision recently donated two complete consulting rooms to the University of New South Wales School of Optometry and Vision Science Clinic. Speaking of the returns that support brings, Will Robertson, Optometry Sales Specialist said, “In a way, giving is a greedy experience, because you get to feel good about what you are giving, knowing that it will have a constructive effect. “Also, knowing DFV is philanthropically oriented has a positive impact on your employees and customers. But in saying that, it is important that DFV continues to support different charities and institutions regardless of the kudos.” Mr. Robertson, who is closely involved with Cambodia Vision, said his own charitable nature can be directly attributed to his parents. “Both volunteered their time all their lives, and even more so since they retired, and I believe that my colleagues also share that level of sincerity.” Bausch and LombGlobally, Bausch and Lomb contributes to eye health by funding research, secondary education into science, supporting charities, mission trips and disaster relief efforts. Managing Director Fabian Dwyer said Bausch and Lomb was often approached to support surgeons performing overseas aid work in developing countries. “We request that these surgeons go to the corporate website to complete a request for assistance. In the majority of cases we assist with product and equipment in lieu of any monetary support. We never attempt to quantify the ‘return’ associated with this support. I firmly believe that as a company we have a corporate social responsibility to support such efforts.” |
References
1. Committee Encouraging Corporate Philanthropy (CECP),
2. www.optometrists.asn.au/LinkClick.aspx?fileticket=AUWBeWklz7s%3d&tabid=250&language=en-AU
