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Tuesday / May 21.
HomemifeatureA Vision for the Outback

A Vision for the Outback

In the vast State of Western Australia, which spans more than 2,500,000 square kilometres, much of it barely populated, delivering health services is nothing short of a mission. But thanks to a no-nonsense team supported by Lions Outback Vision and an innovative Tele-Health initiative, this State has achieved what no other State in Australia has managed to do.

It was Sydney optometrist Margie O’Neill who got optometrists and ophthalmologists working together to get West Australia’s remote eye health service off the ground. Interestingly enough, she pretty much fell into the role through her work in outback Northern Territory. Now, 17 years later, that service has been embraced and developed by Lions Outback Vision.

“After I’d finished studying optometry, I decided to travel around Australia with a friend. We spent time in Perth but I ended up in Darwin where I found regular work in an optometry practice,” said Ms. O’Neill.

“That practice serviced a mining town in Arnhem Land and I was lucky enough to go along on one of the clinical trips. I really enjoyed the exposure to Aboriginal people and I could see a clear need for eye screening that wasn’t being serviced.”

Once you’re working in these remote communities, you find yourself operating in a very tight grapevine – people started to ring from other communities to ask whether I
could offer them the same services

That was back in 1996 and Ms. O’Neill said at the time, there was no funding for remote eye health services. “I had to figure out a way to pay for it,” she said. And she did.

“For the first two years I self-funded my outreach work from my practice, and spent time figuring out how to efficiently manage the logistics – how long it would take to travel to each community, how much time to spend there, where to move to next…

“I also worked closely with the Visiting Optometrists Scheme (VOS) to address the issues of delivering eye care to remote Australia. At that time VOS wasn’t geared up for very remote services – so for example, they didn’t understand the need to have a 4WD instead of a 2WD, the long distances involved or the higher costs of accommodation in remote areas.”

Following a three-year review of the issues by VOS, the funding began to slowly trickle in. Meanwhile, demand for Ms. O’Neill’s services quickly grew.

“I moved to Kakadu and started working with a few remote communities. Then I moved on to the Kimberley and established my base in Kununurra.

“Once you’re working in these remote communities, you find yourself operating in a very tight grapevine – people started to ring from other communities to ask whether I could offer them the same services – my work with a few communities grew into something bigger.”

outbackvision.com.au

Associate Professor Angus Turner is the Director of Lions Outback Vision, which was established in 2010 to improve the eye health of rural, remote and Indigenous West Australians. He works closely with Ms. O’Neill to coordinate and deliver eye-health services to the Pilbara, Kimberley, Goldfields, Midwest, Southwest and Great Southern regions of Western Australia.

“We’ve been working over the last few years to increase the number of services provided to remote and rural areas and to make them more efficient.

“We recently had our first conference, which brought together optometrists, Aboriginal health workers and ophthalmologists and ophthalmology registrars – all those who provide outreach services in WA – for a practical workshop meeting to nut out the year ahead.

“This was particularly helpful in making health workers feel they’re part of a team – they often feel isolated when working out in the communities.”

It was also an effective way to build more efficient systems.

“We’ve identified that one way to improve efficiency is to integrate with the optometry services so that much of the primary eye health is triaged rather than being sent directly to ophthalmology.”

In February this year, Lions Outback Vision launched outbackvision.com.au, an online service that enables optometrists working in remote and rural areas to find out when the next ophthalmology service
is scheduled for their area so they can
book in patients.

Within outbackvision.com.au is a ‘tele-health’ portal. This service was established for the use of all health workers working in remote areas but interestingly, in a series of 100 cases, optometrists were found to use the service more that GPs.

“Tele-ophthalmology can reduce the need for patients to travel to Perth or major regional centres for treatment and provides continuity of care between outreach trips,” said Prof. Turner.

“It offers support for optometrists working in remote areas, some of whom may be relatively early in their career or working as locums. It is also great for patients who may need to see an ophthalmologist. Rather than having to wait for the next scheduled visit to the area, using tele-health we can do a live conference with the optometrist and patient, view any scans sent via email and then we can
start to manage and treat the condition straight away. And it’s free for the patient because the specialist consultation is
bulk billed to Medicare.”

Patients can also access the site to gather information regarding general eye health, diseases, treatment, tele-ophthalmology and the Patient Assisted Travel Scheme.

“Having shown how useful this service is for optometry, the next step is to present a case to the government to create an extra Medicare item number for the provision of a tele-health service in addition to the usual consultation fee for optoms working in remote areas.

Prof. Turner said the only limitation to the online services provided by outbackvision.com.au and tele-health is that some optometrists with practices in rural and remote areas do not have Internet access.

“This is something we’re working on, on a case by case basis, but overall, the website and tele-health are helping to close the gap in remote and Indigenous eye health services by creating a direct line between optometrists and ophthalmologists.

An Integrated Service

That direct line between optometrists and ophthalmologists is something that both Ms. O’Neill and Prof. Turner feel very strongly about maintaining because, they say, it is the backbone of a coordinated approach to delivering quality eye health services to Indigenous populations.

“We’re lucky in WA, we’ve got a nice, integrated service – no-one feels that any patient, any community or any aspect of eye health is ‘their turf’ perhaps because there’s just so much work to be done,” said Prof. Turner.

Ms. O’Neill agrees. “When you’re dealing with communities in WA, the logistics are so huge that you need to minimise the non-essential issues. So there is no competition between the professions – instead there’s a real sense that we’re here as a team and we need each other to provide the service.

“We’ve created one publicly funded program and if any other providers want to get involved, we welcome them to step into our program rather than work independently to duplicate existing services.

“Having everyone on the same page has been one key to our success. Another has been the support of the local people – the local Aboriginal health services know the services we offer, they know who to talk to and they have indicated that they like to deal with those they are familiar with.”

Ms. O’Neill said another key to the program’s success is the leadership of Prof. Turner. “All tribute to Angus – he makes everyone feel that their role in the program is valued. He has an inclusive approach that is important in making a team work well together.”

Margie will be Missed

That’s true, but according to Prof. Turner, its Margie O’Neill who has provided the backbone to the system and made it what it is today. When she steps back in June this year, after 17 years’ of service, she will be sorely missed.

“Coordinating remote services and keeping everyone in the loop is more than a full time job – each hospital has its own clerical staff, health workers, theatre managers, drivers to collect patients to co-ordinate,” said Prof. Turner.

“Margie has been amazing doing that work and providing clinical services as well. So now we need to work out a more sustainable process to cope when she leaves. We’re aiming to take the roles of logistics and coordination away from the clinicians so they can get on with the business of providing eye health.”

Ms. O’Neill said, fortunately there is now a number of people working in Lions Outback Vision and in the field with her, who understand the complexities of eye care services to remote Australia.

“We have optometrists volunteering from all over the State to work for one to two weeks at a time. But you can’t send a group of 15 optometrists into remote clinics for two weeks at a time, and have them feeding patients back to 10 ophthalmologists without coordination.

Additionally, she said, “to work successfully in remote Australia, its imperative to understand the social fabric of the community. You can’t overlay the white medical system onto Aboriginal culture – it just won’t work”.

“So we only ever book clinics a few months in advance and we’ve developed strong social networks in the communities. We’ll always ring up the nurses to find out what’s happening before we head off, because there’s no point planning to screen a whole community of people without knowing whether they’ll be there.”