The Tale of an Optometrist Going Bush

I do at least one, if not more, Northern Territory trips a year. I also try to do a number of rural and regional NSW Aboriginal eye clinics. Brien Holden Vision Institute allows me the opportunity to participate in this much valued service to Indigenous communities.

Earlier this year I spent a week in Central Australia in the communities of Ampilatwatja and Tara. Kerrie Sankey, the Regional Eye Health Coordinator, and I travelled by 4WD from Alice Springs to the community on bitumen and dirt roads.

Travelling out there is nothing like driving in the country of New South Wales. Navigation requires constant attention – signs are not always easy to see; a wrong turn can take you quite a distance from where you want to go.

The first test of our ingenuity on any of these trips is when we’re allocated an examination room on arrival at a clinic. Forget about the luxury of having a lot of equipment at your fingertips – or even an organised space. The first thing we need to do is wrap our heads around the working space and arrange the room in a way that provides adequate distance to test vision using a viewing chart. Then it’s time to assess the instruments that are available. If there is a slit lamp I’ll feel extremely privileged… if not I’ll have to make do with whatever testing instruments are available… or adapt my techniques to suit.

Vision is important – it gives people better opportunities and improved quality of life. With this in mind, when we’re working out bush, we strive to see as many patients as we can muster in any one day.

Back to Basics

It’s back to basics when we’re working in Australia’s regional and remote communities. Diabetic reviews are the norm and dilations are routine for eye examinations. The supply of ready-mades is an important and valuable service that provides useful vision to the community.

There is also the opportunity to catch people who fall through the net. An example of this is a 46-year-old Aboriginal male who had sustained a blunt injury to his left eye that resulted in a cataract and raised pressures.

He was referred but did not attend the appointment. When reviewed again two years later, he had pressures of R 15 and L 36 mmHg, and was prescribed Timoptol bid. Soon after he lost his drops and did not get any more.

A further assessment the following year placed him on the waiting list for cataract surgery. His presenting complaints were that he needed reading spectacles. Pressures were R 16 and L 42 mmHg. Our discussions with the man centred on the raised pressure, the need for an ophthalmological review and for him to continue to attend appointments – we can only hope.

A Day in the Life

Every trip away is different but by my third day I’ve generally got the room well set up and the routine down pat. Health workers help us by bringing the people on the list for review and we do our best to see them all, although at times, that’s just not possible.

During my most recent trip to Central Australia, day three was by far the most intriguing. While the morning was quiet due to an important function in the community, the afternoon brought a surge of people to the clinic, some of whom came with unusual cases. One of those cases was an 11-year old child with Down Syndrome who had a lovely nature but was very difficult to assess, even with the help of a teacher and a health worker.

Being part of the eye care service humbles me – it’s here that I realise the difficulties that remoteness presents… delivering simple everyday eye health services is a challenge.

On the Road Again

Evenings at Ampilatwatja are a little surreal. There’s no hustle and bustle of the city, just the quiet of the breeze, beautiful sunsets, hot clear star-lit skies and the rich red earth. Donkeys walk down the main road and community dogs are the norm.

But time is fleeting and departures from these communities are scheduled early to beat the heat of the day.

By 7.30am the car is packed, we’re on the road and on our way to Tara. We arrive at 9:40am, unload and before we’ve even had a minute to set up the room and try out the new computer system, our first patients arrive.

With the initial rush taken care of, we go door knocking to invite people from the community to come and use our services. It’s a quick clinic – we work through until just before 2pm when we call it a day and once again pack our bags. We have yet another two and a half hour drive through the heat of the afternoon ahead of us. Destination: Alice Springs then home.

There’s no doubt, these trips are fast paced – they’re challenging… exhausting… humbling… so why do I
do it? I want to see Australia and be part of the culture, be part of the changes, be part of this land that is so vast… and perhaps because of my own disability, I want to contribute something back. This is my way of doing it.

Albert Lee is an optometrist who runs his own practice in Sydney’s south. He is also a clinical supervisor at the UNSW optometry for final year clinics and regularly volunteers as an optometrist for the Brien Holden Vision Institute.