Just one month after it took to the road, a mobile vision bus established to address inequitable access to eye health in Aotearoa New Zealand, is delivering on several fronts.
The vision bus is delivering subsidised spectacles to those in need, contributing to vital eye health research in New Zealand, providing leverage for political advocacy, and creating awareness of optometry as a profession.
With all of this in mind, Professor Steven Dakin, Head of the School of Optometry and Vision Science at University of Auckland from April 2014 – April 2022, said the fiveyear wait to get the bus up and running has been entirely worthwhile.
Prof Dakin, who has led the Aotearoa vision bus project, explained that there are several barriers to accessing eye health services across the country – financial, geographic, cultural, and often, a simple lack of knowledge.
Unlike Australia, where the cost of a comprehensive eye examination is rebated by Medicare, every eye examination in New Zealand attracts a fee. For this reason alone, many people, especially the young and old, don’t visit an optometrist unless they perceive a vision problem. Even then, due to a lack of awareness about available services, they are more likely to visit their general practitioner, followed by a trip to the public hospital for free treatment. Access to eye care services in regional areas can be difficult due to distance and lack of transportation, and for Māori and Pacific Islanders, there can be a high level of mistrust of Pakeha health care providers.
“To overcome these barriers, we wanted to enable our student optometrists to take their service out to the communities,” Prof Dakin explained. “While supporting the eye health of people in need, we also believed the students would benefit from new and diverse training opportunities.”
With many of the school’s optometry students still living in their parental home in Auckland, Prof Dakin hoped exposing them to different locations would create an awareness of the unmet need for eye health services outside the cities, challenge them with a range of pathologies they wouldn’t otherwise see, and even encourage some of them to build their professional lives in rural settings.
Interestingly, the visits are also exposing young Māori and Pacific Islander people to optometry as a potential profession, something he hopes will translate to a more representative student intake for the faculty in the future.
Explaining that The University of Auckland has improved representation of Māori and Pacific Islander students studying medicine in recent years, Prof Dakin said, “We know that when Māori and Pacific Islander people deliver health services to their communities, we achieve better outcomes, but the challenge has been to attract young Indigenous people into optometry. We hope to raise awareness of what an amazing career choice optometry can be – one that enables people to engage with and make a difference to community health for all of life.”
THE CHALLENGE OF FUNDING
One of the challenges in getting the concept for the vision bus off the ground was raising funds. To date there has been no research conducted to understand the true prevalence or epidemiology of ocular conditions in Aotearoa, and, as Prof Dakin explained, without evidence of the scale of a problem, you can’t get funding to find a solution.
Although this is about to change, following a government decision to fund a major eye health survey to be conducted by University of Auckland’s Dr Jacqueline Ramke, it was an initial philanthropic donation of NZ$1.8 million that enabled the concept for the bus to come to life.
The donation came about following an interview with Prof Dakin, broadcast on Radio New Zealand’s Nine to Noon Program.
“I thought I was calling in for a five-minute interview with Kathryn Ryan, but we ended up talking for 24 minutes, describing all the details,” Prof Dakin said. Little did he know that Rae and Peter Fehl were listening that day. Stuck in traffic, they heard the entire interview and began to imagine how the concept could be scaled up and rolled out across the country.
The Fehl’s family trust was quick to donate the entire $1.8 million needed to equip the bus and staff it for five years. This was followed by a donation from philanthropist Barbara Blake which enabled the supply of subsidised optical frames, and Essilor, which stepped in to donate lenses.
Synergistically, the Fehls have a strong relationship with University of Auckland, with Peter Fehl having overseen its largest ever capital works programme as property manager for 13 years. Additionally, Ms Blake’s grandfather had operated a mobile optometry service in New Zealand during the war.
Prof Dakin said financial support from the Fehl and Blake families and Essilor enabled the University to approach experienced optometrist Veeran Morar with an offer to run the van and supervise students in their work. A New Zealander, Mr Morar had been working on outreach programs in remote Australia and was ready to return home. He was the final piece of the puzzle.
“Once Veeran arrived, it finally became clear that this really was going to happen. The vehicle was commissioned, the equipment ordered and fitted, and livery designed to draw attention to the service we’re providing.
“It’s been an amazing effort, supported by so many arms of the University and it’s refreshing when a university can deliver a solution to a problem, rather than highlighting problems that need to be fixed.”
Importantly, he said, the bus is being welcomed by communities and is showing how mobile eye health services could make access to eye care more equitable. Additionally, it is providing a valuable contribution to the country’s knowledge of eye disease across different communities, which will support the work of Dr Ramke and provide leverage when advocating for more services in the future.
“While we can’t solve the entire problem (of an unmet need for eye care services) we are collecting evidence and we are demonstrating what can be done,” Prof Dakin said.
BUILT TO SCALE
With more philanthropic support, Prof Dakin hopes the concept can be scaled up, in line with the Fehl’s vision.
“This is a practical way we can make a difference to eye health. We already have effective treatments for eye diseases – so rather than funding research into more treatments, let’s focus our efforts (and funding) on getting the treatments out there, into the communities.”
Having launched the vision bus at an official event attended by the Vice Chancellor of The University of Auckland and New Zealand’s Governor General, Prof Dakin is keen to maintain his involvement.
“I stepped back as Head of School in April and while it is usual for Heads of School to take a break when they stand down, then pursue research, I am committed to continue my involvement with the bus.”
Acknowledging the influence Sir Richard Faull, Knight of NZ Order of Merit and Distinguished Professor of Clinical Anatomy and Medical Imaging, has had on his personal ambitions, Prof Dakin said, “I’ve now gained some experience with philanthropic projects and I’m excited about the opportunity to make a real impact. It’s all about community partnership and ensuring that philanthropy makes a difference to peoples’ vision, and ultimately, to the quality of their lives – that will be how I give back to the University.”