ACO Manager of Aboriginal Services, optometrist Nilmini John at a consultation
As true with many things, great public health work is achieved in no small part through collaboration and partnership with organisations that care deeply about the communities they support. One such partnership is the Australian College of Optometry (ACO) clinic embedded in the Victorian Aboriginal Health Service (VAHS) in Fitzroy, which is celebrating 25 years of operation.
Established in 1998, the ACO clinic aims to address barriers to eye care experienced by Aboriginal and Torres Strait Islander peoples in mainstream services that continue to fail community members and drive health disparities today. The optometry clinic has become an integral part of a larger eye health service that, since 2018, has included ophthalmology services from the Royal Victorian Eye and Ear Hospital (Eye and Ear). Furthermore, a new Aboriginal Eye Health Worker role was added in 2022, thanks to funding by the Fred Hollows Foundation. Embedded services, such as the ACO and Eye and Ear, are privileged to be allowed into the community-controlled spaces to deliver effective care.
We need to provide our patients with as much information, avoiding jargon, so they can make informed decisions regarding their health. This is self-determination at its core
The eye health services are just some of many health care services available to community members. Other services provided include general practitioner medical care, dental, physiotherapy, family counselling, women’s and children’s care, a men’s unit and a preventative health unit.
For those unfamiliar with VAHS, this Aboriginal Community Controlled Health Organisation (ACCHO) supports the social, emotional, physical, and cultural wellbeing of Aboriginal and Torres Strait Islander peoples. VAHS is proudly celebrating 50 years of holistic healthcare provision to Melbourne metropolitan and surrounding areas. In addition to the Fitzroy site, VAHS also operates health centres in the suburbs of Epping, Preston, and St Albans.
The Need for Community-controlled Eye Care
In the late 1990s, blindness was occurring up to 10 times more frequently among Aboriginal and Torres Strait Islander people than in other people.1 Most of the vision loss and blindness was caused by diabetic retinopathy, which disproportionately affects Aboriginal and Torres Strait Islander communities, and can be prevented with regular screening and timely access to treatment.
The idea for the original VAHS optometry clinic was born in response to the 1997 Eye Health in Aboriginal and Torres Strait Islander Communities report prepared by Professor Hugh Taylor. The report emphasised the guideline set by the previous National Aboriginal Health Strategy, which identified community control and community participation as key to improved health for Aboriginal and Torres Strait Islander peoples.
Associate Professor Mitchell Anjou, ACO Clinic Director at the time, alongside VAHS leadership including Chief Executive Officer Tony McCartney and VAHS Board Chair, Allan Brown, worked together closely to establish the arrangement of optometry services at VAHS.
Assoc Prof Anjou said, “The ACO clinic in Carlton was one kilometre from VAHS, yet we never or rarely, knowingly, saw any Aboriginal patients. Clearly there were barriers that needed to be broken to deliver better care to the community and so discussions were initiated in 1997 to immediately respond to the Taylor review. This initiative was also supported by a small statewide Aboriginal eye health committee that had been established at ACCHO.
“We had to create or find some space, get some equipment, and work out a way to darken the room. Magically, given the willingness and enthusiasm shared by ACO and VAHS, it all came together within a matter of months.
“VAHS was very supportive and knew the impact this initiative would have on community access and care. The mindset, in part, was to show it could be done – we could readily set up an optometry service within an ACCHO, and then see if the engagement would work and meet community needs. I am delighted to reflect on the ongoing and continuing success of the ACO optometry service provided with VAHS at VAHS.”
Assoc Prof Anjou’s 2012 paper2 promoted the partnership of optometry services and ACCHOs, and was formed in part by the experience at VAHS. It highlighted that communities within which Aboriginal Health Services host optometric services have a reduced prevalence of visual impairment and provide a higher coverage for distance spectacle correction than communities where services are available through private or state hospital-based facilities.2 The paper asserted that optometric services must be available within Aboriginal Health Services and appropriately linked with primary healthcare services, ophthalmology and hospital services, to support equitable access and eye health outcomes for Aboriginal and Torres Strait Islander people and to effectively close the gap for vision.
Here, people tell us how they want their care delivered, where they want it delivered, when they want to come to appointments, and we try and follow people up
25 Years On
Today, the optometry clinic at VAHS continues to deliver culturally safe care to community members with sessions running every Tuesday and Friday. The team of four ACO optometrists is led by Ms Nilmini John, ACO Manager of Aboriginal Services, who works closely with the VAHS team to continually ensure community eye health needs are met.
“With the support of VAHS and its Aboriginal Health Workers, we have adjusted our visiting optometry to best serve patients. We have a more flexible approach regarding patient arrival times to be more responsive to patients’ needs,” said Ms John.
For Ms John, cultural safety is paramount for all health care settings, and she is passionate about creating safe environments for Aboriginal and Torres Strait Islander peoples.
“As health practitioners, we’re accustomed to telling patients what they should do but when working with First Nations clients, it’s important to ensure patients feel they are ultimately making decisions for themselves. Sometimes these decisions may not be what we would like for, or of them, but we need to accept these decisions.
“We need to provide our patients with as much information, avoiding jargon, so they can make informed decisions regarding their health. This is self-determination at its core.”
Ms John said it was vitally important to “listen deeply” to patients’ concerns about their eye health.
“Often, an Indigenous person’s health care experience or beliefs are shaped by their personal experiences or intergenerational trauma such as the Stolen Generation, so there can be a natural hesitancy or suspicion of health care institutions and workers. Our role is to help community members understand as much about their health so they can make informed decisions that will close the gap in eye care,” she said.
In 2018, the VAHS eye health service evolved significantly with the addition of ophthalmology services provided by the Eye and Ear. With regular fortnightly ophthalmology clinics at VAHS, a full suite of eye care services is now readily available to community members, ranging from primary optometry consultations to laser and injection treatment, and post-operative check-ups.
Dr Rosie Dawkins, Eye and Ear Ophthalmologist, and Natalie Tieri, Aboriginal Health Liaison Officer, have been a driving force behind the ophthalmology service at VAHS, which is the first of its kind in a community-controlled organisation in Australia.
“Delivering care with the community-controlled framework leads to better health outcomes. Here, people tell us how they want their care delivered, where they want it delivered, when they want to come to appointments, and we try and follow people up,” said Dr Dawkins.
More recently in 2022, VAHS Aboriginal health worker Kelli McGuinness was appointed to the newly created role of Aboriginal Eye Health Worker (AEHW) to specifically support the eye health service delivery. This role was created in consultation with ACO optometrists and Dr Dawkins, and was made possible with funding from The Fred Hollows Foundation.
Gavin Brown, VAHS Chief Operating Officer commented, “VAHS Aboriginal Eye Health Worker, Kelli McGuinness Jr has had an immediate impact on the service delivery, and we are designing a model that encourages Kelli to take further higher education steps into eye health.”
The Future for First Nations Eye Health
While much success has come from the dedicated eye care services at VAHS Fitzroy, the challenges facing equitable eye health for Aboriginal and Torres Strait Islander communities are many.
The 2008 National Indigenous Eye Health Survey conducted by the Centre for Eye Research Australia (CERA) in the University of Melbourne indicated that only 20% of those needing screening were receiving it. Indeed, one in three Aboriginal and Torres Strait Islander people had never had their eyes tested. It was estimated that 94% of blindness experienced by the community was avoidable.3
In 2020, an annual update on the implementation of the Roadmap to Close the Gap for Vision reported that the rate of blindness among Aboriginal and Torres Strait Islander adults had halved nationally, but still stood at three times that of other people.4
“VAHS is a recognised leader in the eye health space, and we also acknowledge the incredible work that ACCHOs are doing across Australia. There is a strong synergy by all those involved in improving the eye health in our communities as we continue to be committed to enabling the gift of sight,” said Mr Brown.
Dr Josephine Li, ACO General Manager of Rural VES and Outreach Programs agreed. “We have witnessed first hand that providing eye care services in community-controlled settings is intrinsic to removing barriers and supporting self-determination. It is clear that the best possible health outcomes are made possible with the leadership, teamwork, and guidance of community-controlled health services and Aboriginal and Torres Strait Islander voices. This invaluable input from community is essential across all health services and policies throughout Australia to improve the wellbeing of our Aboriginal and Torres Strait Islander communities.”
Lauren Freir is the Marketing and Communications Manager for the Australian College of Optometry.
This article has been prepared in collaboration with the Victorian Aboriginal Health Service and quoted contributors.
1. Taylor, H. R., Eye health in Aboriginal and Torres Strait Islander communities, 1997.
2. Anjou, M. D., Boudville, A., Taylor, H. R., Why optometry must work from urban and regional Aboriginal Health Services, Clin Exp Optom. 2012 Nov;95(6):615–7. doi:10.1111/j.1444-0938.2012.00805.x. Epub 2012 Sep 20.PMID: 22994546.
3. Arnold, A.L., Dunn, R.A., Taylor, H.R., et al., National Indigenous Eye Health Survey: Minum Barreng (Tracking Eyes), 2009.
4. Taylor, H.R., Gillor, G., Anjou, M.D., 2020 Annual Update on the Implementation of The Roadmap to Close the Gap for Vision, 2020.