Breaking down barriers in Indigenous eye care: Matthew Chung

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Matthew Chung, Optometrist at Specsavers Midland Gate, experienced a different side of Western Australian eye care while participating in a Fred Hollows Foundation outreach trip to Fitzroy Crossing in late September. He discusses his views on the healthcare gap for Indigenous Australians and how he believes the optometry profession can help to address this.

My trip with The Fred Hollows Foundation to the Kimberley region of WA, sponsored by Specsavers, was an experience that is difficult to sum into words. To provide some background, I moved to Perth from Victoria in 2015 when I first graduated. Over the years, I’ve had the pleasure of working with the Lions Eye Institute, where Associate Professor Angus Turner is a researcher. Assoc Prof Turner is best known for his extraordinary work in founding the Lions Outback Vision Van, a three-room, fully-mobile ophthalmology clinic that is largely funded by The Fred Hollows Foundation using Specsavers Community Program donations. This van services regional WA, which is an incredibly vast expanse of land, to say the least. I had heard so much about this van and about Assoc Prof Turner that when I saw the opportunity with Specsavers and The Fred Hollows Foundation, I had to put in an application to go out and experience working with the team for myself.

From my experience, it seems that the eastern states suffer from an underexposure to Aboriginal issues, especially in Aboriginal health. I have found there to be greater awareness and presence of Aboriginal culture felt in WA, which is something I’ve discovered since moving here. We’re always hearing about the healthcare gap in the media but until recently, to me, conditions such as trachoma were just pictures in a textbook.

I travelled to Fitzroy Crossing with Marlene Boulos, a graduate Specsavers optometrist. We spent a lot of the trip visiting Aboriginal communities, many of which are several hours’ drive from the nearest town. It never occurred to me that the communities would be as spread out as they are. I also wasn’t expecting the health centres to be as well-equipped as they were, although unfortunately they still had very little ophthalmic equipment.

Marlene and I assisted the visiting optometrist, Specsavers Willetton Optometry Partner Stuart Aamodt, with vision screenings and instillation of eyedrops. We managed to see quite a few patients in a short amount of time, which was impressive given the lack of typical pre-test equipment. I’d been advised by a colleague that working in Aboriginal communities would mean seeing pathology at a much later stage than I was used to. He was right. Sadly, it was common to see monocular patients and end-stage diabetic retinopathy. The access to eye care, as well as awareness and education on maintaining healthy eyesight, was far less than what we in urban practice consider to be the norm.

I realised how much I take my equipment for granted, especially at Specsavers, now that OCT is being rolled out to mainstream practice. Things that I’d consider ‘basics’, like a slit lamp and fundus camera, simply weren’t available at the health centres as there isn’t enough funding to support having these at every site.

The backlog of patients that needed to be seen was far greater than what we could have worked through in the week. In addition to people referring themselves for examination, each community has specific people that the nurses recommend for eye tests. We’d be fortunate if a handful of them showed up. I was informed that it is very common for Aboriginal communities to have tenuous relationships with healthcare teams, which saddened me.

The joy of rural practice, I think, comes from the ability to help people on a much more personal level. We encountered a gentleman who had severe cataracts in both eyes and needed to be waitlisted for cataract surgery as soon as possible. Since the Vision Van was in Fitzroy Crossing it would have been simple enough for him to visit the clinic for biometry and pre-operative assessment on the day. However, he could not drive, and organising transport was nearly impossible at such short notice as it was a two-hour drive across dirt roads to town.

Having no other option, we provided him with accommodation before bringing him back to town with us. He was assessed and waitlisted for cataract surgery that afternoon. If we hadn’t done this, he would have been walking around with severely reduced vision for the next year. Being able to help people at this level doesn’t happen in everyday practice.

I was glad to see I was able to help in some capacity, but I don’t feel that it was enough. I think there are a multitude of barriers towards permanent change and improvement. The equipment, education and availability of eye care professionals would be a place to start. More than anything, however, we need to have a consistent team of eye care professionals to facilitate good trust and communication, as I think this is a huge barrier towards improving eye health, as well as improving health in general. I hope I can continue to do visits like this with Specsavers, and that this inspires others to do the same.

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