National Trachoma and Eye Health Program

Using $1.4 million in funding from the Australian Government, The Royal Australian and New Zealand college of Ophthalmologists commenced the ground-breaking National Trachoma and Eye Health Program (NTEHP) in the late 1970s.

From 1976-1978, the NTEHP was carried out by hundreds of dedicated eye health personnel, including Fred Hollows as Director and Gordon Briscoe as Deputy Director.

When Professor Fred Hollows (1929-1993) had first visited rural Indigenous communities in Australia in the 1960s he was shocked by the deplorable standards of eye health.

"It was like something out of the medical history books," he said, "eye diseases of a kind and degree that hadn't been seen in western society for generations! The neglect this implied, the suffering and wasted quality of human life were appalling."

The NTEHP set out to eliminate trachoma and other eye conditions in rural and remote communities and, for the first time, record the status of eye health in rural Australia.Up to 50 staff, including ophthalmologists, orthoptists, optical dispensers, microbiologists, nurses, clerical staff and Aboriginal liaison officers worked in a number of teams. 

• Over three years, the NTEHP teams covered more than 84,000 kilometres by road and more by air and sea. More than 465 communities were visited and 100,000 people screened, of whom 62,000 were Indigenous Australians.
• Approximately 27,000 people were treated for trachoma and more than 1,000 operations were performed.
• The NTEHP also identified that nearly half of Australia's Indigenous population had trachoma. In some regions of the Northern Territory and Western Australia, the prevalence of the condition was as high as 80% of the population.

• A body of organisational expertise was developed to efficiently organise the provision of immediate eye care and clinical services to rural and remote areas of Australia.
• A system of central records was developed, which permitted tracking of the changing trachoma and eye health situation.
• More than 80 ophthalmologists volunteered for the NTEHP (for up to three weeks each). Most were taking a monumental step out of their usual environment to work in the difficult conditions, without any modern technologies or conveniences. Some of these ophthalmologists "adopted" communities and continued to provide eye care services after their time with the program.
• Indigenous and non-Indigenous health workers were trained in eye care.

• National attention focused on the problems of Indigenous health, at a time when public awareness of the issues was extremely low.
• Culturally appropriate lines of communication were established with Indigenous communities. In the initial planning for the NTEHP, the need for community liaison was identified. The communities being visited were consulted and it was explained what, why and how the medical teams planned to work. Specific community needs were also accommodated. ‘No survey without service' was the mantra of the program.
• More than 7,000 pairs of glasses were dispensed through the program. Many of the people who received them had never seen glasses before.
• The NTEHP provided an opportunity to assess the prevalence of other identified health problems in rural Australian communities, including otitis media (middle-ear inflammation) and nasal discharge.

Gabi Hollows

"In early 1976, Fred asked me to accompany him on his National Trachoma and Eye Health Program...I saw so much of Australia and have beautiful memories. I was very privileged to be initiated into Aboriginal culture the way I was. Those years changed my life and the way I see things."

Jilpia Nappalljari Jones

Jilpia Nappalljari Jones a Walmadjari woman from the Great Sandy Desert of the Kimberly region in Western Australia, cut short a holiday to work as a registered nurse on the NTEHP team.

During the NTEHP's travels she witnessed a confronting degree of discrimination and injustice towards her people, extreme poor health and shameful living conditions.

"The state of health in Aboriginal communities was very bad," she recounts. "The living conditions no better, such as tin shacks or old car bodies and no running water."

Being part of the NTEHP team was both rewarding and empowering for Jilpia:
"You had to have a sense of humour, determination and a heart and gut commitment to fight for better vision and health for all."

"It is possible to improve aspects of Aboriginal health where we Indigenous people are involved as equal partners in the process."

The Aboriginal flag represents Aboriginal people moving over the red sands of Australia, under a golden sun. It symbolises, for Aboriginal people, their aspirations for national unity and improved status and health.

The NTEHP adopted the flag as its masthead, modifying the "sun" into an eye. The flag was displayed on all NTEHP t-shirts, literature and transport and became a unifying symbol. Some Indigenous people had never seen an Indigenous flag before the NTEHP team visited their community.

What is trachoma?

Trachoma (also known as Sandy Blight) is an infectious eye disease caused by a micro-organism called Chlamydia trachomatis.

The micro-organism spreads through contact with eye or nose discharge of an infected person, especially by flies, fingers, towels, handkerchiefs, etc.

After years of repeated infection, the inside of the eyelid may be scarred so severely that the eyelid turns inward and the lashes rub on the eyeball, scarring the cornea (the front of the eye).

If untreated, this can lead to the formation of irreversible corneal opacities and blindness.

What is the magnitude of the problem?

Trachoma affects 84 million people globally which includes people who are affected by trachoma but may not be blind.

Trachoma is most common in the poorer rural areas of Africa, Asia, Central and South America, Australia and the Middle East.

In spite of a comprehensive national treatment and screening program in the 1970s, Australia is the only developed country in which trachoma is still active and is found almost exclusively within the Indigenous population.

Who does it affect?

Children under the age of five predominantly bear the active infection but the pain, scarring and damage to the eye is often felt in adulthood.

Due to their role as primary carers, women are also often at higher risk of being affected by the condition.

Trachoma is a marker of poverty and low living standards, particularly over crowding, poor sanitation and nutrition.

How is it treated?

In many instances, treatment and control of trachoma has been implemented using the S.A.F.E strategy.

The S.A.F.E strategy involves Surgery, Antibiotic treatment, Facial cleanliness and Environmental improvement, which includes providing access to clean water, to help reduce the activity and spread of the disease.

• National Trachoma and Eye Health Program Report, The Royal Australian College of Ophthalmologists, 1980 (available at University libraries ISBN: 0959478507)
• The Royal Australian and New Zealand College of Ophthalmologists
• Australian Institute of Aboriginal and Torres Strait Islander Studies
• Listen to Fred Hollows talk about the NTEHP