In the outback
In 1968, after seeing two Gurindji elders as patients in the Prince of Wales Hospital eye clinic, Fred was invited to fly up to a Gurindji camp in the Northern Territory with a couple of other doctors.
The poor standard of health in the camp, particularly eye health, was a shock.
“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.”
Fred was especially disturbed by the huge number of children and adults suffering from blinding trachoma – a disease that had largely been eradicated in the rest of Australia.
At a press conference arranged for when they got back Fred said the discrepancy between medical services in the city and the outback and between the eye health of Indigenous and non-Indigenous Australians was “a scandal”.
Shortly afterwards he was invited to attend a meeting of the Aboriginal Legal Service in Redfern where he was asked if he’d help set up a medical service for Aboriginal people. The Aboriginal Medical Service in Redfern opened its doors in 1971, just ten days after a second meeting, and pretty soon they had more doctors volunteering than they could handle.
Fred was later instrumental in setting up similar Aboriginal Medical Services throughout Australia. The Foundation continues to work closely with many Aboriginal-controlled health services that now exist across Australia.
Fred goes to Bourke
Soon Fred was asked if he’d take a medical team to Bourke to do a wide-ranging survey of health and eye health there. His first thought was, “I wonder if they’ve got trachoma there, 800 kilometres from Sydney”.
He found widespread trachoma among the Indigenous population, and none in the non-Indigenous population.
“Until Aborigines share the same basic conditions of hygiene, sound diet, insect-proof housing, sanitation and clean water... Aborigines in rural parts of the country will continue to be afflicted with avoidable diseases such as trachoma,” Fred said, and worked to improve the situation until his death in 1993.
The National Trachoma and Eye Health Program
A trial in Enngonia, a town near Bourke, showed systemic treatment of trachoma could be effective, and a 1974 screening trip through New South Wales, Queensland, South Australia and the Northern Territory revealed widespread need.
With Fred as director, Gordon Briscoe as deputy and funding from the Australian Government, the Royal Australian and New Zealand College of Ophthalmologists ran the National Trachoma and Eye Health Program (NTEHP) across Australia from 1976 to 1978.
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.
Perhaps most importantly, national attention was focused on the poor state of Indigenous health at a time when public awareness of the issues was extremely low.
Working together on the NTEHP
According to Fred, “the important thing about the trachoma program was Aboriginal liaison. And the reason we succeeded was we got a good lot of Aborigines working with us who would go ahead of us, tell the people what we were on about, what benefits they would gain and get the people on our side."
Jilpia Nappalljari Jones, a Walmadjari woman from the Great Sandy Desert of the Kimberley region in Western Australia, worked as a registered nurse on the NTEHP team.
"The state of health in Aboriginal communities was very bad," she remembers. "The living conditions no better, such as tin shacks or old car bodies, and no running water.”
NTEHP teams visited more than 465 communities and screened 100,000 people of whom 62,000 were Indigenous Australians. They found nearly half of Australia's Indigenous population had trachoma and in some regions of the Northern Territory and Western Australia the rate was 80%.
Approximately 27,000 people were treated for trachoma and more than 1,000 operations were performed.
A system of central records was developed, which permitted tracking of the changing trachoma and eye health situation.
Indigenous and non-Indigenous health workers were trained in eye care.
More than 7,000 pairs of glasses were dispensed.
Turning down an Order of Australia
Five or six years later, when Fred went back to some communities the NTEHP had visited and where a lot of work had since been put in to establish local medical services he found the standard of general health appalling.
He turned down an Order of Australia then because he thought, “this isn’t the time to be accepting accolades for Aboriginal health”. He wrote to the Governor-General, meetings were called, and the result was a program to address communicable diseases in Indigenous communities.
Awards can be useful
Awards he accepted in the last years of his life, such as Australian of the Year, gave Fred a platform from which to speak out once again about the issues closest to his heart – Indigenous health and the social and political position of Australia’s Indigenous people, and the responsibility we share, as privileged citizens of developed countries, to help the people of the developing world.
In recognition of his “outstanding contribution and achievement” in improving Indigenous health in Australia, Fred Hollows was entered into the Hall of Fame at the inaugural New South Wales Aboriginal Health Awards in 2004.