Australia

Indigenous children at Ghumarn Cultural Centre, NT. Photo: Claude Ho.

Indigenous children at Ghumarn Cultural Centre, NT. Photo: Claude Ho.

Professor Fred Hollows worked tirelessly to tackle preventable eye disease and other chronic conditions affecting Aboriginal and Torres Strait Islanders.

Overview

 Stephen Ellison

Aboriginal and Torres Strait Islander children have better vision than the mainstream population. By the time they reach adulthood, however, they are six times more likely than other Australians to go blind. Yet, for Indigenous Australians, 94 per cent of vision loss is preventable or treatable.

The work of The Fred Hollows Foundation is inspired by the fierce determination Fred showed in working to improve the eye health and wellbeing of Aboriginal and Torres Strait Islander people. Fred’s boiling anger about the appalling conditions he witnessed in their communities – notably chronic disease and poor general living conditions – gave rise to a raft of revolutionary initiatives and campaigns, culminating in the establishment of The Fred Hollows Foundation in 1992.

The Foundation’s Indigenous Australia Program continues that work, as a partner and leader, in remote and underserviced communities in the Northern Territory, the Kimberley, Pilbara and Goldfields regions of Western Australia, the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in South Australia, western New South Wales and south-east Queensland.

Our core values – integrity, collaboration, empowerment and action – inform our work in Aboriginal and Torres Strait Islander communities as much as they do our programs in the poorest nations of Africa or Asia. We stand up for what is right; we work collaboratively to eliminate trachoma and end avoidable blindness; and we take a lead in advocacy, innovation and research.

The picture across Indigenous Australia is better than when Fred took eye health care on the road throughout Australia in the mid-1970s, but there remains much to be done.

Key Priorities:

  • Eye health – working side-by-side with the Aboriginal Community Controlled Health sector, eye health partners and governments, to pursue our eye disease priorities – cataract, trachoma, diabetic retinopathy and uncorrected refractive error
  • Health – supporting Aboriginal and Torres Strait Islander health governance, as well as better models of coordinated health care
  • Leadership and advocacy – speaking out and identifying pathways for Aboriginal and Torres Strait Islander people to have equitable access to the comprehensive health and eye health services intended for all Australians.

Eye health

In a single afternoon in Katherine, Northern Territory, Professor Fred Hollows saw 15 Aboriginal people who were blind from cataracts. Only once, in his long clinical experience, was a non-Aboriginal person led in to see him who was blind from cataracts. The inequity is telling. A cataract can be removed in a 20-minute procedure and is the most common eye operation – for most but not all Australians.

Fred’s vision – that a good eye service is the right of everybody, not just those who can afford it – is at the heart of all The Foundation does. Restoring sight allows an individual – whether an older person, a younger worker, or a student or child – to reclaim their position in society.

Our goals in a nutshell are: to improve access to treatment for cataract, eliminate trachoma, enhance eye health services for people living with diabetes, and ensure eye health services are sustainable, co-ordinated and appropriately resourced. The scope of our work covers the spectrum of eye health care, and includes support for:

  • Training of Aboriginal Community Based Workers to increase participation in trachoma and eye health screening, treatment and prevention
  • Reducing eye surgery waiting times for people in remote and underserviced areas
  • Innovative telehealth services to improve the detection and treatment of diabetic retinopathy
  • Co-ordination and delivery of ophthalmology and optometry services in remote and underserviced communities

We identify, on a very practical level, the best ways for Aboriginal and Torres Strait Islander people to gain equitable and timely access to high-quality health care, bearing in mind that the barriers to success may be complex and culturally sensitive, and often not understood by non-Indigenous Australians. Distances to travel for treatment are often great and the logistics involved in people attending specialist medical appointments may be difficult to coordinate and expensive. The Foundation has an important role to play in recognising and highlighting these hurdles and finding the best ways to navigate around them.

Health

 Hugh Rutherford

Some of the greatest challenges for The Foundation have come from the stark contrast between the standard of health care available to most Australians, living in one of the world’s most advanced economies, and the care that is accessible to Aboriginal and Torres Strait Islander people.

Although much has changed since Fred started his work in remote communities, Aboriginal Australians continue to experience a disproportionate burden of ill health and disease largely due to an under-resourced health workforce, geographical and cultural isolation and widespread economic disadvantage. Life expectancy still falls more than a decade short of the national average.

Although the Indigenous Australia Program has eye health as its focus, there is an important role for The Foundation to play in working to improve the broader health outcomes of Aboriginal and Torres Strait Islanders.

This includes providing comprehensive health checks for adults and children that include eye care in the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in South Australia. In the Northern Territory, the innovative telehealth services we support to detect and treat diabetic retinopathy are simultaneously tackling chronic conditions like diabetes and cardiovascular disease.

Leadership and advocacy

We are leaders and advocates, engaging with state, territory and federal governments for quality – and equality – in the delivery of eye health care. The Foundation’s advocacy is focused on bringing attention to the health issues facing Aboriginal and Torres Strait Islanders and closing the gap in health and eye health equality with other Australians within a generation (by 2030).

We are vocal participants in the Recognise campaign, which calls on all Australians to support the movement to acknowledge Aboriginal and Torres Strait Islander people in Australia’s Constitution.

We also support the advocacy efforts of a network of 140 Aboriginal and Torres Strait Islander-led organisations, through our partnership with the National Aboriginal Community Controlled Health Organisation.

Achievements 2013

Eye Health

Delivering Services

  • Increased eye surgery rates and decreased waiting times for Indigenous Australians in the Northern Territory, South Australia and New South Wales by improving patient pathways to services
  • Supported 282 cataract surgeries and 34 other sight-saving interventions at intensive surgery weeks in Alice Springs and the Top End
  • Screened 1,044 people in remote communities, providing optometry and ophthalmology services and affordable spectacles to those in need.

Investing in people

  • Supported the employment and training of 12 Aboriginal community based workers to join the Trachoma Elimination Program in remote communities across the Northern Territory – increasing participation in trachoma screening and treatment and boosting uptake of face washing amongst children
  • Trained one doctor, two nurses and two Aboriginal health practitioners to perform sight-saving laser treatment on diabetic retinopathy patients in the Top End
  • Funded two eye health co-ordinators to provide logistical support to outreach optometrists in the Top End
  • Funded an orthoptist to provide eye health services to Indigenous people living in far west NSW
  • Trained 62 primary health care workers from 10 community clinics to detect eye disease and refer patients for further treatment.

Research and innovation

  • Partnered in a project that uses telehealth to manage diabetic retinopathy, diabetes and cardiovascular disease
  • Connected three remote Indigenous health organisations with a retinal grading centre, reducing the time taken to assess retinal images to just 48 hours
  • Funded a new software program to assist health professionals in Alice Springs, Katherine and East Arnhem Land with the management of chronic disease
  • Delivered three retinal cameras to health clinics to increase diabetic retinopathy detection
  • Produced a short film starring Indigenous puppets to educate people about having regular eye checks. Over 900 copies of the DVD Looking Good have been distributed to remote communities.
General health
  • Funded a study which documented alarming rates of anaemia amongst youngsters living in remote areas of northern Australia and highlighted the need for urgent action to improve nutrition for mothers, babies and young children
  • Continued to fund a doctor and three nurses to provide comprehensive health checks for adults and children from South Australia’s Anangu Pitjantjatjara Yankunytjatjara (APY) Lands to tackle chronic disease
  • These doctors and nurses also performed growth checks on all 127 Anangu children under three years old. In addition, all 174 Anangu children aged between six months and six years were fully immunised
  • Funded a resource package for remote health workers aimed at improving nutrition in remote Indigenous communities.
Empowering Leaders
  • Provided training to 82 Indigenous Australians, including health professionals, supporting them to better speak out about their rights. Over the past five years participants in the Diplomacy Training Program have gone on to lead their communities in areas including running for public office, lobbying for changes to intervention laws and joining local boards
  • Along with other Vision 2020 members, we developed and endorsed principles for a national low cost spectacle scheme to address high rates of uncorrected refractive error experienced by Indigenous Australians
  • Supported the development of a set of principles by Aboriginal Peak Organisations Northern Territory to help NGOs work effectively with Indigenous communities. These have now been adopted by local, national and international NGOs.

We achieved these results working together with government agencies and local partners.

About the program

The Foundation’s vision of “a world in which no person is needlessly blind and Indigenous Australians exercise their right to good health” is achieved by the Indigenous Australia Program through partnerships with Aboriginal Community Controlled Health Organisations and their peak organisations, along with the federal, state and territory governments and our mayor eye health partners.

We support:

  • Reform of the health system, to eliminate inequity in service provision, and advocacy for better and more inclusive pathways to comprehensive health care. Our work with specialist eye health partners, referred to below, is integral to these aims
  • The Central Australia and Barkley Integrated Eye Health Strategy, the Greater Darwin Integrated Eye Health Program and the Katherine Regional Integrated Eye Health Program, particularly in increasing outreach ophthalmology and optometry services and program coordination
  • Institute for Urban Indigenous Health - a feasibility project (sparked by eye health data) for a day surgery unit in South-East Queensland
  • Projects in Western New South Wales, including orthoptist funding for the Outback Eye Service and project support at Royal Flying Doctors Service
  • Brien Holden Vision Institute, particularly in training Indigenous liaison officers, who increase uptake of comprehensive eye health services through, for example, stronger social, emotional and cultural support for patients
  • TEAMSnet remote access project that uses telehealth to manage diabetic retinopathy, diabetes and cardiovascular disease in remote locations
  • Trachoma Elimination Program and training of Aboriginal Community-Based Workers. The program is integral to the work of The Foundation in the Northern Territory, and is earmarked for expansion into Western Australia and South Australia (if needed and supported by those communities). As we do wherever we work for the elimination of trachoma, we promote the SAFE strategy, where SAFE stands for screening, antibiotic treatments, face washing and environmental improvements
  • Aboriginal Medical Services Alliance Northern Territory, National Aboriginal Community Controlled Health Organisation and Indigenous Organisations Advocacy Network, in the vital areas of governance, policy capacity, advocacy and health service leadership.

    Facts and figures

    More than a third of Indigenous homes in the Northern Territory (NT) are over-crowded, putting people at greater risk of infectious diseases and other physical and mental health problems. Recent studies show:

     
    Eye health In the Northern Territory, nearly 20% of Indigenous children under 10 have active and infectious trachoma, an eye disease that causes blindness if left untreated, and 32% of Indigenous people over 20 have corneal scarring.
    Aural health  Up to 40% of young children in Indigenous communities living in remote parts of Australia are affected by chronic suppurative otitis media (CSOM), a serious middle ear infection that causes permanent hearing loss. The World Health Organization considers Australian Indigenous people to be a 'special high risk group' for CSOM.
    Life expectancy approx. 10 years less than for other Australians (lowest in the Northern Territory with 61.5 years for men and 69.2 years for women). Indigenous Australians aged 35 to 54 are 23 to 37 times more likely to die from type 2 diabetes than other Australians in that age group.
    Infant mortality rate 13.6 per 1000 in infants less than one year of age in the Northern Territory, twice the rate of non-Indigenous infants
    Nutrition 13% of Aboriginal children 0-5 years in remote NT are underweight and 31% of 6-12 months were anaemic, according to the ‘NT Healthy under-Five Kids’ program (2009).
    Literacy rate only a third of Indigenous children living in very remote communities can read at the accepted minimum standard.
    What we can do

    Help keep Fred’s dream alive.

    4 out of 5 people who are blind in the developing world don't need to be. Routine treatment costing as little as $25 can restore sight and hope.