Feature, Orthoptics Australia

Closing the Top End Gap

Orthoptist MADELAINE MOORE moved to the Northern Territory to escape the city limits. But on her way, she’s found fulfilment working to improve eye health outcomes for indigenous communities.

The move to Darwin as a junior orthoptist was sparked by the excitement of flying to work as opposed to sitting in Melbourne traffic. After my first day working with Aboriginal and Torres Strait Islander patients there was a strong need for me to learn more about their way of life. A mandatory Aboriginal cultural awareness training program in orientation instilled a thorough understanding and appreciation.

Madelaine Moore.

The ophthalmology team at Royal Darwin Hospital (RDH) is the eye hub for the Northern Territory’s Top End. The Top End includes three regional hospitals, RDH, Katherine Hospital, Gove Hospital and approximately 50 Aboriginal communities. Due to the large geographical area our team services, we find ourselves on small aircrafts most weeks to visit these locations.

Flying during the wet season can have its hiccups, and occasionally the clinic is cancelled due to cyclone warnings or ‘sorry business’ – which refers to a funeral in the community.

The general comment rotating registrars or visiting specialists mention is the significant advancement of disease and delayed patient presentation. This may be caused by limited access to eye services due to remoteness of living and cultural values which may place health lower on their priority list.

Other cultural challenges we face when working with our Aboriginal patients include poor compliance, whether it is due to patient’s health values or an appointment notification lost in transit, particularly if the patient is moving through various communities.

A shift in language is also often required when informing a patient of a procedure as they have no cultural knowledge or words for things such as cataracts, refraction etc. It is recommended to utilise images and meaning based interpretation to maximise comprehension of the procedure. And of course, with the advanced progression of eye disease comes increased challenges, particularly in the operating theatre. Regularly, surgeons are facing dense cataracts with a history of trauma.

Contrary to these challenges is that on the first day post-operation, patient satisfaction is high, and we often see ‘sisters’ dancing in waiting rooms together after dressing removals.

Over the years of the NT outreach program, the three regional hospitals have become equipped with resources to deliver baseline eye assessments and treatments, including intravitreal injections, various laser treatment and routine surgeries.

Government initiatives have also provided a high percentage of the community health centres with a slit lamp and retinal camera. Historically, patients were flown into RDH to have a basic test such as an OCT. Due to excessive expenditure on patient travel, procurement of this essential diagnostic equipment in all regional hospitals was complete, enabling our team to service patients nearer to their home.

In recent years, with improvements in patient travel processes, including patients’ willingness to travel, the remote services model has evolved to spend increased time in our regional hospitals and decreased time in small Aboriginal health centres. After reviewing previous models, our team found a high percentage of patients were referred to their regional hospital for further diagnostics or treatment. Since the remodelling, we have decreased duplicate patient episodes.

This new model would not be achievable without optometrists who spend more extended periods in community healthcare centres to provide screening and monitoring services to the community patients.

Like other regional places, recruiting an orthoptic workforce is a challenge. Our team has two orthoptists and an optical technician to support a team of nine ophthalmologists of varying levels; infrequently, the orthoptists work together due to our outreach program.

We co-work with an excellent nursing team; however, some days can feel overwhelming when you have no one to share the problematic cases with, during an overbooked clinic. With a supportive group of ophthalmologists, the growth potential and responsibility as a junior orthoptist is unmatched. The experience equips us with efficiency, adaptability and all-round orthoptic skills, as well as learning the fundamentals of clinic management.

Working regionally and with our remote Aboriginal patients has its challenges; however, this is outweighed by the personalities we meet.

Each month we go on a new adventure, pinch ourselves when we land on the untouched coastlines of the NT, and play our small part in ‘Closing the Gap.’

ABOUT THE AUTHOR: Madelaine Moore is an orthoptist and Indigenous eye health coordinator working in Royal Darwin Hospital, Northern territory. She has a Bachelor of Health Sciences/ Master of Orthoptics (La Trobe University) and a Postgraduate in Health Service Management (Griffith University).

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