An ophthalmology project set up at Griffith Base Hospital in NSW to improve access to eyecare services for Indigenous and non-Indigenous people living in the Western Murrumbidgee Local Health District has hit the ground running and with further support can strengthen its delivery of eyecare to the region.
When an ophthalmologist and a hospital director floated the idea of establishing a visiting eye health service at Griffith Base Hospital – a six hour drive west of Sydney – little did they know that 24 months later their initiative would be nominated by the hospital staff for a NSW Government Murrumbidgee Local Health District (MLHD) Excellence Award.
At a ceremony in Wagga Wagga in June, ‘Saving Sight is our Vision’ was named winner of MLHD’s Keeping People Healthy Award, one of 15 award categories.
At the time, MLHD CEO Ms Jill Ludford said it was rewarding to see the number of activities happening across the district with sincere efforts to support First Nations communities.
“Improving access to eyecare services through the delivery of high quality, sustainable, affordable, regular and culturally sensitive eye services has been Griffith Ophthalmology’s focus.”
Led by Associate Professor Geoffrey Painter, one of the founders of Gordon Eye Surgery and a director of Foresight Australia, and colleague Dr Dominic McCall, a group of mostly Sydney-based ophthalmologists visit Griffith Base Hospital every four weeks to see and operate on patients from the Western MLHD. In addition, Foresight has sponsored two training courses to upskill employees from the Griffith Aboriginal Medical Service.
“By providing a comprehensive eyecare service in Griffith it prevents people from having to travel excessive distances for routine eyecare”
“The project started with A/Prof Painter, and Kerrie Legg, hospital director and director of nursing at Chatswood Private Hospital with support from Foresight Australia and Turramurra Rotary,” McCall says. “For close to a decade, under the auspices of charity organisations Foresight Australia and Open Heart International, we were part of a team that used to go to the Philippines every year on outreach trips – until COVID prevented it.”
Like many organisations during the COVID pandemic, Foresight Australia turned inwards, so that the team could pivot to providing outreach in NSW, particularly in Aboriginal health. Painter and Legg, whose extensive nursing career led to specialising in ophthalmology, visited Griffith Base Hospital in June 2021 to begin negotiations on how to provide support.
Providing specialist medical services in regional NSW has always been challenging. In 2021, RANZCO made a submission to the NSW Government parliamentary inquiry into health outcomes and access to health and hospital services in rural, regional and remote NSW, noting that 80% of permanent visual loss can be prevented through timely access to appropriate eye treatment.
“Southwestern NSW was identified as an area of need by NSW Health, and our group was asked to assist. This coincided with the well-deserved retirement of the local ophthalmologist in Griffith,” McCall says.
With extensive support from Griffith Base Hospital management and the MLHD, the retiring ophthalmologist’s equipment was purchased, and the Griffith Base Hospital Ophthalmology Department was established, with the service commencing at the beginning of 2022.
“Our department now supports the routine eye health needs of the Western MLHD including towns such as Lake Cargelligo and Hay. It is supported by emergency and specialist ophthalmic services in Wagga Wagga (a two-hour drive), and Albury (a three-hour drive) which have well-established ophthalmic services delivering very high levels of care for their communities which commonly spans many hundreds of kilometres,” McCall says.
The partnership between Griffith Base Hospital and the Griffith Ophthalmology Project was to deliver three goals in line with the MLHD strategic goals:
• Provide short term assistance to reduce the cataract surgery waiting list for the Western MLHD at Griffith Base Hospital.
• Provide long term sustainable ophthalmic care for the Western MLHD based at Griffith Base Hospital.
• Develop an effective ophthalmic outreach program for the Indigenous people of the Western MLHD.
The team have been gradually increasing their workload to achieve these goals, with the assistance of the administrative staff of Griffith Base Hospital and the help of St Vincent’s Community Private Hospital Griffith. The surgical wait list has been dramatically reduced and the clinic is working hard to reduce the waiting time for routine clinic appointments.
“We’ve been going four-weekly, sometimes more regularly, depending on need. We usually have two or three consultant ophthalmologists each visit. Additionally, Chatswood Private Hospital provides a registrar and Gordon Eye Surgery provides an orthoptist. Interested Resident Medical Officers and medical students join the team from time-to-time. A majority of consultants are from Gordon Eye Surgery at the moment, but some are from different practices throughout Sydney, and one from Melbourne. We are hoping to expand this to other practices in the future,” McCall says.
The team typically take an-hour-and-a-half flight, arriving on a Sunday evening and leaving on Wednesday afternoon or evening.
“We spend about three days every four weeks in Griffith operating and seeing an increasing number of patients. We are looking to expand the service to every two weeks, but the limiting factor at the moment is staffing, unfortunately,” he says.
“We’ve been privileged to have local administration staff that have been trained to work in high volume outpatient clinics and a local assistant in nursing (AIN) who has been helping us in the clinic. The clinic could not survive a day without their tireless efforts. I’m looking to upskill local clinical staff to make the service more sustainable from a local perspective.”
The team has also met with local optometrists who are supporting the eye department by providing a valuable triage and co-management of patients for referral and are keen to provide support.
“As the workload increases, especially as the Indigenous screening project increases referrals, we’ll need even more staff. If we can’t employ local staff, we’ll need to find people who are willing to go out there on a semi regular basis – we’re talking about orthoptists, optometrists, registrars and consultant ophthalmologists, everyone is an important part of making it sustainable long term.”
Amid the four-weekly clinics, the team have also been working with the Griffith Aboriginal Medical Service to get screening programs off the ground in more remote locations for both Indigenous and non-indigenous patients in more remote communities, McCall explains.
“While it is satisfying, from a personal perspective, to go out and see communities in regional areas, logistically it’s much better having people that are trained, that know the community, who can screen for significant eye disease locally and then refer them to a centralised service,” he says.
“So far we have done two teaching symposia for the Griffith Aboriginal Medical Service on how to screen for vision, intraocular pressures, cataract, and diabetic retinopathy. There is a retinal camera at a couple of their clinics for the detection of diabetic retinopathy and we have been teaching how to implement a screening program, as well as teaching general eye pathology and what to look out for.”
Further training courses for local Aboriginal healthcare workers from the Griffith Aboriginal Medical Service and Griffith Base Hospital as well as nurses and doctors from these organisations are planned for the near future.
In addition, the team is establishing referral pathways so patients at the more distant clinics can be seen in Griffith, reducing cost and travel involved.
“That’s the key. By providing a comprehensive eyecare service in Griffith it prevents people from having to travel excessive distances for routine eyecare. It’s a long way when patients are travelling two or three hours just to get to Griffith, and then it’s another two hours to get to Wagga, the next regional centre, if our service didn’t exist,” McCall says.
A/Prof Painter says it was therefore with great pride for the team that the Griffith Base Hospital staff nominated the project for an MLHD Excellence award.
“It was even more pleasing that the project won the award. It is a recognition of all the hard work that Griffith Base Hospital staff, the project members and the sponsoring organisations have put into establishing and running a Griffith Base Hospital ophthalmology department,” he says.
Compelling case for a Griffith Base Hospital eye clinic
At the commencement of the program in March 2022 there were 123 patients on the waitlist for ophthalmic surgery with an average wait time of 131 days.
As at March 2023, the program had 10 patients on the waitlist, signalling a significant reduction in wait times. There have been 13 public clinics conducted in the 12 months resulting in 1,796 consultations for an average of 138 consultations per four-week visit. Approximately 8% of these patients identified as Indigenous.
While the data shows what impact the clinic has had in the 12 months it has been operating, McCall says the anecdotal evidence is even more compelling.
“The patients often tell us how appreciative they are that they don’t have to travel further for ophthalmic care and family members don’t have to take time off work to drive them there,” he says.
Being a public hospital ophthalmology clinic, the team has been invited to contribute to the development of the State-wide Referral Criteria (SRC) for NSW Health specialist outpatient services.
Facilitated by the NSW Ministry of Health in partnership with the Agency for Clinical Innovation, the project’s aim is to facilitate safe, timely and effective referral and prioritisation of patients requiring access to NSW Health specialist outpatient services. SRC are intended to support patients and referring health professionals when issuing referrals as well as NSW Health specialist outpatient services at the point of screening and triage.