Ben Whitham shares his experience working as a senior orthoptist with the Outback Eye Service, reflecting on the challenges and rewards of providing crucial eyecare to remote communities in NSW.
I have experienced four plagues in my life, and all of them have been while working as an orthoptist in remote NSW over the past 12 years. They were mice, locusts, fall armyworm moths and stink bugs, each somehow finding their way into my bed after a very long day’s work.
I always joke about how, once a month, I have the world’s longest commute. The alarm goes off at 4:45am. I drive my car to Bankstown Airport. I get a taxi to Sydney Airport where I enjoy a coffee among the bustling business people. I fly to Dubbo, collect a car from the hospital and set off on the four-hour drive due north-west to my final destination: Bourke, New South Wales.
Nine hours away from the warmth of my bed, I start the process of setting up the IOLs in numerical order and calibrating the diagnostic and surgical ophthalmic equipment. If there has been a rain shower, I have to phone the local shire to confirm the roads are still open so the community transport can get through.
I also must ensure every patient on the surgery list for the next two days has overcome any roadblocks that might prevent them accessing their surgery
These are the final steps to ensure the next two days run smoothly. The pressure is on: months worth of phone calls, ordering, social work, transport bookings, accommodation reservations and linking medical services with government services will come to a head, and 17 patients will access potentially life-changing cataract surgery in their own backyard.
But it hasn’t always been this way. Professor Fred Hollows pioneered this remote vision care in the 1970s, recognising a significant gap for Aboriginal and Torres Strait Islander communities in remote NSW. Some 50 years later – and against the odds – we deliver a remarkably resilient and comprehensive ophthalmic service called the ‘Outback Eye Service’. This is headed by the Department of Ophthalmology at Prince of Wales Hospital and has expanded to 16 ophthalmologists, two nurses and I; the senior orthoptist.
My training in orthoptics has been instrumental in delivering high-quality care, enabling me to screen, diagnose, and manage eye conditions effectively. This comprehensive approach ensures that patients are treated promptly and appropriately, often reducing the need for them to travel long distances to access care.
Looking back, there are countless stories of memorable moments, tears, hardships but – most of all – some good old-fashioned yarns. These have become the stories I get to share with my friends, family and colleagues. For example, a patient forgot their post-operative drops after attending the day-one check. This ended with me leaning over a remote property gate, yelling the patient’s name as loudly as I could while I was confronted by two hungry dogs trying to eat me through a fence that had seen a few too many summers.
Some people experience more hardship than others, for a multitude of reasons. It has taken me many years to gain the knowledge and skills necessary to recognise those challenges and barriers to ensure each patient is equal. But it goes beyond this. For clinicians, adopting a diverse, patient-centred approach is crucial. This not only ensures that all patients can access the same services but also means when clinicians provide certain resources and apply their knowledge, they can make patients feel able, comfortable, and willing to seek care. It is this, in my experience, that differentiates the city and the country, the private and the public.
This approach can only be established by building rapport with the local community. I have visited the same towns for so many years that I have become well-known and recognised. For example, I can shop locally at a supermarket near my home and only get acknowledged by the odd parent from my child’s local school. But, when I am in Bourke, someone would spot me refuelling the car and pull over to ask me about a pain in their eye and what drops I think they should use.
I often receive feedback from the locals about how lucky they are to have the eye team visit the town, but I feel as though I am the lucky one to have found a career that is as equally fulfilling to me as it is essential to the patient.
About the Author: Ben Whitham is senior orthoptist at Prince of Wales Hospital. He completed a Bachelor of Applied Science (Orthoptics) from Sydney University in 2006. He spent the first part of his orthoptic career working in private clinics across southern Sydney and joined a volunteer group of eyecare professionals on a mission to Peru and later continued his work in outback NSW.
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