Perhaps nothing is more important than good sight and hearing, but as research continually shows, there is a significant gap between the eye (and ear) health of Australia’s First Nations people and the broader Australian community.
This impacts in major ways on people’s daily wellbeing, including the learning abilities of young people, and has recognised lifelong repercussions.
The key goal pursued by Lisa Penrose-Herbert, a Public Health and Clinical Optometrist, is helping to ‘Close the Gap for Vision’ and this has been the focus of her work, supported by the Churchill Trust. Currently, the gap is three-fold, although narrowing slowly as the value of Lisa’s work becomes recognised for having wider applicability than the area of Queensland where she is based.
In 2016, Lisa was awarded a Churchill Fellowship to explore models of integrated Primary Health care to improve Indigenous eye health. The focus of this integrated eye health and vision screening program was Goondir Health Services, an Aboriginal controlled health organisation that services communities in Queensland’s Western Downs region.
In 2022, Lisa was named as a recipient of the Trust's Impact Funding program, an initiative to enhance the outcomes of Churchill Fellows’ research and subsequent professional achievements. In her case, as with the other recipients, her contributions were already impressive and significant.
Eye health conditions are neither inevitable nor intractable. As Lisa says, ‘Over 90 per cent of visual impairment is preventable or, when necessary, treatable, often through relatively simple and low-cost strategies.’
During her Fellowship, Lisa visited the USA and Canada to meet with staff and clinicians working with First Nations people and to study the multidisciplinary approaches to managing conditions that often parallel those experienced in both urban settings and remote and regional Australia.
Lisa also advocated for collaborative forums to communicate knowledge and learnings internationally in the area of Indigenous eye health, and this has gathered pace in the ensuing years.
Of particular interest was Lisa’s conclusion that, ‘Eye health programs for First Nations Peoples are most effective when integrated into a holistic and well-coordinated Primary Health Care System.’
In other words, building on existing strengths and recognising that eye health is an important component of chronic disease management.
This accords with advocacy from Aboriginal health services and other representative bodies aware of the gains to be made when quality services are delivered in consultation with local people and are tailored to meet clinical health needs in a culturally safe environment.
‘As most eye services to primary health care are visiting only (not full time), eye health and vision screening within primary health care is very important in order to prioritise visiting eye clinic appointments, and to effectively deal with eye emergency situations between visits,’ Lisa says.
She advises that, ‘When designing an eye screening system utilising eye (retinal) imaging, it is important to not focus too much on the hardware.
‘While procurement, image reading, training, retraining, process design and maintenance are important considerations, the integration of culture and spirituality into a multi-disciplinary approach to health is important for a holistic health program to be optimally effective.’
In the years following her Fellowship, Lisa presented at many conferences and was appointed as Principal Project Consultant on two major national projects in the Indigenous Eye Health sector. She has also developed and implemented a children’s eye screening program in 12 Aboriginal community controlled health clinics across Queensland.
‘The clinics expressed a desire to know more about identifying young people who may have eye and vision problems that needed addressing,’ Lisa explains.
‘I successfully advocated for funding for the program, developed the training modules, delivered the training onsite, and mentored the participants over a six-month period. This project was very successful, resulting in increased numbers of young people with eye and vision issues being referred into the Optometry clinic.’
Along with helping spread awareness amongst both clinic staff and parents of the importance of checking children's vision, Lisa has been a major player during the federally funded Provision of Eye Health Equipment and Training Project to roll out over 200 retinal cameras to Aboriginal Medical Services.
‘Through this involvement I have built networks at a local level within the Aboriginal and Torres Strait Islander Community Controlled health sector across Queensland in over 30 locations.’
Lisa notes the structural limitations to achieving her goals, including many retinal cameras sitting idle in clinics because of a lack of a central reading centre such as she had seen in North America. Another problem was camera operators being seen as an "add on" to existing roles in clinics, rather than as dedicated, well-trained staff working in primary health care clinics.
Lisa says, ‘In many locations there are long waitlists and many patients are referred to see the visiting clinician too late, when sight loss has already occurred. With the accurate triaging of patients, early referrals and a screening program delivered by well-trained staff, these factors can be reduced.’
Lisa’s Impact project, now completed, confirms this finding.
‘Through the regional eye health screener role there has been a significant improvement in effective referral pathways for eye health within the Goondir Health Services.
‘Over the three-month pilot program, 38 patients were referred either to me or Roma Hospital eye services as urgent referrals (prior to the screening program there was no classification of referrals).
‘Children and young people (up to age 16) have been referred into the eye services in increasing numbers during this period, with an increase of 31 per cent in young patients seen in the Optometry Clinic.’
The project also delivered a major surprise: ‘I had believed the screening program would assist in reducing the wait list for visiting Optometry services. In fact, it has done the opposite. So, effective systems can often make problems more apparent!’
Lisa’s Impact project focused on developing an intensive training program for a regional eye screener to travel between all four Goondir clinics, akin to a model she saw working well overseas. The enhanced screening has assisted in prioritising waitlist referrals, while the resulting learnings will help Lisa’s team to advocate for increased (Australian Government) funding for visiting eye health clinicians to Goondir for both optometry and ophthalmology.
The broader aim is an integrated eye health service engaging an Optometrist who could visit a range of rural and remote locations, both in Aboriginal and Torres Strait Islander communities and urbanised Queensland Health clinics whose patient cohort also has a high number of First Nations people.
‘There has been no significant eye screening occurring despite the still sizeable – up to three-times – Gap in Vision,’ Lisa says.
A Director of the North Queensland Eye Foundation, she has also mentored final year Optometry students considering rural and remote eye health work through accompanying them on outreach trips and presenting at academic forums.
Lisa says the Churchill Trust’s Impact Funding greatly enhanced her Fellowship learnings for setting up an effective eye screening model where the key elements also utilise what is already there.
‘Cameras, AI, or training are important tools but not magic answers by themselves, although they’re obviously important, and especially with the right system to support them.
‘With over 200 underutilised retinal cameras around Australia there is terrific scope to scale up after this pilot, not just for Goondir Health Services and the communities they serve, but for the country more widely.
‘This step of the journey could not have been made without this extra support from the Churchill Trust, and I feel honoured to be trusted to carry it forward. The true winners here are the many thousands of First Nations people whose futures without proper eye health would be severely limited.
‘So, on behalf of them, I offer a big “thank you” for enabling this project to be undertaken.’
The Churchill trust sponsors an ophthalmology specific Fellowship. Applications for the next fellowship open on March 1st, 2024.