Introduction by Croakey: The recent National Aboriginal and Torres Strait Islander Eye Health Conference (NATSIEHC) 2021 — The Gap and Beyond, had a welcome and critical focus on community-led eye care, according to Simone Kenmore, the newly appointed Country Manager of the Indigenous Australia Program at The Fred Hollows Foundation.
In the post below, Kenmore writes about the importance of listening to family and community leaders to drive two-way learning approaches in eye care and the urgent need to grow an Aboriginal and Torres Strait Islander eye health workforce, as well as to invest in Aboriginal community controlled health services.
Simone Kenmore writes:
The eye health sector in Australia has a role and responsibility to strengthen the eye health knowledge of our Aboriginal and Torres Strait Islander communities.
The clinical expertise in the eye health sector in Australia is world class, but critically we are missing the voice of Aboriginal and Torres Strait Islander Peoples.
As a Yankunytjatjara woman I was taught by my grandmother to ‘kulila’ (listen) and spent many of my early years listening and learning from my family and community leaders on the Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands).
When we really hear what our communities are saying and understand their needs, we, as Aboriginal leaders, can speak with authority.
I was heartened to see that community led eye care was also a focus of the recent National Aboriginal and Torres Strait Islander Eye Health Conference.
Professor Marcia Langton spoke of self-determination being a practice that prioritises locally-driven solutions and engages with communities on the design of eye health services for Aboriginal and Torres Strait Islander Peoples.
The success of Aboriginal and Torres Strait Islander leaders and Aboriginal Community Controlled Health Organisations (ACCHOs) in protecting their communities from COVID-19 was a key focus of the conference.
The call from Aboriginal and Torres Strait Islander leaders at the conference was clear: apply these lessons to the way we deliver eye health care.
Kulila should be central to the design and delivery of eye health care into the future and self-determination should be our underlying principle.
Two way learning
What does this look like? How do we implement this in practice?
As a first step, we need to prioritise two-way learning approaches. I grew up watching service providers fly-in and fly-out of my communities on the Anangu Pitjantjatjara Yankunytjatjara Lands and seeing programs come and go and come back again.
This approach is not sustainable. Community is our greatest resource in the eye health sector.
We need to start listening genuinely and effectively support our communities to lead the discussions and strengthen our community leaders’ knowledge in eye health, so they can make informed decisions for their communities.
Capacity building must be two-way: clinicians building the community’s capacity to deliver eye health services, and communities building the eye health sector’s capacity for culturally safe and sustainable local solutions.
Driven by locally identified priorities, we also need to invest in ACCHOs to design, determine and deliver eye health care to their communities.
In 2017 I led the SA Trachoma program for the SA Government.
I redesigned the model to fund Aboriginal Medical Services (AMS) and ACCHOs, to strengthen the capacity of Aboriginal Health Practitioners to screen for trachoma and promote key eye health messages.
This kept the skills and knowledge in the community. It also reduced the number of communities at-risk of trachoma from 11 to seven.
This isn’t surprising. Since their inception ACCHOs have been shown to progressively improve individual and community health outcomes for Aboriginal and Torres Strait Islander Peoples, compared to mainstream health services.
Investing in ACCHOs also provides a better return on investment than mainstream services as they are cost-effective, provide opportunities for employment and training, add substantial economic value to Aboriginal communities, and generate flow-on effects to education and other sectors.
Grow and strengthen the workforce
We also need to prioritise the development of an Aboriginal and Torres Strait Islander eye health workforce.
Currently, there is only one Aboriginal ophthalmologist in the country, and there are only seven registered optometrists, or 0.1 percent of all optometrists, who identify as Aboriginal and/or Torres Strait Islander.
Aboriginal and Torres Strait Islander Peoples currently make up 0.6 percent of optical dispensers and 0.5 percent of optical mechanics.
Aboriginal and Torres Strait Islander eye health professionals would need to grow up to 10-fold to meet population parity (for ophthalmologists alone, we would need another 29 Aboriginal and/or Torres Strait Islander Peoples to take up the profession).
We know that employing Aboriginal and Torres Strait Islander health professionals contributes to the development and maintenance of culturally safe workplaces, and assists in addressing institutionalised racism.
An Aboriginal and Torres Strait Islander eye health workforce is fundamental to the change that is needed.
Aboriginal and Torres Strait Islander Peoples are three times more likely to experience vision loss or blindness than other Australians.
ACCHOs, eye health clinicians and Aboriginal and Torres Strait Islander leaders are working to close this gap.
With the successes of the past decade we are also looking beyond, at what a world class eye health system, driven and designed by Aboriginal and Torres Strait Islander communities would look like, and what it will take for us to get there.
The Indigenous Australia Program team within The Fred Hollows Foundation, made up of Aboriginal and Torres Strait Islander Peoples from across Australia, has extensive experience in eye health.
Our vision is to re-engage with our Aboriginal and Torres Strait Islander communities in a formal two-way learning process to inform our leaders to speak with authority and measure our impact.
Over the next 12 months we will take considered steps to transition to a community-led eye health sector.
Simone Kenmore is the Country Manager of the Indigenous Australia Program at The Fred Hollows Foundation. She has worked extensively in remote communities in the community services and eye health sectors. In her previous role as Manager of Anangu Pitjantjatjara Yankunytjatjara Community Programs, Simone worked across remote communities in South Australia to improve outcomes across health, aged care, disability and employment. Prior to this, she was Assistant Director at the National Disability Insurance Agency, working in remote communities to develop culturally relevant, co-designed models of disability supports with community.
See previous Croakey articles on Indigenous Health issues.
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