Eye Health Services in the Pacific

Losing eyesight is a loss far greater than losing the ability to see.

It’s the loss of independence, the loss of earning potential and it has an impact on families and economies. It is estimated tens of thousands in the Pacific are blind and don’t need to be.

In many parts of the Pacific, people have no access to eye health services. Complications from diabetes, injuries, infections and cataracts, all go untreated. This leads to avoidable eye damage and blindness.

People save for months to make the long journey from around Vanuatu to go to the National Eye Centre in Port Vila. Often, people who come to the clinic have had to give up work because of their failing sight. In some cases family members have also given up work to care for them – home is not a safe place to be if the cooking is done on an open fire, or water comes from a tank on the other side of the village.

One elderly woman told staff at the eye centre her failing eyesight meant she hadn’t had the confidence to go to the toilet on her own in four years.

Regular eye checks can catch problems early and slow down the onset of eye disease. Infections can be treated with antibiotics.

Eyes are a delicate part of the body, but some surgical interventions are surprisingly simple: cataract surgery can be completed within 20 minutes, without general anaesthetic, and with a very high success rate of fully restoring sight.

THE FRED HOLLOWS FOUNDATION NZ

The New Zealand Government provides funding to The Fred Hollows Foundation NZ to support its work to address preventable blindness in the Pacific. The Foundation supports eye clinics throughout the Pacific, including the Vanuatu National Eye Centre, which opened in February 2019. Its activities include:

• Training Pacific eye health nurses and doctors who will go on to work in their own countries, developing the workforce.
• Outreach teams who travel to support local eye clinics and provide specialist services like surgery in areas where those services wouldn’t exist.
• Working with local health authorities to strengthen their health management and referral systems, so that people in need can access the services that will save their sight.
• Research and development to improve eye health services across the region.

Through the New Zealand Government and The Fred Hollows Foundation NZ partnership: 23 doctors and 244 nurses from across the Pacific have received postgraduate training in eye care. These eye doctors and nurses have been trained in Papua New Guinea or at the Fred Hollows Foundation’s Pacific Eye Institute in Suva, Fiji.

In 2018, with funding from the New Zealand Government:

• 76,281 people received specialist health advice and treatment
• 9 nurses graduated with a postgraduate diploma in eye care
• 1 doctor graduated with a Master of Medicine in Ophthalmology
• 3 doctors graduated with a Postgraduate Diploma in Ophthalmology
• 3 nurses from Solomon Islands graduated, joining 30 other eye nurses providing eye care in Solomon Islands

THE DOCTOR CAN SEE YOU NOW

Dr Duke Mataka has recently returned home to Tonga to be the country’s only eye doctor. The previous ophthalmologist left nearly two decades ago. Dr Duke completed his Masters of Medicine in Ophthalmology at the Pacific Eye Institute in Suva in 2017 with funding from the New Zealand Ministry of Foreign Affairs and Trade.

Before Dr Duke returned to Tonga, the eye clinic was staffed by two senior nurses and a health officer. For serious conditions or surgery, Tongans needed to wait for an outreach team to travel over from Suva. When asked what difference a permanent eye doctor makes for Tonga, Dr Duke's answer is unequivocal.

With all surgery being performed by outreach teams since 2000, gaining the trust of local people was a personal priority for Dr Duke.

“Building a good reputation was essential and challenging as well. Patients have been used to having visiting expats doing surgeries and eye treatments for quite a long time. Informing them that a local person will do their surgeries now raised a few eyebrows.”

But the benefits of having a permanent doctor based in Tonga are undeniable. There are faster responses to emergencies, more continuity in follow-up patient care, and more procedures being done. With the clinic based in Nuku’alofa, Tonga’s capital, outer islands are still serviced with outreach visits, but overall coverage has improved with an in-country doctor.

Facilities remain a challenge. Because the eye clinic has had no doctor based there for such a long time, there is limited equipment.

There is no dedicated operating theatre for eye surgery, and initially there was no allocation in the hospital theatre schedule for eye surgery, which meant they could only perform surgery when theatre time became available. But time was scheduled, and Dr Duke and his team worked 6 days a week for the first 4 months of the year.

“There were a huge backlog of patients that accumulated over the years awaiting surgery.” Despite the massive task, Dr Duke sees himself as fortunate and honoured to be in his role and giving back to his own country.

“Eye surgery is one of the most rewarding surgeries I’ve known. On the following day after their surgery, their eye pad comes off and you can see the sincerest smile you can ever witness.”

STEMMING THE NCD TIDE

Pacific Island countries have a very high incidence of non-communicable diseases – that is, diseases that are not infectious and can’t be caught from another person. Conditions including heart disease, diabetes, cancer, and chronic respiratory diseases represent the single largest cause of premature mortality in Pacific Islands countries. The rise of these illnesses has been driven largely by four major risk factors: tobacco use, unhealthy diets, physical inactivity, and the harmful use of alcohol. Diabetes is one of the most common diseases: Seven out of the 10 countries with the highest rates of diabetes in the world are in the Pacific. Retinal eye disease is a complication from diabetes, and it is having a toll on eye health in the region.

Reducing premature mortality from non-communicable diseases is one of the global 2030 Sustainable Development Goals. But New Zealand’s health focus in the Pacific is not just about preventing deaths. New Zealand is working with Pacific partners to reduce the impact of these illnesses on people’s lives. This includes increasing access to technology, treatment, drugs, and specialist services - like eye care.