Indigenous Health Care: Action Needed
Surprisingly, in the 21st century, Australia is the only developed country in the world where blinding trachoma still exists.
In an article in the latest edition of the Medical Journal of Australia, Hugh Taylor, Professor of Ophthalmology, Centre for Eye Research Australia, in Melbourne, provides an overview of two important Australian studies on trachoma.
Professor Taylor believes the way to stop the spread of trachoma is to improve living conditions by upgrading the basic services and housing of Indigenous communities in the outback to the same minimal standard that every other Australian enjoys.
"After all, this is what happened in mainstream Australia 100 years ago", said Professor Taylor.
"Australians ... expect to have the basic facilities ... such as a house, electricity, clean running water and sewerage, a made road and a rubbish collection facility. We expect them as a right - just recall the outrage in Sydney when the water supply was contaminated in 1998!"
Endemic trachoma persists in areas where living standards are inadequate, with poor personal and community hygiene that permit the frequent spreading of infected eye secretions from one child to another.
The late Father Frank Flynn, an ophthalmologist and a Catholic priest, was the first to recognise the frequent occurrence of trachoma among Indigenous people in the Northern Territory in the 1940s, and their welfare became his life's work. Fred Hollows, as Professor of Ophthalmology at the University of New South Wales, established the National Trachoma and Eye Health Program in the late 1970s. Trachoma Program teams visited every Indigenous community in Australia, treating almost 40 000 people and setting up recommendations to eliminate trachoma.
Today, this chronic disease remains prevalent among certain groups of Indigenous Australians. In some communities, fewer children are affected than 20 years ago, but their elders still suffer from scarred eyelids and blindness from the inturned eyelashes caused by trachoma. However, in some communities in the Western Desert and Musgrave Ranges, the rates of trachoma in children have not changed over a 20-year period.
The World Health Organization has devised a four-component "SAFE strategy" to eliminate trachoma, encompassing Surgery, Antibiotics, Facial cleanliness and Environmental improvement. The strategy has been accepted by the Federal Government to be implemented in all communities where trachoma still exists.
In 1997, on accepting the report, the Federal Health Minister, supported by the Prime Minister, gave an undertaking to "do whatever it takes".
However, Professor Taylor says that, since then, disappointingly, little has changed in many places, even though the problem has been clearly identified.
"One in five of the older people have inturned lashes, and about half of these are either blind already or will eventually go blind. It is a tragedy to see their children or their grandchildren suffering from trachoma, because you know that they are on the same escalator and will certainly suffer the same fate if things do not improve."
"Trachoma is entirely preventable," said Professor Taylor.
In another article in the Medical Journal of Australia, Ross Bailie, Associate Professor of Public Health at the Menzies School of Health Research and Flinders University Northern Territory Clinical School, Darwin, highlights the need for research into household infrastructure in the move towards improving Indigenous healthcare.