Health

Trachoma & eye health

Trachoma is an infectious eye disease that can lead to blindness. As it is easily treated with antibiotics, trachoma is regarded as a disease of poverty and is now unknown in developed countries—except Australia.

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Selected statistics

0%
Percentage of children aged 5 to 15 who test positive to trachoma in Ghana, Mexico, Saudi Arabia, Iran, Morocco and Oman. [1]
3.8%
Percentage of children aged 5 to 9 who test positive to trachoma in at-risk communities in Australia in 2017. Same figure for 2009: 14%. [2]
3
Times an Aboriginal adult is more likely to be vision impaired than a non-Aboriginal person. [2]
12
Times a blinding cataract is more common among Aboriginal people than non-Aboriginal people. [3]
1.9%
Percentage of Aboriginal adults who were blind in 2010; in 1980: 8.2%. [4]
6
Times an Aboriginal adult is more likely to be blind than a non-Aboriginal adult. [4]
5
Times an Aboriginal child is less likely to have vision loss than a non-Aboriginal child. [5]
7
Times an Aboriginal person is less likely to have sight-saving surgery than a non-Aboriginal person. [6]
35%
Percentage of Aboriginal adults who have never had an eye examination. [3]
95%
Percentage of vision loss which can be prevented in Aboriginal communities through early detection. [3]
10.4%
Percentage of Aboriginal adults aged over 40 who suffer from vision impairment or blindness. [2] The percentage varies from 7% (VIC) to 24% (NT).
56%
Percentage for Aboriginal adults aged 80 and over. [2]
40%
Rise of Aboriginal hospitalisations for cataract surgery from 2009 to 2019. [2]
141days
Median waiting time for cataract surgery in 2016–17 for Aboriginal patients; for non-Aboriginal patients: 89 days. [2]
Detail of a human eye
Up to 25 percent of Aboriginal children test positive to trachoma, a disease which causes blindness. Third-world countries around the world have successfully eradicated trachoma. Australia did not. Photo: Flavio Takemoto, sxc.hu
Fact

Good eyes: Aboriginal children, especially in remote areas, often have better eyesight than their mainstream peers, but it worsens as they move into adulthood. [7]

After adjusting for age, the proportion of Aboriginal people with an eye or sight problem in 2018 is 8% lower than that of non-Aboriginal Australians. [2]

What is trachoma?

Trachoma is a disease that starts with an infection but gradually turns the eyelashes inwards so that they scrape the cornea, scarring it, rendering it opaque, causing blindness.

It is a long-term ailment that only becomes a serious medical issue 20 or 30 years after the initial infection. [8]

As it is easily treated with antibiotics, trachoma is regarded as a disease of poverty and is now unknown in developed countries. Gambia, Malawi, Nepal, Ghana, Mexico, Saudi Arabia, Iran, Morocco and Oman have all eliminated trachoma. [1]

All except Australia.

[The] dire state of Indigenous eye health was one of the most well documented, yet enduring features of Australian eye care. — Dr Kristopher Rallah-Baker, Australia's only ophthalmologist [9]

Trachoma alive in Aboriginal communities

Trachoma was eradicated in the 1920s but remains endemic in many Aboriginal communities, [10] with 'endemic' meaning that over 10% of the population are infected. [11] The rate among children can be twice as high. 60% of Aboriginal communities are affected. [6]

The trachoma infection is mainly spread through poor hygiene and living conditions.

Professor Hugh Taylor, head of the University of Melbourne's Centre for Eye Research Australia, identified "a lack of government commitment and a lack of targeted resources on the ground" as the main impediments to eliminating the disease among Aboriginal Australians [12], especially in NSW and QLD where the majority of Aboriginal Australians live. Federal and state bureaucrats meet every 3 months only to postpone resolving their differences for another 3 months. [13]

"We know how to eliminate the disease," Taylor says. "If Morocco can eliminate trachoma in 10 years, then [Australia] should be able to." Experts estimate that it takes 5 years and "proper funding" to eliminate the disease [13]"Systemic" bureaucratic indifference left "a significant amount" of $16 million set aside by the Rudd government for trachoma eradication in 2008 unspent. [8]

"If you look at all these diseases that the Aboriginal people suffer from, they are the same diseases that were prevalent in [white] Melbourne a hundred years ago," says Professor Jonathan Carapetis, director of the Menzies School of Health Research in Darwin. "The difference is in overcrowded housing, income, hygiene and sanitation conditions." [14]

The difference between the often-cited 'third-world' conditions of Aboriginal people in Australia and people in third-world countries is that theoretically Aboriginal people have access to high-quality medial care in Australia.

Another impediment is that Aboriginal people in remote communities, though highly mobile, are sometimes reluctant to wait for treatment when they have pressing cultural obligations such as sorry business. [8]

If we think we can provide medical care and expect people to live healthy lives in communities where there is poverty, and overcrowded housing, and where people don't even finish school then we are kidding ourselves. — Prof Jonathan Carapetis, director Menzies School of Health Research, Darwin [14]

What can prevent trachoma?

To prevent trachoma, just being able to wash faces helps.

Waste management is important to help control the flies that spread the disease.

The Fred Hollows Foundation predicts trachoma could be stopped within five years with campaigns to encourage hygiene, eye-washing and medical intervention. [6]

There is also a lack of eye specialists (called ophthalmologists) in Australia. In 2019, there was only one: Yuggera and Juru-Birrigubba man Dr Kristopher Rallah-Baker at at Noosa Hospital in Noosa, Queensland. To bring the number of Aboriginal specialists to parity, Dr Rallah-Baker says, "we need another 29 of me”. [9]

A successful Trachoma health program of the 70s

The National Trachoma Eye Health Program (NTEHP) was set up in 1975 by Fred Hollows and ran until 1979. In a radical departure from previous programs, it was characterised by respect for Aboriginal people and culture. Within the program there was a strong commitment to Aboriginal engagement and leadership. [10]

Aboriginal staff were considered to have important knowledge essential to the program.

The NTEHP set benchmarks of community engagement and empowerment that many health programs are still unable to meet 30 years later.

The important thing about the trachoma program was Aboriginal liaison. And the reason we succeeded was we got a good lot of Aborigines working with us who would go ahead of us, tell the people what we were on about, what benefits they would gain and get the people on our side. — Fred Hollows [15]

Over 30 years on, despite the successful NTEHP, Australia is the only developed country to still have the preventable disease. [12]

Other eye problems

Apart from trachoma, most Aboriginal vision loss is caused by unoperated cataracts, diabetes, and uncorrected refractive errors, research has found. [4] Cataract and and diabetes-related blindness in adult Aboriginal Australians is about 12 to 14 times higher than in the mainstream.

Eye conditions in Aboriginal communities include:

  • refractive error: reduced vision due to an error in the focusing of light; responsible for 61% of blindness; [2]
  • cataracts: a clouding in the crystalline lens of the eye which is responsible for 20% of blindness in Aboriginal communities. [2] Blinding cataracts are 15 times more common in Aboriginal adults, but only 65% of those needing surgery were operated on; [16]
  • diabetic retinopathy: damage to the retina, about 5.5% of blindness; [2]
  • optic atrophy;
  • diabetic eye disease;
  • glaucoma which causes irreversible sight loss.

More than 90% of vision loss associated with these eye diseases is preventable and treatable. [16]

References

View article sources (16)

[1] [1a] 'A shamed nation turns a blind eye', SMH 16/11/2009
[2] [2a] [2b] [2c] [2d] [2e] [2f] [2g] [2h] [2i] 'Indigenous eye health measures 2018', Australian Institute of Health and Welfare 6/8/2019, retrieved 9/9/2019
[3] [3a] [3b] '$780,000 eye care boost for Victorians', Koori Mail 483 p.46
[4] [4a] [4b] 'Eye health still lags', Koori Mail 472 p.46
[5] 'Blindness taking toll', Koori Mail 461 p.3
[6] [6a] [6b] 'Blind, but soon they'll see... Australia's first indigenous eye doctor goes to work', SMH 4/10/2014
[7] 'Thurston backs eye campaign', Koori Mail 483 p.49
[8] [8a] [8b] 'In spite of Hollows, the dark goes on', SMH 29/12/2012
[9] [9a] ''Fred believed this was a social justice movement': Hollows' plan to stop Indigenous blindness', SMH 8/9/2019
[10] [10a] 'Insiders' story of trachoma program', Koori Mail 442 p.54
[11] 'Prevalence of trachoma in Aboriginal communities in the Katherine Region of the Northern Territory in 2007', The Medical Journal of Australia, 2008; 189 (7): 409
[12] [12a] 'Trachoma programs fail Indigenous Australians', www.abc.net.au/science/articles/2007/12/19/2114236.htm
[13] [13a] 'Eye disease effort undermined by 'glacial' leadership', SMH 29/12/2012
[14] [14a] 'Working towards good health', NIT 6/8/2009 p.30
[15] 'In the outback', Fred Hollows Foundation, www.hollows.org.au/fred-hollows/about-fred/outback, retrieved 8/10/2014
[16] [16a] 'Eye health is in focus', Koori Mail 502 p.48

Harvard citation

Korff, J 2019, Trachoma & eye health, <https://www.creativespirits.info/aboriginalculture/health/trachoma-eye-health>, retrieved 12 December 2019

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