The Trachoma issue – what does it take?

There are times when people involved in trying to close the gap in Aboriginal health hold up their hands in despair and scream “what does it take?”
Following the statement of achievements during February 2009 by Prime Minister Kevin Rudd to “Closing the Gap” the Aboriginal Medical Services Alliance of the Northern Territory has called for a way to get the dollars promised to the ground as directly as possible.
Congratulations to AMSANT for the suggestion that a single authority accountable to the Parliament be established to deal with all matters pertaining to Aboriginal health and the funds that are promised for this use.
It is so often the public forgets the announcements, makes a judgment at the time and then waits for the next one assuming the previous has been actioned. It does not work that way. By the time a policy proposal moves along the three levels of government a time space of years has gone by and governments have changed meaning the proposal as it stood is probably lost.
This is where the AMSANT proposal makes so much sense - a direct line from politician announcement to program implementation on the ground by community controlled (not government controlled) health services.
In reality there has to be an agency that is holding governments and politicians accountable for the promises that are made.
As an example of just how hard it is to make things happen take a look at the problem of trachoma – a debilitating eye disease that can send people blind if not treated properly (and simply) with improved personal hygiene and Azithromycin.
Mr. Rudd also announced during the week that $58.3 million would be made available for eye and ear health with a focus on eradicating trachoma, a disease that leads to blindness. It has been eliminated in all other developed countries.
The PMs Media Release said (interalia)
“Our objective must be clear: to eliminate trachoma among Indigenous Australians within a finite timeframe”.
Now wind the clock back to 1997 when in The Age 27th June it is stated:
“Dr Wooldridge said the Government would spend whatever was necessary to fix what was preventable blindness striking 100,000 Australians. The minister said he was angry that after so long little had improved in relation to the eye health of Aborigines in remote communities”
And then in the SMH on 18th November:
“Aboriginal eye health …has worsened, with the rates of the blinding disease trachoma found to be 80 per cent among some children, and indigenous people 10 times more likely to be blind than other Australians.”
This followed a study, by the head of Melbourne University's Department of Opthalmology, Professor Hugh Taylor - the first such review in two decades – which found the eye health of Aborigines in remote communities had barely improved in that time.
To which Minister Woolridge’s office responded that:
"These things take time," he said.
The amount of money the government committed in March 1998 was $4.8 million but who remembers what happened, whether it worked and ask why this is still going on. (See on left extract from "The Age" March 1998)
The price has now increased to $58 million although that does include ear health.
Professor Hugh Taylor, the long time advocate for action on eye health must be really wondering how much time it needs for what should be a simple undertaking. Read the transcript of ABC Ockhams Razor program on 1st July 2001 on the link to the title of this article.
Pharmacists involved in Aboriginal health will know that it was the desire to have Azithromycin made free to remote living Aboriginal people that lead to the Section 100 supply arrangements for the entire PBS Schedule Yellow Pages. It was during the PMs visit to Maningrida (NT) in 1998 that prompted the action that lead to the implementation of this change in April 1999 and now follows to all remote Aboriginal Health Services.
Picture on right shows the writer assisting the RFDS Nurse at Tablelands Station in the Kimberley administer Azithromycin suspension to children diagnosed by the visiting doctor with Trachoma.
This column supports the AMSANT call for a National Aboriginal Health Authority and calls on pharmacy organisations to give their support to the proposal by agreeing to work with it in ensuring the quality use of medicine is exemplary in whatever programs it administers.
Close the Gap is not just about life expectancy – it is about reducing the distance between the politicians announcements of money being available and that money then being used on the purpose for which it is intended with the minimum of administration in between.
With two levels of health bureaucracies (Australian and State/Territory governments) dealing with programs and even then it not being delivered the total sum quickly diminishes.
The Aboriginal community controlled sector needs support in responding to such calls.
In the Northern Territory there are 47 government controlled health clinics as against 26 community controlled. This gap needs to be narrowed also until they are all community controlled and using the money directly that is voted through the Parliament for spending on improving Aboriginal health.