Dr Tim Henderson is the only ophthalmologist in the Central Australia and Barkly region. He services a population of more than 50,000 people who are dispersed over an area larger than Spain. Originally from the UK, Dr Henderson has lived and worked in Alice Springs for the past 17 years and has restored sight to thousands of people.
His passion for his craft, genuine care for his patients, and dedication to improving Aboriginal health is truly inspiring. Recently, Dr Henderson restored sight to 30 Aboriginal patients from remote communities during the 17th Intensive Eye Surgery Week, supported by The Fred Hollows Foundation and partners.
We sat down with Dr Henderson to chat about eye health in the region.
How did this Intensive Eye Surgery Week go?
The week went really well. It’s always difficult trying to get all the different components to come together at the right time because there are so many variables. You’ve got a whole load of patients who you are trying to get in from remote communities who may have many other things going on in their lives and you try to get everything together so they can come and they can have surgery as smoothly as possible, and not have to stay longer than necessary.
We had a large number of patients this week who had really quite advanced cataracts and very poor vision, a significant number of them were registerable as blind.
For them to see again the next day it really gives you the reward and the buzz. This is why this is such good value care and it’s why we need to make the effort to put those resources together to allow them to access it regularly and reliably.
How are patients identified for surgery?
We have a really well worked out regular schedule for visiting communities. We do between 35 and 40 visits a year to around 30 communities. There’s also really good support by the visiting optometry scheme to enable optometrists to go out and screen the communities. I get those referrals, and we’ve had a lot. We’ve had a significant increase in referrals in the last two years.
The efficiency of the outreach scheme means that at the moment we don’t really have the resources to keep up with it.
It’s quite a challenge because we know the workload is there and we know that we can actually deliver the results that are required, but you’ve got a limit to the resources that are available.
What are some of the barriers that patients face in accessing services?
Well, a lot of the patients that we saw this week were from some of the more remote communities – think of Eastern Western Australia…that’s a heck of a long way to come. The patients have got many other things going on in their communities, quite often there’s cultural business and responsibilities that patients are expected to be involved with, council responsibilities, responsibilities as elders.
We’ve also often got quite a few patients who will have been identified by the optometrists as needing something done, either lid surgery, cataract surgery, or other procedures…but we still need to develop the relationship with the patient…so that the trust can develop to allow us to deliver the treatment or procedure that they actually need.
How do you address these barriers? What is the role of culturally appropriate eye care?
Being culturally appropriate means different things for different patients, and we deal with patients from a very wide geographical range and therefore cultural background. You would not expect an Italian to be treated like a German, and it’s the same here.
Fundamentally, it’s about treating somebody with the respect that you would expect yourself.
All the different community areas are very different and so that's why it's important to have the local support staff. That’s why we have our Aboriginal Liaison Officers, why we want interpreters to come, why we want Aboriginal healthcare workers involved, why we want relatives to come with patients, in order to allow patients to feel as comfortable as possible.
I cannot speak their languages fluently, I can speak a few words in some of the appropriate languages but even that helps. It’s about meeting somebody who’s an equal and saying, ‘I’m here because I’ve got the skills to do your operation, but I want you to be happy and comfortable while we’re doing it so you understand what’s happening’.
We have got quite good at looking after patients who are scared about being in hospital, who are scared about what you are doing, who are scared about the whole environment and need every step supported. That’s why we need the level of staffing to allow all the dots to be joined, to allow patients to have a seamless journey through the process, so there are no surprises, so they are supported through it.
How important is eye health in this region and more broadly?
The cost-effectiveness of eye surgery means it’s one of the most worthwhile procedures that you can do, particularly in patients like we see here, where you are transforming their life.
It is genuine, microsurgical magic. We are able to let people see again. We are giving people their lives back, and there are not many procedures that can genuinely say that.
It’s very difficult to really communicate the scale of the gain that occurs if you can help somebody see again, and it doesn’t really get factored into all of the decisions around resourcing because if it was, everybody would throw money at eyes because we can actually make the difference – we can keep people independent, we can keep the elders being functional members of the community, and the value add that you get for the community is almost incalculable, it’s just fantastic.
What are the current challenges you face?
Within Central Australia the only other place that you can get cataract surgery [apart from Alice Springs] is in Darwin or in Adelaide, so 1500km in each direction. In the Top End and in Adelaide you have the option of lots of private facilities that can undertake surgery if you’re prepared to pay. We don’t have that facility here, and it means that we try and make the limited public resources go as far as possible.
The difficulty is, that in some ways doing the regular surgery weeks has meant that we have taken the pressure off the wait list because we are dealing with the patients who really need to be seen.
In an acute healthcare setting it’s very difficult trying to get the resources to be able to provide the same level of care day in day out, week in week out, which is what we should be doing.
Ideally, once you’ve got someone that you’ve identified as having visually significant cataracts, we need to find a way of doing that surgery within three months, because they’re already being handicapped for their day-to-day activities. Cataracts do not go away, so why make someone wait for months or years with poor vision, further compromising their ability to have a normal life when all we have to do is an operation?
The problem for us is that what we’re providing in eye care is preventative, chronic, outpatient care, and that’s the most difficult to get support to get resourcing for because the acute care takes precedence…and eye patients just quietly go blind.
How can The Fred Hollows Foundation continue to support eye health in the region?
I think The Fred Hollows Foundation has been incredibly supportive and personally the thing that has made the biggest difference is the support for the fellows and particularly the hands-on support very early on with the project officers.
In the long term, The Fred Hollows Foundation has the right and the privilege as an international eye NGO to advocate and say ‘We should do better – the patients deserve it’, and I would hope to then work with as many interested local organisations, who I think would have a passion for developing an appropriate level of service, to actually really get a team together and develop a model that will allow patients to access a good level of care.
What inspired you to become an ophthalmologist?
I think it was when I saw eye surgery for the first time that I thought, ‘Yeah I’d quite like to do that’ and then as you get the opportunity, as you train, you think ‘Yeah this is an extraordinary privilege’. It makes so much difference, it’s a very precise task, it’s complex, there are lots of components to it. I feel very privileged to operate, and it’s an incredible buzz to do a good operation really well, and really feel that your training has been worth something to be able to do that.
Can you describe the feeling you get when you take a patient’s patches off?
It’s incredibly uplifting and fulfilling. You occasionally get hugs, and kisses and thanks from patients who are so delighted that they have got through this process, and can see the difference immediately. ‘I can see colours’, ‘I’m going to be able to see the kids again’, they say, and they’re going to be able to drive again and they can go back to work. It’s difficult to put into words quite how much of an impact it is.
One of the anecdotes that I’ve used a number of times before is from an Aboriginal elder. After he’d had bilateral cataract surgery, he described the impact as like getting his manhood back because he was able to be a whole person again. He could go shooting, he could teach the young fellas the ‘men’s business’, he started to run the night patrol in his seventies.
It’s impossible to really quantify quite how much of an impact it can have, particularly in this environment, and it sure makes you feel privileged to be able to do that for people.