Outreach is Rural Workforce Agency Victoria’s (RWAV) vehicle to secure the highest attainable standard of primary healthcare access for all Victorians. It involves a health practitioner travelling to a regional area regularly, such as weekly or monthly, to provide the community with medical care they might not otherwise have access to.
Since 2002, RWAV’s federally funded outreach programs have increased access to maternal, paediatric, mental health, chronic disease, and ear and eye health care for rural and regional Victorian communities.
One of the outreach programs, the Eye and Ear Surgical Support (EESS) program, aims to remove barriers to accessing eye and ear health care for Aboriginal and Torres Strait Islander communities. The program expedites access to surgical interventions to support Aboriginal and Torres Strait Islander people who require eye surgery (largely cataracts) or ear surgery for conditions caused by middle ear infections (otitis media).
Distance, limited access to streamlined referral pathways for public waitlists and the lack of culturally safe services are common barriers faced in rural communities, particularly in Echuca, a town 200 kilometres north of metropolitan Melbourne.
Within the Echuca region, patients have no access to affordable public eye or ear surgery within the clinically recommended timeframe. This has resulted in long wait times to receive surgery for both children and adults. Furthermore, Aboriginal Community Controlled Health Organisations (ACCHOs) with very limited access to public surgical pathways for ear, nose and throat (ENT) and ophthalmology services have patients accessing private specialists for initial bulk-billed consultations and being placed on public surgical waiting lists for small regional hospitals, with waiting periods of over 12 months.
While working on opportunities to increase the referral pathways for surgery, RWAV submitted a proposal to the Victorian Department of Health in October 2022 to provide patients within the Echuca region with support for private surgery costs until June 2024. As there are currently no public pathways within the region, this has allowed eligible patients to undergo surgery within a clinical timeframe without a special arrangement form.
The Aboriginal Health Worker at Njernda Aboriginal Corporation in Echuca has provided positive feedback regarding the support for private surgeries:
It has been challenging, especially with the changes to the service delivery standards; it has been a big barrier. However, we have been able to work through this together, as it is more flexible, and more kids and adults are being seen for private surgery.
As an example, we had an Elder in the community [who] was informed that she had a cataract that was obscuring vision in her left eye and another one forming in her right eye as well that was maturing very quickly … She was told that the public waiting list was between one and five years. Her vision started to get worse every day. She was tripping over things and was unable to go out or even feed her cat. She had no quality of life without her sight and she was almost blind.
Thanks to RWAV EESS funding she was able to receive her cataract surgery within three to five months. She now lives a completely independent life and is able to do things for herself once again.
Without the funding to support the surgery, patients will not be financially able to proceed with required surgeries, which will have an obvious negative impact on their health. Public access to ENT surgeons and opthalmologists in Echuca is challenging as we rely on visiting specialists.
Patients and carers have provided positive feedback regarding RWAV supporting the surgeries and allowing kids to receive surgery within the clinical timeframe. This has also helped with the number of waitlisted patients at Njernda Aboriginal Corporation, especially for some surgeries that have a wait time of over five years.