Eye clinic project in jeopardy

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In British Columbia, a mobile diabetes unit is on the road, and sometimes, in a plane, to bring eye exams to remote communities.

It began in early 2002 as a pilot project operated by the First Nations Chiefs' Health Committee in partnership with the University of British Columbia Department of Ophthalmology, Health Canada's First Nations and Inuit Health Branch and the Canadian National Institute for the Blind.

But the project is in jeopardy, with the First Nations Health Branch planning to axe the chiefs' health committee as early as March 31.

"We are all scratching our heads over this," said Shaunee Pointe, executive director of the First Nation's Chiefs' Health Committee.

"The regional director for Health Canada here at the First Nations Health Branch is planning not to fund the committee after March 31 of this year. We are doing a lot of lobbying, but we wonder why the government would decide to axe a project and a committee that have done nothing but good things? We have many projects just like the mobile outreach clinic that we have been successful at implementing. As a regional voice, this committee has the support of the majority of First Nations in B.C., but for some reason Health Canada does not see fit to keep the committee alive."

The eye exam program has been a real success, said Pointe. "Virtually 100 per cent of the people who have been tested say they will come back, that they appreciate the service. They like it."

The program provides more than just eye exams. It provides information on diabetes prevention and treatment that people in the remote communities might not otherwise get. More than 350 people have been examined in 15 different communities since the program began.

British Columbia is unique in that the majority of First Nation's communities are small and remote, mostly with populations of 200 to 500 people and at varied distances from health services.

"It could be a two-day drive, a plane ride or even a boat ride to access health care," Pointe explained. "People will not get treatment if they are up in the isolated rural villages. We are trying to change that by taking the service to the people, not making people come to the service."

The nurse and eye care technician travelling with the mobile unit provide eye examinations and diabetes education to known diabetics and those who have a number of family members with diabetes.

"Diabetes runs in families, and all First Nations seem to have higher rates than the general public in terms of diabetes," said Pointe. "It is a problem common to Indigenous people around the world."

The eyes are key to preventing complications of diabetes. During the eye examination, a camera takes photographs of the retina and through a tele-medicine process, sends the digital images via the Internet to Dr. David Maberley at the Vancouver Hospital and Health Sciences Eye Care Center.

"It is an early screening device," said Pointe. "When people start getting eye disease that is related to diabetes, there are no symptoms. This is an early way to look at preventing blindness. In early stages there are some treatments that can be used to diminish the effects of the disease."

Routine testing for visual acuity may not include an examination of the retina to check for the presence of eye disease, she said.

"The service we provide includes a teaching piece," said Pointe. "It is important to understand the implications of having diabetes, the potential for higher rates of blindness, amputations and heart disease. People have to understand how to look after their diabetes, using medications if they are ordered, follow a proper diet and get proper exercise. They are all pieces of the puzzle. It isn't just that you better get your eyes tested, it is a matter of look after your body. There are some serious things that can happen if you let your diabetes get out of control."

The unit plans carefully with the communities for when it is convenient for the staffto come in.

"In small communities, if one of the health care workers is not available that day or a death occurs or there is some other crisis, the eye clinic will just not happen."

The unit has to have access to a physical location to set up the equipment.

"Sometimes it is difficult to find a location in a community, to set up without taking up someone else's working space. Many communities do not have a health clinic, so the unit has to go to a facility nearby and people from the outlying communities will go there. In some cases it is a big deal for the patients to get to the clinic. Some drive a couple of hours to get to the other village and others spend a whole day travelling. It is pretty difficult because not only are the diabetic patients not feeling well, and often elderly, in many cases, but also they do not speak English. We rely on the community caregivers to help us out. They know their people, know how to get their interest, promote the project, pick them up, drop them off."

Depending on the severity of what is found in the eye test, the patient may be referred to a specialist at the nearest health facility.