Junior doctor Randolph Dobson is seeing a different side of Western Australia as part of the Lions Outback Vision team.
By Ara Jansen
They say our eyes are the mirror of our souls. For Dr Randolph Dobson, looking deeply into people’s eyes is taking him around Western Australia and giving him a crash course in country, health and culture.
After finishing medical school two years ago and working at Fiona Stanley Hospital and Bunbury Hospital, Randolph is now six months into a job with the Lions Eye Institute as part of their Outback Vision team.
Lions Outback Vision and their visiting ophthalmology services aim to address the unique challenges of delivering specialist eye health care to regional and remote communities around WA. They also work closely with the group’s Visiting Optometry Services.
Randolph, 26, is a junior doctor on the Vision Van, a mobile eye clinic which completes several circuits around the State each year. It provides services in and around Albany, Esperance, Katanning, Kalgoorlie, Leonora, Laverton, Wiluna, Newman, Meekatharra, Roebourne, Karratha, Port Hedland, Onslow, Exmouth, Broome, Derby, Fitzroy Crossing, Halls Creek, Kununurra, Wyndham and Warmun.
The doctors aim to build local capacity by up-skilling and training health workers during their visits and harnessing a strong partnership between community, corporate bodies and government to meet the increasing demand for eye health services.
The van – which is more like a container on the back of a truck – has three consulting rooms fitted with specialist equipment. The travelling team consists of two drivers (who are also mechanics) and two junior doctors and a senior one who provide comprehensive ophthalmology care for cataracts, trachoma, glaucoma and diabetic retinopathy. It has been running since 2017 and is a free service.
Eye on eyes
Initially, Randolph’s undergraduate work was in biomedical science with a major in immunology but after going to an interesting pathology lecture on the altering of genetic code and how that could help vision impairment, that changed his focus to eye health.
After declaring several specialties – including ophthalmology – Randolph says he got lucky when Dr Angus Turner became his mentor. The associate professor is director of Lions Outback Vision, an associate professor at UWA and a clinical lecturer for the Rural Clinical School at UWA and Notre Dame.
“I tried to learn as much as possible from him. Having that link to Lions Outback Vision and seeing what he was doing was fascinating and inspiring. Now in my third year I’ve been able to see the impact it is having on people’s lives. A 20-minute operation can help someone improve their vision for decades. That’s life-changing,”
“The van can do almost anything you could get at a country ophthalmology practice so we try to take it to areas where there’s no permanent ophthalmologist and which don’t have access to such services.”
The doctors see between 20 and 40 people a day. The work can include anything from a regular eye exam to injections, scans and back-of-the-eye check for diabetes.
“Some people drive for hours to see us. We try and connect with the local medical community so they can refer people as well. I’ve liked making those connections because when you come back to a town you don’t feel so isolated.
“In places like Laverton, we have such great support from the community health centre that we’ve been able to help people who have slipped through the cracks. We also notice in some places we offer a service which local GPs don’t have time to deal with or don’t always consider in their diagnosis.”
Travelling with the van has opened Randolph’s eyes to the gulf between care levels in Perth versus regional and remote areas. He says the ease of access – or lack of it – is clear.
Free to access
“A good number of our patients can’t afford to pay to see an ophthalmologist. We’re a public ophthalmology service for country WA providing a service at no cost. That’s something I really love about it.
“If it’s taking months to get to your GP, that’s broken up your care, so with us coming through regularly, hopefully we can be part of the care team and improve that.”
While he’s working in one discipline, Randolph says he likes the fact that when they roll into town, they never know what kind of issues they might be asked to deal with.
“In places like Wiluna, a steady flow of people come to see us. Some days you think there’s only four or five people around and then suddenly 20 people will turn up. We try and see as many people as possible and usually stay in one place for two or three days.”
As a kid, Randolph spent school holidays camping out in the regions and he particularly remembers a trip out on the Gibb River Road as a teenager. Since then, he’s loved exploring the State and this job has given him the opportunity to explore further when he’s not working. Hiking in picturesque places is a wonderful perk of the job.
To date, one of the big highlights has been exploring the gorges around Kununurra which Randolph describes as mind-blowing. On his wishlist is to hike Mount Augustus, the world’s largest monolith, 390km east of Meekatharra.
“Some of the days are long but the reward is that you get to go adventuring as we’re away the whole time and don’t come back to Perth in between or for weekends. It can make you a little homesick but it’s busy and interesting.
“You get to know some of the locals and you make new friends. I think like with every job, it’s the people you meet along the way who make it such a great experience.”
Seeing new ways
Something he treasures is the opportunity to expand his understanding of Aboriginal culture by working with diverse groups as well as offering help for some of the chronic health issues present in regional communities. He’s also thankful to the people willing to teach him.
“What has shocked me is to learn that the Closing the Gap target to eliminate avoidable blindness as a national health issues has been pushed back to 2025.
“We can fix some of these problems in about 20 minutes – and that has shocked me the most. That’s why I try to give patients some health literacy, which can be life-changing for them. If there’s anything which has shaped my last six months, it has been that.
“You don’t see trachoma in the city, yet in the Kimberley it’s endemic and completely reversible. I’m proud that the work we do contributes to helping change those statistics.”
There’s also the added challenge that avoiding eye contact is a cultural gesture of respect, which is difficult when you’re trying to look deep into someone’s eyes and examine them.
“You really are up in someone’s business when you are looking at their eyes. It’s a challenging part of the job. I also saw one woman who believed she had lost her sight because of a cultural punishment. She was frail and in her 70s and we couldn’t convince her there was something else going on, which was reversible. Hopefully, we can see her again and work on that.”
During one of their visits, the team were invited to a bush barbecue with locals in Laverton. They sat down with traditional owners, elders and community health workers to discuss how to improve Aboriginal health and the local traditions which impacted health and healthcare. Randolph says it was a special event and another opportunity to gain further understanding about the communities he’s working in.
“It has been eye-opening to meet people from so many different cultural groups. It has felt like a crash course in just about everything, but I’ve really enjoyed that.”
Working with the Vision Van has confirmed for Randolph that he always wants to have one foot in the public system while hoping to be accepted for further training in ophthalmology.
“It’s important for me to be part of a service where people don’t have to pay. I think that will always be part of my ethos – to provide access to people who don’t have it in rural and remote areas. I want to be able to do what I can. I think that’s one of the greatest strengths of the Australian health system.
“It has definitely sharpened things for me in that I am seeing the issues first-hand that come with having a system of public and private services. The access to specialists in country areas has been a real eye-opener.
“Everyday we work with people living far from the health care they need and we try and figure out how we can improve their access and give them tools to help themselves at the same time.”
ED: Check www.outbackvision.com.au/vision-van/ for van locations for the rest of 2021. For information and bookings, contact email@example.com or 9381 0802 or contact your regional health clinic.