Papua New Guinea is a Pacific Island nation between Australia and Indonesia of great geographic and cultural diversity, as evidenced by its 851 unique languages. Its challenging terrain prevents usual road and rail communications, constraining internal travel to foot, boat, limited road, and air. This remains a further issue, as approximately 80% of Papua New Guinea’s population live in rural areas.
Papua New Guinea has high rates of visual impairments and blindness, with the main causes being cataract, pterygium, untreated eye infections and refractive error. Due to the remoteness and isolation of its environment, it makes distribution and readily available access to health care services difficult for all and especially for women, girls and those with sensory, cognitive and physical impairments.
We have been active in Papua New Guinea and the Western Pacific region since 2002, formalised in 2007 when our focus was to establish vision centres in Papua New Guinea and support the development of a national non-government organisation (NGO) as a social enterprise. This was in response to research in 2005 that indicated that Papua New Guinea had one of the world’s highest prevalence of avoidable blindness and vision impairment, and that needing spectacles was a leading cause of vision impairments (RAAB 2005). Since then, PNG Eye Care has evolved into a strong partner who is forging a leadership role in eye care development and systems strengthening throughout Papua New Guinea.
Our partnership with PNG Eye Care has resulted in strong research that informs the National Eye Health Plan, the World Health Organization and enables our program planning to be relevant and appropriate to Papua New Guinea’s priority needs. Extensive collaboration with other national organisations and service providers, including national Lions Clubs, support ongoing awareness-raising nationally. As an active member of the National Prevention of Blindness Committee, the Foundation continues to support excellence in eye health through collaborative efforts such as the Cataract Surgical Quality Assurance initiative which responds to the Rapid Assessment of Avoidable Blindness research findings conducted by the Foundation in 2016.
COVID-19 and our response in Papua New Guinea
A State of Emergency was declared in Papua New Guinea on March 24th, 2020 in response to the threat to the nation’s health by the novel coronavirus, COVID-19, compromising many of the activities scheduled for 2020. We have been able to support our partner in Papua New Guinea, PNG Eye Care in their response with support from the Australian Government’s Department of Foreign Affairs and Trade (DFAT). In collaboration with City Pharmacy Limited, a national pharmacy and wholesale company, Pivot projects have included the supply of Personal Protective Equipment and consumables to enable ongoing service provision of emergency cases presenting to the Port Moresby General Hospital Eye Clinic and Vision Centre plus outreach awareness raising. Additional equipment has also been supplied to support ongoing teaching for under-graduate medical and post-graduate ophthalmology candidates and to enable the National Prevention of Blindness Committee meetings to transition to online. Additionally, the online facility will enable a Low Vision Seminar scheduled for the end of 2020.
Service delivery and training support
Vision Centres and the National Spectacle Supply Scheme
Throughout the formative years of our work in partnership in Papua New Guinea, 6 vision centres were established within provincial hospital settings, operated by national refractionists and optical technicians that were trained by the Foundation. Port Moresby Vision Centre is thriving under the management of PNG Eye Care and two of the other vision centres remain operational and are the full responsibility of their Provincial Health Authority. The others continue as spectacle supply units.
PNG Eye Care has maintained the National Spectacle Supply Scheme for up to 11 different locations throughout the country, which continues to grow. The Foundation continues to support PNG Eye Care in developing collaborations, supporting research, and sourcing ethically produced and sustainable spectacle frames and lens suppliers.
The Port Moresby General Hospital is situated in the adjoining grounds of the University of Papua New Guinea’s Medical School’s Taurama campus and is the registered quartenary teaching hospital for the country. From 2016 to 2020, the Foundation has supported the refurbishment of learning facilities in the Taurama campus and the Eye Clinic in the hospital in collaboration with Lions Club International Foundation. From this collaboration, the Lions National Resource Centre for Eye Health was developed and provides a training and lecture facility for 4th year under-graduate medical students and post-graduate ophthalmology candidates. The Lions National Resource Centre for Eye Health is the venue used by the National Prevention of Blindness Committee, the peak coordinating body for all eye health activities in Papua New Guinea, for their 4 annual meetings March to September. It is also used for workshops, guest lectures by visiting experts, and presentations, for example, as part of the inaugural launch in the Pacific of the World Health Organization’s World Report on Vision on March 5th 2020.
As a result of the refurbishment, the Eye Clinic in Port Moresby General Hospital has increased floor space, multiple dedicated clinic rooms and operating theatre with the latest technology available to enable the eye doctors and surgeons to provide the best possible care for patients. Dedicated Paediatric and Low Vision Centres have also been established within the facilities. PNG Eye Care’s Vision Centre is now located in the Eye Clinic which greatly increases the ease with which patients can obtain all of their vision care needs.
Low Vision Network and National Referral Pathway Policy
Following on from research we conducted in 2014 and published in 2017, we have focused on enabling a national network of service and support providers for children and adults with vision impairment including blindness. In August 2019, the National Low Vision Network was formed and by March 2020, following a strategic planning workshop facilitated by the Foundation, the Network is developing a nationally viable referral pathway for all people with vision impairment and blindness. The Foundation is supporting the production of the Policy Document as well as induction training for all personnel involved with any point of the referral process.
The Low Vision Network is multi-sectorial and includes the national Departments of Health, of Education – Inclusive Education, of Community Development and Religion, the National Orthotic & Prosthetic Services (DoH), Disability Sector Coalition, PNG Association of Blind and Vision Impaired, PNG Blind Union, PNG Assembly of Disabled Persons, University of PNG (Ophthalmology), the National Prevention of Blindness Committee Chair, as well as national and international non-government organisations.
Cross Cutting Issues
Gender inequality and gender equity
High levels of violence against women and girls in Papua New Guinea have been documented for decades and is an ongoing issue gathering political and civil society momentum. However, the link between women and girls wearing spectacles and subsequent reprisal had not been appreciated until research undertaken by the Foundation in 2012. This knowledge has informed ongoing program development and in 2017, the Foundation ran a Gender Equity in Eye Health Training workshop which targeted multi-sectorial participants in Papua New Guinea.
Our monitoring systems being used by our partner organisation demonstrate changing trends of women and girls attending the vision centres and purchasing spectacles. This information informs our targeting of awareness events and also to understand the impact of external events such as COVID-19. During the State of Emergency, a downturn in female presentation at Port Moresby General Hospital Vision Centre is evident.
The Pacific Island Nations as a group already experience the effects of a changing climate with projections of catastrophic habitable land loss caused by erosion and rising sea levels. Providing health care services is known to represent 4.4% of the global carbon footprint, which raises the uncomfortable paradox of health service provision driving climate changes that could ultimately disadvantage those communities who are at most disadvantage. As such, the Foundation has in place policy and actions to ensure that spectacle production does not affect water ways, and that our programs consider the impact of their activities from travel through to ethical procurement.
The PNG program manager is working with the Pakistan country team to develop a tool to assess the environmental impact of our program implementation pulling on existing resources while developing measurement rubrics.
Training and Planning Workshops
The Lions National Resource Centre for Eye Health has become a hub for training activities and is used by the Royal Australian and New Zealand College of Ophthalmology (RANZCO) to support the ophthalmology registrars in sub-specialty training such as paediatric ophthalmology and low vision assessments. It is also used for research training, research results dissemination and planning workshops. Research and planning workshops held by the Foundation have provided critical information to support the National Eye Plan and national eye health workforce training plans.
Human Resource Development
Held in May 2016, the Human Resource Development workshop informed the renewed National Eye Health Plan which is incorporated into and informs the National Health Plan 2021-2030. The Foundation facilitated the workshop to enable a cohesive strategic plan for the development of eye health cadres in PNG using both the World Health Organization (WHO) Global Action Plan and the WHO Human Resources for Health: Workforce 2030 frameworks. The strategy has enabled an ongoing commitment to maintain detailed knowledge of the eye health workforce annually and for universities and international funders to work closely to maintain cadre development most appropriate for the needs of Papua New Guineans.
Gender Equity in Eye Health
Our Gender Equity in Eye Health training workshop, which was co-developed between the Foundation’s Pakistan and Papua New Guinea teams and was held in the Lions National Resource Centre for Eye Health in March 2017. The combination of earlier research in 2012, which highlighted the cultural barriers for women and girls accessing eye health care and purchasing spectacles to wear, and the Rapid Assessment of Avoidable Blindness conducted in 2017, which indicated that twice as many women as men had avoidable blindness in the Highlands region, informed the Gender Equity training program design.
The results of our research are always shared with our implementing partner, PNG Eye Care, and key stakeholders, the Departments of Health and of Education, Prevention of Blindness committee, and other national and international non-government organisations for the development of eye care strategy and program development.
Rapid Assessment of Avoidable Blindness plus Diabetic Retinopathy (RAAB + DR)
The previous Rapid Assessment of Avoidable Blindness (RAAB) was undertaken in 2005 and was conducted mainly within and around Port Moresby in the National Capital District. In 2017, as part of a multinational collaboration with Sightsavers (UK), International Coalition of Trachoma Control and the London School of Hygiene and Tropical Medicine, the Foundation conducted a multi-province RAAB to understand the level of vision impairment and blindness and the main causes. The main targeted conditions in a RAAB are refractive error (needing spectacles), cataract, trachoma, diabetic and age-related eye disease. The key findings from this research are that more women than men live with blindness. In the Highlands, Coastal and Islands this was found to be nearly double as many women as men. The 2017 RAAB also provided information about the outcomes for those who had previously received surgery. It is the combination of this information that drives the Cataract Quality Assurance Strategy.
Global Trachoma Mapping Program (GTMP)
Trachoma in the Pacific has proven to be an enigma as although often the condition is found in many young children there are few to no signs of blindness as a result of in-turned lids and eyelashes consequently rubbing and causing scarring of the eye. This was especially true in Papua New Guinea. The Global Trachoma Mapping Program as a part of the global initiative GET2020 (Global Elimination of Trachoma by 2020) was implemented in Papua New Guinea to determine the prevalence of trachoma in young children (aged 1 – 9 years) in suspected endemic areas. The results demonstrated that in some areas there is a high prevalence of trachoma amongst these children. However, anecdotal data of the last 4 decades did not support a high prevalence of resultant trachomatous blindness in older people. A more recent ancillary survey has been done in the identified high prevalence areas to determine whether the normal World Health Organization protocol is appropriate for Papua New Guinea. Similar results have been found in other Pacific Island Nations and the research protocols are ongoing.
Perceptions of Eye Health and Services amongst adults
This research undertaken in 2011 captured some of the issues relating to gender inequity and cultural barriers. It was found that to provide equitable access to eye care and refractive error services in Papua New Guinea, practitioners need to consider accessibility and awareness of services while tailoring health care services to the more under-served populations of Papua New Guinea. Mobile clinics and health awareness campaigns in local languages as well as providing health promotion materials in formats that are accessible for people who are unable to read may improve access to services and reduce barriers for these particular groups. Additionally, women participants and those from underserved areas were more likely to report shame and fears of jealousy and subsequent reprisals from others if they wore spectacles.
Situation Analysis of Vision Impairment
This research conducted in 2012 was key to informing the need to develop a national low vision network, increase the knowledge of all service providers of each other’s available services while increasing the number of eye health, rehabilitation and education/employment training specialists in the work force. This program continues in the development of the National Low Vision Network, the National Referral Pathway for People with Vision Impairment and a National Policy Document for the cross-sectorial support of children and adults living with vision impairment in Papua New Guinea.
Quality of Life for people with vision impairment in Papua New Guinea
Conducted from 2009 to 2011, the key takeaways from this research are that a 17-question questionnaire – the PNG-VS QOL questionnaire – can be used to determine quality of life for people with vision impairment in Papua New Guinea. Uncorrected refractive error and cataract demonstrated worsened quality of life of adult Papua New Guineans, particularly for those who are older and less educated, and had lower income.