By Layal Naji
When I was first invited to practise at the provisional eye clinic at the Newtown Asylum Seeker Centre, I was elated.
An honours research project which I pursued with my colleague and dear friend Homma Ebrahimi culminated in a working pathway to provide asylum seekers, who had no access to Medicare, with comprehensive ocular examinations and access to goods such as spectacle correction or therapeutic eye-drops.
On entering the facility, I was greeted by health manager Kerry, a middle-aged woman with blood-red hair styled with blunt bangs and an edgy undercut. She was dressed in tartan pants tucked into knee-high socks, suspenders and a beanie. My inner/repressed Avril Lavigne was silently screaming. I knew this place was going to be something.
After becoming so accustomed to automated procedures in corporate optometry (autorefractor, NCT, automated phoropters and retinal photography), working at the centre has brought me back to foundations and allowed me to re-examine my appreciation of the art of optometry.
Whether it is the gold standard of applanation tonometry or the benefits of natural viewing posture with trial frame refraction, which is particularly relevant to patients who use eccentric directions of gaze, this clinic has reminded me of the benefits of the foundational techniques that cannot always be obtained from automated contraptions.
Keeping it real though: that is not to say that retinoscopy and refraction for a high astigmat with no method of focimetry besides ‘lens neutralisation’ is an art form that I enjoy practising, so if anyone has a spare focimeter to donate, it would be much appreciated. On that note, I thank both the UNSW Optometry Clinic and the Essilor Vision Foundation for being so generous in donating their equipment and prescription spectacles, respectively.
Learning to see
I got to know the stories of each patient I saw, and have learned so much about how a patient’s circumstance and state of mind influences the approach we, as clinicians, should take with communication.
For instance, I have a young patient who fled three countries, and remained stateless* through it all. Never having a place to call home, never being conferred the rights of citizenship and never living in a place where he is not considered a second-class citizen imparted within him a severe distrust in institutions.
Of course that would account for his fearful and distrustful stance when he first met me. It is our role as primary care givers to disarm that fear by getting to know the patient, and this goes beyond the traditional scope of optometric practice.
Most would agree that optometry offers some of the least confronting or invasive types of health care assessments. In my experience here at the centre, I can see how optometry can function as a means of gaining trust in the Australian health-care system.
Our stateless patient, for example, had poorly controlled diabetes and a complex related to insulin therapy, even though he greatly needed it. As a result, he had a cataract and BCVA in his left eye was 6/48, with no improvement with pinhole. His condition stemmed from the memory of his mother passing away while taking insulin medication, even though it wasn’t the cause of her death.
By building rapport, which in this case was as simple as bonding over how the pinhole worked, I was able to start a meaningful dialogue about his diabetic management and warm him to the idea of insulin therapy.
One fundamental lesson I have learned is not to make assumptions about asylum seekers. I have seen the full spectrum, from patients who were too embarrassed to request free single-vision spectacles to those who presented to the centre wanting breast-augmentation surgery.
Through my work at the Asylum Seeker Centre, I have learned how to communicate despite language barriers. Surprisingly, I had opportunities to develop in-depth understanding of patients, with access to blood work, medications taken and emotional histories. My experience here has shown me the value in gaining knowledge of the patient’s health status more formally. At the same time, it has encouraged me to be more patient.
These lessons are universally applicable, across patients of all backgrounds. The practice I work at formally is in an affluent area, and one day I detected an epiretinal membrane with vitreo-macular traction in a patient on routine review. She was from China, visiting her daughter on holiday.
She came back into the practice a few months later for a clinical review, and I was met with the predictable reaction of front-of-house asking if it could be a ‘quick one’. After enquiring, I learned that because of her diagnosis here, she had developed confidence in the surgeries available in Australia and so had arranged for a second trip back just for the operation.
Subsequent to the membrane removal, the patient developed a cataract and wanted counselling on its cause and prognosis, because she had developed so much trust from her first consultation with me.
I am thankful for my experience with centre because it helped me to develop the patience and understanding that really embodies the value of ‘quality and continuity of care’ as opposed to being overly-fixated on convertible tests. Patients are people too.
Aside from my clinical life, having such an active role at the centre has helped me in my personal life and pulled me out of an inner slump and into an active mindset. It continues to be a challenging and rewarding experience.
* Under international law, a stateless person is defined as someone who is ‘not considered as a national by any state under the operation of its law.’
Visit the United Nations High Commissioner for Refugees (UNHCR) website for more information.
To learn more about the Asylum Seekers Centre Newtown, visit asylumseekerscentre.org.au