Sustaining remote-area programs: retinal camera use by Aboriginal health workers and nurses in a Kimberley partnership

Richard B Murray, Sue M Metcalf, Philomena M Lewis, Jacqueline K Mein and Ian L McAllister
Med J Aust 2005; 182 (10): 520-523.


Objective: To describe how a novel program of diabetic retinopathy screening was conceived, refined and sustained in a remote region over 10 years, and to evaluate its activities and outcomes.

Design: Program description; analysis of regional screening database; audit of electronic client registers of Aboriginal community controlled health services (ACCHSs).

Setting and participants: 1318 Aboriginal and 271 non-Aboriginal individuals who underwent retinal screening in the 5 years to September 2004 in the Kimberley region of north-west Australia; 11 758 regular local Aboriginal clients of Kimberley ACCHSs as at January 2005.

Main outcome measures: Characteristics of clients and camera operators, prevalence of retinopathy, photograph quality, screening intervals and coverage.

Results: Among Aboriginal clients, 21% had diabetic retinopathy: 19% with non-proliferative retinopathy, 1.2% with proliferative retinopathy, and 2.8% with maculopathy. Corresponding figures for non-Aboriginal clients were 11%, 11%, 0 and 0.4%, respectively. Photograph quality was generally high, and better for non-Aboriginal clients, younger Aboriginal clients and from 2002 (when mydriatic use became universal). Quality was not related to operator qualifications, certification or experience. Of 718 regular Aboriginal clients with diabetes on local ACCHS databases, 48% had a record of retinal screening within the previous 18 months, and 65% within the previous 30 months.

Conclusions: Screening for diabetic retinopathy performed locally by Aboriginal health workers and nurses with fundus cameras can be successfully sustained with regional support. Formal certification appears unnecessary. Data sharing across services, client recall and point-of-care prompts generated by electronic information systems, together with policies making primary care providers responsible for care coordination, support appropriate timely screening.

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  • Richard B Murray1
  • Sue M Metcalf2
  • Philomena M Lewis3
  • Jacqueline K Mein4
  • Ian L McAllister5

  • 1 Kimberley Aboriginal Medical Services Council, Broome, WA.
  • 2 Disease Control, Kimberley Population Health Unit, Broome, WA.
  • 3 Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, WA.



We acknowledge Dr Peter Graham for his vision and early championship of the program, the late Matthew Wade and Chris Barry for training efforts, the many dedicated camera operators, and local Aboriginal boards of Kimberley ACCHSs for their interest and support.

Competing interests:

None identified.

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