Palm Islanders living with threat of diabetes

By Janelle Miles, The Sunday Mail (Qld) on Dec 11, 2016

Fightback for Palm Islanders living with threat of diabetes and blindness as IDEAS takes off. The children of Palm Island can look forward to a brighter future thanks to the Indigenous Diabetes Eyes and Screening (IDEAS).

QUEEN Elizabeth II is unlikely to step foot on the Aboriginal settlement of Palm Island, 65km northeast of Townsville, but she has given a priceless legacy – the gift of sight.

When Her Majesty celebrated the Diamond Jubilee of her coronation in 2013, few Queenslanders would have been aware of the Newman government’s tribute – a one-off $5 million grant to tackle avoidable blindness in indigenous communities.

Palm Island, on the Great Barrier Reef northeast of Townsville, looks idyllic but hides a devastating epidemic facing the population. Pic: Jamie Hanson

Social entrepreneur Lyndall De Marco, who spent eight years working for the Prince of Wales International Business Leaders’ Forum, is the driver behind the innovative project centred on a mobile eye clinic, dubbed the IDEAS (Indigenous, Diabetes, Eyes And Screening) van.

For almost three years, the 18.5m truck and trailer has travelled more than 170,000km throughout rural and regional Queensland, hauling $900,000 worth of equipment on a regular circuit of indigenous medical clinics in eight communities – Toowoomba, Cherbourg, Hervey Bay, Bundaberg, Charleville, Mount Isa, Rockhampton and Palm Island.

Five or six times a year, the semi-trailer is loaded on to a barge for the four-hour journey to Palm, the island so breathtakingly beautiful some residents, including Anna May Sarabo, describe it as “paradise”.

Watching the joyful faces of children performing somersaults off the island’s jetty on a sweltering afternoon, it appears nothing but idyllic. On a clear day, the surrounding waters sparkle brighter than sapphires in the Crown jewels.

But Sarabo’s story is testament to the clouds that are never far from the troubled community’s horizon.

Much of its population of about 2300 people is made up of Aborigines and Torres Strait Islanders – and their descendants – forcibly removed from throughout Queensland last century and relocated to the island.

For others, it was an indigenous prison, where Aborigines were transported after committing crimes.

Anna May Sarabo, 65, is among those diagnosed with type 2 diabetes. Pic: Jamie Hanson

Sarabo was taken from her family as a toddler on the Atherton Tablelands, southwest of Cairns, and sent to Palm Island, where she lived in a dormitory, part of the Stolen Generation.

“This is my home now,” says the 65-year-old member of the Bwgcolman people, the contemporary Aboriginal name for Palm Islanders, meaning “many tribes – one people”.

As the community continues to confront complex social issues linked to its turbulent past, a health scourge is firming its grip on the island – type 2 diabetes, bringing with it the risk of permanent blindness, amputations, kidney dialysis and heart disease. Sarabo is among those diagnosed.

A 2016 Australian Institute of Health and Welfare snapshot of the nation’s health shows indigenous people are 3.5 times more likely than the rest of the population to have diabetes and four times as likely to die from it.

The IDEAS van’s mission is to tackle diabetes and associated eye complications. That includes diabetic retinopathy, caused by damage to blood vessels at the back of the eye. Without laser treatment or injections into the eye – or both – the condition can lead to vision loss and, eventually, permanent blindness.

Key to addressing the problem – apart from keeping blood glucose under control with diet or drugs – is detection.

De Marco says 27 retinal cameras, worth about $20,000 each, have been supplied to Aboriginal Medical Services and outreach health providers, such as the Royal Flying Doctor Service, to screen for diabetic eye problems.

The images are digitally transferred to ­Sydney where they are graded. So far, more than 21,000 photos from about 4000 patients have been assessed.

The hope is that with time, screening will increase to 20,000 of Queensland’s 150,000 indigenous residents.

Information from the photographs is used to determine which patients need to be seen in the IDEAS van. About 2200 patients have been treated in the van, which bulk bills all services.

Palm Island GP Dr Raymond Blackman, 44, understands aboriginal health much better than most. Pic: Jamie Hanson

Twenty optometrists, 17 ophthalmologists and their orthoptists, who assist in diagnosing and treating eye disease, devote one day a month from their city practices to work on the mobile eye clinic. They liaise with general practitioners servicing indigenous communities.

Palm Island GP Dr Raymond Blackman played on the wing for the North Queensland Cowboys in their inaugural season in 1995 and worked as a plumber before studying medicine. The 44-year-old graduated from Townsville’s James Cook University a decade ago.

Few people understand Aboriginal health – and the historical, social and environmental factors that influence it, as he does. Out of 90,000 doctors working in Australia, he’s one of about 250 who are indigenous. But he refuses to view his medical degree as an accomplishment.

“I don’t see it as amazing,” Blackman says. “It’s always been for my people. I had a foothold in knowing how to train hard in football. It’s exactly the same skill. You’ve just got to not give up.

“From a western point of view – making the Cowboys, becoming a doctor – those might be achievements. But to me, that’s not an achievement. Achievement is when every Aboriginal person around Australia has better health.”

Blackman grew up in Ayr, south of Townsville, but would visit Palm Island regularly. It’s where members of his family were relocated after removal from their traditional lands under Queensland’s Aboriginal “protection” legislation, which ruled indigenous lives for much of last century.

His late father, Raymond Foster, lived in a dormitory on the island before moving to Townsville with nothing in his twenties, sleeping underneath the bandstand in Anzac Memorial Park. He turned his life around, eventually setting up an alcohol rehabilitation service in the north Queensland city.

“Palm Islanders would come,” his son says. “He did it for his people.”

Dr Vicki Stonehouse had little exposure to Aboriginal health until arriving on the island in 2010, then in 2013, she and Blackman established a GP practice. Pic: Jamie Hanson

Blackman tells his father’s story to emphasise the importance of Aborigines being involved in solutions to community health problems.

“I’ve grown up in overcrowded environments, grown up with my father, grown up with all the stereotypes,” he says. “I understand how social factors impact medical factors. How can you understand if you haven’t lived it? If you want to help Aboriginal health, you want to make sure you have some background and knowledge before you start delivering.”

Blackman says the IDEAS van liaises closely with Palm Island’s primary health workers to deliver eye care.

“We have a great relationship and that’s what it’s all about,” he says.

His colleague, Dr Vicki Stonehouse, had little exposure to Aboriginal health before joining the island’s hospital, the Joyce Palmer Health Service, in 2010. Working with the Palm Island Community Company, she and Blackman established a GP practice in 2013.

“I fell in love with the community,” she says.

“It’s an amazing mix of medicine from cradle to the grave. My cultural learning has been phenomenal.”

Stonehouse says she’s seen Palm Islanders in their teens and twenties with type 2 diabetes – about 20 years younger than it typically develops among non-indigenous Australians. As part of their health checks, the Palm Island practice screens patients for signs of the disease from about 15 years old.

While acknowledging the causes of type 2 diabetes are multi-factorial, Stonehouse believes high rates on the island are linked to its history as a dumping ground for the Stolen Generations. Removing people from their ancestral lands robbed them of traditional hunting, eating and exercise practices, she says.

“People from more than 40 different tribes were brought to Palm – desert people, rainforest people, all with different traditions,” Stonehouse says.

The Indigenous diabetes eyes and screening truck (IDEAS) arrives on Palm Island. Pic: Jamie Hanson

“Some people didn’t know what the ocean was so they would have had no clue how to hunt for fish. They weren’t allowed to speak their language, weren’t allowed to dance.”

The island has been spared infiltration by multinational junk food operators. However, a takeaway store, Sunset Snack Foods, is popular with the locals, selling a range of fried foods and sugary drinks.

Eating healthily on Palm Island is a struggle. Prices at the community retail store are grossly inflated compared to the city.

“You might be paying $7 for a head of broccoli on Palm Island, whereas you can walk into one of the markets in Townsville and get it for $1,” Stonehouse says. “There’s definitely a diet issue but it’s also about access to fresh fruit and vegetables, as opposed to high-processed food that’s cheaper and goes further.”

The island’s latest health plan shows only 1.6 per cent of its population is aged over 65, compared with more than 12 per cent of non-indigenous Queenslanders. Death rates occur at relatively young ages, fuelled partly by diabetes, which can be responsible for strokes and heart attacks.

Palm Island Aboriginal Shire councillor Deniece Geia, a former Queensland Health worker, says the IDEAS van gives the community a “sense of hope” for better control of residents’ diabetes.

“There’s no excuse for a Palm Island person to miss out on getting their eyes checked, their sugar diabetes checked or their feet checked by a podiatrist,” she says. “All of those services are now available on the island.

“We want to see our people live a long life. We don’t just want to be another number. We’re tired of being researched.

“It’s sad when we’re going to a funeral service for someone who has passed away from a disease that’s preventable. Prevention is our top priority.”

Robert James, 40, the Palm Island council’s essential services manager, says he “got a bit of a shock” after developing a diabetic foot ulcer and was told he was in danger of losing two toes.

“That’s why I’m here at the IDEAS van to make sure my eyes are okay,” he says. “I don’t want this stuff to impact on my life. You can’t do much when you’re blind.”

Stephen Boyd, 49, has his eyes checked at the IDEAS van, having had relatives go blind. Pic Jamie Hanson

Stephen Boyd, 49, who takes drugs to control his type 2 diabetes, has also come to the van to have his eyes checked after watching some of his relatives go blind from the disease.

Brisbane ophthalmologist Dr Rowan Porter says the project is Queensland’s first large-scale indigenous diabetic eye-screening program.

Porter, a member of the IDEAS van’s steering group, says all diabetes patients should have their eyes screened annually.

“It’s a window to see what the state of diabetes is throughout their body,” he says. A key component of the project is a telehealth service that can link patients on the van with Princess Alexandra Hospital endocrinologists in Brisbane, such as Associate Professor Anthony Russell, when no local specialists are available.

Through telehealth, patients can receive consultations on how to better manage their diabetes.

“The van is a beacon,” Russell says. “People come along to get their eyes examined and treated. It then provides a significant opportunity to address the rest of the patient’s diabetes. It’s doing a much-needed job to try and close the gap.”

Although the van can identify cataracts, which can develop at an earlier age in diabetes patients, an operating theatre is needed for their removal. The IDEAS van can streamline the process for Palm Islanders to fly to Townsville for surgery.

World-renowned ophthalmologist Professor Paul Mitchell, who is involved in grading the scheme’s retinal images with colleagues at Sydney’s Westmead Institute for Medical Research, is under no doubt the project is saving indigenous patients’ eyesight.

Lyndall De Marco who lead the initiative of the IDEAS van. Pic: Jamie Hanson

“The success is really in whether we’ve been able to change the course of diabetic retinopathy over time.

“I think we probably have,” he says. “We’re providing access for indigenous people to eye care services. There are not a lot of specialists that bulk bill.

“If you can get people before they’ve lost central vision, or before that vision loss is marked, you can actually reverse that loss, or stabilise it,” Mitchell says. “Once that vision loss has been there for a year or so, it becomes permanent.”

While the IDEAS van has attracted significant sponsorship, including from Volvo, which provides the truck, ongoing funding is needed to transform what started as a pilot project into a permanent fixture within indigenous health. De Marco has registered the van as a charity.

Comments are closed.