March 15, 2019
For the past ten years, the Auckland Regional Charity Hospital (ARCH) has been providing a number of free elective surgeries, performed by volunteer surgeons and their nurses. Over the past two years, Re:Vision’s Dr Trevor Gray – has been providing pro bono cataract surgery as well.
ARCH has access to a number of private facilities which volunteer surgeons use, either at cost or for free. Dr Gray’s recent partnership with ARCH has allowed them to offer treatments to cataract patients that have been turned down by public hospitals and are unable to fund private treatment. Patients are typically referred to ARCH by their GP, Optometrist or Ophthalmologist. If they qualify, this usually means they:
Today, we’re taking a look at why the initiative for pro bono cataract surgery is so valuable to our society and how it works, with input from our own Dr Trevor Gray who was recently interviewed on the subject by the NZ Herald.
More often than not, the public health system’s inability to serve everyone comes down to location. Different district health boards (DHBs) have it within their power to assign more or less money toward the treatment of cataracts. Some DHBs have very efficient and well-resourced eye departments, and so struggle less to help everyone who needs it. Demand also varies based on location - some DHBs may be overburdened simply because their local residents are an older age-group.
This leads health boards to set different qualifying thresholds for treatments – something Dr Gray touched on in his Herald interview. He pointed out that surgery thresholds varied for a number of reasons, including funding, demand, capacity and efficiency.
For example, the Auckland DHB has relatively low thresholds. “In Auckland, patients who are just about to lose their drivers licence but haven’t lost it yet, will almost always get their cataract surgery,” Gray said.
But as close as the Counties Manukau side of the boundary line, it’s a completely different story.
“…if they live on the opposite side of the road at Otahuhu – you have this line – you have already lost your driver’s licence before you are even half considered for cataract surgery. There is huge variation in access and delivery of care like cataract surgery around the country.”
Cataracts typically affect elderly, already retired citizens, but there are many cases of those suffering from cataracts while still working. In these cases, residents have had driver’s licences cancelled and their livelihood endangered, before qualifying for publicly funded cataract surgery, and it’s cases like these that spurred Dr Gray on to volunteer his time, skills and resources.
Dr Trevor Gray worked in the public system for 20 years, and has seen how the situation has devolved over time. Even though the public health system has a number of strengths, the way thresholds determining access to surgery are handled across districts, is certainly a weakness.
These weaknesses drove Dr Gray to think that if private surgeons such as himself set aside the time in their own operating theatres to do small amounts of volunteer work, many cataract patients who slip through the cracks would be cared for. This is why Gray decided to partner with the pre-established Auckland Regional Charity Hospital – an organisation that already had the experience needed to work with volunteer surgeons and manage the referral and assessments processes.
Since the initiative began, several other ophthalmologists have signed-on, and cataract treatments have been carried out for patients from Northland, Auckland, Whanganui and more. That said, Dr Gray said in his interview that he hoped more surgeons would sign-up with ARCH, as surgeons would only have to volunteer as little as 20 minutes a month, in order to have a huge positive effect across the country.
He went on to detail the difficulties that many optometrists face when trying to access public cataract surgery for their patients. “We’d often see patients referred to the public hospital from their optometrist who say, ‘Well, my patient here, I can’t do anything more with glasses, and their vision is worse than driving level vision, so I’m forced, legally, to cancel their driver’s licence.’
The simple fact is that turning people away actually winds up costing more long-term as it can have significant big-picture knock-on effects in New Zealand’s medical system.
Dr Gray expressed hope that the public sector would be able to make the charity work obsolete, however, if trends continue to develop in the direction that they have been for the last 20 years, it’s going to take some significant effort to turn things around. In the meantime, Dr Gray and other volunteer surgeons working with ARCH will continue to offer pro bono cataract surgery for those in need.
To find out more about Dr Gray, get in contact with the team here at his private practice, Re:Vision Sight Correction Centre.