Vision impairment affects more than 285 million people worldwide however the burden is heaviest in communities with limited resources and poor service access. Papua New Guinea (PNG) is the largest South Pacific country, with a population of 11 million. It is geographically diverse with rugged, mountainous terrain and far-flung island provinces. The remoteness of even major centres leads to uneven distribution of resources and eye health services struggle to access medical supplies, equipment, facilities and personnel. There are only 11 ophthalmologists and 120 ophthalmic nurses with most eyecare facilities being in urban areas. However, as most of the population (87%) live in rural areas they generally lack access to eye care. As a result, PNG has one of the highest rates of blindness globally. The 2017 Rapid Assessment of Avoidable Blindness found 5.6% of adults >50 years were blind and 13.8% had moderate to severe vision impairment, with the most common cause being cataract.
Outreach services offer many advantages for the provision of eye care, including greater convenience for patients and their families, and reduced travel costs. However, there are many challenges to outreach including workforce shortages, transportation issues, inadequate spaces, and lack of awareness. The latter includes not understanding cataracts can be treated, not being aware of community outreach services, and/or the free surgery offered. Despite these challenges, over the past 13 years there have been more than 43,000 outreach consultations and 8,300 surgeries in diverse locations across PNG. Four out of five surgeries were for cataracts, including pediatric congenital cataracts. A key factor for successful outreach has been close collaboration between the visiting team and local staff, who assist with logistics and pre-screening. This approach has enabled those most in need to benefit from life-changing eye care, despite challenging circumstances. While much has been achieved, there remains much work to be done, with a backlog of many thousands of patients still waiting for surgery.