$10m boost to indigenous care
A wider focus may see a new indigenous health initiative succeed where others failed, writes Health editor Adam Cresswell
BORN and bred in the northern outback NSW town of Brewarrina, Aboriginal health worker Maria Tattersall knows first-hand the benefits that someone in her position can bring. Now working in Broken Hill, Tattersall has a diploma and advanced diploma in indigenous primary health care, which allows her to visit Aboriginal communities and take not just the message, but also the practice of primary health care to where it’s most needed.
Her qualifications mean she can measure blood pressure and conduct urine analysis, both of which can pick up the warning signs of diabetes or other chronic conditions. If these measures indicate a problem, the patient can be referred to a doctor for diagnosis.
And being Aboriginal herself means she is trusted and accepted, and more people who have chronic conditions get picked up and referred for treatment.
‘‘ We can see where they’re coming from, why some people shy away from health services,’’ Tattersall says. ‘‘ I can understand why they don’t want to come into hospital, because Aboriginal people view a hospital as a place to go to die. A lot of people think they are not going to come out if they go in.’’
A new Centre for Indigenous Health, being planned by the University of Sydney as a result of receiving a pledge for its biggest-ever donation of $10 million, is the latest program that hopes to turn some of this around.
As reported in The Australian last month (26-7/1), the donor — whose name has yet to be released — stipulated that he wished something practical to be done to improve health outcomes for indigenous people.
The university’s initial proposal was to set up the centre with a three-pronged strategy: to organise fly-in, fly-out specialist clinics to treat patients in under-doctored areas; to include medical students on the trips to expose them to indigenous health and preferably inspire some to pursue a career in the field; and to conduct research on what types of indigenous health programs work best.
The clinics will initially be held in four towns — Broken Hill, Dubbo, Bourke and Brewarrina — and if shown to be successful in a subsequent evaluation the federal Government will be approached for funding to allow the scheme to go national.
The university’s dean of medicine, professor Bruce Robinson, last week travelled to Broken Hill for a two-day consultation and fact-finding mission with seven other senior faculty members to map how the proposal might be developed, after an earlier trip to Bourke and Brewarrina. Consultations were held with the local Aboriginal medical service, called Maari Ma, as well as local GPs and health workers, the town council and the town’s University Department of Rural Health — itself part of the University of Sydney.
While community groups have seen plenty of indigenous health programs come and go in the past, often leaving little trace, the university stresses that the $10 million funding will be stretched over at least 10 years, and more if governments contribute funds of their own, giving it the chance to be more than a transient influence.
Since the trip Robinson says it’s clear that aspects of the initial proposal will have to be changed or expanded to take account of the insights the team gleaned.
Some of these changes are logistical — such as trying to ensure that the fly-in, fly-out clinics involve the visiting specialist staying at least overnight and socialising with the local doctors and community members to get a better sense of the local conditions and forging better relationships.
Others go deeper, such as widening the focus of the initiative so that it also tackles, or at least advocates for, change in various other key areas.
Tattersall, who was present at one of the meetings with faculty staff last week, can attest to what these other areas might be.
Her own experience shows the value of having what’s called ‘‘ culturally appropriate’’ services in place.
But social factors affect health too, such as housing, education and the more nebulous variables, such as a pleasant environment and positive role models that create a sense of contentment and purpose.
‘‘ Many things have to be thought about, and you have to try and tackle many things at once,’’ Tattersall says. ‘‘ In small communities, we have this big issue with overcrowding and not enough housing.
‘‘ It’s common to have three or four families living in a three-bedroom home. The housing is also sometimes just not fit — there’s often no airconditioning, and it can get up to 48 degrees indoors. Especially with the overcrowding, if only one family member has a skin condition it can spread through the whole family like wildfire.’’
Education is another important determinant of health. Without it, job opportunities are curtailed, in turn restricting not only income but also potentially increasing the risk of depression and anxiety.
‘‘ If you don’t have literacy, how do you know what medication you are taking, or what you are trying to do?’’ Tattersall says.
Wilcannia, a town on the Darling River that Robinson’s team visted during the Broken Hill trip, illustrates some of the challenges that face any serious attempt to lift indigenous health outcomes.
Dental health is a huge problem because there is no fluoridated water supply. Dental caries is common and staff tell of patients brought in by ambulance with swollen faces, and families who clean their teeth with charcoal. One pregnant woman was treated after presenting with a huge fissure and pus draining from a hole in a tooth.
Although it has an airstrip, Wilcannia is not one of the towns that will get the planned new clinic flights, partly because services supplied from Broken Hill are already unusually well integrated and it’s felt that existing relationships with local doctors and health workers need to be preserved — which can be done by sending the help direct to Broken Hill, in turn freeing up local resources so they can devote more attention to communities such as Wilcannia.
Wilcannia’s problems are by no means unique: remote areas such as the Central Darling Shire in which it lies, and very remote areas such as the Unincorporated Area of the Far West that surrounds Broken Hill, continue to face health deficits. People in remote areas can expect to die four years earlier on average, or 10 years earlier in very remote areas, and are more likely to die from avoidable causes.
In these two regions — where the population is 7.3 per cent Aboriginal, compared to 2 per cent across the entire state — one in 23 Continued inside — Page 17
Accepted: Maria Tattersall of the Broken Hill Department of Rural Health checks the heart beat of colleague Tony Kickett