$10m boost to in­dige­nous care

A wider fo­cus may see a new in­dige­nous health ini­tia­tive suc­ceed where oth­ers failed, writes Health ed­i­tor Adam Cress­well

The Weekend Australian - Travel - - Health -

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

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