E21 How a health clinic on a school campus is improving Indigenous health

Isaac: [00:00:00] We at the Cape York Partnership acknowledge that this podcast is produced on the traditional lands of First Nations people, and we pay our respects to elders past, present and emerging. [00:00:10][10.6]

Isaac: [00:00:53] Welcome to Time to Listen, a podcast that gives a space and a platform to the voices of Aboriginal and Torres Strait Islander peoples, as well as people working in Indigenous affairs. You with your host Isaac McCarthy and today on the podcast, I'm introducing another entity within the Cape York partnership, Ngak Min Health, and helping me to do that is the general manager of Ngak Min Health, Charmaine Nicholls, as well as nurse practitioner Mel Dunston and Dr Matthew Carson. Due to the remote nature of many Indigenous peoples, residential status health issues often go undetected. Even those that are detected often remain untreated for prolonged periods, and geographical complexity is not the only reason for this. Ngak Min is a unique, innovative and culturally safe Indigenous health service. It is co-located with Djarragun college and maintains a strong relationship with Djarragun in order to conduct health screening of the students and wider Indigenous community for preventative and early intervention purposes. It also serves a myriad of other purposes and functions, but I'll allow the Ngak Min Health staff to address these. Collectively, Charmaine, Mel and Matthew have a wealth of experience in providing health services in remote Indigenous communities. In addition to talking about Ngak Min and the role that it plays in Indigenous health, they also share their observations for best practises in engaging with Indigenous people for the sake of bettering their health outcomes. I thank Charmaine Mel and Matthew for their time and you, the audience, for taking the time to listen. OK. I'm down at Ngak Min Health today, and I'm sitting here with the general manager, Charmaine Nichols. I'm also sitting here with a nurse practitioner, Mel Dunston, and I'm sitting here with Matthew Carson, who's one of the doctors at Ngak Min Health. Thank you all so much for joining me here. And what we're doing today is we're just doing an introduction to Ngak Min Health and we're going to talk all about the role that Ngak Min serves and and its purpose and how it came to be and how it operates on a day to day basis and why it does what it does. So without any further ado. Charmaine, I'm going to ask you to introduce yourself first and give us a bit of an idea about what your background is. Yes. [00:03:11][138.1]

Charmaine: [00:03:11] Thank you, Isaac, for this opportunity. So my name is Charmaine Nichols or Nee Kenny. Born and raised in Alice Springs. I identify as an Arrernte woman through my father and I have Croatian heritage through my mother. My background has only been in primary health care, in particular Aboriginal health, and I started that journey when I was about 15, working in Alice Springs at one of the largest and oldest Aboriginal health services in this country. As a medical receptionist, until I worked my way to the very, very top and was three IC of a $50 million primary health care Aboriginal health service. So I've gained a lot of knowledge at all levels in Aboriginal health. Primary health care. [00:04:05][53.4]

Isaac: [00:04:06] And how is it that you came to be at Ngak Min Health? [00:04:08][2.1]

Charmaine: [00:04:08] So I relocated from Alice Springs into Queensland about 10 years ago and came to Cairns with my family. And I've basically been working in management roles in Aboriginal Health, in Mackay, other locations around Cairns and an opportunity at Ngak Min seven months ago presented itself for a general manager. And this is my passion, personal and professionally, and I was successful in being appointed as the GM at Ngak Min Health. [00:04:42][34.1]

Isaac: [00:04:43] What about yourself Mel? Give us an idea of your background and also how you came to be here at Ngak Min. [00:04:47][4.4]

Mel: [00:04:48] So my background is quite extensive. I've worked in Aboriginal health for a number of years and come from a background of working in rural and remote communities with the Flying Doctor Service. So I've worked in a lot of the communities where the kids that come through Djarragun boarding school have have been. So that's a real advantage for me in a real connection with the kids. My background was I did a lot of my nursing in Melbourne and then moved to Country Mildura on the banks of the lovely Murray River and did my midwifery and stuff in that. While I was there, I worked with young mums and and then moved to child health and moved into the community and worked with an Aboriginal health service there. So that's where I got my love of Indigenous health. I then worked in community there and worked with High-Risk mothers and really got a love of working with young mums in particular and sort of the child protection system and how I could really influence lives and how I could really change people's lives for the better and then got the wonderful job working with flying doctors. And that's just been astronomical and then decided that I hated the wait times for people in communities and having to refer to people that weren't available. So that's why I became a nurse practitioner. So being a nurse practitioner, I abled me to be able to do a lot of the work that people were waiting for. So I was able to treat the illnesses that I was seeing and being able to do the referrals and just speed up health care for people. So that's why I did nurse practitioners so happy nurse practitioner to the other nurse practitioners out there in the world. And then after that, I the burden of disease in diabetes was huge in these communities, and so I saw the way diabetes education was delivered or not delivered in communities. And so I became a diabetes educator after that as well. So I then worked in homelessness and GP land for a while and then position at acting came up and I was like, Yeah, this gives my love of Indigenous and rural care, but I get to sleep in my own bed every night. So that was perfect for me. So my love of children, but also women and community is is is part of working here. [00:07:07][139.4]

Isaac: [00:07:08] What a varied background. Yeah, yeah. And now we turn to Matt Matt, who's just recently had a shave. He's lost his beard. Actually barely recognise him. Mate. How did you come to be at Ngak Min Health and what you've been doing with your professional life? [00:07:20][12.1]

Matt: [00:07:21] Yeah, thanks Isaac. I am originally from New Zealand and came over just over 10 years ago to study medicine. Did my training and did my med school in in Brisbane and and then did some junior doctor years on the Sunshine Coast. Then about four years ago, moved up to Cairns with my wife and decided to specialise as a as a GP. Um, did some of my training in a um, community GP practise and then also some in a Aboriginal, um, health service. And that included in that was a little bit of six months of of travelling up the cape to community with a paediatrician. Um, and I just found that working in that setting was very rewarding and enjoyable. Um, and then so yeah, yes, I've qualified about two years ago and have worked pretty much, um, mainly in Aboriginal health since and actually went down to Brisbane at the end to 2020 for six months. Um, and then came back at the beginning of 2021 and started working at Ngak Min. [00:08:50][89.0]

Isaac: [00:08:51] And so what is it about Aboriginal health that draws you to these kind of roles? [00:08:54][3.5]

Matt: [00:08:55] I think I've just really enjoyed, um, the people, you know, getting to know, um, Aboriginal people and coming from New Zealand. I wasn't so aware of the, you know what it's been. It's been really good learning about the, you know, the history. And you know, I recognise there's a lot of there's a lot of need in Aboriginal communities for primary health care. And yeah, it's just been it's been really nice to be part of that part of that solution. Yeah, that's right. [00:09:33][38.2]

Isaac: [00:09:34] Okay, great. Charmaine, why don't you tell us what is Ngak Min Health and what services does it provide? [00:09:38][4.7]

Charmaine: [00:09:39] So Ngak Min Health is and if we use the right language that we use in Aboriginal and Torres Strait Islander health, Ngak Min is a health service in mainstream they may call it a general practise, but for us it's a health service and we provide a comprehensive and holistic primary health care to approximately 600 clients. Majority of those Djarragun college students. But we're starting to see families from the local community come in and access our services as well. So primary health care is a model that surrounds the individual client and their care is tailored and based on the individual needs of what the client may need in terms of optimal health or best client outcomes. So in primary health care, you would have a medical model, you would have a social emotional model, you would have a mental health model, you have allied health, transport drivers. All of those people positions surround a person in order to provide them with the best type of treatment and management that they actually need based on what their presentation is, whether it's acute, chronic or complex. And because our population group is predominantly Aboriginal and Torres Strait Islander people, we're also, by definition, an Aboriginal medical service. So that is basically what we do we're a health service who provides primary health care and we're an Aboriginal medical service. [00:11:15][96.5]

Isaac: [00:11:16] And so you've mentioned Djarragun college, there are Ngak Min Health is actually co-located, you know, on the same grounds as Djarragun College. Now we we've introduced Djarragun College before on this podcast so people can find out all about them by going to previous episodes. But would you also mind describing that relationship that Ngak Min Health has with Djarragun College? [00:11:35][18.9]

Charmaine: [00:11:37] I think Mel would be good at best Answer this question. Mel's been with Ngak Min Health for over 12 months now, and Mel has some really good understanding of that relationship. [00:11:47][10.9]

Mel: [00:11:49] So obviously we're co-located next to Djarragun College in around the grounds of Djarragun College, and the majority of clients that we see day to day are students of Djarragun College. So we see where our doors are open to any students and the families of Djarragun students. So our day to day work would mostly be Djarragun students, both boarding and day students. [00:12:10][20.6]

Isaac: [00:12:11] We're sorry, we're talking all the way from Kindi to Grade 12. [00:12:14][4.0]

Mel: [00:12:15] Yeah, so when I first started, we didn't see a lot of day students and a lot of the primary kids, but now that's changing. And so as we're building relationships with these kids, it's super cool to see that the kids just walk through the door now. But the other thing that I've seen changed over the last 12 months is that we're now seeing the families of some of The students walking through the front door as well, so that's super cool, too, so school holidays, traditionally we didn't see many, many people come through the door, but now we're getting kids coming through the door in the school holidays, and that's super cool to see. But we're also getting a general public coming from community, coming through the door as well. So that's great too. [00:12:55][39.8]

Isaac: [00:12:55] And it sounds like this previously wasn't the case. Like, it's taken quite a bit of time for Ngak Min Health to, I suppose, show its value and engender trust with its clients to get to this point. Now, where people like you say, people are just walking in and comfortable being accessing the service. [00:13:14][18.5]

Mel: [00:13:14] Definitely. I think that's part of Indigenous health. Sometimes it's it's really about relationships and building trust, and it's a slow process and sometimes it's just saying hi. And being a friendly face is a consultation and being approachable is part of being a nurse, I think, or being a health care provider and it's being an open door. It's part of what we do. [00:13:39][24.9]

Isaac: [00:13:40] Would you agree with that, matt? Same thing for being a doctor. It's, you know, half the battle is just being someone who can be approachable. [00:13:46][6.5]

Matt: [00:13:48] Yeah, definitely. And it is really rewarding to to see kids and then and just, you know, we always encourage them to come back and have a yarn about things. And it is really rewarding when you might see someone for a, um, acute injury and then you other issues might come up and you just provide a bit of encouragement. And I think it's it's such a positive space. Um, and uh, it's it's just, yeah, it's really nice to to see the kids, um, just approaching us and on their own volition. [00:14:23][34.9]

Isaac: [00:14:23] So Charmaine, now what I want to talk about is why Ngak Min Health was founded in response to what particular problem or issue or concern, because it's an initiative of the Cape York partnership. And I also want to talk about the benefits of being a health service that is co-located with the school, and I believe we can do this a little at the same time because we're all well aware of that there are some stark gaps in health outcomes between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians, and we but we're also we also have solid data that these gaps in health outcomes start early. They start at an early age when Aboriginal and Torres Strait Islander people are in school, and it's my understanding that Ngak Min Health was founded in response to this under the principle of early intervention. Would you mind elaborating on that or or making a comment counter to that part? [00:15:14][50.7]

Charmaine: [00:15:14] So my understanding of the establishment of Ngak Min Health was towards the end of 2018, and Djarragun College and CYP recognised that the school population is Aboriginal and Torres Strait Islander students from primary school right up to secondary school day and boarding students. And what they recognised is that due to the burden of disease. Having such a large boarding school population, there was a need to provide an independent, onsite co-located health service for easy access, mostly for boarding school students. So they did not have to take students off site to access a GP, etc. So that's my understanding of how Ngak Min came to be. It's really important for anyone working in in health and especially in Aboriginal health, that they have a really good understanding of the complexities surrounding an individual and everything we do has to be based on trauma informed. We have to think about the social and the environmental risk factors. We have to think about the psychosocial risk factors that's going on in someone's life. But Mel can add onto to that. [00:16:46][91.9]

Mel: [00:16:47] I guess the advantage for us working in this space is that I think the coolest thing is that we can get this a primary school here, so we can screen the primary school kids and pick up things before they even get sick. Or we have the opportunity to do health promotion so we can teach kids how to brush your teeth. How to cough, had a clean your ears. How to look after your ears how to look after your skin. So I've worked in places where I've done school education on how to just keep yourself healthy in the boarding space and in the high school level, talking about safe relationships and consent, and raising topics about safe sex and consent. But. Also, safe relationships, safe, peer to peer sort of conversations, alcohol, drug use, but also safe providers of care and creating a safe space to talk about emotional health as well. We've got a great opportunity to change lives and change lives early. [00:17:54][66.9]

Isaac: [00:17:54] We often hear about these health gaps, usually around sort of adult age where, you know, life expectancy. The difference in life expectancy is this the prevalence of chronic health conditions like diabetes and cardiovascular disease and other issues, you know, is this. But do you think whilst where we're focussing not so much on the wrong thing, but our area, our focus could be better channelled towards the kids, the youth and fixing it at that level rather than trying to fix it when people are, you know, in their advanced years. [00:18:25][30.5]

Matt: [00:18:26] Yeah, totally agree. And um, I think the more funding and services directed at primary health level, um, is I think it's been been shown that that's where you get the best bang for your buck in the health system. Um, and you know, preventing those those chronic diseases and you know, those those bad outcomes, um, is extremely important. [00:18:54][28.4]

Isaac: [00:18:55] Charmaine, there's a few data points that I'd like to run past you and get your comment on. And I think these were used when when thinking up this health health initiative that is Ngak Min health back in 2018. And, you know, so we have a we have a discrepancy or we have quite a gap in child mortality rates between Indigenous and non-Indigenous kids. We there's there's a lot of concern around poorly managed medical conditions, particularly poor perinatal care, I think is the correct term. But the one, the one that really stuck out to me was that, according to the 2019 Closing the Gap report, there's a 43 percent chance. Well, sorry, I'll rephrase that. Indigenous people are 43 percent less likely to access health services than non-Indigenous people, and it sounds like there's a real hesitancy that to engage with health services there. Would you mind providing some comments on that data? [00:19:53][58.3]

Charmaine: [00:19:54] Yes. So when looking at that specific statistical data, you have to be really, really careful about how you actually interpret that and apply that. So we definitely know from three decades of data that there is a population age group between 15 and 25 years, and males will less likely access any sorts of health care service. So we know that through about 30 years of collecting data and in fact, my brother who lives in Darwin, he actually done a P HD 10 years ago on the same thing Aboriginal and Torres Strait Islander male access to health services. And it is quite it's quite alarming. So based on those sorts of statistics, in particular with male, some some listeners out there might remember that within the space of Aboriginal health, they developed this programme called the pit stop. The pit stop was based on how we would look after our vehicle in terms of fuel oil servicing and things like that. So that programme was rolled out around the country, in particular in rural and remote and very remote locations, and it was a whole day of trying to bring in that male population group. But anyone to say this is why you need to have regular contact with a health service at least once a year. And this the health annual health check started to be born out of that as well and became really formalised. Access to health services If you're in remote and very remote location, the concerns are and they will continue to be, is the health care workforce, not just health care, but let's look at it from a holistic point of view allied health professionals and medical specialist. So the current way to get services into a lot of remote and very remote locations is the old FIFO. But we know that doesn't work but right now because of the type of health care professionals and the number of those professionals there, very few and far between. So if that's what we can provide, those remote and very remote locations right now as a FIFO service. Well, well, that's better than. Nothing. It's limited. But that's another reason why people don't access health services as well. And there's also every community is going to be different from the next community. So that really is very, very individual. But in terms of access for Djarragun college students, that Ngak Min we have seen in the last, say, four to six months that our barrier to access is is slowly disappearing. And that's one of the biggest barriers in Aboriginal health is the barrier to access or transportation is the number one thing. A lot of our mob don't have transport. So how are they going to get to the doctor if they're unwell? And that's why a lot of Aboriginal health services provide transportation now for our mob to get just to the doctor, but also to help them get to medical specialist appointments. Our barrier to access here at Djarragun college. Like I said, it's it's almost gone [00:23:38][224.1]

Isaac: [00:23:39] because you have co-located with the school, the kids can just walk straight in. Yeah. And Mel, I saw you before you were sort of nodding knowingly when Charmaine brought up the pitstop story and you must have been working in remote health at that time. Would you mind sharing an anecdote or two about how well received or not that that programme was? [00:24:00][20.4]

Mel: [00:24:00] That's very well received. I've used that myself actually in many places and particularly flying into remote communities and doing field days. It's a great model to just get people interested and particularly males that and disengage from care. It's a great way to get them engaged in health care. It's quick, it's easy, and it's a really short, sharp, sweet way to get blokes involved in care. [00:24:27][26.4]

Isaac: [00:24:27] Matt, have you noticed when it comes to this sort of the gendered nature of this issue? Have you noticed as a male physician that people in community have males in the community have been more comfortable approaching you than say they might have female health practitioner? [00:24:42][14.7]

Matt: [00:24:43] Yeah, I think so. Yeah, to a certain extent there definitely is is there's some of that and often, um, yeah, you know, you've got men's business. So you know, the the men will respond a bit better and perhaps open up to you a bit more as a as a male practitioner. Um, and but I've also noticed, you know, you can you can respectfully talk about certain aspects of women's business with the female clients, but it also is I've noticed it's for, you know, certain examinations or certain conversations. It can be beneficial to have a female practitioner there. [00:25:30][46.7]

Charmaine: [00:25:30] I just want to add to that. I think with what Dr. Matt is saying, that you know, that gender, that gender balance, yes, in Aboriginal people and Torres Strait Islander people, there's very much that male female aspect in the way we approach things, because that's culturally how we've been brought up. But I'd like to to add just through my observation, being at Ngak Min Health, our students are now coming in and they're actually requesting who their primary healthcare provider is. And that is a very, very strong indicator in our space of the respect and trust that that client has with their identified primary health care provider. So we might even have a young, you know, secondary school student female come in and I could have both male and the other Aboriginal health worker and Dr. Matt also on today. But she might request she would like to see Doctor Matt, and that does happen. I have young fellows now and that teenage age group who are coming to Ngak MIn in and actually telling me without me in any questions. I need a sexual health check today. I need an STI screen. So that's another indicator sign to me that they are feeling so comfortable with coming and accessing the service and even having those open conversations and dialogues about why they're coming and if they if they're talking openly. I just tell them how deadly they are and how proud they are and how they need to promote that message to their mates. And and they're feeling pretty chuffed about that. [00:27:24][114.1]

Matt: [00:27:24] Just to add to that, you know, it's it's amazing what you can talk about with with the kids as long. As you know, you do it in a respectful way and you, you know, ask their permission to talk about certain topics and um yeah, it's amazing what what you know what they can be comfortable talking to you about, you know, whether they're male or female. [00:27:46][21.8]

Isaac: [00:27:47] Um, one thing I quickly want to say is Charmaine, you just use that phrase deadly, which up here for everyone who knows, that's a that's a phrase. It sort of equates to being awesome. But it's for anyone who doesn't know what that means might sound a bit of a strange phrase to use, especially around the health space. But for anyone who is a bit alarmed by that, perhaps deadly just does. It's a it's a common term up here that just means that's great. That's awesome, [00:28:09][21.7]

Matt: [00:28:09] I must admit. Cool. When I came from New Zealand, that took a while to get used to. [00:28:12][3.3]

Isaac: [00:28:13] Yeah, when people saying your health care services deadly, I'd say, [00:28:16][2.9]

Matt: [00:28:17] I think I was a student and I went to Mount Isa and I first came across that word on a poster and I was like, Huh, what does this mean? [00:28:25][7.9]

Isaac: [00:28:26] Oh dear, I've just walked into a deadly town. Yeah, yeah, that's funny. I just note in some of the statistics, Charmaine on your activity update report from July to September of this year, you had a fifty six new clients accessing mental health services, a mental health counselling, occupational therapy and provisional psychologist now. While that might sound a little bit alarming, there's 56 new people who access that service. Is that also encouraging that number? Because that amount of people, you know, may not have had access to the service or be comfortable coming forward to that service, but still would have had issues in that space are now accessing Ngak Min Health? [00:29:06][40.2]

Charmaine: [00:29:07] Yeah, sure. And that's a conversation. And the question that we often get in Aboriginal health, especially when we're at national conferences and mainstream, will say, Well, that just tells me that your people are really, really sick. But no, actually, what it actually tells us is that our access to service is open and we've taken away the barriers to access those services. And if we have the right type of people in the positions, it's again building those trusting, respectful relationships and the clientele. Your population group going, I can trust that person. That person will help me and that's why we have very high numbers is because we're building those relationships and it could just be simply walking by a student or a client and saying, How are you going today? And just that friendly smile. But in Aboriginal health, we do get that on average in a normal Aboriginal community controlled health setting our mob will access the service between four and six times in in a year. And again, mainstream would say. But that's because your people are sick, will. No, it's not. We've actually taken away the barriers to access, so we don't have a three week waiting to get in to see the doctor. We're resourced enough to actually say you will get an appointment today. [00:30:42][95.6]

Isaac: [00:30:43] Look, I just want to talk a little bit now about the notable gaps in health outcomes that exist between Aboriginal and Torres Strait Islander people and non-Indigenous people. What are they? What are the gaps that you think Australian society should be particularly aware of and concerned about? And you know, I'm happy if you want to talk it at national state level, a regional level like region such as Cape York and the Torres Strait, or even a kind of local level around here in Cairns. [00:31:10][26.9]

Mel: [00:31:11] I guess for me, that is the comes back to the social determinants of health, its access to to housing, its access to jobs, its access to health care, its access to, you know, the basics that we have in other places that are just not in some of the communities. [00:31:30][19.7]

Isaac: [00:31:31] So the socioeconomic factors that are causing a lot of these outcomes, [00:31:35][3.6]

Mel: [00:31:36] there's overcrowding and a lot of the communities and cairns, to be honest. [00:31:40][4.0]

Isaac: [00:31:41] What about from your perspective, Matt? What's what's on your radar? [00:31:43][2.7]

Matt: [00:31:44] So I agree with everything, Mel said. Um, so it's yeah, I mean, a big one is is is health literacy, you know, understanding of of of, you know, what a healthy lifestyle is and and, you know, understanding of, um, chronic disease. [00:32:03][18.7]

Charmaine: [00:32:03] But I think I'll just add to that. There's a conversation happening in academia at the moment, whether health literacy and I've grown up with health literacy in all of my life. Is health literacy the same as literacy? So through my degree and opportunities, we talk about the Literacy for Life programme that actually rolled out of in the 1960s and then that programme was rolled out in six Aboriginal communities in northern New South Wales, and there was also some research done in Darwin through Charles Darwin University, and they interviewed 700 Aboriginal and Torres Strait Islander adults and they assessed the literacy. So literacy covers everything. They assessed the literacy levels of these 700 adults. Nine out of 10 of them could not read and write to get through a normal day in their life. And then you add English as a second, third or even fourth language. So from the beginning, there's there's massive barriers and massive gaps, but that literacy, just basic reading and writing. Is required in all of our people, and it's got to start early. [00:33:32][88.6]

Isaac: [00:33:33] Mel, over your time here, what are they common health issues that you've seen present to Ngak Min and you spoke before about the social determinants of health outcomes? What do you believe is contributing to some of these issues? [00:33:44][11.3]

Mel: [00:33:46] Oh, great question. I guess the presentations vary across the term, which is really interesting. So at the beginning of the year, I would add it depends on the weather as well. So at the beginning of the year, we'll get a lot of skin complaints. So um, and to me, that goes back to what's happening in their home communities, particularly with the boarding students. So to me, that's that's overcrowding back in their home communities. They will also be just general health screening stuff. So we're picking up diabetic patients. Rheumatic heart disease patients, I think, are a big part is access to healthcare back in their own communities. So we will be picking up things that have have been missed back at home. So we're doing screenings. We try and do screenings on every child as they come through school. So I think I think the the fun thing for us is that we're known and constant carers. And that doesn't happen in their own community. [00:34:49][63.7]

Matt: [00:34:50] I think that coordination is really important role that we do. So we might have kids from community come in and, you know, a specialist appointment might have been missed or, you know, they should be on a medication that not taking in part of our role has been to try and, um, you know, do a lot of work with contacting various UM players and try and coordinate the care for that particular child. And yeah, seeing doing those health checks for the kids that come, I think is is is a really important thing that we we can do when they first come to school to full health check. You know, that's when a lot of the issues and issues, you know, come become known and we can sort of follow up. Um, but in terms of, you know, this is a large it's a large range of things we see, um, I and [00:35:48][57.6]

Isaac: [00:35:49] anything particularly different from a regular GP practise that they would see, yeah, [00:35:54][4.8]

Matt: [00:35:54] there's a lot of E & T. Um, so ear infection, throat infection, tonsillitis, um, we have diagnosed a couple of acute rheumatic fevers, which is is pretty much um so that that can lead to rheumatic heart disease and um, and that is pretty much nonexistent in non-Indigenous community. [00:36:17][23.0]

Isaac: [00:36:18] And let's take that one, particularly why. Why are we seeing that more in an Aboriginal and Torres Strait Islander health service? [00:36:25][7.1]

Matt: [00:36:26] So I think it's it's there are there may be genetic reasons, but also so rheumatic heart disease and acute rheumatic fever is like an accumulation of, um, of infections. So as they get, you know, if you have reinfections as a child, you build up this immune response and eventually you can have acute rheumatic fever. So that's with recurrent tonsillitis and recurrent skin infections that can lead to this. Um. So with overcrowding and now Mel was mentioning before you can we see a lot of kids who have had that high burden of infection and so the the more we can recognise those infections early and get them treated, the the less likely it is that we'll go on to, um, to become rheumatic fever. [00:37:21][55.7]

Isaac: [00:37:22] Mel, when I go up to communities and I walk past the maybe the one shack in the in the town that sort of doubles as a as a health service, you know, once a month or maybe once every two months, you'll see a sign on the door that says the dentist, the doctor, the whoever will be next in on this day, make sure you all get down here. Otherwise, he won't be back for two months, or she may not be back for two months. I've seen that in plenty of communities I've been to. Matt here is talking about how an accumulation of infections is leading to rheumatic fever and possibly even heart disease is just is it just the fact that people don't have somewhere to go when they have an issue that crops up on a particular day, they might be waiting for so long to finally access health care services, especially now we're coming into summer holidays for the kids who are in college. They're going to be back home in community for a month or two. What happens if something you know, occurs now? [00:38:18][56.6]

Mel: [00:38:19] So there's always access to someone, but it's just not probably the level that they require. So there's always access in some community. But it's just the service doesn't meet the demand or the the service that there is not culturally appropriate. [00:38:37][17.5]

Isaac: [00:38:38] And so people may therefore not even want to come in and and cultural consideration and safety is what I do want to talk about next. And Charmaine, I'd love to know how at a group level, so organisation of Ngak Min and at individual levels, cultural safety, cultural sensitivities and needs are accounted for in the practises and operations of Ngak Min Health. [00:39:02][24.2]

Charmaine: [00:39:03] Yeah, OK. So we fly around these words, it's being culturally appropriate and responsive. And another two words that really sit in with in my mob self-determination and empowerment. But what is being culturally appropriate and what is being responsive? And how do you actually empower someone for them to have self-determination and to take control of of their life? Do you know what I mean? So from my perspective as a manager, but also as a Aboriginal woman who's also been through my cultural stuff for myself and for my brothers, and I'm exposed to that every other day in my life. How do I help my team learn so we don't use the word educate. We we learn by observations from where I come from, and I can only speak for our mob. We don't get told about our culture. We we sit there with observation and it's instilled in us even before we're born. And a lot of what we do is really telepathic. It's unwritten I can't explain it, but if I'm able to say and I had a conversation with our counsellor the other day about sorry business and this is back home in my community, and it was one of the students going back into a situation, and I was talking to her about the handshake and and how you actually shake someone's hand if you know that they're going through sorry business. And we kind of fumbled our way through this conversation because there's in this situation, a handshake is just more than a gesture of respect. I acknowledge that you've gone through sorry business. It's so much more deeper than that. And then Kerry came back to me after this counselling session with this young person, and she said, I'm so glad you had that conversation with me about what a handshake actually means when it's in regards to sorry business, because the biggest thing that this young fella mentioned to Kerry in the counselling session. He goes, It's hurting me that I'm not there to be able to shake my family's hand. And if she didn't have the conversation with me prior about what that handshake meant, she just would have shrugged it off as just the handshake, if that makes sense. So I try and help my staff to learn when things actually present themselves. But I'm also very clear and very strong that I don't come from this country. I come from a different country. And even if there's a community 50 ks down the track from my mob, they'll have different responses and different customs and beliefs. So it's very, very you've got to be very clear when you're being approached as an Aboriginal person to provide cultural advice around what is culturally appropriate and responsive, everyone that accesses any service needs to be treated with culturally appropriate approaches. So that's about understanding that our population group has English As a second, third fourth language. So how do we effectively communicate a health message to someone who can barely speak English. And that's about saying, Okay, respectfully, I might draw a diagram because Aboriginal way, that's that's how we communicate by drawing and stuff like that. Very few words are actually used. So it's just about finding the right tool in the medium, and it's always based on what is going to be respectful, respectful and who who is the person sitting in front of me. So I try my hardest to explain certain things around being culturally appropriate and responsive. And and the team have already so many years of experience even before Ngak Min working in Aboriginal health. Working in remote communities, in very remote communities, so it's a very strong team. [00:43:35][272.0]

Isaac: [00:43:35] To summarise your response, if I may. Would you say that a good starting block for a health practitioner possibly listening to this is to just engage with the local Aboriginal and Torres Strait Islander community, seek out advice, seek out cultural experts, the people in that space and just ask what is appropriate according to local custom? [00:43:58][22.6]

Charmaine: [00:43:59] Absolutely. And for someone starting out in this area, there's a lot of online training modules now like I know our RACGP, for doctors have spent a lot of time, actually decades of putting things online to help junior doctors, registrars and, you know, other people who have come from overseas or not even worked in Aboriginal health online information about Aboriginal and Torres Strait Islander people. So there's a lot of resources out there these days, but it's also about if you have an opportunity as a healthcare practitioner to work in an Aboriginal health service, take the opportunity because what you experience and what you will learn and observe there you could. You'll never get in in Melbourne or Sydney or anything like that. And I think it does really open your eyes up. And I've seen over my 30 years of working in Aboriginal health, I've seen a lot of doctors from the big cities come to Alice Springs to do their registrar placements. And I just spoke to one the other day who came there in 2006 when I was the executive manager and as a registrar, and he's still there today is one of the senior doctors back home. So, you know, I so it's kind of once you go into Aboriginal health and primary health care, you'll find it very hard to leave yep. [00:45:32][92.8]

Isaac: [00:45:35] Thank you for taking the time to listen to keep up to date with future episodes of the podcast. Hit the Subscribe or follow button in your podcast app of choice. You can also follow the Cape York partnership on Facebook and LinkedIn, where we provide regular updates. We invite you to give the podcast a rating and review, which can be completed on the Apple Podcasts podcast and Stitcher apps. This episode has been brought to you by the Cape York partnership. [00:45:35][0.0]

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