Marie McInerney reports:
Twenty years ago, only 12 Indigenous people attended the Inala Community Health Centre, a primary care service in a south-western Brisbane suburb where Aboriginal and Torres Strait Islander people were estimated to make up eight per cent of the local population.
Clinical director Associate Professor Noel Hayman commissioned an Indigenous community focus group and telephone interviews to find out why.
The results were clear: community members found the service unfriendly, inflexible, intolerant and they objected to there being no Indigenous staff members and no sense of culture.
“They said: ‘Look Noel, we just don’t feel welcome coming here’,” Hayman recounted at the 2014 Australian Indigenous Doctors Association (AIDA) conference, held recently in Melbourne.
Hayman, one of the first Aboriginal students to complete a medical degree in Queensland, developed five main strategies in response:
- To employ an Aboriginal or Torres Strait person as either a nurse, Health Worker, receptionist, or a liaison person for the centre.
- To purchase culturally appropriate health posters and artefacts for the centre (and from local artists) to help make Aboriginal & Torres Strait Islanders people “feel more at home”, and to play Aboriginal radio “AAA Murri Country” on occasions.
- To provide cultural awareness talks to all staff within the centre.
- To disseminate information into the Aboriginal and Torres Strait Islander community about what services are available at the Inala Community Health Centre.
- To promote intersectoral collaboration, including by inviting the local Woolloongabba Aboriginal & Islander Community Health Service (AICHS) to conduct a clinic within Inala, and liaison with the Inala Aboriginal & Torres Islander Women’s Health Support Group.
The results are clear: the transformed Inala Indigenous Health Service (IIHS) now has more than 10,000 Aboriginal and Torres Strait Islander people on its data base with approximately 3,000 regular patients.
Also known as the South East Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, it aims to provide integrated primary and secondary care, training for the next generation of health care professionals, culturally sensitive outreach services (including an all Aboriginal team for the community of Cunnamulla) and a “community controlled” research agenda focused on chronic health and service delivery.
Hayman said Inala wanted to provide a culture of research excellence, including by building up Indigenous research capacity. “What better way to tackle emerging issues?” he said.
“We really cranked up our research arm… to build up the evidence about what works in Indigenous primary health care settings so we actually know we’re doing the right thing and getting good outcomes.”
Since the Centre of Excellence was opened in 2009, it has:
- produced 40 peer reviewed research publications
- made 70 National and International conference presentations
- won six nationally competitive research grants
- enrolled one PhD student
- won 2 Novice Researcher Fellowships.
Community control vital for research
A big part of its success, he said, was the establishment of the 14-member Inala Aboriginal and Torres Strait Islander Community Jury for Health Research, currently chaired by a local Elder, which vets and provides cultural oversight for all research done at Inala.
To gain approval, researchers have to present their proposal to the Jury, in plain English, focusing on the benefit for the community
“Research was a dirty word (for Indigenous people) when I started medicine. Non-Indigenous people would go in, do a PhD and nothing would happen,” said Hayman.
The jury, he said, “makes us very much community driven. It’s not a rubber stamp. Even though they are lay people, they give very constructive criticism, particularly on cultural aspects. Some people have to go back two or three times before they get support. I think that gives a good way of ownership for the community and also a knowledge about what research is done in our community.”
The benefits to the community of all the changes at Inala, Hayman said, include:
- Indigenous people find it easier to access mainstream health services
- Culture exchange with other (non-Indigenous) doctors
- Screening and early detection of chronic diseases
- High immunisation rates (children and adults)
- Employment of more staff.
“In summary, Aboriginal and Torres Strait Islander people will access mainstream services, as long as you work closely with the community,” he said. “Not only that, the feedback we get is they come because we have Aboriginal doctors, nurses and health workers.”
With reports that 74 per cent of GPs do not screen for diabetes retinopathy and that an estimated 40-50 per cent of Indigenous people with diabetes are not screened, Hayman said the clinic looked at how to get more Indigenous patients to access specialist services. The answer was to integrate it in primary care, so that people don’t have to travel often significant distances for hospital-based specialist outpatient clinics.
Now seven visiting specialists provide between one and four clinics monthly. Exercise stress tests and echocardiograms are done at the clinic and, Hayman says: “We are a one stop shop for treating diabetes retinopathy at Inala, and one of the first in Australia to have liver treatment done in an Indigenous primary health care setting.”
• Read more in The Medical Journal of Australia.
See also this reporting from the Twittersphere (click on images for a larger version):
• You can track Croakey’s coverage of the conference here.