Daniela: Welcome to the ‘I can see clearly now’ webinar series, with the first webinar in the series, the RCGP and NACCHO resource hub.
To begin with we would like to acknowledge the traditional custodians of the land on which we live and work and we pay our respects to Elders past and present.
Now on to our presenters. Today's presenters are Dr Mary Belfridge, a medical advisor the national guide project and general practitioner. Mary has been a medical practitioner for 30 years and has worked as a GP in community health and in Aboriginal community settings. From 2009 to 2017 Mary was a medical director at the Victorian Aboriginal Health Service in Melbourne.
Mary has been involved for many years in teaching medical students and GP registrar's about working effectively with Aboriginal patients and communities. She has also been involved in numerous research projects and held policy and clinical advisory roles in a wide-ranging areas including primary care, population health, effectiveness and acceptability of models of health care, and safety and quality of healthcare. Mary was also an author of the chapter in the latest edition of the National Guide to a preventive health assessment for Aboriginal and Torres Strait Islander people and most recently led the RACGP-NACCHO project to review and develop new recommendations for the MBS item 715 annual health check for Aboriginal and Torres Strait Islander people.
We are also joined by Miss Jacinta Mackenzie, an Integrated Team Care Supervisor and Indigenous Health Project Officer, Wellness our way at Country & Outback Health in South Australia.
Thirdly we are joined by Miss Ada Parry. Ada is the Cultural and Education Advisor of the RACGP faculty of Aboriginal and Torres Strait Islander Health. Ada, is a Brinkin woman, a grandmother of 12, and her languages are Marrithiel/Nganghikurrungurr. Ada has a long standing relationship with the RACGP from being a cultural educator (of Medical students and GP registrars) from 1996 to 2000 and a community representative on the RACGP Aboriginal and Torres Strait Islander Health faculty Council in 2015. In 2018, Ada took on the role of Cultural and Education Advisor with the RACGP Faculty of Aboriginal and Torres Strait Islander health and is heavily involved in all areas of operation ranging from education and training, and policy and advocacy. Now Dr Mary Belfridge will start the webinar.
Mary: Thanks very much, Daniela. As Daniela said, this is the first of three webinars that we hope will better equip general practices to provide effective culturally safe healthcare for Aboriginal and Torres Strait Islander people.
These webinars have been developed particularly for GPS and staff working in general practices rather than those working in Aboriginal or Torres Strait Islander Health Services, which we know already have strong cultural elements integrated into their whole service model, but we probably have participants from all these different settings.
And of course everyone's really welcome, especially as we all find our way through the COVID-19 pandemic, so thank you everyone for attending this webinar this evening. We'll explore some of the principles underpinning culturally safe healthcare and familiarize past participants with the resources on the RACGP NACCHO resource hub on the college website, particularly the good practice tables that we've developed. The second webinar will focus in on a case study that demonstrates the application of some of the key themes that we'll talk about tonight, and also demonstrate some of the practical ways. Ways to work effectively with really good outcomes for patients, and in the final webinar will be looking particularly at the annual MBS 715 health check and where this sits in the overall primary health care. So we'll start with a few questions to get to know a little about you the participants firstly who are you if you can select which one applies to you.
Okay hundred percent of people attending tonight GPS or if those sort of answered the poll a GPS. Okay, so interested to know where you work, i.e. urban, rural or remote settings. So, a bit of a spread with a lot of rural and remote participants which is great, and finally, how often do you see Aboriginal and Torres Strait Islander patients? So every day every week or occasionally. Okay, so that's a really good spread. It may be that some of the people seeing Aboriginal Torres Strait Islander patients every day are in at ACCHOs. Well, let's move on to the first of our key themes which is about identity and identification, Ada.
Ada: Thank you, Mary.
The definition of identity I like best is the fact of being who or what a person or thing is. The word ‘is’ is what I relate to most because it's about who I am not just as an Aboriginal woman, but as a Brinkin woman whose language is Marrithiel, and I'm from this little place called Woodygupildiyerre (Woordy-gup-il-di-yerre) southwest of Darwin.
It is one of the strongest feelings that I had about who I am and I know that many of my countrymen have this feeling too. In the Territory, when an Aboriginal person is asked where they're from, we always say that we're from our homeland, even though we may live and work somewhere else. In getting back to you as clinicians in our communities, doesn't matter if it's an Aboriginal community or urban, looking after us as your patients, what does your clinician identity mean to you? Do you hold it close to you? Whoever you are or go, it follows you by your interactions with us as your patients, your reputation in our communities, your workplace or even your own circle of friends. If you are living in my community, and the community people valued you as a good person and as a good clinician, you would be referred to as a good warnunggul (wa-nung- gul), which means traditional healer in my language, some of you may be familiar with the word Nungkari (nung-ka-ri) from the central Australia region, which means the same thing.
This identity given to you by my family and other countrymen, is spread widely amongst our linked communities, whether it's by catching up with family from other communities or by telephone and even the new thing Facebook, which I'm not familiar with, but I know that people use widely in our communities. That is the thing about you, if you work well with our people it follows you to each community and even to people that you don't know. Back to you Mary.
Mary: Yeah, thanks Ada. From a clinician and practice point of view, some of the practical considerations of identity and identification that correctly identifying Aboriginal Torres Strait Islander patients identifies eligibility and enables access to particular services, for example, MBS specific items such as the 715 health check, PBS subsidy of medications which people are probably aware of known as the PBS Close the Gap Co-payment Measure. But also other services like cultural liaison and support and advocacy services in some parts of the country, translators or other social services.
I think another point is that appearance does not accurately indicate Aboriginal and Torres Strait Islander status, and that people may not volunteer Indigenous status in a practice. That is unless they're specifically asked and feel safe enough to do so.
There’s strong evidence that strong cultural identity is protective and improves health outcomes, which is part of the strong case around the importance of culturally safe health care. I think it's important too, to acknowledge some of the risks around identity and identification. Historically for example, from 1910 to 1970, the Australian government had a policy of forced removal of many Aboriginal Torres Strait Islander children from family country and culture. Aboriginal and Torres Strait Islander people experience ongoing racism and negative stereotyping. So particularly for people that don't necessarily look Aboriginal or Torres Strait Islander, they may not feel safe to identify as such and the people experience negative stereotyping and we'll talk more about that a little later. So, I hand over to you Jay to talk about our next theme around engagement.
Jacinta: Thank you Mary for that. I just wanted to add value to that just express that part of the Stolen Generation as well, there's a lot of history that comes with the identification side of thing. In moving forward, it's accepting the person for who they are and trying to work in a sensitive manner to try and build strength around identity.
Looking at engagement, we all have our views of what engagement from an individual perspective, but it's important to recognize that the key principle to providing culturally appropriate care is focusing on the health and well-being of each Aboriginal patient that you deal with. We also need to recognize that the opportunities to engage is vital in the care planning process, follow-up process and that we need to make sure that we build trust with our Aboriginal clients. I can speak from an Aboriginal perspective as well that this has impacted on me in several different areas, but I've looked at ways of trying to encourage better ways of working.
So engagement is the key to getting an understanding of the health needs of an Aboriginal client. It’s not just providing the medication or looking at ad hoc services. The ad hoc services that we hear about in a community is the band aid treatment. Building the trust and showing that you care about the next steps of care for the client you're dealing with also shows that you're acknowledging the challenges, the cultural aspects, and that we need to consider the sometime our community or individuals like to go back to country. They’re connecting with culture, land and community. So when we're looking at a holistic view, we’d like to be considered in all elements of any health check a clinician takes.
Yes, engagement does take time however if we are persistent and we have active listening, the care will guide us and not only as individuals you will help us with working towards better outcomes for ourselves. We make our choice in regards to what is cultural safety.
We also need to look at considering the conversation. Yes, sometimes you might have 10 minutes in a consultation, but then a lot of Aboriginal people up the narrative. So do we consider looking at engaging in different stages of a consultation rather than trying to put everything into a time frame of 10 minutes? This not only helps GP but it also helps a person who is seeking care. I would also encourage GPS and practice nurses to engage Aboriginal cultural mentors. As Mary mentioned earlier, they’re significant in the care planning and they will also advocate for families who don't have the health literacy to be able to go the next steps for engagement. The cultural mentor can provide insight and also contribute to conversations as permitted by the person you're dealing with.
Moving towards welcome and respect. It's important that we're setting up our practice environment so that we feel there's a safe place to come and see a GP. Cultural safety gain is key, and this forms the acknowledgement to the person's identification, again referring back to culture. Feeling safe within the space is important and yes, we need to look at what that means for us. The practice needs to consider what does the welcoming environment look like? This could be looking at items that are Aboriginal artefacts, the Aboriginal map which identifies each person when they come in, they feel their connection to a country looking at the map. Just having an acknowledgement of country whether a sitting on the desk or there sitting in the waiting room, or whether it's sitting in another place where it's visual to not only the Aboriginal clients that use your practice but also to other communities for learning.
So if we look at respectful engagement, we want to reflect that you are hearing what we are saying and that we're sharing our story with you in a confidential manner. Then if you're engaging with us by active listening, it shows that you actually care about our healthcare journey, and that you're willing to understand the challenges that we face as a disadvantaged group. When we look at pre-planning medical appointments, there is a purpose to doing that which I will touch base in the case study. We need to look at how we provide the education point of view. If we're looking at building health literacy, we need to engage in the conversation to make sure that as an Aboriginal patient we understand what you're saying and not just hearing the voice, but we actually hear the meaning of what we need to do to stay strong and healthy. At the end of the day it comes back to caring, caring for the person that you're dealing with and caring for the outcomes because we all have a vision to work towards building better health care outcomes for Aboriginal and Torres Strait Islander communities. Now I would like to pass you on to Mary.
Mary: Thanks Jay. We're just going to look a bit more specifically at cultural safety. We felt it was important to present the fairly recently developed AHPRA definition of cultural safety that was developed over the last couple of years and released last year, which is endorsed by AHPRA all the health disciplines under their wing. The definition was developed because there was recognition and acceptance that cultural safety is inextricably linked to patient safety for Aboriginal Torres Strait Islander people.
So the AHPRA definition is clear that cultural safety must be defined by Aboriginal and Torres Strait Islander people, not for Aboriginal and Torres Strait Islander people, and that it requires a high level of self-awareness by clinicians. I would add by practices and services.
AHPRA has a list of how-to's that to ensure culturally safe and respectful practice, what health practitioners must do. These are largely about acknowledgement and an awareness acknowledgement of the impact of colonization and racism, and other determinants on health outcomes. Acknowledgement and the need to address racism and bias in provision of care, and I'd suggest that's both at a personal level and in an Institutional or at a service level. Also the importance of self-determination and agency in the way health services are offered and provided.
Some of the practical elements of culturally safe healthcare are service design that combines cultural and community knowledge, and values and practice, with the technical and clinical evidence based components of care. To get this right there needs to be a strong presence of Aboriginal and Torres Strait Islander people in the design and whenever possible delivery of services. That's what Jay’s really emphasizing that's an element of it is the cultural mentorship or Aboriginal health workers and I think it's just this year that NATSIHW, the national peak body for Aboriginal Torres Strait Islander health workers and practitioners has managed to negotiate a broadening of the scope of practice so that Aboriginal health workers and practitioners are employable across many primary healthcare settings, not just in the Aboriginal Health Services. That services are family-cantered, strengths-based and have flexible approaches including outreach and home visiting. Importantly, that services take into account the complexity of social factors that impact on health and health services and health service access. I think, you know to add to that, the idea of cultural safety emerged in a health setting. It's obviously a more generic principle but as clinicians, you know, we're talking Health here, and that's where it emerged. It was first described by a Maori nurse, Irihapeti Ramsden in the 1980s, and I think you know the way I've come to understand cultural safety in my practice is that it's people feeling like themselves, that there's no sense of assault or challenge or denial of identity. Ada or Jay would you like to add anything to that?
Jacinta: I just wanted to add that culture is the vehicle for enhancing self-esteem and it builds individuals confidence. It should be at the centre of Engagement and it now is recognized that the cultural mentors are important to supporting the healthcare journey of Aboriginal clients. Ada, is there anything that you would like to add?
Ada: I just wanted to add a bit more about the acknowledgement, you know, too many times we hear yeah that happened but let's move on, but people don't realize that you know, we still live with what happened all those years ago. For some of us it still hurts, you know, if you say you're going to acknowledge stolen generation as some people would call Invasion Day, think about what effects it has on people without moving on and dismissing it because it's it is part of a history. Thanks
Mary: Thanks, Ada. So another dimension of the safety and effectiveness in health care, of safety effectiveness is health care that is trauma-informed. You know trauma is part of the landscape for many Aboriginal Torres Strait Islander people both his historical and contemporary. Obviously the cascade of impact of devastation from colonization that then has an intergenerational passing on the specific impact of the stolen generations of forced removal of children from family and culture and country. So stolen generations doesn't just refer to the children, the people that were removed as children, it's to the generations, the parents and kin family that lost that child, the siblings and then the children of those children that were removed and the grandchildren, so it just has a cascading effect.
Then there's you know completely contemporary and personal individual experience of trauma. So it creates issues of trust, huge issues around trust and engagement challenges to building trusting and engagement in healthcare, and building an effective therapeutic relationships. So trauma-informed services - there’s a whole lot of literature around trauma informed services built on an understanding and acknowledgement of trauma and its impact where specific attention is given to ensuring safety and building trust, and where the therapeutic relationship is fundamentally collaborative and a partnership rather than a power differential, with attention given to integration and linkage of health and social support services.
So these are general principles that are highly applicable when engaging with and providing healthcare for Aboriginal and Torres Strait Islander communities and we've included some key resources for clinicians and practices around trauma informed care at the end of the presentation. Ada or Jay is there anything you want to add to that?
Ada: Just little things, like with grandparents now that were taken away as children. They didn't have a parent there to teach them how to raise their own kids. So just keeping that in mind that some parents or grandparents aren't engaged with their children or grandchildren, because it's still there.
Mary: Thanks Ada. Over you to Jay.
Jacinta: I'd like to share a story with you just in regards to my own experience. As a confident person, I believe I am strong enough to advocate for my health care needs and I would like to share my story where there was a time out of many situations that I felt broken.
I arrived in the consult room ready to see the GP. The environment that I entered was uncomfortable. I had people staring at me, so that made me feel uncomfortable. I presented to the reception area as this is the first point of contact, and the receptionist sitting at the desk asked me ‘What are you here for?”, But in my mind I'm thinking a medical appointment and I responded with that comment by saying a medical appointment at 3:00 p.m. There were sections in the waiting room for me to sit. I made my way to this section with several people sitting in the waiting room. As I was approaching and see I could see people restless. I don't know if it was because I had my knee injury and they felt my pain, or if it was my Aboriginality. I felt my pain and then I felt sorrow. A question that comes to mind was are they trying to work out which seat in the waiting room I was going to take, which was painful to observe and to know that this was what was going on again It made me feel uncomfortable. I placed myself in the corner where I felt safe.
The GP called me in no greeting, just take a seat. The GP assist me very briefly. It was quick. I felt he had no interest in my health care, was sitting with his arms folded which to me showed that he wasn't interested because of how his body language was. I explained to the doctor that I had a knee injury from playing sports and would like to see if I can get a scan and a referral for a physio for my 715 health check. He stated bluntly ‘We don't give handouts’.
I felt deflated in the space and replied with the justification that I work every day and have my own private health insurance, and I'm only here to be treated not to be judged. I never went back to this practice because I felt judged and a question came to mind, was this one form of racism? But if I speak up, I'll be judged again. So I walked away in silence. I left a practice head down in pain not heard, devalued and felt there was no outcome. I also felt that I was a burden to the practice. So because of this, I now prepare myself for all my GP appointments because I can see all obstacles in my way.
If this is happening to me, I wonder how others are being treated. I just want to point out the importance of removing the unconscious bias, because everyone has a right to good health care regardless of race. Again, I'm only here to be treated not to be judged. I can't change the colour of my skin. It's who I am. Now I'll pass you onto Ada, who will also share her story.
Ada: Thank you. I'm black and I can get away from that fact. Living in Darwin, people say that Darwin is a multicultural town, but for me, it's not true because I always have to think about where I can go in this town, whether it's a restaurant, shop or anything else for that matter. That makes me carry a heavy load on my shoulders. I don't want to be walking around with a log on my shoulder, but that's just the way it is here in Darwin.
The only time that I feel like myself is when I go to Melbourne to the office there and to the street where I stay, I feel like I'm just another person. When I go to somewhere it really helps when we know someone, whether it's in a general practice setting, a restaurant, hospital setting. I do get the stares that Jacinta spoke about but it's sometimes because the person who's talking to me is talking to me as if they shouldn't be talking to me in that way. You know being friendly and that sort of stuff. I live with that every day of my life. I have good non-Aboriginal friends who I go out with. Like at Christmas time we have a Christmas dinner and they always say to me, where would you like to go? And I always pick the same restaurant to go to dinner. Maybe for some of you, you might not think about that. You can walk into any shop maybe without being followed around the shop or without being spoken to loudly, whether people thinking that you might be deaf. I've had people talk to me very loudly thinking that maybe I was deaf.
It's an everyday thing that I have to live with but I try not to let it get to me. I mind my own business going about my own things, but there are always people out there who throw stuff in your face. Thanks Jacinta
Mary: Thanks Ada. I guess from my experience non-indigenous person and as a GP had many examples where I've seen frank racism or subtle or casual racism. For example, when I was the medical director/advisor, a woman who'd been to an outpatient clinic in a one of Melbourne's public hospitals who was met with by a registrar who didn't introduce themselves with ‘No offense, but are you Aboriginal?’. Which of course was offensive and then who got her consultant to come in for his opinion, and without introducing himself he peered closely into this woman's eyes, her pupils were uneven and said ‘Oh have you got syphilis?’ was one of his opening comments. So, you know that felt very uncomfortable for the patient and you know can pretty easily suggest that there's a racist undertone in it. Also access to Clinical Services, there's plenty of descriptions in the literature around major variation in healthcare where particularly of Aboriginal and Torres Strait Islander people having less access or less experience of certain cardiac procedures for example.
I had an experience again when I was working in a remote desert community and had sent a young guy in with a badly fractured forearm to a regional hospital and when he had an open reduction and internal fixation and came back to the community. He came to see me and I asked him for his discharge summary when he didn't have one. He hadn't been given one. I asked him when his follow-up appointment was and he said he hadn't been told about a follow-up appointment. I asked him when his plaster needed to come off and he said he didn't know as that hadn't been mentioned. When I rang the hospital and spoke to the resident he said of the discharge summary ‘Well, they lose them’ and of the outpatient appointment ‘Well, they don't turn up anyway’, and of the timing of the removal of the plaster ‘well they remove it themselves anyway”. So, of course I had to take a fair bit of action there because that was well, I'm not sure which is first and which is second. It's both racist and incompetent.
So I think I've seen many examples of that and that is part of how Aboriginal, my experience has only been with Aboriginal people, but for Aboriginal people what it takes to navigate the health system.
I want to say a little bit about another side of this that this stereotype threat. A term coined in the US by Steele and Aronson a study that was done in 1995 where a group from the dominant culture that is Caucasian and a group from a minority culture who experienced racism and negative stereotyping that is African-American college students. All of them college students were given some complex word exercises, which were framed on the one hand just as complex word exercises and on the other hand as an IQ test, so two separate tests that they all undertook. When people believed they were just word exercises the results from each group were equivalent and when people believed it was an IQ test, the African-American group did much worse. The authors of the study called this the stereotype threat and explained it that cues in the environment trigger physiological and psychological responses that cause changes in behaviour, and it's been reproduced in many settings and many times since. So in terms of health care there's some really interesting writing about the impact, the negative impact on adherence to treatment on the quality and effectiveness of communication. Of course we know in general terms how anxiety impedes effective communication that it leads to a lack of trust of the source of information which directly impacts or can impact on clinical feedback, you know management of diabetes or believing/accepting the harms of smoking. For example, it leads to disengagement of avoiding unpleasant experiences and a range of other really a range of other behaviours that can really impact negatively on health outcomes for people. So, you know, it's interesting and obviously pertinent for Aboriginal and Torres Strait Islander people, or more accurately for non-Indigenous people providing health care to Aboriginal and Torres Strait Islander people. It’s part of the cultural safety picture and why it's so important to be thinking as an as non-Indigenous people about one’s own attitudes and behaviours and taking practical steps towards offering called for culturally safe patient-cantered primary health care. The evidence is that this really supports Better Health outcomes. Ada or Jay would you like to add to that?
Jacinta: No further comments from me Mary
Ada: Me either. Thanks.
Mary: So Ada is going to talk a bit about the importance of GP self-care.
Ada: Thanks. As Aboriginal people we don't come alone and sometimes even to your clinic. For us, in our culture we have lots of expectancies that is demanding from not only from our family, but from others as well. Sometimes some of us give more than we take and that's every day. I chose to live away from country and family because I wanted to bring my kids to Darwin for an education. The biggest thing that I had to learn, wasn't about learning how to navigate a big town life, it was learning to say the word ‘no’ to see family and other countrymen. It took many years for me to get used to it. To this day it doesn't come without feeling guilty and feeling sorry that I've said no to someone, especially if it's someone from my own family, but I did it to look after myself. For you as clinicians, how many patients do you see in a day that have multiple issues and how many of them do you worry about? Because every time you see them they're getting worse from their illness or from their medication is not working or it's making them sick.
How do you look after yourself after hours? I know that you know we have families but you know, sometimes we need space to ourselves, and that's another big thing a big learning curve for me is that I've learned from non-Aboriginal people that I love my space. I feel a bit crowded sometimes from family and other countrymen. So on the RACGP website you can find self-care resources available to you online. Thanks.
Mary: Thanks Ada, and you know, I think as a GP there's just enormous challenges of working closely with patients people who have complex health needs, as many Aboriginal Torres Strait Islander people do and people who face enormous adversity in life who have deep suffering, trauma and grief. I think the real challenges of that there's a there's a technical one as a clinician around organising complex consultations so that there really are useful valuable outcomes for people, but also the challenge of managing the carious trauma of absorbing that adversity, and pain and suffering that people experience. That is a challenge for GPS and other practice staff.
We're going to have a look at the resource hub. This is the RACGP NACCHO resource hub on the College website. This is the home page. I really encourage people to explore it. I'm going to show you a couple of things, one is the MBS item 715 health check window there, which is about to have a whole lot of new resources on it. The recommendations that we made are currently sitting with the department and are certainly going to be changing the MBS requirements around 715s, but they're also with both NACCHO and College Board process of being in endorsed. So they'll be things to look at there and will also be the subject of our third webinar in June. There's the NACCHO RACGP National guide to preventive health assessment for Aboriginal Torres Strait Islander people, so the guide and the evidence base to the guide are available through this link. There's various other resources there. We'll have a look at the specific resources to support general practice. Again, there's a range of resources here, draw your attention to a couple one is the identification of Aboriginal Torres Strait Islanders. This is a clinical audit that's available to practices as a group 1, 40 point activity. There's cultural awareness cultural safety training links here.
We'll just have a look at the good practice tables which we've recently developed. This was again in partnership with NACCHOH. The aim of these was to really provide practical activities for the whole practice team. So you can see that the five of them one about preparing the practice, the second one specifically about identification of Aboriginal Torres Strait Islander patients, and how that is recorded in the patient record. The third one is around the MBS item 715 health check with the aim of providing a health activity that's valuable to the patient and is high-quality. The fourth one’s around the registration for the PIP Indigenous health incentive and eligible patients for the PBS co-payment measure, and the fifth one about the use of appropriate clinical guidelines and programs for Aboriginal Torres Strait Islander patients. So just as an example, we'll have a look at one.
So this is the second one around identification. All of the five tables have this the first steps and then good practice, what good practice looks like and then what best practice looks like. All of these tables are support accreditation, and we've listed which standards they pertain to. So encourage you just to you look through these and to bring them into your practice teams and work through them.
Okay. We've coming to the end of the webinar with we have listed resources. These are the ones available through the College so that hub that we were just looking at, the National guide, the green book around prevention and the resource that ADA was talking about self-care and mental health resources for general practitioners.
We've also listed some other resources particularly around trauma informed care, the Healing Foundation resources, the Blue Knot Foundation, which is the National Centre for Excellence for Complex Trauma, and there are clinical guidelines and guidelines for practices around trauma-informed care. There’s best practice around psychosocial assessment. These are new guidelines that were released just last year which I think in the title are for psychosocial assessment in emergency departments, but I would suggest and from my experience, that they're really applicable to psychosocial assessment in primary care as well. They're a really great resource and I’d encourage people to have a look at them. Then there’s the Australian Health Practitioner Regulation Agency’s the Aboriginal Torres Strait Islander Health strategy, which has got a whole lot around the development of the cultural safety definition.
Daniela: Panellists question time. We've got a couple of minutes left so if anybody has any questions, please type it in the question box, and we'll try to get to as much as we can considering the time. Otherwise was definitely will respond after the webinar to all of the questions and feel free to also email us at firstname.lastname@example.org.’
We’ve got a great question, thank you to Dr Farhat ‘My biggest concern is that despite having the feeling that my PT has got quite engaged and understands the nature of seriousness still getting non-compliance to medications and appointments and not responding to the requests made for the important lab tests. I would like to know the key tips and ways to make them feel welcome by the health carer”
Jacinta: So coming back to cultural mentors, it's really important that you engage the cultural mentors from either Aboriginal Health, Aboriginal health workers or practitioners, or looking at accessing the Aboriginal outreach workers within the integrated team care. That's a national program under Closing the Gap. They provide care coordination and outreach support within the community setting and they will look at an assessment from a clinical perspective via their nurses and then the Aboriginal outreach workers will provide the cultural perspective.
What's the value in this healthcare journey, which I will explain in the next webinar, is that there are opportunities to look at engaging other Aboriginal mentors or family members as they can become the strength within the person's life. So I would recommend that you look at all your other avenues and your local support, and see if you can invite Aboriginal workers or families in to have the discussions.
I am aware that the care coordinators are registered nurses and nurses with in ITC integrated team care and you'll find those guidelines on Department of Health website is well, but that'll give you an explanation in regards to what type of service they would provide. I would say that I would recommend accessing those services because they are complementary to your practice and they not only look at the service delivery, they will also look at the medication compliance, but then they'll try and support the clients in community about how they can improve, whether that's accessing Webster-paks or understanding the medication that they are taking. So I would recommend access local support. Don't feel that you're alone within your GP practice and don't feel that you're the only GP that needs to come up with the solution. The solution sits with people as individuals, but there are service providers out there that will be able to complement your practice. Thank you.
Mary: I think what I'd add to that is, that I'd encourage you to look at the good practice tables because they're exactly the sorts of challenges that that we have in mind and in a way they’re another way of asking those questions. Really fundamental part of it is how culturally safe is that patient experiencing the service that's on offer. I think it's useful too and this is from my experience over a long time, but it's good to ask people what would best support them. So I think that combination of the good practice tables informing hopefully an orientation of a practice to the provision of welcoming, hospitable, safe, effective Healthcare and then the investment in the relationship with the patient and engaging them as a partner in their care rather than a recipient of the advice that you offer them. Ada do you want to add to that?
Ada: Yeah, my mother was a traditional person and towards the end of her life she had a dosette box and sometimes she'd come to Darwin to stay with me. I had to take her to the Aboriginal medical service here in Darwin to get refill sometimes, but even before we started I’d ask mum where’s your medication box. She'd say to me [and I know it's not funny, but I have to laugh] ‘I emptied them all out because they were making me sick’. Anyway, we went to the doctor and got the doctor to explain what each medication did for her and in some clinics, I know they have maybe the pull apart mannequin or photos, you know posters of bodies and different parts. It really helps, I think, if you explain the medication to people and what it's doing to keep the illness at bay or helping them maybe get better or to feel better. And I know that my mum changed in her way of thinking about things when the doctor explained things to her.
Daniela: Wonderful. Thank you very much for that Ada. We’ve hit the eight o'clock mark and do have some more questions that we’ll answer offline. So apologies that we didn't get a chance to cover those. Thank you very much everyone for participating and just before we go, just a couple of last words from Jacinta the close-off this webinar and get you ready for the next one. Thank you Jacinta.
Jacinta: Thank you very much to all the participants who have joined us today. It's really appreciated. So just to move forward, we are going to look at some strategies and demonstrate some practical ways and supporting an Aboriginal client, and we're going to present a case study. So the case study we will focus on different strategies that may be able to help you within your GP practice. We’re hoping that you can join us for the case study on Wednesday 6th of May. So thank you very much for joining us this evening. We appreciate it.
Ada: Thank you.
Daniela: Thank you very much. The webinar will close now. Thank you for your attendance.