Dr Hannah Visser believes the GP is one of many links in the chain of Aboriginal and Torres Strait Islander health.
Dr Hannah Visser, the RACGP’s 2015 Rural Registrar of the Year, was exposed to rural healthcare from a very early age when she was growing up.
‘My mum is a rural GP back in Germany, so I grew up with an old school practice on the ground fl oor and we lived on top of it. My mum is a 24/7 GP,’ Dr Visser told Good Practice.
As a result, rural general practice has always been Dr Visser’s goal throughout her healthcare career.
‘You are a part of the whole community and it’s about continuity of care,’ she said. ‘The care you provide is broader because access to some resources is more diffi cult in the rural setting, so you have to provide more services. You make more clinical decisions and usually treat the patient there and then.’
After completing her medical studies in Germany, Dr Visser lived and worked in several places before settling in her current location in the Northern Rivers region on the north coast of New South Wales.
‘I did my university studies in Germany and during this time did a lot of travelling. I fi rst went to Sydney for my internship in 2004 and then spent six months in South Africa, working in a township hospital, before coming to Australia again in 2006,’ she said.
‘When I came back to Australia I went to the Sunshine Coast [Queensland] and did a year at Nambour Hospital.
‘Then I moved to Melbourne for a year, then to Newcastle for a year, then back to Melbourne. I then moved up to the north coast of NSW three years ago and have been there ever since.’
That fi nal move to the north coast of NSW saw Dr Visser take a position at the Bulgarr Ngaru Medical Aboriginal Corporation Casino Clinic, an Aboriginal medical service (AMS) that offers medical and dental services, chronic disease management, mental health services and health education programs covering substance use, sexual health and lifestyle management.
‘My biggest passion is working with the communities with limited or no access to services. That has always been my main interest,’ Dr Visser said. ‘After being in the hospital system for most of my other time in healthcare I found myself wanting to do Aboriginal health, and now that I am doing it I will never do anything else.’
Team approach
Dr Visser’s time at Bulgarr Ngaru Casino has helped her develop a new approach to healthcare, one in which the GP is one of several people involved in its delivery.
‘I have been here mostly full-time for the past 2.5 years and I have really had great access to the community. They have been very welcoming of me and I really enjoy working as part of a team,’ she said. ‘Working in Aboriginal health services is different than working as a mainstream GP; you can often be in situations where you might be the GP but you’re not calling the shots.
‘The team of Aboriginal health workers will help you with cultural things or an understanding of what’s going on with the situation of people’s lives in the community, which helps you make your treatment plan or approach people differently.
‘Basically, service delivery is just a bit different because you’re guided by your team members.’
Dr Visser has used her expanded knowledge base about the role of the GP in Aboriginal and Torres Strait Islander health to help other registrars working at AMSs.
‘I recently gave a talk to registrars at North Coast GP Training – we have a meeting with all the new registrars working in AMSs in the region – and I said, “It’s not about your agenda, it’s really about the agenda of other people around you”.
‘You try to work your health message around that and make it work and see what the best chance is that it’s actually been taken up or followed,’ she said.
Dr Visser’s international background has also proven to be something of a benefi t when communicating with Aboriginal and Torres Strait Islander patients.
‘Cultural understanding is very, very important in the Aboriginal health setting,’ she said. ‘I’ve always thought, with my German background, I could just ask very straightforward questions – tell me about this or that – because obviously I don’t know the history that well. So I could still get very interesting stories and cultural background explained to me.’
’ That ability to develop a clearer cultural understanding has allowed Dr Visser to tailor her healthcare approach accordingly, offering Aboriginal and Torres Strait Islander patients services that are more appropriate to their needs and desires.
‘Aboriginal and Torres Strait Islander peoples have a different understanding of health, or often different priorities,’ she said. ‘For example, if they have to go to a funeral today, you need to discharge them from the hospital, or they are not going to the hospital even if you think, as a doctor, they really do have to. So you have to kind of negotiate plans around that.
‘It’s very important to give Aboriginal and Torres Strait Islander patients the choice to decide what they think would work best for them. I think a lot of it is about empowerment.’
Broader scope
Research is another of Dr Visser’s healthcare passions outside of the consulting room. She is currently undertaking a project on population health with the University Centre for Rural Health, working with and teaching students from the Sydney University, Western Sydney University and the University of Wollongong, with her work funded by the Department of Health.
‘I’m doing an academic term at the moment, which is 1–1.5 days of research and another day of teaching per week,’ she said. ‘Working in the Aboriginal community got me to realise about population health. We can treat little things and give antibiotics and we can do this and do that, but there is also the broader aspect of what’s behind it. That’s what led me to have some ideas about research projects we can do to change policies and practice and improve the health of the people.’
Dr Visser loves the holistic yet constantly varied nature of her role as a rural registrar, particularly working with Aboriginal and Torres Strait Islander peoples.
‘I think it’s nice to see different generations and have the continuity of care of rural general practice,’ she said. ‘And with Aboriginal health, you do more than just the doctor role; you are a liaison offi cer and social worker and advocate. You have a few roles.’
Regardless of the specifi cs, Dr Visser recommends that those considering working in an Aboriginal and Torres Strait Islander community never lose sight of the fact their a pproach to healthcare must remain flexible.
‘You have to be very open and able to be guided by the community and what their needs are, and broaden your skills as much as possible,’ she said.
Being named the winner of the RACGP’s 2015 Rural Registrar of the Year Award is a lot to take in for the usually reserved Dr Visser, but being recognised by others in her profession means a lot to her.
‘I really appreciate it,’ she said. ‘It’s an appreciation and recognition of the work that I do and my compassion towards the community that I work in, and the research that I’m doing.’
First published in Good Practice October 2015:16-17