The Northern Territory’s Dr Janelle Trees hopes to encourage more GPs to engage in Aboriginal and Torres Strait Islander health and cultural awareness.
As the sole doctor in Yulara, an isolated town located 28 km from Uluru in the southern region of the Northern Territory, where the closest emergency department is a six-hour drive away in Alice Springs, Dr Janelle Trees is a remote GP in the truest sense of the term.
sense of the term.
‘My medical centre is situated in the resort town at Uluru and it is a full-time job where I am the only doctor,’ she told Good Practice.
‘In such a remote community, I am lucky that I am supported by some magnifi cent remote-area nurses.’ Yulara’s estimated population of 1200 swells signifi cantly throughout the Northern Territory’s dry season of May to October, as huge numbers of tourists visit the area.
of the year when the weather is nice. At this time of year [July], Yulara has the highest turnover of tourists of any place in Australia,’ Trees, an RACGP member since 2009, said.
‘We’ve got about 25% Aboriginal people in Yulara, which is quite similar to the rest of the Northern Territory. The difference in Yulara is that most of the Aboriginal people living here have come to work from all around the country.’
As a healthcare professional of Aboriginal descent in a remote area of Australia, Trees was featured in the 2013 fi lm Utopia, a documentary from Australian journalist and fi lmmaker John Pilger that explored the experiences of Aboriginal peoples in modern Australia. Trees’ involvement with the fi lm allowed her to express some of her beliefs and concerns about Aboriginal peoples.
‘John Pilger caught me on a day when I was feeling like I really wanted to speak about what is going on,’ she said. ‘We sat down on the veranda of my house and I told him some stories and about some of the issues that people in Aboriginal communities face.
‘It goes beyond general practice and health. It is about the whole person, their culture, relationships, family, history, social standing and
financial status. A lot of this is beyond what a GP can do, but being there and supporting these people is important to them.’
Challenges to care
According to Trees, while general practice locums provide some much needed relief for rural and remote GPs, communities usually benefi t the most from having a more permanent healthcare presence. ‘Being a GP who lives in the community means that I can provide continuity of care, which is the main thing that is of benefi t to my patients,’ she said. ‘If you live in the community, patients get to know you and you know what they’re like when they’re tired, when they’re cranky, and all the drama going on in their lives.
‘You can also achieve a lot when you stay in one place because you develop a structure of how you are doing things that can benefit your patients.
‘It’s like planting a fruit tree and sticking around long enough to see the fruit grow.’
As is the case with many other Aboriginal and Torres Strait Islander communities throughout Australia, accessing healthcare can often be a challenge in Yulara.
‘Access is not brilliant in that our clinic seems to be a bit understaffed at this time of the year and it can be quite hard for our patients to come in to see me, or to see the nurses,’ Trees said. ‘There is a local Aboriginal community, but because we have such a large number of tourists we tend to see quite a bit of trauma such as car accidents and people falling off the rocks.
‘This means that the ordinary, everyday chronic disease care that our people who live here need can be hard for them to access.’
Trees believes the socioeconomic burden experienced by many Aboriginal and Torres Strait Islander peoples presents another signifi cant barrier to accessing healthcare, as does a diffi culty in properly understanding and acknowledging differing languages and cultures.
‘We still have excess mortality and morbidity, and we have problems accessing quality healthcare that are common to anybody who lives in remote areas,’ she said.
‘You have to look at people who are living in poor housing, all of the problems with health that go with that, and the emotional and psychological trauma that comes from feeling excluded from the place where you belong.
‘Every Aboriginal community has got impressive and amazing achievements, but they are just not really understood. It would be really nice if people understood the different languages and cultures that each group has.’
Fostering the GP–patient relationship may be one way to increase cultural awareness among doctors.
‘Acknowledging and understanding a patient’s individuality is really key to helping them heal as it makes it easier for them to make the connection that they need to get better,’ Trees said. ‘When it comes to GPs increasing and doing better with their cultural awareness, it really is a life-long challenge that will defi nitely benefi t your patients and community.
‘There are some small things that we can do to connect with the people of other cultures in our communities; listen to somebody and let them tell you about the story of where they came from, for example.’
General practice pathway
Trees graduated from the University of New South Wales with a science degree in 2000. She later decided to return to study and complete her medical degree, graduating from Sydney University with fi rst-class honours in 2005.
‘I really wanted to learn about science and I also enjoyed looking after people,’ she said. ‘Therefore, I thought being a doctor would be a good way to combine the two and really be able to try and have an impact on my community.’
Trees completed her general practice registrar training in Gerringong and at the Illawarra Aboriginal Health Service in New South Wales, before working in Tjuntjuntjara in Western Australia and Mutitjulu in the Northern Territory.
Her medical education led Trees to conclude that general practice was the speciality that would best allow her to see patients from all walks of life.
‘I liked the broad scope of the learning of general practice. I also liked the ease of moving around remote areas and the immediacy of access to health for Aboriginal people,’ she said.
‘General practice is one of those professions where you can see patients and really be able to form a connection and build a relationship with them, which is important to good primary care.’
Trees’ love and respect for the country is one of the reasons she was determined to work in rural and remote communities after her medical education.
‘I grew up urban, like most Aboriginal people do, and I was a bit daunted by the prospect of going to work in remote communities,’ she said.
‘I was always very attracted to the land because I loved the country.
‘I went to Broome [WA] as a student, which was as far from Sydney as I could go and still be on the mainland, and I just loved it so much up there.’
Trees’ subsequent career in rural and remote medicine has given her a deep respect for not only her profession, but also her patients and their culture.
‘Why wouldn’t you want to work with Aboriginal people? It is one of the most interesting cultures in the world and it is an absolute privilege to be able to work with them,’ she said. ‘I value and treasure all of my patients and understand that they all have their own stories to tell.
‘As their GP, I am there to listen and to care for them. That’s what being a good GP is all about.’
First published in Good Practice September 2015 18–19