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Meeting Aboriginal communities on their land |
The Aboriginal villages of Jubullum and Muli Muli on the Northern Rivers of NSW welcomed about 30 doctors, health workers and practice staff to their communities in February 2000.
The doctors had come to yarn over a cup of tea and learn first hand about some of the barriers Aboriginal communities face in accessing health care.
Kyogle GP, Jacqueline Boustany, organised the trip on behalf of the Northern Rivers division, which plans to set up a project based around some of the day’s outcomes. Jacqueline, who has a particular interest in Aboriginal health, worked two days a week at the Aboriginal Medical Service in Casino until recently. She also runs outreach clinics to the communities of Muli Muli, Jubullum and Coraki.
The first outcome of the trip is organising more outreach clinics. Jacqueline has lined up specialists in O&G, ophthalmology, paediatrics and ENT and hopes they will become regular clinics.
Indigenous health remains at a fourth world standard she says. Aboriginal people have a higher incidence of western lifestyle problems such as diabetes, heart disease, cancer, chronic respiratory disease, drug and alcohol abuse and mental ill health. They have higher infant and maternal death rates and suffer more malnutrition and infectious diseases. They die 15 to 20 years younger than other Australians.
“Violent conflicts resulting in about 20,000 deaths in the south eastern states alone by the 1920s and the forced assimilation and child displacement programs of the Aboriginal Protection Council between 1909 and 1969, predictably contributed to the cultural and social disintegration of Aboriginal communities,” Jacqueline says.
Differences in lifestyle and control have resulted in many of the health problems experienced by Aboriginal people today, explains Mavis Golds, Aboriginal health coordinator for the Northern Rivers Area Health Service, who accompanied the trip. It was always other people who controlled the lives of Aboriginal families: “We are still trying to deal with the past and cope with the future. History still affects us today in social and mental problems.”
In Jubullum, for example, people become elders now in their 50s. Many, like Joan Bell, 52, coordinator of the Jubullum Land Council, consider themselves too young for the role. However, she acknowledges that until more in her community reach old age, this will not change.
Jubullum is also more than 60 kilometres from the nearest large town, Casino, so transport is a major barrier in getting adequate health care. Public transport consists of one bus, which passes the village in one direction at 11am and back in the other at 3pm. There is a community bus, but few people have licenses to drive.
Jacqueline says that often too, women do not have a driving license. Or, they don’t have the money for the medications they need, or sometimes even a fridge to keep the medication in.
Despite the weekly visit from two community nurses, there are still barriers to accessing adequate health care. “There are so many kids, many will not tell their parents or carers that they are sick or that there’s something wrong,” Joan Bell says. She estimates about three quarters of the 250-300 strong population are under the age of 16.
Older people often do not like to trouble others with their problems, according to Jacqueline. It may be a problem they are ashamed of, or there may be family commitments, transport or financial issues making it almost impossible to get to the doctor.
Jubullum was established as a mission in the late 1940s when the local Aborigines were moved from the river flats.
“Quite a few of the doctors don’t understand the history and wonder why they don’t leave these places,” says Mavis Golds. “It’s only since 1967 that Aboriginal people started to be more involved.”
As Aboriginal elder Chris Charles, who works with the Intensive Family Based Service in Casino, explained to the group as the bus approached Jubullum: “We may not have chosen this place, but it’s our home now, please respect it.”
Joan says the community thought the doctors’ visit was very positive. “It was a great day and a couple of the babies and mums were seen by the doctors,” she said.
The Jubullum community has successfully applied for a grant of $30,000 through the NRAHS to convert and renovate a building as a health outpost, where it hopes to attract visiting health workers, GPs and specialists.
Next stop on the trip was lunch with the people of Muli Muli on the outskirts of Woodenbong, more than 60 kilometres north west of Kyogle. Woodenbong has its own GP, so the community does not experience the same problems of access as the Jubullum people, although Jacqueline says it is still difficult for people without transport and the less mobile to get to the doctor.
Muli Muli elder, Charlotte Page, 80, who came to the lunch, chatted easily with the visitors. She thanked the group for coming and said a special prayer at the end of the visit.
Mavis Golds thought the day was a good step towards reconciliation: “It shows that doctors do want to be involved more in Aboriginal issues and working together in partnerships. Some of us as Aborigines were overwhelmed by the day. I think the doctors too - overwhelmed and overloaded.”
As well as the outreach clinics, another idea to come out of the trip was a buddy system based on the idea of using the knowledge of the extended family. For example, a niece, nephew or other educated relative could be encouraged to accompany older patients to a consultation so they could reassure and explain what was happening. Dr Boustany says it is easier to get a patient to go in to hospital if a relative is on side.
She also flagged the problem of miscommunication. “We need to try to couch things in their language. It’s not all doom and gloom and we need to talk about the positive aspects too.”
She spoke about the culture of silence and contemplation in Aboriginal communities: “Silence does not mean assent, it is usually the opposite.”
And she drew attention to the connection Aborigines make between spirituality and disease: “It is notable that the Aboriginal community have in themselves a whole-of-life view of their health and understand that their psychosocial problems relate in real terms to the state of their physical health.”
Other proposals included cultural awareness training for doctors and practice staff, community selected and supported health workers to deal with day to day follow up, and busing people into clinics in town.
The trip to Jubullum and Muli Muli showed the doctors some of the issues they were up against, Jacqueline says, but she is optimistic the day will lead to positive outcomes for the communities and a better understanding on both sides.
Her optimism is supported by the communities themselves. “The feedback from the community people is saying how it was a good thing and they would like to see it happen more often. I actually think they felt honoured to have the doctors visit with their communities,” Mavis Golds says.
Everyone agrees it is important to keep the momentum going. The trip to Jubullum and Muli Muli was just the first step.
This article was published in GPSpeak in April 2000.
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