Hospitals, doctors, health &
Aboriginal people

Limited access to doctors in remote communities

Only 20% of Aboriginal people who live in remote communities of more than 50 people have access to a doctor on a daily basis according to Australian Bureau of Statistics (ABS) figures from 2006 [1]. A further 41% have local access to a doctor once a week or once a fortnight.

But 3% could only see a doctor in their own community once a month, the ABS found.

The ABS estimated 18% of Australia's Aboriginal people live in a discrete Indigenous community (a geographic location, bounded by physical or legal boundaries), most of which are considered remote. Only 10% of them lived in a community with a hospital.

Although more than 140 community services across Australia provide health care to remote Aboriginal populations, less than 50% of these clinics have medical coverage [19] due to a shortage of doctors.

For Aboriginal people living in remote areas access to pharmaceuticals is usually limited due to a lack of infrastructure [16].

Experiences of Aboriginal doctors

The Australian Indigenous Doctors' Association (AIDA) has published a rare resource called Journeys Into Medicine. It is a book in which 15 Indigenous doctors and five medical students reflect on what it means to be an Aboriginal or Torres Strait Islander person balancing the demands of a Western, bio-medical system while remaining faithful to Aboriginal culture, family and community.

They tell about their challenges and their triumphs. Their careers before medicine and the experiences within medical schools and within the medical profession are as different as the stories themselves.

Journeys Into Medicine aims to challenge stereotypes about the standing of Indigenous people in Australia's workforce.

The book is of special value for high school students contemplating their future and university students studying within medical schools or those enrolled in nursing degree programs online.

The book can be downloaded for free at www.aida.org.au.

Fact Prof Helen Milroy from Wintrop, WA (near Fremantle), is Australia's first Aboriginal doctor [20].

How to make hospitals work for Indigenous people

For many Aboriginal people being in a sterile hospital environment conjures up memories of racism and mistreatment. Many Aboriginal people have a lot of mistrust towards the existing health system [16] due to the history of mainstream services in their lives.

Many members of the Stolen Generations choose not to see a white doctor or only when their condition has severely deteriorated. For example, only 67 Indigenous adult health checks were performed in an area in Queensland with more than 12,000 Indigenous residents [14]. Less than 0.6% had their health checks done.

Alice Smith, a Punjima woman from Western Australia, remembers: "I didn't want to have my kids in hospital because the doctor is a man. Out in the bush you don't have anyone. The mother got to sit down by herself, and a woman is there just to help… None of the women used to go to the hospital. I used to have bush medicine all the time. If they get sick we know what tree to get, and to boil it or whatever we needed to do… I grew up in the bush and never had a tablet to fix me." [9]

For a medical environment to work for Aboriginal people it needs to overcome the barriers they perceive. It should

• employ Indigenous staff,
• have an Indigenous-friendly feel, for example by displaying Aboriginal artworks [2]. Aboriginal artwork on the outside of an ambulance also helps Indigenous communities develop a sense of pride and ownership in the vehicle [3];
• ensure that Aboriginal patients understand their disease. Many are uncertain about what has caused their condition [4]. Use clear, simple language with fewer words and more pictures [17]. Computer-animated movies employing three-dimensional Aboriginal characters talking in patient's native languages have "revolutionised" the delivery of critical health messages [18];
• ensure informed consent. For traditional Indigenous people 'informed consent' for medical procedures must come from the 'right' person within the network of kinship and community relationships, not necessarily solely the patient [5]. Disrespect for such a process might lead to payback for the ill person;
• ensure Aboriginal patients are fully informed in their own language about potential harms or benefits of the procedures offered [5];
• provide medical dictionaries to improve communication between health professionals and Aboriginal patients;
• communicate well: while the western approach looks at health from a biological perspective, Aboriginal people often have a more holistic approach to looking at health [16];
• have culturally aware staff who have been trained in Aboriginal culture;
• provide culturally appropriate services. For example, a woman might not feel comfortable being treated by a male health professional;
• offer low price treatment as many Aboriginal patients have a low or no income;
• address remote locations and lack of transport which is a challenge for patients in remote communities.

There is a substantial body of research evidence indicating that the development of a skilled and professional Indigenous health workforce is an essential prerequisite for improvements in Indigenous health. —Dr Mick Gooda, CEO Cooperative Research Centre for Aboriginal Health [8]

Traditional healers—"They think it is voodoo stuff"

Marjorie Parker comes from the Pilbara region in north-west Western Australia where she has been working as an Aboriginal nurse. She explains that some Aboriginal patients request the services of traditional healers [10].

"In hospitals they should have Aboriginal videos, playing culture for the people. There is nothing for Aboriginal patients to make them feel supported in the cultural, spiritual being. The hospital staff don't take into account the spiritual well-being of the Aboriginal patients. It's all medical treatment. Sometimes you need to go further."

"Some patients have requested treatment from their own culture, from medicine men. Hospitals do not recognise the legitimacy of treatment that traditional healers can give and this is wrong. They think it is voodoo stuff."

Using traditional Indigenous art to explain good health

Doctors in Australia's Northern Territory have found an amazingly obvious way to teach Aboriginal people about diseases and good health [7].

They use paintings produced by local Aboriginal people in Oenpelli's Health Clinic, near Kakadu National Park (about 300km east of Darwin). The paintings encourage patients to participate in discussions about body systems, especially when patients realise that the paintings have been produced by their uncles and cousins.

Aboriginal people are able to identify immediately that the paintings were from the area and painted by people they know. Due to a life's experience of hunting animals for food many Aboriginal artists have a better knowledge of anatomy than mainstream doctors [7].

[Health paintings are] a perfect starting point to build the doctor-patient relationship. —Hugh Heggie, GP, Oenpelli Health Clinic [7]

Out of respect for Aboriginal culture I use Indigenous sources as much as possible.
[1] 'Aborigines waiting up to three months to see doctor', Koori Mail 431 p.51 [2] Koori Mail 413 p.48 [3] 'Deadly ambulance to help new officer improve health', Koori Mail 441 p.34 [4] 'Frustration over kidney disease, research shows', NIT 13/11/2008 p.11 [5] 'Cultures vary widely on 'informed consent'', Koori Mail 440 p.54 [6] 'A column by our own doctors', Koori Mail 438 p.54 [7] 'NT doctors use pictures to paint a vision of good health', NIT 13/11/2008 p.12 [8] 'In good hands with Dr Shibasaki', Koori Mail 454 p.54 [9] 'Karijini Mirlimirli', Noel Olive, Fremantle Arts Centre Press 1997 pp.85 [10] 'Karijini Mirlimirli', loc.cit. p.132 [11] Koori Mail 471 p.46 [12] 'Funds needed to train Indigenous doctors', Koori Mail 472 p.9 [13] '$35m for health workers', Koori Mail 474 p.81 [14] 'Boost for Institute', Koori Mail 476 p.50 [15] 'Base is in ideal location', Koori Mail 498 p.32 [16] 'Research will help Aboriginal patients', Koori Mail 499 p.67 [17] 'Program helps people take control of diabetes', Koori Mail 415 p.57 [18] ''Marvin' delivers healthy messages', Koori Mail 412 p.57, see www.marvin.com.au [19] 'Cold facts on health', Koori Mail 404 p.51 [20] 'Doctors set for symposium', Koori Mail 511 p.13 [21] 'Transient care the focus of research', Koori Mail 513 p.54