Greatra Mayana

Career & Employment Opportunities

A Valued Profession: Cultural Expertise in the Health Team

Hello, I’m Daniel Browning. Welcome to this program about Aboriginal and Torres Strait
Islander health workers – A Valued Profession: Cultural Expertise
in the Health Team, coming to you
on the Rural Health Channel. And on behalf of everyone here, I’d like to acknowledge
that this program is being broadcast from the land of the Wangal people
of the Darug, traditional custodians, and we acknowledge their elders
past and present. It is well documented and recognised that Aboriginal
and Torres Strait Islander people suffer poorer health outcomes
and a shorter life expectancy than non-Indigenous Australians. Contributing to this
are the barriers they face in accessing
culturally safe healthcare. Aboriginal and Torres Strait Islander
health workers play a unique and valuable role
in overcoming these barriers. However, their role is not often
well understood. Recent reports highlight that we are not realising
the full potential of this workforce to help close the health gap. In this program, we’ll explore
some of the reasons behind this. We will hear
the panel’s personal experiences of why it is so important to have that cultural expertise
in the health team – and how it strengthens interprofessional
relationships and has a positive impact
on health outcomes for Aboriginal and Torres Strait
Islander communities. This is
a professionally accredited program from the Rural Health
Education Foundation, broadcast on
the Rural Health Channel. It is also being broadcast
simultaneously via a live online webcast
and on NITV. As with all of our live programs, we’d love to put your questions
to the panel. You can get in touch
by phone, text, email or fax. The details are on your screen now. So send your emails
to [email protected] And you can text us on 0408 408 932, or phone us on 1800 817 268. You can also fax your questions
to 1800 633 410. And if you’re watching via
the webcast on your computer, type your questions into
the Live Talk box and click ‘submit’. We’ll be taking questions live
throughout the panel discussion, so, please, send them in as they arise. And the first poll question tonight – it’d be good to know
who’s watching us tonight, and to let us know
what profession you belong to. Are you an Aboriginal
or Torres Strait Islander health worker or practitioner? Are you a nurse?
Are you a GP? Are you a pharmacist?
Do you work in allied health? Are you a specialist?
Are you a student? Are you are a manager?
Are you an employer? Or something else? Now it’s time to introduce our panel. Jenny Poelina is a Njikena woman
from Derby in WA. She’s a senior
Aboriginal health worker and is currently Senior Manager at the Centre
for Aboriginal Primary Health Care Training, Education & Research at the Kimberley Aboriginal
Medical Services Council in WA. Jenny is also Chair of the National
Aboriginal and Torres Strait Islander Health Worker Association,
or NATSIHWA, as we know it. Angela Dufek grew up
in the Adelaide Hills and is a registered nurse
and midwife. She has a Masters degree
in Rural and Remote Health and has worked as a remote area nurse
in the Kimberley. She’s been at Port Lincoln Aboriginal
Health Service for 12 years and is currently the Senior Manager
of Client Services. Peter Pangquee has been an Aboriginal
health worker for over 30 years, and is currently the Principal
Aboriginal Health Worker Advisor for the NT, the Northern Territory
Department of Health. He’s Chair of the Aboriginal
and Torres Strait Islander Health Practice Board of Australia, and has been involved with Aboriginal
Health Worker regulations in the NT for over 14 years. Peter’s also been closely involved
in developing the National Aboriginal
and Torres Strait Islander Primary Health Care qualifications. Rita Williams is
Aboriginal Health Education officer at the Children’s Hospital
at Westmead in New South Wales, and Rita was responsible
for setting up the ARDAC study into renal disease
in Aboriginal children. She comes from Tingha
in north-west New South Wales, and she’s worked in Aboriginal health
for the past 35 years and is Chair of the Aboriginal
and Torres Strait Islander Health Worker Forum. Last but not least, Professor Richard
Murray is a GP and Dean of Medicine at James Cook University
in Townsville. He’s also President of the Australian
College of Rural and Remote Medicine. Richard spent 14 years working in
the remote Kimberley region of WA, and he’s been directly involved
with Aboriginal health worker training and the development
of the national qualifications and competency standards. Welcome to you all. We’ll get straight into it, Jenny, and I guess it’s really important
at the outset to define what we mean
by the Aboriginal health worker. Their role – what do they do? The role of Aboriginal
health workers are very vast, depending on what area
of the country that you live in and where you work, and it can range from
working in a clinic or working in a hospital system, and a range of other things. The main role, though,
is working in primary healthcare within the community for our people, and I think that’s why
it’s so important that we have
Aboriginal health workers. There’s a very broad scope
of practice. – There is.
– They do a lot of things. There is, yes, Daniel, and that broad scope of practice is… We’ve recently, you know, developed a professional framework
for Aboriginal health workers, which, again, is broad because it’s around understanding what
people know, understanding what skills they have, and therefore putting that into place. DANIEL: And that
professional-practice framework, there’s some very key principles. I think the core principle
at the heart of it is culturally safe… JENNY: Absolutely.
– Culturally safe environment. JENNY: So providing
that culturally safe environment for our people when they’re
accessing health services, you know, and
delivering healthcare in a holistic way,
the whole way, and remembering that all our clients
are part of a community – and it’s very important that
we look at the whole community – and also to be able to provide
leadership and being a role model
for other Aboriginal people who may be thinking of going into
Aboriginal health, yes. And, Peter Pangquee, we’re going
to encounter this difference between the practitioner
and the health worker. Can you maybe draw a line between
those two different occupations? Yeah, sure. First of all, there is
Aboriginal health workers, and within that workforce, there’s the Aboriginal and Torres Strait
Islander health practitioner. And the practitioner role
is a registered practitioner, registered under
national legislation. There’s 14 other health professions
in this category, from nurses and doctors and dentists
and all the rest of them. The Aboriginal and Torres Strait
Islander health practitioner has specific training, the clinical training that they have. They can use medication
and assess clients and have a more in-depth
clinical aspect to their work. That doesn’t make them
any different to, I guess, the Aboriginal health workers
who do the community work as well. I mean, the health practitioner
does get out there in the community and work in that
primary-healthcare model, but trying to match up
that clinical practice along with the primary-healthcare role
in the community. Mmm. Just on that issue, Jenny,
because your expertise is in education and training
for our health workers, what’s the training that they undergo? OK, so it’s what they call VET training, so Vocation Education Training,
so it’s a skill-based training, so their National Aboriginal
Health Worker training package actually starts at the Certificate II, which is like a VET in schools – it’s a bit of an introduction
for young people if they want to get into
Aboriginal health in the schooling area. And then they go into a Cert III, which is the employable certificate
at the moment, and this is where they learn to have
basic health-assessment skills, you know, knowledge around
anatomy and physiology and about being part of the team. Right through to the advanced
diploma in primary healthcare, which could mean that people
could be advanced clinicians. It could also mean that
Aboriginal health workers would be able to manage
and go towards management. We’ll just get some results
from our first poll question: So interesting spread
in our audience. And poll question two, we’d like
to get an idea of where you work: Now, this whole question
of national registration – Peter, can I ask you,
is it the same across the country? Because that’s part of your role
on the board. Yeah, look, national registration is,
as the name suggests, it’s national. There’s one legislation,
and the legislation is the same as for doctors and nurses as well. There is a national board that
develops standards and guidelines for registration of this workforce. The training – first of all, it’s the Aboriginal
and Torres Strait Islander Primary Healthcare Cert IV Practice. There is a process where
registered training organisations, or RTOs, will be accredited
by the board, and the qualification
has to be accredited. So there’s a set standard around that,
and it is a national scheme. Are they pretty rigorous,
those standards? I mean, what’s needed to register? Yes, they are pretty rigorous. We have to make sure
that they are rigorous because the main aim of registration
is protection of the public, protection of the practice that Aboriginal health practitioners
undertake, so we have to make sure
that it is rigorous and that the standard of training
is right up there for that safe practice. I guess it’s really important to know
what kind of numbers, Jenny, that we’re talking about. I mean, there aren’t any
concrete numbers, are there? No, we know that there is about
300 registered health practitioners. But it’s been very slow –
the uptake’s been very slow of Aboriginal health workers
becoming registered. And offhand, I think there’s probably only about
1,800 around the country altogether. And the uptake has been bigger in places like the Northern Territory
and Queensland where there’s an established system,
I suppose – a system that’s been operating
for a long time? Yeah, absolutely. Part of the national registration,
the Act, part of the national Act, was that for health professionals
that had already registered boards in those states and territories were automatically rolled over
into the national scheme. And of course,
the Northern Territory was actually
the only state or territory that had a State registration
for Aboriginal health workers. So the bulk of those
registered practitioners are actually
in the Northern Territory. It’s important to note
the Northern Territory… Peter? Just a point on that. We have had registration
for Aboriginal health workers for 27 years until 1st July this year,
when it went national. Yes, the Northern Territory
leads the way in terms of national registration. Now here are the results
of our second poll question – they’re coming in thick and fast: Now, poll question three – we’d like
to know the sector you work in: Now, the next part
of our discussion – why, Jenny, do you think Aboriginal and Torres Strait Islander
health workers, why are they so important? Aboriginal health workers
are so important because they provide culturally safe
healthcare for Aboriginal people accessing health services. And so that doesn’t matter
where they’re going – there needs to be
Aboriginal health workers in all of those health-sector areas. And, Rita, can I bring you in here? What do you think it is that the Aboriginal health worker
brings to a team? They can break down
the culture barriers, especially on access
to mainstream services. And in a sense, a typical day
can happen almost with anything. Families arriving
three weeks ago on my door, as soon as I opened the office, and said that they had referrals
to the specialist, they said they had appointments, and they said they had accommodation. – They didn’t have any.
-Mmm. They didn’t have any of those,
and so what I did was… First thing was I got on the phone
and rang the specialist – I don’t ring their secretaries,
I just ring the specialist – and, straightaway,
we had an appointment, two appointments, theatre appointments. But because they weren’t patients
at that stage – the child wasn’t a patient – so therefore they’re not eligible
for accommodation. So, luckily, they had a family that they stayed with
over the next three days because we weren’t able to get them
an accommodation into the hospital until three days later,
so there they stayed. The child went to theatre. And actually,
today they went home with success, and I’ve already booked
their accommodation for in three months’ time, and also we have appointments
and we have theatre dates as well. – Good result, good result.
– Mmm. It gives you a sense of
the kind of breadth of the role, the diversity in the role. Peter, what makes our Aboriginal and
Islander health workers so unique? I mean, those cultural barriers
that need to be overcome for our people to access
the healthcare that they need? Yeah, well, it’s about
their cultural knowledge, but also their networking
with the families – they know the families well. The language skills, often,
in a lot of our remote communities. There are language skills that the other health professionals
don’t have in a lot of cases. Community knowledge
is a very strong thing. But also, they do have skills, they do have skills
around the health services, and they know the health services. It’s not just the doctors and nurses
who know this stuff. The health workers
in those communities have those clinical skills
and have the knowledge. They know the system,
they know when to refer, they know when to involve family – you know, sometimes you need to
involve other members of the family. They know when to do that,
and they do it really well. Richard, as far as
you’ve been able to observe, what kind of impact do they have,
not just in terms of access, but broadly – what kind of impact
do our workers have? Look, I guess in terms
of formal studies, there have certainly been
a number of studies I can think of – for instance, impact of
health worker-led medication, and chronic-disease management on death and kidney failure,
for instance, in one Top End study. Other things which tend to be
a bit disease-based – you know, ear health, eye health
and so on. I think beyond that,
it’s just a really good model of comprehensive primary healthcare. The rest of the country
has a lot to learn. Having a really solid base of people who are deeply connected
with community and family, who have understanding
of what the dynamics are, the causes of health,
the determinants of health, that operate locally. What needs to be done in addition to recognise when people
are really serious about something, or not so serious,
where you might draw on resources. And I can say
from years of experience that there is no way in which
my work would have been as effective without working alongside,
learning with, learning from, and teaching
Aboriginal health workers. There are some myths
and some misconceptions, and I’d like to hear you perhaps
kind of outline some of those, ’cause they’re quite key, and we can’t get further
into this discussion without perhaps confronting those. I think that’s probably right. I guess the things that many of us have
struck over the years have been misapprehensions
about what it is in clinical care that might be legal, if you like. And so, for instance, people worry that perhaps
making an assessment, getting a history,
performing a physical examination, collecting a urine specimen, taking blood,
performing a Pap smear, taking genital swabs, for instance – that somehow there’s some law
that makes that… You know, only certain classes of
professional can do these things. That’s actually not true. There are certainly employer policies,
but they’re employer policies. There are certainly
custom and practice and what people might think
is a medical duty or a nursing duty or whatever. Actually, none of that’s
got anything to do with the actual reality
of the legislative framework in which we work. And, look, the truth of where
we’re going with healthcare teams is that we need to just lose
a lot of this nonsense, get used to the idea that everyone
brings a particular expertise to the situation, and that everyone’s expertise
is evolving and growing every day – we learn with and on our patients. And if somebody’s showing aptitude,
has a base amount of training, is showing aptitude and interest
in something, is able to demonstrate they’re
performing a task proficiently, well, they can do all of them from
now on, as far as I’m concerned, and call me when
there’s a tough one. And I think that’s the way in which
you get effective healthcare teams working to the top of everybody’s
licence at all times in a way that’s most responsive
to the community. Yeah, I used to get asked about what
can an Aboriginal health worker do. This is back in the NT,
and, you know, our response was, ‘They can do whatever
they’re trained to do, within the guidelines and
your policies and that of your…’ One of the only bits of law,
I suppose, Peter, is the Poisons legislation, and, actually, mostly,
that’s not a big issue. How have you found it in the Territory? Yeah, look,
in the Northern Territory, we have legislation,
the Poisons and Dangerous Drugs Act, which allows Aboriginal and Torres
Strait Islander health practitioners to possess and supply medication. It’s through a Gazettal order
under that Act. And they’re able to do that
effectively. But it’s not just
using the medications – it’s about the processes before that
and learning how to assess a client, you know, do the observations,
do all those things, and then make a clinical judgement
on what they should do. I mean, it may not be medication. It may be referral to another person,
to another health practitioner. So that’s the training
that our practitioners have had. Well, a key focus
for Aboriginal health workers is improving access to
health services for their community. Let’s see how one group at Noarlunga
Aboriginal Primary Health Unit supports this through their regular
Nunga Lunch. -Hey, it’s Malcolm.
– Yeah. Hey. How you doing? – Bigby sort that out for you?
– Yeah. The reason I got into
Aboriginal Health was because I got sick and tired of seeing family members
and community members dying at young ages
due to a lack of education and just not being aware of diseases
and disabilities that they have. The whole team on a Wednesday
are in attendance, and that’s an opportunity
for the community also to touch base
with the health workers, to speak to the health workers
and get information on some of their health issues, you know, health information
that they’d like to know about. So we promote that at all times. That’s good. Get a hold of that. Things about eating. Yep. You haven’t been diagnosed
with type 2. You’ve been diagnosed
at risk of getting type 2. Yeah, well… I’ve known
even since I was in high school that I wanted to be
an Aboriginal health worker. I run health sessions
and presentations on diabetes, heart disease. That sounds good. Yeah,
I’d be really interested in that. Great innovation down there
at Noarlunga with the Nunga Lunch. Peter, if I could ask you, I think the clip illustrates one of
the points that we’re trying to make, and it’s about how Aboriginal
health workers can improve access, can get our people into care quicker. Do you have similar experiences? Is there something like that that you’ve
seen up in the Northern Territory? Um, not quite like that one, but there are other
health promotion-type programs and ways of getting people involved
in their own health, and I think that’s a good example
of a program that allows, I guess, the community
to get involved with it. You know, the health worker
going out and picking up people and going into the workplace and then doing
the health-promotion things. And with those sorts of practice, I think it just describes
the diversity, I think, of the role of
the Aboriginal health worker and Aboriginal health practitioners. Jenny, there’s an experience
you were talking about at Bidyadanga – just getting fresh food
into people’s mouths. I mean, that’s as important as it is,
that kind of thing, improving access. Absolutely, Daniel. As part of the Certificate III in Aboriginal Primary Health Care
training, we teach about nutrition
and good nutrition and the basis of nutrition. And one of the things
that we have to do is that we then go into
the community store and we suss out what foods are there and what’s good for you
and what’s not good for you. And it was really
quite a shock for me when I realised that the community
doesn’t actually have good access to fresh food all the time,
and it’s very expensive. And you know, if you eat lettuce
and tomatoes and cucumber and things that they tell us
is good for you, it doesn’t keep your tummy full
for long. So therefore, our people are often… You know, because
there’s such poor social structures and stuff like that, they often have to buy flour,
which is what keeps your tummy full, which, of course, we know
that processed carbohydrates leads us down to ill health
if we continue to eat bad foods. Now, a question to you, Angela –
what’s been your experience working with Aboriginal and Torres
Strait Islander health workers? You’ve had quite a long experience.
Tell us about… I guess in the beginning
when I was remote area nursing, the Aboriginal health worker
was often considered an ancillary or an aide to the nurse, whereas I’m really pleased to say
that’s changed now. They are the connection
with community that everyone has mentioned so far. And the Aboriginal health workers
are so valuable in teasing through
a lot of the social issues to get to the medical problems. You know, traditionally,
nurses and doctors go straight to the medical problem,
which we know is very important, but you’ve got to tease through
a lot of social problems first before you can get to
the medical problems. And can you pinpoint what difference
it’s made to the way the team works and to achieving those… It’s a mutual respect, so it’s encouraging
the non-Aboriginal health staff – and by that I mean
nurses, doctors and everyone – respecting the knowledge and the capacity
that the health workers have to provide that care as well, and taking it, not only teasing through
the social problems, but then, as Peter’s mentioned, actually doing the clinical examinations
and that as well. – Mmm.
PETER: Trust them. Let’s look at another clip now and hear from
Aboriginal health workers at the Karpa Ngarrattendi
Aboriginal Health Unit at Flinders Medical Centre about their role working with patients
in a hospital environment. It’s a big thing
if you’ve never left your community. I’m going up to see Natalie. OK. Our job is to look after
the Aboriginal patients, but also advocate on their behalf because Aboriginal people
are very shy people. You know,
we don’t like to look at people, we don’t like to talk to
non-Indigenous people, especially in a hospital,
like doctors and nurses, so Aboriginal health workers
are very important. – I’m here to see Natalie.
– She’s in bed No.9. Thank you. – Telling you something wrong…
-A problem with my heart. Problem with your heart. So did you have
that procedure yesterday? – No, today.
– Today. When they’re in the hospital, then the liaison workers visit them
on the wards and then liaise with doctors
and nurses about cultural aspects that they might need to think about. Now you’re gonna have
your angiogram. Artery. – Angiogram today.
-OK. OK. – I came down for this.
-Yes. Do the angio. – Maybe put a stent with the balloon.
– Yep. I was just letting her know what sort
of procedure she was having, whether she understood
what she was having and whether she was happy
about having it. And then you’ll fly home
after five days. – After five days.
– After five days, after the stent. So you’ve done really well, Natalie,
because I remember you wanted to go home
the first day you came here. (Chuckles) I’m passionate about this job
because Aboriginal people die 17 to 18 years before
non-Indigenous people. I just want to make a difference,
even if it’s a small difference. Some good work being done
at Karpa Ngarrattendi. Now, Rita, you would have encountered
some of those issues that we just saw in the clip – people wanting to get out of hospital
as quick as possible. As quick as possible. From the time they arrive, Daniel,
in a sense. But whilst they’re there, they also play a very important role
in their child’s health. And encouraging them
to be at every consultation and be in ward rounds when doctors
actually deliver the information. And if they have any further information
or questions to ask, you know, I encourage them
to think about it. Like, if you don’t think
about questions now, write them down,
and next time they visit the ward then they may have
some other questions that they might need to ask. Richard, a question for you – what evidence – I guess
we always come back to evidence – what evidence do we have
that Aboriginal health workers positively affect patient outcomes? I guess I’ve mentioned some of
the issues in a specific disease-based or condition-based studies. I suppose more internationally
what’s really clear is that access to primary healthcare can be positively correlated
with healthy populations. And that’s in contrast,
say, for instance, to the density of specialist
medical practitioners to population, which doesn’t so much
reflect population health. So there’s some very important
international evidence, and certainly on the basis of often specific conditions
being better managed. Chronic disease is a classic example. Prevalence of chronic disease, Aboriginal and Torres Strait Islander
communities – typically 30%-40% of adults will have
one or more chronic conditions. And that just puts
a whole different flavour on the challenges of communication,
Rita, like you say, and how you go about
organising the care. And honestly, without that
broader primary healthcare team, it just is not possible
to do really effective work. Angela, can I ask you… You’ve been able to see how Aboriginal and Torres Strait
Islander health workers operate. In terms of improving access,
in terms of getting people into care, what difference have they made? Well, again, they provide that access
to the clients, to the community. They can actually
go out into the homes, bring people in to the service or take services out
into the community as necessary and as appropriate. Yeah, identify issues, often before
they flare up and become worse. And are very important cogs in the whole care, care plan,
care management of a client. Jenny, I have to ask – there seem to be very many
different job titles. We were talking about registration versus other ways of becoming
a health worker or a practitioner. Do you think there are
maybe too many titles? I think perhaps
if we have the two titles – ‘Aboriginal health worker’
and ‘registered practitioner’ – as part of that Aboriginal
health worker profession… And I think that our job roles
will always be varied, depending on where we’re from. But also it’s about community, and it’s about
community’s expectation of us as Aboriginal health workers. I mean, you know, an urban community may not have the same expectation
as a remote community of their Aboriginal health worker. And I think that’s
the really important thing and why there needs to be
diverse roles. Although there’s more specific
roles and responsibilities around a health practitioner. Because Aboriginal and Torres Strait
Islander health workers are in and of the community,
aren’t they? -Absolutely.
– We can’t lose sight of that point. No, absolutely.
And I think that’s the key thing. When we’re recruiting Aboriginal
health-worker students, for example, one of the key questions
that we ask them is, do they have
their community’s support? Because we know that if
the community’s not supporting people to come and do
their health-worker training, then, when they go back, they’re not gonna be supported
when they go back. And so it’s about
that whole cog of community and being part of community,
and why it’s so important. And here are the results
of our last poll question on the sector
that you work in: And poll question 4: Time now to see another clip – this time from Wuchopperen
Aboriginal Health Service up there in Cairns, about how Aboriginal health workers
form a core part of their services. Every client seen at Wuchopperen
here in the medical clinic is seen initially by a health worker. And we call it screening,
but it’s much, much more than that. My name’s Bruce.
I’m one of the health workers here. What can we do for you today? I was just asked to come in
for some tests, blood tests and that,
to see if I’m diabetic or not. No worries. We’ll check your
blood pressure and blood sugar. There’s the gathering of medical data, but there’s also the gathering
of information. Often that information is, shall
we say, more subtle or more private or more culturally appropriate than would be perhaps understood
by a non-Indigenous caregiver. Bit up today.
Just jump on the scales here. Alright. I’ve got his story from him
and why he wanted to see the doctor, and I’ve also discussed with him
what else we can do for him, what other services we can offer. So it’s a good idea to get it checked. Wuchopperen’s always believed
that the health workers are front and centre to healthcare. They tend to be the first person
to speak to the client. They’re also the first person
that the clients will turn to if there’s some confusion or they need further clarification
and so on. And then, in our model here, they’re also the last person
they speak to because they’re the people
that are organising their follow-up and their transport
and their recalls. Do you have any family history
of diabetes? – I’ve no idea.
– There’s a good chance you do. I mean, Indigenous people
do have a higher rate of diabetes and things like high blood pressure. And I’ve also noticed
that you’ve been referred to a diabetes educator. – Oh, yeah.
– Yeah. When we go down
to see the diabetes educator, will you be coming down? Yeah, no worries.
That’s not a problem. ‘Cause I’m not sure what questions
I should ask him. That’s OK? – Yeah, it’s fine.
-Yeah, good. Richard, Dr Vlad Matic
up there at Wuchopperen talks in that clip
about how Aboriginal health workers are able to get more information. He talks about medical data
versus information, by which I think he means cultural
information, sensitive information. Is that the experience
that you, too, have had? Look, indeed. It’s just about having an
understanding of the local context and also how you might
efficiently use the skills of your healthcare team. So if you’re running
a busy primary-healthcare clinic, you don’t want doctors
spending a long time trying to extract information. They probably
don’t really fully understand and maybe haven’t got
the ears to hear, and this is where the teamwork
really comes in. Being able to bring the prior knowledge
of the community context, being able to bring that
to the decision-making so that the best possible
decisions are made. And also I really liked that clip. I think the fact that clearly
the young male health worker, who’s got a lot of confidence, who’s building his skills
and abilities on a constant basis, patient by patient, is absolutely the right way
for any primary-healthcare team and any professional
to be working together. And it’s about health services having good, firm policies
around the Aboriginal health worker being the first point of contact. And as we’ve seen in some of
these videos, the last as well. Jenny, can I ask you, the culture
at Wuchopperen clearly seems to value the work of the Aboriginal and
Torres Strait Islander health worker, but it doesn’t always happen like that. Why do you think other services
don’t see the value of Aboriginal and Torres Strait Islander
health workers? I guess it’s because
it is the diversity of the roles, and I think it’s part of our job
as Aboriginal health workers that we need to be role models and we need to encourage
other Aboriginal people who are working in health because it’s there in their spirit,
in their ‘liyan’. We need to encourage them to do it,
and be able to talk up as well. So it’s about encouraging
our mob to talk up and be confident in what they do. And I think education programs
like this, for example, are very, very important
for non-Aboriginal people to understand
the roles and responsibilities of Aboriginal health workers. You would have seen, though,
in your time, teams where
it wasn’t being recognised, where the role wasn’t being valued
and the skills and expertise of the Aboriginal
and Islander health worker wasn’t being recognised. I mean, what can be done
in that situation? Boy, we do see a lot of Aboriginal
health workers being deskilled, particularly in their clinical
skills that they’ve learned. And I think it’s really important around making sure
that Aboriginal health workers are part of that
primary-healthcare team, and making sure
that we’re changing the culture of the way we do business, particularly for Aboriginal
and Torres Strait Islander people – because that way
it’s culturally safe then. And I think, for mainstream services, they need to acknowledge
that the Aboriginal health worker is absolutely
an important role and place in the total care
of Aboriginal peoples’ health. I think we need to make
a distinction, too, Angela, between community control
versus mainstream. Aboriginal and Torres Strait
Islander health workers seem to do better
in community control than they do in mainstream services. As Jenny said, it’s about
familiarity with the role, so it’s important
that mainstream services do encourage employment and set target rates
for employing Aboriginal people and becoming familiar with the roles. – And with training, Angela.
– With training. Yes, with training. ‘Cause often they don’t have training
or are not encouraged to train. And they don’t… their degrees
are not always recognised, because if you’re looking
for regrading, forget it. And I was only a senior Aboriginal
health worker on the ARDAC study, but when I came back
to work with the families after they deleted my role,
they took the ‘senior’ title off me. And then you go down in pay. But there’s no justification. – Just a comment on teams.
-Mm-hm. I’ve been in a position where,
as a manager in a region, an Aboriginal health worker manager
in a region, I’ve seen highly functional teams
that are working really well together. And you could almost pick the things
that make that team strong. It’s a good understanding
by the manager, who’s generally a nurse that’s come
into the community from outside. And they’ve got, you know,
the compassion, they’ve sat back and they’ve actually
learned about the community, about the role of the health worker and about the systems and that
in that workplace. And quite often,
they’re really highly functional teams. And then you can
go to another community and that same teamwork isn’t there. So you’ve got to sit back and say, ‘Well, why doesn’t it work in that place
and it works over here?’ And quite often,
it can come back to the manager and about the team – about the manager not having
the same, I guess, compassion, the same knowledge
about the role of the practitioners or the health workersand the community. So it does… Having a whole lot of different factors
impacting on that team. Often, if the higher-functioning manager
in that team leaves and someone else comes in, you’ll notice that they’ll be operating
at a very high level, and then the manager leaves,
and a new one comes in, they come in down here and they drag the team
back down to where they were. And, you know, with some of
our health workers, over the years, they’ve seen this day in… Well,
not day in, day out – but, you know, every year they might have a
different manager, every two years, and sometimes they get sick of that
so they vote with their feet. Which is what
we don’t want to happen – we want to keep strong teams
and that in place. We’ve got some questions
from the audience. ‘Is anyone doing anything about
the differences in State legislation that are limiting health practitioners
in their scope of practice?’ That’s from Bruce at Wuchopperen. So the differences in State legislation. Peter, is there a discrepancy in the law governing the work
of health practitioners? Probably the main one
that’s impacting at the moment is the Poisons and
Dangerous Drug Act in various… DANIEL: It’s the administering of drugs.
– The administering of drugs, yeah. In the Northern Territory,
as I’ve mentioned before, we do have, you know,
a strong legislation, and the health practitioners
are able to practise to their fullest. But in other jurisdictions,
they’re sort of restricted by not having the legislation
in place that helps them to do that. There is national projects at the moment
to look at harmonisation of legislation. There’s other projects around… ..prescribing
for non-health practitioners and for other practitioners
who don’t have it at the moment, and that’s being looked at
and worked on now. Another question – I think
we’ve possibly answered this one, but I’ll ask it anyway,
from Gayle in Tamworth. ‘Do Aboriginal health workers
need to become registered to be health practitioners?’ Yes, they do. Yes, well, you can’t use that title. ‘Aboriginal and Torres Strait Islander
health practitioner’, or ‘Aboriginal health practitioner’ or ‘Torres Strait Islander
health practitioner’ are the three protected titles
under national law, and it’s illegal to use those titles. But going back to the workforce itself, I think if you were doing a practice that can endanger a member
of the public in that practice, I think you probably
should be registered. There are some practices out there that you’d need to have, I guess,
specific training around and skills,
but as Richard mentioned before, you have to be careful
that the practice they’re doing is one that needs to be regulated
as well. ‘Cause one thing you don’t
want to do is overregulate. Mm. Of course. Richard, can I ask, why do you think some non-Indigenous
health professionals don’t recognise the role of Aboriginal and Torres Strait
Islander health workers? I think you’d be in a position to know why it is some people
don’t value their roles. Look, I think a lot of
it’s just straight-out ignorance. I mean, there’s not a lot of
bad intention to people out there. Mostly, health professionals
are trying to do the best they can for the patients they’re looking after. But they’re uncertain and they’ve been exposed often
to particular industrial models within their own craft group – you know, medicine, nursing
or subsections thereof – and are uncertain about these people
who seem to be doing things, they’re not quite sure how that fits in. So I think that’s part of it. It’s probably the major part, actually. There’s a little bit
of risk aversion, maybe, in relation to, ‘Well, is that legal?
Could I get sued?’ And of course, there is no getting past
everybody’s duty of care, including
Aboriginal health practitioners’, to be applying best judgement
and to be appropriately prepared. And so a lot of this
is about providing a system of quality and effective practice – standing orders, guidelines,
review of position descriptions, supervision arrangements, delegation, where you’re happy
for people to do certain things but they call you if there’s something
that’s outside of that. And all of these things
being worked out in the workplace, and more broadly now,
with registration, with Poisons Act reform, as Peter said, is part of providing a broader framework that goes right
from the legislative level down to the level
of the individual practice. Is there discrimination and racism
going on? There is.
I’m wearing my STAR badge – my Stand Together Against Racism
in healthcare. A great concept. I think you have to speak and name
and understand and recognise racism. Mostly, I think, though, it’s not racism
at the level of the individual – it’s something deeply seated. I think what we mostly see
is institutional racism – you know, a culture that develops
in an often highly itinerant health-professional environment, where people
are turning over frequently, when the language becomes, maybe, ‘Why do they let their kids
get like that?’ or, ‘Why didn’t they come earlier?’ And this sort of language enters
the workplace and becomes the norm. And that’s really the basis, I think, of a lot of discriminatory practices
in healthcare, rather than people having some sort
of deep-seated nastiness to them. I think, therefore, the challenges
are around providing… Say, for instance,
the cultural safety training gives people a different lens. I think even more importantly if you can make
the delivery of healthcare with and from the community
rather thantothe community. And this is really, surely, where
the Aboriginal health worker role really comes to the fore. Because it’s more than just
the provision of effective care, it’s people having a sense that
they can control their own destiny and shape their own lives
and those of their kids. JENNY: Absolutely. And it does – it draws
that line between acute care and primary healthcare. And doctors and nurses
are very much trained in acute care. Fortunately, now, primary healthcare
is developing a real focus. That’s a very good point. And it’s that holistic
primary healthcare. Jargon, we hear it all the time –
that’s what it is. The only profession
trained entirely in primary care. So there you go. We do have some poll results. ‘Do you think the team
you work in fully values the role of the Aboriginal and Torres Strait Islander Health Worker or Practitioner?’ And the next poll question: What do you think needs to be done
to improve the situation, Richard? I think this is a fairly
broad question but quite targeted – what can we do so that we can make this
much easier for our health workers? If I can speak maybe
just from a doctor perspective, I think doctors can really
play a very effective role in advocating for and expanding
Aboriginal health worker roles and have a responsibility to do so. I think that teaching… As I say, every patient encounter is
a teaching and learning opportunity in both directions, and should be used
and regarded as such. And a point I think Peter made you know, that no doctor should be
leaving any healthcare team with less skills than what they found. And so I think
that’s particularly important. I think also a role for doctors in teams
is working with everybody but also having people’s back,
from a technical point of view, so there’s a sort of contributing
medical expertise to the team and people feeling comfortable
that someone’s got their back. Then when there’s a tough one,
there’s someone that you can go to. So I think these are really important
cultures to bring to the workplace, and a particularly important role,
I think, for doctors. Angela, what can an employer
do in this situation? If you were speaking to the chief
executive of a local health service, what would you ask them to do to, I guess, improve these
kind of relationships that we need? Well, certainly, recognise the role. I think Richard’s referring to medicos, but we need to look at
true multidisciplinary teams of which everybody has an
equal part – and that’s where, with the Aboriginal health worker
registration and the recognition as a profession, that will certainly assist that process. And it’s about
knowledge and understanding. You know, again, when we talked before,
we talked about ignorance. And unfortunately, there’s still
a lot of people that are ignorant. And that’s not being disrespectful – they may not have had
the opportunity to learn. But it’s our mandate to educate
and get the message across. Jenny, can I ask you,
is there one specific thing that you’d like to see changed? Oh, I think recognising
Aboriginal health workers for what we are. Registration is one step. And I think it’s education programs
like this and the fact
that Aboriginal health workers are standing up now nationally
as an Aboriginal health profession, I think, is one of the key things. Registration is definitely the key one, because then we’re considered
to be real professionals. There was that report, Peter Pangquee,
the Growing Our Future report, which said that Aboriginal and
Torres Strait Islander health workers weren’t always fully empowered
to deliver their role. What can we do to make sure that
our health workers are empowered? Look, I believe
that other health professionals need to really get behind this
profession and push this profession. I think employers need to get out there
and really look at the value – why do you want a health worker? – and actually emphasise the fact
that this is a growing profession and that we want to grow it. We want mobility across Australia and we want to be able
to do what nurses and doctors do and go and work in other jurisdictions and have the same level
of respect and admiration that we have
for our other health professionals. Get behind the health-worker profession,
I think, is a really key thing. Mm. Rita, a question for you. What are the main aspects
of a workplace that make it safe for Aboriginal and Torres
Strait Islander health workers in your experience? How do we make our workplaces
culturally safe for them? -Well, we need more recruitment.
RICHARD: Yeah. Enough of them. There’s not enough, because there’s only me in the
Children’s Hospital at Westmead. There’s only one person next door
in the adult hospital. And across the country,
across New South Wales, there is just one. In some places, you know,
there’s three or four. So… you know,
talking about recruitment, the health workers currently
that are in the system now… ..are gonna be retiring soon. And we’ve been talking about,
you know, recruitment for the last 20 years, saying that
there needs to be new incentives to bring the next generation in
to be trained up as health workers, like ourselves, because, at the end of the day,
when all that happens, there’s gonna be a wide gap
of knowledge, expertise… – And who’s gonna fill that gap?
-Mm. Because it’ll be a time frame
to train all that as the health workers grow
and stay in the workforce. Let’s take a look at some of
the responses to our last poll question as we run out of time here: Yes, we need to look at
some further resources here. There are a number of organisations who have a range of useful information
available on their websites and who generously contributed
their time and expertise as part of an advisory panel
during the development of this program and the associated documentary, A Unique Profession: Jenny, could you speak to this slide? NATSIHWA – we’ve talked about them, the National Aboriginal and Torres Strait Islander Health Worker Association. JENNY: Yeah, as the chairperson of NATSIHWA we are on the ground rounding up membership, we’re advocating for Aboriginal health workers and advocating for Aboriginal health workers to become registered practitioners. There’s the Practice Board of Australia as well. The Registered Training Organisation Network. NACCHO is another source of information. And Health Workforce Australia, which is an Australian Government initiative. And of course the Rural Health Education Foundation website – The Rural Health Education Foundation is collating a DVD
which will have a copy of this program as well as the documentary
A Unique Profession and the extended case studies, with interviews with health workers
and practitioners along with other resources from the organisations we’ve just mentioned. It’ll also contain a structured Learning Guide for those who wish to undertake accredited, in-depth education on this topic. The DVD is available to order from the RHEF website. Jenny, some key take-home messages. One key take-home message
as we run out of time. I guess to recognise
that Aboriginal health workers play a key role in the improvement of Aboriginal and Torres Strait Islander
peoples’ health. Angela? Just that it boils down
to basic respect, as a non-Aboriginal nurse,
and I’m talking about respect for another culture
and openness to learning. We expect Aboriginal people
to be learning all the time and forget that
we’re very task-orientated. We need to learn
to always see the broader picture, always consider it in context
and not just the here and now. Peter. Yeah, I’d like to see
all health professionals promote this profession, get on board, work with Aboriginal health workers,
Aboriginal health practitioners, and if you think you’ve got Aboriginal
primary healthcare and you don’t have
Aboriginal health workers, you don’t have primary healthcare. And Rita, yours was recruitment. It was recruitment, yes. I mean, I did say that,
but at the end of the day, it’s about time we started
respecting the difference. Richard. Look, take-home message –
dispel the myths, there are no barriers
to flexible, team-based care, where everybody contributes
and you have a comprehensive model. And just embrace that
as your practice approach. Thank you. Now, if you’re interested
in obtaining more information about the issues raised in this program or would like
to watch this program again, please visit the Rural Health Education
Foundation website and click on the A Valued
Profession program web page. Now, if you are
a health professional, don’t forget to complete
your CPD evaluation form, which can be completed online. You’ll receive
a certificate of attendance and, if eligible, CPD points. Our thanks to Health Workforce Australia, an Australian Government initiative, for making this program possible, and to all those organisations and individuals who have contributed to its development and who have generously shared their stories with us. And our thanks to you
for taking time to watch and contribute to our discussion today. We’d appreciate your feedback
on the program. Your comments
are very important to us. Let us know you watched the program
by sending us an email or a text, and feel free to share your views –
we’d love to hear them. I’m Daniel Browning. Goodbye. And join us again
on the Rural Health Channel. Captions by
Captioning & Subtitling International Funded by the Australian Government
Department of Families, Housing, Community Services
and Indigenous Affairs. The Rural Health Education Foundation is producing a DVD which will have a copy of this program as well as the documentary A Unique Profession and the extended case studies and interviews with health workers and practitioners, along with other resources from the organisations we just mentioned. It will also contain a structured Learning Guide for those who wish to undertake accredited, in-depth education on this topic. You can order your free copy now by going to the RHEF website – The Rural Health Channel broadcasts 24 hours a week. To see what other programs are showing tomorrow and for the rest of the week, jump onto the Foundation’s website and click on the RHC TV Guide on the left-hand side�

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