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14 May 2018

BY AMA PRESIDENT DR MICHAEL GANNON

Last month I was invited to accompany the Hon Warren Snowdon MP, Member for Lingiari and Shadow Assistant Minister for Indigenous Health, to the Northern Territory to meet with local Aboriginal leaders, medical and other health staff.

I saw first-hand the unique challenges that exist in providing primary health care services in the remote Aboriginal communities of Kintore and Utopia.

The Pintubi people of Kintore and the Alyawarra and Anmatjirra people of the Utopia region, separated by hundreds of kilometres, nonetheless share a history, having both returned to their traditional lands to re-establish their communities in the 1980s.

Both suffer from insufficient functional housing and overcrowding. Both have high levels of food insecurity, including limited access to affordable, healthy food and a consistent potable water supply.

Both communities have crippling levels of diabetes and resultant kidney disease, as well as other chronic diseases and communicable infections.

Both communities are serviced by dedicated, generous and passionate health staff who are committed to improving the health of the communities they serve.

Both communities have used their passion and connection to art to drive self-determination for their people.

These communities are proud, with many examples of resilience and empowerment. But the reality is that they face significant and complex challenges.

Funding for local health services remains inadequate. Something as simple as the maintenance and repair of air conditioners, far more than a luxury in the searing heat of central Australia, can cost more than $60,000 per year. Costs associated with transferring a patient to Adelaide for tertiary level care fall on the local health service. It is cost effective to pay for loved ones to travel with patients to Alice Springs, in doing so providing not only comfort, but reducing the rate of discharge against medical advice. However again the costs of transport and accommodation come out of fixed budgets.

It is difficult to attract skilled medical and other health professionals to work in remote areas, and it can be even harder to get them to stay, with many working on a fly-in-fly-out basis or only on short term contracts.

It is also logistically challenging to provide health care in remote communities. While the Commonwealth Government has just announced that they will fund a major expansion of the sealed road to the Urapuntja health service in Utopia, many of the outreach communities, like Kintore, can only be reached by air or via unsealed roads. While rain is necessary and often welcomed in the Northern Territory, it can also isolate communities from services, including the Royal Flying Doctor Service.

The need for haemodialysis in remote Aboriginal communities is extremely high. I was amazed to find out on my tour of Alice Springs Hospital that it is the largest dialysis service in the southern hemisphere. Leaving family and country to be treated in town is problematic.

Connection to culture is important to the health and wellbeing of Indigenous people and is known to produce positive health and life outcomes. Aboriginal people need to be supported to stay in the communities where they are connected to their land, culture and families.

Western Desert Dialysis, better known as Purple House, is an Aboriginal-controlled dialysis service based in Alice Springs that has established dialysis units in remote communities, including Kintore, as well as providing support to other remote communities like Utopia.  

I was already familiar with the inspiring story of how Aboriginal artists from across the western desert grouped together and painted artworks that raised more than $1 million to allow Purple House to begin their community dialysis service. They operate across nine remote communities in the Northern Territory and Western Australia. As well as permanent chairs in these locations, they also provide a mobile dialysis service via their Purple Truck which drives to remote Aboriginal communities.

I gained a deeper understanding of local health issues and the challenges that doctors and nurses face in delivering health services in remote areas. I was truly impressed by the passion, commitment and dedication of doctors, nurses and other health staff who work tirelessly in very challenging environments.

I found that each community has their own unique challenges, but the overall messages that I heard was one of survival and determination. Aboriginal people in remote areas continue to face great adversity, but within each of these communities I saw patient, resilient, strong-willed and determined local Aboriginal people taking control of their own health – with some positive outcomes occurring.

Because of my clinical background, I have long been familiar with the concept of Developmental Origins of Health and Disease (DOHaD). Diagnosis of Type II Diabetes in childhood is as remarkable as it is tragic. The sheer scale of pathophysiology I saw demands a focus on Social Determinants of Health. Of course this informs the AMA’s work nationally on alcohol, nutrition, sugar taxation and other aspects of preventive health. But on the ground health services, provided with funding according to need, are required now.

I am extremely grateful to Warren Snowdon for making the visits to these two communities possible and accompanying me on the trip. I am hopeful that we will see further progress made in improving outcomes for Aboriginal and Torres Strait Islander people across Australia, determined that the AMA will maintain its leadership in advocating for improvements to the health outcomes of Indigenous Australians.

 


Published: 14 May 2018