Life Changing Indigenous Placements

I had always been interested in Indigenous health and the reasons behind the health gap between rural and Indigenous Australians. The life expectancy of the Indigenous population is significantly less than the non-Indigenous population (10.6 years less for males and 9.5 years less for females). Indigenous Australians die at five times the rate of non-Indigenous Australians between the ages of 35-44.¹

Gaining a deeper understanding

Yalata was my first glimpse of what health care in a remote Indigenous community was like. It was completely different from anything I had ever seen. Their Aboriginal Controlled Health Service had a GP visit for only two days, once or twice a month. Most of the time, the clinic was run by Aboriginal health workers and nurses. I saw many advanced disease processes such as trachoma, middle ear infections leading to ear drum perforation, and end-stage diabetes complications. It amazed me how much was managed in these small remote clinics.

Since my visit to Yalata, I have visited Indigenous health clinics in Coober Pedy and Alice Springs to gain a deeper understanding of Indigenous health. It has given me insight into some of the factors that I feel are contributing to the Indigenous health gap:

• Lack of staff and resources, and often rapid turnover of staff in remote Indigenous communities, mean patients sometimes cannot access adequate care and follow-up.
• The ambulatory nature of the Indigenous population who often move between different communities make follow-up difficult.
• Indigenous Australians view health as a spiritual matter and often need spiritual as well as medical care.
• English is often a third or fourth language to many Indigenous Australians living in remote communities and language barriers may impede care.
• There are many underlying socio-economic factors such as lack of employment opportunities and activity in these communities leading to poverty and drug or alcohol abuse, which compound medical problems.

Small things can make a big difference

While this makes Indigenous health sound very gloomy, these placements were the most rewarding time at medical school because I was also able to see how small things can make big differences.

I met the most dedicated medical, nursing, allied health and community staff in these communities who contributed 150% to their job to make a difference. A nurse in Alice Springs has significantly improved the adherence to benzyl-penicillin injections for rheumatic heart disease prevention through a stringent follow-up program and widespread community education programs. Other creative measures like making school attendance compulsory in order to visit the community pool in Yalata has greatly increased school attendance. This will hopefully be linked to an increase in health literacy and community health, given higher levels of education is associated with better health outcomes in Indigenous Australians.²

An enlightening experience

I strongly encourage anyone to undertake a placement in a remote Indigenous community as it exposes you to a very different medical experience. You see disease processes not often seen in other parts of Australia, such as rheumatic heart disease, trachoma and scabies. It is also eye-opening to see the many cultural, language and resource barriers associated with Indigenous healthcare. It is a worthwhile experience even for those who will never work in remote Indigenous health. The knowledge gained will also facilitate better care of Indigenous patients in our cities.

The University of Adelaide has many Indigenous health placement opportunities including the Insight Indigenous Health Program. I would encourage students in other universities to seek out similar placement opportunities.

Dr Cicy Li (MDA National Member)
Intern, Royal Adelaide Hospital

Dr Cicy Li is a recent graduate of the University of Adelaide. She won the Rural Doctors Association of Australia (RDAA) Medical Student of the Year Award in 2015. She was recognised for her strong interest in rural medicine and her dedication to encouraging others to pursue a rural medical career.

References

1. Australian Institute of Health and Welfare, Australia’s Health 2014.
2. Australian Bureau of Statistics 2010. Available at: abs.gov.au/AUSSTATS/abs@.nsf/lookup/4704.0Chapter365Oct+2010