Effective health delivery for Aboriginal and Torres Strait Islander communities requires two-way knowledge and mutual communication.
An old Aboriginal man from a remote community rests motionless in bed 7A and stares at the wall, disengaged from the comings and goings in the ward, the television programs and the conversations in the beds around him.
He’s bored, but because English is his third language, he doesn’t understand a lot of the fast talking on the TV. He’s lonely and misses his family, who are only allowed for an hour or two during visiting times. He’s sick, and trying to hide the anxiety about whether the translator they got in to help him talk to the doctor was getting the right words across. He’s also hungry, because although the hospital provides good food, the menus are indecipherable because he can’t read English.
He could be an Elder who has been holding his community together for years, or simply a man who has lived a good life and wants to keep doing so. But his capacity to get back to full health is compromised by a narrow focus on the selection and delivery of medical care, without addressing his overall needs.
It's with the needs of individuals and their communities foremost that Flinders University’s Poche Centre for Indigenous Health has developed a lofty ambition, with a grounded premise: to deliver measurable improvements in the current and future health of Aboriginal and Torres Strait Islander people through two-way knowledge transfer, research translation and holistic health leadership.
One of the daily challenges for the Centre’s Acting Director, Dr Maree Meredith, is to find a new way of mutual communication, one that truly engages the many different communities she’s striving to support and empower, and which delivers tangible outcomes – not just nice words.
Dr Meredith and her colleagues are striving to introduce change. Their research shows that Aboriginal and Torres Strait Islander communities experience health and talk about it very differently to mainstream health workers. She contends that the mainstream community needs to listen. “We need to shape the health conversation in the community’s terms. It shifts power to the people who need to benefit from our medical research. If not, we won’t make progress.
“We’re advocating for a social model of health. For Indigenous Australians, you cannot have an effective conversation about health unless it is also about language, culture, country and family. These four aspects cannot be separated from what it means to be healthy. It must be a holistic conversation.”
Dr Maree Meredith
Dr Meredith says that the biomedical model and relationships with doctors will not improve unless broad relationships are improved with Aboriginal communities. It’s not only about reframing the health conversation, but also the model of how health institutions operate. The wealth of research currently conducted to improve the health of Aboriginal and/or Torres Strait Islander people is rarely prioritised or even contemplated by communities. Equally, the localised priorities of communities are often not considered when shaping research programs.
“This is about privileging the voices of Aboriginal and Torres Strait Islander people. They are not going to talk unless we create the right space.”
This requires a big shift from how the medical sector currently operates, with Dr Meredith saying greater empathy needs to be employed. “The biomedical model is only one way of dealing with health. There are customary healers who have been practising for millennia, and Indigenous knowledge also needs to be at that interface; if Aboriginal and/or Torres Strait Islander people choose to visit a healer before they visit the doctor, that may change the timing and nature of medical interventions,” Dr Meredith says. “Equally, if patients feel uncomfortable, hungry, anxious or lonely in hospital because of cultural issues, that can have a significant impact on their willingness to undergo medical procedures and their recovery.
“Medical people come with their expertise, but Aboriginal people bring their lived experience, along with their experience as customary healers. It all has to come together.”
Dr Meredith, a Bidjara woman from southern Queensland, worries that the capacity for ill Aboriginal and Torres Strait Islander people to get back to full health is compromised by a narrow focus on the selection and delivery of medical care, without addressing people’s overall needs. “The recent news that federal, state and territory governments are set to hand back some of the control over health programs to empower communities is a watershed moment for the nation, but it also requires a new model of research translation and two-way knowledge exchange.”
Dr Meredith based her PhD research on how Aboriginal art centres are critical to maintain and improve health and happiness in remote communities. “My first-hand experiences helped me to understand what the priorities of individual people were before any research agenda could kick in. Going into community, you have to listen very deeply to conversations. While the art centres were beneficial, the people I met there were very sick. They weren’t just the subjects of my research. Their lives were at stake.”
Now, as the first PhD graduate of the Flinders Poche Centre for Indigenous Health, Dr Meredith is in a strong position to drive change through improved Indigenous health programs. “The great opportunity right now is how we train the current generation of students to be the next practitioners. It’s a transformative time; the University is implementing its first Reconciliation Action Plan, it has increased the numbers of Aboriginal and Torres Strait Islander staff, and it’s why we have Indigenous Elders on campus, so that when a non-Indigenous person comes into our program, the first thing they see is an Aboriginal face.
“This is where the new journey starts, and it broadcasts a bigger message about our reconciliation. We can start to unpack what this really means in our research and our teaching.”
Dr Meredith hopes it will serve as a beacon to other institutions. “If it can start with a university, then why can’t the same type of inclusion extend into other institutions, like health and hospitals? Commitment has to come from everyone if there is a genuine desire to change. Without that aspect of working together, it’s never going to work.”
Dr Meredith believes effective health delivery can be an important signal of how Australia reconciles in the future, and a significant part is a health system that respects Indigenous community approaches. “We don’t go into a community unless we are invited. We don’t impose our ideas. Instead, we accept their invitation, either from individuals or from communities. That’s the first step of respect.” Due to this, invitations for the Poche Centre to work with communities are coming thick and fast.
Her focus is on turning research into policy changes. “It’s so important that this research doesn’t sit still.” Where will the wins come? “Well, I’m meeting the health minister this week,” Dr Meredith says, explaining her advocacy for an Indigenous arts and health framework in the NT that will sit separate to the national framework and clearly articulate the priorities for people in the NT.
CRICOS Provider: 00114A TEQSA Provider ID: PRV12097 TEQSA category: Australian University
Last Updated: 20 Oct 2022
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