The start of something...

When Tim Senior and I started together, it was with a degree of excitement that has continued to mark our relationship in the practice. It was a Tuesday afternoon, my first in the practice, and Tim was letting me in on his plans for #supertwision. In the intervening weeks the plans have grown and become better informed as we both come up with ideas about how to engage with social media with general practice in the context of indigenous health.

 

Across the first weeks in the practice (as I slowly put together this post) I reflected on what my perspectives are about the delivery of healthcare. The basic determinants of health have been a sideline in the previous parts of my career looking after people in a tertiary teaching hospital. The ideas of wellbeing including personal freedoms, good social relations AND physical health are the cornerstone of indigenous health. Wellbeing considers a more holistic view of health which is in keeping with the concept that:

 

“There is no word in Aboriginal languages for health.”

Prof Judy Atkinson

 

It is becoming clearer, from the first few weeks and Tim’s pearls, that a ‘traditional’ view of the general practice consults won’t reach through to encompass true wellbeing. Trying to find a consult style that works will be a big part of what I blog about over the next 6 months.

 

This is my first exposure to general practice in an Aboriginal Medical Service and also my GPT1 term (my first term as a trainee on the Australian General Practice Training Program). So even understanding general practice in the healthcare system is a little alien to me. The practice room is now starting to feel like my own and a place for expression for the people who come in.

 

My postgraduate career has been a bit of a mixed bag; working for the military, having clinical interests in maternal & child health and mental health, working my way through a Masters in Public Health and taking a stint away from clinical practice to be an advocate for the health profession. But maybe it’s the kind of mixed bag that will make for a successful and enjoyable journey in indigenous health, you can watch my progress and tell us what you think.

 

Follow our journey here at the blog, with the #supertwision hashtag and with each of our accounts (@timsenior and @michaelbonning) where we both post on things in healthcare and beyond that interest us.

 

Trying to be exciting about dull stuff – or a note about terminology!

Words are important. Sticks and stones might break bones, but words can certainly cause quite a bit of harm. So it’s worth just taking a moment to set out some of the thinking behind terminology I’ll be using on the blog, and my thinking behind it. Have you ever read a more boring blog sentence? Well, let’s see if we can make this a fun post. Or failing that, a short one.

The thinking behind what we call Aboriginal and Torres Strait Islander peoples has been heavily influenced by colonisation without us even noticing. Aboriginal is an English word which has come to mean the diverse group of peoples who are the original inhabitants of the land masses we now call mainland Australia and Tasmania. Torres Strait Islanders are the group of people who originally inhabited the islands between the northcoast of Queensland and Papua New Guinea. It’s intriguing that the name we’ve given references a Spanish explorer. I’ll try to write Aboriginal and Torres Strait Islander people when that’s what I mean. Much of the time I’ll write Aboriginal and I’ll mean to include Torres Strait Islanders too, really just for clear English purposes – which I am a bit sorry about, as should English trump the needs of Aboriginal and Torres Strait Islanders once again? I won’t be using the term Aborigine, as I find that dehumanising – it’s all too easy to forget we’re talking about people. And I won’t be using ATSI either, as abbreviations are usually a way of using jargon that allows us to forget the concepts behind the words.

I’ll use indigenous in the context of non-indigenous, meaning people who are not Aboriginal or Torres Strait Islander. I’ll also use indigenous when I want to talk about the indigenous people of other countries, as, for example, in the UN Declaration onthe Rights of Indigenous Peoples.

Other phrases it’s worth being clear on are AMS or Aboriginal Medical Service, which is a primary care service servicing predominantly Aboriginal and Torres Strait Islander people. An Aboriginal Community Controlled Heath Organisation (ACCHO), are essentially owned and run by their local communities. Not all AMSs are ACCHOs – Inala in Queensland is an example – and there are some ACCHOs which are not AMSs, providing social rather than health care. Often, the term Medical Service doesn’t do these organisations justice, as that is only a part of what they do, and they are much more than a doctor’s surgery that happens to see Aboriginal patients.

And, just to put a nice cap on all the confusion, there’s Close the Gap and Closing the Gap. Surely they must be the same thing? I’m afraid not. Closethe Gap is the campaign that you’ve heard of, kick-started by the then Social Justice Commissioner, Tom Calma, and supported by Oxfam and led by a range of Aboriginal organisations supported by a large number of non-indigenous health and reconciliation organisations. If you’re reading this, take a moment to sign the pledge, and think about joining or organising a morning tea for National Close the Gap day on March 22^nd.

Closing the Gap on the other hand, is the government program with 6 targets across a range of health, education, and social measures to, er, close the gap. Oh, it does get confusing.

So, that’s cleared that up, then. And with a hop and a skip we move on to the next post.

AMS Doctor - making sense of my work

Last week the Prime Minister, Julia Gillard, released the Closing the Gap report. She and Tony Abbott spoke to it in parliament. Everyone knows that there is large gap in health outcomes between Aboriginal and Torres Strait Islander people and non-indigenous Australians and this report sets out the progress against the goals in remedying this. In other (related) news, constitutional recognition of Aboriginal and Torres Strait Islander people is on the agenda, and there are good reasons why this will contribute to improved health outcomes for Aboriginal Australians. And, in a sign that this issue is important and hurting people right now, we have fresh in the memory a fairly peaceful protest reported as a riot on Australia day. Fortunately, most people agree that something needs to be done about this indigenous disadvantage. And this is where my fancy gets tickled! There is quite a lot of information out there about what works well (and what doesn’t) and quite a lot of opinion and policy. There are even places which collate much of this information in one place (see the award winning AustralianIndigenous Health Infonet which does a brilliant job of collating all the knowledge that’s worth knowing in this field.) But how do we make use of all this information so it can actually make things better for Aboriginal people across the country. I’m going to try to be a guide around all this knowledge. It’s not that I’m an expert, it’s just that I try to make sense of this to improve my own practice, and publishing this will help me do this. I will try to be the sort of guide that I enjoy most – knowledgeable, opinionated and occasionally entertaining. I hope. I shall try to distinguish between evidence and my opinions formed on the basis of that evidence. And I’m happy for contributions and discussion – none of us have all the answers, and so I will learn more than anyone. However, none of us will learn from abuse or personal attacks for opinions we disagree with, except that the attacker has just lost the argument. None of that here please.

My views are heavily influenced by the fact that I spend my primary job seeing patients. I think of this as an advantage (but then I would, wouldn’t I!) as too often people think they know what doctors are doing behind those closed doors, and get the policies wrong. I’ll reflect on my clinical work in an Aboriginal Community Controlled Health Service and the importance of Community Control. I’ll highlight research and reports that are published and comment on how it helps me improve what I do. And I’ll comment on the impact of policy on my patients and my consultations.

Because I’m a GP (not “just a GP” but a proud member of that specialty!) I’ll also highlight old and new GP philosophy and research that impact on my care – mainly because I can’t help myself!

A word of warning however. As a non-indigenous Australian, I will be fervently trying to avoid the mistake we non-indigenous Australians keep on making. We still have a tendency to put on a big red cape and wear our underpants outside our tights as we descend, briefly, on to an Aboriginal community with “The Answers.” The problem with this is that it just makes us look silly. Not just because that’s not where you should wear underpants, but because we’ve tried this as a solution, and it doesn’t work. It hasn’t worked for over 200 years now.

The only way these problems will be solved is to work with Aboriginal people and communities. Let me rephrase that. The only way these problems will be solved is to work with Aboriginal people and communities. So, one of the main reasons for writing this blog is that I’m a doctor, and I work in this field. That means people end up listening to what I have to say. And this is what I have to say, in essence: “You’re listening to the wrong person! Yes, I have some opinions, but you need to go and listen – not speak to, but listen, understand – to some people in your local Aboriginal community.” And that is essentially the central message of this blog. I’m optimistic that the gap will be closed, and excited by the nation that we can become. After all, get this right, and we will all be changed for the better.

Enough introductions now. Let’s see what shape this thing becomes...

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