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07 Jul 2022

Q&A: How do we improve Indigenous experiences of healthcare?

  • St Vincent's Hospital Melbourne
  • VCCC Alliance
  • University of Melbourne

To celebrate NAIDOC Week, the VCCC Alliance hosted a special Monday Lunch Live centred on improving care for Aboriginal and Torres Strait Islander patients with advanced disease.

An expert panel featuring Professor Gail Garvey (GG), Abe Ropitini (AR), Clare O’Reilly (CO) and consumer Leah Lindrea-Morrison (LLM) discussed the more practical side of improving palliative care for Aboriginal patients with cancer in line with the Victorian Aboriginal cancer journey strategy.

What are some of the main issues in supporting aboriginal people with advanced disease?

LLM: Doctors that are seeing us need to be culturally aware and sensitive to our needs. It's about understanding and respecting and acknowledging Aboriginal and Torres Strait Islander people's beliefs. In different areas and on different Country, we have different beliefs in our care, and some people don't understand that or aren’t aware of those beliefs. Western medicine focuses on, “OK, there's a diagnosis and we need to treat that”, whereas Aboriginal people look at things more holistically. I think it’s about having a western medicine style but also complementing that with an Indigenous cultural way, and that could be in many different forms.

GG: It's about how we as Aboriginal and Torres Strait Islander people see and experience our health – it's not about us as an individual, it's about us as a collective. The caregivers and the families are of critical importance to the health and wellbeing of Aboriginal and Torres Strait Islander people, and we have to be mindful of that when we're providing services in a cancer care setting.

Our focus is not on our illness and our disease, it's on our family, it's on our Mob, it's on our Community.

What opportunities does the current 10-year time horizon in the National Cancer Plan provide for improving cancer outcomes for Aboriginal and Torres Strait Islander people?

GG: Back in 2015, we developed Australia's first Aboriginal and Torres Strait Islander cancer policy – the National Aboriginal and Torres Strait Islander Cancer Framework – and in looking at the current discussions around Australia's Cancer Plan, lots of the recommendations and barriers and enablers that we suggested back then are still current today here in 2022. What's critically important in having plans is developing some monitoring and evaluation frameworks so you can actually see progress as well. Otherwise, you have what happened with the National Aboriginal Cancer Framework – it's still there on the shelf and as relevant today as it was seven or so years ago.

AR: What we're wanting to see within the short- to medium-term is good sector strengthening, particularly in Aboriginal community health, from Aboriginal Community Controlled childcare services through to Primary Health Services, social and emotional wellbeing services and aged care services as well. Effective partnerships with mainstream health services are also vital to ensure these services are culturally safe. If an individual chooses to go to a mainstream health clinic, there is still a baseline expectation that that service is making efforts to become more culturally safe.

There should be no 'wrong door' for anybody in accessing healthcare services wherever they want to access them.

What are some strategies for healthcare teams who are caring for people who are disconnected from their country either through loss of knowledge due to the Stolen Generations or through disconnection with family?

GG: I think if there were programs around the training of non-Indigenous health professionals to ensure culturally safe and competent care in the cancer care setting, perhaps then health professionals may know what to do or how to provide cancer care for Aboriginal and Torres Strait Islander people, whether they’re Stolen Generation, disconnected or not. Engage and have discussions about how you might support that person locally through discussions with your Aboriginal Liaison Officers, Aboriginal health workers or community organisations. There needs to be more workforce planning and support in palliative and cancer care so that healthcare professionals have someone cancer-specific who can help them map out and work through that journey for patients. Having an Aboriginal and Torres Strait Islander Patient Navigator has been recommended for years and is still being recommended as someone who could be critical in providing that sort of support for clinicians and for the patient. It’s also important we consider the psychosocial aspects of cancer care and the social determinants of health. If we can link in with the patient and the family around those aspects, it might help support how you might care for someone who's disconnected from Country.

CO: We also can't assume that whilst we’re talking about connection to Country and that's important for some people, it may not be for everybody. There are community members who may not be living on Country and would actually rather be closer to where their own family is, so I think the important thing is to actually ask the individual and their families, because that's what's going to be important for them.

LLM: I would like to see a lot more offerings of cultural classes for people that are in care or having treatment. I think it's important that workers just have a yarn with people and find out what they're comfortable with. We talk about loss of culture, but it’s important to realise they haven't actually lost it; it's sleeping, so having those yarning groups could bring out some conversations that might help.

AR: I think the key thing is to consult with the Aboriginal Hospital Liaison Officers around the best approach to connecting people to the right support at the right time. There is a social and emotional wellbeing framework that has been developed which helps to understand what’s important to a lot of Aboriginal people in relation to access to health services and potentially disengagement from health services. The onus really is on health professionals in mainstream health to be aware of that framework.

If there is a lack of cultural safety and a lack of understanding around how to engage, then outcomes will be poorer.

To find out more about our work in addressing health inequities, explore our Health Equity hub.

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