ROYAL COMMISSION: Access to health care, health literacy and language barriers

Dr Kate Fox, General Practitioner (GP) at Kimberley Aboriginal Medical Services (KAMS) and Broome Regional Aboriginal Medical Service (BRAMS), faced the Commissioners today to tell her own experiences working within the Aboriginal communities in Broome.

Her main focus was on the poor access for Aboriginal communities who have no travel options, the difficulty in promoting preventative care and finding symptoms of more serious diseases and conditions, as well as the language barriers between GPs and their patients.

A very rich community for Aboriginal culture, the Bidyadanga people live around the Broome area, with up to five different Aboriginal languages spoken in the area.

Most Bidyadanga people don’t have access to their own transport, which requires them to either walk to a clinic to get health care or have transport and pick up provided.

“That’s obviously the next level of difficulty with access, because it relies on – it always is going to rely on someone to be able to transport them to clinic and… we often have difficulties with older, morbidly obese, or, you know, even just frail patients who sometimes can’t access the vehicles that are available to KAMS,” says Dr Fox.

“Bidyadanga has a significant amount of complex, really poorly controlled, but also difficult to control despite optimum management, chronic medical conditions… With older people, those conditions are much more prevalent and usually much more difficult to control. And obviously, the usual complexities that comes with being older are suffered by people in Bidyadanga.”

In many cases, Elders are visiting clinics with acute or minor issues, rather than addressing chronic conditions that could result in worse problems further down the disease process.

Dr Fox says, “It’s the underlying health literacy that prevents people from being able to come in and address their chronic needs.

“If you have lots of people that are coming in for acute care needs… it makes it increasingly difficult to be able to address underlying chronic care needs for older patients in Bidyadanga.”

Language barriers in Broome are quite significant, with older Indigenous Australians speaking limited or no English.

While there are ways to break down the language barriers, like through a professional interpreter, it can impact the trust building necessary when treating an Aboriginal Elder.

Sometimes Dr Fox has a member from a local organisation who can sit in on a consultation and help with communication or involve a family member, but that can bring its own complications.

“It’s really important to build relationships of trust. and I think, you know, trust is important in any therapeutic doctor/patient relationship, but it’s the next level when it’s a white doctor and an Aboriginal patient,” says Dr Fox.

“I think that’s due to the… historical impacts of colonisation and past discriminatory government policies and marginalisation of, essentially there was exclusion of Aboriginal people from… white Western health services.

“Those past discriminatory policies have engendered this transgenerational distrust in white people and white health services. So I’m fighting an uphill battle to build a relationship of trust, and trust is important, so that I can build some rapport and engage a patient in care, and make sure that they can be engaged and can be empowered to improving their own health outcomes.”

Dr Fox thinks awareness of these underlying issues is important to create a trusting relationship with Aboriginal Elders, but it does take time and continuity.

She admits that over her two and a half year involvement at Broome, she has been there longer than most other GPs, suggesting that medical staff retention is difficult in remote areas.

Dr Fox agreed with the Commissioner about the importance for older Aboriginal patients to stay on country as long as possible, however lacking services and resources results in many Elders having to leave country.

“I think it would be amazing to have some better resources for bigger communities like Bidyadanga so that older people can stay on country because… Aboriginal people in Bidyadanga have a deep connection with family and with country,” says Dr Fox.

“There’s evidence to show that people do better staying on country for as long as they can.

“Also being able to start that process of helping people understand more and improving health literacy levels about the importance of preventative health care and chronic disease management. It’s ultimately those chronic diseases… that prevents people from being able to remain on country.”

Extra training for staff to be culturally safe when providing care along with an improved employment strategy involving an intake of Aboriginal workers would also help with providing remote community aged care.

Commissioner Mr Richard Tracey AM RFD QC mentioned after Dr Fox’s testimony that, “It has been fascinating hearing about how things are dealt with, the need to adapt medical practice to suit the environment in which it has been provided.”

Hearings will continue next Monday, June 24, at 9.30am AWST in Perth, WA.