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June 2, 2021
Indigenous health remains one of the biggest challenges facing the nation.
While we work towards “closing the gap”, the fact remains that if you are an Aboriginal or Torres Strait Islander you are likely to experience worse health outcomes and shorter lives than most other Australians.
As part of Reconciliation Week it’s worth noting how a team at St Vincent’s Hospital have developed a new approach that is achieving good Indigenous health outcomes.
St Vincent’s, located in Sydney’s inner east, has a large pool of potential patients among its local urban Indigenous communities.
But the team found that how Indigenous Australians relate to western medical institutions large and small is a big part of a wider problem.
Around Australia an estimated 7.5 percent of Aboriginal and Torres Strait Islanders leave hospital before receiving adequate care. Ill or injured, they present for treatment, but often leave before it is complete, thus missing out on sometimes vital health care.
At St Vincent’s the problem was often worse, with up to 30 percent of Indigenous Australians walking away.
It’s a serious issue, as it means a simple health problem can go untreated, become chronic, and have major long-term effects.
Last year St Vincent’s doctors and Aboriginal health staff worked to identify several key issues behind the problem:
● Aboriginal people were sometimes daunted by hospitals;
● They disliked how they were treated;
● Importantly, they didn’t like waiting to be treated.
“A high number of Aboriginal people were coming in through our emergency department and were leaving us, not completing their treatment,” St Vincent’s director of Aboriginal health Pauline Deweerd told ABC radio in an interview last month.
“It was because of past experiences. They didn’t like waiting and they didn’t like the way we treated them. It wasn’t that long ago that Aboriginal people weren’t allowed in hospitals.”
St Vincent’s set out to try to fix the problem, and the results have been astounding.
In the Emergency Department’s new Indigenous Flexi-Clinic patients are offered faster triage, more flexibility, and also a level of cultural support. As a result the rate of incomplete treatments for Aboriginal patients fell from nearly 20 percent to just 1.6 percent.
“Everyone’s got different values and everyone’s got different priorities, and in this group of patients we needed better options,” Emergency Department director Paul Preisz told the ABC earlier this year.
Dr Preisz said hospital staff realised early on the main thing missing was flexibility, which the new clinic has helped rectify.
“We found we could have patients come for a while, come back when they needed to, and keep their treatment running,” he says.
“We didn’t have an appointment system, we opened a card which basically said ‘you can walk in and we will continue this where we left off’.”
Culture and inclusion are also factors in the program’s success.
The Flexi-Clinic, which opened in June, is headed by Yuin man Scott Daley. Not only does the clinic ensure presenting patients are quickly triaged, where possible they are also cared for and supported by Indigenous staff.
“You’re able to make those connection points – ‘where’s your mob from, where’s your mum from’ – you start to get, ‘oh, we’re related’,” Mr Daley told the ABC. “That makes a big difference for outcomes and that level of safety.”
Indigenous patients now speak of “feeling safe and secure”, knowing they will be well cared by staff who are sympathetic to their individual situations.
The lessons from St Vincent’s could go beyond state level and hospital staff are proud of their success.
“I’ve been here since 1982 and it’s been a problem since at least then,” Dr Preisz said. “We had really good doctors and nurses and the patients needed our help, but something wasn’t connecting.
“It’s our attempt at closing the gap for our small part of the world. We not only brought it (treatment completion) to the level of the general population, we made it a little better.”
