I endorse the views of Dr Tamara Mackean about the need to listen to indigenous Australians when it comes to designing health services that will better meet their needs (or any other public services as she so rightly points out).
However, I have had quite a bit of experience working with Aboriginal people and have had the privilege of learning even more through involvement in formal research on the health service needs of Aboriginal people. What I think is quite remarkable is the great consistency in their views, regardless of the health issue – from antenatal care, HIV treatment and support, cancer care, management of heart attacks and cardiac rehabilitation to delivery of alcohol and drug services. There is also surprising consistency despite huge differences in the geography and circumstances from which they come.
For those of us ashamed to live in a country where descendents of the original inhabitants suffer so profoundly from health and other disadvantage on a large range of social indicators, the Rudd government’s commitment to close the life expectancy gap within a timeframe that everyone regards as challenging is more than welcome – it is inspiring and uplifting.
While moving forward on this substantial task definitely needs to be done working closely with Indigenous communities and people, I feel squeamish at the thought that it will begin with (yet more) consultation. My indigenous friends and colleagues often complain about the number of consultations they have participated in where the recommendations are never implemented. So wouldn’t it be heartening to see a commitment to action on consultations already undertaken.
Since most of the money in health gets spent on hospitals, let’s start there. The National Health and Hospitals Reform Commission in a recent report to the Government setting out the framework for the next Australian Health Care Agreements has highlighted 12 critical challenges for which there is already extensive documentation of the need for improvement.
The first of these is to “Close the Gap” in Indigenous health status, and others includes recognising the health needs of the whole person and ensuring enough well-trained health professionals. Arguably health professionals are not well trained until they understand and practice cultural safety in their dealings with people of different cultural backgrounds.
I’d also argue it is very difficult for a hospital that has over 3000 staff and has 5-10% of its bed days occupied with Aboriginal patients to practice cultural safety when there are less than 10 Aboriginal people employed within the institution. It amazes me how we produce all manner of statistics on various aspects of health, but try asking about the number or proportion of Aboriginal people employed in a teaching hospital (yes, that’s right, a TEACHING hospital), and the number/proportion of Aboriginal patients, and the figures seem suddenly very difficult to get.
And endless amounts of research or consultation will tell you the same thing – that Aboriginal people want to be cared for in an environment that respects them and in which they feel safe, by a experienced, competent health care professionals and by a healthcare team that includes Aboriginal staff. This has something to do with black faces and a lot to do with shared cultural beliefs and trust. Healthcare providers don’t have any trouble understanding the need for Aboriginal staff as they are often very aware of their own limitations. As they often say, “it’s not rocket science”. So we are left to wonder why more concerted action has not occurred …
I don’t know anything about André Gide but there is a quote attributed to him that I am particularly fond of which seems to me to capture perfectly how indigenous Australians must feel about research and consultation. “Everything has been said before, but since nobody listens we have to keep going back and beginning all over again.”
Please, please let us not keep engaging in endless consultation with indigenous Australians, but pause to listen and then act with integrity and respect for the information we have already been given.