We don’t yet know the rights and wrongs surrounding the case of the four-year-old girl whose death last week at Doomadgee in Queensland’s Gulf of Carpentaria is now the subject of various inquiries.

What can be said with absolute certainty, however, is that Aboriginal people have good reason to be mistrustful and suspicious of mainstream health services.

Historically speaking, health services have been part and parcel of racist policies — it is not so terribly long ago that they were involved in the incarceration of Indigenous people suspected of having sexually transmissible infections, for example. Until the 1960s, Aboriginal people in public hospitals were segregated from other patients.

In more recent times, the term “institutional racism” has been used to describe, according to this article in the Medical Journal of Australia “the ways in which racist beliefs or values have been built into the operations of social institutions in such a way as to discriminate against, control and oppress various minority groups”. The article gives many examples of how health policies and practices have excluded Indigenous people from access to appropriate care.

That apparently straightforward term “access to appropriate care” hides a multitude of complexities and subtleties. It is not simply a matter of whether health services exist.

As an example, let’s take a trip back 15 years to visit a mainstream clinic, then known as the Inala Community Service, based in a poor area in Brisbane’s south-west with a high concentration of Aboriginal residents.

At that time the practice boasted only 12 regular Indigenous patients. Of course, this didn’t mean that those in the area didn’t need health care. It meant they weren’t comfortable enough with the service on offer to seek its help. It wasn’t seen as friendly, flexible or particularly concerned about their needs.

Fast forward to the present and that service has been transformed. From the moment patients walk through the door, there are many overt signals — from the large colourful mural to the faces displayed on posters to the attitude of the receptionists — that this is a place wanting Aboriginal people to feel at home.

According to this recent report last year there were 3006 Aboriginal and Torres Strait Islander patients registered to the practice, a Queensland Government operation now known as the Inala Indigenous Health Service, with about 900 medical consultations per month.

It is no coincidence that two of the people responsible for driving the service’s transformation are Dr Noel Hayman and nurse Nola White, both Aboriginal health professionals who have worked closely with the local Elders and community.

However, the ultimate expression of Aboriginal people taking control of their own health is when the local Aboriginal community itself establishes a health service, according to Dr Sophie Couzos, Public Health Officer with the National Aboriginal Community Controlled Health Organisation (NACCHO).

She says there are now 150 Aboriginal community controlled health services providing the bulk of primary health care to the Aboriginal population. She also notes that the Doomadgee community has no local ACCHS. “Discussions should be had around what type of service might best meet the needs of this community,” she adds.

It is also noteworthy that many in the community controlled sector feel they are being sidelined by the COAG processes driving Aboriginal health investment despite the emphasis in the new National Health and Hospitals Reform Commission report on strengthening the community controlled sector.

In recent weeks, I’ve spent some hours speaking to nurses and others working in Aboriginal health, in both the bush and cities, as part of research for an Australian Nursing Journal article.

A few themes have emerged. Those from non-Indigenous backgrounds face a huge learning curve in developing an understanding about how to engage effectively with Aboriginal people — even after they’ve undergone cultural safety training. And even those who’ve spent many years working in the area are still learning of the potential for miscommunication.

So while the rights and wrongs of this particular case at Doomadgee are important to establish, especially for the grieving family, it is also worth noting that the adverse events and missed opportunities that flow from miscommunication, mistrust and misunderstandings are a routine part of health care for many Indigenous people.