Annabelle Wilson, Sandy Wilson, Sharon Perkins Aboriginal Primary Health Care Unit, Murray Bridge - Rural Doctors Workforce Agency Relationships ...

Rural Doctors Workforce Agency
Relationships first: Addressing nutrition-related chronic
         disease in one Aboriginal community

Annabelle Wilson, Sandy Wilson, Sharon Perkins
Aboriginal Primary Health Care Unit, Murray Bridge

Acknowledgement

 We would like to acknowledge this land that we meet on today
 as the traditional lands for the Kaurna people and that we
 respect their spiritual relationship to their country.

 We acknowledge the Kaurna people as the custodians of this
 land and that their cultural and heritage beliefs are still
 important to the living Kaurna people today.

Presentation Outline


   Who are we?
     – Sandy, Sharon, Annabelle

   Aboriginal Primary Health Care Unit (APHCU)

   Dietitians in rural areas

   Creation of the dietitian position

   Dietitian role at APHCU

   Elements of practice

   Reflecting on the process

   Challenges & overcoming them

Sandy

 Sandy Wilson - Ngarrindjeri Miminar Regional Aboriginal Healthy
 living Coordinator (Chronic disease prevention and care) Programs
 within a holistic view of health. Work in close collaboration with:
 Area Diabetes Program Coordinator and other area healthy living
 program workers to Facilitate education, understanding and
 knowledge of social, health and wellbeing issues relating to healthy
 living
 Develop and implement Health Promotion and Healthy living education
 programs and activities across and within the community

 Promote the empowerment of Aboriginal people/communities by
 ensuring that programs and services are delivered from a social view
 of health and within the principles and goals of Primary Health Care.
 Negotiate / advocate with GP’s on behalf of Aboriginal clients to
 facilitate program effectiveness

Sharon

 Sharon Perkins is a Kaurna/ Narrunga woman who has worked
 in Aboriginal Health for over 20 years, mainly as an Aboriginal
 Health Worker and now is managing Aboriginal Health services
 across Mallee Coorong and Hills, Southern Fleurieu and
 Kangaroo Island clusters and a part of that role is to facilitate
 the strategic directions for Aboriginal Health.

 Sharon is passionate that Aboriginal Health is Everybody’s
 business.

Annabelle


   Accredited Practising Dietitian


   Interest in Aboriginal health from work as a new graduate
    dietitian in rural & remote SA


   PhD
     – Set in 2 Aboriginal communities, including Murray Bridge
     – “Addressing Uncomfortable Issues: The role of White health
       professionals in Aboriginal health”


   Work with APHCU led to employment as a dietitian


   Annabelle’s journey

What is (APHCU)?


   Aboriginal Primary Health Care Unit

   Aboriginal people supporting Aboriginal people

   Free health services for Aboriginal people

   Clinics include physio, GP, diabetes educator,
    dietitian, podiatry, counselling, psychiatry, dental,
    well women’s, eye health & hearing

   Clinics staffed by Aboriginal Health Workers &
    qualified health professionals

Dietitians in rural areas


   Generally spread very thinly
     – Lots of roles including clinical, community, public health


   Where does Aboriginal health fit?
    – Aboriginal community specific positions (few)
    – Most work with Aboriginal community as part of wider role

Creating the dietitian position at APHCU

>Working in a community health setting as a minority the Aboriginal staff realise we can’t be
   experts of everything other than our own lives

>We must be able to work alongside non-Aboriginal workers to ensure our communities receive
   the best health care to ensure good health outcomes.

>Having Annabelle do this work is an appropriate way of getting to know community at our
   pace, not being pushy, listening rather than dictating, working alongside, not dragging us
   along was an enlightening experience.

>It was after watching how Annabelle worked and how well she worked with our community that
     we decided we really needed her as a resource to help our community understand the
     importance of 2 way relationships. We managed to find some funds on a regular basis to
     ensure this happened we managed to put to our general practice network that we would
     like to employ a Dietitian to work with us and found the Rural Doctor’s Workforce Agency
     has some Medical Specialist Outreach Access Program- Indigenous Chronic Disease
     funding so we could continue with Annabelle’s important work.

Creating the dietitian position at APHCU


   Relationships built during PhD
     – Attending community events
     – Activities of reciprocity
     – Informal mentoring


   Attempts to build a formal reference group replaced with
    informal processes

Dietitian Role at APHCU


   Clients 1:1


   Kids’ Café


   Healthy Eating & Lifestyle Program (HELP)
     – Modification of a manual


   Utensil women’s cooking program-Housing


   Women’s cooking program -Aphcu
    – Talking about healthy eating while preparing food


   Nutrition discussions amongst APHCU staff

Elements of practice


   Working alongside Aboriginal people


   Opportunistic approach to discussing nutrition


   Practice based on community-identified need


   Be prepared for challenges


   Relationships are vital to good practice


   Reciprocity & being willing to give


   Being open & honest

Elements of practice


   Flexibility & persistence

   Importance of support networks

   Using appropriate processes

   Sharing knowledge together

   Steeping outside your comfort zone

   Common interests

   Regular catch-ups

   Recognising the value of
    supporting & guiding each other

Reflecting on the process

 
   Relationships have been crucial for:
      – Obtaining the dietitian position
      – Trust with clients/staff
      – Development of groups
      – More responsive action to community identified need

 
   Opportunity to practice while doing research

Challenges


   Relationship building is time consuming

   Complexity of the area

   Barriers can exist within organisations & at the
    management level

   Data – how it covers the work that we do

   Not coming in as the expert

   Client centered approach

Overcoming the challenges


   How can relationship building be made a priority in the work of clinicians?
     – Support from management
     – Structured opportunities to work together
     – Captured in statistics or other measures of work


   Reorient approach - meeting the community’s needs first


   Allow plenty of time

Conclusion


   Importance of relationships between
    clinicians, Aboriginal Health Professionals,
    Aboriginal people and communities to assist
    in delivery of services

   Focus on building relationships first

   One way to do this is through reciprocity – be
    willing to give

Contact details

Aboriginal Primary Health Care Unit
Phone: 8535 6800
Email:
sandy.wilson@health.sa.gov.au
sharon.perkins@health.sa.gov.au
annabelle.wilson@health.sa.gov.au