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Closing the gap by opening the door to cultural understanding
It is vital to explore the past, in order to secure better health outcomes in the future for Aboriginal and Torres Strait Islander communities, according to James Cook University (JCU) cultural educator, Henry Neill.
General Practitioners (GP) must learn to appreciate the impact of history on health, as well as how to engage meaningfully with Aboriginal and Torres Strait Islander patients, in order to help close the gap.
Mr Neill is better placed than many to appreciate the challenges involved. His father, a post-war, white English immigrant, and his mother, an Indigenous women, “went through a lot of racism for being together.”
“In order to move forward together to provide better health care for Aboriginal and Torres Strait Islander communities, we need to understand the past,” Mr Neill observed.
“There are historical reasons why we die earlier than most, suffer more from chronic conditions and are the least employed. We didn’t wake up one morning and think ‘we’re going to be all those sorts of things’.
“But we previously have had no power in policy development for our health and education and the like. This is slowly changing, with the input of the Queensland Aboriginal and Islander Health Council and National Aboriginal and Torres Strait Islander Community Controlled Organisations.
“But the residual effects of some laws and past policies are real in the living memory of lots of our Elders. These include issues of transgenerational trauma, the Stolen Generation and the lost generations. Trainee GPs need to know this. Not to have sympathy, but empathy.”
Raised by his parents to value education as a key to opportunity, Mr Neill became a school teacher. Providing academic and pastoral care to both young Aboriginal and Torres Strait Islander students and non-Indigenous students led to a series of cultural education related roles in the tertiary sector and with Primary Health Networks in Queensland.
In 2017, he was recruited by JCU’s GP training program to play an integral role in equipping GP registrars with the necessary engagement skills to improve healthcare outcomes for Aboriginal and Torres Strait Islander peoples.
He now delivers cultural awareness training programs to GP registrars and JCU staff throughout Queensland. While such programs feature common learning objectives and evaluations, the content is tailored to reflect the culture, history and current local issues in each region.
“A lot of people think that Aboriginal communities and Torres Strait Islander communities are generic,” he said.
“But we are not all the same. We have differing histories, cultural beliefs and languages. And each area has a different set of local issues.
“The only way to provide good health service is via culturally appropriate engagement and you can’t engage with our community unless you are aware of our cultural norms and our history – the positive bits and certainly the different bits which make up the fabric of the community.”
Training programs are developed through close consultation with the local Aboriginal and/or Torres Strait Islander communities, particularly community controlled health services operating in the region.
Each service employs cultural mentors who are a crucial gateway to GP registrars seeking to better engage with local communities.
“They are from the community and know the community. They live and breathe community,” Mr Neill said. “We encourage our registrars and cultural mentors to work together so that the service to the community is culturally appropriate. This involves regular contact and a shared role in engagement.”
Registrars are immersed in a range of cultural activities to help foster equitable engagement with community members. Prior to such activities, they are encouraged to “unpack” their own background and beliefs, including cultural and social attitudes.
“If they can understand themselves better, they can then look at other people and not judge them on pre-existing perceptions, Mr Neill said.
These doctors also learn that establishing a connection with patients is central to helping them achieve better health outcomes.
“Because in our community, when we meet each other in the street, it’s all about connection and engagement,” he said.
“Similarly, in a clinical setting it’s not about a doctor saying, ‘hello Mrs Smith, what can I do for you?’ It’s about saying ‘you were telling me last week about going to your auntie’s birthday party. How did that go?’ Then moving on to the medical issues.
“We need to know as a community that doctors care for us as a person. Not just as a patient, but as a person.”
The impact of JCU’s cultural awareness training programs extends far beyond Aboriginal and Torres Strait Islander communities.
“Registrars grow as a result,” Mr Neill said. “The skills they learn are not just applicable to Aboriginal and Torres Strait Islander communities. They are applicable to all communities within Queensland.”
In June 2018, Mr Neill was elected Deputy Chair of the Governance Committee for the National Cultural Educators and Cultural Mentors Network.