Battling disease in a deprived outback town
An Aboriginal Community Controlled Health Service is getting results in one of Australia’s sickest communities.
There can’t be many Australian communities in worse health than the people of Doomadgee in far north-west Queensland.
Malnutrition and diabetes are common in this remote Aboriginal town, 630 kilometres by road from Mt Isa.
Also rife is rheumatic heart disease – an easily preventable, rare condition in most rich countries.
“The health statistics in Doomadgee are some of the worst in the world – on a par with sub-Saharan Africa,” says Lesley Salem AM, Australia’s first Aboriginal nurse practitioner and an NSWNMA member.
Doomadgee was once a church mission, where girls and boys – members of the Stolen Generation – were raised to work for white landowners on cattle stations.
Only about one third of the population of 1400 has access to a fridge, let alone a phone or computer.
Life expectancy is 55, compared to 83 for the general population.
However, health indicators are improving thanks to an Aboriginal Community Controlled Health Service called Gidgee Healing.
Gidgee provides “holistic and culturally appropriate” health services for Aboriginal people in the Mount Isa, Northwest and Lower Gulf regions of Queensland.
Gidgee hired Lesley to help set up the service in Doomadgee almost six years ago. She’s still there in the role of generalist/chronic disease nurse practitioner.
Previously, Lesley worked in hospitals, a detention centre, and other Aboriginal community health services.
In 2022, she was made a Member of the Order of Australia (AM) for significant service to nursing and to Indigenous health.
Before Gidgee opened its doors, Doomadgee had one tiny hospital, which locals usually avoided until they were very sick.
“They never had anywhere they could go with just a simple sore or a vague feeling of being unwell,” Lesley says.
“Can you imagine living without a doctor and you’ve got children sick and there’s nothing you can do?
“And there’s no chemist shop; the only self-management strategy is bush medicine. But a lot of sickness is related to Western bacteria, which bush medicine never had to tackle.
“As an Aboriginal community-controlled organisation, Gidgee knew what service model was needed and got the funding to go into Doomadgee.
“The service offers so much more than a regular GP service would. It’s much more holistic. We provide a head-to-toe health check every 10 months, with blood tests, follow-ups and home visits by health workers supplying the medicines you need.”
Lesley says the service is characterised by “constant flexibility and a willingness to change to meet community needs”.
“We are still moulding ourselves to meet this community’s needs. Unlike the local hospital, you won’t have to wait up to five hours to be seen and you won’t be sent away with just some Panadol. You’ll have blood tests done, and we’ll get on top of any STIs.
“Importantly, as an Aboriginal-controlled and managed service, Gidgee allows every person and the community as a whole to have a voice in how they are managed.”
Lesley says it is “an absolute disgrace” for Doomadgee to have the world’s worst rate of rheumatic heart disease, typically caused by repeated skin and throat infections. She has seen patients as young as seven with the disease.
“When I first got to Doomadgee, the sores covering the kids were horrendous. They were so infected you’d have to give intramuscular antibiotics.
“Now we are starting to get on top of RH disease by encouraging people to see us earlier.
“We’ve run sores clinics at the school, where we show the kids that they can avoid a painful needle if they see us early for dressings and maybe oral antibiotics.
“Meanwhile, we have to care for the cohort of post-op RH disease patients – including some with heart valve replacements – back in the community.”
Lesley says Gidgee is making progress in encouraging Doomadgee residents to embrace prevention.
“More people are getting regular health checks, which can be lifesaving in a community where adults typically have at least three chronic diseases.”
There’s also a role for bush medicine, she says.
“Some bush medicine works beautifully if it’s used early. We show people how to use bush medicine in a modern way, in soaps, creams and oils.”
Fewer than half of Doomadgee children go to school and Lesley believes higher classroom attendance is vital.
“New approaches are being tried, such as an after-hours school, and holding classes down by the river.
“When you have good education, you make better health choices.”
‘When I first got to Doomadgee, the sores covering the kids were horrendous. They were so infected you’d have to give intramuscular antibiotics.’
‘More people are getting regular health checks, which can be lifesaving in a community where adults typically have at least three chronic diseases.’
NSWNMA helped to stop bullying
Lesley says she would not be working as a nurse practitioner today without the support of the NSWNMA.
“In my first role (as an NP) I was being bullied by the doctors,” she told The Shift with Shaye podcast.
“They did things like put my pathology inbox in the trash out the back and wrote letters warning that I was going to kill people.
“I stopped having that problem after the NSWNMA stepped in.
“If it hadn’t been for the support of you guys in my first eight weeks out, I would not be working as a nurse practitioner today.”