aboriginal nurses

Corinne Dyson: our January Nurse of the Month

January 28, 2020 by Rayan Calimlim Leave a Comment

This Year of the Nurse and Midwife, we’re honouring 12 outstanding nurses and midwives who exemplify the values we embody as professions. This month, Natasha has nominated her colleague Corinne. Here’s what Natasha has had to say about Corinne’s incredible work and the impact of her actions.

I have personally witnessed the profound and inspirational effects that Corinne imbues with the consumers in her care. As a now senior member of staff who identifies as Indigenous, Corinne utilises her background and cultural heritage to enable consumers to firstly heal, then recover at their own volition, with a level of sensitivity and recognition that only a lived experience by Corinne could enable.

One such example is that of a young Indigenous woman with children in care and another on the way. This young woman was trapped in a cycle of domestic violence and drug abuse with little to no hope of seeing her own survival following countless attempts of suicide.

Corinne entered her life by way of case management just over 12 months ago, and in that time has assisted this young woman, in ways that would be classed as above and beyond, to regain her identity and sense of purpose. Corinne has supported this young woman in many psychological/ medico legal ways, as well as laughing, crying and most importantly listening to what is required to keep moving forward.

This young woman is now clean from substance abuse, she has maintained custody of her new baby and is working towards regaining custody of her older children. She is safe from her perpetrator and will not end up as yet another statistic of violence towards women in rural Australia. Her life has completely transformed to a positive one, and I and other’s attribute this to not only this young woman’s determination to survive and heal, but the gentle and ever so respectful way that Corinne imparts her support.

Furthermore, Corinne absorbs herself in learning and reading about domestic violence at every opportunity, to which the entire team benefit from by her regularly transferring what she has learnt with pride.

I am honoured to work alongside of a colleague of Corinne’s calibre and even though she wouldn’t want a fuss made over her, completely deserves recognition of her as a wonderful Registered Nurse and human being.

Do you know of an outstanding nurse or midwife like Corinne? Nominate them today.

To close the health gap, we need programs that work. Here are three of them

January 20, 2020 by Rayan Calimlim Leave a Comment

The tenth Closing the Gap report to be tabled in Parliament today is expected to show progress in the two health targets – to close the gap in life expectancy by 2031 and halve the child mortality (death) gap by 2018. But only the latter is on track.

The Indigenous death rate has dropped by 15% (from 1998-2015), but we’re not on track to meet the deadline. Chronic diseases such as diabetes, heart disease and cancer are responsible for the majority of this gap.

While death rates from heart and kidney disease have dropped among Indigenous people, death rates from cancer are on the rise, and the gap here is widening.

The child death rate has dropped by 33% for the 1998-2015 period, and is reportedly on track to meet the target.

But overall, progress is slow. As governments talk about “refreshing” targets, three experts – in diabetes, maternal and infant health care, and rheumatic heart disease – provide evidence for how giving more support, funding and control to the Indigenous community leads to actual results.

Remote diabetes services

Diabetes is three times more prevalent in Aboriginal and Torres Strait islander people compared with non-Indigenous Australians. Rates in remote communities are even higher – up to 30% in some. The reasons are complex and include lifestyle factors such as poor diet and lack of exercise, poverty, and poor access to medical care and health literacy. Genetics and epigenetics also play a major role, but aren’t yet well defined.

Over the past eight years, the Baker Heart and Diabetes Institute has been involved in remote diabetes services – as part of our outreach health services.

We’ve been shocked by the extreme levels of ill health associated with poorly controlled diabetes in these communities. The remote clinical services we visit are generally ill-equipped to manage complex chronic disease and the type of diabetes we see is aggressive and unusually resistant to treatment.

Diabetes contributes to illness and death through its complications, which include heart disease, kidney failure and limb amputations. Control of blood glucose (sugar) levels is central to managing complications.

Our service is made up of five doctors, and two diabetes educators. We visit eight communities in central Australia and intensively manage patients with poorly controlled diabetes. The doctors, based in Melbourne and Alice Springs, work closely with the nurse educators based in Alice Springs. The educators frequently visit the communities. Their follow-up and feedback are critical to overall management.

The program’s evaluation (not yet published) has shown significant improvements in glucose levels and cholesterol in more than 100 patients. We’ve also had success in finding effective medications for these types of diabetes and initiated a clinical trial of a once-weekly diabetes medication in these communities. This less frequent dosage helps with adherence rates and we have so far seen improvements in patients involved in the trial.

With more funding and resources for remote clinical services, and greater involvement and feedback from the communities and community leaders, the impact of diabetes and its complications can be greatly reduced. – Neale Cohen

Birthing on Country

Birthing on Country – a movement that has been benefiting Indigenous women in Canada for decades – is about bringing birth back to community and back to country. It’s also about offering safe and culturally appropriate maternity services for Aboriginal and Torres Strait Islander mothers and babies.

In Australia, we’ve been running a Birthing On Country service in Brisbane since 2013, but tailoring it to an urban setting. We call it Birthing in Our Community.

Key aspects of our program include an Indigenous governance framework and 24/7 midwifery care in pregnancy to six weeks postnatal care by a named midwife. This is supported by Indigenous health workers and an Indigenous team coordinator. Our program also offers support for Indigenous student midwives through cadetships and placement.

Birthing on Country has been shown to be effective, and is strongly supported by Indigenous organisations.

Evaluation of Birthing in Our Community has shown significant reductions in preterm birth, caesarean sections, and low birth weight infants and babies being admitted to the neonatal nursery. We’ve seen more women coming to us in early pregnancy, as they feel safe to do so. There has been an increase in antenatal care, normal birth and breastfeeding rates.

Currently, Birthing in Our Community is run and funded through a partnership between the Institute for Urban Indigenous Health, the Aboriginal and Torres Strait Islander Community Health Service Brisbane and the Mater Mothers’ Hospital. Evaluation of the program is funded by the National Health and Medical Research Council.

We recommend scaling up the Birthing in Our Community program to address the preterm birth rate, which hasn’t changed since Closing the Gap targets were released in 2008. This would also impact positively on infant and child mortality in Australia.

We also recommend full implementation of Birthing On Country in urban, rural and remote areas, with dedicated funding for Indigenous organisations to establish their own Birth Centres and structural barriers to this (regarding insurance and regulation) removed by government.

Birthing On Country was recommended by the national maternal services policy, released in 2010. It is also supported by international evidence, the Indigenous community and professional organisations. – Sue Kildea and Ms Jody Currie (CEO of Aboriginal and Torres Strait Islander Community Health Service, Brisbane and a Yugambeh woman).

Rheumatic heart disease

Rheumatic heart disease is a rarity in mainstream Australia. But in remote communities of northern and central Australia, it continues largely unabated. The average age of death from the disease in Aboriginal people is 40. Many children and adolescents are among those who die. Rheumatic heart disease is responsible for the highest gap in life expectancy between Indigenous and non-Indigenous Australians; higher than diabetes or kidney failure.

Yet, it is preventable. It’s caused by an abnormal immune reaction to infections by the group A Streptococcus bacterium (that causes strep throat and skin sores). The reaction causes inflammation in heart valves (part of the condition known as rheumatic fever). If left untreated, this can progress to rheumatic heart disease.

The disease can result in heart failure, and causes death and disability in children, adolescents and young adults.

Until now, rheumatic heart disease has been largely tackled entirely within the health system. That doesn’t work for a disease that is inherently complex and made up of many factors. And for one that starts as an infectious disease in childhood but ends up as a chronic disease of adolescents and young adults.

There are medical approaches to treatment and prevention, such as regular penicillin injections to prevent strep A infections. But housing, living conditions and education are core determinants for preventing infection.

The END RHD Centre for Research Excellence – that began in 2014 (through funding by the National Health and Medical Research Council) – is developing a strategy to eliminate rheumatic heart disease in Australia. A critical aspect is to help communities take ownership of ways to target rheumatic heart disease as a condition requiring attention, provide leadership and training within health services, connect the health service with clients, families and communities, and engage other services outside of the health system.

We recently conducted research in ten remote communities in the Northern Territory, trialling a number of ways to assist local clinics to improve care and prevention of rheumatic heart disease. We found the communities that did best were those that tackled multiple aspects of prevention and treatment of the disease.

This meant delivering preventive treatments through streamlining systems at the clinic, and embracing ways to connect community members to the health service in culturally sensitive and appropriate ways.

Rheumatic heart disease is almost uniquely a disease of Aboriginal people in Australia. It deserves particular attention as part of closing the gap. To eliminate it from Australia, we need to identify it as a priority, and equip communities with the information and tools they need to tackle it. – Jonathan Carapetis

Neale Cohen, General Manager Diabetes Services, Baker Heart and Diabetes Institute; Jonathan Carapetis, Professor, Paediatrics, Telethon Kids Institute, and Sue Kildea, Professor of Midwifery, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

More indigenous nurses builds trust in health

July 9, 2018 by Nurse Uncut Editor Leave a Comment

Aboriginal nursing and midwifery cadetships have transformed the lives of indigenous nurses and patients alike.

Midwife Leona McGrath first had an inkling she might like to become a nurse when she was a young girl and saw her sister give birth to her niece.

“I thought how wonderful to do something like that. But it didn’t seem like a reality because I didn’t think I was smart enough.”

Leona left school when she was 14 and had children young; she didn’t think nursing was a realistic option for her to pursue.

“Just one per cent of nurses and midwives are Indigenous, and we are three per cent of the population,” she says.

Outside of seeing her sister give birth, Leona’s experience with the health care system as a young Indigenous girl growing up in Queensland had not been a very positive one.

“Our health is at third world standards. From a historical perspective, we know that Indigenous people have gone in to health facilities and don’t come out.”

“You have a lot of people who don’t trust the health care system for a lot of reasons.”

Despite multiple barriers to a career in nursing, Leona’s life changed when she read about UTS’s bachelor of midwifery program in 2006, and at the same time she heard about a NSW Health program for Aboriginal nursing and midwifery cadetships. Leona applied for and was accepted into both the degree and the cadetship program.

The cadetship, which provides a scholarship and paid hospital placements to Indigenous trainees, “dramatically changed my life,” says Leona. She trained at the Royal Hospital for Women in Randwick, but she now works with the health department as the senior adviser for the Aboriginal Nursing and Midwifery Strategy.

Leona now helps to run the cadetship scheme, which provides students with a study allowance for 40 weeks a year. Cadets are also required to undertake a paid work placement during the ten-week non-teaching period each year.

Since the program commenced in 2004, 132 nursing and midwifery students have graduated in NSW.

“There are now 68 Aboriginal cadets in the program across NSW,” Leona notes. Another 60 students are receiving financial scholarships, she says.

A need for cultural safety

For Leona, the program is not just about giving Indigenous students career paths that otherwise might be closed to them, it’s also about addressing the Indigenous community’s needs for cultural safety.

“Unfortunately the reality is that racism means that health services can be unsafe for a lot of Aboriginal people.”

“I know that my pregnancy would have been a whole lot different if I had another black face. Aboriginal people have that connection with each other.”

Skye Parsons, the project officer for the Aboriginal Nursing and Midwifery Strategy, has worked as a midwife at the RPA in ante- natal health, seeing Aboriginal women and women having Aboriginal babies.

“To see another black face there really puts people at ease,” Skye says.

At RPA she offered a flexible service and appointment time. “Antenatal attendance was much earlier. People were booking in during the first trimester.”

Having a program specifically designed for Aboriginal women had a positive impact on the community, she says: “People were having healthier babies.”

The cadetship program is growing, Skye notes, with 15 nursing and midwifery students enrolled last year.

“Working in a hospital they learn policy and procedure. Cadets are work ready when they graduate,” she notes.

As Leona puts it: “It’s transforming lives.”

This article was originally posted in the NSW Nurses and Midwives’ Association‘s publication, The Lamp.

The long history of Indigenous nursing

July 3, 2018 by Rayan Calimlim

The complex relationship between nursing and Indigenous Australians includes a long tradition of Indigenous nurses, a panel of Indigenous nursing experts told an audience on International Women’s Day this year.

Aunty Dulcie Flower, a trained midwife who was instrumental in setting up Aboriginal medical services in the 1970s, spoke of the disenfranchisement of Indigenous women from the mainstream health system, including Indigenous women in childbirth being turned away from maternity wards in the early stages of labour.

“A close relative died in child-birth and she shouldn’t have … and that was through lack of attention,” she told the audience at the panel to celebrate Indigenous nurses, organised by the University of Technology Sydney’s Jumbunna Institute.

The oldest of seven children, Aunty Dulcie said she “always had a sense of being singled out to do things on behalf of other people”. In her community she saw that “Torres Strait Islander people just wouldn’t go to hospital because they were on the mission … Cairns was the only hospital covering a whole district.”

While Indigenous people have felt marginalised from the mainstream medical system, the history of Indigenous nursing nevertheless goes back to as early as 1906, when May Yarrowick, a northern NSW woman, trained to be a midwife.

“She worked as a midwife on a horse and dray until she passed away in 1949,” said Associate Professor Odette Best, a trained nurse and now an academic and nursing historian at the University of Southern Queensland.

May’s father was Indigenous and her mother was white. When her mother died, “her mother’s family claimed May,” Professor Best explained. Growing up with her mother’s white family gave her access to education and white privileges and she trained in Crown Street Hospital. But it didn’t protect her from the racism of the hospital system, as she discovered when she found the matron’s notes in the Crown Street Hospital’s records. “She wrote that [being a] half-caste was not enough reason not to train her however, she was not to be housed with the other student midwives. So, she was actually segregated.”

Professor Best’s work, uncovering the history of Indigenous nursing in Australia is important in changing what she describes as the “discourse of Aboriginal women as passive recipients of healthcare”. In fact, as she remarks: “We’ve actually been active providers of health care for well over 120 years in this country.”

Discrimination IS common

In Professor Best’s interviews with Indigenous nurses, she has found that “racism is something that every single one of us and every single RN I have interviewed all talk about receiving since the 1940s onwards … from other nurses or patients or administrators of hospitals.”

“Aboriginal nurses haven’t been afforded the same privileges that white nurses have, due to racism. Promotions [were] always afforded to the white nurse and not the Aboriginal nurse – unless it was on missions, because white nurses didn’t want to go there – and so Aboriginal nurses were matrons there.”

Aunty Dulcie spoke about the importance of Aboriginal medical services for creating spaces where Indigenous people can exercise greater self-determination in their own healthcare. “The mainstream system is run on looking at body parts and they separate the mind from the body … and they don’t think about spirituality, except for the religious hospitals.

“And this is so contrary to the way Aboriginal people view health. Health is a state of being to Aboriginal people.” It means a holistic approach: “What affects the individual affects the community; what affects the community affects the individual,” Aunty Dulcie said.

Professor Juanita Sherwood, Deputy Vice-Chancellor of Indigenous Strategy and Services at the University of Sydney, spoke about the way “colonialisation and racism are key determinants of health” for Indigenous people. For her, terms such as “cultural competence” and “cultural safety”, are useful if they mean teaching non-Indigenous people about their own whiteness and privilege and how they actually impact upon Aboriginal health.

She sees some hope for the future though, as Indigenous nurses and advocates are beginning to have an impact on health policy and research. “We are changing the research agenda; we’re having an effect on funding bodies, the National Health and Medical Research Councils, ARCs. A whole lot of those funding and grant bodies are [beginning to be] open to our ways of knowing and being and doing.”

The panel’s advice for Indigenous student nurses

Aunty Dulcie Flower: Don’t be afraid to share the good times  and the bad times. If you are getting a hard time, particularly on your placement, make sure you go and tell your senior person.  Do not endure bullying.

Professor Best: I always tell our Indigenous students that there is always an expectation that you’re going to go and work in your community. I give them the exact opposite advice. Go out and have fun: get a visa, see the world, work out the speciality you want to work in. You are going to work in the community at some stage and the more skills you bring to the community, the better for your community and for yourself.

Professor Sherwood: It’s really important to debrief. Find your voice. It is difficult to be a whistleblower; you do need the protection of your association – join your association. They are only as strong as the membership, so please when you do graduate, join the local nurses’ association and please take an active role in that.