Supporting better health for First Nations communities

Professor Elizabeth Elliott has been partnering with the Aboriginal community in Fitzroy Crossing in regional Western Australia since 2009 to support children affected by Foetal Alcohol Spectrum Disorder (FASD).

As a paediatrician working at the Children's Hospital at Westmead, her publication on FASD came to the attention of the women in Fitzroy Crossing.

“It’s really important to me that the community reached out to us,” said Professor Elliot.

“The women were concerned that there were high levels of drinking and pregnancy in their community and their children were struggling.

"They identified FASD as a priority and asked for help to understand if a problem existed.”

From their initial contact with the community, Professor Elliot Professor Jane Latimer and PhD students James Fitzpatrick, Barbara Lucas and Emily Fitzpatrick confirmed that there were high rates of FASD in the communities and that many of the children had major behavioural problems.

They used this insight to advocate for services.

“I’m really pleased that we were able prove the value of the research by showing both immediate and long-term benefits such as providing healthcare, training, referrals to specialists, or programs to help families and teachers – such as a positive parenting program to help support kids at home and school," said Professor Elliot.

"It's allowed us to build a long-standing relationship with the community."

Connection to the community was crucial to the success of the work undertaken by Professor Jennifer Alison and PhD candidate David Meharg.

David’s thesis centres on partnering with four Aboriginal Community Controlled Health Services (ACCHS) in regional NSW to implement pulmonary rehabilitation and contribute to lung health service provision.

Chronic obstructive pulmonary disease (COPD), or chronic lung disease, is so prevalent in Aboriginal communities that it’s seen as an inevitable illness.

Raising awareness of COPD was a challenge for Jennifer and David, as many people aren’t aware that there are treatments available to manage the condition.

Equally challenging are the barriers to attending hospitals due to feelings of fear, distrust and alienation from past experiences of racism.

Professor Alison and David worked to bring the treatment to the local communities in an effective and culturally safe manner, by upskilling local health professionals to help them educate their patients on how to manage COPD.

“We were very privileged to have the support of an Aboriginal Elder, Associate Professor Boe Rambaldini, who was Director of The Poche Centre for Indigenous Health at the University," said Professor Alison, recalling how they started. 

"Having a personal introduction from a trusted Elder helped us form connections with the chief executives of the ACCHS with whom we partnered.”

The Susan Wakil School of Nursing and Midwifery is also leading change by engaging more First Nations nursing academics.

Professor Roianne West has recently been appointed Professor of Nursing to lead the Sydney Nursing School’s First Peoples Health program of work in accordance with our One Sydney, Many People Strategy.

Professor West is the first Professor of Nursing at the University who identifies as Aboriginal.

A proud Kalkadunga and Djaku-nde woman hailing from a long line of healers, Professor West joined the University because of the opportunity to work with Professor Debra Jackson AO, who has been a mentor, friend and colleague for over a decade, and was inspired by Professor Brendan McCormack’s leadership and commitment to innovative nursing education approaches towards improving health outcomes for Aboriginal and Torres Strait Islander Peoples.

“I’ve often felt that other organisations will appoint an expert in a field and then all First Nations matters are their task," said Professor West.

"My colleagues at the Sydney Nursing School are all committed to improving outcomes for our students and their patients, and willing to learn and take on tasks themselves.

“I’ve seen first-hand the impact my family and I have had and know that it works.

"Nursing provides a lifeline to remote communities, but has also transformed the lives of my brothers, sisters and now daughters.".

"One of the biggest challenges of working in remote communitiesis the distance," said Professor Elliot.

“Fitzroy Crossing is 400 kilometres from Broome, and surrounding communities are even farther. It’s tropical and many roads are inaccessible in the rainy season.

"Just getting people to come to a medical appointment can be hard as there’s no public transport, and very few people have computers or phones so it’s hard to contact them!

"My colleague Dr Lauren Rice identified huge issues with accessing NDIS support in terms of technology and language barriers.

"Even if they can get the funding, there are no facilities nearby. It’s like a different reality.”

Professor Alison and David also faced issues with distance, but found a silver lining in the COVID-19 lockdowns. 

“They were a blessing in disguise for us. We had started in-person education sessions with Aboriginal health workers but we moved to virtual meetings during the pandemic,” said Professor Alison.

“Removing the travel component made it much easier to schedule sessions – we were able to set up about 64 sessions in total.” 

They were able to use the flexibility of online meetings to run their information sessions, allow participants plenty of time to develop a ‘yarning’ script in their words and language, and workshop those scripts to provide accurate information in the most effective manner.

Educating more nurses to work with remote Aboriginal communities is something Professor West is passionate about. 

“Since nurses make up 60 percent of the health professional workforce – a statistic that increases the more remote you go – it’s key to get it right with teaching the next generation of nurses,” said Professor West.

"So to improve health outcomes for First Nations people, our focus is on improving the teaching standards for all students, and attracting and retaining more First Nations students to come to the University.” 

Professor Elliot recently followed up with the children she saw at ages seven to nine as part of her FASD study, who are now 17 to 19 years old.

“We wanted to give them the power to advocate for themselves, and hear their voice and their needs," said Professor Elliot.

"As well as health services, we found they wanted practical help: how to get a birth certificate, driver’s licence or Medicare cards; advice about pregnancy and parenting; or assistance to receive training and applying for work.”

Professor Elliot reflects that it takes a long time to gain trust within the community and work as equal partners.

She took care to respect their immense traditional knowledge while offering her expertise in clinical health education and research skills.

“Whatever we do as academics must be led by their needs and priorities," said Professor Elliot.

"I have seen how much money and time has been spent on the wrong things, without adequate consultation with Aboriginal communities.

“I also see the power of women in leading many of these movements and the strength of the next generation who are educated, moving into professional roles and who hopefully will be able to address the problems for their communities.”

Professor Alison and David are hugely grateful for the generosity of the Aboriginal communities.

“They shared their stories about chronic lung disease and their wisdom about how we should research with community," said Professor Alison.

"These ways of engaging and collaborating provide valuable approaches to research practices in general.”

And it’s been successful. 

“We’ve helped implement programs in three of the ACCHS," said Professor Alison.

:We raised the awareness of COPD in the Aboriginal communities through awareness days and art competitions, and have upskilled Aboriginal health workers to perform spirometry, which is a key diagnostic test for COPD."

Professor West is optimistic for the future of Indigenous and non-Indigenous nursing students. 

“I’m co-chairing the School Curriculum Conceptualising Committee to synthesise the Person-centred Curriculum Framework with the Cultural Safety Curriculum Framework, which is an excellent example of integration of Indigenous knowledges and Western knowledge towards new and more sophisticated ways of working together,” said Professor West.

“By recognising their differences and similarities, nursing education can benefit from a broader approach that incorporates both person-centredness and cultural safety principles.”