Month: January 2002

Patricia Fagan: new senior medical advisor at the Office for Aboriginal and Torres Strait Islander Health added

Issue: Vol 2 No 1 January 2002 - March 2002

In October 2001, Patricia (Trish) Fagan was appointed as senior medical advisor (SMA) at the Office for Aboriginal and Torres Strait Islander Health (OATSIH). She brings to the position a wealth of experience in Indigenous health. The Australian Indigenous HealthInfoNet asked Trish to submit a brief article to the HealthBulletin regarding her recent appointment. She has provided an informative piece that explains OATSIH’s primary objectives, the role of the SMA within the Office, her own background in Indigenous health, and what she hopes to contribute as SMA at OATSIH.

About OATSIH

The Office for Aboriginal and Torres Strait Islander Health (OATSIH) was established in the mid 1990s when responsibility for Aboriginal and Torres Strait Islander health at a Commonwealth level moved from the Aboriginal affairs to the Health portfolio (OATSIH is located in the Department of Health and Ageing).

Since its beginning, the Office has developed its vision to reduce the gap in health status between Indigenous and non-Indigenous Australians through strengthening primary health care for all Aboriginal and Torres Strait Islander people. Support for Indigenous specific community-controlled services and the improvement of functional access to general health services are priorities. The Office supports strategies to reform existing health systems and improve the infrastructure, workforce and information systems on which comprehensive primary health care rests. It aims to address specific health issues and to enhance the evidence base that underpins health interventions. In addition, OATSIH seeks ways to maximise whole-of-government responses across all levels of government and jurisdictions to achieve improvements in Aboriginal and Torres Strait Islander health.

The Office is organised around three broad streams of activity: health and community strategies, program planning and development, and workforce, information and policy. Within these streams, current activities include:

  • the primary health care access program (PHCAP) directed at improving access to primary health care through supporting mechanisms to increase community-control, reforming existing health system structures, and increasing the available resources within selected PHCAP sites;
  • initiatives directed at improving access of Aboriginal and Torres Strait Islander peoples to general health programs (for example, the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme);
  • consultation on a draft National Strategic Framework for the Aboriginal and Torres Strait Islander health workforce
  • assisting the Minister’s National Aboriginal and Torres Strait Islander Health Council in its task to consult on and finalise a second National Aboriginal and Torres Strait Islander Health Strategy;
  • the development of policy frameworks in the areas of chronic disease and maternal and child health; and
  • support for the work of the Research Agenda Working Group in its task to develop a strategic ‘roadmap’ to facilitate and guide initiatives, nationally, in Aboriginal and Torres Strait Islander health research.

The breadth and depth of activity is impressive.

The role of SMA at the Office

The senior medical advisor (SMA) position is important in linking the Office and other areas of the Department of Health and Ageing, in particular those areas concerned with medical professional activity. The SMA facilitates liaison with outside organisations (such as medical schools, universities and research institutions) and maintains communication with medical and other health professionals and organisations in the Indigenous health field. Within the Office, and in collaboration with other staff, the SMA provides clinical and public health expertise, and guidance for policy development work. There is considerable room to move within the position, with scope to take on projects of interest and to allow one’s particular experience and talents to be utilised.

My background in Indigenous health

With Queensland Health in far north Queensland

I arrived in the Office from far north Queensland (FNQ) in October 2001, having worked for some years for Queensland Health as a community women’s health program manager. I established an outreach women’s general practitioner service for remote area Aboriginal and Torres Strait Islander women (now operating under the auspices of the Royal Flying Doctor Service (Qld) as the Rural and Remote Women’s Health Program). In FNQ, this service is supported by visiting district mobile women’s health teams (comprising registered nurse and health worker), an accredited training program, comprehensive information systems, and access to specialist services. This well-women’s program has increased women’s access to a skilled women’s health practitioner and to appropriate reproductive health and well-women’s screening services. It has resulted in 200-300 per cent improvement in cervical screening participation rates over the course of the 1990s (albeit from a very low base). Importantly, all elements of this program continue today.

Other activities during my time in FNQ included:

  • the establishment of the breast screening service in Cairns;
  • overseeing the feasibility study that explored options for the provision of breast screening to remote area women in FNQ; and
  • the development of the medical aspects of a sexual assault service. Since1993, the Cairns-based sexual assault service has provided a female medical officer to attend adult women immediately following sexual assault.

I worked also for ‘The Well Person’s Health Check’ project as the sexual health physician for the first 18 months of its operation, and was involved in the implementation of an important initiative that has introduced screening for domestic violence in Queensland Health facilities (the Queensland Domestic Violence Initiative). I was a member also of the FNQ Community Corrections (Parole) Board up to October 2001, building on an early interest in Indigenous prison health that arose from clinical visits to prisons in Sydney during the 1980s.

With the Redfern Aboriginal Medical Service in Sydney

Prior to my time in Queensland, I was privileged to work in Sydney at the Aboriginal Medical Service (AMS) in Redfern for nine years. I started work at Redfern as a young(ish!!) medical officer having recently returned from post-graduate clinical training (with an emphasis on women’s and children’s health) in England. I returned to Australia in order to work at the Redfern AMS and, indeed, I had to wait six months (for the departure of Dr Archie Kalokerinos) before they could take me on. Working at Redfern was grand – a great clinical experience within a pretty cohesive community.

It was a tremendously steep learning curve:

  • interacting across cultures (with bemused and tolerant teachers);
  • operating in a multidisciplinary health care team;
  • participating in intersectoral action in health service provision; and
  • working in an organisational structure that fostered community-control and made community development a reality for many individuals and satellite communities.

After five years as a full-time general practitioner within the AMS I took on a more public health role, working only part-time in the clinic. Over the following few years, I completed a Master of Public Health and was involved in much project work at Redfern. These projects included writing submissions (such as: Far West Children’s Home at Manly, asbestos mining at Baryulgil, drug and alcohol treatment programs in the inner city, prison health, etc.), development of health promotion programs (HIV, breast-feeding, diabetes, immunisation), and the conduct of research (mental health problems presenting to Indigenous primary health care services in NSW – the subject of my masters thesis).

How I hope to contribute to OATSIH’s vision

The OATSIH has come far since its establishment. There have been gains – but the strengthening of primary health care remains a continuing challenge and core business for a department of health. At a broader level (than health alone can achieve), it is critical to improve the environment into which many Aboriginal and Torres Strait Islander children are born. I hope to contribute to this vision during my time in OATSIH, in particular through:

  • strengthening OATSIH’s links across the Department and with medical professionals/organisations involved in Indigenous health; and
  • the carriage of projects that will benefit from my medical and public health experience (across a diverse range of Aboriginal and Torres Strait Islander health settings – in urban and remote locations, and within both the community-controlled and government health sectors).

Dr Patricia Fagan FAFPHM, DCH, DRCOG
Senior Medical Advisor
The Office for Aboriginal and Torres Strait Islander Health
Department of Health and Ageing
Patricia.Fagan@health.gov.au

Sharing an Aboriginal aged care quality assessor’s journey

Issue: Vol 2 No 1 January 2002 - March 2002

The following report has been reproduced from The Standard with kind permission of the author, Noela Baigrie.

‘Elders have always played a critical role in maintaining the health of Indigenous nations. They are living libraries, repositories of the oral traditions for their nations. They remember the old ways, old ceremonies, songs to sing for gathering the plants, medicines to use that will cure their people. In the face of environmental degradation and excessive agricultural use of the land, this foundation has been shaken to its core’ (L.A. Colomeda & E.R.Wenzel, 1999. ‘Medicine Keepers: Issues in Indigenous Health’ ).

My first recollection of caring was the nurturing role of my Grandmother and Mother. It was through these influences that my passion for caring was awakened. My Grandmother and Mother encouraged and guided me into truly understanding and accepting the dual role of embracing and choosing the best from both cultures. It is my true passion and desire to care for my old people and that has enabled me to apply my skills to develop best practice models for Indigenous aged care facilities.

My career in nursing commenced in 1967 and by 1997 I was the Director of Nursing at Jimbelunga Indigenous Nursing Centre. In my 30 years as a registered nurse I have found that one of the greatest opportunities for improvement lies within the true identification and assessment of the needs of Indigenous aged peoples in Australia.

In July 2000 I was sponsored to undertake training as an aged care quality assessor. I could see that the achievement of my registration as an aged care quality assessor was another milestone in my journey and passion for caring for my old people. When I successfully completed my quality assessor training and was placed on the Quality Society’s Register as an aged care assessor, another part of my dreaming was realised.

When the Aged Care Standards Agency in Western Australia contacted me about my availability to undertake an audit in the Kimberley’s, my initial response was one of shock. After this instinctive reaction had passed there was a tingle of excitement and an even greater surge of honour and pride that came with the privilege of being selected as the first Indigenous aged care assessor to conduct an aged care audit in Australia.

The challenge facing me was not being able to follow in anyone’s footsteps and not having an Indigenous mentor or role model was quite daunting. This was overcome through the positive and real support and encouragement provided by: Alan Litschner, a colleague and dear friend; Michael Menso from the Systems 3 Group; and Suzanne Leavesley, State Manager, Aged Care Standards and Accreditation Agency WA. My thanks and appreciation must go to these remarkable people.

My auditing journey commenced with a day’s flight from one side of the country to the other and this not only moved me geographically but tossed me right out of my comfort zone. My long flight gave me, not only the opportunity to ponder this adventure, it provided me with the chance to reflect upon the influences of my Grandmother and Mother that led me to follow my dreams in aged care. It was during this journey I realised that they would be happy to see this achievement for our people. This thought gave me the courage and strength to positively participate in one of the greatest challenges in my working life.

In my journey toward the facility being audited I experienced mixed emotions about the history of Indigenous aged care within this country. These feelings were shared with my fellow auditors Christine Martin and Jenny Pike. Through our sharing of experiences during this journey Jenny and Christine provided me with confidence that the aged care auditing system was positively focused and flexible in the assessment of Indigenous aged care facilities.

Upon reaching the facility I was encouraged and delighted to observe my elders receiving high quality care in a safe and comfortable environment that was culturally acceptable and suitable. The harmonious environment of the facility was underpinned by the cooperation and positive interaction between all levels of the management and staff.

Another prominent feature of my observations related to the encouragement of residents and staff to retain and use their tribal language. This was music to my ears! This was further reinforced through discussions with other people from the area as they were delighted to see one of their own people assessing one of their own facilities.

Another memorable aspect was the positive and constructive spirit in which the facility greeted and interacted with me. Whilst the facility management and staff may have experienced some minor apprehensions about my visit, these were quickly dispelled and I delighted in the positive interaction with the team at this facility.

From an auditor’s perspective one can appreciate that the implementation of the Aged Care Standards could be viewed as a potentially arduous exercise. It is extremely pleasing to have been exposed to one of the success stories.

In summary, I can only say that the opportunity to undertake this audit was initially intimidating, however it quickly transformed into one of the most memorable and pleasant experiences of my career. My true thanks has to be extended to Christine & Jenny for their support, encouragement and mentoring during the audit. It was truly wonderful to meet and to work with two such practised auditors who gladly shared their understanding and knowledge with me.

I look forward to my next opportunity to audit with the Agency

It is hoped that all readers of this article will appreciate and recognise the right of Indigenous aged care facilities within Australia to maintain their true spirit, purpose and individual sense of identity.

Thank you for allowing me to share my story with you.

Noela Baigrie
Principal Advisor
Sharing Solutions
Queensland

Please feel free to provide me with reader feedback by email: noelab@sharingsolutions.com.au or ph: 0407 200 888