Jenny Darr, Hanni Gennat, Jacinta Elston, Lynore Geia, Adrian Miller, Vicki Saunders.
It has been acknowledged by both community stakeholders and government that Aboriginal and Torres Strait Islander women are in the high-risk group for complications at any stage of pregnancy1. Infant mortality rates for Aboriginal and Torres Strait Islanders remain unacceptably high, with prematurity and low birth weight still prevalent especially in remote areas2.
Earlier recruiting of Aboriginal and Torres Strait Islander pregnant women into antenatal programs is essential, as maternal nutrition, substance abuse, high blood pressure and infections are all important risk factors for low birth weight babies. The anecdotal experience by Aboriginal and Torres Strait Islander women is commonplace.
In order to meet the demand of providing adequate services and programs, the health workforce must be trained. Aboriginal and Torres Strait Islander participation in the workforce is essential and should not be an optional add-on for any Indigenous community. Aboriginal and Torres Strait Islander Health Workers have been recognised through numerous government and community reports as being central to the provision of health services for Indigenous people, and invaluable in the role of cultural and health brokers3, 4. Aboriginal and Torres Strait Islander Health Workers provide culture-specific knowledge, access, and an ability to liaise with Indigenous communities about their interactions with the health care system.
Today, throughout all States and Territories there is an expansive network of Aboriginal and Torres Strait Islander Health Workers, employed in either Aboriginal Medical Services or by State/Territory Health Departments. Their scope of practice and career paths as health professionals within the broader health field has been slow since the creation of the Aboriginal and Torres Strait Islander Health Worker role.
A major objective of this education program offered through James Cook University, School of Public Health and Tropical Medicine, is to increase the number of skilled Aboriginal and Torres Strait Islander Health Workers in maternal health, to help address the unacceptably high levels of Aboriginal and Torres Strait Islander perinatal mortality and morbidity, through improving access to and appropriateness of obstetric services especially in under-serviced rural and remote areas.
The National Centre for Maternal Health Education for Aboriginal and Torres Strait Islander Health Workers has an innovative program entitled ‘Maternal Health for Aboriginal and Torres Strait Islander Health Workers’. The Program provides theoretical knowledge and clinical skills enabling Aboriginal and Torres Strait Islander Health Workers to better manage maternal health care within their communities.
The Royal Australian College of Obstetrics and Gynaecology (RACOG, now RANZCOG) established a pilot program in 1990 with funding from the Federal Government (DEETYA) to provide a Skills Transfer (Maternal Health Education) Program for 12 Aboriginal Health Workers, in Broome, Western Australia. The Aboriginal and Torres Strait Islander Health Studies unit in the School of Public Health and Tropical Medicine (SPHTM) at James Cook University taught the skills transfer program.
This early collaboration developed into the current partnership between RANZCOG, the SPHTM at James Cook University, Kimberly Aboriginal Medical Service Corporation (KAMSC) and the teaching hospitals involved in the program. A Commonwealth grant in 1997 saw an injection of financial resources enabling the partners to increase the numbers of courses on offer each year and the number of sites where teaching occurs. This improved access for Aboriginal and Torres Strait Islander Health Workers whose ability to study was limited by family, community and work commitments.
The Maternal Health Education Program is aimed at transferring both practical skills and knowledge to female Aboriginal and Torres Strait Islander Health Workers, allowing them to practically contribute to the obstetric care of Aboriginal and Torres Strait Islander women during their antenatal, labour and post natal terms. The course has been designed to provide the experienced health worker with a solid foundation in both theoretical background and clinical experience. It aims to optimise the management of normal pregnancy and the early identification of at-risk pregnancy. It is now offered to both experienced and non-experienced health workers.
The Maternal Health Education Program is delivered in block mode comprising a two-week theoretical component with face-to-face delivery of lectures and a clinical placement, consisting of an additional two weeks within an appropriate tertiary level maternity hospital.
The program examines current maternal health epidemiological patterns and includes an examination of various maternal health programs and their comparative impact. The curriculum includes a basic knowledge of female anatomy and obstetric anatomy and physiology; the principles of normal pregnancy and antenatal care, the recognition and management of high risk and abnormal pregnancy, and management of the puerperium. Other topics include: the recognition of onset of labour, management of out-of-hospital deliveries, communicating effectively with hospital staff, abnormal palpation and the use of foetal Doppler and stethoscope.
A variety of teaching techniques are used to achieve these learning objectives. These include small group learning sessions and clinical skill laboratories using mannequins and case studies. Teaching aids such as videos and mock case studies help reinforce the theoretical content. Nutrition, sexual health, breast feeding, risk factors for high-risk pregnancy, and post-natal care at home and hospital, are subjects delivered by guest lecturers with particular expertise in these topics. During each block guest lecturers who work or reside in the community where the block is being delivered are identified and invited to lecture on specific subjects. This enables a local community perspective and flavour to be fostered within particular sessions inclusive of the objectives that have been outlined in curriculum.
The content is delivered in such a way that it aims to contextualise Indigenous worldviews and experiences within the western medical setting, as appropriate for maternal health. Consequently, the students participate more effectively in the learning process.
The structural design of the program content enables students to follow a logical pathway in basic maternal health care. It exposes students to technical terminology and practices of maternal medicine whilst being delivered in the context of Indigenous learning. The topics are sequenced from pre-conception to antenatal care and then on to postnatal care and are delivered in the context of the physiological processes that would occur in a normal pattern of pregnancy. Additionally, the course structure is designed to address those factors such as nutrition, sexually transmitted infections, substance misuse, and other factors that contribute to high-risk pregnancies which are prevalent amongst Aboriginal and Torres Strait Islander mothers.
The clinical component of the course is designed to cement the knowledge acquired during the theoretical component by immersing health workers in a clinical hospital setting. This ensures student learning by hands-on, practical experience within a major tertiary (teaching) maternity hospital. This is further reinforced by the clinical assessment, which requires the student to attain specific skills while on placement. During clinical placement, students are exposed to a variety of ward areas within the hospital to experience and attain a wide range of skills. The students are required to complete a Clinical Experience Record that demonstrates they have observed and conducted a range of appropriate clinical and program activities whilst on placement.
Many factors impact on the ability of the graduates to successfully apply the skills and knowledge attained during the course. There is some anecdotal evidence that the program is contributing to increased antenatal attendance and at an earlier stage in pregnancy at several sites around Australia5. This experience includes several Aboriginal Community Controlled Health Organisations who have established dedicated Maternal and Child health programs utilising the skills and knowledge of staff that have successfully completed the program.
The course has had national uptake. There has also been an increase in hospital sites participating in the clinical phase of the program to accommodate the increased number of students in the course. The hospitals include: The Townsville Hospital (Townsville, QLD), Royal Darwin Hospital (Darwin, NT), King Edward Hospital (Perth, WA), Nepean Hospital (Penrith, NSW), and King George V Memorial Hospital for Mothers and Babies (Sydney, NSW). A range of tertiary hospital sites are utilised to expose Aboriginal and Torres Strait Islander Health Workers to the treatment and care that the majority of high-risk Indigenous mothers and babies experience in these hospital settings.
The Maternal Health Education program featured as part of the recommendation in a report to the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and the Victorian Department of Human Services6. The report recommended that the James Cook University Maternal Health Education Program be made available to all female Aboriginal and Torres Strait Islander Health Workers involved in maternal and child health care. VACCHO emphasised that the course is Aboriginal owned and recommended that Aboriginal and Torres Strait Islander Health Workers who are employed to provide maternity services, undertake this training.
In 1997, a new course, Basic Ultrasound Skills for Indigenous Health Workers in Remote Locations was written as a partnership between SPHTM, RANZCOG and the Australasian Society of Ultrasound Medicine. The course was designed to provide female Aboriginal Health Worker in rural and remote settings with limited access to sonographers, skills in maternal ultrasonography. The ultrasound course is skill specific and is only intended to assist Health Workers to identify a normal pregnancy via ultrasonography. The course emphasises that any abnormal findings should be referred to a doctor. Since the commencement of this course a total of nine students have been trained in maternal ultrasound skills. All of the ultrasound students are currently based in rural or remote communities. Indigenous women appear already to be attending the antenatal clinic earlier often in the hope of having an ultrasound examination. It has also become apparent that the partners of the pregnant women are also attending the ultrasound examination, which was previously unheard of in this community7.
Health Worker Profile
Heather Lee successfully undertook her Health Worker training at Townsville TAFE, and the Maternal Health Education Program in 1999, also in Townsville. Heather completed the clinical component of the course at Kirwan Hospital for Women (now The Townsville Hospital) and stated that this experience was good. She has since been working at Townsville Aboriginal and Islander Health Service (TAIHS) as the Coordinator/Health Worker of Mum’s and Babies Clinic. Heather has always had an interest in the medical field and her experiences as a birthing partner for friends and family led her to pursue studies so that she could formally provide health assistance to the Indigenous population.
In the Mum’s and Babies Clinic Heather finds that she utilises her maternal health training on a daily basis and the program has grown successfully since her employment in this position. Heather says that being able to provide holistic and culturally appropriate care to Aboriginal and Torres Strait Islander women has improved their health and wellbeing and she enjoys being part of this important team.
When asked whether she thought her training had been of benefit to her employer, Heather said she thought her training had helped to generate an increasing client base to the Mum’s and Babies clinic, which has an atmosphere where everyone feels comfortable and safe to attend. Heather feels that her maternal health training has improved the quality of the service that she provides as she is able to discuss women’s issues with clients in a safe environment and feels confident about giving them information that they can easily understand.
Heather believes that all of the Townsville community, particularly those who attend the clinic (and their families and partners) have benefited from her training and has helped to break down barriers between non-indigenous and indigenous people. This unique Mum’s and Babies clinic has been funded for a two-year period by Rio Tinto, and provides an important service. Unfortunately at this point in time, TAIHS has been unable to secure future funding for this successful program.
Ms Heather Lee – Coordinator of Mum’s and Babies Clinic at TAIHS
References
