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

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