Ruth Armstrong: Many ways to reconcile

TODAY is National Sorry Day: a day set down to commemorate and remember those affected because of government policies that saw forcible removal of Aboriginal children from their families, resulting in the Stolen Generations.

In a column published in MJA InSight to mark the day, Northern Territory psychiatrist Robert Parker reminds us that, far from being a historical curiosity, the decimating effects of the stolen generation are a very contemporary issue with far reaching effects on the current generation.

Sorry Day is followed by National Reconciliation Week, with this year’s  theme being “Walk the talk”. Parker also points out ways in which “walking the talk” in health care, by genuine engagement with each other, can have transformative results.

A more prosaic meaning of the word “reconcile” is used by accountants to describe making one account consistent with another — or to balance the books. This meaning is top of mind as we enter Budget recovery mode, and several of this week’s InSight stories tackle situations that are proving challenging to reconcile.

A study from the Northern Territory, published online today in the MJA, has exciting results. It shows that remote-living Indigenous people with diabetes are at significantly decreased risk of being hospitalised or dying if they access regular primary care, thus saving money and adding years of life.

However, some health leaders featured in our first news story are finding the federal government’s plans for a copayment for GP visits difficult to reconcile with the emerging evidence that we should be doing everything we can to improve Indigenous Australians’ access to primary care.

Discussions and negotiations are underway, and we can only hope that the government’s reaffirmed commitment to, and budget for, improving Indigenous health outcomes involves using the expertise of Indigenous leaders to identify where and how the resources are best directed.

It is hard to reconcile antibiotic prescribing practices with what we know about many common illnesses — that they are self-limiting, rarely caused by invasive bacteria, and that antibiotics have potential to do harm in multiple ways. Our second story highlights research from the US on antibiotic prescribing rates for bronchitis, with an Australian expert bringing some homegrown data to the table.

Medicine is not like accounting: often the elements on each side of the ledger are not directly comparable. Such is the situation for psychiatrists using injectable antipsychotic agents to relieve the symptoms of patients with schizophrenia. The disappointing results of a recent US trial, covered in our third news story, suggest that adverse effects rather than efficacy should be top of mind when choosing which drug to use, but how do they compare?

In her column this week, Jane McCredie reveals a terrible statistic from The Lancet’s recent series on global newborn mortality: worldwide, about 5.5 million babies die each year without ever having had their births registered.

The need for these statistics to be reconciled was well put by the lead researcher, Professor Joy Lawn: “Counting and naming every newborn is a statement that we expect that baby to survive and receive the care he or she needs, especially around birth.”

This week, as we consider the multilayered meaning of reconciliation between Indigenous and non-Indigenous Australians — including acknowledgement, empathy, engagement, relationship and action — there is much to celebrate, with Aboriginal and Torres Strait Islander people excelling and leading in many spheres, including medicine and other walks of life.

But barriers remain. Parker points out that racism is still one of them. His account of the casual racism meted out to his family is consistent with the lived experience of other Indigenous Australians and there is ample evidence that this is linked to poor health.

Discussions about racism are difficult, confronting and somehow embarrassing but we still need to have them. The organisers of this year’s Reconciliation Week may well have had the oft-quoted words of Atticus Finch in mind when they chose the “Walk the talk” theme: “You never really understand a person until you consider things from his point of view ... Until you climb inside of his skin and walk around in it.”

We can’t do that but we can listen, read, talk and walk. A fine assignment for those who want to be reconciled.

 

Dr Ruth Armstrong is the medical editor of MJA InSight. On Twitter @DrRuthInSight