more_vertShe has been called “Canada’s Martin Luther King”, the “conscience of the nation”, and a “national hero”, but Cindy Blackstock bristles at the accolades. “The only reason my job exists is because racism against First Nations children has been used as a cost-saving measure. I don’t want that job to exist—now or ever.” Blackstock is the Executive Director of the First Nations Child and Family Caring Society of Canada, a charity that, for 20 years, has lobbied for First Nations children to have equitable access to health and social welfare services.
Preference: Administration and Health Services
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Traditional Aboriginal healing and western medicine meet with Ngangkari project
A hospital upgrade usually focuses on new equipment and revamped wards. But the $32 million upgrade of the Alice Springs Hospital, due for completion this year, included an unusual and culturally significant part of traditional Aboriginal healing.
A Ngangkari – an Anangu traditional healer – recently went through the entire hospital looking for lost spirits.
Ngangkari have received special tools and training from their grandparents, and attribute many illnesses and emotional states to harmful elements in the Anangu spiritual world.
The Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council employs 10 Ngangkari to work in communities in the region, and in hospitals, nursing homes, hostels, health services, and jails in regional centres.
“The hospital has been very supportive,” project manager Angela Lynch said.
“The goal is to make people better – the way you go about it doesn’t matter.
“Healing is a very strong part of Aboriginal tradition, and when the Ngangkari can explain better what they do, there will be more acceptance by western medical professionals.
“The younger doctors in particular are really interested in what the Ngangkari do, which has come about through people having a really good understanding of what traditional healing can offer.
“People are frightened to be in hospital, they are worried about having an operation – the Ngangkari can calm them. Ngangkari are peacemakers.”
AMA President Dr Michael Gannon, who visited the NPYWC during his April visit to the Northern Territory, said that traditional healing and western medicine were not necessarily exclusive.
“As doctors, we spend a lot of time warning people against non-medical treatments, but we also acknowledge the importance of spirituality and, although I don’t personally like the word, wellness.
“The concept of wellness has been hijacked to a degree. Wellness isn’t something that you buy in a bottle.
“Concepts of healing and wellness aren’t foreign to medicine, but so much of what we do is focused on intervention and science.
“Medicine needs to look at traditional healing methods sometimes, rather than reach for the script.”
The Ngangkari look for ways to complement and work with western medicine, rather than present themselves as the alternative, Ms Lynch said.
“A lot of the Ngangkari have chronic illnesses themselves, and they have enormous faith in western medicine to fix things they can’t, like dialysis, and the effects of petrol sniffing,” she said.
“They tell their patients that there are two paths, and you also need to go to the doctor. You need to stop smoking. Smoking marijuana and drinking alcohol are not good for your spirit.”
NPYWC chief executive officer Andrea Mason said that the level of trauma in Aboriginal communities was only now being recognised.
Family and domestic violence is a major factor in trauma, whether the person experiences it or witnesses it, she said.
“Psychological unwellness is a big factor in chronic disease,” Ms Mason said.
“Does one trigger the other, or do these factors work together?
“The rolling-in of the rhythm of western culture – going to school or work every day, driving not walking – this rhythm is a sandpaper to the Aboriginal culture.
“Once we begin treating the causes of trauma, the next step is saturation – to counter the level of trauma with the level of healing resources, and wrap people in healing.”
Ms Lynch said that one of the problems was the lack of a word for “depression” in Pitjantjatara.
“People don’t ask for help, and there is no help to give for suicide,” she said.
“We have started a new project to try to address this, with Ngangkari sitting down with families and psychiatrists in clinics to develop an understanding that incorporates both traditional and western views.”
The project has turned into an app, “Kulila!”, available for both iPhones and Androids, which translates different words for feelings from Pitjantjatara to English, and vice versa. Words like “kawa-kawa”, which means muddle-headed or mixed up, of “kulintja kurra”, meaning troubled mind.
It can be used in intensive care units and other medical settings to get some depth and understanding of how people are feeling.
“We also use mood cards to help people identify what’s going on in their lives,” Ms Lynch said.
“We’ve come to understand that a lot of behaviour is the result of trauma – seeing domestic violence, car accidents, etc.”
The Women’s Council has also put together a storybook for children, available from the Centre’s gift shop, which tells the lives of two children, Tjulpu and Walpa, whose lives take different paths based on early trauma.
The book was illustrated by a doctor at Alice Springs Hospital, and it is also being turned into a digital story.
The Centre also provides colouring books, and not just for children.
“When I first came to a meeting here, I saw that there were notepads and coloured pens on the tables in front of the women,” Ms Mason said.
“As the meeting went on, they all started to doodle. The more intense or confronting the conversation got, the more intense the doodling became. It’s a calming mechanism, so we’ve incorporated it into our regular activities.”
You can learn more about the activities of the NPYWC at https://www.npywc.org.au/.
MARIA HAWTHORNE
Doctors and medical students ‒ ten reasons why you need a GP
OPINION – BY DR ROGER SEXTON
So you think you are going OK, do you? Feeling fine mostly but perhaps a little tired at times. Some stress, but nothing unusual or too unmanageable and no significant physical problems.
You probably haven’t needed to see a doctor about anything for some time. You may have managed to get by with some medication samples from work or prescribed by one of your politely compliant but quietly reluctant colleagues.
The convenience of being able to bypass all of those annoying steps that our patients have to undertake to see a doctor is surely one of the great benefits of membership of the medical profession!
It is one of the biggest risks, too.
The choices available to doctors seeking medical care for themselves include the formal option of a consultation with their doctor in the correct clinical setting. They may opt for informal care from a colleague in the corridor or self-medication and self-investigation. Thirdly, a doctor may use a combination of both. This ‘blended’ care option is in my experience very widely practised by doctors who prefer this to avoid the inconvenience of a formal appointment, the potential for illness disclosure, the erosion of privacy and having to endure the ‘waiting room experience’.
Doctors also suffer their fair share of common conditions including infections, acute physical and mental conditions and injuries to name a few. Doctors can be unaware of age-appropriate health screening tests and can present late in an illness, due to incorrect self-diagnosis or wanting to avoid ‘trivial’ illness presentations.
GPs are centrally placed to assist the health of the medical profession. They are a precious resource and the following list reminds us of the value of all doctors and students having their own GP of choice.
Selection of the right GP for you can take time and it is important to be as helpful to your GP as possible and if you practise blended care, tell them.
- Your GP is your independent advocate in the health system. GPs spend all their time going in to bat for their patients and are very good at it.
- Your GP has a different set of referral networks to you and can decide who is most appropriate to see you for further specialised care. It is more than likely that your own informal network of professional friends from medical school really do not want to see you.
- Your GP is a very broadly trained generalist and understands the broader impact of work, relationships and lifestyle on the mental and physical health of the individual.
- GPs focus on preventive medicine including immunisation and age-appropriate health screening. This is underdone among doctors in particular.
- GPs have recall systems and high levels of computerisation which assist with caring for patients and reducing prescribing errors.
- GPs are confidential and understand the importance of confidential advice to the medical profession.
- Your GP maintains your complete medical record and can coordinate clinical handover when you are travelling or moving interstate.
- Your GP is interested in you as a person and understands what it takes to be a sustainable and successful medical professional.
- Your GP looks at you holistically and independently. They will see things you will not.
- Your GP will help you live longer. There is good evidence for the benefits to longevity from having a GP.
You will live longer if you have your own GP because prevention really is better.
Dr Roger Sexton is the Medical Director at Doctors’ Health South Australia and a Director of Doctors’ Health Services Pty Ltd (DrHS), a subsidiary of the AMA. DrHS is funded by the Medical Board of Australia. Find out more at www.drs4drs.com.au
Mapping the cost of health-related work incapacity
A Federal Government statutory authority is releasing new research that estimates the scale and cost of health-related work incapacity in Australia. And it looks at opportunities to improve the situation.
Comcare, the Government’s compensation insurer and work health and safety regulator, late last year established an innovative public-private initiative known as the Collaborative Partnership to Improve Work Participation.
It is focused on aligning the various sectors of Australia’s work disability system to deliver better outcomes for people with temporary or permanent physical or mental health conditions.
The Partnership includes the Australasian Faculty of Occupational and Environmental Medicine (AFOEM), the Departments of Social Services and Jobs and Small Business, the ACTU, the Insurance Council of Australia, insurer EML and experts Lucy Brogden, Chair of the National Mental Health Commission, and consulting Professor Niki Ellis.
AFOEM is leading work to strengthen the role of GPs in improving return to work outcomes for injured and ill workers – including helping GPs prescribe work as part of recovery.
Through a range of projects, the Partnership is working across sectors including workers’ compensation, life insurance, superannuation, disability support and employment services to improve disability employment and return to work rates for people experiencing work incapacity through illness and injury.
It is also the first time all the major compensation and benefit systems have been examined together to identify the flow of people through them, how the systems interact, and where they can be improved to deliver better health and productivity outcomes.
The Partnership commissioned Monash University to undertake the research. The resulting report The Cross Sector Project Mapping Australian Systems of Income Support for People with Health-Related Work Incapacity is now being released.
The study considered data and services across the systems that support people to work – workers’ compensation, disability support, veterans’ compensation, superannuation, life insurance and motor accident compensation.
Among other things, the study found that 786,000 Australians who were unable to work due to ill health, injury or disability received some form of income support in 2015-16.
Also, about $18 billion was spent on some form of income support in that year.
This research sheds new light on how many Australians have health conditions that impact their ability to work, and the cost for employers, Government and insurers. The numbers include 155,000 people in workers’ compensation and 469,000 people in social security.
Researchers also produced a conceptual map of Australia’s income support systems, showing the volumes of people, the types of income support they receive and how they might move through the various systems.
“These findings mark the first step in establishing an evidence base in a critical area of public health and social policy,” Comcare CEO Jennifer Taylor said.
“It gives us a basis for improving Australia’s service delivery model for supporting people with work-related injury or disability in their return to work.
“Australia’s benefit and compensation systems are siloed and operate with little reference to each other. There’s growing recognition that what happens in one system impacts others, and the costs often just shift between the systems.
“Considering the sectors as a whole rather than as independent systems will lead to a better understanding of how they operate in relation to each other, how they connect and where gaps or tensions exist.
“It’s clear that taking a cross-system view and a collaborative approach gives us a platform to design and trial new service offerings. We have significant opportunities to improve health and productivity for a very large number of working age Australians.”
Monash University’s Insurance Work and Health Group, led by Professor Alex Collie, was asked to develop a high-level system map of the current Australian service delivery model for supporting people with a work-related injury or disability in their return to work. The project also analysed and mapped system-related data and data gaps.
The project scope included investigating five categories of services: return to work services; healthcare and treatment; job finding or employment services; functional support services; and case management services.
The Monash team mapped 10 major systems of income support in Australia: employer provided entitlements; workers’ compensation (short tail and long tail schemes); motor vehicle accident compensation (lump sum and statutory benefits); life insurance (income protection and total and permanent disability schemes); defence and veterans’ compensation and pensions; superannuation; and social security.
The report estimated the number of people accessing income support and associated costs from each of the systems during 2015-16 and identified opportunities for improvements in the various systems.
Potential improvements include information and data sharing to provide greater understanding of the systems of income support; and better aligning service models – particularly through reforming GP certification and work capacity assessment – to reduce overlap and improve service delivery.
The Collaborative Partnership is considering these recommendations and working towards addressing the opportunities for change. Members are already examining ways to improve data sharing between the various compensation and benefit systems to get a better understanding of how they interact and how they can work together more effectively.
CHRIS JOHNSON
The Cross Sector Project report can be found on the Partnership’s website: http://www.comcare.gov.au/collaborativepartnership
PICTURE: Comcare CEO Jennifer Taylor launching the Collaborative Partnership to Improve Work Participation.
Scanning on top of the world
Radiographic imaging equipment has been delivered to the top of the world – almost.
Kunde hospital is located 24.6 kilometres from Mount Everest Base Camp and a Carestream Vita Flex CR System was recently delivered and installed there by Capital Enterprises.
The equipment provides imaging services to 8,000 local residents as well as mountaineers, sherpas and others who support those who attempt to climb Mount Everest.
The imaging system was transported by plane to Lukla, Nepal. The Lukla airport (officially called the Tenzing-Hillary Airport) is regarded by many as the world’s deadliest airport due to its high elevation and unforgiving terrain.
From there, porters carried the x-ray equipment on their backs for 30 kilometres to the hospital, which is staffed and operated by local physicians and nurses.
The system is used by medical staff to capture digital x-ray images of shoulders and extremities that have been broken or sprained.
It is also for the head and neck area to diagnose sprains or concussions; as well as chest exams that may indicate a patient has pneumonia, altitude sickness, or evidence of a heart attack or other serious medical conditions.
These imaging studies are essential to diagnosing diseases and injuries to climbers, sherpas and other workers at base camp.
“The images are available in minutes and physicians decide if a patient can be treated at the hospital or must be transported to Kathmandu… by helicopter or airplane,” said Carestream’s Charlie Hicks.
Kathmandu is 136 kilometres from Kunde Hospital. The Kunde hospital, which was founded by Sir Edmund Hillary in 1966, is 3,840 metres above sea level.
CHRIS JOHNSON
GMP clearance process improvements – Post implementation update
GMP Clearance Process – Common issues when completing the online application form in TGA Business Services
[Editorial] UK COPD treatment: failing to progress
Chronic obstructive pulmonary disease (COPD) is a major cause of mortality in the world today. More than a million British people lived with diagnosed COPD in the UK in 2014–15, or just under 2% of the population. COPD admissions to emergency services in the UK are on the rise, but, access to treatments shown to reduce patients’ time spent in hospital is still woefully inadequate.
[Correspondence] Compulsory admissions in Greece: multifaceted action is required
It was with great concern that we read the Editorial in The Lancet (Jan 27, p 282)1 regarding institutional and coercive mental health treatment in Europe, in which Greece was among the countries with substantial shortfalls in mental health services and violations of patients’ human rights.
[Correspondence] Mapping and understanding exclusion
On behalf of Mental Health Europe I would like to respond to the Lancet’s Editorial (Jan 27, p 282)1 written about our Mapping and Understanding Exclusion report.2 Although we welcome the coverage of our report, we were disappointed to see a reference to the need to uphold the status quo on coercive measures, which might lead to confusion regarding the conclusions of our report. The Lancet’s Editorial stated that: “Involuntary treatment and detention are a necessary part of mental health care”.1 This statement is contrary to the core message in our report, which recommended that to reduce coercion in mental health services European states should adopt policies and practices that aim to immediately reduce coercion in mental health services and ultimately make such practices by exception only, in line with human rights standards.
Mandatory reporting burden to be eased
New, nationally consistent laws will ensure doctors are no longer obliged to report colleagues under their care to AHPRA over mental health issues.
In a statement following last week’s meeting of the COAG Health Council, Federal, State and Territory Health Ministers agreed unanimously to “strengthen the law to remove barriers for registered health professionals to seek appropriate treatment for impairments including mental health”.
They agreed to a nationally consistent approach with “exemptions from the reporting of notifiable conduct by treating practitioners”, with new legislation that will have to be passed by the various State and Territory legislative bodies. Western Australia already has such laws, which it says it will retain as is.
Currently, doctors in all states other than Western Australia are legally obliged to report the mental health impairments of any registered health professional under their care to AHPRA or the Medical Board of Australia. In some cases, this can lead to a suspension of a doctor’s registration and right to practise. The issue of mandatory reporting has been a point of simmering tension in the medical community following a tragic spate of doctor suicides. The AMA, the RACGP and other representative bodies have argued that under the current regime, doctors battling with depression or other mental health issues often avoid seeking help for fear of being reported to AHPRA and losing their registration.
Under the new approach, doctors would still be under the obligation to report “past, present and the risk of future sexual misconduct”, as well as “current and the risk of future instances of intoxication at work and practices outside of accepted standards”.
The statement from the COAG Health Council meeting has been met with cautious approval from doctors’ organisations. AMA President Dr Michael Gannon said the Ministers had acknowledged the AMA’s concerns and that he was confident better laws could be crafted and implemented.
“It is clear that all the Health Ministers are committed to removing barriers from doctors seeking help from other doctors about their mental health or stress-related conditions,” he said.
But he took issue with some of the wording in the COAG statement, in particular with regard to the “future misconduct” of health professionals.
“It is unreasonable and unworkable to expect treating doctors to predict the future behaviour of any patients, including their colleagues,” he noted.
The RACGP’s response was a little more measured. The GP body described the COAG statement as a step in the right direction, but cautioned that it left “significant room for doubt and confusion”.
RACGP President Dr Bastien Seidel said the proposed changes were “short on detail” and that the retention of requirements for reporting a health professional practising “at a lower standard” left doubt for doctors seeking healthcare.
“Much of the conduct identified as grounds for mandatory reporting is subjective, open to interpretation by both the health professional and their treating practitioner,” he said.
“If there is room for doubt on what should or shouldn’t be reported, the fundamental issue of there being barriers to healthcare remains,” he added.
AMSA, the body representing Australia’s 17,000 medical students, applauded the rethink on mandatory reporting.
“It sends a strong message about the culture of medicine, that we encourage people to talk about their mental health, to seek help early, and that doctors who find themselves on the other side as patients deserve the same access to care as everyone else,” the body said in a statement.
But it also was worried about the wording around future misconduct.
“Predicting future behaviour is a complicated area, and leaving this as grounds to affect a doctor’s registration and career is troubling. In revision of the reporting procedures, we hope that it is remembered that the aim is to help doctors, not punish them.”