Aboriginal and Torres Strait

Islander Health in remote

settings

Dr Vlad Matic

MBBS(Syd)FACRRM FRACGP FAICD

• Director of Medical Services at

Wuchopperen in Cairns

• Previously worked in Walgett for >15

years, 2 years in Bourke and prior to

that did 2 years of RRMA 7 locums in

Lake Cargelligo, Brewarrina,

Condobolin and Moree

• Platinum Frequent Flyer status with Air

Ambulance, Aero-Medical retrieval,

NETS and RFDS

• First name basis with state wide

consultants and retrieval doctors

• Good working relationships with ED’s

ICU’s

What is special

• History – was quite positive until about

200 years ago

• Culture – pre-dates “European”

• Family and priorities of life

• Paradigms of wellness / unwellness

• In-Country issues

Well known facts

• Disproportionate disease burden index

• Decreased life expectancy

• Greater in hospital complication rates

• Greater re-admission rate

• High rate of loss to follow up

• Disproportionate incarceration rate

Some realities

• ESecondL or ESThirdL

• Limited literacy – especially health

literacy

• Agreement for the sake of agreement

• Limited experience of or willingness to

undertake air travel or leave home

• Limited financial resources

Cultural awareness

• I know there is a school zone

Cultural safety

• I will drive at the speed limit through the

school zone

Cultural competency

• I will drive appropriately to the

conditions and I will be extra vigilant to

make sure that despite all my caution I

haven’t missed a warning sign of

something predictable – in short, all my

skills are required at this time to get the

best outcome

• None of this is “Political Correctness” it

is common sense

• As a trained medical specialist the aim

is to get the best result

• One model of care does not fit all – we

tailor our care daily to children, women,

men, the elderly and to migrants

My experience

• Respect – implied, demonstrated, felt

• Explanation with understanding

checked

• Tell the truth – every time

• Ask the same question several different

ways

• Build and earn Trust – don’t promise

unless you can deliver

My experience

• The non medical or non surgical

component of the remote GP / VMO

referral was minimally incorporated into

the treatment approach or plan

• In time I could predict which transfers

were going to do badly

What could EDs do

• Acknowledge – the Patient, the fear, the

concern, the unfamiliarity and the

dislocation

• Communicate clearly, more than once

and using different approaches

• Explain what is happening now

• Make room for support people – on or

off site, or access support

What could EDs do

• Negotiate expectations

• Explain the next step

• Explain the timelines

• Ensure truly informed consent

• Listen

• Make time

• Try to understand varying paradigms

What could EDs do • Acknowledge and incorporate the

holistic referral components

• Communicate back to the referring GP

or Hospital – they will be the point of

health system contact for the relatives

at which progress questions are asked

• Communicate back to country with

extended family – usually via the GP or

ALO or AOW

What could EDs do

• Clear discharge summaries in a timely

manner – more than one copy and not

just via the Patient

• Address follow ups at this time

• Address prognostic factors in

communications

What could EDs do

• Cover more than the surgery or the

medicine or the pathology results,

address compliance, mood, concerns

• Understand and avoid as possible the

tyranny of distance

• Make appointments rather than suggest

appointments, locally where possible

Benefits

• Do it once

• Fix the problem

• Build trust

• Better outcomes for Patients

• Lower re-admission rate

• Lower complication rate via improved

compliance

Benefits

• Improved community agreement to

medical strategies – evacuation, earlier

presentation, preventative intervention

• Improved truly informed consent

• A culturally competent workforce

• Decreased adverse incident rate in ED

Closing the Gap

• The aim is to align the disease burden

and life expectancy and quality of life

between Aboriginal and Torres Strait

Islander peoples and non-Indigenous

Australians

Closing the Gaps

• Knowledge

• Navigational skill

• Paperwork and bureaucracy

• Transport

• Awareness

Closing the Gaps

• Individual empowerment

• Compliance

• Confidence

• Cultural paradigms incorporated

• Trust

Questions

Thank you