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From a broom cupboard: 20 years of rural health at Monash University

Ch 07. Aboriginal health

Leading the way

Adjunct Professor Marlene Drysdale

Prior to 2002 Monash University had not committed to including Aboriginal and Torres Strait Islander health in the medical, nursing and health sciences curricula. However, there were some committed staff members and unit coordinators who included information and lectures about Aboriginal health where possible. Evidence showed, and still does, that Aboriginal people have the worst health status of any group in Australia, and there was a call at the national level to do something about the situation.

In 2002 Dr Janice Chesters and Dr John Togno, two passionate advocates of Aboriginal health, approached me to ask if I would be interested in setting up the Indigenous Health Unit at the School of Rural Health under the leadership of Professor Roger Strasser. After several meetings with Janice Chesters and then Associate Professor, Elaine Duffy, I was seconded from Aboriginal Studies in the Faculty of Arts to the School of Rural Health, mainly because I had a particular interest in the health and wellbeing of Aboriginal and Torres Strait Islander peoples; I had already written an Aboriginal health unit for the arts faculty. I was also well connected at a regional, national and international level and an active participant in Aboriginal organisations at a local level.

The School of Rural Health was a vibrant, forward-thinking school. It passionately advocated for the health and wellbeing of rural and Aboriginal people by providing leadership and support to local rural organisations, developing quality research and inspiring medical, nursing and allied health professionals to think about a career in the bush. Another unique feature of the school was its commitment to working with and building the capacity of local communities. Most of the committees within the School of Rural Health included in their management teams community representation that enhanced the work of the school and the credibility of the work they were doing. The Indigenous Health Unit had strong links to the Gippsland community and we relied on them to guide our curriculum and research initiatives. In the spirit of reciprocity we provided governance training, project leadership and committee representation.

The School of Rural Health had strong leadership in Roger Strasser and then Elaine Duffy, both of whom moved onto prestigious positions in Canada. During my time I saw eight different heads of school who were all committed to making a difference and to fighting for ongoing funding and recognition of the high quality work being performed.

The Indigenous Health Unit was established to provide leadership and develop policy across the whole of the University on Aboriginal and Torres Strait Islander health, and to encourage others to include Aboriginal and Torres Strait Islander perspectives in their programs. Some incorrectly assumed that our focus was only rural and resisted our attempts to encourage inclusion of Aboriginal health issues in their curriculum. However, those who embraced the opportunity worked closely with us to develop culturally appropriate teaching materials and helped us to deliver lectures and tutorials.

The Indigenous Health Unit had very humble beginnings with only one staff member, but its vision was to strive to be a centre of excellence in the delivery of an Aboriginal health curriculum across the University. Progress began with the employment of two new staff members, Lyell Wilson and Isabel Ellender, who had previously worked with me and were qualified to develop, deliver and assess a quality curriculum. The development of a unit, SRH2002 Aboriginal Health and Well-being, was taught both on-campus and by distance learning at the Gippsland, Peninsula and Caulfield campuses of Monash, with enrolments of 500 plus students.

Many students who wanted an Aboriginal health unit as part of their university experience were from remote, interstate or overseas areas and required special and individual attention to support their learning needs. This led to the employment of Heather Kelly who took a coordinating role with all students. Heather came with great depth of experience in the area of student support and was a valued contributor to the vision of the Indigenous Health Unit. Leanne Turnbull was employed as my personal assistant and her contribution and dedication to the unit was invaluable. As the workload increased many other staff were employed, including Anton Isaacs and Hilton Gruis. Hilton has been the director of the Indigenous Health Unit since my retirement in December 2011. Robyn Collins, Sue Barker, Ann-Maree Nobelius and several other sessional staff, as well as the MUDRIH staff, helped with our lecture program. Janice Chesters and Mollie Burley, in particular, were dedicated to the advancement of rural and Aboriginal health and interprofessional learning, and provided a depth of knowledge and experience which they readily shared with us.

The early years

The newly developed Indigenous Health Unit provided expertise and support for the whole of Monash University and this was a challenge for the capacity of the unit. While our main focus was on medicine, nursing and health sciences, we also engaged and consulted with several other faculties, as well as local communities and key organisations such as the Victorian Aboriginal Community Controlled Health Organisation and the Victorian Aboriginal Education Unit.

As the program developed and expanded it became clear that there was a need to increase the number of academic and support staff to meet the growing needs and expectations. In Mildura, Rose Gilby was appointed as a lecturer to help develop the northern region curriculum and build partnerships with the local Aboriginal organisations and community.

Attempts to employ another person at the Bendigo Regional Clinical School were only partly successful. However, the ongoing support and encouragement of Professor Geoff Solarsh, director of the Bendigo Regional Clinical School, and Professor John Humphreys, head of research, were valued and welcomed; their expertise and passion in the area of rural health helped us overcome some of the early hurdles.

Aboriginal health curriculum

One of the first areas of inclusion of Aboriginal health was within the medical curriculum which incorporated lectures, problem-based learning scenarios and OSCEs (objective structure clinical examinations) that had Aboriginal issues embedded in them. Students were also encouraged to participate in the selective program and were offered the opportunity to attend a cultural immersion week at Iga Warta in the Flinders Ranges. Later, similar weeks were established at Mildura and Broken Hill. Twenty students per year attended these selectives over a ten year period. While they ran, they proved successful and popular in educating student doctors on Aboriginal issues and provided exemplars for similar programs in the future. The experience of the Indigenous Health Unit is that exposing students to rural community life and allowing them to witness the challenges faced by those communities’ health care needs, is far more effective than simulated exercises and lectures.

Professors Chris Browne and Ben Canny, in particular, have been great faculty supporters of the Indigenous Health Unit’s work in medical student training. From within the medical student cohort the Wildfire club also supports Aboriginal health programs. Among other activities, Wildfire runs the Matthew Campbell Memorial Lecture each year to honour the memory of Matthew, one of the early advocates for Aboriginal health in the faculty. Matthew was tragically killed in a car accident before he finished his studies.

The roll-out of the Aboriginal health unit to nursing, health sciences, paramedics and sociology students was a major coup. The inclusion of the unit into these courses ensured that all graduates from our faculty would be acquainted with the issues relating to the health of Aboriginal and Torres Strait Islander people. The delivery of the unit was difficult at times as it cut across internal funding arrangements within the faculty and student reactions were variable. Nevertheless the introduction of the unit was a hugely important step in the cause of recognising the issues and improving the health of Aboriginal Australians; the Indigenous Health Unit showed the way. It was guided for many years by a strong and active Community Advisory Council which consisted of key rural and Aboriginal organisations, community leaders and members of the general public. The council provided advice on the needs of the local rural communities and provided focus on future directions for research and programs. It also enhanced the applications for funding as many of the members were strongly connected to political lobby groups and advocated for rural and Aboriginal health.

Projects

The first of the major projects undertaken by the Indigenous Health Unit was Building Healthy Communities: A Rural Chronic Disease Initiative, of which Di Wyatt was the chief investigator and program leader. Of the 26 sites the project covered, nine were Aboriginal communities. Our role was to visit and support the community initiatives, to ensure protocols were followed and that the community engaged with the project team. This was a national project that required sensitive and culturally safe approaches. The project was very successful and stimulated far greater national and international interest than had been envisaged at the beginning.


Launch of the Rural Chronic Disease Initiative ‘Building Healthy Communities Resource Kit’ 2004: back left to right – Keith Salvat, Marlene Drysdale; front left to right – Janice Chesters, Susan Fawkner.’

The second project – Footprints Forwards: Better Strategies for the Recruitment, Retention and Support of Indigenous Medical Students – was also a national project of which I was chief investigator and program manager. The project was undertaken by the consortium of Monash University, James Cook University and University of New South Wales, and investigated opportunities and barriers to Indigenous students’ entry to medical education in Australia. It examined existing information relating to Indigenous recruitment and support, identified reasons for the low completion rates of students, reviewed existing promotional materials, developed an interactive multimedia product, designed and piloted a flexible and sustainable model of recruitment, and established a project reference group. The project’s final report made eight recommendations that were intended to enhance the recruitment and retention of Indigenous medical students. The two phases of the project were completed on time and within the budget.

In collaboration with Andrology Australia, the Indigenous Health Unit was commissioned to write the Aboriginal men’s health unit for Aboriginal health workers, which included culturally appropriate activities that were to focus on Aboriginal men’s health needs. This project was trialled at chosen sites and is now part of a Certificate IV course for Aboriginal health workers. Hilton Gruis and Anton Isaacs both had a specific interest in Aboriginal men’s mental health and were successful in obtaining a Beyond Blue research grant.

Several other staff were involved in projects while completing masters or PhD degrees. They contributed to the research capacity of the school by publishing articles in carefully targeted journals.

One of our key projects was the development and delivery of cultural safety training both for University staff and various community organisations which provided services to Aboriginal people and communities. This activity provided financial resources for the unit that allowed staff to participate in conferences and professional development activities. It also allowed for some support for community activities.

Immersion programs

One of the innovative successes of our work was the immersion programs. These programs allowed students to learn about Aboriginal culture directly from the people with lived experiences who were willing to take students on a journey of understanding through shared knowledge within an Aboriginal community. Some of the cultural activities included visits to the original Aboriginal mission sites where they heard the history from people who had lived there through hardships and happy times. Other activities included visits to sacred sites, interpretation of art sites, bush tucker and medicines as well as Aboriginal bush survival skills. These opportunities were limited to 20 medicine, 20 nursing/health science students and four staff members. The program was cultural safety in action. Students started with an understanding of the protocols required such as respect, dress code, listening, and involvement in all group activities. Each day there was a debrief session including games and a sing-along by the campfire. Students met local Aboriginal people, including elders, Traditional Owners, health workers, and traditional healers, and heard about how they work in their communities. These people were always ready to talk to students and answer any of their questions.

Awards and recognition

During the 10 years of my time at the Indigenous Health Unit we were recognised for our achievements with awards such as the Vice-Chancellor’s Excellence Award, twice; Leaders in Indigenous Medical Education Award for excellence in the recruitment and support of Aboriginal medical students; Australian GPET (General Practice Education and Training) award for registrar training; and several community awards for reconciliation, governance and community support. Other awards were given to individual staff members for their contributions to community organisations. It is important for people who work hard in their areas of expertise to be recognised for their contributions and, more importantly, acknowledged by their peers. The School of Rural Health always celebrated their achievements as a family, understanding the environment of rural and Aboriginal health and the challenges it presents.


Marlene Drysdale graduates with her Doctorate of Communication from Deakin University 2010.

Challenges

One of the challenges that the unit undertook was to increase the number of Aboriginal students in the medical courses. When the Indigenous Health Unit was established, Monash had only one Aboriginal medical student and no recruitment strategy, identified student places or support mechanisms. Within a network of other university Indigenous units and a close working relationship with the then Centre for Australian Indigenous Studies student support unit, we began a recruitment campaign to enrol more students. Our first port of call was VTAC (the Victorian Tertiary Admissions Centre) to identify Aboriginal students interested in medicine and follow them up to make sure they were prepared for the UMAT (Undergraduate Medicine and Health Sciences Admission Test). A similar approach was taken with postgraduate students to support them to sit the GAMSAT (Graduate Medical School Admissions Test) entrance exam. Our relationship with the Australian Indigenous Doctors Association resulted in some referrals. Progress required a personal approach to each student and often to their parents. We provided support for students to attend interviews and introductory sessions. After enrolment, we provided academic and personal support to enable them to complete their studies.

In 2011, 11 Aboriginal students enrolled in the medical course, proving the success of the recruitment campaign.

In 2004 the Monash University Faculty of Medicine, Nursing and Health Sciences became a signatory to the Indigenous Health Curriculum Framework developed by the Committee of Deans of Australian Medical Schools. The framework has since been included in the Australian Medical Council’s accreditation guidelines for basic medical education and requires all medical schools to include core Indigenous health content in their medical curricula. The framework recognised that all medical graduates need to be both clinically and culturally competent to affect positive health outcomes for this portion of the population whose health outcomes were, and are still, unacceptably poor. The Indigenous Health Unit had the task of implementing the framework within our faculty and worked tirelessly to educate staff and students about Aboriginal health issues. The advocacy and support provided by the School of Rural Health was crucial in successfully embedding Aboriginal health as a core unit into all courses offered by the faculty. I am particularly grateful for the support of Janice Chesters, John Togno, John Humphreys and Mollie Burley at this time.

Reflections and the future

There were some wonderful and exciting times, as well as some inevitable disappointments. The commitment and tenacity of the team and our supporters always enabled us to keep moving towards achieving our goals. The Indigenous Health Unit has certainly satisfied our initial aims of providing leadership and developing policy across the whole University on Aboriginal and Torres Strait Islander health. Although there were many changes, there was always support for the work we were doing and trust in our professionalism to uphold the integrity of the school and the vision of the University.

An exciting advance in Aboriginal health has been the establishment of the School for Indigenous Health within the Faculty of Medicine, Nursing and Health Sciences at Monash. The school was built on the foundations provided by the Indigenous Health Unit, but now, with increased status and reach across the faculty, it ensures that the Aboriginal health message, education, research and support activities are able to gain maximum leverage. The school and the unit share the following aims:

  • to train Aboriginal and non-Aboriginal people to more effectively address Aboriginal health

  • to broker and conduct high quality research

  • to support the health and community development goals of Aboriginal communities

  • to provide strong governance and leadership to ensure that the whole faculty shares responsibility for Aboriginal health

Through collaboration with the School of Indigenous Health, the Unit of Indigenous Health concentrates specifically on rural aspects of the charter. It is hoped that this structure will build on the past advances made by the unit, and that it will ultimately make a significant impact on health outcomes for Aboriginal people.

Congratulations to the School of Rural Health, MUDRIH and the Indigenous Health Unit on what has been achieved in the past 20 years! On a personal note, thank you for the opportunities you have given me to follow my passion and thank you to the many wonderful people I have had the pleasure of working with. I reflect back on those times with great fondness and pride.

Drysdale, Marlene. 2012. ‘Aboriginal health: Leading the way’, in From a Broom Cupboard: 20 Years of Rural Health at Monash University, edited by Clough, Robert. Melbourne: Monash University Publishing. Pp. 112–120.

From a broom cupboard: 20 years of rural health at Monash University

   by Robert Clough, editor