The Aboriginal Hospital Liaison Officer
What is Aboriginal Health?
Aboriginal health is a specialised area in medicine and a very important part of healthcare in Australia. [1] [2] [3] To facilitate a positive working relationship with the local community that is maintained and respected, it is crucial to have an Aboriginal Hospital Liaison Officer (AHLO) at each hospital. [4]They provide emotional, social and cultural support to patients and their families and information about hospital services and assist with referrals to Aboriginal and non-Aboriginal organisations. [5] Most importantly, however, they advocate and liaise on behalf of patients and families. [5] [6] Indigenous Australians from Colac are referred to the Wathaurong Aboriginal Cooperative (WAC), an Aboriginal organisation in Geelong. [7] In this Wiki, I will highlight the advantages of having an AHLO has in a health service and the difference it has on an Indigenous patient's experience in the hospital as opposed to one which doesn't.
Wathaurong Aboriginal Cooperative
WAC is one of 24 Victorian Aboriginal Community Controlled Health Organisations (VACCHO). It is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate healthcare to the community which controls it. [8] Aboriginal health is not just the physical wellbeing of an individual, but is the social, emotional and cultural wellbeing of the whole community in which each individual is able to achieve their full potential thereby bringing about the total wellbeing of their community. It is a whole-of-life view and includes the cyclical concept of life-death-life [9]. The WAC plays an important role for those who live in the Geelong area, particularly in dealing with post discharge issues which is vital in continuity of patient care. They offer a wide range of services for Aboriginals such as an outreach program, drug and alcohol services, home and community care and a needle exchange program. Over the years, WAC has developed an excellent working relationship based on the concept of community control ensuring the hospital program is community driven. This benefits the local community and the hospital by ensuring that the health needs of Indigenous Australians are identified and addressed.
AHLO at Barwon Health
My experience with the AHLO in Geelong Hospital demonstrated the importance of culturally sensitivity. I had a 51 year old female patient who was admitted to ICU because of an exacerbation of her chronic obstructive lung disease on a back ground of diabetes and alcohol abuse. The patient was abusive towards staff and refused treatment, telling doctors and nurses to 'get away from her'. It wasn't until the AHLO came that she finally calmed down. The AHLO sat for hours with her and her family and explained how the hospital worked, what the management plan was and what they were doing and why doctors had organised certain tests. She explained the roles and responsibility of each staff member involved with her care, and the use of different pieces of equipment. She was able to provide the support, respect and wisdom that was culturally appropriate to the Indigenous patient in an honest and transparent manner which facilitated ownership of her own health and acceptance of medical treatment, which positively impacted the Indigenous patient's experience and attitude towards the healthcare system, gaining her trust and improving patient compliance.
The absence of an AHLO in Colac Area Health
On the contrary, Colac Area Health (CAH) was not trained to address Indigenous issues of cultural and gender sensitivity. The Emergency Department was run by nurses, a resident and GPs on-call, none of who had much training or experience in Aboriginal health. Many Indigenous Australians had a negative attitude towards the hospital and the health care system even before presenting there. [10] They saw hospitals as a threat, were often suspicious of medical practitioners and hold the belief that they go there to die, which meant they would avoid hospitals at all costs. [11] When there was no AHLO to dismiss these beliefs, or to support and educate them about why they were in hospital and what the doctors were doing, this compounded on the patient's negative experience. There were only 30 beds in Colac hospital; if one of their people had to have "sorry business" in the hospital, there was nowhere to put other Indigenous patients, because it was culturally inappropriate to put Indigenous patients in the same bed or part of the hospital. The hospital had no contacts such as an elder in the community it could contact locally to come in and talk to the patient. If patients were discharged from other health services such as Geelong Hospital or a Melbourne hospital and transferred to CAH, there would be issues with continuity of care and the provision of culturally sensitive care.
Future directions
I believe we need to advocate for our Aboriginal and Indigenous patients, especially in health services such as Colac. Hospitals need to work closer with Aboriginal organisations such as the WAC and the Department of health to provide training for staff to deliver care that is sensitive to the culture of the Aboriginal people within the area. There needs to be greater transparency and honesty between doctors and the Aboriginal people to improve communication, access and delivery of services. [12] Although it will take time to change Indigenous Australians' attitude towards healthcare services, change must begin somewhere. As a student, I play an important part in raising the awareness of Aboriginal health issues and the importance of having an AHLO at the hospital, or at least having access to adequate resources which help healthcare practitioners in managing Indigenous patients (see useful links below). I can suggest hospital management to fund staff to the Aboriginal health conference and help organise training sessions in Aboriginal health as a part of professional development at the hospital, inviting an experienced healthcare worker from WAC to talk about their personal experiences. Indigenous Australians' attitudes towards health services would not improve until we did something actively to change the way health services are run. As a medical student in Colac, I was able to make a difference to patients by promoting health and by promoting health as a career to Indigenous Australians. Before I began my placement in Colac, I represented NOMAD, Deakin's Rural Health Club, at the career's fair in Colac and encouraged kids to pursue careers in health such as medicine, nursing and as an AHLO. I found it a very rewarding experience, and would recommend it to all students studying health. By immersing ourselves into the community and engaging with Indigenous Australians at a grassroots level, we as students and future medical practitioners will be able to improve Aboriginal health outcomes, and help close the gap between Indigenous and non-Indigenous Australians.
Useful resources
Indigenous Australians in the Hospital
National Aboriginal Community Controlled Health Organisation
Aboriginal Hospital Liaison Officer Factsheet
Victorian Aboriginal Health Services
Wathaurong Aboriginal Cooperative
Wathaurong Aboriginal Cooperative
Department of health and ageing - Aboriginal and Torres Strait Islander Health
References
- ^ Better health channel [Internet]. Melbourne: Victorian government. [Updated 2010 April; Cited 2011 Nov 30] Available from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Aboriginal_health_issues
- ^ Lloyd J, Wise M. Improving Aboriginal Health: How might the health sector do things differently? [Internet] Sydney: University of Sydney. [Updated 2011 Feb; Cited 2011 Nov 30]. Avaialble from http://www.australianreview.net
- ^ Durey A, Thompson SC, Wood M. Time to bring down the twin towers in poor Aboriginal hospital care: Addressing institutional racism and misunderstandings in communication. Intern Med J. 2011 Oct 27.
- ^ Coffin J. Rising to the challenge in Aboriginal health by creating cultural security. Aborig Isl Health Work J. 2007 May/June; 31(3):22-4.
- ^ a b Baeza JI, Lewis JM. Indigenous Health Organizations in Australia: Connections and Capacity. Int J Health Serv. 2010;40(4)719-42.
- ^ Taylor KP, Thompson SC, Dimer L, Ali M, Wood MM. Exploring the impact of an Aboriginal Health worker on hospitalised aboriginal experiences: lessons from cardiology. Aust Health Rev. 2009;33(4):549-57.
- ^ Department of Health [Internet] . Melbourne: Department of Health. [Last updated 2011 Dec 2; Cited 2011 Dec 3]. Available from http://www.health.vic.gov.au/
- ^ National Aboriginal Community Controlled Health Organisation. [Internet]. Canberra: National Aboriginal Community Controlled Health Organisation. [Updated 2011; Cited 2011 Dec 3]. Available from http://www.naccho.org.au/
- ^ National Aboriginal Community Controlled Health Organisation [Internet]. Canberra: National Aboriginal Community Controlled Health Organisation. [Cited 2011 September 28]. Available from http://www.naccho.org.au/.
- ^ Zimmet MD. Early impressions of paediatric health in Alice Springs: trying to see beyond the gaps. MJA 2010 May 17;192(10):606-7.
- ^ De Leeuw E, McInnes L. Aboriginal Health: The Aboriginal Hospital Liaison Officer Learning Package. Doctors, peoples, cultures and institutions. Geelong: Deakin Medical School; 2011.
- ^ Duke M, Ewn S. Implementation of Indigenous mental health training in Victoria. Australas Psychiatry. 2009;17(3):228-32.
The Aboriginal Hospital Liaison Officer
What is Aboriginal Health?
Aboriginal health is a specialised area in medicine and a very important part of healthcare in Australia. [1] [2] [3] To facilitate a positive working relationship with the local community that is maintained and respected, it is crucial to have an Aboriginal Hospital Liaison Officer (AHLO) at each hospital. [4]They provide emotional, social and cultural support to patients and their families and information about hospital services and assist with referrals to Aboriginal and non-Aboriginal organisations. [5] Most importantly, however, they advocate and liaise on behalf of patients and families. [5] [6] Indigenous Australians from Colac are referred to the Wathaurong Aboriginal Cooperative (WAC), an Aboriginal organisation in Geelong. [7] In this Wiki, I will highlight the advantages of having an AHLO has in a health service and the difference it has on an Indigenous patient's experience in the hospital as opposed to one which doesn't.
Wathaurong Aboriginal Cooperative
WAC is one of 24 Victorian Aboriginal Community Controlled Health Organisations (VACCHO). It is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate healthcare to the community which controls it. [8] Aboriginal health is not just the physical wellbeing of an individual, but is the social, emotional and cultural wellbeing of the whole community in which each individual is able to achieve their full potential thereby bringing about the total wellbeing of their community. It is a whole-of-life view and includes the cyclical concept of life-death-life [9]. The WAC plays an important role for those who live in the Geelong area, particularly in dealing with post discharge issues which is vital in continuity of patient care. They offer a wide range of services for Aboriginals such as an outreach program, drug and alcohol services, home and community care and a needle exchange program. Over the years, WAC has developed an excellent working relationship based on the concept of community control ensuring the hospital program is community driven. This benefits the local community and the hospital by ensuring that the health needs of Indigenous Australians are identified and addressed.
AHLO at Barwon Health
My experience with the AHLO in Geelong Hospital demonstrated the importance of culturally sensitivity. I had a 51 year old female patient who was admitted to ICU because of an exacerbation of her chronic obstructive lung disease on a back ground of diabetes and alcohol abuse. The patient was abusive towards staff and refused treatment, telling doctors and nurses to 'get away from her'. It wasn't until the AHLO came that she finally calmed down. The AHLO sat for hours with her and her family and explained how the hospital worked, what the management plan was and what they were doing and why doctors had organised certain tests. She explained the roles and responsibility of each staff member involved with her care, and the use of different pieces of equipment. She was able to provide the support, respect and wisdom that was culturally appropriate to the Indigenous patient in an honest and transparent manner which facilitated ownership of her own health and acceptance of medical treatment, which positively impacted the Indigenous patient's experience and attitude towards the healthcare system, gaining her trust and improving patient compliance.
The absence of an AHLO in Colac Area Health
On the contrary, Colac Area Health (CAH) was not trained to address Indigenous issues of cultural and gender sensitivity. The Emergency Department was run by nurses, a resident and GPs on-call, none of who had much training or experience in Aboriginal health. Many Indigenous Australians had a negative attitude towards the hospital and the health care system even before presenting there. [10] They saw hospitals as a threat, were often suspicious of medical practitioners and hold the belief that they go there to die, which meant they would avoid hospitals at all costs. [11] When there was no AHLO to dismiss these beliefs, or to support and educate them about why they were in hospital and what the doctors were doing, this compounded on the patient's negative experience. There were only 30 beds in Colac hospital; if one of their people had to have "sorry business" in the hospital, there was nowhere to put other Indigenous patients, because it was culturally inappropriate to put Indigenous patients in the same bed or part of the hospital. The hospital had no contacts such as an elder in the community it could contact locally to come in and talk to the patient. If patients were discharged from other health services such as Geelong Hospital or a Melbourne hospital and transferred to CAH, there would be issues with continuity of care and the provision of culturally sensitive care.
Future directions
I believe we need to advocate for our Aboriginal and Indigenous patients, especially in health services such as Colac. Hospitals need to work closer with Aboriginal organisations such as the WAC and the Department of health to provide training for staff to deliver care that is sensitive to the culture of the Aboriginal people within the area. There needs to be greater transparency and honesty between doctors and the Aboriginal people to improve communication, access and delivery of services. [12] Although it will take time to change Indigenous Australians' attitude towards healthcare services, change must begin somewhere. As a student, I play an important part in raising the awareness of Aboriginal health issues and the importance of having an AHLO at the hospital, or at least having access to adequate resources which help healthcare practitioners in managing Indigenous patients (see useful links below). I can suggest hospital management to fund staff to the Aboriginal health conference and help organise training sessions in Aboriginal health as a part of professional development at the hospital, inviting an experienced healthcare worker from WAC to talk about their personal experiences. Indigenous Australians' attitudes towards health services would not improve until we did something actively to change the way health services are run. As a medical student in Colac, I was able to make a difference to patients by promoting health and by promoting health as a career to Indigenous Australians. Before I began my placement in Colac, I represented NOMAD, Deakin's Rural Health Club, at the career's fair in Colac and encouraged kids to pursue careers in health such as medicine, nursing and as an AHLO. I found it a very rewarding experience, and would recommend it to all students studying health. By immersing ourselves into the community and engaging with Indigenous Australians at a grassroots level, we as students and future medical practitioners will be able to improve Aboriginal health outcomes, and help close the gap between Indigenous and non-Indigenous Australians.
Useful resources
Indigenous Australians in the Hospital
National Aboriginal Community Controlled Health Organisation
Aboriginal Hospital Liaison Officer Factsheet
Victorian Aboriginal Health Services
Wathaurong Aboriginal Cooperative
Wathaurong Aboriginal Cooperative
Department of health and ageing - Aboriginal and Torres Strait Islander Health
References
- ^ Better health channel [Internet]. Melbourne: Victorian government. [Updated 2010 April; Cited 2011 Nov 30] Available from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Aboriginal_health_issues
- ^ Lloyd J, Wise M. Improving Aboriginal Health: How might the health sector do things differently? [Internet] Sydney: University of Sydney. [Updated 2011 Feb; Cited 2011 Nov 30]. Avaialble from http://www.australianreview.net
- ^ Durey A, Thompson SC, Wood M. Time to bring down the twin towers in poor Aboriginal hospital care: Addressing institutional racism and misunderstandings in communication. Intern Med J. 2011 Oct 27.
- ^ Coffin J. Rising to the challenge in Aboriginal health by creating cultural security. Aborig Isl Health Work J. 2007 May/June; 31(3):22-4.
- ^ a b Baeza JI, Lewis JM. Indigenous Health Organizations in Australia: Connections and Capacity. Int J Health Serv. 2010;40(4)719-42.
- ^ Taylor KP, Thompson SC, Dimer L, Ali M, Wood MM. Exploring the impact of an Aboriginal Health worker on hospitalised aboriginal experiences: lessons from cardiology. Aust Health Rev. 2009;33(4):549-57.
- ^ Department of Health [Internet] . Melbourne: Department of Health. [Last updated 2011 Dec 2; Cited 2011 Dec 3]. Available from http://www.health.vic.gov.au/
- ^ National Aboriginal Community Controlled Health Organisation. [Internet]. Canberra: National Aboriginal Community Controlled Health Organisation. [Updated 2011; Cited 2011 Dec 3]. Available from http://www.naccho.org.au/
- ^ National Aboriginal Community Controlled Health Organisation [Internet]. Canberra: National Aboriginal Community Controlled Health Organisation. [Cited 2011 September 28]. Available from http://www.naccho.org.au/.
- ^ Zimmet MD. Early impressions of paediatric health in Alice Springs: trying to see beyond the gaps. MJA 2010 May 17;192(10):606-7.
- ^ De Leeuw E, McInnes L. Aboriginal Health: The Aboriginal Hospital Liaison Officer Learning Package. Doctors, peoples, cultures and institutions. Geelong: Deakin Medical School; 2011.
- ^ Duke M, Ewn S. Implementation of Indigenous mental health training in Victoria. Australas Psychiatry. 2009;17(3):228-32.