Editor's Note: Currently there is a greater focus in repect of Indigenous health. And about time, some would say.
Only very small pockets of the pharmacy profession have attempted to come to terms with this major problem, and they genuinely need your management assistance.
Rollo Manning could well be regarded as the pharmacy expert in indigenous health, and he vigorously defends the rights of indigenous people to enjoy good health - just like the rest of the Australian community.
Rollo's sympathetic insights reflect his long association with, and understanding of, the issues surrounding indigenous health.
By Rollo Manning PhC MPRIA GradDipPR
Consultant to Aboriginal communities and organisations in economic and social development.
TRAINING FOR WORK
The contribution pharmacists can make to the National Close the Gap day to be held on 2 April is to commit to training an Aboriginal person to work in pharmacy and help to devise a system whereby Aboriginal people can understand medicines and their role in the management of chronic diseases.
Recent research in the Medical Journal of Australia has shown that Aboriginal children are not predisposed to chronic diseases such as renal failure, diabetes or circulatory diseases and that these conditions are brought on by lifestyle choices in later life.
As the Nation focuses on Close the Gap pharmacists too should be examining what they can do to contribute in a way that is more than just supplying medicines and feeling the day’s work has been done.
There is one trap that can easily be fallen into and that is imagining that everything should be done in the same way as it has been for western society – making the assumption that “they” can be like us. “We” have developed our culture - its norms and its customs after thousands of years of living in a world that has been constantly changing and with advances in transport, mode of living (houses), food sources and industrial activity.
Aboriginal people too have developed there culture through the same time period but with the dramatic difference of being isolated from the rest of the population of the world.
It is so different when there are no means of transport (the wheel was not even there); no metallic objects; no materials for housing; and food that had to be found day by day.
To many of these people, especially in remote Australia, access to the developed world has only been available for the past 100 years and in some cases in the last 50 years.
This is a minuscule period of time and the change to a different way of thinking has to be done gradually, with sensitivity to their beliefs, and in a manner that takes account of their view of the world. This was well described in the book by Richard Trudgen, “Why Warriors lie down and die”, and that has become a standard reading text for anyone entering the Aboriginal health industry across the North of Australia.
We have to understand where Aboriginal are coming from in their understanding of disease states, why they occur, what can be done to overcome the onset and the management practices (that suit their ways) and which will maintain a life that is symptom free.
It is not just a matter of devising a training course that embraces subject areas that have worked in western culture because they are there.
There is little evidence to show that VET Certificate courses in business administration, community health, community services, health administration and others have produced workers who are able to understand the tasks needed to improve the workplace and its clients.
Often Aboriginal people attend training because it is a condition of receiving a Centrelink benefit and afterwards do not even remember what the training course was or upon receipt of a certificate cannot recall having done the course.
The Department of Education Employment and Workplace Relations (DEEWR) is stacked with principles, guidelines, protocols and acronyms that point towards funding for training.
The only trouble is there are not the jobs to be undertaken when the training is finished and whatever was learnt is quickly forgotten.
Pharmacy is at the sharp end of a revolution that will try and close the gap.
It (pharmacy) is in an ideal position to develop WITH Aboriginal people training programs that help to bridge the gap and provide knowledge in a manner that can be used. It is no use trying to teach anyone the mode of action of an ACE inhibitor to control blood pressure and increase the flow of blood through the kidney without knowing:
- What the kidney does?
- How it does it?
- Why it is important?
- What causes it to malfunction?
- What needs to be done to prevent this?
- How people should live to avoid kidney damage?
- And finally what the drug will do in contribution to a good functioning kidney given that all, preventative measures have been exhausted.
Without this understanding the elements in training for a pharmacy technician in an Aboriginal Health Service could be useless because it is not relevant to the needs of the client.
In developing any training program the main focus has to be on the client (patient) and not what conforms to the downloadable training package available from the National Industry Training Council.
Sure there is funding available for mainstream training packages but what use is that if the patient will still not understand why their kidneys have packed it in.
There is a lot to be done in devising training programs that meet the needs.
The time to start is now.
Play your part. Help to close the gap by demanding that training meets the needs of the client – not the criteria that works in mainstream.
Whether it is pharmacy technicians at urban Aboriginal health services, remote health clinics or as an adjunct to other health professionals make sure it meets the need – and that is not necessarily an already established training package.
1. Patterns of mortality in Indigenous adults in the Northern Territory, 1998–2003: are people living in more remote areas worse off? Karen Andreasyan and Wendy E Hoy.MJA 2009; 190 (6): 307-311
2. “Why Warriors Lie Down and Die” by Richard Trudgen. Aboriginal Studies Press. ISBN: 0-646-39587-4