Community Solution to Indigenous Health Care

In the past, non-compliance with medical treatments has been attributed to patient behaviour.

Now, Dr Zinta Harrington of Flinders University, and fellow researchers, have examined this question.

They studied residents of a remote Aboriginal community in North East Arnhem Land to determine the factors affecting treatment programs for rheumatic fever (RF) and rheumatic heart disease (RHD).

Rising rates of RF and RHD in Arnhem Land suggested that patients were not complying with the monthly injections needed to treat the condition.

Through interviews with patients, family members and health service providers, researchers uncovered trends that suggest patient compliance was more about their relationship with health services, than a failure to understand their disease or a lack of responsibility.

"Patients felt the role of the clinic was not only to care for them physically but that staff should also show nurturing holistic care to generate trust and treatment compliance," Dr Harrington said.

The community expressed a desire for a more pastoral role for health-care workers, with a greater emphasis on emotional connection - such as that felt between family members.

One patient told researchers: "The health workers used to go through the camps, so that we can feel the relationships and communication. After a few years stopped. A lot of people became sick, because of that."

Interviewees felt the relationship worked best when there was a sense of belonging to the clinic, like belonging to a family, fostering greater trust on both sides.

Dr Harrington said switching to a more holistic model of health care could aid in the treatment of many conditions in remote Indigenous communities.

"There is no reason to believe that our conclusions pertain only to patients with RHD," she said.

"Chronic disease, pregnancy and mental illness have their own complexities and all require ongoing cooperation between patients and health-care staff."

Indigenous Australians have the world's highest rates of RF and RHD, Dr Graeme Maguire, a regional physician with the Western Australia Country Health Service, said in an editorial in the same issue of the Medical Journal of Australia.

Reducing those rates would not be easy, he said.

"While the underlying socio-economic determinants of acute RF/RHD may be clear, the solutions are neither simple, nor exclusively in the domain of health services and health resources," Dr Maguire said.

"Primary prevention of ARF/RHD requires broad-scale political commitment to addressing the social, economic and environmental inequities experienced by Aboriginal Australians.

"In the meantime, there is great capacity for health care providers to concentrate on meeting the needs of those with ARF/RHD through better diagnosis, prevention and access to care."

The Medical Journal of Australia is a publication of the Australian Medical Association.