A Pharmacy Student Placement Out Bush

Over the last nearly ten years I have had a large number of students visit me out bush. They came from a mere week to a month or more. Unfortunately they never have time away from me, sharing my house and my working hours. I try to get them to write an article,or their university does. And sometimes they do it! Here is one of their stories. Some slight editing so patients from past years cannot be identified.

A Pharmacy Student Placement Out Bush

Outback, remote, arid, red dirt, abandoned Fords, Landcruisers and Jag left to mark the passing of time. Vast landscape that remains changeless despite the impact of bush fires, adaptation of people and spirit. Somewhere in miles of red dirt, we travel the connecting roads from Jameson to Kiwirrikurra, 750kms, many parts across the Sandy Blight.

Bore on the Sandy Blight Road
Bore on the Sandy Blight Road

Robbo drives with ease of experience along sandy bush tracks, visited by him only two weeks prior, he warns me of impending corrugations, found along this now dry twelve hour drive. The long range tanks filled with diesel at $2.80 a litre will theoretically make the distance, a rogue pot hole threatens to undo the chassis.

I am relaxed during the drive despite the potential chance of danger, a remote possibility the wind might change southerly. The bush fire as our neighbour taints a smokey horizon creating a spectacular sunset, a burning flame of a sun that dips slowly in the sky as a full moon of the same colour meets it, a change of guard from day to night.

Robbo is well versed in outback travel and spending just a week with him its obvious that his knowledge has a practical side, combined with a teasing humour that puts me at ease. On the other hand, do I really have a choice!

I talk a lot at first, when Robbo asks me about my experience so far. One week at Jameson. A small community of under 200 people, I am not sure yet if I am getting what I want out of the journey. It’s always dangerous to invite expectation, it takes time for people to trust you, to share themselves and to gain respect. I feel like an alien, white skin dominated by black, the foreign tongue of Ngaanyatjarra in my ears, and a complexity of issues witnessed from a distance.

The challenges faced in terms of medications and health outcomes are intertwined with family tensions, living conditions, a shifting of culture and language barriers, to name a few.

The challenges faced in terms of medications and health outcomes are intertwined with family tensions, living conditions, a shifting of culture and language barriers, to name a few.

Robbo’s interventions are equally social as medical. Over the course of the week I have observed him warmly embracing a young man who climbed the water tower whilst he was away in an attempt to commit suicide. Ensuring timely medication infusions for a patient with an auto immune disease, giving a lift to Warburton for a fortnightly monoclonal antibody treatment 125km away. A discussion with the grandmother who looks after her grandson’s phenytoin medication. She wishes to go out country with the ladies, who will be responsible that the dose is not misplaced or forgotten.

These experiences and many so far had consolidated my understanding that being a pharmacist and achieving concordance is about relationship building. Coupled with many additional challenges, management of chronic disease, seizures, mental health, boils, scabies and lice to name a few, management of aboriginal health requires management on many fronts.

Robbo’s experience and relationship with the people enabled him to address some of the social issues, whilst ensuring other aspects of pharmacy also ran smoothly. Remoteness requires a timely and adequate supply of stock, making available to other health professionals useful tools and multi-tasking with a nurse or doctor at a distance.

Apart from personality and experience, I also witnessed the use of many resources and tools whilst working with the Aboriginal people. Just now I noted on Robbo’s blog a series based around alcohol with a theme to reshaping drinking habits and misconceptions over alcohol in Aboriginal communities. Pharmacists in a remote setting must also be teachers and use these valuable resources as tools.

In the end I would say I learnt many things from those around me as well as the location and the people themselves. I think its important for us newly fledglings that we are green and so looking to the guidance of experienced people and adopting and adapting there methods, as well a being guided by resources and tools will enable me to fashion my practise. Watching it in action is for me the best way to learn.

Summing up my lessons would be:
1) Don’t judge a book by its cover
2) Humour is a tool
3) Be genuine
4) Write down dosages and calculations,
5) How to pack metformin into dosette boxes
6) Get the client to demonstrate how they will take their medications
7) Use your mirrors when backing out of driveways or avoid reversing all together
8) Life and people are complex understanding good management in this context takes time and experience
9) Being in remote Australia requires multiskilling, working closely with nurses and doctors
10) Systems are useful to avoid errors
11) The joy of quality research and tools in order to avoid reinventing the wheel and wasting time.
12) It’s better to drive of the road then scare your student by fishtailing!

George Tambassis, Pharmacy Guild President interviews Robbo

If you follow the blog you would know the Pharmacy Guild President, George Tambassis, came and visited me a few weeks ago and he wrote this piece on The Challenges of Bush Pharmacy

As well as that piece George also interviewed me. See the agonising the seven and a half minutes below.

George Tambassis, Pharmacy Guild President interviews Robbo

Changes needed to close the gap for Indigenous Australians with disabilities

Occasionally I will be republishing articles from “The Conversation” that look at Indigenous issues.

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Government data shows Aboriginal people are twice as likely to have a core activity limitation as non-Aboriginal people. AAP Image/Karen Michelmore

Alongside high rates of incarceration, unemployment, homelessness and some of the poorest health outcomes in Australia, Indigenous people’s access and use of disability services is under-representative of the total Aboriginal population.

The high prevalence of disability in the Aboriginal population results from poor social health status and disadvantage that are a legacy of European colonisation and dispossession. Many Aboriginal communities experience inter-generational depression and trauma as a direct consequence of cultural dispossession, racism and social segregation.

Government data shows Aboriginal people are twice as likely to have a core activity limitation as non-Aboriginal people. And they’re more likely to be caring for a person with a disability than non-Aboriginal people.

Earlier this year, the Productivity Commission reported the need for a targeted approach to improve the participation of Aboriginal people in government-funded disability supports and services. As a result, the government is undertaking a number of pilot programs in response to the recommendations of Commission’s report on the Disability Care and Support Scheme.

Current limitations

Disability service providers adopt two common strategies that fail to establish a culturally responsive service system for Aboriginal people.

Firstly, they invest in staff training programs in Aboriginal cultural awareness. This appears to be a positive step, showing that disability service providers acknowledge cultural differences between Aboriginal communities and mainstream community services.

Such programs aim to educate non-Aboriginal workers on Aboriginal cultures, politics and history. But cultural awareness training doesn’t work if the disability service provider is not committed to network and engage with local Aboriginal communities on a regular basis.

Research undertaken by the National Disability Services Association found that some non-Aboriginal workers get caught up in a permanent state of self-consciousness when interacting with Aboriginal people. As a result, non-Aboriginal workers are disinclined to work with Indigenous families as they fear they may offend them.

Second, some disability service providers have undertaken Aboriginal recruitment initiatives to establish a culturally safe environment for Aboriginal people. Research indicates that many Aboriginal people prefer to work with an Aboriginal person than a non-Aboriginal person.

So management committees and staff wrongly assume that placing responsibility for all “Aboriginal matters” and Aboriginal clients onto the Aboriginal workers is culturally respectful. Putting this into practice means non-Aboriginal workers don’t have to engage in Aboriginal communities. And it’s result is that the non-Aboriginal workforce doesn’t learn about local Aboriginal community cultural protocols and practices.

Meanwhile Aboriginal workers develop high workloads and are limited in their career development. The end result is that Aboriginal workers become dissatisfied with their workplace and resign.

These two strategies inevitably fail when used in isolation because there’s limited emphasis on relationship building between disability stakeholders and Aboriginal communities.

The focus on cultural and language differences between Aboriginal and non-Aboriginal communities emphasises such differences and disregards the diversity of cultures and experiences within the Aboriginal population, perpetuating the myth of Aboriginal homogeneity.

Better approaches

Disability stakeholders and Aboriginal communities need to interact at the cultural interface to improve the level of engagement between Aboriginal communities and disability service providers.

The cultural interface is the realm where the trajectories of cultures, histories, beliefs and experiences of both Aboriginal people and non-Aboriginal people intersect, creating tensions and challenges for both cultural groups.

We need to resolve this contestation and tensions to overcome barriers to participation and access for Aboriginal people in the disability service system. The key to this is having Aboriginal communities and disability stakeholders improve communication and relationships under the reforms to the aged care and disability services sector.

One such strategy is creating community interagency forums. This would require stakeholders and Aboriginal communities to establish local networks to identify and address service and program priority areas.

Many disability service providers and Aboriginal communities in New South Wales have developed such networks, which have improved relationships and opened dialogue between the two groups. These networks have undertaken disability awareness campaigns, hosted Aboriginal carer workshops and Aboriginal cultural awareness programs.

The initiatives have helped establish a shared understanding of disability and the benefits in accessing disability services for Aboriginal communities.

Tomorrow (December 3) is International Day of Persons with Disabilities, designated for celebrating and commemorating the successes of the disability rights movement. The theme this year is “Together for a better world for all: including persons with disabilities in development”. Hopefully, it will inspire the sector and the government to make the changes needed to change the fate of Indigenous people with disability.

John Gilroy will be presenting a paper at the World Report on Disability: Implications for Asia and the Pacific Symposium at The University of Sydney on December 5 & 6.

Dr Tom Calma’s Presentation at 11th National Rural Health Conference

I couldn’t make it to the biannual National Rural Health Conference this year.

One of the speakers was Tom Calma. Below is a video of his short presentation (8 mins in) and the slide show titled “Indigenous Health and Closing the Gap” . I urge you to watch it

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