by MAREE MEREDITH
Trump is on the TV in the ward, footage of his latest gaffe playing in between COVID-19 updates.
The world’s in a hurry for a cure – for the Coronavirus, for international diplomacy, for the economy. But in bed 1, sitting quietly, an old Aboriginal man from a remote community can only watch on, waiting to get better.
He’s bored, but because English is his third language, he doesn’t understand a lot of the fast talking on the TV and he misses his family, who are only allowed for an hour or two during visiting times. He’s sick, and he’s trying to hide the anxiety that the translator they got in to help him talk to the doctor was getting the right words across. But he’s also hungry, because this hospital provides good food, but the menus are indecipherable, because he can’t read a menu in English.
The man could be my uncle, or an Elder who has been holding his community together for years, or simply a man who has lived a good life and wants to keep on doing so. But his capacity to get back to full health is compromised by a narrow focus on the selection and delivery of medical care, without addressing his overall needs.
The news that the Federal, state and territory governments are set to hand back some of the control over health programs to empower communities is a watershed moment for the nation, but requires a new model of research translation and two-way knowledge exchange to give it power.
At Flinders U’s Poche Centre, set up nine years ago to improve Aboriginal and Torres Strait Islander health, we have resolved to develop a new benchmark for community-driven translational research alongside the new Closing the Gap strategy; piloting new ways to improve the health of Aboriginal and/or Torres Strait Islander people that deliver tangible outcomes, not just nice words.
To make this new approach to Aboriginal and / or Torres Strait Islander health work, we need to set up expert teams to provide a porous interface for knowledge. The wealth of research currently conducted to improve the health of Aboriginal and/or Torres Strait Islander people is rarely prioritised or even contemplated by communities. Equally, the localised priorities of communities are often not considered when shaping research programs.
For example, traditional healers have had a role in Aboriginal communities for millenia. Their expertise and practice is beyond the scope of many biomedical research programs, but if Aboriginal and/or Torres Strait Islander people choose to visit a healer before they visit the doctor, that may change the timing and nature of medical interventions.
Equally, if patients feel uncomfortable, hungry, anxious or lonely in hospital because of cultural issues, that can have a significant impact on their willingness to undergo medical procedures and their recovery.
Giving all the control to communities is no more an answer than retaining all control in the medical system – both sets of knowledge, prioritisation and understandings of patient care need to be brought together if we are to make significant strides in improving health outcomes.
That’s why we have set aside the old playbook, and written a clear new set of priorities for our small centre. As a group of staff from diverse backgrounds, we have repositioned ourselves at the interface between medical researchers and Aboriginal and Torres Strait Islander communities. Universities like Flinders have made huge strides in medical research – and now this new approach is set to translate research into practical outcomes through pilot programmes in community and also tapping into community priorities for action.
Our Elders on Campus play a pivotal role in guiding the direction of our team and connecting with communities, while our team is exploring new ways to engage young people and remote communities in pilot health programmes that can turn research outcomes into practical outcomes more quickly.
We are certainly not pretending to have all the answers, but believe more centres led by Aboriginal and/or Torres Strait Islander people have a key role to play to facilitate two-way knowledge exchange, respect and understanding if the new approach to Closing the Gap is to have its best chance of achieving significant results.
It’s time to re-write the rules about the roles and operations of Aboriginal and Torres Strait Islander health research centres – ensuring that Australian university research has every opportunity to be translated into impact for the communities that need it most.
Dr Maree Meredith is Acting Director of the Poche Centre for Indigenous Health at Flinders University.