Adelaide born Gillian Hicks survived the 2005 London Underground suicide bombings but lost both her lower legs in the attack. Since then she has devoted much of her time to building better relations between the various ethnic groups in England. As part of this work she counsels young radicalised Muslim men on the impacts of their actions on the community.
She relates the story of one young man, with whom she had been working for some months, who announced that he had finally given up the idea of becoming a martyr to his cause. In a difficult area, where feedback is rare, Hicks was desperate to know why.
"Was it something I said?", she asked. "No." he replied, "I just really love playing soccer."
In Australia, life expectancy has increased by almost 25 years over the last century and continues to rise at the rate of 3 months every year. Alas, this marked improvement has not extended to the Indigenous community.
This issue of GPSpeak reports on the parlous state of Aboriginal health and explores some ideas for narrowing "the gap". The solutions are unlikely to entail more medication, information or resources. It will not depend on greater efforts to ensure compliance with the doctor's recommendations.
Tthe way forward requires a more consultative approach. The traditional didactic format of the doctor informing the patient of the diagnosis and management fails in indigenous health. It also fails in community public health discussions, chronic disease management and cancer care. Nobody likes being told what to do, particularly in what may become their life or death decision.
Many people come to major decisions by learning about their options, talking with family and friends and mulling on things for a while. We are informed by hearing and seeing what other people are doing, whether this be “show and tell" in kindergarten, a beer at the pub or a cup of tea at the CWA.
Dr Andrew Binns along with Associate Professors Gary Eggins and Dr John Stevens are pioneering shared medical appointments in Indigenous communities on the North Coast. "Havin' a yarn" with your peers over common troubles has more impact than the presentation of research data, guidelines and flow charts. The impact of chronic lung disease or renal dialysis on a patient's family and community is rarely caught in scientific papers. Facts may inform us but attitudes and beliefs move us.
It remains crucial that group consultations are supported by trained health professionals. The medical options must be made available in a format suitable for the patient. Tools to help understand complex medical issues are becoming increasingly available through groups like Shared Decision Making and Option Grids. However, resources may need tailoring to the Australian environment and cultural awareness training remains crucial for all health professionals working with Indigenous patients.
The shift to deprescribing in Australia may yet be followed by the trend to deinvestigating. It is far better to do the "right thing" than take lots of drugs and do lots of tests. Lismore City Council should be congratulated on their national award for creating healthier communities with their Move2Change program. GPSpeak has quoted Dr Robert Butler previously. "If exercise could be purchased in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.”
The Council should also be congratulated on including cycle safety in its new traffic plans. The benefits and risks of cycling was the subject of the previous issue of GPSpeak and remains very much a personal, as well as a professional, issue for many of us.
Local artist, Adrian Cameron, has provided the image on the cover of this issue of GPSpeak. The "Clever fella" used his knowledge of plants for medicinal purposes but, as Adrian tells us, "was also known for his mystical and spiritual powers, which he could use to captivate people". When the drugs don't work, a truly "clever fella" will try other approaches ... like going outside to kick the soccer ball around with his mates.