Supporting long term change - where to start

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You know some people say that we won’t see changes in Aboriginal Health for 20 years and I know what they mean in terms of morbidity and mortality data. But, the thing is that if you fix people’s houses (their intimate living environment) and you follow up on other environmental problems, then health does improve. To measure this improvement we need health staff to keep good health records. How can you know what you’ve achieved if you don’t have figures? I can’t stress this point enough. It’s another way that health staff can help out. Keeping good records, and working together with us on the basics.

Bill Hardy, EHO, East Arnhem

Health Centre staff see the end of a problem. Somehow they need to become more aware of the beginning of the problem otherwise they get frustrated and bail out after a year, thinking that a system is not changeable. But you can change it, it is do-able and affordable.

Staff need to think about what they are saying to the people (like go and wash your clothes, cook good food for your kids etc), whether people can actually do it when they go home. They need to map the health territory in which they are working. Know if what they’re advocating is feasible. So they could ask the mother or grandmother of kids who are presenting all the time with skin problems. Can you wash the child at home? Does the shower work? Is there a lack of privacy, is the door broken? Can you wash bedding?

Look at possible range of problems which may exist. Look at whether there is something that’s stopping them from being able to do what’s being suggested. So - on a daily basis keep asking the questions. It doesn’t have to be detailed.

Stephan Rainow, Nganampa Health Council, Alice Springs

Every time someone new comes to a community they get ideas about what needs to be done (usually to do with dogs and rubbish) but they first need to get an understanding of what has led to success and failure in the past. I think new staff need to be aware that they aren’t the first person to go into a community and try to make things better. But it’s usually not that simple, so they need to ask around, do some research. Find out what has and hasn’t worked in the past. Not only in the NT, but also nationally.

We have to make sure that we aren’t just re-inventing the wheel, and a square wheel at that! What I mean is that it’s so often the case that projects or whatever that weren’t successful don’t get documented. People leave and there’s no record, no chance for others who come later to learn about what went wrong. The same mistakes happen again. Sure, it’s really important to write about successes, but it’s also really important to write about failures and partial failures.

Jeff Standen, EHO, Operations North

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