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UQ works to Close the Gap with physio placements

Emma Breheny
6 October 2016

Healthcare practitioners know all too well about the significant gaps in health outcomes between Aboriginal and Torres Strait Islanders and other groups. A major issue the Close The Gap campaign has identified is the lack of culturally safe healthcare services, a problem that is compounded by an under-representation of Aboriginal and Torres Strait Islanders in healthcare professions.

While closing that particular gap could take one to two decades, the ability of non-Indigenous healthcare providers to deliver services in a culturally appropriate way is an achievable solution in the short-term, something that many institutions, including UQ, have recognised.

The university’s Faculty of Health and Behavioural Sciences has spent several years building relationships with Aboriginal and Torres Strait Islander communities and, as of two years ago, began partnering with these communities to offer placements for physiotherapy students. Ruth Dunwoodie, APAM, Clinical Education Liaison Manager, and Amy Fagan, APAM, Clinical Operations Manager at UQ Health and Rehabilitation Clinics, play a key role in coordinating the placements.

‘We started off by asking the Indigenous health communities what the barriers were to engaging with physiotherapy and listening to what their needs were,’ Amy Fagan explains.

This simple act of having open conversations is perhaps one of the key aspects to addressing health inequalities. In 2016, the Close The Gap Parliamentary Report stated that the government’s priorities must include meaningful partnerships between Aboriginal and Torres Strait Islander and non-Indigenous communities and health services. The call to do things with Aboriginal and Torres Strait Islanders, rather than to them, is one that’s often made when progress towards equality is discussed.

As a result of UQ devoting the time to build strong and trusting relationships with health services, education providers and key community figures, they’ve been able to establish five-week placements for physiotherapy students at organisations working closely with Aboriginal and Torres Strait Islanders. There, they support the delivery of physiotherapy services to clients ranging from children to older adults under the supervision of clinical educators.

Host services benefit from a much-needed additional practitioner, while their clients gain a stronger awareness of physiotherapy treatments and, hopefully, positive experiences that will encourage them to access physiotherapy services in the future.

Students themselves undergo a significant learning curve as they build skills in communicating across cultures, altering service delivery to meet client needs, and thinking more laterally. Essentially, the experience prepares them for the needs of today’s healthcare consumer.

The cornerstone to the success of these placements in Ruth and Amy’s eyes has been the university’s willingness to commit to closing the gap over the long term. UQ has a pro-vice chancellor who oversees Aboriginal and Torres Strait Islander engagement, one of a handful of Australian universities with such a role.

The university’s current strategic plan has a specific focus on learning, discovery and engagement among and with Aboriginal and Torres Strait Islander communities, with the aim of providing all students with ‘inclusive perspectives’ in a ‘culturally embracing environment’.
The Faculty of Health and Behavioural Sciences, which includes psychology, occupational therapy, nutrition sciences and others in addition to physiotherapy, has focused on developing relationships with the community to design specific interventions that can contribute to better health outcomes.

For physiotherapy students, this has ranged from service provision in internal UQ clinics, providing field-side support at an Aboriginal and Torres Strait Islander community sports carnival, and delivering outreach services at schools and communitycontrolled health centres.

‘A lot of that work was reciprocal and ongoing for extended periods of time in order for us to get to where we are right now,’ Amy reflects.

Equally important is the preparation students undergo well before they’re even considering their clinical placements. Cultural awareness is introduced early in the curriculum, with first-year subjects that discuss cultural diversity and the application of different theories or techniques when working with different populations.

By third year, students are hearing from Aboriginal and Torres Strait Islander people directly in a series of lectures, tutorials and case studies on health in these communities.

‘They get really inspired by those sessions,’ Ruth says. ‘Around the same time, they nominate where they’d potentially like to undertake placements, and often they’ll come to me and say, “We had a really awesome experience when we did the Indigenous learning and I’d love to be placed in that area”.’

Students must first express an interest in working with this population to be considered for one of the placements. Those who are successful undergo a significant orientation period with their host organisation which is then followed up with opportunities throughout their placement to meet with key community members.

Together, these focal points help to address potential challenges students might experience in working with this population group for the first time.

A major barrier to overcome is being accepted by a particular community.

‘You can’t just come and go with Indigenous communities. You have to be respected as someone and welcomed into that community. It can take a while to build relationships with the elders, the key personnel within the organisation, but also with the recipients of healthcare within the community,’ Ruth explains.

However, her regular liaison with the clinical educators in the field, coupled with feedback from hosts and students, indicates that the program is going well and likely has a bright future.

‘Once everything goes well with one provider and the community embraces the student presence, that provider can commit to having students with them and we can begin to expand on those opportunities,’ Ruth says.

Now, the university is seeking more partners to accommodate the high level of interest from their students in these placements. Amy encourages any services that have reservations about hosting student placements to put those concerns aside, as the clinical educator liaison roles at UQ take a highly supportive approach to building the clinical educators’ capabilities in each facility.

‘Students want to work in this space. If your practice or organisation even has a small amount of contact with Indigenous people, there are opportunities to be a clinical educator.’

With major Close the Gap targets—such as eliminating the difference in life expectancy—due to be met in 2030, these graduates will be part of the push to keep these goals at the forefront of healthcare planning.

‘The students value that they can have a greater input into Indigenous health. They keep bringing back to the table in conversations with the academics and clinical placement teams that they would like to engage with more of these opportunities as much as they can,’ Amy says.


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