An integrated approach to maternal and child health care

Palm Island is located 65 kilometres north of Townsville in Cleveland Bay, Queensland.

The Manburra (Mun-burra) people originally occupied this region prior to first contact with Europeans. In 1914, Palm Island was gazetted as an Aboriginal reserve and, over the subsequent decades, a settlement was established for Aboriginal and Torres Strait Islander people who were forcibly removed and relocated from throughout Queensland. These people and their descendants are known as Bwgcolman (Bwook-a-mun) people, which means ‘many tribes – one people’.

Currently, women on Palm Island receive a mixed model of antenatal care comprising a Queensland Health midwife clinic, Townsville University Hospital maternal fetal medicine (MFM) obstetrician and general practitioner (GP).

The Queensland Health midwifery clinic has two midwives who are available from Monday to Wednesday on Palm Island. On Thursdays, they work from Townsville where they can meet with and coordinate the care of women who have transferred to Townsville. Women can present directly without appointments or can be referred. These midwives coordinate antenatal care, provide education and transition to care in Townsville for labour and birth.

Once a month, a sonographer and MFM obstetrician visit Palm Island for an obstetric ultrasound clinic. Approximately 60 Palm Island women give birth every year and, on average, two-thirds are classified as high risk.

Gaps have been identified in the postpartum follow-up for women and their babies. On the island there is a primary care clinic, as well as allied health, social and emotional wellbeing and other support services. There is a monthly visiting paediatric outreach service from Townsville and community child health services. Some women will stay in Townsville with extended family for the first few months postpartum and are often lost to follow-up in the transition back to Palm Island.

Current services function well individually; however, they have difficulty engaging women and children in ongoing care. Continuity of care, timely referral and follow-up have historically been lacking.

We are aiming to adopt a case management approach with an Aboriginal and Torres Strait Islander health worker able to engage with women throughout their pregnancy and follow mum and bub through childhood. This would improve the flow from one service to the next and ensure that care is consistent and culturally appropriate. Once concerns are identified, Palm Island has a range of existing services that can be utilised in the care of children.

To achieve significant improvement in key priority areas, it is essential that an integrated and cooperative approach be adopted between services. This includes streamlined referral processes and avenues for multidisciplinary team case conferencing.

Moving forward, we would like to see care that is women-centred, Palm Island-based and community-supported, from conception through to birth and beyond.

Early detection, prevention and intervention

• Early engagement in care and comprehensive screening.

Culturally safe education

• Aboriginal health worker-led and facilitated with the support of midwifery, medical and allied health practitioners.

Continuity of care

• Multidisciplinary team involving multiple services including general practice, midwifery, obstetrics, paediatrics and allied health.
• Clearly identified referral pathways and handover of care between services.

Mind and spirit

• Commencement of regular yarning circle and mums and bubs group to provide education and emotional support.
• Connection to country and community.
• Referral pathways to psychology and social and emotional wellbeing services.

Until services, regardless of their funding sources, can work collaboratively towards a common goal, women and their children will continue to fall through the cracks. The silo mentality serves no-one and often results in unmet need and inefficient use of resources.