Outreach boosts culturally safe diabetes care

Diabetes-related foot disease (DFD) is a leading cause of foot ulcers, lower extremity amputations and death among Aboriginal and Torres Strait Islander people in regional and rural Australia. A recent study found that First Nations people with diabetes are three to six times more likely to experience lower extremity amputations compared to non-Indigenous Australians.

Based on 2021 census data, as cited by the Gippsland Primary Health Network (PHN), 5811 people identify as First Nations in Gippsland. This regional area in Victoria is equal first in Australia for having the highest prevalence of diabetes (63 per 1000 people). Due to the complexities involved in treating DFD, it is recognised that rapid access to an interdisciplinary service like the Gippsland High Risk High Foot Clinic (GHRFC) – an ongoing collaboration between Latrobe Community Health Service (LCHS) and Latrobe Regional Hospital – is critical to reduce the number of avoidable diabetes-related amputations. Yet, a survey by the Gippsland PHN reveals over one-third of First Nations people tend not to access such mainstream services due to a lack of cultural safety and appropriateness.

Aboriginal Elder Clifford Wandin has lived with type 2 diabetes for many years and has experienced barriers to accessing care. He underwent a kidney transplant seven years ago and believes it was the best thing that’s happened to him. However, like many others, he admits he initially took far too long to seek medical help. He attributes this to cultural differences, noting the reservations that First Nations people might have when seeking care.

‘[First Nations] people don’t like seeing doctors. We still believe that a man’s and woman’s business should be separate; so a male will not see a female doctor and vice versa. In addition, [they] believe hospitals are a place where you go to die, so they will live with the pain [rather than going there to seek treatment]. It’s the fear [of death] that keeps them away. Finally, many [First Nations people] live with diabetes and other medical problems but are too ashamed [to seek help]. They just don’t know anything about their condition and how it can affect their wellbeing,’ Mr Wandin says.

With these differences in mind, the GHRFC co-located its services with Aboriginal Community Controlled Health Organisations (ACCHOs) across Gippsland to determine whether a change in the environment (that is, to one more culturally safe and appropriate to First Nations heritage) would affect the engagement of these communities with the care they need.

Three outreach clinics were run over six months at the Gippsland and East Gippsland Aboriginal Co-operative in Bairnsdale and the Ramahyuck District Aboriginal Corporation (RDAC) in Morwell. First Nations people who visited these clinics were treated by a multidisciplinary team, including a senior podiatrist, endocrinologist, general practitioner, wound care consultant, diabetes educator, dietitian, pharmacist and chronic disease nurse.

In the six months before these clinics began, 2.5 per cent of all patients attending the GHRFC identified as First Nations. However, after six months of outreach, this increased to 11 per cent – suggesting outreach at the ACCHOs may be associated with higher levels of engagement from First Nations communities.

Mr Wandin reinforces that ACCHOs are able to overcome many barriers associated with accessing care due to the provision of culturally safe and responsive services to Aboriginal communities.

‘Most [First Nations] people have trouble getting to appointments. Our co-ops have medical drivers to get them to the doctors. It’s also a culturally safe place to meet.

‘When families come together at the co-ops for their check-ups, they feel connected and support each other with their problems too. It is an opportunity to catch up with family members.’

In summary, cultural safety and responsiveness are important factors to consider when planning, organising and resourcing health initiatives to improve the health and wellbeing of First Nations people in Australia.