Successfully bridging the gap for First Nations people with chronic illnesses

  • L-R: Paul Skipper, Charlie Knight and Nyleeta Jeanes are BDAC’S ICT team. They work together to assist and support First Nations people of all ages with chronic disease. 

L-R: Paul Skipper, Charlie Knight and Nyleeta Jeanes are BDAC’S ICT team. They work together to assist and support First Nations people of all ages with chronic disease. 

Bendigo and District Aboriginal Cooperative (BDAC) delivers Integrated Team Care (ITC) in Dja Dja Wurrung Country. It’s one of the services Murray PHN (Primary Health Network) has commissioned across its region to help First Nations people with chronic disease access primary care services and to provide care co-ordination. ITC providers play a key role in improving access to culturally appropriate mainstream primary care for First Nations people.

Working collaboratively with patients, general practices, specialists and other health providers, BDAC’s tight-knit ITC team helps people of all ages manage chronic disease. Right now, the youngest is one year old and the eldest is 98.

Paul Skipper is BDAC’s ITC Chronic Care Coordinator, who believes that while Integrated Team Care is a not the most culturally relevant name, it describes the program well.

“Our job is to look at gaps in people's healthcare and attempt to bridge them, to bring an integrated approach to their care. This can be transportation to appointments or providing funding, but it’s more than that. It’s helping people understand clinical information, answering questions related to people's ongoing chronic disease management, and building relationships so people feel safe.”

The team also includes Charlie Knight, ITC Aboriginal Outreach Health Worker and Nyleeta Jeanes, ITC Team Administrator.

Charlie describes himself as Community-orientated and an “out-and-about man”. He follows up the referrals he receives and organises transportation, takes patients to appointments, and introduces them to Aboriginal liaison officers. His days are as varied as the people he assists.

“Sometimes, it’s an early start. If a client has a 7.30am appointment in Melbourne, I’m up at 3am. Other times, a client might have three appointments in a day, so I liaise with specialist clinics to set coordinating times and provide taxi vouchers. I also bring feedback from appointments to Paul or the clinical practice manager.”

“I also like going to people’s homes, having a yarn, keeping them up to date about their appointments. There’s an education side too, talking to them about their condition to help them understand more about their health.”

Paul explained that this holistic approach was key to the program’s success.

“In a broad sense, our work is to build trust and deliver culturally appropriate access to the healthcare system for people with chronic conditions. While funding is vital, it’s also about creating a feeling for our clients that they're being supported in the situation for which they're presenting.”

“I’ll give you a specific example of this impact. Recently we had a lady who had a fair bit of anxiety about going to a private clinic for an exam. She’d not been to this clinic before, didn’t know where it was, or what would be involved with the exam. I spoke with her about it. I spoke with her GP too,” he said.

“We were able to help her with her anxiety levels so she could go to the appointment. When people are part of this program for any length of time they start to develop and build trust, and ultimately, that helps them look after their health, whether they are mums, dads, young people, or Elders.”

Nyleeta’s role as program administrator ensures all the dots are joined and the program runs smoothly, but it’s the people side of things that she enjoys the most.

“What’s good about my role? I love being engaged with Community. It’s really lovely.”

Paul agreed with this sentiment, explaining that the ITC program is part of everything else at BDAC.

“Community gets to see we're not just about ITC and those that we are employed to look after,” he said. “It’s next level connectedness because there might be an Aunty in our program and she's got her grandkids here at the kindergarten, and then she's introducing them.

“So, there's all those other amazing connections that are made. It ends up almost like a family. There's lots of emotion that comes with the program as well.”

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