After 30 years of working within the Aboriginal Community Controlled Health Service (ACCHS) sector, James Cook University (JCU) Associate Professor in General Practice and Rural Medicine Dr Sophia Couzos reflects on the milestones that have been achieved for Aboriginal and Torres Strait Islander health, as well as the work that is yet to be done.
Originally hailing from Melbourne, Sophia did a degree in microbiology before pursuing medicine. She spent time in rural Victoria gaining obstetric, neonatal and general practice (GP) experience before heading to the Kimberley region of Western Australia in 1991.
She completed GP training with the East Kimberley Aboriginal Medical Service (now known as the Ord Valley Aboriginal Health Service) and the Broome Regional Aboriginal Medical Service.
‘Training remotely and wholly within the ACCHS sector was, at that time, an uncommon thing to do. These health services were established by some of the most inspiring people I have ever met, who were committed to offering communities quality, culturally appropriate primary health care that was unavailable from within mainstream health services,’ she says.
Sophia would spend the next 14 years in the Kimberley region, working within the network of ACCHSs in the region and becoming an advocate for community-led healthcare delivery.
‘These are health services established by Aboriginal peoples for Aboriginal peoples, which means that doctors are working within those community governance structures. You don't have that hierarchical structure where the doctor sits at the top and everyone else is at the bottom; it's real teamwork.
‘The ACCHS model of care was effectively a game-changer as it flipped the health system power structures towards being more patient-centred, well before the term had even been invented.
‘Working within this health workforce structure of predominantly local Aboriginal community members means that the work you do is so much more effective, because you're actually embedded within that cultural environment.
‘Aboriginal peoples themselves are best equipped to identify the problems that are a priority and are then able to model the preferred type of health care to address those needs. So having a health workforce made up of majority local Aboriginal peoples or Torres Strait Islanders is absolutely vital to improving health outcomes of their communities.
‘We often use terms like primary health care without understanding what they really mean. But it is best exemplified by the comprehensive model of care delivered by ACCHSs in which patients’ healthcare needs are treated as a continuum across their lifespan, in a ‘one-stop shop’ context that also provides a strong focus on health promotion and preventive health care.’
Undertaking further specialist training as a public health physician through the Royal Australasian College of Physicians, Sophia then accepted a position in 1998 as Public Health Medical Officer for the then newly formed National Aboriginal Community Controlled Health Organisation (NACCHO), based in Canberra.
Sophia witnessed the growing relationship between NACCHO and the Australian Government which proved to be pivotal in providing impetus to the Closing the Gap (CTG) campaign and initiatives for Aboriginal and Torres Strait Islander health equity that were launched in 2008.
‘I was fortunate to be part of the original secretariat of NACCHO, and it was incredibly exciting to be a part of something so ground-breaking. It was also a great honour and a privilege to work side by side with the inaugural NACCHO chair, the late Dr Arnold (Puggy) Hunter.
‘During my time with NACCHO, I witnessed some tremendous health policy changes and was fortunate to be part of the establishment and implementation of a range of programs and resources that have made a real difference to people’s lives.’
One example of a significant change to government policy that was achieved during Sophia’s time with NACCHO was the CTG Pharmaceutical Benefits Scheme (PBS) Co-Payment Measure for Aboriginal and Torres Strait Islander peoples.
‘The scheme has significantly enhanced access to medications for Aboriginal and Torres Strait Islander peoples, who can register for it at GP clinics and ACCHSs,’ she says.
‘This significant change in government policy and funding came about as a direct result of an earlier NACCHO and Pharmacy Guild partnership initiative known as the Quality Use of Medicines Maximised for Aboriginal Peoples (QUMAX) program which started in 2005.’
Another significant milestone was the publication of the book, Aboriginal Primary Health Care: An Evidence-based Approach, with co‑author and current Deputy Vice Chancellor of JCU’s Division of Tropical Health and Medicine, Professor Richard Murray. The research for the book led Sophia, on behalf of NACCHO and with the encouragement of Dr Hunter, to develop a comprehensive resource for clinicians known as the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. The Guide was subsequently adopted by the Royal Australian College of General Practitioners.
Although no longer part of the NACCHO secretariat, Sophia continues to be involved in Aboriginal and Torres Strait Islander health via her part-time role as a specialist public health physician consultant to the Queensland Aboriginal and Islander Health Council (QAIHC).
‘In my current capacity as consultant for QAIHC, I supervise other public health physicians to optimise healthcare delivery together with the Aboriginal and Torres Strait Islander community. I also coordinate and deliver masterclasses to training registrars, as part of the partnership between QAIHC and the JCU GP Training Program that is preparing the next generation of general practitioners and rural generalists for rural and remote Australia. The masterclasses involve leaders and practitioners from ACCHSs passing on their knowledge and skills to the GP registrars.’
Research on public health systems, structures and policies is also an important aspect of the role of a public health physician. One initiative is the evaluation of a pilot project called Integrating Pharmacists into Aboriginal Community Controlled Health Services (IPAC).
The project – a partnership between JCU, the Pharmaceutical Society of Australia and NACCHO – sought to embed pharmacists within 22 ACCHS sites in Queensland, Victoria and the Northern Territory over a period of 15 months.
‘Pharmacists are allied health professionals who could work in much better ways with ACCHSs to improve medication-related health outcomes. Despite the higher burden of chronic disease within Aboriginal communities across Australia, people often have limited access to appropriate medication advice, particularly in remote areas. And we of course know that drugs don’t work if patients don’t take them, so finding ways to overcome this problem is a vital health system improvement.
‘The IPAC project has, in fact, turned out to be one of the largest interventional studies involving consented Aboriginal and Torres Strait Islander peoples to be completed in Australia. The findings have been really promising and are currently being reviewed by the Australian Government’s Medical Services Advisory Committee.’
In addition to her work in research and public health advocacy, Sophia also teaches in the Bachelor of Medicine and Bachelor of Surgery program at JCU, delivering health system science units to first-year students and coordinating the capstone Aboriginal and Torres Strait Islander health assignment for sixth- and final-year students.
‘My goal is to help to foster a new generation of health professionals who are competent working in an Aboriginal and Torres Strait Islander health environment, in partnership with patients and with members and leaders of the local community, to deliver high-quality, patient-centred health care.’