It’s a crisp, Spring morning for the visit to Waminda South Coast Women’s Health and Welfare Aboriginal Corporation. There’s been rain, so the pastures and bushland surrounding the NSW South Coast town of Nowra are lush and green. The town and its surrounds sit beside the Shoalhaven River, nestled between the Coolangatta Mountain and the sea: landforms of great significance for what is known as the Yuin Nation, and its peoples.
The area has a traumatic colonial history of dispossession, violence and family separation; its legacy continues for the Aboriginal community today, but this is not a story of defeat. It’s a story of strong women, strong community and strong culture. Of how doing healthcare the Waminda way brings wholeness to women and their families.
Waminda is much more than the sum of its clinics. No opportunity to connect with the community is missed. Clients from all over the Shoalhaven region – Jerrinja and Wreck Bay Aboriginal communities, Nowra/Bomaderry and as far afield as Ulladulla and Kiama – access Waminda’s services in various ways. These are just a few of them.
Nowra and its surrounds sit beside the Shoalhaven river (bottom), nestled between the Coolangatta Mountain and the sea: landforms of great significance for what is known as the Yuin Nation, and its peoples. Image credit: Ruth Armstrong
No Wrong Door: Holistic Health Clinic
There’s free fresh fruit at the reception desk in this downtown Nowra location, which hosts Waminda’s clinical services including Aboriginal Health Workers, General Practitioners, Nurse Practitioners and Midwives. It’s the place of first contact for many clients, while others are referred from elsewhere in the service. Every person is triaged by an Aboriginal Health Practitioner first up.
Practice Manager Sharon Trindall, says there are currently more than 1,400 Aboriginal women and family members on the books, after a period of exponential growth following her arrival at Waminda (straight out of acute care nursing) four years ago. Care is client-driven, and 715 health checks are offered to everyone who is eligible.
“We watch our data really closely – see where the gaps are; where we need to improve. What we’re picking up is complex. The checks identify chronic conditions, multiple comorbidities, social issues, family issues. They are holistic. Even if that person doesn’t elect to do their screening or preventive care you have the conversation with them” explains Trindall.
There are currently more than 1,400 Aboriginal women and family members on the books at Waminda, which prides itself on a holistic, ‘no wrong door’ approach. Image credit: Ruth Armstrong
Hayley Longbottom, Waminda’s Health and Wellbeing Manager and also an Aboriginal Health Practitioner, explains the service’s woman-led, integrated and holistic ethos.
“Here there’s no wrong door approach,” Longbottom says. “A woman walks through that door and we deal with everything she brings with her. We walk beside her, not in front of or behind, but right beside her. People are their own healers. Everyone’s on their own journey. We’re talking about a whole person in terms of her family, her community” says Hayley Longbottom.
This approach is beautifully illustrated in two key graphics, the Waminda Model of Care, and the Balaang (Women’s) Healing framework, which was developed through women’s yarning circles.
The Waminda Model of Care (top) and Balaang (Women’s) Healing Framework (bottom). Image credit: Supplied
Led since 2007 by dynamic CEO Faye Worner, Waminda’s 110-plus staff are a tight-knit bunch. It’s a uniquely collaborative environment and, as we yarn, people frequently finish each other’s sentences in a way that is amplifying and supportive. Many are from the Yuin nation and have grown up locally. There’s an immense satisfaction in giving back to community.
“One of the things I’m proudest of isn’t clinical. It’s the fact that since I’ve been here so many family members have followed me over. They were seeing mainstream doctors or not getting much healthcare at all. Here they feel comfortable and safe, and happy to see mob around. They’re not going to be judged”
Loretta Longbottom
“You get people coming in and saying, ‘I wouldn’t be alive without Waminda’. That’s a powerful thing”
Case management: connecting to country
Tamara Ardler, Drug and Alcohol Caseworker says most of her clients’ problems with addiction relate to past or ongoing trauma. Rather than focusing on addiction, she tries to bring hope and focus on strengths.
Support available within Waminda includes Healing Counsellors, physical and mental health checkups through the doctors, and referral to Dead or Deadly or Balaang Gunyah (see below). Connecting women back to country and community is a major aim.
“Through drug and alcohol use a lot of people lose their connections. It’s about bringing them back,” Ardler says.
Birthing on Country
Melanie Briggs is an Aboriginal midwife and Waminda’s Project Officer for Birthing on Country. For Waminda, that means making birthing culturally safe for women so that they feel connected to their culture and feel safe in the space: bringing culture back in to birthing practices.
Currently, Waminda provides a maternity model of care to women who are having an Aboriginal baby through the Minga Goodjaga (Mother and Baby) program. Midwives deliver antenatal and postnatal care through pregnancy and the first six months postpartum, but Briggs wants to do much more.
In the short term that entails working with Nowra’s hospitals and stakeholders, so that women can have continuity across the spectrum of midwifery care with their chosen Aboriginal or culturally sensitive and competent non-Aboriginal midwife. In the long term, there’s a proposal on the desks of the State and Federal Ministers for health, and the Minister for Aboriginal Affairs, for a purpose-built service, designed by and for Aboriginal women.
“ACCHOs are the highest employer of Aboriginal people in the country – over 6,000 –, and yet we’re still having to access mainstream services to get birthing support. There’s so much to do” says Briggs.
Innovations in comprehensive care
Kristine Falzon is Waminda’s Cancer Care & Wellness Project Coordinator, supporting programs for health and wellbeing, tobacco control, palliative care, and cancer prevention, investigation and management. It’s “a whole of life approach to health care, from prevention, right through to screening, investigation, treatment support, palliative and end of life care,” she says.
Waminda’s regular pamper days in outlying communities are popular. Along with beauty and self-care services, these events provide opportunities for cancer screening and education, and identification of social and other needs, acting as a “soft” referral pathway.
Much of Falzon’s work involves advocacy, preparing submissions, working with external bodies like Cancer Australia, and looking at opportunities arising from funding for specific initiatives. She recently presented on behalf of Waminda’s cancer services at the World Indigenous Cancer Conference in Calgary.
A big win for the community was a Cancer Institute Grant Partnership with Shoalhaven Cancer Care Centre when the Centre was first being built seven years ago.
With good leadership on both sides, the project resulted in “cross-learning rather than coming from a deficit or superiority position” Falzon says. Aboriginal Health Workers act as conduits between the community and mainstream services, helping to make the Centre more culturally safe. The model is described in further detail here. Though a great example of “how things can be done effectively and appropriately in collaboration” Falzon notes that the partnership was not extended beyond 2012/13, meaning lobbying has had to continue.
Asked what it is about Waminda that allows innovation to flourish, Falzon underscores connectedness to the community and a deep understanding of its needs as pivotal to their success.
“We’re accountable to our community first and foremost and we are community women,” she says. “It’s also about being brave and fierce enough to be able to stand your ground and say, no that’s not right for our community.”
Going the extra mile at Nabu
Behind a double shopfront, on a leafy downtown street, sits the headquarters of Nabu, Waminda’s Intensive Family Support Service. Nabu works for preservation (keeping children with their families) and restoration (restoring children in out-of-home care to family). Sitting with the team, their shared passion and commitment is evident, and their success rate (100% for preservation and 91% for restoration in 2016/17) reflects this.
The team consists of Caseworkers, Family Support Workers, Cultural Mentors, and Elder/Cultural Mentors. The caseload is shared, and all Waminda’s resources can be called upon when the families need them.
With all activities led by what their clients need at any given time, no two days are the same. Whether it’s going the extra mile to support a client in court or packing boxes to help someone move house, this team goes all out to support their families.
“Nabu, known as grandmother for being the beholder, the mother of all being, the circle of Family, that cycle of life & creation. First tier Grandmother was and always a mother, second tier woman becoming binji (pregnant) and the last tier is giving birth of a Boori (child) and so the cycle begins and never ends”. Image credit: Ruth Armstrong
Nabu was recently funded for twelve months through Their Futures Matter and is about to expand, in response to a burgeoning waitlist.
Nabu HQ is also the home of Waminda’s Healing Counsellors. Debra Bowman, who trained through Nunkuwarrin Yunti in Aboriginal narrative practice, explains that she provides therapeutic support across the whole of Waminda, wherever it’s needed.
“My work involves walking beside the woman and letting her reconnect to who she is, because every person is their own healer, it’s just about providing that space and that support,” Bowman says.
Tina Dickson, Cultural mentor
“Growing up, I had experience with out of home care. When I see these families coming together and mum standing her ground and being the strong woman keeping her family together, it’s a healing thing for them and me”
Moo Morunga, Caseworker
“When our families are in crisis, we sit with them and listen. Let them unpack and just sit with it. We don’t have to give advice – just sit, listen and respect ”
Tehika Hepi, Community Mentor
“Our referrals from Family and Community Services look at the risks, whereas we look at the strengths”
Dead or Deadly
Though it is situated in an unassuming dwelling in suburban Nowra, Waminda’s flagship healthy lifestyle service is a bit famous. It was singled out in 2018, by then-Minister for Indigenous Health and Aged Care Ken Wyatt as a success story in chronic disease prevention and management.
It’s been a labour of love for Waminda, with the service “robbing Peter to pay Paul”, even depending on contest prize winnings to keep Dead or Deadly afloat because “we knew women wanted and needed the program,” says health and wellbeing manager Hayley Longbottom.
When a woman comes in, “it’s not just about her jumping on a treadmill. It’s about her journey, her wellness,” the team explains. Every person’s needs are assessed by an Aboriginal Health Worker and a plan is made.
Smoking, diet, risk factors, diabetes screening and management, mental health and social isolation are all on the agenda – if the woman wants them to be. Over the past couple of years, shared medical appointments have been instituted. These health-focused yarning circles, which include a facilitator, a doctor and an Aboriginal Health Clinician (sometimes with the in-house cook on hand), have proved a huge success.
The cook also gets involved when Youth Social Worker, Olivia De Pietro, leads after-school outreach to girls aged 12 to 18, in Dead or Deadly’s Bulwul Balaang (young women’s) program.
Waminda’s flagship healthy lifestyle service Dead or Deadly is about so much more than jumping on a treadmill. As well as a gym (bottom), the centre features a kitchen (centre), with an in-house cook who attends shared medical appointments and is involved in Bulwul Balaang, the after-school outreach program for young girls. Image credit: Ruth Armstrong
Anita Mongta, Aboriginal Health Worker.
“We all work with our clients to support their mental health and wellbeing. We cater to everybody; make them feel welcome. And once they do identify mental health issues, our healing counsellors can come into our space, or they can meet clients somewhere else where they feel comfortable. We don’t isolate mental health from the rest of care”
Kalinda Wills, Aboriginal Health Worker
“A lot of our clients do have anxiety and depression. They’re coming in here because it’s a safe space where they feel welcome; where they don’t focus on their anxiety and depression. They focus on their health, and coming in and socialising, and getting their needs catered for”
Clever fearlessness, and a garden by the Shoalhaven
It’s back in the car for our next stop, as we follow the Shoalhaven river out towards the coast, then turn down a country lane and into the driveway of a redbrick house. The first thing to notice is the garden, home to Kareela Ngura (country of trees and water), Waminda’s sustainable permaculture and bush tucker rural industry project.
Upstairs, the small NDIS team endeavours to address the “massive unmet need” for assistance in the Shoalhaven region for women with disabilities. Alison Moyle is Program manager of Waranj Dhurawaraga (growing strong together). She and Aboriginal Health Worker, Stephanie Rooney, support people to access and use their NDIS funding.
This can be very labour-intensive. For instance, many people will need support to apply for NDIS several times before they are deemed eligible, but here again the Waminda way – walking beside people as they exercise their own choice and control – prevails.
“I love Waminda’s clever fearlessness. Looking at things strategically but saying, ‘Look there is the need there so we’re going to step into this space and do what we can” – Says Moyle.
Following the Shoalhaven River (top), you come to Kareela Ngura, Waminda’s sustainable permaculture and bush tucker rural industry project. Image credit: Ruth Armstrong
Respite and healing at Balaang Gunyah
Out by the coast at Orient Point we reach today’s final destination, Balaang Gunyah (Women’s place). It’s a rambling old beach house with a wide, inbuilt verandah. There’s a safe play area out front and huge, mature eucalypts surround the compound. Cullunghutti can be seen in the distance, and Jerrinja Aboriginal community is just down the road.
Balaang Gunyah feels like the place where all Waminda’s services intersect. People have been talking about it all day as a place of congregation, respite, yarning, culture and healing. Open for about three and a half years, it’s the only Aboriginal women’s place in the Shoalhaven region, and was much needed.
Following the Shoalhaven River (top), you come to Kareela Ngura, Waminda’s sustainable permaculture and bush tucker rural industry project. Image credit: Ruth Armstrong
Cultural Mentor Tresia Farrellis from Jerrinja. Along with facilitating Balaang Gunyah’s very popular Arts and Crafts Group and other activities, part of her job is to take people out on country, show them significant places, share yarns about those places and help them reconnect. She’s seen women “blossom” when they replace social isolation with connection.
Donya Whaddy, a Support Officer, is from Wreck Bay Aboriginal Community. She has been involved with Waminda for a long time, including as a client when she faced some difficulties of her own. Like everyone who works there, she’s immensely proud to be part of everything that Waminda stands for.
“Our Elders worked really hard to get this place off the ground. It’s been a long journey and it’s powerful to be able to work and give back to women, our community. All respect to my Elders past and present who made this happen. If it wasn’t for them, I wouldn’t be here” says Whaddy.
Balaang Gunyah’s Tresia Farrell (L) and Donya Whaddy. Image credit: Ruth Armstrong
The Your Health Your Future (YHYF) Ambassador Jack Wilson, the ‘’Deadly Ninja Warrior’’ scored goals at the 2019 Koori Knock Out (KKO) in Tuggerah on the Central Coast of NSW. With little time and not enough of the Deadly Ninja Warrior to go around, Jack ochred-up, shook a leg, had a yarn and pulled in a crowd.
Jack’s main message was:
‘’Your health is very important. When I talk about health I’m talking about, mind, body and spirit, so make sure you train, you eat healthy, you respect others and you respect the land ok. Your Health Your Future! Get your health checkup! Stay deadly!’’
It was great catching up with AH&MRC Member Services at the KKO. Many of the staff enjoyed yarning and getting a photo with the Deadly Ninja Warrior. Over the three days, AH&MRC shared a tent with the Bellbrook Bulldogs, giving out YHYF resource packs. Prizes for participating in the YHYF video campaign included YHYF shirts and drink bottles.
AH&MRC also offered free ear health screening, checking for hearing loss and ear health problems. As we know ear health problems can have a large impact on speech and educational development of children, adversely affecting their social interactions, employment and wellbeing. AH&MRC successfully screened 20 children and 10 adults.
Congrats to the winners of the women’s footy comp, the Wellington Wedgetails and winners of the men’s comp, South Coast Black Cockatoos.
Welcome to the land of the three rivers. Welcome to Wiradjuri country.
It’s the first thing you see as you walk through any entranceway here, a very special campus of sorts in the centre of Wagga Wagga’s health district. It’s somehow fitting that the Riverina Medical and Dental Aboriginal Corporation – or RivMed, as it’s known to locals – was founded, and is still rooted in, a family home; family is at the heart of what they do, and everyone is greeted as kin.
Yandarra, a Wiradjuri word that means “coming together”, captures the essence of RivMed, an Aboriginal community-controlled health service that was established by a dedicated group of Elders some 30 years ago. These lands have, for tens of thousands of years, been a meeting place for the Wiradjuri, the people of the three rivers, and after British invasion it became a major resettlement community.
Yandarra – Photo Credit: Amy Coopes
“They took them and put them all on the missions, and then they decided to move them off the missions and put them into towns,” explains RivMed CEO Tangerene Ingram, a Wiradjuri woman from the community of Brungle between Tumut and Gundagai, with a wry smile. “We have so many different nations living here.”
Ingram gestures at a map of Aboriginal nations as she traces the history of this town on the Murrumbidjeri, or Murrumbidgee, one of three rivers that give the Wiradjuri their name. Such maps are displayed prominently across RivMed, a celebration of and commitment to belonging.
Tangerene Ingram, RivMed CEO – Photo Credit: Amy Coopes
“It’s not just the medical needs that are being met, and the dental needs, it’s also a meeting place,” explains Ingram of what sets RivMed apart. “Because it’s such a culturally safe space, you do feel comfortable. You go there, you see family, you see people you know, you see the Aboriginal person at the counter, it’s that type of service.”
Copies of the Koori Mail and photo albums celebrating events including the annual Yandarra health promotion festival are scattered throughout the waiting room of the Valda Weldon Primary Health Care Centre, named for Aunty Val, one of RivMed’s indomitable founders, whose portrait looks out over the glass doors.
The television in the corner broadcasts Aboriginal Health TV (“We didn’t want to show mainstream,” says Ingram). A whiteboard next to the reception desk advertises community events: women’s cooking classes top this week’s schedule.
A tongue-in-cheek artwork depicting nunay ngurruway (bad choice) and marang ngurruway (good choice) has pride of place, with the latter panels featuring the preparation and hunting of traditional foods and a group of Wiradjuri women in ceremonial dress lifting weights around a stereo. ‘It’s your choice to be healthy’ the artwork states.
RivMed clinic art board – Photo Credit: Amy Coopes
Though it retains a homely, familial warmth, RivMed has come a long way from humble beginnings in a house near the Wagga Wagga Base Hospital with just a handful of medical and dental staff. It’s now a thriving multidisciplinary service with some 6,000 clients and will soon boast almost 90 staff spanning the region, from Narrandera, Griffith and Leeton through Cootamundra and Brungle right down to Albury on the Victorian border.
“There’s a lot of things happening for RivMed,” says Ingram.
Steph and Sharma – Photo Credit: RivMed
Families in focus
Ingram, whose background spans correctional services, health, social and emotional wellbeing and child protection and welfare, has overseen a remarkable expansion at RivMed in recent years, with a focus on at-risk children and families. She is ambitious and unapologetic about pushing the boundaries, with pride in the service’s work that is both boundless and infectious.
RivMed is one of the only services in regional NSW to offer a strengths-based, in-home program known as Functional Family Therapy (FFT), an early intervention targeting vulnerable families whose children are at risk of being taken into care due to issues ranging from substance use, domestic violence and trauma, through to squalor, grief and loss.
“The therapist goes into the home, and they start at the point at which the family is,” explains program manager Felix Machiridze, a former journalist who fled Zimbabwe as a refugee and has retrained in social work as part of his recovery.
“There is no top-down kind of approach, we say the family itself are the experts of their own issues, but what we try to do is to make the family see these issues in a different way.” – Felix Machiridze, Social Worker
Felix – Photo Credit: Amy Coopes
Not every family in the program is Indigenous, but Machiridze says it resonates for Aboriginal people because it focuses on collective responsibility, inherent strengths, and social capital. In the two years it has been running, just one family out of 100 has needed to repeat the program, and it is such a success RivMed has hired staff in Albury, Narrandera and Cootamundra to extend its reach.
In a major win for the service – and a precedent that will now be rolled out statewide – RivMed convinced the NSW Government to broaden the referrals pathway so that it is not only Family and Community Services (FACS) and the Department of Communities and Justice that can refer families to the program. Instead, RivMed’s GPs and other staff, as well as the Family Referral Service, also will be able to direct families into the program.
“We have found for some families, especially most Aboriginal families, because of historical issues they do not want to do through the FACS pathway. They would rather not participate where FACS is concerned” says Machiridze.
Saraya and Latoya – Photo Credit: RivMed
In addition to FFT, RivMed runs an intensive 18-week family-based services initiative for Aboriginal families at risk and has been funded by FACS to offer two-year preservation and restoration programs working with families whose children have been or are at risk of being removed, with the aim of supporting a reunion or keeping a family intact. The project will have staff in Griffith, Narrandera and Leeton.
Following five years of lobbying, RivMed has just secured accreditation to offer out-of-home care to Aboriginal children, something of which Ingram is particularly proud.
“RivMed has always looked at the social and emotional wellbeing of the whole of the family,” she says. “Now we can take care of the health side, whether it’s the mental health, the drug and alcohol, your general GP health needs, to what’s happening with the family in terms of child protection… It’s a whole package, and we’re growing.”
dental ed – Photo Credit: RivMed
Charting community need
Almost as swiftly as they move into a new building, RivMed outgrows it, such is the demand for services. The dentist needs another chair, there aren’t enough consult rooms for the busy roster of GPs, specialists, allied and mental health staff, and the clinic will soon have its very own in-house pathology lab on site. They have a clinic at Brungle, between Gundagai and Tumut, and have been involved in talks about supporting the Narrandera Aboriginal community with their health needs. Some 6,000 people are on the RivMed books.
Everything they do at RivMed is carefully calibrated to community need. They are one of four AMSs participating in the Sax institute’s longitudinal SEARCH study looking at the health and wellbeing of Aboriginal children, and their focus on vulnerable children arises directly from this research. According to the data, the most disadvantaged child in these populations are boys aged between three and nine who are in foster care, Ingram says.
“It’s really making us look at the program and how we can work better with our families.” – Tangerene Ingram, RivMed CEO
Nat and patients – Photo Credit: Amy Coopes
Food security has also emerged as a major pressure point for local people in the Sax study, particularly for people who “live out in the suburbs and can’t get into town because they don’t have the money, or mum’s on a pension, how can they get access”, Ingram says.
“If you’ve only got ten dollars you’re not going to be able to purchase meat and your veggies or whatever, they are going to go and spend it on a big heap of chips and Devon or bread because that’s going to feed all the kids.” – Tangerene Ingram, RivMed CEO
The service works with Oz Harvest locally to give out fresh food at the clinic and is leading discussions with local NGOs including St Vincent de Paul and the Salvation Army on how to better support the community.
Yandarra fry up – Photo Credit: RivMed
As part of a multi-AMS consortium in the region caring for those with chronic conditions, RivMed administers Integrated Team Care Program funding, providing transport to specialist consults, accommodation if required, even paying for appointments. In the few years it has been running, this program has been a huge success. A dedicated Aboriginal Health Worker, Patrick Sagigi, does chronic care outreach into the community, following up with patients after procedures and operations. A beaming, burly young Torres Strait Islander who exudes bonhomie, he grins as we talk about his work.
Aboriginal Health Workers are what makes the service special, according to Practice Manager Jane Kearnes, who started her life at RivMed working on reception and now oversees the day to day operations of the medical clinic.
Damian and Jenaiha with clients – Photo Credit – RivMed
Because they are known in the community, and for our community a face that they know in our service, it makes them more comfortable… They have really important roles within the organization” says Kearnes.
Natalie Smith has been an Aboriginal Health Worker at RivMed for almost ten years and speaks with passion about her work.
“It’s so important to have us, [to overcome] that barrier between our clients and the GPs. Our clients are happier to engage with us, and for us to go out into the community and find them, we’ve got more knowledge of the communities, the families,” she says.
Navigating the mainstream
Helping people navigate the mainstream health system is an essential part of her job, and something thrown into sharp relief by the death of Naomi Williams, 27, and her unborn baby at Tumut Hospital in 2016. The incident sent shockwaves through the RivMed community, with many local people, including Ingram, calling Williams family. “It really impacted on this community,” she says.
An inquest into the young mother’s death found “clear and ongoing inadequacies” in her care and called on the Local Health District to improve the cultural safety of its service by bolstering its Indigenous workforce and addressing implicit bias. Ingram has been in talks with the district on “how we can work better together, and service the smaller communities as well”.
Smith will accompany clients who need escalation to hospital and stay with them until they are triaged, seen by a doctor, and handed over to the care of the Aboriginal Liaison. She will ensure they understand what is going on and feel safe before she returns to the clinic.
Trust of mainstream services is an ongoing issue for the community. Of the four services participating in the SEARCH study, RivMed has the highest percentage rate for mental health presentations to hospital, and Smith says these largely occur after hours and on weekends when RivMed’s team are not available.
RivMed Exterior – Photo Credit: Amy Coopes
“I think it’s our clients not wanting to access mainstream services, not having a familiar face from our community in the services,” she says. “For us, it’s about looking at what we can put in place to try and fix that for our community.”
Down the hall, Annika Honeysett’s rooms are a hive of activity, mums with prams exchanging news while their babies squawk happily. Honeysett is the AHW attached to the maternal and child health team, working closely with the midwife and shared care GPs to care for expectant and postpartum mums.
“I love it, especially when you see a mum from when they first come in to when they bring in the babies,” says Honeysett, who has been at RivMed for four years and trained as an AHW “to help my family and my community”.
“If we don’t help our community, nothing gets done… They see our faces and they know who we are out in the community. That makes them feel comfortable, safe” she says.
Annika working – Photo Credit: Amy Coopes
Vignettes
Natalie Smith, AHW and SEARCH Research Officer
Wagga born and bred and a dyed-in-the-wool community advocate, Wiradjuri woman Natalie Smith has been an AHW at RivMed for almost 10 years and says she can’t imagine doing anything else. “I’d had no experience whatsoever in health, and I had no idea what I was getting myself into, but I love it and I’m still here,” she says. “[I love] our community, working with our community, improving the health of our community.” Smith is one of a small, tight-knit team of AHWs who keep RivMed’s clinical, dental and family services operations humming. She works closely with the GPs, following up patients in the community, triaging drop-ins to the clinic and assisting with high school health checks, as well as collecting and collating data for the SEARCH study. When patients have to go across to the Wagga Wagga Base Hospital she will go with them to ensure they are properly handed over and understand what is going on. “It’s about trying to stop the barrier between the client and mainstream, the client understanding what the doctors are telling them, because that is what our biggest problem is.”
Natalie Smith – Photo Credit: Amy Coopes
Annika Honeysett, AHW, Maternal and Child Health
As an AHW attached to the maternal and child health team, Ngiyampaa woman Annika Honeysett has a unique connection with RivMed’s growing families. She will see expectant mothers from early pregnancy through to delivery, and do baby checks and immunisations once their little ones arrive. “I love it, especially when you see a mum from when they first come in to when they bring in the babies,” she says. Honeysett provides all the antenatal care a midwife can, charting heights, weights, kidney function and blood sugars, but it’s the ongoing relationship, and that trust and understanding that is so tangible in what she does. “They see our faces and they know who we are out in the community. That makes them feel comfortable, safe.”
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Tucked away on reclaimed farmland outside Cowra, there’s something rather special going on. People who have been marginalised are finding a way back into the life they want to lead. But it’s no miracle. Here, at the Weigelli Residential Drug and Alcohol Service, understanding, not demonising, is seen as key to confronting problem drug use, with an individual’s context, education and skills viewed as assets to recovery. An unmade bed is not taken as wilful disruption, for example, but considered the act of a person who has, perhaps, never had anyone in their life to show them how.
“We do a lot more than just physically have the person here… We talk about their whole wellbeing – physical, dental, emotional, grief and loss.” Norm Henderson, Senior Alcohol and Other Drug Worker.
Established 26 years ago by the local Aboriginal community, Weigelli was both a response to a growing local need for residential rehab and a rebuke to the prevailing 12-step treatment orthodoxy. Known variously as ‘The Medical Model’ or the ‘AA approach’, these conventional methods centred and sought to treat the problem drug use rather than the person seeking treatment. Weigelli flipped this on its head.
Jannet Grey is the Aboriginal Mental Health Worker and Caseworker and was one of those involved in Weigelli’s foundation back in 1996. There was heavy resistance, at the time, from local residents, with several attempts at securing a site falling through at the eleventh hour due to an abrupt withdrawal of support. Not to be deterred, Grey kept the conversation going, and the more she talked with people, the more stories she heard about families touched by problem drug use. One such family eventually offered their farm, which was up for sale, to be used to set up Weigelli. It remains on the same site to this day, with images of the complex at different points in time on display.
Cultural Meeting Area – Photo Credit: Dr Tim Senior
Weigelli offers up to 21 places for a 12-week residential rehabilitation program after people have gone through detox. Everyone I speak to stresses the importance of keeping numbers low.
“It means we can get to know people well,” says Steven Taylor, the Aboriginal Alcohol and Other Drug Worker on the Community and Family Support team. “We can be individually responsive.”
“It feels like one big family”, adds Kerri-Anne Cutmore on reception.
Kerri-Anne Cutmore – Photo Credit: Dr Tim Senior
Flexibility and responsiveness are at the heart of what Weigelli do, and a critical factor in their success, explains Sandy Whiteman, leader of the Community and Family Support team.
“Being regimented is not culturally appropriate… There is some space for reflection. People can start thinking and planning.”
This isn’t to say the 12-week program is unstructured. There is a formal evaluation at the six-week mark, and discharge planning starts in week eight. During their admission, people have to work and do chores around the site. They are given more responsibility as their stay goes on. When I visit, residents are building a new roof over an outdoor area, under the supervision of a local TAFE instructor. The aim is to equip people with life skills and work skills they can continue to use, says Henderson.
“We create an environment where people feel like they are in a community,” he says. “We’re not chasing people with clipboards and questionnaires.”
Art room at Weigelli – Photo Credit: Dr Tim Senior
Community and mutual respect
How this works in practice soon becomes apparent. “Hello,” I say to one person who approaches as I am shown around the site. He tells me his name, and I ask, “So, what do you do here?”
“I am one of the residents,” he responds with a smile. There’s not a clear hierarchy between staff and those receiving treatment, because everyone subscribes to the community view. As we chat, he shares many of the same benefits I’ve already heard from several of the staff.
Weigelli Warriors Gym – Photo Credit: Dr Tim Senior
Over lunch with the staff and residents, the sense of community and mutual respect is palpable, with the same kind of collegial banter and good humour you’d expect in any workplace.
There’s frustration about the environment that people go back to after rehab. There aren’t interventions available for other family members and there is no network of safe houses for people to go back to. The ongoing impacts of trauma are significant; Henderson tells me 1 in 2 of the women and 1 in 3 of the men have been sexually abused.
“Even three months clean and sober is a win, though … It gives them a rest, and it gives family a rest.”
There’s an understanding that attachment to culture is important in recovery, and it suffuses the program, with Weigelli’s Aboriginal staff playing an essential role. Celebrations peak in NAIDOC week, with a march, cooking of bush breads and other traditional foods, cultural site visits, art workshops and activities to mark men’s and women’s business. The service also remains accountable to the local community through its board of Wiradjuri elders.
“Many of our residents don’t know where they are from,” says Taylor, reflecting on the importance of belonging, of place. He takes me to a beautiful spot he has crafted on the grounds for outdoor cultural activities, a trail winding through eucalyptus trees to a circular meeting area, with a separate path out.
Cultural Meeting Area Entrance – Photo Credit: Dr Tim Senior
As a rehabilitation service, KPIs remain a necessary evil, tracking progress against conventional treatment metrics. But the success stories I hear can’t be measured with statistics. It is the mother with a 20-year addiction who first came in with her partner. He is now in custody, but she is working and has access to her children. The man who celebrated his 45th birthday in rehab and cried as the residents and staff brought him a cake and sang Happy Birthday, because it was the first time anyone had done that in his life. It is the couples who get their children back in their care.
Norm Henderson says it best of all: “We love people back to life.”
Everyone at Weigelli leaves a handprint – Photo Credit: Dr Tim Senior
Vignettes
Jannet Grey – Aboriginal Mental Health Worker/Caseworker
Jannet Grey is a fine example of the diverse roles taken on by Aboriginal Health Workers. In her current position, she supports and counsels residents, helping them to problem-solve and identify their strengths, as well as planning and coordinating activities for the groups, in conjunction with the rest of the team. A respected local Elder, Grey has been part of the community for many decades, with vital connections to local people and culture. She was instrumental in Weigelli’s establishment, recognising that there was a need for residential drug rehab that wasn’t being met by mainstream services. While her job title is Aboriginal Health Worker, Grey’s achievements at Weigelli are a continuation of her life’s work, doing whatever is required to serve the needs of her community.
Janet Grey – Photo Credit: Dr Tim Senior
Steven Taylor – Alcohol and other drug worker, community and family support team
Steven Taylor is an Aboriginal health worker whose influence extends across every activity at Weigelli. He works through the 12 week program with residents, and sits down with them to prepare for their return to the community. After discharge, he stays in contact with residents for as long as necessary through Facebook Messenger, so he hears firsthand about their setbacks and successes. Taylor is connected to the local community and culture and arranges the Weigelli NAIDOC celebrations. He has crafted an outdoor cultural meeting space among the eucalypts on the grounds. Taylor sees reconnecting people to culture as a central part of their recovery. “This isn’t about staff and residents,” he says, “ it’s about everyone learning together. Everyone is learning and developing.”
Steve Taylor (left) and Norm Henderson (right) – Photo Credit: Dr Tim Senior
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Driving through Gamilaraay country in the remotest reaches of northwestern NSW, the single most striking feature is the dry; vast expanses of parched land. At the Walgett Aboriginal Medical Service, the walls are beginning to crack because the soil the building stands on is too dry to support its weight. On the day I visit, the water from the taps runs yellow, sediment settling in it from the artesian basin below, and the Shire Council advises locals to boil it before drinking.
Walgett is not expecting rain for another three years, and though it is nowhere to be seen, water – or, more precisely, the lack of it — courses through every conversation. The situation is so precarious the AMS is now receiving donated water and storing it casks on palates for distribution on Mondays and Wednesdays to those who need it most.
Water stored in casks on palates. Photo credit Dr Tim Senior.
This doesn’t seem sustainable, but for Christine Corby, CEO of the long-running Walgett AMS, it is simply one more way in which the service offers comprehensive and holistic primary care.
It may look like a conventional medical clinic, offering a range of programs including acute medical care, chronic disease management, dental and oral health services, allied health, psychology, specialist clinics, child health and antenatal care, but Walgett AMS is so much more than a one-stop shop for health. It is of, by and for the community. Really, it *is* the community, and Aboriginal Health Workers and Practitioners are integral to its success.
“One of the biggest factors is getting trust,” says Wayne Beddall, an AHP coordinating the chronic disease management program Healthy 4 Life.
Originally a driver in the Kimberley, Beddall was drawn to AHW training by the huge unmet need in Aboriginal men’s health, and was quick to recognise the opportunities for improvement, when he started at Walgett AMS 20 months ago, in chronic disease. One of his priorities is ensuring that people can see the same GP for their ongoing management, not just for continuity of care, but because relationships are what keeps people coming through the doors.
“By getting rapport, we also meet our KPIs and raise our Medicare revenue,” he says.
Walgett AMS CEO Christine Corby, Aboriginal Health Practitioner Wayne Beddall and Admin Team Leader Sally Barton. Photo credit Dr Tim Senior.
The human touch
AMS staff ensure people get to their appointments, providing transport as far away as Dubbo – some three hours distant. They know when people are homeless or couch-surfing, or when families are struggling to put food on the table – a burden made worse by the razing in June of this year of the local supermarket. The clinic runs a community garden (with wicking beds to combat the effects of the drought) and has published recipe books; in future it hopes to open a commercial kitchen to train local people. They know the best place in town for heathy frozen meals (the newsagent, run by two chefs), or a decent cup of coffee (the same). There’s a focus on children, too, with a playgroup doing outreach around town, encouraging active play by parents with their children and embarking on a new focus on injury prevention, being co-designed between the community and the University of New South Wales. In April, the AMS joined other service providers to participate in Walgett Shire Council’s ‘Bustin the Dust’ festival, highlighting the impacts of the drought on people’s physical and mental health.
“It’s about the human touch, the caring touch,” explains Beddall.
The AMS owns multiple properties in town so it can accommodate a complex roster of visiting specialists, allied health professionals and GP locums, all of whom are regulars in Walgett and known to the locals. Three weeks out of four, the AMS has a permanent GP, Dr Paige Darlington. From the outset, the board of Walgett AMS decided that they were a service for everyone in the community, and 40% of their clients are non-Aboriginal.
Corby, who has been at the helm since the AMS opened its doors back in 1986 and was recognised in 2006 with an Order of Australia Medal for her achievements, takes pride in the Service’s contributions to and place within the community.
It is a major employer in the town, and does what it can to help businesses and services struggling to recruit and retain workers in Walgett by attempting to offer roles, for example, to the partners of police and teachers who move to the town. When it comes to Aboriginal people, it employs and trains a larger number still.
As Corby pointedly asks, “Where else would the Aboriginal people be employed?”.
Aboriginal Health Worker Jenny Hunt. Photo credit Dr Tim Senior.
Many have worked their way up the ranks. Jenny Hunt, who this year marks 11 years as the Service’s Aboriginal Health Worker in eye health, started off as a cleaner at the AMS. Selene Dennis, who works as an AHW in the Yinaar Gaali alternative birthing program, is expecting to pursue her midwifery studies and take over stewardship of the program from non-Indigenous midwife Bet Ineke.
Aboriginal Health Worker Selene Dennis and midwife Bet Ineke. Photo credit Dr Tim Senior.
“The reason for our success is the commitment of the staff,” explains Sally Barton, a non-Indigenous admin team leader who is fairly new to the service. “We’re prepared to bend the rules, to do what’s necessary, keeping people safe.”
Holistic primary health care in Walgett is not just about providing the full suite of services to people, though that is a central part of what they do. It is also being an employer and advocate; a voice for the community and a force for change, come drought, fire or flood.
Asked what their greatest achievement is, Corby’s response is simple.
“I’m most proud of our longevity,” she says.
VIGNETTES
Aboriginal Health Practitioner, Wayne Beddall
Wayne Beddall started out as a driver in the Kimberley and was encouraged to retrain as an Aboriginal Health Worker because of the shortage of male health workers, and the need for men’s business in the Kimberley. Now an Aboriginal Health Practitioner, he’s passionate about his work in community control on chronic disease. “An Aboriginal Community Controlled Health Organisation is what the community needs,”he says, contrasting this with acute care in the hospital. He emphasises the importance of rapport, and how this led him to shift the regular GP’s workload away from acute presentations to chronic care. “With only short-term doctors, there was no proper follow-up. People would have to retell their story again, and GP Management Plans were started over and over again.” Beddall takes me on a tour of the town, pointing out the AMS houses and the community garden. His sense of excitement at any opportunity to enhance people’s health is tangible. He’s moved his family up to Walgett for this work, and has been welcomed into the local Aboriginal Community here. It seems like he is only just getting started.
Aboriginal Eye Health Worker, Jenny Hunt
Jenny Hunt started out as a cleaner at Walgett, but has now been the eye health worker for 11 years. She does outreach to the local community, and helps people get glasses. Self-effacing,Hunt describes her work in terms of helping visiting optometrists and ophthalmologists, though when I suggest that she must have a good degree of knowledge herself, she smiles and agrees. In the dedicated AMS eye room, where we chat briefly, she proudly produces the retinal camera, the screens for Snellen Charts, the slit lamp and the box of equipment she takes on her outreach visits. Hunt is an ever-present community expert on ensuring people’s quality of life isn’t impacted by poor vision.
Aboriginal Health Worker, Yinaar Gaali, Selene Dennis
Selene Dennis is an Aboriginal Health worker on the maternal health program Yinaar Gaali. She works closely with a midwife, and the plan is for Dennis herself to take over as a midwife in the future. She is obviously enjoying her role, and looking forward to continuing training. Dennis is reluctant to blow her own trumpet, but Bet Ineke, the midwife who works alongside her, describes her as invaluable to the team. “Selene is a young mum herself, and understands what these mums are going through and their experiences with non-Indigenous health services. She is trusted, and people will tell h r things that they just wouldn’t tell me.” As a result, the AMS is seeing improved engagement by women with antenatal care throughout their pregnancies.
This article was written by Dr Tim Senior and edited by Amy Coopes, on behalf of Croakey Professional Services. It was sponsored by The Aboriginal Health and Medical Research Council (AH&MRC) of NSW, which had final say over the content.
Croakey Professional Services help generate funds to sustain our public interest journalism activities, and also aim to provide a useful service to our readers. To find out more about the range of services on offer, see here.
In late September AH&MRCs Public Health Team set out to the Kids in Care Cup in Albion Park as part of the Your Health Your Future (YHYF) campaign.
The Kids in Care Cup raises awareness of the need for foster carers in NSW, in particular Aboriginal foster carers for Aboriginal kids, by bringing together children and adults to play rugby league. It has run successfully for the past 11 years, always running prior to the Koori Knockout. The Cup featured over 300 players competing in a round-robin style format, with age groups including the Under 10s, 13s, 15s, 16s, women’s and men’s teams.
Despite the indecisive weather and a slippery field, there was still a great atmosphere of spirited competition from everyone on the day. All teams involved put in quality efforts and even looked the part in their deadly jerseys promoting the YHYF campaign.
AH&MRCs Public Health Team provided Kids in Care Cup participants with health information, skipping ropes, footballs and handballs to promote a healthy lifestyle. We also learned many ways of taking care of our own health from the kids themselves who gave us healthy living advice such as:
Have a shower and brush your teeth. Stay active by playing rugby league.
The results from the Kids in Care Cup were:
Under 9’s- Draw (won 1 game each) Illawarra Titans Vs All Stars
Under 11’s- Draw (won 1 game each) Illawarra Titans Vs All Stars
Under 10’s Girls League Tag- Draw (won 1 game each) Illawarra Titans Vs All Stars
Under 13’s- Butucarbin Warriors defeated Mindaribba Warriors
Under 16’s- Butucarbin Warriors defeated Illawarra Titans
Men’s- Memorial Bears defeated Illawarra Titans
The Memorial Bears were highly anticipated competitors in the competition. Their team played to raise awareness and promote the importance of screening for bowel cancer.
