How doctors communicate with Indigenous patients

Tegan Taylor: In Royal Darwin Hospital there is a well-documented divide. The majority of the patients are Aboriginal and the majority of the healthcare providers are not, and the culture and language barriers wrapped up in this have real health implications for patients. So, Vicki Kerrigan, a researcher in intercultural communication at the Menzies School of Health Research has found that doctors really want to deliver good care to Aboriginal people but they aren't always sure how to. So she and her colleagues have created a podcast that brings together common questions that healthcare workers have and put them to the experts, in this case Aboriginal leaders. We are going to talk to Vicki in just a sec, but first let's get a sense of the podcast by taking a listen. It's called Ask the Specialist: Larrakia, Tiwi and Yolŋu stories to inspire better healthcare. Here's a snippet from the first episode:

Question: In my experience people love talking about where they are from and where their family are, but does that question put them in a position of ease? Does that open them up to a more relaxed state? What do you want your doctor to ask you about yourself?

Aunty Bilawara Lee: I think to begin with to introduce yourself, 'Hi, I'm Dr Pete' or 'Nurse Jane' or whatever. 'How are you? Where are you from?' And then share about yourself, tell them where you're from, whether you're married, whether you've got kids, if you follow football or some other sport, just so that gives some information about you before you start getting information from them, because they will feel much more comfortable with conversation than a question-and-answer time because we've had generational experience of authority and police coming in and asking questions.

Oh, and always when you say to the patient, 'Hello, my name is Dr Pete, what's your name?' And they might say, 'I'm John Brown.' 'Mr Brown, how would you like me to call you? Uncle John? Mr Brown?' And if that's what they say, that's what you do. That's why I always say to people I prefer to be called Aunty Bilawara. Just the plain Bilawara is very disrespectful if it's an older person.

Rarrtjiwuy Melanie Herdman: Just about what you talked about in the doctor's comment, 'Where are you from? Where's your family?' Because then you will understand, by my God, they've travelled 600 kilometres to be here and they are here for two months without family, living in temporary accommodation. I'm pretty sure if we were all stuck in a confined space for two weeks, we would go mad. So there needs to be some kind of understanding built and a relationship established for that person to then say, oh, so this person is here to help me, they really want to know who I am and what I'm here for, and if I don't know what I'm here for, this is the person to ask because they really care about me. I'm not going to talk to someone if someone is just coming in to tick boxes and take my blood pressure and ask me questions and then walk off. So once you get to know someone, they open up and they trust you, you want them to respect you as the doctor that's going to help them get better, but you also have to respect them for allowing you to look after them and have trust in you that you are doing the right thing for them.

Tegan Taylor: So, Vicki Kerrigan, creator of this podcast, welcome to the Health Report. Tell us about the people who we just heard there. They are Elders but they are also people with really deep health sector experience.

Vicki Kerrigan: Absolutely, yes, thank you. The first person you heard was Aunty Bilawara Lee who says 'call me Aunty, otherwise it's disrespectful'. Aunty Bilawara Lee is a Larrakia Elder, she was one of the first Aboriginal women to be trained as a nurse a very long time ago, she is reviving Larrakia language, she's an educator, she's a traditional healer as well. And then you also heard from Rarrtjiwuy Melanie Herdman who is a Yolŋu leader. She has a background in health promotion and health research, her work spans the political sphere to supporting rangers on country. And Rarrtjiwuy is also a bilingual speaker, so there she is speaking her second language, English, her first language is Dhaŋu which is a dialect of Yolŋu Matha.

Tegan Taylor: I love the wording here, you've called it Ask the Specialist, which in a healthcare setting usually is referring to the doctors but you are really flipping the script. Is that intentional?

Vicki Kerrigan: Absolutely, yeah, it's definitely about flipping the power dynamics and saying that really if you are going to deliver patient-centred care, which is given a lot of lip-service in the health service, then the specialists are your patients, especially in the Northern Territory where, as you said at the start, the majority of people unfortunately who require health services are Aboriginal and that is a result of the ongoing impact of colonisation.

And so the specialists are Larrakia, Tiwi and Yolŋu people in this podcast and there is also an Aboriginal interpreter, Bernadette Nethercott, who speaks three languages and interprets them all. She is a Kriol speaker, her original dialect and language is Burarra, and she also speaks English. So there are a number of specialists in there and none of them wear a white coat.

Tegan Taylor: So you published your findings based…this is part of a broader research project, what are the findings that you're publishing and are they applicable to other settings?

Vicki Kerrigan: Absolutely applicable to other settings, in fact the feedback that we've received from the podcast in particular is there are people in the Northern Territory who work in the education sector and the justice sector who really actually quite like the model that the podcast was based on. So the podcast Ask the Specialist was obviously created in collaboration with Aboriginal leaders, but the twist on the podcast is that I suppose it's based on the questions of the people who are experiencing the problems themselves. People who are experiencing the problems are the health providers who haven't actually had the opportunity to get the kind of education they require, and it's not just about learning about other cultures, it's not just about learning about other Aboriginal peoples across the Northern Territory or across Australia, it's also about trying to get to the cultural biases and the institutional and individual biases that we have. So at the heart of this we are actually trying to get to racism, we are trying to get health providers to think and reflect on their own behaviour and their own attitudes and actually get to racism.

Tegan Taylor: So one of your collaborators is Alan Cass and he has actually done previous work on cultural barriers and has reported that it's not just between whitefellas and Aboriginal people but sometimes Aboriginal healthcare workers, they come from a different language background or cultural background. Is that something you've looked at?

Vicki Kerrigan: No, not specifically with my research, but yes, absolutely, Alan Cass, who is the director of the Menzies School of Health Research where I have just submitted my PhD today in fact…

Tegan Taylor: Good timing.

Vicki Kerrigan: Yep, the relief, amazing! Yes, there are a lot of people, including there's an amazing researcher called Stephanie Topp who has done a lot of research with people like Dr Sean Taylor who is from the Torres Strait Islands, on Aboriginal health professionals in the health sector. So we do know that both Aboriginal interpreters and Aboriginal health professionals often feel culturally unsafe within the health service, and so it can be a similar experience to what the patients experience as well, which is why for me as a white person it is up to us to work with Aboriginal peoples across the country and to change these white systems that continue to perpetuate the negative impacts of colonisation.

Tegan Taylor: Right, so it's cultural safety, it's not simply just awareness training.

Vicki Kerrigan: It's cultural safety, and for those who work in the health sector, I don't need to tell people who work in the health sector that that's a very different to awareness. Cultural safety is antiracism, that's what we are trying to get to here. So with cultural safety we want to change the institutions so they offer better services to those people who need the services.

Tegan Taylor: Thanks Vicki.

Vicki Kerrigan: Thank you.

Tegan Taylor: Vicki Kerrigan studies intercultural communication at the Menzies School of Health Research in Darwin.

And that's it from us at the Health Report this week, we'll catch you next time.