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Helping people become 'health seekers'

2 Dec 2021

Lesley Salem became Australia’s first Indigenous Nurse Practitioner 19 years ago. Now, she works in Doomadgee in Far North Western Queensland where the 2017-founded primary health care service is encouraging people to become active ‘health seekers’. But self-determination doesn’t happen overnight and Salem views her life’s work as just the beginning.

I always want­ed to help a com­mu­ni­ty that was in need,” says Les­ley. The health sta­tis­tics here [in Doomadgee], where life expectan­cy is 49, are some of the worst in the world. Rheumat­ic heart dis­ease is rife, a con­di­tion that’s rare in most high-income coun­tries, yet in Aus­tralia it per­sists in Abo­rig­i­nal and Tor­res Strait Islander peo­ples. It is pre­ventable. Hun­dreds in this com­mu­ni­ty have dia­betes and malnutrition.”

Les­ley has been work­ing for four years with Gidgee Heal­ing after being sought out by the Abo­rig­i­nal health­care provider when it opened Doomadgee’s first ever pri­ma­ry health care ser­vice in 2017.

Until then, the com­mu­ni­ty of around 1400 had one tiny hos­pi­tal with a cou­ple of rooms for emer­gen­cies where you only went if you were sick,” says Les­ley. Today, Les­ley sees her role as help­ing locals embrace pre­ven­tion and become health seek­ers.’ And she says it’s work­ing.

Engage­ment with peo­ple in the com­mu­ni­ty is won­der­ful,” says Les­ley. We are suc­ceed­ing in encour­ag­ing peo­ple to enrol with us.

We can then iden­ti­fy their chron­ic dis­eases – we find adults have at least three – and put man­age­ment plans in place. We encour­age reg­u­lar health checks – not wait for some­thing to go wrong.”

Rheumat­ic heart dis­ease, caused by repeat­ed infec­tions such as impeti­go, skin sores and scratchy throats, should not be here, says Les­ley. She has seen patients as young as sev­en with the disease.

It used to be that peo­ple were so infect­ed, the com­mon sit­u­a­tion was the need for antibi­ot­ic injec­tions,” says Les­ley. That’s chang­ing with more knowl­edge in the com­mu­ni­ty. Now, even young chil­dren at school rock up when they have one sore that needs a band-aid.”

Peo­ple becom­ing health seek­ers’ rep­re­sents a mas­sive change from the ori­gins of the com­mu­ni­ty, says Les­ley. Doomadgee began as a mis­sion in the 1930s, when girls and boys, mem­bers of the Stolen Gen­er­a­tion, lived in sep­a­rate dor­mi­to­ries and were used as labour on neigh­bour­ing pas­toral sta­tions. The mis­sion final­ly left in the 1980s.

Lesley’s grand­moth­er, a Gringai woman, left the area she was raised in when her dad was a young boy.

She want­ed him to have an edu­ca­tion and Les­ley remem­bers sto­ries of her nan, sib­lings and par­ents liv­ing in a two-room shack on the Karu­ah River.

Self-deter­mi­na­tion is a won­der­ful con­cept, but log­i­cal­ly, this can’t be done overnight. We need to be trained and be capa­ble of being inde­pen­dent and to suc­ceed,” says Lesley.

Les­ley point­ed out that, apart from the short his­to­ry of med­ical sup­port in the com­mu­ni­ty, there are added hur­dles of pover­ty in the area where only 30 per cent of peo­ple have a fridge, many have poor lit­er­a­cy skills, and the lack of phones and com­put­ers make it dif­fi­cult to access services.

Les­ley believes edu­ca­tion is the key, a con­cept drummed into her since she was a child by her dad (Les Elvin), an emi­nent Indige­nous artist, who con­sid­ered edu­ca­tion was the way to pro­tect cul­ture and people.

Les­ley grew up in Cess­nock in the Hunter Val­ley on Won­narua Coun­try. She grew up with high-achiev­ing rel­a­tives who were deter­mined to make a difference.

In my mind the solu­tion is edu­ca­tion, get­ting the kids into school,” says Les­ley. When you have good edu­ca­tion, you make bet­ter health choices.

There’s only 45 per cent atten­dance in Doomadgee at the moment but there are some good peo­ple in the com­mu­ni­ty and good pro­grams being pro­mot­ed, such as an after hours school, and hold­ing school ses­sions down by the river.”

Les­ley also strong­ly believes that health pro­mo­tion pro­grams need to focus on today. Look­ing to the future is fine if you have a future to look for­ward to,” she says.

For many of these peo­ple, they don’t see much future; they’re inter­est­ed in today. So our health pro­grammes have to focus on the ben­e­fits today – let­ting them know you’ll be able to walk down to the riv­er with­out get­ting breath­less’ for exam­ple, and you’ll be able to bait your own fish­ing hooks’.”

Les­ley says she fell into nurs­ing’ when she left high school at the end of the 1970s. Before the intro­duc­tion of Nurse Prac­ti­tion­ers (NP) – Reg­is­tered Nurs­es who have com­plet­ed addi­tion­al uni­ver­si­ty study at Master’s degree lev­el and the most senior and inde­pen­dent clin­i­cal nurs­es in our health care sys­tem – Les­ley was work­ing at advanced lev­els, par­tic­u­lar­ly when she was in rur­al hos­pi­tals. She took advan­tage of all oppor­tu­ni­ties for advanced train­ing on offer to become the country’s first Indige­nous NP and the 13th overall.

I’ve loved every job I’ve had, and I love my work here – but it’s not all a bed of ros­es,” says Les­ley. I get despon­dent about the lack of resources and feel frus­trat­ed when I can’t do all the things we need to do.

I’m head­ing for 61. I look to the future with hope for this com­mu­ni­ty. But I have to accept that I will be retired before full ben­e­fits are evident.”

Read about Nurse Prac­ti­tion­ers Lyn Byers and Stephen Far­ring­ton.