The title of the project is long: Out­reach Kid­ney Trans­plant Yarn­ing Ses­sion for First Nations Peo­ple of Queens­land. The prin­ci­ple is plain and sim­ple, says Gary Tor­rens: appro­pri­ate communication. 

Gary, a Bund­jalung man, who has spe­cialised in renal dis­ease since he grad­u­at­ed in 1997 and worked in Aus­tralia and also in the UK for 12 years, is cur­rent­ly with the Queens­land Kid­ney Trans­plant Service. 

“I have been giv­en a lot of sup­port to focus on Abo­rig­i­nal and Tor­res Strait Islander peo­ple,” says Gary, who is pas­sion­ate about chal­leng­ing bar­ri­ers that are caus­ing the gap in sta­tis­tics that com­pare Indige­nous and non-Indige­nous dial­y­sis patients. 

“The amount of Abo­rig­i­nal and Tor­res Strait Island peo­ple who receive a trans­plant is very dis­pro­por­tion­ate,” he says. ​“It’s a very poor ratio com­pared with non-Indige­nous patients.

“Every­one has a right to ask for a trans­plant, and the project we under­took in Queens­land was aimed at reach­ing and inform­ing Abo­rig­i­nal and Tor­res Strait Islander peo­ple about the trans­plant pro­gram. Our aim was to empow­er patients with infor­ma­tion to help them under­stand the process so they can make choices.” 

Yarn­ing, a tra­di­tion­al way to receive and share infor­ma­tion, was the lynch­pin of the road­show Gary took to var­i­ous loca­tions through­out the state, fund­ed through the Nation­al Indige­nous Kid­ney Trans­plan­ta­tion Taskforce. 

“It was the first Indige­nous-led road­show of this kind,” says Gary, who said the team includ­ed a sur­geon, a dieti­cian and a num­ber of senior nurs­ing staff. The loca­tions vis­it­ed were Mount Isa, Townsville, Cher­bourg, Toowoom­ba, Woora­bin­da and Rock­hamp­ton. Unfor­tu­nate­ly, the Rock­hamp­ton ses­sion had to be post­poned due to a COVID-19 lockdown. 

Gary recog­nised the impor­tance of a more tac­tile, face-to-face approach after watch­ing the video links on ses­sions explain­ing about trans­plants, deliv­ered to peo­ple on dial­y­sis liv­ing out­side of Bris­bane. Very few were Abo­rig­i­nal or Tor­res Strait Islander people.

“There are many rea­sons for this,” says Gary. ​“They don’t like tech­nol­o­gy at times; they are fear­ful and shamed talk­ing to peo­ple down the video link; and in gen­er­al are scared to ask ques­tions and look foolish.”

This led to yarn­ing as the cho­sen approach.

“We sat down with the patients, break­ing down that hier­ar­chi­cal sys­tem that so often hap­pens in health sys­tems, intro­duc­ing our­selves by first name, shar­ing infor­ma­tion about our­selves and shar­ing healthy food,” Gary says.

“We made sure we invit­ed all the stake­hold­ers to the ses­sions, includ­ing Elders, hos­pi­tal health work­ers, non-gov­ern­ment organ­i­sa­tions, health units, as well as the patients and their families.”

The yarn­ing was also aimed at cut­ting through assump­tions and cul­tur­al bias­es, says Gary.

“Both patients and staff at cen­tres per­haps mak­ing assump­tions about a patient’s abil­i­ty to have a trans­plant,” explains Gary. ​“They may focus on oth­er health issues. 

“Our aim was to empow­er patients to ask ques­tions. ​‘Can I go on the trans­plant list?’ ​‘What can I do to get on the list?’ ​‘Why am I being denied access to the list?’ It is a real cul­tur­al learn­ing curve.” 

As part of the road­show, the team engaged cham­pi­ons in the com­mu­ni­ties who have had trans­plants to yarn with the dial­y­sis patients about the whole process, and also pre­sent­ed a tac­tile mod­el and a video to give more infor­ma­tion on how dial­y­sis and the trans­plant process work. 

The team also had the oppor­tu­ni­ty to con­duct a trans­plant assess­ment clin­ic, which usu­al­ly involves patients hav­ing to fly to Brisbane. 

Since the road­show, Gary has recog­nised that peo­ple are talk­ing to each oth­er and shar­ing information. 

The amount of refer­rals for trans­plant from patients in rur­al and remote com­mu­ni­ties has increased, as has the amount of patients who have received trans­plants, says Gary, who is look­ing to build on the road­show to vis­it more loca­tions in the future.