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surgery
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telehealth
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Ahead of #VicVotes, community health advocates take to the streets with some powerful messages

Marie McInerney writes:

Community health advocates took to the streets in Melbourne last Friday, participating in a #CroakeyGo act of walking journalism that highlighted a diverse range of critical concerns in health, social policy and justice ahead of this weekend’s Victorian election.

More than 50 people from a range of professions and sectors helped make it the biggest #CroakeyGO event to date. It trended on Twitter nationally throughout the day (and trended again two days later), amplifying the impact beyond the streets of Collingwood and Fitzroy in inner city Melbourne.

The event was co-hosted and sponsored by leading Victorian community health service provider cohealth.

This was the first time a #CroakeyGO has been sponsored in what was for Croakey a welcome recognition of the importance of public interest journalism, and the need to find new ways for different sectors to come together, hear about problems and solutions, and seek to hold power to account.

The event finished with an extraordinary chance meeting at a Stolen Generations memorial in Fitzroy with Alfred (Uncle Boydie) Turner, grandson of legendary Aboriginal leader and activist William Cooper, and Abe Schwarz, who shared an invitation to join them in a march in Melbourne on 6 December.

The event will replicate the march that William Cooper, a Yorta Yorta Elder and Secretary of the Australian Aborigines’ League, led on the German Consulate in Melbourne on 6 December 1938, the only known private protest against the Nazi regime.

The serendipitous meeting was a timely reminder of how long struggles for justice can take, of the power of determined activism, and of the human rights leadership that Aboriginal and Torres Strait Islander people have provided on national and international stages.

Here’s a quick tour of the #CroakeyGO route, and related conversations.

VACCHO: A welcome and a warning

With its striking mural, the head office of the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) is an iconic Melbourne landmark (as seen in the #CroakeyGO flyer at the end of this article).

VACCHO Acting CEO Trevor Pearce, a Kamilaroi man from north-western New South Wales with strong ties to both the New South Wales and Victorian Aboriginal communities, kicked off the #Croakey Go with an Acknowledgement of Country, paying respects to the Wurundjeri people of the Kulin nations.

As is a #CroakeyGO tradition, we began with participants introducing themselves and sharing the health issues on their minds via three live broadcast interviews (each clip shares a short introduction before interviews with participants; watch them here, here, and here).

Staff from VACCHO were among those who joined us, outlining how much is at stake for the organisation and for Aboriginal and Torres Strait Islander people in Victoria in this state election. That includes the state’s treaty process, being guided by former VACCHO CEO Jill Gallagher, that the Liberal Party has pledged to halt if it wins government.

VACCHO’s key election asks also warn of the disproportionate impact on Aboriginal and Torres Strait Islander people in Victoria of the “law and order auction” driving justice policy in Victoria, and the need to address racism in health care settings as a big barrier to improved health and wellbeing for Indigenous people, as reported at Croakey.

VACCHO is calling on the Victorian Government for a review of exclusion and racism in mainstream tertiary health services to be led by an independent Aboriginal Health Commissioner, saying that racism too often presents a barrier to better health for Indigenous people.

Pearce said:

Our mob just don’t access services quickly enough or when they do access services they are four times more likely to discharge without medical advice.

We need to really address that as a sector and a society as a whole.”

It’s a concern that was also raised by Janine Mohamed, CEO of the Congress of Aboriginal Nurses and Midwives (CATSINaM) and chair of the National Health Leadership Forum (NHLF), which represents peak bodies in Aboriginal and Torres Strait Islander health.

Mohamed has three important keynote addresses coming up in the next week.

“The big take home issue (for each) is racism as a social determinant and how we can address racism particularly through the intervention of cultural safety,” she said.

Mapping issues of concern

The #CroakeyGO participants were a diverse group, coming from health, social policy, and education sectors, and from across the state, from Shepparton in the west to Gippsland in the east.

Health equity was an overall theme driving their interest, with many shared and intersecting concerns, particularly around access to services, homelessness and the justice system.

Other state election issues raised included:

  • the need to double to around 800,000 people the number of Victorians able to access public dental care  – Tony McBride, Victorian Oral Health Alliance (VOHA) (see also Labor’s announcement today on the return of free school dental care)
  • sustained action to address family violence in the wake of the Royal Commission into family violence – Nicole Lee, a survivor of family violence, disability advocate andindependent candidate for the State’s Upper House on Saturday
  • health equity and the “new world” of data and digital health – Dr Ruth de Souza, who works with the University of Melbourne, cohealth and CATSINaM
  • the focus in a stream of big political announcements on “mega roads” which will entrench car dependency in disadvantaged neighbourhoods: Dr Jerome Rachele, Research Fellow at the Centre for Health Equity, University of Melbourne
  • the hypocrisy of governments who declare their focus on health and mental health, yet rely on gambling fees for much of their revenues: Dr Tim Woodruff, Doctors Reform Society (who also questioned the need for the Labor promised Royal Commission on mental health, versus investing the money that is already needed).

Fron Jackson-Webb, deputy editor and senior health and medicine editor at The Conversation, said she was there to listen and learn about the key health issues that need to be presented to her readers (and Victorian voters) this week, ahead of the state election.

She said the “hollowing out of newsrooms” in Victoria has been evident in quieter mainstream media coverage of the issues this election.

cohealth: “I want to live in a community where….”

Cohealth headquarters was our next stop for an interview.

It’s another landmark location, the historic home of community health services in Victoria, but “a bit rickety” and in big need of investment by the State Government, according to CEO Lyn Morgain.

A block away is a public housing tower, one of a number in the area that have been home to waves of migrants and refugees and other communities needing safe, affordable housing – the traditional community serviced by cohealth.

Kim Ling Chua, one of the organisation’s local community advisors, told us that for many people, cohealth has become “a second home” over the years.

One big side wall of the cohealth building invites passers by to respond to the question “I want to live in a community where….”

As #CroakeyGO participants chalked in their thoughts, Morgain and cohealth colleague Aram Hosie talked about community health as “that intersection between providing services directly to people who need them and advocating for those systemic structural changes to things that cause ill health” – such as lack of access to housing, income and food.

Echoing earlier concerns about racism, Morgain highlighted the role of stigma and discrimination “both in creating ill health but also as a barrier to care” and of cohealth’s recognition that services have to strongly integrate the social context with clinical care.

“It is our contention that a failure to do that within the mainstream health system is what produces barriers to care and what ultimately means that people who are in some way marginalised have significantly poorer health status,” she said.

As previously reported, cohealth is also part of the #standwithcommunityhealth campaign launched by the Victorian Healthcare Association (VHA) in partnership with the state’s 29 community health services.

The campaign is focused on securing six key ‘asks’ to strengthen and expand community health services in the state in the leadup to the election.

Public health researcher Penelope Smith left a message for state politicians on the wall, after learning about the scrapping in 2010 of the promising Neighbourhood Renewal program in Victoria – a ‘place-based’ approach in areas like Collingwood to reducing inequalities across a range of social, educational and health outcomes.

“One of the questions I have for parties and politicians is ‘how can you think about the use of evidence when you make policy and how can you think about doing things better for communities because that was a program that worked’,” she said.

Neighbourhood Justice Centre

Along busy Wellington Street, at about the half way point of the walk, we came to the Neighbourhood Justice Centre (as pictured in the #CroakeyGO flyer below).

This is Australia’s first and only community justice centre that brings together a multi-jurisdictional court with a range of community services and initiatives designed to prevent and reduce crime, improve public safety, and increase local confidence in, and access to, the justice system.

It’s an innovative and evidence-informed response to complex issues, with a recent evaluation finding it has achieved significant improvements in at least two areas critical to the justice system: community order compliance and recidivism.

It provided a strong backdrop and sharp contrast for the concerns of many #CroakeyGO participants from across the health and social sectors about the “tough on crime” approach from both major parties in Victoria and some media outlets.

This has demonised the local Sudanese community and led to regressive justice policies, including mandatory sentencing.

Innerspace: a one stop shop for more complex needs

For many participants, a highlight of the event was being able to drop in to cohealth’s innovative drop-in primary care health service, Innerspace, and to hear from program manager Paul Hamilton, about the need for wrap around, flexible services for people who are often not welcome at traditional health services, or who find it difficult to engage with them.

He said most people who use the service bring a number of complex issues, including homelessness, mental ill health and a history of trauma, all of which impacts on their physical and mental health and capacity to make and keep health appointments.

Innerspace offers access to doctors, nurses, pharmacotherapy, needle exchange, allied health services, dental services, alcohol and other drug counselling, specific dual diagnosis services and a drop in space where people can have a shower, do their laundry, have something to eat, and get assistance with housing or other counselling needs.

But its funding is precarious. “It’s a year by year thing,” he said. “Services like this, you could spend triple the amount of funding and still not make a dent in [demand].”

Watch this video interview with Hamilton and with Yarra Drug and Health Forum executive officer Greg Denham about the long battle for a safe injecting room in the area.

A ‘town hall’ meeting on mental health

Australasian College for Emergency Medicine president Dr Simon Judkins had come from work at the Austin Hospital in Melbourne’s north-east in time to meet #CroakeyGO on the steps of the Fitzroy Town Hall, before heading to Perth for the ACEM annual conference this week (previewed here by Amy Coopes).

Dr Simon Judkins (L)

Judkins talked about many of the issues raised at the recent national summit convened by ACEM to address the failure of the health system to meet the needs of people who present to emergency departments needing urgent mental health care. (See Croakey’s coverage).

He said there is a need to improve specialist mental health skills and the physical environment of Emergency Departments, but the solutions lay also in having all parts of the system working better together and the need for more 24/7 community services.

He highlighted a recent story in The Age about the growing demand on Victoria’s crisis assessment and treatment teams for acute mental crisis which also meant that going to an Emergency Department is too often the “default option”.

Watch his interview with Croakey editor Dr Ruth Armstrong about this and other issues of concern.

Atherton Gardens: walking on

The final landmark on our walk connected us with an historic walk from the past.

At the Stolen Generations memorial, we met Uncle Boydie Turner, who will lead the Walking Together event on December 6 to mark 80 years since his grandfather William Cooper led a march on the German Consulate in Melbourne to protest the persecution of Jewish people.

Reflecting on the day, CATSINaM board member Joshua Pierce said the chance meeting with Turner was an inspiration, giving him hope that the fight to Close the Gap might also one day be won.

Uncle Boydie Turner and Abe Schwarz join the #CroakeyGo walkers

Watch this wrap-up video for reflections from other #CroakeyGO participants.

For Tony McBride, former chair of the Australian Health Care Reform Alliance, the route and services along the way underlined the complexity in the lives of people and communities – and why health services should not slice their responses into “six minute episodes”.

What stood out for cohealth’s Aram Hosie was that “community knows the solutions”. The challenge is to ensure government has “the same will and commitment that community does to fund those things, take them to scale, keep making sure they stay strong and grow”, he said.

Dr Tim Woodruff from the Doctors’ Reform Society was delighted to have seen people working at the frontline and their commitment for “the systemic change that is absolutely essential to make all of the good things we seen today to be generalised”.

He said Victoria’s community health system is “a beacon for Australia”.

What struck Dr Ruth Armstrong was that each stopping point along the route represented what would, at a macro level, be seen as “wicked problems” – the intersection between homelessness and mental health and drug and alcohol issues, the issue of poorly resourced communities and access to care.

“But everywhere we went we saw solutions and positivity,” she said, “and I think if only we could translate these micro solutions and these really functional services we’ve been seeing into macro policy, then we’d really be on a winner.”

That also of course raises issues for the many communities, particularly in growth suburbs and rural and regional Victoria, who don’t have access to services like those profiled during the #CroakeyGO.

• Bookmark this link to follow our ongoing reports from the #VicVotes #CroakeyGO. More to come!

 

 

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