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‘Bridging the gap’: community health a pandemic lifeline

Introduction by Croakey: With uniformed military personnel rolling in to support Sydney’s COVID-19 lockdown as the city continues posting triple-digit daily case numbers, there have been renewed calls for a deeper engagement with and empowerment of community groups instead of punitive enforcement approaches.

In a joint statement issued Tuesday, groups including the Australian and New South Wales Councils of Social Service, the Asylum Seeker Resource Centre and Settlement Council of Australia called for a refocusing of the NSW outbreak response to support locally-led approaches instead of rolling out troops and a heavy police presence in south-west Sydney.

Noting that many of the region’s residents were from culturally and linguistically diverse backgrounds, including a not-insignificant number of refugees who had survived conflict, Violet Roumeliotis, board director at ACOSS and CEO of Settlement Services International said the pandemic had “considerably exasperated these pre-existing stressors for some community members, and the image of troops patrolling their streets might re-trigger past trauma.”

Settlement Council of Australia CEO Sandra Wright said authorities should be “doing everything we can to mobilise the community sector before bringing in a military presence”:

Our members are specialists in working with migrant and refugee communities, ensuring they understand the health messages, keeping them safe, and encouraging vaccination.

Early in the Sydney lockdown we were able to mobilise 22 of our members in Sydney within a week to support compliance with public health messages and keep communities safe, with financial support from the government. But they have been limited in how much they can achieve due to the limited funds. We could be doing much more.

Only when we’ve exhausted what can be done at a community services level should we bring in the military.”

Kon Karapanagiotidis, director of the ASRC, said deployment of the military was “heavy-handed and counterproductive” and betrayed a “deep and profound lack of understanding and consultation” with the thousands of asylum seekers and refugees living in south-west Sydney who had fled military persecution.

“We need multilingual information hotlines, accessible platforms to book vaccinations and a culturally inclusive community-led approach,” he said.

NCOSS chief Joanna Quilty said the the lockdown was exacerbating existing inequalities across Greater Sydney and “the solutions are communication, income support and vaccinations”, not punitive compliance. (You can read an excellent piece from Daniel Reeders on this issue here)

Concluded Cassandra Goldie from ACOSS:

Instead of fear and division, people need information that they trust and financial support that enables them to stay safely at home and put food on the table.

The Federal Government’s lockdown support excludes those on the lowest incomes – people who had fewer than eight hours paid work have been excluded, despite everyone in lockdown being restricted from finding paid work.

Adequate support and a community-led approach must be the priorities, not harsh enforcement.”

In this timely piece for Croakey, cohealth’s Shola Adedoyin reflects on her experiences as a senior community health nurse working in Melbourne’s public housing towers, which were subject to a harsh and heavily-criticised snap lockdown later found to be a breach of human rights, during last year’s Victorian second wave.


Shola Adedoyin writes:

As a Senior Community Health Nurse at the Flemington public housing tower on Racecourse road, I’m in charge of everything health-related on site to support around 1500 residents who live in the 850 apartments. Before this I worked in private mental health, both general and aged care.

I love working in mental health, I’ve got a great interest in knowing how the mind works, but I love working within a community as well. And an understanding of mental health is integral to working with community.

I came to Australia in 2006 from the western part of Nigeria with my two children and ex-husband, and now I have three children.

I started with cohealth in December last year, working in the outbreak prevention team and at cohealth’s testing clinics.

The outbreak prevention and management team works with people living in over 800 rooming houses, backpacker hostels, supported accommodation facilities, community housing and public housing providers in Melbourne, which are considered high-risk because of things like multiple shared spaces, poor ventilation and narrow exits.

The team conduct in-depth audits to assess potential risks in the event of an outbreak and make recommendations on how to make these places more COVID-safe for residents.

The Flemington public housing tower was one of these sites, and I started being based there from April 2021.

Flemington tower, photographed during the 2020 lockdown. Source: Twitter/Samantha Dick

A deeper understanding

The role of the community health clinics in the high-rises is to help with the prevention and spread of COVID-19 transmission  by improving our preparedness and developing outbreak management plans for the residents and workers.

We work with the community to gain a deeper understanding of their health, wellbeing and social needs.

Firstly, we do this by navigating different community resources for the residents and providing them with the latest COVID information, like updates on restrictions, vaccine information, testing clinics, our GP clinic and other health related information which is appropriate for different age groups within the estate.

We are also conscious of the diversity amongst residents, so we ensure that all resources are translated into the language which is easiest for them to understand. These are provided by our community engagement team who collect information, data and the latest advice, quickly translating it into different languages and sending it to Community Health Nurses like myself who are based across a number of estates.

I work closely with the Health Concierges who take care of distributing this information to residents.

During the hard lockdown last year, cohealth employed high rise estate residents from a huge diversity of cultural backgrounds to share vital health information with their community. It’s a brilliant relationship because Health Concierges receive training and experience, and in turn they bring their expertise on cultural approaches to health and those invaluable trusted relationships.

At my clinic we provide direct clinical care to residents, like helping with regular blood pressure and blood sugar level checks, wound dressing and basic first aid needs.

Two months ago, a resident from one of the buildings came in for a blood pressure check, and while he was being assessed we discovered he was having an active heart attack, so we called an ambulance and he was transferred to the hospital.

Home visits are also another service we provide if the residents are dependent or elderly.

We run health promotion weeks in all the high-rise clinics on different topics, like exercise, breast cancer awareness, men’s health, women’s health and heart disease.  We source information, get it printed and distributed to all sites, then run education sessions for the Community Service Officers (CSOs) and Health Concierges.

The Health Concierges, in turn, help to pass the message on to residents. We’re aware that Health Concierges don’t have the clinical skills to answer or address some of the questions they’re asked by residents during the promotion, and so they direct the residents back to the clinic where they can speak with someone like me.

The CSOs and Health Concierges are the link between myself as the nurse and the residents. The CSOs help with the daily running of the clinics, collecting and updating any information or resources which can help residents. They work directly with myself  and the Health Concierges to make sure day-to-day activities run smoothly.

The Health Concierge’s role includes checking in with residents to work out their needs or requests, which can also be non-health related, like maintenance issues, requests about government grants and how they access them, and ongoing construction works in and around the estates. Residents have really benefited from this.

Federal Labor MP Bill Shorten pictured with tower residents celebrating an end to the outbreak, in October 2020. Source: Twitter/Bill Shorten

Bridging the gap

I think having the health clinics on site has made a lot of difference to residents by bridging the gap between them and the Department of Health.

For many residents, the hard lockdown at the high rises was traumatising and challenging, but now there’s a clinic onsite, they know they’re getting first-hand information.

The clinic is also a place to find out about the vaccines, where to get tested, any sudden changes that might happen, and interpreters are always available to residents who don’t speak or understand English.

Macca Halal Foods delivering care packages to locked down tower residents in 2020. Source: Twitter/Bill Shorten

The pop-up testing clinics have also been a huge success; residents know they can come to us for a COVID test without the hassle of waiting in a long queue. We support any residents who are isolating by doing food drops or helping with grocery shopping, laundry and care packs.

Roving testing is also another service  we offer; for those who are immobile or isolating after being at Tier 1 exposure sites, they can be tested in their homes by nurses.

The vaccination pop-up clinics onsite were also a positive move in terms of bridging the gap.

Bringing the vaccines to the residents regardless of eligibility was a bold move from cohealth and the Department. Both Pfizer and AstraZeneca are being provided, along with information and resources on their possible side-effects.  We help to improve accessibility of the vaccine for older people by providing taxi vouchers  to get to and from clinics.  The clinic’s number is given out to all vaccinated residents if they have any questions after their injection, and we get a lot of calls from people experiencing different side effects.

Our pop-up vaccination clinics at Flemington closed last week and will return in August, mainly for second doses. The first time we had the vaccination pop-up clinic around Ramadan in April for 6 weeks, we were administering only AstraZeneca, and very few residents came to get it. There were a whole lot of questions about the efficacy and side effects. Our second popup vaccination clinic has Pfizer available, but some residents are still hesitant to get the vaccine, just like many people in Australia are.

We used a range of engagement tactics to encourage people including Zoom sessions; information nights with cohealth GPs and community members that had been vaccinated; coffee carts with free coffee and drinks; and promotional posters in relevant languages.

There’s lots of misinformation circulating on media and social media, especially about side effects and specifically blood clots – people are very unsure of who and what to believe, with those in power continuously clashing with conflicting messages.

I think some people are watching and waiting to see what is going to happen with those that have had the vaccine. People are worried: for a lot of residents it’s religion, and for others it’s because they’ve got pre-e