Introduction by Croakey: Residents in Sydney, the NSW Central Coast, Blue Mountains and Wollongong will spend at least two more weeks in lockdown as authorities grapple with high COVID-19 case numbers and, more worrying, high numbers of people out in the community while infectious.
Victoria is also on high alert, after 11 new cases today, mainly linked to a Sydney crew of removalists who worked in Melbourne and South Australia over the past week and a family that returned from Sydney.
The growing cluster now centred in Sydney’s south west raises major health and wellbeing concerns for people living in larger households, with chronic health issues and more precarious jobs and incomes, and the urgent need for tailored communications and supports that are led by community.
For the many Aboriginal and Torres Strait Islander people living in Sydney’s west and south-west, communities and services are now ramping up their support efforts, as Nicole MacKee reports below.
Nicole MacKee writes:
The extension of the Greater Sydney lockdown to contain the latest outbreak of COVID-19 is expected to put added strain on Aboriginal and Torres Strait Islander communities with implications for management of chronic health conditions, social isolation, and mental health, say community experts.
However, the outbreak is also expected to encourage increased vaccination rates among Aboriginal and Torres Strait Islander people, particularly with increasing access to the Pfizer vaccine.
A key concern for Professor Aunty Kerrie Doyle, Associate Dean, Indigenous Health, Western Sydney University, is the interruption of the care of chronic conditions for south-west Sydney’s 6,000-strong Aboriginal and Torres Strait Islander population.
“This halt in day-to-day health business will have huge impacts down the road,” said Doyle, a Winninninni woman.
While she said phone consultations were valuable, there were limitations to this care.
“You are less likely to go and do things that you need to do; like, do you need to have your blood taken for your diabetes? How’s your podiatry going?”, she told Croakey.
Aboriginal and Torres Strait Islander communities across Australia have been recognised for their success in COVID prevention, contracting far fewer infections than Indigenous people globally, and being six times less likely than the wider Australian population to contract the virus.
According to the latest June 2021 figures, collated before the Sydney outbreak, the number of COVID-19 cases in Aboriginal and Torres Strait Islander populations remained at 154, and there continued to be no associated deaths nor cases in remote communities reported.
But Aboriginal and Torres Strait Islander people suffer disproportionately from lockdowns, and community groups were this week ramping up their support efforts.
Dr Paul Saunders, a Biripi man, medical doctor and Research Fellow in Translational Health Research at Western Sydney University, said reduced access to care in a lockdown was an issue for the whole community, but its impact would be felt more acutely among Aboriginal and Torres Strait Islander people.
“Indigenous people have an over-representation of chronic illnesses, these are just exacerbated by this decreased access to health care,” he told Croakey.
Saunders is also concerned about the impact of the lockdown on Aboriginal and Torres Strait Islander youth, who may as a result feel disconnected from important community and cultural support networks.
“Elders in the community are vital to Aboriginal communities, so those Aboriginal young people who can’t necessarily physically contact Elders to have that cultural support is an issue, particularly given the barriers and the challenges that young Aboriginal people face,” he said.
“An example would be experiencing racism at school; a lot of the young children look to the Elders for that support, so not being able to go and have a yarn to one of the Elders can have a huge impact on a young person.”
Both Doyle and Saunders said social isolation would be a major challenge for the community in the coming weeks.
“We are a communal culture,” Saunders said. “We depend on not just our immediate household members but our extended community for support on various things, even just to meet up and have a yarn. So, for the Elders not being able to provide that support in person and having to do that over the phone can have a huge impact as well.”
Social isolation is a challenge familiar to Jessica Wellington, who lives in Penrith in Sydney’s west.
Wellington, a 28-year-old Wiradjuri woman, lives alone and has hypertension and diabetes. She is currently working from home as a full-time special education teacher.
“I don’t drive either so I can’t go anywhere, so I am literally stuck at home 24/7,” said Wellington, who is studying for her Master’s degree.
Wellington said she was concerned about accessing COVID-19 testing, should she need to be tested, and was also running low on diabetes medication.
Caring for community
Tharawal Aboriginal Medical Service, which covers the south-west Sydney region most impacted by the latest COVID-19 outbreak, is doing its best to protect community members from COVID while continuing to provide essential healthcare services.
Tharawal GP Dr Heather McKenzie said the service was providing a limited number of face-to-face consultations during the Sydney lockdown.
“We don’t want lot of people coming in and risking exposing other community members, but we are still seeing people if they need to be seen face to face,” she said.
“We are doing our best to run a ‘middle ground’; doing as much as we can over the phone and then when we need to, we are still bringing people in for preventive health care like routine childhood immunisations or cervical screening.”
Patients with new symptoms may be offered a telehealth consultation then, at the doctors’ discretion, may be able to attend for an appointment.
To further support Elders, Tharawal is providing hampers of essential items.
Sophia Malie, community dietitian/nutritionist at Tharawal, said the service distributed 50 hampers to Elders last week, and would send out another 60 this week.
“We are working on our second delivery now of basic pantry staples, plus a stock of fresh fruit and veggies, and things like toilet paper,” Malie said. “We are hoping our Elders can stay at home and not have to go out for anything whatsoever.”
Tharawal will partner with Reiby Juvenile Justice Centre to deliver to the community 80 hot meals per week in the coming days. Tharawal is also running online cooking and exercise classes, which Marlie said provided a crucial point of community connection.
“We notice that [participants] are just happy to see each other’s faces, hear each other laugh and know that everyone is doing okay,” she said.
Ken Zulumovski, founder and managing director of Gamarada Universal Indigenous Resources and honorary doctor of health sciences at the University of Sydney, said lockdowns increased stresses on families who were already under pressure.
He said single parents or grandparents who relied on the Aboriginal workforce in education or childcare may also feel additional burdens. He also expressed concern for those experiencing the financial consequences of a lockdown.
“Then there is also the compound grief that is already amongst First Nations communities that sensitises them to triggers and extra stress,” he said.
“Communities are functioning in the context of transgenerational trauma with high rates of [post-traumatic stress disorder], grief and loss due to family dislocation, high rates of imprisonment, and children removed by the system,” said Zulumovski, a Kabi Kabi man.
“COVID brings an environment where there is little reprieve from those pressures,” he said, noting that programs to provide mental health support were drastically underfunded.
He said Gamarada had co-designed a psychological support program with Gandangara Aboriginal Health clinic in Liverpool, to deliver mental health programs one day a week, but it was booked out three months in advance.
Zulumovski is now turning to volunteers to help deliver Gamarada’s community healing program online. The program, which is usually delivered weekly, will be available daily during lockdown (see details here).
“We are trying to be innovative and responsive, not waiting for government to fund, we have responded by delivering the program with volunteers,” he said.
Saunders said the “big issue” in protecting Aboriginal and Torres Strait Islander communities was access to vaccination.
“Even though the blood clots are [a rare side effect], there is still this issue with the Astra Zeneca vaccine, so increased access to Pfizer vaccines is important, not just because I am Indigenous, but I am part of a vulnerable population and really should be prioritised in my opinion,” Saunders said.
McKenzie said Tharawal started the rollout of the Astra Zeneca vaccine in March, and this attracted a core group of Elders – about 50 per cent – who were keen to be vaccinated.
However, she said, the interest soon dwindled. Some community members were opposed to being vaccinated at all, while others remained uncertain about the risks and benefits.
McKenzie has recently held two “clinical yarning sessions” to answer patients’ questions about vaccination, and Tharawal also commenced rollout of the Pfizer vaccine last week.
The first Pfizer vaccination clinic delivered more than 200 doses in two days, and a second clinic will be announced on Facebook later this month. Tharawal then plans to hold Pfizer vaccination clinics weekly.
“Initially, we are prioritising regular Tharawal patients, but that might change when we have done our first doses,” McKenzie said.
“There is a lot of interest…I feel like the tables have turned with the Pfizer vaccine and this current outbreak; some people who have been quite hesitant have gone on to get the vaccine, so it’s good for the vaccine rollout.”
While Jessica Wellington was initially hesitant about vaccination, the latest outbreak has prompted her to investigate her options.
“With my heart condition, I just wasn’t sure about the blood clots [associated with Astra Zeneca], but I have now booked an appointment with my cardiologist as well to just double check that Pfizer is the right way to go,” she said.
McKenzie said there was a need for greater communication on when a COVID test was necessary. She said many people she treated didn’t realise that a new test was required every time they experienced new COVID-like symptoms.
“Some people think, ‘I had a test about a month ago, so I don’t need one now’,” she said.
McKenzie said Tharawal did not have testing facilities and the closest testing site was a drive-through clinic at Leumeah, seven kilometres away.
“There is an access issue for people who don’t have access to a motor vehicle,” McKenzie said. “I have asked a few patients to have a test, and they have said they can’t get a test because they don’t have a car.”
Doyle also noted that that public transport was lacking in south-west Sydney.
“There is drive through testing up at Plough Inn Road [in Leumeah], and the other ones are at the hospital and the rest are spread through Narellan and Camden, so they are difficult to get to,” she said.
Access to testing was a concern to Wellington. She said mobile testing clincis would be helpful for people like her who didn’t have access to a car, and also for the elderly.
“That would be ideal because if you are not in walking distance to a testing centre that you don’t have to drive through, then it is challenging.”
Police presence concerns
Aunty Kerrie Doyle joined critics this week of the increased police presence deployed in south-west Sydney, described by Greens Senator Mehreen Faruqi as a ‘double standard’, given they were not sent in to higher socio-economic outbreak areas like Bondi or Avalon.
Doyle said the threat of mounted police patrolling the area was particularly concerning.
“The relationship the police have had with the Aboriginal community is part of the long echo of colonisation,” she told Croakey.
“Those mounted police are scary. My family wouldn’t go out if they were around. Even if you don’t look Aboriginal, members of your family will, and you will be targeted.”
Doyle said people may ask why people are out on the streets during a COVID lockdown, and she said it often came down to the social determinants of health.
“They may be on the street to wait for the really cheap meat in Coles,” she said, noting that people living on the aged pension may have to make choices about whether to buy medicine or food.
Doyle said the fact that there had been such low rates of COVID among Aboriginal and Torres Strait Islander people was testament to the fact that “we can look after our community”.
“When you look on our Facebook page for Tharawal, you can see there is this real leadership in our communities,” she said.
Saunders agreed, saying money spent on additional policing could be much better spent in providing additional resources to community organisations to provide essential support services, and to increase JobSeeker support. The Australian Council of Social Service has raised concerns that the Federal Government’s lockdown support measures has to date excluded those on the lowest incomes.
“The more power that you give to the community to be able to create an effective community response, the better they can do things,” he said.
“It’s that autonomy and that determination to be able to say ‘right, it’s in our community, we are the ones that best know how to protect our community’.”
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