*** Aboriginal and Torres Strait Islander readers are advised this article mentions someone who has passed ***
Introduction by Croakey: The exciting work of a new community-controlled health commissioning body, which will operate across a vast area of northern Queensland and the Torres Strait, was highlighted at the recent Queensland Aboriginal and Islander Health Council (QAIHC) conference.
The fledgling Cape and Torres Health Commissioning Ltd (CaTHC) is an independent, not-for-profit organisation that will oversee health commissioning for Cape York, the Northern Peninsula, and the Torres Strait — a land and sea area the size of the United Kingdom, and home to 33 distinct communities and 27,000 people, 67 percent of whom identify as Aboriginal or Torres Strait Islander or both.
Backed by the Federal and Queensland Governments to date, CaTHC will progressively assume full responsibility for health commissioning in the region over the next decade, enabling place-based self-determination.
CaTHC deputy chairperson Flora Warrior, a Traditional Owner from Mabuiag Island in the Torres Strait and a respected community advocate and leader, told the QAIHC annual members’ conference last week about why she joined the CaTHC board.
In the article below, taken from her address, she shares three shocking stories of community members receiving poor healthcare, highlighting the need for local decision-making, equitable access, and culturally safe care.
Beneath her article, Marie McInerney reports more about CaTHC, with CEO Abbe Anderson describing the organisation’s 10-year vision.
Flora Warrior writes:
When I was asked to come and speak about the work of Cape and Torres Health Commissioning Ltd (CaTHC), I wondered ‘how am I going to talk about something as complex as this?’, all the way from Mabuiag Island in the Torres Strait.
I thought the only way I can do this is to speak from my heart and to share my stories with you, so that you can understand where I come from and how I found myself on this journey.
Often, when I speak to people, I talk about a lens, and how important it is to understand where another person is, what lens they are talking from. So today I’m hoping to offer you a glimpse of the lens that I’m trying to speak from.
I found myself being asked to come on board with CaTHC, not only to help keep this initiative alive, but to lend that very important voice from the outer islands of the Torres Strait, something which I’m very passionate about.
There are 15 outer island communities of the Torres Strait, very distinct, discrete communities. And we all look through different lenses. I don’t talk for people on Saibai Island or Poruma island, as they don’t speak for us. And I think that’s a very important philosophy to take into this community initiative.
Community triage
So story one that I want to share with you is about my own experience in primary healthcare delivery on Mabuiag.
A doctor visits from Thursday Island for half a day every two weeks – if we’re lucky and it’s not cancelled due to doctor shortage or weather or some other problem.
A couple of years back, I was waiting for the doctor to arrive. There were a lot of people lined up already from the community and other people came after me. After a while, we all realised there was not going to be enough time for the doctor to see everyone, and so you start doing the triaging yourselves – as community people, based on your values.
So you go, ‘Auntie, you go first, you’re a chronic patient’, and then the mother with the kids who is stressed out, and Uncle who hasn’t seen a doctor for a long number of years. And at the end of that doctor’s visit, we still had people left over that weren’t seen.
That’s how we roll in the community. You give up your place for those who are more priority than you and have a pressing condition. So I thought, ‘that’s all right, I’ll come next fortnight’. And I did, and the same thing happened, and then it happened again.
And then shortly after that, I got medevac-ed, first to Thursday Island and then to Cairns and into emergency surgery, because I ended up with a very serious issue that had not been attended to.
The only thing I could think of on the helicopter was ‘how much is this bloody medevac costing and wouldn’t it have made sense to put the money into primary healthcare in the first place, for the doctor to stay an additional night for more people to be seen?’.
No duty of care
Story number two is about one of our Elders. He is a very strong fisherman and a hunter, and it was the first time I ever saw him cry because he was in so much pain from a tooth abscess.
At the time we had the air strip closed on Mabuiag because we didn’t meet the CASA regulations. So this Elder set out to sea in a tinny in very rough weather, to go to the dentist on Thursday Island.
Normally our outer islands people are put forward first to be seen because they have come so far. But he was told to go home and come again tomorrow. This is an Elder, who was already in a lot of pain, and we prayed for him to come back safely across the sea.
He finally arrived back home at nine o’clock at night, after up to four hours in rough weather in an open boat, having been turned away at the counter with no duty of care.
We were so concerned that he would lose his life at sea, just to get seen for emergency dental care.
Harmful care
Story number three.
My mother is no longer with us but I have her permission to tell this story.
Some years back, when I was a carer for my mum, she was admitted to hospital in Cairns. After a while, the hospital was trying to discharge her without a diagnosis.
They told us they had done every test they could, but they couldn’t come up with anything. It got to the point where we had to protest at the hospital to keep our mother there. We thought she was the most vulnerable one in the ward and we questioned why it should be her who was sent home.
So, they said, ‘well, the only test we haven’t done is a biopsy’. The family authorised that, because if you’re frail and old, you need theatre time for a biopsy.
And so that was done on my mother, and we received a call straight away with the results, and what we found out shocked us. We had not been able to get one doctor to see Mum in the hospital for a while but when this happened there were suddenly six doctors around her who went straight into damage control.
What we found out was that Mum had a reaction to the tablets that she was taking, in particular to the statins. The ill health she was experiencing was the result of that medical intervention that turned into a toxin in her body and was killing her. We were told she had dementia, heart failure, lung failure, renal failure, and that she would go on renal dialysis.
This was really upsetting for everyone and I’m sharing this story today because I think it’s a very important story.
Because, later on, we were told it was a drug she probably didn’t need to take in the first place. And if she hadn’t needed to take that particular drug, then she didn’t need take some other drugs that she took because of that drug.
We were also shocked to find out that there were a lot of old people in our community who had had the same symptoms and who passed away without diagnosis.
I was asking myself, how many people are dying, without a diagnosis, possibly of the same thing, and why are we not talking about it? Why are we not talking about it in the community, when we can see and feel that something is wrong, when we know everyone intimately in our communities? Why haven’t we picked this up before? And how widespread is this issue?
We’ve lost a lot of Elders in our community – strong people – and, again, their families were told no one knew what they were dying of.
Reform needed
So I share those stories from my experience and from my lens, so you can see where I advocate from and why I advocate for reform. Because the health system just isn’t working, and that’s why I’m standing here today with you and why I’ve committed to come on the board of Cape and Torres Commissioning Ltd.
Why do I share these stories?
You can’t have serious reform without talking about pharmaceutical reform, without talking about infrastructure reform, without talking about service delivery reform. So that’s part and parcel of the structural reform that we need to have, and there is the opportunity through this vehicle of the Cape and Torres Commissioning Ltd for that reform to happen. This is one of those opportunities for that place-based self-determination to occur.
In closing, I hope that we can stand up as people and take ownership and agency and be able to look at ourselves in the mirror as well, because we have to be able to act with integrity and pull each other up if we’re not delivering a good service.
At the end of the day, there has to be accountability back to community.
Watch this interview with Flora Warrior
Marie McInerney writes:
It’s the sorts of stories that Flora Warrior shared about how the health system actually works on the ground that can make a difference in health service delivery and to closing the gap in health outcomes, Cape and Torres Health Commissioning Ltd CEO Abbe Anderson told Croakey at the conference.
“People here in Brisbane and in Canberra, as much as they are great people doing great jobs, they can’t possibly know how the local system works because they aren’t in it, and they therefore don’t have the answers to what solutions could be applied to best meet the needs that are there,” she said.
When it comes to partnering with local communities, currently governments still have primacy of decision making over what happens in terms of the healthcare system and health delivery in the region, said Anderson, who is non-Indigenous and has worked as CEO of the Brisbane North Primary Health Network and National Director of Commissioning at Te Whatu Ora | Health New Zealand.
CaTHC, an initiative led first by the Federal and Queensland Governments that is now community owned and controlled, will shift that primacy and “actually change fundamentally the trajectory of the health system and the health spend”, Anderson said.
“Our intent is to try to reduce the health problems that we know are happening that have been entrenched for a long time, a lot of which have to do with the fact that self-determination hasn’t been honoured,” she said.
“Our 10-year vision is that, if we do everything well, and the governments actually stay true to the course…the entire health budget for the Cape York, Northern Peninsula, and Torres Strait Islands will be given to (CaTHC) to make those local decisions about how to deliver health.”
That arrangement would enable the region to go “outside and past that usual argument that happens between the state and the Commonwealth about who should be funding what”, she said.
“We don’t need to argue about that anymore. We can fund where it makes most sense, and we can fund based on what communities say is most important to them,” she said.
“So if communities say actually investing in our kids and our grandkids is more important to us than investing in renal chairs, then that’s what we can do.”
Tailored approaches
Anderson said CaTHC, which was set up a year ago, recognises that what works in one place won’t necessarily work in another.
“It’s a very tailored approach to those 33 communities, getting in and finding out what the aspirations are in a way that is well informed, because we know we’re not going to have enough resources in the whole system to satisfy every need, much less every want,” she said.
It’s a much more sophisticated approach than just doing some low level engagement, saying, ‘What do you want? What’s not working?’, she said.
“It’s much deeper than that. It’s much more enduring than that, and it’s about building the capacity of communities to do this well.”
The change of government in Queensland late last year has cast some uncertainty over CaTHC, but Anderson welcomed a recent visit to Cairns by Health Minister Tim Nicholls, where he met with the board.
“I am a little concerned [about the State Government’s continuing commitment to funding NGOs] but this sector has gotten through tougher times than this so we’re continuing on with the good fight,” she said.
Anderson said CaTHC’s work is, first and foremost, for the people of the Cape, Northern Peninsula and Torres Strait, where Aboriginal and Torres Strait Islander people are the majority
“But secondly we’re doing it for all of the [community-controlled health] sector, because if we can do this well, and we can prove that that we are more than trustworthy in the handling of these monies, and that we can make improvements in the health system and in the outcomes for people, real improvements over time, then that will impact absolutely everybody,” she said.
“I’m involved in this because, quite frankly, I believe this is the most exciting thing happening in health in Australia or over the ditch in Aotearoa right now.”
• Dr Tess Ryan, a member of Croakey Health Media, provided a cultural safety review and edit of these articles.
Watch this interview with Abbe Anderson
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