Flexibility, practical advice and the power of a yarn are the keys to a quit project that is helping Aboriginal communities give up and stay off the smokes in Central West NSW.
This article is published by Croakey Professional Services as sponsored content. It was created in collaboration with the Aboriginal Health and Medical Research Council (AH&MRC) of NSW, which funded the #NRT4Community and #OurHealthOurWay series.
Coonamble is six hours away from Sydney, two hours from Dubbo, on Wailwan country.
A sheep, wheat and rodeo town at the foot of the spectacular and sacred Warrumbungle Ranges in central western NSW, 30 percent of Coonamble’s population are Aboriginal or Torres Strait Islander.
Smoking is a fact of life for many in the town, but it’s a tide that’s slowly turning under the watchful eye of Steven Smith, better known to clients of the Coonamble Aboriginal Health Service as JJ.
JJ (pictured second from R in the feature image above) is Coonamble born and raised, and has worked for ten years now in the Aboriginal Health Service’s smoking cessation program. He has a quit rate most mainstream initiatives could only dream of: 43 percent of his clients give up smoking in the first year of the program.
There are many factors in his success, but the foundation is a deep connection to and understanding of the community and the lived experience of those who come to see him.
JJ’s instinct is to meet people, and sit and chat with them, get to know them. The orthodox approach to smoking cessation typically involves referral to a telephone counselling service such as Quitline, and a prescription for nicotine replacement therapy, and these are important elements of the Coonamble program, but JJ understands the value of a one-on-one conversation.
“They get more out of working face to face,” he says of his clients.
As the Service’s Aboriginal Health Worker, JJ collaborates closely with the doctors, many of whom are locums although the town recently recruited a GP to stay for three years – a considerable period in Coonamble terms.
JJ offers invaluable continuity in an ever-changing roster of clinicians, and people will open up to him, not just about smoking, but about other things too, including other drug and alcohol problems, Hepatitis C and getting appointments at the health service.
Sometimes that first quit conversation will be initiated by the GP, who “might provide a prescription and refer them on to me,” JJ explains. But more often than not, he says it’s a case of “people approach me in the supermarket, and ask if they can join the program. They are more likely to quit”.
In a place where “everybody knows everybody”, word of mouth is critical.
“We don’t knock anyone back,” JJ adds, “I don’t say ‘Oh, I don’t work weekends.’”
JJ celebrates every small win with his clients, understanding how significant the challenges can be, and the value of making incremental progress.
“I’ve never smoked,” he says. “My first clients were my mother-in-law, my father-in-law and my wife.”
“Even if they are cutting back from ten to three, you must be doing something right. Even if you get one out of every five, even if you only get ten people to quit, it’s a bonus.”
Practical advice, flexible approach
Counselling is a central part of what he does, and JJ’s approach is both supportive and pragmatic.
He provides detailed, practical advice on how to use a variety of nicotine replacement products, and what to expect with different kinds of patches, inhalators and oral preparations. This covers everything from rashes, strange dreams, weight gain and other side effects, to ways they can space out treatments to make them last.
“They can get Nicotine Replacement Therapy from the chemist,” he says, “but not everyone can read how to use it on the box.”
Flexibility is also important in JJ’s 12-week program. He says some will quit well before the 12-week mark and want to keep coming; others need support well beyond this deadline.
He can see the effects almost immediately when people do manage to quit. “People feel different, you can tell. They are talking more, smiling, the whole person feels better. Some people feel bad because they get their tastebuds back, they start eating out of their fridge and put weight on.”
JJ knows the journey is far from straightforward, and many people will have slip-ups, particularly in times of stress, trauma and grief: “When my father-in-law died my wife took up smoking again.”
“When a tragedy occurs, I will leave the door open for people to come and chat,” JJ says. “Sitting down, having a yarn relieves the stress while quitting.”
Though some people have opted to have the program delivered to them at home so they don’t have to come into the health service, JJ says the coronavirus pandemic has – fortunately – had little direct impact on his work.
Indirectly, however, he has seen the strain the COVID-19 outbreak and economic impacts are having on people, and on the cost of smoking.
“People are going to find it hard to get cigarettes as prices are rising. People are already doing it hard,” he says.
The external funding for Coonamble’s smoking cessation program was withdrawn in 2014, but the Service has paid to keep it going, recognising how successful and essential the work is.
For JJ’s part, his aspirations are simple:
“Keep going!” he laughs. “I don’t mind doing anything that I can do to help my people.”
This article was written by Tim Senior and edited by Amy Coopes, on behalf of Croakey Professional Services. It was sponsored by the Aboriginal Health and Medical Research Council (AH&MRC) of NSW to share strengths and successes of Aboriginal Community Controlled Health Organisations in NSW.
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