As the coronavirus pandemic threatened to erupt across Australia, Bulgarr Ngaru Medical Aboriginal Corporation acted swiftly, in community partnership, to keep Bundjalung Country safe on the NSW north coast.
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 #OurHealthOurWay series.
As the first wave of COVID-19 swept across Australia and health services stepped back from business as usual, the team at Bulgarr Ngaru Medical Aboriginal Corporation asked themselves a different question: how can we step in?
An Aboriginal Community Controlled Health Service on Bundjalung Country, Bulgarr Ngaru were acutely aware of the risks to the communities they service along the New South Wales North Coast, from Grafton through to Tweed Heads on the Queensland border.
Cases from cruise ships and intestate travellers were beginning to filter into the region, and the Service knew they had to get on the front foot, explains GP Hannah Visser.
“We made a list of patients we thought might be at risk and started providing welfare checks. An Aboriginal Health Worker or a nurse, sometimes a doctor would call them weekly to make sure they were OK,” she says.
“It wasn’t just medical, either,” adds Marnie Smith, who is the Quality Improvement Officer at Bulgarr Ngaru. “We’d make sure people had access to food and things like that.”
Like primary care providers across the country, Bulgarr Ngaru had to adapt its operations in response to the pandemic.
Outreach clinics – as much an opportunity for communities to get together to “sit and talk and drink tea” as they were for a visit to the GP – were cancelled due to social distancing, Visser says. Appointments continued at their main clinic in Casino, where it was possible to ensure adequate space for screening and separation of patients.
Practice teams were split into remote service and face to face groups to protect the staff, some of whom were vulnerable themselves to severe consequences of COVID, and to ensure that – in case of infection – the clinic could continue to run.
Telehealth had an important role, but Visser says it was closely tailored to community need.
“Most people didn’t have a computer or internet, so we just did phone consults,” she says.
“But also, because many people didn’t have credit on their phone, management arranged for a free number, so that patients could still call us.”
One community
Bulgarr Ngaru was approached early in the pandemic to provide a federally-funded respiratory clinic at its Casino practice, with a brief to focus on testing in the local Aboriginal communities.
“But Scott, our CEO, said, ‘We’ll be doing it for everybody, if we’re going to do it’,” explains Smith, who manages the clinic.
In the words of Visser: “Coronavirus doesn’t make a distinction between Aboriginal and non-Aboriginal people.”
“We may be an Aboriginal Medical Service, but in fact we are all one community.”
In such a dispersed and diverse geographical area, the Bulgarr Ngaru team also recognised that a drop in or drive through service was not going to reach everyone, or be accessible to some of those most in need, so they worked with the Local Health District (LHD) to establish and deploy a series of mobile testing clinics to remote communities in the Service and LHD catchment.
These mobile testing services were a true partnership, with Bulgarr Ngaru providing the GP and a nurse coming from the LHD. Collaboration and communication has been at the heart of the Service’s – and indeed the community’s – pandemic response.
“It’s been a learning process for everyone,” says Visser. “It was hard for all of us. Doctors, managers, community – we all had to learn quickly, to keep each other updated.”
The group quickly identified that the coming influenza vaccination season was going to be a critical piece of the public health puzzle in keeping their communities well and they made it a major focus as the pandemic took hold.
Smith shares their vaccine success story:
We’re very fortunate in Casino, we’ve got a big basketball stadium that joins the clinic. So we created a one-way flow in the basketball clinic and we had our little stations: registration, then onto a GP, next through to the nurses, then had a rest station.
We did it for five days initially, and it was invitation only. We identified high risk patients – pregnant, people with multiple chronic conditions and we called them and invited them in. And then we did it opportunistically, so if patients presented at the clinic, the GP might send them over for a flu vaccine.”
This setup meant the vaccination clinic was kept completely separate from the rest of the practice, including the respiratory clinic, and, as Visser says, ensured “we didn’t get the sick people who need to use the service mixing with people just coming for their flu vaccine.”
Outreach to remote communities was again recognised as crucial, and Bulgarr Ngaru partnered with the LHD to promote and provide one-day pop up flu clinics, staffed by a GP from the Service and LHD nurse.
Influenza immunisation rates were much higher than previous years across the catchment, underscoring the success of their approach, which was rooted in a deep understanding of and connection to community.
In spite of the many obstacles COVID-19 has offered, Bulgarr Ngaru has not only managed to protect its people from the virus, but continued caring for patients – perhaps not quite in the usual way, but with the same ethos and commitment as ever.
For Visser, it has been a powerful lesson in the value of collective action, and of coming together in unprecedented times for public health.
“It has really shown that working as a team in a crisis situation works really well,” she says.
“It’s the care that we are giving to each other. As staff working at the AMS, at the COVID clinic, at the flu clinics we all have the same goal, and we’re looking out for each other because we are all faced with it.”
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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