Trainee works to address frequent attendances in Mparntwe

Dr Sophie Collins has seen first-hand the ongoing effects of colonialism on the health of Aboriginal and Torres Strait Islander people during her placement at the Alice Springs Hospital Emergency Department.

A self-proclaimed “reformed city kid” from Sydney, Sophie is the first trainee to undertake ACEM’s Specialist Skills Placement (SSP) in Indigenous Health.

Sophie’s placement is with the ED Care Coordination Program and supports a local cohort of frequently attending Aboriginal patients.

Sunset at Ellery Creek, Arrernte Country.

Frequent presentations are typically a symptom of unmet needs, said Sophie, including chronic disease management, conflict, displacement and especially social determinants of health such as housing and food insecurity. “These are all the ongoing effects of colonialism.”

The patients, who come from remote communities in Mparntwe and surrounding areas, often speak up to six languages besides English, including Arrernte and Pitjantjatjara.

Sophie works closely with the ED Aboriginal Care Coordinator for the Alice Springs Hospital, proud Central Eastern Arrernte woman, Kim Gorey.

“I learn a lot from Kim,” said Sophie. “She provides that crucial cultural safety element for Aboriginal patients, and she’s an incredibly generous and knowledgeable person.”

Together, Sophie and Kim work with frequently presenting patients to get a comprehensive understanding of their needs, map the services available in and out of the hospital, then liaise with internal and external care providers to link patients with the care they need.

““Trying to build bridges between the western hospital system and the community-controlled health centre can be a challenge, but it’s ... vital to understand how those systems work together.””

The program aims to build strong links between the hospital and the Central Australian Aboriginal Congress, the Aboriginal community-controlled health organisation in Mparntwe.

“Trying to build bridges between the western hospital system and the community-controlled health centre can be a challenge,” said Sophie. “But it’s so important to work with and support Aboriginal community-controlled health organisations, and vital to understand how those systems work together – even at a simple level, like making sure the discharge summary goes to the right place.”

This job has furthered Sophie’s understanding of Aboriginal ways of being and knowing, and how they don’t always work easily within the limits of western medicine and emergency department systems.

“Aboriginal and Torres Strait Islander people have resilient and active culture,” Sophie said, “so we need to be thinking of ways to show respect to people, and ways of meeting their needs – and acknowledging that those needs might be different from our own. It’s important to be flexible, and to really have a mind to cultural safety when interacting with every patient.”

““Alice is an amazing place to work, and amazing country. There’s also a lot of medical need here, and the medicine can be really fascinating. You see things here that you won’t see outside remote areas of Australia.””

Sophie values the program’s emphasis on “slow medicine” and holistic care. Due to the small size of the cohort, she is able to spend hours at a time with patients, taking the time to get to know their background and stories. This can be difficult to do, she said, in typical emergency medicine spaces, due to demand and constantly shifting priorities, and it is vital when working with Aboriginal patients. “We get to build relationships, which is really special.”

Sophie also spent her internship year in Mparntwe. “It is an amazing place to work, and amazing country. There’s also a lot of medical need here, and the medicine can be really fascinating. You see things here that you won’t see outside remote areas of Australia.”

Alice Springs Hospital has received Commonwealth funding and Australasian College for Emergency Medicine (ACEM) support for this activity as part of the Australian Government Department of Health and Aged Care Specialist Training Program.