I asked Laura for her perceptions of the failure of the health care system for aboriginal people. She said, "Too often it assumes and doesn't communicate or ask the patient anything. They don't ask if they understand. There is a huge divide between services. The assumption is that someone else is taking care of it and it falls back on the patient.
"I think the aboriginal medical services do an outstanding job but we don't have enough health services or health workers to meet the need, particularly outside of Perth. We still have a lot of services in Perth but people can't afford them. Few services advertise that you have no cost for your appointment or that you have a much smaller cost.
"In Perth we have one aboriginal medical service where people get a free medical appointment under the close the gap initiative. Any aboriginal person at risk for getting a chronic disease gets free medication. Private practice gp's can bill the government for aboriginal patients or not. It's up to them. Any patient can take their receipt from the doctor and get a rebate from Medicare. A lot of people don't have the money to pay up front for the appointment. A lot of elders will put them last and not have funds for their appointment or their medication or even their transportation.
"Renal dialysis is one of the saddest examples of that division. A lot of places have no public dialysis services. You can get a machine in your house that the government pays for. You have to have enough space to house the machine and keep it away from children, etc. You have to own your own home or be able to stay for a long time. A lot of people are in Perth just to get their dialysis treatment. 80% are in Perth because there's no dialysis at home or they're waiting for people to die so they can get their spot on the machine. Quite often we have patients who have absconded. We get calls about patients who are not turning up for dialysis. I'll find them staying in the park down from my office because there's not very much in the way of affordable accommodations. That's where they find other countrymen who care about them and look after them. Or they've been kicked out of hostels which care for aboriginal patients because drinking is forbidden and they've had a drink.
"We advocated for a lady getting dialysis for quite a while. They gave her a tablet. She stopped turning up for her dialysis appointments. The service alerted us. We found her. She thought she just needed to take the tablet now and no longer needed dialysis. She didn't understand that without a transplant she'd be on dialysis for the rest of her life. We don't really have accessible interpreting services for a lot of regions. Even in Perth there's a lot of ignorance that aboriginal persons speak languages other than English. Often they let a grandchild do the interpreting. A lady found out she had cancer in Perth. They got her granddaughter to interpret. By the time she found out what her options were, they weren't possible any more. The cancer had progressed too much. We've had quite a few cases in the past 18 months."
"What about mental health care?" I asked.
"One of the biggest things because we ask people what issues they have is the lack of counselors or accessible programs or culturally secure programs for aboriginals. It's a huge void. Namely, the commonest thing is a family member ringing the service for help for someone else. Service says it's unethical to help without the person coming into their office or the gp making a referral. Then the crisis is not managed and the call ends in suicide. Yet they consider acting and preventing a suicide unethical. I think for our population a family referral would be very valuable.
"When people do manage to access services, the family is very out of the loop. A lot of services say that would be unethical because that's a breach of confidentiality. I know that a lot of patients want their family to come to the appointments but the providers still say it's a breach of confidentiality. The person is living with the family and even if they don't want the family involved, the people who are living with them need to be involved. Sometimes the patient doesn't even understand English and the services are using an interpreter and still refusing to involve the family.
