Injury, Int. J. Care Injured (2008) 39S5, S73–S75
www.elsevier.com/locate/injury
The building blocks of a professional response to Indigenous injury Kelvin Konga, *, Russell L. Gruenb a
John Hunter Hospital, Newcastle, New South Wales; b University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia KEYWORDS Indigenous; Injury; Surgeons
On November 22nd, 2007 the Royal Australasian College of Surgeons convened a symposium entitled Injury in Indigenous Populations Towards a Safer Future. It brought together people committed to improving the well-being of Indigenous people through lessening the impact of injury. Indigenous and non-Indigenous health professionals from Australia, New Zealand, North America and the Pacific Islands, along with health policy experts, injury researchers and representatives of professional bodies, met to define the magnitude of injury-related morbidity and mortality, to share and reflect upon experiences of past programs and policies, and to consider effective strategies for the future. Many different perspectives on the common problem of Indigenous injury were voiced. There was broad agreement that Indigenous injury concerns are complex, and that interpersonal violence and even road trauma are intertwined with social, circumstantial, cultural and historical factors. We heard of the need to challenge views that violence, in particular, is ‘normal’ and unavoidable. Approaches are needed that include, but also go beyond, the traditional domains of health care. High-quality surgical care, often provided by dedicated individuals, is necessary, but on its own, it is insufficient. An overarching approach to * Corresponding author. Mr Kelvin Kong. Suite 1.6, NPH Medical Suites, Lookout Road, New Lambton Heights, NSW, 2305, Australia. E-mail:
[email protected] (K. Kong). 0020-1383/$
Indigenous surgical care requires focus on good governance and policy and a broader conception of the role of professionals. The successes underpinning a national reduction in road trauma mortality clearly demonstrate that lessening the impact of indigenous injury requires a multisectoral approach, which profession groups are ideally placed to promote (see Box 1). The proposed agenda for a professional response to reducing Indigenous injury highlights the importance of collaboration and the need to strengthen community, government and professional partnerships. It also stresses the need for more Indigenous people in health-related professions. From the perspective of a professional college, an improved approach to address health problems, patients, their families and communities requires focus on policy and service provision, and on quality data to inform both. We heard of the need to fill in the gaps in national, state and local Indigenous health policy; in particular, the need to be more specific in the detail about problems, actions, goals and targets, and to better use data to drive this policy agenda. Service provision would benefit from guideline development to promote best-practice Indigenous health care, with emphasis on communication, family, cultural, and system factors. Given the problems many Indigenous people have accessing services, specific accessibility targets could help to promote timely care. Maximising participation of Indigenous people in the workforce (both at a
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K. Kong, R.L. Gruen Box 1: A proposed agenda for a professional response to injury-related concerns in Indigenous populations
(1) Strengthen relevant traditional professional responsibilities (a) Ensure high standards of surgical care for injured patients through training and quality assurance (b) Maintain adequate workforce in areas where Indigenous people live (c) Ensure timely access to necessary professional services (2) Enhance the relevance of current activities to Indigenous people (a) Clinical training increase trainees’ exposure to Indigenous patients and their concerns (b) Workforce diversity (i) Encourage development of an Indigenous workforce (c) Trauma System improvement (i) Tailor systems to the needs of Indigenous people and communities (ii) Tailor training courses especially to the needs of rural/remote areas (d) Research (i) Targeted scholarships for research related to Indigenous injury (ii) Support and mentoring from experienced researchers (3) Develop internal professional goals (a) Foster understanding of and positive attitudes to Indigenous health among trainees and fellows (b) Encourage commitment to provision of service to needy groups and to addressing disadvantage (c) Fostering individuals’ knowledge, skills and attitudes to be involved in community and health service processes and as individual advocates (d) Support formal Indigenous groups within the profession and the development of a policy on Indigenous Health (e) Make Indigenous injury a regular agenda item for trauma and Indigenous health committees (4) Promote collaboration Build on existing relationships and seek new relationships with all stakeholders in Indigenous health, including communities and Indigenous groups, Government and non-government organisations, researchers, etc. (b) Provide deliberative forums for problem solving (c) Be willing to learn from others, including overseas experiences (d) Ensure relevant and high quality data is collected and available, and ensure that research about what works and what doesn’t is widely accessible (5) Advocacy (a) Be a responsible, dispassionate and authoritative voice in public debate on Indigenous injuryrelated issues (b) Address indigenous injury and its causal factors (c) Learn from previous successful and unsuccessful advocacy activities
policy level and at a grassroots level in primary health-care centres and clinics), too, improves access. A key theme throughout the symposium was the need for collaboration between professional colleges and other groups, including those with particular expertise in injury prevention or service delivery. For other groups, professional colleges have vital roles in providing professional expertise and guidance. Data collection, availability and quality underpins improvement in many areas of Indigenous health. Professional colleges would benefit from formal links with injury researchers and systems of
health surveillance that generate data on which important decisions can be based, and seek to improve the quality of data. Generation of new data through research is another important professional role. It is important to Indigenous people that policy-makers and service providers know what works and what doesn’t. It is also important that researchers are cognizant of the history of, and contemporary concerns about, research on Indigenous people. Professional groups can foster research that serves to meet the needs and aspirations of Indigenous people and their communities, and engages them in the process.
The building blocks of a professional response to Indigenous injury Professional groups also have important roles in advocacy. Organisations and their members can use their often privileged and respected position in society to promote the health of underprivileged or underserved groups. A surgical college can and should speak out about the social and other factors impacting on injury-related harm for which there is evidence. We must ensure quality care of the injured. But this is only part of the story for lessening injuryrelated harm. Our challenges are also to collaborate and consult with many varied stakeholders, to learn lessons of the past policies and practices, to be thoughtful and yet innovative, and to forge relationships with Indigenous communities, governments and non-government agencies, and other professional groups. In doing so, our society
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will have a better opportunity to promote the physical, mental, social and spiritual health of Indigenous people.
Funding and Conflict of Interest statement Russell Gruen is supported by a National Health and Medical Research Council Career Development Award. The Symposium was supported by the Royal Australasian College of Surgeons and the Foundation for Surgery. Neither authors nor the Royal Australasian College of Surgeons or the Foundation for Surgery has any conflict of interest to declare.
