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Miwatj Health Operational Areas

Provision of Clinical Services

Miwatj Health provides clinical services by doctors, nurses and Aboriginal Health Workers at its fixed clinics in Galiwin’ku, Gunyangara (Marngarr) and Nhulunbuy, and through mobile outreach services to nearby communities on the Gove Peninsula and within Galiwin’ku. This comprises a wide range of professional services including diagnosis of illness, treating acute trauma, carrying out full adult and child health checks, ante-natal and post-natal care, providing medications, developing chronic disease care plans, undertaking brief interventions, transporting patients for further radiological investigations, and the full range of health care services.

In its clinical services, Miwatj Health must balance the need to provide acute care for short-term medical problems with the need to address the prevention and management of long-term chronic illness and child health problems. It is these long-term issues which are the biggest threat to the overall health of our population, and Miwatj is now better placed to address them as a consequence of a growth in the funding provided by the Commonwealth Government in recent years. In addition to general primary health care funds, Miwatj now receives specific funds to tackle child and maternal health and chronic illness, both on the Gove Peninsula and in Galiwin’ku. We have used these funds to employ a range of additional clinical staff and community workers, with an emphasis on taking services out of the clinics and into the community, treating people as and providing education on the issues which underlie long-term health problems.

This approach is a consequence of the changing nature of disease: the biggest killers today are the chronic illnesses – the diseases that often build up slowly over many years, and which are best detected early. Our Chronic Disease Policy recognizes this importance.

On the Gove Peninsula, our Child and Maternal Health Outreach Team (nurses, a midwife, doctor and Aboriginal Health Worker) makes regular visits to nearby communities in a specially equipped bus with the aim of ensuring mothers and their young children receive high quality ante-natal and post-natal care. And the Miwatj Chronic Disease Outreach Team (nurses, doctor and Aboriginal Health Worker) has a regular weekly round of visits to camps and nearby communities, providing both medical care and preventive education. Recently, in response to figures showing a low attendance by men at our clinics, Miwatj Health has started a specific Men’s Health outreach program, aiming to provide preventive health checks and follow-up to Aboriginal men at sporting and other non-clinical venues around Gove – this approach is having success accessing men who would not normally attend a clinic until they were very ill.

At Galiwin’ku, the clinic staff at Ngalkanbuy Health provide a primary health care service to a large community from cramped and inadequate conditions. The health service building at Galiwin’ku was constructed in the 1980s as a hospital rather than a primary care facility. The population has grown since then, and the nature of care required has changed. Despite these difficulties, our Galiwin’ku staff provide a holistic service which links a high standard of professional medical care with preventive education and strong links to the community. A particular characteristic of the health centre at Galiwin’ku is the important role played by local Aboriginal people - Aboriginal Health Workers and Community Workers work side-by-side with western professionals, ensuring effective communication and a bicultural perspective in health care. As the sole provider of health care in Galiwin’ku, Ngalkanbuy Health Service has had to be relatively self-sufficient – it operates a 24 hours 7 days a week emergency on-call service, has its own mental health team, is pro-active in developing co-operative arrangements with the East Arnhem Shire (in such areas as aged care and child health) and with Marthakal Homelands Health Service.

All the clinical services provided by Miwatj Health, both at Galiwin’ku and on the Gove Peninsula, take part in quality improvement processes which measure our compliance with accepted clinical best practice. Our health services at Gove and Galiwin’ku participate in the One21Seventy project (formerly called the Audit and Best Practice in Chronic Disease Project) of the Menzies School of Health Research, and our services on Gove Peninsula also take part in the Australian Primary Care Collaboratives. Our clinics at Nhulunbuy and Gunyangara (Marngarr) have both achieved AGPAL accreditation, and the clinic at Galiwin’ku is undergoing the AGPAL accreditation process in 2010.

Community-Based Educational and Preventive Programs

Miwatj Health has always recognized that primary health care includes taking action to prevent illness arising, in addition to treating it. Education about the beneficial impact of eating well, of not smoking, of not abusing alcohol, and of getting more exercise, are an essential part of delivering health services in the region.

The single biggest factor underlying high Aboriginal mortality rates in East Arnhem Land is tobacco smoking. Tobacco use is embedded in the history of the region, with Macassan traders bringing it to the northern coastline for hundreds of years before European settlement. And missionaries across Arnhem Land handed it out as payment for work, for decades. Miwatj Health is now managing a major 3-year Tobacco Control project, as part of the COAG Indigenous Tobacco Initiative. The aim of the project – starting from a low base – is to increase awareness of the harm caused by tobacco smoking, and introduce population health initiatives focused around this. It operates on the Gove Peninsula, and is expanding across the region to Gapuwiyak, Numbulwar and Galiwin’ku, employing community-based workers to spread the message that ‘smoking stinks’.

On the Gove Peninsula, Miwatj Health provides a range of services to address social and emotional wellbeing problems and issues. We subscribe to the National Aboriginal Health Strategy Working Party Report's definition of health, i.e. "not just the physical well-being of the individual, but the social, emotional and cultural well-being of the whole community." Miwatj believes that treatment of the person's health cannot be done in isolation from issues such as spiritual attachment to land, economic status, social and emotional well-being. We also has a commitment to employment and mentoring of Yolngu to ensure sharing of skills and knowledges “both-ways”. The following programs all engage in community development strategies to ensure ownership of solutions at the community level. The Raypirri Rom project employs local community-based workers to implement culturally appropriate solutions to issues and events which disturb community life. The Alcohol and Other Drugs Program of Miwatj employs a professional social worker and two local Yolngu to minimize the harm caused by substance abuse. Through its Suicide Mitigation program at Gove, Miwatj is building community capacity to prevent suicide, to deal with it when it happens, and develop effective early intervention and referral practices. The way in which we work, in addition to what we do, reflects our commitment to addressing the determinants of health.

At Galiwin’ku, local Community Workers are employed by the health centre to work with households on identifying and addressing specific housing issues which impact on child health. Miwatj Health is participating in a research project of the Menzies School of Health Research which aims to identify the links between housing maintenance and children’s health status in Galiwin’ku.

Policy, Planning Advocacy and Data

Since its inception, Miwatj Health has always seen that advocacy is one of its core functions. Advocacy which points out the vital role of community-controlled health organizations, and which aims at ensuring an adequate level of primary health care service provision, is an essential part of our activities. Miwatj employs a fulltime Policy and Planning Officer. Some of the issues about which Miwatj Health has taken a stand include:

• the need to fluoridate the water supplies of remote Aboriginal communities so as to lessen dental problems;
• the need to remedy the current fragmented health service funding process through pooling of government funds;
• the need to replace old and inadequate health infrastructure in the region;
• the negative impacts of the Intervention on Aboriginal people in this region; and
• the need to make Aboriginal hostels smoke-free zones.

Health service planning requires data and evidence. Miwatj Health bases it’s health services on an objective understanding of the prevalence of illness, and on evidence of what works. In this process we rely on data about our clients and data about illness. Clinical staff of Miwatj Health utilize a sophisticated computerized Patient Information and Recall System (PIRS) - the population health data provided by this system allows us to see what the key health problems are, which groups in the community require our services, and the impact our services are having on the population. For many of our services, we measure our performance using the broad framework of the Aboriginal Health Key Performance Indicators project, the details of which can be seen at: http://www.nt.gov.au/health/ahkpi/Reports/KPIDefinitionV1_3_1.pdf. All Aboriginal health services in the NT are required measure their services using this KPI framework.

In addition to the PIRS, the Emotional & Social Wellbeing Section of Miwatj Health maintains a comprehensive and detailed database on their activities and the issues they deal with.

Governance & Management; Business Services, Finance and Administration

The rapid growth of Miwatj Health in recent years has brought about a need to upgrade and professionalise our corporate support function.

We have recently reviewed our administration, finance, human resource and support service areas to ensure these services are able to effectively support our primary health care function. All our administrative policies and procedures have been reviewed and revised. Controls over use of our assets have been tightened. Two new fulltime positions of Human Resources Officer and Senior Finance Officer have been created, and new financial and administrative systems introduced to cope with the complexity of grant funding – in 2010, Miwatj Health received 46 separate grants, all of which require separate reporting and separate acquittal, placing a great strain on administration and finance areas. The good work has paid off, with Miwatj Health now having a ‘perfect score’ in the risk assessment process used by OATSIH.