Wellness team- Hopevale Pelican (09)

Samia Goudie, Emma Hubbard ,Tegan St Ledger, Jessica Cross, Louisa Tatton, Kerri Hubbard, John
Cadden

Time for Hope project is a collaboration that developed out of the University of Queensland student medical group TIME’s (toward international medical equality) desire to extend into the area of indigenous health. TIME vice president Kerri Hubbard lecturer and PhD candidate Samia Goudie from the Indigenous Health Unit, School of Population Health regarding potential projects that the medical students could be involved in. This year with the help and guidance of Samia Goudie (Lecturer, Indigenous Health Unit, School of Population Health, UQ) and at the invitation of community elders a new health focus into the Pelican-Hope Vale camp.
For several years Samia has been involved in the Pelican-Hope Vale camp. Hope Vale is an Indigenous community located 400km north of Cairns in Cape York. Since 2004 the Hope Vale –Pelican Project has held a two-week on-country camp each September, which provides rest and respite for the community while engaging the youth with daily activities that promote caring for country, marine science and preservation of culture. This program is community driven, was initiated in response to suicide and youth issues, and is designed to address community issues in creative ways.
The central partnership for the project is that between Hope Vale community and Pelican Expeditions – an NGO focussed on developing and running innovative projects connecting the broader community with the marine environment and scientific research. Their vessel, Pelican1, is based in Melbourne and sails to Cape York to work with the community annually.
Samia had been involved in the Pelican-Hope Vale camp for many years. She had planned to incorporate health into the agenda of the camp and had recruited a Brisbane general practitioner, Dr John Cadden to attend the next camp. She understood that by suggesting the involvement of medical students in the camp to the community (both) there would be benefit both to the community and to the medical students by gaining experience in Indigenous health.

Development
In April of 2009 TIME held the first meeting to discuss the Hope Vale project and soon after the group met with Samia Goudie to discuss the project. The strategy the group adopted involved several steps.
During this time we developed these goal and objectives;
Goals and objectives:
1. Enhancing future medical practitioners knowledge and experience in indigenous health
a. Develop understanding of self identified health/social issues (children’s and adults)
b. Exposure to indigenous culture
c. Understand the factors which contribute to indigenous health
2. Establishing a long-term and sustainable relationship with UQ medical students and the Hopevale community
a. Coordinating and liaison with health services in the area by identifying and referring people with health issues and transferring information to the local doctor (with the approval of participants)
b. Documenting and evaluating outcomes with the intention to enhance future project in conjunction with the local community
c. Ensuring a positive experiences for the community members and us alike
3. Promoting health and well-being of community
a. Through collaboration with community members
b. Health education, screening and referral
c. To facilitate the aims of the camp to empower the attendants.
4. Establish a model that can be reproducible by other medical schools
a. Through documentation of project development, training, implementation and evaluation
b. Dissemination of information regarding project development and outcomes.
Community contact
The initial step was to make contact with the community and gain an understanding to the specific issue facing Hope Vale. To do this we contact Elders Estelle Bowen and Des Bowen and the Hope Vale Health Clinic and spoke to resident general practitioner Dr Melania Scrace. During these discussions issues such as diabetes, otitis media, alcohol abuse, mental health, sexual health and adult health checks were identified as issues significant to this community. We determined that some problems common to other indigenous communities where not present in Hope Vale such as skin infections.
A video conference was held between the medical students and Samia in Brisbane and the Aboriginal health workers, nurses and Dr Scrace to further discuss what issue need to be addressed and how to approach them. It was also important to determine the level of health care available and level of health seeking behaviour. We determined that the local clinic was well staffed and equipped and Cook Town was a 40 minute drive for emergency cases. There was a high level of health care access by the majority of the community with individuals volunteering for regular screening such as mammograms. However, as with most communities, there is a proportion that avoid health care.
Resources
The next step in developing the project was to broaden out to the larger health community in the in Cape York area. To do this we spoke to Apunipima, the Cape York health council specifically Dr Mark Wenitong (senior medical officer), Jason Leon (regional coordinator), Claire Bonon (nutritionist) and Kristy Strout (Healthy Lifestyles Program coordinator) who were most supportive and informative as well as AIDA (Australian Indigenous Doctors Association).
Next we gathered resources relevant to indigenous health from a wide range of sources, mostly from the internet. Australian Indigenous Health Infonet contained strong evidence based Indigenous health information as well as Close the Gap Campaign and Australians for Native Title and Reconciliation. Some other independent sources were useful such as Sugarman (M Porter, Country Health SA ), Pit Stop program (Gayscone Public Health Unit) and several government websites.
Australian Indigenous Doctors Association (AIDA) donated several boxes of pencil cases, books and rulers for the children to promote health care professions in the future. Snake, an Indigenous specific sexual health initiative from Marie Stokes International, donated several boxes of condoms, posters, bracelets and booklets regarding sexual health for the teenagers. We also gathered posters on a range of topics from places such as Quit Line.
Activities
With such a broad range of topics to address it was difficult to know where to start. We determined that we would have no more than three students at the camp at any time and that we would spend some time in the clinic with the Aboriginal health workers carrying out community health work. We divided our target population into age groups and recognised that we would mainly engage youth at the camp and adults in the community.
For the children in the camp we developed a range of educational activities and games. These included a 2 meter tall man on which we places organs created out of everyday objects, such as electrical wire to represent the brain and a sponge to represent the liver. With this we intended to teach the junior school children about how the body works. We developed a game for brushing teeth and collected tooth brushes and toothpaste to give away, a music rap about health and some ball games.
In the community we decided to run a program called the Pit Stop Program, which was developed by Gayscone Public Health Unit group in Western Australia. It was originally developed to as a non-threatening fun way to educate all men about health and has been successfully run at a range of locations including shopping centres and festivals. It uses the analogy of a how a racing car relates to the human body with oil pressure representing blood pressure, fuel representing diet etc. The participant is given a service from and moves from station to station learning about health.
We took this concept and adapted it to the issues faced by the Hope Vale community and the skills we had as medical students. We settled on 5 stations; Chassis check and Fuel – diet and weight where we calculated the participants BMI and advised them on their weight; Oil pressure where we took the participants blood pressure and discussed with them the significance of high blood pressure; Oil – where we took a random blood sugar level and discussed diabetes and renal function; Spark plugs – men’s health, including prostate checks and smoking and Head lights – which addressed mammograms, pap smears and smoking for women’s health.
Funding
The greatest challenge of this project was finding funding for the program. We applied for grants, approached companies for sponsorship, asked the School of Medicine and approached not-for-profit organisations Indigenous Community Volunteers and Royal Flying Doctor Service. Indigenous Community Volunteers is an organisation that connects communities in need with volunteers that have skills in that area. They provide cultural training and support and organise transport and accommodation. They funded 5 people to carry out this project. The Royal Flying Doctors service covered the final 2 people for transport, plus covered car rental for 2 weeks, donated the use of their accommodation in Hope Vale and provided $1000 work of food. We also were sponsored by Skytrans for 2 return flights from Cook Town to Cairns. While we managed to cover the minimum there was limited funds for general purchases and a further $1000 would have allowed a greater range of activities.

Activities
Community
In total about 7 days were spent in the community and in the health care clinic. During this time students spend time in the clinic observing primary care and participated in community activities such as a PCWY dance and a church service in the park. During this time the students gained an understanding of how a clinic in a remote location functions.
Pit Stop
The Pit Stop program was held on a Tuesday morning in the function room of the clinic, beginning at 10 am and finished at 1pm with a barbeque. The program was set up so that the stations for Chassis check, Oil pressure and oil check were carried out in a common room. The room was well decorated with posters, pamphlets and flowers and the pit stop theme was carried through with road lines and stop lights. Some health models were available with one example being a demonstration of how a kidney is damaged in diabetes whereby a sieve with large holes was compared to a sieve with normal holes and small balls used to represent protein. The men’s and women’s health stations (spark plugs and head lights) were allocated separate rooms to ensure privacy and comfortable environment. Each station had a briefing which contained information about the diseases relevant and examples of how to explain them for the students conducting the station. Health related games were developed for the children to play with.
During the three hours approximately 19 people passed through. Initially we intended to have a student at each station and the participant move from station to station. However, we found in practise it was easier to move with the participant through the stations. If the participant was male he was introduced and passed onto Dr Cadden to discuss men’s health. In total approximately 40 minutes was spent with each participant.
The mean age of the participants was 56yrs (range 22yrs to 87yrs), with approximately even numbers of men and women. Nine completed work order forms containing the information intended for the participant’s medical record were collected.
We found that the participants had a very good level of health education and were proactive in maintaining their health, including taking regular medication and participating in screening such regular pap smears. The participants that had been previously diagnosed with hypertension or diabetes were all well controlled. We took special efforts to congratulate these people and explain why exactly it is important to maintain this trend. We did not identify any participants with undiagnosed diabetes or hypertension, however, there were many important discussions regarding the options for quitting smoking, the importance of prostate checks, methods for losing weight and the importance of a low salt, low sugar diet. There were many occasions where we felt the information was well received that the participant will consider making changes to their lifestyle.
While for the first attempt this Pit Stop program could be considered a success, it could be enhanced by conducting it outside at a local meeting place to reach out to the members of the community that do not access health care regularly. More work is required to streamline the flow through and it would be great if there were members from the community involved with promoting the program and encouraging participation. A defined starting time will allow an opportunity for an introduction of us and a brief explanation of the program. We estimate that with 6 people running the program we could process 30-40 people in three hours at future events.

Camp
This year, unfortunately, the boat Pelican1 did not acquire the funding to attend the camp. As a result it was moved from Cape Flattery to Elim Beach, a 45 minute drive away. A range of activities were conducted at the camp by external groups such as AFL Cape York and Champion music as well as from the community , traditional weaving and education from Elders Estelle and Des Bowen.
The medical students contributed to the camp by conducting several activities with the children. These included an explanation of the organs of the body using fun models, making juggling balls, painting and free tooth brushes.
The students and the doctor were in charge of first aid, for which over a dozen people were treated. Several adults spoke to Dr Cadden about mild health complaints for which he advised them. Over several nights some frank discussions were informally conducted with the early teens about puberty and sexual health. As sex education is carried in grade 7 many of these children were beginning puberty but had no understanding of what to expect. The pre-teens involved actively requested these discussions and personally thanked the medical students for taking the time to talk to them.
In future we would like to expand the information we have available for the early teens. Furthermore, we would like to spend more time with the adults discussing with them major issues like diabetes, smoking and cardiovascular disease and will endeavour to be more proactive in this. We found the teenagers hard to engage and will have to develop more strategies to address this.

Outcomes
Personal
In terms of outcomes for the students this was a fantastic opportunity to understand what is meant by Indigenous health and how rurality and culture affect a person’s health. We gained a greater confidence in a broad range of areas and felt truly welcomed into the community.
Community
Unfortunately, there are no hard and fast measures of success for this project. We spoke to many people about their health and aimed to explain things in more depth than there is time for in a GP consultation. The Community, both the elders and participants of the camp, and the clinic were happy to host us and have invited us back for next year.

Summary
In September of this year 5 medical students, Jess Cross, Kerri Hubbard, Tegan St Ledger, Louisa Tatton and Emma Tippett, Brisbane locum Dr John Caddon and Samia Goudie, lecturer and program coordinator, travelled to Hope Vale in the Cape York to participate in the annual Pelican-Hope Vale Camp and to spend time in the community and clinic. During their time they conducted a Pit Stop program, observed primary health, carried out basic first aid and promoted health education.

Conclusion
The TIME for Hope project achieved most of its aims and was overall a success.
Acknowledgment and Thanks
The greatest thankyou must go to the Traditional owners, community, health clinic and Well Being clinic of Hope Vale for their support and welcome, especially Estelle and Des Bowen. Indigenous Volunteers Association and the Royal Flying Doctor Service made this whole project possible and we thank them for their belief and support. We also thank Skytrans for their sponsorship and the support of the School of Population Health and the School of Medicine, University of Queensland.


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