In 2009, RPA consultant cardiologist Dr Rajesh Puranik asked Aboriginal elder Chicka Madden a simple question: why was the attendance at follow-up cardiac appointments so low among Indigenous people? The answer led to the establishment of a dedicated mobile cardiac clinic for Aboriginal people, a revolutionary approach to providing patient care that has seen attendance figures at follow-up appointments soar from 10 per cent to 90 per cent.
“Uncle Chicka told me that Aboriginal people were uncomfortable attending appointments at hospitals and specialist clinics, and that they often felt alienated in such an environment,” Dr Puranik said. “So we took the cardiac clinic to them, at the Redfern Aboriginal Medical Service.”
The clinic, consisting of an echo machine provided by the University of Sydney’s Poche Centre for Indigenous Health, and clinical staff from Royal Prince Alfred Hospital, is held at the Redfern Aboriginal Medical Service once a fortnight. The clinic sees about a dozen patients and performs five or six ultrasounds each time, and has provided care to nearly 500 patients since its inception.
The convenient location has been a key factor in the success of the cardiac clinic. Its presence in the community has helped the clinic achieve more diagnoses and resulted in improved patient care, because it takes place in a familiar environment. Support by elders has also been fundamental to the clinic, providing cultural endorsement and helping to build the rapport with the community that has been critical to achieving a high rate of attendance at appointments.
In addition to assisting the local community, the clinic also sees a lot of patients from rural and regional areas, who take advantage of the service when visiting friends and relatives in Sydney.
The cardiac clinic initiative is being co-presented by Dr Puranik and the General Manager of the Redfern Aboriginal Medical Service, Laverne Bellear, at the Sydney Local Health District Innovation and Research Symposium on May 16. The symposium is a showcase of the latest advances in healthcare by the area’s leading experts and researchers.
This new approach to providing cardiac treatment within an urban Aboriginal community setting is likely to have a profound impact on improving Aboriginal patient care, and how that care is delivered.
“The same service wouldn’t work at the hospital or at a tertiary clinic. The patient perspective needs to be better integrated in the model of healthcare, a concept shift from the clinic to the community where the clinician goes to the patient, not the patient to the clinician,” Dr Puranik said. “If we really want to close the gap, we have to make the care mobile.”
