Indigenous Health & Cultural Competency

Dr Alyssa Vass explains the importance of cultural competency in our ED
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When Alyssa Vass became a qualified doctor, she packed up her belongings and went overseas to work with impoverished communities. Over time, however, she realised that people in her own backyard experienced just as much disadvantage, so she came back to Australia to work in rural and remote Indigenous communities.

“Working in remote Australia was just like going to another country,” she said, “There are so many cultural differences and such different ways of understanding health.”

Alyssa, Project Manager for the Indigenous Health and Cultural Competency (IHCC) project, has spent much of professional life working on health education programs in remote communities. She spent four years in Arnhem Land and even learnt one of the local Indigenous languages, Djambarrpuyngu.

“A lot of the work we were doing was trying to find ways to talk about modern medical concepts in Indigenous languages, so people could understand more about what Western health care is all about,” she said.

Alyssa saw a big gap between the care that Indigenous people needed and the care they received. Indigenous cultural norms are often not fully understood outside the indigenous community, making communication in a hospital setting difficult. Alyssa saw a way to improve matters for both indigenous patients and ED staff, by providing doctors with the opportunity to learn more about cultural competency.

That’s when she joined the IHCC project. ACEM had just received funding from the Australian government for the project and, along with her colleagues, Alyssa began the process of fleshing out what it would eventually become.

“The number one goal of the project is to improve the quality of care that is provided at the bedside with the aim that it will improve patient outcomes,” she said, “But more than that, it’s about improving the satisfaction that a doctor can have in creating a genuine partnership with their patients.”

Having worked a lot with Indigenous people, both in a hospital setting and in their communities, Alyssa was quite aware of the issues faced by doctors working with Indigenous and other culturally diverse patients—but she certainly didn’t feel she had all the answers. The first step was to establish a project reference group. In a first for ACEM, this group included experts beyond ACEM’s membership, including Aboriginal Liaison Officers and representatives of peak groups such as the Australian Indigenous Doctors Association.

To give the project a strong base, an extensive literature review was also conducted to analyse what evidence was available on Indigenous health in emergency medicine.

“There are a number of significant gaps in the literature so we really had to take the information we got from conducting focus groups and interviews with doctors and Aboriginal health staff and apply the principles of care that are described in the literature and bring them together to the emergency department context,” she said, “It was really stepping out to a new area that hadn’t been explored in-depth before.”

The next step was to create the education resources – a series of modules and podcasts. For the IHCC team it was very important to ensure that the content was engaging and rewarding. They wanted to create resources that didn’t just inform doctors what they could be doing to enhance the interactions with their patients, they also wanted to give them the tools to put these into practice.

“The benefit of doing the modules is that the skills that you learn are going to impact the greatest on those patients and interactions that are really challenging: the ‘poor historian’, the agitated patient, the guy that just wants to leave and the person who never takes their medications,” she said, “Although really, they will help with all your patients and we’ve had fantastic feedback from doctors saying the modules are definitely making a big difference to their clinical interactions.”

As a doctor, Alyssa is very aware that time is a valuable commodity, and she wants to stress that not only can these modules give doctors greater work satisfaction and better outcomes for their patients, it can also save them time overall.

“If you do this right at the start of your interaction with people you’re going to save a lot of time in the long run and you’re going to save unnecessary investigations and you’re going to reduce the risk of adverse events happening,” she said.

The IHCC project is now coming to a close, but the resources that have been created will continue to be available, both to ACEM members and other healthcare professionals.  

Alyssa and the team are thrilled that the benefit of their work can be shared through the broader medical community because it means that emergency departments will not have to rely on emergency doctors alone to make a difference. The modules and podcasts cover the learning objectives in the new curriculum of the specialist training programme, to ensure that trainees have access to education on cultural competency - a core skill for every emergency medicine physician.

“The future from here is for more and more physicians to take up these resources so that they can continue to develop their skills in this area, and help the patients most in need,” she said.

This week, IHCC has released its last podcast for the project – “Patient Centred Decision Making: A complex retrieval case”. You can access all the IHCC education materials on the dedicated webpage.