Pharmacists can have a key role in breaking down some of the many and complex barriers to quality, accessible health care for Aboriginal and Torres Strait Islander Australians, says a leading pharmacist.
“Aboriginal people have a huge burden of chronic disease which often results in polypharmacy,” says PSA Pharmacist of the Year Lindy Swain (right), a clinical pharmacist at Bullinah Aboriginal Health Service and part-time lecturer, University Centre for Rural Health, School of Public Health, University of Sydney.
“There’s lots of medicines to manage, and that can often lead to GPs, in a GP consult, having to prioritise the issues they can discuss. Often, medicines are low on that list of priorities.
“I see a lot of Aboriginal people with lots of medicines, about which no-one’s ever tried to have a good conversation with them.
“There’s often a lack of knowledge about why they’re taking the medicine, which leads often to non-adherence or poor medicines adherence.”
Pharmacists have a huge role to play in assisting their patients to understand what they’re taking, how to take it and why, and generally “giving a good story about the benefits of taking medicines”.
They also need to be aware that pharmacies are often considered an uncomfortable or even threatening environment for Aboriginal Australians, she says.
“With the Aboriginal patients I work with, they’ve often had a lack of relationship with their pharmacist or pharmacy, and I’m generalising here, of course, but they often don’t feel very comfortable in a pharmacy environment,” Swain told the AJP.
“There’s a huge amount of work needed to make pharmacy culturally safe, and pharmacists and their staff need to have that discussion around what strategies they’re going to use to make sure Aboriginal people feel confident and welcome, and able to talk about their health in a non-threatening environment.”
One simple step is to embrace events, such as Close the Gap Day (19 Mar) aimed at highlighting the disparity between Aboriginal and non-Aboriginal health in Australia – or NAIDOC Week (5-12 July), which celebrates Aboriginal and Torres Strait Islander history, culture and achievements as well as the contribution Indigenous Australians make to our society and country.
“Close the Gap Day is a fantastic opportunity for pharmacies to dress up their shop and acknowledge their Aboriginal customers,” Swain says. “It’s a way of saying to your local Aboriginal community that you’re welcoming and would like to engage further.
“Even something like having a sign up that names your local mob – for example, Bundjalung people are welcome in this pharmacy – is a very simple but effective thing to do.”
- Develop a relationship with your local Aboriginal Health Service to help find your way through the maze of complex systems set up to aid Aboriginal health, such as CTG scripts. “We have all these different schemes, it’s hard for anyone working within the system to understand it, let alone the patient: QUMAX funding, CTG, Section 100 funding… and the poor patient’s moving around trying to navigate these things, they have no idea why their medicine’s sometimes subsidised and sometimes it isn’t.”
- Consider whether you’re affected by organisational racism. “It’s not that the individual is racist, it’s about the organisation, the pharmacy, not having addressed these issues and not having taken the time to think about ways to make their patients feel more comfortable and welcome,” Swain says.
- Don’t assume that urban pharmacies aren’t affected. “There’s actually more Aboriginal people living in the urban setting than in rural and remote Australia,” says Swain. “I think sometimes we think of this as just a rural and remote challenge, and it isn’t.”
- Ensure all pharmacy assistants are welcoming to Aboriginal customers. “It’s so important that everyone within a pharmacy is on board in creating that welcoming environment. So often the patient interacts more with the pharmacy assistant than the pharmacist. They need to be empathic to a patient’s feelings and perceptions: when a pharmacy assistant ignores a patient, they might do that to all patients, but an Aboriginal person might not know that, and instead worry that they’re being ignored because they’re Aboriginal. Make sure they can understand this from the other person’s point of view.”
- Seek education. “Pharmacists and pharmacy assistants have very little training in this area,” Swain says. “But it’s important to increase your knowledge of Aboriginal history and how trans-generational trauma affects people, so that when you’re talking to a 60-year-old person you have a better understanding of what might have happened in that person’s life that influences the way they might engage with you. There’s always lots to learn.”