1. Get to know your patient

(upbeat music) - Ask the specialist, a podcast where doctors from Royal Darwin Hospital ask a team of specialists to answer the questions they have about working with Aboriginal patients. - My name is Bill Warile. Bill Warile means the red tumbler cock too. I'm an elder of the larykin nation. - My name is Brawai Engie, oriental maria, a TV elder. And my name is Rattoy Melanie Hirdman, and I am from Irelandland. - The specialists are larykia, Tiwi, and your moon leaders, who have all had personal experiences in hospital in the Northern Territory of Australia. - Hi, I'm Vicky. Royal Darwin Hospital in the capital of the Northern Territory is very different to any other hospital in Australia, which is probably one of the reasons you wanted to work here. 60% of people you treat identify as Aboriginal, and in the renal department, for example, and astonishing 90% of patients are Aboriginal. You've told us that you want to provide culturally appropriate care, but that you need some help, and you struggle to attend cultural education because your workload is just so intense. So we've developed a series of podcasts that you can listen to anytime, anywhere, that will hopefully give you some insights to help you deliver culturally safe care to your patients. - Like testing. I'm Stuart McGraw, Irish, my last name. Father's family is from down south. I grew up in Kalunko, Elko Island, Unique, Matamata, Skibic. You're the irritable. It's all the accusations there. - I'm land. - Around the accusations. I'm Aboriginal Health practitioner. Now I'm back in Charlestown University, doing my Bachelor of Nursing, and working in men's ears. - I'm Vicky. Vicky Carrigan, PhD student. My last name also happens to be Irish. I'm a white Australian, I grew up in a farm in New South Wales, but I've lived in Darwin on LaraCare Country for over a decade. I worked at ABC Radio for a really long time, but now I'm doing this. I'm working on a PhD research project, which is about culture and communication. So there's one more person you need to meet, and it's my mate, Richard. - Hello, UnRichard. I'll be the voice of all the doctors that you're going to hear. Okay, so we can get started. This first podcast is about the importance of getting to know your patient. Here's LaraCare elder, Auntie Billowarale. - If you take the time at the beginning, it absolutely reduces the expense. It reduces the repeat presentation. It will possibly make their health a lot better. So taking time at the beginning is critical. In best health care. - I've learned, and for my own experience as well, but also from the great man Nelson Mandela, who said, "The first thing you have to do is learn his language, learn a word." So what I'm saying obviously is the doctors, perhaps need to learn a word, one word to say, "Hello, good morning." That will hit here, right in the heart. That patient will feel comfortable. - That's like an icebreaker sort of. - You like icebreaker. Yeah, so that's a very first thing. It may not be a big thing to other people, but for an indigenous person, Aboriginal person to hear, a foreigner say a word or two to it. That means a lot. (dramatic music) Okay, here we go. That's recording now. What's that, so the T.W. word for "Hello, what is it?" - It's "Ongana, ohngana." - That's hot, oh, oh, oh, no, no. - No, oh, no, no. - What's that N.G. sound that you're doing there? - Well, it's like the end of the song, like, song, except it's in the middle, and a lot of times she said the beginning of our T.W. vocabulary as well. - Yeah. So, "Ongana, ohngana." - "Ongana." Very, very tricky. You're going to keep practicing it. - Do it again. - "Ongana." - So, even if a doctor listens to this, and they practice and practice and practice, and they might still make a mistake. - Aboriginal people always laugh at non-Indigenous people when they try to pronounce Aboriginal words, because they're like, "Oh, that's funny." In a good way. - Yeah. - So, that's Pirawangi, Purantata Mary, who was trying to teach me a bit of T.W. as we had a chat after the interview. Pirawangi is a T.W. elder, and he's also the former deputy mayor of the T.W. Adams Regional Council. - He works as a health worker. What do I mean? - Yeah, for 10 years. - He spent 27 years on the T.W. elder and council. - "Seri is a single man." Like, he's a traditional song man, yeah. - You've got that N.J. sound, don't you, as well? In Yongumata. - Yeah, yeah. - "Ungana." It's just normal. - What's "Hallo" in your language? - "Yo." - Oh, well, that's easy. - Yeah, this general across all the clans, your one, just "Yo." Yeah, "Yo namari." Like, "How are you?" - "Yo namari." What are the dialects again? - In Yongumata. - I speak Jambarapino. There's heaps. - "Gupa pino." - "Gummach." - "Estoala." - There's "doya." - There's public dialect in Goberia. - Yeah. - But yeah, they're all similar. - In my experience, people love talking about where they're from and where they're family are. But, you know, does that question put them in a position of ease? Does that open them up to a more relaxed state? What do you want your doctor to ask you about yourself? - I think to begin with, to introduce yourself, you know, "Hi, I'm Dr. Pete or Nurse Jane or whatever. How are you? Where are you from?" And then share about yourself. Tell them where you're from. Where they're married. Where they've got kids. Well, you know, if you follow football or some other sport, just so that gives them information about you before you start getting information from them. - So it's pretty much yawning rather than formal questions? - Absolutely. Because they'll feel much more comfortable with conversation - Yeah. - than a question and answer time. That does not put most of us at ease, because we've had generational experience of authority and police coming in and asking questions. Oh, and always when you say to the patient, "Hello, my name's Dr. Pete. What's your name?" And they might say, "Oh, I'm John Brown." "Oh, Mr. Brown, how would you like me to call you?" Uncle John, Mr. Brown. And if that's what they say, that's what you do. So while I always say to people, "I prefer to be called Danny Billowara." Just the plain Billowara is very disrespectful if it's an older person. - Just about what you talked about in the doctor's comment, where you're from, where's your family, because then you will understand, oh my god, they've traveled 600 kilometers to be here and they're here for two months. Without family, with no, you know, not at work, living in a temporary accommodation, I'm pretty sure if we were all stuck in confined space for two weeks, we would go mad. So there needs to be that some kind of understanding built in a relationship established for that person to then say, "Oh, so this person is here to help me." They really want to know who I am and what I'm here for. And if I don't know what I'm here for, this is the person to ask, because they really care about me. It's establishing that. I'm not going to talk to someone if someone's just coming in to take tick boxes and take my blood pressure and ask me questions and then walk off. So once you get to know someone, they open up and they trust you. You want them to respect you as the doctor that's going to help them get better, but you also have to respect them for allowing you to look after them and have trust in you that you're doing the right thing for them. So that's your cousin? Melanie Erdman and her mother's clan is from the Gummuch, which is where I come from, from the Gummuch clan, yeah. I suppose my question is why doesn't the patient automatically respect the doctor? Because that's what the doctor might be thinking. Why do I have to invest this time? Why don't they just respect me? I don't know, I think past history. For instance, where they have this notion back home at Gallaudin or when someone's going to Adelaide usually means you return in a box. So people generally when they're interacting with the healthcare provider they're going in with fear more than trust first? Yeah. Well, in terms of legal matters, political matters, health matters, all sorts of history of oppression, so that doesn't really help the situation. Where it's important for doctors to give the patients some empowerment and let them know that that's their body and it's their health, they're entitled to make any decisions. Yeah, but most patients don't know that. That's why I usually say, you know, you're the boss for your body. What do you want to do? Is it okay to make eye contact? Sometimes yes and sometimes no. If you have somebody there that's really mucking up and you often get patients that are in there, you know, maybe under the influence and if you're an older person and then you can make direct eye contact to emphasise, if you're of the opposite gender and you're staring, well, sort of the main reason is that, you know, you can f me. If you're two males, it will might often mean, do you want to fight? So, you know, you don't sit face to face, turn slightly sideways, prolonged eye contact can have some very bad connotations. So like even when you consult with your patient and you sit directly, that's very rude and they just shut down. Or when you say any questions in the end, they're just going to be like, nope, because you're sitting directly and looking at them. I guess what we need to understand is that just because they're not looking at you, which is what our teachers taught us to do, to stare at their soul while they're speaking, even though they're not looking at you, they are listening. And the reason why you know that is because you can see them nodding or confirm with them, asking open ended questions, slowing down what you're talking about and also, you know, being aware that some people, and it doesn't matter what gender they are, what age they are, they shy, or they have that respect in themselves that they don't want to have that long eye contact. Or it also is indicating that something else is going on. They're not happy. Something is not right. They might not be comfortable talking to that person. I do I contact is not a thing among Aboriginal culture because we have avoidance relationship. People that we can't talk to, we can't associate with, we can't sit with those avoidance relationship, which is why there's no I do I contact. And now at the end of our first podcast about the importance of getting to know your patient, let's go over what we know. In fact, let's call this little summary, the podcast paper round. Getting to know your patient is part of delivering good healthcare. You want your patient to trust you and you want to trust your patient. Taking time at the beginning is critical in best healthcare. Share a little bit about who you are. Learn a few phrases in local Aboriginal languages. Ask your patient how they would like you to refer to them. Mr. Mrs. Uncle or Aunty or maybe they would like you to use their Aboriginal name, not their English name. Try to avoid direct questions. Give your patient power. That's why I usually say you know you're the boss for your body. And one of the most commonly asked questions is it okay to make eye contact. But try not to sit face to face. Instead sit side by side with your patient. Next time I want to ask the specialist, there are opportunities to make communication better for indigenous people. To answer your questions about how you can better communicate with your patients. Thank you to Aunty Balawara Lee, Pira Waiing, I'm Vicki Kerrigan. We hope you've learnt some stuff you can try at work. But we also hope you've been inspired to think about who you are and how you work. And also, while it's helpful and completely fascinating to learn about Aboriginal cultures. If we're sincere about wanting to improve health outcomes for everyone, we need to critically think about our culture and how we can change. Not just as individuals, but also take a look at the places where we work and the policies we've created to suit how we think the world should operate.