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‘I’ve not seen an easier way to save lives’
Most Aboriginal and Torres Strait Islander adults are at risk of severe disease from COVID, but vaccine coverage requires patient identification.
Professor Peter O’Mara, a Wiradjuri man and Chair of RACGP Aboriginal and Torres Strait Islander Health, fears some communities may remain unvaccinated – and vulnerable.
Two-thirds of Aboriginal and Torres Strait Islander adults (59%) have an increased risk of developing severe disease from COVID-19, being admitted to ICU, requiring mechanical ventilation, or dying.
These are the sobering findings of a new study, led by the Australia National University and involving researchers and practitioners from the RACGP, the National Aboriginal Community Controlled Health Organisation (NACCHO), and the Lowitja Institute.
According to the authors, the research has reinforced the need for Aboriginal and Torres Strait Islander people to remain a priority group in the vaccine rollout, as well as the broader pandemic response.
But as Australia moves towards easing restrictions as states aim to reach vaccination targets, Professor Peter O’Mara, a Wiradjuri man and Chair of RACGP Aboriginal and Torres Strait Islander Health, fears some communities may remain unvaccinated – and vulnerable.
‘[NSW Premier] Gladys Berejiklian is saying that she’s going to open up at 70% double dosed and we’re rapidly approaching that, thankfully,’ he told newsGP.
‘But if Aboriginal communities are only at 55%, given the cultural connections and the overcrowded living, it’s just going to be absolutely devastating.’
Ensuring all Aboriginal and Torres Strait Islander people have the opportunity to be vaccinated first and foremost comes down to being identified. But Professor O’Mara says he is aware that some GPs find it challenging.
‘For some doctors it’s been a bit of a challenge because some of the patients will be fair-skinned like me,’ he said.
‘It’s been part of our challenge as educators in the space over the years to say you don’t expect an Aboriginal man to be standing there with a lap lap, spear, big long grey beard, and really deep black skin.
‘We come in all shapes, sizes and colours, and so you won’t know until you’re asked that question.’
In line with the Australian Institute of Health and Welfare (AIHW) best practice guidelines, the standard question to ask is: ‘Do you identify as Aboriginal and/or Torres Strait Islander?’
Professor O’Mara acknowledges that some GPs may be anxious about how to ask the question. He advises approaching it like any other, similar to querying family medical history.
‘I’ve been doing that all my life and I’ve only had one person who got angry at me asking,’ he said.
‘It was an older man and he said, “Why do you want to know that?” and I said, “Well, if you are an Aboriginal person, I know that Aboriginal people suffer diabetes, kidney disease and these other things at higher rates, and I’ve got to … be more vigilant about it”. And he said, “Oh. Well, I’m not”.
‘Often it’s just a matter of explanation. But you can guarantee, if you’re embarrassed to ask the question, the person might be a bit reluctant to answer it, so just ask it in the vein of any other question.’
Alternatively, Professor O’Mara says GPs can use COVID-19 and vaccination to start the conversation.
‘You might say, “Because of the COVID situation we’re checking if we have any Aboriginal patients. Are you Aboriginal or Torres Strait Islander?”,’ he said.
If a patient does self-identify as Aboriginal or Torres Strait Islander, Professor O’Mara suggests attempting to form a connection by simply asking, ‘Where’s your mob from?’
‘That’s what we do as Aboriginal people around the country, too,’ he said. ‘You might say, “I’m not Aboriginal, but I used to live out at Mudgee” or “The countryside out there is beautiful”.
‘Most of the time, if you respectfully try to find out about our people and our culture in the right way, people are really going to embrace it and they quite enjoy telling you.’
Practices can also endeavour to create a culturally safe space by having Aboriginal art and signage, as well as a welcome to country acknowledgement in the waiting room. There are also health-related posters developed by NAACHO that may be useful.
‘If you have those kinds of things around, people at least think, “Maybe this environment is happy to acknowledge who I am and will have some respect around it”,’ Professor O’Mara said.
Though there have been reports of vaccine hesitancy among Aboriginal and Torres Strait Islander communities, rates are increasing, but there is still a way to go.
While the Australian Technical Advisory Group on Immunisation (ATAGI) recommends AstraZeneca for people over 60, Professor O’Mara says the critical nature of vaccinating Aboriginal patients means alternative arrangements should be considered where possible.
‘Aboriginal people have a reason to have distrust around these things because of what’s been done in the past,’ he said.
‘If you’ve got an Aboriginal person who wants to be vaccinated but they’re reluctant to get AstraZeneca, just give them Pfizer. Just do it.
‘All the services that I’ve had this conversation with have said that’s a good idea; we’ve just got to get Aboriginal people covered.’
Thanks to community-led efforts, Aboriginal and Torres Strait Islander communities have largely been protected from COVID-19. But that has changed since NSW’s Delta outbreak.
Professor O’Mara says it is important for the rest of Australia to heed the warning.
‘The saving grace is going to be getting the community vaccinated because the overcrowding situation in homes and that kind of stuff, we can’t solve that overnight,’ he said.
‘But in three weeks, we can solve the vaccine problem.’
However, cultural identification is key.
‘I study pretty much every day because I want to be the best doctor I can. I’ve not seen an easier way to save lives than to do this,’ Professor O’Mara said.
‘It’s just so easy, but so important.’
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