Cultural immersion in Kakadu

Her interest started in medical school.
 
After completing a rotation in Cherbourg, a small Aboriginal community a few hours from Brisbane, Dr Krystyna de Lange knew she’d found her niche.
 
‘I knew from this experience that I wanted to work in Indigenous health, so I jumped at the chance to complete some of my GP training in an Aboriginal Medical Service. As a new Fellow I have now returned to that same service and I’m as passionate about it as ever,’ she said.  
 
In her work, Dr de Lange regularly treats patients who do not want to go to hospital.
 
‘It is not uncommon for Aboriginal and Torres Strait Islander people to refuse to go to hospital. It may be because of previous negative experiences, stories they have heard, their current social situation or because they make an association between hospital and death – as in, that’s the place you go to die,’ she said.  
 
‘My workplace already has a model where we try to break down some of these barriers.
 
‘Non-GP specialists come to the patients rather than the other way around. We have plenty of Aboriginal and Torres Strait Islander staff, from receptionists to doctors to Aboriginal health workers. The health workers are key to helping improve access and ultimately outcomes.’

Dr de Lange, the RACGP’s Registrar Representative, recently spent three nights on a cultural immersion camp for registrars in Murrumburr clan country in Kakadu, organised by Northern Territory General Practice Education (NTGPE).
 
She credits the camp with helping to deepen her understanding of Aboriginal culture and history.
 
‘It is so important to understand the context in which patients present to us,’ she said. ‘It helps us to understand why they come in and ensures we are doing everything possible to help guide them through their health journey.’
 
The camp has also made her more determined to deliver culturally appropriate care to her patients – an experience she recommends to all registrars.  

Held at the Kakadu Billabong Safari Camp, a four-hour drive from Darwin, the camp is owned by Mandy Muir and her family, Traditional Owners of the land.


The group of registrars spent three days in Kakadu.
 
Soon after arriving, Dr de Lange was given a new name to demonstrate how she would be placed in Aboriginal culture.
 
‘I was given the name Albangardi. I learnt who my mother was, my sister, my brother-in-law. Who was right skin and wrong skin,’ she said.
 
‘This kinship model has governed family and marital relationships and obligations for millennia in Aboriginal culture. A clever method of maintaining genetic diversity in smaller groups.’
 
The kinship experience gave Dr de Lange a new insight into her Aboriginal and Torres Strait Islander patients in Brisbane, more than 3000 km away.
 
‘Often at work, someone will come in and refer to someone as “mum”. Later I’ll find out that she is not their blood relation, but instead their mum through the kinship model,’ she said.
 
‘This can have an impact when asking about family history and getting consent.’
 
Over the three days, Dr de Lange and other registrars from NTGPE walked trails in Kakadu and saw the rock art. She learned the art of weaving pandanus leaf bracelets, tried magpie goose and made damper.
 
One day, the registrars had the opportunity to visit Gunbalanya, a remote Aboriginal community with around 1200 residents. They sat in the medical service and heard about the GPs, registrars, nurses and health workers working tirelessly in the community.
 
The group was told about the challenging conditions, how logistics and distance made everything far harder, and about the breadth of the work they do – everything from complex and chronic conditions to acute emergencies like car accidents and heart attacks.
 
‘Sometimes I lament about the wait to get a non-GP specialist appointment in Brisbane or difficulty accessing an MRI, but this was a whole different level and certainly put some of the challenges I see in city practice into perspective,’ Dr de Lange said.
 
‘What do you do when the nearest X-ray is hundreds of kilometres away?’
 
At night, Dr de Lange read her book, The Moment of Lift by Melinda Gates. One line in particular jumped out at her – advice Gates was given about working with people from different cultural backgrounds. 
 
‘The advice was: “Their cup is not empty. You can’t just pour your ideas into it. Their cup is already full, so you have to understand what is in their cup,’ she said.
 
‘Gates goes onto write: “If you don’t understand the meaning and beliefs behind a community’s practices, you won’t present your ideas in the context of their values and concerns, and people won’t hear you.”’
 
Dr de Lange left the camp, still thinking about the quote.
 
‘It sums things up nicely. I cannot simply take my ideas and impose them on somebody else. Their lives are already full with values, perceptions and history,’ she said.
 
‘Yes, patients learn from us. I see a big part of my role as a GP as teaching health literacy and helping patients drive their health rather than being a passenger. ‘But, to me, that quote turns the idea of doctor as expert on its head. Patients learn from us but we are always learning from them. The experiences and stories that they bring into the consult room is crucial to helping us grow as practitioners.
 
‘And that means that, hopefully, I can do a better job as their GP.’

Aboriginal and Torres Strait Islander indigenous health Northern Territory