IWD: Inspiring hope, one patient at a time

Even after the COVID-19 pandemic was declared in 2020, little was known about the novel virus. But the concern for society’s most vulnerable communities was instant, with regions highly populated by Aboriginal and Torres Strait Islander people topping the list in Australia.
 
So, when a safe and effective vaccine became available some 18 months later, the healthcare sector breathed a sigh of relief.
 
Unfortunately, they now had a new challenge on their hands; while community-informed efforts had proved largely effective at keeping the virus out, the spread of misinformation was a harder beast to control.
 
As the vaccines started to arrive in the Warmun and Kalumburu communities via the Royal Flying Doctors Services, GP Dr Catherine Engelke, a Gija woman, instinctively knew the strategy needed to be more nuanced.
 
‘There was a lot of fear because of misinformation, because of mischief and also because we really hadn’t provided any education in regard to what the vaccines were like,’ Dr Engelke told newsGP.
 
‘So I basically said to them you’re not going to be able to vaccinate this community without one of the doctors coming down.
 
‘You may have visited their community a couple of times [but] there is true fear about this; they need to have someone there that they know and trust.’
 
Dr Engelke has both a personal and professional connection with the communities in north-west Australia.
 
She was born in Derby and raised in Halls Creek, less than four hours’ drive south of her current home in Kununurra – a relative stone’s throw away in a state that would be the 10th largest country in the world if it were an independent nation.
 
And as a member of the Western Australian Country Health Service (WACHS) and the lead medical educator for the Rural Clinical School, she automatically put her hand up to visit the remote Aboriginal communities to try and promote vaccine uptake.
 
The response was near instantaneous.
 
Once word got out that Dr Engelke would be on site, community members started to turn up to the vaccination clinic in droves, with staff from the Kimberley Public Health Unit managing to vaccinate more than 83% of the community in two-and-a-half days.
 
‘I have to say, I don’t think I’ve worked anywhere near as hard as those two days to get the community vaccinated,’ she said.
 
The success Dr Engelke has had directly contrasts with the wider Derby-West Kimberly area, which still has the lowest rates of double-dose vaccination in the country, raising the question – what made her approach so effective?
 
Aside from having an established relationship and firsthand understanding of the communities as an Aboriginal woman herself, she says the key was bridging the cultural gap.
 
This meant finding a way to communicate a complicated process in a way they could understand.
 
‘I had a bit of a spiel,’ Dr Engelke said.
 
‘I basically said the vaccine is like a photo, and that there’s some really smart people that have had a look at COVID and because the virus changes shape all the time, they found the bit that stays the same and then they put that bit into this COVID vaccine.
 
‘So your body’s army is a thing that’s going to protect us; it’s strong and it’s smart, but the problem is it’s never seen COVID before, and the vaccine is going to allow our immune system to check it out, to see it, and get used to it.
 
‘And the reason we’re giving one needle now and one in three weeks’ time is we need to remind our immune system; it needs to be sharp, it needs to be ready, it needs to be strong, and it needs to keep looking out for this virus – and when it comes, it needs to give it the biggest hiding and get rid of it before the COVID virus gives our body a hiding.’
 
The response was telling.
 
‘They were like, “Well why didn’t anyone tell us this?” The majority of people, once they came to the clinic and heard that, all signed up and were vaccinated,’ she said.
 
‘Those that weren’t vaccinated weren’t coming to the clinic, and they often had religious influences rather than fear of the vaccine. That’s taken some time to address, which we’ve got around.’
 
Dr Engelke’s approach is one that aims to empower the patient with knowledge to make the right decision for themselves, their family and community.
 
The Kununurra-based GP has played a leading role in the long-term efforts in the region to improve health literacy, and says it is important to recognise people’s capability to make decisions for their own health.   
 
‘I don’t practice paternalism,’ she said.
 
‘Being told, “This is what you’ll do because I’m the doctor and I know best” has long gone; that doesn’t exist now in medicine – and if it does, it shouldn’t. Our patients need to make the decisions.
 
‘With COVID it’s no different. Some people were being told “If you don’t have the vaccine you’ll die” and Aboriginal people were saying “Well, we’re all going to die. I want to make the decision whether this is right for my body – how does it work?”.’


The Kimberly has one of the lowest COVID vaccination rates in the country, but Dr Catherine Engelke has used her local knowledge and connections to make a difference. (Image: AAP) 

For Dr Engelke this work is not just a professional duty, but an undertaking close to her heart, as she sees herself and the community as one.
 
A trained nurse and midwife, it was when her two daughters were aged just 10 months and two-and-a-half-years-old that she decided together with her husband to move from Kununurra to Perth to study medicine.
 
Dr Engelke says she refrained from telling many people the real reason for her move because of an underlying sense of self-doubt that she struggled to shake.
 
But the thought of one day having to admit to her daughters that she held herself back from following her dreams was too much to bear.
 
‘I was concerned they would one day ask me “Mum, did you always want to be a nurse and a midwife?” And being honest, I would have had to say to them “No, I wanted to be a doctor, but for whatever reason it didn’t happen for me. But you follow your dreams”,’ Dr Engelke said.
 
‘Then they could turn around to me and say, “But mum, you didn’t” – and I was never going to be able to defend that.
 
‘So I decided that I would go as far as I could. And not only did I follow my dream, I achieved it and I have to say that I’m doing what I love and I’m working with the communities that have been instrumental in my life.’
 
Her daughters, now aged 21 and 19, have gone on to study biomedical science and medicine – career paths she insists they have carved out for themselves with ‘no pressure from me’.
 
But beyond inspiring her own children, for Dr Engelke the end goal was always on a community scale; she was committed to returning to her roots, where she could care for not only for people’s health, but be a role model.
 
‘From time to time I’ll have a mother in the clinic who will say “Gee, these kids’ve been naughty; they won’t take their medicine and now they all won’t go to school”. And I say, “You know babies, you need to go to school; it’s really important, you learn from school and then you can be like me”,’ she said.
 
‘And their mother will smile and say “Yeah, you didn’t know hey? This is Dr Catherine; she went to school in Halls Creek with me”.
 
‘Then they look at me in complete disbelief, and I say, “That’s right baby; I went to school with mum, and I stayed at school, and I worked really hard, and I went and became a doctor – and you too can do that”.
 
‘And you can see that it then changes, and it becomes possible.’
 
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Aboriginal and Torres Strait Islander health International Women's Day