Gudbinji Chronic Disease program

The prevalence of chronic disease amongst Indigenous Australians is significantly greater than that of non-Indigenous Australians, such that the life expectancy of Indigenous Australians is almost 20 years less than that of non-Indigenous Australian.

Chronic disease is a relatively broad term, but the Australian Institute of Health and Welfare provides the following list of elements in defining:

• have complex and multiple causes
• usually have a gradual onset, although they can have sudden onset and acute stages
• occur across the life-cycle, although they become more prevalent with older age
• can compromise quality of life through physical limitations and disability
• are long term and persistent, leading to a gradual deterioration of health
• while usually not immediately life threatening, they are the most common and leading cause of premature death.

Generally, there is no definite cure for chronic diseases.

Understanding this, and with funding provided by the Federal Government through the Office for Aboriginal and Torres Strait Islander Health as part of the ‘Healthy for Life’ initiative, we have established a dedicated Chronic Disease Program.

The Program is currently staffed by a Chronic Disease Coordinator, a Registered Nurse, two Aboriginal Health Workers, and an Administration Officer, and is provided with support from visiting Wurli Doctors and Wurli’s Health Promotion Coordinator.

It is important to note that a number of major chronic diseases are preventable or able to have their onset delayed, while others, which may not be currently preventable, can have their progression slowed and associated risks reduced. To achieve such outcomes, there needs to be an increased understanding of the risk factors for chronic disease, including poor health in early childhood, smoking, alcohol and substance misuse, poor diet and nutrition, physical inactivity, excess weight, high blood pressure, and high blood cholesterol.

For this reason, the Program places enormous emphasis on developing preventative strategies revolving around health promotion and education.

Early detection strategies are also emphasised by the Program, and well-persons health checks play a large role in this. They are conducted at various levels. At an individual level, all clinical staff take the opportunity to undertake the well-persons check as clients visit the clinic or one of the program areas. At a population level, planned screening days target groups that are deemed to be at higher risk, with checks undertaken within the community as appropriate.

Obviously, there are those who have already been diagnosed as having a chronic disease, and these individuals need to be managed. To this end, care plans are developed, tailored to individual requirements.

An important aspect of the Program is the Patient Information Recall System, which assists in ensuring that clients are provided with the follow up treatment as required.

Rheumatic Heart Disease

Rheumatic heart disease is another condition with an especially high prevalence amongst Aboriginal people, children in particular, and is the result of complications stemming from untreated rheumatic fever. It is characterised by damage to the structures of the heart, including valves, lining, and muscle.

Rheumatic heart disease is potentially fatal, and is incurable. However, treatment can manage the symptoms and reduce the risk of complications.

Again as part of the clinic, and in conjunction with the Northern Territory’s Centre for Disease Control who maintain the Rheumatic Heart Disease register, we manage those clients with notifiable rheumatic fever.

Primarily, this involves preventing further ‘bouts; of rheumatic fever through antibiotic therapy.

Using the Register, the rheumatic fever Aboriginal Health Worker ensures that clients continue to receive this therapy at the appropriate frequency, and as necessary, will work with transport staff to ensure that access to the clinic is not an impediment to treatment.

Education also plays a large part of the Aboriginal Health Worker’s role, as we try to make people aware of the risks of rheumatic fever, and of the importance of having ‘strep’ infections (‘strep’ refers to the Group A streptococcus bacterium which can cause rheumatic fever) treated as early as possible.

Diabetes Day

The D Day program has been running every Thursday since July 2008 at Gudbinji—Wurli's feeling better place. It aims to improve the well being of clients with type 2 diabetes through a supportive environment that promotes self-management and provides comprehensive care.

When clients arrive at around 8.30am they go through the following stations:

• registration with our Receptionist
• self-assessment of blood sugar level, blood pressure, weight and waist circumference to make a record in their personal diabetes diary
• healthy cooking session
• education session, a 12-week education program
• care by an Aboriginal Health Worker and a Doctor. Referral to specialists and allied health services
• shared lunch, DVD watching, book reading, informal social interactions
• transport services available until 4.00pm.

The program was formally evaluated in September 2011 and we have found that D Day has significantly improved social and emotional wellbeing outcomes and clinical outcomes.

Heart Day

H Day was inspired by the success of the D Day model and has been running every Friday since August 2011. It aims to improve the well being of clients with cardiovascular conditions like ischaemic heart disease, heart failure, rheumatic heart disease, cerebrovascular disease and cardiovascular risk factors such as high blood pressure, dyslipidaemia, obesity and large waist circumference.

Clients also engage in self-assessment, healthy cooking, a 10-week education program, medical care and social interactions through lunchtime.

Women’s Exercise Class

The chronic disease program has been offering physical activity sessions to women since 2009 every Wednesday from 9.30 to 10.30am. Transport services are available.