” In Barunga NT where high-risk pregnancies are on the rise, Aboriginal health practitioners (AHPs) like Desleigh Shields are in high demand.
Acting as a translator between doctor and patient and using her hard-earned medical training and insights from growing up on country, Ms Shields is at the forefront of an immense health battle gripping Aboriginal communities.
That battle is chronic disease, and in communities like Barunga, AHPs of Ms Shields’s calibre are critical to the cause.
Ms Shields has taken up the fight with her mother, Joanne Berry, (pictured below ) who has been an AHP in Barunga for over 30 years.
But as Ms Berry has witnessed pregnancies become increasingly complicated due to chronic disease in the town, she says she is still seeing women miss vital scans during pregnancy. “
- There has been a 52 per cent increase in young Aboriginal people with gestational and pre-existing diabetes in the NT over the last four years
- Aboriginal women are three times less likely to go to a clinic for their first antenatal visit to detect diseases
- Medical professionals say Indigenous healthcare workers are key to helping pregnant women attend clinics for their scans
Concerningly for AHPs like Ms Shields and Ms Berry, cultural stigmas attached to health clinics can often lead to women missing such scans.
“For teenagers, sometimes it’s a shame job, ashamed of coming to the clinic,” Ms Berry said.
According to a Menzies School of Health Research study in 2018, Aboriginal women in the Territory are three times less likely to go to a clinic for their first antenatal visit before the required 14-week mark to detect diseases like diabetes.
But without more AHPs providing comfort, communication and expertise in Aboriginal communities, professionals like Ms Berry and Ms Shields remain undermanned in their fight.
Aboriginal Health Workers and the link to healthy communities
On the ground in Barunga, front-line health professionals are lamenting a lack of funding and support for AHPs, who face critical barriers such as a lack of housing and professional development opportunities.
Some professionals are even linking the lack of housing options for AHPs directly to health outcomes for pregnant women in communities.
Bill Palmer, the acting chief executive of Sunrise Health, which runs Barunga’s health clinic, said many AHPs want to upskill, but “the pathways to having that happen are not clear”.
Mr Palmer said AHPs were not afforded the same provisions as police officers or doctors, and therefore struggle with accommodation when working in remote locations.
But the work of AHPs like Ms Shields and Ms Berry has not gone unrewarded.
According to Menzies Health, there was a significant improvement in antenatal visits during the first 14 weeks of pregnancy among Aboriginal women — from 36 per cent to 50 per cent — between 2001 and 2012.
Communities losing their loved ones
The rise of intergenerational type 2 diabates in Aboriginal communities presents a daunting challenge for AHPs.
In the town of Ampilatwatja, about 320 kilometres north of Alice Springs, 50 per cent of the community’s population of 500 are estimated to have diabetes.
The malignant form of type 2 diabetes prevalent in the town can lead to amputated limbs, poor life expectancy and end-stage kidney disease requiring dialysis.
The community’s battle is an example of what Menzies Health diabetes researcher Louise Maple-Brown says is a growing problem in the Northern Territory.
Professor Maple-Brown, who is also the head of Royal Darwin Hospital’s endocrinology department, said one in five Aboriginal women in the Territory have gestational or pre-existing type 2 diabetes during pregnancy.
“Those [type 2] rates were 10 times higher in Aboriginal women than non-Aboriginal women in the Territory in 2016,” Professor Maple-Brown said.
She said intergenerational diabetes was on the rise because a mother’s in-utero environment contributed to a higher risk of obesity or diabetes in their baby, which led to early onset of the disease as the child grew up.
If that child is a female, she’ll then carry that diabetes during her own pregnancy and pass on the same risks, Professor Maple-Brown said.
What is type 2 diabetes?
- It occurs when the pancreas doesn’t produce enough insulin or is ineffective
- 90 per cent of diabetics have type 2
- It is caused by a combination of genetic and lifestyle factors
- There is no cure but it can be managed through medication and treatment
- It usually affects adults but there’s been a rise in cases in children
- The condition can lead to cardiovascular disease, blindness, kidney failure and foot neuropathy
- Type 2 diabetes can double the risk of death
For more information visit the Diabetes Australia website
“In the last four years in the Northern Territory we’ve seen a 52 per cent increase in young Aboriginal people with diabetes in the age group of 15 to 25 years,” she said.
“So we’re particularly focusing on working with that group to improve care,” she said.
Professor Maple-Brown said AHPs were critical to improving care through ensuring pregnant women attend clinics for their scans.
“Strengthening the Aboriginal community-based workforce is a key priority for many health services in the Northern Territory,” she said.