Young Doctors
Knowledge Circle Practice Profiles

Overview

Practice focus

Health improvement by training young Aboriginal people as Young Doctors – delivered by Elders and respected local leaders - with a contemporary understanding of health and health leadership and engaging in activities that honour traditional understandings.

Delivered by

The program is an intensive community self-support service delivered by the Malpa Project involving the whole community. It is delivered principally for Aboriginal and Torres Strait Islanders but where appropriate involves non-Indigenous young people.

http://www.malpa.org.au/

Service type

The program is an intensive community self-support service delivered by the Malpa Project involving the whole community. It is delivered principally for Aboriginal and Torres Strait Islanders but where appropriate involves non-Indigenous young people.

Location(s)

Rural townships, remote town camps and urban environments, including: Utopia, Alice Springs Town Camps, Bellbrook, Aldavilla, South Kempsey, Barrack Heights, Broadmeadows and others.

Description

The program aims to assist Aboriginal people to take control of their own health by using traditional approaches to holistic medicine combined with modern medicine. Specifically, the goal is to grow young leaders – “health ambassadors”, strengthen communities, create employment and create employment pathways.

The need for the service emerged from a combination of first hand experiences in communities and town camps and the appalling health status of children.

As the flagship initiative of the Malpa Project, Young Doctors brings together young Aboriginal children (7 to 10 year olds) who are chosen by Elders, traditional healers and local leaders for their attitude and aptitude to understand and deliver health interventions. These Young Doctors are trained in the broad principles of western medicine and also learn traditional medicines and understandings by spending time on Country with Elders.

The Young Doctors learn about leadership, personal hygiene (including regular washing, cleaning noses, hand hygiene, wearing clean clothes) environmental health (keeping the house clean and keeping the community clean), nutrition and health literacy. They are then tasked with looking after others in their community.

Independent research has shown that these simple techniques can significantly improve primary health outcomes and address longer term chronic health problems.

The Young Doctor model is based on a combination of the evidence-based UNICEF Child Doctor projects operating in Nepal, Indonesia and India but with traditional Aboriginal modalities of delivering health.

Every Project uses local language. Projects include Dhalayi Doctors (Dunghutti Country around Kempsey) Kurdu Kurdu Doctors (Warlpiri Country) and Umbarkalya Doctors (around Utopia).

Resourcing

The Young Doctors program is a Deductible Gift Recipient (DGR) charity where all donations over $2 are tax deductible. Funding and support for the program is also sourced from other charities, private donations and corporate organisations.

Practice

MOST promising aspect

The heavy emphasis on community consultation in developing and implementing the project has powerfully engaged Indigenous people in every location where Malpa operates. In this sense, every aspect of the program is promising because it proactively responds to the self-identified needs of children, the Elders and the communities. The project builds the capacity of the staff to meet the needs of their community.

The program is culturally appropriate because it echoes the traditional way of selecting healers and is mainly delivered by local people.

Evidence base and opportunities

The Young Doctors program adopts a range of "best practice" principles, including:

  • the involvement of the community representatives to identify family and community need;
  • a collaborative approach to service delivery by sharing information and resources in communities;
  • using culturally specific materials to engage with participants;
  • spending time in building relationships within communities and establishing trust; and,
  • training staff who are committed to service delivery and ongoing improvement.

The project methodology has been identified by the Australian Red Cross as "best practice" and was given a NAIDOC award in 2013.

A feature of the Young Doctors program is its "graduated" approach to primary healthcare, where practical program activities are linked to the higher aim of improving the health of Aboriginal and Torres Strait Islander families and communities. In this sense, the initial focus to address chronic health problems like otitis media through the use of specific program activities has the potential to include a broader focus on child protection and welfare issues.

For the program to run effectively and regularly and with enough dedicated energy, local champions who are reliable, committed and good with children have been identified. Malpa has found such champions in Utopia, Bellbrook, Aldavilla, Kinchella, South Kempsey, Barrack Heights and Broadmeadows where further programs will take place 2014.

Cultural relevance

Involvement of Aboriginal and Torres Strait Islanders

The backbone of the program respects the importance of being culturally responsive in different ways in different places and is highly dependent on the authenticity of relationships with Aboriginal and Torres Strait Islander people.

The Project then supports Indigenous people as they become advocates to other communities about the project.

The projects are run entirely by a combination of Elders and local leaders. They devise and deliver the programs with the support of The Malpa Project team.

We have found that:

  • Elders and respected community members feel empowered by being in control of the content and delivery of the project; and,
  • the children quickly become pro-active in their community and bring about changes in their own health and that of their community.
Cultural practices and materials

The project draws from a range of Aboriginal cultural practices and materials in developing, implementing and delivering the program, including bush tucker, bush medicine and acknowledging the importance of Country in providing a successful response to health issues. Content is linked with the needs identified by the local leaders.

Cultural adaptability is central. For example, most of the people who were engaged to assist in developing the original program in Alice Springs, and all of the child participants were Warlpiri. The project was delivered on Arrente land. The deep significance and importance of Country was highlighted during a session which was near a sacred site and without permission from a Arrente people. The group felt uncomfortable and unsafe and felt restricted from talking about traditional ways in any sense. The presence of Arrente “spirits” made the group fear the Warlpiri children would be “stolen and taken into the rocks”. Once this was understood the Project was relocated to safe Country.

Evaluation

Evaluation status

The program has undergone an internal evaluation and the evaluation report is available on request. The next planned level of evaluation will be child- and community-led research. The young people themselves will decide what they want to know and who gets to own and see it. For an overview of the lessons learned from the evaluation and from implementing the program see the "replicability" section below.

Effectiveness

Demonstrated outcomes

In Utopia the Project employed two local leaders to train fifteen young people one afternoon a week for ten weeks to become Umbarkalya Doctors. The leaders actually trained thirty nine children every afternoon of the week for ten weeks.

In Bellbrook the Dhalayi Doctors became concerned at an outbreak of head lice in their school. With their leaders they made a medicine (approved by our consultant Doctor) and distributed it to the whole school community. In a short time no-one suffered from head lice. Then they became concerned about the incidence of conjunctivitis and enlisted the help of their school principal to have qualified medical people come and address the issue. This level of health leadership exceeded every expectation.

The enthusiastic involvement of Elders in every location testifies to the desirability of the approach and currently there is a high demand for the Project.

One school Principal was so pleased with the first group of fifteen Young Doctors that he has requested the project be available for every child in his school.

Other demonstrated outcomes of the internal evaluation or the instruments used were not detailed for this Promising Practice Profile. However, the anticipated short-term impacts of the program are listed as:

  • improved basic health and health literacy;
  • improved communication between Aboriginal people and clinicians;
  • an increase in notifications of ill-health;
  • improved self-respect;
  • improved understanding of tradition culture and medicine;
  • improved social coherence; and,
  • improved cultural resilience.

In the longer-term, the service is expected to lead to improved cultural resilience, improved basic health, decreased chronic ill health, decreased morbidity, "closing of the gap" and, opening career paths (one of our leaders had the Project as his first full-time job and as a result of his work was invited onto the local hospital Board).

Other evidence

The project in Dhungutti Country (Dhalayi Doctors) was filmed by the BBC for Euronews at the request of the Australian Red Cross who have committed to ongoing support for Malpa. Aboriginal people in NSW (six sites around Kempsey and Barrack Heights), the NT (Alice Springs town camps, Utopia) and Victoria (Broadmeadows) have committed to running further projects.

Replicability

Lessons learned from a combination of the evaluation and from implementing the program:

The Malpa Project’s Young Doctors was designed to be adaptable and replicable. The need to avoid a “one size fits all” approach was a lesson learned from so many other failed projects. The project is “bottom up”, not “top down” in every sense.

Young Doctors allows every community to develop the Project to suit its own cultural and health needs. It is responsive to the different levels of cultural understanding that exist in different locations. It puts local people in charge of design and implementation but fully supported by the central project team.

Currently a full suite of materials is being assembled for communities to use, adapt, add to or use as a basis for their particular location.

 

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