Annual health check for Aboriginal and Torres Strait Islander – podcast – Ngiare Brown part 2

This is the second part of a 2-part podcast hosted by Mayrah Sonter and featuring Dr Ngiare Brown talking about the benefits of a regular 715 health check.

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Announcer

Now, in part one of our two-part podcast, we talked through why it’s important to get a 715 health check, how to make an appointment and what to expect. Today, we’ll talk about what will happen at the physical examination. Let’s join host Mayrah Sonter, and Dr Ngaire Brown to talk about why your health is in your hands.

Mayrah Sonter

Well, thank you very much for joining us here in this podcast. My name is Mayrah Sonter, and I will be hosting today but also share some of my experience of having recently undertaken my first 715 Health Check. I can't believe I didn't know about it before. Now I'm 35, how come I didn't know about it? It's interesting to go through it and to find out that my sister actually has a 715 every year. Even within our own family, we weren't kind of all across it, but what we're here to talk about today is, the 715 from the perspective of a patient as well as a doctor. I'd like to introduce Dr. Ngiare Brown, who is one of the first identified Aboriginal medical graduates from New South Wales and one of the first Aboriginal doctors in Australia. Hi, Dr. Brown, how are you?

Ngiare Brown

Morning, thanks for thinking of me.

Mayrah Sonter

Of course, it was a no brainer

I think we've talked through all the various people that might come in and be with you potentially, and now you've gone through some of the initial things with the doctor, what about physical examination? Is the doctor going to want to ... Are they going to put something on your body? What do you call that thing?

Ngiare Brown

It's a [inaudible 00:39:52]

Mayrah Sonter

Tell us about the physical might entail?

Ngiare Brown

I think you've mentioned a couple of the sort of the non invasive kind of tests that we can do. Although in some services, they're done by nursing staff prior, so they're out of the way and they have a baseline on some of your vitals. Your blood pressure and your heart rate and your height and your weight and all that kind of fun stuff, maybe whizz in a jar, make sure there's no ketones or nitrates or red blood cells or glucose ... In some community controlled services, the Aboriginal health workers, they're more than capable of doing that.

They do some of the Front end screening whilst you're waiting for your consultation with the doc. But once you're in there, they'll probably check that stuff, make sure you still have a pulse, then, start with the hands, you want to make sure that there's no wounds or injuries or deformities or disabilities. We will look in your eyes and your ears and have a quick gander in your mouth and your teeth and we will literally just do a full and comprehensive physical clinical examination. Now we might focus on an area if you have said, "Well, look, I've had some abdo pain or my knee really hurts, or I've got a bit of a cough."

We can focus on that but as part of the 715, we should do a comprehensive assessment. Everything whether you're walking okay, to if your speech is alright, if your vision is okay, and we can do that. Not necessarily in with that doctor, but as part of that the service provision. Listen to your chest, your lungs, are you breathing? Listen to your heart, any moments, is it regular? Are you getting a good perfusion in your feet and your fingers. All the little things that we wouldn't necessarily think about on a day to day basis, as well as all of the big things like does your brain work, does your heart work, are your lungs working, is your belly ... Probably got to be more than I should.

All of your organs where they are and then of course, for blokes that will go on off on a slightly different tangent around genital sort of tract and for women this time you have sexual and reproductive health. Because, of course, we have delightful additional bits so we also need to be very aware of, and to take very good care of, and have assist on a regular basis.

Mayrah Sonter

I think you've talked that through really well. I suppose the other question that came into my mind during that was, as you've told your family history. My family has some breast cancer in it, I mentioned that as part of the discussion with the doctor, therefore, they gave me some extra information about screening for breast cancer and what you can do at home and gave me a pamphlet. It's an opportunity to learn, it's not just to come in and be checked. But it's your duty to find out more about how your body works, what you can do to fine tune to make sure it's ready to rock and roll out there. It was interesting to get that sort of information.

Ngiare Brown

Absolutely and I think that's fantastic. The notion like I said, they can then focus some of the exam, and the feedback and information they provide to you, or any suggestions to additional referral and assessment is important dependent upon age risk factor. Have you been doing sort of your breasts off examinations? Have you found anything? Has anything changed? If it has, off you go and we'll do this. Maybe I'm going to call them boobagrams, but they're mammograms, blah, blah, blah.

And also, it's fantastic for tailoring that relationship and that responsive feedback and the health planning, which you're entitled to at the end of the consultation investigation, sort of a record of what the health plan is. You get to negotiate that and contribute to what that looks like. But also, if you said for example, "Yeah, but I'm smoking a packet a day at the moment, and I really want to cut down. I'm not quite sure what strategies or what I should do." Then we should be able to step in with brief interventions, and at least starting the journey to support you to change some of your health habits and to reduce some of your risk factors.

Mayrah Sonter

We've talked about well being and that Aboriginal Torres Strait on people, they're at the forefront of that. Lovely to hear, I hadn't thought of it like that before. That's a good new, positive way to look at our health more generally. But also mental health is a big issue in our community. Being able to talk about what might be worrying you, what's stressing you out, how you're feeling about things, that's not always easy. Some people don't like to talk about their feelings, but it really does help to share with your doctor, some of those concerns. They're not going to share it with anyone, and they might be able to pick up on a few things and help you through that. Can you tell us a little bit about mental health and why that's important to share?

Ngiare Brown

I will absolutely. And just from a baseline sort of perspective, and I work with kids affected by trauma. In fact, there is so much of what we experience now that is deeply rooted in both historical and contemporary disconnection and policy that was meant to basically fight us out. We're still feeling and living the repercussions and impacts of that intergenerational transmission, so there's that. It manifests itself in our behaviour and our mental health and well being and particularly I see it in our young ones, because the connection to culture and positive cultural practises has been made very tenuous or disconnected entirely or ruptured in some instances.

So identity, connectedness, resilience, and strength that would ordinarily sit around all of that. They're unsure, and they don't know where they fit and they struggle with that particularly in their adolescent years. And that then translates across early adulthood and the trajectory of their life course, for example, and manifests as mental health issues and substance abuse. And the notion that we have so many of our people incarcerated, that's not who we are. The more willing and able that we are to speak about mental health and social emotional well being issues, to find health providers that are willing and able to have those conversations, to bring us into their confidence and to help us on that journey, I think it's extraordinarily important.

And the more open we are to having those conversations with a provider and someone we trust, but also amongst ourselves, and within our communities to say, "Look, you're not the only one, here's how we can begin to create positive change for ourselves and others." I think addressing the mental health issues will be extraordinarily important and the opportunity to then change outcomes, not just for individuals, but families and communities is extraordinary. It's not a conversation that we're very good at in Australia, we're trying to get better. But I think a culturally competent, sensitive and appropriate service will get that for Aboriginal and Torres Strait on peoples.

Cultural competence isn't about understanding Aboriginal people, it's about understanding your own cultural background irrespective of where you're from, in order to be able to better connect with the people that come to see you. Put their trust in you that you can assist and support them then to be well across all aspects of their health and the better we get at, the mental health conversation, the more quickly we will be able to point that trajectory in a positive direction.

Mayrah Sonter

You've summarised that really well. It's quite a complex issue that basically talks about it [crosstalk 00:47:10]

Ngiare Brown

It's long-winded version to talk about it.

Mayrah Sonter

That's good. That's why we're interviewing a doctor from your perspective, and your expertise, treating lots of patients and understanding all of that in all it's complexities, that's how it's been captured and that's why it's really important that as a patient, you find the doctor that you feel comfortable with, so that you can have those conversations. Because that's just going to not only help you but your family and the community more broadly. Would there be questions around sexual health?

Ngiare Brown

Yes, there are always questions around sexual health. Some people are just confident enough to have that conversation with anybody and that's fantastic. I also, to be honest, I know that there will be lots of mob who don't want to have those conversations with practitioners that they don't know, or they might not want to use certain services because of family connections, and concerns about confidentiality.

Mayrah Sonter

Now, everyone at AMS, I know everyone there, shame drop, I'm going in that kind of stuff.

Ngiare Brown

Look, that's okay, that's your personal perspective and that should be valued and acknowledged. But then we should have support and assistance to find an appropriate provider, don't ignore it, or don't have it addressed because you feel a bit of shame about going to a certain service or an individual, because they're important. Because a lot of this stuff around sexual and reproductive health, we might not have symptoms, we might not be able to see some things that's abnormal. You might not necessarily get pain, there might not be something that you can see but there's stuff going on that could significantly impact not only your health, but the health of others.

Or it could be that it can impair your ability to have children of your own in the future. If there's something that's concerning you, then you need to work out the courage to find someone that will help you and then take someone with you, that can be your support. Your mom or a sister or an aunt or another female friend, or you find a practise that is specifically focused on that because I can also address other issues within the 715 but with a focus on your sexual and reproductive health, whether you're male or female. But don't put it off because you're a bit shame about talking about the things that should not be mentioned.

Mayrah Sonter

I like how you call them delightful bits. You should put that on post card.

Ngiare Brown

Talk about your delightful bits today.

Mayrah Sonter

You've also not mentioned the kind of summary of all of that is, that it's going to be health action plan with referrals. It's basically a fact finding mission for the doctor, you're telling all this information and the doctor is processing and getting as much information as possible to kind of give you a bit of a diagnosis or a bit of, you're in great health or well done on these bits. I always ask lots of questions. What does that mean? And has along the way through, 'cause the more you know, the more you're informed to make better decisions, as you've said. with that kind of health action plan and referrals, and then the referrals are coming back is the extra part of that as well. What's your experience with health action plans and referrals?

Ngiare Brown

I love the notion, and we always talk about it in Aboriginal affairs, but the notion of self determination, that should extend to every aspect of our life, our work, how we function, and it's the same with your health. Your doc might take all of this information on board now then say, "Well, okay, these issues have popped up today, let's prioritise some of those." Yes, it might be that your blood pressures too high, or you're due for a pap smear, or there's something else where you're not following ... There's something else going on. You prioritise that in conversation with your doc.

And they'll go, ‘Okay.’ For issue number one, here are the things that I think that we should do, here's some of the referrals and get on to that and for issue two, and issue three, for example. And then if you are provided with a referral to another service provider that might be within that same practise, or it might be somewhere else, you need to speak to a diabetes educator or a podiatrist, to get your eyes or your teeth done. Then sometimes, particularly for community controlled services that are quite comprehensive, they'll be co located, which is a bonus. Something about your sexy health, then they'll often have those staff that are available in Aboriginal health workers that are trying that are fantastic.

But if not, and they're offside or there at another service, then information from that referral, that consultation and examination and any other investigations will then come back to your referring doctor, so they have that info, and then they will make that available to you. Now sometimes they'll say, "Okay," when you've have that done make an appointment to come back and see and identify that it's a follow up for these particular issues and we'll book you in. Or if something's going to be urgent, they might get the staff to give you a call and say, "Dr. Smith, just had some results someone wants to have a yard can we get you in this afternoon to talk about that, or tomorrow or whatever? Or it might just be in a timely manner, when next time you have availability to come back and just make sure everything's fine.

That way, there is a bit of pathway for continuity of care and again, sort of that loop the strengthening the relationship. Having the information available, so that then you can negotiate. Okay, well, what are the next steps in? We have this information, it's been enhanced by this information from a specialist. And how does that thing fade into the overall story for you, and then how do we move forward.

Mayrah Sonter

I've been nerdy, and I'm sure most people are like that. I did get a referral for blood tests, but it was one of those blood tests where you have to not eat for eight hours before or 12 hours, whatever it is. I couldn't go straight ahead and get it done and it took me ages to get in and decide the time to even go and get the first kind of 715. But I still need to go and get the blood test eight o'clock in the morning sometime. And then those tests needs to come back, and then I need to go back. So that kind of loop and that continuity of care, doesn't just sit with the doctor, I put my hand up and saying I need to still go and do that.

It's my health that's a priority to me. I need to make sure that I follow up with that and come back. But the health professionals can assist with that in other ways to sending out reminders or phoning up et cetera. You really have to self advocate, self determination phase and looking after your health. Are there any tips that you would give to people about making sure that they follow up and do the things that the doctor's saying come back when you're supposed to?

Ngiare Brown

Yeah, I'm not quite sure if you know our tips are ever kind adhered to, but you're quite right. There's obviously a certain degree of responsibility that we fail to at least nudge our patients towards doing the things that we've both agreed to you doing yes. They say, "We're not making you, we can't make you." But the notion that you're, "Okay, I have to make this a priority for me, and I will get it done in a timely manner." We know people are busy, and they have multiple responsibilities however, the conversation I always have with people and I'm the worst at this is well, I mean, seriously. But if you are not well, then you are no used to anybody else.

If you become unwell or things spiral out of control, and you haven't done any, you've taken any of the steps that you agreed to in the first instance, as much as a provider can remind you or try to help you organise another meeting or call and say if you had that done yet. The bottom line is those particular aspects are on you and if you don't do it for yourself, then who will do it for you. And remember that of all the other responsibilities that exists in your life, children, parents, social responsibilities, employment, whatever else, then they won't happen if you're not there. You need to make your own health and well being a priority, and very few of us do.

Mayrah Sonter

We also need to encourage others to look after their health as well, as women in the family are often the ones that kind of check in on everyone make sure they're getting their health check kids, the dentist, all that kind of stuff. A part of this is making sure I wish my sister had said, "Are you getting yourself 715?" I would love to say not only individuals looking after their health, but making sure that their family members, friends are getting their health tested as well. If we all do that, I'm positive that, that will uplift the health in our communities.

Ngiare Brown

Absolutely positive role modelling and sort of mentoring in that space is incredibly important. And if you say, "Well, you should have this done, or have you done at all? No, not yet 'cause I haven't even began." Well, it doesn't send the same sort of message as, oh yeah, absolutely. I've done this every year at this time, or I've had that done and I've had the blood test, came back really quickly. It was painless, great advice from my doc. I really recommend that you do it, and that kind of positive reinforcement without the nagging. And I know it's a fine line and I sometimes don't know the difference between encouragement and nagging. But we also then have to be positive role models around health and well being practise.

Mayrah Sonter

And now some people may have some ongoing health care that's going to be required, so that's kind of the process that we talked through for everyone mobile days at 715. Some people will find things that they need to go and get other things taken care of. What my ongoing care look like for some particular patients, based from your experience?

Ngiare Brown

Now that's going to depend on what the health issue is, of course. It might be high blood pressure that requires maybe some non medication related intervention in the first instance. A bit of weight loss, a bit of exercise, be careful about what you eat and drink through to getting to know this is, pop a vessel if you actually don't address this immediately. And then how do we manage that with specialist care and with medication. You need to have that, monitored and managed in an ongoing manner. But it's really the case that we have certain things in isolation, the older that we get. We often get stuff in clusters.

We have concerns about diabetes, and cardiovascular disease and renal disease all together because they're quite interconnected from a systems perspective. How do we address complex physical issues, that may be paired with a physical disability, for example? How do we manage complex needs? And that can be done by your provider being your point of call for some of that facilitation, and coordination across a variety of health needs. But it's a lifelong journey, and we can't anticipate that, that stuff will be answered within a month or two.

And so being willing then not to be reliant upon a health provider, but again, the relationship within negotiation and taking responsibility for how I can then change my trajectory for this, and these chronic diseases. And there will be other things that are associated with that. And the impact is on family, environment, work, education, all of that. We have so many of our older people with complex needs. We have younger people with kids involved in their care, and we're losing our human capital, if that makes sense. If we are better connected to our health providers, and to our health services, less reliant upon communities and families to bear that burden right, then they'll be free to then get on with their own things in the context of community well being, that's kind of a random answer.

But we tend to think of things in isolation, and they're absolutely not. You have a system that is equipped to care for you and to meet your needs, we just need to have some of that facilitated and negotiated for us and your relationships and starting with the 715s is a really good starting point.

Mayrah Sonter

What are some of the ongoing benefits to having a health assessment every year?

Ngiare Brown

I like to focus on the positives and so knowing then that perhaps you're either maintaining or improving on some of your metrics. Your blood pressure might be getting better, you might have lost a bit of weight, you might be a bit more active, you can do more stuff with the kids, for example. You've stopped smoking or you've reduced your reliance on certain medications. And then within yourself, your issues around your social and emotional well being will improve. That way, if you're having regular checkups, this might sound a bit facetious. But doing a beep test, for example, it's actually a metric against which you know, you're improving or not.

If you're having a health check every year, and having everything come back better, improved positive, you go, ‘Yes, I'm maintaining my well being or I've made this better, because I've put in the effort.’ And being able to celebrate those successes, I think we underestimate the power of that. You can have little competitions within your family. My hubby had a weight loss competition with his father and his brothers-in-law. They gave themselves a finite period of time, yep whoever loses the most weight 'cause they all had big, big guts, got to love them.

Whoever loses the most weight and has the best sort of health metrics at this particular point in time, wins whatever it was that they wanted, probably cash. It's always a great incentive. But we can do that for ourselves and for those close to us every year, and then you know how you're tracking. Or it also means that you pick up things earlier than if you weren't having a regular check, something might be going awry, your blood pressure might be getting worse, your renal function might be getting worse. There might be a mass in your abdomen, for example or your vision may be failing and not just age related, which we all have. If you're having regular checkups, you catch it early and therefore you can intervene early. And then you prevent the progression and or mitigate all of the negative impacts that would come with that, had you not had that health check in a timely manner.

Mayrah Sonter

You got to get it every-

Ngiare Brown

Go and do it.

Mayrah Sonter

Go and do it.

Ngiare Brown

I'm doing it for my birthday every year.

Mayrah Sonter

This is not nagging this is very informative, so I'm just letting you know, you're sitting on that one. Can you give an example ... We're almost done. Thank you very much for sharing your time.

Ngiare Brown

We've only had a coffee.

Mayrah Sonter

You got a large one too. Can you give an example of where a patient 715 checkup has revealed an underlying health illness that maybe wouldn't have been found if they hadn't come in for it? Got an example of that in your history, maybe not.

Ngiare Brown

Well I do. It's very close to home though.

Mayrah Sonter

You don't have to.

Ngiare Brown

No, look, I'm happy to and I should actually. We touched on a very briefly earlier this morning, but I decided because earlier this year I turned 50. It's my year of being 50 and fabulous, that I should actually start having regular health checks. Particularly the woman's parts of that. As part of that, we discovered that I did have a health issue that I needed a major surgical procedure for. Fix now, I'll be better, and I'll be great.

Mayrah Sonter

Back to the theory.

Ngiare Brown

Back to the things that I really love doing like being with my children, being active, and being a sort of a positive example, in that sense, and go back to swimming and outrigger paddling and all of those things. But if I hadn't gone for that health check, it would have missed completely and I probably would have deteriorated to the point of a certain degree of incapacity before I did anything about it.

Mayrah Sonter

so lucky you had it early.

Ngiare Brown

Very much so.

Mayrah Sonter

And you are certainly 50 and fabulous. You continue to have a good year now-

Ngiare Brown

I made it an entire year not just to die but entire year.

Mayrah Sonter

That makes sense and whilst were sharing during my 715, talking about the blood test, I'm at risk of diabetes within the family, so that's why I really had to go and have that blood test, but I have stopped drinking this year, totally. Three months in, and that's really awkward one because people come, "Why are you not drinking?" Like it's a weird thing, instead of a, "Hey, that's really great that you haven't had any alcohol all year." But it's just one of the things I can do to try and reverse the negative effects of diabetes and other things and losing weight. And so that kind of first definitive month five that before intervening from any medicine. It's just like, let's get the weight down, let's get active more, let's eat better, let's stop drinking, kind of that's a part of it. I'm really privately proud of it and having to deal with a lot of people's kind of pressure to why are you drinking instead of a, that's awesome.

Ngiare Brown

I know isn't that interesting in this day, and we talk about this generally not just for Aboriginal mom, but it's a social norm, that we are big drinkers in Australia. In fact, that's not something we should celebrate or be proud of. It's something we should be way more considerate of and sort of change those expectations and social norms. I don't drink and I stopped when we decided that we wanted to try to have a family and have munchkins and I've just never gotten back into it. But yeah, I don't often say it out loud, because then of course, people want you to explain yourself and I feel no responsibility to explain myself.

I just don't, maybe I'll have half a glass of Crisma or something like that. But it's just not something that bothers me and it's not something that I do. It might have been all right once upon a time when I was young and fabulous. Now I'm old and fabulous, and it just doesn't sit so well. But that's a personal choice, and you should be empowered by your personal choices, and supported and celebrated for taking those positive steps which are often outside of the expectation of the social box.

Mayrah Sonter

And that's important to talk about it, I think. Thank you for sharing, we're all being vulnerable and having to talk about our health more broadly. If we're going to change the conversation, make our communities happy, we've got to talk about it. I hope this encourages more people to go and get their health checked. Final tips that you think that people don't listen about health and just general tips from a doctor. While we are here we would love to get your general advice on looking after your health please.

Ngiare Brown

Oh dearie me, says she who's only just started doing things herself. But not feeling selfish if you want to put your health first, particularly if you're concerned about certain things. Now, if you're otherwise were an active and on top of your game, then that's great. And it's not normally something you would think about, apart from say, just going to a physio or having your sexual and reproductive health checks done and that's fantastic as well. But always think about putting your health first in the context of where you are in your life. And who else is around you at that particular time, because they're also part of that, and they want to see you be your best and do your best. That's super important and don't ever feel that that's selfish. It's actually essential. 'Cause like I said, if you're not well, you're useless, so there's that.

And then the good things are usually the hardest to do and then to stick to, but it takes perseverance. The notion that even if it's walking up the flight of stairs, instead of taking a lift or the escalator then fine, then do that. Spend more time outside with the kids doing things that they love, I think that's important. Being engaged socially and culturally, because we know and we have evidence that, that is the stuff that improves health outcomes. It takes no medication, it takes no medical intervention whatsoever, just a positive personal perspective and you taking that action, for example.

And this is simple stuff, 'cause everyone bangs on about eat more fruit and veg and drink less alcohol and you have more water and be active. Yes, absolutely. But that has to be supported and augmented by your attitude and your efforts. Positive thoughts, positive actions, I know it's easy to say and hard to do, but if it's worth it, and it's worthwhile and you make it a priority, you are more likely to then engage, and to maintain that and sustain really positive outcomes comes for yourself. And then role model those positive outcomes for those around you that are most important.

Mayrah Sonter

There's no more better advice than that. I don't think from all that experience as a doctor, as a health professional from all the research that you've done. Thank you so much, Dr. Ngiare Brown for sharing your expertise, and your story and your experience of being a doctor in community right around the country of many, many years. Congratulations on all that and thank you for sharing your tips and encouraging our mob to get out there and have their 715 check every year. If you'd like to find out more head to health.gov.au where there's more information about health check that can help you in your local community. And let's get out there and get our families and communities healthier, stronger by getting a 715 health check. Thank you, Dr. Brown.

Ngiare Brown

My pleasure.

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