Increasing Aboriginal and Torres Strait Islander women's ... - APNA

Increasing Aboriginal and Torres Strait Islanderwomen’s access to BreastScreenSandy AndersonBaarlinjan Medical ClinicBallarat & District Aboriginal Co-operative Ltd

AcknowledgementI would like to pay my respects to the Wurundjeri people, of the Kulinnation, on whose land we meet today and to the Wutherong people withwhom I have had the pleasure to work alongside and without thepartnership of the Koori women there would not have been anything toreport to you today.I would also like to pay my respects to the Wurundjeri and Wutherongelders both past and present and all other elders here today

Central Highlands and Wimmera BreastScreen

Baarlinjan Medical ClinicBallarat and District Aboriginal Cooperative

Initiatives for increasing BreastScreen access for Indigenouswomen using a practice wide systematic approachThrough this paper I will highlight the initiatives undertaken to:• Identify where services fail to meet to increasewomen’s access to screening• Developing a systems approach to identify Kooriwomen’s BreastScreen history and implement a recall systemto build screening participation• Partnership where both services are committed to increasingKoori women’s access to BreastScreen services.

Victoria showing health Department of Human Servicesregions and Primary Care PartnershipsNorthern MalleeLoddon MalleeSouthern MalleeRegional Victoriaincluding Primary Care Partnerships andDepartment of Human Services regional boundariesWimmeraBendigo-LoddonUpper HumeGrampiansCampaspe Goulburn ValleyHumeCentral HumeCentral Victorian Health AllianceEast GippslandSouthern Grampians-GlenelgGrampians PyreneesCentral HighlandsMetropolitan mapLower HumeWellingtonGippslandSouth WestBarwon South WesternCentral West GippslandBarwon0 50Kilometres100South Coast Health Service ConsortiumBoundaries based on Local Government AreasAustralian Standard Geographical Classification 1 July 2006

BADAC’s role to increase Koori women’s accessto BreastScreenHistory that began the collaboration• From 2006-10 Baarlinjan Medical Clinic staff had workedcollaboratively with Women’s Health Grampians to organise busgroups for Koori women to attend BreastScreen• Women’s awareness of the need for breast awareness andBreastScreen were raised at women’s health days, educationsessions and individual consultation with women• With much work by all partners there would have been one bustrip a year taking 8-10 women

Past BreastScreen systems for booking women fortheir BreastScreen• Prior to early 2011, all booking for BreastScreen was through acentralised state wide booking number booking about a month ahead• A group booking needed to work on similar timelines butBaarlinjan Clinic bus trips women always changed rightup until the morning of the bus trip• Last minute women booked in would tend to be difficult for BreastScreenstaff to process them in time for their mammogram.• This had the potential to look unwelcoming for the Indigenous womenwho where in generally very wary of mainstream services due to pastdiscrimination• Staff unfamiliar with Aboriginal cultural issues

Earlier systems used to identify women for BreastScreen• Prior to early 2011, BADAC could only work from lists of Aboriginalwomen aged 40 – 70 years without knowing their breast cancer history• When the clinic didn’t know the details of the women’s past screeninghistory and BreastScreen needed time to access this information soanother complexity was added• If BADAC had 16 women planning to come three days before the trip onthe day they might be lucky to have 8 attend• Some of those would be different from the original list of sixteen

Bus trips to BreastScreen are held every two monthsBallarat puts ongood weather fora bus trip toBreastScreen buta good afternoontea, women’sspace, sometalking time andlots of laughtereased theexperience for all.As alwaysdebriefing in thebus on the wayback to BADAC

On one bus trip some of the Aboriginal women feltdiscriminated against and not very welcomedThe issue was taken to the AboriginalTaskforce meeting a regular occurrencebetween Ballarat Health Services, whoauspice Central Highlands and WimmeraBreastScreen and BADAC.Issue provided the another catalyst to improve they way bothsystems interactedA plan was made for cultural training for BreastScreen staffbefore the next BADAC women’s bus trip attending BSV

Cultural Training for the Central Highland andWimmera BreastScreen staffKym Kyatt, Women’sHealth & BreastScreenManager said the culturaltraining was excellent –“some staff reported thatthey think it has given staffa different perspective toconsider”.Following the cultural training BADAC women reported the differenceand felt genuinely welcomed by all staff. Women found themammogram demonstration helpful and allayed many of theirconcerns. When the Elder Violet encourage them to tell other womenof their positive experiences they where happy to do so.

Other changes at BreastScreen to increase access• Ability to process women as drop in clients at the Ballarat office or lastminute women joining the BADAC bus trip• Demonstrations of how the machine works, how the radiographerpositions women and pressure used to take the mammogram• Had two radiographers working to ensure the bus trip moved throughquickly• Understanding of the role of additional support staff such as anAboriginal Health Worker or Elder

A group of women returning from BreastScreenHaving asupportingElder VioletMcPhersontravel with upon the bus tripsand advocateto thecommunity theimportance ofwomen healthandBreastScreenhas had apowerful impact

Developing new systems at BADAC• Recall system was set up differentiating between women who had adiagnostic mammogram and BreastScreen screening – accommodatingover 40 years of age for Aboriginal women and over 50 years of age fornon Aboriginal women• Permission were gathered from women when they accessed the clinic topopulate both Pap test and BSV history ie at health checks, bloodcollection, immunizations etc• Women who had a previous BSV history date recorded in progress notesand recall established• Women who had a previous diagnostic mammogram with a normal resulthad a recall for BreastScreen added if age appropriate

BreastScreen made further changes to enhance systems• BreastScreen reserved appointment block of time for 10 women• Appointment block made immediately after staff lunch break sowomen had the waiting room beside the change room, for theirspace only• To enhance the women’s outing aspect of the bus trip an afternoontea and fresh fruit where provided• BreastScreen introduced to all BADAC staff and the elder whowere attending to support the women

BADAC and Goolum Goolum ATSI Women’s Health DayA time to gather in the peaceful and spiritual spaces at Branbukin Halls Gap, Victoria

Reconnecting with family and friends and making newfriends and breast healthWomen yarning in the beauty of thebush in Halls Gap which is situatedin the Grampians GariwerdNational Park in Western VictoriaEven Esmeralda was seenat Brambuk over a discussionabout Breast Health awarenessand BreastScreen

ATSI womenIn early April there were 89 ATSI women attending the service aged40-70 yearsTotal number of ATSI women 40-70 years and non ATSI women 50-70years with a mammogram recall for any time is 90 totalOver the next 3 months 49 ATSI women are due for their mammogram manyof who will never have had one before

PrimaryCare Sidebar and PCS Clinical Audit ToolDue to the service participating in a PrimaryCare Sidebar pilotwhich enables recording mammogram history. The service iscommittee to be entered BreastScreen results manuallyHaving entered it into PrimaryCare Sidebar PCS Clinical AuditTool can provide specific lists of women at various stages of thescreening journey and the pop up prompts are greatFrom PCS Clinical Audit Tool lists of recall where then able to beaccessed and then specific invitations could be made to KooriwomenPermission to access Pap and BreastScreen histories have beenadded into health assessments

Partnership between BADAC and BreastScreen continues to growBADAC and BreastScreen processesThe program supports women who are not comfortable to make anappointment to attend BreastScreen independently.Comfortable experiences with a mainstream service are always a positivefor future accessWhen talking with women who are not free to attend the planned trip forthe next bus many women want to go on the next trip so the program isgetting momentum.Whilst 49 women are due in 6 months there are already 15 indicatinginterest in the next trip.

BreastScreen and BADAC processesAs the Baarlinjan Medical Clinic has been given permission to receiveeach woman’s results.A coordinated approach occurs when a women is called back forassessment. The clinic is notified before the woman and an appropriatelydesignated staff member contacts the women after notification to ensuresupport is available and also follow up for whatever the processes maybe.I and the BreastScreen nurse counsellors connect women with McGrathnurses and the Koori Liaison Officer at the hospital.With the clients permission good communication occurs between us all

Closing the Gap - always more to doAll of this work is just the start in ensuring all ATSI women are wellscreenedAnd achieve the benefits which Cuzick recently report that toimprove breast cancer mortality outcomes women need to be wellscreened for five yearsJ.Cuzick 2012 ”Breast cancer screening – time to move forward” , The Lancet, Vol379,Issue 9823, A7 April 2012From the statistics I have quoted from the Baarlinjan MedicalClinic there remains much to be done but a start has been madeWith every interaction Central Highlands and WimmeraBreastScreen, Baarlinjan Medical Clinic and the ATSI women ofthe local community are working together to improve womenaccess to screening and better health outcomes

Sandy AndersonWomen’s Health NurseBaarlinjan Medical ClinicBallarat and District Aboriginal CooperativePhone: (03) 5331 5344Email: sanderson@badac.net.au