The Victorian Aboriginal Health Service, Fitzroy, Melbourne
Community Controlled Healthcare
The Victorian Aboriginal Health Service was my first job as a junior GP in what is known as a Community Controlled Clinic. The board members are Aboriginal community members, as are most staff including nurses, midwives, receptionists and Aboriginal Health workers.
It is a unique GP environment - Aboriginal health workers triage patients and offer invaluable insight into the practicalities of people's lives, and the context in which their illnesses exist. I learned quickly that conventional medicine does not apply in Aboriginal health care. People have unique demands on them as individuals and different expectations of doctors. Referring them to a specialist is often not a solution to their problem. Asking them to take a medication each day may not be not viable. The ability to be resourceful, creative and flexible are skills I quickly needed to develop.
I had a wonderful supervisor at VAHS who was an inspiration in my style of doctoring. He's an Irish expat, who spent time in remote parts of the Northern Territory amongst Aboriginal communities. He smokes rolled cigarettes, is small framed and has a softness in the way he narrates - and he loves to narrate! Our 'teaching' sessions were over a cup of coffee on Brunswick Street and he'd tell me of his exploits.
The most important thing he told me (I'm paraphrasing) while I was in tears after hearing a horrific story from a patient about their childhood trauma -
- you can't solve every problem, it isn't possible, it isn't your job. Your role (and particularly in Aboriginal health services) is to be part of something bigger and more important. These health services represent Aboriginal people having some autonomy to make decisions for their lives. It may not be perfect now (and it absolutely is imperfect), but it will be a little better for the next generation, and a little better for the one after that. Being part of that is what's important about your job -
It's a philosophy that I've carried into every role I've had, even within mainstream general practice. I can apply it to a single conversation, or interaction with a patient. Problems aren't solved in 15 minutes. Sometimes I barely fathom how I was any use. But whenever people come back to me, I feel reassured that something small I said, or the way I said it, or that they know they can ask me, is what helps them get a little closer to being well.
There are fundamental differences between Aboriginal healthcare and mainstream general practice. Mainstream practice is about symptom matching, diagnosis and treatment. Aboriginal healthcare however, is much more about juggling illnesses of the body, the mind, the environment and helping people to minimise dis-ease.
Fitzroy and the Black Mile
The Black Mile is a name given to Gertrude Street in Fitzroy, Melbourne that begins at one end with a big Morton Bay Fig Tree. Many of the surrounding houses had only 1 or 2 rooms, so indigenous people would meet in parks and spend evenings under the trees.
Gertrude Street also housed many 'black pubs' (the most popular being the Builders Arms) and early Aboriginal organisations including the health centre, legal and housing groups. Charcoal lane was another meeting place, named because of the briquette factory at the end.
Koori people who migrated into central Melbourne chose Fitzroy as it offered cheap accommodation and was set amongst industrial factories.
"during the mid 1930s the Aboriginal community of Melbourne consisted of about 10-12 families living in Fitzroy with one or two families living in Richmond and North Melbourne; approximately 100 people"
As Fitzroy has gentrified, factories have been converted into exclusive warehouse loft apartments.
VAHS was originally opened at 136 Gertrude Street, that is now home to the trendy and upscale restaurant eponymously named Charcoal Lane.
On the wall of the entrance are the words
You are part of a unique and exciting program of Mission Australia, in partnership with the Victorian Aboriginal Health Service, William Angliss Institute and employers. Charcoal Lane provides the opportunity for Aboriginal and disadvantaged young people to transform their lives through training and working in this iconic building.
All the profits and any donations from the Charcoal Lane restaurant go to supporting this important program that provides many traineeship and apprenticeship opportunities each year.
Together, we can transform lives.