Partnership approach to Indigenous primary health care and diabetes: a case study from regional New South Wales

Abstract

Type 2 diabetes is a major problem in Indigenous Australians, who have a higher self-reported prevalence (11%) than the general population (3%). 1 The selfreported prevalence is probably a considerable underestimate, as the AusDiab study found a national prevalence of 7.4% with glucose tolerance testing, but had inadequate numbers to estimate the prevalence among Indigenous Australians. 2 Onset occurs at an earlier age, and results in greater morbidity and mortality from the complications of diabetes.1 Despite the fact that complications are avoidable or manageable with appropriate community-based primary health care, 3 diabetes was implicated in 18% of all deaths of Indigenous people in 1999-2001.1 Guidelines identify an annual cycle of care recommended for managing diabetes, 4 but in rural areas, the lack of specialised diabetes clinics, shortages of health workforce, large distances and poor transport infrastructure make these difficult to follow for any population group.Many Indigenous people do not access health care until an acute event when it is difficult to reverse the complications of diabetes, 5 leading to a situation where a population group with extreme need has very poor access to appropriate care.In the Northern Rivers of New South Wales (NSW), Indigenous people form 3.2% of the population.5 The Dharah Gibinj Aboriginal Medical Service (AMS) in Casino provides care for approximately 4000 members of the Bundjalung Nation or 'Goorie' community.Goorie is the term that Aboriginal people of the Bundjalung Nation use for themselves, and Dharah Gibinj means rubbing or massaging.The AMS also provides outreach clinics at several smaller, more isolated communities.

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