How an Aboriginal Medical Service handled COVID-19 risks

by Scott Monaghan, Andrew Black, Marion Tait, Hannah Visser

Bulgarr Ngaru Medical Aboriginal Corporation (BNMAC) was established in 1991 to provide health services to the Aboriginal communities of the Clarence Valley, and now operates a regional network of comprehensive primary health care services covering the traditional clans of the Yaegl and Gumbaynggirr Nations and a large proportion of the Bundjalung footprint.

BNMAC provides services to communities from Tweed Heads to Grafton, including Grafton, Baryulgil, Malabugilmah, Yamba, Maclean, Casino, Box Ridge, Muli Muli, Tabulam, Kyogle, Tweed Heads South, Chinderah, Fingal Heads and Banora.

The emergence of the global pandemic necessitated BNMAC, like society at large, to respond to unprecedented circumstances. The extensive media coverage, the incessant social media postings, even conspiracy theories, heightened the confusion and anxiety felt by many in the Aboriginal community. The economic situation of disadvantaged communities added to this anxiety.

From the start we knew that access to reliable and timely information about the virus was important. Soon BNMAC took on the role of trusted information broker in regard to the virus. Facebook proved a viable platform for disseminating accurate information to the community. This was supplemented by BNMAC health workers communicating important information through their networks.

In developing a response to the new circumstances, social and cultural matters relating to the Aboriginal community were thought through carefully and consulted upon with the community and the Aboriginal staff at BNMAC. We recognized that the Elders had to be protected, given their custodianship of community knowledge and their role in Aboriginal community life.

They bring much-needed resilience to the community. The multigenerational nature of Aboriginal communities introduced an important consideration. The children in Aboriginal communities move freely and are cared for by the older folk and enjoy a closeness to them. This presented a potential risk, as the children could become unwitting vectors for the spread. Also, living arrangements in the Aboriginal community often accommodate many in the same household, making quarantine or self-isolation harder.

The mobility of the Aboriginal population was another important consideration. We thought small in-land isolated towns such as Tabulam provided a layer of protection; little did we think that family members in large cities during lock down may seek to escape the loneliness and restrictions imposed on them. They came to enjoy the freedom that these small settlements offered. Coastal towns such as Yamba that have a substantial Aboriginal population, though isolated, are surrounded by wealthy, retired non-Aboriginal populations that undertake travel and cruises, which could unintentionally expose the Aboriginal community to health risks.

In BNMAC, like other services, we were initially unsure how to prepare our response to this health crisis, and the community was uncertain how to protect itself. Our existing plans and procedures were not adequate for responding to a pandemic of this nature. We had to act quickly, adapt, and develop an appropriate response. We updated our flu pandemic plan, modified the infection control procedures, and adjusted care delivery.

After a review, to minimize and mitigate the risks of exposure for the workforce as well as the community, the number of locations from which clinics were offered was reduced. We developed a workforce strategy and stratified staff by personal health risks and took steps to protect them. This guided the arrangements for BNMAC staff who worked from home and those who continued to work from the clinics.

The clinic waiting rooms were rearranged to ensure patient physical distancing, with clearly marked patient and clinician zones. We exercised many site drills and simulations involving the entire workforce in the clinic – starting with the receptionists and the important role they played in ensuring safety and management of sick patients with potential COVID-19 exposure and communicating with patients unable to quickly understand the instructions.

A process was established early on to stratify and prioritize the care of patients with highest risks. Those aged 40 and over with more than one chronic ailment were categorized and each patient’s health profile closely examined. The most vulnerable were listed. Our clinicians were also given the opportunity to add other patients to the list, at whatever age, that they considered susceptible.

Weekly or fortnightly contact was made with these at-risk patients by a nurse or Aboriginal health worker to carry out a ‘well-being check’. Through the conversations it was determined whether