Innovation at work: Community Control success stories at Katungul | Croakey

Telehealth has been a game changer for the Katungul Aboriginal medical service on the New South Wales south coast as it sought to support its community through the devastation of the 2019-20 bushfires and the risks of the COVID-19 pandemic.

This article is published by Croakey Professional Services as sponsored content. It was created in collaboration with the Aboriginal Health and Medical Research Council (AH&MRC) of NSW, which funded the #OurHealthOurWay series.

The rapid roll-out of telehealth during the COVID-19 pandemic has provided unexpected and ongoing benefits for clinical staff and patients at Katungul Aboriginal Corporation Regional Health and Community Services in New South Wales.

For Dr Muhammad Azfar Nor Zaihan these benefits have included a higher patient appointment attendance rate and more time for preventative health.

“It’s a huge game changer, especially for rural GPs and rural patients,” said Azfar, a GP at Katungul which is based on Yuin Country on the far south coast of NSW.

At the peak of the pandemic restrictions from March to July 2020 around 80 per cent of his appointments were by phone telehealth but by December 2020 he was still doing 40 per cent of consultations by phone.

Grief and fear

COVID-19 arrived in Australia just as the NSW south coast had battled devastating bushfires. Seven people died, hundreds of homes were destroyed and thousands of people were evacuated.

Katungul Acting Chief Executive Officer Joanne Grant said 2020 had been an enormously challenging year.

“We have grieved for our burnt land, the evacuation of our communities and suffered the isolation and fear of the pandemic,” she said.

“We saw our frontline staff and management adapt to the constant change and incredible pressure of both the fires and the pandemic.”

GP Registrar Dr Michael Connard said the continuity of care made possible by telehealth services has been an “unexpected benefit” for healthcare delivery.

“We have a highly mobile population and as travel restrictions have eased and people have started to travel again to see family and fulfil cultural obligations, it’s meant they can still communicate with their regular GPs for routine issues,” he said.

Services changed overnight

Federal Health Minister Greg Hunt said the pandemic had accelerated the government’s telehealth timetable when he announced on 27 November 2020 that it would become a permanent fixture of Medicare.

“We have skipped a decade and jumped from 2030 to 2020 for the delivery of telehealth for all Australians. Universal, whole of population telehealth and it will now be permanent,” he said.

Katungul provides healthcare to 4,000 Aboriginal and non-Aboriginal community members.

Early in the pandemic it ramped up telehealth at its clinics in Batemans Bay, Narooma and Bega “from the moment we got notification from Medicare, the MBS item number, that we could actually do telehealth over the phone”, said clinical co-ordinator Sam Teague.

“Our services changed pretty much overnight, especially for our Elders,” Teague said.

“The majority of our Elders have chronic diseases but we were able to offer them phone consults so they could stay safe at home and we could still provide them with the holistic patient-centred care that Katungul delivers on a daily basis to our community.”

In practice, telehealth at Katungul is mainly via phone due to unreliable internet connection in the region but patients will sometimes text to doctors or midwives photos of visible medical conditions like rashes, or videos of children with respiratory problems that manifest at night.

While nothing beats face-to-face contact between the doctor and patient, telehealth overcomes a lot of barriers for remote patients.

“Some of our patients live a long way away but it can even be difficult for full-time workers to physically get to the doctor because they can’t spare the time to wait in the clinic; now they can do a telehealth consultation in their lunch break,” Azfar said.

Then there’s the savings on the indirect healthcare costs for patients who have to travel long distances – petrol, bus fares or even having to hire a car.

Keeping COVID-safe

Katungul’s telehealth program was designed to keep both patients and staff safe.

Connard explained: “One of the horrifying scenarios we all had to consider was if one of our staff members was to get COVID we could very quickly spread it around the community.”

Australia’s Aboriginal community-controlled health sector has been hailed for its pandemic responses, with Aboriginal and Torres Strait Islander peoples — unlike many Indigenous populations across the world — having escaped the COVID-19 pandemic largely unscathed.

At Katungul, every safety procedure was taken – each clinic had a designated isolation room, staff wore personal protective equipment, temperature checks were taken on entry and clinic patients were asked to sit outside.

The Wallaga Lake Aboriginal community went into voluntary lockdown, at-risk residents were asked to self-isolate and entry was limited to residents and essential workers.

Katungul ran three COVID-19 clinics – two in Eden and Bega to check for respiratory illnesses, and a pop-up testing clinic in Batemans Bay that used a rapid testing GeneXpert machine that could return results within an hour.

The respiratory clinics run by Dr Azfar assessed, tested and diagnosed mild to moderate respiratory conditions, including COVID-19, influenza and pneumonia, and were designed to take pressure off emergency services and allow people to have their health managed in one place by a GP clinical team.

Teague and Connard ran the Batemans Bay pop-up clinic, conducting the swabbing and pathology. The rapid testing machine, supplied by South Australia’s Flinders University, was critical during the “Batemans Bay scare” in July 2020 when 10 cases of COVID-19 were linked to the Batemans Bay Soldiers Club and two local schools.

Katungul staff had socialised at the club and had children at the schools so Teague and  Connard tested all Batemans Bay staff, their families and close contacts.

“The practical consequence of this testing is that people are a lot less scared because we can tell them quite quickly about their result,” Connard said.

“We were able to process those swabs within that hour window and let staff members know, let the CEO know, there were no positive cases. We were able to open Katungul the next day and allow our community members to continue with their healthcare needs,” Teague said.

“Had we not had that GeneXpert machine and pop-up clinic our Katungul community would have had to self-isolate for two weeks.”

Koori health in Koori hands

As life slowly returns to ‘COVID-normal’, despite the recent Sydney outbreaks, telehealth is now a standard feature of Katungul’s clinics and doctors report they are doing more phone reminders about health checks, monitoring chronic diseases, organising tests and following up the results.

“The combination of dedicated telephone history-taking, and people coming in for face-to-face consults if needed, means the patient is actually spending more time looking after their health,” Connard said.

However, Katungul is also encouraging the community to come back to the clinics and see their GPs, especially those patients with chronic illnesses.

“Telehealth is here to stay, it’s just been too good of a process not to continue with it,” Teague said.

“But our community members like to come to Katungul to see a friendly face and have that yarn. We haven’t seen some of them for months due to the fear of COVID-19 but they have kept in contact and looked after their medical care through telehealth.

“We’re really proud of the work we do for our community. Our logo is Koori health in Koori hands; that speaks millions.”

This article was written by Linda Doherty and edited by Marie McInerney, on behalf of Croakey Professional Services. It was sponsored by the Aboriginal Health and Medical Research Council (AH&MRC) of NSW to share strengths and successes of Aboriginal Community Controlled Health Organisations in NSW.

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