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12 July 2019

Caring for carers – how to help Indigenous health workers close the gap

James Cook University's health systems researcher, Associate Professor Stephanie Topp, is conducting a pioneering study into how Aboriginal and Torres Strait Islander (A&TSI) Health Workers – regarded as crucial to helping ‘close the gap’ – are coping with their high-pressure roles.

Working in close collaboration with the Torres and Cape Hospital and Health Service (particularly the Executive Director, Aboriginal and Torres Strait Islander Health and Manager, Health Worker Services) she is seeking to identify current challenges faced by A&TSI Health Workers in the region, and how to better support their efforts.

“They occupy this very unique and very challenging position in the health system,” Professor Topp observed. “Their role is, in part, constituted by their cultural and community connections. They are cultural brokers of relationships between community and health services; builders of trust between clinicians and patients, enablers of information flow.

“So on the one hand, they are employees of a government health service, accountable to their employer, but in order to be effective in their jobs, they also have to be accountable to their communities and to culture.”

Her qualitative study aims to interview 70 A&TSI Health Workers’, their clinical colleagues and managers, as well as government health policy makers, to explore how A&TSI Health Workers deal with “the differences between on-paper expectations and the personal vision they had when they took on this job”.

Professor Topp has interviewed more than 65 A&TSI Health Workers to date. She has found that many face an ongoing struggle to reconcile conflicting professional responsibilities.

“In the mainstream health system, what constitutes success is a very cut-and-dried monitoring and evaluation process that looks at how many health checks have been done, how many immunisations delivered, how many outreaches were achieved,” she said.

“These are important, but cultural brokerage requires you to spend time building relationships with patients. Quantifying that effort is very difficult and often doesn't happen. Which means that the centrality, the importance of the A&TSI Health Workers’ contribution, is easy to dismiss.”

The emotional burden shouldered by A&TSI Health Workers who are required to liaise with fellow community members during harrowing health events is also largely unrecognised.

“It’s hugely traumatic,” Professor Topp said. “Because of their role as broker and relationship builder, they are usually the first point of contact, and often in situations where things go badly and someone is injured or dying, they are the face of the health service – and they bear that.”

She hopes that her research findings will inform structural health system reforms to address workplace obstacles for A&TSI Health Workers – and improve the recruitment and retention rates of these frontline operatives.

“Health systems are not machines,” she said. “They are social systems. And without an understanding of the relationships and the dynamics between all the different peoples involved in this social system, we can't really hope to have an impact.”

A/Professor Topp’s current research is funded by a JCU Rising Stars Early Career Researcher Leadership Program Award and a Hot North Career Development Fellowship. 

Associate Professor Stephanie Topp - CPHMVS


Veronica Graham - Research Officer, CPHMVS


Rachel Cummins - Research Officer, CPHMVS


Josslyn Tully  - Manager, Health Worker Services, TCHHS.

Photo (left to right):  Veronica Graham, Rachel Cummins, Stephanie Topp, Josslyn Tully 

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