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How to Reduce Creatinine Level without Dialysis | Real Testimonial




Hello sir!
I welcome you here at Planet Ayurveda Center.
I would like to know what is your name and from where do you belong?
My name is Sandeep and I am from Gurgaon - Haryana
Sir, I would like to know that who is patient and what problem he had?
My father, who is having blood pressure, blood sugar and heart problem.
Got to know 1 and half to 2 years back that he has kidney problem too. Creatinine level was increasing.
We had treatments and tests from many places but all in vain, it kept increasing only.
Dialysis was a big issue.
One day while surfing net, got to know about Planet Ayurveda. We thought to give a try once. We came and met Dr. Vikram Chauhan.
He advised to continue with the medicines which my father was taking for some more time and added his also.
These have been proved effective.
Creatinine level which was 3.94 is now reduced to 1.94.
Sir, can you mention the medicines which Dr. Vikram Chauhan recommended you?
Yes sure â€" these are â€" Mutrakrichantak Churna, Varunadi Vati, Rencure Formula and Punarnava Mandoor.
Sir, did Dr. Vikram Chauhan advice for some dietary changes?
Yes he asked to take less salt, cheese etc. don’t skip breakfast and use wet towel if it sweats. All it helped a lot.
Sir, any message for viewers or for people who are suffering with kidney problems?
Why not?
I would like to say that we tried a lot and worked hard in many big hospitals but got the results here only.
I hope within 1 to 2 months creatinine levels would be with in limit.
I would like to say that as my dad is 63 years old and got good results here, sure viewers or people who are suffering will get great results like us.
Sir, thank you for visiting Planet Ayurveda center and guiding people so nicely.
Thanks!

https://www.youtube.com/watch?v=VVJeDniih9Q


Low Sodium Food Additives May Be Unsafe for Kidney Patients




Eating less salt can have health benefits
like lowering high blood pressure, but some
low-salt foods may have additives that make
them unsafe for people with chronic kidney
disease. I'm Rachelle Grossman with your latest
health news. The issue that when sodium, or
salt, is removed from these foods, manufacturers
often replace it with additives like phosphate
and potassium for flavor. Now, a new study
finds that the added potassium in some low-sodium
meats and poultry may not be beneficial to
people with kidney disease. That's because
patients with kidney disease are advised to
limit the amount of potassium in their diet
since their kidneys may not be able to process
high levels of it. Experts say you should
seek the advice of your doctor or a nutritionist
if you suffer from chronic kidney disease.

https://www.youtube.com/watch?v=_HL5TAxoPk8

How to Reduce Creatinine Level without Dialysis | Real Testimonial - Low Sodium Food Additives May Be Unsafe for Kidney Patients

Help Human Beings Live Better Lives - Common Cat Medical Problems : How to Give Cats Subcutaneous Fluids

Sharing Solutions: Indigenous Communities Tackling Chronic Disease - Banfield Pet Hospital - Risks and Signs of Dental Disease in Dogs and Cats

Blood in the Urine: What does it mean? - Anemia of chronic disease

Sharing Solutions: Indigenous Communities Tackling Chronic Disease




Hello, I'm Daniel Browning.
Welcome to this program,
Sharing Solutions:
Indigenous Communities
Tackling Chronic Disease.
On behalf of everyone,
I would like to acknowledge
that we are meeting on the land
of the Wangal people.
The Wangal people are
the traditional owners of this land
and form part
of the wider Aboriginal nation
known commonly as Eora.
We also acknowledge the elders and
the descendants of the Wangal people.
The gap in life expectancy
between Indigenous
and non-Indigenous Australians
is about 10 to 12 years.
Most of this gap is due to
preventable chronic diseases,
such as diabetes, lung,
heart and kidney disease.
In this program,
we'll emphasise the need
for a new approach to their prevention,
treatment and management.
We'll examine risk factors
and look at some of the ways
that Indigenous communities
are tackling the problem.
In other words, we'll be sharing
some of their solutions.
There are also useful resources
on the website:
Now, let's meet our panel.
Dr Alex Brown is currently the head
of the Centre for Indigenous
Vascular and Diabetes Research
25
00:01:61,240 --> 00:02:02,400
for the Baker IDI
Heart & Diabetes Institute
based in Alice Springs.
Dr Sally Goold is a Wiradjuri woman
and currently the Chairperson
and Executive Director
of the Congress of Aboriginal
and Torres Strait Islander Nurses.
Dr Mark Wenitong is from the Kabi Kabi
tribal group of south Queensland
and he's the Senior Medical Officer
at Apunipima Cape York Health Council
in Cairns.
Deanne Minniecon is an Aboriginal
and Torres Strait Islander woman
from Queensland.
She's a Senior Health Promotion Officer
with Queensland Health.
Currently, she chairs the Steering Group
of the National Aboriginal
and Torres Strait Islander
Nutrition Strategy and Action Plan.
That's a mouthful.
Welcome to all of you.
(All greet)
To start,
we're going to talk about this notion
of, I guess, a singular idea
or conception of Indigenous health.
Mark Wenitong,
could I direct my question to you?
Is there one perspective
on Indigenous health?
45
00:02:60,400 --> 00:03:03,880
Look, I think the issue
is that Indigenous people
occupy a whole lot of spaces
across the intercultural space,
and there's different perspectives
on that all the way through.
So we're talking about
some traditional people
right through to urban Aboriginal
well-educated people.
Having said that somebody
is urban and educated,
it doesn't mean they don't have
traditional views on lots of things
and vice versa.
There's a lot of spaces along there,
and for clinicians that work with
Aboriginal and Torres Strait Islanders,
it's important to try and contextualise
it with the people they're working with
to get an idea
of where they're coming from
and what their health beliefs
and belief systems are,
because it's got huge implications
for the way that you practise
and for the way that patients pick up
your management regimes, etc.
and the issue of compliance,
which is a bit of a loaded question.
How that works in practice
is based a lot
on the Indigenous person's perspective
of what they think health is
and what causation is.
And it's also based on
what the health professional,
the stuff that they bring
to the interface as well.
Alex, you may have
a different perspective.
Is there one holistic notion
of Indigenous health
or is that a myth?
I think Mark's point's
really important here.
There is a lot of heterogeneity
in terms of the way
in which people understand health
and what might be
contributing to illness.
From our experience, there are
a couple of fundamental things
which are held true across
all of the Aboriginal communities
we've certainly dealt with.
These are things
like the importance of connectedness,
of the importance of family,
of maintaining harmony
in relations between individuals
within communities
and with communities
in broader social structures.
And the importance of land and place
and that connection to it
is really important too.
While there are differences,
there are also some unifying things
that are important for
practitioners to really know.
The only way to know is,
as Mark suggested,
getting into conversations
with patients and families
within that local context and try to
understand where people are coming from.
Sally, you'd also have a different
perspective on this question.
What do you feel?
Well, I believe,
as there is diversity in mainstream,
so too is there diversity
amongst Aboriginal
and Torres Strait Islander people.
And, I... (Clears throat)
Pardon me.
..believe that one size doesn't fit all.
I guess one of the dimensions
we have to consider
when we talk about
this notion of Indigenous health
is the wellbeing of the community.
We often talk about how you can't have
healthy individuals in a community
if the community itself is not healthy.
Deanne, what's been your experience
of this idea of wellbeing in a community
translating to the wellbeing
and the health of an individual?
Well, I guess an individual,
and not for all Aboriginal
and Islander people,
but for some,
individual health will be determined
by the family, by community as well.
So if the community's not well,
in some cases,
it may be that that individual
not be well
because the community's not well.
I guess, Mark, you touched on this,
the difference between urban,
regional and remote settings.
What are the major differences
as far as you can tell
between our communities,
as diverse and spread as they are?
I think it's probably much more about
the common things Alex talked about
rather than the differences.
The differences... I've made mistakes
before in clinical practice
about assuming things
about Indigenous patients.
Young, urban, educated people
will have a very different idea
about illness causation
than what I think they understand.
When I think they understand Western
concepts of disease pretty well
and they actually
think quite differently,
it's interesting to go into
different communities -
lots of people work across Australia
in different communities,
from the Torres right through.
The diversity's pretty amazing.
As Alex says,
there's a lot of common themes.
I think, for clinicians approaching
Indigenous communities
and working with them,
it's important to understand
at least the common themes,
so you've got some basis to build on.
It can be very different approaches
to everything,
like the Torres Strait's
traditional adoption
and other things they do there,
as compared to Central Desert
Aboriginal communities
where other things are very important,
around men's business
and women's business.
So our Indigenous conception of health
is not just the physical wellbeing
of our bodies?
It runs much deeper, doesn't it, Sally?
SALLY: It does.
Community health and wellbeing.
I think that a lot of Aboriginal people
consider if there is harmony
in the community
and community wellbeing,
that all is overall well.
That, though they may be ill,
they don't consider themselves ill
if there's a feeling of wellbeing
within the community.
And if there is
this Indigenous perspective on health,
has it evolved over time?
We can talk about the great advances
in the management of chronic disease
in Indigenous communities
over the last 20 - 40 years.
Are we developing a more integrated way
of seeing Indigenous health?
I think there's a couple of ways
to answer this.
One is, are Indigenous people
taking on Western medicine
and understandings of health?
They certainly are,
and there are elements of culture
which will never change,
but there's also parts of it
that do change,
because you can't survive
if you stay still.
And that's how Aboriginal people
have survived through time.
The other question is
does Western medical science
accept the way in which
Aboriginal people view the world?
Has it integrated in some way
or has it developed a more nuanced
or broader understanding of health?
I'd suggest that it hasn't yet,
and if only it would,
then it might be better for everyone.
MARK: That's the area where
I think we need to do a lot of work.
I think we've done a lot around
evidence bases and clinical medicine
and we've got pretty good evidence
around how to approach health
and chronic disease
and best practice.
But the interface between us
as health professionals
and Aboriginal people as individuals
and as communities,
I think we've got
a really long way to go there.
You can see it when you work
with traditional healers -
they get almost 100% compliance,
probably because people
are scared of them.
Having said that, they do get that,
they understand the way people think
and they manage that
in their treatment regimes
and people do what they tell them to do.
For us, we come in and we don't get...
Obviously, we wouldn't have a problem
if we had 100% compliance.
We don't even get 100% compliance
in mainstream GP practice in Australia,
so it's really difficult stuff.
But we really need to think
a lot more about that interface
and it's just not
the medical part of it.
It's how we relate and interact
that can make a big difference.
That's something we haven't done
much work on at all, I don't think.
SALLY: Could I make a comment, please?
DANIEL: Absolutely, Sally.
Mark, I have to take you to task
about the word 'compliance'.
It's a word I don't like
because it, to me,
denotes a power relationship.
And I think, to care for people,
you need it in partnership,
not as a power relationship.
I'm sorry, Mark.
That's OK. You're my elder.
I'm scared of you,
so you can say whatever you want.
Let's take a look
at our first case study,
the Yarrabah Family Wellbeing program,
where the goals
are to build and strengthen
the social and emotional wellbeing
of individuals, their families
and their communities.
MAN: We all have got crisis, eh?
Crisis with your family,
crisis at a workplace,
crisis in a community.
Have you had a family crisis?
Oh, yeah.
I just stopped drinking and that
and just walked away.
Coming here to Men's Group
really helped me,
for support and that.
MAN: The Men's Group started
just after we had a string
of suicides here in Yarrabah.
We had one of the highest
suicide rates in the world.
I think we were second in the world.
It was pretty devastating
back in the early '90s.
Some of the men at the time
were feeling confused, a bit hurt,
so a group of men got together
and formed this Men's Group.
It was good for our community
to offload how they were feeling
but also get their ideas on solutions,
how we can fix this.
We started getting people in
from the University of Queensland.
They were training us up
in Family Wellbeing program,
which is our core program.
MAN: The Family Wellbeing program,
it's an accredited counselling course.
It was developed by Aboriginal people
for Aboriginal people.
That was in 1993 in Adelaide,
and the people that developed it
were part of the stolen generation.
It has five stages, and it looks
at understanding relationships,
listening, having compassion,
looking at your life journey.
It's about understanding yourself,
it's about balancing the body,
mind and emotions.
Just be a man in what you do
and how you go about it, you know?
Be a man - stand up and don't be afraid
to show your emotion.
BRIAN CONNOLLY:
We all had this perception
of men had to be this particular type
of person, you know?
Very strong, very closed
about our feelings and emotions.
We knew that that wasn't right.
We knew that we were human beings
and men needed to express themselves.
So we felt by involving men in the group
and having a program
such as the Family Wellbeing,
it would allow men to offload
some of the pressures
that they were experiencing
at that time.
Me and my woman, we're back together
and we're going alright now.
We're not fighting, not arguing.
We're just going along
smoothly, you know?
I'm coming to see if anyone
from Men's Group is there.
Just hold up.
I'll get someone for you on the line.
BRIAN: If a male comes to our door,
we usually get one of our male
health workers to have a chat with him
and find out what's
the underlying issues.
OK, just step in this room here.
Young fella's at home there,
breaking in, broken home.
Just coming back from holidays and that.
I'm really angry and I don't wanna go
and get them boys.
It's not gonna solve no problem, eh?
If you'd like to come in
and attend Men's Group
and then we can lay it
on the table, you know?
See what other men think about it.
Possibly get more solutions
to help you out, brother.
Yeah, that's what Men's Group
is all about -
trying to sort us out as men, you know?
How we used to do it
before our old people.
We would then sit down
and have a case planning meeting
where we would bring
in the rest of our team,
made up of men's and women's health.
And also our BTH counsellor for people
suffering from generational trauma.
So you said that he's frustrated,
feels like harming someone.
Yeah, he's harming
these youths who broke in.
Is he only angry because
of the breaking and entering
or he's been experienced
at anger before that?
Just with the break and enters
and frustration with the police.
We might need to go doorknocking
and see if anyone will talk to us
and see where the children are.
BRIAN: I think we need to deal
with this one quite rapidly.
Over the last ten years,
I've seen huge changes.
I think we're looking between
80% to about 98% reduction
in suicides here in Yarrabah.
MAN: Well, I was going
with my ex-wife for 15 years
when she told me she was seeing someone
and it really affected me.
I went on a drinking spree
for about three or four days.
When I finished drinking,
I saw my kids standing around me.
It was pretty sad
seeing the sadness in their face.
Myself and my wife,
we both been sexually abused
when we were younger.
And...
..because I had a sort of
hatred towards women
and she had a hatred towards men
and we used to clash all the time.
I had hatred for her, yeah.
My hatred was like
a big ulcer in my guts
and it was really killing me.
When this Family Wellbeing came out
and we got the facilitator's training,
then we went through it.
Then I started to apply
some of it to my family.
I brought it into my home,
'cause I needed to reprogram my mind.
'Cause, um...
..just growing up
with that mentality,
how we should live, that's
how we should treat people
and it was all wrong.
But then I got these tools
that reprogrammed my mind
how to find solutions.
It brought a lot of healing
in my spirit and my soul,
emotionally and mentally.
I'm physically strong and fit, you know?
It helped me a lot.
It's a guide for my life.
It prevents me from
doing the wrong things,
but also to share
with other men out there
who experience
the same thing I'd experienced
or other things that
they can get healed.
Take some deep breaths,
have time to think. Stay calm.
MAN: I think I learned to be humble.
One of us had to change,
'cause my family was going downhill.
So I rose up, you know?
That's part of Men's Group's vision
is to restore their rightful role
in the family.
When you sit back and reflect
on what we used to do, gee!
I can't believe I did that.
Yeah, that's true, eh?
BRIAN: Someone
who's got a crushed spirit
or is full of anger or bitter
feels emotion that really plays
with the physical parts in their body.
We believe that through
social and emotional health,
we could address those issues
that hopefully will address
the chronic health diseases
that we are currently facing
in most Indigenous communities.
Mark, talk about the success
of that program,
why you think it's succeeding.
First of all, I think
they're really brave,
those men that come on and talk about
some of their personal issues.
I think that's fantastic.
One of the things
that sticks out for me is that
there's a theoretical
or conceptual underpinning
in the way
they're approaching that program
and that's the empowerment of people.
So this is working with people
to be able to take more control
back over their lives
in small, incremental ways.
In a real framework,
so it's not just touchy-feely -
there's a framework involved in this,
and those men are growing through that.
It will affect other aspects
of their lives, like the physical, etc.
I think it's really important that,
when we're looking at developing
health programs in primary healthcare,
that we look at all of the whole person.
When we're looking at
those kind of things,
we're empowering people.
Alex can talk a lot more to the control
as a risk factor for cardiovascular
disease and things like that.
But there's actually a scientific basis
for this as well.
But it's really important to be able
to work with the whole person,
and I think those men demonstrated
really clearly
that there's lots of things
they can change in their life,
but they have to be empowered to do that
and there has to be
some framework or process.
I think when we do primary healthcare,
we just go on with the clinical stuff
and forget about the other things.
Alex, how does Yarrabah
compare to Central Australia?
The issues that were presented
by those gentlemen
were the same stories we hear in places
around Central Australia.
Even down to the commentary
about explanations -
guys with crushed spirits
are going to be physically unwell.
That's very strongly the story we get
and I think
it's a very important lesson for us.
One, as Mark mentioned about communities
can develop their own solution,
they need the right frameworks
and support around them.
Secondarily, if we're gonna make
a difference in chronic disease,
if we're not dealing with
where people's hearts and spirits are,
we can't actually make a difference
in chronic disease.
It really is a very important
eye-opener for us as a system -
if we're not dealing
with people's emotional wellbeing,
we can't possibly hope to
engage them around chronic disease.
Sally, can you speak to that?
The disconnection between the physical
body and the emotional self.
Are we taking care emotionally?
Are we taking care of Aboriginal people?
No, I don't believe so.
Because without knowledge
of the history,
it's very hard for people
to understand the difficulties
that many Aboriginal people
have gone through,
and I think it's a great description,
I guess,
or explanation of how closely entwined
our soul and emotional wellbeing
are with our physical wellbeing.
It's really interesting -
a few years ago, Gifford stated
that people who have been deprived
develop soul-sickness.
And that, I think,
is a really quite apt term
for many of our people -
that they are soul-sick.
And the gentleman on that video
who said his soul was crushed.
And why was this, one has to ask.
Also, one term I want to pick up on,
that the gentleman raised
in that package
and that was this question
of intergenerational trauma
which some people watching
may not be too aware of.
In layman's terms, can you tell us,
Mark, how that translates...
or maybe Alex, how that translates
for us Aboriginal people.
Because we know it exists.
It has real health effects.
I think Alex is going to talk a little
bit later with some slides and things.
It's the way that trauma is borne
across generations,
and the way that
it can affect people both physically
and spiritually and emotionally
along the way.
I guess the bottom line
for health professionals
is if you're trying to give somebody
some pills for diabetes,
and they don't give a rat's,
they just don't give a rat's.
They're not gonna take them.
That's what we're trying to get at here.
I think that's what
they're trying to say with our program
is that you've got to deal
with intergenerational issues
and the way that people's...
what we call their spirits are like
in today's society,
particularly in rural and remote,
but in urban settings as well.
Without dealing with that,
it's really hard to say,
'Of course they're going to do
everything I tell them to do
with my diabetic regime'
and things like that.
'They're gonna exercise an hour every
day, five days a week,' blah, blah.
When they're in that kind of condition,
they won't listen to you.
So you do have to do that.
Don't get me wrong - we still have to do
best clinical practice
and we have to do everything we can do
and we can make some difference.
But at the end of the day,
to make real difference,
which is what
we haven't been doing so far,
you have to engage with those issues.
At that point, Alex, I should ask you -
can you give us an overview
of chronic disease?
I guess it's important to state
what these chronic diseases are
and how they affect
our Indigenous communities.
Look, chronic disease - it's very hard
for people to really understand
what chronic diseases are from
a community or lay perspective,
because people know when they're sick
and they seek help when they're sick.
The problem with chronic disease
is it's a longstanding, lifelong
non-curable illness.
When we talk about chronic disease
in Aboriginal communities,
we tend to focus on diabetes,
heart disease and kidney disease.
But there's also other chronic
conditions which are probably important.
Chronic lung disease
from smoking-related injuries
and also depression.
I think the case study
from Yarrabah really talks to
how important it is to include
that emotional component as well.
They're probably the big players
in the chronic disease space
for Aboriginal communities
at this stage.
Cancer's important as well,
but it tends to get less airplay in
Aboriginal communities at this stage.
But that won't last forever.
We do know that
the impact of chronic disease
across Aboriginal communities
is enormous.
You can see from some slides
we're going to put up now.
This first slide gives us an idea
of the proportion of people
who are dying at a given age.
0 on the bottom,
right up towards 80 at the top.
We're comparing Indigenous Australians
on the left-hand side
and non-Indigenous on the right.
DANIEL: It's visually amazing, isn't it,
the discrepancy?
ALEX: They're completely different
population death profiles.
You can see that Aboriginal people
are far more likely to die young
and the vast majority of that
is in middle age.
We're finding the primary contribution
to this pattern of death
is really from chronic disease,
early and preventable.
We know that chronic disease
is the number-one contributor
to the life expectancy gap.
We all talk about 'closing the gap' -
it's become part of the vernacular.
We know chronic diseases
are the most important contributor.
What this slide really shows
is the top line on both sides
is the life expectancy
for a non-Indigenous Australian.
The bottom line is the life expectancy
for an Aboriginal Australian.
You can see there's a massive gulf
between the two.
The different colours are really
trying to unpack
what the causes are within that space.
You can see the big green bit
is really how much chronic disease
contributes to that life expectancy gap.
So together, heart disease,
kidney disease and diabetes
contribute to about 75%
of the life expectancy gap.
So of that 17 years, the vast majority
is caused by chronic disease.
We have to be doing something about it.
We all know the history. We all know
how bad health is in our communities.
But seeing those slides, even if
you can't decipher all of the content,
you just see those disparities.
There's such a gulf.
It brings it into sharp focus.
Mark Wenitong.
The other issue to be mindful of
is population growth projections.
So, for Indigenous people,
especially across the Top End
where we've seen projections of
39% - 42% population growth
by 10015.
By 2015. What did I...
Which isn't that far away
and compared to the rest
of mainstream Australian growth
which is 2% or something like that,
if you don't count refugees
and everybody else that's coming in,
the population explosion is going to be
around the middle-aged group,
and that's what they're projecting.
We can really expect
more chronic disease
and high levels
and a bigger morbidity load
in that age group.
It's something we've got to do
a lot with now, rather than waiting.
What then are the social determinants?
We often hear that phrase, but what
are the social determinants of health
that are of particular relevance
in our Indigenous communities?
Things like unemployment.
I know Mark's got particular interest
in this area,
but I'll kick off.
We know that, across any population,
poverty's really bad for your health.
So, if you don't have a good income,
if you're not employed,
if you don't have a good education,
you live in bad housing,
you don't have access
to healthy infrastructure,
we know that those things
are important contributors
to poor health in pretty much
any population you'd care to meet.
The difficulty in
an Aboriginal setting in Australia
is those markers tend
not to work the same way
they work in non-Indigenous communities.
Because I get a dollar
in an Aboriginal community
and that dollar's up for grabs
for everyone.
So you don't preserve
the health-protecting benefits
of that income necessarily.
Similarly, there's a bunch of other
things impacting on health status.
So those social markers are probably
likely to play a bit differently.
What we've looked at
is really how important
people's sense of control
over their own life is,
whether or not they feel
that they've got a say in their future,
whether or not they feel
that they've been done wrong
or harmed by the social institutions
of their life.
Whether those things
have impacted on them.
And the impact of racism.
And these are the social determinants
that are very important
in an Aboriginal context as well.
Because racism has health effects,
doesn't it, Mark?
Yep,
and they're measurable health effects.
There's some reasonable studies
from the US with black Americans
on the effects of racism
on blood pressure and other things
that are measurable.
The other thing to think about
with social determinants
is there's some positive social
determinants, like social capital.
This is like the extended family
taking care of each other.
We often see the dysfunction,
but we often don't see
the added benefits
of having lots of people
taking care of you, and sharing,
and a lot of other things
that are quite nice.
We could learn a lot
from some of this stuff.
And you find that lots of clinicians
and people who live in Aboriginal
communities for various lengths of time
come back with changed attitudes towards
material things and things like that.
There's some positive aspects to
some of the social determinants
and I think one of the key ones is
the social capital or social networks
and family supports
and extended family supports.
And I'm not sure
if we utilise that enough
when we're trying to promote
good health programs.
Deanne, what do you
have to say about that?
(Clears throat) Excuse me.
It's important to remember
there are many positive things
about being Aboriginal, and one of those
is in our family relationships.
When our families have broken down,
we see the effects,
but the strength of our communities is
also really important to emphasise here.
I don't think it's valued enough
by health practitioners
when they're saying, 'Go home
and manage yourself this way
in terms of your health'.
They forget that the extended family
will support you
in doing that sort of work,
in terms of improving
your health outcomes.
You could be, 'This week,
I don't have any money
to buy the food I need to buy
to help manage this particular illness,'
but you've got family
to call on all the time.
And how does the whole question...
We often hear about being
connected to land and connectedness,
but how does this relate
to urban Aboriginal people?
Is there a marked difference?
I think there would be.
As we mentioned before,
heterogeneity or difference
is really the calling card
of Aboriginal Australia,
rather than necessarily
the similarities across everything
and 'one size fits all'.
But connection is important
in any context.
It's not just important
for Aboriginal people -
it's important for all Australians.
If only, as Mark and Deanne were saying,
people took stock of how important
and useful as a health-promoting thing
being connected is,
then we'd all be better off,
all of Australians.
Connection is fundamentally important.
It's what defines that connection
and what connection to
that really is valued by that individual
that's important.
That can be land,
and for many people, it is.
Or that can be an identity
or where your family's from
or that can be your family
or your social network, football club.
These are all health-affirming
processes.
So connection's very important.
It's interesting - there's a few studies
that have been done on this.
One is coming out of Darwin,
about rangers working back on land.
And their control of blood pressure
and sugar and how that affected them
and they got positive results from that,
measurable positive results,
and the other thing I think
that's really interesting
has been the work that Robyn McDermott
did earlier on with a very remote...
So we're talking about outstations,
really, people living on country
and with that and Alex can...
if I'm wrong...
I think the data hasn't changed.
They had a ten years'
better life expectancy
than people in just remote community
so these were people who'd gone
from the artificial communities
where everyone's shelved together back
to live on country and at that stage -
it's an older study now so I'm not sure
if anything's changed -
but certainly, when we did the mapping
for geographic information system
with NHMRC
for that cardiac rehab manual,
the statisticians looked at that
and thought it was a mistake.
So in very remote locations,
the life expectancy improved
and that is likely to be related
to something to do with identity and
land and being in touch with country
but, you know...
What, then, are the main risk factors
for chronic disease
in Aboriginal communities?
I think we know what they are but...
Well, look,
there's a whole raft of them.
What we know across the world
in sort of any population
you'd care to look at,
the same risk factors are
the primary cause of chronic disease.
So whether you're from Pakistan,
whether you're from Central Australia,
whether you're from New York,
if you've got high blood pressure,
if you've got high blood cholesterol,
if you smoke,
if you're carrying too much weight,
particularly around your stomach,
if you're exposed to poverty
and disadvantage
and whether or not you've got diabetes,
those things are potent contributors
to chronic disease.
So that plays true across pretty much
every population you'd care to look at.
The things that are important, though,
is to unpack
what might be driving the difference
between population groups.
So, why are Aboriginal people
more likely to have chronic disease
than non-Aboriginal populations?
Poverty's important,
disadvantage is important,
exposure to poor environmental
conditions are important
and these aren't shared the same
across Aboriginal
and non-Aboriginal communities.
There's a whole range of reasons
around being exposed
to infectious diseases
that might predispose Aboriginal people
across their life course
to more chronic disease
and then there's the fact that
Aboriginal people
are more likely to share
all those things all at the same time,
to have diabetes and heart disease
and kidney disease
and that's a potent contributor
to whether or not
you're gonna have a bad outcome
particularly if you're likely to die
so...
We also know that the system isn't
necessarily doing all the things it can
equally across every population group
so whether that's access
to coronary angiography or angiograms
for people who are at risk of having
a heart attack or have had one...
An angiogram is where you check
the state of the heart?
That's right, you check the blood flow
through the heart
to see if there's blockages there
that can be fixed.
So then there's issues
of resourcing health services.
Do people with the highest need
get the most resourcing?
Well, we know that
that's certainly not the case,
so there are some very complicated
reasons and risk factors at play
and they're all sort of mixed up
and they're very hard to deal with.
And then finally, we've really got to
take into consideration
the early life markers experienced by
disadvantaged populations.
There's some tremendous data from the US
and other places now
that show that if a child was exposed
to adverse environmental conditions,
if they've got a bad family environment,
if they've got a parent
who's got a substance misuse issue
or a chronic mental illness
or had been to prison,
as adults, those kids
are far more likely to be smokers,
to be obese, to be depressed,
to be angry
and to not engage
in physical activity.
So behaviours don't happen in a vacuum.
And we need to understand those things
to understand chronic disease.
Given all those factors at play,
and they're diverse,
we talked about the provision
of healthy food
in remote Indigenous communities,
the appalling state of that,
how preventable, though, Sally,
are these chronic diseases?
We know what they are,
how preventable are they?
Very.
Because if we dealt
with the social justice issues
of housing, clean water,
adequate sewerage...
..education and access to education...
..cleaning up the kids' ears
from their chronic otitis media
so that children can learn -
a child who can't hear can't learn -
and also...
..the opportunity for employment...
..and available employment,
not just opportunity but they are able
to access employment.
I think if we sorted those...
Now, these, as the previous
Prime Minister had said,
was a black armband view
and 'Oh, whatever'
but however, those social justice issues
are the rights of every Australian,
not just Black Australians
and if we sorted
those social justice issues,
we'd be doing extremely well.
On this issue of how preventable is it,
we only have to go back 30 or 40 years
and look at how many Aboriginal people
had chronic disease
and it was very, very few there, if any.
It's been this rapid transition
into another way of life
that Aboriginal Australians
weren't prepared for,
it was nothing like they were used to
and so we're now seeing
the consequences of that.
So how preventable is it?
It's very preventable.
And I think
there's a whole lot of things
that sometimes as clinicians
we don't push hard enough.
And we're not talking here
about being judgemental with patients
but we're saying, 'Look, you know,
if an Aboriginal patient is a smoker,
you do the brief intervention
and you give them strong advice
about quitting smoking,' you know.
And the same with alcohol, you know,
giving up the grog and things like that.
There's ways of getting into those areas
and without being patronising
or without being judgemental,
you know, clearly you're a doctor
or a nurse or a health worker,
you've got kind of a figure of authority
and sometimes,
sometimes that actually gives people
an excuse to opt out
of some social obligation
that will continue them
in some of the risk factor behaviour.
So I think we've got to be fairly clear
about some of those things
and I've often had other health
professionals come to me and say,
'I didn't want to talk to that person
about cigarette smoking
'cause it's the last, you know,
they've got a lot of other stresses
in their life.'
But to me,
within an empowerment process,
what you're saying about that is,
'Well, this is one thing they can
actually have some control over,'
or have a go at having some control over
with your support
and with the right, you know,
infrastructure in place to support them
to give up and things like that.
So, I think we get caught up
in the acute stuff
because we know if we don't fix up then,
they'll come back tomorrow
and, you know, bad things will happen.
If they go away still smoking,
'Oh, well.'
'I don't want to ruin my therapeutic
relationship with that person'
or anything like that
but in actual fact,
they'll die of a smoking-related illness
sooner or later statistically.
So I think sometimes
we've got to be very clear
and clean up our act a bit
as health professionals as well
and not be scared to, you know,
really push good risk factor
behavioural modifications
and Aboriginal and Islander people
are not stupid, they know this
and they'll respond to things, you know.
And it's come up lots for me
within the prison system
when I trained prisoners
and you'd think that was the last place
they'd want to give up cigarettes
and heaps do.
So I think
there's some clear guidance too.
Let's look at the current
strategic directions and policies
that are being used across the board
to address chronic illness
in Indigenous communities.
We know what the government's policies
are on chronic disease.
But what do you think the policy
directions ought to be right now
for tackling chronic disease?
Well, I suppose this...
As a whole panel, there's probably lots
we can talk about in this space.
I'll try to be brief.
We're currently seeing
an unparalleled time of opportunity.
There's never been such a strong focus
on chronic disease in Aboriginal people
so, you know, now's the time
if we're ever to make a difference.
The current approach
is really focusing on, you know,
primary care infrastructure
and systems.
This is a very important part
of the healthcare system
to make a difference in chronic disease.
My understanding
of what's currently on the table
is looking at risk factor reduction -
so, looking at helping people
to give up smoking,
helping people to lead
healthier lifestyles -
looking at better remuneration
into primary care
to better manage chronic disease,
looking at the employment
of some alternative workforce
to help people access services,
increased access to specialist services
through medical specialist outreach
and what have you.
So there's a whole raft
of particular components
that are being put forward.
They'll have to be coordinated,
they'll have to make sure that
they deliver the goods across the board,
they'll have to allow flexibility for
local regions and local communities
to set their own
key strategic directions, I would think,
because one size doesn't fit all, Sally,
as you mentioned before.
And I think that a one-off investment
in chronic disease in Aboriginal
communities will be problematic
and it should be ongoing
because this problem
is not going to go away.
Then what are some of the significant
and exciting areas of research
into our study of chronic disease?
ALEX: Well...
What's the most interesting thing
happening?
Well, I think probably the most
interesting beginning of some work
is really starting to look at this
transgenerational or intergenerational
chronic disease burden stuff,
looking at how important
the maternal environment is
to passing on certain pathways
to chronic disease
in her children and offspring.
I think that this area
will be the most important
and I think it relates
to that point we made earlier
about, you know,
behaviours and chronic disease
doesn't occur in a vacuum,
it really does occur within a context.
So I think that the important research
will be around
understanding those pathways,
so that we can intervene
as early as possible
and I think looking at alternative ways
of dealing with chronic disease
in communities.
Engaging the family, I mean,
we talk about how important it is
and there's really
no intervention trials yet
that are focused on the family
as the place
where all the chronic disease
prevention activity can happen.
Looking at alternative workforce -
nurse practitioners,
physician's aids, I mean, who knows what
the workforce is going to look like
but it's going to not be just doctors in
remote communities doing the business.
I think the other thing
that Alex spoke about earlier
was that transgenerational stuff around,
you know,
kids being brought up with
various levels of trauma in their life
and I think
that's one of the things that
that Yarrabah video spoke to I think,
about how do you address
some of those issues
because the average clinician
is sort of going,
'Oh, what do I do about
the transgenerational stuff?' You know?
But the way they've done things there
at Yarrabah has been fairly simple
and it's just an approach of empowerment
and these are some of the things
I think we need to add
to chronic disease programs
to give them a bit more...
I mean, it's qualitative kind of data
which, you know,
most of us go... pretty average.
But in actual fact, we really need
a lot more qualitative data
because we have got a reasonable amount
of quantitative data around what to do,
it's how we do it.
If the government's closing the gap,
health target is to close the gap
in life expectancy within a generation,
what are some of the ways this target's
being addressed on the ground
or is it, I mean, we've talked...
Do you think it's a realistic target
to start with, Sally?
SALLY: No, I don't.
I don't agree with that
because I think that is too short
a time span
and would be really virtually impossible
to achieve within a decade,
for goodness sake,
when how long has this been going on?
I think it's an admirable objective.
But I don't think it's possible.
I'd like to think so
but I don't believe it is.
I just want to go back a little way,
if I may, to...
..research when Mark and Alex,
are the researchers here...
We've been researched and researched
and researched
and there've been
so many recommendations made,
so many policies made.
As a previous
Aboriginal health leader said,
'If policies...', what was it?
'If policies improved health, we'd be
the healthiest people in this country,
in this nation'.
And I think that that's true.
The policies that have been developed,
that have not ever been implemented,
if they took them off the shelf
and implemented some,
some of them would be a lot better off.
I think, look, every person
who works in primary healthcare
will understand
that there's political imperatives
and there's a whole lot
of ideological things that drive
where the funding goes in policies
and the two levels of government
which can kind of stuff up
the best policies
and so things get driven
in various directions
and then just don't turn out to be
very coherent on the ground.
So your average clinician working there
is going,
'Well, I know this will work
if I'm gonna do this program'
but they actually don't have
the resources and funding
to do it themselves on the ground.
Or the community has got insufficient
infrastructure to make it work.
So it's a really challenging area
and I think it would be great
if we can get it going but, yeah.
Well, we've got some questions
from our audience,
some questions for the panel.
And... (Clears throat) Excuse me.
I guess a lot of the questions
are focused
on the wellbeing program in Yarrabah.
One of the questions is how are
the outcomes from the wellbeing program,
how are they measured,
what are the tangible outcomes
and what are the obvious changes
within the community?
I think you could see from that package
that it had quite positive effects
on those men.
The initial research that was done
around the Men's Group in Yarrabah
was based on
participatory action research,
so it was based on
self-assessed improvements
in their own,
whatever their own targets were.
So in the Yarrabah Men's Group,
they had a lot of different areas
that they wanted to improve
and a lot of them were
more personal things like, you know,
'I want to spend more time
with my wife and kids',
'I want to teach my kids,
spend more time with the kids
doing fishing and hunting
and stuff like that',
'I wanna have better communication',
'I wanna do...'
There's a whole lot of things there
and measured over time,
they showed significant improvements
but that's, you know,
this is once again qualitative data
and it's actually hard when you're
dealing with small groups of people
to get good long-term quantitative data
out of that
so I don't think we've,
the Yarrabah group anyways,
has looked at how they're gonna measure
those, you know,
hardcore health outcomes
like drops in blood pressure
and stuff like that
and better chronic disease control yet
but it's a good start and it will really
help to inform us, you know,
inform the evidence base around how
we approach some of these programs
from basic sort of work with men
right up
but it's useful information.
Suicide rate, I mean,
it's dropped significantly.
I mean, that's a pretty hard outcome
and a very good outcome
for that process.
Another question from Paul in Goulburn.
He says, 'In my experience,
Indigenous communities
tend to have high rates of smoking.
Are these statistics
and other health-related statistics
recorded anywhere so that
health professionals can access them?'
It's a fair enough question.
Yeah, I mean,
there's a wealth of literature out there
about smoking rates
in Aboriginal communities
ranging from data collected
as part of the Australian
Bureau of Statistics' work
right through to the, you know,
Aboriginal Torres Strait Islander
health survey
that companions that every four years
and then there's a whole raft
of policy papers on smoking,
cross-sectional surveys
of community members -
men, women and pregnant women as well -
so there's a wealth of literature.
You could just google
'smoking in Aboriginal'
and get an absolute packet
of information.
The useful one of the biannual report
from ABS and
Institute of Health and Welfare
which has most of the data in it.
It has a whole lot of that data
that you can capture
and most clinicians
can have a good look at them
and get updated on
where everything's up to statistically.
The second case study, the Dharah Gibinj
Aboriginal medical health service
has a chronic care program that looks at
prevention, treatment and management
of chronic illness.
Part of the program
is a Healthy Lifestyle program
that covers nutrition, physical exercise
and mental health.
The chronic disease management program
at Dharah Gibinj
consists of three components -
the first is prevention,
the second will be screening
where we screen for people at risk
and people who might have
chronic disease they don't realise,
and the third would be treatment
of illness.
The Healthy Lifestyle program
is a series of sessions.
There's 12 sessions
and they cover things
like healthy cooking,
fats, serving sizes, food labels,
exercise component,
we talk about drug and alcohol,
depression
and they cover other chronic diseases
that affect our lives.
I can see huge differences
in the way people look at
chronic disease management today.
Two years ago,
there would have been heads in sand,
it would have been overwhelming,
they wouldn't have known where to start,
the only thing they knew
was that it kills them.
Oh, Suz. Good to see you, mate.
That's for
the Healthy Food Awareness program
and this is the time,
the schedule for what's going on.
My name is Wayne Richie and my position
here is an exercise physiologist.
Slide him up.
Basically, we go to Namatjira Haven,
we go to Woodenbong,
out to Bonalbo, Coraki, Kyogle
and we just basically try
to get the message across to people
that, you know, the Aboriginal people,
just a little bit of education
and just looking after their health.
Yeah, mate, just gotta grab the easel
and we're right.
I've got a heart here.
They're coronary arteries which
actually run down the front of the heart
and you see all that white plaque
in there?
Well, that's actually caused by diet,
genetics, lifestyle,
there's a number of issues
that can cause it.
So I'm actually just gonna find
a coronary artery
and I'm gonna just squirt a little,
a bit of saturated fat through it.
And you can actually see
the arteries blow up... and block.
Do you wanna... Anyone wanna have a go?
MAN: I'll have a go.
- Yeah?
Tell somebody a thousand things
but if they can see it
and actually do it
and feel what they're doing,
it sinks in more with them.
..close to your chest.
The main health issues is obesity,
that's rampant
out in a lot of the communities.
Like, we've got people out there
that are 150, 160kg
and they're under 25 years old.
Hmm, and that's a really big thing
because if you put obesity to...
It's pretty much
all the metabolic diseases in one.
That's actually
what a kilo of fat looks like
so, you know,
if you're ten kilos overweight,
you're gonna have ten times that amount,
if you're 40kg overweight,
you're gonna have 40 times that amount.
You just get the message, you know,
if youse eat well
and cut out your saturated fats, youse
are definitely going to live longer.
You know, I really mean that sincerely.
You just gotta plant that seed
on their health
and just let it grow and let them
think about what was said
and then the next day they come along,
they'll be a little bit more open
to their health
and then next time we see them
and that's how we do it.
Yeah, it's just a real slow approach.
We have devised a number
of multidisciplinary clinics so...
For example, if someone has diabetes,
they need to have a yearly screening
of a number of different types
of disease processes
so we have a DCAC - Diabetes
Complications and Assessment Clinic -
where they come in and that screening
is all done on the same day,
at the same place
so they don't have to go to eight
different types of appointments
over a long period of time
and that is much more
culturally appropriate.
We've also done the same
with respiratory.
Patients would have to go away
for their spirometry and testing
and then go off and see a specialist.
We now provide that as a clinic
and they come in, they will see the
nurse and have all their testing done
and they will see
an exercise physiologist
and have their exercise levels recorded,
then they will go and see
a respiratory specialist
and have their lungs assessed and their
condition diagnosed and treated.
So it all happens on the one day.
And my people, like,
they're just so casual about things
that if they come to town,
and even if they come around
to see the doctor,
they would never say, 'Look,
check my blood sugar. See how it is.'
Unless the nurse out here
got them in and asked them about it,
you know.
Just slow it up a bit, mate.
Just come down to your chest height.
Chest height, yep, chest height.
Nice and slow back...
Two seconds down, two seconds...
Breathing in, breathing out.
(Laughter)
I like to use results
because they're concrete
so I like to show patients
their results,
I like to give them a goal,
a good result to aim for
and I like to use graphs
and visual things
so that they can see themselves
improving.
When they see their blood pressure
coming down
because they are taking
their blood pressure medication,
I think that's very powerful.
You get them coming back and saying,
'So that worked!
What else can you teach me?'
And then you've got a road in and
you can teach them a healthy lifestyle.
If you wanna take it up
a little bit more resistance,
just hit that button there
on the right-hand side.
I was a type 2 diabetic
and I used to poke my needles
in there
but what I did is just lost my weight
and eat healthy food,
I'm no longer on needles at all.
All I do is a diet
for my type 2 diabetes now.
Yeah, you can change your lifestyle,
you know,
if you do the right thing, you know.
Because it's up to you
to motivate yourself
and get out and do the things instead
of blaming your sickness, you know?
See, the doctor wanted to put me
on pension but I said no,
I'd still rather work
than get on pension, you know?
Because I've been active all my life
and I just want to be active
till the day I die, you know?
I think we can deal with the acute
but overall, if we want to close
that gap that everyone's talking about,
we really need chronic disease to be
he forefront of Aboriginal health.
Good to see they're having some success
in Casino
with the Dharah Gibinj program.
I guess that leads to my next question
and that is,
what are those strategies that work best
in Indigenous communities?
What health promotion strategies?
Deanne, you'll be able
to answer that question.
What health promotion strategies work
well with Indigenous communities?
Health promotion strategies
need to be multilayered.
It's great to be able to work
with individuals and families
so you've got programs like
the Healthy Lifestyle program
that works with,
it's a group-based program
or you have your brief intervention
which is practitioner,
individual sort of approach
with the practitioner and the patient
but then you also need to look at those
things that will support the individual
to take up those healthy lifestyles.
So if there's no food in the stores
or healthy foods in the stores,
then it's gonna be difficult.
So we need to address those things
that are at that particular level,
the local level,
and also looking at, you know,
expecting someone to go
and do physical activity
without the right environment
needs to be addressed as well.
So, supportive environments,
making sure there's food supply,
those sorts of things
and a workforce to do that.
DANIEL: Yeah, of course.
There are some systematic and
effective primary healthcare principles
which we know work well
in Indigenous communities -
they're things like consultation,
community input -
what do you say to that, Mark?
I mean, they're obviously
the really important...
They're really basic things, I think.
And probably things
we get the most wrong.
And the oftenest, you know,
is that we say,
'Yeah, we did
some committee consultation' -
which was a consultation of one, often.
We really need to get that systematic
and work out ways of working
with the broader community
and, you know, it's...
..not very smart to think you're gonna
get full community consultation
'cause, you know,
you can't expect every person
in every single community
to wanna put their hand up
and come along and discuss their health
every time that you run a meeting
'cause it probably happened to them
15 times before anyway.
So we've got to get
the consultation part right.
We've got to learn to delve down
a bit deeper
than just saying,
'Well, what do you want?
What do you think the issues are
and what do you want?'
and when people say,
'Nutrition program',
we've got to go deeper and go,
'How would you like that done?'
It's when community mobs
start telling you
exactly how you can do it,
how it will fit in
with what happens in their community -
that's really rich, important data
that we often don't do anything with.
Partly because we're used
to delivering services a certain way
and operationally,
particularly for remote communities,
you know, we have
these cost efficiencies
and a whole lot of other ways
that we deliver our programs
and it doesn't always fit with the way
that should work most effectively
for communities.
So it's really important that
we get the data to do something with it.
Once again,
we've just done a consultation
and let the community down, basically.
There's a whole idea of being
really systematic about care,
so this is more than the audits we do
of just the clinical notes of the people
that go to the clinic regularly
and often, you'll see
that there's a lot of people
that don't access the clinic regularly
and they're often the ones that need
help the most from the health service.
So it's how we engage with
the entire community systematically
and regularly with that
so it's not about humbugging them
and turning up on their porch every day
for, you know, blood pressures
and sugars
but it's about engaging people
and letting them understand
that the clinic and the services
are accessible,
the programs are accessible,
they can be comfortable there,
you know, with the health staff
and it's about us getting out a bit more
of our comfort zones
as health professionals
and try to reach out a bit more.
And then all of the usual things
that are involved in this,
you know, good quality
improvement processes,
using evidence-based clinical guidelines
and sticking to them
rather than just going off and doing
what we sort of reckon is the best thing
and, look, there's a real need for us
to monitor and evaluate ourselves
when we're doing this to make sure
we really are hitting the mark.
And if we're not,
then we've got to change.
And it's not good enough
for us to continue
to do the same things
over and over and over again
and say, 'Well, that's all we can do.'
There's plenty more we can do
and we've got to evaluate.
There's also
just the logistical nightmare
of getting people to treatment.
I mean, people have to leave
their communities for treatment
as we see in such large numbers
in Central Australia.
Those present major problems,
don't they, Alex?
They certainly do and we're creating...
You know, when we talked before about
how important connectedness is,
we're actually disconnecting people
for them to access services
and we're creating a whole range
of sort of medical refugees,
people who are completely dislocated
from their family structures
and community environments
to just access services.
And people accept that
that's the reality
but it comes at an enormous cost
and we don't really understand
or fully accept what that cost is
and it's borne by communities.
We need to really understand that.
I think that... Sorry, I think building
on what Mark has just mentioned,
building on that strength
when you engage in community,
find out what the strengths
of the community are
and you build on those strengths
and so, Yarrabah was a good example as
well as the New South Wales example,
is being able to ask a community
what they want,
how they want it and when it's done
and going back to, you know,
accessing traditional foods
if that's what people want to do
and if that's the easiest thing to do,
then certainly, health promotion people
need to take into consideration
and other health professionals
about the strengths of the community,
what they have there available to them,
I guess.
Now to our next case study.
How do we encourage self-management
of chronic illness?
Let's have a look at how one service
is using an old concept
with a new approach
by personalising client-held records.
My name is Bernadette Heenan, I'm part
of a team called the IPHCI program
which is Improved
Primary Health Care Initiative.
It's a program that started in 2006
and the idea was to deliver medical
and allied health services
to remote Indigenous areas
to try and achieve better outcomes
in chronic disease management.
95% of the clients I see
are Indigenous Australians.
Most of those people live up
Cape York Peninsula or Mossman Gorge
which is about an hour and a half
from Cairns.
Mossman Gorge community itself
has between 120 and 170 people.
The percentage of diabetes
in that community
is anywhere between 30% and 40%.
So diabetes generally
in Indigenous Australians,
you're looking at about 20% usually
and this is, can sometimes be seen
as double that.
Also, there's a high number of people
with some
of the end-stage complications.
There's about six people
from that very small community
with end-stage renal disease
who are on dialysis.
DOCTOR: Get any better?
BERNADETTE: We work with a number
of other health professionals
in the diabetes section -
dieticians, podiatrists,
physiotherapists,
psychologists, counsellors, GP
and also, the person who's most crucial
to the success of our team -
our community engagement coordinator.
- Well, I'll go tomorrow and see Herbie.
- Yeah.
- Just to let him know that...
- That we're coming, yeah.
Just ask him to bring his monitor
as well
so we can see how his sugars
have been going.
My job is to link the team
with the community
and get the community to feed back
to the team
on how to provide a service to them.
- Hey, Herbie.
- Hello.
How are ya?
- How are you today?
- Good.
Yeah? That's good.
We've got Bernadette up there today
and she was wanting to see
if you're wanting to come up there
and go through...
- Yep.
- To have a catch-up.
It's always important to have an
Indigenous person for the team's sake
who knows about the dynamics
around the community
and what's happening
and for also the community people to
come and feel comfortable to talk to me.
Only 'cause of that funeral and
everything, we put everything back.
We look at some
of the underlying issues
which is part of what my job is as well
to help the team to recognise those
and to get the community to tell me
what those underlying issues are
that contribute to this high number
of people in the community
with chronic disease.
Hello, hello!
How are you?
BERNADETTE: A lot of how we deliver
our services
has been tailored to suit our clients,
so we don't just work in clinics,
we'll do home visits.
So we provide services
wherever there's a need for it.
You've got something happening with your
monitor and you want to see Bernadette
so I'll let her sit down and youse
can find out what the issue is there.
BERNADETTE: What's been happening?
Fighting fit and healthy and everything?
MAN: Yeah.
- Yeah, and I see you brought
your folder and everything.
We came up with the idea
of a self-management folder
that belongs to them.
So rather than having
all the information about their body
whether it be blood tests,
blood pressure, blood sugar, etc.
being kept in the files either at a GP
or at a clinic,
the idea is that it's actually given
to the person.
So back in March, it was 10.4,
that's your average sugar...
- Yeah.
- ..over the last three months
and it's come down to 7.4,
you know, at about three, four months
later after that
and that's the best it's ever been
so that's awesome.
- Good.
- Yeah, look.
We always try and put
clinical measurements
like a blood pressure and a blood sugar
and a waist measurement
into the folder at the time of doing it
so that the person understands
the relationship
between the tests
that have just been done
and the actual results
so that it's basically giving immediate
education.
Having my own folder helps a lot.
I know where I'm at and,
you know, all that so it's pretty good.
I like...
..the diagram that
Bernadette drew up for me
explaining what I'm having,
take your food and all that.
Not to drink helps, whatever you take,
it goes into your blood stream
and all that.
And she keeps me up to date
with all this here.
The idea also is that
the information can be shared
between all
the different service providers
who assist the client
to look after themselves
and manage their diabetes
so there's a calendar at the front of it
showing little icons
of people who are involved in the care
for someone with diabetes
and we encourage the person
to take the folder with them
to other healthcare providers.
Yeah, if you go to the doctor's
and they give you that number,
and then ask them...
And you can take this folder
with you too.
Yeah.
Whenever you get
your blood pressure done...
I've got one of these...
We try and educate at every opportunity
rather than just writing things
on one little scrappy bit of paper,
so that they can plot changes
and explain,
'Ah, well, your blood pressure's crazy
today. Did you take your tablets?'
If not, then we'll also write that on
as a note on the paper for it to show
and when they take their tablets
and we do their blood pressure later,
you can see the difference.
I just pop it in like that...
One of the things we've found
is that when we educate people
and make them feel in control
and empowered,
they actually gain
quite a bit of confidence
and they become experts in doing maybe
their own blood glucose monitoring
or in maybe understanding
various aspects of their care.
I've learned a lot now about diabetes.
I've learned, just talk to my kids...
..to watch themselves
when they're eating sweets and whatever.
You can see how it used to be, you know,
you had sugars way up in that range.
- Yeah.
- Now they're all in that range there.
We've seen some people definitely start
to become the boss of their diabetes
and sometimes you can measure this
in figures
so we've seen some people
with an HbA1c of 10%
when we first met them.
Within a few months, come down to 7%
but along with that usually goes
improved blood pressure as well
and always an increased knowledge
of what has made that change happen.
So, yeah, we've seen people
take on ownership and acceptance
and yeah, get in the driver's seat
of their diabetes.
Some great work being done
up in Mossman Gorge.
What's some of your reactions
and comments to that case study?
I mean, it was great having
a community engagement officer
walk into the community and really
be part of that delivery of healthcare.
Absolutely. Can I just say that
that's the most fantastic team
I've seen in a long time?
And then can I also add that
they're now working for Apunipima,
my organisation,
so I'm a little bit biased there
but in actual fact, they are,
all of that team's a fantastic team.
They work really well with communities
and as they were saying, one of the keys
is good community engagement.
There's various ways of that working,
so we'll engage at different levels
from with the council,
with the men's group,
with the women's group,
with various teams like
the health action teams in communities
and volunteers who work on health
in communities
right through to individual
community engagement officers like that
and the program works effectively
and it was working very effectively
before we took it over.
So the Far North Queensland division
of general practice
originally ran that program,
it's been great.
One of the things that
we've been working on with that team
is how we ensure that the person
like the community engagement officer...
Now, because, you know, and I think
they are the critical, central...
..they play the central role there
but unfortunately
they're usually the lowest-paid as well
so this is about workforce as well
so one of the things
the team's working on
is how we encourage people
like, you saw Keely,
the young community engagement worker.
She's fantastic and, you know,
as a person that's involved
in Aboriginal health workforce,
I just can't go past a person like that
and say
we really need to be able
to develop them more
so that they've got a clear structure
so we can build on that,
we can build on the skills
that they have of working with people,
we can build on their medical
and their health knowledge
in any direction they want to go,
really.
But it's part of the workforce process
as well,
but engagement's hugely important.
I think a really critical question and
I address this to anyone on the panel,
and is it... the self-management
of chronic disease,
is it a bit rich to ask the most
disadvantaged communities in the country
to self-manage their chronic disease?
Well, I think it's problematic.
I think what that last case study showed
was how important good communication
with your client is
and then, you know, anything's possible
and it's just fantastic to see that,
you know,
people are supporting good communication
with clients around their condition
and I think that's something that
we've lacked in Aboriginal communities.
The issue of self-management
is a complex one
and a problematic one for me
because I think
in disadvantaged populations
it's very hard to expect them
to step up to the plate
and pull themselves up
by their boot straps
and manage their own conditions,
which are often conditions
they don't fully understand
which haven't been communicated well,
which are labels
they don't necessarily comprehend
or accept or agree with
and don't understand
and then expect them
to lead a life of, you know,
doing all the things
that we tell them to
without creating an environment
around them
where they can make those choices
to lead a healthier life.
So I think it can set up people to fail.
I think the importance with, really,
the case study from Casino
was really about setting
realistic targets
and helping people achieve those
and how that was
a very positive way for it.
I think self-management can be
problematic in disadvantaged communities
where they don't have
all that infrastructure around
to support behaviour change.
What's the importance of training
Indigenous health practitioners?
We know how important work
like you've done, Sally,
but how important is it getting,
you know, our people trained up
to work in our communities?
Extremely important.
The community engagement coordinator,
what a wonderful example that was
and there should be more of them,
certainly,
and if it's necessary to create
a career path for them,
in which... for their level of expertise
and if they wanted to stay in that role,
they should be remunerated appropriately
for the valuable work they do.
And it's the same
with Aboriginal health workers
and the wonderful job that they do
and we couldn't function without them
out in the remote communities.
I would like to think that CATSIN,
my organisation,
the Congress Of Aboriginal
and Torres Strait Islander Nurses,
and the Aboriginal health workers
have a good relationship
and we have done thus far
and we'll be even better
now that they've set up
and have their own Aboriginal
Health Workers Association set up
and I think that that's really great
and I think that they don't get...
..as much 'good' publicity
as they should have.
What can the mainstream services learn
from this kind of example, this model,
Deanne Minniecon?
I mean, you know, this is how
Indigenous people do health, isn't it?
Yeah, by engaging again
a local workforce,
using a local workforce,
they know what's going on
in the community,
they know when the professional
should come in
or when they shouldn't come in
but at the same time
we certainly do need to build up
the health professional workforce also
whether it's across medicine, nursing,
nutrition, you know,
podiatry, optometry, we also need
to build up those positions in policy,
you know, so that we have
Aboriginal, Islander people
working in those areas to direct policy
to suit Aboriginal, Islander people
as well.
So right across the health workforce,
not just in specialised areas.
Now, we've got some questions
from our wonderful audience.
And the first question is from Aaron.
He is working
in an Aboriginal community -
'I'm part of a diabetes team
in an ACCHS,
an Aboriginal Community
Controlled Health Service,
and I've found more people
starting on insulin
because they have control
over their dose.
It's a small area
which improves concordance
and enables health education to occur
at the same time.
Can we call that empowerment?'
That's Aaron's question.
I mean, I think you can.
I mean, empowerment comes
in many different colours and faces
and it has many different facets to it.
I think people maintaining
a sense of control over
their medication regime,
the way in which it's delivered,
is all part of that process.
We're starting to see more people,
more Aboriginal people, on insulin.
That's both probably a good thing
and a bad thing.
Good that people are taking that option,
the bad thing
that there's a need for that.
But I think that, you know,
there will be medical solutions,
I think, in the future, which will make
insulin and long-term
diabetic medication
easier for communities in the future.
Another question here - 'I agree
that empowerment, not spoonfeeding,
is essential for long-term,
meaningful change
but when someone is not
in the frame of mind to be empowered,
how do we generate the desire
from within?
Especially when
there is no acute disaster,
for example suicide rate,
to spur people into action?
How do we change from passive acceptance
to proactive action?'
Yeah, look, I think, we've done
a bit of work with men's groups on this
in various locations.
There's always a locus of people
that want to be empowered,
that want to do things, that want to
take responsibility in communities,
there's always some in every Aboriginal
and Torres Strait Islander community
that you can build on,
it's just finding them,
identifying them
and starting to work with them.
It may not be everybody
and empowerment is a process
that may not work for everybody.
Its roots really lie in education
in disadvantaged communities
from South America
and it's been proven
to work pretty well in that area
as well as, there's been WHA,
evaluations of empowerment as a process
for health promotion particularly.
But getting someone to the stage
where they are happy to accept...
..another person's input into
where they're going in life,
a lot of that depends on the way
that you communicate with them
and the way that you engage with them
from the start
and you have to really ensure
that you're...
A lot of this is about the way
that we project culture
or dominant culture or whatever
with people that we're working with,
we have to be really clear
that we're approaching it the right way,
for a start,
and the second thing is really
finding out where people are at.
If people are clinically depressed
or there's other issues going on,
they're probably,
they're not gonna respond that well
but the idea of this is to work
with people in the long term,
not just to expect
that they'll suddenly go,
'Wow, I wanna be empowered.'
It's more about
sort of a long-term process
engaging with communities
and with individuals over a long term
and actually building trust,
relationships
and, you know, as most people that work
in Aboriginal communities know,
it's all based on relationships,
not how good a professional you are
but your relationship with the person.
So my answer would be, yeah,
that you continue to work with people
and that you never give up
because it's hard enough when Aboriginal
communities themselves lose hope
but when the health professionals
lose hope as well,
you're in real problems then.
We have to remember too
that these sorts of experiences
are not just for Aboriginal,
Islander people, it's for all people
and so, how you deal with that in
other communities is gonna be similar.
We've just got to remember
what Mark had just mentioned
is think about our own cultural baggage
that we come into the communities with
and how that's gonna affect the way
that we deal with individuals.
I'd like to thank our audience
for those questions.
We didn't get time to all of them.
I guess now we have to think about
what our take-home messages are
from each of the panel.
Can I start with you, Sally?
What do you want people to take away?
I'd like to think that
people would consider... tolerance...
..acceptance...
..look at the principles
of reconciliation
and also look at why we're here tonight.
Why are we here tonight
if we're not hoping to make
a difference?
So that we can make a difference
with Aboriginal
and Torres Strait Islander health...
..that we can work together
for the greater good.
DANIEL: Alex?
Yeah, I suppose I do get asked
this question quite a bit.
I suppose the first bit of advice
I'd give is
if we delivered everything
we knew we should deliver,
we'd make an enormous difference
so reduce the gaps
between evidence as we know it
and evidence as we practise it,
we'll make a huge difference.
Mark just touched on an important point.
You know, if health practitioners
give up hope, we're in trouble.
So don't give in and certainly
don't give in on your patients.
You know, it might be
the first 10 or 20 times you see them,
they're not interested
in engaging with you
but at the 30th visit or the 40th visit,
that might be the opportunity
to make a real difference and change
in that person's life,
so never give up on your patients.
And, really, bring to the table
what it is that you do
better than anyone else
and contribute that to Aboriginal health
and if we all do that,
we'll make a huge difference.
Deanne Minniecon,
your take-home message.
That it is everybody's business
to improve Indigenous health.
But one of the key things would be
to value Indigenous knowledge,
to value your workers that are there in
that community, in your local community
but yeah, basically to value
that knowledge that's already there.
DANIEL: Mark.
I guess from my perspective is
it's, we're all trained really well
in acute medicine.
Doctors and nurses especially -
other health workers are probably
better trained
in broader aspects of health -
but doctors and nurses - don't hit me -
we really are well-trained in that area
and we've got to start thinking
outside of that area
and it's a challenge for us to do that,
to think about populations
and public health approaches
and how we do target interventions
and how we respond to audit trails and
a whole lot of other things, you know.
But the key is, I think,
to not be defensive,
is to say, 'Look, we've been doing
a lot of acute medicine,
now we need to change
the way we do things
and look at chronic disease models
and take it on board
and start working with it'
because we'll see results and there's
documented evidence in Australia,
that, I mean, Alex has published,
and it's where you can do good,
systematic, comprehensive
primary healthcare
and it works and there's results
and you see decreases
in mortality rates.
That's what we all want
and I think we can do it.
We definitely can do it and
it's just a matter of staying focused
on the broader sense of good primary
healthcare from my perspective.
Thank to our wonderful panel.
I hope you've enjoyed the program -
Sharing Solutions: Indigenous
Communities Tackling Chronic Disease.
If you're interested in obtaining
more information
about the issues raised in the program,
there are a number of resources
available
on the Rural Health Education
Foundation website
at rhef.com.au.
Don't forget to complete and send in
your evaluation forms
to register for CPD points.
I'm Daniel Browning. Goodnight�

https://www.youtube.com/watch?v=SnNUM8BXAaE


Banfield Pet Hospital - Risks and Signs of Dental Disease in Dogs and Cats




[Music]
>>NARRATOR: Periodontal disease.
>>DR. WEBB: Hi, I'm Dr. Webb, a veterinarian
at Banfield Pet Hospital.
As your partner in pet care, it's our goal
to help you keep your pet healthy and happy.
Today we're going to share some information
with you about periodontal disease.
>>NARRATOR: Healthy teeth and gums are one
of the best healthcare gifts you can give
your pet.
Did you know that 68% of cats and 78% of dogs
show signs of periodontal, or dental disease
after age three?
Dental disease is a bacterial infection of
the tissue that surrounds the teeth.
It sounds harmless, but the truth is that
dental disease can cause a lot more than just
bad breath.
In fact, Banfield's Applied Research & Knowledge
team, called BARK, has found that dental disease
is the most common disease in dogs and cats.
Here's what you should know about dental disease's
signs and symptoms.
Just as in humans, dental disease begins with
plaque and tartar buildup on your pet's tooth
surface.
Food particles and bacteria rest along the
gum line, forming plaque.
At first, it's soft and easy to remove at
home with brushing or dental chews.
If it's not removed quickly, within three
to four days, plaque mineralizes and hardens,
turning into tartar, which is a yellowish-brown
color.
The bacteria in tartar can cause gingivitis,
which is inflammation of the gums.
If tartar isn't regularly removed, it will
continue to accumulate along and inside the
gum line,
encouraging more bacterial growth.
Gingivits can easily and rapidly progress
to more severe inflammation, or periodontitis.
This leads to infections, tooth loss, bone
damage and associated pain.
>>DR. WEBB: If left untreated, severe dental
disease can lead to bacterial infections that
spread through the bloodstream to other organs
in the body including the heart and kidneys,
causing chronic disease and even organ failure.
It's important to visit your Banfield veterinarian
if you notice any of the following signs in
your pet.
These may appear suddenly or develop slowly
over time:
>>NARRATOR:
Bad breath
Decreased appetite
Pain when chewing or chewing only on one side
of mouth
Weight loss
Yellow teeth
Red or swollen gums
Missing, cracked or broken teeth
Nasal discharge
Tearing or swelling below one eye
Thanks for listening.
Remember, you know your pet best.
And we know how to help you keep them healthy.
For more information on this and other pet
healthcare topics, visit banfield.com
[Music]

https://www.youtube.com/watch?v=V1Chy66GV00

Common Cat Medical Problems : Excessive Cat Urination - Can Diet Protect Against Kidney Cancer?

Diabetes Rx May Be Safe for Kidney Patients - Renal Hemodynamics Animation

How To Improve Kidney Function Part 3




http://howtoimprovekidneyfunction.net gives
you detailed tips on how to reverse kidney
damage naturally.
How To Improve Kidney Function (Part 3)
What are the signs and symptoms of kidney
damage?
Early Symptoms
The early symptoms of diabetic renal disease
are typically not seen in individuals who
have diabetes. This condition can be diagnosed
by a routine urine examination. Other laboratory
examinations which can help with the diagnosis
are increased blood potassium concentrations
and elevated blood urea.
Some of the noticeable symptoms in the early
stage of kidney disease include:
* Sleepiness and Fatigue
* Leg swelling
* Nausea
* Bad breath as well as a reduction in appetite
* Foamy or frothy urine
* Excessive sleeping
* Increased urination frequency at night
* Inability to concentrate for long periods
* Lethargy
* Seizures
* Leg restlessness
* Peripheral neuropathy or tingling sensation
How To Prevent Diabetic Kidney Disease?
Find out your answers in Part 3 of our “How
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Check out these related videos too:
How To Improve Kidney Function Main Channel:
http://www.youtube.com/user/improvekidneyhealth
How To Improve Kidney Function - FREE Mini
eCourse:
http://www.youtube.com/watch?v=GtRL88STaIw
How To Improve Kidney Function Part 1:
http://youtu.be/GltJSGlbsyc
How To Improve Kidney Function Part 2:
http://youtu.be/vyb9t4EuJcI
How To Improve Kidney Function Part 3:
http://youtu.be/WtbIjrX-0bY
How To Improve Kidney Function Part 4:
http://youtu.be/enudWV2_IHM
How To Improve Kidney Function Part 5:
http://youtu.be/gUH6ieIDr0o
How To Improve Kidney Function Part 6:
http://youtu.be/z2qHr3ih1f8
How To Improve Kidney Function Part 7:
http://youtu.be/oKv6jsoNUM4
How To Improve Kidney Function Part 8:
http://youtu.be/zCARwEL1R68
The Kidney Disease Solution - Start by Understanding
the symptoms Of Kidney Problems (Part 1)
http://youtu.be/zrebLcPYgdY
The Kidney Disease Solution - Start by Understanding
the symptoms Of Kidney Problems (Part 2)
http://youtu.be/dD50sYmrDxw
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How To Improve Kidney Function Part 3:
http://youtu.be/WtbIjrX-0bY

https://www.youtube.com/watch?v=WtbIjrX-0bY


Warren County teen preparing for kidney transplant




CALL KENTUCKY STATE POLICE.
A WARREN COUNTY TEENAGER IS
STRUGGLING TO SURVIVE.
BUT THANKS TO A WOMAN ALMOST 3
TIMES HER AGE, SHE'S GETTING A
SECOND CHANCE AT LIFE.
WLWT NEWS 5'S EMILY WOOD
REPORTS ON THE LIFE-SAVING
KIDNEY DONATION, A HIGH SCHOOL
JUNIOR HAS BEEN WAITING FOR.
EMILY: 17-YEAR-OLD KENZIE
GILBERT WILL BE ADMITTED TO
CHILDREN'S HOSPITAL EARLY
TOMORROW MORNING.
THE DONOR IS ONE OF HER MOTHER'S
CHILDHOOD FRIENDS AND HER
SURGERY WILL TAKE PLACE AT UC
MEDICAL CENTER, MAKING THIS
DONATION THE FIRST OF IT'S KIND
IN CINCINNATI.
POINTS UP AND YOU COUNT THESE
POINTS.
EMILY KENZIE GILBERT HAS KNOWN
: KELLEY FITZGERALD HER ENTIRE
LIFE.
AND IN LESS THAN 48 HOURS, THESE
TWO WOMEN WILL SHARE AN
UNSHAKEABLE BOND.
I FEEL GREAT, I'M EXCITED
ABOUT IT.
IT'S AN OUTSTANDING GIFT.
EMILY BASED ON BLOOD WORK,
: KELLEY IS A PERFECT MATCH TO
DONATE ONE OF HER KIDNEYS TO
KENZIE.
DIAGNOSED AT FOUR MONTHS OLD
WITH POLYCYSTIC KIDNEY DISEASE,
KENZIE HAS SPENT THE LAST 17
YEARS IN PAIN, AND HER DOCTORS
SAY DIALYSIS IS NOT AN OPTION.
THEY SAID THAT I WAS A
MYSTERY TO THEM.
THEY ALWAYS SAID THAT I WASN'T A
NORMAL KIDNEY PATIENT.
EMILY FOR KELLEY, DONATING A
: KIDNEY WAS ONE OF THE EASIEST
DECISIONS SHE'S EVER MADE BUT
BEING OVER 50, SHE HAS TO HAVE
THE OPERATION AT UC MEDICAL
CENTER, WHILE KENZIE IS AT
CHILDREN'S.
ONCE WE DID QUALIFY WE DID
HAVE TO WAIT FOR SEVERAL MONTHS
FOR CHILDREN'S HOSPITAL TO GET A
POLICY IN PLACE TO BE ABLE TO
TRANSPLANT OR TRANSFER THE
KIDNEY.
EMILY AND ONCE HER NEW KIDNEY IS
: PLACE, KENZIE CANNOT WAIT TO
LIVE HER LIFE LIKE EVERY OTHER
TEENAGER.
I'VE HAD TO GIVE UP DRIVING
AND HAVING A JOB AND I DON'T GET
TO GO TO SCHOOL MUCH AND THOSE
ARE ALL THINGS I REALLY WANT TO
DO JUST TO BE NORMAL.
,
EMILY KENZIE WILL CHECK INTO
: CHILDREN'S MEDICAL CENTER
TOMORROW MORNING.
HER SURGERY IS SCHEDULED FOR
7:30 AT UC MEDICAL CENTER.
REPORTING LIVE, EMILY WOOD
, WLWT
NEWS 5.
LAST YEAR IN OHIO MORE THAN
70% OF ALL KIDNEY TRANSPLANTS
CAME FROM LIVING DONORS.
CURRENTLY, IN CINCINNATI THERE

https://www.youtube.com/watch?v=xOEl0XQ9jWQ