In a series of journal articles co-authored with collaborators who included the University Centre for Rural Health North Coast’s Lesley Barclay and Shawn Wilson, then-doctoral researcher Liz Rix raised important questions relating to the provision of hemodialysis services to Indigenous people.

As the title of one paper (Rural and Remote Health, 3/6/14) bluntly put it, ‘Can a white nurse get it?’

The study concluded that the challenges faced by Aboriginal patients negotiating a system where racism and victim blaming are institutionalised can be mitigated by clinicians engaging in “three layers of reflexive practice… examining self within the research, examining interpersonal relationships with participants, and examining health systems.”

This theme, which emerged from research involving HD patients in northern NSW, was explored further in the BMJ Open (“Service providers’ perspectives, attitudes and beliefs on health services delivery for Aboriginal people receiving haemodialysis in rural Australia”, 29/10/13, and “Beats the alternative but it messes up your life: Aboriginal people’s experience of haemodialysis in rural Australia”, 17/9/14), and a major contribution in Hemodialysis International 2014 (“The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: A qualitative study”).

“Under an overarching theme of “Avoiding the ‘costly’ crisis,” we identified four pragmatic themes that relate to the goal of service improvement,” the authors said.

These were:

  • engaging patients earlier
  • flexible family focused care, which incorporated better engagement at diagnosis between services and family, and more flexibility within services to encompass family and cultural obligations
  • managing patient fear of mainstream services
  • service provision shaped by culture

“Patients and health care providers believe that current services are not flexible, optimally accessible, or family focused,” the authors concluded.

“Aboriginal specific services and support mechanisms need to be embedded within a redesigned system. This may not only provide services that are more effective and efficient, it is likely to be less “costly” to the system and certainly less “costly” to Aboriginal patients and family.”