Monday, 6 October 2014

Indigenous health focus

It’s a long way from Bangalore in India to Gippsland but Dr Anton Isaacs has identified some synergies.

His work in public health in India helped improve the lives of many disadvantaged people and the same is happening in Gippsland’s Indigenous community.

Dr Isaacs, a qualified medical practitioner who lives in Warragul with his wife and two children, has worked with the Monash University Department of Rural and Indigenous Health (MUDRIH) in Moe for seven years.

A researcher and lecturer, he has been awarded the 2014 Medicine, Nursing and Healthy Sciences Faculty ECR (Early Career Researchers) Publication Prize for Social and Educational Research. His publication was titled “Help seeking by Aboriginal men who are mentally unwell: A pilot study”.
As part of his PhD research, Dr Isaacs developed a Koori men’s health day. The outcome has seen four Gippsland Koori men secure funding for, and now run, that pilot program, started by Dr Isaacs with the help of colleagues and the local Koori community.

“When we finished implementing it, the men took over which is the outcome I wanted,” he said.  “I would like to see it run monthly around Gippsland rather than two-monthly.”

Dr Anton Isaacs and five men from the Koori Men's Health Day team
Team work: Dr Anton Isaacs (back left) from MUDRIH in Moe with members of the Gippsland Koori Men’s Health team (from left) Tony Carson, Cliffy Wandin, Berwyn Lampitt (LRH) and Paul Cruickshank (LRH) with front, Rex Solomon

He was supported in his efforts by the Latrobe Regional Hospital mental health service, mental health nurse Berwyn Lampitt and the four Koori men – Laurie Marks, Cliffy Wandin, Rex Solomon and Tony Carson.

He said building trust in the Indigenous community was the key driver to success. A program for men was chosen because of the cultural difficulties in working with women too.

“My colleague Hilton Gruis, a community facilitator, has worked closely with the local Indigenous community and introduced me,” he added. “We identified three people as cultural consultants who in turn introduced me to other people within the community. Once you win trust, there are few issues with people coming forward. I have made many friends within the community which I value.”

Dr Isaacs would like to see every Aboriginal organisation run a men’s mental health program, similar to the local one which he believes is making a difference.

His work in Indigenous mental health has won national recognition. The Victorian Government asked him to evaluate its Aboriginal youth suicide prevention program and the West Australian Government has now asked for his help with its suicide prevention program which includes Aboriginal health.

He has received a $50,000 grant from Beyond Blue to conduct more research into mental health.
Dr Isaacs’ interest is developing services for niche areas in the health sector, especially in communities which are disadvantaged and under-serviced.

“There are two aspects to my work; designing the service then getting the people to come and use it,” he added.

He intends continuing to work in Aboriginal health. “When you work together you get the real success. That's my big hobby horse...get Aboriginal people and mainstream people working together and you get the best outcomes.”

From Bangalore to Gippsland…

Anton Isaacs wanted to be a surgeon from the time he was a young child.

“I was always very good with my hands and my lecturers (at medical school) told me I would make a great surgeon,” he recalled. “It’s all I ever wanted to do.”
That was in Bangalore, a bustling city of seven million people in India. A long way from Gippsland where the Dr Isaacs is now based; living in Warragul and working in Moe at the MonashUniversity Department of Indigenous and Rural Health (MUDRIH).
As part of medical training at St Johns Medical College, students must work in a medically under-served area for two years. That’s when Dr Isaacs’ life changed.
He was in a village in the southern state of Kerala, known as the spice centre of India, sparsely populated hill country also famous for its tea.
He was drawn to the local people, working in a rural area where health services weren’t readily available. “You must understand the social determinants of health,” he explained. “It’s not easy to get to a large metropolitan hospital. People get chest pains, go to work in the fields then on the way home, drop into the small hospital. They have no money to pay for medicines.”
There were two distinct types of people; those who worked on the land and those who owned the land. The first group would be likely to present with infectious diseases, cuts and fractures while the second group would have diabetes, hypertension and heart disease.
“Their health was linked to their socio economic status,” Dr Isaacs added. “I became very attached to these poor village people who would often pay for services with fresh vegetables.”
One and a half years into his rural placement, Dr Isaacs literally woke up one morning and decided surgery was not for him so he applied to specialise in community medicine and public health, working with socially and economically disadvantaged people.
While assisting the professor of community medicine at St John’s Hospital, Rotary International, together with the Rotary Club of Bangalore and the Rotary Club of Columbia (US) offered $250,000 to set up a rural mental health service. Unfortunately, 9/11 put paid to that grant.
“It was some time later that Rotary International sent us $25,000 and my boss gave it to me to do what I could with it in the rural area,” Dr Isaacs added.
That money was the start of a successful rural mental health program that still exists today – the Maanasi Project in the village of Mungalur. Maanasi means “intellectual woman” in the local language.

Today, Dr Isaacs still follows two important concepts he used back then; the first is to get the design of the project right ensuring it’s feasible, sustainable and affordable. The second is to get people to come.

There were no services in the village at all and he identified “mental health problems everywhere”.
He persuaded four local women who all showed leadership qualities to help him. He gave them a week’s training in recognising mental health problems then sent them house to house, conducting a simple survey as a means of identifying mental health issues. The women then suggested to the women they met that free help was available.

The first clinic attracted five people, the second had 10, the third 12 and from then it grew to have 1500 clients.

Dr Isaacs had contacted a local pharmaceutical company which donated medicines.

Eventually Maanasi extended to 25 villages with 15,000 people surveyed. It became sustainable with all patients eventually paying for their medicines.

Rotary International awarded him the highest honour in Rotary, the Paul Harris Fellow, for his work. “I was very honoured,” Dr Isaacs added.

He started to get overseas grants for more research and one day “stumbled” on the Monash School of Rural Health and its work in mental health. He asked to collaborate on a project which eventually resulted in an invitation for him to move, with his family, to Australia and complete his PhD, focusing on Aboriginal mental health. The invitation came from Dr Mark Oakley-Browne, how chief psychiatrist for Victoria, who was working with SRH at the time.

He was based at the school’s MUDRIH site in Moe.

“Socially, the situation for Aboriginal people is far worse than the people I worked with in India,” Dr Isaacs said.

Dr Isaacs immediately fell in love with Gippsland and its people. “Many Dutch families in particular who I met through St Marys Church in Newborough took me under their wing,” he recalled. “I love being part of my community. I open the front door every day and still love the beautiful colours of the countryside.”