Tuning in to local learnings

With a background in nursing, education and project management, Christine Howard of UQ’s Centre for Online Health is passionate about empowering local communities.

Howard is Project Manager of DREAMT, which employs Indigenous health workers in remote Aboriginal and Torres Strait communities to use telehealth to assist in the early identification of dementia.

UQmedicine caught up with Howard to discuss the DREAMT project and her work connecting Indigenous communities with geriatricians in Brisbane and Cairns.

You’ve spent a lot of time on Badu in the Torres Strait recently. Tell us about implementing DREAMT in that community. Is it typical of other communities you’ve visited?

It’s been like walking up a very steep mountain. I’ve learnt that there is no such thing as ‘typical’. Badu is one of seven communities we’re working with in the Torres Strait and South West Queensland. Each community has something unique and special about it. Whether it be the environment or the people, they are all different

The other communities involved are Kubin, St Pauls and Mabuiag in the Torres Strait, and Charleville, Cherbourg and Cunnamulla in South Eest Queensland. Unsurprisingly, nothing I have done with the project has been done alone. It has been a huge team effort so far. It isn’t until you work on a complex project such as DREAMT that you truly appreciate how much work goes into it.  

How do you engage with local Elders and Indigenous health workers to ensure that programs like DREAMT will be successful and useful for years to come? 

By taking the time to ask advice from local health services and residents, we find out what the community’s needs are, how they believe the service should run and how we can work together to achieve the best outcomes. Setting up the administrative process and identifying key stakeholders has taken a good deal of time and expertise, but there have been no set rules because everything has needed to be tailored for each community.

Where does your passion to create change in remote communities come from?

The people and communities themselves are what drive me. I have witnessed and experienced some of the adversities that people living in rural and remote locations face, and it drives me to create change. The team at UQ’s Centre for Online Health have many years’ experience working with Indigenous communities, and we all want to do our best to make DREAMT successful. We want to assist with the provision of community-led and culturally appropriate services through DREAMT.

During my time on Badu, I have been fortunate to have been welcomed by the community. I’ve come to understand that family and community are everything, that Country is more than just a piece of land, and that spirituality is both strong and powerful. But the biggest lessons I’ve learnt so far have come from witnessing how things are often out of the control of the local people. Things such as the difficulty of getting services up and running, or finding meaningful work opportunities that allow people to remain in their communities and close to family.

How can programs like DREAMT empower communities and provide better outcomes for patients?

DREAMT does this by giving ownership over how the project is implemented to the communities and their local health services. In saying that, DREAMT is definitely a collaborative effort. The local health services work with Elders and other members of the community to identify people with dementia and refer them for telehealth consults with specialists at the Princess Alexandra Hospital Telehealth Centre and Cairns Base Hospital. So even though ownership sits with the communities, DREAMT needs to be a strong partnership to get the best outcomes for everyone involved.

To empower people in their role, funding from DREAMT has enabled dementia awareness and education to be provided to health workers, broader health staff and the community.

Has working on a project that spans incredibly remote and diverse communities challenged you to adapt and work differently? 

Without a doubt! We recently held dementia education workshops on Badu, Kubin, St Pauls and Mabuiag in collaboration with Dementia Australia. The experience taught me to take everything I have learnt previously about promoting and running a workshop, and throw it out the window! What might work in Brisbane, such as sending out calendar invites or promotional flyers, simply doesn’t work in rural and remote communities. Here, community social media sites and word-of-mouth have been the best promotional tools.

Before DREAMT, I spent 22 years working with students, health professionals of all disciplines, and academics in both the tertiary and vocational education and training sectors. I know and understand a thing or two about teaching and learning – or so I thought. In Indigenous communities, education and the services themselves need to be driven by local people. Local health workers know and understand who needs the services, how to engage with them and what times and places are best suited for people and families. It’s our role to listen and work around what the local health workers and people advise.

Now that the project is up and running in places like Cherbourg, where do you see the DREAMT program in five to ten years? 

The team is working hard to evaluate the service so that our experience can be shared. We are interested in showing the successes and challenges learnt during the implementation of the service. We would like the project to continue being funded to allow the services in the communities to remain and grow. We would also like to expand into more areas of Queensland and Australia. That is our dream. We are the DREAMT team after all!

This story is featured in the Summer 2018 edition of UQMedicine Magazine. View the latest edition here. Or to listen, watch, or read more stories from UQ’s Faculty of Medicine visit our blog, MayneStream.