Reaching out to rural and remote communities
Robert Martinez has been providing services to rural and remote communities in country New South Wales for more than five years. Here, Robert shares the many challenges that remote and Aboriginal and Torres Strait Islander communities—and the practitioners who service them—face.
Having grown up in the outback town of Lightning Ridge, in north-western New South Wales, has helped Robert Martinez, APAM, find a deeper level of acceptance in the Aboriginal and Torres Strait Islander communities he now services through his outreach work. And Robert’s past is now also helping to shape his future.
Having left his country roots behind him as a young man, Robert moved first to Orange to study physiotherapy at Charles Sturt University and then moved on to the big city of Brisbane as a new graduate, where he took a job in aged care. Robert quickly realised that job wasn’t for him and he gave notice three months in, after which he accepted a job in paediatric physiotherapy back in Orange. This was a job he loved. It was also where Robert first began working with young patients from remote areas, many of them from Aboriginal communities dotting the district.
‘I stayed in that position for about four years and I loved it. I loved every part of it,’ Robert says. ‘I was seeing children from infants to 18 years old with everything from cerebral palsy to mild and very complex conditions.
'I was working for the Cerebral Palsy Alliance in the Orange region that covered a two-hour radius from Lithgow to Cowra to Parkes, Forbes and then we had another team in Dubbo which I ended up helping support the physio out there.
‘But at the same time, I kind of had a passion for rural health and I was wanting to keep my skills diverse,’ Robert says. ‘And being a rural person, I felt drawn back to the country. Somehow saw an ad in the paper about a position with the NSW Rural Doctors Network and I started working in Wellington with the Wellington Aboriginal Corporation Health Service (WACHS).’
The NSW Rural Doctors Network (RDN) is a not-for-profit, non-government charitable organisation and is the Federal Government’s designated Rural Workforce Agency for health in NSW. The RDN forms partnerships with Aboriginal health services and other non-government organisations to support better health and wellbeing for people living in remote, rural and regional and disadvantaged communities, particularly those in NSW and the ACT.
In the gym at the local health district centre, Robert would undertake assessments of his many Aboriginal and Torres Strait Islander clients as well as run exercise programs that were designed to keep his clients coming back.
‘You have to be a bit adaptive to try and make people want to come back again. It is not just like “oh, let’s just do this”. You’ve got to make it fun and social thing, a yarning thing. That was my first experience with rural Indigenous health, and I was quickly learning the do’s and don’ts.
‘From there, I was working with the Walgett Aboriginal Medical Service (WAMS). I had a meeting with them and I started a monthly service which I think I’ve been doing for six or seven years now. That started off because they had a need for cardiac rehabilitation. They had identified that there were obviously a lot of high-risk community members and also an increasing number of people coming back from surgery who were in need of culturally appropriate rehabilitation.’
Robert began developing and implementing what was to become the ‘Heart Matters’ cardiorespiratory program. Understanding that many of his clients presented with comorbidities, Robert began researching best practice and incorporating resources and evidence from the Heart Foundation to come up with the 12-week education and exercise program to target those specific comorbidities.
‘I came in gung-ho thinking “oh yes, this is what I’m going to do, this is the gold standard approach”. I networked with all these people to come up with the education resources and I started getting some clients in—but they just weren’t coming back,’
Robert says. ‘So, I started a bit more of a structured program there, which really wasn’t working either. As time’s gone on, we’ve had to adapt it. So now we have kept it simple, added a “veggie box” raffle for attendees, utilised Aboriginal health workers and encouraged transport provided by WAMS. Through making simple changes and utilising the local workforce, we are seeing more people with increased attendance rates in a supervised exercise program and giving them some education throughout.
Currently WAMS is building a new facility, which incorporates a gym facility where this program will move into. I look forward to the new challenges and work towards increased community access to such services.’
Robert stayed in Orange for four years before moving back to the country, this time to the picturesque Hunter Valley. When his pharmacist partner bought a pharmacy in Raymond Terrace, Robert took the opportunity to co-locate his allied health practice, Raymond Terrace Therapy, there. He began taking on work opportunities, developing an allied health service engrained in a community pharmacy setting.
Additionally, Robert has been expanding his outreach work, ‘Outback Therapy’, in Indigenous health to include Ungooroo GP & Health Service and Koonambil Aged Care.
Increasingly, Robert felt the need to take on more staff and soon he had expanded his practice to include an occupational therapist and a speech pathologist—and the practice continues to grow.
Robert’s experiences have given him an appreciation of the difficulties of accessing health services in the rural parts of the state, particularly for Aboriginal communities.
Client perceptions about those services, when they are available, can also be a barrier for many families, he says.
‘So, we have to try and establish rapport with local people, educate local stakeholders, and use cultural competence,’ Robert says. ‘I think your approach is important; communication is especially important, and each community is different. So, it is really hard to know how one community is to the other. I think building a rapport is equally as important. I grew up in the country, so the people are familiar. But if you’re an outsider, you’re seen as an outsider and it may take time to establish trust.
‘With the Indigenous communities, time and being on time, is not always a priority. You have to understand that some people might not attend their appointment or they may forget. You can’t hold grudges that they failed to attend, you need to keep trying to encourage them to come back in, or try a different approach to see them—you might consider doing home visits if you’re permitted, or depending where the client is located,’ Robert says.
‘Your clients need to know that you are trustworthy, and you need to be flexible with your appointments and approaches.’
Robert is passionate about improving access to allied health services, particularly in reducing the gap in health outcomes for the Aboriginal and Torres Strait Islander population. He says maintaining professional contacts in a variety of disciplines is essential for rural and regional practitioners, as being out in various communities requires them to treat a wide range of conditions and also to refer to other services where applicable. And as equally important, he says, is having good problem-solving skills and being able to think on your feet. Adaptability and a bit of experience are also vital when working away from the big cities.
‘It is very important to have that support because you’re going to see everything and you have to come across as a real generalist physiotherapist practitioner, even if you’re not titled. You’re going to have to provide services and you don’t have the luxury of being in the city where someone might need a specialist. In the country, you’re going to see … clients who present with all manner of problems, complaints or needs, and that might vary from women’s health, sports, musculoskeletal, chronic health, paediatric or disability need,’ Robert says.
When the coronavirus pandemic hit in late March, Robert set about providing services to those remote and rural communities via telehealth. Out in Walgett during Robert’s last visit there he discussed the new way of service delivery with his patients to reassure them that they would have continued access to physiotherapy and the other allied health services he offers. He also stays in touch with community elders to offer reassurances about the continuity of service to isolated and remote communities.
‘The community is still vulnerable … they still need a service for speech, they still need physio, they still need the services of our OT. Those chronic needs are still going to be present regardless of COVID-19,’ Robert says. ‘Those services would usually go out one week a month for OT and speech, and two days a month for physio, but now we’re doing two days speech, physio and OT every week via telehealth. These services are at no cost to the individual, thanks to the support of the local Aboriginal community-controlled health service, WAMS and funding partners from Rural Doctors Network.
‘A lot of my clients that are in the cardiac rehab program, Heart Matters. We’re now calling them every week [due to COVID-19 restrictions]. A collaborative approach with local staff that support this program, including dietitian/exercise physiologist Danielle Fletcher, allied health assistant/ lifestyle modification Annie Deane, and myself will be walking with them while on the phone because these are people who were already at risk. It’s so important to maintain their exercise—and now they’re going to be even more isolated.
‘I am managing not to put off any staff so far. We are going to continue, but this is just a new era of service. I know friends of mine who work as contractors and this has been pretty difficult, their work has just ceased,’ Robert says. ‘It has been difficult for a lot of people, but we must continue to provide services as best we can under the circumstances to those who are vulnerable and require essential allied health services.’
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