Associate Professor Emma Kennedy
BMBS ’93
By David Sly
Shared understanding between doctor and patient is the ‘cure’ to improve medical care – and in Australia’s Top End, Associate Professor Emma Kennedy knows this means greater cooperation and communication with Aboriginal and Torres Strait Islander people.
As Director of Flinders University’s Medical Program in the Northern Territory, she knows that extreme health inequity has compounded problems facing First Nations patients and says improving this is a primary focus of her attention.
“I understand the importance of recognising that people have choices about their health – both good and bad – and that it’s only improved avenues of information and trust between health professionals and patients that lead to the best choices,” says Associate Professor Kennedy.
“There are lots of reasons behind the choices that people make in regard to their health, but if trust fails, if communication fails, you are only left with poorly informed choices.”
She is pleased that a strong model of person-focused care is taught in the Flinders NT Medical Program, with a realisation that a patient brings their own agenda to medical consultation – some aligned to a science basis but other parts that are not. “All of that has to be recognised if we are to contribute positively to the health decision-making process. The patient must be trusting and involved if we are to get a positive outcome.”
Breaking the Barriers
Flinders’ involvement in the NT started in 1998, which coincided with Associate Professor Kennedy commencing her medical education role with Flinders. Having been raised in the tropics as the daughter of two doctors, she implicitly understands the core health issues at stake in the NT, but her challenge remains how to implement person-focused solutions to lingering healthcare problems.
Associate Professor Kennedy’s decades of work as a clinician in the Northern Territory has informed her work as a teacher and Director of the NT medical teaching program. She realises that a gap has existed between medical teaching and effective delivery of health services, especially with Indigenous patients, and that this must be addressed.
“In the medical system, we can easily be patronising. We can fail to realise the barrier that exists when we wield authority, so we have to develop a more shared understanding of what people’s health problems are, and that stretches far beyond a simple diagnosis of symptoms,” says Associate Professor Kennedy.
“The medical profession has a lot of power in being able to define things and raise awareness of them, so in my position I need to be aware of how that power is managed.
“Because there is such a health need that sits within a larger context, we need to address ignorance about Aboriginal and Torres Strait Islander cultures in order to make a significant
impact on health. It’s not only money or expertise that will address health issues, or for people to recognise solutions to their own problems, but the future is how we all move forward in Australia together.”
Building Resilience
An effective medical teaching program in the NT points the way forward, but the onus is on teachers and students to be understanding and adaptive to best address pertinent NT health issues.
“There’s not much point teaching people to work a certain way if the health services aren’t working in a way they recognise. So, our learners need to be resilient. They need to be able to read the reasons why health services are structured in a certain way, and to be reactive to the people and experiences they are presented with. Health care must meet the context of the communities that need it.”
For these reasons, it is crucial that more medical students remain in the NT, so they can apply the regionally focused and community-specific health knowledge they have learned through the Flinders programs.
“It’s crucial for us to be investing in people who are adaptable and recognise the solutions to problems they are presented wit in the Northern Territory, and are probably specific to certain parts of the NT,” says Associate Professor Kennedy.
“Sometimes, you have to be in a place for quite a long time to see and understand what works in that place, and what doesn’t – to understand the specific factors involved in all of that. It’s not what you learn from texts or in a classroom. It’s what you learn from being a part of that community.”
Understanding Local Culture
Flinders’ NT medical program is now making a significant difference, with record numbers of NT applicants now studying in the program – and increasing numbers of graduates remaining in the NT to continue their work rather than moving to other cities.
“We now have more than 90% of the applicants coming into our program every year that are Northern Territorians,” says Associate Professor Kennedy. “We also have research into the retention of medical staff in the local workforce, and this has shown that more people coming through our program become attached and connected to NT communities.”
She is very conscious of the need to equip graduates with an understanding and appreciation of Aboriginal and Torres Strait Islander culture, so she is therefore delighted to see more NT health graduates developing confidence in their skills to provide medical care relevant to the communities where they live – both large and small.
“I get frustrated by the ignorance of policies and decision making that don’t adequately provide for the populations that are in dire health need – especially remote communities,” says Associate Professor Kennedy. “Our health initiatives focus on individuals; however, the outcomes could be better, with more community-driven solutions. Shared models of decision making are essential. It is important to also guide students with more student-centred approaches.
“The key to improving all of this is building trust – between everyone. It’s fundamental to person-centred care, to develop a very real understanding between the medical providers, the patients and the entire community.
“Reconciliation is about working out where things have gone wrong and recognising that. The biggest thing is to come together and move forward together. Our society can’t change if we are not aware of the problems and prepared to face up to them. We all have to own them.”