Have you considered podiatry in the Northern Territory?

Danila Dilba Health Service is an Aboriginal Community Controlled Organisation, based in Garamilla (Darwin).   This is the land of the Larrakia people, and Danila Dilba is proudly a community-driven organisation with strong roots to Larrakia people and country.  Danila Dilba provides health and wellbeing services through its seven clinics, including a mobile outreach clinic.

The podiatry service is still relatively new – having only been established four years ago.  This has given me the unique perspective of observing the service unfold and become better understood and sought after – which is what has really made me realise and appreciate the value of podiatry.

I feel very privileged to be in a position where I help people to feel good every day.  I think that’s relevant to all podiatrists.  Podiatry resources are scarce in the Northern Territory (NT), so I often see people who have never seen a podiatrist before – and usually, they walk out of the clinic feeling better.

Being able to provide a podiatry service at Danila Dilba is particularly important because we are an Aboriginal Community Controlled Organisation, which is largely trusted by the community.  This is not to say that working here means you are automatically seen as providing culturally-safe care.  That part is the challenging part – the part I have needed to work on the hardest – but also the part I love the most.  Although the journey of becoming a culturally-safe podiatrist is long, surprising and always evolving – it comes with much personal growth, and both personal and professional challenge.  It is certainly one of the things that I have enjoyed the most about my time at Danila Dilba.

I also feel very fortunate to work in an organisation that promotes, supports and nurtures the importance of culturally safe practice.  I’m lucky to be able to respond to my clients’ cultural needs by working in an environment that is designed to support this.  This includes culturally-appropriate resources and access to support from Aboriginal and Torres Strait Islander colleagues – from whom I am always learning.   I acknowledge that many clients bring traditional knowledge about foot health and healing, and that some foot conditions may have cultural or spiritual significance beyond the clinical presentation.  Working collaboratively with clients, their families and Aboriginal Health Workers is a big part of my role – and being open and willing to learn and listen has been critical.

The role of the podiatry service at Danila Dilba – in my humble opinion, is a critical one.  Not only is it an environment where podiatry resources (and many medical and health resources) have historically been very scarce, but it is also a population that has the highest rates of lower limb amputation in Australia.

Providing podiatry services is not just about clinical consultations, and podiatry treatment.  It is also about improving access to resources such as footwear, footcare equipment, diabetes foot check tools and foot health information.  It’s about increasing other health colleagues’ knowledge and confidence with assessing and managing diabetic foot wounds and other complications.  It is also about advocating within the health service and the broader community about foot health.  This is, I think, is a really important part of this role – especially as a new service.

Our goal is to achieve stronger healthier feet. We want to promote this idea that foot pain is not something you have to put up with, and lower limb amputation is not something that has to happen when you have diabetes. These are things that the podiatrist, and the team at the health service, can help with.   I love this multifaceted aspect of my role.  There are so many ways that I as a podiatrist can contribute in the organisation and in the community. This is what makes it such a rewarding role.

Recently I met a 14-year old with Rheumatic Heart Disease – a condition that predominantly affects Aboriginal and Torres Strait Islander people in Australia, is preventable and is most prevalent in developing countries. She presented with a chronic low-grade infection of her hallux – which had been persisting for over six-months.  This sort of infection puts her at greater risk of further damage to her heart – dramatically increasing both morbidity and mortality.  She had never seen a podiatrist before, and had been managing the toe herself at home.

This client was from a remote community, now living in Darwin with her family.  She didn’t like attending any clinic, let alone a mainstream clinic or the hospital. So being able to provide this podiatry procedure at Danila Dilba, in a culturally safe environment, meant that I was able to provide her with the right treatment, promptly, in a comfortable and safe setting.  It was quick and easy to do, but potentially prevented serious medical complications for this young lady.

Given the nail was super involuted and there was a great big hunk of hypergranulation tissue, she had been doing a great job keeping serious infection at bay!  The client, together with her mum, consented to the PNA and we did it the following week.  It was healed within two weeks – she was pain free and the risk of unnecessary foot infection was resolved.  It may seem like a small win, but it’s these sorts of wins that feel big to me.

In recent months, I have been performing lots of PNAs – the people and the lives that accompany these gnarly ingrown toenails are the interesting part of this story.  This has been somewhat of a focus of discussions at work recently, in trying to advocate for more podiatry positions. We all know that a chronic ingrown nail which  presents with recurrent infection can be easily resolved with a PNA.  In Darwin, options for accessing this procedure are limited for those who are financially disadvantaged.  I have seen many clients who have suffered with painful ingrown nails and reoccurring infection for years – only to be finally relieved of this pain with this simple procedure.

I think podiatrists have an opportunity to impact people’s foot health and mental health in two unique ways – the first impact is obviously about reducing foot pain. Foot pain, for those who have suffered with it, is there constantly. It affects your ability to walk, to sleep, to move, to drive, to exercise, to wash – to participate in all aspects of daily life.  Often, we are able to take some or all of that pain away almost immediately – through our treatment.

People walk into our clinics, sometimes a little grumpy, tired with the pain, and in low spirits.  Through our treatment, we are able to alleviate some or all of that pain, and see them leave our clinic, smiling, lighter, hopeful for a change to their quality of life.  That’s a really special gift we have as podiatrists, and something we should hold on to.

We are not just cutting toenails – and we know it!!  Even for chronic, more slow-moving pain – we have many tools and knowledge at our disposal, which can lead to improvements in foot health and mobility.  Although change is slower in these cases, these are the clients who we may impact most profoundly.

I think there is another special gift, or impact, that we can offer as podiatrists –   the gift of connection and empathy.  As podiatrists we often see the same clients, frequently and over long periods of time.  We get to know our clients.  I have found that, particularly in my current role, clients open up and share really personal stories. Sometimes it may be special treasured stories of the past, and sometimes it can be painful and difficult things they may be grappling with.

There’s something about the way we work with clients that fosters a really strong connection.  Perhaps it’s through our gentle physical touch, or the fact we are touching their feet – and our willingness to pamper and nurture that important part of the body, which  is sometimes seen as dirty or unattractive?  I’m really not sure, but I am certain that podiatrists have a special gift and an important privilege (and responsibility) when it comes to connecting with people on a personal level.

Our intervention  can affect our clients’ mental health and general wellbeing in ways that reach far beyond just footcare.  Many clients who access our service have very complex medical needs, and addressing these needs from a podiatry perspective takes a lot of time and care.   From a community or client perspective, people are very appreciative and grateful – not that they need to be. It is a joy to see smiling faces at the end of consults.

A client recently told me that her father used to see one of the private podiatrists here in Darwin for many years – when he recently passed, the podiatrist was specially mentioned in the eulogy at her father’s funeral. Her father used to love attending his appointments for a yarn with his podiatrist.  This had such a big impact on her father’s life,  and  I was very moved by this story. A shout out to my colleague in private practice, Stephen Bond who is making a big impact in our community!

I think the biggest challenge in my work is the scarcity of podiatry resources in the region.  There are only 32 registered podiatrists in the NT, and in Darwin, and I am the only community-based podiatrist who works  in a not-for-profit setting.  The demand is huge.

Having little podiatry resources in the region means there are also fewer colleagues to lean on – whether that be for referrals, shared care or just peer support.  Fortunately, I am lucky to have a small but wonderful group of podiatry colleagues at the hospital and who work  remotely in the region.  I also connect with colleagues who work across similar settings in the NT and Western Australia mostly.  We have even formed a group, where we meet online every month to  share stories and resources.  Connection with other podiatrists is very important when you work in a sole practitioner role such as this.

Podiatry has always been warmly welcomed and accepted by my colleagues and the community.  In terms of the opportunities – there are many opportunities that present themselves when you work in a more isolated or remote setting, with a specialist skill to share!  I think the organisation values the role that podiatry has to play in improving and maintaining the health of our community, and it has been very supportive of the service and its establishment.  It is extremely rewarding to work in a space where your skills are so valued and so needed.

There are also so many opportunities to advocate for better outcomes for Aboriginal and Torres Strait Islander people who have diabetic foot disease – especially  through involvement in projects, networks, the media and community events.  Then there is the exposure to Aboriginal culture – which I am fortunate to experience through living in the NT and working for an Aboriginal Community Controlled Organisation. Working alongside Aboriginal and Torres Strait Islander colleagues and within an Aboriginal-led organisation has provided invaluable learning opportunities about the world’s oldest continuous culture, with Aboriginal and Torres Strait Islander staff generously sharing their knowledge to support better health outcomes for the community.  I feel so privileged to have this opportunity– it is something that has impacted me greatly both on a professional and personal level.

I would strongly encourage podiatrists who are keen for a shake up, both in their personal and professional lives, to consider looking at remote or more regional job opportunities.   I have been a podiatrist for over 20 years, and have worked in a range of clinical and nonclinical roles during that time.   After two and a half years in my current role, I would still have to say that this is the most rewarding job I have had.

Clinically, I get to see a broad range of presentations and age groups, so there is always something new, challenging and interesting happening.  Professionally, I am fortunate to have many opportunities to be involved in community events, advocacy work, education and training and countless projects.  And on a personal level, working within Aboriginal-led healthcare has deepened my understanding of holistic health approaches and the importance of community-controlled healthcare in addressing health inequities.  This has had a profound impact on me. I think these sorts of roles provide once in a life time opportunities for growth and development – and I am lucky enough to be living that now.

Podiatrists considering remote work in Aboriginal communities should prioritise cultural awareness and safety training, understand the ongoing impacts of colonisation on health, and commit to being guided by Aboriginal and Torres Strait Islander colleagues and community protocols. This isn’t about ‘helping’ communities, but about contributing to Aboriginal-led health solutions that address systemic inequities.  I would love to speak to any podiatrists who are thinking about a role in an Aboriginal Medical Service or in remote or regional Australia. I would be very happy to share my personal journey and some more stories. So please reach out! Anna.Stybowski@ddhs.org.au