Currently enrolled as a third year podiatry student at Charles Sturt University and also working as an allied health assistant at the High Risk Foot Clinic in Wagga NSW, Nicole Barby is proud of her Aboriginal heritage and humbled regularly by the support of Wiradjuri Elders and Community members. She believes, “We can all create positive moments to close-the-gap, no matter your location or work environment”.
As a proud Aboriginal woman living on Wiradjuri land, Nicole Barby was offered a cadetship to further her studies and grow the number of Aboriginal health practitioners. Here is just some of what she can teach podiatrists and other health professionals.
I’m the recipient of a cadetship with NSW Health, which is backed by Health Education and Training Institute (HETI). I’m also employed as an allied health assistant as part of this cadetship, so I get to spend 12 weeks a year in my local high-risk podiatry department. As a single parent, there is no way I would have had the means to pursue this opportunity without the cadetship.
It’s been a wide ranging and fantastic experience. I’ve seen Charcot neuroarthropathy, and all different types of wounds. I’ve learned that you have to understand biomechanics to be able to help the wounds heal. I’m also seeing the same clients come through and I get to see their progression.
I’ve had experience with the nurse practitioners, allied health professionals, with the doctors, the rehab department, and vascular specialists. It really gives you a very broad range of experience.
Here are some lessons I’ve learned through my time in the podiatry department. It is still early days for me but I share my perspective in case it’s useful, whether as a reminder to experienced podiatrists or as a learning experience for the first time.
There’s all these other aspects to healing a wound that I have learned to take into account. My time on this cadetship has taught me a lot about the role mental health plays in wound healing. As well as looking at the logistics involved – what people can afford, how difficult it is to get transport in to a health clinic, and so forth.
This reminds me that it’s a person sitting in front of you. It’s not just, ‘I have a wound to treat, I need to use certain dressings’. Or, ‘I have to offload in a certain way.’ That’s still part of it but I’ve been reminded that you need to have a chat with someone, to build rapport and really make them comfortable enough to open up to you.
Then they may say, ‘I’m actually really struggling to afford to come in here two or three times a week’. Or, ‘It (the wound) has made me feel really down, I can’t go to work as much.’ Or, ‘My relationship with my partner is damaged because of it.’ It reminded me that you need to step back from the clinical side of things every now and then.
My passion for high-risk foot care has grown from working with podiatrists who aren’t afraid to share their passions. I think podiatrists really have an opportunity to instil some passion in the healthcare students that are coming through. Podiatrists shouldn’t be afraid to show students what they love. Maybe they love working on wounds, or it’s biomechanics. Whatever it is, please share this with any students you’re in contact with, as it really rubs off.
It’s one thing to learn about the shocking statistics when it comes to Aboriginal and Torres Strait Islander health issues, but to actually see these statistics in action was something else. While statistics can perpetuate negative discourse as they often don’t share the cause, we do talk about statistics in class a lot. To then put names and faces to people I know and to see these statistics in action, it was really confronting.
I strongly suggest podiatrists of all experiences and locations choose to see the reality of these statistics for themselves if they don’t already; it has really shaped my perspective. Perhaps volunteer, or travel through your work to these communities. Help out, do research – whatever is feasible.
I get frustrated when we talk about ‘Aboriginal Health’ as only applying to remote communities. An Aboriginal person shouldn’t be shoe-boxed into being someone who lives rurally or even regionally. There are a lot of Aboriginal people who live in the cities and yet I don’t feel many urban podiatrists see this as an area in which they can create positive change.
You can’t look at someone and go, ‘Yes, you’re Aboriginal’. Or, ‘No, you’re not’. Yet a lot of the time, as health professionals we aren’t really paying enough attention to the question of: ‘Do you identify as Aboriginal or Torres Strait Islander?’ Instead, it’s ticked on a box and that’s the end of it. We don’t take it further to understand the relevance of this knowledge to consider the person’s needs and ensure culturally safe practice.
I think a lot of health professionals such as podiatrists may be worried that they’re going to offend someone, or handle a consultation incorrectly. There’s this sense of, ‘I don’t want to do the wrong thing, so I’m not going to do much with that’.
But it doesn’t need to be a complex response. When a patient ticks that box on the form it can start a simple conversation like, ‘Do you also require some of this other assistance that we can give you?’
For example, there are Aboriginal Health Workers (AHWs) employed within NSW Health. So if I have a client who’s not really engaging with the service very well – maybe we’re having trouble getting in contact with them – then I can engage these AHWs who potentially already have a relationship with this person. The AHW can explore what obstacles are keeping the client from accessing the service, and they can do this in a supportive and culturally responsive manner.
Whether in private practice or working in the public sector, it’s important to connect with your local Aboriginal-controlled health service and explore what they already have in place to help improve access to your service for Aboriginal clients who are experiencing difficulty. They’ll know what is available. The help is there and it shouldn’t be a hard process to access it.
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