'They get a bit funny about going'--transfer issues for rural and remote Australian Aboriginal people

The integration of health care among providers to achieve good outcomes has been investigated in urban locations. However, more information is needed about what happens to people from rural areas, particularly when travelling away from their families and healthcare provider to receive hospital care. Therefore, a national project was conducted in 2004 that aimed: to document the experiences of people travelling to and from rural and remote areas to city hospitals; to identify factors that affect their optimal health outcomes; and to improve the exchange of information between primary healthcare providers and hospital staff. The Australian Rural Health Education Network (AHREN) coordinated the study, which consisted of several case studies. This article, part of the larger investigation, presents a segment on issues for Aboriginal people living in a rural and remote Australian area that were identified by local health workers, and suggestions that might assist in overcoming them.

Research and ethics approval was obtained from our university, hospital and the Aboriginal Health Council. Three Aboriginal health workers, employed at the community controlled Aboriginal health centre, involved in transport, consented to be audiotaped in a group interview. They are named researchers. Questions were: What are the issues in transfer to and from the city hospital? What special problems exist for the Aboriginal people you are involved with? What improvements/systems changes would you suggest?

Funding and equity of the Patient Assisted Transport Scheme (PATS) created problems. Raising payments for PATS and extra costs to clients and families were big issues. Antisocial arrival times, separation from family, transport to hospital and accommodation all caused distress and confusion. Potentially dangerous misunderstandings happened through language and cultural differences. Traditional people travelling unaccompanied were at risk. Often PATS notification requirements could not be met in emergencies and onsite accommodation was described as frightening and culturally inappropriate. At the time of interview, Stepdown transport did not cover people staying with families. Lack of privacy, different understandings of family and other issues important for Aboriginal people continue to add stress for families already suffering.

PATS could be streamlined and more user-friendly. Aboriginal Liaison Officers in hospitals provide a link for Aboriginal clients, but unrealistic expectations may be placed on them and they are not available 24 hours a day. Strategies for improved communication are needed. A space and campfire in hospital grounds for traditional people and their families to gather would assist.