Interview with Aunty Faye Clarke – Ballarat and District Aboriginal Cooperative (BADAC)

As we wanted to highlight the great work of First Nations healthcare workers, we sat down with Aunty Faye Clarke, diabetes educator at Ballarat and District Aboriginal Cooperation, to discuss her career serving her community.

Do you have to balance the education with other general duties within the BADAC clinic?

When I argued for my role, I unrealistically proposed that id’ be able to see people, do their health checks and plans and then hone in on their diabetes… but it’s too much!

Why did you decide to focus your career on diabetes?

When I first started it was just myself, the practice manager and a couple of health workers. I was doing everything… we had to follow diabetes RACGP guidelines. So, I was starting to do a lot of that diabetes work already, it was our main chronic condition. There was an opportunity to do the training in an Indigenous specific graduate certificate in diabetes education, which Colin was involved with organising through the partnership between Diabetes Victoria, Deakin University and VACCHO. The intention was to get Aboriginal health workers to do the course to foster more conversation about the condition between patients and the health workers. It was an intensive week… because I had kids at home just being able to spend the week down there gave me the time to focus on the training.

As someone living with type 1 diabetes, I remember when I was diagnosed years ago that they really tried to impress upon me the doom and gloom with some pretty serious messaging, less about empowering and supporting recently diagnosed. What have you seen over the years that has led to a shift away from this sort of messaging?

The bulk of my job, I suppose, is finding that balance – you’ve got to try and make a connection that will make them want to come back, you can’t possibly address everything in one session. The first session is just about getting to know them, exploring their lives, diets, activity… then I identify the biggest risk areas in their lives from tests and conversation. You don’t want to be “scary” but at the same time you have this real awareness that newly diagnosed people do need to know the risks.

Do you think you’d have a different approach talking to mob about this than if you were talking to the general public?
We’re lucky in that we are free to support people here… an approach that is holistic, addresses complex needs, addresses barriers to specialists such as finances etc. I think working for community is different – for example, I’ve sometimes filled in the role of Aboriginal health workers and other staff doing thing like driving vulnerable patients to their allied health appointments. It’s a privilege to give that kind of support, help them make good decisions, make myself available to build good rapport.

So it’s almost like a whole health intervention sometimes?

Yeah, and it’s good – there’s all these balls in the air, and sometimes they drop them, and that’s ok – sometimes we do to – but it’s about having those systems in place to be able to pick them back up and say, “ok, well, what do we need to do next to get back on track?” That’s where reviews of management plans are important, to see what’s fallen through the cracks.

Mental health is such a big issue that impacts on people living with diabetes – how important is it that there are clinicians with both an understanding of chronic conditions and cultural safety?

Patients come in from so many backgrounds and life experiences… many of them having things like mental illness that in fact has led to the diabetes diagnosis. It’s a bit of a double whammy to have so many clinicians who do not understand living with disease and also lack that cultural lens. Finding the appropriate psychologist is really important for our patients… imagine if we had someone on hand that was educated enough to talk about these really complex issues? It is a really big gap that I see in the Australian health system.

How do we open up a conversation to combat the shame and stigma of diabetes, particularly in our old people? Things like obesity, alcohol and drug abuse, poverty, etc?

I suppose that the complexity of the human life itself too? Like the way we’re made genetically, the way we have learnt to do things… you know, life gets in the way and before you know it, you’re back in a bad situation. It’s normal! It’s normal to not be perfect, to not be able to keep all of those balls in the air. If we all did everything that we were supposed to do every day, we wouldn’t have a health industry! Going back to your question about how I’d be different working with the mainstream population - I think I’d be terrible. I have the freedom here to have the time to have those hours-long conversations when I need to, to grasp the complexities of an individual.

How have you as a health professional navigated COVID-19?

My main recollection was the breakdown in communication from working at home. The people still at the clinic were flat out, the level of change we needed, negotiation with management around infection control, new staff rostering and patient traffic through the clinic, keeping ourselves safe… being ready to change as new information came out, working from the carpark giving swabs. Things were missed and miscommunicated. The clients themselves were great – they adapted really well, we put together vulnerable patients lists, we made sure that they were being looked after. I probably struggled because the number of patients with diabetes was so huge. We moved things to Zoom, coaching patients how to use it, got guest speakers and held social things like bingo and a yarn.

What is important going forward?

I want to be more thorough - I want to cover all the things that need to be, now we are moving out of restrictions. Making sure people are much more informed in all the aspects that diabetes impacts. Making sure patients come in regularly enough to cover everything that’s important. I’ve noticed that when I started, you had to know about diabetes because I was the only nurse here. In bigger teams like the one I’m in now, where they have me as a specialist, a lot of diabetes cases are referred to me. I wonder if this is also going to see a de-skilling of staff… If I go on holiday for 8 weeks, who will pick up the pieces? It’s important that every Aboriginal health worker and nurses working in community access extra training, access diabetes education courses, get the support from their clinics to diversify their skills. I think providing the opportunities is really important, building their capacity.