Linking Indigenous health care with school education

Last year, during a visit to Alice Springs, we witnessed first hand the consequences of inadequate provision of health care for Indigenous children. Although we are all specialist doctors, we were travelling in our capacity as fathers, accompanying our sons in a school-based “service” program.1 We experienced a unique, independent Indigenous school that we believe could provide a nexus for delivering health services to students and their communities. New models of service delivery are required to improve Indigenous health outcomes, and we believe that crossing bureaucratic boundaries between health and education might permit such progress.

Yipirinya School does not have a student fee structure, hence has limited funding.2 The school is comprised of a child care centre, preschool, primary school and growing secondary section, and enrols about 200 seriously disadvantaged Indigenous children from the Alice Springs region, including 20 town camps and eight outstations within 75 kilometres.

We lived and worked at Yipirinya for 10 days, in a group consisting of 20 fathers, our adolescent sons, and support staff. Our involvement with this community was privileged and rewarding yet, at times, distressing and confronting. We arrived wondering how a group of affluent, non-Indigenous outsiders could help, let alone engage, the local people. During our stay, we went on school bus runs into camps, served meals, assisted in class, played football at lunchtime, and gradually seemed to make friends. At night, before retiring to our swags in the school gymnasium, we reflected on events that had disturbed us — the ravenous appetite of a hungry child at breakfast, the filthy dwelling to which we delivered a 6-year-old in the afternoon, or the child who was misbehaving in class because of domestic violence. Were we ultimately successful in engaging with the locals? If the tears shed on our departure (by ourselves and our new Indigenous friends) were a measure, we succeeded.

Although we helped with teaching, we also learnt. We learnt about the community’s pride in Indigenous life, culture and their land, and also learnt of stark gaps between us. As doctors, we were particularly dismayed by the stark contrast between the access to health care of the students of Yipirinya and that of our own sons. Might this school represent an opportunity for more effective delivery of health services to its students? The school authorities had previously thought so and, independently, we came to the same conclusion.

At Yipirinya, there is a holistic approach to schooling: five separate bus runs pick up and drop off children each school day, as few would otherwise attend; children receive a sit-down breakfast and lunch; clothing is provided when needed, especially on cold winter days; basic hygiene is directed by dedicated and friendly teachers; and an academic program embraces conventional and Indigenous education. For many children, this represents a temporary release from an otherwise chaotic lifestyle; on some days it may simply represent a place to eat, sleep and feel safe.

Yipirinya enrols more Indigenous students from town camps and outstations than all Alice Springs government and private schools combined (personal communication, Ken Langford-Smith, Principal, Yipirinya School). The school represents a central node from which nutrition, washing, clothing and education are regularly provided for these disadvantaged children. However, because of the independent status of Yipirinya, together with sporadic and diminishing support from local health services, there is no school nurse to provide care beyond that given by teachers. The provision of health care through the school, encompassing education, prevention, and acute medical or nursing care, would narrow the existing service gap.

Perhaps more importantly, an extraordinary opportunity exists for more effective delivery of paediatric, and ultimately even adult, health care to those living in camps and outstations. Yipirinya is a highly respected and culturally sensitive organisation, with Indigenous language speakers and elders who could help to facilitate and support the provision of effective health services. We hope that our own approaches to Northern Territory health officials, together with recent submissions from Yipirinya, will lead to the provision of a dedicated full-time school nurse. We are certain that this will improve regional Indigenous health care services — starting with the children.

Finally, we came across this situation and the opportunities presented by chance. Opportunities must surely exist in schools and communities elsewhere to more closely align Indigenous health care and education, and thereby improve the wellbeing of children and families living in these disadvantaged communities.