Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Expanding Roles of Aboriginal Health Workers in the Primary Care Setting: Seeking Recognition

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Expanding Roles of Aboriginal Health Workers in the Primary Care Setting: Seeking Recognition

Article excerpt


Aboriginal health workers are an important part of the health care workforce and the primary health team. They often work in partnership with non-Indigenous nurses and general practitioners, a partnership which has its strongest benefit in promotion of effective communication and health care management with Aboriginal clients.

The work of Aboriginal health workers (AHWs) is strongly affected by the setting in which they work. This article is written from the point of view of AHWs and general medical practitioners (GPs) working in a large Aboriginal community-controlled medical service in Western Sydney, formerly named Daruk Aboriginal Medical Service, but now renamed as the Aboriginal Medical Service Western Sydney (AMS WS). The historical background, the varied educational and training pathways and the diverse work roles of AHWs will be examined. The need for increased numbers and improved recognition and training opportunities for AHWs will be discussed. Several case studies illustrating the daily work of different AHWs at our service are presented.


The beginnings of AHWs as a professional group in Australia goes back to the 1950's when Aboriginal people, usually women, were employed as leprosy workers and later as medical assistants in the Northern Territory. At that time their role is said to have mainly been cultural brokerage. This preceded the international recognition in the 197Os of the importance of using Indigenous workers to deliver effective primary health care within Indigenous communities (Curtin Indigenous Research Centre 2001) and the subsequent establishment of Aboriginal community-controlled Medical Services in Australia.

Development of AHWs' professional standing and use of clinical skills in Australia has continued to grow, particularly through the expansion of Aboriginal Medical Services, of which there are currently over 130 (National Aboriginal Community Controlled Health Organisation 2006). These vary in size from small services without medical practitioners to large multi-disciplinary services with multiple GPs and visiting allied health and specialist services, but common to all is the central role of the AHW.


The work roles of Aboriginal health workers are very varied, depending on their interests and the local needs. A universal and primary role is that of cultural brokerage (Williams 2001; Bird & Henderson 2005), essentially assisting Aboriginal people and non-Aboriginal health care providers to communicate better, and allowing Aboriginal people and mainstream services to interact more effectively by overcoming cultural barriers.

Extensive clinical skills are required in many settings, with AHWs taking responsibility for clinical care such as immunisations, pap smears and health checks (Mitchell & Hussey 2006). AHWs may have a prominent role in consulting and individual patient health education, including home visits, and management of chronic disease and skin problems (Thomas, Heller & Hunt 1998).

Health promotion is an important AHW responsibility (Rose & Jackson Pulver 2004). AHWs run many different health promotion programs, including programs around child health, drug and alcohol issues, and healthy lifestyle programs (Moore et al 2006; Rowley et al 2000).

AHWs are frequently called upon to provide leadership and advocacy for their community (Rose & Jackson Pulver 2004). They also have a pivotal role as educators about their community and as cultural mentors (James Cook University 2003). Cultural mentors support the learning and day to day work of non-Indigenous health professionals, usually nurses and doctors, in their efforts to effectively communicate and work with Aboriginal people. Many Aboriginal community-controlled health services offer training placement to nursing and medical students and GP registrars. At AMS WS we would supervise approximately 50 students and registrars throughout the year in placements ranging from one day to one year. …

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