(Note: all photos are my own or taken with my camera by a collegue)
Last week I got to travel to Thursday Island for the first time. I had heard of its beauty many times and was excited to see it for myself. I was not disappointed. The views and the colour of the water were breathtaking (photos are not doing it justice) and the place has that distinct vibe you can only find on a small, tropical island. It is hard to find an accurate description but it feels like suddenly, the world slows down and becomes a little more peaceful.
Thursday Island is the administrative centre for a group of islands scattered around the Torres Strait, the strip of ocean between Papua New Guinea and the tip of Far North Queensland. It is the northern-most town of Australia and has quite a colourful history (read up here if interested). The plane lands on Horn Island, a bigger but less populated island close by, then it's a short ferry trip across, or rather around a big sandbank, to the shore of Thursday Island.
On the ferry with Rhondda (my friend and colleague)
The people who live on Thursday Island seem happy and relaxed. I hear some Torres Strait Islander work mates in Cairns say how much they miss their tranquil island homes. However, when it comes to health and health care, there are many challenges.
Aboriginal and Torres Strait Islander people are disadvantaged with regard to health care, especially in remote locations, and their life expectancy is about ten years shorter than that of non-indigenous Australians. This is unacceptable and partly due to the terrible injustice that was and still is inflicted on our first people. Incidentally, just two days ago I came across this excellent new post by @riverflows about the hidden truths of Australian history after white settlement. It is a sad but necessary eye-opener for everyone who is not familiar with it yet. I've known about it even before I came to Australia but it still saddens me to the core.
The massive gap in health and other outcomes between Indigenous and non-indigenous Australians has however been recognised. Ten years ago, the Australian government introduced the Closing the Gap framework to address and rectify the situation. Much of the funding is going into health care but progress has been slow. Hepatitis B is only one of many conditions that disproportionately affect Aboriginal and Torres Strait Islander people.
So my trip to Thursday Island was not a holiday but a work trip to educate Torres Strait Islander health workers about hep B. While the infant immunisation program works very well and transmission from mothers to babies is now extremely rare, chronic hep B infections are very prevalent in the area, and the outcomes are often terrible because of limited knowledge and access to care.
The biggest concern are older people who were infected decades ago and often present with end-stage disease after sustaining long-term undiagnosed liver damage. There are also many misconceptions (as described in my previous post on this topic) which can lead to unnecessary fears and prevent people from seeking health care. In addition, there is a general lack of knowledge about the complexities of chronic hep B infection.
Therefore, it was a great privilege to be invited to deliver education to these wonderful health workers who often wear many hats and have varied important roles in their communities. The day was funded by the Queensland Government (Queensland Health) and organised with help from the Australasian Society for HIV and Hepatitis Medicine.
Our cheerful but serious attendees from several surrounding islands
Everyone likes a personal story, right? It really is a great way to capture people's attention and especially to bring messages across that may be a little scary. While the clinical knowledge about hep B may not be there (yet), many Torres Strait Islander people have lost a relative or a friend to liver disease, usually within a short time after diagnosis. So what these people need is reassurance, something that takes the fear component away and enables the health workers to confidently encourage the people in their communities to get a check up and seek the care they need.
Hearing someone tell a personal story of hope and options for care and treatment provides that reassurance. We believe this is why it was so well received and we made such good connections. I was able to showcase that it is indeed possible to live a healthy, normal life with chronic hep B, and even to reverse existing liver damage and make that liver healthy again. All attendees were engaged, asked lots of questions, and shared their experiences working on their respective islands.
My personal story was interspersed with information about the condition itself, but slides like this one (don't tell my kids, haha) were definitely the most popular:
A big part of our education is smashing stigma. Stuber, Meyer, & Link (2008) describe the negative effects of stigma, prejudice and discrimination in health very well and the definitions are still the same. Even perceived stigma, or the anticipation of being treated badly or differently because of a health condition is enough to cause fear and head-in-the-sand syndrome. It prevents people from seeking health care, no matter how well a clinic is equipped or how easily treatment is accessible. Stigma of any kind must be reduced or removed first in order for people to feel comfortable and confident to seek the care they need.
With regard to hep B, this involves moving the condition away from the infectious disease context and into a chronic disease model. Although a lot of the work is currently done by the Cairns Sexual Health Service (where Rhondda and I work), we're making a big effort to portray it as family and community issue. We're encouraging everyone to talk about it and normalise it rather than brushing it under the carpet for fear of judgement. This is what I love about telling my own story. You can feel attitudes shifting and light bulbs lighting up. It is very rewarding.
The weather on the island was funny. I went for a late afternoon walk and got soaked twice within 15 minutes with a bit of brilliant sunshine and blue sky in between. I didn't mind because it was warm. I went for a lovely walk through a bit of greenery...
...and up the hill where I could see the rain come in, fast and furious
A bit of culture at the local art gallery and cultural centre:
This was the view out of my hotel room:
And then came the flight home which was even more beautiful than the flight in. The light was just right and I couldn't stop taking pictures out of the plane. I wish I could post them all but here at least a couple for your enjoyment. First a bit more of that magnificent colour on the ferry. And then you can see the Great Barrier Reef along the way and again, the photos don't do it justice but I was just in awe the whole time. I have a feeling these islands will see me again some day!
Reference about stigma:
Stuber, J., Meyer, I., & Link, B. (2008). Stigma, prejudice, discrimination and health. Social Science & Medicine (1982), 67(3), 351–357. http://doi.org/10.1016/j.socscimed.2008.03.023
