Aboriginal Health Workers – Primary health care at the margins

By BillGenet with SharonBushby, MayMcGuire, EileenTaylor, YvetteWalley and ThelmaWeston . Published by University of Western Australia Press , 2006 . Paperback, 240 pages . ISBN 1 920694 76 5 .

Reviewed by Priscilla Robinson, School of Health Sciences, La Trobe University, Victoria

In this book, Bill Genet and colleagues lead us on a journey of discovery about what the continuum of life and work is like for a group of 10 Aboriginal Health Workers (AHWs) in Western Australia. He weaves the fabric of his story with data about the state of Indigenous health and its social determinants from published government sources and embellishes it with the patterns and colours of detail from interviews with health workers, beautifully illustrating the tensions and (mis)trusts of their work.

The book includes five densely packed and lengthy chapters that document the history of AHWs, the contexts of their practice, and how they engage with their clients, other health workers and the health system more broadly. The recurring themes of large responsibilities with small amounts of training, of lack of respect from other health workers, with the underpinning history of dispossession and disempowerment are at once sad and happy; sadness for ill-health that is so hard to address, and happiness for the small but important victories and the recognition of the unique role the AHW has among his or her people.

The history of the AHW evolved from the Alma Ata declaration, which requires that a somewhat wide-ranging set of skills and competencies, unrealistic for a single person to possess, be available to village communities. (The model has been put into practice in many places in different guises, such as the possibly more familiar barefoot doctor system in China.) This book shows how Australia's AHW roles are not focused on wellness and sickness matters alone but take in a broad sweep of social determinants, which in turn makes their role incomprehensible to other (mainly regulated) health care staff. One gritty section in the chapter about working alongside mainstream health staff addresses the issue of professional competence as seen from various perspectives, underpinned by a discussion on disease processes versus holistic care.

The bibliography is extensive and appropriate, and the book includes useful but very occasional footnotes to explain some Indigenous words. The index is a little brief. However, an interesting aspect of the book is that it is paced well; it is not hurried, flows easily, and the merging of different kinds of evidence appears effortless (but I bet it wasn’t.)

In the current Public Health Education and Research Program (PHERP) agreements for teaching public health, there is a requirement for Aboriginal health to be more explicitly included and embedded in the core content. Extremely easy to read and very engaging, this book could easily be included in subjects covering public health principles and practices, sociology, and health promotion.

Genet, who has been working in Aboriginal health for several years, now works at Onemda, the Koorie Health Unit at the University of Melbourne, and his five co-authors are all Aboriginal Health Workers. They have provided us with an extraordinary opportunity to walk with them in their daily lives and experience their daily joys and frustrations. It is quite a privilege.