As part of my Bachelor of Medicine/Bachelor of Surgery at Monash University, I completed a "Community Based Placement" at The Salvation Army Westcare.
I entered medical school clueless as to what I wanted to "do". Many of my family and friends are involved in community welfare and social justice, and I grew up wanting to help those most in need of help. Throughout my studies, and particularly over the course of the placement, it has become clearer to me that physical illness is often the symptomatic manifestation of wider social dysfunction.
For individuals to be healthy they must live in a nurturing environment, surrounded by supportive people and with the means necessary to pursue their own ambitions. Instability at home impairs a child’s capacity to engage in school and later on in their capacity to dream of meaningful employment. Abuse and neglect hinder the formation of loving and caring relationships and leave deep scars which, in the absence of therapeutic healing, might only be dulled by risk-taking behaviour.
During my placement, I spent time moving around the different social programs run by the organisation. Some weeks were working with TSAY assisting young people in shopping for homewares or assessing their suitability for different accommodation options. Others were spent at the Residential Units, where we engaged with young residents and observed the amazing supportive and administrative roles of the residential unit supervisors. I accompanied case workers on outreach visits with clients, and spoke to various service providers such as Drug and Alcohol counsellors. At the Secure Welfare Units I spoke with healthcare professionals about the difficulty of protecting at-risk young people. I observed case management meetings co-ordinated between Intensive Case Management Services, residential unit workers and other care-givers of Westcare’s clients. Various administrative and managerial meetings within the organisation gave great insight into the complexities and intricacies of running such a broad-reaching but closely integrated group of services.
Our academic requirements for this placement entailed researching the influences on the health of our placement organisation’s "client cohort". The inter-generational cycle of disadvantage and social marginalisation made much more sense once recognisant of the impact of adverse childhood experiences on attachment and behavioural regulation. The increasing scientific understanding of the neurobiological effects of trauma and neglect provides further evidence of the critical need to protect children and young people’s development. It was amazing to see how integrated this knowledge is to the way staff at Westcare interact with young people – patiently and gently fostering trusting relationships, and recognising that the complexities in the behaviour of some young people are responses to prior traumatic experiences.
The insight of staff with years of experience in the field highlighted the difficulties in attaining equity of health care for disadvantaged young people. I came to recognise the extraordinary complexity of making timely and conveniently located medical or therapeutic appointments. Once face-to-face with a medical practitioner, meaningful engagement can only occur if the professional interacts in such a way that nurtures a sense of acceptance, trust and security. In light of the history of young people involved with Westcare, for whom instability is a central feature of life, continuity of care is paramount. To attain positive health outcomes, young people must be supported to formulate a holistic, carefully tailored and realistic treatment plan that encourages them to participate in their own healthcare.
What struck me most about Westcare is the amazingly warm and supportive attitude of each and every staff member. While they work amongst the most vulnerable in our community, they are sustained staff in their exhausting and often emotionally demanding efforts by an extraordinary optimism. One more than one occasion I found myself somewhat overwhelmed by the endless crises faced by Westcare’s young people. However the amazing people around encouraged me to recognise value of every little bit of difference that we can make, and of persistence in pushing for long-term change. It might not necessarily be possible to "solve" the problems faced by a particular young person, but Westcare has an enormous capacity to make each day easier.
If I could change the healthcare system to reflect my learning as part of this placement, I would pour resources into the public sector across the board – providing easily accessible counselling and therapeutic services for all who require them. As a community we need to pay closer attention to the upstream influences on health – the social exclusion and disenfranchisement that accompany poor educational attainment, unemployment, adverse childhood experiences, mental illness, drug and alcohol abuse and domestic violence. It is essential to the wellbeing of the community as a whole that we ensure every child has the best possible start to life, so that they can grow into healthy and happy members of society. Health practitioners should, in their efforts to improve the physical health of their patients, be vociferous advocates for the strengthening of social institutions which are the most effective preventative health programs available.
My placement at Westcare affirmed and perhaps clarified my aspiration to work in community health. The most vulnerable in our community have the most difficulty accessing the assistance and support that they need to optimise their quality of life. Children and young people shouldn’t be denied their opportunity to enjoy fulfilling lives as a result of tumultuous beginnings. A deepened understanding of the factors that perpetuate the intergenerational cycle of disadvantage has fuelled a desire to assist in finding ways to heal and perhaps even prevent the trauma of adverse childhood experiences.