Overcoming health challenges with culturally safe support: Beverley’s story
Beverley, an Aboriginal woman from the Kimberley region of Western Australia, has called South Australia home for over 30 years. Living on Kaurna Country (Adelaide), she raised six children and dedicated many years to working in the education sector. Her journey with Sonder’s Closing the Gap – Integrated Team Care (CTG ITC) program began when her GP referred her for diabetes management support.
The CTG ITC program supports Aboriginal and/or Torres Strait Islander people to better manage chronic health conditions by providing personalised care coordination, help to develop self-management skills, and practical assistance to access necessary services.
Nicola, Care Coordinator, along with an Outreach Worker from the CTG ITC program worked closely with Beverley to ensure she had the support she needed to manage her diabetes. They coordinated her medical appointments with her GP, diabetes clinic, and podiatrist, and provided essential items like supportive footwear and tools to help with medication management. Through these efforts, Beverley’s health initially stabilised.
However, an unexpected emergency bowel surgery brought new complications. As her health needs grew, Beverley increasingly relied on Nicola and the CTG ITC team for continued support. During her hospital stay, Nicola actively participated in case conferences to ensure Beverley’s transition back home was smooth and well-coordinated.
Once home, Beverley wanted to focus on regaining her strength and staying in the comfort of her own home. Nicola organised a My Aged Care assessment and advocated for an urgent high-level care package to meet her evolving needs. In collaboration with Tanya, an Aged Care Advisor from Aboriginal Community Services, and Tina, an Aboriginal Services Advisor from RDNS, Nicola arranged home medication deliveries, essential in-home services, and physiotherapy to support Beverley’s recovery.
As time went on, Beverley’s leg ulcers worsened, which compounded her health challenges. Nicola stepped in to advocate for better pain management and secured a dermatologist appointment. Unfortunately, after further assessment, it became clear that Beverley would need another hospital stay for treatment.
Given Beverley’s multiple health conditions, including heart failure, osteoporosis, osteoarthritis, rotator cuff syndrome, and now vasculitis, returning home was no longer feasible. Following her discharge, it was determined that she would need the comprehensive care provided by a nursing home. Nicola worked with the Placement Team at Flinders Medical Centre to secure a facility close to Beverley’s family.
Now settled in her nursing home, Beverley enjoys regular family visits and has seen improvements in her health and mobility. The treatment for her ulcers together with the new pain management and physiotherapy regimen has improved her mobility and overall quality of life.
She credits the program’s support, saying,
“The help I’ve received has been excellent, and I really appreciate all the help I have been given.”
Nicola remarked,
“Beverley’s resilience and determination have been truly inspiring. It’s been a privilege to support her through these challenges and see her regain some independence and quality of life.”
Thanks to the dedicated efforts of Nicola and the CTG ITC program, Beverley has not only managed her medical needs but also found the strength to face her health challenges with dignity and hope. The program’s collaborative and compassionate approach ensured that Beverley was never alone in her journey, demonstrating the profound impact of integrated care.
Looking for culturally sensitive care?
To get started, make an appointment with your regular GP or Aboriginal Health Worker, and ask them to complete a 715 Aboriginal Health Check and/or a GP Management Plan and make a referral to Sonder’s Closing the Gap ITC program.
If you do not have a regular GP, contact us and we can support you to access the service. Call (08) 8209 0700 or email info@sonder.net.au to chat with our friendly team.
Closing the Gap Integrated Team Care is supported by funding from Adelaide PHN and Country SA PHN through the Australian Government’s Primary Health Network Program.