The healing place
When trainee doctor Larry Yee was studying for his specialisation and signed up for a locum position to earn some extra cash, he had no way of knowing how it would affect his future practice of medicine. It was 1997, and Larry was about to meet Leavina Reid, a Senior Aboriginal Health Worker at the Armidale Aboriginal Medical Service in NSW.
As a Gamillaroi woman with 20 years experience in the Indigenous health sector, Leavina had already learned a great deal about what wasn’t working in terms of improving health outcomes for her people. Leavina shared with Larry her dream of establishing an Aboriginal medical service to provide meaningful and culturally appropriate health care for her community. An inspired Larry told Leavina to get in touch if she ever got her idea off the ground.
In 1997 Leavina Reid moved to the Nambucca Valley on the mid-north coast of NSW, and in 1999 Dr Larry Yee got a phone call…
In 1999 Leavina and Larry organised a community meeting in the Nambucca Valley to discuss the region’s need for vastly improved primary health care within its local Indigenous communities. Addressing community elders, local and state government agencies, business owners and stakeholders from local health services, Leavina pitched her idea for an accessible bulk billing medical service that would be Indigenous owned and operated, but available to the whole community.
It quickly became apparent that government funding wasn’t available for this initiative. In spite of that, the local Indigenous communities — with Leavina leading the way — resolved to join together to form the Bawrunga Aboriginal Medical Service (BAMS). ‘Ongoing politics had left us with no avenues to access funding’, said Leavina, ‘so we had to rethink. We had a group of very strongly committed people, we were incorporated, and we had our constitution… So we looked at devising a five year business plan… We thought about our social enterprise model, established a board, and looked at achieving a self-sustainable business model, and moving away from a ‘welfare mentality’.
After approaching the local council, BAMS were offered a vacant council chamber rent-free, with one condition being that the clinic must secure the support and services of a fully accredited GP. Fortunately Larry was one such GP.
BAMS opened its first clinic in Bowraville in 1999, and for the next four years Larry travelled 400km from Sydney to volunteer his GP services on a weekly basis. With limited income, the clinic was heavily reliant on donations and the goodwill of volunteers. Larry recalls: ‘The plan was for me to work one day a week… We wanted to build up the clinic and attract other doctors to work there… Because there was a serious need there, and we were one of the only bulk billing services in the region, we were absolutely swamped. People were lining up. And all the staff were volunteering — we had board members and community elders on the front desk, and Leavina out the back doing dressings… And if someone needed transportation then that was Leavina’s car! And we were opening our doors to everyone’.
In 2001 BAMS recruited its first fulltime GP, and its income increased exponentially. Over time it became apparent that the service needed a larger, more centralised and accessible location to meet local demand. BAMS approached IBA who provided Leavina and her board of directors with the services of a business consultant, Tony Shaw of Northern Rivers Business Solutions.
Tony assisted Leavina and her team to learn about financial management and planning, risk assessment and how to create a sustainable revenue stream to sustain the operation. That learning enabled BAMS to secure a loan from IBA to purchase and fit out a flagship clinic in Nambucca Heads in 2008.
In receiving ongoing mentoring and business support and corporate governance training for the board, BAMS created the basis of a self-sustainable business model that would eventually allow it to achieve the autonomy it was striving for.
‘That is a huge badge of honour for Bawrunga’, said Tony. ‘If you ask them why they’d probably say that independence brings self-determination. They have a genuine pride that they have delivered for the Aboriginal people… If you look at where the business came from and where it is now, you’ve got to give credit to all those involved.
‘You’ve got a CEO (Leavina) whose vision this was and who worked unpaid for more than five years to make it happen, and you’ve got most of the original board from eleven years ago still giving their all as they have from day one’.
Tony believes it’s the commitment and stability at a senior management level that has been key to the organisation’s success. He said: ‘You’ve got a strong leadership team with an intimate knowledge of the business, who have seen both the good and bad times and are now truly capable of making informed value judgments. It’s their belief, commitment and enthusiasm mixed with their ability to draw on past experience that makes it all work’.
And worked it has. BAMS is currently 100 per cent Indigenous community owned and operated, fully funded through its bulk billing services, and employs seven fulltime doctors and 30 administrative and nursing staff. The service has opened new clinics in Macksville,Toormina and Dubbo, and more remotely in Gilgandra and Gulargambone, delivering vital GP services and primary health care to more than 15,500 patients since it started.
Each BAMS clinic has been established using the same business model, generating operating income through its bulk billed GP services and partnering with community organisations to deliver preventative health and education programs targeted to that particular community. Leavina says that from the outset, community consultation in planning and priority setting around health services is vital. ‘It’s easy to build something, but harder to hang onto it’, she said. ‘So we meet with community and work in conjunction with them’.
‘Community buy-in is fundamental to (a clinic) succeeding long term. And it’s about community ownership. But we always look at it as a business’.
‘Our first priority is to generate income through Medicare. We have to establish a base first, put GPs in place and generate income to cover all necessary overheads. Then we look at what programs are needed in that particular community, and we look at tapping into existing services that are already funded and become allies — the whole community working together’.
Despite its seemingly rapid growth and success, it has by no means been an easy journey for the organisation. Larry said: ‘There were so many setbacks through the years, so many times that it took so much out of Leavina. But she knew that this was so important and would make such a difference’. Key to that success has been a willingness to learn. ‘It hasn’t been smooth sailing’, said Leavina ‘and there have been wrong roads, but lots of learning experiences… We were learning as we were going, and we’ve been mindful of asking for help, being curious and taking up those opportunities for learning’.
Throughout the journey BAMS has retained its grassroots approach to delivering its services to Indigenous communities. Leavina said: ‘You need to do things in a culturally appropriate way. Our people won’t come and sit in a lecture room and listen to a talk on diabetes, so you set up a tent, put on some food, and go and sit on the grass and talk one-on-one’.
BAMS has also retained its commitment to opening its doors to the whole community, and to promoting reconciliation and unity. Larry said: ‘I think it fosters stronger ties between the Indigenous and non-Indigenous communities. In any waiting room you’ll see a cultural mix of people being treated in a culturally appropriate way. And those people see a strong, functional and positive service being delivered by Aboriginal people — so they become supporters of it’.
Tony agrees: ‘Bawrunga is a truly multicultural organisation that manages to maintain dignity and tradition so essential to its Aboriginal heritage…The service heavily promotes the concept of social equity as a foundation for its work and has achieved strong community recognition for this. Being unselfish, non-denominational in cultural terms and respecting and valuing every client irrespective of race, colour or creed resonates at a base community level’.
Although Larry no longer makes his weekly journey north, he remains closely involved with the service, lobbying for donations and program funding, participating in the recruitment of new GPs, and acting as a sounding board for his friend Leavina. But he maintains that he continues to receive more than he gives from his involvement. He said: ‘From right back in 1999 I’ve seen how a small amount can fix so much. As a doctor, the things I have done here have helped entire communities. I’m enormously proud of being involved in creating change on that level. I’m part of something bigger than myself, my own environment.’ But Larry is also quick to credit Leavina. ‘An inspirational leader is a powerful thing’, he said, ‘and that’s why I’m still involved today, because I believe in her, in this project’.
Leavina is equally quick to deflect the credit towards others. She said: ‘I have a committed team who support me. I have a board that isn’t divisive, that is unified and able to see the bigger picture… I’ve never seen building Bawrunga as a chore or a job — it’s a passion. I’ve been fortunate right from the word go to have a group of people around me who shared that vision, who could walk towards it’.
Going forward, BAMS hopes to establish a charitable foundation and partner with other organisations to provide scholarships and grants for local Indigenous Australians.
Larry said: ‘Health and wellbeing for Aboriginal people is a holistic thing. So the clinics address illness and health education, but wellbeing is also about your quality of life, empowerment through having choices about education, employment, housing and training. And that’s what closing the gap is all about — embracing all those aspects. And you need to empower Aboriginal people to want to achieve that level of health and wellbeing for themselves’.