Why the Covid vaccination program in the Torres Strait islands depends on trust

Disruptions are not uncommon on Badu Island, one of the largest islands in the Torres Strait. When the Covid-19 pandemic hit in 2020, the Torres Strait went into lockdown in line with the rest of the country, and locals were encouraged not to travel between islands.

Charlotte Nona, the director of Queensland Regional Health in the Torres Strait and Northern Peninsula, says there is only one frontline health worker for the entire population on Badu.

“We have more patients per capita with chronic disease here, so it is not realistically sufficient to provide sufficient care,” she says.

• Charlotte Nona, with her granddaughter Sunny, 9 months, at her home on Badu Island. Charlotte is the Director of Primary Health Care in Torres Strait.

When, in early April, the federal government announced that the Astra Zeneca vaccine not be given to people under 50, the planned vaccination program for the Torres Strait was immediately suspended. With 80% of the population in the Torres Strait under 50 years old, the suspension was understandable, yet it was another change in policy for locals to understand.

“English is a third language for many people here,” Nona says.

A perceived lack of ongoing community engagement and cultural awareness has raised concerns about how the Covid-19 vaccine rollout program will be received on Badu, when it eventually takes place.

• A Queensland Health covid vaccine poster with information on vaccination dates, locations and times is seen on a notice board outside one of two general stroes on Badu Island.

“If you want good outcomes in these communities, you need to first and foremost build trust, and to build trust you need to come in at least one or two weeks ahead.”

“You really need to do health promotion, one-to-one health education with the people, and have community meetings. We can make things work here but you really need to have the conversations with the people.”

Horace Ngagalaig is solidly built, and at 60 his years of crayfish diving, hunting and playing football are evident. Ngagalaig was raised on Badu Island and now works in Brisbane providing cultural care for Torres Strait Islanders and other Indigenous people who travel to the mainland for specialist medical care.

“The gap between community consultation and any vaccine rollout is reassurance. It’s the same when they come to the hospital and they are not in their own community. They will always look to the Indigenous person to become a supportive voice for that reassurance.”

• Horace Ngagalaig, 60, on Badu Island in the Torres Strait.

Ngagalaig has first-hand experience rolling out a vaccine program in the Torres Strait. In 1995 an outbreak of Japanese encephalitis hit the region.

“We had people die from it, but we had time to sit with people before the vaccination came. People were able to absorb all the information, and the health workers were also getting the vaccination to show that it worked.”

“But this one is so quick. We had a lot more information back then, but people forget that it was rolled it out from a primary healthcare model with locals on the ground.”

Ngagalaig and Nona say sustained, locally delivered health education is vital to any vaccination program.

“Yarning is important because you have to get that information as well as give it, it takes time to observe that information, understand it and ask questions,” Nona says.

“You can’t come in and just expect people to trust you if you are a stranger.”

• A Tombstone Revealing ceremony on Badu Island in the Torres Strait. Tombstone Reveal ceremonies are important cutural practices for Torres Strait communities and are the final celebration for the life of a deceased community member.

“With the boys, we know that football and traditional hunting [of dugong and turtle] are big things. So we can use those topics of conversation.”

“The yarning could be about something else, but it’s about integrating the health information into that process, and then the questions will be asked.”

Ngagalaig recently travelled to Badu Island for a tombstone revealing ceremony, one of the most important ceremonies in Torres Strait culture. With widespread travel restrictions within Australian in 2020, many of these important cultural ceremonies were postponed.

“We might be at a tombstone revealing ceremony or a funeral but after, when we are sitting around having a yarn, we are asking questions and consulting with each other about potential issues.”

After two delayed vaccine rollouts, the Queensland Health Department has now said it will hold information sessions on Badu prior to the Pfizer vaccine being delivered.

• Voictor Nona, 80, a Badu Island elder, has a cup of coffee before a feast celebrating the tombstone revealing ceremony for his wife’s grave.

Dr Tony Brown, the executive director of medical services for the Torres Strait and Cape York, says it’s vital to reach out to each community and provide them with “clear information and advice about the vaccines, the risks and benefits associated with them and anything else our communities might want to know prior to restarting the vaccination program.”

Charlotte Nona remains positive that the rollout can be delivered with success.

“We can make things work here but you really need to have the conversations with the people.

“Just not with the expectation that you come in on the Monday, and provide sessions to the community, and then you do the rollout after lunch. It doesn’t work like that.”