Living with a long-term illness can be hard, especially when it means travelling long distances, seeing lots of different health services, and making big decisions along the way. For Aboriginal and Torres Strait Islander people across Western and Far West NSW, the Integrated Team Care (ITC) program helps make that journey feel more supported and less overwhelming.
Commissioned by WNSW PHN, ITC supports Aboriginal and Torres Strait Islander people living with chronic health conditions by helping them navigate the health system, stay connected to care, and get support that works for their life and community.
One woman living with diabetes and kidney disease had been finding it increasingly hard to manage her health. As her conditions became more complex, she needed regular check-ups, monitoring, education and support from different health professionals.
Through the local ITC team, she received ongoing care from nurses, doctors and allied health staff who took the time to build trust, explain her options and support her at each step. When she needed to travel to a major city for specialist care, transport was organised and her care plan followed her home, so she stayed supported once she returned to community.
With the right information and steady encouragement, she felt more confident to make decisions about her health. Over time, she chose to start dialysis, a step she had previously not felt ready for. Having people alongside her made the difference.
For another ITC client, being diagnosed with cancer meant facing surgery, treatment and many appointments all at once. On top of the emotional and physical impact, the cost of travelling for care added extra stress.
With help from ITC-supported services, transport and accommodation costs were reduced so the client could focus on healing. Recently, they reached a major milestone by finishing chemotherapy and ringing the bell, a moment of pride and relief after a long road. Radiation treatment is now underway, with ongoing support continuing as needed.
Integrated Team Care is about more than appointments. It’s about making sure people feel supported, listened to and respected. The program helps Aboriginal and Torres Strait Islander people living with chronic conditions (such as, but not limited to, diabetes, cancer, cardiovascular disease, chronic respiratory disease, chronic kidney disease, eye health conditions associated with diabetes, and mental health conditions) by offering care coordination, help getting to appointments, support to access specialists and allied health services, and education to better understand their health.
Delivered in partnership with local Aboriginal Medical Services and health providers, ITC helps keep care connected and culturally safe.
These stories show what’s possible when people are supported in a way that makes sense for them, their family and their community.
Learn more about Integrated Team Care and how to access the program here.
