Art meets science: Collaboration breaking the barriers in Indigenous bone health

In 2014, before she came to Monash University, Dr Ayse Zengin was at Cambridge University in the UK, and embarked on a study of bones and muscles among older people in The Gambia, Africa.

“The Gambia is a small county in West Africa,” she says. “We wanted to understand bone and muscle health in that population, as dietary calcium intake was very low compared with Western populations.”

Dr Zengin is now head of the Bone and Muscle Research Group within the School of Clinical Sciences at Monash Health. She specialises in bone imaging of older and underserved populations.

“Over the years, we’ve realised that a one-size-fits-all approach is not appropriate in different ethnic populations due to genetics and lifestyle differences.”

Her new study – called SIMBA (Study of Indigenous Muscle and Bone Ageing) – could revolutionise bone health management for Aboriginal and Torres Strait Islander peoples, because current osteoporosis screening guidelines are based on data mainly from non-Indigenous Australians.

This can leave First Nations people at more risk of fractures and subsequent health complications than they already face.

“We realised that Aboriginal and Torres Strait Islander peoples might be completely missed for osteoporosis screening and management,” Dr Zengin explains. “Our goal is to collect evidence that could change these screening policies.”

Transformative collaborations

SIMBA’s collaborations are similarly transformative. Dr Pete Tually, from Spartan First Imaging, a health clinic in Kalgoorlie, Western Australia, has joined the project to use his state-of-the-art scanners – the DXA (Dual-energy X-ray Absorptiometry), the gold standard for diagnosing osteoporosis, and, down the track, the pQCT (peripheral quantitative computed tomography).

“We’re the most remote nuclear medicine clinic in the world,” says Dr Tually, “and Australia’s first Indigenous medical imaging service with radiology and nuclear medicine.”

He says medical imaging technology advances constantly and revolutionises healthcare, but “access is not universal”.

“The scanners give more detail about different compartments in bones, as well as bone size and strength,” Dr Zengin says. “This data is essential to fill the gap in our understanding of Aboriginal and Torres Strait Islander people’s bone structure.”

Spartan First Imaging is an Indigenous-owned health service. CEO and co-director is Des Headland, who played Australian rules football in the AFL for the Brisbane Lions and Fremantle, winning a premiership with Brisbane in 2002.

Providing a sense of belonging

In a great initiative fusing art and science, Dr Tually and Headland asked local artist and Wangkatja Mirning woman Carol Thompson to lead a painting project, of Indigenous art, directly onto the surface of the DXA scanner.

“Medical imaging can be very scary for many Indigenous community members, especially those who visit from the traditional lands out in the Western Desert. The Indigenous artwork physically painted onto our scanner helps provide a sense of belonging, acceptance, and calmness.”

It’s about cultural safety, he says. “Clinics and these machines are sterile, foreign places. There can be strong feelings of shame attached to them.

“The artwork is tactile. I see patients come in and run their hands over it and feel the bumps and dots, they look at the orange blossom and the ants. It’s a stunning piece of work, and it talks about this as a healing place.”

The approach is working. Already the no-show rate for scans has been significantly reduced.

“Forming this new collaboration with Pete and his clinic will allow us to significantly expand our reach with this study and include many people who could benefit from this research,” Dr Zengin says. “This is crucial for making meaningful interpretations about bone and muscle health among Aboriginal and Torres Strait Islander peoples.”

More work to bridge the gap

But Dr Zengin says there’s still much work to be done in bridging the health gap. She says building trust with Indigenous communities takes time and requires a deep commitment to cultural respect and understanding.

“It's been an enjoyable process. We're learning from one another, hearing stories, and connecting with the community.”

The aim is for the study’s data to become evidence to inform potential health policy shifts.

“Forming this new collaboration with Pete and his clinic will allow us to reach our target sample size in order to be able to make meaningful interpretations of bone and muscle health among Aboriginal and Torres Strait Islander people,” she says. “The data collected will enable us to provide the evidence required to make change.”