“We could almost turnaround to the government and say, problem solved because we’ve got everyone in Orange coming in here but that’s not the case.”

Unfortunately, there is little space to accommodate everyone and the complexity of the challenges facing Aborigines means the AMS is trying to move sand with a pitchfork.

Aboriginal medical services were set up with an eye to early intervention and primary health care but in reality, this is a tall ask.

Well documented social and financial pressures mean frontline services can be very difficult to deliver.

Mr Newman says one of the biggest problems with Aboriginal health in mainstream medical services is the need for upfront payment but having to travel away from family can make getting people through the door even more difficult.

The AMS does what it can do make services affordable and easily accessible through free access to specialists, patient advocacy and transport services but often clients will still need to be go hundreds of kilometres from family for treatment in Sydney.

The knowledge a problem may require a potentially lengthy trip out of town is enough to stop some people seeking help even if cost is not an issue, Mr Newman said.

Invasive or uncomfortable procedures like pap tests and colposcopies are enough to put people off of a visit to the doctor in many cases but when it also carries the risk of being taken out of town and treated far away from friends and family, the decision is already made for some clients, Mr Newman said.

In the case of gynaecological issues, the AMS has made some headway, with visiting specialists coming to Orange now making the aforementioned examples much less problematic.

The effective provision of primary health care to Aborigines requires the majority of services to be delivered locally but once Aboriginal people are getting health checks, the next step is to make sure all of their other issues, be they financial, social or medical are addressed.

“You have the AMS which can do health checks but without addressing all those social issues all of the health problems will continue,” Mr Newman said.

Anecdotal reports of employers shying away from Aboriginal workers because they are seen as unreliable and likely to miss work on a regular basis can be related to problems that can be fixed by a doctor but they are also related to numerous problems that cannot.

The service is working with some Orange schools to get young Aboriginal people into regular health checks but more of an effort is still needed if the problem is to be solved, Mr Newman says.

While a Northern Territory style intervention could never work in cities like Orange, it is important nonetheless for governments to look at multi-pronged, co-ordinated approaches.

He said if the AMS, Department of Housing, Centrelink and employment agencies worked together to support Aboriginal people in all areas of need, they could break the cycle of unemployment, short-term employment, poverty and the resultant domestic and social problems.

In the meantime, the Orange AMS is looking to expand its services but without the space to do so, Mr Newman says it will struggle to deliver primary health care to about 800 Orange Aborigines who are not currently AMS clients.

It faces difficulties attracting funding this time around because Aboriginal people have a traditionally higher rate of non-participation in the census.

In an age where governments and bureaucrats do little without numbers to back them up, the AMS is now looking at how it can work to attract the funding to expand its services.