Personal Interaction with the Aboriginal population.
The following reflective essay will address the issues of the interaction with Aboriginal patients, their families, and Aboriginal health workers in view of the health concept as stated by National Aboriginal Community Controlled Health Organisation (NACCHO) (Husebø, O'Regan, and Nestel 2015). The Aboriginal population viewpoint of health consists of overall wellbeing and other aspects including the social, emotional and cultural as well. Their concept of health is centred on their community. Following the interaction, there will be discussion regarding the importance of delivering health services that can ensure the Aboriginal and Torres Strait Islander population receive proper health in view of their cultural and individual well-being. The last segment will focus on the advocacy activities that are intended with the aim of providing contribution to closing the gap in health inequality and inequity among the Indigenous and non-Indigenous population.
The Aboriginal population including the patients and their families mostly have had negative experiences while going through the health care. Cultural differences leading to poor experiences with the clinicians and other health workers, or their general practitioners (GPs). They complained of being blamed for the health burden, presumption of social stigmas, discrimination because of being culturally different and an overall biased and terrible attitude. They felt misunderstood when the health worker could not understand their behaviour and were labelled as being noncompliant (Paradies 2016; Turin et al. 2016; Zambas and Wright 2016; Jacklin et al. 2017).
Due to the long history of colonialisms they felt the instructions provided by the health workers to them felt like orders and authoritative in nature leading them to a non-obligatory feeling towards the health workers. In particular the elder population felt being told to do reminded of the earlier days leading to distrust. They complained of travelling long distance for specialist care, lengthy waiting time for be seen at the clinic. They were unable to perform any cultural rights according to their tradition in the hospital environment (Paradies 2016; Turin et al. 2016; Zambas and Wright 2016; Jacklin et al. 2017). There were instances where they said Aboriginal health care programs were scarce whose primary focus was the treatment of Aboriginal population. There were lack of health care workers in their residing places, along with little to no Aboriginal health workers in those places (Paradies 2016; Turin et al. 2016; Zambas and Wright 2016; Jacklin et al. 2017). The Aboriginal family members complained being marginalized during health care (Hole et al., 2015; Wotherspoon and Williams 2019).
Positive experiences were also shared by the Aboriginal and their family members where they felt that the clinicians listen to their chief complaint and addressed them accordingly. There were culturally approached methods used by the health workers respecting the Aboriginal’s culture and heritage (Hole et al. 2015; Jacklin et al. 2017; Kingsley et al. 2018). The Aboriginal health workers felt they had an important part to play in providing care to their respective communities as they alone could bridge the gap between the modern clinicians and the Aboriginal representing patient population. An Aboriginal worker was tuned as to the visible differences that took place in the care of an Aboriginal patient and when they were visited by family. They understood that in the Aboriginal community the sense of family and togetherness is strong and is revolved around their culture (Conway, Tsourtos and Lawn, 2017; Kingsley et al. 2018).
There is huge burden of disease on the Aboriginal population, mostly due to their high prevalence of chronic disease which include cardiovascular diseases type 2 diabetes. They need to be encouraged to access the health care services provided for them. The optimum approach to tackle the issue and provide them with proper health care delivery would involve using the holistic approach. The holistic approach would be taking into account the Aboriginals cultural values, community and family members in addition to the physical and psychological elements (Askew et al. 2016; Davy et al. 2017; Kingsley et al. 2018). This would have to be associated with acknowledging that they were victims of colonisation and racism and every effort would be done to address this systemic barrier. This would require a collaboration from the Aboriginal health workers and researchers to contribute equally as they are knowledgeable in the local culture and know where the changes are required to be made in the health care facilities or policies (Askew et al. 2016; Davy et al. 2017).
For the health care delivery “strong research partnerships” associated with the Aboriginal community needs to be addressed. Health care programmes with specific target; high prevalence of ear disease followed by hearing loss should aim at providing specific ENT clinics for the Aboriginal affected population with health care workers having knowledge about the local Aboriginal culture. The research data accumulated will help in finding more patterns related to a specific condition in the community and aid in targeting those specifically (Young et al. 2017).
Health education about the Aboriginal population among the doctors and health workers will help them in understanding the Aboriginal’s patients, their family’s behaviour and why they might be non-complaint towards the treatment regime provided. Separate spaces should be provided in hospitals for them to perform any cultural specific ceremony (Jacklin et al. 2017; Kingsley et al. 2018). The concept of Cultural Safety when implemented can provided an approach to improve the Aboriginals overall health outcomes. This concept emphasize on the patient’s “socio-political” scenario where they feel left due to past politics status and colonial historical impact. Through this the health worker can provided treatment to the Aboriginals in the surrounding environment which is culturally appropriate for them (Hole et al. 2015). More Aboriginal families need to be involved in the specified clinics that can cater to their specific needs (Young et al. 2017).
The non-Indigenous population can reduce the health and cultural deficit by reconciliation and will to engage. The reconciliation and healthy engagement between the Indigenous and non-Indigenous. The sense of belonging together within the community which the Indigenous population have needs to acclimatise with the non-Indigenous. This would need the non-Indigenous population for a more active participation in all aspects that affect the Indigenous population life and knowing what part they could play to reduce the disadvantage that is among the Indigenous (Clark, de Costa and Maddison 2017).
The gap in health outcomes that exists between the Indigenous and non-Indigenous population is vast and although it has closed down, the deficit is still huge. The experiences by the Aboriginals, their families and Aboriginal health worker have been documented in the research papers as mentioned above and require a collaborative effort from every facet of the community. The cultural difference needs to be added by educating the non-Indigenous population about what kind of atmosphere and behaviour is acceptable by the Aboriginals. The hospitals or health care centres should a separate allocated place for them to perform the cultural rituals as it is a deep part of their identity. Adding more Aboriginal in the health force will also help in reducing this burden. Reassuring them and being more personally involved in their care will reduce their distrust feeling in the health care systems and in the clinicians as well.
Askew, D.A., Togni, S.J., Schluter, P.J., Rogers, L., Egert, S., Potter, N., Hayman, N.E., Cass, A. and Brown, A.D., 2016. Investigating the feasibility, acceptability and appropriateness of outreach case management in an urban Aboriginal and Torres Strait Islander primary health care service: A mixed methods exploratory study. BMC Health Services Research, vol. 16, no. 178. https://doi.org/10.1186/s12913-016-1428-0
Clark, T., de Costa, R. and Maddison, S., 2017. Non-Indigenous Australians and the ‘Responsibility to Engage’?. Journal of Intercultural Studies, vol. 38, no. 4, pp.381-396. https://doi.org/10.1080/07256868.2017.1341393
Conway, J., Tsourtos, G. and Lawn, S., 2017. The barriers and facilitators that indigenous health workers experience in their workplace and communities in providing self-management support: A multiple case study. BMC Health Services Research, vol. 17, no. 1, pp.319. https://doi.org/10.1186/s12913-017-2265-5
Davy, C., Kite, E., Sivak, L., Brown, A., Ahmat, T., Brahim, G., Dowling, A., Jacobson, S., Kelly, T., Kemp, K. and Mitchell, F., 2017. Towards the development of a wellbeing model for Aboriginal and Torres Strait islander peoples living with chronic disease. BMC Health Services Research, vol. 17, no. 1, pp.1-13. https://doi.org/10.1186/s12913-017-2584-6
Hole, R.D., Evans, M., Berg, L.D., Bottorff, J.L., Dingwall, C., Alexis, C., Nyberg, J. and Smith, M.L., 2015. Visibility and voice: Aboriginal people experience culturally safe and unsafe health care. Qualitative Health Research, vol. 25, no. 12, pp.1662-1674. https://doi.org/10.1177/1049732314566325
Husebø, S.E., O'Regan, S. and Nestel, D. 2015. Reflective practice and its role in simulation. Clinical Simulation in Nursing, vol. 11, no. 8, pp. 368-375. https://doi.org/10.1016/j.ecns.2015.04.005
Jacklin, K. M., Henderson, R. I., Green, M. E., Walker, L. M., Calam, B., & Crowshoe, L. J. 2017. Health care experiences of Indigenous people living with type 2 diabetes in Canada. CMAJ: Canadian Medical Association journal = journal de l'Association medicale canadienne, vol. 189, no. 3, pp. E106–E112. https://doi.org/10.1503/cmaj.161098
Kingsley, J., Munro-Harrison, E., Jenkins, A. & Thorpe, A. 2018. “Here we are part of a living culture”: Understanding the cultural determinants of health in Aboriginal gathering places in Victoria, Australia. Health and Place, vol. 54, pp. 210-220. https://doi.org/10.1016/j.healthplace.2018.10.001
Paradies, Y., 2016. Colonisation, racism and indigenous health. Journal of Population Research, vol 33, no 1, pp.83-96. http://dx.doi.org/10.1007/s12546-016-9162-3.
Turin, T.C., Saad, N., Jun, M., Tonelli, M., Ma, Z., Barnabe, C.C.M., Manns, B. and Hemmelgarn, B., 2016. Lifetime risk of diabetes among First Nations and non–First Nations people. CMAJ, vol. 188, no. 16, pp.1147-1153. https://doi.org/10.1503/cmaj.150787
Wotherspoon, C. and Williams, C.M., 2019. Exploring the experiences of Aboriginal and Torres Strait Islander patients admitted to a metropolitan health service. Australian Health Review, vol. 43, no. 2, pp.217-223. https://doi.org/10.1071/AH17096
Young, C., Tong, A., Gunasekera, H., Sherriff, S., Kalucy, D., Fernando, P. and Craig, J.C., 2017. Health professional and community perspectives on reducing barriers to accessing specialist health care in metropolitan Aboriginal communities: A semi‐structured interview study. Journal of Paediatrics and Child Health, vol. 53, no.3, pp.277-282. https://doi.org/10.1111/jpc.13374
Zambas, S.I. and Wright, J., 2016. Impact of colonialism on Māori and Aboriginal healthcare access: a discussion paper. Contemporary Nurse, vol. 52, no. 4, pp.398-409. https://doi.org/10.1080/10376178.2016.1195238
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