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Community Issue Essay

Aboriginal people living in Australia have to face multiple health problems. They are socially, culturally and economically disadvantaged compared to non-indigenous people of Australia. In addition to that, they have poorer health status and because of which, they have lower life expectancy. They also have increased cases of chronic diseases and mental health problems in their community, for example, cardiovascular diseases, chronic kidney diseases and diabetes. Government is making strategies so that health disparity among them and non-indigenous people could reduce (Health direct, 2020). But still, there are multiple problems which do not let that happen such as unequal access to health services, facing racism, discrimination and stereotypes and not able to get quality care according to the set standards and codes. Therefore, in this essay, similarities and differences between Aboriginal Medical Services and an urban outpatient renal unit will be discussed. With that, observation will also be made about the reasons Bill may choose to stay in his community despite knowing this is a life-limiting decision. After this, strategies will be outlined that can be implemented in health service in Perth which would make the experience of Bill culturally safe and secure. 

The similarity between the Aboriginal Medical Services and an urban outpatient renal unit is that both the institutes provide clinical help to the Aboriginal patients so that their health status could be enhanced and preserved. Both organizations offer emotional and social support to diseased individuals. They work so that patient renal problem and discomfort associated with the disease reduces. Strategies are applied so that health disparity among the population could be diminished and that Aboriginal people live healthy and longer lives. The two of the institute acknowledge the needs and requirements of the patient and try to improve their wellbeing (Canuto et al., 2018).

The difference between the Aboriginal Medical Services and an urban outpatient renal unit is that Aboriginal diseased individuals do not face the problem of racism or discrimination in the Aboriginal Medical Services whereas when they are taken into an outpatient renal unit they are not provided with efficient services because of the community they belong to. In addition to that, healthcare providers in the urban unit also avoid direct contact with them which results in increased complications in their end-stage kidney disease (Rix et al., 2015). This further leads to patient avoidance and not going and presenting for the treatment and screening procedures. Urban healthcare institutes have racism embedded in their organization due to which there is a clash of cultures and values between the Aboriginal community people and non-indigenous community people. With that, they are also not provided with proper support and there is a problem of accessing the healthcare facility. Because of this, their adherence to the treatment and hemodialysis also reduces (Rix et al., 2015). Also, for Aboriginal patients with the renal problem getting to the outpatient unit is difficult whereas they can easily access the Aboriginal Medical Services in their area. For them travelling to greater distance could be very challenging and tough. It can also be tiring and frightening (Kelly et al., 2014). Also, the outpatient renal unit does not understand and acknowledge the health troubles that are faced by Aboriginal men. They do not recognize that their needs are different from their non-indigenous counterparts and also from Aboriginal women. Lack of attention towards them reduces their interest in the treatment and prevention procedure. Furthermore, for Aboriginal males, people working in the outpatient unit also have stereotypes which are generally negative in nature. They are usually being portrayed as lazy, drunk, uneducated, violent and primitive which causes hindrance in their kidney-related health problem (Canuto et al., 2018).

There can be multiple reasons why Bill may choose to stay in his community despite knowing this is a life-limiting decision. The first reason can be that he might be afraid of disrespectful treatment from the healthcare providers of Perth. He knows that he belongs to the Aboriginal community and most of the times they are looked down or treated in an inferior manner. Bill might do not want to experience discriminatory behaviour or racism while he is fighting a complex disease. Bill can also be scared about racist comments or interaction with people and he might have the assumption that healthcare providers would not be considerate of him or his situation (Wylie et al., 2019). The second reason can be Bill thinks that he will not get culturally appropriate care in Perth. He might feel that his culture, beliefs and values will not be understood and recognized by the healthcare providers and they will be violated. He might fear that healthcare providers will not make a therapeutic relationship with him because he belongs to the Aboriginal community. He could also feel that the environment in the Perth healthcare setting will also not be welcoming towards him and people would not attend him properly (Davy et al., 2016). The third reason for Bill not wanting to go to Perth could be he thinks he will feel low over there and will also be disempowered by the healthcare providers of the institute. He might feel that he would not be appreciated and asked to make his health decisions. He may also be frightened that his autonomy and human rights might get compromised as people know that he belongs to a different community. Bill could even think that in the healthcare institute of Perth, his emotional and social wellbeing will not be promoted or enhanced. Thus, it could further lower his health and mental status (Conway, 2018).

The fourth reason for Bill wanting to stay with his community could be because he feels connected to his land and community people and that is why it is crucial for him to stay with them while he was facing end-stage kidney disease. He might also do not want to dissociate from his people because they gave him emotional and social support and look after his needs and requirements. He might also feel empowered by being surrounded by his community people and therefore, he does not want to relocate to another facility (Conway, 2018). The fifth reason for Bill wanting to stay with his community is that he might be anxious about the fact that he would not be able to meet his friends and family members as often as he meets them now. He also may be stressed about travelling back and forth from healthcare facility to his people because it can be very challenging for him being a kidney disease patient. Also, he might worry about the transportation facility and the cost of travelling to meet his community people (Conway, 2018). The sixth reason for Bill not wanting to go to Perth can be that he can have economic problems. As in the literature, it is mentioned that Aboriginal people are socio-economically disadvantaged and thus they are not well-off. Also, the hemodialysis is an expensive treatment option for the patient which generally put a lot of financial burden on the diseased individual. With that, staying in the hospital and transportation to the institute are other major expenses for patients like Bill. Therefore, after seeing his financial condition, he might have refused to go to a better treatment facility located in the urban area (Conway et al., 2017).

So, to help Bill, strategies and techniques could be outlined that can be implemented in the health services in Perth that will make his experience culturally safe. The first strategy which could be used is making nurses work in accordance with standards and legislations. The nurses could read those standards and guidelines and thus implement it in their practices. For example, they can follow that a registered nurse should provide person-centred care to the patient which is also based on the current evidence (Nursing and Midwifery Board of Australia, APHRA, 2020). By doing this, the patient could be receiving the utmost quality care which would enhance his health status and thus he would feel safe. Also, nurses can provide the nursing care which is according to his values and beliefs. Thus, with the help of this, he could gain culturally safe care and nursing practice. In addition to that, the registered nurse could also understand and acknowledges Bill's cultural, spiritual and social needs which aid in decreasing the health inequality among communities of Australia (Nursing and Midwifery Board of Australia, APHRA, 2020). The other strategy which could be used in the health services in Perth is that healthcare providers could be given training and education about culture safety. They could be told about different cultures and community and what is their background and present situation. The healthcare provider could also be made aware of cultural differences and the values and beliefs of other people. They can be told about how they can practice giving the best care with keeping their culture needs in mind. In addition to that, they can also be educated about the things which should not be said to the patient as it would be considered as racism or discrimination against them. Therefore, by doing this, the concept of cultural safety would be embedded in their healthcare practice (Doran et al., 2019).

Another strategy which could be employed in the health service in Perth is that medical staff belonging to the Aboriginal community could be more recruited. This would thus increase the cultural safety of the patient and would also raise the rate of retention of Aboriginal patients. Patient’s like Bill will feel more comfortable and at home with his community people around him. There will not be any cultural or language barrier and thus proper treatment of the kidney disease could be provided to the patient (Jongen et al., 2019). In addition to that, Bill also will not experience any kind of discrimination and racism against him. He would also not feel low or disempowered while staying in Perth. Also, the practice which is given to him will be culturally safe. The aboriginal healthcare providers or workers would also advocate for him and would explain the culture requirements of the patient efficiently. They would also aid in creating an environment where culture safety is promoted. The aboriginal staff member could also become a mentor and educate other people in delivering safe care. Therefore, they can act as culture brokers who will increase the safety and trust of the patients. With that, if there are more Aboriginal healthcare workers then they can also facilitate their community people in accessing the healthcare facility more easily (Jongen et al., 2019). The other strategies which also could be deployed in Perth are strengthening the stability of the workforce, capacity growing, having leadership which is strong and working well together. By doing this, culture safety could be executed at each and every level of the healthcare institute which would help patients like Bill and their disease condition (Jongen et al., 2019). Therefore, by making use of these techniques Bill and his condition could be affected positively. 

In conclusion, it can be said that Aboriginal people have to go through multiple problems while their health is in concern. They are socially, culturally and economically disadvantaged as compared to non-indigenous people of Australia. The similarity between the Aboriginal Medical Services and an urban outpatient renal unit is that both the institutes provide clinical help to the Aboriginal patients and also provide social and emotional support. However, the differences are Aboriginal diseased individuals do not face the problem of racism or discrimination in the Aboriginal Medical Services which they experience in the outpatient renal unit. Also, for Aboriginal patients with the renal problem getting to the outpatient unit is difficult whereas they can easily access the Aboriginal Medical Services in their area. In addition to that, Bill could avoid going outside his community because he might be afraid of disrespectful treatment from the healthcare providers of Perth or he wants to stay with his community due to the connection he feels with them. Also, the strategies which could be implemented in the health services in Perth that will make Bill's experience culturally safe are healthcare providers working under the guidance of standards and guidelines; healthcare providers getting the training and education about the culture safety or more recruitments are done in the Perth healthcare institute who belongs to the Aboriginal community.

References for Indigenous Patient Experiences

Canuto, K., Brown, A., Wittert, G., & Harfield, S. (2018). Understanding the utilization of primary health care services by Indigenous men: A systematic review. BMC Public Health18(1), 1198. https://doi.org/10.1186/s12889-018-6093-2

Conway, J., Lawn, S., Crail, S., & McDonald, S. (2018). Indigenous patient experiences of returning to country: A qualitative evaluation on the Country Health SA Dialysis bus. BMC Health Services Research18(1), 1010. https://doi.org/10.1186/s12913-018-3849-4

Conway, J., Tsourtos, G., & 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 Research17(1), 319. https://doi.org/10.1186/s12913-017-2265-5

Davy, C., Cass, A., Brady, J., DeVries, J., Fewquandie, B., Ingram, S., Mentha, R., Simon, P., Rickards, B., Togni, S., Liu, H., Peiris, D., Askew, D., Kite, E., Sivak, L., Hackett, M., Lavoie, J., & Brown, A. (2016). Facilitating engagement through strong relationships between primary healthcare and Aboriginal and Torres Strait Islander peoples. Australian and New Zealand Journal of Public Health40(6), 535–541. https://doi.org/10.1111/1753-6405.12553

Doran, F., Wrigley, B., & Lewis, S. (2019). Exploring cultural safety with nurse academics. research findings suggest time to "step up". Contemporary Nurse55(2-3), 156–170. https://doi.org/10.1080/10376178.2019.1640619

Health direct. (2020). Indigenous health. Retrieved from https://www.healthdirect.gov.au/indigenous-health#:~:text=Health%20programs&text=The%20Indigenous%20Australians'%20Health%20Program,Australian%20Government%20Department%20of%20Health.

Jongen, C., McCalman, J., Campbell, S., & Fagan, R. (2019). Working well: Strategies to strengthen the workforce of the Indigenous primary healthcare sector. BMC Health Services Research19(1), 910. https://doi.org/10.1186/s12913-019-4750-5

Kelly, J., Dwyer, J., Willis, E., & Pekarsky, B. (2014). Travelling to the city for hospital care: Access factors in country Aboriginal patient journeys. The Australian Journal of Rural Health22(3), 109–113. https://doi.org/10.1111/ajr.12094

Nursing and Midwifery Board APHRA. (2020). Registered nurse standards for practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Rix, E. F., Barclay, L., Stirling, J., Tong, A., & Wilson, S. (2015). The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: A qualitative study. Hemodialysis International. International Symposium on Home Hemodialysis19(1), 80–89. https://doi.org/10.1111/hdi.12201

Wylie, L., & McConkey, S. (2019). Insiders' insight: Discrimination against Indigenous peoples through the eyes of health care professionals. Journal of Racial and Ethnic Health Disparities6(1), 37–45. https://doi.org/10.1007/s40615-018-0495-9

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