TOPIC 1: “Spoken and written language is the basis of good communication, yet when it comes to cross-cultural communication in Australia, language [for indigenous peoples] is not taken seriously at all” (Trudgen 2000, p.83)
Cross-Cultural Communication is the study of the ways in which different communities communicate with each other, in different as well as similar ways, among themselves, and the way in which they attempt to converse with each other. In this type of communication, people try to observe the world around them from their own perspective. However, there is a gap between the language which the healthcare workers speak and the patients speak. This is evident in the communication between the Indigenous Australians and the health professionals, which has a great impact on the health of the patients (Lowell, et al. 2012; Cass, et al. 2002; Mitchell, Lowell, & Ralph,. 2016; Amery, 1999). The communication break can be mostly seen in remote areas where the language and culture differences are huge (Amery, 2017). As there is a huge language and cultural gap, the communication complications in these communities are superior to the language obstacles alone. The aim of this paper is to provide a detailed analysis on the consequences for the Indigenous language speaking people relating to the nursing care, in Australia. For this reason, this paper will discuss the different characteristics of the issues of cross-communication among the healthcare providers and Indigenous language speaking people, and its consequences on their health, followed by the concluding paragraph.
Life expectancy of the Indigenous Australians, inhabiting the remote areas, as compared to the people living in the urban and rural areas is lower. 70% of the Indigenous people live in isolated areas, with 60-65% speaking Indigenous language, which acts as a communication gap that is sponsor to the areas of under-rated and under-researched (Amery, 2017). In the 2011 Australian Census, it was seen 60,550 people or 11.8% of the Indigenous defendants specified that at home, they spoke Indigenous language, where 17.5% of the respondents demanded that they had no education regarding English properly and had difficulty in using rapports such as Tumour, Contagion, High Blood Pressure, Heart Attacks and many more such words (Biddle, 2012). Aboriginal people are often seen speaking English terms in their own language, which is different from conventional English (Amery, 2017).
When visiting healthcare personnel, there may be misinterpretations, which may arise due to the boundary of culture and communication, which may be a result of the perspectives of the world, rather than linguistics. There are various Aboriginal people who may refuse to visit the medical professional as they may not trust him/her. They often reply to a certain question after a long pause, which, for foreign doctors may be impolite and this may act as a communication gap. This may lead to the patient not being treated by the doctor or medical professional (Trudgen, 2000; Harris, 1980; Queensland Health Aboriginal and Torres Strait Islander Cultural Capability Team, 2015). To overcome this barrier, the non-indigenous nurses need to be patient and give time to the indigenous people to be able to receive a natural and unaffected communication as well as countenance (Amery, 2017).
There is an observable, yet infrequently admitted fact that the English-only speakers often chose not to communicate in a proper manner with people speaking a different language than English. In a paper by Taylor and Guerin (2010; p.125), it was mentioned that the nurses and further health specialists frequently described the Indigenous patients as ‘non-compliant, non-communicative, poor historians,’ among others terms. Language is connected to different problems of self-importance and identity, which ultimately affects the health of an individual. When there is absence of a mutual understanding of the Indigenous Language of the clients’ right to their own dialect as well as individuality, obtaining health services becomes a difficult task for the Indigenous people (Taylor, 2010). Having communication problems can lead to having issues related to informed consent, legal concerns, loss of treatment options, as well as duty of care (McGrath & Phillips, 2008). These issues lead to the health professionals to work in an atmosphere of illegal adherence, which can mean that the potential for lawsuit is significant (Taylor, 2010). Wren (2007) has stated that over the past years, there can be seen, a huge upsurge in the number of foreign medical professionals, employed in Central Australia, which leads to a rise in the available problems in the healthcare sector.
In a report by ABS & AIHW (2005), it was stated, around 11% of the total Indigenous populations faced difficulty in understanding the service providers or were not able to describe their issues properly to them. A study was conducted on the effect of language barriers, affecting the health of the Indigenous Language speaking people by being greatly affected by cancer, their treatment and diagnosis in the Northern Territory of Australia. The Indigenous people have a higher chance of death by cancer than English Language speakers. When they are diagnosed with cancer, they are at a higher risk of having an advanced stage, as well as they receives poor treatment after their diagnosis, which further acts as a subsidizing aspect to their death. There are various alterations between the Indigenous and Non-indigenous communication practices, one of which is seen in the question and answer modes (AIHW, 2008). In the Western process of questioning and answering, direct questioning is preferred rather than indirect forms and is considered as common. Nurses here collect the information of the patient, further probing them for their personal details, without introducing himself or herself, which is considered rude among the Indigenous Language speaking people (Taylor, 2010). According to Fryer-Smith (2002), Indigenous people consider indirect form of communicating and often find it difficult to answer the questions laid down by the nurses, and they consider the sharing of personal information as a two-way process, which, in the Western culture is not significant.
Along with the public health workplaces, nurses have a significant role to play in their patient’s lives, through the process of direct nursing care, as well as upstream navigating. They also help in reducing the impact of various disorders, promoting the well-being and proper health of their patients (Hunt, et al 2015). However, when considering the cases of perinatal cases, there is a huge burden of uneven burden of perinatal results among the Aboriginal and Torres Strait Islander mothers and their children when associated with the non-indigenous mothers and their children. In a report by Humphrey et al (2015) and AIHW (2016), it was stated that the Indigenous mothers suffer from an increased maternal mortality rate, that is, 13.8 versus 6.6 deaths per 1, 00,000 women who gave birth between 2008 and 2012, low birth weight, that is, 118 versus 62 per 1,000 births; preterm births, that is, 140 versus 80 in 1000 births; including perinatal deaths, that is, 14 versus 9 in 1000 births. Every health professional has to be aware of these inequalities and play a significant role in minimizing their date rate and improving the care for the Indigenous pregnant women to reduce the gap between the non-Indigenous women and Indigenous women.
In the work of Clarke and Boyle (2014), it was found that a study conducted on the midwives in a huge hospice in South Australia led to the result that communication and generating significant support among the Aboriginal healthcare workers and families was an important element for the midwives who worked with Indigenous families. It was also found that the midwives has certain problems in identifying the physical needs of the pregnant women due to communication barriers, and because their cultural needs were separate from the pregnant woman’s culture which led to the misunderstanding of the concept of culture. There is the presence of different barriers for the avoidance of the delivery of intrapartum midwifery cases in remote areas (Corcoran, Catling, & Homer, 2017). Although the maternity services in Australia are designed based on the western medical world, to provide women with the best physical care, they are different from the Indigenous worldview (Barclay, et al. 2016).
According to the Indigenous worldview, their definition of fitness not only comprises the bodily well-being of a distinct person, but also his/her social, mental, expressive and national well-being, as well as their community (Australian Government, 2013). The maternity systems of the Australian government have been unsuccessful in integrating the worldview of the Indigenous women, on the effect of their social life and their trust that not being innate on their land threatens their claim to their land (Ireland, Wullili, Belton, & Kildea, 2011; Ramsey, 2014). The Indigenous culture is vastly different from the Western culture, where the Indigenous pregnant women believe that being away from their community while giving birth, leads them into anxiety, stress as well as depression, and also believe that their child will be susceptible to the Child Protection Services when they are not around (Ramsey, 2014).
The Nursing and Midwifery Labour Force Census delivers data regarding nurses who recommence their registering or acceptances in relation to a state or Land Nursing and Midwifery Registration Board, when the Nursing and Midwifery Labour Force Census is piloted. As it was stated in a report by AIHW (2008), in 2005, the number of indigenous women who enrolled themselves as registered nurses was merely 0.9% and 0.3% respectively. This shows that the communication gap between the two cultures, that is, indigenous and non-indigenous, increases, as they are both incompetent about each other cultures and different methods. Communication in the Central Australian Health is a significant problem, which affects the volume of the health specialists and the amenities, which they deliver with safety and care. There are various studies which have acknowledged the effect on the individual health professionals and the effect of communication gaps on the patients as well as the healthcare service providers (Cass et al, 2002; Trudgen, 2001).
Further, the English speaking healthcare providers refuse to take Aboriginal languages completely, which results in less than optimum medical consequences, and also leads to the creation of the approaches of suspicion, disentanglement with the health sector and non-compliance with the treatment governments (Reid, 1983). They fail to develop a proper understanding about the Aboriginal people living in isolated areas, the reasons for their diseases, which is significantly different from the English-speaking patients (Maher, 1999). There are different sources of data which suggest that only a small portion, that is, only 10% of the Indigenous Australians under the age of 60 years are not able to speak English well, however, most of them can communicate with outsiders about their everyday life, but cannot communicate when it comes to communicating about health and other specialized zones (Aboriginal Resource and Development Services (ARDS), 2008). Women who live in the remote areas have very limited access to antenatal care, as and when compared to the ones received by pregnant women in the rural and urban sector. Working in the remote areas require unique abilities and is quite challenging for the midwives (Obs Gynae & Midwifery News, 2009).
Thus, the aim of this paper was to provide a detailed analysis of the consequences for the Indigenous Language speaking people, relating to the nursing as well as midwifery care and interactions in Australia. This paper provides an analysis on the various aspects of the different problems faced by Indigenous people, as compared to the non-Indigenous people, which includes communication issues that create problems during pregnancy, receiving proper care and various other issues. Thus, it can be said, that the cross-communicational issues between various cultures creates barriers, such as anxiety, racism, typecasting, and its main root cause is the cultural differences and knowledge.
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