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Health Care Assignment: Case Study Analysis of Indigenous Australian

Question

Task:
Case Study

Emily is a teenage girl who identifies as being Aboriginal. She presented to the Fiona Stanley hospital with nausea and has been unwell on and off for a number weeks. She is accompanied by her nana, aunty, and older sister. The triage-nurses on duty examine Emily and after an overnight stay and extensive investigation the doctors conclude that Emily is 6 months pregnant, furthermore, she has gestational diabetes, which is likely the reason she has been feeling unwell.

Emily is originally from the Pilbara town of ‘Dampier’ and came to live in Perth with her nana and aunty for schooling 6 months ago. She has not enjoyed the isolation of the city and having to catch public transport to get to school. On finding out that she is pregnant Emily wants to return to Dampier to be close to her mum. The hospital wants to keep Emily in for a week for observation, particular because she has not had any antenatal care. Emily is transferred to the King Edward adolescent clinic. Furthermore, as gestational diabetes can have serious consequences, Emily’s nana is concerned that if Emily returns home she might not get the care she needs from the Dampier hospital.

During Emily’s stay in hospital she feels lonely and is scared to sleep at night because she has never been away from her family. Most of the nurses on the ward are friendly and some spend time talking to Emily when they come through her ward and offer her magazines to keep her entertained. Emily’s nana, aunty, and sister visit regularly and try to stay for as long as they can, when visiting hours finish one or two of Emily’s family members normally stay on, the nurses do not mind as Emily and her visitor(s) sit talking quietly or watch television.

Emily’s mum and one of Emily’s uncles is in ‘town’ (an Aboriginal Australian English word for visiting the location you reside in) and accompanies nana, aunty, and sister to the hospital. A new nurse is on duty this day and instructs the family they are being too noisy, visitor’s hour is over, and they have to leave. The family instantly quieten down and ask if they can stay if they are quiet. The nurse refuses and says ‘no visitors hour is over and other patients need to rest’, no alternative is offered. Emily gets very upset by this and wants to leave with her mum.

You are required to write a health care assignment identifying a number of concerns and ways to supporting the client and their family in this case study. You are required to concentrate on TWO of the Social Determinants of Health (SDH) One MUST be specific to Aboriginal and Torres Strait Islander peoples (see workshop 4) the other one can either be: another SDH specific to Aboriginal and Torres Strait Islander people OR one of the WHO 10 SDH

Answer

1. Introduction
"We've got to be careful, in our pursuit of genuine equality in health and other important areas, that we don't repeat the same mistakes of the past in deciding for Aboriginal people what their welfare is"(Fogarty et al., 2018, p. 22). Emily, a teenage Aboriginal girl, is six months pregnant. She has gestational diabetes which further worsens her condition. She has to stay with nana and aunty because her hometown Dampier lacks the sufficient healthcare facilities available in Perth. Her condition of gestational diabetes reinforces her nana's commitment to making her stay at Perth. Emily in the case study is influenced by multiple social determinants of health during her pregnancy. Social determinants of health, when considered inadequately, act as barriers for health programs and health outcomes. This highlights the need for health professionals for providing culturally appropriate outcomes (Vallesi et al., 2018). Connections to land and healthcare accessibility are playing a fundamental role in Emily’s case.

2. Case description
Emily, a teenage Aboriginal girl, has been unwell for several weeks. On examination at Fiona Stanley hospital, she is revealed to be six months pregnant and has gestational diabetes. Gestational diabetes is considered to be the reason for her health deterioration in recent times. She is originally from Pilbara town and has been living with her nana and aunty for schooling for six months at Perth. Emily has been missing her hometown and wants to return to her mother during her pregnancy. However, she is forced to stay in Perth since her hometown is not equipped with a proper facility for the management of gestational diabetes. She is transferred to King Edward adolescent clinic for receiving proper antenatal care. Being away from home, Emily feels lonely and scared to sleep at night. However, the nurses in the ward are friendly and understand her condition. Even, her nana and his family visit regularly and stay for longer periods for providing her company during her hospital stay.

Her mother and uncle have accompanied her nana for visiting Emily at the hospital. However, a new nurse instructs her family to leave and prevents them from staying for an extended period. The new nurse is very firm with the instructions. Emily wants to leave with her mother to her hometown. This can have serious implications on Emily's health during pregnancy.

3. Social determinants of health for the case study
This section of the case study has identified two social determinants of health. These health determinants are explored and its impact on Emily is discussed. Suggestions are framed aiming to address the mentioned social determinants of health.

3.1. Social determinant of health: Connection to land
Indigenous health has been largely impacted by colonialism, economic reforms and government reforms. The trauma and loss of the Indigenous people over the generations have influenced the physical, mental, emotional and spiritual health of Indigenous people. To compensate for the prolonged association with grief and trauma and promote healing, Indigenous people need reconnection with their natural environment (Freeman, 2019). This establishes the importance of land connection in the lives of Indigenous people. The rights and interests of Aboriginal and Torres Strait Islander are recognised and acknowledged. Land connections hold special significance in the lives of Indigenous Australians. It is associated with cultural, spiritual and economic domains (Niaa.gov.au, 2020).

Emily has been staying at Perth with her nana's family for schooling. The urban conditions of living have failed to make her happy. During her pregnancy, she wants to stay with her mother in her hometown. Moreover, her health complications during her pregnancy force her to stay in Perth since her hometown may not provide the best care for gestational diabetes. This shows a period of prolonged detachment with her land. The case study reveals her mental struggling phase to stay at Perth for the sake of her health. The emotional well-being is negatively impacted due to detachment from her hometown.

3.2. Its suggested solution
Smith et al. (2020) conducted interviews to explore the quality of life for Aboriginal Australians. This highlighted the role of country, culture and community for having a "good life" for Aboriginals. The participants in the interview revealed spending time on the country has a restorative impact on theirsocial well-being and emotional. This reflects a strong connection with their land. This is interconnected with the comfort of being associated with their culture and reconnection with their family members (Smith et al., 2020). This can be used for developing guidelines for healthcare professionals at King Edward adolescent clinic where Emily has been admitted for antenatal care.

For compensating the gap of cultural comfort, healthcare professionals and nurses can support and encourage Emily to continue the antenatal care, a major requirement for her health. They should allow Emily’s family to stay even after visiting periods provided they do not disturb other patients. This will help Emily emotionally during her stay away from her land.

3.3. Social determinant of health: Accessibility of healthcare facilities
Accessibility to health services is measured in terms of physical accessibility to Indigenous health services based on driving time to services and physical accessibility to general healthcare services. A health report of 2016 highlights limited access to Indigenous services and general services. Service gap is evident in remote areas of Queensland, Western Australia and New South Wales (Aihw.gov.au, 2020).

The Pilbara town of Dampier lacks sufficient healthcare facilities compared to the city of Perth. Emily requires antenatal care and management of gestational diabetes. For receiving the best possible care, she is forced to stay at Perth and gets admitted to King Edward adolescent clinic. The lack of proper healthcare facilities at Dampier hospital forces her to stay in the city despite her unwillingness to stay away from hometown. This reflects the lack of healthcare services in non-urban areas and poses accessibility barriers for receiving healthcare services.

3.4. Its suggested solution
The health disparity is still prevalent in Australia. This is reflected in the health gap between Indigenous and non-Indigenous people. This calls for health promotion and providing tailor-made solutions for the development and application of health programs. Despite the adoption of health initiatives to promote health equity, health disparity still persists. This highlights the importance of considering the lives Indigenous people living in rural and remote areas. This can be accomplished by the collection of data for outlining the needs of Indigenous Australians (Griffiths & Smith, 2020). Accessibility issues can be solved by understanding their health needs and development of health services and its implementation in remote and non-urban areas. This will reduce the hassles of travelling to the city for receiving health services.

Conclusion
The case study reflects on the health needs of Emily. This highlights the social determinants of health which have a profound impact on her well-being during pregnancy. Gestational diabetes makes Emily feel ill during her pregnancy. Lack of proper healthcare services at Dampier forces Emily to receive antenatal care from the urban hospital. This reflects the need for proper services in Dampier. Emily is emotionally affected due to her prolonged time away from her hometown. This case study reflects the impact of social determinants on the health of Indigenous people. Land connection and accessibility of healthcare services are explored in the report. ?

Reference
Aihw.gov.au. (2020).Retrieved 4 November 2020, from https://www.aihw.gov.au/getmedia/01d88043-31ba-424a-a682-98673783072e/ah16-6-6-indigenous-australians-access-health-services.pdf.

Fogarty, W., Bulloch, H., McDonnell, S., & Davis, M. (2018). Deficit Discourse and Indigenous Health: How narrative framings of Aboriginal and Torres Strait Islander people are reproduced in the policy. Deficit Discourse and Indigenous Health: How Narrative Framings of Aboriginal and Torres Strait Islander People Are Reproduced in Policy, xii. [https://www.academia.edu/download/59709186/deficit_discourse_report20190613-34013-1ubjl8o.pdf] Freeman, B. M. (2019). Promoting global health and well-being of Indigenous youth through the connection of land and culture-based activism.Global health promotion, 26(3_suppl), 17-25. [https://doi.org/10.1177/1757975919831253]

Griffiths, K., & Smith, J. (2020). Measuring health disparities in Australia: Using data to drive health promotion solutions. Health Promotion Journal of Australia, 31(2), 166-168. [DOI: 10.1002/hpja.340]

Land and Housing | National Indigenous Australians Agency.Niaa.gov.au. (2020).Retrieved 4 November 2020, from https://www.niaa.gov.au/indigenous-affairs/land-and-housing. Smith, K., Gilchrist, L., Taylor, K., Clinch, C., Logiudice, D., Edgill, P., ...&Bessarab, D. (2020). Good Spirit, Good Life: A Quality of Life Tool and Framework for Older Aboriginal Peoples. The Gerontologist, XX (XX), 1–10.[Doi:10.1093/geront/gnz185 ]

Vallesi, S., Wood, L., Dimer, L., & Zada, M. (2018). “In their own voice”—incorporating underlying social determinants into aboriginal health promotion programs. International Journal of Environmental Research and Public Health, 15(7), 1514. [http://dx.doi.org/10.3390/ijerph15071514]

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