Healthcare Essay: Contemporary Issues Encounter By Aboriginal & Torres Strait Islanders
Healthcare Essay Instructions:
Tanika is Aboriginal and lives in a small rural town where she has strong connections to family and country. She is 16 years old and pregnant with her first child. Physically, mother and Baby are well but because there are no birthing services in her community she is required to go to the nearest major city (several hundred kilometres away) to wait to birth her baby. Tanika is refusing to go to town saying that she would prefer to birth in her community with the assistance of the local Aboriginal community-controlled health service staff. Using the concepts learned in this unit, analyse Tanika’s situation regarding the pros and cons of birthing on country and birthing in a metropolitan hospital. Discuss concepts from the unit that relate to her situation and provide some recommendations that would ensure the availability of culturally safe care in a metropolitan hospital.
The main focus of this healthcare essay is on the community of Aboriginal and Torres Strait Islander People who are from the familial heritage of Australia that existed in Australia before British colonization. Maternal and infant health disparities have been present among the aboriginal and Torres Strait Islander people and the non-indigenous communities of Australia (Health.qld.gov, 2021). Addressing the health care issues among the Aboriginal and non-aboriginal Australians has been long overdue because of lack of inclusion of the communities in the tackling of the issues. There are various issues seen in the provision of healthcare provision to Aboriginal and Torres Strait Islander people such as poor access to healthcare, unequal power, racism, victim blaming and social determinants (Humanrights.gov, 2021). The essay analyzes the similarities and differences in health services of country and metropolitan city. Further, the essay identifies the pros and cons of giving birth on country and in metropolitan hospital based on different concepts and recommends strategies that can help manage health issues in a culturally safe way.
Similarities and Differences in Health Services
There are several similarities and differences in health services that effectively shows the advantages and disadvantages in giving birth in the country hospital or in metropolitan hospital. Gomersall et al. (2017) has stated that there are several differences that persists between the metropolitan and country hospital. The patients in the country hospital has more chronic medical conditions compared to metropolitan patients. This means that metropolitan hospitals have better treatments and recovery rate is faster than the country hospital and this acts as a benefit of giving birth in metropolitan hospital than in country hospital. Further, it is evident that there are fewer alternative services available in country community hospital than in the metropolitan hospital. This has been the major reason behind the increase in the outpatients’ number in the community hospitals. This further shows that choosing metropolitan hospital over country hospital for giving birth is better. Wilson et al. (2020) additionally, points out that unlike health services in metropolitan areas, there is only one mainstream health services that exists in the community such as the Aboriginal Community Controlled Health service. Likewise, Harfield et al. (2018) has noted that the Aboriginal and indigenous healthcare services are often controlled by the local communities unlike mainstream services and thus are underpinned by the values of the community they service. This shows that the health services in Aboriginal country is usually based on their local values, however, in non-aboriginal or metropolitan hospital the treatment is based on knowledge and expertise. The health services in Aboriginal community hospital are controlled one, unlike mainstream health services.
Along with the differences there are also various similarities in the health services in aboriginal region and metropolitan areas. Both aboriginal community health services and mainstream healthcare focus on general practices in various areas such as cardiac and diabetes care (Harfield et al.,2018). Further, both the health services in Aboriginal community and mainstream healthcare focus on patient-centered medical home model. This has been possible because of the Aboriginal community-controlled health services in Australia. This has helped Aboriginal community-controlled health services has become equally efficient in delivering care for prevention of chronic disease. This has helped in bringing some similarities between health services in Aboriginal community and non-indigenous community (Campbell et al.,2018).These are some of the similarities between the health services in Aboriginal community and non-aboriginal community. There are more differences than similarities in their health services due to high disparities, accessibility and inequalitiesand this creates a difference in health status of Aboriginal and Torres Strait Islander Peoples and non-Indigenous Australians.
Concepts that Relate to the Case Study
There is unequal power for providing health services to the aboriginal people in their community hospital and in city hospitals. According to the report of Korff (2021), About 1500 more Aboriginal health workers are needs in Australia to access the Aboriginal patients. Likewise, Aboriginal midwives comprises only 1% of the total midwifery workforce in Australia. Likewise, Campbell et al. (2018) has noted that there are differences in levels of system support for emergency for patients in aboriginal country hospital and metropolitan hospital. Due to such unequal health service power the Aboriginal people have to travel to long distances from rural to remote setting for getting effective medical treatment. This has been logistically challenging, tiring and at times frightening for the Aboriginal community. This is because it becomes highly difficult for Aboriginal people to travel to long distances while being unwell. In relation to this it is seen that it would highly be challenging for Tanika to travel such long distance with her pregnancy condition. Weetra et al. (2016) further pointed out that huge financial concerns to travel long distance also creates a barrier between Aboriginal patients and carers. This further makes it challenging for Tanika to bear such huge travelling cost and travel to metropolitan hospital for giving birth. However, Davy et al. (2016). points out that Aboriginal community make use of traditional healers in health services, while, metropolitan hospital uses highly advanced technologies for health services. In this relation it would be beneficial for Tanika to travel to the nearest city for increasing the chance of protective birth in a metropolitan region and saving her baby.
Many Aboriginal people have experienced a sterile hospital environment with instances of racism and mistreatment. This has increased their mistrust towards the existing health system in the mainstream health services. There is health system in the city that treat the Aboriginal patients in an unfriendly way and this has raised their distrust in regular health services. Such high racism shows the disadvantages of using mainstream health services for the Aboriginal people (Campbell et al.,2018). This has also been the case in case of Tanika where she is afraid and does not trust the health service given by the metropolitan hospital. Health.qld.gov. (2021) in the report states that experience and fear of racism has been the biggest barrier to Aboriginal people staying away from city hospital. There are Aboriginal patients that request services of traditional healers in their own community. This has been the case with Tanika’s situation as well where she prefers to take traditional treatment in her own community than going to any metropolitan hospital. However, Korff (2021) argued that the instances of racism are not the same today, as many Aboriginal people are being the part of the city hospitals. More than 150 Aboriginal community-controlled health services (ACCHSs) has opened in Australia and more than 5000 Indigenous Australians has registered as health professionals in Australia. Thus, Tanika can choose to travel to any ACCHSs in the city for her treatment with less racism.
Disparities and inadequate access to health care shows the differences in country hospital and in metropolitan hospitals of Australia. This is because of poor socioeconomic factors including low income, poor education, poor living conditions and social exclusion. This has contributed to the higher chronic disease burden in the Indigenous population (Humanrights.gov., 2021). The culturally diverse Indigenous people of Australia has different notion of the accessibility, appropriateness and quality of the primary health care compared to the western notions. This is because they believe in care that is much holistic in nature and involve body, mind, spirit, custom and environment of the community. This has further reduced the accessibility of the Aboriginal people to health services (Gomersall et al.,2017). Tanika is facing lack in accessibility of good health service in her own country due to such believes and poor socioeconomic conditions. Thus, such lack of accessibility to good health service makes it necessary for Tanika to avail to city hospital for giving birth to her child with proper treatment.
Strategies to Mitigate the Health Issues in a Culturally Safe Way
To give birth in the metropolitan hospital it is necessary for Tanika to get a culturally safe care environment in the city hospital. She should feel protected with any kind of negligence and victim to racism that may harm her as well as her baby. A culturally safe environment will also help in increasing the confidence of Tanika to travel to city hospital for her treatment. Some of the recommendations that would ensure a culturally safe care environment for Aboriginal people like Tanika in the metropolitan hospital are:
Firstly, the metropolitan hospital should employ more Aboriginal doctors, nurses and midwives that can help lower the unequal power between the Aboriginal community health services and city health services. The number of Aboriginal clinical staffs in the metropolitan city is still limited and increasing this staff number would help increase Aboriginal patients attending city clinics. Further, this will also ensure a culturally aware staffs that are knowledgeable and trained in handling Aboriginal patients (Korff, 2021). Having Aboriginal doctors and health workers would give message to the Indigenous people about the culturally safe environment and ultimately women will be more likely to access the city hospital service for giving birth.
Secondly, it is recommended that the metropolitan hospital should create an Aboriginal friendly feel in their clinics and care center where the community can connect with the place. Some of the examples are such as making an Aboriginal artwork outside the ambulance or to treat the Aboriginal patients with cultural considerations and a holistic care environment (Campbell et al., 2018). This will help the health services to connect to Indigenous communities and will make women feel safer to choose city hospital for her delivery.
Thirdly, offer a culturally appropriate alternatives to the women of the community. Such as a birth giving program that can help give the Aboriginal women a place of their own such as a birthing center with Aboriginal governance and thus a feel of their community in the care center (Korff, 2021).
Lastly, the Aboriginal patients should be informed and treated for their health issues in their own language. This will help the patients understand the actual cause of the harms and the benefits of the treatment procedures in a better manner (Korff, 2021). This will further make Tanika feel comfortable to give birth in the city hospital where she can communicate in her own language for her condition.
From the above analysis it can be concluded that Aboriginal receive much poor health services compared to hospitals in metropolitan hospital. Aboriginal people find it uncomfortable and difficult in traveling to city hospital for taking health related treatment. This is because of lack of accessibility, racism and unequal power. However, there are advantages that the community can receive in the city hospital such as better and advanced service and better doctors. However, Tanika is afraid of moving to city hospital for her treatment because of poor behavior with Aboriginal patients. However, various actions such as increasing Aboriginal clinical staffs in city hospital, recruiting culturally knowledgeable staffs and creating an Aboriginal friendly environment will help in offering Aboriginal women a better health service condition in city hospital.
Campbell, M. A., Hunt, J., Scrimgeour, D. J., Davey, M., & Jones, V. (2018). Contribution of Aboriginal Community-Controlled Health Services to improving Aboriginal health: an evidence review. Australian Health Review, 42(2), 218-226.
Davy, C., Harfield, S., McArthur, A., Munn, Z., & Brown, A. (2016). Access to primary health care services for Indigenous peoples: A framework synthesis. International journal for equity in health, 15(1), 1-9.
Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J., &Bessarab, D. (2016). Improving healthcare for Aboriginal Australians through effective engagement between community and health services. BMC Health Services Research, 16(1), 1-13.
Gomersall, J. S., Gibson, O., Dwyer, J., O'Donnell, K., Stephenson, M., Carter, D., ... & Brown, A. (2017). What Indigenous Australian clients value about primary health care: a systematic review of qualitative evidence. Australian and New Zealand journal of public health, 41(4), 417-423.
Harfield, S. G., Davy, C., McArthur, A., Munn, Z., Brown, A., & Brown, N. (2018). Characteristics of Indigenous primary health care service delivery models: a systematic scoping review. Globalization and health, 14(1), 1-11.
health.gov. (2021). 3 Pregnancy care for Aboriginal and Torres Strait Islander women. https://www.health.gov.au/. Retrieved 25 May 2021, from https://www.health.gov.au/resources/pregnancy-care-guidelines/part-a-optimising-pregnancy-care/pregnancy-care-for-aboriginal-and-torres-strait-islander-women.
Health.qld.gov. (2021). Aboriginal and Torres Strait Islander Patient Care Guidelines. Health.qld.gov.au. Retrieved 25 May 2021, from https://www.health.qld.gov.au/__data/assets/pdf_file/0022/157333/patient_care_guidelines.pdf.
Humanrights.gov. (2021). Social determinants and the health of Indigenous peoples in Australia – a human rights based approach | Australian Human Rights Commission. Humanrights.gov.au. Retrieved 25 May 2021, from https://humanrights.gov.au/about/news/speeches/social-determinants-and-health-indigenous-peoples-australia-human-rights-based.
Korff, J. (2021). Making health services work for Aboriginal people. Creative Spirits. Retrieved 25 May 2021, from https://www.creativespirits.info/aboriginalculture/health/hospitals-doctors-health-aboriginal-people.
Weetra, D., Glover, K., Buckskin, M., Kit, J. A., Leane, C., Mitchell, A., ... & Brown, S. J. (2016). Stressful events, social health issues and psychological distress in Aboriginal women having a baby in South Australia: implications for antenatal care. BMC pregnancy and childbirth, 16(1), 1-12.
Wilson, A. M., Kelly, J., Jones, M., O’Donnell, K., Wilson, S., Tonkin, E., & Magarey, A. (2020). Working together in Aboriginal health: a framework to guide health professional practice. BMC health services research, 20(1), 1-11.