For a very long time, the Aboriginal and Torres Strait Islanders have been cut-off from the rest of the Australian society. Unlike their non-indigenous communities, the Aboriginal and Torres Strait Islanders have socio-cultural determinants that make it quite challenging for them to easily access quality health care services. Aboriginal and Torres Strait Islanders is like any other indigenous community whose historical trauma and minority expose them to racism, discrimination and isolation (Mitrou, Cooke, Lawrence, Povah, Mobilia, Guimond & Zubrick, 2014). However, the situation might change if the objectives of the Aboriginal Community Controlled Health Organizations (ACCHOs) and National Aboriginal and Torres Strait Islander Health Plan 2013-2023 are fully achieved. This paper presents an in-depth and critical analysis of the historical events that have influenced the current health status for the Aboriginal and Torres Strait Islanders, the concept of culture in relation to the social determinants of health, the principles of Primary Health Care and their application to the indigenous Aboriginal and Torres Strait Islanders, and nursing practice.
Historical Events that have influenced the Current Health Status for Indigenous Australians
Aboriginal and Torres Strait Islanders are the indigenous communities in Australia. As a minority group, the Aboriginal and Torres Strait Islander have been discriminated by the other non-indigenous communities. Unlike the rest of the society, the Aboriginal and Torres Strait Islander are located in the rural areas and do not get an equal access to health care services. According to historical records, the problems of these indigenous communities began in the 1700s when they were invaded by the European imperialists who had colonized Australia. The colonization of the Aboriginal and Torres Strait Islanders negatively impacted on them in many ways (Dempsey, Elliott, Gorton, Leamy, Yeganeh & Scott, 2015). Apart from forced labor, the community lost its land, got displaced from its ancestral lands and lost a large percentage of its population due to the outbreak of influenza, small pox, measles and chicken pox.
As it is today, the Aboriginal and Torres Strait Islander are worse-off in terms of health. The Aboriginal and Torres Strait Islander have lots of disadvantages such as cultural traditions, poverty, low level of education, and isolation. These have made it challenging for them to access health care services just like their non-indigenous counterparts. However, there is hope that, one day, the Aboriginal and Torres Strait Islanders will obtain equal access to health care services thanks to the government, which has so far instituted and heavily supported the Aboriginal Community Controlled Health Organizations (ACCHOs) and National Aboriginal and Torres Strait Islander Health Plan 2013-2023. ACCHOs, an indigenous community-run organization has been playing a significant role in delivering quality and culturally-acceptable health care services to the indigenous communities (Mitrou, Cooke, Lawrence, Povah, Mobilia, Guimond & Zubrick, 2014). On the other hand, the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 is a policy framework that has outlined health objectives to be accomplished for the Aboriginal and Torres Strait Islanders by 2031. Through such initiatives, efforts are being made to eliminate racism and other forms of discrimination that have been barring the indigenous communities from having access to quality health care like the rest of the society that greatly benefits from the mainstream health care system.
The Concept of Culture in Relation to the Social Determinates of Health
Culture is a way of life of a given community in the society. In Australia, there exist the native and non-native communities. Each of these communities Aboriginal and Torres Strait Islander peoples included, has sets of cultural beliefs and traditions that define and give them a unique identity. Culture is manifested in the form of language, ethnicity, sexual orientation, gender, age, religion, group history, geographic origin, socioeconomic class and religion. Culture is one of the social determinants of health in the society (Mitrou, Cooke, Lawrence, Povah, Mobilia, Guimond & Zubrick, 2014). Culture, alongside education level, infrastructure, social inclusion, geography and socioeconomic status play a very significant role in determining the status and success of health care in any particular society. This clearly shows why culture has been a great determinant of health amongst the Aboriginal and Torres Strait Islander native communities across Australia.
As an evolving dynamic, integrated and continuous practice, culture has been influencing the Aboriginal and Torres Strait Islanders attitude towards health care services available to the people. Although health decisions are largely personalized, the native communities have developed a set of beliefs to influence how exactly people should respond to health care services delivered to them. The value and respect given to the culture cannot allow each person to deviate from the norm. Individual choices are influenced the indigenous communities’ attitudes towards diseases, causes, diagnoses, treatment, medication, prevention, and death (Funston & Herring, 2016). Only medical interventions that are accepted by the cultural beliefs are accepted by the members of the native communities.
Besides, culture provides language to the community. Language is a very important factor in health care delivery. For any patient to acquire quality and effective health care services there should be a proper communication between them and the healthcare providers. However, this has been posing some challenge to the minority Aboriginal and Torres Strait Islanders because, on many occasions, they need to be served by practitioners who do not necessary speak or understand their language (Brown, O'Shea, Mott, McBride, Lawson & Jennings, 2015). Indeed, the presence of non-indigenous practitioners has been acting as a hindrance to health care services amongst the conservative indigenous patients who do not prefer to be served by the non-indigenous practitioners due to inferiority, stigmatization or intolerance.
Primary Health Care (PHC): Its Principles and Application to the Aboriginal and Torres Strait Islander specific Health Care Settings
Primary Health Care (PHC) refers to a health care approach which aims at providing socially-acceptable, scientifically-sound and universally-accessible health care services to the community regardless of the socio-political, economic and cultural diversities. Basically, PHC is based on principles that if properly applied, can help in availing accessible health care services to the Aboriginal and Torres Strait Islanders. These are discussed herein:
Principle of Equity: According to this principle, PHC services should be made accessible to everyone in the community without any form of discrimination. It recognizes PHC as a basic and fundamental service that should be provided to everybody in whichever location they are (Parker & Milroy, 2014). To accomplish this, the health care providers should make efforts to evenly distribute PHC services to all corners of the society to ensure that it is accessed by all the people irrespective of their age, gender, culture, race ethnicity, religion or political affiliation. Indeed, the principle of equity is applicable to the Aboriginal and Torres Strait Islanders. For a very long time, these indigenous communities have been excluded from the mainstream health care services (Brown, O'Shea, Mott, McBride, Lawson & Jennings, 2015). Their cultural traditions and rural location has been preventing them from having equal access to health care services like other urban-based non-indigenous communities. However, with the adoption of the principle of equity, quality PHC services will be rendered to the Aboriginal and Torres Strait Islander discrimination-free.
Principle of Community Participation:
According to this principle, PHC should be implemented by incorporating the contribution of the local communities. Although it is always the responsibility of the government to provide health care services to the people, it can be much better if the efforts of the government are supported by the locals. The contribution of the locals is very important because they identify with the community and are very much aware of the health challenges that need prioritization. Hence, the efforts of the government of Australia in delivering quality PHC to the Aboriginal and Torres Strait Islanders can be boosted if the locals are involved (Gajjar, Zwi, Hill & Shannon, 2014). It is for this reason that the government has been collaborating with the Aboriginal Community Controlled Health Organizations (ACCHOs) in delivering PHC to the Aboriginal and Torres Strait Islanders. The partnership between the government and ACCHOs is commendable because it is this organization that has been at the fore front in delivering health care services to the minority Aboriginal and Torres Strait Islanders that have been feeling isolated from the mainstream health care system.
Principle of Appropriate Use of Technology: PHC, just like any other sector, is prone to diversities. Therefore, it can be much better if it incorporates the use of modern technology that is required delivering quality health care to the patients. PHC should not be left out, but needs to be responsive to the constant changes in technological innovations in the health care sector (Fredericks, Lee, Adams & Mahoney, 2015). Actually, this principle can imminently contribute to the Aboriginal and Torres Strait Islanders. In order to satisfy these indigenous communities, the government should use appropriate technologies to help in the storage of drugs, screening, diagnosis, treatment, and surgical operations (Baba, Brolan & Hill, 2014). Nonetheless, these devices should be deliberately made to be culturally-acceptable, safe, affordable and accessible to all the Aboriginal and Torres Strait Islanders even if they are located in the remote villages.
Principle of Intersectoral Collaboration: Although this principle acknowledges the responsibilities of the government in providing health care services to its people, it advocates for a collaborative approach amongst different sectors of the government. For instance, whereas the government avails and health care facilities, the Non-Governmental Organizations (NGOs) can fund these facilities with drugs and medical equipments (Jongen, McCalman, Bainbridge & Tsey, 2014). So, in its pursuit to avail quality PHC services to the Aboriginal and Torres Strait Islanders the government of Australia should bring together different stakeholders including the department of health, rural development, agriculture, public works, sanitation, education, housing, communication, and volunteers (Tieman, Lawrence, Damarell, Sladek & Nikolof, 2014). Each of these sectors has a significant contribution to make to the Aboriginal and Torres Strait Islanders. For example, while the ministry of agriculture tackles the issue of food security, the department of public works can help in providing basic hygiene and safe water to the indigenous communities. Quality PHC can be obtained if other basic needs like food and housing are availed.
How an Understanding of Culture and PHC Principles can Influence Nursing Practice
One of the major basic roles of a nurse is to deliver quality Primary Health Care to the public. However, when doing that, nurses may be confronted with numerous challenges such as diverse patent needs, that might hinder them from effectively discharging their duties. Such challenges can be addressed if he nurse has a deeper understanding of the culture and PHC principles which can of course help the nurse in many ways.
First, the knowledge of culture can enable a nurse to deliver high quality services to all the patients. A professional nurse should acknowledge the fact that the society is quite diverse because it is made up of people from different backgrounds (Gubhaju, McNamara, Banks, Joshy, Raphael, Williamson & Eades, 2013). By learning to tolerate and accept each person’s culture, a nurse cannot find it challenging to serve patients regardless of their background. A nurse who applies a multicultural approach when handling the patients can manage to win the confidence of the patients and create a good rapport with them. After all, a patent can feel respected, dignified treated as an important part of the society. As a result, the nurse can be accepted and given the necessary support by the patient (McDermott, Schmidt, Preece, Owens, Taylor & Esterman, 2015). If there were cultural tolerance amongst the Australian nurses, the Aboriginal and Torres Strait Islanders would not be discouraged from seeking for health care services (Russell, 2013). In this regard, it is important to point out that the knowledge of cultural diversities can enable a nurse to be accepted by the patient and get an ample opportunity to deliver quality services to all the patients.
On the other hand, the knowledge of PHC principles can help a nurse in many ways. First, the principle of equity can enable a nurse to acknowledge that health care services should be provided to all the people in the society. A PHC nurse who subscribes to the principle of equality can not engage in any form of discrimination whatsoever. Instead, such a nurse is committed to promoting equality and serving all the patients without any form of bias (Donato & Segal, 2013). Besides, the principle of community participation can enable a nurse to consider the contribution of the local communities in the delivery of PHC services. The acknowledgement of local participation can make a nurse to accept the local culture and take all the necessary measures to identify and meet the needs of the local communities in an appropriate manner.
Moreover, the PHC principle of appropriate use of technology can help in guiding a nurse to adapt to and embrace modern technologies in health care. For a nurse to deliver quality services to the patient, a nurse should be knowledgeable on all the modern technological innovations that are required in delivering safe, efficient and quality services to the patients. This principle can also help in making the nurse to be ready to use readily available and affordable equipments that can not jeopardize the health of the patient whatsoever (Hill, Grant, George, Robinson, Jackson & Abel, 2012). Finally, a nurse who is committed to applying the principle of sectoral collaboration can become a real team player who is always ready to embrace a multidisciplinary collaboration (Doolan, Najman, Henderson, Cherney, Plotnikova, Ward, Kemp, Dev & Smirnov, 2015). This can help in promoting effective interpersonal communication between different specialists as they consult, refer complex cases and engage in collective decision-making.
As a minority indigenous group, the Aboriginal and Torres Strait Islanders are not exempt from racism, discrimination and socio-cultural determinants that prevent them from having access to quality health care. However, with a committed intervention of the government, the community-based ACCHOs, a thorough implementation of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 will be a success. This will help in eradicating any form of discrimination and ensure a delivery of effective PHC services to the communities.
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