Table of Contents
Introduction
In the Mary Barrunga case study we read about Mary, an Aborinal lady who is fearful and upset after her surgery at the hospital. Mary’s story starts many years ago when she was forcefully removed from her family and her culture as a 5 year old and placed in an institute for children. The trauma and stress this has caused Mary and her family is something that will impact her life and her health forever. Over 11% of Australian Aboriginal and Torres Strait Islanders before 1972 were removed from their families (Heasley, 2019). It is well know that this has caused lasting impacts on Aboriginal Australians as life expectancy is 7.8 years shorter than non-Aboriginal Australians (Australian Institute of Health and Wellness, 2020). In this case it is particularly important to recognise the Aboriginal model of health which can be described as the ‘physical wellbeing of an individual, but refers to the social, emotional, and cultural wellbeing of the whole community (Edith Cowan University, 2020).
Social Determinant of Health
The social determinants of health can be defined as the ‘circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness (World Health Organisation, 2008). Mary is a person who has been affected by a large proportion of social determinants of health.
The early years are a major contributor to someone’s health outcomes, in Mary’s case associated with stress and trauma of being forcibly removed from her family and culture. The stress and anxiety coupled with a lack of supportive relationships increase the risk of poor mental health and premature death (Wilkinson R. & M. Marmont, 2003). Long term stresses particularly affect cardiovascular health (Wilkinson R. & M. Marmont, 2003) which is perhaps a cause of Mary’s 3x cardiovascular events.
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Mary finished school at 13 and was sent to a station to be a cook and cleaner. A lack of adequate education can result in insecure employment options which have flow on effects to poor housing and poor decision making (Wilkinson R. & M. Marmont, 2003). This is called the socioeconomic gradient which is associated with lower health outcomes as the disadvantage continues on (Wilkinson R. & M. Marmont, 2003).
Mary doesn’t have many friends outside her group that meet at the Aboriginal Health Clinic. Mary lives alone and has one daughter who is busy with her own life. She is lonely and isolated and lacks a good social support. Social exclusion and isolation are known to have poorer chance of survival of heart attack (Wilkinson R. & M. Marmont, 2003). Mary is also experiencing feeling different and separate to her family.
According to Australian Bureau of Statistics 65% of Indigenous Australians live in remote or very remote areas (Australian Bureau of Statistics, 2019). The vast distances that people must travel to seek healthcare are a contributing factor to health outcomes. Mary lived and worked in rural and remote areas of South Australia and Victoria and has to see many specialists due to her comorbidities which require a lot of travel. Mary travels to Adelaide after experiencing a 2 month wait, she is then travels back to Murray Bridge in country South Australia where she is restricted in her social activities and social contact. The lack of access to healthcare in rural and remote areas make achieving optimal health difficult.
Reflection
Indigenous Australians particularly in remote areas are affected by all or many of the social determinants of health. These include: lack of education, lack of employment opportunities as well as housing overcrowding and lack of access to healthcare services. These all contribute to poorer health outcomes because they make life more difficult. Having grown up in a remote area and lived in a remote Aboriginal community I have an understanding and appreciation for the difficulties Aboriginals face each and every day.
As a future health professional it is vital to be non-judgement of people and their situation because as I have learnt that we are shaped from our experiences and the circumstances that are beyond our control. The trauma of being taken away from your family, friends and culture is something I can’t fathom. Having family and a support network is so important in handling the highs and lows of life and if we did not have these it would affect one’s mental health. We must always remember people from poorer environments are at higher risk of poor health, illness and disability (Australian Bureau of Statistics, 2019). We must always be understanding of people and their story.
Aboriginal Health System Experiences
Mary was deeply concerned for her upcoming surgery and spent time googling the surgery to be more informed, however she still didn’t get enough information. Mary would have felt great disappointment as she had been reliant on the Aboriginal health worker coming to explain things to her and keep her anxiety levels down. The Aboriginal health worker plays a pivotal role in healthcare as they provide essential information and assist with culturally appropriate interventions (Hooper K Thomas Y & M Clarke, 2007). They also provide a key link and support network to Aboriginals who are far from their country.
In 2012–13, 20% of Indigenous Australians reported being treated poorly by health care staff within in the previous 12 months. (AIHW, 2019). These negative health care experiences make people reluctant to seek healthcare and often forming distrust with health professionals. Some of the experiences noted in the study included negative body language and feeling like wasting their time (Bureau of Health Information, 2019). Due to Mary’s past trauma, she would be very fearful of trusting people and would be looking for someone to support her whilst going through anxious period whilst she is away from her home and support network.
Mary woke up from surgery confused because she didn’t realise her leg was also being operated on, this could have been prevented by the use of an interpreter service.
In the Northern Territory, 58.3% of Aboriginals speak English as their second language inadequate communication can result in adverse health outcomes including death (Ralph, 2017),. The use of interpreters are a key tool to help with poor communication between healthcare providers and Aboriginal people. Interpreters can relay information between health professionals and patients to ensure everyone is fully informed (Ralph A.P. Lowell A. & J Murphy, 2017). Sadly there are a number of barriers to greater uptake of interpreters including ‘booking complexities, time constraints, inadequate delivery of tools and training, and greater convenience of unofficial interpreters’ (Ralph A.P. Lowell A. & J Murphy, 2017).
Reflection
Mary would feel incredibly vulnerable and alone in the hospital and whilst they have placed her in a 4 bed mixed ward, which she would have been uncomfortable with. This would be considered women’s business and is causing her great stress with men also in the room whilst feeling so vulnerable. It is clear that Aboriginals are more comfortable with a culturally safe healthcare team as 70% of people living in remote areas usually saw a doctor who was part of an Aboriginal Medical Service (Australian Bureau of Statistics, 2019).
The importance of a cross cultural team could have given Mary a very different outcome as they would have understood her discomfort, anxiety and stress. Effective communication between health professionals and Aboriginal health workers is a vital component of health care (Hooper K Thomas Y & M Clarke, 2007) .
In my future as a doctor I would want my patients to feel as ease whether having surgery or health check up. There are a number of barriers including language and the reliance of family members or friends to relay the information and the associated cultural implications. The use of medical terms become lost in translation, which highlight the importance of interpreters and the Aboriginal health worker. Mary should have been offered an interpreter or another Aboriginal health worker to help with the anxiety and fear of the surgery, but also so she could make an informed decision. If Mary was not comfortable or fully informed then the surgery should have been delayed until she was.
I felt confused why Mary was sent home for 1 week with little activity as this would have started the anxiety because she could not longer play with her grandchild or go to the health clinic for her social contact. This seemed very out of touch as she is alone, from a rural area and could not access her support network.
Conclusion
Indigenous Australian’s have shorter life expectancies compared with non Indigenous Australians (Australian Bureau of Statistics, 2019). The inherent racism that minorities face each day would make them hesitant to seek healthcare especially if they had a bad experience in the past. The poor health outcomes associated with inter-generational trauma because of the Stolen Generation will last for many years (Heasley, 2019). It will take some time before we can close the gap, however there must be more cultural awareness and respect for our First Nation’s people.
It is vital that health professionals understand that Aboriginal health is seen in terms of the whole-life-view (Edith Cowan University, 2020) and that there are many aspects to it. The increased uptake of interpreters and additional cross cultural training are essential in minimizing the barriers to communication. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces’(WHO). If Australia can create a healthcare system where all cultures are comfortable and accommodated, we would expect to see better health outcomes for all.
References
- AIHW. (2019). Cultural safety in health care for Indigenous Australians: monitoring framework. Australian Institute of Health and Welfare.
- Australian Bureau of Statistics. (2019). National Aboriginal and Torres Strait Islander Health Survey, 2018-19.
- Australian Institute of Health and Wellness. (2020). Life Expectancy. Retrieved from https://www.aihw.gov.au/reports/life-expectancy-death/deaths/contents/life-expectancy
- Bureau of Health Information. (2019). Aboriginal people’s experiences of hospital care. Bureau of Health Information.
- Edith Cowan University. (2020). Australian Indigenous Health Info Net. Retrieved from https://healthinfonet.ecu.edu.au/learn/cultural-ways/aboriginal-and-torres-strait-islander-concept-of-health/
- Heasley, J. (2019). Stolen Generations and the Way Ahead. Thirroul: Spinney Press.
- Hooper K Thomas Y & M Clarke. (2007). Health professional partnerships and their impact on Aboriginal health: An occupational therapist’s and Aboriginal health worker’s perspective. Australian Journal of Rural Health,, 15:, 46-51.
- Ralph A.P. Lowell A. & J Murphy. (2017). Low uptake of Aboriginal interpreters in healthcare: exploration of current use in Australia’s Northern Territory. BMC Health Serv Res, 733, 17.
- Ralph, A. L. (2017). Low uptake of Aboriginal interpreters in healthcare: exploration of current use in Australia’s Northern Territory. BMC Health Serv Res , 733, 17.
- Wilkinson R. & M. Marmont. (2003). Social Determinants of Health – The Solid Facts. Geneva: World Health Organisation.
- World Health Organisation. (2008). Social Determinants of Health. Retrieved from World Health Organisation: https://www.who.int/social_determinants/en/
