Assignment title:
Contemporary Topic
Unit code and Title:
NUM2308 Aboriginal and Torres Strait Islander
Peoples’ Health and Wellness
Lecturer:
Dr. Kylie McCullough
Student Name:
Student Number:
Date of Submission:
29th October 2022
Word Count:
1619
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Contemporary Topic
Introduction
The town of Doomadgee is located in rural north-west Queensland that is home to a
community of Aboriginal and Torres Strait Islander People. The documentary by 4 corners
investigates the perspectives of members of this community and their relationship with both
Rheumatic Heart Disease and the health care system (Milligan & Nettleship, 2022). Analysing
the perspectives of these people gives and insight into how nurses can develop their level of
care with Aboriginal and Torres Strait Islander people. Concepts such as social determinants
of health, Australian historical events, racism, access to health services, and the codes and
standards of nursing and midwifery practice will be discussed in relation to this documentary.
Understanding these concepts and applying them to practice will help develop strategies to
manage health issues in a culturally safe way.
Concepts that relate to the case study
Social determinants of Health & Australian Historical Events
Providing holistic care to a patient includes taking into consideration their social
determinants of health. These determinants are factors such as age, socioeconomic status,
housing, and place of birth all effect the emotional, physical, and psychosocial wellbeing of a
patient (Munns et al., 2019). As reported by Louise in the documentary Shakaya is shown to
have come from a low socioeconomic area where housing is not sufficient. Alec: Shakaya's
uncle, says in the documentary that the living conditions are not ideal for people like
Shakaya, families living in three-bedroom homes using the same facilities, enabling the
spread of diseases that can lead to Rheumatic fever and Rheumatic Heart Disease in
Shakaya's case. This low quality of housing has a large impact on the level of health for the
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population occupying the space, with an increase in crowding correlating with an increase of
infectious disease, poor nutrition, and social disruption (Bailie, 2020). This housing crisis is a
result of historical events where Christian missionaries were established throughout rural
communities in Australia in the 1820's and 1830's (Mitchell, 2020). Although these
missionaries may have initially been altruistic in nature, in the case of Doomadgee once they
left in 1980, they left behind a community in extreme poverty, as Louise Milligan reports in
the documentary.
Racism
Doomadgee hospital has been shown throughout the documentary to have consistent
cases of mistreatment towards to Aboriginal and Torres Strait Islander patients. Gray et al.
(2019) defines Institutional Racism as the; "incorporation of racist ideals in policies and
practices within an organisation." An example of institutional racism is seen in the
documentary when Alec recounts Shakaya's experience with how the healthcare system failed
her. After waiting eight days in Townsville while in heart failure with an experience of a
Rheumatic Heart Disease. This exemplifies how institutional racism discriminates against
Aboriginal and Torres Strait Islanders' ability to be treated with a level of equality from
services, specifically healthcare services, in comparison to the rest of the Australian public
(Hampton & Toombs, 2013). This is congruent with the data where the mortality rate of
Aboriginal and Torres Strait Islander People are significantly higher than that of nonindigenous Australians (Colquhoun et al., 2015). Specifically effecting young Aboriginal and
Torres Strait Islander people living in rural Australia. Although many factors attribute to this
disparity, Institutional Racism plays a large role in the level of healthcare provided.
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Codes and Standards of Nursing and Midwifery practice
The standards for practice for nurse and midwives outline a framework for a safe and
evidence-based approach to healthcare. Standard 4: Comprehensively conducts assessments
is clearly shown to not be followed in the documentary when Alec talks about Shakaya being
admitted and released from Doomadgee hospital with just Panadol. Although Shakaya has
previously been diagnosed at age 8 for Rheumatic Heart Disease by Dr Remenyi and was
reported to by Alec to have symptoms of heart failure. (Nursing and Midwifery Board
Australia, 2016). Standard 4.3 specifically was not followed, which states that nurses should
take into consideration factors of people and population to determine priorities for action
and/or referral. Conducting a more holistic approach such as taking into consideration
Shakaya's medical history and the factors of Aboriginal and Torres Strait Islander people
living in rural communities, which include high mortality rates of Rheumatic Heart disease
should have been implemented (Australian Institute of health and Welfare, 2021). If this
standard was followed correctly then Shakaya should have immediately been referred to a
cardiologist at a high priority. This same standard of conducting holistic assessments was
shown again to not be followed in the documentary when Adele who also was reportedly
suffering from symptoms of heart failure from Rheumatic Heart Disease was admitted to
Doomadgee hospital where basic check for the disease were not performed, with her husband
Edgar stating that she had clear case of oedema in her legs. A Symptom known to be an
indicator of heart failure, not reported in the assessment. These lapses in policies and
procedures are what allowed the risk of Rheumatic Heart Disease unfortunately developing
into the adverse effect which was the preventable deaths of two important women in this
community (Watson et al., 2019).
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Access to health services
As previously discussed, there is a great disparity between the level of healthcare
provided to Aboriginal and Torres Strait Islander people compared to the rest of the
Australian population (Hampton & Toombs, 2013). Aboriginal Community Controlled
Health Services such as the National Aboriginal Community Controlled Health Organisation
(NACCHO) help try and close these inequalities in healthcare. A clear example of this
difference in healthcare can be seen in the documentary when Marilyn states that they feel
like they have been treated like animals, referencing the death of Betty who was failed by the
healthcare system. NACCHO health services would have helped in this case where the family
would have been more involved in the healthcare of their relative. NACCHO actively
employs more Aboriginal and Torres Strait Islander staff which increase the communication
of healthcare (NACCHO, 2022). The need for these specific healthcare services grew because
of historical racism that denied service to Aboriginal and Torres Strait Islander people (Ward
et al., 2017). This limited access to healthcare is still prevalent today as seen in the
documentary from the example discussed.
Location and communication are limiting factors for Aboriginal and Torres Strait
Islander people accessing healthcare services (Munns et al., 2019). As seen in Shakaya's case
in the documentary she was unable to access healthcare services that had the resources to
treat her disease in time. This is the case for many Aboriginal and Torres Strait Islander
people living in rural communities, where transport between often multiple hospitals is
needed to treat the diseases present (Biles et al., 2019). As seen in Shakaya's case it is often
too late by the time they can access the required care. Even then if healthcare services can be
reached in time, then communication proposes another barrier. Breakdowns and
misunderstandings of communication between healthcare providers and Aboriginal and
Torres Strait Islander people are prevalent, with many health care professionals not equipped
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with the cultural competence to communicate effectively (Biles & Biles, 2019). If healthcare
professionals do have the skills to communicate with Aboriginal and Torres Strait Islander
people, it is much more likely to build a therapeutic relationship and therefore provide a
higher level of healthcare.
Strategies to manage health issues in a culturally safe way
Australian Cultural competence is an ongoing development of a nurses' skills, practices,
values, and beliefs and how they impact the healthcare provided to Aboriginal and Torres
Strait Islander people (Biles & Biles, 2019). Through this consistent development and
conscious reflection, a nurse can provide care that is more culturally safe (Best, 2017).
Critically thinking about who defines health and understanding the cultural ideals of health in
Aboriginal and Torres Strait Islander Peoples communities is an important concept for the
nurse to consider, Standard 1.3 (Nursing and Midwifery Board Australia, 2016). The impact
of community, family and spirituality on Aboriginal and Torres Strait Islander Peoples' health
is paramount (Curtin et al., 2019).
Healthcare facilities in rural Australian communities such as Doomadgee need to
develop strategies to deliver healthcare in more culturally safe ways. In the documentary Alec
reports how Shakaya was repeatedly dismissed from Doomadgee. In her case she was not
prescribed with the adequate level of care even with an extensive medical history specifically
with Rheumatic Heart disease. This shows a lack of understanding from the healthcare
professionals of the population around them. For Shakaya to be treated in a more culturally
safe way there should not be assumptions about her health or an unwillingness to listen and
communicate with her (Best, 2017). As previously discussed there has been a great power
imbalance between the Aboriginal and Torres Strait Islander people and the health care
services of Australia. This is highlighted in the documentary when relatives of Betty, who is
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suffering from heart failure, are not allowed to visit her in the Hospital. As Clennon, Betty's
cousin, reports that he was not permitted to enter the hospital while she was being treated.
This shows a lack of understanding on the health care providers behalf. If they understood the
importance of family and community in Aboriginal and Torres Strait Islander Peoples' health,
they should have let the family visit the patient.
Conclusion
The development of a nurse must be evolutionary in nature to ensure the highest level
of healthcare provided. Consciously reflecting about one’s own culture and ideas empowers
the nurse to be more culturally aware and practice in a culturally safe way. Concepts such as
racism, access to healthcare services, Australian historical events, social determinants of
health and codes and standards of nursing and midwifery practice must be understood and
applied to practice to ensure growth in the health care professional.
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References
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