Health Issues: Australian Indigenous Population

Introduction

Although there have been a number of health promotion initiatives targeting the Indigenous people in Australia, their health status, compared to the rest of the population, is still low. The low health status of the Indigenous people is attributed to a combination of factors including socioeconomic status, income, employment, and education, which indirectly influence their healthcare choices. Maddocks and Rayner, in the article “Issues in Palliative care for Indigenous communities”, examine the death rates among Indigenous people relative to the availability of healthcare services (2007, p. 17). They establish that cultural issues influence the Indigenous people’s usage of palliative care services, which the authors attribute to the high mortality rates.

In contrast, prior examines the perception of cancer among Aboriginal women and how this influences their healthcare choices (2009, p.281). The author establishes that Aboriginal women lack confidence in conventional cancer treatment therapy, as it does not address their cultural needs. McGrath and Philips, on the other hand, examine the factors that facilitate improved palliative care from the perspective of Aboriginal peoples in the Northern Territory (2009, p. 636). They establish that support and regular visits by health professionals can overcome the challenges associated with palliative care delivery to Aboriginal people. In Australia, the indigenous peoples, including the Aborigines, have unusually high mortality rates compared to the white population. As a result, palliative care delivery is critical to improving their health status and lowering mortality rates. However, palliative care delivery is largely unavailable and unpopular among the Aboriginal communities. This paper reviews three studies that have explored the organization and delivery of palliative care services to the Australian Indigenous people in their cultural context.

Organization of Palliative Care services in Aboriginal Settings

In Australia, palliative healthcare services are concentrated mostly in urban areas with a majority white Australian population. Under these settings, palliative care is more focused, and it involves specialist healthcare personnel (Rhymes, 2004, p. 407). By contrast, organizing palliative care services for Indigenous communities is often challenging mainly due to cultural factors, sparsely distributed population, and fewer local healthcare specialists (Schofield et al., 2006, p.398). Consequently, nurses and other primary care specialists are crucial to the organization and delivery of palliative care to the Indigenous communities. Maddocks and Reyner evaluated the delivery of palliative care services to Indigenous communities in Australia. The authors identify four Cardinal Health conditions that often increase fatalities among the Aboriginal communities: diabetes, respiratory diseases, cancer, and circulatory diseases (2007, p. 19). Demographically, the death rates among Indigenous populations are five times those of the white population. The authors observe that the Indigenous people use healthcare facilities that lack indigenous medical services reluctantly. Thus, serious conditions such as cancer are diagnosed late, such that therapeutic interventions cannot be useful. On the other hand, a high number of indigenous people frequent care facilities that incorporate indigenous medical services. The Royal Darwin Hospital that incorporates indigenous care at any given time has 65% inpatients from Indigenous people. However, other public healthcare services in regions with a high percentage of the Indigenous population such as the Northern Territory are inadequate. The authors note that the Indigenous medical services offered by indigenous care facilities are not linked to the mainstream services or palliative care services available locally.

Conversely, the mainstream health service providers do not recognize the outstanding health needs of Indigenous patients. Additionally, health support networks within the cultural context are unavailable to them. In this regard, palliative care services that incorporate Indigenous care are lacking and consequently, palliative care services are accessed to a lesser extent. Besides the inadequate palliative care services, cultural beliefs regarding health, disease, and death affect the Indigenous people’s use of conventional medicine. In particular, the authors identify three indigenous cultural beliefs that have implications on palliative care services used by Indigenous communities: beliefs about death or dying causes of disease, and decision-making regarding individual care needs. Similarly, McGrath and Phillips identify the involvement of traditional healers and integration of traditional medicine with conventional medicine as fundamental in building trust relationships.

Thus, traditional healers and Indigenous healthcare workers who have a better understanding of the underlying beliefs can be used to liaise and communicate with Indigenous communities in care settings. Indigenous healthcare professionals are currently involved in promoting various health initiatives among the Indigenous communities (Fried, 2001, p. 17).

Prior, on the other hand, using interpretive ethnography explores how perceptions shape the Indigenous people’s tendency to seek conventional medical services (2009, p. 283). The study investigates the Aboriginal women’s reluctance to seek medical therapy after a cancer diagnosis. Using interviews and focus groups involving rural Aboriginal communities, two themes emerged; a negative attitude towards cancer (considered fatal) and a skeptical attitude regarding the efficacy of conventional treatments. In contrast, Maddocks and Reyner identify the lack of indigenous medical services in palliative care and cultural beliefs as the underlying reason for Aboriginals’ reluctance to seek palliative care services for terminal illnesses.

McGrath and Phillips take a different approach: the development of trust relationships (between the Aboriginal people and healthcare workers) as an effective strategy of promoting palliative care (2009, p. 638). This survey of healthcare professionals working with Indigenous people established that positive relationships, to enhance the use of palliative care by Indigenous people, could be achieved through respect for their cultural and spiritual practices such as grieving for the dead and the incorporation of traditional medicine in treatment (Twomey et al, 2006, p. 49). Thus, the nurses and healthcare workers should endeavor to establish trust relationships that would foster cultural exchange with regard to palliative care delivery.

The Findings of the Articles

The key findings from Prior’s study were a hat, Indigenous people (the Aboriginal women) exhibit a fearful attitude towards cancer and a dislike for conventional (white man’s) medical treatments. Further, the study found out that Aboriginal women find it difficult to visit clinics or hospitals with medical services that do not reflect the Indigenous needs. This implies that cultural considerations when providing palliative care services can foster the Aborigine’s use of conventional services for terminal conditions such as cancer. In addition, the involvement of traditional healers among the Aboriginal community would build trust relationships for effective cancer control.

McGrath and Philips’s study involved a survey of health professionals working wite Indigenous people. They found out that cultural respect plays a critical role in promoting the use of conventional medical services among the Aboriginal people. In particular, respect for their spiritual practices and grieving practices, and regular visitation by health workers can result to trust relationships, which enhance positive palliative care for Aboriginal people. This has implications in clinical practice for indigenous communities; a culture-centered approach by nurses can result in positive outcomes with regard to palliative care experiences. Provision of support, respect for patient autonomy and culture, and dedicated care are central to effective palliative care delivery in multiple Indigenous cultural settings.

The key findings of Maddocks and Reyner study regard the cultural considerations during palliative care delivery. They establish that respect for Indigenous perceptions and beliefs about the causes of disease, death, and burial practices and the significance attached to dying in their ancestral lands, is crucial in diagnosis of illnesses and provision of mitigation treatments in palliative care. This implies that, in palliative care targeting Indigenous communities, the involvement of Indigenous care specialists including traditional healers who understand and respect cultural perceptions regarding healthcare can increase their confidence in palliative care services.

The findings from the three studies demonstrate the importance of respecting the Aboriginal cultural practices to ensure successful palliative care intervention for terminal illnesses. As a nurse, I believe this represents the principle of patient autonomy in conventional clinical practice: a patient’s right to free medical choices. Consequently, practitioners working with Indigenous groups should involve a cultural approach in providing treatment for chronic disease. This, I believe would increase the Indigenous people’s confidence in conventional treatments and further inform their medical choices as per the principle of informed consent.

Conclusion

Palliative care services targeting Indigenous populations are a response to their low health status and misperceptions regarding conventional treatments. In this regard, the three studies focus on cultural aspects of Indigenous communities and their influence on perceptions and use of conventional treatments. Maddocks and Reyner establish that, indigenous cultural practices especially with regard to death and disease causation shape their perceptions. Prior, on the other hand, establishes that Aboriginal women have a fearful attitude towards conventional cancer treatments stemming from the lack of Indigenous medical services in health facilities. Similarly, McGrath and Philips establish that, respect for Aboriginal cultural practices can foster their use of palliative care services. These findings imply that any health intervention targeting Indigenous people should take a culture-centered approach.

References

Fried, O. (2001). Proactive Palliative Care: Fred’s Story. CARPA Newsletter, 32, I6-17

Maddocks, I., & Rayner, R. (2007). Issues In Palliative Care For Indigenous Communities. MJA, 179(6), 17-23

Mcgrath, P., & Phillips, E. (2009). Insights From The Northern Territory On Factors That Facilitate Effective Palliative Care For Aboriginal Peoples. Australian Health Review, 33(4), 636-643.

Prior, D. (2009). The Meaning Of Cancer For Australian Aboriginal Women; Changing The Focus Of Cancer Nursing. European Journal Of Oncology Nursing, 13(4), 280-286.

Rhymes, J. (2004). Barriers To Effective Palliative Care Of Terminal Patients; An International Perspective. Clinics In Geriatric Medicine, 12(2):407-416.

Schofield, P., Carey, M., Love, A., Nehill, C., & Wein, S. (2006). Would You Like To Talk About Your Future Treatment Options? Discussing The Transition From Curative Cancer Treatment To Palliative Care. Palliat Med, 20, 397-406.

Twomey, E., Corcoran, G., & Nash, T. (2006). Collaboration In Difficult Pain Control In Palliative Medicine: It’s Good To Talk. Pain Symptom Manage, 31(6):48-51.