Refining Our Approach To Aboriginal Health
How implementing simple changes to our hospitals and doctor’s wards can have a major impact on Aboriginal healthcare.
Contemporary medicine, with its increasing emphasis on managerialism, throughput and efficiency and increasing use of technology, can find itself out of step with the needs of Aboriginal patients.
Simple changes to hospital and doctor’s wards make Aboriginal patients feel at ease and improve their chances of recovery dramatically.
Aboriginal Patients Don’t Complain, They Stay Away
When Aboriginal people have bad experiences with health services they don’t complain, they stay away. Poor experiences, coupled with a fear of racism are the biggest barrier to Aboriginal people speaking up. Many patients are also concerned that if they did speak up they could potentially make things worse.
If Aboriginal people delay going to a hospital they are admitted sicker and should receive treatment that reflects their condition. Unfortunately, prejudice and discrimination may not only change the forms of treatment they receive, it also makes them feel uncomfortable, undeserving and ultimately unwelcome.
The Australian Indigenous Doctors’ Association (AIDA) has published an insightful book titled ‘Journeys Into Medicine’ in which 15 Aboriginal doctors and five medical students reflect on what it means to be an Aboriginal person balancing the demands of a Western, bio-medical oriented system, while remaining faithful to Aboriginal culture, family and their sense of community.
They outline their challenges and their triumphs. They discuss their careers before medicine and relate their experiences of medical schools and the medical profession. Each life story is different and contributes to the aims of the book, which are to challenge stereotypes about perceptions of Indigenous people in Australia’s workforce.
Remote Communities Still Have Limited Access To Doctors
Despite the billions spent on Indigenous healthcare, only 20 percent of Aboriginal people living in remote communities of more than 50 people have access to a doctor on a daily basis according to Australian Bureau of Statistics (ABS) figures. An additional 41 percent have local access to a doctor once a week or once a fortnight.
Shockingly, three percent could only see a doctor in their own community once a month, the ABS found. Tellingly, 25 percent of Aboriginal and Torres Strait Islander people live in communities 100 kilometres or more from the nearest hospital. Only ten percent of Australia’s Aboriginal people live in a community with a hospital.
Although more than 140 community services across Australia provide health care to remote Aboriginal populations, less than 50 percent of these clinics have medical coverage due to a chronic shortage of doctors.
Hospital Fear Factor
For many Aboriginal people, a sterile hospital environment evokes memories of racism, leaving a legacy of Aboriginal mistrust of Australia’s present health system.
Some Aboriginal people fear they will never leave a hospital alive. “For many Aboriginal people in the bush, hospital is code word for ‘the place you go to die’,” opines a resident from Mataranka in the Northern Territory. “People are used to seeing friends and relatives go off to hospital but never coming home. For them, it seems that agreeing to go to hospital means agreeing their life is over. They won’t do it while they are conscious.”
Many members of the Stolen Generation choose not to see a white doctor or only when their condition has severely deteriorated. As Alice Smith, a Punjima woman from Western Australia, recalls: “I didn’t want to have my kids in hospital because the doctor is a man. Out in the bush you don’t have anyone. The mother got to sit down by herself, and a woman is there just to help… None of the women used to go to the hospital. I used to have bush medicine all the time. If they get sick we know what tree to get, and to boil it or whatever we needed to do… I grew up in the bush and never had a tablet to fix me.”
Making Hospitals Work For Aboriginal People
Advocates point to a number of simple measure medical environments can embrace to make them more welcoming for Aboriginal people and help them overcome barriers to acceptance.
- Employ Aboriginal doctors and staff. The number of Aboriginal patients attending a clinic increased “markedly” following the arrival of an Aboriginal doctor.
- Create an Aboriginal-friendly feel. Displaying Aboriginal artworks in hospitals and on ambulances helps Aboriginal people relax and connect with the place while helping Indigenous communities develop a sense of pride and ownership
- Help Aboriginal patients understand their disease. Use clear, simple language with fewer words and more pictures. Computer-animated movies employing three-dimensional Aboriginal characters talking in patient’s native languages have “revolutionised” the delivery of critical health messages
- Verify informed consent. Amongst traditional Aboriginal people ‘informed consent’ for medical procedures must come from the ‘right’ person within their kinship network of and community relationships.
- Inform Aboriginal patients in their own language. This way they can better understand potential side effects and benefits of the procedures offered.