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Indigenous Health

Module 5

Activity 1

Practices or Policies that are Likely to Have Caused Trauma for Aboriginal and Torres Strait Islanders.

The invasion history and continuous effect of colonization resulted in immense mental health problems for aboriginal and Torres Strait Islanders, including traumatic experiences. The practice that significantly contributed to the trauma included widespread grief and loss, caused by deaths of children, infants, adolescents, as well as women and men in their prime.  The deaths were unexpected, sudden and preventable, thus resulting in a feeling of immense trauma. Financial resources and savings of families were wiped out due to economic hardships. Another practice that caused trauma in aboriginal and Torres Strait Islanders was the removal of relatives. Survey results indicate that some of the aborigines reported a relative taken away or missing themselves. Most of those removed from their families were parents, grandparents, uncles or aunts. The major part of those who had been separated from their families suffered tremendous trauma (Larson et al, 2007).

Social and Emotional Wellbeing Issues of Aboriginal and Torres Strait Islanders.

Aboriginal and Torres Strait Islanders still face social and emotional well-being issues, as well as the inadequacy of the key services and measures meant to address these issues. Despite a significant rise in the reported cases of psychological distress among indigenous members of the community, aboriginal people still do not trust mainstream services to handle their social and mental wellbeing. If they do use such services, or use them for a short time, reports mostly indicate cases of chronic levels of distress. It is also evident that that the Australian aboriginal mental health sector has been largely neglected. Health care services that are meant to handle the needs of the Stolen Generations are inadequate and culturally inappropriate. The Western psychology has, on the other hand, provided an individualistic, compartmentalized and pathological approach in relation to the maladaptive behavior, with significant emphasis on cognitive therapy, rather than on insight based therapy (Kelly et al, 2009).

Module 6

Activity 1

Issues Raised by Manning and How They can be Addressed

Manning raises the issue of the poor shape aboriginal health pharmacies were in, especially in the remote region of Katherine. The region has about 23 remote community health centers, which receive medical supplies from the Katherine hospital. Manning expressed his shock at the poor quality of various medications. Other issues included few records in place on the outgoing supplies, lack of adequate labeling on drugs, and provision of limited information to customers on the details of medications. Manning also reported little emphasis and effort in terms of drug dispensation. There is still an issue of no payments being made to cover the dispensing costs to people working in the retail pharmacies, as well as inadequate financing of the pharmacies responsible for supplying pharmaceutical products and services to the remote aboriginal health centers. The issues could be solved there was an agency capable of covering the dispensing costs, e.g. a government institution, an aboriginal health service, or theboriginal community controlled by health care organizations. These issues can also be addressed by ensuring that the aboriginal health care services establish their own internal operations, in order to gain control over the process of pharmaceutical care. Successful implementation of this strategy can result in the sharing of the wealth generated from pharmaceutical services (Manning, 2010).

Activity 2

Indicators and Initiatives of the Queensland Government for Each Closing the Gap Target Area

In 2008, the Queensland Government signed a Statement of Intent, which committed the relevant parties to working in unison in order to achieve improved health status with equality, and life expectancy of the non-aboriginal, Torres Strait Australians, as well as the aboriginal and Torres Strait Islanders. Initiatives and indicators were established in order to achieve closing the gap targets. The initiatives or interventions included improved diagnosis and management of diseases that make up 80% of the health gap. Health education and promotion would help avoid risky health issues and eliminate the risk factor for ineffective health outcomes. Other initiatives included early childhood development, adolescent health, maternal and child health, as well as parenting support. Another intervention is the improvement in continuity of care and cultural capability in the whole health care system, as well as dealing with the needs of urban dwellers and those living in discrete communities.

Module 7

Activity 1

Principles of Cultural Safety that Should Have Been Practiced by the GP

• The GP should have considered its actions or prescriptions before telling JA to abide by them.

• The GP should have been more empathetic and willing to understand JA’s situation of not wanting to move to another city for treatment, or when JA indicated his inability to quit smoking.

• The GP should not have assumed that because JA looked calm he was handling the situation well. JA informs him of his concerns, but the GP proceeds to instruct JA to move to Darwin for active treatment.

• The GP should have gotten to know JA’s local community and family to understand their opinion about JA’s case. The GP should have found out about the role of community control and health status of the society in order to provide JA with a way to deal with his situation in a culturally safe way.

• The GP should not have assumed that his advice was the best just because he is experienced in his field of duty, either. He should have looked at JA’s situation from different perspectives, which would have enabled him to make appropriate medical decisions that would work for JA and his community (Smith, 2008).

Activity 2

Impact on JA and his Family

When JA informed his family about his health status and the GP’s decision to refer him to another city for treatment, the family summoned the GP. However, he responded that he was busy and would meet JA in Darwin. Therefore, the family felt that their opinion and concern had been ignored by the GP. This could also have resulted in the feeling of being sidelined as a community or ethnic group. The family had to deal with the deteriorating health status of JA on their own and without proper healthcare facilities. They simply could not manage to have JA in Darwin due to financial constraints and cultural concerns. JA had to come back to continue suffering and later died in Darwin hospital. The family could not visit him in the hospital, as they did not have any means of transportation (Nguyen, 2008). GP’s actions of assuming the concern of his patient and his family cost the family dearly, as they not only lost their loved one, but also suffered from unethical practices on the part of the GP.

Module 8

Activity 1

Transition and Dietary Influences of Aboriginal and Torres Strait Islanders

For several centuries, the aboriginals have practiced hunting and gathering, which they continued with under different climatic and geographical conditions until the time of European colonization. They were largely omnivorous, mainly deriving their food from wild animals and plants. Their choice of food was mainly influenced by the geographical location and season. A key indicator of the quality of meat was a high fat content. Transition to European dietary habits resulted in a decline in communal feeding habits, which entailed the responsibility and culture of sharing food resources. The transition also resulted in the breakdown of traditionally well-defined patterns of food distribution. It also affected the most vulnerable group, such as pregnant women, toddlers, as well as elderly and breast-feeding mothers. The reason for that was that the food administered to young children was low in fat and inadequate in energy (Anderson, Bhatia & Cunningham, 1996). The aboriginal mothers were not allowed to give additional food to their children, while extra rations were given to pregnant mothers, even though there were inadequate rations given to breast-feeding women. Missions and settlement schemes also lacked regular transport, staff and equipment needed to provide a comprehensive, hygienic and nutritious communal feeding service. Transition from the traditional lifestyle of hunting and gathering to a settled and westernized lifestyle saw the nutrition and dietary habits of the aboriginal and Torres Strait Islander people changing from a nutrient-dense and varied diet to an energy-dense diet with high content of refined sugars and fat. In the contemporary world, such a dietary practice indicates the continuing influence of fat, which is characterized by high value. The impact of the continuing influence consists in the incorporation of various new fats and oil in the diet. It also includes the adoption of frying as a new technique of cooking, which influences the adoption of fat instead of meat (Butlin et al, 1997).

Activity 2

Barriers Likely to Impact the Nutrition Habits of Urban Indigenous Populations

Analyses of the nutrition and dietary habits of the urban aboriginal populations revealed that most of them consume takeaway meals more than the non-indigenous population does.

Another barrier that has impacted the nutrition and dietary habits of the urban aboriginal population is the use of salt, as compared to the non-indigenous urban population (Butlin et al, 1997).

Module 9

Activity 1

Health issues directly related to an interaction of housing or housing infrastructure and the environment:

• General housing characteristics

• Overcrowded houses

• High housing costs relative to income

• Inadequate sanitation and water supply

• Inadequate rubbish disposal

• Flooding and ponding

• Sewerage and drainage

Activity 2

Impact of Sea-Level Rise on Essential Services, and the Health and Wellbeing of Torres Strait Islanders

The sea level rise caused by climate change will impact the Torres Strait region. Due to lack of access to standard health care services enjoyed by the non-indigenous population, the indigenous population will be primarily affected in terms of their health. The sea level rise may also cause the extinction of animals and plants that make up the traditional diet of the Torres Strait Islanders (Larson, Gilles, Howard & Coffin, 2007). Another effect can be the intensity and spread of a wide range of diseases, such as water borne, vector borne and respiratory diseases. The change in rainfall and temperature trends will also worsen the control of dengue fever and other mosquito-caused diseases, thus leading to a significant rise in the number of tropical pests and diseases. Sea level rise will occur alongside extreme weather events, such as temperature rise, which will increase the risk of impoverishment and malnutrition. The hardest hit will be the communities in the Torres Strait region, who rely on traditional or natural harvests from the ocean and land, as well as small crops. Other indirect health effects caused by the sea level rise may include a disruption in connection of the indigenous population with the mainland, as well as their responsibility to water and land management (Adrienne, 2010).

Key SEWB Issues Associated with Displacement due to Climate Change

The Action Plan created in 2001 led to the formation of numerous resource centres for Social and Emotional Wellbeing (SEWB) in Australia. SEWBs were created with the aim of establishing curricula and conducting trainings, in order to develop models for interagency cooperation and inter-sectoral linkages. SEWBs were also meant to plan provision of clinical services to the Torres Strait Islanders and health care providers. They would help in developing information systems for improved delivery of training materials. SEWBs serve to emphasize the importance and concept of social and emotional wellbeing in relation to the affected indigenous population. They also serve as a link of obtaining government funding that will improve the health status and livelihoods of displaced indigenous population from the Torres Strait region (Urbis, Keys & Young, 2007).

Module 10

Activity 1

Drinking among the Indigenous Population as Compared to the Non-Indigenous Population in Australia

A survey of the Australian Institute of Health and Welfare revealed that approximately 17% of Australians consume more than 22 drinks, which also translates to over 53% of the total alcohol sales in Australia. Most of Australian health surveys also reveal that aboriginal and Torres Strait Islanders consume less alcohol, as compared to non-indigenous Australians. In the group that is highly at risk, i.e. the youths below the age of 24 years, aboriginal youths consume more alcohol than the young population of non-indigenous Australians. This also applies to the high-risk group, i.e.  individuals above the age of 35, in which indigenous population drinks twice as much alcohol than the non-indigenous population. While the aboriginal population consumes less alcohol than the non-indigenous population, aboriginal and Torres Strait Islanders who consume alcohol do so at hazardous levels.

Activity 2

Reoccurring Themes in the Key Action Areas of the National Drug Strategy

Equitable access to training and educational opportunities in a range of administrative and health disciplines, such as tobacco, alcohol and other drugs, involves creating community awareness and understanding of the impact of various drugs on people’s health.

Another theme is provision of funds through various aboriginal organizations, such as the Aboriginal Health Worker (AHW) and the Aboriginal Community Controlled Health (ACCH) organizations. These organizations provide trainings and education courses for health workers in alcohol and drug-related areas.

There is a need to increase the number of law enforcement agencies, including the authority of the community police in implementing strategies proposed by aboriginal communities. These law enforcement agencies also handle issues related to the control of the supply of harmful substances. There is also a need to create protocols for the referral process from the primary health care providers to specialists in alcohol and drug services at the local or regional levels (Nguyen, 2008).

It is necessary to facilitate programs for peer education through community leaders and parents, in order to raise awareness about the harmful effects of alcohol and drug abuse. This can also be achieved by encouraging parents to educate their children. The theme of cultural awareness is also important. This can be done through the development of culturally appropriate processes of monitoring and evaluation, in order to assess effectiveness and relevance of the efforts and programs on tobacco, alcohol and other addictive substances, such as drugs.

Module 11

Activity 1

The Reasons Why Incidences of HIV are Higher amongst Female aboriginal and Torres Strait Islander Australians than amongst Non-Indigenous Female Population of Australia.

In the period between 1999-2003, the HIV diagnosis levels among female aboriginal and Torres Strait Islander were six times more than in non-indigenous Australian females. This level decreased by half between 2004 and 2008. The high number of indigenous female population diagnosed with HIV can be explained by the gendered power differentials in the risk of contracting HIV. The increase in transmission was caused by sharing contaminated injection equipment. Another reason is corollary and intoxication, whereby aboriginal women are not able to negotiate for safe sex. This situation is aggravated by the lack of empowerment of aboriginal Australian women, thus resulting in an increase in the instances of HIV. Other cases of HIV also result from sexual abuse, which is rampant in the aboriginal populace, as judged against to non-indigenous Australians (Mehrabadi et al, 2008).

Activity 2

A Critique of Condoman Episodes (2-5)

The message behind the episodes lies in emphasizing sex safe by using condoms in every sexual encounter, failure of which can lead to unwanted pregnancies, STIs, or even HIV and AIDS. Condoman targets the audience mainly comprised of the sexually active youth who are full of curiosity for experimentation (Anderson, Bhatia & Cunningham, 1996). Most of the youth do not know about the importance of using condoms or risks associated with practicing unsafe sex. They need to be educated and guided by all the relevant parties in the community, including their peers, friends, parents, mentors and even coaches, as illustrated in Condoman episodes. The message of Condoman is vividly demonstrated when he not only explains all the educative aspects of using condoms, but also stresses the importance of visiting healthcare facilities for regular checkups or after being infected.

Module 12A – Women’s Health

Activity 1

Possible reasons why aboriginal women have low-weight newborn babies:

• Insufficient weight gain during pregnancy

• Little or no antenatal care

• Cigarette smoking

• Young age

• Anemia

• Urinary infections

• High blood pressure

• Alcohol

• Diabetes and cardiovascular disease

• Illness during pregnancy

• Duration of pregnancy

Activity 2

Nancy’s Birthing Story

The principal reason why aboriginal and Torres Strait Islander women prefer to give birth in the country is because some important cultural rituals need to take place during birth. Therefore, it is necessary to help aboriginal and Torres Strait Islander women give birth in the country by giving them access to modern health care facilities. They should also be provided with proper tools and equipment, such as scissors, gloves, antiseptics and sanitary towels. Establishment of culturally appropriate antenatal care can also help these women give birth safely without sacrificing their cultural beliefs and practices. This will also enable them to give birth safely without denying the responsibilities of community members and relatives under traditional lore (Smith, 2008). The born children can also get their rightful share of traditional ownership of land, when they are born on land. Giving birth in the country involves specific cultural practices and beliefs, which are strongly valued by aboriginal and Torres Strait Islander women. There have been reports of positive health outcomes and impacts on aboriginal mothers and infants due to the provision of culturally appropriate antenatal health care services. These positive effects are due to the strong support accorded to aboriginal women by their families and communities in the period of pregnancy and during birth. It is, therefore, evident that aboriginal and Torres Strait Islander women need to be provided with access to antenatal care and a chance to observe their cultural and traditional practices (Couzos and Murray 2007).

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