Issue 34 |  August 2016
Understanding different cultures

I’m reading a biography of Eric Liddell, the main character in the film ‘Chariots of Fire’, a man who played rugby for Scotland and the winner of world records and Olympic gold medals in athletics. He described nine key human attributes: patience, kindness, generosity, humility, courtesy, unselfishness, good temper, gentleness and sincerity. What an amazing list. If we all expressed many of these personal attributes, what a difference our workplace and interactions with others would be.

Within our workplace are many different expressions of humanity. Our patients are often at some of the most vulnerable and difficult places in their lives. Our work colleagues are often under considerable stress.  If we express the characteristics that Eric Liddell considered important, respect of differences, different expressions of how we are, differences in culture, then we will be much more effective in our medical roles, and be more complete as a person. Consider Eric Liddell’s ‘human competencies’.
Addressing Culture for Aboriginal & Torres Strait Islander People in Hospitals

Aboriginal and Torres Strait Islander culture is diverse and ‘one size does not fit all’.  In fact the culture is very complex with long, rich histories.  Aboriginal and Torres Strait Islander culture generally does not separate between self, community and universe or between mind, body and spirit. This is the basis of very different views of both the world and land (1). 

When we consider that the rate of discharge against medical advice from hospitals for Aboriginal and Torres Strait Islander people is 8 times higher than the non-Aboriginal and Torres Strait Islander people, we need to discover why this is happening.  We need to examine how we actively address both the medical and the cultural needs of Aboriginal and Torres Strait Islander people. 



A part of providing services that address cultural needs to Aboriginal and Torres Strait Islander people is being aware of their history. History has had a significant impact on both previous and current generations of Aboriginal and Torres Strait Islander people. For further information visit the Share Our Pride website.

Equally, we need to understand the effect of past and present government policies in relation to Aboriginal and Torres Strait Islander people. From shortly after colonisation until the present day, many policies have been enacted covering Aboriginal and Torres Strait Islander people. These policies have often had significant and long lasting adverse consequences for Aboriginal and Torres Strait Islander communities.  These continue to influence the perceptions of government agencies and health services and can affect health outcomes to this day.  Understanding of all of this can assist us in how we appropriately engage with current generations of Aboriginal and Torres Strait Islander people. A great resource is the paper published by the Royal Australian College of General Practitioners – “An introduction to Aboriginal and Torres Strait Islander health cultural protocols and perspectives”.

When interacting with Aboriginal and Torres Strait Islander people, it is important to consider their cultural beliefs which may include a holistic view of health to include the physical, spiritual, emotional and cultural wellbeing of individuals and communities and an emphasis on community, family and relationships.  This may require the inclusion of family and community in discussions about treatment and health, or the patient may need to consider the interests of the family or community first (1).
References:
  1. Teaching and Learning ethics - ‘Is there an Aboriginal Bioethic’, Journal of Medical Ethics 2004, http://jme.bmj.com/content/30/6/570.full
Communication tips for working with Aboriginal and Torres Strait Islander People
  • Treat everyone as an individual
  • Show respect
  • Be as willing to listen as you are to speak
  • Be aware of your feelings before and during the encounter
  • ‘Listen’ with your eyes as well as your ears; tune in to nonverbal as well as verbal cues and reflect on what you’re seeing and hearing
  • Silence does not mean people of Aboriginal and Torres Strait Islander communities do not understand; they may be listening, being cautious or waiting for family/community support. Respect the use of silence
  • Always wait your turn to speak 
  • It is important to be aware of what is appropriate behaviour between sexes. In some places there is very clearly delineated ‘men’s business’ and ‘women’s business’
  • Be aware and respectful of relevant extended family and kinship structures when working with Aboriginal people. Ensure that extended family is included in important meetings and in making important decisions

Reference: Royal Australian College of General Practitioners – An introduction to Aboriginal and Torres Strait Islander health cultural protocols and perspectives” 
Roles of Traditional Healers

Traditional Aboriginal healing is as old as the culture itself. Over a long time Aboriginal healers built a body of knowledge based on the resources they found on the land.
In the Anangu Pitjantjatjara Yangkunjatjara (APY) lands in northern South Australia, traditional health knowledge is still alive and well and working in a contemporary setting.  The Elders who are working as traditional healers are called Ngangkari, a Pitjantjatjara word that literally means ‘traditional healer’. In the Flinders Ranges they are called Yura urngi in the Adnyamathanha language.

Through family lines Aboriginal traditional healers are born into and raised within a family unit of healers. The family and Community can identify natural healers at a young age and therefore commence the learning journey to becoming a Ngangkari.
The journey of learning spans over many years through a mentoring role from a senior more experienced healer. Aboriginal people consider Ngagkarie’s to have a  status that is equal with doctors in their effectiveness for the people. There is also strong evidence to suggest that through the services of Ngangkari provide that the spirituality helps Aboriginal people to cope, be strong, resilient and determined, and to come to terms with life’s problems (1).


Their status is equal with doctors in their effectiveness for the people. There is also strong evidence to suggest that spirituality helps Aboriginal people to cope, be strong, resilient and determined, and to come to terms with life’s problems (1).

Reference: (1) Traditional Aboriginal Healers, Traditional Aboriginal Health Care, Creative Spirits 2016.

 
Use of Traditional Healers within SA Health System

The Traditional Healer Brokerage Program is an initiative to support the South Australian health system to be responsive to the needs of Aboriginal people in South Australia, through the provision of culturally respectful and inclusive services. SA Health recognises that Traditional Healers have an important role in contributing towards improved health outcomes for Aboriginal South Australians.

Traditional Healers have been practising for thousands of years and are a core component of the healing process for Aboriginal people. They significantly influence and support the positive management and nurturing of the physical, social, emotional and cultural health and well-being of Aboriginal people. 


The SA Health Traditional Healer Brokerage Program provides funding support to SA Health sites including Hospitals, Health Services and Clinics for Aboriginal clients to access the services of recognised Traditional Healers.

For further information please contact the Aboriginal Unit within your hospital or contact Lorraine Lemmens, Aboriginal Health Branch, via email: Lorraine.lemmens@sa.gov.au 

Culture and Person Centred Care - A Refugee Health Perspective
 
Dr Toni Maldari, Senior Medical Practitioner 
Migrant Health Service
 
In working with all people we need to understand the impact that culture has on health – in illness presentation and expectations of health care. Culture is our way of thinking and being; it has multiple influences including ethnicity, religion, family, gender, sexuality, life experiences and education. It is important not to stereotype and take a person centred care approach (1). This is particularly important for people from refugee backgrounds, as they may have had experiences of human rights violations, displacement, war, torture/trauma, grief, poverty and food insecurity compounded by prolonged periods of uncertainty.

The first step in the person centred care approach is to build trust and this helps to develop a positive therapeutic relationship.  Is an interpreter needed – what language, gender and ethnicity?  Many women prefer a female interpreter. A telephone interpreter may be preferred, particularly when there are sensitive issues. 
 
In the initial encounter, relevant questions to ask include:
  • Date of arrival in Australia
  • Country of origin/birth, transit countries
  • Occupation and access to education overseas – helps to assess health literacy
  • Current stressors – housing, school, financial, family
People need to be seen in the context of their pre-migration story and family.  What are their immediate concerns or priorities? It will be challenging for someone to engage in management of their diabetes if they have close family who are living in danger overseas.

Education and health literacy is variable in people from refugee background, and they generally have limited or no knowledge of how our health system works. The cause of illness may be seen as spiritual or environmental rather than due to lifestyle or an infectious cause. People may believe in traditional healing and often family play an integral role in their life. Compliance with treatment is variable and they may not understand the need to continue medication lifelong. The Cultural Awareness Tool is useful when assessing and managing mental illness in people from culturally diverse backgrounds (2), but is also relevant when there are complex or unresolved health issues.

Be interested in culture, ask questions, listen and be non-judgemental, be kind and take time to build trust.  We can learn a lot from our patients. If we listen to them, then they are more likely to listen to us, resulting in better health outcomes. Consider how you may assist someone to overcome some of their barriers to health care. Finally it is essential to communicate treatment plans not only to patients but also to their primary health care providers to improve continuity of care and reduce clinical risks.

References:
  1. Recommendations for Comprehensive Post-Arrival Health Assessment for people from Refugee-like backgrounds, Australian Society of Infectious Diseases 2016, http://www.asid.net.au/documents/item/1225
  2. Cultural Awareness Tool. Understanding Cultural Diversity in Mental Health, Multicultural Mental Health Australia 2002, http://www.mhima.org.au/pdfs/Cultural_aware_tool.pdf
The Migrant Health Service is a specialised service providing comprehensive primary health care to newly arrived refugees and asylum seekers with complex health needs.
The 2016 Aboriginal Health Scholarship Presentation Ceremony was held on the 24 August 2016.
We would like to congratulate all of the scholarship recipients, especially Dustin McGregor, who has recieved a scholarship for a Bachelor of Clinical Sciences/Doctor of Medicine.

Dustin is a Yolngu man from remote North East Arnhem Land in the Northern Territory. Dustin’s desire to become a doctor stems from seeing many community and family members suffering from preventable acute and chronic illnesses is in his mind unacceptable. Through his time spent at University, he has been involved in a number of programs that was relevant to his focus on rural Indigenous medicine. In 2012 Dustin was invited by the Rural Doctor Workforce Agency to present a speech in front of 50 rural high school students regarding the processes involved in admission to medicine. Dustin would like to eventually work in remote/rural area. 
Hannah Fyfe

I am Aboriginal, Torres Strait Islander, South Sea Islander, Scottish, German and English.
I belong to the Djiru people of far north Queensland (FNQ), near Mission Beach. I was brought up in Alice Springs and it was there that I first developed an interest in medicine, with the desire to help my people achieve better health outcomes. I studied medicine at the University of Adelaide and am currently working as an intern at Flinders Medical Centre.

1. As an Aboriginal doctor, can you explain your connection to culture and land?

I am not currently working on the country my people are from, or the country I was raised on. Because of this my connection to land and culture hasn’t directly impacted on my work as an Indigenous doctor so far. However there is something bewitching about country that is difficult to keep away from and I know I will end up back there to work for my communities one day.

2. Why is culture so important to Aboriginal people especially when they are receiving medical care? 

Culture affects the way we view and interact with medical care, and an important part of an effective and accessible health service is cultural safety. I believe that starting conversations with my peers about the culture, history and the barriers to health care for my people can increase my colleagues’ understanding and help them be more culturally safe in their practice. 

3. Is there anything that a doctor can do to make the health care a positive experience for Aboriginal patients?

There are many things that can be done, but the most important thing is empathy. People are very vulnerable when they come into hospital as patients. A simple way to let them know you know they’re still human is to ask them about themselves (e.g. “who is your mob?”; “where are your people from?”)

4. Can you tell us a little of what you aspire to do in your medical future?

I am greatly interested in General Practice and public health. I always envisioned going back up to Alice Springs or working in FNQ to work more closely in Indigenous health. 
21st National Prevocational Medical Education Forum

“Back to the future – the old + new of medical education”

From 6-9 November 2016, the 21st National Prevocational Medical Education Forum will be held in Hobart, Tasmania. Early bird registration is available until 19 September 2016.

For more information, visit the Prevocational Forum 2016 website.

Upcoming workshops in 2016

AIDA 2016
"A journey of strength and resilience"

The Australian Indigenous Doctors' Association (AIDA) 2016 event will bring together AIDA members, guests, speakers and partners from across the sector to discuss the importance of strength and resilience in growing the number of Aboriginal and Torres Strait Islander medical students, doctors, medical academics and specialists.
  • 14-17 September 2016
Registrations are now open! For more information about the event, visit the AIDA 2016 website.

Professional Development Program for Registrars (PDPR)
PDPR aims to improve leadership and management performance in the workplace via a sustainable, national professional development program for Vocational Doctors (Registrars).
  • 24-25 November 2016
Register for PDPR through the online registration form available on the SA MET website.

PERMA+
PERMA+ is a framework concept for individual action to build wellbeing. PERMA training was developed by TechWerks in America from positive psychology, to provide resilience. The PERMA+ program includes the key domains of Positive Emotion, Engagement, Relationships, Meaning and Accomplishment plus physical activity, nutrition, sleep and optimism. The two day course is being facilitated by SA MET. Watch the SA MET website for further updates.


sapmea
Emerging Communities Conference - Save the date!

The Northern Adelaide Local Health Network (NALHN), Adelaide Primary Health Network (APHN) and Northern Health Network (NHN) would like to invite you to participate in the inaugural Emerging Communities conference.
  • 5 November 2016 at the Playford Civic Centre
The Conference aims to bring together different sectors that deliver and receive health care. We will gather input from the community on how we can improve communication and health delivery for Emerging Communities and coordinate better delivery between sectors. Registration and further information coming soon!

Royal Australasian College of Surgeons (RACS) Annual State Meeting
The RACS Queensland Annual State Meeting (combined with the Queensland Health Forum and RACS Trauma Symposium) will be held on:
  • 4-6 November 2016, Brisbane City Hall, Queensland, Australia
Registrations Now Open!
 
View the provisional program, Register online today via the RACS website or visit the website.
For further information email conferences.events@surgeons.org  or phone +61 3 9249 1260


Advanced Paediatric Life Support (APLS)
Established since 1997 with courses throughout Australia, the three day APLS course is recognised as the international gold standard in paediatric emergency training.

The course covers:
  • Basic and advanced life support
  • Assessment and management of the seriously ill child
  • Assessment and management of the seriously injured child
  • Practical procedures – airway management, trauma, radiology, fluid therapy, pain management and more
Course date:
  • 7-9 December 2016 at The Queen Elizabeth Hospital (TQEH)
For further information or to register, visit the APLS website or email: info@apls.org.au
 
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