Hospitals, doctors, health & Aboriginal people
Limited access to doctors in remote communities
Only 20% of Aboriginal people who live 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 from 2006 [1]. A further 41% have local access to a doctor once a week or once a fortnight.
But 3% could only see a doctor in their own community once a month, the ABS found.
The ABS estimated 18% of Australia's Aboriginal people live in a discrete Indigenous community (a geographic location, bounded by physical or legal boundaries), most of which are considered remote. Only 10% of them lived in a community with a hospital.
Experiences of Aboriginal doctors
The Australian Indigenous Doctors' Association (AIDA) has published a rare resource called Journeys Into Medicine. It is a book in which 15 Indigenous doctors and five medical students reflect on what it means to be an Aboriginal or Torres Strait Islander person balancing the demands of a Western, bio-medical system while remaining faithful to Aboriginal culture, family and community.
They tell about their challenges and their triumphs. Their careers before medicine and the experiences within medical schools and within the medical profession are as different as the stories themselves.
Journeys Into Medicine aims to challenge stereotypes about the standing of Indigenous people in Australia's workforce.
The book is of special value for high school students contemplating their future and university students studying within medical schools.
The book can be downloaded for free at www.aida.org.au.
How to make hospitals work for Indigenous people
For many Aboriginal people being in a sterile hospital environment conjures up memories of racism and mistreatment.
Many members of the Stolen Generations choose not to see a white doctor or only when their condition has severely deteriorated.
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. —Alice Smith, Punjima woman, Western Australia [9]
For a medical environment to work for Aboriginal people it must
- employ Indigenous staff,
- have an Indigenous-friendly feel, for example by displaying Aboriginal artworks [2]. Indigenous artwork on the outside of an ambulance also helps Indigenous communities develop a sense of pride and ownership in the vehicle [3];
- ensure that Aboriginal patients understand their disease. Many are uncertain about what has caused their condition [4],
- ensure informed consent. For traditional Indigenous people 'informed consent' for medical procedures must come from the 'right' person within the network of kinship and community relationships, not necessarily solely the patient [5]. Disrespect for such a process might lead to payback for the ill person;
- ensure Aboriginal patients are fully informed in their own language about potential harms or benefits of the procedures offered [5].
There is a substantial body of research evidence indicating that the development of a skilled and professional Indigenous health workforce is an essential prerequisite for improvements in Indigenous health. —Dr Mick Gooda, CEO Cooperative Research Centre for Aboriginal Health [8]
Success story: Prof Noel Hayman
Indigenous Associate Professor Hayman practices at the Inala Health Clinic in Brisbane, Queensland.
To make the clinic more attractive to Aboriginal and Torres Strait Islander patients he employed more Indigenous staff and saw that cultural-awareness programs were provided for all staff [6].
Prof Hayman changed the environment at the clinic to a more welcoming and culturally appropriate by hanging Aboriginal paintings.
The result: Patient consultations increased from around 1,600 per year in 1996 to over 12,000 in 2008.
Traditional healers—"They think it is voodoo stuff"
Marjorie Parker comes from the Pilbara region in north-west Western Australia where she has been working as an Aboriginal nurse. She explains that some Aboriginal patients request the services of traditional healers [10].
"In hospitals they should have Aboriginal videos, playing culture for the people. There is nothing for Aboriginal patients to make them feel supported in the cultural, spiritual being. The hospital staff don't take into account the spiritual well-being of the Aboriginal patients. It's all medical treatment. Sometimes you need to go further."
"Some patients have requested treatment from their own culture, from medicine men. Hospitals do not recognise the legitimacy of treatment that traditional healers can give and this is wrong. They think it is voodoo stuff."
Case study: Cultural-based nursing
Aboriginal nurse Marjorie Parker recalls the story of an old lady who wanted to go home, against the doctor's orders [10].
"One time an old lady, who didn't appear to be very sick, but felt that she wasn't going to last the night, wanted to go home to her family. She was just wailing and wailing.
I said to the sister, 'We can't keep her here, it's cruel we must send her home.' The sister said, 'But the doctor's orders are to keep her here.' And I said, 'Yes, but the doctor is [400kms away] in Exmouth and this poor patient only wants to go home and be with her family. I believe that she spiritually feels that she is not going to survive the night.'
I thought that if this is what she believes then she is entitled to be with her family and to die wherever she wants to, not in this environment.
I said to the sister, 'I must go to Bindi Bindi village and see the relatives.' […] So I got the orderly [hospital attendant] and took her home. She was very breathless and life was dim. Yet she spent the evening with her family and passed away that night.
This is but one example of the cultural-based requirement of nursing and caring for Aboriginal patients.
Using traditional Indigenous art to explain good health
An Aboriginal painting shows the digestive system of the human body. Aboriginal people relate
immediately to this kind of 'medical art' which builds a bridge to the doctor.
Doctors in Australia's Northern Territory have found an amazingly obvious way to teach Aboriginal people about diseases and good health [7].
They use paintings produced by local Aboriginal people in Oenpelli's Health Clinic, near Kakadu National Park (about 300km east of Darwin). The paintings encourage patients to participate in discussions about body systems, especially when patients realise that the paintings have been produced by their uncles and cousins.
Aboriginal people are able to identify immediately that the paintings were from the area and painted by people they know. Due to a life's experience of hunting animals for food many Aboriginal artists have a better knowledge of anatomy than mainstream doctors [7].
[Health paintings are] a perfect starting point to build the doctor-patient relationship. —Hugh Heggie, GP, Oenpelli Health Clinic [7]
Out of respect for Aboriginal culture I use Indigenous sources as much as possible.
[1] 'Aborigines waiting up to three months to see doctor', Koori Mail 431 p.51
[2] Koori Mail 413 p.48
[3] 'Deadly ambulance to help new officer improve health', Koori Mail 441 p.34
[4] 'Frustration over kidney disease, research shows', NIT 13/11/2008 p.11
[5] 'Cultures vary widely on 'informed consent'', Koori Mail 440 p.54
[6] 'A column by our own doctors', Koori Mail 438 p.54
[7] 'NT doctors use pictures to paint a vision of good health', NIT 13/11/2008 p.12
[8] 'In good hands with Dr Shibasaki', Koori Mail 454 p.54
[9] 'Karijini Mirlimirli', Noel Olive, Fremantle Arts Centre Press 1997 pp.85
[10] 'Karijini Mirlimirli', loc.cit. p.132