The prevalence of a certain type of diseases in particular groups has been observed. One such issue is End-stage kidney disease, which is more prevalent in indigenous populations than non-indigenous groups as offering medical care to these communities is a daunting task owing to the issues related to the access of medical services and cultural disparities. Aboriginal and Torres Strait Islander groups have an eight-time higher incidence of renal failure, and that can be treated by kidney replacement than their non-Indigenous counterparts. The biggest challenge to the public health system is to provide accessible, adaptable and proficient care to people suffering from chronic disorders from the aboriginal backgrounds. An absence of cultural security can create an outcome of avoidance of contact by the patients, which enhances the threat of delayed diagnosis and hence, higher mortality and morbidity. The current report is based on a case study on Bill who is suffering from end-stage kidney disease; the study highlights the importance of culturally safe care by monitoring different aspects like analogy and disparity in the health systems of both the contrasting communities. The report discusses the concepts based on racism, colonisation, and social determinants of health and code of conduct of NMBA concerning aboriginal communities to give a transparent view regarding Bill's decision to stay within his community. Based on collected evidence, the strategies to provide culturally safe care are suggested, and finally, a conclusion is withdrawn.
Analogy and disparity comparison between the health systems of both the groups' is interesting as per a survey conducted in the year 2012-2013 indigenous people living in non-remote areas have consulted a general practician or expert in the percentage of 22% while the percentage is 20% for those living in remote areas. The Australian health care system receives appreciation for its services, and it is a well-established fact that a range of public sector aided community services are practices in the entire nation to provide primary health services to the indigenous community. However, not more than 40% of these community health services have medical coverage. Treatment centres and clinics have a density in metropolitan cities in the proportion of 400 nurses for every 100,000 individuals or two times the dispersion of nurses in remote areas inhabited by aboriginal people. The kids with the aboriginal roots and were given birth in 2015-2017 had a lower average life expectancy by approximately 8.6 and 7.8 years than the non-indigenous groups (Stepanikova & Oates, 2016). Also, the net load of disorders on the aboriginal communities was around 2.3 times more than others and is even around three times more susceptible to mental stress and two times more probable to have suicidal thoughts in comparison to non-indigenous counterparts. The evidence suggests that the health care system fails to offer equal quality of health care services to the Indigenous population in comparison to the non-Indigenous groups (Larkins et al., 2016). Aboriginal people have adverse health results in comparison to non-Indigenous groups. The rise of primary health care services initiates because the mainstream health care was not able to meet the requirements of aboriginal people; moreover, the individuals were often discarded and sidelined from the streamlined medical facilities (S. Harfield et al., 2015).The main characteristics of these primary health models were availability of health care facilities, engagement of the entire community, consistent quality enhancement, culturally correct and skilled staff members, flexible health care facilities, holistically offering health care, and self-motivation and empowerment (S. G. Harfield et al., 2018).
According to the case study, Bill is a 55-year older adult and is suffering from End-Stage Kidney disease and now requires haemodialysis treatment three times a week in Perth. Despite the need to immediately avail the health services in Perth, Bill decides to remain in his community under the influence of the following concepts.
Aboriginal individuals encounter various incidents of individual and community racism which contributes to maintaining their low socio-economic status.The impact of racism is severe and is capable of posing an indirect challenge in terms of fewer job opportunities, housing and learning. It also increases the health affecting practices like smoking and liquor consumption in higher amounts (Paradies Y et al., 2015). Inequality is a big factor and can create irreparable damage in terms of physical health and mental turmoil (Markwick et al., 2019). The physiological impact of discrimination can range from developing chronic disorders like heart problems, DM, chronic obstructive pulmonary disease, asthma, increased blood pressure, neoplasms, altered body mass index and the threat of use of illicit substances like tobacco, alcohol and substance use (Markwick et al., 2019). The mental impact of inequality is huge. It may lead to issues like depression, anxiety, stress, socio-emotional well-being, illness indicators like life satisfaction, quality of life, self-efficacy, disease acceptance and prone to suicidal thoughts (Markwick et al., 2019).
Colonisation disrupted the communities and had widened the gap between indigenous groups and non-indigenous groups. The impact is so severe that it resulted in the spread of epidemics like smallpox, measles and influenza and the aboriginal community faced major challenges to overcome these issues. Smallpox has created a destructive impact on the inhabitants of Sydney with an Aboriginal background in a time of a year and two months (Hendrickson, 2013). The female gender has to deal with heinous crimes of sexual abuse and exploitation, which made them vulnerable groups in terms of sexually transmitted diseases. The community tried to raise a voice against the inequality in land rights but suffered major blows. As many as 20,000 individuals lost their lives as an outcome of violence due to colonisation in historical context. The colonisation managed to create health inequalities, and Aboriginal people had limited access to avail medical facilities in comparison to the non-indigenous population.
The social determinants of health are responsible for increased exposure to diseases, and overall well-being and also access to medical services. The various social determinants for indigenous groups are admission to early childhood initiatives and programs, connectivity to relatives, culture, nation, personality and area and independence from racism based inequalities. Also, proper shelter without overcrowding and availability of public transport means, availability and participation in educational programs. Furthermore, lower incidents of culturally-biassed decisions in the judiciary system and equal job opportunities and engagement in the labour force (Osborne 2013).
The Congress of Aboriginal & Torres Strait Islanders Nurses and Midwives (CATSINaM) is the authority that represents and supports the culturally safe medical services to aboriginal people. Principle 3 of the code says that Australia is a land of diverse culture, and care must be taken towards the needs of indigenous people. The nurses should offer holistic care without any inequality and discrimination. They must promote and act as facilitators to provide culturally safe care to indigenous populations and must identify the importance of family, groups and coordination in taking decisions regarding medical care for both prevention and cure strategies (New Codes of conduct for Australian nurses and midwives | Clinical Knowledge Network, 2018).
Cultural safety can be referred to as a method to understand and transform at the personal level or the level of the community the needs of the indigenous population with relation to health and care. The first step in providing the culturally safe care to aboriginal people about end-stage kidney disease is early detection of the disease. It can be achieved by coordination between renal service and Aboriginal Controlled Medical Service (AMS) a reliable resource for detection in Indigenous groups. A culturally regulated predialysis pathway includes the involvement of family members at an early stage and introduction of Aboriginal Health worker at diagnosis. In addition to this home, renal nurse support for indigenous people will help to dialyse at home, keeping it culturally safe and adaptable. A rise in renal nurse support will provide more rural patients to have haemodialysis at their homes. Reports suggest that haemodialysis at home enhances agreement and personal care when the responsibility for medical care is provided to the patients and their families which lead to improved life quality and results.
The money saved by home haemodialysis methods can be utilised for community renal nurse support and indigenous support for renal care to be aligned with the Aboriginal specific predialysis pathway (Rix et al., 2014). Another effective strategy is to adopt "yarning" interview methods which means including no formal communication and reciprocal transfer of information which is in alliance with the indigenous culture. It will engage more people, helps to develop rapport and encourages open and trustworthy interactions. The participation of family members is also an effective measure to provide culturally safe medical care to the patients. The role of family members is vital in extending support and culture-based, and widened family links provide proper support. The health care services must be flexible and should involve family members to offer culturally safe services to the aboriginal people (Rix et al., 2014). Another area of concern for the indigenous groups is to deal with anxiety and fear related to the treatment as experienced by individuals due to suffering and high mortality from haemodialysis and due to untreated end-stage kidney disease. The patients were worried about putting extra pressure on their young children. The health care providers must provide assurance and give complete information regarding the treatment to remove fear and anxiety (Rix et al., 2014). A system where there is more understanding of the health care providers about the indigenous culture is required. It will assist in bridging the gap between patients and health care providers (Durey et al., 2016). A better approach to understanding the culture is to have information on location tea sessions with the employees. The tea sessions will foster better bonding, more chances of effective information exchange in their work environment to create a better relationship with indigenous groups (Rix et al., 2014). The suggestions to provide better home-based services in the end-stage kidney diseases patients are enhancing the education and awareness in patients regarding the dialysis treatment, and training sessions for nephrologists and health care providers to encourage home-based treatment. Other important considerations are initiation for the non-hospital services in the patients who are willing and are prepared for the home-based care treatment. There must be no hindrances in offering the care at home-based setting, and efforts must be made to enhance the number of patients agreeing for utilising home-based care (Durey et al., 2016).
The current study establishes the fact that the Indigenous populations are exposed to potentially dangerous health outcomes. The reason behind more incidents of chronic illnesses lies in increased incidents of racism, instability in the post-colonisation era, social determinants of health also contribute to health inequality and a gap in the health services result in more prevalence of end-stage kidney disease in aboriginal populations. However, the need of the hour is to develop a system of integrated services which are in alignment with the cultural preferences of the vulnerable group. These practices include early detection of renal diseases by arranging a home renal nurse support. Other effective methods are the engagement of family members in the home-treatment regime, and removing the anxiety and fear in patients by spreading awareness and by conducting yarning sessions which will help to develop better relationships and in turn better understanding about the cultural diversity. The informal sessions between patients and their family members can be arranged over tea sessions again to enhance understanding and preferences. These measures can effectively bridge the gap and will provide equal opportunities in terms of health services to the indigenous population.
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