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Introduction:

The current essay aims to discuss the case study of Naomi Williams Aboriginal woman, discussed in the YouTube video. She was six months pregnant and died of septicemia (George Newhouse, 2019). Naomi had a complicated pregnancy, she visited the hospital multiple times but could not receive any specialist care instead of having symptoms like vomiting, nausea, diarrhea and dehydration. Naomi visited the hospital because she had so much pain and could hardly move, but she was sent home without seeing a doctor. She and her baby died fifteen hours later (George Newhouse, 2019The essay will demonstrate the understanding of the concept applying to the case study presented in the video (George Newhouse, 2019). Further, we will discuss the main difference between Aboriginal medical health services and mainstream services. The essay will also convey the strategies to manage health issues in a culturally safe way to make mainstream services more culturally safe.

Concepts that relate to the case study: The concepts that are applied to the case study of Naomi are racism, stereotyping, and cultural safety.

 Racism: Racism is a key determinant of the health of Indigenous Australians that may explain the unremitting gap in health and socioeconomic outcomes between Indigenous and non-Indigenous Australians. Indigenous Australians are still at least three times more likely to experience racism than their non-Indigenous counterparts (Markwick et al., 2019). Aboriginal pregnant women may face barriers to accessing quality healthcare due to systemic racism. This can include difficulties in finding culturally sensitive healthcare providers, transportation issues, or discriminatory treatment within healthcare settings. Racism by healthcare workers can lead to delayed or inadequate prenatal care, which can negatively impact the health of both mother and child. As mentioned in the case study, Naomi had a complicated pregnancy, and to seek medical help, she has visited the hospital several times. However, due to racism, she did not get proper treatment, leading to the death of both mother and child. Racism can erode social support network and connections, making it more challenging for Aboriginal pregnant women to get necessary emotional and practical support during pregnancy and childbirth (Macedo et al., 2021).

Stereotyping: Smylie et al (2019) reported stereotyping as one of the barriers in Indigenous maternity care. Aboriginal people have long been subjected to negative stereotypes related to criminal behaviour and substance abuse. Within healthcare settings, Aboriginal patients may face stereotypes that assume they are non-compliant with medical advice, have higher rates of substance abuse, or do not prioritize their health. Similar happened in the case study of Naomi; she was not allowed to visit an obstetrician or a gut specialist; instead, she was sent to drugs and alcohol. Meanwhile, she does not have a drug and alcohol problem, which showed clear stereotyping in her case and ensured that she didn't get the appropriate care. Aboriginal women may be stereotyped about their lifestyles, women feared being misunderstood and incorrectly judged by culturally biased maternity care provider (Macedo et al., 2021). This kind of social stereotyping affects clinical interaction and decision-making and results in inadequate medical health support. It is essential to recognize that these stereotypes are not representative of the diversity, resilience, and contribution of Aboriginal people and communities in Australia. Challenging and dismantling these stereotypes is essential for delivering equal care to Aboriginal women (Smylie et al., 2019).

Cultural safety: Cultural safety is a concept rooted in understanding and addressing the power imbalance and systemic issues that can negatively impact the healthcare experiences of Indigenous people including Aboriginal women like Naomi. The aim of maintaining cultural safety in the healthcare setting is to emphasizes that the services provided in the healthcare setting are respectful of every individual irrespective of their culture, religion, and tradition. However, in the case study of Naomi, she did not receive culturally safe care. It may be due to the lack of Indigenous representatives in the healthcare settings, such as Indigenous doctors, nurses and cultural liaisons. The absence of an Indigenous healthcare professional may have contributed to her not receiving the culturally appropriate care she needed (Macedo et al., 2021). When healthcare facilities including doctors and nurses, does not provide a culturally sensitive environment it can make Aboriginal patients feel uncomfortable or unheard in the healthcare settings. As mentioned in the case study, Naomi visited several times to the healthcare setting to get appropriate treatment. She was experiencing symptoms like nausea, vomiting, diarrhea, and dehydration. However, nurses working in healthcare did not acknowledge and incorporate with her for providing care (Smylie et al., 2019).

Access to health services:

The case study of Naomi highlights the contrast between Aboriginal Medical Health Services (AMHS) and mainstream healthcare services. AHMS has been designed to address the unique needs health needs and disparities experienced by Aboriginal people (Aboriginal Medical Services, 2023). However, mainstream healthcare services in Australia refer to the broader healthcare system that serves the general population, including Australian citizens and residents from diverse cultural backgrounds. AHMS often uses cultural practices, language, and community engagement to address the unique healthcare needs of Indigenous communities (Darr et al., 2021). AHMS provides a range of culturally appropriate services, including care for pregnancy, child health, mental health, counselling, heart disease, nutrition and dental and access to general practitioners and specialists (Australian government, 2023). AHMS can deliver better care to Aboriginals as they are community-centred and operated by Indigenous communities. AHMS typically employ a significant number of Indigenous healthcare professionals, including doctors, nurses, and health workers. This works to take a holistic approach to health by recognizing the physical, mental and spiritual needs of the Aboriginal patient (Darr et al., 2021).

However, the mainstream services are different from AHMS they may lack cultural competence and often have fewer indigenous healthcare professionals, leading to a potential lack of cultural understanding. Mainstream healthcare services offer access to various medical services including preventive care, diagnosis, and treatment of common health issues, and offer access to medical specialists such as obstetricians (Australian government, 2023). In the case study of Naomi, mainstream services were not adequately provided she did not get the proper diagnosis and preventive care and was not even allowed to visit obstetricians, resulting in underdiagnosis and culturally inadequate care (Nolan-Isles et al., 2021). 

 Some potential issues that may impact on Aboriginal communities’ access to health services are socioeconomic disparities, health literacy, discrimination and bias, cultural competence and limited Indigenous workforce. Indigenous people often face socioeconomic disparities like unemployment, poverty, and inadequate housing, which impacts their ability to afford and access healthcare services (Smylie et al., 2019). Having limited health literacy can act as a barrier to understanding health information and affects their treatment decision and advocate for their own health needs. Fear of experiencing racism, discrimination and biases in healthcare settings can deter Aboriginals from seeking medical care. Meanwhile, when they do not feel culturally safe within mainstream healthcare settings, it results in feelings of discomfort and a reluctance to access healthcare services (Nolan-Isles et al., 2021).

Strategies to manage health issues in a culturally safe way:

Provide cultural competence training to healthcare professionals: All healthcare workers in healthcare settings must understand the value of delivering culturally safe care and being culturally competent. This can be done by creating a comprehensive curriculum and providing training about a range of cultural competence topics (Durey et al., 2016). During training, healthcare workers should learn about the indigenous culture's communication skills to overcome language barriers, culturally safe principles and health disparities. The healthcare worker can select appropriate delivery methods for training programs like in-person workshops, online modules, and case-based learning as per their convenience (Cargo et al., 2019).

Professional standards need to be changed: There is a need to change some of the policies in mainstream healthcare services. Like reputable authorities of both the government and private sector should develop and implement cultural safety policies within healthcare organizations that prioritize respectful and culturally appropriate care. Mainstream healthcare services need Aboriginal community engagement and culturally sensitive facility design (Baba et al., 2021). So, one of the strategies is to actively engage local indigenous communities and other culturally diverse communities who can help in healthcare planning, decision making and program development. Both government and private healthcare care settings should strengthen anti-discrimination policies and practices so that Aboriginal patients do not have to face racism and stereotyping while accessing medical care. Healthcare workers, mainly nurses, should be encouraged to report discriminatory behaviour and ensure that complaints are addressed promptly (Durey et al., 2016).

Appointing Indigenous healthcare professionals: Most Aboriginals face language barriers and cultural gaps; however, appointing healthcare workers who have an Aboriginal background can be helpful in bridging language and cultural gaps (Darr et al., 2021). This can also ensure effective communication and understanding of the related issues, which can promote trust between patients and healthcare professionals. Due to poor health literacy, the majority of Aboriginal patients are not capable of making the right decisions about the treatment plan. The condition gets worse when Aboriginal people do not get any organizational support to promote their advocacy. Meanwhile, appointing Indigenous healthcare professionals can advocate on behalf of Indigenous patients, ensuring that their rights and preferences are respected within the healthcare system (Cargo et al., 2019).

Data collecting and monitoring: There is a need to identify the root cause of disparities in healthcare access between Indigenous and non-Indigenous populations. This can be done by monitoring and analyzing data, which provides information about valuable insights into the service utilization, discrimination rate among Aboriginals and the behaviour of healthcare professionals (Cargo et al., 2019). By identifying the root cause, healthcare organizations can implement target interventions to reduce health inequalities among Aboriginals. Monitoring involves regularly supervising healthcare professionals’ interaction with Aboriginal patients (Darr et al., 2021). Appointed supervisors can actively look for signs of discriminatory behaviour or bias among their team members. Supervisors can ensure that healthcare professionals adhere to organizational policies by conducting periodic audits and working to identify areas for improvement and measure progress (Macniven et al., 2019).

Conclusion:

It can be concluded that implicit racism and discrimination have contributed to dismissing Naomi's symptoms and failing to provide necessary specialist care. The case study highlighted the issue that Aboriginals are facing challenges in ensuring culturally safe care. Some of the major reason that affects the access to the healthcare service are lack of Indigenous representatives, cultural insensitivity, and other socioeconomic factors. The implementation of AHMS is helpful in addressing these differences and challenges and works to provide culturally safe healthcare. Meanwhile, Aboriginals are still facing difficulties in accessing mainstream services due to a lack of cultural competence and an Indigenous workforce.

References:

Aboriginal Medical Services (AMS). (2023). Aboriginal Medical Services on NSW North Coast. https://hnc.org.au/aboriginal-health/aboriginal-medical-services-nsw-north-coast/

Australian Government. (2021). Pregnancy care for Aboriginals and Torres Strait Islander women. https://www.health.gov.au/resources/pregnancy-care-guidelines/part-a-optimising-pregnancy-care/pregnancy-care-for-aboriginal-and-torres-strait-islander-women

Baba, J. T., Brolan, C. E., & Hill, P. S. (2014). Aboriginal medical services cure more than illness: a qualitative study of how Indigenous services address the health impacts of discrimination in Brisbane communities. International Journal for Equity in Health13(1), 1-10.https://doi.org/10.1186/1475-9276-13-56

Cargo, M., Potaka-Osborne, G., Cvitanovic, L., Warner, L., Clarke, S., Judd, J., ... & Boulton, A. (2019). Strategies to support culturally safe health and wellbeing evaluations in Indigenous settings in Australia and New Zealand: a concept mapping study. International Journal for Equity in Health18, 1-17. https://doi.org/10.1186/s12939-019-1094-z

Darr, J. O., Franklin, R. C., McBain-Rigg, K. E., Larkins, S., Roe, Y., Panaretto, K., ... & Crowe, M. (2021). Quality management systems in Aboriginal Community Controlled Health Services: a review of the literature. BMJ Open Quality10(3), e001091.https://doi.org/10.1136%2Fbmjoq-2020-001091

Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J., & Bessarab, D. (2016). Improving healthcare for Aboriginal Australians through effective engagement between community and health services. BMC Health Services Research16(1), 1-13. https://doi.org/10.1186/s12913-016-1497-0

George Newhouse. (2019). Calls for culturally safe care after Naomi Williams Death. https://www.youtube.com/watch?v=ssQmdBm2N4A

Harfield, S. G., Davy, C., McArthur, A., Munn, Z., Brown, A., & Brown, N. (2018). Characteristics of Indigenous primary health care service delivery models: a systematic scoping review. Globalization and Health14, 1-11.https://doi.org/10.1186/s12992-018-0332-2

Macedo, D. M., Smithers, L. G., Roberts, R. M., & Jamieson, L. M. (2020). Racism, stress, and sense of personal control among Aboriginal Australian pregnant women. Australian Psychologist55(4), 336-348. https://doi.org/10.1111/ap.12435

Macniven, R., Hunter, K., Lincoln, M., O’Brien, C., Jeffries Jr, T. L., Shein, G., ... & Gwynne, K. (2019). Accessibility of primary, specialist, and allied health services for Aboriginal people living in rural and remote communities: protocol for a mixed-methods study. JMIR Research Protocols8(2), e11471. https://doi.org/10.2196%2F11471 

Markwick, A., Ansari, Z., Clinch, D., & McNeil, J. (2019). Experiences of racism among Aboriginal and Torres Strait Islander adults living in the Australian state of Victoria: a cross-sectional population-based study. BMC Public Health19, 1-14. https://doi.org/10.1186/s12889-019-6614-7

Nolan-Isles, D., Macniven, R., Hunter, K., Gwynn, J., Lincoln, M., Moir, R., ... & Gwynne, K. (2021). Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. International Journal of Environmental Research and Public Health18(6), 3014.https://doi.org/10.3390%2Fijerph18063014

Smylie, J., & Phillips-Beck, W. (2019). Truth, respect and recognition: addressing barriers to Indigenous maternity care. CMAJ191(8), E207-E208.https://doi.org/10.1503%2Fcmaj.190183

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