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Introduction

Naomi Williams, an Aboriginal lady 27 years old from the Wiradjuri country, is a terrible example of both individual and systemic prejudice in healthcare systems. The concepts and events surrounding Naomi's death will be discussed in this essay, along with the racial bias and ongoing healthcare errors that she experienced. Naomi was six months pregnant with her first kid, but when she went to her local hospital for treatment, the staff there treated her like a person with an addiction. Her symptoms of nausea, vomiting, dehydration, and stomach discomfort were disregarded despite her repeated visits, and she was mistakenly classified as a drug seeker. She had a fatal misdiagnosis and died of meningococcal septicemia as a result. This essay will shed light on the systemic and individual factors contributing to this deeply troubling issue. A comparative discussion on Aboriginal and mainstream health services will follow this. Lastly, the essay will define cultural safety and suggest strategies to make mainstream health services more culturally safe.

Racism and Stereotyping

Fundamentally, racism is the idea that one race is superior to another and breeds prejudice, discrimination, and unfair treatment (Australian Human Rights Commission (AHRC), 2023). It is a prevalent practice worldwide, and Naomi's story is a chilling illustration of how bigotry can creep into the medical system. For Naomi, the system's inability to give her proper care was exacerbated by the systemic racism that shaped her experiences. The hospital staff mistakenly believed that she had a drug and alcohol problem, a stereotype unfairly given to Native people (Goodman et al., 2017). They failed to provide her with the thorough evaluation and care she needed because of this preconceived assumption, which made them blind to the severity of her situation. Furthermore, Naomi's anxiety about visiting the hospital due to her perception that she would be treated like a "junkie" highlights the systemic racism in the healthcare industry. Her Aboriginal identity caused her to feel mistrusted, stigmatised, and estranged racial bias by the medical staff, which directly caused her premature death and incorrect diagnosis. The way racism permeates healthcare relationships and undermines the values of justice, equity, and dignity that all patients should be accorded, regardless of their race or ethnicity, is best illustrated by this instance involving Aboriginal health (Kairuz et al., 2021).

Social Determinants of Health

Naomi's experience with the medical system serves as further evidence of the significant influence of socioeconomic determinants of health. These variables are non-medical and affect how people are born, develop, live, work, and age and are essential in determining how healthy a person is (World Health Organisation (WHO), 2023). In Naomi's case, the historical background of colonisation and the ongoing structural injustices that Indigenous peoples in Australia experience have tainted her social determinants of health. Economic inequalities, cultural loss, and dispossession are all results of colonisation. These disparities significantly impact Indigenous populations' health and well-being. They may restrict access to high-quality housing, work, education, and healthcare, creating unfavourable health outcomes (Adams et al., 2020). Naomi's social determinants of health led directly to her sad experiences. Due to a large part of institutional racism and historical trauma, she had mistrusted the healthcare system and chose not to seek medical help when she should have. Her social environment, shaped by the lingering impacts of colonisation, affected her decisions and ultimately played a role in her death.

Colonisation and Historical Events

An essential foundation for comprehending Naomi's experiences is the historical background of colonisation in Australia. Due to colonisation, Indigenous populations experienced structural abuses, cultural devastation, and land dispossession. Aboriginal and Torres Strait Islander peoples' lives and experiences have been shaped by these historical events, which have a lasting impact (Menzies, 2019). Naomi's unwillingness to seek medical attention indicates the historical trauma caused by colonisation. Her view of the healthcare system was shaped by the lingering effects of colonisation, such as the loss of cultural identity and the passing down of trauma from generation to generation. Aboriginal and Torres Strait Islander people's historical injustices are reflected in their deep-seated mistrust of institutions and healthcare practitioners (Bernardes et al., 2022).

Aboriginal medical health and mainstream services

Due to historical injustices and disadvantages experienced by Aboriginal and Torres Strait Islander communities, Australia has both mainstream healthcare services and Aboriginal Medical Health Services (AMHS). These services are essential in closing the generational healthcare gap because they are specifically designed to meet the health, social, and cultural requirements of Indigenous communities (Nolan-Isles et al., 2021).

Significant health disparities have been brought about by the historical context of colonisation and its ongoing effects on Indigenous communities. According to a study by Gardiner et al. (2021), compared to non-Indigenous Australians, Indigenous Australians had lower life expectancies and greater incidence of chronic diseases like diabetes and cardiovascular disease. Numerous interrelated variables, such as historical trauma, financial hardship, and cultural insensitivity in mainstream healthcare, might be blamed for these differences (Curtis et al., 2019). By offering culturally appropriate care, specialised healthcare services for Aboriginal and Torres Strait Islander people aim to address these disparities (Pearson et al., 2020).

AMHS place great emphasis on cultural competence, emphasising the significance of family and community in healthcare choices, as well as addressing the social determinants of health that are specific to Indigenous people (Verbunt et al., 2021). For example, the Apunipima Cape York Health Council in Queensland provides a range of services that are influenced by the traditional customs of the local Aboriginal and Torres Strait Islander people. This includes programs like "Family Wellbeing," which promotes health and well-being by fusing traditional and modern techniques (Apunipima Cape York Health Council, 2023).

Another meaningful way that AMHS stands apart is through community control. Indigenous communities feel ownership and control over their healthcare because many of these services are run and controlled by the community (Pearson et al., 2020). The Central Australian Aboriginal Congress (CAAC) is one instance of this. With community involvement in decision-making, CAAC is an Aboriginal community-controlled primary health care service that guarantees that services are directly formed by the needs and ambitions of the local Indigenous population (CAAC, 2022).

AMHS offers a wide range of services, frequently multidisciplinary, such as general healthcare, mental health assistance, maternity and child health, and chronic illness management. These services go beyond professional treatment, emphasising people's and communities' overall well-being (Better Health Channel, 2021). For example, a variety of programs, including mental health, family violence prevention, and substance abuse support. These programs target the social and emotional well-being of Indigenous people in general (Humphreys et al., 2022). Lastly, geographic remoteness, a lack of transit choices, and cultural insensitivity can all make it more challenging to receive mainstream healthcare treatments (Nolan-Isles et al., 2021).

Strategies to practice cultural safety in health issues

When it comes to meeting the healthcare needs of Indigenous people, such as the Aboriginal and Torres Strait Islander communities in Australia, cultural safety is a critical and non-negotiable aspect of healthcare provision. Cultural safety goes beyond the mere notion of cultural competency; it entails creating healthcare environments that are safe, courteous, and inclusive, considering historical traumas and biases (Government of Victoria, 2023). One of the fundamental steps in achieving cultural safety is to train healthcare professionals in cultural sensitivity (Jongen et al., 2018). The National Midwifery Board of Australia (NMBA) Standard 1.3 underscores the importance of healthcare practitioners recognising and respecting the cultural and social diversity of healthcare recipients (NMBA, 2018). This aligns perfectly with the need for cultural sensitivity training that goes beyond mere awareness to include a thorough comprehension of the socioeconomic and historical background of Indigenous populations. Healthcare professionals with this knowledge are better positioned to identify and address potential biases and power disparities in their interactions with Indigenous patients (Jongen et al., 2018).

Secondly, creating culturally safe environments involves having healthcare staff who reflect the cultural diversity of the patient population (Stanford, 2020). The NMBA Standard 2.7 promotes culturally safe and respectful practice, making it essential for healthcare organisations to foster inclusivity through diversity within their workforce (NMBA, 2018). Indigenous staff, as seen in initiatives such as the Western Australian Country Health Service's Indigenous employment strategies, not only provide familiarity to Indigenous patients but also offer invaluable cultural insights to healthcare providers (Western Australian Country Health Service, 2023). This aligns with the NMBA standard and ensures Indigenous patients feel respected and understood.

Thirdly, identifying and reporting potential risks is a cornerstone of cultural safety. The NMBA Standard 6.6 emphasises employing the proper procedures to find and report system problems that could pose a danger and instances where the practice may fall below standards (NMBA, 2018). To achieve this, healthcare professionals and organisations should provide regular training, establish clear reporting protocols, foster a culture of open reporting, continuously improve systems, document actions, and prioritise patient safety. This ensures ongoing compliance and cultural safety in healthcare (WHO, 2021). In addition, the NMBA standards require healthcare practitioners to act in a way that safeguards and upholds the privacy and dignity of healthcare recipients (Standard 2.2). Clear cultural safety policies and guidelines are vital in addressing issues such as racism, discrimination, and bias within healthcare settings. By offering a framework for addressing these issues, healthcare organisations can ensure that their practices align with professional and ethical standards (Curtis et al., 2019).

Lastly, to maintain cultural competence and safety, healthcare providers must engage in ongoing education and training (Australian Commission on Safety and Quality in Health Care (ACSQHC), 2023). The NMBA Standard 3.3 requires healthcare practitioners to engage in professional development and education, making it clear that continuous learning is fundamental in healthcare practice (NMBA, 2018). Initiatives like the Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 2016–2026 serve as a guide for healthcare providers in their cultural safety education (United Nations Educational, Scientific and Cultural Organization (UNESCO), 2023).

Conclusion

In conclusion, the tragic case of Naomi Williams serves as an important reminder of the systemic racism, past trauma, and healthcare inequities that Indigenous Australian communities endure. Cultural safety is desperately needed, as evidenced by the institutional and personal prejudices she experienced in the medical system. Strategies including cultural sensitivity training, varied healthcare personnel, language accessibility, and unambiguous anti-discrimination regulations must be put into practice to close the healthcare gap. Moreover, to guarantee that healthcare practices become more culturally safe, community involvement, cultural audits, and continuous education are crucial. Achieving cultural safety is a moral requirement as well as a goal to provide everyone, regardless of culture, with equal and respectful healthcare.

References

Adams, M., Canuto, K. J., Drew, N., & Fleay, J. J. (2020). Postcolonial Traumatic Stresses among Aboriginal and Torres Strait Islander Australians. ab-Original: Journal of Indigenous Studies and First Nations and First Peoples' Cultures (2), 233-263. https://doi.org/10.5325/aboriginal.3.2.0233

Apunipima Cape York Health Council. (2023). About us. https://www.apunipima.org.au/about-community-controlled-primary-health-care-cape-york/

Australian Commission on Safety and Quality in Health Care (ACSQHC). (2023). Action 1.21: Improving cultural competency. https://www.safetyandquality.gov.au/standards/national-safety-and-quality-health-service-nsqhs-standards/resources-nsqhs-standards/user-guide-aboriginal-and-torres-strait-islander-health/action-121-improving-cultural-competency

Australian Human Rights Commission (AHRC). (2023). What is racism? https://humanrights.gov.au/our-work/race-discrimination/what-racism

Bernardes, C. M., Houkamau, K., Lin, I., Taylor, M., Birch, S., Claus, A., & Pratt, G. (2022). Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia. Frontiers in Pain Research , 1041968. https://doi.org/10.3389/fpain.2022.1041968

Better Health Channel. (2021). Aboriginal health services. https://www.betterhealth.vic.gov.au/serviceprofiles/aboriginal-health-services

Central Australian Aboriginal Congress (CAAC). (2022). Our vision. https://www.caac.org.au/our-vision/

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