CURRICULUM

Domain – Aboriginal and Torres Strait Islander health (case)

May 15, 2024 / No Comments

Jonathon tells you he recently spent some weeks back on Country for ‘Sorry Business’ after his older brother’s sudden and unexpected death from a heart attack at the age of 47. Many of his family members talked about needing to look after their health so there would be less Sorry Business for their community. This has motivated him to attend, despite a bad experience he had with a GP some years before where his Aboriginal identity was questioned, which put him off. Jonathon says he generally feels well. He felt renewed by being back on Country and participating in ceremony with his community, and one of the Elders treated everyone with some traditional medicines (mixed plant-based tea) to support good health for the whole family. At the last check-up he had, the GP told him he needed to start taking a medication, the name of which he can’t remember. When the script repeats ran out after six months, he did not get it renewed, as he felt the GP hadn’t really explained to him what it was for or whether he needed to keep taking it.

If this was the first time you had met Jonathon, how would you ask how he identifies himself or his cultural heritage? What are the barriers to a patient identifying as Aboriginal and/or Torres Strait Islander? Why might an Aboriginal or Torres Strait Islander person choose not to identify?

How might you build rapport with Jonathon?

Consider what assumptions you have made about Jonathon (including biases and stereotypes). Where do these come from? How might you adjust your perspective?

Do you know what ‘on Country’ and ‘Sorry Business’ mean? How might you find out more about terminology commonly used by Aboriginal and Torres Strait Islander people in your community?

Thinking about the different geographical locations where you might see a patient such as Jonathon, how might you need to tailor your communication; for example, to adapt to local cultural communication styles or language differences? What is your own cultural communication style? How might you adjust your natural style to accommodate your patients?

Clinical Exam Assessment Area

  1. History Taking
    • Explore Jonathon’s overall health, symptoms, and any specific concerns.
    • Inquire about family medical history, especially related to heart disease.
    • Ask about his previous medical experiences, particularly regarding the medication he mentioned.
    • Discuss his experience with traditional medicines and how he feels they impacted his health.
  2. Physical Examination
    • Conduct a comprehensive cardiovascular examination.
    • Measure vital signs including blood pressure, heart rate, and respiratory rate.
    • Check for signs of cardiovascular risk factors such as obesity, diabetes, and hyperlipidemia.
  3. Investigations
    • Consider ordering blood tests, including lipid profile, glucose levels, and HbA1c.
    • An electrocardiogram (ECG) to assess heart function.
    • Possibly a stress test or echocardiogram depending on clinical findings.

Domains

  1. Communication and Relationship-Building
  2. Cultural Competence
  3. Patient Education and Engagement
  4. Continuity of Care
  5. Clinical Reasoning and Judgment

Asking About Cultural Heritage

  1. How to Ask
    • “Jonathon, can you tell me a bit about your cultural background and how you identify?”
    • “I want to understand more about your heritage and how it might influence your health care.”
  2. Barriers to Identification
    • Fear of discrimination or past negative experiences.
    • Lack of trust in the healthcare system.
    • Concern about confidentiality and privacy.
    • Feeling that the information is not relevant to their care.
  3. Reasons for Non-Identification
    • Past trauma or negative experiences with healthcare providers.
    • Concern about being treated differently or unfairly.
    • Desire to avoid stereotypes and biases.
    • Personal choice and varying significance of cultural identity.

Building Rapport with Jonathon

  1. Demonstrate Respect and Interest
    • Show genuine interest in his cultural practices and experiences.
    • Acknowledge and respect his past negative experiences with healthcare.
  2. Cultural Sensitivity
    • Use culturally appropriate language and terms.
    • Be mindful of body language and non-verbal cues.
  3. Empathy and Understanding
    • Express empathy for his loss and the impact it has had on him.
    • Acknowledge the importance of his cultural practices and traditional medicines.
  4. Trust-Building
    • Be patient and give him time to share his story.
    • Provide clear explanations and involve him in decision-making.

Addressing Assumptions and Biases

  1. Assumptions and Biases
    • Recognize potential biases about Aboriginal and Torres Strait Islander health behaviors and outcomes.
    • Acknowledge any preconceived notions about traditional medicine.
  2. Sources of Bias
    • Cultural stereotypes and societal influences.
    • Previous experiences with similar patients.
  3. Adjusting Perspective
    • Approach Jonathon as an individual with unique experiences and needs.
    • Educate yourself about his cultural background and health beliefs.
    • Be open to learning from Jonathon about his cultural practices and preferences.

Understanding Cultural Terms

  1. Terminology
    • “On Country” refers to being on one’s ancestral land and engaging in cultural practices.
    • “Sorry Business” refers to mourning practices and ceremonies after a death.
  2. Learning More
    • Engage with local Aboriginal and Torres Strait Islander community organizations.
    • Attend cultural competency training and workshops.
    • Read literature and resources authored by Aboriginal and Torres Strait Islander people.

Tailoring Communication

  1. Adapting Communication
    • Use plain language and avoid medical jargon.
    • Be mindful of non-verbal communication and respectful silence.
  2. Local Cultural Styles
    • Understand the cultural communication preferences of the local Aboriginal and Torres Strait Islander communities.
    • Be patient and allow time for trust to build.
  3. Your Communication Style
    • Reflect on your natural communication style and its suitability.
    • Adjust to be more patient, respectful, and culturally sensitive.
  4. Accommodating Patients
    • Be flexible and adapt your approach based on the patient’s comfort and preferences.
    • Seek feedback and be willing to adjust your communication as needed.

What are your priorities for this first consultation?

Consider priorities beyond clinical investigation and management. How would you tailor your history-taking to explore important sociocultural elements of this consultation?

What might you need to consider if Jonathon was a member of the Stolen Generations or had only recently discovered his Aboriginal heritage?

What is trauma-informed care? How might repeated episodes of grief and trauma impact on Jonathon’s social and emotional wellbeing or mental health? How might that impact on your engagement with him? What strengths can you identify in Jonathon?

Priorities for the First Consultation

  1. Building Trust and Rapport
    • Establish a welcoming and respectful environment.
    • Acknowledge Jonathon’s cultural background and recent experiences.
    • Show empathy and understanding regarding his past negative healthcare experience.
  2. Understanding Jonathon’s Health Concerns
    • Explore his motivation for attending the consultation.
    • Discuss any symptoms or health concerns he may have.
    • Address his past medical history, including the unidentified medication.
  3. Cultural Sensitivity and Respect
    • Respect his use of traditional medicines and involvement in cultural practices.
    • Ensure that he feels his cultural identity is acknowledged and respected.
  4. Patient Education and Engagement
    • Provide clear information about any medical conditions and treatments.
    • Discuss the importance of medication adherence if necessary.
    • Involve Jonathon in decisions about his healthcare plan.
  5. Assessing Social Determinants of Health
    • Explore any social, economic, or environmental factors impacting his health.
    • Discuss his support system and community involvement.

Tailoring History-Taking to Sociocultural Elements

  1. Cultural Background
    • “Can you tell me about your cultural background and any traditions or practices that are important to you?”
  2. Impact of Recent Events
    • “How has the recent Sorry Business and your brother’s passing affected you and your family?”
  3. Traditional Medicines
    • “Can you share more about the traditional medicines you’ve been using and how you feel they’ve helped you?”
  4. Previous Healthcare Experiences
    • “Can you tell me more about your past experiences with healthcare providers? What worked well and what didn’t?”
  5. Social Support
    • “Who do you turn to for support when you have health concerns? How involved is your community in your wellbeing?”

Considerations if Jonathon Was a Member of the Stolen Generations

  1. Past Trauma
    • Be sensitive to the potential impact of trauma and dislocation on his health and wellbeing.
    • Approach with empathy and avoid any triggering language or assumptions.
  2. Identity and Heritage
    • If he recently discovered his Aboriginal heritage, explore his feelings and experiences around this discovery.
    • Be supportive of his journey to reconnect with his cultural identity.
  3. Trust and Safety
    • Focus on building a safe and trusting relationship.
    • Validate his experiences and ensure confidentiality and respect in your interactions.

Trauma-Informed Care

  1. Definition
    • Trauma-informed care is an approach that acknowledges the impact of trauma on individuals and seeks to create a safe, supportive, and empowering environment.
  2. Impact on Social and Emotional Wellbeing
    • Repeated episodes of grief and trauma can lead to mental health issues such as depression, anxiety, and PTSD.
    • Jonathon may experience heightened stress, emotional numbness, or difficulties in trusting healthcare providers.
  3. Impact on Engagement
    • Be patient and provide a supportive, non-judgmental space.
    • Allow Jonathon to share his story at his own pace.
    • Focus on creating a collaborative partnership in his healthcare.

Identifying Jonathon’s Strengths

  1. Cultural Connection
    • Strong ties to his community and cultural practices, which provide a sense of identity and belonging.
  2. Motivation for Health
    • His proactive approach to attending the consultation and his desire to improve his health.
  3. Resilience
    • Demonstrated resilience in coping with his brother’s death and participating in cultural ceremonies.
  4. Support System
    • Engagement with his community and participation in traditional medicine, showing a robust support network.
  5. Openness to Care
    • Willingness to seek medical advice despite past negative experiences, indicating a readiness to engage with healthcare services.

How would your health check be different if this patient was seven years old or a 62-year-old woman? How do the preventive health assessment guidelines differ for Aboriginal and Torres Strait Islander people compared with non-Indigenous people?

What are the population-level drivers of health inequities and why do these exist?

How might you respectfully incorporate knowledge about population-level risk factors for Aboriginal and Torres Strait Islander people into your assessment, without stereotyping the individual patient?

What additional conditions would you consider screening for if Jonathon lived in a remote community in Far North Queensland? How would you approach the complex interplay of potential multimorbidity?

Health Check Differences

For a Seven-Year-Old Child

  1. Focus on Developmental Milestones
    • Assess physical, emotional, and cognitive development.
    • Review vaccination status and ensure up-to-date immunizations.
  2. Growth Parameters
    • Measure height, weight, and BMI, and compare with growth charts.
  3. Health History
    • Inquire about diet, physical activity, and sleep patterns.
    • Discuss school performance and social interactions.
  4. Parental Involvement
    • Engage with parents/caregivers to understand the child’s health context.
    • Discuss any concerns they might have about the child’s development or behavior.
  5. Preventive Measures
    • Emphasize healthy lifestyle habits, injury prevention, and oral health.
    • Screen for common pediatric issues like asthma, allergies, and skin conditions.

For a 62-Year-Old Woman

  1. Chronic Disease Screening
    • Assess for common conditions such as hypertension, diabetes, hyperlipidemia, and osteoporosis.
  2. Cancer Screening
    • Ensure regular screenings for breast cancer, cervical cancer, and colorectal cancer are up-to-date.
  3. Menopausal Symptoms
    • Discuss menopausal symptoms and hormone replacement therapy options if applicable.
  4. Functional Assessment
    • Evaluate mobility, balance, and risk of falls.
    • Assess for hearing and vision impairments.
  5. Mental Health
    • Screen for depression, anxiety, and cognitive decline.
  6. Medication Review
    • Review current medications for efficacy and potential side effects or interactions.

Preventive Health Assessment Guidelines

  1. Higher Prevalence of Chronic Diseases
    • Aboriginal and Torres Strait Islander people have higher rates of diabetes, cardiovascular disease, renal disease, and certain cancers.
  2. More Frequent Health Checks
    • Encourage annual health checks from an early age, including comprehensive screenings for chronic diseases and risk factors.
  3. Cultural and Social Determinants
    • Incorporate assessments of social determinants of health, such as housing, education, employment, and access to services.
  4. Mental Health and Wellbeing
    • Regularly screen for mental health conditions and provide culturally appropriate support and interventions.

Population-Level Drivers of Health Inequities

  1. Historical Factors
    • The impact of colonization, dispossession, and the Stolen Generations.
  2. Social Determinants
    • Higher levels of poverty, unemployment, inadequate housing, and limited access to education and healthcare.
  3. Health System Barriers
    • Discrimination and lack of culturally safe healthcare services.
  4. Geographic Barriers
    • Remote living conditions can limit access to healthcare services and healthy food options.

Incorporating Population-Level Risk Factors Respectfully

  1. Individual Focus
    • Start with the patient’s personal health history and current health concerns.
    • Avoid making assumptions based on ethnicity alone.
  2. Cultural Competence
    • Demonstrate awareness of common health issues in the community while respecting individual differences.
    • Use culturally appropriate language and practices.
  3. Patient-Centered Approach
    • Engage in shared decision-making and involve the patient in discussions about their health and preventive measures.

Additional Conditions to Screen for in Remote Far North Queensland

  1. Infectious Diseases
    • Tuberculosis, rheumatic heart disease, and trachoma.
    • Hepatitis B and C, and other sexually transmitted infections.
  2. Nutritional Deficiencies
    • Assess for iron deficiency anemia and vitamin D deficiency.
  3. Environmental Health
    • Exposure to poor sanitation, unsafe drinking water, and overcrowded living conditions.

Approach to Multimorbidity

  1. Comprehensive Assessment
    • Conduct a thorough assessment to identify all existing conditions and their interactions.
  2. Prioritization
    • Prioritize management of the most severe or symptomatic conditions.
  3. Integrated Care Plan
    • Develop a coordinated care plan involving multidisciplinary teams.
    • Consider referrals to specialists and allied health professionals as needed.
  4. Medication Management
    • Review all medications to avoid polypharmacy and potential drug interactions.
  5. Patient Involvement
    • Involve the patient in decision-making and goal-setting.
    • Ensure the care plan aligns with the patient’s values, preferences, and cultural beliefs.
  6. Regular Follow-Up
    • Schedule regular follow-up appointments to monitor progress and adjust the care plan as needed.

What are some cultural determinants of health, and how might these be incorporated into your management through a strengths-based approach?

How might you respectfully incorporate Aboriginal and Torres Strait Islander models of health and wellbeing into your management plan, including use of traditional medicines, if patients choose?

What is your approach to navigating differences between your own and your patient’s priorities (such as family or cultural obligations) when developing shared management plans?

What differences in clinical management guidelines exist for specific conditions in Aboriginal and Torres Strait Islander communities, including for patients who live rurally or remotely?

Cultural Determinants of Health

  1. Connection to Country and Culture
    • Strong ties to land and cultural practices can improve mental and physical health.
    • Encourage participation in cultural activities and connection with community and Country.
  2. Family and Kinship
    • Family structures and kinship systems are central to wellbeing.
    • Involve family members in the care process where appropriate and supported by the patient.
  3. Language and Identity
    • Language and cultural identity contribute to a sense of belonging and self-esteem.
    • Respect and acknowledge the patient’s cultural identity and use culturally appropriate language.
  4. Spirituality and Beliefs
    • Spiritual beliefs and practices can influence health behaviors and coping mechanisms.
    • Acknowledge and support spiritual practices and beliefs as part of the healing process.

Incorporating Cultural Determinants through a Strengths-Based Approach

  1. Recognize and Build on Strengths
    • Highlight the patient’s connection to their community and cultural practices as sources of strength.
    • Use culturally relevant resources and support systems.
  2. Empowerment and Self-Determination
    • Empower patients to make decisions about their health that align with their cultural values.
    • Provide information and options in a way that supports their autonomy.
  3. Collaboration with Community
    • Engage with local Aboriginal and Torres Strait Islander organizations and leaders.
    • Collaborate with traditional healers and incorporate traditional medicines when appropriate and desired by the patient.

Respectfully Incorporating Aboriginal and Torres Strait Islander Models of Health

  1. Holistic Health Model
    • Recognize that health encompasses physical, emotional, social, cultural, and spiritual wellbeing.
    • Develop care plans that address all aspects of health.
  2. Traditional Medicines
    • Be open to discussing the use of traditional medicines.
    • Ensure there are no interactions with prescribed medications and support their safe use.
    • Respect the patient’s choice and incorporate traditional practices into the care plan.
  3. Shared Decision-Making
    • Engage in open and respectful conversations about treatment options.
    • Balance clinical recommendations with the patient’s cultural practices and preferences.
  4. Navigating Differences in Priorities
    • Acknowledge the importance of family and cultural obligations.
    • Be flexible and adapt care plans to accommodate these priorities.
    • Find common ground and mutually acceptable solutions.

Differences in Clinical Management Guidelines

  1. Chronic Diseases
    • Diabetes Management: Regular screening from an earlier age and more frequent monitoring.
    • Cardiovascular Disease: Earlier and more aggressive screening and management due to higher prevalence.
  2. Infectious Diseases
    • Increased screening for diseases like tuberculosis, hepatitis B and C, and rheumatic heart disease.
    • Enhanced preventive measures for communicable diseases, especially in remote areas.
  3. Mental Health
    • Incorporate culturally appropriate mental health services.
    • Provide access to culturally competent counseling and support services.
  4. Child and Maternal Health
    • Focus on reducing perinatal mortality and improving maternal health outcomes through targeted programs.
    • Support for breastfeeding and early childhood development within cultural contexts.
  5. Preventive Health Checks
    • Regular comprehensive health assessments, such as the annual Aboriginal and Torres Strait Islander health check (MBS item 715).
    • Emphasis on early detection and management of chronic conditions.

Considerations for Patients in Rural or Remote Areas

  1. Access to Services
    • Facilitate access to telehealth services and outreach programs.
    • Provide support for travel and accommodation when specialist services are needed.
  2. Community-Based Care
    • Utilize local community health workers and Aboriginal health practitioners.
    • Strengthen local healthcare infrastructure and support community-driven health initiatives.
  3. Resource Allocation
    • Ensure adequate resources for primary healthcare services in remote areas.
    • Address social determinants of health through community development programs.

Approaching Multimorbidity

  1. Integrated Care Plans
    • Develop comprehensive, coordinated care plans that address multiple conditions simultaneously.
    • Use a team-based approach involving various healthcare providers.
  2. Patient-Centered Care
    • Tailor management plans to the patient’s preferences and priorities.
    • Schedule regular follow-ups to adjust the care plan as needed and monitor progress.
  3. Education and Support
    • Provide education about managing multiple conditions and their interactions.
    • Offer support for lifestyle changes and self-management strategies.
  4. Collaboration
    • Work closely with specialists, allied health professionals, and traditional healers.
    • Encourage community support networks to assist in managing multimorbidity.

What do you need to learn about Jonathon’s local community both here and on Country?

What local services exist in your area that might support your care of Jonathon, including dedicated Aboriginal and Torres Strait Islander services, and how would you partner with them in your care?

How would you provide culturally safe care if Jonathon was unable, or preferred not, to access an Aboriginal community controlled health organisation, Aboriginal and Torres Strait Islander health worker/practitioner, or Aboriginal and Torres Strait Islander liaison officer?

If appropriate, how might you incorporate a family-centred approach to care? What is your role in helping patients to develop biomedical health literacy, without judging existing health beliefs?

How will you assess and support this patient’s health systems literacy (the ability to navigate and access health services and systems)?

What is your role as an advocate for Jonathon and the broader Aboriginal and Torres Strait Islander community regarding socioeconomic determinants of health and healthcare access?

Learning About Jonathon’s Local Community

  1. Local Demographics and Health Needs
    • Understand the specific health challenges and needs of Jonathon’s community.
    • Learn about common health issues and the prevalence of chronic diseases within the community.
  2. Cultural Practices and Beliefs
    • Familiarize yourself with the cultural practices, traditions, and ceremonies that are important to Jonathon’s community.
    • Understand the significance of traditional medicines and how they are used.
  3. Community Resources and Supports
    • Identify local community leaders and Elders who can provide insights and support.
    • Explore community events, programs, and gatherings that promote health and wellbeing.
  4. Historical and Social Context
    • Gain an understanding of the historical and social factors impacting the community, including past traumas and current challenges.
    • Learn about the impact of government policies and programs on the community’s health and wellbeing.

Local Services to Support Jonathon’s Care

  1. Aboriginal and Torres Strait Islander Health Services
    • Identify local Aboriginal Community Controlled Health Organisations (ACCHOs) and their services.
    • Locate Aboriginal and Torres Strait Islander health workers, practitioners, and liaison officers.
  2. General Health Services
    • Utilize local GP clinics, hospitals, and allied health services.
    • Partner with mental health services, substance abuse programs, and chronic disease management programs.
  3. Community and Social Services
    • Connect with local organizations providing housing, employment, education, and social support services.
  4. Partnering with Services
    • Establish strong communication and referral pathways with these services.
    • Collaborate on creating comprehensive care plans that address Jonathon’s health needs.

Providing Culturally Safe Care

  1. Respect and Empathy
    • Show respect for Jonathon’s cultural background and health beliefs.
    • Be empathetic to his experiences and preferences.
  2. Cultural Competence
    • Educate yourself about culturally appropriate practices and communication styles.
    • Ensure a welcoming and inclusive environment in your practice.
  3. Patient-Centered Care
    • Involve Jonathon in decision-making and respect his choices.
    • Tailor care plans to align with his cultural values and health goals.
  4. Building Trust
    • Be consistent, reliable, and transparent in your interactions.
    • Take time to build a trusting relationship.

Incorporating a Family-Centered Approach

  1. Involve Family in Care
    • Invite family members to participate in consultations and care planning, with Jonathon’s consent.
    • Recognize the role of family in decision-making and support.
  2. Support Networks
    • Identify key family members and support persons who can assist Jonathon in managing his health.
    • Provide information and resources to the family to help them support Jonathon effectively.
  3. Holistic Care
    • Address the health and wellbeing of the entire family, not just the individual patient.
    • Consider the social and emotional support needs of the family.

Developing Biomedical Health Literacy

  1. Education and Information
    • Provide clear, understandable information about health conditions, treatments, and preventive measures.
    • Use visual aids, pamphlets, and other resources to support understanding.
  2. Non-Judgmental Approach
    • Respect existing health beliefs and practices.
    • Offer information and alternatives without dismissing traditional beliefs.
  3. Building Skills
    • Teach Jonathon how to manage his health conditions, including medication management and lifestyle changes.
    • Encourage questions and provide opportunities for learning.
  4. Assessing Health Systems Literacy
    • Evaluate Jonathon’s understanding of how to navigate the healthcare system.
    • Provide guidance on accessing services, making appointments, and understanding healthcare rights and responsibilities.

Role as an Advocate

  1. Addressing Socioeconomic Determinants
    • Advocate for policies and programs that address social determinants of health, such as housing, education, and employment.
    • Support community initiatives aimed at improving socioeconomic conditions.
  2. Improving Healthcare Access
    • Work to reduce barriers to healthcare access for Aboriginal and Torres Strait Islander people.
    • Promote the availability and accessibility of culturally safe healthcare services.
  3. Raising Awareness
    • Educate colleagues and the broader community about the health inequities faced by Aboriginal and Torres Strait Islander people.
    • Advocate for greater cultural competence in healthcare settings.
  4. Policy and Systemic Change
    • Engage with policymakers and healthcare administrators to advocate for systemic changes that benefit Aboriginal and Torres Strait Islander communities.
    • Support efforts to improve healthcare funding, resources, and infrastructure in underserved areas.

What are your own cultural values and beliefs, and how might these impact on how you relate to or understand your patient’s values and beliefs, and therefore priorities for healthcare and wellbeing? Is there a time you can think of when someone has held a belief about health/causation of disease that was different to that of the biomedical model of disease?

How might you navigate these differences?

How might you endeavour to approach this consultation through a lens of anti-racism?

How will you respond to Jonathon’s disclosure about culturally unsafe care in previous healthcare interactions?

Reflecting on Personal Cultural Values and Beliefs

  1. Understanding Personal Values and Beliefs
    • Reflect on your own cultural background, values, and beliefs about health and wellbeing.
    • Consider how these may influence your perceptions and interactions with patients.
  2. Impact on Relating to Patients
    • Awareness of your values can help in recognizing potential biases.
    • Understanding your beliefs about healthcare can guide how you prioritize patient care.
  3. Navigating Differences
    • Be open to learning about and respecting different cultural values and beliefs.
    • Seek to understand the patient’s perspective and incorporate it into the care plan.

Encounter with Non-Biomedical Beliefs

  1. Example of Different Health Beliefs
    • A patient may believe that illness is caused by spiritual factors or imbalances in the body’s energy rather than pathogens or physiological dysfunction.
  2. Navigating Differences
    • Listen respectfully and validate the patient’s beliefs.
    • Find common ground and explain the biomedical perspective without dismissing their beliefs.
    • Suggest complementary approaches that can integrate both belief systems, if safe and appropriate.

Anti-Racism Approach in the Consultation

  1. Self-Awareness
    • Reflect on your own biases and actively work to overcome them.
    • Be aware of the systemic and institutional racism that can affect healthcare delivery.
  2. Cultural Humility
    • Approach the consultation with humility and a willingness to learn from the patient.
    • Recognize the historical and ongoing impact of racism on health disparities.
  3. Inclusive Practice
    • Ensure that your practice environment is welcoming and respectful to all cultures.
    • Use culturally appropriate language and materials.
  4. Advocacy
    • Advocate for equitable healthcare policies and practices.
    • Support initiatives that aim to reduce health disparities and promote health equity.

Responding to Jonathon’s Disclosure of Culturally Unsafe Care

  1. Acknowledgment and Validation
    • Acknowledge Jonathon’s experience and validate his feelings.
    • “I’m really sorry to hear about your past experience. It’s important for me to understand how it affected you.”
  2. Empathy and Support
    • Express empathy and support for his experience.
    • “It must have been very difficult to go through that. Your cultural identity is important, and it should be respected.”
  3. Commitment to Culturally Safe Care
    • Assure Jonathon that you are committed to providing culturally safe and respectful care.
    • “I am committed to making sure that your cultural identity is respected and that you feel safe and supported here.”
  4. Active Listening
    • Encourage Jonathon to share more about his needs and preferences for care.
    • “Can you tell me more about what would make you feel more comfortable and supported in your healthcare?”
  5. Continuous Improvement
    • Seek feedback on how you can improve the care you provide.
    • “Please let me know if there are any specific concerns or suggestions you have for us to improve your experience.”

Integrating Anti-Racism and Culturally Safe Care

  1. Education and Training
    • Participate in ongoing cultural competency and anti-racism training.
    • Stay informed about the health needs and challenges of Aboriginal and Torres Strait Islander communities.
  2. Building Relationships
    • Foster strong, trusting relationships with patients by showing respect, empathy, and understanding.
    • Collaborate with community leaders and organizations to better understand and serve the community.
  3. Holistic and Patient-Centered Care
    • Adopt a holistic approach that considers physical, emotional, social, and spiritual health.
    • Involve the patient in decision-making and respect their cultural practices and preferences.

By incorporating these approaches, you can provide care that respects Jonathon’s cultural identity, addresses his health needs, and fosters a positive, trusting relationship.

What care elements can you identify that might have been culturally unsafe for Jonathon in the past? What barriers might exist in your clinic that inhibit cultural safety?

What if this were an 18-year-old woman from an urban area? What Aboriginal and Torres Strait Islander-specific PBS or MBS items is Jonathon eligible for? What is the rationale for these population-specific measures?

What are some practical barriers to accessing healthcare services that Jonathon might have? How might you help overcome or reduce these?

Identifying Culturally Unsafe Care Elements

  1. Questioning Cultural Identity
    • Jonathon’s Aboriginal identity being questioned by a previous GP could have made him feel invalidated and disrespected.
  2. Lack of Explanation and Communication
    • The GP did not adequately explain the medication Jonathon was prescribed, leading to confusion and non-adherence.
  3. Lack of Cultural Competence
    • Insufficient understanding and respect for Jonathon’s cultural practices and values.

Barriers to Cultural Safety in the Clinic

  1. Lack of Cultural Awareness Training
    • Staff may lack training in cultural competence and sensitivity.
  2. Inadequate Representation
    • Few Aboriginal and Torres Strait Islander staff members or health workers in the clinic.
  3. Systemic Biases
    • Institutional policies and practices that do not accommodate or respect cultural differences.
  4. Communication Barriers
    • Use of medical jargon and lack of interpreters for those who speak Aboriginal languages.

Considerations for an 18-Year-Old Woman from an Urban Area

  1. Cultural Identity and Representation
    • Similar issues around questioning cultural identity or not feeling represented.
  2. Youth-Specific Needs
    • Addressing issues relevant to young adults, such as sexual health, mental health, and education on substance use.
  3. Urban Health Services
    • Potential access to a wider range of services but may still face cultural insensitivity or systemic biases.

Aboriginal and Torres Strait Islander-Specific PBS or MBS Items for Jonathon

  1. MBS Items
    • 715: Aboriginal and Torres Strait Islander Health Assessment (annual health checks).
    • 10987: Follow-up services provided by a practice nurse or registered Aboriginal Health Worker.
  2. PBS Items
    • Closing the Gap (CTG) PBS Co-payment Measure: Provides reduced-cost medications for eligible Aboriginal and Torres Strait Islander people.

Rationale for Population-Specific Measures

  1. Health Disparities
    • Address higher prevalence of chronic diseases and poorer health outcomes in Aboriginal and Torres Strait Islander communities.
  2. Access to Care
    • Improve access to culturally appropriate healthcare services and support.
  3. Preventive Health
    • Promote early detection and management of health conditions through regular health assessments.

Practical Barriers to Accessing Healthcare Services

  1. Geographic Barriers
    • Distance from healthcare facilities, especially if living in a remote area.
  2. Financial Barriers
    • Cost of healthcare services and medications.
  3. Transport
    • Limited access to reliable transportation.
  4. Cultural and Language Barriers
    • Lack of culturally competent care and language barriers.
  5. Trust and Past Experiences
    • Previous negative experiences with healthcare providers leading to distrust.

Strategies to Overcome or Reduce Barriers

  1. Telehealth Services
    • Utilize telehealth to provide access to healthcare consultations and follow-ups.
  2. Financial Support
    • Assist with applications for financial support programs, such as the CTG PBS Co-payment Measure.
  3. Transport Assistance
    • Provide information on transport services or vouchers to help with travel to appointments.
  4. Cultural Competence Training
    • Ensure all staff undergo regular cultural competence and sensitivity training.
  5. Community Engagement
    • Engage with local Aboriginal and Torres Strait Islander organizations to understand community needs and build trust.
  6. Holistic Care Approach
    • Adopt a holistic care approach that incorporates traditional practices and community support.
  7. Clear Communication
    • Use plain language and provide written information to ensure understanding of health conditions and treatments.

By implementing these strategies, you can help Jonathon and other Aboriginal and Torres Strait Islander patients access the healthcare they need in a culturally safe and supportive environment.

Are there cultural considerations you might need to respond to during examinations and procedures; for example, gender preferences (sometimes known as ‘women’s business’ or ‘men’s business’)?

How would you negotiate what is or is not acceptable to Jonathon in the consultation?

What creative solutions might you use to manage patient preferences?

Cultural Considerations During Examinations and Procedures

  1. Gender Preferences
    • Women’s Business and Men’s Business: Understand that certain health issues and consultations may be considered inappropriate for discussion with healthcare providers of the opposite gender. Respect Jonathon’s preference for a male or female healthcare provider for specific issues.
    • Cultural Sensitivity: Acknowledge and respect the cultural protocols and practices around gender-specific healthcare.
  2. Privacy and Respect
    • Modesty: Be mindful of the patient’s comfort and need for privacy during examinations and procedures.
    • Consent: Always seek explicit consent before proceeding with examinations, especially those that might be sensitive.
  3. Family and Community Involvement
    • Some patients may prefer to have family or community members present during consultations or procedures for support and guidance.

Negotiating Acceptable Practices in the Consultation

  1. Open Communication
    • Ask Directly: “Jonathon, are there any cultural or personal preferences you have regarding how we proceed with your care today?”
    • Explain Procedures: Clearly explain what each part of the consultation or examination involves, and why it is necessary.
  2. Seek Consent and Feedback
    • Permission: “Is it okay if I perform this examination? Is there anything that would make you more comfortable?”
    • Feedback: “How are you feeling about this process? Is there anything you would like me to do differently?”
  3. Collaborative Decision-Making
    • Involve Jonathon: Include Jonathon in the decision-making process about his care plan and respect his input and preferences.
    • Shared Goals: Work together to establish health goals that align with both clinical guidelines and Jonathon’s cultural values.

Creative Solutions to Manage Patient Preferences

  1. Same-Gender Healthcare Providers
    • Staff Flexibility: If possible, arrange for a male healthcare provider for Jonathon if he is more comfortable discussing certain issues with a man.
    • Referral Networks: Use a referral network to find appropriate gender-specific providers if not available within your practice.
  2. Incorporating Cultural Practices
    • Traditional Healers: If Jonathon uses traditional healers, find ways to incorporate their advice and treatments into his care plan.
    • Ceremonial Practices: Allow for the inclusion of cultural ceremonies or rituals that are important to Jonathon before or after procedures.
  3. Community and Family Support
    • Involvement: Encourage the presence of family members or community elders during consultations if Jonathon prefers.
    • Support Systems: Work with local Aboriginal and Torres Strait Islander organizations to provide additional support and resources.
  4. Flexible Appointment Scheduling
    • Convenience: Schedule appointments at times that do not conflict with Jonathon’s cultural or community obligations.
    • Telehealth Options: Offer telehealth consultations if travel to the clinic is a barrier or if Jonathon feels more comfortable in his own environment.
  5. Culturally Appropriate Educational Materials
    • Tailored Information: Provide health information and educational materials that are culturally relevant and easily understood.
    • Visual Aids: Use visual aids and resources developed in collaboration with Aboriginal and Torres Strait Islander communities.

Example Dialogue to Navigate Preferences

  • Respecting Gender Preferences: “Jonathon, some of the questions I need to ask might be sensitive. Would you feel more comfortable speaking with a male doctor? We can arrange that for you.”
  • Incorporating Traditional Practices: “I understand that traditional medicines and practices are important to you. Can you tell me more about them? We can look at how they might work alongside the treatments we recommend.”
  • Community Involvement: “Would you like to have a family member or elder present during our discussions? I want to make sure you feel fully supported and comfortable.”

By approaching the consultation with cultural humility, open communication, and a willingness to adapt, you can create a respectful and supportive environment that honors Jonathon’s cultural values and preferences.

How will you approach the issue of not knowing the previous medical history, in a culturally respectful manner?

How will you approach limitations in your cultural knowledge about Jonathon? For example, how might you find out more about his use of and access to traditional medicines?

Approaching Unknown Medical History in a Culturally Respectful Manner

  1. Acknowledgment and Empathy
    • Acknowledge Gaps: “Jonathon, I see that we don’t have all the details of your past medical history here. It’s important for us to understand your health fully so we can provide the best care.”
    • Express Understanding: “I understand that past experiences with healthcare may have been difficult. I want to make sure we address any concerns you have.”
  2. Open-Ended Questions
    • Explore History: “Can you tell me about any health issues or treatments you’ve had in the past?”
    • Medication Inquiry: “Do you remember any medications you were taking before, even if you don’t recall the names? How did you feel about taking them?”
  3. Gentle Probing
    • Timeline: “When was the last time you saw a doctor or healthcare provider? What was that visit about?”
    • Symptom Exploration: “Have you experienced any health problems recently or in the past that we should be aware of?”
  4. Building Trust
    • Safe Environment: “My goal is to make sure you feel comfortable and respected here. Please share whatever you feel is important for your health.”
    • Confidentiality Assurance: “Anything you share with me stays confidential and is only used to help support your health.”

Addressing Limitations in Cultural Knowledge

  1. Expressing Willingness to Learn
    • Admit Limitations: “Jonathon, I want to be honest that I may not know everything about your cultural practices, but I’m eager to learn and understand how we can incorporate them into your care.”
    • Invite Sharing: “Can you tell me more about any traditional medicines or practices you use? It’s important for me to understand all aspects of your health.”
  2. Open Communication
    • Cultural Practices: “Are there any cultural practices or traditional medicines that are important for you to continue while receiving medical care?”
    • Impact on Health: “How do you feel these traditional practices have impacted your health? Are there any specific benefits you’ve noticed?”
  3. Collaboration and Resources
    • Community Resources: “Are there any community resources or traditional healers you work with that we should be aware of? We can work together to ensure your care is comprehensive.”
    • Educational Materials: “I’d like to learn more about your cultural background and traditional practices. Are there any resources or people you’d recommend I speak with?”
  4. Respect and Validation
    • Respecting Practices: “I respect and value the importance of traditional medicines in your health. Let’s discuss how we can safely incorporate them with any treatments I might recommend.”
    • Validation: “Your cultural practices are an important part of who you are, and I want to make sure they’re respected and integrated into your care plan.”

Practical Steps to Enhance Cultural Knowledge

  1. Engage with Local Community
    • Community Involvement: Attend local community events and meetings to learn more about the cultural practices and healthcare needs of the community.
    • Building Relationships: Establish relationships with community leaders and elders who can provide guidance and support.
  2. Continuing Education
    • Cultural Competence Training: Participate in cultural competence and sensitivity training focused on Aboriginal and Torres Strait Islander health.
    • Resources and Research: Read literature and resources developed by Aboriginal and Torres Strait Islander people about their health practices and traditional medicines.
  3. Utilizing Health Workers
    • Collaborate with Aboriginal Health Workers: Work closely with Aboriginal and Torres Strait Islander health workers and practitioners who have deeper insights into the cultural and traditional aspects of health care.
  4. Patient-Centered Care
    • Listening and Learning: Actively listen to Jonathon’s experiences and preferences. Use his knowledge as a guide to inform your approach.
    • Respecting Autonomy: Ensure that Jonathon feels in control of his health decisions, providing information and options while respecting his choices.

By taking these steps, you can approach Jonathon’s care with cultural humility, build a trusting relationship, and provide a holistic and respectful healthcare experience that honors his cultural identity and practices.

How will you assess the severity of a patient’s illness in situations where cultural differences might change the presentation of symptoms; for example, pain?

Are you aware of the published coroners’ case reports on Aboriginal and Torres Strait Islander deaths due to misinterpretation of illness severity and systemic racism?

Do you understand the local cultural considerations for communicating with family members, and how would you approach this with the family of a patient who is critically unwell if needed?

What might you need to consider if your patient requires an urgent medical retrieval from your clinic, including in rural and remote contexts?

Assessing Severity of Illness with Cultural Considerations

  1. Understanding Cultural Expression of Symptoms
    • Pain Expression: Recognize that cultural differences may influence how patients express pain and other symptoms. Some cultures may underreport pain or discomfort due to stoicism or fear of appearing weak.
    • Observation Skills: Pay attention to non-verbal cues such as facial expressions, body language, and behavior changes that may indicate distress or discomfort.
    • Direct Inquiry: Ask specific, culturally sensitive questions about symptoms. For example, “Can you describe how you feel right now?” instead of “Are you in pain?”
  2. Using Multiple Assessment Tools
    • Pain Scales: Utilize culturally adapted pain scales or descriptive tools that may be more relatable.
    • Clinical Signs: Rely on objective clinical signs such as vital signs, physical examination findings, and diagnostic tests to supplement the patient’s description of symptoms.
  3. Coroners’ Case Reports Awareness
    • Misinterpretation Risks: Be aware of coroners’ case reports highlighting misinterpretation of illness severity in Aboriginal and Torres Strait Islander patients due to systemic racism and cultural misunderstandings.
    • Continual Learning: Stay informed about case studies and reports to understand common pitfalls and improve practice.

Local Cultural Considerations for Communicating with Family

  1. Respecting Family Dynamics
    • Elders’ Role: Acknowledge the significant role of Elders and senior family members in decision-making and communication within Aboriginal and Torres Strait Islander families.
    • Family Involvement: Ensure that communication includes key family members, as they may play a crucial role in the patient’s care and decisions.
  2. Approach to Communication
    • Sensitive Discussions: Use clear, respectful, and empathetic language when discussing the patient’s condition, especially if critically unwell.
    • Cultural Liaison: Involve an Aboriginal liaison officer or health worker if available, to facilitate communication and ensure cultural appropriateness.
    • Private Setting: Provide a private and comfortable setting for family discussions, respecting the need for privacy and confidentiality.
  3. Consent and Information Sharing
    • Informed Consent: Ensure that consent for sharing medical information with family members is obtained from the patient where possible.
    • Regular Updates: Provide regular and honest updates about the patient’s condition, treatment options, and prognosis.

Considerations for Urgent Medical Retrieval

  1. Urgent Medical Needs
    • Stabilization: Focus on stabilizing the patient’s condition before transport, using protocols for emergency care in rural and remote settings.
    • Communication: Clearly communicate with retrieval teams about the patient’s condition, treatment provided, and any cultural considerations.
  2. Coordination with Retrieval Services
    • Local Resources: Be familiar with local and regional retrieval services, including helicopter or fixed-wing air ambulance options.
    • Preparation: Prepare detailed medical documentation and ensure that the patient is ready for transfer, with necessary medications, equipment, and records.
  3. Cultural Considerations During Retrieval
    • Cultural Liaison: Arrange for an Aboriginal health worker or liaison officer to accompany the patient if possible, to provide support and advocacy.
    • Family Communication: Keep the family informed about the retrieval process and where the patient will be taken. Provide information on how they can stay in touch and support the patient.
  4. Logistical Challenges
    • Remote Challenges: Be aware of logistical challenges in remote areas, such as weather conditions, availability of transportation, and communication barriers.
    • Backup Plans: Have contingency plans in place for delays or complications during retrieval, ensuring continuity of care.

Example Approach to Assessing and Communicating

  1. Assessing Pain in a Culturally Sensitive Manner
    • Question: “Jonathon, can you tell me more about how your body feels right now? Are there any areas where you feel discomfort or pain?”
    • Non-Verbal: Observe Jonathon’s body language and facial expressions for signs of pain or distress.
  2. Engaging Family in Critical Situations
    • Family Meeting: “I’d like to invite your family members to join us in discussing your health, Jonathon. Is there someone specific you’d like to be here?”
    • Cultural Support: Involve a cultural liaison: “We have an Aboriginal health worker available who can help ensure our conversation respects your cultural needs.”
  3. Managing Urgent Retrieval
    • Emergency Coordination: “Jonathon, we need to transfer you to a larger hospital for more specialized care. I’ll arrange for an air ambulance to take you there. Is there someone you’d like us to notify?”
    • Cultural Preparation: Ensure an Aboriginal health worker can accompany or meet Jonathon at the destination: “We will make sure you have the support you need during the transfer and when you arrive at the hospital.”

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