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Indigenous Health

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Practices or policies those are likely to have caused trauma for Aboriginal and Torres Strait Islander peoples.

Trauma for Aboriginal and Torres Strait Islander peoples related to the invasion history, and the continuous effect of colonization resulting immense mental health problems including trauma. The practice that significantly contributed to trauma was widespread grief and loss. These involved numerous deaths involving children, infants, adolescents, women and men in their prime were unexpected, sudden and preventable, with a resultant feeling of immense trauma. The grief would extend across regions and communities through the extended families. Their financial resources and reserves of various family networks were depleted through financial costs. Another practice that caused trauma between the Aboriginal and Torres Strait Islanders was the removals of relatives. A survey indicated that some of the Aborigines reported a relative taken away or had been reported missing themselves. Most of those removed from their families were parents, grandparents, uncles or aunties. Most of the people who had been separated from their families suffered tremendous trauma (Larson et al, 2007).

Social and emotional wellbeing issues of Aboriginal and Torres Strait Islander people.

In the 21st century, there still exists persistence of several indicators of the complexity of the social and emotional well-being facing the Aboriginal and Torres Strait Islander people, as well as the inadequacy of the key services and measures in addressing these issues. Despite that significant rise in the number of the indigenous members of this community reporting psychological distress, the Aboriginal people still do not opt for mainstream services handling their social and mental well-being. In cases where they use these services, reports mostly indicate cases of chronic levels of distress, or they engage in these services for a short time. It is also evident that that Australian Aboriginal mental health sector has been largely neglected. There are inadequate and culturally inappropriate health care services, which handle the needs of the Stolen Generations. The Western psychology has, on the other hand, provided an individualistic, compartmentalized and pathological approach in relation to the maladaptive behavior, with significant emphasis on cognitive therapy, rather than on insight based therapy (Kelly et al, 2009).

Issues raised by Manning and how they can be addressed

Manning raises the issue of how the Aboriginal health pharmacies were in poor shape especially in the remote groups found in the Katherine region. This region has about 23 remote community health centers, which receive medical supplies from the Katherine hospital. Manning expressed his shock at the poor quality of the usage of various medications. Other issues included few records being in place on the outgoing supplies, lack of adequate labeling on drugs, and provision of limited information to customers on the details of the medication. Manning also reported little emphasis and effort put on drug dispensation. There are still discrepancies on the issue of no payments being paid for the dispensing costs to people working in the retail pharmacies, as well as what is paid the pharmacies responsible for supplying pharmaceutical products and services to the remote Aboriginal health centers. This issue can be solved that there has to be someone or an agency that needs to pay for the dispensing costs, be it the government institutions, Aboriginal health service, or the Aboriginal community controlled health organizations. These emerging issues can also be addressed by ensuring that the Aboriginal health services establish their own internal operations, in order to gain control over the process of pharmaceutical care. Achievement of this strategy can result to the sharing of the wealth generated from pharmaceutical services (Manning, 2010).

Indicators and initiatives of the Queensland Government for each Closing the Gap Target Area

In 2008, the Queensland Government signed a Statement of Intent, which committed the relevant parties to working in unison in order to achieve improved health status with equality, and life expectancy of the non-Aboriginal and Torres Strait Islander Australians and the Aboriginal and Torres Strait Islanders. Initiatives and indicators were established in order to achieve closing the gap targets. These initiatives or interventions include improved diagnosis, management of the diseases that make up 80% of the health gap. Health education and promotion would act to evade the risky health issues and aim at the risk factor for ineffective health outcomes. Other initiatives include early childhood development, adolescent health, maternal and child health and parenting support. Another intervention is the improvement in continuity of care and cultural capability in the whole health system, and dealing with the needs of the urban settlers and those staying in discrete communities.

Principles of cultural safety that should have been practices by the GP

• The GP should have considered his actions or prescriptions before telling JA to abide by them.

• The GP should have been empathetic and willing to understand JA’s situation of not wanting to move to another city for treatment, or when JA indicated his inability to quit smoking.

• The GP should not have assumed that JA was handling the situation well because he looked calm. JA informs him of his concerns, but he goes ahead to assume JA and proceeds to instruct him to move to Darwin for active treatment.

• The GP should have gotten to know JA’s local community and family in order to understand their concerns and opinions on JA’s case. He would have gotten to learn the role of community control and the health status of the society, in order to permit him know how to deal with JA’s situation, in a culturally safe way.

• The GP should also not have assumed that his advice is the best just because he is experienced in his field of duty. He should have been open to understand JA situation from different perspectives, which would have enabled him to make appropriate medical decisions that would work for JA and his community (Smith, 2008).

Impact on JA and his family

When JA reported to his family about his health status and the GP’s decision to refer him to another city for treatment, the family summoned the GP, but he responded that he was busy and would meet JA in Darwin. The family felt that their opinions and concerns had been ignored by the GP. This could also result to the feeling of being sidelined as a community or ethnic group. The family had to deal with the deteriorating health status of JA, on their own, without the proper healthcare facilities because they could not manage to have JA in Darwin, due to financial constraints and cultural concerns. JA had to come back to continue suffering and later died in Darwin hospital. The family could not visit him in the hospital as they did not have transport (Nguyen, 2008). The GP’s actions of assuming the concerns from his patient and his family cost the family a great deal, as they not only lost their loved one but also suffered unethical practices from the GP.

Transition and dietary influences of Aboriginal and Torres Strait Islanders

For several centuries, the Aboriginals have adopted the lifestyle of hunters and gatherers, which they continued with under different climatic and geographical conditions until the time of European colonization. They were largely omnivorous, mainly deriving their food from wild animals and plants food, which were influences by the geographical location and the season. A key indicator of the quality of meat was a high fat content. The transition to European dietary habits resulted to a decline in the communal feeding habits, which entailed the responsibility and culture of sharing food resources. The transition also resulted in the breakdown of traditionally well-defined patterns of food distribution. It also affected the most vulnerable group such as pregnant women, toddlers, elderly and breast feeding mothers. This is because the food administered to the young children was low in fat and inadequate in energy. The Aboriginal mothers were not allowed to give additional food to their children, while the extra rations were given to the pregnant mothers even though there were inadequate rations given to breast feeding women. The missions and settlement schemes also lacked regular transport, staff and equipment needed for a comprehensive, hygienic and nutritious communal feeding service. The transition to a settled, westernized lifestyle from the traditional lifestyle of hunting and gathering saw the nutrition and dietary habits of the Aboriginal and Torres Strait Islander people changing from a nutrient-dense, varied diet to an energy-dense diet with refined sugars and high fat content. This dietary practice from the contemporary world indicates the continuing influence fat characterized by high value. An impact of this continuing influence is the incorporation of different and new fats and oil in the diet. It also includes the adoption of frying as a new technique of cooking which influences the adoption of fat to meat.

Barriers likely to impact on the nutrition of urban Indigenous populations

The nutrition and dietary habits of the urban Aboriginal populations have revealed that most of them frequently consume takeaway meals more than the non-indigenous population. Another barrier that has impacted the nutrition and dietary habits of the urban Aboriginal population are the use of salt on the table, as compared to the non-indigenous, urban population.

Health issues directly related to an interaction of housing or housing infrastructure and the environment.

• General housing characteristics

• Overcrowded houses

• High housing costs relative to income

• Inadequate sanitation and water supply

• Inadequate rubbish disposal

• Flooding and ponding

• Sewerage and drainage

Impact of sea-level rise on essential services, and the health and wellbeing for Torres Strait Islanders on the Islands

The sea level rise will occur as a result of climate change impacting the Torres Strait region. Most of these effects will be related to human health of the indigenous population, who lack access to standard health care enjoyed by the non-indigenous population. The impact of the sea level rise may also cause the extinction of animals and plants that make up the traditional diets of the Torres Strait Islanders (Larson, Gilles, Howard & Coffin, 2007). Another effect can be on the intensity and spread of a wide range of diseases from water borne, vector borne and respiratory diseases. The change in rainfall and temperature trends will also worsen the control of dengue fever and other mosquito-caused diseases, with a significant rise in the tropical pests and diseases. Sea level rise will occur alongside extreme weather events such as temperature rise, which will increase the risk of impoverishment and malnutrition. This will especially influence the communities in the Torres Strait region, who rely on traditional or natural harvests from the oceans and land, and small crops. Other indirect health effect from the sea level rise may include interference of the connection of the indigenous population to the country, as well as their responsibility to water and land management (Adrienne, 2010).

Key SEWB issues associated with displacement due to climate change

The Action Plan created in 2001 led to the formation of numerous resource centres for Social and Emotional Wellbeing (SEWB) across Australia. The SEWBS aimed at establishing curricula and conduct trainings, in order to develop models for interagency cooperation and inter-sectoral linkages. The SEWBS also would plan provision of clinical services to the Torres Strait Islanders and the health care providers respectively. It would also develop information systems for improving delivery of the training materials. The SEWBs serve to bring forward and consolidate the importance and concept of social and emotional well being in relation to the affected indigenous population. They serve as a link of obtaining government funding that will improve the health status and livelihoods of the displaced indigenous population from the Torres Strait region (Urbis, Keys & Young, 2007).

Drinking among the indigenous population as compared to the non indigenous population in Australia

A survey of the Australian Institute of Health and Welfare revealed that approximately 17% of Australians consume more than 22 drinks, which also translates to over 53% of the total alcohol sales in Australia. Most of the Australian health surveys also reveal that Aboriginal and Torres Strait Islanders consume less alcohol as compared to the non-indigenous Australians. In the group that is highly at risk, i.e. the youths below the age of 24 years, more of the Aboriginal youths consume more alcohol than the young population of the non-indigenous Australians. This also applies the high-risk group apart from those above the age of 35 years, where almost twice of the indigenous population drink more alcohol than the non-indigenous population. While the Aboriginal population consumes less alcohol than the non-indigenous population, those Aborigines and Torres Strait Islanders who consume alcohol do so at hazardous levels.

Reoccurring themes in the key action areas of the National Drug Strategy

Equitable access to the training and educational opportunities, in a range of administrative and health disciplines, such as tobacco, alcohol and other drugs. This involves creating community awareness and education on understanding the impact of various drugs on people’s health.

Another theme is provision of funds through various Aboriginal organizations such as Aboriginal Health Worker (AHW) and Aboriginal Community Controlled Health (ACCH) organizations. These organizations provide training, education courses for the health workers in the alcohol, and drug related areas.

There is a need for increasing law enforcement agencies such as the authority of the community police in implementing strategies proposed by the Aboriginal communities. These law enforcement agencies also handle issues related to the control of the supply of harmful substances. There is the theme of creating protocols for the referral process from the primary health care providers to specialists in alcohol and drug services, at the local or regional levels (Nguyen, 2008).

There is a need to facilitate programs for peer education through the community leaders as well as parents, in order to promote communication on the harmful effects of alcohol and drug abuse. This is also achievable by the parents offering support to the education of their children. The theme of cultural awareness also comes up. This can be through the development of culturally appropriate processes of monitoring and evaluation, in order to assess the effectiveness and relevance of the efforts and programs on tobacco, alcohol and other drugs.

The reasons why incidences of HIV are higher amongst female Aboriginal and Torres Strait Islander Australians than the non-indigenous female population of Australia. In the period between 1999-2003, the HIV diagnosis levels among the female, Aboriginal and Torres Strait Islander were six times more than the non-indigenous Australian females. This level reduced by half between 2004 and 2008. The high number of indigenous female population diagnosed with HIV can be explained by the gendered power differentials in the risk of contracting HIV. The increase in transmission is as a result of sharing injected equipment that has been contaminated. Another reason is as a result of corollary and intoxication, whereby the Aboriginal women are not able to negotiate for safe sex. This situation is aggravated by the lack of empowerment of the Aboriginal Australian women resulting to an increase in the instances of HIV. Other cases of HIV also result from sexual abuse, which is rampant in the Aboriginal populace as judged against to the non-indigenous Australians (Mehrabadi et al, 2008).

A critique of the Condoman episodes (2-5)

The message behind the episodes is the emphasis on sex safe by using condoms in every sexual encounter, failure of which can lead to unwanted pregnancies, STIs, or even HIV and AIDS. Condoman targets the audience mainly comprising of the youth who are at the age of being sexually active and full of curiosity for experimentation (Glaskin, 2008). Most of the young do not know the importance of condoms or the risks of practicing safe sex. They need to be educated and guided by all the relevant parties in the community including their peers, friends, parents, mentors or even the coaches as illustrated in the Condoman episodes. The messages from Condoman are clearly illustrated as he explains all the educative aspects of not only using condoms, but also the importance of being safe and visiting the healthcare facilities in case of any infections or for regular checkups.

Women’s health

Reasons why Aboriginal women may have low birth weight babies.

• Insufficient weight gain during pregnancy

• Little or no antenatal care

• Cigarette smoking

• Young age

• Anemia

• Urinary infections

• High blood pressure

• Alcohol

• Diabetes and cardiovascular disease

• Illness during pregnancy

• Duration of pregnancy

Nancy’s birthing story

The principal reason why Aboriginal and Torres Strait Islander women prefer to give birth on the country is to allow the cultural rituals done during birth to take place. Therefore, it would be necessary to support these women to give birth on country by providing for essential modern day facilities and care while they are giving birth on the land. These include providing them with proper tools and equipment such as scissors, gloves, antiseptics and sanitary towels. Establishment of antenatal care that is culturally appropriate can also aid in supporting these women in giving birth safely and, at the same time, hold on to their cultural beliefs and practices. This will enable these women to give birth safely without denying the responsibilities of community members and relatives under traditional lore (Smith, 2008). The born children can also get their rightful share of traditional ownership of land when they are born on land. Giving birth on country or land is a woman’s business involving specific cultural practices and beliefs, which are strongly valued by the Aboriginal and Torres Strait Islander women. There have been reports of positive health outcomes and impacts on the Aboriginal mothers and infants, due to the provision of antenatal health care services that were culturally appropriate. These positive effects are due to the strong support accorded to the Aboriginal women by their families and communities in the period of pregnancy and during birth. It is, therefore, evident that the Aboriginal and Torres Strait Islander women need to be supported in accessing antenatal care and also get the chance of practicing their cultural and traditional practices (Couzos & Murray, 2007).

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