Essay: Engaging Aboriginal Families - Recommendations For Health Professionals.

Critically reflect on the key recommendations on the best ways to engage with Aboriginal families in your future role as a health professional. Working with Aboriginal Families

Improve clinician–patient communication in Aboriginal health care.

Critically reflect on the importance of clinical and other forms of yarning to improving health outcomes for Aboriginal and Torres Strait Islander people as a future health professional

Reflect on how this policy has adversely affected the health and wellbeing of Aboriginal and Torres Strait Islander people across Australia.

Briefly explain how your understanding of this policy may affect your health practice as a future health professional.

Read chapter 6 on ‘People Centred Care’ in textbook ‘Binan Goonj’ Eckermann et.al. (2010) and reflect on how you will deliver best practice person centred care to Aboriginal and Torres Strait Islander peoples as a future health professional?

Critically reflect on the key recommendations on the best ways to engage with Aboriginal families in your future role as a health professional

Aboriginal individuals are one of those colonised human races in the world, who have a brutal and cruel history of murder, genocide, stolen children and dispossession. This brutal past has a devastating and long term impact on the society of the aboriginals; the whole view of the world in the respect of spiritual beliefs, law, land use and the ways of life have been traumatised seriously. Dawn Bessarab in his book, “Working with Aboriginal Families” has provided ways which can help an individual to understand the ways of the Aboriginal people and work better with them (Bessarab, 200). As a health professional, it would be a lot helpful for me too to gain some insight about the lifestyle and beliefs of these aboriginals so that I can treat them with equality and fairness.

The primary reason behind the ineffectiveness of intervention and obstruction in the process of communication with the Aboriginal community is the lack of knowledge about their cultural systems and also the fact that we try to impose the Western models in their lives which is very diverse than the aboriginal model (Damousi, 2013). The family values of Aboriginals is not different from their community life; therefore if the therapy provided to such aboriginals does not address their cultural values and meaning, then it would mean that the therapy is a simple continuous process of alienation from the outside world. Three main principles have been provided by the author is seemingly of great help for future health professionals like me. I acknowledge these important principles while working with the Aboriginal people; colonisation, cultural meaning and legislative history.

Through circular questioning and obtaining information from the family or individual belonging to aboriginal society will help in the making of a tool known as the Aboriginal Framework. This circular questioning would lead me to the exploration of connections and differences with others or the larger client system (Pietsch, 2013). Generally I have seen problems occurring in a circular way rather than casual or linear manner, which is why this process would be of huge convenience for me in order to understand the problems they are facing and find a solution by applying Aboriginal model instead of any Western model of culture.

Amidst such advices and methods to follow for efficient working with the Aboriginal clients, one of the recommendations that were provided in the book was that the memory of the children of their old generation through stories or other cultural task is removed then a lot of problems would cease (Moorcroft, 2016). However, keeping in mind the antipathy that is present in the mind of every people belonging to an Aboriginal society is resulted from the early legislation directly (Parker & Milroy, 2014). This kind of therapy is indirectly an implementation of Western model in the treatment of them and is not approved by me. I would not recommend any patient to re-locate from their lands and lose the memory of their ancestors or their culture.

Improve clinician-patient communication in Aboriginal health care

Successful communication is a key element in the treatment process of clinical consultation conducted between a patient and a doctor. It is probably the most problematic and a biggest barrier in my way of delivering successful health care to the Aboriginal patients. This is why clinical yarning is of so much importance; it is a patient-centred approach towards healthcare that prefers aboriginal cultural communication with the understandings of the disease and the health through biomedical views (Funston, 2013). There are evidences of cultures and researches that have supported the potentiality of this approach of clinical yarning to provide improved outcomes for the patients.

Clinical yearning as per my perception comprises of three interrelated arenas which are social yarn, diagnostic yarn and the management yarn. Clinical yarning is used to gain trust and rapport with the patients through clinical consultations (Lin, Green & Bessarab, 2016). I admit that with the Aboriginals, this is the best way to approach which is with relaxed and an open-minded way of communication. It would help me understand the patient’s issue within their life context and I will be able to communicate information in a healthy manner. This style of consultation is harmonious culturally with the ways that Aboriginals communicate; hence it is of so much convenience. Social yarn, which one of the three interrelated areas of the clinical yarn, allows the practitioner to find a common ground and lets him/her develop an interpersonal relationship with the patient (Feir, 2016). The job for us is to figure out the common ground which can be anything like sports, or family or weather and more. For instance, the people of Torres Strait Island would likely belong to coastal communities and these people would very likely place the cultural value on the oceans and thus fishing may be one of the social yarns. Since I have good interpersonal skills, I would prefer this approach of treatment for the people of Torres Strait and the Aboriginals.

The diagnostic yarn is the approach where I have to facilitate the health story of the patient while the process of interpretation of the health issue through a scientific lens. The management yarn on the other hand, is the process of employing metaphors and stories as equipments that will help my patients to understand the health issue so that an approach of collaborative management can be adopted (Pesco, 2014). If I am given the choice of approach among these three clinical yarns, I would definitely choose the social yarn as mentioned before, since it allows having the chance of sharing life experiences whilst the process of treatment and my interpersonal skills are good enough to do that. The diagnostic yarn is also favourable for me since it requires the patience of hearing the story of the patient and allowing silence as per the client’s convenience (Milroy, 2014). I have the patience and the knowledge of allowing such things as well as interpreting the issue through the lens of biomedical.

Critically reflect on the importance of clinical and other forms of yarning to improving health outcomes for Aboriginal and Torres Strait Islander people as a future health professional

From the time of 1788 to 1890s, there was no existence of any overarching policies for the Aboriginals; instead there were missionary inspired approaches which were full of neglect and full of elimination for the people of Torres Strait Island and the aboriginals (Eckermann, Dowd & Chong, 2010). It was during the year 1951 that a policy was designed known as the Assimilation policy. It was the first policy that clearly stated the equal manner of living that Aboriginal should attain as the other Australian natives. They will have the enjoyment of the same rights and privileges that they were previously ignored of. This policy was implemented for including the Aboriginal society into the white society with a destructive process of removing children from the families (Murphy, 2013). The policy was adopted by the Aborigines Protection Board and this board substantially increased the brutal practice of removing children that already existed in the then society. The children with fair skin from the Aboriginal society were termed as the “half-caste” and removed from their family to join them with the mainlanders. This policy ultimately led to the destruction of the Aboriginal society instead of improving their condition.

It was during the colonisation of the country Australia, when racism was prevalent throughout the land. The indigenous people like the residents of Torres Strait Island were compelled to live on reserves and in missions, where there was no freedom to hunt or to socialise; there were restrictions in practicing traditional ceremonies too along with the free will to marry (Wilson et al., 2015). Along this time the policy of Assimilation was introduced which turned out to be the continuation of the past atrocities and discrimination. This treatment in turn created long term effects on the psychology and the physical health of the Aboriginals. Studies have shown that this treatment still affects their lives till date; there is visible lack in behavioural development and the ongoing health issues that is still affecting their lives is due to the generations of mistreatment and discrimination. There was lack of the support through cohesive public policies and government failed to provide them with sufficient resources that would have ensured their health. As per my understanding, the reason behind the breakdown of the residents of Aboriginal communities was because the policy took their culture away from them and even then discrimination continued to strive upon them. Their rights and choices were never taken care of; they were not asked what their desire was and instead the white society imposed their decision upon them. A child being taken away from their families was traumatic for the whole community and I think it left them distressed till the present time.  

Reflect on how historical policies have adversely affected the health and wellbeing of Aboriginal and Torres Strait Islander people across Australia

Healthcare is a demanding process that is initiated in a complex health system where the prime focus is on the health condition of the patient. Therefore fundamental ways to meet the needs of the Aboriginal and Torres Strait Islander individuals are needed; among the existing ways to meet the needs of the aboriginals, my personal preference is to take a person centred approach. This approach means to looks at the patient as a whole person and it will not only allow the patients ethically to be involved directly yet it will also empower them in their care by taking in account the patient’s individual and cultural needs, beliefs and even preferences surrounding their comforts and the environment they like to reside in (Shahid et al., 2013). The central principles of Australian Safety and Quality Framework for Health Care and also the Australian Charter of Health Care Rights are aligned with the person centred approach of treatment.

When my patient’s aspects are respected and their aboriginal and Torres Strait Islander cultures are considered by me while delivering the treatment, it ensures that their holistic health and their needs are being met individually. This helps in building a trust and understanding between my patient and me. As a future health professional I am aware of the factors which contribute in the detrimental dysfunction of the patient’s health; for instance, for the people of aboriginal birth, family obligation, responsibilities and kinship are of much more significance than their own personal needs (Eckermann, Dowd & Chong, 2010). A person centred approach would make it better for the patient to understand the importance of their health and let me to continue my treatment.

In order to deliver this treatment, a good interpersonal skill is required in health professionals like me; therefore all the other future health professionals must also nurture their skills. A good exchange of communication is also required whilst treating a patient individually; since there is a difference in verbal and non-verbal communication between the main Landers and the aboriginals, there is a scope of barrier in the communication. Person centred care is hugely dependent on the communication; as a future health professional I would gather as much information about the culture and beliefs of the aboriginals and treat the individual with a diagnostic or social yarn. In the initial stage, I will patiently allow the person to talk about his/her issue and allow silences as much required. Only after building ample amount of trust, I will deliver the treatment process to the patient.  

References:

Bessarab, D. (2000). Working with Aboriginal families: A cultural approach. W Weeks & M Quinn (eds).

Damousi, J. (2013). “We are Human Beings, and have a Past”: The “Adjustment” of Migrants and the Australian Assimilation Policies of the 1950s. Australian Journal of Politics & History, 59(4), 501-516. https://doi.org/10.1111/ajph.12029

Eckermann, A. K., Dowd, T., & Chong, E. (2010). Binan Goonj: bridging cultures in Aboriginal health. Elsevier Australia.

Feir, D. L. (2016). The long?term effects of forcible assimilation policy: The case of Indian boarding schools. Canadian Journal of Economics/Revue canadienne d'economique, 49(2), 433-480. https://doi.org/10.1111/caje.12203

Funston, L. (2013). Aboriginal and Torres Strait Islander worldviews and cultural safety transforming sexual assault service provision for children and young people. International journal of environmental research and public health, 10(9), 3818-3833. https://doi.org/10.3390/ijerph10093818

Lin, I., Green, C., & Bessarab, D. (2016). ‘Yarn with me’: applying clinical yarning to improve clinician–patient communication in Aboriginal health care. Australian Journal of Primary Health, 22(5), 377-382. https://doi.org/10.1071/PY16051

Milroy, H. (2014). Understanding the lives of Aboriginal children and families. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, P. Dudgeon, H. Milroy, and R. Walker, Editors, 373-82.

Moorcroft, H. (2016). Paradigms, paradoxes and a propitious niche: Conservation and Indigenous social justice policy in Australia. Local Environment, 21(5), 591-614. https://doi.org/10.1080/13549839.2014.1000286

Murphy, J. (2013). Conditional inclusion: Aborigines and welfare rights in Australia, 1900–47. Australian Historical Studies, 44(2), 206-226. https://doi.org/10.1080/1031461X.2013.791707

Parker, R., & Milroy, H. (2014). Aboriginal and Torres Strait Islander mental health: an overview. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet, 25-38.

Pesco, D. (2014). Working With Aboriginal Children and Families: Cultural Responsiveness and Beyond. Canadian Journal of Speech-Language Pathology & Audiology, 38(2).

Pietsch, J. (2013). Immigration and refugees: punctuations in the Commonwealth policy agenda. Australian Journal of Public Administration, 72(2), 143-155. https://doi.org/10.1111/1467-8500.12017

Shahid, S., Durey, A., Bessarab, D., Aoun, S. M., & Thompson, S. C. (2013). Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. BMC health services research, 13(1), 460. https://doi.org/10.1186/1472-6963-13-460

Wilson, A. M., Magarey, A. M., Jones, M., O'Donnell, K., & Kelly, J. (2015). Attitudes and characteristics of health professionals working in Aboriginal health. Rural & Remote Health, 15(1).