Australia is a first world country with a first world rating in healthcare. However, the health of Australia’s indigenous population can be compared to those living in third world countries (Rural Health Channel, 2014). The disparities in health care experienced by indigenous people is severe and occurs largely due to cultural differences, determinants of health, racism, as well as dissimilar beliefs and customs. Indigenous people often fear the judgement of seeking medical help from ‘white’ Australians and the current healthcare approaches signpost this group of the population as a minority. Primary health care (PHC) approaches need to be delivered that incorporate cultural sensitivity towards indigenous people in the hope to improve their trust with the healthcare system. As a result, indigenous patients may refuse treatment from health practitioners due to misunderstanding and lack of educational knowledge regarding healthcare. Therefore, in these contexts patients are not acting in a rude or unreasonable manner but rather a misunderstanding and lack of support towards the cultural beliefs, needs and traditions of indigenous people is not met by health practitioners.
The indigenous population of Australia generally experiences cultural-related health equity issues due to a strong sense of identity accustomed with this population group. Fatalistic beliefs, strong sense of belonging to a group and physical and biological differences hinder Aboriginal people with access to universal healthcare coverage (Li, 2017). Indigenous people follow ancient customs and therefore refusing treatment from a young female health practitioner is acceptable as the patient would be experiencing cultural mistrust and often issues with discrimination (Strong, Nielsen, Williams, Huggins & Sussex, 2015). As a result of these implications and ongoing history with inappropriate cultural stereotypes, patients of Aboriginal descent often question whether it is permissible to trust “white fella” attention (Li, 2017). Reflective of these concerns is the poor rate of health amongst Aboriginals, evident in Li’s research (2017) where men are expected to die 11.5 years younger and women 9.7 years younger than their non-indigenous peers. Li (2017), describes cultural competency as a; “set of harmonious values, principles, attitudes and policies that enable people to work effectively across cultures” (para. 7). This is necessary to improve the rates of healthcare differences between the indigenous and non-indigenous populations of Australia. The Advance Care Planning program in Singapore is an excellent representation of how Australia can model cultural competency amongst its indigenous population. This healthcare plan is guided by nurses and social workers to provide quality care and improvements amongst elderly populations. As nurses play a holistic role in healthcare, using this approach to target indigenous populations, will help to advocate for their healthcare on a broader spectrum and create empathy for those affected by disparities in healthcare. In addition, the male patient may have been approached by a healthcare practitioner that wasn’t interested in advocating for his healthcare and therefore made him feel inferior and powerless. In this circumstance refusing treatment is not regarded as being rude or unreasonable.
In addition, the indigenous male patient could be experiencing cultural shock as a result of possible treatment from a younger female health care practitioner and therefore should not be considered unreasonable and rude, (Muecke, Lenthall & Lindeman, 2011). “Cultural shock is often associated with stress, anxiety and discomfort when placed in an unfamiliar cultural environment” (Muecke, et al., 2011, p. 2). Language is one of the central components of culture and 97.5% of the indigenous population in the Northern Territory can only speak their native language (Li, 2017). Communicating with people of non-indigenous descent can cause extreme anxiety for indigenous people and can lead to experiences of confusion and misunderstanding. These cultural differences can create cultural distance between the patient and professional, leading to less co-operation and willingness from indigenous Australians to use the mainstream healthcare facilities available to them (Li, 2017). Ultimately, this results in poor health outcomes where Aboriginal people experience Disability-adjusted-life-years (DALY) rates at the level of non-indigenous 20-30 years older (Zhao, Guthridge, Magnus & Vos, 2004). Failure to communicate successfully includes the inability to understand the spoken language and also the symbolism of the hospital environment, which can have negative health consequences for Aboriginal people. Strong, et al., (2015) identifies that communication is important and can be improved by taking the time to understand the history of the indigenous people, learning to build respect for their culture, as well as developing greater bonds and trust with their patients. Wuchopperen Health Service in Cairns incorporates a teamwork approach in their Indigenous health care facilities, which includes an indigenous health worker who accompanies the patient during all visits with allied health professionals. This helps to eliminate the barrier of communication as the health worker can provide comfort and help to avoid any misunderstanding or confusion by providing support as well as ensuring all needs of the patient are being addressed and met (Rural Health Channel, 2014). This method is successful because it is culturally appropriate and eradicates the possibility of delivering cultural shock and mistrust to the patient. An adaption of this would be necessary to ensure the health needs are met in a culturally appropriate environment for the indigenous male patient.
The large gap between health of indigenous and non-indigenous populations is largely due to the social determinants of health; in particular socio-economic status (“Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report”, 2014). The indigenous male patient may have rejected the help from the young female practitioner as he was poorly educated and didn’t understand the benefits of treatment or the risks of not seeking help. Indigenous Australians with poor education are unlikely to be in excellent or good health in comparison to non-indigenous Australians (Australian Institute of Health and Welfare, 2016). Additionally, other determinants such as physical and cultural access to services may cause problems as indigenous populations do not like to leave their community groups. Adopting policies like those used in the Aboriginal Health unit at Flinders Medical Centre where liaison workers advocate for patients who are leaving their communities for the first time and remove any fears or feelings of shame (Rural Health Channel, 2014). These health workers are helpful in educating the indigenous patients about the procedures that are being done and talk with and amongst the doctors about any cultural concerns that may occur. Typically, these liaison officers are from Aboriginal descent and therefore provide comfort and feelings of cultural safety (Li, 2017). Maintaining culture-oriented communication skills allows trust to be developed between patient and professional and helps to promote health and wellbeing. Additionally, socio-economic status causes indigenous people to be economically, socially, politically and culturally disadvantaged due to the large impact it has on daily life (Li, 2017). Improving quality and consistency of public health care for indigenous patients is a core part of the Australian Government’s Close the Gap program, which needs continued support from healthcare workers and encouragement from indigenous populations. Conclusively, the male patient in this context would not appear as rude or unreasonable as he may be similarly experiencing cultural unsafety in a healthcare environment.
Systemic racism is known to reproduce avoidable and unfair health inequalities amongst indigenous population groups (Paradies, Harris & Anderson, 2008). It is evident that in healthcare, the treatment of indigenous to non-indigenous patients is comparatively different and therefore the male indigenous patient could have previously experienced negative attention from the healthcare system and therefore his “unreasonable” behaviour may be reflective of past experiences. Due to colonisation, ‘White’ Anglo-Australian cultural dominance provides power and privilege to those of this decent and often with it creates entitlement to healthcare over indigenous population groups (Durey & Thompson, 2012). This has damaging effects on healthcare for indigenous people and limits them from receiving health equity as a basic human right; therefore, the best available healthcare possible. Evidently, the current policies don’t do enough to effectively target groups that are marginalised from society and consequently greater support networks for indigenous people are needed (Durey & Thompson, 2012). As a result, patients in similar circumstances to the male patient discussed would feel marginalised while visiting health care services and so the refusal to receive treatment should not appear unreasonable or rude. Instead more policy changes are needed to eliminate these anxious and unwanted feelings for Aboriginal people, such as The NSW Aboriginal Mental Health Worker Training program. This is a great support network for indigenous people and provides an excellent platform for advocation and community trust (Aboriginal workforce in NSW Health, 2016). It aims to employ and train Aboriginal people as mental health professionals in local health districts. This helps to enhance the workforce, while supporting the individualistic needs of the Aboriginal people within their own communities. Reconsidering the current approach to Aboriginal healthcare needs by providing them with primary health care services that eliminates unfair health inequalities and are culturally acceptable is necessary.
Heritage and traditional customs play a large role in the understanding of healthcare within Aboriginal culture. For indigenous people, bush medicine is essential to their daily life, where more than a quarter indicated that they have been treated with bush medicine from their family members (McInman, 2000). Despite this, the use of bush medicine is not often shared with western doctors as fear of embarrassment and shame, as well as it being a secret only to be shared amongst Aboriginal people. Thus, indigenous people might face problems in being understood by non-indigenous doctors or themselves experience a lack understanding of healthcare due to contradictory knowledge of health care and cultural norms (McInman, 2000). Often aboriginal people experience ‘verbal and non-verbal silence in response to pain’ and due to different cultural understandings and the fear of western medicine the likelihood to report pain to the health practitioners is very low (Strong et al., 2015). In this case, the male patient could fear the hospital environment and the western medicine involved, causing him failure to be honest with his symptoms and current healthcare problems. In this circumstance, the behaviour of indigenous people in hospitals shouldn’t be regarded as rude or unreasonable but rather allowing greater acceptance is obligatory in order for the correct recording of health problems, which will allow a sensible treatment response.
In conclusion, the rate of heath care within the indigenous Australian population is very poor compared to non-indigenous Australian’s, and as a result rids this group of achieving the basic human right of healthcare. Factors discussed such as cultural differences, determinants of health, racism, as well as dissimilar beliefs and customs; create barriers that challenge the implementation of successful healthcare. Due to the nature of Aboriginal heritage and belief systems; cultural shock, cultural safety and health inequity are often experienced. It is therefore evident that indigenous people may fear the healthcare system, are unware through lack of education to use services or due to beliefs believe it is unnecessary. As a result, indigenous people have more severe rates of poor health than the rest of the Australian population. Additionally, it has been discussed that implementing culturally appropriate PHC services is vital in improving the rate of healthcare amongst these population groups as well as allowing members of their own community to encourage and support those around them. These considerations allow the conclusion to be made that the indigenous male who refused treatment from a younger female health practitioner was not being unreasonable, nor rude and instead there are a number of factors that should be deliberated before judgement.