Remote Aboriginal Communities And Their Health Issues - Coursework Example

Running head: Health impact of diabetes in remote aborigine community. Instructor: Date: Name: Introduction According to historical account, the aborigine community has lived under occupation for over 20 thousand years which is a significant human experience. The coming of Europeans well over the past 216 years unfolded a new dimension in aborigine community history (Lester, 2004). Land and community co-existence were interrupted, coupled with massacre and slaughtering to give way for foreign occupation of the arable land. In addition the intrusion brought about emergence of new diseases that were never present in that part of the continent (Lester, 2004). Some of these diseases include leprosy, cholera small pox and others that the aborigines had no immunity against them. Consequently, Aborigines lost self identity and pride as an indigenous Australian community due to the discriminatory and genocide practices that has extended up to modern times (Lester, 2004). The spirited fight for the rights of aborigine community has resulted to enactment of legislations aimed at improving livelihood of Torres Strait islander and aboriginals. One key area is the provision of improved health standards (Lester, 2004). The occurrence of cultural and social fabric degeneration can be attributed to the long historical injustices that have resulted to poor health status. Most recent statistics from Royal commission into aboriginal deaths in custody report 1991 reveal that despite aborigines comprising only 2% of the total Australian population approximately 20% aborigines are incarcerated (Lester, 2004). However, in recent time special interests for aborigines have been raised in various government departments for better housing facilities. The situation on the ground is still wanting. This highlights one of the socio-economic pressures for better sharing of individual and community issues (McMurray, 2003, pp. 76-98) Major health issues among the Aboriginal Community Immune deficiency has a devastating impact on aborigine community caused by vitamin deficiencies. This propagates recurrence of infections, continuous treatment and over reliance on health care services and practitioners. Vitamin C deficiency is among most prevalent conditions aborigine population. Alcoholism contributes to health issue problem because it has risen to acute status in the aborigine population. The alcoholics become more prone to disease infections. This situation has intervention through community service organizations. However scarcity of funding, cultural beliefs in drinking has hindered progress or success of the program (Lester, 2004). Drug addiction is another important health issue, there is rising frequency in drug addition among aboriginal communities. The most risk areas are urban centers where illicit chemical substances are abused. While in rural and remote areas, sniffing of glue and petrol among other substances are most prevalent. Studies reveal absence of established correctional or rehabilitation centers for individuals addicted to drugs (David et al, 2006). Hearing impairment is another health issue prevalent among the aborigines. Children suffer from impaired hearing which is caused by glue ear, otitis media and other infections of ears. These conditions require early diagnosis and treatment since they have a direct impact on learning opportunities of the children (David et al, 2006).In case the problems are not corrected, they will prevail up to adulthood. However because most aborigines cannot afford aids for hearing, there survival rate is greatly reduced (Lester, 2004). Hepatitis B will be considered as a health issue among aborigines because has prevalence linked to racial grouping, poverty and vulnerability to the disease (Cowley, 2002). Next health issue among aboriginal is multiple sclerosis. Although this is a new disease, reported cases in the aboriginal community are alarming yet most aborigines are not informed about it (David et al, 2006). Diabetes is a very important health issue. According to survey statistics this condition is acute among the Toress strait Islanders and aborigines. The infection rate for diabetes is higher than acceptable level. Impact to patients includes amputations, loss of vision, and kidney disease. There is high demand for machines to be used for kidney dialysis among those infected. Research on this health issue is scarce however. Welfare services reveal that workers gather most information by word of mouth when visiting the households. Poverty and lack of skilled manpower in the health sector and among the aborigine population is the major contributor risk factors on Diabetes as a heath issue (Winsome, 1998, pp. 63-70). Secondly, lack of awareness on equality to access government services, qualification for support through non-governmental or various government agencies is an impediment to indigenous communities. There is general belief among most aboriginals to established programmes in mainstream health care, they view them as having no bearing to cultural relevance or are intimidating. They don’t even recognize rehabilitation centers mend for them. Another causative factor is the racial discrimination during treatment by health care staff. Aboriginals also do not sick further service after completing initial treatment (Winsome, 1998, pp. 63-70). Generally, most of the health issues affecting the indigenous communities are for people of low socio-economic empowerment. However since 1970’s the aborigine communities have undertaken measures aimed at alleviating their livelihood through welfare and community self controlled health care services. This realization has formed the basis of owning the social problems they are faced with and strive to resolve them (Winsome, 1998, pp. 63-70). Diabetes mellitus Diabetes mellitus can be defined as a condition where the pancreas can no longer produce sufficient insulin or response to secreted insulin by cells is impaired. This results to accumulation of blood sugar since it can not be absorbed. Signs and symptoms include excessive thirst, frequent urination, hunger and lethargy. Other signs that may develop gradually are poor wound healing, infections in the urinary tract, sudden loss of weight, disease of gum and poor vision. The main treatment involves dietary changes, oral medical treatment or injection of insulin on daily basis (Valanis, 1999, pp. 313-333). There are two types of diabetes, Type 1 and Type 2. Type 1 is also referred to us juvenile onset or non-insulin dependent diabetes, where the body is in capable of producing Insulin. Type 2 diabetes is common among adults and sometimes is referred to us age-onset. Type 2 diabetes is considered to be milder due to its late onset and treatment using oral medicine and control of diet. However, in untreated and uncontrolled state Type 2 diabetes consequences are as fatal as type 1 (Valanis, 1999, pp. 313-333). Causative factors for diabetes mellitus are unknown however, environmental and hereditary factors are involved. Type1 diabetes is a condition where body’s immune system is believed to be triggered possibly by an agent like microorganism or a virus which result to destruction of pancreas cells which are responsible for insulin production. This is different from type 2 where obesity, age and family history play role (Valanis, 1999, pp. 313-333). Typical individuals at high risk in population are those who are obese, family history of diabetic members, those who belong to ethnic group that are at high risk, high blood pressure, those diagnosed with diabetes during gestation and baby delivery weight more than 4 kilogram’s, increased cholesterol lipoprotein density levels equal or less than 35mg/dl and equal or greater than 250mg/dl triglyceride levels (Valanis, 1999, pp. 313-333). Chronic status of diabetes mellitus requires lifestyle and life long change in behaviour. It is management is better approached by empowering patient to manage the condition successfully. In nursing intervention involves organization, coordination, and developing a health care plan in all health disciplines aimed at providing education, care and promotion of the patient’s livelihood (Wise & Signal, 2000). Why Diabetes Mellitus is a major health issue. The main reason for choosing diabetes mellitus among the other health issues is the socioeconomic impact of diabetes mellitus which can be described as a devastating problem to healthcare systems. Diabetes has been recognized as a public concern worldwide. According to survey, mortality rates in northern territory for Diabetes mellitus has been increasing since 1977 to 2001.Consequently, the gap between death rates of total Australian population and indigenous is getting wider for the common chronic conditions (Thomas et al, 2006). Australian bureau of statistics provides important epidemiological data to justify the socio economic impact of diabetes mellitus in aborigine community. According to statistical report from Australian bureau of statistics for Torres strait Islanders and Aborigine population, 6% or six out of 100 are diagnosed with long term elevated blood glucose levels or diabetic (ABS). Diabetic condition is high in remote indigenous population in comparison to non-remote regions (fig.1.) (Source: Australian Bureau of statistics 2004-05 in Thomas et al, 2007). The rate increased blood sugar levels among female and male members of the aborigine and Torres Islanders population is 7% to 5% consecutively. According to the report 10% of diabetic females live in remote areas, this percentage is almost double for those living in non-remote areas at 6%. The pattern is almost similar to males with non-remote having 4% and remote 8% (Wise & Signal, 2000). Diabetes comparison among different age groups and levels of income show prevalence that increases us individuals advance in age and low incomes. Among the indigenous population aged 65 years and above, 36% are determined to have high blood sugar or diabetes. However the pattern is different within the range of age between 0 to 24 years with only 1% being positive, fig. 2 (ABS 2004-05. in Thomas et al, 2007). (Source: Australian Bureau of statistics 2004-05 in Thomas et al, 2007). The main diagnosis test performed to screen for diabetes mellitus are, testing of blood for glucose levels form the primary test, followed by subsequent tests to define the Type of diabetes. There are four major screening tests conducted, most of them are random tests for blood sugar, test for fasting glucose levels, test for Hemoglobin AIC, and Oral test for glucose tolerance which is more common. This is performed routinely during 24 and 28 weeks for screening gestational diabetes (Valanis, 1999, pp. 313-333). Treatment of diabetes mellitus is majorly by lifestyle change, diet, exercise and maintaining of required weight are basic management and control. However if they fail then, medications are basically dependent on Insulin injection mainly for Type 1 and to some extend Type 2. There are alternate drugs for treating Type 2 diabetes like sulfonylurea, meglitinides, biguanides, thiazolidinediones, alpha-glucose inhibitors and drug combinations. Control of glycaemic condition is viewed as a main intervention; however the difference in ethnic orientation is to the disadvantage of aboriginal population because of poor control of glycaemia (Thomas et al, 2007). Examination of response to similar treatment and management practices among Caucasian and indigenous patients lead to general consensus that risk factors manifest varying patterns especially in microvascular diseases, levels of lipids, control of blood pressure. According to National Evaluation of frequency of renal impairment, the patterns show increased complication for indigenous population (Thomas et al, 2007). (Source: Australian Bureau of statistics 2004-05. in Thomas et al, 2007) There is a difference in developing diabetes and ethnic orientation (Thomas et al 2007). Indigenous and non-indigenous patients display different patterns of causative factors for diabetic condition. Intervention in Indigenous communities to stop smoking and management of glycaemic condition remain a major target. Therefore, aborigine as an ethnic group is a major risk factor for development of macrovascular and microvascular disease. This will help healthcare practitioners in ascertaining patients who require multifactorial consideration in intervention (Valanis, 1999, pp. 313-333). Nursing intervention plan. The rationale for intervention plan is to improve, facilitate practices and intervention strategies, and commit stakeholders at all levels in the healthcare provision in order to give remote aborigine community a better and longer life. Consequently, the intervention plan is to assist in successful implementation of multifactorial, partnership and community based participation of the indigenous individuals (Winsome, 1993, pp. 73-78). This is in respect to Jakarta declaration and Bangkok charter on health issues. In addition, Alma Ata declaration which outlined principles for universal accessible primary health care plan is divided into social-cultural, behavioral and lifestyle, medical, cost effectiveness, and risk safety management (Winsome, 1993, pp. 73-78). Table 1 displays the identified strategies, and for each strategy that addresses a specific need, there are actions and activity or resource to be applied. Eventually, the plan is assessed of the results of intervention as outcomes to evaluate the success of the plan (Ewles, 2003, pp.231-250). The guiding principles for setting up intervention plan are based on strengths of aborigine community. The primary health care plan has characteristics of being flexible and easily revised depending on the dynamics of causative factors of diabetes, community driven, competent in handling cultural and socio-economic issues with measurable variables within the aborigine community on the escalating mortality rates caused by diabetes mellitus (Winsome, 1993, pp 73-78). Table1. Is a model of health care plan based on nursing intervention strategies in line with Bangkok and Jakarta charter. Health strategy Aim & rationale Resources for Implementation Challenges & Outcomes Evaluation plan Environmental strategy To identify, environmental contributors to prevalence of Diabetes and necessary actions to taken. Tackling poverty and improvement of living status of aboriginal community limits causative factors on diet and associated factors Enhanced quality of life in remote aboriginal communities through provincial governments, federal government departments and aboriginal organizations. Reflective issues in the socio-economic aspects like accessibility, affordability, frequency, and cultural sensitivity to diabetes treatment. Chronic inflammation, genetic predisposition and reduced birth weight pose major challenge on diabetes care Frequent review of time and dosage injections in correlation with activities, meals and bedtime as per patient’s insulin regimen, and giving instruction to the patient on the importance of accurate preparation of insulin and timing of meals to avoid occurrence of hypoglycemic conditions. Cultural, social and community strengthening. To establish the interrelationships in social and community activities that predisposes aborigines to Diabetes. The non-compliance to treatment measures due to beliefs, race and cultural system The intervention that is approved and designed for multidisciplinary service. This brings awareness among aborigines to understand and own consequences of Diabetes mellitus and possible remedy. Improved awareness through sharing and collaboration of information. Reducing isolation in remote groups and increasing knowledge on important practices. patient compliance to prescribed therapies, dietary modifications, and lifestyle bring disparity in management and treatment Emphasize on exercising as a major contributor to weight loss. Advising patient to check blood sugar before extraneous exercise session and consumption of carbohydrates snacks before exercise to avoid hypoglycemic situations. Vocational and Educational training strategies. This aims to emphasize focus on dissemination of information on diabetes mellitus to provide early diagnosis and management. In addition to building personal and public policy. Education and appropriate guiding and counseling will empower the aborigine community about diabetes control which then will and lessen dependence on health care providers. Initiation of collaboration both from outside and within government by creation of horizontal linkages Regular diagnosis of patients for signs and symptoms. Behavioral and medical strategy. To establish quick and viable provision of primary health care and also determination of psychological status of individuals to adhere to treatment regiment. The availability of competent health care personnel and social workers. The government and federal states should place diabetes mellitus as a devastating condition that requires immediate solution. Mainly by advising patient on the importance of dietary planning to reduce weight and assistance to comply with the lifestyle change. Assessment of patients for sensory or cognition disorders that may hinder ability to administer accurately insulin injections. Explanation and demonstration of the insulin injection procedure in order for the patients to master the technique. Maintenance of skin integrity through protection of feet breakdown. Avoid smoking or stopping the habit which is the main cause of vasoconstriction and advice patient to enhance flow of peripheral blood. Adapted based on: Promoting health a practical guide about helping people to learn (Ewles, 2003, pp.231-250). According to Bangkok charter, health should be viewed on a broad and global perspective and that member states of world health organization have goodwill to initiate implementation programmes and set policies that opens avenues to implement health activities in a partnership with private sector, civil society and communities, health promotion to be a key government function and central in setting of development agenda. Similarly, the Jakarta declaration which was first to be held in a developing country stated that health is a basic human right and a key investment that is important in economic and social development (WHO International conference, 1997). The aim of the declaration was to increase life expectancy by limiting the gap between developed and developing countries through health promotion policies geared towards the new millennium (WHO International conference, 1997). Health care Plan Strategies and resources Self-determination and empowerment is an important strategy. The principle behind this strategy is to educate aborigines on implementation, development and ownership of their problems which will en able them to initiate suitable interventions to improve health (Winsome, 1998, pp. 63-70). Alternatively, a holistic approach strategy can be employed to sensitize the aborigines to have reflection on their diversity in cultural, economic status, political, gender, spiritual and lifestyles (Wass, 2002). The next strategy is called continuum care. This is a crucial strategy that emphasizes on the recognition of interventions in health care system that will cross the whole continuum lifespan and care of the aborigines. The concepts behind this model advocates for, preventive health care, promotion of health education, early diagnosis and intervention of patients, quality clinical care, proper management and treatment of infections and conducting follow-ups (Valanis, 1999, pp. 313-333). The fourth strategy is the integrated approach which is based on building collaborations and partnerships in the health care management with other related sectors like education and correctional services (Winsome, 1993, pp. 73-78). This strategy is closely linked to the Partnership approach that involves all the structures of government, common wealth, territory, states local governments, private sector, main stream health care and community controlled groups. The overall accomplishment of these strategies is achieved at the level of planning, policy formulation, and allocation of resources and partnerships programmes in health (Wise & Signal, 2000). Challenges, outcomes, and possible solutions to social and health issues. The hall mark of aborigine community social problems is the poverty cycle which was created by loss of access to bush medicine and traditional lands. Similarly, the aborigines lack cultural identity, independence, suffers from racial discrimination, and education system that lacks institutionalization of children and language. The mortality rate of aborigines is always on the higher side with life expectancy low of 52.7 years in comparison to 75 years of Australian general population (Dixon, 1989, pp. 82-89) Cultural deprivation is another major contributor to various medical conditions that professionals in medical field can not discern. It is hard to diagnose such conditions through application of western medical intervention principles (Dixon, 1989, pp. 82-89). For example, some of the most common social issues identified in this essay that has direct cause to cultural disintegration are psychiatric and mental disorders, drug abuse and addiction. In addition, environmental problems have immensely contributed to health issues among indigenous community through pesticide sprays and chemical dumping in the rural areas (McMurray, 2003, pp. 76-98). This incidences result to aborigines’ kidney, skin and neurological disorders. It is also very important to note that most aborigine community use English only as the second language. This is a challenge to service provision by mainstream programme developers. Therefore, communication barrier in English is an addition to the long list of problems that aborigines encounter. Learning hurdles directly linked to lack of cultural irrelevance of education system illustrates lack of proper avenue to address aborigine needs. Secondly, most indigenous communities who have immigrated to urban centers find themselves living in deplorable conditions that render their access to proper health care provision impossible because they are unemployment and mostly depend on unemployment benefits and social security (McMurray, 2003, pp. 76-98). Under such conditions intervention through maintenance and rehabilitation aids becomes impossible to reach this group. Subsequently, rehabilitation and health services available practically lack enough support from relevant authorities. This essay established need for urgent and sufficient health management programme to improve the standard of living in indigenous households to acceptable and equitable levels in the general the population of Australia (McMurray, 2003, pp. 76-98). Findings and further research Most of health issues are interconnected and therefore difficult to discern possible causative factors precisely. Secondly, different tiers in the health and social issues need to be addressed through governance and capacity building in diabetes mellitus, cost of living for the aborigines needs to be alleviated, and more information is required to address permeating issues like economic and social development, housing and education. More efforts need to be directed to recognition and solving of the differences in strengths among the aborigine community (Saunders, 2000, pp. 157-172). Another area that requires more research is the existence of diversity among aboriginal living status. Intervention plans that recognize society issues based on gender, political beliefs, religion or spiritual beliefs and to some extend the different living locations and lifestyle of the aborigine community may have a greater impact on the provision of necessary health care services. This is because the health issues of aborigine community encompass political, historical, cultural, economic, community and social contexts (Saunders, 2000, pp. 157-172). Conclusion Diabetes mellitus has been identified as an important factor affecting social and economic progress for Torres Islanders and Aborigine communities living in the remote areas. This essay has established that health care plan and intervention should be comprehensive and preventive at primary health care level through opening up of avenues that will facilitate access to mainstream and local health care services. In addition, Prior considerations of hindrance factors like psychological or physical capabilities, gender orientation, and uphold to cultural traditions is required in designing frame work for social and health well being (Wise & Signal, 2000). Secondly, collaboration, flexibility, and efficiency of intervention plan needs to be adjusted to outcomes in order to improve health of aborigines by drawing partnership and sustainability among the indigenous community or family, non-governmental, private sector, and government health care or related services. These initiatives should be based on evidence, this will help in designing and formulating knowledge and skills that can be shared and easy to be evaluated based on the results of the outcomes (Saunders, 2000, pp. 157-172). References Australian Bureau of statistics (2009). Diabetes in the Aboriginal and Torres Strait Islander population, 2004-05. Online version http://www.abs.gov.au/AUSSTATS/abs@.nsf/webpages/statistics?opendocument Cowley, S. (2002). Public health in policy and practice: a sourcebook for health visitors and community nurses. Ed. Dalziel, Y.Community development as a public health function.Edinburgh. Bailliere Tindal. 217-238. David, P. T., John, R. 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