Activities on Aborigine Community Health Care System - Case Study Example

Running Head: Activities on Aborigine community health care system. Institution: Module: Name: Date: Abstract Australian Aboriginal community health status is still poor according to documented records despite numerous interventions, research and policy formulations. Binang Goonj works in the book Bridging Cultures in Aboriginal Health analyzed the practices and processes in a way to explain the current status of health among the Aborigines. In addition, Binang Goonj’s second edition book provides guideline on practical strategies with the objective of redressing the existing situation. Activities in this paper outline challenges facing Aborigines in examination of cultural relativity, community empowerment, and ownership of values which can bring change to the current health care issues against the past colonization complexities (Eckermann et al, 2006, pp.177-196). Activity One. South Australians in 2008 are still faced with challenges of the past racism and colonialism impacts meted out almost 170 years ago. This includes displacements and land ownership issues, disadvantaged families and communities as a result of cultural distortion which should be addressed by the commonwealth administrations (Eckermann, 2006). Eckermann (p.2) described cultural dynamism within individual and environmental context. Eckermann suggested this process to be the best approach to analyze colonization in terms of time and changes in cultural values in relation to social, historical, economic, and political environments (Eckermann, 2006, pp. 63-82). The second process is by understanding principles of colonization in academic approach context. This approach generated a lot of criticism especially from aborigines who value self identity in terms of land, culture, language and lore as the pillars. The third process is the principle of adaptation, which states that aboriginal identity evolved through adaptation of culture for over 40,000 years. Through adaptation they acquired special religious, social, economic, and cultural way of life (Eckermann et al, 2006). The events drastically changed by 1788 when Australia was discovered, which is actually the polite way of defining colonization by Europeans. The European culture and aborigine culture interaction resulted to conflict, direct clash and cultural shock as a result of their diverse environmental backgrounds with different adaptation processes (Eckermann, 2006, 63-82). Culture clash is the incompatibility of people due to their differences in cultures. In addition, cultures can have conflicts if people from different culture fail to adapt or integrate to each other. In instances like those presented in Eckermann’s book (Eckermann, 2006), if one culture becomes more powerful than the other, then the superior culture imposes philosophies and principles to the inferior culture through processes of legislation or violence. This process of imposing foreign principles and ideologies is what amounts to colonization (Eckermann, 2006, 63-82). Colonisation processes and principles have caused adverse effects on restructuring strategies and programs to improve health care service to Australian indigenous communities up to present time. The effects can be outlined as follows, 1. Intellectual and scientific beliefs affected cultural evaluation differences. 2. Colonization resulted to cultural interaction and contact which requires specific concepts and terms to resolve resultant conflicts. 3. Present day legacies associated with emotional and social disease characterizes society values to the past practices and policies (Eckermann, 2006, p.1). Activity two. At present there still exist impacts of external agents of a condemnatory society and oppressive legislation on identity, cultural and personal worthiness of Indigenous Australians today. For example lack of cultural awareness by foreigners created a cultural gap defined in Eckermann et al (p.20) as cross-cultural interactions. This gap is prevalent even at present and comprises, ambiguous tolerance, capacity of misjudgment and empathy against the Aborigines. Cultural irrelevance is the main cause of unfair equality across cultures and the need for government to formulate strategies that accepts different cultural adaptations in terms of socio-economic, historical, political and natural environments (Eckermann, 2006, p.11). The intellectual capability, worthiness and civility of indigenous Australian societies and their cultures as depicted by scientific racist proponents and colonialists are still being misjudged based on historical accounts to be inferior. Although the Aborigines have competence in making concrete thoughts, they could not make generalizations, abstractions and perform analytical thoughts in terms of customs, reasoning, and norms imposed by European modes of reasoning and formal logic (Eckermann, 2006, p.). The misconceptions, negative values and attitudes formed about indigenous aboriginal communities were modeled on the scientific thought concept. It is true that in current contemporary society, there is persistence of similar stereotypes who continue to propagate marginalization of aborigine communities (Eckermann, 2006, p.). To illustrate this claim, there were no records of collected data on aboriginal epidemiology before 1970, the main reason was the believe that the indigenous communities culture was inferior and were dying out due to curiosity than any social or health issues. For example, aborigines immigrants to urban cities remain confined to areas with no service structures, this state is similar to those living in remote areas (Eckermann, 2006, p.). Subsequently, health statistic surveys reveal that diabetes death rate in Perth outer urban areas is eight times more than the whole state for aborigines aged between 45 to 64 years. The rates are almost 20 times more compared to the entire state records. One reason in defense of this disparity could be due to the education system which is unfavorable to aborigine culture, for example the word health don not exist in the language spoken by the aborigines. However, Eckermann blames this on historical, political and bureaucratic systems, which created power imbalances and the view survival of aboriginal culture through misconception that it is no longer relevant (Eckermann, 2006). Activity three. Cultural Safety and primary Health Care approaches are essential delivery tools to enable effective health care delivery for Indigenous Australians across the life span. According to foundations of Ottawa health promotion charter (1986), it requires a complete state of mental, social and physical wellbeing of individuals to be realized and identified in every aspiration to serve community. These aspects need be adjusted to change and adhere to environmental needs of the Aborigines (Eckermann et al, pp. 63-82). These is achieved by creation of fundamentally improving living standards of by creating balance and ping the aborigines on the aspects of income, peace, food, social justice, shelter, sustainable resources and equity. Primary health care inequality has been manifested as one of the main source of cross-cultural problems on racist and humanitarian ethos (Eckermann et al, 2006, pp. 177-196) Therefore appreciation and understanding difference culture without owning their beliefs and cultural values is the right avenue for enhancing communication through acceptance and establishment of trust (Eckermann et al, 2006, pp.103-145). Government agencies and health care providers need to be prepared to meet the needs of aborigines and understanding of their difference in culture to reduce chances of conflict, and create cooperation (Eckermann et al, 2006). From 1967, there have been marked changes and measures on provision of health care services incorporating values and affairs of aborigines. The health care system currently focuses on cultural diversities and equity of the Australian nationals, this is one example of appropriate culturally based primary health care actions. The 1978 Alma Ata policy on primary health promotion and health care delivery based on community involvement models. Motivation and promotion of community governance and self determination has empowered Aboriginal community ownership and control of the health care system (Eckermann et al, 2006, pp.103-145). Activity Four The process of primary health care and self-determination is supported by empowerment. However, there exist individual and structural forces which can impede empowerment processes. These forces prevent effective and appropriate delivery of health care services to Indigenous Australians (Eckermann et al, 2006, pp. 177-196) Aborigine’s participation in Primary healthcare systems and Self-determination is the main objective to counter this barrier. The two approaches have a perspective of recognizing the formal rights of indigenous community. Self-determination within the nation’s wellbeing is achieved through enhanced participation in political activities by Torres Islander and aborigines (Eckermann et al, 2006, pp. 177-196) Australian continent colonialist found indigenous communities with an existing legal, political and social system in place entirely. However, the indigenous communities never had a chance to participate in nation-building activities. The need for renegotiation of this relationship is the highest agenda of the Aborigines aspirations to create vital balance that can be defined as self-determination (Eckermann et al, 2006, pp. 1-62). Self-determination is not secession as reflected unfairly to indigenous communities’ aspirations. It is the foundation of involvement in decision making that has to be negotiated by the Australian Central Government in order to enhance national cohesion and unity. In addition, it is a reflection definition of participation in decision making and autonomy for owning responsibilities by aborigines in programs and services to be delivered. This wholesome recognition is what encompasses right of exercise, responsibility, authority and freedom in economic driving forces of the nation (Eckermann et al, 2006, pp. 1-62). According to economic, political, cultural, social and civil rights international covenants in the United Nations human rights, self determination is principally fundamental. In recent Australian Government structure, there exist self-determination models for indigenous communities in form of Aboriginal Councils and Torres Strait system. However, limited existence of stereotype and Cartesian reductionist line of thoughts prevent publication of information that defines actual rural health problems in scientific manuals due to organizational hierarchy structure that has less decision makers at community level (Eckermann et al, 2006). Consequently, the interface of cross-cultures creates barriers reminiscent of obstacles caused by historical structure in society. The obstacles can be identified as follows, 1. Institutionalized health care system that does not account for isolated issues related to community, personal and family care. 2. Colonialism history, institutional and scientific racism recreated through dependency, negative legislation and minority anxiety. 3. There are incidences demanding professional structures which eventually override or overshadow personal needs of clients and to care givers as well(Eckermann et al, 2006). 4. The biomedical model of health care concept has philosophy which focuses on curative instead of holistic approach. 5. The unspoken paradigms of individualistic health service delivery that is traditional to Australian and other developed nations (Eckermann et al, 2006). Activity Five Culture shock is the occurrence of incidence or perception of one culture being inappropriate. This perception then generates feelings of uneasiness and stress among the foreign or affected persons (Eckermann et al, 2006, p.4). Alternatively, it can be described as the occurrences where habits that are well established suddenly become incompetent to fulfill expected consequences (Eckermann et al, 2006, p.4). Cultural shock is manifested through stressors which include 1. Difference in communication style is the key stressor resulting to cultural shock. Physical characteristics in body language, voice tone, and undesirable behaviour is characteristic of both non-verbal and verbal difference in communication. Communication stressor in healthcare requires adherence to, conventions and rules, nonverbal and verbal, acceptable etiquette and behaviour (Eckermann et al, 2006, pp.103-145). 2. Mechanical differences are notable between aborigines and non-indigenous communities in terms of household items, power, telephone, Gas, movies, and electricity.3. Isolation this stressor is characterized by professional, cultural and social isolation.4. Customs contribute a major cultural shock stressor on beliefs about death, birth, and disharmony. 5. Attitudes and beliefs involve, respect for aborigine beliefs and health intervention strategies (Eckermann et al, 2006, pp.63-82). Cultural shock in health care system consists of.... phases...., 1. Honey moon phase, involves fascination and excitement to new challenges encountered. 2. Conflict phase causes disenchantment of habits and values to those of local beliefs and attitudes. 3. The third phase is the harmony phase where behaviour patterns start to function in harmony effectively due to change and compliance to environment through resolution (Eckermann et al, 2006, pp.63-82). 4. This phase is the functional stage where cross cultures work appropriately in unity. 5. Transition phase is the complete adaptation to new beliefs and lifestyle that no thoughts of returning back to previous culture and is associated with resentment or distance from environmental work (Eckermann et al, 2006, pp.63-82). Activity 6 Cultural vitality is defined as the resistance to change, continuation and maintenance of cultural values, practices, and ways of life. However, the description omits elements of struggle, aspirations and insistence which are central to vitality. The general agreement is on how spirit and emotional strength defines the struggle and aspirations to maintain self identity and at the same time adapting to new environmental challenges in addition to passing of distinctive practices, cultural values and ways of life (Eckermann et al, 2006, p.84). Colonisation brought interaction of foreign culture with non-aboriginals. As a result of this interaction the notion of culture continuum resulted to erosion of aboriginal values and ways of life. This is blamed on sharing of environmental influences that affected aboriginal lives and adaptations (Eckermann et al, 2006, p.85). Examples of cultural vitality are outlined through processes in the framework of decision-making, reciprocation patterns, family organization, identity and spirituality among the urban or rural Australian aborigines (Eckermann et al, 2006, p.85). The Case study points to land ownership and self identity as the central issues for the struggles and aspirations among the aborigine community. During colonisation there was struggle to defend land rights however Aborigines were aggrieved when they lost due to sophistication and superiority of the foreigners (Eckermann et al, 2006, p. 97). The gurindji struggle is one recipe for persistent struggles on cultural vitality and prior ownership recognition (Eckermann et al, 2006, p. 97) it is notable from the case study that elements of prejudice exist among communities, perseverance and the strengthening clamour for land claims show how effective cultural vitality has helped the aborigines (Eckermann et al, 2006, p. 99). Cultural vitality in the group encountered challenging elements and forces (Eckermann et al, 2006, p.100), however, aborigine’s perseverance and self realization to strive and achieve cultural vitality had override over the little material gain in the struggles in this case study. Aboriginal recognition rekindled negotiation which enabled them to hold rights of certain crown land areas (Eckermann et al, 2006, p. 101). The Aborigines held a general belief that land rights, self determination and cultural vitality have direct link and cannot be dissociated from health (Eckermann et al, 2006, p.150). Cultural vitality elements as depicted in the case study are for example the incidence where revelations of the language group non existence shocked the cultural heritage and local community were shocked. Secondly, the group learned that land actually belonged to their western neighbours and they were not recognized (Eckermann et al, 2006). The third element is the revelation that the name given by the group refers to vomit in the foreign language. These elements resulted to acts of outrage by the Aborigine group who called for a meeting and conducted reflections of their past history based on the slogan ‘Our past is our future’ through discussion of historical boundaries. According to the case study the group developed a memorandum which was then presented to the regional land council. In addition, the group organized a protest by blocking of the pipeline (Eckermann et al, 2006, pp. 83-102). Consequently, despite lack of funds, the committee managed to conduct interviews with elderly members of the community in the region to establish historical oral and archival records which offer relevant literature. This was compiled into a connection report on the historical ownership of the land for generations. In addition, a series of children folklore and curriculum was designed based on aboriginal studies that recognize language and culture. These are alternative elements to secure future generations’ struggle which connects present to the past (Eckermann et al, 2006, p.100). The government acceptance of reconnection report was preceded with series of federal court hearing that bore little achievement. The dispute with another group, their southern neigbours prevented the scheduled handing over ceremony and indeed the land despite early agreement (Eckermann et al, 2006, p 100). On this account harmony and reconciliation had to take and alternative approach through the model of cultural safety. Cultural safety is the recognition of aborigines, beliefs and cultural values from their perspective point especially in terms of health through the holistic nature (Eckermann et al, 2006, p 100). The model provides the necessary tools for Primary health care system and dismantles power imbalance through recognition of safety of environment in order to facilitate service provision through consideration of patients, ethical, physical and legal safety. Cultural safety is the actual recognition by health care system of the needs of aborigines in terms of their preferred ways, language, attitudes, customs, culture and beliefs (Eckermann et al, 2006, p 100). Activity Seven The aborigine culture recognizes verbal words and unspoken expression. This difference in linguistics creates mistrust and friction. This can only be resolved by recognition of local etiquette to avoid offence of community or generation of misunderstandings. The daily confrontation in hospital emergency and accident departments are compounded with cultural insensitivity, miscommunication, poor diagnosis and assessments which result to fear and trauma through non-verbal and verbal differences in communication which cause confusion and sense of powerlessness and inferiority (Eckermann et al, 2006, pp.103-145). The cross-culture interactions sometimes result to poor delivery due to lack of understanding of different cultures and poor communication channels. For example, there is a direct confrontation of indigenous traditional healing sense and the western type of advanced technology, expertise and safety of healthcare systems (Eckermann et al, 2006, pp.103-145). Subsequently, Aborigines still view large buildings and hospitals and associated them to past bad experiences like police interrogation centers which makes the community welfare opting to take their children away. The governments need to urgently initiate rural mobile and outreach programs as a strategy to ease accessibility problem and lay foundation of proper communication and education programs. This strategy need to involve local communities for successful implementation which builds trust and relationship with health care providers (Eckermann et al, 2006, pp.103-145). Psychological isolation and fear is profound among aborigines that prevent patient’s active advocacy of their needs in the healthcare system. The perceived negative or racist attitude from hospital staff predisposes unprecedented illness caused by fear to open up to healthcare workers and seek explanation or request for healthcare services (Eckermann et al, 2006). The doctor-patient interactions can be fostered through acknowledgement of relationship concept which complies with western medical framework of appropriateness of cultural interaction model. National rural health alliance has a mission to promote accessibility, quality and necessary provision of high standard health care in remote rural areas through partnership of healthcare providers and consumers. In addition, cultural safety model which recognizes communication as a two way process should be considered as a vital tool in a holistic approach (Eckermann et al, 2006, p 147). Activity Eight: In 1990, the Australian Federal Government announcement of a fair go policy aimed at investigation of rural life aspects through seminars, conferences, and workshops. This resulted to various expert consultations and taskforces being set up which include, National Rural Health Alliance, National Health Strategy, Rural incentives program and Rural Health Support Training and Education programs(Eckermann et al, 2006). Organizations like Reconciliation SA, Aboriginal Alliance Coalition Movement, Link up, Nunkuwarrin and Tandanya are emerging to address community based healing, reconciliation and focus of the future needs. However, the reality of the tasks is far from being achieved due to historical injustices like discriminatory acts, removal, dispossession, and dispersal of indigenous communities (Eckermann et al, 2006). The Government legislated Aboriginal and Torres Islander Heritage Act 1984 and Racial Discrimination Act 1975 as a measure that would support other initiatives aimed at reconciliation and respect for Aborigine human rights. Despite all these efforts, statistical data reveal less progress on socio-economic status in terms of improved standards of living, life expectancy, and access to essential services that other Australians enjoy(Eckermann et al, 2006). The existing gap keeps widening and is a major impediment to reconciliation efforts until equal citizenry rights and equity is balanced. Recognition of Aboriginal and Torres Islander aspiration to redeem communal values and self identity as the true Australian natives is of vital importance in reconciliation initiatives. Strategies and objectives of Aboriginal and Torres Islander are geared towards, 1.Heritage, culture and land, 2.Equality, and social justice, 3. Political participation and self-determination, 4. Reforms of legislative acts and constitutional rights, 5. Community awareness and Education (Eckermann et al, 2006). Problems facing Aboriginal Community are rural health accessibility, this can be attributed to 1. The depressed rural economics surrounded with high unemployment, property repossession by banks and family breakdown.2.The occurrence of disease is a high burden on already collapsed rural economy. This result to lower life expectancy compared to non-indigenous Australians. 3. Accessibility to essential medical services correlates to poor service delivery like health promotion, diabetic services, mental health, antenatal care, baby care, sexually transmitted diseases and women’s health (Eckermann et al, 2006). Conclusion In summary Binan Goonj focuses on well elaborated remedies to problems facing indigenous Australian communities through case studies and narrations that comprise a holistic approach, which recognizes community participation in primary health care comprehensively. Identification of cultural diversity, vitality, empowerment and safety as pillars to built trust between patients and service providers (Eckermann et al, 2006, pp. 83-102). Aborigines are divided over cultural paradigms which create unfavorable situation for self-advocacy, education on available services, lack of money and transport, and social support. It is also debatable though acceptable that results of various taskforces on Aborigine issues instead of being implemented become semantics and rhetoric for debate by managers and government. This concludes that economics and politics affect health of indigenous communities more than medicine and doctors (Eckermann et al, 2006). References Eckermann, A-K., Dowd, T., Chong, E., Nixon, L., Gray, R., & Johnson, S. (2006). Binan Goonj: Bridging cultures in Aboriginal health. Sydney: Churchill Livingstone Elsevier. (10-216). Read More