Remote Aboriginal Community and Diabetes - Coursework Example

Remote Aboriginal Community and Diabetes Part I This paper is about the Indigenous Peoples and the Torres Strait Islander people in Australia and the phenomenon of high sugar level among them viz. the needed nursing interventions to improve their health conditions. Consisting around 2.6% of the nation’s population, the Aborigines of Australia are very much like the Indigenous Peoples in New Zealand, Canada and even United States. All of them are still being affected profoundly and disparately by the 18th century European colonization especially on areas of their autonomy, access to resources, and community health status (Hurst & Nader 2006, p. 294). At home, the Aborigines are in a sorry state of social living. Fact is, they have a shorter life expectancy (see Leeder 1999, p. 1; McDermott 2009, p. 477). Their communities are far from city centers; the “basic infrastructure including water and waste disposal” (Leeder, p. 5) is sparse; and, among them, there is a hardly accessible elementary health care (Leeder) much less a culturally-sensitive medical framework (Hurst & Nader 2006, 296) in their communities. Now, the issue of health is connected to broader external social and political factors. Not surprisingly, in these communities, there are reports of high incidence of – among others – diabetes (Hurst & Nader). Fact is, in the whole of Australia, the highest prevalence of diabetes is said to be among the inhabitants of Torres Strait Islands (McDermott, Tulip & Sinha 2004, p. 295). Part II Diabetes mellitus has long been considered an important health issue among the Australian Indigenous population. This disease is being considered as responsible for the population mortality and morbidity (McCulloch et al. 2003, p. 397). Not only is their health status dramatically below that of the Australian non-Aborigines (Leeder, p. 3), the data compiled by Thomas et al. (2006) highlight the increase in death rates because of diabetes among the Indigenous peoples in the six-year period beginning from 1977 to 2001. The truth is, “diabetes-associated mortality in areas of Queensland with high Indigenous populations has been reported to be ten times than in Queensland over-all” (McCulloch). The Australian Bureau of Statistics (2009) presents the figures associated with this health issue: six per cent (6%) of the Aboriginal population reported diabetes as long-term health condition – with higher rates among those in remote areas than in those who live in major cities and towns; more women than men – 5% and 7% respectively – are afflicted with diabetes; and the prevalence of diabetes increases with age – e.g., 36% of those aged 65 years and over are with the sickness compared to just 1% for those aged 0 to 24. And the more this issue becomes of primary importance should a comparison be drawn between the health fates of the Aborigines and the non-Aborigines: the ratio of diabetic between the two racial groups is 3:1; Indigenous males were three times as likely and Indigenous females four times as likely as non-Indigenous males and females to report diabetes (Australian Bureau of Statistics). It is not only the genes and/or the lifestyle of the Aborigines that account for the high incidence of diabetes among the Indigenous communities. It is also said to be the outcome of the “Coca-colonization” with junk foods that are not only tastier but are also more often cheaper (see Hurst & Nader) than the healthy foodstuff. Aggravating the problem is the Indigenous people’s alarming alcohol consumption practice (of similar level with the Indigenous non-diabetic drinkers). In addition, there is also much to be desired on the Indigenous peoples’ smoking habit so that should they be able to cut back on it, diabetes could have been addressed more effectively (McCulloch et al.). Diabetes among the Indigenous peoples is also explainable by what McDermott (2009) calls “health gap”. In effect referring to the disparity in the access to medical care by the Aborigines and the non-Aborigines, health gap is indeed a blow against inclusive health policy of any nation and an obstacle against the universal access to health. If one takes the case of the Indigenous people, one finds that none of the diseases that afflict the Aborigines is actually unique – that is, “they suffer mental disorders, lung and heart disease, injuries and diabetes like the rest of (Australians) only more so” (Leeder, p. 6). Usually, health gap is bureaucratic in nature; and, undeniably, it is telling about racialism. But, similarly, health gap may also be accounted for by an inadequate medical approach – with its insufficiency vividly manifesting as it gets implemented. For sure, the medical model in public health consciousness that once was followed in bringing health services by the providers to the people subsequently proved wanting. Later appraisals of it showed that this approach resulted to deficiency in what medical personnel can actually do in public health (see Dalziel 2002, p. 219). Still, from a much bigger perspective, one may consider as another reason for the high incidence of diabetes among the Indigenous peoples the phenomenon of poverty. Medicine is never a complete panacea for ill-health. Doctors and nurses do not and cannot cure illness by a simply dispensation of tablets or capsules. Considered more much deeply, an effective health measure is a more comprehensive solution; and, socio-economic transformation -- such as ensuring that food supply is equitable and accessible; security is not lacking; response to health issues is adequate; housing, sanitation and environmental needs are effectively responded to; and social capacity building for communities is facilitated – is having an even more long-term impact (cf. Dalziel, p. 217). Part III Part IV With the preceding discussions as the backdrop, one may now turn to the more pointed question of what can be practically done to improve the health of Australian Aborigines. This question is indisputably more urgent for medical personnel who are directly involved with Aboriginal communities and who see for themselves the reality and the impact to social living of diabetes mellitus. It is but proper that at the outset a mention is made about the fact that basic diabetes care plans among Aboriginal communities supported by a specialist outreach service is practically helpful (McDermott, Tulip & Sinha; see also Wise & Signal’s [2000] writing on the development of health promotion in Australia [and New Zealand].). However, there is still a lot to be and can be done. And, drawing on from the foregoing, one may broadly sketch a tentative plan for/or nursing interventions. Firstly, the most basic nursing intervention is to embrace the “line of attack” of the community development approach, which is clearly a departure from the previously implemented medical model. According to Dalziel, the community development approach is “a holistic approach, … which recognizes the central importance of social support and social network, (facilitating) individual and collective action around common needs and concerns identified by the community itself and not imposed from outside” (p. 224; St. John [1993] calls this approach ‘the health for all approach’ [p. 73]; see McMurry [2003] calls it the ‘top-down’ model or socio-ecological approach [p. 76]; Wass 2000). The very crucial element of the community development approach is that it is defined as collective action on whatever issue, particularly health (as the issue of this paper). The community members are never treated as passive beneficiaries of the health program, but as active “shapers” of the program. That means, a nursing professional engaging Aboriginal communities must essentially consider the latter as able partners and not simply as program clients or, much worse, a patient needing medical attention. In the concrete, it means serious and meticulous consultation with community members as regards their health conditions and training their own people as “auxiliaries” to the professional nurses, among others. Concomitant to this, a nursing personnel intervening among the Aborigines needs to keep in mind that the cure of diabetes would mean more than control of the weight of the diabetics, regulation of the patients’ glucose level, and effectively putting in effect screening process (cf. Valanis 1999, p. 313). For community development approach is practically a macro perspective. It would mean that diabetes actually is cured when there is available and affordable healthy food (see McDermott, Tulip & Sinha), and when the “socio-economic, cultural and political inequality (is addressed) and … health is rooted in the way society functions” (St. John 1993, p. 73). Very clearly, this generally-sketched intervention is in consonance with the provision of the Jakarta Declaration on the promotion of social responsibility for health, consolidation and expansion of partnerships for health, and the increase of community capacity and empowerment of the individual. Substantially, too, it dwells on primary health care principles of inter-sectoral collaboration and public participation. But the most basic nursing intervention that is briefly presented in the foregoing is not going to materialize if the Aboriginal communities are not ascertained to be sufficiently “health literate (capitalizing) on the resources within their own environment that can be used to improve health and reduce the risk of illness” (McCurry, p. 77). Being health literate in this means that community members are being capable to identify their own needs, establish their (local) goals and objectives for health, and identify the available local resources to realize their goals. Concretely, this provides for the selection, appointment and training of Aborigines as primary or secondary health workers. Already in theory, this is a great leap forward because in the past, Aborigines were suspicious of health workers and researchers coming from outside of the community. And it was understandably so after they saw for themselves how these non-Aboriginal medical or research personnel were serving their vested agenda while they relegated the communities’ interest into the back seat, so to speak. As it is in programs dealing with other important issues, a health program that is developed with the participation of health-literate communities is expected to be more “highly responsive to local community needs” because in the first place they are run by the people themselves (Leeder, p. 6). This second nursing intervention strikes at the heart of the Jakarta Declaration on community capacity building and empowerment, for there is no debate that community building empowerment is possible only through the route of education or literacy. In itself, community organizing efforts are educative. And, education is as always helpful in issue promotion and inclusive participation by the community members. Thirdly, a nursing intervention should likewise concern itself not only with biological issues but also – and, in this case, more so – with human behavior in its totality. Medical interventions, to be efficacious, must factor in effective behavior modification tactics (see McCulloch et al.). Without doubt, behavioral changes such as (further) reduction of smoking and decrease of alcohol intake among diabetics are needed for optimal self-management of the illness (see Deal 1997, p. 122 about home-based interventions that practically do so). More than scratching the surface, however, the role of the health professionals in this intervention is “not to persuade people to undertake certain behaviors because it will be ‘good for them,’ but to help people recognize the personal, social and structural influences and elements of their lives and their environment that have a health-enhancing potential” (McMurry, p. 76). Obviously a micro intervention in comparison the first two nursing interventions mentioned in the preceding, one finds in this approach an attempt to make concrete Jakarta Declaration’s provision for individual empowerment. Health is indeed an issue of and by the people. Ultimately, individual health state is determined by concerned person’s ability to take action to influence the determinants of health. With this approach, the cure to diabetes is ultimately not monopolized – in a manner of speaking – by the medical professionals; but is made very accessible to the common people. Finally, turning to the nursing personnel, one realizes that given the sketched interventions medical personnel becomes required to improve their skills. For mere medical know-how does not make a good health educator who “get results in the form of measurable learning achievements by the individuals and groups with whom they work, such as greater retention of information and better application of the learning in learners’ own lives… (For) to be effective, health educators need to understand key principles of adult learning” (Ewles and Simnett 2003, pp. 231). What is meant here is that nurses in the communities are going to be educators among the Aborigines. And teaching is practically a different science and art. Skills improvement also mean training in and practice of leadership skills, which include among others the know-how to documents and technically write research and reports that will enhance planning, implementation and evaluation of health programs. With this step, the provision of Jakarta Declaration for infrastructure for health promotion is potential to be fulfilled. Of course, Jakarta Declaration means a lot about securing health promotion networks. In this section, what is being limitedly endorsed is the building up of human resource infrastructure in the person of the professional nurses. One of the primary health care principles calls it appropriate technology. In this paper, the emphasis is put on the enhancement of, obviously, appropriate human technology. Conclusion In a compendium, the identified nursing interventions are meant to more effectively address diabetes among the Indigenous peoples. Believing that medical interventions are actually not wanting, the strategy that this paper advocates is inspired by community organizing and education – which is being regarded as the most effective mode and/or route to social transformation. On this account, this paper puts the premium on human resources in the fight against high sugar level among the Aborigines – with the nursing personnel together with Aboriginal community members as the primary dramatis personae. In anticipation, then, the success of these nursing interventions would depend not only on the soundness of the medical technology that is brought into the community, but obviously on how well the education of the community members has been done. And, on this account, one can soundly anticipate that the level of learning – which translates to behavioral change(s) – or health literacy of the community members is going to be main criterion for eventual evaluations of these interventions. References: Australian Bureau of Statistics. (2009). Diabetes in the Aboriginal and Torres Strait Islander population, 2004-05. Retrieved 26 April 2009 . Dalziel, Y. (2002). Community development as a public health function. In S. 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