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Effective communication in indigenous healthcare delivery

Communication difficulties due to cultural and linguistic differences between non-indigenous heath care providers and the indigenous patient base has for long being a major barrier to better health services. Effective communication between heath care providers and the patient base happens only when the two share lingual and cultural backgrounds, or simply linguistic understanding (Andrews & Boyle, 2008). This essay seeks to identity why indigenous patients are “uncooperative” to mainstream healthcare attendants, how the heath attendants race, religion, and culture affect indigenous perception and response to healthcare services, and discussion of two factors – education and building trust – for effective communication between healthcare attendants and the indigenous patients.

Miscommunication is not only limited to the healthcare attendant and the indigenous patient relation, but also in other critical health care processes including research, education, planning, and implementation. The most challenging and common problem in the communication barrier phenomenon is the lack of interpreters in the majority of rural health centres especially in the northern territory. Through the various ways communication or effective communication is hindered, the ultimate result is that health care success remains seriously and unnecessarily compromised.

Due to the communication gap that continues to hinder successful health services delivery, many indigenous patients just like Mr Farrell exhibit non-corporative behaviours in health care sessions. Several reasons explain these behaviours, especially not responding to questions. According to Andrews & Boyle (2008), one of the reasons is linguistic differences. The majority of indigenous patients might require the services of an interpreter to comprehend what the health care attendant is saying.

In cases where linguistic difference is not the problem, then the patient might simply turn dumb because of the cultural differences between the non-indigenous healthcare attendant and the patient (Homel, 2006). Several factors accrue to the culture gap. First, if a female health care attendant is asking the medical questions, then the male indigenous patient might turn dumb because of the gender issue within indigenous culture – where there are men issue and female issue. Secondly, indigenous people have a high regard for their kinships were the family plays a key role in communications. Being alone in the examination room may make the individual feel singled out, abandoned by his group and insecure hence, simply go mute.

The solution to this problem will mainly depend on the problem. One of the solutions is to bring in an indigenous nurse. According to Stoneman & Taylor (2007b), a nurse speaking the native language is a solution but it is not as effective like bringing in an indigenous nurse. The fact that it is an indigenous nurse serves to breach almost all problems whether linguistic or cultural or simply the feeling of intimidation by the foreign-community nurse.

Effective heath care communication between the indigenous patients and health care providers of the immigrant communities has seen numerous challenges. These barriers are founded from several socially oriented phenomenons which include race and culture (Singleton & Krause, 2009). Even though the influences of these factors are a two-way traffic, the indigenous communities pose increased response from these factors. The majority of nurse in the mainstream health care system are of the immigrant communities, even though with continued empowerment of indigenous communities, the number of indigenous nurses is on the increase (Bain, 2011). Nevertheless, the issue of race and culture is between non-indigenous nurses and the indigenous patient base.

Race is a barrier in effective communication between nurses and an indigenous patient. The issue of race come in through several forms one of them being racism. Racism is a too way and a multifaceted element (Joint Commission, 2009). The immigrant communities have perceived superiority over the indigenous communities which might come into play through asserted dominance to a patient. Through this assertiveness, an indigenous patient is intimidated and cowardice follows. Due to cowardice, they simply won’t answer to any questions even if they are fully aware of the answer. The second form is barrier due to race is through shame and shyness due to previous experienced with the immigrant communities. For example, due to torture, forced removal of children from their family homes, and injustices perpetuated during the colonial period.

Race is also played by indigenous patients through disregard of the nurses who don’t come from the indigenous communities. This form of racism is sources from the facet of,”not out own or not fit according to our way” (Watson et al., 2001). For an indigenous patient being interviewed by a non-indigenous nurse, they simply ignore the nurse because they consider them not one of their own. This problem according to Dudgeon et al. (2010) can be resolved through two ways; immigrant nurses learning local dialects or employment of indigenous nurses.

Culture is the other major factor influencing healthcare delivery to the Australian indigenous communities. Indigenous people’s culture is very different from the mainstream culture. First, indigenous culture holds high regard for the family (Singleton & Krause, 2009). The family and kinship ties are very important to a person. The importance of the family in manifested through passing of information deemed important, decision making, and through culturally oriented groups. For example, the decision to participate in a mainstream health care exercise will require consultation with the entire family and possibly approval of the same by community leader. In addition to kinship effects, indigenous culture does not recognize mainstream western-oriented health care, they belief in traditional healers and bush medicine, and mainstream treatment is only as a last resort.

Indigenous culture does segregate between men and women affairs. There are issue that are known as “men only issue” and other which are known as “women only issue” (Homel et al., 2006). Mainstream healthcare system does not under the normal circumstances operate in such a manner. Therefore, if a female nurse attends to a male indigenous patient, then there definitely will be effects among them, communication inadequacies. For effective delivery of health care services to the minorities, then as stated by Coffin “culturally fit health care services that delivery on culture security to the indigenous groups need to be designed”(2007 p. 24).

Closely related to culture is religion and it has its fair share of influence in health care delivery. The indigenous religion is spiritualistic in nature and defines almost every aspect of indigenous lifestyle (O’Neill et al., 2004). In health care, indigenous belief in divine intervention and explanation cover the entire disease process from causation to treatment and end-of-life in the case of terminal illnesses. Indigenous belief that anyone who catches a disease it’s as a punishment by the gods or because of having partaken in evil activities and the disease is a consequence (Andrews & Boyle, 2008). Due to their religion and strong attachment to their homeland, many indigenous terminally ill patients will prefer to spend their last days at their home rather than in hospital care.

The delivery of health care to indigenous groups can be improved by implementation of strategies for the neutralization of the existing barriers. Education and building trust of indigenous people for the health care system are two of some of the most effective strategies.

Education is a strategy that involves every party in the health care delivery systems. It is undeniable that while mainstream health care have vital benefits, indigenous communities will continue to avoid it unless they are fully aware of the benefits accrued (Singleton & Krause, 2009). The way forward is the creation of a middle ground where mainstream healthcare addresses indigenous people concerns and in return, indigenous people relax their beliefs against health care. Education has proven to be the best tool for creating this harmony.

For the health care delivery system to address indigenous people’s concerns, education needs to be targeted to the health care providers; nurses and doctors. The majority of nurses and doctors are from the immigrant communities therefore; they do not understand indigenous cultural aspects, linguistics, and other social concepts which actively play anti-healthcare (Joint Commission, 2009). The education curriculum for nurses and doctors needs to include indigenous topics on how to handle indigenous patients for effective health care delivery. It is not enough to have only nurses and doctors operating in rural and in hospitals targeting indigenous people take the additional course on how to relate with indigenous people as this is promoting biasness. The training curriculum for every professional in the healthcare profession should be competent in dealing with indigenous patients through education.

In addition to educating the immigrant healthcare professionals, it is also of great importance to train the indigenous people on the importance of mainstream health care services (Watson et al., 2001). For example, in cancer cases, indigenous patients will only seek health care assistance after every other of their treatments has proved futile, at this stage; the cancer is at an advanced stage. If only through education they could seek healthcare help in time, then the cases of cancer death would be minimal. Additionally, educating indigenous to take up nurse and doctor position is a strategy proving to be fruitful.

One of the reasons why indigenous people don’t have much faith in the mainstream health care and prefer their inferior and crude traditional treatments is lack of trust in the western-oriented healthcare system (Bain, 2011). To build trust through culturally competent health care services is one of the ways towards achieving not only effective communication, but also increased participation in health care services by the indigenous groups. Building trust promotes increased understanding of each other, services to quash any misconceptions, and creates mutual respect between the health providers and the patients.

One way to build trust is by designing health care delivery programs that factor in indigenous people concerns (Racher & Annis, 2007). Overtime, there have been numerous documentations of health care aspects that are against the indigenous people’s culture. In addition to these documentations, the indigenous people should be involved in the designing process. This strategy is effective because it helps to create a sense of ownership by the indigenous groups as they have actively participated in the design process. Moreover, participation in the program design process is an avenue for indigenous groups to participate in the decision process hence an empowerment to voice out there concern when not satisfied with the program services.

In cases where programs designed without consultation with the indigenous groups are already operational, it is still possible to build trust through indigenous approval (Racher & Annis, 2007). To achieve the acceptance and the approval of the groups, the first step is to bring onboard community leaders. In most indigenous communities, there are elders who govern community. These elders are the opinion leaders therefore, making them trust the healthcare programs and the services on offer will eventually lead to acceptance and approval by the community members. However, as pointed out by Coffin (2007), before the group members can come in and freely accept healthcare services it might require modification of the program to fit indigenous requirements.

Building trust requires incorporation of indigenous culture concerns in the health care system. If the system does not respect and respond to indigenous concern, then it is simply void and it won’t work (Dudgeon et al., 2010). There are several cultural concerns among indigenous people that don’t exist in the western lifestyle. For example, indigenous people have clear boundaries set between the two genders.  For example, Mr. Farrell will simply not open up to a female nurse because his health issues are men-only-affair.

 

In conclusion, ineffective communication or lack of communication between healthcare provider and the indigenous patient-base has continued to hinder success in healthcare delivery in indigenous rural Australia.  This ineffective communication is as a result of linguistics and culture differences with the majority of indigenous culture aspects not being factored in the healthcare delivery programs. Race as a factor is practised through racism to hinder effective communication, culture hinders effective communication through violation of indigenous cultural norms, and religion hinders communication through wayward and misleading believes held against mainstream treatment. Education and building trust are two factors that have the power to change the current situation and promote healthcare among indigenous. Education is two way with healthcare provider being educated on indigenous ways and indigenous people being educated on benefits of mainstream healthcare. Trust is build through engaging indigenous elders and opinion leaders in the healthcare design and delivery machinery. For increased effect and fact response, the various factors for improving communication should be interwoven to work in synch.

References

Andrews, M.M., & Boyle, J.S. (2008) Transcultural concepts in nursing. New York: Wolters Kluwer/ Lippincott, Williams & Wilkins.

Bain, M.S. (2011). Adapting to difference: another look at Aboriginal–Western interactions. Brisbane: BookPal.

Chenowethm L, Jeon Y-H, Goff M & Burke C 2006. Cultural competency and nursing care: an Australian perspective. International Nursing Review 53(1):34–40.

Coffin, J. (2007). Rising to the challenge in Aboriginal health by creating cultural security. Aboriginal & Islander Health Worker Journal 31(3):22–4.

Dudgeon, P., Wright, M. & Coffin, J. (2010). Talking it and walking it: cultural competence. Journal of Australian Indigenous Issues 13(3):29–44.

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Homel, R., Lamb, C. & Freiberg, K. (2006). Working with the Indigenous community in the Pathways to Prevention Project. Family Matters 75: 36–41.

Joint Commission, (2009). One size does not fit all: meeting the healthcare needs of diverse populationsOakbrook Terrace, IL: The Joint Commission.

O’Neill, M., Kirov, E. & Thomson, N. (2004). A review of the literature on disability services for Aboriginal and Torres Strait Islander peoples. Australian Indigenous Health Bulletin 4(4): Reviews 2.

Purnell, L., & Paulanka, B. (2008). Transcultural health care: A culturally competent approachPhiladelphia: F.A. Davis.

Racher, F.E., & Annis, R.C. (2007). Respecting Culture and Honoring Diversity in Community Practice. Research and Theory for Nursing Practice: An International Journal, 21(4) 255-270.

Singleton, K. & Krause, E. (Sept. 30, 2009) Understanding Cultural and Linguistic Barriers to Health Literacy OJIN: The Online Journal of Issues in Nursing. Vol. 14, No. 3.

Stoneman, J. & Taylor, S.J. (2007b). Pharmacists’ views on Indigenous health: is there more that can be done? Rural and Remote Health 7:743.

Taylor, K.P., Thompson, S.C., Smith, J.S., Dimer, L., Ali, M. & Wood, M.M. (2009). Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology. Australian Health Review 33(4):549–57.

Watson, J., Obersteller, E.A., Rennie, L. & Whitbread, C. (2001). Diabetic foot care: developing culturally appropriate educational tools for Aboriginal and Torres Strait Islander people in the Northern Territory, Australia. Australian Journal of Rural Health 9(3): 121–6.

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