Aboriginals have the worst health in Australia, they suffer a higher rate of illness, have a life expectancy well below other Australians,have a greater rate of poverty, unemployment, lower levels of education, social isolation, compounded by remote living where they have access to limited health facilities and the local store supplies limited good foods (Reid & Lupton in Reid and Trompf, 1991. Commonwealth of Australia, 1998). It wasn’t always like this, prior to European arrival Aboriginals had good health and lived a hunter a gather lifestyle which ensured frequent exercise, they lived on a wide range of naturally occurring plants and animals allowing a well-balanced diet of protein, high in fibre and low in salt sugar and fat (Burden, 1994). They lived in small kin based groups (Burden, 1994).
One morning a 17 year old male (Mr. X), presented to the emergency department, wrapped in a blanket and shivering cold, an older Aboriginal male was with him. It was quickly determined that something had gone wrong with his initiation ceremony. Mr. X was dirty, cold and covered in blood, he gave consent to be assessed, there was some concern by the older Aboriginal male as it was going against tradition for Mr. X to be seen by females during ceremony time. It was explained that that there were no male nurses or doctors present at this time, Mr. X was aware of the risks to the ceremony but consented to be treated by female staff. Upon examination it was found that the cut made to his penis had passed through a tiny artery and the bleeding was uncontrolled, the patient had been like this for several hours prior to presentation to the Emergency Department, he was also in considerable pain. The patient was warmed up, cleaned up and a pressure dressing of sorts was applied to his penis, he was given fluids and kept comfortable, his contact with the hospital staff was kept to one nurse and one Doctor out of respect to the ceremony, the curtains were drawn at all times. The patient’s parents were contacted but due to the ceremony Mr. X’s mother was not allowed to be informed of what had happened, this was extremely difficult to deal with for staff as she was quite distressed, however the patient was of the age of consent and out of respect to the ceremony confidentiality was not breeched. Mr. X was happy for any treatment, he told staff he did not want to go back to the initiation ceremony and finish. He was flown to the regional hospital via RFDS for emergency surgery. When Mr. X returned he was admitted to hospital, a vague complaint of complications and back injury were told to the family by the patient but he was admitted at his request to avoid going back and continuing the ceremony, he was extremely upset and stressed by the thought of having to complete the ceremony, he may never have full use of his penis again, he stayed in hospital until after ceremony time, with the knowledge that during the next years ceremony time he would make sure he was far away.
Health and illness is experienced differently by Aboriginal men than non Aboriginal men. The way they approach and use healthservices are very different, this is usually due to cultural reasons (Williams &Kakaious, 009). In Aboriginal culture women’s and men’s business are kept separate and discrete, if breached punishment can result. A great shame can be experienced by aninitiated Aboriginal man if treated by a female (Mobbs chapter 7 inReid and Trompf). Most ceremonies practiced in Aboriginal Communities cannot be discussed fully due to their sensitive and scared nature (www.indigenousaustralia.info/culture.html). Initiation ceremonies are preformed to introduce adolescent boys and girls as adult members of the community, by being initiated the adolescents are taught and prepared for their f\roles with\thin the community as an adult, these ceremonies can take place over years (www.indigenousaustralia.info/culture.html). Non indigenouspeople cannot attend these ceremonies(www.indigenousaustralia.info/culture.html). The ceremonies can include having a permanent symbol on their bodies, initiated members may have a tooth removed, their ears or noses pierced or flesh cut with particular sacred markings (www.indigenousaustralia.info/culture/inititation-ceromonies.html)
In Aboriginal culture a male going through initiation is not allowed to be seen by a female, if illness or injury occur the person often presents wrapped entirely in blankets and his contact with female staff is limited as much as possible. Initiation ceremonies are important spirituality. As it is taboo to be seen by females this can cause damage. In the case of Mr. X just by presenting to the hospital and being seen by females was taboo and harmful to the initiation ceremony, only Aboriginal people know exactly the harm this causes, however urgent medical attention was required, the patient wanted treatment and consented to it, the hospital staff did what they could to maintain confidentiality and respect the ceremony as much as possible.
Cultural safety is a relevantly new concept, the idea is for nurses to provide quality care for people from different ethnicities than the mainstream, nurses must provide that care within the cultural values and norms of that patient (www.wikipedia.com). Unsafe culture practices is any action that diminishes, demeans or disempowers the cultural identity and wellbeing of an individual(The Royal Australasian college of Physicians, 2004). Cultural safety gives Aboriginal people the power to comment on the care provided, it allows Aboriginal people to be involved in changes in health services (The Royal Australasian college of Physicians, 2004).
There are no actual guidelines available for staff on initiation and treatment of a male during this time.. Long term staff attend cultural awareness programs that cover the basics of indigenous culture such as kinship, taboo relationships, communication and lifestyle (reference). There are also interpreter services available, and the hospital employs a liaison offer, who often helps the patients with any forms that have to be filed out, language, and getting to and from appointments.
The Northern Territory government has recently developed a policy for Aboriginal Cultural Security, the policy states that by providing culturally secure services all Territotrians can have access to safe and effective services (Aboriginal Cultural Security, 2009). The policy requires health services to identify the elements of Aboriginal culture that affect the delivery of health and community services in the Northern Territory, to review service delivery practices to ensure they do not unnecessarily offend Aboriginal peoples culture and values, change service delivery practices where necessary and to monitor service activity to ensure that the services continue to meet culturally safe standards(Aboriginal cultural Security, 2009). It is a strategy to improve services to Aboriginal people by making sure the way health services are delivered takes important cultural matters that may have a bearing on health and community outcomes into account (Aboriginal Cultural Security, 2009). The Department of health and community services will work closely with Aboriginal communities, some changes to services provided; the number of Aboriginal people employed and the way quality is assessed in the workplace (Aboriginal Cultural Security, 2009).This policy of cultural security is a commitment to further strengthen Aboriginal people’s access to health and community services. Ideally this policy would see health services develop partnerships with aboriginal peoples to better improve the way they view and access health services.
Australian Nursing and Midwifery council code of professional conduct for nurses in Australia (2008) “sets the minimum standards for practice a professional person is expected to up hold both within and outside of professional domains in order to ensure the ‘good standing’ of the nursing profession” (pg 1). Standard 4 of the code states “Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment and of their colleagues” (pg 1). Nurses should uphold the standards of culturally informed and competent care, ensure the safety and quality of care is not compromised because of harmful prejudicial attitudes about race, culture, ethnicity, gender, sexuality, age, religion, spiritually, political, social or health status (Code of Conduct, 2008, pg4)
The Code of Ethics for nurses in Australia outlines the nursing professions commitment to respect, promote, protect and uphold the fundamental rights of people who are both recipients and providers of nursing and health care. Value statement 3 of the code states “Nurses value the diversity of people” (pg6).
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Health professionals can only provide quality health services to the extent that they understand the attitudes, customs and beliefs of Aborigines (Germanos-Koutsouadis, 1990). Building cultural security reduces conflict, improves quality and outcomes, enhances efficiency and improves customer satisfaction (Aboriginal Cultural Security, 2009). In order to achieve good cultural safety, further in-depth cultural awareness programs should be offered, to all staff including the staff on short term contracts. Employment of male and female Aboriginal health workers to assist with language barriers, communication problems, follow up and to aid in good , care and instructing in regards to men’s and women’s business. High staff turnover, lack of specific knowledge about the cultural variables of different groups can also cause problems. Changes to health services include improving knowledge base of all staff employed, changing public health , clinical and administrative practices to incorporate critical cultural standards, monitoring progress and continuing services provided, ensuring the Aboriginal community is involved in developing and monitoring polices implemented by health services.
The Northern Territories Department of health and familiescorporate plan 2009-2012 recognises that developing and delivering a system of services that is underpinned by culturalsecurity, safety and quality is essential for the effective delivery of health services. The department of health and families Aboriginal and Torres Strait Islander Strategic workforce plan 2008-2011 recognises strengthen the Aboriginal and Torres Strait Islander workforce is a priority to help and improve the economic and social health and well being of Aboriginal and Torres Strait Islander people, building a sustainable Aboriginal and Torres Strait Islander workforce, strengthening a capable Aboriginal and Torres Strait Islander workforce, attraction and retention of Aboriginal and Torres Strait Islander talent and optimizing the Aboriginal and Torres Strait Islander workforce.
Reference List
Aboriginal Initiation Ceremonies 2009,www.indigenousasutralia.info/culture/initiation-ceremonies.html
Accessed 22/08/09
Introduction aboriginal Culture, 2009www.indigenousaustralia.info/culture.html accessed 22/08/09
Aboriginal Cultural Security an outline of the policy and its implementation (2009). Department of health and Community Services Northern Territory Government.
accessed 20/08/09" www.nt.gov.au/health
accessed 20/08/09.
Burden, J. 1994, ‘Health: A holistic approach’, Aboriginal Australia, eds C. Bourke, E Bourke & B. Edwards, University of Queensland Press, Brisbane, pp 162-7 & 159-62.
www.wikipedia.com accessed 19/08/09
Germanos-Koutgoundis, V, 1990 “Fair go” access and equity issues for Australians with disabilities who are from non-english speaking backgrounds (NESB), Aboriginal, Torres Strait Islanders, women and from remote areas, Australian Disability review, vol 3, pp3-10.
Code of Ethics for Nurses in Australia
Code of Professional Conduct for Nurses in Australia
Mobbs, R 1991. In sickness and health: the sociocultural context of Aboriginal well-being, illness and healing p292-325 in Reid and Trompf, the health of Aboriginal Australia
Reid & Lupton
Australian Introduction to cultural Competency (2004) An Introduction to cultural competencywww.australianindigenousdoctorsassociation.com.au accessed 04/08/09.
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