HLSC 120 2015 eModule 6 Page 1 HLSC120: Society, Culture and Health eLearning Lecture Enhancement eModule 6 2015 Module 6: Aboriginal and Torres Strait Islander People Introduction: Welcome to the last of the six eModules for this unit. In this eModule we will apply many of the sociological concepts and issues introduced and learnt in the first half of the unit. The intention of eModule 6 is to enrich your knowledge to help you care for your future clients, particularly those of Aboriginal and Torres Strait Islander background. This eModule is specifically about Aboriginal and Torres Strait Islander peoples, the Indigenous peoples of Australia, who are a marginalised and vulnerable community in this country. You will learn about their culture, their history and consequently their health status. This eModule will introduce you to concepts that may be new to you and it will involve you critically examining your thoughts and attitudes about caring for vulnerable people. Challenges may arise for you as you reflectively consider the cross cultural issues that influence your behaviour and that of organizations. The eModule is divided into five separate weeks – weeks 6,7,8,9 &10. You are strongly urged to stay up-to-date with your self-directed work in this eModule, rather than leave it all until the last minute. This will help you to reflect adequately on the content, and to clarify any questions that may arise during your reflections. It will also assist you with your examination preparation. Any of the questions under the Reflective Learning and Writing section green box at the end of each week, and student seminar questions may appear in the examination. Also, all content in the eModule can be examined in the multiple choice items in the examination paper. Learning Outcomes and Graduate Attributes: In eModule 6 the following unit Learning Outcomes (LO) and ACU Graduate Attributes (GA) are relevant: Learning Outcomes:  LO 5 Differentiate the health issues of vulnerable people in marginalised social groups in Australia;  LO 6 Discuss the socio-historical-political context and health related issues of the Australian Aboriginal and Torres Strait Islander peoples. The aligned Graduate Attributes are:  GA 1 Demonstrate respect for the dignity of each individual and for human diversity.  GA 2 Recognize the student’s responsibility to the common good, the environment and society.  GA 4 Think critically and reflectivelyHLSC 120 2015 eModule 6 Page 2 In eModule 5 we identified and explored health issues related to a number of vulnerable groups. To further enhance your understanding and appreciation of the issues affecting vulnerable groups, this eLearning Module will explore in-depth issues related specifically to Indigenous Australian communities. By now you should be very familiar with Germov’s Sociological Imagination Template and be able to apply it to analyse sociological issues. Figure 1: Sociological Imagination template [Willis, cited in Germov, 2014, p 8] Let us consider the health of Aboriginal and Torres Strait Islanders from various perspectives. In your analyses and reflections, all sociological concepts introduced during the last weeks should be considered, such as globalisation, power, politics and health care, socialisation, social constructions of health and illness, and the health care system, to name a few. During each week we will be discussing Aboriginal and Torres Strait Islander culture and consequently the health of these communities. Each time you read and hear about these topics take a moment to reflect on your attitude, knowledge, and on what grounds you acquired your perceptions/beliefs about the original custodians of this land. Here is an activity for you: Each week we will highlight different aspects that will lead you from the past into the current social, political, economic, educational and health conditions. The above sociological template is a most valuable tool if you want to analyse the content for each week, and then maybe compare the weeks with each other. You can also reflect and identify if your attitudes are changing over the weeks. Now we will commence with the content of the first week of this final eModule. Historical Structural Sociological Analysis Cultural Critical Activity 6.1: Reflect upon how you would feel about caring for Indigenous people who are ill? Use a rating scale of 1 to 5: 1 means you would feel fine about it 5 means you would feel very uncomfortable. If you scored around 4-5, then you might like to reflect upon your feelings/attitudes. What is the source/origin of these feelings of discomfort?HLSC 120 2015 eModule 6 Page 3 Week 6 In order to understand people, we need to be aware of and value their culture. What historical, political, economic and social factors impacted on them? How do these factors influence them socially and spiritually as individuals, and as a community, and what are the political and economic implications that have a bearing on their daily living, particularly in light of their health and well-being? Reflecting on these issues will influence your health care practice in a positive way. To extend the content you had in the lecture, please read the following pages in your textbooks. Gray and Saggers (2009) base their chapter on a sociological theoretical foundation, while Eckermann et al. (2010) adopt the socio-cultural or historical perspective. These two approaches combined shall provide you with a wider knowledge base. Reading: Gray, D., & Saggers, S. (2014). Indigenous health: The perpetuation of inequality. In J. Germov (Ed.). Second opinion: An introduction to health sociology (5th ed.). (Chapter 8, pp. 147-162). South Melbourne: Oxford University Press. Eckermann, A-K., Dowd, T., Chong, E., Nixon, L., Gray, R., & Johnson, S. (2010). Binan Goonj: Bridging cultures in Aboriginal health (3rd ed.). (pp. 2-13, 108-120). Sydney: Churchill Livingstone Elsevier Australia. For Weeks 8 & 9: Investigate http://www.hreoc.gov.au/social_justice/about_social_justice.html for  The Bringing Them Home Report (i.e. the findings and recommendations of the National Inquiry into the separation of Indigenous children from their families); and  Indigenous Deaths in Custody Report mentioned in the lecture. You can find this report at this URL: http://www.austlii.edu.au/au/other/IndigLRes/rciadic/ Resources: Activity: Visit the Indigenous Australian section on the Australian Museum website at http://archive.is/maHT8 Listen to several stories of the Dreaming. Question: Do you find similar stories in your country’s culture? What is your experience of how history is passed on in your community? Compare the two approaches. Click on the following icons ‘Culture’ / ‘Indigenous Australia’ / ‘Timelines’. Each section will open up a ‘new world of cultural diversity’. Reading and Resources 6.1HLSC 120 2015 eModule 6 Page 4 Working through the Sociological Imagination Template process, reflect on the following questions: 1. What is the importance of storytelling in the Aboriginal culture? 2. The significance of custodianship is not necessarily understood by the wider Australian community. Explain the value of this custom in the 21st century and compare it with customs within your own culture. Identify the major issues raised in the 1. heritage and 2. Spirituality sections and relates them to what we call these days ‘the importance of a healthy and balanced life-style’. The lecture and the wider reading introduced you to some thoughts behind the colonisation process, and the clashes between attitudes, cultures and traditions. Take into account this background knowledge when you read the summaries of government policies and their effect on the perpetrators’ practices and Aboriginal reactions over a period of more than 200 years (Eckermann et al., 2010, pp. 22-25). Now research and reflect on the questions for this week: 1. Aboriginal people were dispossessed several times over the decades. Identify and reflect on the losses the original owners of the land had to endure. 2. Why is the time between the 1890s and 1950s called the ‘era of protection’? 3. What were the benefits to the Aboriginal communities of the Assimilation policy? It is important that you analyse these questions thoroughly and reflect, using the sociological imagination template. These questions may appear in the examination paper. _________________________________________________________________________ Learning Activity 6.2 Reflective Learning and Writing 6.1HLSC 120 2015 eModule 6 Page 5 Week 7 In the lecture this week we concentrated on the policies created by various Australian Governments and their effects on Aboriginal and Torres Strait Islanders and discussed their responses. We examined the issue of racism and its implications for individuals, communities and institutions. One issue we are often not aware of is institutional racism. Carmichael and Hamilton 1967 (as cited in Eckermann, 2010, p. 17) were the first to define the term in Australia as follows: Institutional racism is manifest in the laws, norms and regulations that maintain dominance of one group over another. It is covert and relatively subtle; it originates in the operation of essential and respected forces in society and is consequently accepted. Because it originates within the society’s legal, political and economic system, it is sanctioned by the power group in that society and at least tacitly accepted by the powerless, it receives very little public condemnation. Reflection: Look around you and assess your environment for institutional racism. Reflect on what you discovered:  Has your thinking be affected by institutional racism?  Why has institutional racism been ignored for so long? Gray, D., & Saggers, S. (2014). Indigenous health: The perpetuation of inequality. In J. Germov (Ed.). Second opinion: An introduction to health sociology (5th ed.). (Chapter 8, pp. 149; 153 – 154). South Melbourne: Oxford University Press. Read the section on alcohol in Indigenous Australia. Relate this story to the ‘Cycle of Poverty’. Now continue in your quest for more information on the Aboriginal and Torres Strait Islander communities’ issues in the following Activity section. Reading and Resources 6.2HLSC 120 2015 eModule 6 Page 6 Activity: 1. Continue to investigate and answer the associated questions http://www.hreoc.gov.au/social_justice/about_social_justice.html   The Bringing Them Home Report (i.e., the findings and recommendations of the National Inquiry into the Separation of Indigenous children from their families) In relation to this first online reading answer these questions: a. Why is so much of the Report focused on the past? b. How can you judge the past from the perspective of the present? At the time people thought they were doing the right thing by the children. c. Some people believe that Indigenous children were removed for their own good. Being taken away from their Indigenous families gave them a good education and opportunities they would not have had otherwise. If you agree/disagree with this statement, explain your answer. d. Why was the forcible removal of Aboriginal and Torres Strait Islander children considered by noted scholars (e.g., Manne, 2003, Tatz, 2010 and Madley, 2008) to be genocide?  Indigenous Deaths in Custody Report mentioned in the lecture. Access the Human Rights Commission site:  http://www.hreoc.gov.au/social_justice/publications/deaths_custody/index.html Look at the profile for your State What are the major themes highlighted in these storiesHLSC 120 2015 eModule 6 Page 7 It is time to concentrate on the controversial 2007 “Northern Territory Emergency Intervention (NTER)”. For background information and an opportunity to reflect on the government action, read the following:  Eckermann et al. (2010). Binan Goonj: Bridging cultures in Aboriginal health (3rd ed.). (pp. 31-34). Sydney: Churchill Livingstone Elsevier Australia.  ABC on-line, Indigenous Special Topics NT Intervention Reflect on the following questions: For the following questions you may need to expand your research skills. To be able to use the sociological imagination template fully, you may have to access several government websites, or even some newspaper articles, to mirror the public mood to the intervention. 1. What are the reasons that many critics believe that this “intervention” was a ‘return to institutional racism’? 2. The NTER was prompted by the Howard government, but retained by the following two Labour governments. Why did the Labour governments maintain the program? What were the benefits, firstly to the Indigenous population, and secondly to the governments? 3. ‘Surf’ the net and review the NTER for yourself. Draw up a list of positive and a list of negative effects. Why have you identified some of the measures as positive? Why do you think some are negative? Please reflect carefully. You may find one of these questions in the examination paper. Reflective Learning and Writing 6.2HLSC 120 2015 eModule 6 Page 8 Week 8 The very essence of the Aboriginal Community-Controlled Services (ACCHS) and Aboriginal Medical Services (AMS) is to be independent and community controlled, meaning the governing bodies are self-determined and self-managed by the Aboriginal community. When the clients have control and feel in harmony with their holistic view of health, they can feel empowered. This self-empowerment, ‘the process whereby decisions are being made by a person who wants to make his/her decision and has the capacity to do so’ (Eckermann, 2010, pp. 170-183) has to be supported by a health service that permits these processes and practices. 1. Read the following reference: Eckermann et al. (2010). Binan Goonj: Bridging cultures in Aboriginal health (3rd ed.). (pp. 196-218). Sydney: Churchill Livingstone Elsevier Australia. 2. Answer the first activity question on page 202. 3. Now answer the following questions: a. Considering the notion of empowerment, do you think that the Northern Territory Intervention (2007) into remote Aboriginal communities enhanced/failed to enhance the self-determination and self-worth of the Aboriginal population? b. Did the Northern Territory Intervention (2007) into remote Aboriginal communities support the delivery of health services in those regions? If yes, why? If no, why not? Please reflect upon the following questions, making sure you use the sociological imagination template to do so: “The effects of trauma in one generation are the causes of trauma in the next generation, creating a continuous cycle which is very difficult to break” (Ranzijn, McConnochie & Nolan, 2009, p. 124). 1. What is your response to the social and emotional stress, disadvantage, and cultural dislocation seen in many Indigenous individuals, families and communities in relation to the above quote? 2. What is your response to the individual and collective trauma which Indigenous Australians have experienced over the past 220 years? 3. Do you think people can be strong and proud if they don’t believe they have a culture? If ‘yes’ why? If ‘no’ why? Reflect on your responses and write a couple of paragraphs to show your reaction to these questions. Learning Activity 6.3 Reflective Learning and Writing 6.3HLSC 120 2015 eModule 6 Page 9 Weeks 9 &10 This week we are concentrating on 1. Health related issues of Australian Indigenous peoples, and 2. Health promotion within a diverse cultural setting. In the lecture, we highlighted the high incidence of chronic health conditions in the general population, and more specifically in Aboriginal communities. Check your notes to recall the prevalent chronic illnesses in Indigenous communities.  Explain some reasons why conditions such as cardiovascular ailments are three times higher in the Indigenous communities than in the wider Australian society. The social and environmental circumstances in which many Indigenous Australians live create risk conditions (e.g. poverty, poor housing and inadequate food supply), which predispose this population to the development of chronic diseases and the uptake of risk behaviours which may lead to physiological risk factors for chronic disease. Study the following health statistics/causes of death of the Indigenous population: Indigenous Deaths, main causes, 2001-05 - Standardised Mortality Rate Cause of Death Males SMR Females SMR Diseases of the circulatory system 3.2 2.7 Neoplasms (including cancer) 1.5 1.6 Endocrine, nutritional and metabolic diseases 7.5 10.1 Diabetes 10.8 14.5 Diseases of the respiratory system 4.3 3.6 Diseases of the digestive system 5.8 5.1 Australian Institute of Health and Welfare, Australia’s Health 2008, ABS cat no 8903.0 (2008) Table 3.4.HLSC 120 2015 eModule 6 Page 10 In contrast, look at the general Australia wide data: Cause of death ranking Cardiovascular diseases 1 Strokes 2 Dementia & Alzheimer disease 3 Cancer 4 Diabetes mellitus 5 http://www.abs.gov.au/ausstats/[email protected]/Products/B6940E9BF2695EE1CA25788400127B0A?opendocument 1. What do you think are the reasons for these discrepancies? You may want to remember what you have learnt so far in this unit and in your other units, when you are looking for the answers. The diagram below is being used by the NSW Department of Health to summarise the factors contributing to the chronic diseases in Aboriginal people. (You may want to search the other State/Territory Departments’ of Health sites to find similar support diagrams). It is a health specific analytical tool incorporating our well known sociological imagination template. You can see the interconnection between the multiple disciplines. Embodied are some of the circumstances that lead us into the reasons why such burden of disease is experienced by the Indigenous communities. Learning Activity 6.4HLSC 120 2015 eModule 6 Page 11 HLSC 120 2015 eModule 6 Page 12 Now consider another, but related issue: Access to cultural specific and appropriate medical services and medication are a constant struggle by many Aboriginals and Torres Strait Islanders. The opportunity to acquire medication is for most Australians not an issue at all, but for the Indigenous peoples it can be a serious problem. Noel Hayman (2011) writes about a number of issues in regards to access to medication as follows Please read Hayman, N. (2011). Improving Aboriginal and Torres Strait Islander people's access to the Pharmaceutical Benefits Scheme. The Australian Prescriber, 34, 38- 40. Retrieved from http://www.australianprescriber.com/magazine/34/2/38/40 Learning Activity 6.5 To apply the knowledge and skills we have learnt in the last number of weeks, we shall look now at a case study. Please read carefully and give appropriate answers to the questions Case Study: Managing a chronic disease Doris is a 63 year old Aboriginal pensioner with diabetes mellitus, which was diagnosed several years ago. She lives in an outer metropolitan suburb and has two of her seven children, and up to ten grandchildren living in the house with her. She participated in health screening by having a random blood sugar test and her blood pressure measured when she attended a National Aboriginal and Islander Day of Celebration (NAIDOC) event where various health agencies were undertaking health checks and encouraging people to be tested. Her random blood sugar was raised and her blood pressure taken on the day was 180/105 mm Hg. Doris was told that it was really important that she go and see her health care practitioner to get treatment for her raised blood sugar level and high blood pressure. Doris feels tired all the time. She does not like going out because she gets tired and breathless, and has been “wetting” herself quite often. Therefore, she does not like to go too far from home. Doris has not attended the local Medical Centre for some time, because the Aboriginal Medical Service (AMS) which provides free health care is a long way to travel. She does not have a car and gets too tired using public transport. In the past when she has been sick, Doris has gone to see a general practitioner in the suburb where she lives. The last time she saw the doctor, whom she did not like; Doris could not afford to buy the medicine the doctor prescribed. Most of the day, Doris watches television and helps to take care of her younger grandchildren. Doris is aware that her vision and balance are not as good as they used to be. Doris is not sleeping well because her daughter and her partner are always fighting when he is in town, and she feels scared when he starts drinking and becomes abusive. Reflective Learning and Writing 6.4HLSC 120 2015 eModule 6 Page 13 She is also feeling very stressed about two of her grandsons who have often been in trouble with the police and now have to attend a committal hearing after being involved in a fight in which another Aboriginal youth was seriously hurt. Doris has promised to look after her ‘grannies’ while her daughter attends the Aboriginal legal service with the two grandsons who have their case coming up soon. She was meaning to go to the doctor but had to give the last of her money till next pension day to her grandkids so they could buy themselves some lunch at school. She feels much the same as she has for the last few months, so she cannot see why there is any real urgency for her to go to the doctor. When her oldest daughter, who is a health worker, visits in a couple of months’ time from interstate, Doris is sure her daughter will help her get to the AMS for treatment if she thinks it is important. Now reflect on Doris’ life situation 1. Considering Doris’ daily life, would attending the local medical service cater for Doris’ medical, mental and cultural needs? Explain in detail why Doris may/may not receive a culturally holistic treatment. 2. What are possible advantages and disadvantages for Doris in using an Aboriginal Health Service rather than the local general practice? (Think widely, consider all sociological concepts introduced in this unit) Adapted from Thackrah & Scott (2011, pp. 180-181) Australian Bureau of Statistics. (2004-05). National Aboriginal and Torres Strait Islander health survey: New South Wales. ABS Cat. No. 4715.1.55.005. Canberra: ABS, 2006. Available at www.abs.gov.au/AUSSTATS/[email protected]/mf/4715.1.55.005 Australian Bureau of Statistics. (2010). Cat no 3302.0.55.003 - Experimental life tables for Aboriginal and Torres Strait Islander Australians 2005-2007. www.abs.gov.au/ausstats/[email protected]/PrimaryMainFeatures/3302.0.55.003 Population Health Division (2010). The health of the people of New South Wales - Report of the Chief Health Officer. Sydney: NSW Department of Health. Available at www.health.nsw.gov.au/publichealth/chorep/ Queensland Health. (2011). The health of Queenslanders 2010. Report of the Chief Health Officer. Brisbane., Queensland Health. http://www.health.qld.gov.au/cho_report/ Health Department. (2012). Victorian population health survey 2008 report. Melbourne. Health Department Victoria. http://www.health.vic.gov.au/healthstatus/survey/vphs2008.htm Resources 6.4HLSC 120 2015 eModule 6 Page 14 Week 10 We will now explore interpersonal behaviour in a cross cultural situation and the role of Indigenous health workers and the health care teams in urban, rural and remote areas. By ensuring the client is in a culturally safe environment you will enhance her/his management and recovery. You might like to think back to your early lectures in this unit when you learnt about cultural awareness, cultural sensitivity and cultural safety (Eckermann et al., 2010). We will reflect further on what cultural safety means and how cultural awareness and cultural sensitivity create culturally competent professionals who can create an environment in which their clients feel safe. Here is a Case Study to reflect on and assess your attitude to your patients. Are you culturally sensitive and inclusive? Can your patients feel culturally safe when you will be their health worker? Case Study: Urban setting John, an Indigenous man, has had a heart attack and has discharged himself early from the hospital against the Doctor’s advice. A health professional has been asked to visit John at home to encourage him to attend a cardiac rehabilitation appointment located at the major hospital in the Metropolitan Region. After speaking to John the professional realizes that he knows how important it is to attend cardiac rehabilitation. Whilst with John, the health professional finds out that it is difficult for John to access the hospital because his car has broken down several times and he is unable to travel and public transport is not easily accessible. John is also worried about his housing situation. A family member with a drinking problem, who was staying with John and his family, behaved very badly and did a lot of damage to the house, which John now has to pay for. This causes him considerable stress. John knows that smoking is not good for him, and this is also ‘stressing (him) out’. But he enjoys smoking with a few mates who also smoke. Discussion Questions 1. Describe the cultural issues in this scenario. 2. Describe several culturally safe approaches for staff to use when caring for John in this situation and consider how these might be put into practice. 3. Using a culturally safe approach, who do you think would be the right person for John to talk to and discuss the importance of cardiac rehabilitation? What is the reason for your choice? 4. What culturally sensitive strategy could you suggest that a. allows John to talk with his friends without him smoking? b. assists John to keep his appointment in the hospital? c. helps John to find a way to pay off the house damage? Adapted from Thackrah & Scott (2011, p. 39) Reflective Learning and Writing 6.5HLSC 120 2015 eModule 6 Page 15 Please read the following pages from your textbook – Eckermann, A-K., Dowd, T., Chong, E., Nixon, L., Gray, R., & Johnson, S. (2010). Binan Goonj: Bridging cultures in Aboriginal health (3rd ed.). (pp. 183-195). Sydney: Churchill Livingstone Elsevier Australia Eckermann, A-K., Dowd, T., Chong, E., Nixon, L., Gray, R., & Johnson, S. (2010). Binan Goonj: Bridging cultures in Aboriginal health (3rd ed.). (pp. 196-218). Sydney: Churchill Livingstone Elsevier Australia Conclusion to eModule 6 Well done! You have completed all of the eLearning Lecture Enhancement eModules for this unit. Hopefully, you have increased your awareness and understanding of the processes that are making us feel we live in a global village with numerous intersections and relationships, rather than in a world with totally separate countries and nations. In this eModule, you have revised and explored the connection between globalization and health care practice and practitioners; aspects of health care from ethical, legal and political perspectives and the importance of health care practitioners being aware of human rights when caring for vulnerable human beings. You hopefully can now interconnect the colonisation processes and the relationship between socio-economic, political and social forces and the earlier and current health status of Indigenous communities. Finally we hope you understand the concept of global health and how health problems experienced by individuals have broader social causes and determinants. You have also been introduced to some key concepts of importance to Aboriginal and Torres Strait Islander communities. We encourage you to continue your journey of knowledge as this eModule and series of lectures will only be a foundation for future knowledge and interaction with Aboriginal and Torres Strait Islander patients, their families and communities. Reading and Resources 6.5HLSC 120 2015 eModule 6 Page 16 References Aboriginal Health & Medical Research Council of NSW. (2010). Living better longer. 2010 Living Better Longer Conference Report, Sydney. Broom, A., & Germov, J. (2014). Global public health. In J. Germov (Ed.). Second opinion: An introduction to health sociology (5th ed.). South Melbourne: Oxford University Press. Eckermann, A-K., Dowd, T., Chong, E., Nixon, L., Gray, R., & Johnson, S. (2010). Binan Goonj: Bridging cultures in Aboriginal health (3rd ed.). Sydney: Elsevier. Gray, D., & Saggers, S. (2014). Indigenous health: The perpetuation of inequality. In J. Germov (Ed.). Second opinion: An introduction to health sociology (5th ed.). (Chapter 8) South Melbourne: Oxford University Press. Madley, B. (2008). From terror to genocide: Britain’s Tasmanian penal colony and Australia’s history wars. Journal of British Studies, 47 (1) January, 77-106. McLennan, V. & Khavapour, F. (2004). Culturally appropriate health promotion: Its meaning and application in Aboriginal communities. Health Promotion Journal of Australia, 15(3), 237- 239. Ranzijn, R., McConnochie, K., & Nolan, W. (2009). Psychology and Indigenous Australians. Foundations of cultural competence. South Yarra, Victoria: Palgrave Macmillan. Tatz, C. (2010). Genocide in Australia. AIATSIS Research Discussion Papers No 8. Retrieved from http://www.kooriweb.org/gst/genocide/tatz.html Thackrah, R., & Scott, K. (2011). Indigenous Australian health and cultures: An introduction for health professionals (1st ed.). Sydney: Pearson Australia.