Aboriginals and Torres Strait Islanders Paper 2022

Running head: ABORIGINALS AND TORRES STRAIT ISLANDERS
ABORIGINALS AND TORRES STRAIT ISLANDERS
Name of the Student
Name of the university
Author’s note

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ABORIGINALS AND TORRES STRAIT ISLANDERS
Introduction
This paper will draw on the case scenario of an aboriginal child, who is 5years old and
has contracted scabies. Scabies had been a serious problem among the aboriginal children.
Overcrowding of the houses and lack of cleanliness has been found to be one of the reason
behind the widespread transmission of the disease. This paper will also throw light on the
underlying pathophysiology of the disease followed by the nursing interventions and the cultural
considerations while caring for an aboriginal client.
Case study scenario
Name of the indigenous client: Tarni
Age: 5 years
Sex: Female
Next of kin: Nappaljarri
Family support: The family is getting benefit from the aboriginal Family support program and
get educational, cultural, preventative and supportive services to the children and the parents.
Currently, she stays with her parents, her grandparents, her two uncle and two aunt. Tarni resides
in a remote area with just two small rooms. Tarni’s distant uncle and aunt have recently visited
their place.
Schooling: Community school

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Medical history: the child has past history if asthma. Her sibling Kierra had also contracted the
scabies.
Conditions prior to the intervention: Widespread eczematous erythema can be found all over the
skin with persistent itching.
Cultural needs: The cultural needs of an aboriginal child involves social rights, employing
aboriginal female staffs in the primary care centres, providing health literacy to the families in
simple language. In this case study. Tarni’s mother did not want her to be examined by any male
nurse, Tarni being a female client. In such cases it should be ensured gender matching, where
both Tarni and her family will feel free to share their grievances.
Topic Information
There had been a disproportionate burden of disease in the remote communities of the
aboriginal people. Among the aboriginal people, the prevalence of scabies is about 10%. In the
remote communities of Australia about 50 % of the children and 25 % of the adults had been
found to be infested with scabies at times (Aung et al. 2015). Remote Aboriginal communities in
the northern Australia have the world’s highest prevalence of scabies with more than 80% of the
children affected by the first birthday (Aung et al. 2015).
Secondary infection of the scabies lesions is common. The prevalence of Group A
streptococcal pyoderma is common in the Northern territory of Australia. 50-60% of the cases
have been reported to be secondary scabies. Group A streptococcal pyoderma causes acute post-
streptococcal glomerulonephritis. Links have been found between the prevalence of rheumatic
fever and scabies. Scabies infection often leads to Group A streptococcus infection (GAS). The
transmission of scabies occurs with the burrowing of the Sarcoptes scabei in to the epidermis of

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the skin. The fertilised adult females mites burrow in to the stratum corneum. The common
sources of transmission is prolonged skin to skin contact with the effected individual. The
pathogenesis of scabies involves complex immunological pathways. Inflammation of the skin,
papules, purities results from an immune mediated antigen specific delayed hypersensitivity
reaction. The clinical manifestation resulted from the type and the intensity of the innate,
humoral and the cellular responses to the mite proteins (Hay, Steer, Engelman, and Walton
2012). There are reports that have documented that patients with scabies have a strengthened
cellular and humoral response. Crusted scabies among the aboriginal people are mainly due to
the overcrowding of the houses. Children are unable to maintain hygiene or keep distance from
those contracted with scabies. Hence, prevalence of scabies among the aboriginal children are
found to be much higher. Infants have a widespread eczematous erythema, particularly on the
trunk, that is often more symptomatic than the lesions on the typical sites. Pinkish brown nodules
can be seen.
Nursing interventions
The main nursing interventions for Tarni involves correct diagnosis of scabies,
elimination of the mites with the help of scabicides, treatment of symptoms and treatments of the
secondary infection. Initially, it the duty of the nurse to check whether the infestation has
occurred to any other members of the family (Hotez 2014). Some of the common medications
involves application certain medicated creams and lotions that are available within the doctor’s
prescriptions. The medications includes Permethrin cream, Lindane lotion, Crotamiton and
Ivermectin (Hardy Engelman and Steer 2017). Nurses might educate Tarni’s family regarding the
maintenance of the basic cleanliness, like keeping a clean house, cooling and soaking the skin to
minimise itching, providing medications like antihistamines.

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Cultural safety
Tarni is a small girl child, hence there lies certain extra ethical concerns while caring for
someone who come off an aboriginal background. A conflict took place while suggesting Tarni’s
family to refrain themselves from visiting other’s home and to refuse others from visiting their
house. It should be remembered that the aboriginals remembers a strong sense of family and
kinship. The aboriginal are likely to identify themselves by familial relationships. Hence, it
might sound culturally harsh, to refuse someone to their house. Considering their cultural
sensitiveness, these people can be instructed to maintain few rules like keeping the patient in an
isolated room, creating an open and conducing environment, such that patient or anybody
visiting the house does not hide any physical concern (Laverty, McDermott and Calma 2017).
Integration of cultural safety in an active manner reconfigures the health care allowing greater
equity of the realised access (Hole et al. 2015). It has been argued that the existing health safety
and the quality standards are not sufficient to ensure a culturally safe care for the aboriginal
people. The peak indigenous bodies have argued that boosting the likelihood of culturally safe
clinical care can subsequently contribute to health improvement of the indigenous Australians
(Hole et al. 2015).

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References
Aung, P., Cuningham, W., Hwang, K., Andrews, R. M., Carapetis, J. R., Kearns, T., …
Campbell, P. T. 2018. Scabies and risk of skin sores in remote Australian Aboriginal
communities: A self-controlled case series study. PLoS neglected tropical diseases,
12(7), e0006668.
Hardy, M., Engelman, D. and Steer, A., 2017. Scabies: a clinical update. Australian family
physician, 46(5), p.264.
Hay, R.J., Steer, A.C., Engelman, D. and Walton, S., 2012. Scabies in the developing world–-its
prevalence, complications, and management. Clinical Microbiology and Infection, 18(4),
pp.313-323.
Hole, R.D., Evans, M., Berg, L.D., Bottorff, J.L., Dingwall, C., Alexis, C., Nyberg, J. and Smith,
M.L., 2015. Visibility and voice: Aboriginal people experience culturally safe and unsafe
health care. Qualitative health research, 25(12), pp.1662-1674.
Hotez, P.J., 2014. Aboriginal populations and their neglected tropical diseases.
Laverty, M., McDermott, D.R. and Calma, T., 2017. Embedding cultural safety in Australia’s
main health care standards. The Medical Journal of Australia, 207(1), pp.15-16.

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