Comparison between Aboriginal Medical Services and Urban Outpatient Renal Unit

This essay explores the similarities and differences between Aboriginal Medical Services (AMS) and Urban Outpatient Renal Unit (UORU) and how these factors influence the decision of patients from Aboriginal communities. It also discusses strategies to manage health issues in a culturally safe way.

Contemporary issue
essay
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Table of Contents
Introduction......................................................................................................................................3
Comparison between different healthcare services..........................................................................3
Introduction of aboriginal medical services and urban outpatient renal unit.........................3
Similarities between AMS and UORU...................................................................................4
Differences between AMS and UORU..................................................................................4
Factors influencing Bill's choice......................................................................................................5
Historical and cultural perspective.........................................................................................5
Socio-economic perspective...................................................................................................5
Culturally safe alternative presented by Indigenous Healthcare Services..............................6
Strategies to manage health issues in a culturally safe way.............................................................6
Cultural safety .......................................................................................................................6
Practises to manage healthcare in a culturally safe way.........................................................7
Conclusion ......................................................................................................................................8
References........................................................................................................................................9
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Introduction
Aboriginal is a term used for self-identification by communities of indigenous people that
are found in mainland Australia and many if its islands (Versiani, Souza, and De‐Deus, 2015).
These communities are often closed to outsiders for cultural reasons. These people have a
broadly shared genetic history and deals with many issues such as historical trauma, social
disadvantages, less access to education and are a little more alienated than mainlanders in
availability of healthcare and economic facilities (Bar-Zeev and et. al., 2019). Aboriginal
Medical Service (AMS) is an aboriginal community controlled health service. It aims to
improve health standards in aboriginal communities across Australia which were relatively far
less beneficiaries of the urban medical facilities and development (Baylis, Wirtz, and Gray,
2018).
This essay aims to understand the similarities and difference between aboriginal medical
services and an urban outpatient unit and how these factors influence the decision of patients
from aboriginal communities (Hill and et. al., 2018). For the sake of fluency of essay and easy
understanding of topic, a 55 years old patient of End Stage Kidney Disease – Bill, from a remote
desert community is considered who is managing his peritoneal dialysis with the help of AMS
but is now recommended haemodialysis in Perth. Such strategies which urban outpatient units
can adopt to make patients like Bill feel culturally safe are also discussed.
Comparison between different healthcare services
Introduction of aboriginal medical services and urban outpatient renal unit
Aboriginal Medical Services (AMS)
Aboriginal communities have a long history of social inequality, disempowerment,
poverty and discrimination (St Clair and et. al., 2019). AMS is a medical service started,
controlled and managed by aboriginal community to provide a culturally appropriate alternative
to mainstream medical services. It is taken as symbol indigenous rights and empowerment by
addressing health disparity.
Urban Outpatient renal unit (UORU)
Outpatient units are those departments of a hospital where patients do not stay overnight.
They visit the doctor, get themselves checked, are prescribed or given a treatment and then leave
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the hospital. Urban Outpatient renal unit refers to those outpatient units where diseases and
issues related to kidney and its functions are diagnosed and treated.
Similarities between AMS and UORU
Code of Conduct for nurses and midwives – Australia has defined professional standards
which define the practices and behaviour of nurses and midwives (George, Pope, and Reid,
2015). All nurses and midwives shall compulsorily be registered with Nursing and Midwifery
Board of Australia (NMBA). The Congress of Aboriginal and Torres Strait Islander Nurses and
Midwives (CATSINam) is the peak body that represents, advocates and supports aboriginal
nurses and midwives in Australia (Deidun and et. al, 2019).
Other medical services – Both AMS doctors and Urban Outpatient renal unit doctors
resort to same kinds of medicines and both are covered under same Health Insurance (Guilmoto,
and Jones, 2016). Although, to promote mainstream healthcare services among aboriginal
communities, AMS and its indigenous patients are provided with additional benefits.
Differences between AMS and UORU
Management and control – AMS are operated and controlled by the local aboriginal
community and is managed by a locally elected Board of Management while UORU are either
owned, operated and managed by Government, public sector or private sector which chooses
Board of directors accordingly.
Treatment – AMS undertakes treatment of all types of medical issues that they can
manage such as they were providing peritoneal dialysis while UORU are concerned with issues
related to only nephrology i.e. kidney related issues and are able to provide all kinds of
treatments.
Approach – AMS try to deliver holistic healthcare and service to indigenous
communities while UORU are units of mainstream hospitals and follow standard medical
practices without any special regards to any specific community.
Cultural Safety – AMS focuses on providing cultural safe environment that can foster
sense of safety among aboriginal patients while UORU are focused on providing healthcare
services to everyone equally without any regards to any culture (Gwynne, Jeffries and Lincoln,
2019).
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Factors influencing Bill's choice
Historical and cultural perspective
Aboriginal communities of Australia has a separate genetic make up from mainlanders.
They have genetic inheritance from ancient Asians while mainlanders have European descent.
With the time they lost most of their indigenous languages and most of them now speak English
with phrases from their dialects. They have a separate culture which includes number of
ceremonies centred on a belief in the Dreamtime and other mythology. Because of their different
culture and ethnic identity from mainlanders, they often experience discrimination and racism
(Anderson and Brady, 2018). Historically, these people were original inhabitants of Australia
and were dispossessed from their land by British on their arrival in 1788. They were deprived of
full citizenship rights of the new nation on the grounds of their race and new laws were
introduced to prefer white European immigrants over original inhabitants. Though these laws
now stand dismantled and practising any kind of racial discrimination is forbidden by law, racial
discrimination against aboriginal has become a part of culture among white dominated
mainlanders. Ignorant mainlanders stereotypically believe that colonization was in the past and
indigenous people need to move on. They shall leave their cultural identity behind to integrate
with them. This stereotype can lead a medical practitioner to believe that aboriginals are
unwilling to get better with their practises, which can foster prejudice against them as such
treating them is a waste of time.
Socio-economic perspective
Aboriginal communities are largely away from access to improved health services.
Therefore, indigenous population have high rates of chronic diseases (Lemma, and Lynch, 2015).
They are often unable to have an access to improved services because of different types of
economic barriers such as high cost of healthcare, high level of unemployment, lower education
and skills level, lower income levels, etc. and social barriers such as experiences of
discrimination, racism and difficulty in communication with healthcare professionals (Vallesi
and et. al., 2018). Also, mostly aboriginal communities have a low population level and are often
confined to spatial factors such as locations and distance. It makes it difficult to have a primary
healthcare centre nearby which are built by government according to population-provider ratio.
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Culturally safe alternative presented by Indigenous Healthcare Services
Aboriginals have higher level of unemployment and lower level of education which often
aid and assist the act that mainstream primary healthcare access is not within their easy reach.
Moreover, their cultural identity is not recognised and respected by mainstream practising
doctors. All these issues are addressed by indigenous healthcare services which are owned,
operated and controlled by aboriginal communities. They present an alternative which is likely to
be free of racism and more culturally appropriate than mainstream services. They hire doctors,
nurses, midwives from within aboriginal community to provide them with employment
opportunities and also to make patients feel secure in a familiar environment. They also provide
transportation facilities to and from appointments to patients, charge less fees from patients with
low income and prefer identifying and addressing healthcare needs in close consultation with
community members, etc. Bill has been getting himself treated from an AMS doctor who had
been managing his peritoneal dialysis even in the remote desert community (Siontis and et. al.,
2018). All the above reasons make indigenous healthcare services appears to be better place for
Bill to choose over having haemodialysis in urban outpatient renal unit in Perth even though it
could be life-limiting issue from him. Indigenous healthcare services would provide him an
alternative where he would feel secure, wanted and cared by wholeheartedness, all of which will
contribute in him having peace of mind and belief over treatment methods, which are paramount
for a patient to be successfully treated.
Strategies to manage health issues in a culturally safe way
Cultural safety
For mainstream practitioners to foster a safer and more effective healthcare system which
is inclusive of aboriginal patients, they need to do away with all types of prejudices and
stereotypes that could result in reduced care and discrimination against them (Coresh and et. al.,
2019). This will lead them towards the journey which will increase cultural safety and equity in
health and healthcare.
Safety is needed to be defined in terms of those patients from indigenous communities
who are supposed to be receiving the service, not of those who practitioners who are going to
provide it. Cultural safety is touted as an influential perspective that can help develop better
healthcare facilities for indigenous people. Cultural safety shall not to be confused with concepts
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like cultural awareness, cultural sensitivity, cultural competency and cultural humility. It focuses
on concentrating on roots of health and healthcare inequities faced by aboriginals on the social
and historical context such as colonization, not on their social and historical indigenous culture
which differs from one community to another. Cultural safety approach considers those contexts
such as structural and interpersonal power imbalances, which shape health and healthcare
experiences. Practitioners need to be self reflective of the impact of their power and position over
the patients, especially indigenous people.
Practises to manage healthcare in a culturally safe way
It is highly discussed that boosting likelihood of culturally safe clinical care may
substantially improve indigenous health. More specific embedding of cultural safety within
mandatory standards of clinical care may cover the gap in healthcare delivery (Alves and et. al.,
2018). First of all, medical practitioners shall introspect and reflect on their own character and
practises. They shall analyse how their own beliefs, values and actions are influencing others.
They can also take help from their peers, colleagues and family to know the impact of their
actions. Accordingly, they should try to minimise the power differentials between themselves
and their patients such as Bill, irrespective of their ethnicity and race. Doctors and other
healthcare professionals shall try to engage in conversation with the client and build a
relationship with them so that they feel safe, secure and wanted. All people shall be treated with
respect to their culture and individual differences i.e. diversity between cultures shall be
appreciated. Healthcare Professionals shall try to take special care to not demean, diminish or
disempower others through their actions that can leave aboriginal patients uncomfortable and
restless.
Government of Australia is committed to remove all practises against aboriginal
communities and provide them with health literacy. In line with objectives set by government,
The Australian Health Practitioner Regulation Agency (AHPRA), also pledged to support health
equity for all Australians alike. Various related institutes such as Australian Physiotherapy
Council, The Royal Australian College of General Practitioners, Aboriginal Health Council of
Western Australia, National Aboriginal and Torres Strait Islander Health Worker Association,
etc. have designed cultural safety training programs to help their practitioners extend their
knowledge about aboriginal culture and influences of their behaviours on perceptions and
assumptions of indigenous patients in a clinical setting (Goto and et. al., 2019). These trainings
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help to enlighten healthcare professionals about all that they need to know to work actively
towards cultural safety such as the historical fights of the aboriginals, how they have developed
trust issues with the non-indigenous people, myths like there are all drunkards and drug-addicts,
etc. It also helps them know their professional and moral responsibility towards their indigenous
patients. Finally, it prompts them to do something with good intention such as speaking out
against racism, create a system that can support culturally safe approaches and lastly, take
responsibility of their own learning and commit to lifelong journey of providing equitable
treatment to indigenous and non-indigenous people without any bias or stereotype.
Conclusion
From the above, it can be concluded that aboriginals are indigenous communities of
Australia and that they have long been suffering from racial and socio-economic discriminations
which has resulted in their unwillingness and inability to just access to mainstream healthcare
facilities for various reasons even if it is life-threatening situation. Thus, to provide them with
equitable opportunities of healthcare services, concept of Aboriginal medical services was
introduced. AMS is by the aboriginals for the aboriginals. They provide medical facilities to
aboriginal near their communities by their community professionals so that they feel culturally
secure in that environment. To extend mainstream healthcare services to aboriginal in the way
that there is not inequality among the healthcare access to indigenous and non-indigenous
people, concept of cultural safety was introduced. It encourages healthcare professionals to have
a self-reflective process to learn about the influences their behaviours and actions cast on others,
especially their biased actions based on stereotypes against aboriginals. Many institutes also
provide cultural safety training to their professionals so that they can bring a positive change in
Australian society and take it towards becoming an equitable society in whole.
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References
Books and Journal
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Medical Services:‘ICAN QUIT in Pregnancy’step-wedge cluster randomised
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Hill, I. and et. al., 2018. Accuracy of national key performance indicator reporting from two
Aboriginal medical services: potential to underestimate the performance of primary
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St Clair, M. and et. al., 2019. Telehealth a game changer: closing the gap in remote Aboriginal
communities. Med J Aust, 210(6 Suppl), pp.S36-S37.
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Medical Service in the Northern Territory. Journal of Pharmacy Practice and
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Goto, N.A. and et. al., 2019. Geriatric assessment in elderly patients with end-stage kidney
disease. Nephron, 141(1), pp.41-48.
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Stephens, D. and et. al., 2019. Demand study for alcohol treatment Services in the Northern
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