INDH2490: Foundations of Aboriginal and Torres Strait Islander

INDH2490: Foundations of Aboriginal and Torres Strait Islander Health
Assessment 2 - Written Assignment Case Study - 30%
Case study
Questions
Q1. “Briefly identify any barriers and cultural considerations that the family may face
when accessing Aunty Letti’s treatment”
In the case scenario of the elderly client, Mrs. Letty, it can be found that she is an Aboriginal
individual dealing with type 2 diabetes disorders. The condition is insulin controlled and later
has also been exposed to chronic kidney disorder. Living in an Aboriginal and Torres Strait
Islanders community in Australia, the individual would be considered to fall under a
culturally, politically, socially and economically disadvantaged group (Lorkins et al., 2016).
The Aboriginal client can experience inequalities in accessing health care services. Letti is
also inclined to face several cultural barriers during accessing health care for her illnesses.
There are several cultural barriers that play an essential role in determining the inequality of
health care services between non-Indigenous and Indigenous individuals of Australia. The
potential differences in languages, medical procedures, and practices, or conceptions of
gender and sexuality are primarily raised while accessing healthcare services (McBain, Rigg
& Veitch, 2011).
Due to these barriers, the patient can face miscommunication issues in receiving suitable
treatment and care. Cultural or language barriers can also impose obstacles among various
healthcare professionals to understanding the healthcare requirements of Mrs. Letty and
looking for effective treatment. Further, unsatisfactory health outcomes for Aboriginal clients
like Mrs. Letty can deteriorate her health condition even more (Mobula et al., 2015). She can
anytime be exposed to a massive heart attack or complications in the kidney. Due to her
unique cultural beliefs, she also faces difficulty in accessing health services including going
to check-ups regularly and undergoing health screening as well as carried out through
hospital appointments (Newman et al., 2007). Another major barrier is unsatisfactory health
outcomes that the elderly client can face is ineffective communication due to language
barriers. When there is a lack of effective communication due to cultural issues it leads to

increased confusion and misunderstanding among healthcare providers and the client while
providing health services.
Q2. “Briefly describe the determinants of health, and inequalities that Aunty Letti and
her family are facing to receive adequate health care?”
Cultural identity defines the cultural background of an individual and in this case the client,
Letty belongs to the Aboriginal community. It has been known that clients from Aboriginal
and Torres Strait Islander groups hold a strong connection to their family, land, culture, and
language which form the basis of their social and economic well-being (National Indigenous
Australian Agency, 2020). Moreover, the physical, as well as biological differences, also can
create a gap between Aunt Letty as well as her family members. This cultural gap holds these
people to avail health benefits similar to other non– indigenous Australians. Several
determinants of inequalities and health can be found that the client along with her family are
currently experiencing while accessing health care which include their cultural identities,
family and kinship, language, and participation (Australian Institute of Health and Welfare,
2020).
It has been reported by the ABS under the analysis of the AIHW report that the health gap
exists between aboriginal and non–Indigenous people of Australia is due to the limited
accessibility of indigenous people to health care and influence of cultural and historical
effectors (Australian Institute of Health and Welfare, 2018). Colonization has impacted the
people of Torres Strait Islander and Aboriginal group to a large extent affecting their culture.
The incidences of the past which included violence and epidemic have put them under a lot of
suffering including "loss of life, the occupation of land by settlers and the restriction of
Aboriginal people to reserves disrupted their ability to support themselves". The various
disputes regarding their families, kinship, living together, having a large family to feed;
unemployment, and insufficient income are some of the factors that determine the health of
Aunty Letti. Moreover, the lack of health services in her area for which she had to travel a
long distance and the cultural stigmatization faced by them from hospital staff are some of
the determinants that affected the health of Aunty Letti.
Q3. “Identify what health services and resources could be accessed to help support the
care of Aunty Letti in the admission and treatment process? And why it is important to
use culturally appropriate resources?”

There have been establishment and implementation of several policies and legislations to
provide equal opportunities to these people in attaining health care yet these issues remain
unresolved and require specific measures to be taken (AIHW, 2015). The most crucial role in
uplifting the status of indigenous Australians could be played by health professionals by
delivering a potential solution to eliminate ethnic and racial disparities. The major emphasis
is on the role of nurses who can actively participate in addressing cultural barriers among
Indigenous Australians (Li, 2017). It has been observed that people belonging to the
Indigenous population do not prefer to use mainstream health services due to their reduced
positive health outcomes for diverse health situations of these people. Therefore, it is
necessary that health services are customized according to the specific needs of the patients
which could be done by engaging Aboriginal individuals in the healthcare field with their
effective collaboration could help them achieve better patient outcomes (Davy et al., 2016).
Several actions have been taken by the government of Australia since the time period of
colonization by reducing the incidences of removal of their children and making health
services easily accessible to them.
As in most circumstances, it has been observed that unavailability or delayed accessibility of
health services had adversely affected their physical and mental health. However, the
Australian health care system has lacked coordination with the government authorities and
other health service providers. Due to these reasons, timely, effective and culturally safe
health services are not accessible to Torres Strait Islander and Aboriginal people (Nolan–Isles
et al., 2021). As Aunty Letti has been referred to a nephrology specialist in town, it took her
some while to reach the correct location in the hospital as they were culturally shamed by the
warded man on which the administrator also commented “these people out bush are never on
time”. However, after examination, Letti also has to undergo with the condition, renal failure
and prescribed dialysis three times a week. It would be difficult for Letti to travel so many
times to the hospital asked for help. To improve the health condition of Aboriginal people
like Letti, it is necessary to plan a culturally safe and patient driven approach at all levels and
elements of the healthcare unit varying from national healthcare policy and local services of
primary healthcare (OECD, 2015).
Q4. “Identify and describe how a culturally safe environment could be ensured for
Aunty Letti through her hospital admission and treatments?”

It has been well observed that healthcare inequality exists between Torres Strait Islander and
Aboriginal people with non – Indigenous Australians which could be justified with the help
of data published by the ABS in terms of lower life expectancy and increased incidences of
chronic, infectious and non – communicable diseases. The life expectancy was estimated as
11.5 years less for Aboriginal and Torres Strait Islanders than Non – indigenous Australians
(Australian Bureau of Statistics, 2011). Increased rates of infant and child mortality, low birth
weight, age-standardized death rates, perinatal mortality and low birth weight have also been
estimated particularly due to social and economic disparities and cultural differences. In
addition to this, higher rates of chronic diseases (CVD) and increased risks of infectious
(Hepatitis) and sexually transmissible diseases (HIV/AIDS) have also been reported for
indigenous groups. To ensure a culturally safe environment for Aunty Letti, it should be
ensured that people belonging to Torres Strait Islander and Aboriginal communities are
coordinated for health care services in the hospital offering renal care to Aunt Letti. For this,
the Culture and capability Programme of the Indigenous Advancement Strategy provides
funds to support and maintain Indigenous communities. There are different projects under
this strategy that helps for enhancing the economic and social life of Australia by increasing
the participation and collaboration of indigenous individuals in the health sector (National
Indigenous Australians Agency, 2020). The hospital must take appropriate actions to ensure
that Aunty Letti could easily access the dialysis on time.
Evidence-based healthcare practices need to be undertaken by healthcare providers to cultural
safety of the Aboriginal client. Such an approach would require coordination at a national
level as well as an appreciation of the interconnectedness of the entire healthcare system
which may be achieved by adopting an ecological, or ecosystem perspective (Richard et al.,
1996). Potential strategies can be found to make sure cultural safety is maintained for the
Aboriginal clients while receiving necessary treatments. This would be providing a reflection
on individual beliefs, attitudes, and culture while agreeing to the treatment measure
undertaken. Respectful, open, value-free, and open communication is also required from the
side of nurses and other healthcare providers to disclose to the client every important health-
related measure for the treatment along with significant complications associated with it. All
these factors have also been identified and can have a fundamental effect on the client and her
whole family. Further, it would pose a serious impact on their physical and mental health
conditions through social systems that maintain disparities (Australian National University,
2020). Practices which are culturally safe would be very important for the Indigenous client

as they would comprise actions identifying and respecting other people's cultural identities
along with safely fulfilling their rights, expectations, and requirements. Altogether, the
healthcare team would be required to provide social, spiritual, and emotional assistance to
Mrs. Letty and help her to make a communication with them, other staff, and her family
members (ABS 2019). Care provided to her in the healthcare setting should be informed like
dialysis procedures, and treatment techniques like providing her insulin for diabetes.
Q5. “Reflect on the actions and conversations from hospital staff and how you felt about
the situation”
The first thing which according to me has hampered equal health opportunities for Torres
Strait Islander and Aboriginal client like Aunty Letti can be identified as the remote location
of their inhabitation of specialized health facilities. Instead, the local hospital located in her
area has only a 10-bed facility and one permanent doctor without any specialized doctor for
her renal problems. Aunty Letti had to face the problem of traveling such a long distance for
her doctor's visit as she is old and should be accompanied by someone (HealthInfoNet, 2019).
Her daughter Marli agreed to take her to the neighboring hospital which is 3 km away from
their home while she had to appoint someone to take care of her children. The actions and
conversations of the hospital were very judgmental and culturally stigmatized. The ward boy
behaved badly when they ask him about the direction of the facility by saying "well I guess
you aren't from here are you". Further, they managed to reach the facility in 10 minutes to
which they overheard administrator staff saying "these people out bush are never on time".
These exclamations of hospital staff made me realize the problems people from indigenous
communities had to face while taking health care services that are not accessible to them
readily. Later, the doctor in charge was not at all cooperative in helping Aunty Letti in getting
dialysis as she was prescribed three times a week and had to travel multiple times or rather
had to stay in hospital accommodation. All these actions and conservations of the doctor and
the hospital staff have put a lot of problems for both Aunty Letti as well as her family
members.
The adverse health and socio-economic condition of the Aboriginal client and her family
were very much clear to me when she was facing complications to receive appropriate
healthcare services. This leads to a significant decrease or minimization in obtaining positive
and enhanced health outcomes. Another vital factor that needs to be serious consideration I
found was language issues which are the inability of the client to speak English. It is due to

the linguistic and cultural barriers that people belonging to Aboriginal and Torres Strait
Islander groups experience health disparities. Ineffective communication or
miscommunication led to inappropriate interventions and even misdiagnoses (Lowell, 2013).
Bias and cultural discrimination was clearly noticed in the scenario and for this Mrs. Letti
faced many troubles along with her family. They had to bear bad behavior from the ward boy
and the healthcare professional in charge of providing treatment. For these reasons, they are
often victims of cultural stereotypes which arises critical issues including low staff
motivation, low staff confidence, confusion about specific roles, and cultural incompetency in
health care settings leading to inadequate health services for patients like them. Geographical
locations also serve as barriers to access services of healthcare by Indigenous individuals.
These populations are more often located remotely and in regional areas where it has been
found difficult to access health care (Australian Bureau of Statistics, 2016). Besides this, the
complexities in her life got even stronger due to financial instability and residing in a remote
region where she couldn't communicate effectively.

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