My name is Nathan Taylor, I am Tubba-Gah man from the Wiradjuri Nation. I am also the Aboriginal Health Worker at St Vincent's Health Network, Sydney. Given my role as an Aboriginal Health Worker, I will predominately be providing my answers from a health perspective.
The modern history of Australia since colonisation has led to the Aboriginal and Torres Strait Islander Peoples having a difficult relationship with the various institutions that exist within our society e.g. 'health, justice, education'. In today's society, a higher proportion of Aboriginal and Torres Strait Islander Peoples have a lower socioeconomic status, when compared to the general population, meaning they have poorer health, poorer education, and higher rates of incarcerations, among other factors. All these factors cumulatively contribute to the life-expectancy of an individual, which is why the significance of 'closing the gap' in life-expectancy between the Aboriginal and Torres Strait Islander Peoples, and the general population, has become so important.
To properly improve outcomes for our Aboriginal and Torres Strait Islander communities we need to properly address not just the social determinants, but also the cultural needs of the individuals, the families, and the communities. However, due to effects of colonisation, and the various government policies since then, it has become increasingly difficult in today's society to separate the cultural needs of our Aboriginal and Torres Strait Islander Peoples, from the needs of those living within low socioeconomic conditions. The two are often talked about interchangeably, to a point where disadvantage has become synonymous with the various Aboriginal and Torres Strait Islander cultures.
In answering the below questions I will try to make the separation clearer, and only address the cultural needs of a patient.
- In meeting with an Aboriginal and/or Torres Strait Islander whose English communication skills are limited, what methods could be used to better communicate, including in obtaining a medical history, family history and life style? What questions should be and should not be asked?
Health, or the idea of health, can often be interpreted differently amongst patients from different Nations, communities, and even families, so there is no one-size-fits-all method to approaching this.
In my role I have found that patients identify with, and convey their health in holistic terms that relate more to their social and emotional wellbeing, rather than their physical wellbeing. Factors that are important to social and emotional wellbeing include a person's connection to country, spirituality and ancestry, relationships with family members and friends, and connection to community. However, it would be wrong to exclude the fact that poor health literacy within some individuals exists, with the association of a cause and effect, such as alcohol abuse and liver damage, not always known or understood properly.
In order to obtain the relevant information to perform your role, the health discussion should take a less formal approach through asking questions about an individual's family, and community and showing genuine empathy by validating or acknowledging how a patient might be feeling emotionally about their health. This can be an effective way of developing a good rapport with the patient.
- Are there any special issues to be considered in obtaining consent to medical treatment?
For a practitioner or clinician, it may be a relatively minor health procedure or treatment option, but it can be a daunting prospect for a patient. For this reason, individuals may wish to have family involved in the conversations surrounding major health considerations, and it would be best to ask the patient if they would prefer their family, and/or the Aboriginal Health Worker to be present when seeking consent for surgery or medical treatment.
- Can you please explain the role of community members and Elders? In dealing with Elders, how should they be addressed? What is their authority?
Within my Nation, the Wiradjuri Nation, the Elders are the keepers of knowledge, and oversee the education of the youth, the upholding of cultural beliefs and protocols, and seasonal migration to ensure sustainable use of the land. In today's society, the Elders roles still encompass many of the same values, but have also taken on roles that encompass our modern society such as community activism, and the representing the communities in dealing with corporations and governments.
Elders are currently addressed or known by the titles of Uncle, for males, and Aunty, for females. This is not a title that is formally bestowed, but rather signifies the status and respect an individual has within a community. The Elders within the Wiradjuri Nation are represented by the Wiradjuri Council of Elders; similar representative bodies exist within other Nations.
- Can you please explain men's and women's business? Is it best to have a doctor/nurse of the same gender involved?
Traditionally, these terms were used to represent how knowledge and cultural protocols were taught, and shared. In the Wiradjuri Nation, information was taught by the male Elders to the male youth; with the female Elders teaching the female youth.
In a modern health context, this would mean having a male Nurse/Doctor treating someone of the same gender, however in practice this is not always an available option. Some health Institutions have male and female Aboriginal Health Workers, others do not. I myself am a male Aboriginal Health Worker, and approx. 50% of my patients are female. Even as an Aboriginal person, I will ask in my first interaction if the patient would feel more comfortable speaking with a female Social Worker. These considerations of, and observing cultural protocols, can be significant in making a patient more receptive and comfortable in a delicate situation.
- What about communicating future appointments and medications?
As well as communicating the significance of future appointments and medications, it is important to address any inhibiting factors that could limit whether or not an individual might be able to attend an appointment, despite agreeing to it. When communicating future appointment and medications, ask questions that can address hindrances e.g. 'Do you have a way to get to the hospital? Do you have family who can bring you to your appointment? Do you know where the local pharmacy is, or have a preferred one? Have you used a Webster pack before? If I need to contact you, what is the best way to do so?'
In addressing the inhibiting factors, it will give the patient greater power and responsibility over their health care, and give you the opportunity to further build an open, honest, and positive relationship with your patient.
- Are there holistic medicine issues to be considered?
See question 1.
- What interpreter services are available?
Language revitalisation, particularly in South-Eastern Australia, is still in its infancy; I am not aware of any interpretation services that currently exist. Where the languages of Nations are still spoken more frequently, such as Northern and North-Western Australia, there may be interpretation services available. In other parts of the country, it would be best to involve your Aboriginal Health Worker, Aboriginal Liaison Officer, or other institution equivalent, when engaging with patient/client.
- What can and cannot be said about death and the deceased or other issues?
The protocols surrounding death vary from Nation to Nation. For instance, within the various cultures of the Noongar Peoples of WA, the first name of the recently deceased in not said for a period of time until the community sees fit; these protocols are, however, not shared across the country. To find out more information relevant to your community, you can seek advice and understanding from your local Elders Group/Council, Aboriginal Incorporated Body such as the Aboriginal Medical Services and Aboriginal Community Controlled Health Organisations, and Aboriginal Land Council.
- What is taboo?
Again, in a broader sense, to find out more specific information about the Nation's culture that your city is located in, you should seek advice from the local Elders Group/Council, Aboriginal Incorporated Body such as the Aboriginal Medical Services and Aboriginal Community Controlled Health Organisations, and Aboriginal Land Council. This can also vary in individuals, and it is important to be mindful of institutional, and/or intergenerational trauma, this is when an Aboriginal Mental Health Worker or other appropriate mental health services should be engaged.
Whilst not taboo, something that is often done, in order to build report with a patient, is to relay that you have been to or worked in an Aboriginal Community elsewhere in Australia. While that fact is in and of itself fantastic, it is not always relevant to the patient, and may come off as disingenuous. The similarities between the cultures, and communities in Arnhem Land in Northern Australia and the Biripi Nation on the Eastern Seaboard, are vastly different. It is better to ask the patient about where they are from, as their community and Nation will hold more significance.
- How else can patient outcomes for our Indigenous and Torres Strait Islander Community be improved?
As I hope this has come through in my answers, empowering our individuals to take further control and ownership over their health is an important way to improve patient outcomes within our communities. Aboriginal Community Controlled Health Services are also an effective means for improving health outcomes.
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