Indigenous Health

1
Indigenous Health

• Communication
• Cultural Sensitivity

2
Cross Cultural interaction

• Obstacles to positive interaction
• Culture shock health workers
• Culture Shock stressors
• Cultural Shock indigenous clients
• Cultural safety

3
Positive Cross-cultural Interaction when

• Equal status contact between members of various
  ethnic groups
• Contact is between members of majority and higher
  status members of minority group
• When authority and/or social climate in favour
  of an promote the intergroup contact
• When contact of intimate rather than casual
  nature
• When intergroup contact is pleasant or rewarding
• When members of both groups interact in
  functionally important activities that are
  greater in importance than individual goals of
  each group
• Hewstone and Brown Contact and conflict in
  intergroup encounters, Basil Blackwell, Oxford
  1986

4
Obstacles to Positive Interaction

• Structural
• Highly institutionalised health system isolated
  from issues related to personal, family and
  community care
• History of colonialism, scientific and
  institutional racism, legacy of negative
  legislation, minority anxiety, dependency, mutual
  stereotypes
• Professional structures and demands which
  overshadow client and caregiver personal needs
• Biomedical curative rather than holistic health
  models

5
Obstacles to Positive Interaction

• Individual/Personal 1
• Our perceptions and attitudes to professional
  role - not just about quality service (Race,
  creed, religion ARE important)
• Our perceptions of power
• Our perception of and attitude towards change

6
Obstacles to Positive Interaction

• Individual/Personal 2
• Our perceptions and attitudes to professional
  role - not just about quality service (Race,
  creed, religion ARE important)
• Our perceptions of power
• Our perception of and attitude towards change

7
Culture Shock Health Workers

• When well established habits no longer have
  expected consequences
• (Bochner, S. Cultures in Contact Studies in
  Cross-Cultural Interaction, Pergamon, Sydney 1982
• Three phases most people move through, and if
  they adapt well enough further stages follow.

8
Culture Shock Health Workers

• The honeymoon phase
• Short lived
• Excitement, fascination
• Different
• Friends and colleagues act as buffer, little if
  any real contact with the culture

9
Culture Shock Health Workers

• The disenchantment phase
• Stuck here
• The quaint becomes aggravating
• Having to do things in a different way
• Anxiety and inadequacy
• Compensated for by seeking out fellow countrymen,
  excluding the indigenous population OR going
  native
• If you last, then a chance to take on board
  different ways of understanding, doing things

10
Culture Shock Health Workers

• Beginning Resolution Phase
• Seeking to learn, making friends, becoming
  participant and observer as much as possible
• Characterised by the return of the sense of
  humour?
• Brink and Saunders Transcultural Nursing A
  book of Readings, Prentice Hall, Toronto 1976
• Increased ability to predict the actions and
  reactions in situations
• Ability to function in more culturally
  appropriate ways

11
Culture Shock Health Workers

• then the worker may achieve
• Effective Function Phase
• as comfortable in the new setting as the old.
  Disadvantage may include reverse culture shock
  when he goes home
• Reverse Culture Shock Phase
• May need debriefing. Ideally the worker should
  become as comfortable in one culture as the other

12
Culture Shock Stressors

• Communication
• verbal and nonverbal
• complexity of ideas
• rules and conventions
• acceptable behaviour and etiquette (respect
  especially to children and the elderly)
• Promises and what they mean (sometimes there is
  the need not to say no, while at the same time
  not to say yes!)
• (I call that Eastern Standard Koori Time)

13
Culture Shock Stressors

• Mechanical Differences
• Things are different in the bush.
• Power
• Gas
• Electricity
• Telephone
• Water
• Shops
• Movies

14
Culture Shock Stressors

• Isolation
• Cultural Isolation
• Social isolation
• Professional isolation

15
Culture Shock Stressors

• Customs
• Death in some cultures the deceased is not
  mentioned, some they are remembered, some are
  adamant about returning to their land to die,
  many attend the funerals because it would be
  disrespectful not to
• Birth born into the community and introduced to
  it as soon as possible
• Disharmony gossip and shaming help groups
  control those they think have acted unacceptably.
  It is an INTERNAL mechanism - stay out of it

16
Culture Shock Stressors

• Attitudes and Beliefs
• Health Intervention - when reinforced by
  legislation is not good - compulsory vaccination,
  chest X-Rays, mantoux tests
• Respect cherished beliefs. They change far slower
  in communities than in journals
• Changing the message every few years is NOT good
  practice

17
Culture Shock Indigenous Clients

• It may seem strange but the issues that affect
  the health worker also affect the health care
  recipient
• Changes deeply affect the indigenous patient
  transferred to the big city for surgery - loss of
  identity, loss of autonomy, alienation, loss of
  personal space, shame/embarrassment,
  powerlessness, fear, anxiety
• Dealing with you in the community or outside it
  presents them with all the same issues raised so
  far.
• Communication
• Mechanical Differences
• Isolation
• Customs
• Attitudes and Beliefs

18
Cultural Safety

• Health workers are aware of the importance of
  physical, ethical and legal safety in health
  care, but unaware of or insensitive to the
  importance of providing culturally safe
  environment to facilitate physical, ethical and
  legal safety of the clients
• Ramsden, Whakaruruhau Cultural Safety in
  Nursing Education in Aotearoa. A report for the
  Maori Health and Nursing Ministry of Education,
  New Zealand, 1990

19
Cultural Safety

• Cultural safety, as defined in 1988 by the Hui
  Waimanawa, Christchurch, requires that
• The validity of Maori cultural values be
  recognised, especially as they relate to their
  perceptions of health, their tapu, and the
  holistic nature of their being
• Ramsden, Whakaruruhau Cultural Safety in
  Nursing Education in Aotearoa. A report for the
  Maori Health and Nursing Ministry of Education,
  New Zealand, 1990

20
Cultural Safety

• Cultural safety then is the need to be recognised
  within the health care system, and to be assured
  that the system reflects something of you - of
  your culture, language, customs, beliefs,
  attitudes and preferred ways of doing things
• It must adopt a holistic approach, as must your
  communication
• Communication is a two way process

21
Cultural Safety - from the community

• Health is the well-being of the whole person -
  if you feel good in your spirit, thats health -
  its not just a medical thing. If youve got a
  good spirit youre happy in your heart People
  have a good spirit when you can have all of your
  family with you, to know your children are well,
  to have your child born on your land, to have a
  job, not to have to worry about where your next
  feed is coming from, to be where everything is
  familiar, to feel comfortable, to be free of
  worries about health problems, to have choice
  without fear of reprimand - an anxious mind
  drains a good spirit.