- What are the main barriers identified in the paper to accessing and using health care for the Indigenous infants in the study area? Can you think of any additional barriers that may be applicable?
One of the most significant reasons for the health issues Aboriginal children face is their lack of access to medical services. Bar-Zeev, Kruske, Barclay, Bar-Zeev, and Kildea (2013) identify the leading causes as poor organisation, inappropriate care models, inadequate staff competence, and a lack of Aboriginal staff. As a result of these factors, delivery of quality care to a sufficient number of patients in a reasonable time frame becomes challenging, and trust issues arise.
Another issue that may be worth considering is racism toward Australian Aboriginals, which influences their physical and mental health. According to Kelaher, Ferdinand and Paradies (2014), nearly all members of the population experience incidents of racism at least once a year, and the number is generally much higher. This treatment elevates their distrust of the medical system, which is mostly staffed by white people, preventing them from seeking medical care unless there is a direct danger to a person’s health or life. Lastly, the generally low income of the remote Aboriginal families may lead them to be unable to access the necessary healthcare measures.
- What do you think are the main underlying reasons for the very high rates of infant malnutrition observed in this study?
Malnutrition is a significant concern for Aboriginals, as it is present in many of the population members, children as well as adults. According to Bar-Zeev et al. (2013), the condition is common in infants, particularly in their first year of life, with 86% of children experiencing growth faltering as a result. Such early malnutrition would have to be associated with the condition of their mothers, who would provide the primary source of a child’s food intake via breastfeeding.
The parents of Aboriginal children also tend not to establish healthy eating habits. According to Lee and Ride (2018), parents often do not give their children fruits and vegetables because the children do not like them. The population does not meet the vegetable, fruit, grain, milk product, and lean meat consumption guidelines, but consumes excessive amounts of sugar. This inadequacy is caused by a variety of factors such as unemployment, lack of education, and overcrowding.
The food has to be delivered to the locations of the Aboriginal towns in large amounts, which incurs significant costs that the residents are unable to compensate. As a result, food providers prefer to supply foods that are not healthy but can spend a long time on the shelf without spoiling to minimize the number of costly deliveries.
- The background section of the paper states that Aboriginal people living in remote communities usually have worse health outcomes than those in urban or larger rural areas. What are some of these health outcomes among remote Aboriginal people, and why are they worse than those in urban or larger rural areas?
The indigenous population of Australia primarily resides in urban areas, but some members live in remote locations. According to Bar-Zeev et al. (2013), the residents of rural communities tend to have worse health outcomes than their urban counterparts. This tendency extends to all aspects of physical well-being, such as the state of their teeth or the various postpartum complications in mothers. The primary reason for this difference would appear to be the gap in service accessibility, as people living in urban settings would have access to a broader range of care providers that would also be closer to their location. Furthermore, people in remote areas have less access to fresh produce and are more dependent on unhealthy foods, which exacerbates malnutrition and its consequences.
The quality of service available to rural communities is also considerably different, with weaker adherence to procedures and worse record keeping. According to D’Aprano et al. (2016), remote Aboriginal health centres often do not conduct developmental checks, and formal screening measures are not commonly utilized. Furthermore, the quantities of recorded parent reports and staff observations vary widely between different facilities but are generally not high. The lack of proper record keeping leads to a lack of recognition for developing issues, which results in worse health outcomes.
- In Table 5, the authors list a number of strategies to improve the quality of remote infant health care. To what extent do you think Indigenous infant health will be improved if all these strategies were to be successfully implemented? What additional strategies can you suggest improving remote infant health?
Various approaches can be employed to improve the quality of care provided by rural health care centres that primarily focus on internal changes. Bar-Zeev et al. (2013) suggest ideas for the improvement of the service organisation, workforce supply, education and training, and clinical governance and leadership. These measures should significantly improve the health of the indigenous population, though their well-being will likely still stay below the national average due to their lesser access to various healthcare facilities. The measures will not resolve issues that are not related to primary care, such as the group’s food consumption patterns.
As such, food and nutrition programs are necessary to support the health of the Aboriginal population, particularly the children. Browne, Adams, and Atkinson (2016) suggest the incorporation of education on nutrition and breastfeeding into childcare materials and services, the introduction of Aboriginal nutritionists, the improvement of access to nutritious foods, and the adoption of setting-based interventions. The resolution of the food-related concerns of the indigenous population will lead to considerable health improvements in people of all ages and remove a significant source of concern.
- Among the barriers to service delivery, the authors mention families’ need to attend funerals and traditional Aboriginal ceremonies. Can you suggest ways for health service to reconcile this need with the need to attend health care services and follow-up appointments?
The indigenous people place great importance on ceremonies such as funerals, which they may attend for periods that extend to months. According to Bar-Zeev et al. (2013), families with children would often be unable to participate in health care procedures on their own or refuse to do so due to inconvenient timing. This factor further complicates a situation that is already difficult due to the general distrust of the population toward healthcare institutions. Cultural sensitivity demands that the needs of the families take precedence, but the traditions endanger the health of the children, creating ethical conflicts.
Health care procedures should adapt to incorporate the possibility that patients may suddenly be required to stop attending the care facility and participate in lengthy ceremonies. Rix, Barclay, Wilson, Stirling, and Tong (2014) suggest a change in the model that involves a focus on prevention of diseases, the slowing of their progress, and education. These measures will improve health and reinforce the community’s trust in health care, and then it may be possible to secure their collaboration and integrate them into a traditional model or create a new joint system.
- Administrative duties were reported to take up a significant proportion of AHW’s workload. It can be argued that these duties are likely to increase further if recommendations in Table 5, especially those for clinical governance and leadership, are implemented. Do you agree, and what can be done to improve AHW’s workloads?
Aboriginal Health Workers (AHWs) are vital to the operation of remote care services, as they are figuring the population can trust. Bar-Zeev et al. (2013) state that due to their understanding of the indigenous culture, they are often relegated to administrative roles despite their clinical expertise. However, if the care improvement measures mentioned above are implemented, it is likely that their workloads will decrease in size. The reason is the more in-depth understanding of the culture that is the goal of the changes.
Initially, the number of tasks before AHWs will increase, as they will have to educate other staff and the community. However, once the other workers are adequately instructed in the details of the environment and more AHWs are recruited, the workloads of individual specialists can be distributed, which will lead to an increase in administrative efficiency, according to Thompson et al. (2015). Furthermore, the changes will allow AHWs to work in their original fields and transfer administrative duties to more qualified workers.
- The authors noted the “very poor engagement of clinicians with carers to address growth and nutritional issues and absence of community-based services”. In what ways were clinicians expected to engage with carers about these issues? What are some of the steps that can be taken to improve this engagement?
The promotion of topics such as proper nutrition involves the engagement of clinicians with the caretakers of infants. However, according to Bar-Zeev et al. (2013), such interactions are lacking in remote care settings, and the health of the indigenous community is negatively influenced as a result. Clinicians are expected to provide information and education to parents and provide community services such as learning sessions. These services help improve the community’s health by teaching them to take care of themselves and develop the trust people have in health care services.
Aside from increased practitioner participation in such events, the methods of engagement can be improved and tailored to the community’s needs. Somerville, Cullen, McIntyre, Townsend, and Pope (2017) suggest strategies such as increased family orientation instead of prioritising the individual, a focus on de-stigmatizing activities, and the use of culturally appropriate methods such as yarning. They state that the use of proper strategies will improve participation and outcomes, especially if the Aboriginal population is allowed to determine the appropriate processes and procedures.
- What, if any, are the instances of community participation in health interventions that can be gleaned from the information presented in the paper? Such participation can be in the form of community members being actively involved in the planning, implementation/delivery and/or evaluation of health care programmes. Can you suggest additional participatory strategies that can be undertaken to improve health outcomes for remote Indigenous infants?
Community-based initiatives are critical for successful early interventions, as many issues can be eliminated before they fully develop without the need for a hospital visit. According to Bar-Zeev et al. (2013), such measures have been highly successful in under resourced communities, including remote Aboriginal settings. However, community care programs are not widespread in the indigenous areas, primarily due to the poor engagement mentioned above. However, AHWs can be considered community members who are involved in the implementation of health care strategies.
Additional community engagement strategies can be utilized to increase engagement and improve health outcomes for the indigenous population. Cinelli and Peralta (2015) propose the use of volunteering, community outreach, and role modelling programs to develop the community’s trust and implement health care initiatives such as medical services and education. Such programs can help the urban population understand the indigenous people and vice versa, reducing racism and promoting the use of medical services.
References
Bar-Zeev, S. J., Kruske, S. G., Barclay, L. M., Bar-Zeev, N., & Kildea, S. V. (2013). Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery. BMC Health Services Research, 13, 250. Web.
Browne, J., Adams, K., & Atkinson, P. (2016). Food and nutrition programs for Aboriginal and Torres Strait Islander Australians: What works to keep people healthy and strong? Web.
Cinelli, R. L., & Peralta, L. R. (2015). ‘Achievement, pride and inspiration’: Outcomes for volunteer role models in a community outreach program in remote Aboriginal communities. Rural & Remote Health, 15(4). Web.
D’Aprano, A., Silburn, S., Johnston, V., Bailie, R., Mensah, F., Oberklaid, F., & Robinson, G. (2016). Challenges in monitoring the development of young children in remote Aboriginal health services: Clinical audit findings and recommendations for improving practice. Rural and Remote Health, 16(3). Web.
Kelaher, M. A., Ferdinand, A. S., & Paradies, Y. (2014). Experiencing racism in health care: The mental health impacts for Victorian Aboriginal communities. The Medical Journal of Australia, 200, 1-4. Web.
Lee, A., & Ride, K. (2018). Review of nutrition among Aboriginal and Torres Strait Islander people. Web.
Rix, L., Barclay, L., Wilson, S., Stirling, J., & Tong, A. (2014). A qualitative study of service providers’ perspectives on service delivery for Aboriginal people receiving haemodialysis in rural NSW. BMJ Open, 3(10). Web.
Somerville, R., Cullen, J., McIntyre, M., Townsend, C., & Pope, S. (2017). Engaging Aboriginal and Torres Strait Islander peoples in the ‘Proper Way. Newparadigm: the Australian Journal on Psychosocial Rehabilitation. Web.
Thompson, S. C., Haynes, E., Shahid, S., Woods, J. A., Teng, T. H. K., Davidson, P. M., & Katzenellenbogen, J. M. (2015). Shedding light or fanning flames?: A consideration of the challenges in exploring the relative effectiveness of Aboriginal Community Controlled Health Services. Quality in Primary Care, 23(3), 141-149.