There are many effective models of service and program delivery in indigenous communities which have been developed and delivered in a manner that is respectful of and responsive to indigenous needs. This paper will highlight a health program for indigenous people being delivered in a remote, urban or rural setting by an indigenous organization and research the background of the program, identify its aims and objectives, how it is being delivered and what outcomes are being achieved. In this case, this paper will discuss a program spearheaded by Katungul Aboriginal Corporation Community and Medical Services, which aims at improving the health outcomes for Aboriginal communities found in New South Wales, Australia. This report highlights the steps, which have been taken by Katungal Aboriginal Corporation Community and Medical Services, to address the problem of alcohol and other drugs in aboriginal communities.
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This paper will begin by providing a literature review on the history of alcohol and drug use in Aboriginal communities found in New South Wales. The literature review will also highlight the history of the organizations spearheading the aforementioned program. This paper will then discuss the aims and objectives of the program in question, how the program is being delivered, the outcomes of the program, and the limitations of the program. The report will also provide a number of recommendations and a summary.
Literature Review: The effect of White Men Colonization
Aboriginals in New South Wales
Aborigines found in New South Wales, Australia, are indigenous Australians who are believed to have migrated to their current location approximately 40,000 years ago (MCS, 2006). This community was in existence even before the settlement of Europeans. New South Wales Aborigines had a semi-nomadic lifestyle combined with farming, and to a lesser extent hunting and gathering (Perkins et al., 1994). These communities have coexisted for a long time, and this has significantly influenced their languages, beliefs and customs. Currently, Aborigines constitute 2.4 percent of the Australian population (Meyerhoff, 2000). Aborigines are struggling to access primary health care when compared to non-Aboriginals in Australia (Smith, 2008). According to Couzos and Murray (2008), this is attributed to historical events most importantly, European colonization, which created a socioeconomic imbalance between Aboriginals and non-Aboriginals in Australia.
History of alcohol and drug use in New South Wales Aborigines
Recent studies have indicated that Aborigines especially Moruya, Wallaga, Bega, and Eden communities have a misconception of some diseases, and most importantly sexually transmitted diseases and viruses transmitted via blood (Black et al., 2008). In addition, there is a growing percentage of injecting drug use and alcoholism in New South Wales Aborigines; a phenomenon that has contributed to high HIV prevalence in this community (DHA, 2007). This phenomenon is attributed to historical precedents. As a result, Aborigines have lost faith in the government and other research bodies (VicHealth, 2000). In addition, individuals who engage in acts of alcoholism and injecting drug use do not identify themselves, and it is difficult to ascertain the causative factors (DHA, 2010). Individuals who inject illegal drugs often hide from the community’s limelight and from their family members and friends, and this makes it even more difficult to recruit them to join the rehabilitation program (Gray, 2005).
An increase in the use of drugs and alcoholism has been attributed to a number of factors. One major factor is colonization. It is believed that the settlement of Europeans had a significant impact on the social-economic activities of the Aborigines. As a result, their lifestyles changed owing to the westernization that came along with colonization (Larson, Shannon, & Eldreidge, 1999). The impact of European colonization is still felt at the moment.
Westernization has changed the lifestyles of the Aborigines. Social activities like entertainment are of Western origin, and they depend on the availability of money. Social permissiveness and the lack of finances force many hopeless Aborigines to engage in alcoholism and drug use (Gray, et al, 2001). Although other forms of drug use exist, incidences of injecting drug use and alcoholism have been found to be significantly high in Aborigines living in New South Wales. A report produced by the Australian Drug and Alcohol Council indicated that injecting drug use and heterosexual contact contribute to a majority of HIV transmissions in Moruya, Wallaga, Bega, and Eden communities (ADAC, 1999). Another report produced by The Well Persons Health Check indicated that a significant number of participants had hepatitis B and C, which are blood-borne viruses (DHA, 2008). Thus, the lack of proper information on the transmission of STIs and viruses transmitted in the blood contributes significantly to the higher cases of hepatitis B and C, and HIV in New South Wales Aborigines (Day et al., 2006).
History of the Program
Katungul Aboriginal Corporation Community and Medical Services organization was established in 1993 after three local Aboriginal communities merged (Holly, 2001). They include the Narooma Community Centre, Makarling House, and Ghuryunguan. The three communities merged with the objective of establishing a community-based health organization that would enhance the health outcomes of indigenous communities found in New South Wales. The organization’s objective endeavoured to assist the communities in question to achieve self-determination and self-management, and emotional health. As such, the organization’s objectives prioritize the spiritual, emotional and cultural well-being of the Aborigines living in New South Wales in order to eliminate historical imbalances created by European Colonization. The current program involves addressing the problem of alcoholism and other drugs in Aborigines living in New South Wales.
Analysis of the program
The Aim of this program
This program aims at treating indigenous patients who suffer from disorders, which are caused by alcoholism and other drugs in Aboriginal communities especially Moruya, Wallaga, Bega and Eden (ADAC, 1999). This program provides rehabilitation services to the affected individuals. This organization also aims at voicing the victims’ needs and concerns (ADAC, 1999). Moreover, the organization aims at providing quality and culturally necessary healthcare to the aforementioned local communities (ADAC, 1999).
How the program is being delivered
Katungul is funded by the State and Commonwealth Government Agencies. The program targets Aboriginals and Torres Strait Islander people in communities like Moruya, Wallaga, Bega and Eden (ADAC, 1999). In addition, Office for Aboriginal and Torres Strait Islander Health (OATSIH) has provided funding for comprehensive primary health care (ADAC, 1999).
The Katungul substance misuse workers union delivers treatment to the patients by holding weekly support group meetings in the communities mentioned above. These support groups facilitate the rehabilitation process of clients from the aforementioned communities. In this case, a client must have successfully completed the first 4 steps of the “12 Steps to Recovery” program for him or her to be enrolled fully into the program (ADAC, 1999). The first 4 steps are the major components within this program and by the time the client has reached this stage, a client is prepared and confident to complete the rest of the program, and support others within the support group when Katungul’s staff members are not available (ADAC, 1999).
Clients who have disorders related to substance abuse are referred to Katungal staff, by the Department of Community Service, Probation & Parole, Greater Southern Area Health Service, Families, Hospitals, Prisons, Courts, Schools / TAFE, Youth Centres and Commonwealth Rehabilitation Service (ADAC, 1999).
Detoxification is apart of the process required for rehabilitation. For detoxification to occur, a client must have been admitted in a hospital for one week (ADAC, 1999). Katungul substance misuse workers provide counselling services to the clients by visiting them in their homes or contacting them through the phone. Katungul’s substance misuse program has had 44 clients who have undergone detoxification within the past 12 months (ADAC, 1999). Out of the 44 clients, 18 are females between the ages of 18-45, and 26 Males aged 18–45 (ADAC, 1999). In addition, 15 clients have already enrolled into their rehabilitation (ADAC, 1999).
Rehabilitation support is also a part of the Substance Misuse Health Workers’ role. The support process begins when clients decide to join the rehabilitation program since it is a client’s responsibility to contact the rehabilitation service centres (ADAC, 1999). Katungul’s substance misuse health workers have supported 15 clients attending rehabilitation facilities comprising of 5 females between the ages 20-30 years old, and 10 males between the ages 18–45 (ADAC, 1999).
A major problem is the unavailability of beds in the rehabilitation facilities and clients are placed on a waiting list (Black et al., 2008). This is a big barrier for the rehabilitation process. It is important to have a follow up program for individuals who are undergoing rehabilitation so as to prevent the chances of such individuals from reverting to substance abuse (Black et al., 2008). There is a misconnection between members of the Katungul organization and the individuals who have just completed their rehabilitation programs. In addition, accessing alcoholics and those who engage in injecting drug use is challenging owing to the fact that most of them isolate themselves from their families and the rest of the community (Black et al., 2008). Given the challenges and limitations affecting New South Wales Aborigines, there does seem to be no appropriate goals set to address these challenges. Besides, there are only a few studies which have been conducted to elucidate the magnitude and causative factors of alcoholism and injecting drug use (Black et al., 2008).
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The program partners suggest that current health promotion methods which focus on the youth should be investigated in order to determine gaps present in the provision of information (VicHealth, 2000). Thus, the partners recommend that the department of education and early childhood education should provide educational programs which cover youth at an early age (VicHealth, 2000). This department should also conduct campaigns that enlighten parents on how to guide their children. The Australian government should work with local communities to develop policies and procedures which will enhance health promotion (VicHealth, 2000). For example, health promotion programs can use vehicle campaigns to deliver messages around the community.
In terms of improving access and service responses, the partners recommended that the government should work with other stakeholders to ensure that the local community gets sterilized injecting equipment (VicHealth, 2000). This can be achieved through out reach programs, pharmacies, and syringe vending machines. Services should be reoriented in order to deliver a home based model of care. There is a need to increase funding so that Katungal can expand the scope of its services (VicHealth, 2000). This can be achieved by identifying and implementing new grants regimes. There is also a need to initiate harm reduction training through the use of nationally accredited and standardized programs (VicHealth, 2000). The government should work closely with other stakeholders in organizing awareness campaigns (VicHealth, 2000). These campaigns should aim at educating the Aborigines the risks of injecting drug use and alcoholism. Furthermore, individuals who come from rehabilitation centres should be economically empowered so that they do not turn back to their initial immoral behaviours (VicHealth, 2000).
This report has noted that there are many effective models of service and program delivery in indigenous communities which have been developed and delivered in a manner which is respectful of and responsive to indigenous needs. Katungal Aboriginal Corporation Community and Medical Services aims at improving the health outcomes for Aboriginal communities found in New South Wales, Australia. Recent studies have indicated that Aborigines especially Moruya, Wallaga, Bega, and Eden communities have a misconception of some diseases, and most importantly sexually transmitted diseases and viruses transmitted via blood. In addition, there is a growing percentage of injecting drug use and alcoholism in New South Wales Aborigines; a phenomenon which has contributed to high HIV prevalence in this community. This phenomenon is attributed to historical precedents. These programs endeavour to assist indigenous patients who have disorders caused by alcoholism and substance abuse in Aboriginal communities especially Moruya, Wallaga, Bega and Eden, by providing support to these patients and monitor their recovery. This organization also aims at voicing the victims’ needs and concerns. The organization also endeavours to provide quality and culturally necessary healthcare.
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Black, E. T., et al. (2008). National Drug and Alcohol Research Centre: Australian Drug Trends 2007. Sydney: NSW Press.
Couzos, S. & Muray, R. (2008). Aboriginal Primary Health Care: an Evidence-based Approach (3rd Ed.). Melbourne: Oxford University Press.
Day, C. E., et al. (2006). Patterns of drug use and associated harms among rural injecting drug users: Comparisons with metropolitan injecting drug users. Journal of Rural, 14,120-125.
Department of Health and Ageing (DHA). (2008). A Review of Enablers and Barriers of Indigenous Drug Users Accessing Needle and Syringe. Canberra: ACT Press.
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