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Indigenous Health


Equal status contact between members of various ethnic groups ... Biomedical 'curative' rather than holistic health models. Obstacles to Positive Interaction ... – PowerPoint PPT presentation

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Title: Indigenous Health

Indigenous Health
  • Communication
  • Cultural Sensitivity

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

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
  • 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

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
  • Professional structures and demands which
    overshadow client and caregiver personal needs
  • Biomedical curative rather than holistic health

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

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

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.

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

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
  • If you last, then a chance to take on board
    different ways of understanding, doing things

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
  • 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

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

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)

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

Culture Shock Stressors
  • Isolation
  • Cultural Isolation
  • Social isolation
  • Professional isolation

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

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

Culture Shock Indigenous Clients
  • It may seem strange but the issues that affect
    the health worker also affect the health care
  • 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
  • Communication
  • Mechanical Differences
  • Isolation
  • Customs
  • Attitudes and Beliefs

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

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

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 is a two way process

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.