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Jennifer Delima - Department of Health, Northern Territory - Considerations when Providing Health Care to Indigenous Patients in the Forensic Arena
 

Jennifer Delima - Department of Health, Northern Territory - Considerations when Providing Health Care to Indigenous Patients in the Forensic Arena

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Dr Jennifer Delima, Addiction Medicine, Alice Springs Hospital, Department of Health NT presented this at the 2nd Annual Forensic Nursing Conference. ...

Dr Jennifer Delima, Addiction Medicine, Alice Springs Hospital, Department of Health NT presented this at the 2nd Annual Forensic Nursing Conference.

This is the only national even of its kind promoting research and leadership for Australia's Forensic Nursing Community. The program addresses future training of forensic nursing examiners, forensic mental health consmers, homicide and its aftermath, ethical dilemmas in clinical forensic medicine, child sexual abuse, providing health care to indigenous patients in the forensic arena and more.

To find out more about this conference, please visit http://www.healthcareconferences.com.au/forensicnursing

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    Jennifer Delima - Department of Health, Northern Territory - Considerations when Providing Health Care to Indigenous Patients in the Forensic Arena Jennifer Delima - Department of Health, Northern Territory - Considerations when Providing Health Care to Indigenous Patients in the Forensic Arena Presentation Transcript

    • Health care in the Forensic arena: Considerations for the Indigenous patient Jennifer Delima MBBS, MHA FACRRM, FRACGP, M Forensic Med, FAChAM
    • Indigenous Australians : Wikipedia 2011
    • Who am I to speak? • ‘Mainstream’ Australia from another culture • Experiencing the cultural competence or not of ‘mainstream’ Australian service providers • Residing in a remote Aboriginal community, & being ‘adopted’ within & participating in some of the culture • Working within varied environments of the NT, with its high Aboriginal population compared to the remainder of Australia – Regional, and remote from an Eastcoast urban health provision context • Providing Forensic medical services through the varied environments of Sexual assault, Custodial medicine, some Watch-house work and Addiction medicine • ….so my reflections on these, I share…
    • 1. Everyone has a right to access high quality and safe health care 2. A partnership of care between families, carers, patients, consumers, and services 3. Recognises International Human rights agreements -to provide the highest possible standard of physical and mental health care 4. Respects and acknowledges different cultures and ‘ways of life’ that make up our society
    • Our usual health care environment: • For the patient’s benefit -> improve wellbeing • Aim to reduce the power differential between clinician and patient by being patient centric • Maintain patient autonomy • Personal information only divulged with patient permission • Non punitive
    • Forensic health care tasks: • Assess fitness to examine, detain, police interview, charge, release • Assess for substance intoxication / withdrawal, mental disorder / illness • Examine complaints of assault – victim / alleged assailants • Document and interpret injuries • Collect forensic samples • Interpret findings • Provide expert opinion in Court / Tribunals • Provide initial medical management • Recommend ongoing treatment plan if appropriate
    • Forensic health care environment: Clinical medicine interacts with the law, judiciary, police and the living person • Service across both forensic and health care • To assist assessment of crimeJustice centric • Not always for the patient’s benefit • Cannot reduce the power differential between clinician and patient • Cannot maintain patient autonomy • Personal information may be divulged • May have a punitive outcome
    • Context of the Indigenous patient Northern Territory Australia Population: 239,500 Indigenous: 31.6% Population: 23,130,900 Indigenous: 3% Incarceration: 821/100,000 Indigenous: 86% 706 /100,000 Incarceration: 0.2% 130 /100,000 Indigenous : 1868/100,000 (x14 that of Non- I) 3238.0.55.001 Estimates of ATSI Australians June 2011 , ABS 4713.7.55.001 Population characteristics ATSI, NT June 2006, ABS ABS 4517.0 Prisoners in Australia 2011; Population studies Brief 2009 CDU
    • ABS 4517.0 Prisoners in Australia 2013
    • General health delivery recommendations: • • • • • Avoid eye contact …? Same gender provider as the patient..? Speak softly, don’t shout..? Don’t rush the patient, give time..? Careful about asking about sexual history and follow through examination – taboo areas..? • Different culture = different needs..?
    • Concepts in Indigenous health • What does “Indigenous Health” mean? • The social determinants of health: - economic and social conditions influencing health - education, employment, access to basic needs - access to health, discrimination experience, - Maslows hierarchy of needs, • Concepts of identity • Concepts of culture • Concepts of ‘what is health?’
    • WHO ‘Social Determinants of Health Conceptual Framework Social Determinants of health CDC and Prevention
    • What do we know of Indigenous culture • Many different culturally distinct groups identified by land areas, language, ‘dreamtime’ stories and lore. • The Land and relationship to it is fundamental to the person’s spirituality • Kinship system of ‘Family’ provides an extended network with roles different to that of mainstream Australia
    • Considerations when providing health care…. The environment - proximity to tradition and ‘country’, - socioeconomic state - family connectedness • • • • • The The The The The Urban Regional urban ‘Town camp’ ‘Remote’ ‘Destitute and exiled’
    • Urban Aboriginal • Long embraced ‘mainstream’ Australian Culture • Lifestyle, family relationships, life goals, comprehension of law is no different to ‘mainstream’ • Awareness of ‘Country’ and Kin but not closely adhered to • Influence of ‘Country’ and Kin is by choice not ’ imperative APPROACH: usual ‘mainstream’ care acknowledgement of culture need as advised by the patient , typically minimal modification required
    • Regional Urban Aboriginal • Embraced ‘mainstream’ Australian Culture BUT still toggles their Traditional Aboriginal culture • Life goals, comprehension of law may be similar to ‘mainstream’, BUT lifestyle and family relationships are traditionally strong • Aware and sensitive to needs of ‘Country’ and Kin • Influence of ‘Country’ and Kin is sometimes little by choice APPROACH: ‘mainstream’ care with cognisance of possible different cultural need. Often with a shyness and reticence to advise of their cultural need.
    • ‘Town camp’ Aboriginal • Reside on the outskirts of ‘mainstream’ Australian Culture and maintain an almost complete Traditional Aboriginal culture and beliefs • English language competency is typically limited • Lifestyle and family relationships are traditionally strong • Life goals, comprehension of Australian law may be confused especially as it may be contrary to ‘traditional’ requirements • Influence of ‘Country’ and Kin is imperative APPROACH: ‘mainstream’ care comprehension of cultural need. proactively modify approach to facilitate the mainstream processes Interpreter* services Cultural broker
    • ‘Remote’ Aboriginal • Reside on Traditional lands, where the culture is Traditional and the minority population is ‘mainstream Australian • English language is not practised. Service providers speak ‘pidgen’ • Lifestyle and family relationships are traditionally strong • Life goals, comprehension of Australian law is distant and confusing and often contrary to ‘traditional’ requirements • Influence of ‘Country’ and Kin is imperative APPROACH: ‘mainstream’ care ‘active’ comprehension of cultural need. proactively modify approach to facilitate engagement of mainstream processes. Interpreter* services Cultural broker assistance
    • The destitute and exiled…. • Typically the ‘Town Camp’ or Remote Aboriginal • Living in the ‘river-bed’, ‘long grass’, ‘under the bridge’ etc • English language is typically idiomatic and limited • Itinerant lifestyle and lost family relationship • Absent life goals, comprehension of Australian law is confusing • Maslows hierarchy of needs – basic food, shelter and sleep, warmth, sex • Influence of ‘Country’ and Kin has resulted in exclusion APPROACH: ‘mainstream’ care comprehension of cultural need. proactively modify approach to facilitate the mainstream processes. Interpreter* services Cultural broker assistance
    • So in Clinical Forensic Medicine….. • Practice is synonymous with knowledge, fairness, independence, impartiality, upholding basic human rights • We remain health providers as distinct from the police and judiciary • Our patient may no longer have the privilege of autonomy and self direction • And when our patient is Aboriginal and not fully versed with ‘mainstream’ Australia….
    • Specific Considerations: 1. Seek information about the link to traditional culture 2. Allow for a longer and slower progress in consultation time 3. Use pictorial communication despite overt english language fluency 4. Preparedness to extend your own role 5. Consider need to have appropriate kin presence (not necessarily our mainstream kin role) 6. Permit a graduated number of consults to facilitate confidence, trust, engagement 7. Consider gender issues** 8. Maintain professionalism – maintain an unbiased and caring ‘health’ presence
    • So forensic health care to the Indigenous patient Culturally safe practice - Cultural awareness :aware that there are differences between people. – Cultural sensitivity :Recognising that difference is okay and that an individual’s difference might impact on others. Take steps to provide care that is supportive – Cultural competence : that we meet the patient’s cultural needs – Cultural safety :accepts that the care provided is meeting their cultural needs.
    • Thank you !
    • References: • Health care and Indigenous Australians; Cultural safety in practice. K. Taylor and P. Guerin. Palgrave Macmillan, 2010. • Inequity and Health: A Call to Action. RACP Policy Statement 2005. • Cultural safety - what does it mean for our work practice? Robyn Williams, Lecturer in Indigenous Health, FATSIS, NTU • http://www.creativespirits.info/aboriginalculture/ health/hospitals-doctors-health-aboriginal-people