Name: Sarah Stocks
Student Number: 5422329
Tutor: Coleen Niland


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Photo © 2009 Dave Hunt
THE ARTIFACT
The artefact I have chosen to display on this wiki is a photograph of an Aboriginal man (tribe, age unknown) in traditional paint and dress smoking a cigarette. It depicts a clash of traditional and modern, of natural and artificial, of spiritual and ... evil? In whatever context, smoking cigarettes is only one of many risky health behaviours that sadly, a majority of the Australian indigenous population partake in.

THE PUBLIC HEALTH ISSUE
The constant issue of poor Aboriginal health in Australia is one that looms over the Public Health Sector like a dark cloud. It is estimated that over 50% of indigenous people smoke, compared to 19% of all Australians. The population consistently reports poorer health, increased infant mortality rates and participating in risky health behaviours.

‘If a person feels safe, has a job that earns enough money and feels connected to their family and friends, they will generally be healthier.’
- AIHW, 2012

When dealing with an indigenous population and trying to educate them regarding issues such as smoking, it is important to have a knowledge of the theory of ‘Cultural Safety’. This involves knowing one’s own culture and having an open mind, to be able to provide a safe place for patients to be treated in. The issues that the Aboriginal population face are those of mistrust, lack of education, often poor socioeconomic standing and inequity of access to healthcare services. This is where cultural safety comes into effect and why it is so important that it is applied in EVERY facet of the Healthcare System.

LITERATURE REVIEW
Cultural Safety, even as a pure definition, has about 3 or 4 different variations, due to the subjective nature of the topic. In Williams (1999) definition he defines it as


“An environment that is safe for people: where there is no assault, challenge or denial of their identity, of who they are and what they need. It is about shared respect, shared meaning, shared knowledge and experience, of learning, living and working together with dignity and truly listening”.

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Dr. Irihapeti RamsdenPhoto Author unknown

All the definitions for cultural safety have been developed from research conducted by Maori nurse, Dr. Irihapeti Ramsden. The research she conducted in the 1980s was due to her rationalizing that the consistent poor health and health disparities experienced by the Maori population in New Zealand was due to the history of the nation, the harsh colonization and the century long cycles of poverty that ensued. Dr. Ramsden intended to improve the quality of healthcare provided to the Maori people by exploring the impact colonization had on the population (Ramsden, 1993).

By the mid 1990s Dr. Ramsdens work had been recognized as an important facet for inclusion in health frameworks. It grew from being relative to the native people of New Zealand to being applied all over the world and incorporated into nursing training (Gerlach, A. 2012).

Cultural Safety has been widely explored and critiqued over the last 10 years (Gerlach, 2012). It has been recognized as an important issue throughout the world, one that needs attention and time dedicated towards developing an understanding of the underpinning theory - that having a thorough understanding of your own culture is the only way to have an open mind and be able to accommodate other cultures and their beliefs while interacting with them.

Cultural and individual beliefs have an overwhelming effect on the way that a population percieve and utelise healthcare. The ideology of 'Patient Centered Care' and terms such as 'Cultrual Competence' are used widly in the indigenous health arena. Yet, there still remains a large disparity bewteen the health status of non-indigenous Australians and those in the indigenous community. The causes of these differences are multifacetable and most easily relateable to the social and environmental determinates of health. Poorly handled intercultural interactions have resulted in clinical problems including non-complience from patients (regarding medication or continuing treatments), delays in obtaing informed consent and the ordering of unnecessary tests (Nguyen 2008). It was thought that incorporating cultural safety training into healthcare providers regime of learning was a way to reduce the disparities. as a result, health care providers are now being supplied with the tools that will enable to them to decrease the gap between the indigenous community and the rest of Australians as the first line of defence for health.

Initiatives such as ‘Close the Gap’ are seeking to literally close the gap between the indigenous and non-indigenous populations in regard to health indicator rates and figures. An Australian Human Rights initiative, it aims to raise awareness and provide healthcare workers with knowledge to be able to treat and hopefully decrease the gap between aboriginal and non-aboriginal populations in regards to healthcare. The following graph comes from the Australian Indigenous Health InfoNet website and depicts the life expectancy for indigenous and non-indigenous people, both male and female, according to the Australian Bureau of Statistics in 2009.

Figure 2. Expectations of life at birth for Indigenous and non-Indigenous males and females 2005-2007
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Source ABS, 2009

As is shown in the first columns – there is almost a 20 year difference between male populations and almost a 10 year gap between females.

Statistics such as these are commonplace throughout the indigenous health industy and it has been suggested by the Australian Insitute of Health and Wellbeing that these statistics may still be higher than reported due to the difficulty of gaining comprehensive survey results (due to majority of indigenous residents living in remote/inaccessable areas).

CULTURAL AND SOCIAL ANALYSIS
Coming from a similar background (historically) as New Zealand, Australia stands to gain a lot from the theory of Cultrual Safety. The brutal way in which the Aboriginal population has been treated in the last 100+ years has been filtered down into present day problems. Chronic disease, living in poverty and partaking in unhealthy, risky behaviours are just some of the repercussions of having an indigenous heritage. Although as a nation we have made great progress in turning around our attitudes toward the indigenous population, there is still alot left to do. Although the 'scariness' of not-norm cultures have been lessened in the last 20 or so years there is still a differentiation between 'them' (peoples of non-white background, different culture to the 'norm', migrants etc) and 'us' (the english speaking, white Australian). Some may say that the shift toward a regime of 'terror' is to blame, undoing any previous improvement, where people from a different culture are automatically tarred with the same 'terrorist' brush.


"Culture hides much more than it
reveals, and strangely enough
what it hides, it hides most effectively
from its own participants.
Years of study have
convinced me that the real job is
not to understand foreign culture

but to understand our own."
Edward Hall, 1959


One could argue that, as a whole nation, we are all affected by the issue of cultural safety within healthcare. Living in such a multicultural nation, with migrants and refugees from over 200 countries (ABS 2009), it is hard to see who would not come into contact with another person fom a different culture at some point in their social, work or private life. It is these casual and professional interactions that can make a difference to an individuals feeling of safety and improve their chances of truly being heard.

According to the research mentioned previously and the extent of the number of journal articles and other literature written on the subject, it raises strong postive evidence for the benefit of inclusion of cultural safety training for healthcare professionals. The public health domain has been benefited by providing more information to health professionals reagrding cultural safety and will continue to do so if the current regime is amplified. The incorporation of more indigenous health workers has also improved the outlook for indigenous health. The comfort that is provided by having an indigenous health worker on hand is immeasurable and opens doors for improvement in education, economic standing and a shift in the over representation of indigenous individuals reporting poor health.

ANALYSIS OF THE ARTEFACT AND OWN LEARNING REFLECTIONS
The artefact to me represents the danger that the indigenous population are in. The lack of education and poor social standings are hurting the aborignal people in a way that needs to and can be addressed. It represents a degredation of culture, tradition slowly being replaced by convienience and modernism. It represents the issue of cultural safety in the way that without effective management and comunication, these health behaviours that are so detrimental to the aboriginal culture and people, will rapidly become acceptable. Finding ways to communicate, educate and nurture traditional beliefs are important to be able to slow the descent.

The way I percieve indivduals has changed as a result of this assessment. The concept of understanding my own culture and maintaining an open mind has greatly influenced the way I interact with customers in my current workplace and no doubt will positively affect the way I interact with others in future careers. Being able to remain empathetic and open minded when being confronted with different issues will allow me to maintain an understanding role and hopefully positively enhance the experience of the person or patient I am conversing with. Learning about my own culture will enable me to do this and also allow me to recognise my strengths and weakneses regarding my cultural competence, which I can improve with each interaction.

REFERENCES

Australian Institute of Health and Welfare,

http://www.aihw.gov.au/indigenous-data/

Australian Indigenous Health InfoNet,

http://www.healthinfonet.ecu.edu.au/health-facts/summary

Cultural Safety Definition

http://culturalsafetytraining.com.au/home8/what-is-cultural-safety

Gerlach, A. J. (2012). A critical reflection on the concept of cultural safety. The Canadian Journal of Occupational Therapy, 79(3), 151-8. Retrieved from http://search.proquest.com/docview/1030257525?accountid=13380

Nguyen, H. (2008). Patient centered care: cultural safety in indigenous health. Australian Family Physician, 37(12), 990-994. Retrieved from http://search.informit.com.au.ezp01.library.qut.edu.au/fullText;dn=351890330015262;res=IELHEA

Ramsden, I. (1993). Kawa whakaruruhau: cultural safety in nursing education in Aotearoa (New Zealand). Nursing Praxis in New Zealand, 8(3), 4-10.