Week 8: Cultural Competence and Care in Communities

This week covered working within community as a healthcare provider and issues such as being accepted and trusted which affect utilisation of the service.  Expanding this, specific community groups were explored such as drug users, Indonesian brides, homelessness, anti-vaccination, rural/indigenous communities.  Improvement strategies included changing from institutional to patient centred-care including showing people respect and acknowledgement of being heard.  Lastly the positive role of Community Liaison officers (CLOs) was discussed and how they help to engage and empower a community.

The interview with Rosalie and Rikki provided some very helpful insights on how to care for someone with an intellectual disability.  It alarmed me that Rikki would be sent to hospital by herself without a carer.  This places quite a burden on a nurse without a carer and medical/personal history especially with her fear of operations.  Chris also related back his difficulty with stereotyping and assumptions of hospital staff that they knew better than him on his treatment.

Chronic illness, mail-order brides, gay, anti-vaccinations, homelessness and rural issues were either my own or family/friend’s lived experiences.  I felt that topics were covered well but did not agree with the vaccination presentation.  The pro-vaccination presenter used wording and suggested strategies that made me feel there was no option but to vaccinate.  If I was mother confronted with this language and instructions, I would have walked out and never returned.  I felt that the presenter did not foster a patient-centred approach and did not make me feel that I could trust her or would have been listened to if I was considering conscientious objection.

I learnt that the social determinants of health were difficult to provide whilst allowing people to lead a life they choose.  A lack of health literacy, lifestyle, chronic illness, housing issues and location of resources all contribute to reduced health outcomes and risky behaviour (Fisher, Milos, Baum, & Friel, 2014).  The use of CLOs assist the government to better service the needs of at risk communities through higher level funding and policy, however I learnt that when in need and let down by community, people turn to non-government sources such as St Vincent De Paul and the Salvation Army (Baum, et al., 2014) for help.

In practice, I will used strategies such immersion to become accepted and trusted in a community.  Approaches like stereotyping lead to discrimination and assumptions for treatments made which can lead to reduced health outcomes.  I must be truly and genuinely interested in the patient with enough knowledge of local resources to enable the person to feel empowered to make their own decisions. 

Picture 4:  Dont Feed Them. Cartoon Art Museum (2016)

References

Baum, F., Freeman, T., Jolly, G., Lawless, A., Bently, M., Vaarto, K., . . . Sanders, D. (2014). Health promotion in Australian multi-disciplinary primary health care services: case studies from South Australia and the Northern Territory. Health Promotion International. Retrieved from http://m.heapro.oxfordjournals.org/content/29/4/705.short

Fisher, M., Milos, D., Baum, F., & Friel, S. (2014). Social Determinants in an Australian Urban region: a 'complexity' lens. Health Promotion International. Retrieved from http://m.heapro.oxfordjournals.org/content/early/2014/08/08/heapro.dau071.short