Psychology

Australia has been on a struggle of debate on the meaning and value of its identity as a nation.  There are gaps between the non-indigenous and indigenous people that should be bridged to address issues like misrepresentations as well as oppressions that cause them to suffer especially in dealing with health issues.  Health problems should be given utmost importance without violating their culture since it poses threat in the Aborigine population.  In the earlier times, health care was already a problem among them.  The Aborigines are the ones that feed the diversity in the area. They have a rich culture which can be reflected in their lifestyle, language, social organization and religion.  For over 50,000 years, they have perfected the art of the hunter-gatherer and the nomadic lifestyle too.  They have knowledge on their surroundings and value local territory.  For them, land is the core of their spirituality and the spirit of the country.  Although there are 600 different tribes in the country, belief in kinship and sacred sites are well established.  Music, song, dance and indigenous visual arts also reflect the diversity in Aboriginal culture.

The Aborigines were driven away from their land by force and most of them acquired diseases from buying alcohol and drugs from the settlers, causing the balance between nature and people to be destroyed.  Until the modern times, similar problems have been resurfacing.  Aboriginal deaths from respiratory diseases are six times higher than non-Aboriginal deaths from child infection, fifteen times higher  from renal failure, eleven times higher from diabetes, eight times higher and  from homicide, six times higher (Territory Health Services 199621). Aborigines tend to suffer from appropriate health care due to economic and physical barriers. Lack of education cause false notions about health care because of the Aborigines traditional beliefs. Some are not treated with proper health care due to economic status.  The Aborigines have low employment rate and affected by poverty thus not being able to afford clean water, housing, clothing and medical needs.

There is a heavy throw down between the Aboriginal culture and the current problems faced by them.  All are linked in the strong culture that some are not willing to change for important reasons like health care for example.  The traditional belief in the Aboriginal medical system causes ineffective treatment of the illness.  Some Aborigines perceive that the illness is caused by sorcery and do not admit themselves in the hospitals until they are in the worst condition.   Some are discouraged to go to the clinics or hospitals because they are intimidated by the biomedical environment.  Hence, philosophical perspective is an important factor influencing the status of health care of Aboriginal Australians. Currently, the nature of the Aboriginal perspective and its gaps from mainstream European perspective has been poorly understood (Morgan, Slade  Morgan, 1997).  This statement supports the reason that the problem in dealing with the health issues is linked with strong ideals in life of the Aborigines.

The Department of Health and Ageing under the Australian government takes on the role of implementing appropriate palliative care which is defined as specialized care of people who are already dying, regardless of the cause of death or age. The main objective of palliative care is giving the right for the dying person, and their families in choosing the manner, setting and type of care they receive.    Basically, respect for the dignity of the dying person and the family members while keeping the cultural and spiritual needs intact is an important element in the foundation of palliative care. Way back in 2002, a pioneer research regarding professional awareness of palliative care was done.  This was continued on the year of 2005 in which the main goal of the research program is to make the community understand the importance of palliative care.

In the coming of years, the government has planned to immerse the Aborigines in the ways of palliative care that is culturally appropriate.  In doing so, key elements must be given focus on.  These are valuing the difference while inculcating the value of palliative care, avoiding assumptions and establishing the importance of communication. Palliative care services need a basic understanding of the diversity of indigenous culture. Cultural, socio-economic, emotional, historical and political factors, which potentially make the experience of death and dying different for Indigenous Australians, should be considered by service providers to provide accessible and relevant palliative care (Wagstaff, 1997).  Through these, cultural safety while practicing palliative care can be improved.  Although a few of the Aborigines are already supported by palliative care, training of the staff is still not enough.  As mentioned earlier, the Aborigines tend to choose late admission in the hospitals making their case a terminal one.  They choose to die in their own communities rather than being given physical treatment.  Flexible models of palliative care are needed to adapt to different choices of the natives.  In addressing the issues, communication and cultural knowledge should be considered (Lowell, 1998).   Sources of miscommunication can be seen during the scenarios when non-Aboriginal health staffs find it difficult to interact with the Aborigines regarding their health needs and problems because of cultural and language differences between the staff and patients, lack or inadequate use of interpreters and the insufficient sociolinguistic knowledge of the hospital staff (Watson 1987).   Imbalance of power in the health services can also be a source of miscommunication.  This occurs between Aboriginal and non-Aboriginal health staff.    These miscommunications are the causes of the major consequences that affect the quality of health care for the Aborigines. The consequences include misdiagnosis, patients lack of knowledge on the side effects of the medicines, proper maintenance of medicine intake and incompetent health promotion strategies.

In order to overcome these consequences, cases for having improved conditions must be created.  This can be done through provision of specialized training programs in medical interpretation and in work as well, presenting the sources of miscommunication and the consequences for the awareness of the staff and clients, providing services for the non-Indigenous people who speak languages aside from English, having access to interpreters that are trained with Aboriginal languages,  providing comprehensive cultural and language opportunities, giving an area fro developing intercultural communication, changing the policy so that the needs of both Aborigines and non-Aborigines will be met and lastly setting formal requirements to ensure that interpreters are being used properly. Formal approaches in dealing with the health care for the Aborigines include policies and recommendations for implementations.  The Territory Health Services have stated that developing methods for effective communication between the Aborigines and the non-Aborigines is of high priority.  An interpreter should be employed but not if there is still no established translator service.  A funded project by the Northern Territory Employment and Authority spearheaded the trial service of the Aboriginal language interpreter.  The service was free of charge and involved 87 interpreters.  At the end of the trial, it was reported that the use of interpreters led to accurate diagnosis, lesser hospital fees, lesser days of stay in the hospital and better doctor-patient communication after being discharged from the hospital.  Unfortunately, despite the successful outcomes of the trial, there were no indications from the pioneer that the service will be continued.

On the other hand, efforts from the Indigenous Australians can be viewed as a solution in providing health care to their fellow natives.  Employing Aborigines in the health care real as well as creating career paths for them can be of great help.  There are almost 167 Aborigine health workers in Western Australia.  They have been educated and were able to get Certificate IV in Aboriginal Primary Health Care Work.  Health workers can now as interpreters giving them the advantage that they have shared understanding regarding the culture so that the patient can have a better understanding of the diagnosis and medical advice given by the doctor.   At the same time, the Aboriginal health workers can promote understanding of their beliefs and medical practices of both parties involved.  The Aboriginal health workers take down notes to monitor the progress of the patients.  They can also encourage Aboriginal families to attend community meetings where they can acquire knowledge about health issues and ways to prevent diseases.  Before employing the Aborigines, they are provided with higher education that sustains knowledge systems in a National Indigenous Learned Academy (ILA).  The ILA would serve its function in affirming indigenous knowledge and philosophy which enable indigenous scholars and researchers to develop a national vision and context.  Trainings for the doctors and nurses are also funded by the government to meet the demand of Aboriginal nurses, dentists and mental health professionals.   Providing financial incentives for the Indigenous health workers can help in establishing health equity in order to become doctors and nurses.  As part of educating them, information and communication systems (ICS) are also being immersed in the knowledge of the Aborigines.  These can increase their level of literacy through the use of the Internet as an information resource.  It can broaden their understanding and use it as a tool in medical transactions.  There have also been symposiums held by the Australian Indigenous Doctors Associations (AIDA) to let the Aborigines pursue health careers.  One of the participants, Dr. Kevin Kong said that, I can recall the very day that cemented my interest in pursuing a medical career. I was in year 8 and participated in a careers day a university. Two of the hen Indigenous medical students were talking about studying medicine and how as an Indigenous person it was a realistic option. Prior to this, studying beyond year 10 was something I had never considered. These two students, now very successful Indigenous doctors, Dr Louis Peachey and Dr Sandy Eades gave me the inspiration to follow in their footsteps.

Conclusion
The current state of affairs is that an existing estimate of 77,000 people each year is diagnosed with terminal illness.  The Council of Australian Governments (COAG) included a health reform in the meeting last 2009.  The National Healthcare Agreement includes giving emphasis on indigenous health in providing excellent care. Recommendations for implementing practices include tasks for organizations like developing referral protocols with Aboriginal Medical Services to provide conferences and support, partnering with Aboriginal organizations in the planning system, seeking advice from Aboriginal elders, personnel and community leaders to gel a clearer view on how to deal with the ways of the Aborigines and addressing the legal, ethical and emotional issues of the Aborigines as an aid in policy-making.  Other recommendations include the incorporation of media in line with the Aborigines in educating them, confirming with the patient and the family that all instructions are understood and lastly, taking time to build relationships with the patient and the family.  All these steps are relevant since utmost patience and hard work are required in meeting the goals of the solutions.  Employment rates in order to achieve the goals of dealing with the gap of indigenous health. There will always be a reason for hope in dealing with the problems of indigenous health care.  Creating opportunities for the Aborigines in education and employment can provide venues fo for solving health issues.  Starting off with an individual effort can be a good start but a collective effort is required by the government to reach larger areas and larger number of Aborigines.  Also, continuous research, planning and implementing must be carried out