Practical Considerations for Health Professionals Working with Aboriginal Clients
General Information
- Aboriginal people speak different languages and have different values and totems, but they do have some things in common.
- If you want a person's correct name then ask for their family name as you may otherwise get a nick name.
- Some people may be naturally shy and uncomfortable asking questions, or asserting themselves. If this is suspected to be the case then encourage the client to bring a family member or friend as support.
- Avoid making assumptions.
- Very few aboriginal people have the same concept of time as do non-Aboriginal people. For example, "take medicine every four hours" may not be understood but "take one tablet when you get up, one at lunch and another with dinner" is more likely to be followed.
- A lack of transport, a limited income, or no Medicare card, combined with a high tolerance for negative symptoms, may lead to delayed presentations.
- Allow extra time for appointments. This is particularly important during the initial appointment as time to talk and build rapport and learn about the person's background is important, prior to trying to address clinical issues.
- Personal, family or community events can become the most important commitment for a person at that time and will therefore take precedence over any other arrangement. Take the time to discover the reason for any missed appointments.
- As Aboriginal people have a holistic view of health, their immediate practical needs should be addressed before a complete assessment can be made.
- Aboriginal people tend to identify with one worker and may expect to retain this same person as their worker.
- Self referrals need to be taken very seriously because their accessing non- Aboriginal organisations for help indicates that the person is likely to be in desperate need for help. Avoid asking them to come back later because they probably will not do so.
Communication
- Some Aboriginal people may not speak, read or write English very well.
- Consider using alternative methods of communication, such as pictures, sign language, or interpreters if available.
- Written information on medicines could include pictures to assist in communication. For example, a picture of the sun or moon could indicate day or night.
- Consider acknowledging sensitive questions right from the start. Beginning a consultation with "Maybe it is a bit embarrassing to ask you about this..." is likely to make the person feel more comfortable in responding.
- Be mindful of questions that can seem intrusive. Answers of "yes" may not be accurate as the client may be attempting to take the path of least resistance through what to them is an uncomfortable situation.
- Avoiding eye contact is polite in some communities. Therefore, just because a client is not looking at you doesn't mean that they're not listening. This is particularly relevant for cross gender interactions. It is most often appropriate for men to maintain eye contact with other men, and women to maintain eye contact with other women, but not for a man and a woman to do so.
- Be mindful that your body language will be giving a message.
- Avoid finishing sentences for people as they may just be searching for the right English word to express what they are trying to communicate. Give them time to do this.
- Men's and women's business does exist in Aboriginal cultures. You may be facing a gender-related barrier if you're having difficulty obtaining information. Where possible it is recommended that services are provided by a clinician of the same gender as the client
- Take an interest in from where the client comes as this goes a long way to establishing a rapport. Share your background too in this cultural exchange.
Creating a Supportive Environment
- Clinicians should be aware that when an Aboriginal client is being examined, the client is also likely to be examining the clinician and environment. Having aboriginal posters or art work, or aboriginal staff members may assist in creating a more-friendly environment.
- Reception staff play a key role in making a service culturally 'safe' to Aboriginal people. Reception staff having access to cultural awareness training may assist.
Clinical Practice
- If there is something that needs to be done then try and avoid being too prescriptive about what, when and how to do it. Consider asking the client how they could achieve what needs to be done. This will also allow you to check that the client has understood your recommendations.
- Clinics should expect women to have many visitors as this is a custom of kinship. This should be supported as best as possible.
- Don't expect clients to discuss scars and wounds on our bodies. These could represent initiation, conflict or grief.
- Pregnancy and child bearing - Don't assume that women have attended antenatal classes or seen a doctor during their pregnancy. They may have little idea about what is to take place during birth and the hospital stay. Often the child's father may not attend the birth, but other family female members may attend. This should be accommodated as far as is possible.
- Alcoholism - Aboriginal people are aware of the destructive effects of drug use on individuals, families and communities. It has been identified that the concept of the 'drinking years' is useful when talking about alcohol abuse. This may help overcome the way drinking can be seen as fatalistic and therefore assist to provide individuals, families and communities with hope that a person can move past the drinking years. Community members who have made it through this process are valuable in supporting the sobering-up process.
Aboriginal Health Workers (AHWs)
- It is recommended that a health worker has active assistance and support from an Aboriginal Health Worker (AHW), regardless of the level of Cultural Awareness Training undertaken. An AHW is recommended when providing a service to Aboriginal families.
- If you are unsure where or how to contact an Aboriginal Health Worker then the National Aboriginal Community Controlled Health Organisation (NACCHO) (http://www.naccho.org.au/) lists all the Aboriginal-controlled and operated health services. They may be able to link you with a worker.
- Offer Aboriginal clients the option of having an Aboriginal Health Worker, friend or relative present in the consultation.
- Ask for advice on how to communicate with Aboriginal clients. Speak to Aboriginal health workers, or community members.
- Indigenous people are reported to feel much more comfortable seeing an indigenous health worker than a non-indigenous worker at first contact.
- It is important that non-indigenous health workers recognise the important role AHWs play in the health team. They are trained in primary health care and in basic clinical skills. They are often invaluable in breaking down barriers between indigenous clients and non-indigenous workers and systems.
- Information sharing between the AHW and other staff is a key to good health care. Learn about how culture relates to health issues and provide information how western medicine relates to them. These two views working together is optimum.
- Be aware of gender issues.
- Build and maintain effective trust with the AHW.
- The AHW can be your peer, mentor and guide in dealing with indigenous issues.
- The AHW can liaise with traditional healers.
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