FOCUS Indigenous Health by 2031. In Australia, Aboriginal and Torres Strait Islander clients commonly access healthcare for treatment of chronic diseases such as diabetes, heart and renal disease (AIHW 2010). The incidence of which is marginally higher in Indigenous populations often requiring this population to be treated with prescribed pharmaceuticals, sometimes starting at a younger age and continuing for longer periods of time (NITV, 2016).
HOW CAN SCHOOLS OF NURSING AND MIDWIFERY PREPARE THEIR GRADUATES TO ENCOURAGE MEDICATION ADHERENCE FOR AUSTRALIAN ABORIGINAL AND TORRES STRAIT ISLANDER CLIENTS? By Lynne Stuart and Brian Sengstock Research undertaken in mainstream Australian studies show that the overall rate of medication non-adherence has been reported to be high, for Aboriginal and Torres Strait Islander peoples of Australia leading to adverse and critical health outcomes (AIHW 2010). These poor statistics, and associated poor health outcomes, have their roots in historical and contemporary healthcare which discounts traditional healing practices, historical mistreatment of Indigenous people including pharmacological trials without informed consent, poor treatment of Indigenous people by health professionals, and poor identification of Indigenous clients (Lovett 2014). These factors have resulted in a lack of trust in white man’s medicine, which is exacerbated by the high admissions and death rates of Aboriginal and Torres Strait Islander peoples in Australian healthcare facilities. This cycle continues with the use of culturally inappropriate communication from health professionals where Aboriginal and Torres Strait Islander clients are ‘shamed’ and thus do not ask for important information about their medication and continues to result in poor medication literacy in Indigenous peoples. This is due to Indigenous peoples of Australia still 42 April 2017 Volume 24, No. 9
being subjected to the ‘culture of blame’ where the person is ‘blamed’ for their poor health, and when coupled with institutional racism, this further exacerbates their already poor health status (Barclay and Wilson 2014; Larson et al. 2007). A recent television news report highlighted the attention given to medication safety for older people, children, and pregnant women in Australia, however, Indigenous Australians were not included (NITV 2016). This makes it imperative for nurses and midwives, as the largest health workforce engaging with Indigenous clients, to be educated about the cultural barriers specific to this population in relation to medication adherence, and to ensure that they are provided with the knowledge to proceed and promote culturally responsive healthcare ensuring safe medication practices (PSA 2014). One target area for ‘Close the Gap’ in 2017 that is not currently on track is closing the gap in life expectancy
ONE OF THE CURRENT ISSUES THAT ESCALATES THE INCIDENCE OF CHRONIC DISEASE IN INDIGENOUS POPULATIONS IS NON-ADHERENCE TO MEDICATION REGIMES.
To highlight the seriousness of this issue, the incidence of diabetes has been cited by the World Health Organization (WHO), with rates as high as 26% for Australian Aboriginal and Torres Strait Islander people, which is six times higher than the general Australian population (WHO 2007). One of the current issues that escalates the incidence of chronic disease in Indigenous populations is non-adherence to medication regimes. This means that if adherence to medication regimes to treat chronic conditions are intermittent or absent, the clients’ disease symptoms can worsen, causing additional hospital admissions and longer hospital stays, resulting in further stress on the affected clients, their families and communities. To this end, nursing and midwifery students need to be educated about working with their Aboriginal and Torres Strait Islander clients with chronic diseases, in ways that can improve medication adherence, and therefore support Close the Gap targets by promoting Indigenous peoples and their communities’ overall health and wellbeing. Lynne Stuart, (Mandandanji) is Senior Lecturer in Nursing, School of Nursing, Midwifery and Paramedics at the University of the Sunshine Coast. Dr Brian Sengstock is Lecturer in Paramedicine, School of Biomedical Science at Charles Sturt University.
PHOTO: ELISE DERWIN
References Australian Institute of Health and Welfare (AIHW). 2010. The health and welfare of Australia’s Aboriginal and Torres Strait Islander people – an overview. Canberra. www. aihw.gov.au/WorkArea/ DownloadAssett.aspx? id¼ 10737418955 (Acc essed 17 February 2017) Barclay, L., Wilson, S. 2014. Can a white nurse get it? ‘Reflexive practice’ and the non-Indigenous clinician/researcher working with Aboriginal people. Rural and Remote Health (Internet) 2014; 14: 2679. www.rrh.org. au/articles/subviewnew. asp?ArticleID=2679 (Accessed 17 February 2017) Larson, A., Gillies, M., Howard, P & Coffin, J. 2007. It’s enough to make you sick: the impact of racism on the health of Aboriginal Australians, Australian and New Zealand Journal of Public Health, vol 31, pp. 322-329. Lovett, R. 2014. A history of health services for Aboriginal and Torres Strait Islander people, YATDJULIGIN, Aboriginal and Torres Strait Islander Nursing & Midwifery Care, edited by Odette Best & Bronwyn Fredericks, Cambridge University Press, Chapter 2, pp. 31-48. National Indigenous Television (NITV) News 18 January 2016. Absence of data on safety of medications for Indigenous community putting health at risk. www.sbs.com.au/nitv/nitvnews/article/2016/01/18/ absence-data-safetymedications-indigenouscommunity-puttinghealth-risk (Accessed 17 February 2017) Pharmaceutical Society of Australia (PSA). 2014. Guide to providing pharmacy services to Aboriginal and Torres Strait Islander people. Canberra. www.psa. org.au/wn-content/ uploads/Guide-toprovidingpharmacyservices-to-Aboriginaland-Torres-StraitIslander-people-2014.pdf (accessed 17 February 2017) Who Health Organization. 2007. Health of Indigenous peoples, Fact sheet No.326, October 2007. Cited from Diabetes in Indigenous Populations, Anthony J. Hanley, Medscape Today. www.who.int/ mediacentre/factsheets/ fs326/en/ (Accessed 17 February 2017)
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