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WHAT DOES THE “THIRD SPACE” MEAN TO YOU AS A
HEALTH PROFESSIONAL?
Eileen Tan
Lisa Molony
Kate Brazzale
ACKNOWLEDGMENT OF COUNTRY
We respectfully acknowledge the past and present traditional owners of this
land on which we are meeting, the Noongar people. It is a privilege to be
standing on Noongar country.
INTRODUCTION
Why should health professionals be aware of the "third space"?
What should health professionals take into account when looking after Aboriginal and Torres Strait Islander patients?
Why are cultural implications important for health professionals to take into consideration?
IMPORTANCE OF IDENTITY
What does it mean to be Aboriginal?
"An Aboriginal or Torres Strait Islander is a person: of Aboriginal or Torres Strait Islander descent who identifies as an Aboriginal or Torres Strait
Islander and is accepted as such by the community in which
he (she) lives.“
What does your identity mean to you?
CULTURE SHOCK
Culture shock: the tension and anxiety, combined with feelings of isolation, sensations of loss, confusion and powerlessness, associated with entering a new culture.
ABORIGINAL TERMS OF REFERENCE
A way to determine Indigenous viewpoints on issues within an Indigenous context.
Core values include: The worth and validity of contemporary Indigenous cultures The right of expression of Indigenous realities Self-determination and self-management Positive social change Social justice The recognition and acceptance of Indigenous
diversity Reconciliation of contending issues between
Indigenous people The worth of the group
HOW THIRD SPACE APPLIES TO THE HEALTH INDUSTRY? “WA Health Is dedicated to working with the Australian
Department of Health and Aboriginal communities in building new partnership for services provided; developing culturally appropriate Health services and providing safe, high equality and accountable Health service to the Aboriginal community” (Health Reform Implementation taskforce, 2007).
• Indigenous and Health professions has a variety of differences that are met and respected together as one.• Cultural belief• Views and Values • Expectations• Traditions• Historical factors• Family structure
HOW THIRD SPACE APPLIES TO THE HEALTH INDUSTRY?
o It is the space for the four dimensions to be met between the Aboriginal and non- aboriginal domain.• Experiences
• Concentrates on the experience of Aboriginals in relation to the issue under discussion.
• Aspiration• Concentrates on what the critical reference group
wants to achieve in relation to the issue.
• Understanding• Focuses on the persons understanding of the issue
• Cultural element• It draws on cultural differences and traditions which
includes current culture practices.
CHALLENGES FOR HEALTH PROFESSIONALS
o Communicating among the aboriginalso Understanding their traditions and beliefso Traditional healing o Not being able to achieve the outcome until a
certain level of trust has been createdo Obtaining informed consent for treatmento Explaining diagnosis and treatment to patients
(Ngyuen, 2008, p.990-992)
HEALTH PROFESSIONS AND ABORIGINAL MAY CLASH IN A HEALTH ENVIRONMENT
o Communication and language issueso Poor cultural understandingo Racism and prejudiceo Values and beliefso Mistrust of the system
(Aboriginal Health issue committee, n.d., A guide for Health Professionals working with Aboriginal people)
OPERATING WITHIN THE THIRD SPACE
assumptions or stereotypes may still happen within the third space about an individual based on their racial or ethnic background.
Advantages Disadvantages
Access to higher quality services
Culturally secure services that will improve health outcome for Aboriginal people
Improve customer satisfaction
Provide opportunity to improve the broader determinants of health
ABORIGINAL HEALTH STATISTICS
Males Females0
10
20
30
40
50
60
70
80
90
62.7
72.9
78.5
82.6
IndigenousNon - Indigenous
Life expectancies of Indigenous versus Non-Indigenous Males and Females.
On average Indigenous Men die 11
years earlier then Non- Indigenous Males
Indigenous Females die 9 years earlier then Non-Indigenous Females.
Data from the Australian Bureau of Statistics 2005-2007 data surveys.
ABORIGINAL HEALTH STATISTICSHealth
complicationComparative
incidence rateComment
Circulatory system 2 to 10-fold
5 to 10-fold increase in rheumatic heart disease and hypertensive disease, 2-fold increase in other heart disease, 3-fold increase in death from circulatory system disorders. Circulatory system diseases account for 24% deaths.
Renal failure 2 to 3-fold
2 to 3-fold increase in listing on the dialysis and transplant registry, up to 30-fold increase in end stage renal disease, 8-fold increase in death rates from renal failure, 2.5% of total deaths.
Communicable 10 to 70-fold
10-fold increase in tuberculosis, Hepatitis B and Hepatitis C virus, 20-fold increase in Chlamydia, 40-fold increase in Shigellosis and Syphilis, 70-fold increase in Gonococcal infections.
Diabetes 3 to 4-fold11% incidence of Type 2 Diabetes in Indigenous Australians, 3% in non-Indigenous population. 18% of total deaths.
Cot death 2 to 3-fold
Over the period 1999–2003, in Queensland, Western Australia, South Australia and the Northern Territory, the national cot death rate for infants was three times the rate of Non-Indigenous.
Mental health 2 to 5-fold5-fold increase in drug-induced mental disorders, 2-fold increase in diseases such as schizophrenia, 2 to 3-fold increase in suicide.
Optometry/ Ophthalmology
2-fold A 2-fold increase in cataracts.
Neoplasms (Tumour)
60% increase in death rate
60% increased death rate from neoplasms. In 1999–2003, neoplasms accounted for 17% of all deaths.
Respiratory 3 to 4-fold3 to 4-fold increased death rate from respiratory disease accounting for 8% of total deaths.
ABORIGINAL HEALTH STATISTICSSelected Chronic Conditions: Ratio of Indigenous
Australian’s to Non-Indigenous Australians — 2004–05
ABORIGINAL HEALTH STATISTICS
Diabetes Comparison between Indigenous and Non Indigenous 2005
Cardiovascular Comparison between Indigenous and Non Indigenous 2005
IMPLICATIONS FOR HEALTH PROFESSIONALS Third Space
“A place where Indigenous and Non-Indigenous people can come and work together without fear of prejudice from ‘baggage’.”
An area of mutual respect between Indigenous and Non-Indigenous people where they can work collaboratively.
Health Professionals need Knowledge.
Of where the other comes from; their “space” Understanding
Of roles and responsibilities Empathy
Towards both sides Willingness to be open
Accepting of differences Avoid stereotyping
IMPLICATIONS FOR HEALTH PROFESSIONALS Aboriginal and Torres Strait Islanders are not the same.
Discontinue use of out-dated, derogatory terminology. Half-caste, full-blood, quadroon, etc. Always use the terms Aboriginal Man/Woman/People or Torres
Strait Islander Man/Woman/People.
Aboriginal people mistrust people who offer services related to “protection” and “intervention. European colonisation. Government Policies post colonisation. The “Stolen Generation”. Government policy til 1969.
“Keep your word.” Changes made.
e.g. Kevin Rudd’s “Apology”.
NSW Department of Community Services 2009 & National Disability Services WA 2009
IMPLICATIONS FOR HEALTH PROFESSIONALS Sensitive issues due to past Government policies have contributed
to:• Dispossession of land• Family fragmentation• Mental health issues• Social and emotional wellbeing issues• Grief and loss issues
• Self-harm and intentional injury• Over-representation of Suicide rates • Family and domestic violence issues• Loss of country• Loss of identity
• Poverty• Racism• Unemployment• Poor health outcomes• Poor education outcomes• Below standard literacy and numeracy rates• Alcohol and substance abuse/misuse• Over-representation in the juvenile and criminal justice system
NSW Department of Community Services 2009 & National Disability Services WA 2009
IMPLICATIONS FOR HEALTH PROFESSIONALS Respect
Elders, The Land, Animals, Ancestors. “Sorry Business”
Kinship Defines roles and responsibilities within the family. Ensure that extended family is included in important meetings or when
making decisions.
Gender responsibilities. Men’s Business – issues which have a male perspective within aboriginal
culture. Women’s Business – issues which have a female perspective within
aboriginal culture.
NSW Department of Community Services 2009 & National Disability Services WA 2009
IMPLICATIONS FOR HEALTH PROFESSIONALS Language
Originally 300 nations speaking 250 languages with up to 600
dialects. Nonverbal cues
Eye contact. Hand and facial gestures. Silence Progression of Conversation.
Semantic Ambiguity Swearing
Communication Techniques Use uncomplicated language, Not “jargon”. Be wary of comprehension
NSW Department of Community Services 2009 & National Disability Services WA 2009
CLOSE THE GAP CAMPAIGN Australia’s largest Campaign to improve Indigenous Health.
Aimed at reduced the Life Expectancy Gap between Indigenous and Non Indigenous Australians to 0 years by 2031.
OXFAM is campaigning to: Increase Aboriginal and Torres Strait Islanders’ access to health
services Address critical social issues such as poor housing, nutrition,
employment and education Build Indigenous control and participation in the delivery of health
and other services Get governments at state and national level to work in partnership
with Indigenous communities, health organisations and experts to develop and monitor a plan to tackle the Indigenous health crisis
Promote real and meaningful partnerships between Indigenous
COAG, 2011 and OXFAM 2006
NEED FOR EDUCATION To understand the needs of our Aboriginal or Torres Strait
Islander Patients The majority of Aboriginal people access health care from Non-
Aboriginal services.
Downing and Kowal 2011 Majority of Nurses interviewed felt that didn’t receive enough
cultural training to look after Aboriginal and Torres Strait Islander patients
They felt that they weren't giving them the level of care the needed and deserved.
Canada’s Approach Kilpatrick, 2004
Looked at the need for Aboriginal Education.
REFERENCES
Aboriginal Health issue committee (n.d.) A guide for Health Professionals working with Aboriginal people Retrieved February, 2001, fromwww.sogc.org/guidelines/public/100e-ps4-february2001.pdf
Ngyuen, H. (2008). Patient centred care. Cultural safety in Indigenous health, 37(12),p990- 992. Retrieved December,2008, from Theme Indigenous health site at www.racgp.org.au/afp/200812/200812nguyen1.pdf