Cultural understanding key to protecting remote communities

Anastasia Tsirtsakis

11/03/2020 4:40:00 PM

Chronic diseases and a lack of access to culturally appropriate care makes Aboriginal and Torres Strait Islander people vulnerable to coronavirus.

Indigenous mother and child.
A greater understanding of Indigenous cultural practices could help to protect some of the nation’s most vulnerable from coronavirus.

As GPs try to navigate national guidelines for coronavirus (COVID-19), a number of Aboriginal and Torres Strait Islander community leaders have stepped in to manage their own infection control.
‘For example, in the Northern Territory quite a few communities are putting in place their own procedures around how they’re going to manage it. ’ Dr Tim Senior, Medical Advisor for RACGP Aboriginal and Torres Strait Islander Health, told newsGP.
‘[They’re] isolating themselves from [the] outside and I gather even saying, “Actually, we don’t want health professionals coming in at the moment to keep ourselves safe”.’
This was seen in the Anangu Pitjantjatjara Yankunytjatjara (APY) lands on Monday, where strict rules for entry were introduced under the APY Land Rights Act, requiring those visiting to sign a statutory declaration to say they have not been exposed to the virus and are not returning from high-risk countries.
‘We are protecting our people,’ APY general manager Richard King told The Guardian.
‘Especially those who hold our ancient cultural knowledge, and we know they are already vulnerable as they are quite old.
‘The problem with this one is it has a [global] 3.4% fatality rate, which is high, but with our cohort, if it gets here, it’s going to be devastating.’
Aboriginal and Torres Strait Islander people were four times more likely to be admitted to hospital with H1N1 influenza during the 2009 pandemic than non-Indigenous Australians, a costly lesson the Australian Indigenous Doctors’ Association (AIDA) says ‘must be heeded’.
The NT confirmed its first case of coronavirus last week after a man, who had returned from Singapore, tested positive after flying in from Sydney to Darwin. Two people who had been sitting on the plane near the 52-year-old were tracked down by NT Health and placed in isolation at Maningrida for 14 days.
In preparation for a possible outbreak, the first pandemic clinic has been set up on the campus of Royal Darwin Hospital, with plans for more, and the NT Government is considering using non-residential community buildings for isolation purposes.
In recognition of the tens of thousands of Aboriginal and Torres Strait Islander people living in remote areas with limited access to medical resources, the NT Government finalised a plan on Monday that was reportedly issued to all major health networks to manage any possible coronavirus outbreak in these communities.
The plan acknowledges the ‘severe’ risk that coronavirus poses for remote communities.
Dr Senior said the high prevalence of chronic diseases among Aboriginal and Torres Strait Islander people, often from a younger age than non-Indigenous Australians, indicates that they are ‘more vulnerable to widespread COVID-19’.
In an attempt to reduce the risk, the plan suggests all unnecessary travel to remote communities be limited, a recommendation Dr Senior has welcomed.
‘We’re seeing that that will be helpful and I think that’s going to be easy to do in remote communities,’ he said. ‘So the isolation I would think is going to be a quite effective thing to do.’
Dr Senior praised the Federal Government’s Department of Health (DoH) for its early involvement of peak bodies such as the National Aboriginal Community Controlled Health Organisation (NACCHO) and AIDA in its planning regarding the containment of the virus as it relates to Aboriginal and Torres Strait Islander people.
The planning has not been without its challenges, however.
Dr Senior said that Aboriginal Medical Services (AMSs), like many mainstream practices, have found themselves trying to navigate ‘mixed messages coming through federal and state governments’ that are ‘varying from week to week’.
‘I suspect that AMSs will trust information put out by NACCHO and by their own state and territory peak bodies. So I think there might be some easier and well-trusted lines of communications that will actually benefit the AMSs,’ Dr Senior said.

Tim-Senior-Hero-1.jpgMedical Advisor for RACGP Aboriginal and Torres Strait Islander Health Dr Tim Senior.

When it comes to coronavirus messaging for AMSs, the information has been rather standard across the board, with suggestions around strict hygiene. But Dr Senior said the need for local cultural understanding is ‘actually really important’ in helping to effectively implement infection control measures. 
One of the concerns raised in a webinar between NSW Health and the Aboriginal Health and Medical Research Council (AH&MRC) on cultural practices was overcrowding, which could increase disease transmission.
‘If you have a sick child, they’re often placed in the middle of the room so everyone can keep an eye on them. So what does that mean in terms of social isolation and social distancing?’ Dr Senior said.
Another key issue to consider is the language around infectious disease control, which Dr Senior says can have ‘negative controlling’ connotations regarding colonisation for many Aboriginal and Torres Strait Islander people.
‘We talk about social isolation, we talk about infection control, we talk about disease surveillance, and all of those have historical connotations regarding the control and surveillances of Aboriginal and Torres Strait Islander people in the past,’ Dr Senior said.
Dr Senior also highlights that, as a result of past negative experiences with health services, it may also mean that Aboriginal and Torres Strait Islander people present much later, with access made even harder due to a lack of transport and electronic communications infrastructure.
The NT coronavirus plan recommends that health workers: 

  • encourage early presentation of all respiratory illnesses, particularly in vulnerable community members
  • strongly promote flu vaccination to reduce the concurrent burden of the virus
  • isolate all respiratory cases who fit the clinical case criteria and their close contacts. 
‘It is imperative for health professionals to ensure culturally safe healthcare for Aboriginal and Torres Strait Islander peoples at all times. The importance of early detection in mitigating a pandemic, however, makes these efforts critical,’ AIDA said in a media release.
Dr Senior says that in addition to the regular measures being taken for all patients, there should be particular emphasis on communicating the reasons behind each measure being taken when it comes to being culturally aware with Aboriginal and Torres Strait Islander communities.
‘A large part of it will be explaining to people the rationale for the way they are doing things,’ he said.
‘There’s the potential of being gowned and masked up, or turning people away with a form, [which] could potentially be seen as being dismissive when it’s actually not – those are infection control measures.
‘So really good explanation about the reasons for what’s happening and standard advice around social isolation and handwashing [is needed].’
NT Deputy Chief Health Officer Dianne Stephens said an exercise is planned for Thursday 12 March, with a number of stakeholders from the remote and rural health centres taking part to work through the logistics in remote health communities.
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