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Emergency rooms need cultural overhaul, experts tell Govt

Australia’s hospital emergency departments should be overhauled to make them culturally-friendly for Aboriginal and Torres Strait Islander people, according to the Australasian College for Emergency Medicine.

In a submission to the federal Department of Health’s advisory group on Aboriginal and Torres Strait Islander health, the ACEM said more Indigenous staff were needed in emergency rooms and that non-Indigenous emergency room staff should be trained in cultural competency.

It said the benefits included more accurate diagnosis, less patients discharging themselves against medical advice and increases in the rates at which patients attended follow-up appointments.

Chair of the College’s Reconciliation Action Plan Reference Group and its Indigenous Health Sub-committee Dr Elizabeth Mowatt said emergency rooms’ frontline status made them critical to people’s hospital experience.

“We are the front door to the hospital,” Dr Mowatt said. “If people come and have a bad experience in the emergency department, that taints their whole vision of the hospital and the mainstream health service, so we have an enormous capacity to do a lot of damage quickly.

“That means we really have to try to make sure that that initial engagement is positive and hopefully that will flow on through the rest of the hospital.”

Dr Mowatt said Aboriginal and Torres Strait Islander people presented at emergency departments for treatment at higher rates than the non-Indigenous population, but she did not have exact figures.

She said more work needed to be done to look at how culturally responsive emergency departments were around Australia.

“We haven’t looked at our specific emergency departments ourselves and I think that’s a bit of work that is in our future – to see what departments are culturally safe, what’s the reflection of the staff who work there. We don’t have that at our fingertips at the minute,” she said.

“But there is a lot of literature out there that proves that racism makes people sick.”

Dr Mowatt said it was important for non-Indigenous hospital staff to understand Aboriginal and Torres Strait Islander history and to have a respect for their cultures.

Emergency rooms should also become part of their local communities and relationships with local Aboriginal medical centres would benefit patients.

“There’s a lot more for us to learn and know,” she said. “And because it’s so broad I don’t know what comes first.

“Certainly being aware of Aboriginal history (is important) so that they understand all the issues that reside within a person when they present to an emergency department.

“It’s easy for staff just to focus on this incident now, but there are lots of stories that when an Aboriginal and Torres Strait Islander person presents to an emergency department they are bringing much more with them to the door.

“It’s really important non-Indigenous people really understand more about the history. I think they need to learn basic skills around cultural competence and how to approach somebody from a different culture to them and the ability to cross that divide, which can be boiled down to human respect.

“Then I think they then need to understand a lot more about the context in which Aboriginal and Torres Strait Islander people live.

“It could be someone living in a remote community — whether they have a fridge to keep medications in or about someone having extensive family commitments and therefore appointments made; they need to balance so many things just to be able to turn up to an appointment.

“It can be access to a phone or transport and then health literacy is always an important thing for us to consider and making sure people understand the questions we’re asking them, what we’re giving them, what their diagnosis is and prognosis is.

“I’ve always believed the onus is on us as health professionals to cross that divide.”

The Health Department’s consultation is part of its implementation of the ‘My Life, My Lead: Implementation Plan’ for the National Aboriginal and Torres Strait Islander Health Plan.

By Wendy Caccetta

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