Social Context
The Purple House Dialysis program aims to help residents of the Western Desert suffering from kidney failure. Efforts to provide healthcare to people in remote areas began in 2003 (Andersen & Hadley, 2020). In 2015, the remote dialysis access program was launched, helping hundreds of people get the healthcare they need (Australian Government Department of Health and Aged Care, 2023). The program was established because of the need to increase the access of the Indigenous people to vital medical services without disconnecting from the country.
Indigenous people in remote areas often travel hundreds of miles to access dialysis, making it difficult to continue treatment and leading to poor health outcomes. Indigenous peoples are nearly four times more likely to die from chronic kidney disease (Australian Government Department of Health and Care, 2023). The Purple House has extensive experience delivering kidney dialysis to remote Indigenous communities (The Purple House, n.d.). The provision of care for kidney failure was possible before, but it meant almost a lifetime of placement in a medical center without access to the native community.
The Purple House Dialysis program is connected with the social context as it helps and assists people in distress to improve their well-being. Initially, the main purpose of the Purple House was to provide a place where people from Western Desert communities could undergo dialysis and later return home (Charles River Labs, 2021, 00:03:00-00:04:00). This goal changed to creating a place where patients could achieve the best possible life.
In a social context, the program is important because it allows one to keep in touch with family during the treatment. The Purple House takes into account the social context in which the Indigenous population exists and strives to minimize the number of refusals of treatment. The program addresses the need for community retention and social inclusion. Such an assistance program could significantly reduce Indigenous mortality and improve well-being across cultural barriers.
Self-Determination
Self-determination largely influences the values and the worldview of the community. One of the most important self-determinants, especially for Indigenous peoples, is freedom. This concept assumes that these people will be endowed with equal rights with all citizens (Korff, 2019).
At the same time, they should have the right to avoid pressure and be free to choose how they live and spend their time (Korff, 2019). Freedom means being able to be creative and ambitious, as well as having the desire to express oneself in any chosen way (Korff, 2019). Free people do not need to trade their inalienable human rights for support or services.
The principle of freedom is implemented in the Purple House Dialysis program. For example, the concept of freedom implies the ability to make mistakes. Therefore, the Purple House program is completely voluntary, which leaves behind the right to freedom of definition and choice of medical care. At the same time, considering the principle of freedom improves health outcomes since it creates trust and reduces the number of refusals.
The Indigenous Assistance Program under review is inspired by the self-determinant of freedom, as it is consistent with the principles of respect for individual rights. Indigenous peoples have the right to choose their own place of residence and pastime and may not agree to live outside their family (Department of Health and Aged Care of the Australian Government, 2023). However, equal healthcare is part of the clause on freedom as an opportunity to be citizens with equal rights. All Australian citizens should have equal access to healthcare.
At the same time, informing the public about the danger of a particular disease, such as kidney failure, is also the responsibility of public healthcare. That is why the provision of assistance within the framework of a comfortable commune is consistent with the principle of self-determination of freedom (Korff, 2019). Aboriginal people can receive family support and still rely on quality healthcare and the awareness raised by the actions of health professionals.
Cultural Safety
Principles of cultural safety imply the elimination of health inequalities among Indigenous groups. One of the principles for achieving cultural security is to minimize power differentials. This principle involves equalizing the opportunities of the client and the provider of medical services (Curtis et al., 2019). Cultural safety within the framework of this principle also involves considering cultural differences in power in society and puts forward the requirement for medical workers to take into account these differences (Curtis et al., 2019).
A deep understanding of the role of power in a helped society contributes to the proper care of Indigenous peoples. Minimizing the inequality of differentials allows one to achieve the most effective treatment results. For example, a more informed patient will take a more responsible approach to self-care. The principle of minimizing power differentials allows one to find an approach to the Indigenous people, establish trusting relationships, and not abuse the position of awareness on the part of the medical worker.
The principle of minimizing power differentials is integrated into the Purple House Dialysis program. An example of the integration of this cultural safety principle can be seen in the order of medical services. Healthcare providers recognize the difference in strength by providing comprehensive information about the need for dialysis in people with diagnosed kidney disease.
At the same time, doctors do not abuse their own power and influence, providing only the necessary range of services with full consent. Minimizing power differentials is important to achieve effective treatment outcomes because it creates a trusting relationship between doctor and patient (Elvidge et al., 2020). For example, an Indigenous person seeking dialysis will be aware of communicating as equals and providing only necessary medical services. Such a tolerant and careful approach will reduce fears and achieve the best results of treatment, as the patient will trust the medical worker. Accounting for inequality of power is a fair approach to providing healthcare to Indigenous peoples.
Cultural Strengths
Cultural strengths are innate cultural characteristics that distinguish Indigenous peoples. Such features of the representatives of the Indigenous peoples of Australia are the connection with the country and respect for elders. The connection with the country implies a deep historical and psychological connection with the land where the representatives of the Indigenous peoples lived for centuries. The importance of the place is determined by the idea of it as a source of strength for the natives, establishing the values of the people and their norms and defining the vision of the world (Schultz & Cairney, 2017).
Respect for elders is also a common feature of the culture of Indigenous peoples, which is expressed in honor, privilege, and access to power for members of the older generation (Gibson et al., 2020). Taking into account the cultural forces of Indigenous peoples is the key to providing competent medical care, as it is based on a deep understanding of cultural characteristics.
The Purple House directly bases its program of helping Indigenous peoples on influencing their cultural strengths and their intelligent integration into the recovery process. The affordable dialysis program is based on the deep connection of Indigenous peoples with the land. An example of this cultural strength being taken into account is the fact that dialysis is provided in places accessible to Aboriginal people or in a place where a commune is formed. In a global sense, Aboriginal people do not need to leave their land to receive the necessary medical care (The Purple House, n.d.). Taking into account this factor of cultural strength gives the Indigenous population confidence in the success of the treatment.
Another important factor – respect for elders – is taken into account by understanding the target group, which is aimed at helping the Purple House. For example, the target audience for the Purple House Dialysis program is the elderly, who are most likely to need a procedure (Andersen & Hadley, 2020). Recourse to cultural forces is an advantage that allows one to get qualified help.
Social Determinants
Social determinants are important factors in defining the health and well-being of the community. Two social determinants that mostly affect the well-being of Indigenous peoples in Australia are unequal access to healthcare and lack of access to transportation (Pearson et al., 2020). Inequality includes barriers faced by the population, which may be cultural incompetence of workers, substandard services, and lack of healthcare in remote regions.
Access to transport is also an important social determinant, as it defines whether it is generally possible to get to a health facility. Among Indigenous peoples, lack of access to transportation can be a major barrier to accessing healthcare and gaining health awareness. For the remote communities of the Aboriginal and Torres Strait Islander peoples, lack of access to healthcare and lack of transportation are major threats to well-being and maintaining health.
The Purple House Dialysis program simultaneously addresses both social determinants to ensure a healthier community. For example, the unavailability of transport is solved by transportation provided by the Purple House to the place of the procedure (The Purple House, n.d.). The unavailability of medical care is also addressed during this process, seeking to level cultural barriers. For example, all medical personnel are aware of the cultural characteristics of the Indigenous population and provide assistance in full accordance with them (Andersen & Hadley, 2020).
Reducing cultural barriers to improve the proper accessibility of medical services includes minimizing the language barrier and taking into account beliefs and prejudices. Full cultural awareness of medical personnel makes the treatment results the most effective because it provides easier contact between the patient and the healthcare provider. Moreover, since 2018, the assistance program has been funded by Medicare, which makes it possible to count on the availability of the procedure (The Purple House, n.d.). Taking into account social determinants allows the Purple House to achieve fair medical care for the Indigenous population.
References
Andersen, N., & Hadley, B. (2020). Dialysis on Country: A study on Renal Care within remote Aboriginal Communities of Central Australia. Travelling Scholarships Journal Series. Web.
Australian Government Department of Health and Aged Care. (2023). New renal dialysis units for remote First Nations patients. Web.
Charles River Labs (2021). The Purple House way – Mobile dialysis for remote communities [Video]. In YouTube. Web.
Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S. J., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: A literature review and recommended definition. International Journal for Equity in Health, 18(1), 1-17. Web.
Elvidge, E., Paradies, Y., Aldrich, R., & Holder, C. (2020). Cultural safety in hospitals: Validating an empirical measurement tool to capture the Aboriginal patient experience. Australian Health Review, 44(2), 205-211. Web.
Gibson, C., Dudgeon, P., & Crockett, J. (2020). Listen, look & learn: Exploring cultural obligations of Elders and older Aboriginal people. Journal of Occupational Science, 27(2), 193-203. Web.
Korff, J. (2019). Principles of self-determination. Creative Spirits. Web.
Pearson, O., Schwartzkopff, K., Dawson, A., Hagger, C., Karagi, A., Davy, C., & Leadership Group guiding the Centre for Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE). (2020). Aboriginal community-controlled health organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia. BMC Public Health, 20(1), 1-13. Web.
Schultz, R., & Cairney, S. (2017). Caring for country and the health of Aboriginal and Torres Strait Islander Australians. Medical Journal of Australia, 207(1), 8-10. Web.
The Purple House. (n.d.). Remote dialysis funded by Medicare. Web.