Donna
Royal College of Nursing have a little publication "Transcultural
Nursing in Multicultural Australia" by Akram Omeri which I would suggest
as a possible source of background reading. Leniniger (who she
references in in book, I think she studied under her)
did a model of cultural assessment and sensitivity. I believe that this
could be used to form the basis of care rendered to indigenous women,
purely by making those doing the care aware of the specific cultural
sensitivity issues for this community. And the individual women - we are
all different.
I worked in a midwife led community clinic, or birthing centre in South
Africa. We basically provided ante-natal care birthing and post-natal
care by home visit for the so called "Cape Malay population". Our
back-up was via a dedicated flying squad to the major teaching hospital.
We also had a direct line to the Obstet on call.
Yes the women wanted so called good care just like any typical
Australian or South African women. However many of them just were not
able to define good care due to lack of education, resources and
knowledge. However what these women could define was sensitivity and
culturally appropriate care. Not in any grand verbal terms but purely by
the way they were treated and listened to. They did not want to be
scolded because their baby was IUGR or foetal alcohol syndrome. They
need loving support and education.
They needed access to social care as much as medical or midwifery care.
The forces of poverty, poor education and often family dysfunction are
major challenges that these women may be dealing with daily. There has
been a lot of research work done on training lay folk to carry out
certain aspects of primary care. A friend of mine did research in
Calcutta where she looked at the issue of ante-natal care and education
- her thesis reported positive results. Possibly a worthwhile idea is to
look at a model that incorporates using the women to provide ante- natal
education/facillitation groups to their community. The same could be
true for breastfeeding. This is one way to ensure that the care is
culturally appropriate and "easy listening" for the women.
While I was working in the unit one night the following happened to me:
This really tiny young women (prob 5 ft max) presented in strong
labour - unaccompanied. Primigravidae, obese and unbooked. I barely
got her onto a bed and the head was crowning. I ended up having to deal
with badly impacted shoulders. The women was "off her face" I could not
get her to keep her legs open, she kept trying to close them tight.
Needless to say I could not try any of the manoeuvres or get her to turn
to all fours. Since It was obvious that I was loosing the baby fast I
fractured the clavicle. Child ended up with an erbs palsy but alive. It
transpired later that mother was diabetic, unmarried and feeling great
shame. All she wanted to do was hide her face.
I was devastated by what had happened, for a good few reasons, but
essentially the system had failed her, had she have come for care in the
beginning things could have been different.
I wonder if she had had someone in her own community that she could have
at least reached out to, without feeling threatened, if it would have
changed things.
As Maxine said in her post "you have to give it back to the women" but
you can't give them anything they do not feel they have ownership of.
Kind Regards
Mandy
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