Soapbox

Your say about nursing issues

Helen Calabretto
School of Nursing, University of South Australia, SA

PP: 139 - 140

Article Text

The politics of pap smears

'If every woman in Australia had a pap smear every two years, 90 per cent of cancer of the cervix could be prevented', cites Geraldine Doogue in the Cervical Screening promotional literature. Why then do only approximately 50 per cent of Australian women have regular pap smears? Not surprisingly, the noncompliant groups are commonly minority race (non-English speaking) and rural women. The challenge is to make pap smears an acceptable and available service to this client group.

Until recently, a nurse practitioner used a provider number from a cooperating doctor to submit pap smears. However, the Australian Medical Association has now advised their members against this practice unless the doctor has personally examined the client. The focus has moved away from women's health to a dispute of professional territory. Is a general practitioner working out of typical suburban rooms, with a rack of pap smear pamphlets in various languages likely to improve the compliance rate? The obvious and most cost-effective service would be to have women's health nurse practitioners, recruited as necessary from ethnic groups, taking the service to these women. Why then does the nursing profession have such difficulty in achieving autonomous practice? The South Australian Breast Screening Service provides a good working model where radiographers enjoy autonomy, with secretarial and pathology support.

Currently, the Cervical Screening Service and Medicare are considering a system whereby the nurse practitioner can use an identifier number, not the status of a provider number but a step in the right direction nevertheless.

Chris Spencer RN

A failing health care system

The nursing profession is in a key position for implementing changes necessary to Australia's Aboriginal health care system. Despite more than $40 million being spent annually, this health care system is not working. Such basic goals as increased wellness and decreased mortality and morbidity of Aboriginal people are not being met. Today the health status of Australia's indigenous people is amongst the worst for any population group in the world. Infant mortality is three times higher than in the non-Aboriginal population. At birth, an Aborigine's life expectancy is twenty years less than that of the rest of the population.

Death from respiratory disease is thirteen times higher in Aboriginal children. In 1991, 63 per cent of Aborigines over the age of fifteen years were earning less than $12 000 a year. Many non-Aboriginal people like to believe that the laziness, substance abuse and domestic violence which are closely related to the above statistics are part of the Aboriginal character- an inescapable racial flaw. Taking a look at the historical perspective will reveal a more accurate view. The truth is that colonisation leads to ill health and early death among the people invaded and displaced. It is almost impossible to maintain one's health while drowning in a sea of negativity.

For decades, the Australian government's attitude was basically that the Aboriginal problem would disappear when the Aboriginal people died out. Fortunately, genocide is no longer seen as the solution. Erik Erikson gave us the 'Eight Stages of Man (sic)' and described the fourth as occurring during mid-to-late childhood as children begin to leave the protective bosom of their families and develop a sense of industry. They seek out teachers as role models who can guide them in their quest for a meaningful adulthood.

My observations indicate that most Aborigines only make it to this fourth stage of maturity before becoming unstuck by a society which demands English literacy, a European diet and standard of cleanliness. It also expects adherence to a medical model of health which seems reluctant to give Aborigines the freedom of self-expression. At school-age, children are sent into a society which, by and large, doesn't want them. While learning to cope with this rejection, the children look to their adults to find role models, and see unwanted, unemployed, substance abusers who may solve their problems with violence. Aboriginal people have been told to remain in a society which has been subtly determined by non-Aboriginal people. Women of the Northern Territory say, 'Our vision of who we are is lost'. 'The kids have already become socialised. Putting up your fists or picking up a stick solves problems.' 'Women get killed, men go to prison and children carry it onto the next generation.' 'When you know our story you will know our shame and sadness.' Atkinson (1991). Their eloquence is tragic. Millions of dollars are being spent to maintain a Western medical model which, in the end, gives very little benefit to those it is meant to help.

Investing time and money in the repair of the Aboriginal psychosocial structure will surely yield better dividends. It is said that 'the health of the population... socially shaped and collectively experienced' (Davis & George 1988: 24). It might also be said that for a health care system to work, it must be owned by those for whom it is intended. Aboriginal health workers who understand and own spiritual/traditional components of the wellness/ illness continuum are also expected to understand and use the Western medical model. In too many cases, skills are taught to health workers by clinicians, who cannot or will not accept that Aboriginal ways not only exist but are often valid forms of treatments. In most instances, the clinicians training the health workers and running the government health centres in Aboriginal communities are registered nurses. By virtue of their numbers and influence, theirs is a position of power and nurses can play a vital role in improving health care delivery.

With understanding and sensitivity, nurses working within these communities can help Aboriginal people find their own way to improving their health while simultaneously helping them recover their self-respect. You can't have one without the other.

Brooke McReynolds RN

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