Providing community-based pandemic healthcare for First Nations

Aboriginal-led health organisations are working to ensure First Nations communities’ health needs are being met during the COVID-19 pandemic. Carissa Lee Godwin, Editor of APO’s First Peoples & Public Policy Collection, explains.

COVID-19 and First Nations communities

During the COVID-19 pandemic, it has become clear that the elderly, those with pre-existing health conditions and immunocompromised people are at higher risk of severe illness and death, and that many First Nations people fall into these high-risk categories. This is a major issue for nations with Indigenous populations across the world, and Aurora Milroy’s ANZSOG article on Indigenous people and COVID-19 has looked at government responses and infection rates in New Zealand, the US and Canada.

Although Australia’s governments have implemented broad strategies to deal with the COVID-19 pandemic, First Nations people need plans of action that are tailored to their respective needs as communities. Aboriginal Community-Controlled Health Organisations (ACCHOS), including the Aboriginal Health and Medical Research Council of NSW and the Aboriginal Health Council of Western Australia, have put together First Nations-led toolkits for their communities to combat and prevent cases of COVID-19:

• Aboriginal community-controlled health services pandemic response toolkit (AH&MRC toolkit)
• Aboriginal Health Council of Western Australia Coronavirus (COVID-19) response toolkit for member services (AHCWA toolkit).

Community considerations

These resources highlight the importance of working with First Nations communities to ascertain the specific solutions that will work best for them. One of the recommendations to aid the prevention, treatment and recovery of COVID-19 cases, is to address the unique needs and challenges of each community that need to be navigated in culturally safe ways, including:

1. Factors that can increase the risk of transmission include frequent travel between cities, towns, and communities for family and cultural reasons as well as a steady influx of visitors to and from remote communities (AHCWA toolkit, page 6).
2. It is important for First Nations family and social linkages to be maintained while reducing the chance of spreading this disease. Health workers are advised to be conscious of and respectful towards the different family and community ways of doing things and to work with these communities to identify ways to reduce the risk of transmission. (AH&MRC toolkit, page 30).
3. A major issue for some remote First Nations communities that poses a hindrance to slowing the spread of infectious diseases is the overcrowded housing provided. (AHCWA toolkit, page 6).

Key strategic responses

Both toolkits have created strategies that deal with the prevention and treatment of potential COVID-19 cases in ways that allow for flexible and responsive modes of care and for First Nations input to be interlaced throughout the processes:

1. Healthcare providers should avoid a deficit discourse when creating messaging for First Nations people regarding COVID-19: “Messages should be strengths-based and encompass Aboriginal ways of living, including family-centred approaches during both prevention and control phases.” Messaging should also address strategies to overcome potential barriers for First Nations people, such as living arrangements and accessibility to services (AHCWA toolkit, page 7).
2. Quarantine can be a distressing thing to undertake for anyone, it could be especially painful for First Nations people because family and community involvement is so fundamentally important. With this in mind, the AH&MRC recommends that: “Families should feel empowered and be part of decision-making around quarantine, and exploring with families what quarantine looks like, and working through how it might impact on the family and ways of living and identifying ways around it.” (AH&MRC toolkit, page 31.)
3. There needs to be flexibility around health services for First Nations people during a pandemic, such as the possibility of home visits, and flexible opening hours for assessment and treatment. (AHCWA toolkit, page 7).
4. As indicated above, it is important to avoid negative language in print and online communications with First Nations people, and this needs to be extended to the way healthcare professionals interact with patients. Conversations need to be open, engaging, and framed in a positive manner: “Families experience of conversation with clinicians, public health professionals and Aboriginal Health Workers have a ripple effect in families and communities” (AH&MRC toolkit, page 31).

Key strategic responses

Both toolkits have created strategies that deal with the prevention and treatment of potential COVID-19 cases in ways that allow for flexible and responsive modes of care and for First Nations input to be interlaced throughout the processes:

1. Healthcare providers should avoid a deficit discourse when creating messaging for First Nations people regarding COVID-19: “Messages should be strengths-based and encompass Aboriginal ways of living, including family-centred approaches during both prevention and control phases.” Messaging should also address strategies to overcome potential barriers for First Nations people, such as living arrangements and accessibility to services (AHCWA toolkit, page 7).
2. Quarantine can be a distressing thing to undertake for anyone, it could be especially painful for First Nations people because family and community involvement is so fundamentally important. With this in mind, the AH&MRC recommends that: “Families should feel empowered and be part of decision-making around quarantine, and exploring with families what quarantine looks like, and working through how it might impact on the family and ways of living and identifying ways around it.” (AH&MRC toolkit, page 31.)
3. There needs to be flexibility around health services for First Nations people during a pandemic, such as the possibility of home visits, and flexible opening hours for assessment and treatment. (AHCWA toolkit, page 7).
4. As indicated above, it is important to avoid negative language in print and online communications with First Nations people, and this needs to be extended to the way healthcare professionals interact with patients. Conversations need to be open, engaging, and framed in a positive manner: “Families experience of conversation with clinicians, public health professionals and Aboriginal Health Workers have a ripple effect in families and communities” (AH&MRC toolkit, page 31).

Closing the Gap on First Nations healthcare

First Nations people need to feel as if they can access healthcare without the risk of judgment, and to know that identifying and addressing their needs will be a collaborative process between them and health workers. This applies not only during a pandemic, but more generally.

Since the failures iterated in the recent Closing the Gap 2020 report, the proposed partnership of Aboriginal groups with governments has recognised that the best plan of action is to involve Aboriginal groups in efforts to close the health gap between Indigenous and non-Indigenous people. This latest Closing the Gap report proves that the governments must listen to First Nations people about what they need in the areas of health, education and employment.

First Nations-led resources such as these toolkits are essential to ensure not only that needs are being met to provide communities with proficient healthcare during a pandemic, but also that wellbeing and quality of life can always be maintained. Both resources make it clear that it is important to offer community-based ways of delivering health services that inform and empower First Nations people to decide how they want to approach their healthcare options. Challenges such as poor housing, accessibility to health services, and social issues also need to be addressed to ensure that First Nations people can survive this pandemic.

About the First Peoples & Public Policy Collection

As part of its mission to improve Indigenous policy in Australia and Aotearoa-New Zealand, the Australia and New Zealand School of Government (ANZSOG)  is working to increase knowledge of Indigenous culture and history. One way that is is being achieved is through the support of the APO  First Peoples & Public Policy Collection, launched at the ANZSOG Reimagining Public Administration conference in February 2019.

The First Peoples & Public Policy Collection is curated from a broad selection of key Indigenous policy topics, and provides a valuable resource on Indigenous affairs, with a focus on diverse Indigenous voices.

Resources

• Search APO’s First Peoples & Public Policy Collection
• Subscribe to APO’s free newsletter service
• Sign up to ANZSOG’s Indigenous news mailing list
• Find out more about ANZSOG’s Indigenous engagement