Subject Code & Title : NSG2204 Indigenous Culture And Health
Weighting : 40%
Word limit : 1500 words
Assignment Type : Case Study Report Assessment 4
NSG2204 Indigenous Culture And Health Case Study Report Assessment 4 – Australia.

Background History :
Hope Vale is a remote town in Far North Queensland (FNQ) on the Cape York Peninsula, about 46 Kms NW of Cook town (the nearest town), 372 km from Cairns the nearest city and 2,029 km NNW of the Queensland capital city of Brisbane 1 . The population of Hope Vale is 92% Aboriginal and/or Torres Strait
Islander people 2 , who make up thirteen clan groups who mostly speak Guugu Yimithirr and other related languages, as well English 3 . The Guugu Yimithirr people are the traditional custodians of the land and are estimated to have occupied this area for approximately 100,000 years. The Aboriginal Shire Council proudly state that Hope Vale is located in ‘a valley surrounded by tropical native bushland, mountain ranges,pristine coast and diverse flora and fauna’ and it is the most Northern township on the Eastern seaboard that can be accessed by Bitumen (road). The town is remote, and the weather can be extreme due to tropical cyclones that can make movement in and out of the town difficult.

There are a number of services available in Hope Vale for the 1500 or so residents, including education,
health, community and social services 4 . However, there are a high proportion of people who do not access services due to socioeconomic disadvantage as a result of low income, low educational attainment, high unemployment, and having no access to a motor vehicle 5 . Furthermore, the remote Indigenous population experience poorer health outcomes than non-Indigenous people in the region including a higher burden of chronic diseases such as Cardiovascular disease, Diabetes mellit us, and Chronic respiratory diseases compounded by limited access to integrated team care 6 . In addition, some services such as those available for mental health and social & emotional well being have been identified as not culturally appropriate, meaning access and treatment outcomes are poorer for the Aboriginal and Torres Strait Islander people in the area 8

Dora Barnes is a 48 year old Guugu Yimithirr woman from Hope Vale who speaks a dialect of Guugu
Yimithirr and some English. Dora was born small and premature at 33 weeks and had to be tube fed due to prematurity and then later bottle fed, as her mother had difficulty breast feeding and was unwell having gestational diabetes most of her pregnancy. Dora grew up living with her mother, father, grandmother and 3 siblings, making living conditions cramped and difficult and the transmission of infections common between household members.

Dora recalls that ‘good tucker’ was scarce when she was a child due to the cost of food in town and the fact that there was very limited food choices at the local store. However, she remembers fondly that the best tucker was when someone had gone hunting and returned with some kangaroo, or even better when
someone returned from the coast with some turtle which was her favourite (Turtle fat is highly desirable in
many communities, but usually reserved for elders or special occasions). Dora does not remember visiting a doctor or nurse very often as a child or even as an adolescent, but when she did it was always strange and scary to meet a new ‘white stranger’ who didn’t seem very friendly.

NSG2204 Indigenous Culture And Health Case Study Report Assessment 4 – Australia.

Current Medical History :
Dora has felt quite unwell lately with lack of appetite, nausea, shortness of breath, and feeling exhausted
most of the time. Dora informs the nurse that she has also been ”passing water” less frequently over the
past few weeks. Her sister took her to see the doctor at the local medical service who examined her, took
some blood and a urine test and explained that she needs to see a nephrologist urgently for a renal biopsy,at the Royal Brisbane Hospital. Dora is alarmed (as is her family) as Brisbane is 2,045 km from Hope Vale and ‘a long, long way off country’ as Dora says. Dora has never travelled this far ‘off country’ or away from her family for any length of time and is very nervous about going to hospital so far away. After much
discussion Dora understands she is very unwell, and the doctor organises to access funding for her sister to fly down to Brisbane with her.

Dora’s blood tests show significantly elevated urea and creatinine. Her urine tests indicate albuminuria and haematuria.

Dora’s provisional diagnosis is deterioration of Chronic Kidney Disease

PAST MEDICAL HISTORY
• Overweight
• Hyper cholesterolemia
• Hypertension
• Diabetes (T2DM) – diagnosed age 30.
• Multigravida (2 live births)

FAMILY MEDICAL HISTORY
Mother – CKD, Gestational Diabetes – now Diabetes Mellitus (T2DM), Obesity, Glaucoma, Depression
Father – Alcohol dependence, Hypertension, Mitral Valve replacement (secondary to RHD)
Sister #1 – Diabetes Mellitus (T2DM), obesity
Sister #2 – Hypertension, CAD,
Brother#1 – Hypertension, Hyper cholesterolaemia, CAD

CURRENT MEDICATIONS
Simvastatin 40mg (note)
Atacand 32mg/d
Lantus 20units/bd

CASE STUDY REPORT INSTRUCTIONS :
Please read the case study carefully, so you have the context for Dora’s health condition and impending admission to hospital.
• Address each question below in 1,500 words +/- 10%
• USE HEADINGS to make it clear which question you are addressing. Note: headings are NOT counted in the word count
• Beside each question is a guide to the word limit to help you structure your report. This is a guide only, so you may be under or over the suggested word count, as long as you answer each of the questions sufficiently to meet the rubric criteria and do not exceed the 1,500 word +/- 10%
• Each response must be referenced appropriately with relevant and recent literature and a reference list with at least 10 references must be included with your submission.
• Please make sure that you proof read your work for spelling, grammar and syntax prior to submission
• You must use APA 7 th referencing style for this submission.

CONSIDERATIONS AND PREPARATION FOR HOSPITAL ADMISSION AND DISCHARGE

Please respond to ALL the following questions described under EACH HEADING. Include a cover sheet and reference list with your submission to the drop box on Bright space

Epidemiology, risk factors and SDH that contribute to Chronic Kidney Disease
Refer to current health data about Chronic Kidney Disease (CKD) in Australia to identify the prevalence and pattern of disease in Indigenous people. Critically analyse why Dora at risk of developing CKD? What are the circumstances (or social determinants of health) that have created this risk?

Barriers experienced by the patient
Discuss some of the barriers Dora experienced to treatment and management for this condition.

NSG2204 Indigenous Culture And Health Case Study Report Assessment 4 – Australia.

Cultural Safety
Critically analyse why travelling ‘off country’ so far away to Brisbane could be concerning for a Guugu Yimithirr woman. What can health care staff do to advocate for Dora in hospital to ensure she feels culturally safe?

Collaborating for safe, quality care
A new medication regime has been organised to better control Dora’s blood pressure to sustain her kidney function. Describe what integrated team care Dora will need to maintain good health in Hope Vale? Who needs to be involved in her care and how will they collaborate to hopefully help her avoid dialysis in the future? Include how Dora can be supported to take her medication safely and regularly.