Culturally Diverse Populations

“People fail to get along because they fear each other; they fear each other because they don’t know each other; they don’t know each other because they have not communicated with each other.” – Martin Luther King, Jr.

Members of cultural minorities around the world typically face poorer health outcomes. This is due to numerous complex and intersecting factors that span across the economic, political, social and geographical spheres. As such, the solution is not simple. Regarding health, it requires top-down re-evaluation of the systems in place, and advocacy for ground-up initiatives to support these vulnerable people.

As Australians, this is something that is all too familiar to us. Indigenous Australians comprise ~2.5% of the Australia’s population. Indigenous people in Australia experience much poorer health outcomes than non-indigenous people. The most common causes of death in this population are circulatory disease (26%), neoplasms (19%), and external causes (15%) – which includes suicide (30%), transport accidents (28%), accidental poisonings (10%), assault (9%) and drowning (4%). Four groups of chronic conditions account for the majority of the gap in mortality between Indigenous and non-indigenous Australians; these conditions are circulatory disease, endocrine/metabolic/nutritional disorders (including diabetes), cancer, and respiratory disease. Our track record of providing health to our migrant population is similarly poor.

This exhibition aims to give a few example of the inequities inherent in health systems, both here in Australia, and abroad. Unfortunately, despite the current state of affairs, there is little education and training available to medical students regarding cultural safety. Consider your own competence when it comes to delivering culturally appropriate healthcare. Do you know the right questions to ask? How comfortable would you feel asking them?


IN A NUTSHELL:

  • Australia has a poor history of providing care to the culturally diverse members in our population – particularly Indigenous Australians and people seeking asylum.
  • Examining the history of medicine globally, this story is no different, with the impact of institutionalised racism and discrimination evident in patient outcomes.
  • As future medical practitioners, we all play a role in fighting the racism that is entrenched in the medical system, to ensure the delivery of healthcare that is both culturally sensitive and accessible to all.

Image #1 (sourced here): Henrietta Lacks (1920 – 1951), a young mother of five, presented to the Johns Hopkins Hospital with vaginal bleeding in 1951. John Hopkins was, at the time, the only hospital to treat poor African American citizens. On examination, she was discovered to have a large malignant cervical cancer. Henrietta passed away, aged 31, later that year.

A sample of her cancer was sent to Dr Gey, a prominent cancer and virus researcher, who noticed that Mrs Lacks cells doubled in number every 20-24 hours, rather than dying like his other samples. These cells, named ‘HeLa cells‘, are still in use today to study the effects of toxins, drugs, hormones and viruses on the growth of human cancer cells. They played a crucial role in the development of the polio vaccine and have taught us about the human genome. HeLa cells are the oldest and most commonly used immortal cell line in scientific research. Read more about Henrietta’s legacy here, check out Rebecca Skloot’s novel, or watch the film.


Collection #2: The Tuskegee Syphilis Experiment

Patients involved in the Tuskegee syphilis experiment, the infamous and unethical clinical study conducted between 1932 and 1972 by the US public health service. The purpose of the study was to observe the natural history of untreated syphilis. Study participants were all African-American men, who were told that they were receiving free healthcare from the US government. Even when penicillin became available to treat syphilis in 1947, participants did not receive the drug. The study was conducted without informed consent. Read more here. (images sourced here & here).


Collection #3: Medevac

On Tuesday 12th February 2019, the Medevac Bill passed by one vote, guaranteeing medical transfer of sick asylum seekers from Nauru and Manus Island to Australia for treatment. A prime example of Australian doctors standing together to advocate for change. Read more about the Medevac Bill, the health crisis on Manus and Nauru, and the campaign led by Dr Neela Janakiramanan and Dr Sara Townsend (image 3.1). (images sourced here, here)


Collection #4: Close the Gap

The concepts of health and healing in Indigenous Australian culture are intimately connected to nature. Bush medicine is a practice where plants are utilised for their healing properties, for example boiling the leaves of ‘old man’s weed’ (Centipeda cunninghamii – pictured 4.1) to sooth the symptoms of arthritis. Each Australian region has its own plants. The practice of bush medicine thankfully endured colonisation despite the instigation of typically patriarchal western medical systems and the failure of said system to recognise the legitimacy of natural Indigenous healing. The great divide between these two divergent medical systems, at cultural, spiritual and philosophical levels, cannot be ignored as a significant and ongoing contributor to the gap in health outcomes between Indigenous and non-Indigenous Australians that still exists today.

A number of initiatives are in place to rectify the current state of affairs regarding Indigenous Health outcomes in Australia. These include the Close the Gap initiative, which started in 2008 and aimed to eliminate the gap between Indigenous and non-Indigenous Australians across a range of parameters (health, education, employment). This has been supported by a range of Australian organisations including Red Dust and NACCHO, and has seen the establishment of innovative and creative ways to deliver healthcare in remote communities, including the dialysis bus. That said, there is still a long way to go in closing the gap – and all of us have a part to play.

Read more about the Close the Gap targets and recent progress. Get more information about the reasons why things are the way they are in Indigenous Health by reading this in depth literature review. Also check out the UoM Medical History Museum’s awesome exhibition titled ‘The Art of Healing’, a celebration of 65000 years of Indigenous Australian healing practices through contemporary art. (images sourced here, here, here and here).


“Three generations of imbeciles are enough.” – Justice Oliver Wendell Holmes (USA)

Forced sterilization of women was commonplace throughout the 20th century. Women with undesirable traits such as ‘feeblemindedness’, ‘promiscuity’, mental illness, developmental disability were medically sterilized. Forced sterilization largely targeted the least powerful people, with minority women and immigrants making up a large proportion. The sterilization of American Carrie Buck (pictured) is one such example. Read more about the eugenics movement in the USA here.

Forced sterilization was a manifestation of the growing eugenics movement, that gained momentum under the Nazi Germany regime after the establishment of the ‘law for the prevention of genetically defective progeny’. Between 1970 and 1976, 25-50% of all African American women were sterilized. This was happening everywhere, however was most prevalent in Puerto Rico.

Collection 5: sterilization. (images sourced here, here, here and here)

Collection 6: eugenics. (images sourced here, here, here and here)


WANT MORE?

Check out The Vault’s reading & film recommendations.

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