Making hospitals more accessible for First Nations people

Many First Nations people who present to a hospital emergency department leave before they’ve even seen a doctor. Even if they are seen and admitted to hospital, First Nations people are 2.5 times more likely than non-First Nations people to discharge themselves early against medical advice, research from Federation University shows.

Dr Aziz Rahman, Associate Professor of Public Health and Research Advisor from the Institute of Health and Wellbeing, says changes are needed in hospitals so that First Nations people feel welcome, safe, understood and able to access full medical care.

Profile: Associate Professor Aziz Rahman

Dr Rahman has experience across the world in public health issues, including with Indigenous, migrant, multicultural, rural and disadvantaged communities. Over the past few years, he has joined a team led by Professor Kerry Arabena at Karabena Consulting and former head of the Indigenous Health Equity Unit at the University of Melbourne to research the experiences of Australia’s First Nations people in hospitals.

The work is ongoing, with an extensive report on emergency departments published in 2020, based on research at three hospitals in Elizabeth, South Australia; Alice Springs, Northern Territory; and Nowra, New South Wales.

“In my experience working in public health in different national and international contexts, and coming from a developing country [Bangladesh], I did not expect there would be differences in terms of access and treatments for First Nations people in Australia,” Dr Rahman says.

“Yet there is a clear difference in health outcomes for First Nations people, such as a 10-year difference in life expectancy, so that was a big surprise to me. Why should that happen when they are accessing the same facilities?”

In the research, First Nations people were interviewed about their experiences in emergency departments. Many identified that they felt “shame”, discriminated against and “avoided” if they were left alone for long periods, if a First Nations professional did not see them, or if awareness of cultural sensitivity was lacking.

Some study participants reported they choose not to identify as First Nations people when they go to hospital because they feel they will be discriminated against. Others say they have actively avoided emergency departments because of previous bad experiences. “They didn’t feel safe or didn’t find people receptive to cultural differences,” Dr Rahman says.

“One of the critical things is probably the sensitivity of people who are handling these First Nations patients. They have the intention to help, but they often don’t know how. Sometimes they don’t know what is important culturally.” For example, a man may not want to be attended by a female doctor or nurse. A patient who gives up their seat or bed for someone else may just be showing respect to an elder rather than indicating they feel well.

Dr Rahman says requirements that hospital staff have cultural safety training usually involve a one-off course. “It should be regularly updated with training every year about this,” he says.

The research has identified that the employment of Aboriginal Hospital Liaison Officers could help with some of these issues. “It would be very good to have someone there to yarn and calm you down while we are coming to terms with the whole emergency department experience,” one patient said. The research team are also evaluating whether a pictorial triage system and a new way of taking a patient history would work better with First Nations people.

Dr Rahman says the ongoing, multi-year research is now looking at hospital procedures, staff training and transitions between areas of the hospital, and analysing patient data over the past ten years to work out how best to make hospitals accessible for First Nations people.

“We are trying to compare, for example, the patient who left without being treated with one who was,” he says. “Are there common traits among the patients who left hospital, regardless of whether they are First Nations or non-First Nations people? Can we predict something is going to happen and take some action?"