Aboriginal women badly served by health care

Page 26

Aboriginal women across Canada are facing problems accessing health care, due in part to system's inability to address cultural and language issues.

Recent studies commissioned by the Atlantic Centre of Excellence for Women's Health (ACEWH) show shortcomings in health care provision for Aboriginal women-as well as immigrant, refugee and minority women-living in Atlantic Canada.

The research highlights three major obstacles to providing health care to these marginalized women, including the health care system's lack of understanding about how some diseases affect different ethnic groups, and the lack of culturally appropriate treatment alternatives available.

Issues surrounding language and communication are also highlighted, both in terms of these women not understanding the language health care services are provided in, and in not having the language skills needed to be able to seek out the services they need.

The third area where the studies found the health care system came up short was in its ability to be sensitive to the specific cultural needs of these women, which in turn could lead to them by-passing the system altogether.

Based on these findings, the ACEWH has come up with recommendations to improve the situation for Aboriginal, immigrant, refugee and minority women. To address the language issue, the centre recommends providing more health care interpreters, and providing them with better training in order to improve communication between these women and their health care providers. It also recommends that organizations provide health information and information on how to use the health care system in the languages of the women they are serving.

Other recommendations include making cultural sensitivity training part of the standard training for health care providers, and increasing the amount of community-based, culturally-relevant research done on ways to address the health care delivery needs of these specific groups of women.

While the reports and recommendations look specifically at the situation in Atlantic Canada, the findings are pretty much representative of the situation facing Aboriginal women right across the country, said Marlene Larocque, executive director of the Native Women's Association of Canada (NWAC).

"I just started working here at NWAC in May, but before that I was working at the Prairie Women's Health Centre of Excellence, which is the sister organization of the Atlantic, the people who put this out. And I think that the research all across from the centres of excellence would show that Aboriginal women and minorities-black women, immigrant women, refugee women-all have the same access to health care. Culturally-appropriate health care is an issue," she said.

The recommendations coming out of the Atlantic-based reports, if acted upon, would help address the situation faced by Aboriginal women, but they are only a start, Larocque said.

"I think, basically, that's part of the answer. When we have medical staff that have culturally-appropriate training, that's one step of the way. But we also need to educate women on their rights, basically. And we need to make all of the language and terminology that's used, we need to make that user-friendly so that women know what services that they're getting, and what this term means, for example. And then, of course, women need to be able to access transportation to go see a doctor. Some doctors won't see you unless you have a fixed address. Well, a lot of our people migrate to urban centres and they don't have a fixed address, so they fall through the social safety net, for example. It's part of that. And there also needs to be an increased funding. Governments-the federal, provincial, local government, the regional health authorities-need to see this as well as a priority, and do their parts."

In order for the health care system to adapt to better meet the needs of Aboriginal women, changes have to take pace from the top down-t the policy level-and from the bottom up?initiated by the communities themselves. But for changes to happen at the grassroots level, Aboriginal women need to find ways to come together and work together to bring about change, Larocque said.

"I think that grassroots women are isolated, and their issues, such as poverty and access issues, and there's that whole self-esteem thing where isolation keeps us from really forming any kind of political alliance. So there needs to be work on that level, and then I think all women need to basically come together and force the issues and say, 'This is an issue for us,' and outline the importance of that.

"And on the other hand, yes, there needs to be huge changes in public policy . . .. For example, Aboriginal women are the population that AIDS is increasing, they're the highest percentage of new AIDS cases, but there's a lot of stigma attached to that. Because people only see, you know, 'Oh, they have AIDS,' for example. But they don't look into the socio-economic situation. And also, those reports indicate that Aboriginal women are getting AIDS through drug use, not necessarily through heterosexual or homosexual contact. So I think in those cases, there really needs to be some work done in examining why is there drug use in the first place. And then addictions come in, and then there are abuse issues, that's why they're addicted. Or there's poverty issues. There's underemployment . . . women ultimately selling the only thing they have which is their bodies."

These issues could be better addressed through a more holistic approach to health, Larocque explained, with health care providers looking not just at a woman's health, but at all the factors impacting on it.

"I think some people see health just as physical health, physical or mental health. And there needs to be a more integrated, a more holistic look at health. And I know that woman-centred health concepts are very inclusive of housing, o income, of access to transprtation, childcare, all of those combined together, employment, all of those combined together affect women's health. So there needs to be a broad definition of health and how we support people's access to health.

"And also, there needs to be a recognition of different models of health care. Not just the western, go see a doctor. Because some people might go that route."

There are a number of ways an Aboriginal woman can advocate on her own behalf, and help ensure she receives the health care services she needs, Larocque explained.

"I think the first thing is to not become isolated. Because once you become isolated, then it's really hard to make those links. And I think it's reaching out. You need to educate yourself, basically, on your rights. And I think Aboriginal women need to reach out more. There are organizations that exist in urban areas, but they have very little funds to do any public awareness. Regional health authorities, I think, need to make that information available, as to where they can access medical care . . .

"Really doing a lot of your own personal research, or reaching out to outreach workers, or maybe the friendship centres have nurses. There's this whole push toward community health, getting smaller geographical areas in cities, having their community health representatives. Anything to sort of get out of an isolated situation."