Discuss about the Healing circle Primary Health Care In Action.
Healing circle at Gnibi is the primary health care program in Kalumburu village. The two social determinants of health, addressed by the health care project are the social environment, and social support network (McMurray & Clendon, 2015). Both these determinants are vital for the health of the people. For instance, a positive social environment helps overcome social isolation, a factor depicted to be the major risk factor for the child abuse and neglect in the given video by Rural Health Education Foundation (Producer), (2008). Similarly, strong social support network will help build strong community which helps creates a safe and healthy place for children and facilitate effective functioning of families.
According to Navarro (2009) lack of adequate social support network and social isolation decreases access to health care services and is the risk factor for poor mental health and overall wellbeing. Social support is considered a factor for good health as an individual has the access to assistance when in need. It fosters the perception and actuality in people that they are cared for Cacioppo & Cacioppo (2014) argued that people with long term experiences of traumatic events like sexual assault, child abuse and neglect and social isolation need social support else they will be more vulnerable to depression. It was highlighted by Garbarino (2017) that social environment is necessary for social participation and integration hat related to work, neighbourhood, school and others. The social interactions created by the environment built by people have strong implications and influence on health behaviour.
The same was evident from the video, the healing circle at Gnibi helped to develop strong community as it is vital to raise healthy children according to one of the primary health care project head. It was also mentioned in the video by one of the member of the Gnibi health team that, “Strong community is central to children well being and development” (Rural Health Education Foundation, 2008). The project focused on these two social determinants as the community members were. It was evident from the video, healing circle created social support for people of all age groups. Thus circle promoted socialisation through various activities to deal with emotional stress and helplessness. Social support network was promoted by giving care and support.
The project in the video was guided by the two primary health care principles which are-
Intersectoral collaboration directed the primary health care principle in Kalumburu village and was evident from the healing process focused through healing circle under Mango tree. It focused on the family education on healthy parenting style to improve relationship among the family members. Overall the interventions were targeted to community rebuilding by addressing the existing problems at grass root level using the community resources. Men and women along with experts can collaborate to discuss concerns with the effective management of daily life activities. Since, young adults, middle aged adults, grandparents, and teenagers are all included for health promotion, it provides medium to blurt out resentment and anger. Such collaboration seems to maximise the community people’s self reliance, participation and self control. According to Nielsen et al. (2015) such group activities promote social inclusion and collaboration. It will help better deal with the child maltreatment events; stimulate community responsiveness to various mental health risk factors.
Empowerment, health literacy was also the significant primary health care principle that directed the project. It was evident from the men support group as they were left out and lacked support given to the women and children. By help of the healing circle the people were educated about activities that may be healthy for child development. It includes dancing, playing, engagement in fishing and other activities. They were educated and empowered about the trauma recovery and affects of drug and alcohol. Health literacy is promoted by providing tailored information on healthy lifestyle. Community change was fostered by the including people of different age groups irrespective of their values, beliefs, race and ethnicity. The healing circle was believed to have positive influence on the future generations. This aligns with view of McMurray & Clendon, (2015) on community participation, which is to help people take ownership of health and wellbeing through education and awareness.
The National Health Priority Area that will be impacted on the result of the program is the “Mental health”. It is evident from the traumatic events in the community such as sexual assault, child abuse and neglect depicted in video. The prevalence of the mental health issue is evident from the high drug and alcohol consumption in the concerned community. Further, people were unable to cope up with depression and anger. Men were in need of support like women and children. The community people were challenged with healthy parenting style and safeguarding their children. They had feeling of insecurity and betrayal due to past experiences of abuse by Europeans that led to stolen generations. Social isolation, lack of health awareness, and education are the main factors of mental health problem in this community. The above mentioned mental health issues are risk factors for depression, poor coping mechanism and poor well being. Childhood trauma if not addressed at an early age, leads to chronic illness in adulthood and make children vulnerable to abuse and emotional neglect (Truong, Paradies & Priest, 2014).
This national health priority has a high potential to impact the health of children and adults in community both in present and in future. With the help of the healing circle, youth activities, people in community can have strong social support and build strong family relationships. They can have healthier children and adults in future. The families can function effectively by promoting safe and healthy environment. Stress and depression can be reduced by playful and mindful activities like dancing, painting, singing, and fishing. As per various qualitative and quantitative studies, activities like singing, significantly reduces the feeling of mental distress, depression and anxiety (Sun & Buys, 2016). Overall the health promotion program with the holistic approach promotes the social capital, and will impact at the relational and community levels.
Cultural competence refers to interacting with people across cultures through effective communication and understanding. In regards to health care provision it is the ability to meet the health needs of people while considering their cultural barriers, values, ethics, and health beliefs (Betancourt et al., 2016). Cultural safety refers to the promotion of safe environment for people where they will have no fear of harm or denial. It refers to understanding one’s own culture and relating with others to promote cultural safety (Baba, 2013).
These practices are important for development of this program to understand the cultural values, beliefs and the health behaviour of the people to develop targeted interventions. It will help assess the diverse experiences of people to develop strategies for social inclusion. Understanding the linguistic needs will aid in promoting health messages of health education accordingly. Cultural safety factors will help promote the sense of self among community members and sense of identity. Considering these cultural factors will help health experts to involve the community members in the health related decisions (Baba, 2013). The community building project of Gnbi focuses on information sharing, effective communication with adults and children, fostering relationships, education, and empowerment of men and women. According to Keehan (2013) these practices align with the traits of the culturally competent care. Further benefits of considering these factors include prevention of discrimination at any level or stereotyping. It will promote health equity by developing interventions that address the personal and health needs of people. Staff with skills on cultural competence and cultural safety can provide integrated care (World Health Organization, 2017). Montagu (2013) argued that the culture greatly influences the health and safety. Decisions made by people and their thinking can be related to the cultural belongings, food choices, perceptions, risk perceptions of illness, and physical activity. In planning health interventions culture cannot be omitted. The rationale being illness is considered to be grace of God by some Aboriginal people in Australia. Such believe may hinder the health promotion process. Therefore, it is vital to consider the cultural competence and cultural safety factors in health related programs.
The project looked at present culture, and developed strategies based on while simultaneously considering the past trauma. For instance the Gnbi project promotes kinship network among the Indigenous women and men through their preferred traditional methods like story-telling, group dancing and singing. The evidence of implementation of the cultural safety factors were evident from the formation of circle under the mango tree, with water indicating the information shared by the community will be maintained of confidentiality and privacy. It was necessary to maintain their respect and dignity, to build trust and faith, as people were having trust issues due to abuse and betrayal by Europeans. Active listening to people’s concerns promoted cultural safety. Further, activities used for health promotion such as painting also were a part of Indigenous traditions.
References
Baba, L. (2013). Cultural safety in First Nations, Inuit and Métis public health: Environmental scan of cultural competency and safety in education, training and health services. Prince George, British Columbia, Canada: National Collaborating Centre for Aboriginal Health. Retrieved from: https://cahr.uvic.ca/nearbc/media/docs/cahr5194682829965-cipher_report_en_web.pdf
Bath, J., & Wakerman, J. (2015). Impact of community participation in primary health care: what is the evidence?. Australian Journal of Primary Health, 21(1), 2-8, Doi: 10.1071/PY12164.
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports. Doi: https://doi.org/10.1093/phr/118.4.293
Cacioppo, J. T., & Cacioppo, S. (2014). Social relationships and health: The toxic effects of perceived social isolation. Social and personality psychology compass, 8(2), 58-72.
Garbarino, J. (2017). Children and Families in the Social Environment: Modern Applications of Social Work. Routledge. Retrived from: https://www.taylorfrancis.com/books/9781351528979
Keehan, C. (2013). Culturally competent care. Journal of Healthcare Management, 58(4), 250-252.
McMurray, A., & Clendon, J. (2015). Community Health and Wellness-E-book: Primary Health Care in Practice. Elsevier Health Sciences. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=C4-bBgAAQBAJ&oi=fnd&pg=PP1&dq=models+of+Social+Determinants+of+Health+and+Principles+of+Primary+Health+Care+from+Chapter+1,+McMurray+and+Clendon+(2015).+&ots=Z695UQhrTk&sig=TOpOXozbYTmqtjGIxNc9CQARou0&redir_esc=y#v=onepage&q&f=false
Montagu, A. (2013). Coming into being among the Australian Aborigines: The procreative beliefs of the Australian Aborigines. Routledge.
Navarro, V. (2009) . What we mean by social determinants of health. International Journal of Health Services, 39(3), 423-441.
Nielsen, L., Meilstrup, C., Nelausen, M. K., Koushede, V., & Holstein, B. E. (2015). Promotion of social and emotional competence: Experiences from a mental health intervention applying a whole school approach. Health Education, 115(3/4), 339-356. DOI: https://doi.org/10.1108/HE-03-2014-0039
Rural Health Education Foundation (Producer). (2008). It takes a village [Online video]. Retrieved from: https://www.youtube.com/watch?v=XcXGuq_k2K8
Sun, J., & Buys, N. (2016). Effects of community singing program on mental health outcomes of Australian Aboriginal and Torres Strait Islander people: a meditative approach. American Journal of Health Promotion, 30(4), 259-263. Doi: https://doi.org/10.1177/0890117116639573
Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC health services research, 14(1), 99, doi: 10.1186/1472-6963-14-99
World Health Organization(2017).Chapter7:Health Systems: principled integrated care.Accessed from https://www.who.int/whr/2003/chapter7/en/index1.h
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