On my rural prac, I worked in the paediatrics unit and the biggest group of patients we treat are of the indigenous community. It is an ongoing challenge to be treating this group of people as their beliefs, mentality and upbringing are so different from what I am use to. One of our clients was a 15y/o CP child and needed a physio review. I managed to get her mother on the phone after leaving about six messages. She then promised to come for several appointments but never did turn up and so I left it at there.
Last week the child was admitted to emergency for chest infection due to aspiration and had a seizure episode. Once the child was medically stable, I took the opportunity to assess the child and spoke to one of the speech therapist about the childs feeding issues. After assessment, the biggest problem identified was muscle contracture in her lower limb muscles. I was certain that this child is going to need some form of intervention that can range from serial casting, botox or even surgery for tendon release. Whatever the management ends up being, this child is going to need ongoing therapy which is not possible with non-compliant parents. Each time the mother saw me in the ward she would ask me when they can take her home. I was so frustrated that the mother appeared unconcern about the daughter being ill. I tried asking her how is she managing at home and she would just say “yeah, we’re managing awrite”. I asked my supervisor for guidance on how to convince this lady that her daughter is going to need ongoing therapy and that she must be able to attend the appointments. My supervisor just said to do my best but if I can’t just let it go because there is only so much we can do.
I then decided to have a chat with the aboriginal liaison officer and ask for some advice. He suggested contacting a family member that would be able to help out eg: aunty. The paediatrician had decided that the child is going to need a tendon release surgery. With the mother’s permission, I tried getting in touch with the aunty and explained the situation with the child. She agreed to bring the child for physio appointments and help with the rehab. She sounds genuinely convincing. Just to share something that I found interesting in their culture, the mother is just there to give love to the child but the aunty is also the mother of the child that is responsible for the upbringing and there to discipline the child. Therefore, by trying to get the aunty involved I hope to enhance the chances of this child receiving the rehab she is going to need post tendon release.
From my experience in this case, I have learnt that knowing and understanding one’s culture will definitely have an impact of how we are going to tailor our treatment to create better compliance. In the future I will endeavor to understand a culture that is different to mine with the hope of achieving a better treatment outcome.
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I similiarly had many encounters with indigenous australians on rural prac this year. The patients I was seeing were compliant and willing to attend physio, but the most fustrating thing was my patients' disregard for time, and 330pm on a friday could mean lunch time or even 430pm. This is again normal once I gained an appreciation for indigenous culture.
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