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Discussion 2: with Dr. Ellis and Dr. Ishigaki
Moderator
We would like to enter into the discussion and question-and-answer session. Any person asking a question, please raise your hand and mention your name and your organization.
Audience 1
I’m a freshman. My name is Yamada. I come from the Prefectural College of Nursing here in Okinawa. I have a question for Dr. Isabelle Ellis. You mentioned medical practices, nursing practices for aborigines. In Okinawa or in Japan, we have people of certain religious background, and we have to take consideration to people like that with different needs. When you provide nursing practices to aborigine people, are there special considerations, any special examples that you might be able to offer?
Dr. Isabelle Ellis
In different parts of Australia, aboriginal people have many different cultural practices, and in the place in Australia where I worked in the Northwest, some of the cultural practices around death are very specific. So, when a person is dying, many of their family members will come be part of the process of dying and to see the person into the next life, as they believe. The nursing role in this is actually to also respect the cultural practices. Aboriginal people will collect the hair of the dying person and they will keep that hair and make it into a special belt that is worn for special ceremonial purposes. So, when they have a law practice, which means that they’re passing on their traditions, they wear the hair of many of their ancestors when they are doing the dancing. So, as a nurse, in the final stage of someone's life, you have to assist with collecting the hair. This is easy if the patient is in a remote area and they are dying close to home. But of course, many people go far away when they’re very sick, to tertiary hospital. The remote area nurses’ job is to explain to the nurses in ICU and in other places far away about the importance of collecting the hair and then sending it back to the family so that this cultural practice can happen. Now, some hair-belts are many, many hundreds of years old. They’re very thick and they have the hair of the ancestors, many, many generations of ancestors and people would be very very upset if this was not carried out, which are unique to aboriginal people. In each area in Australia, the nurses’ job is to work closely with the community to understand what are the significant practices.
Moderator
Thank you very much. Next question?
Audience 2
Thank you very much for your wonderful presentation. I have a question for Dr. Isabelle Ellis. You live in a big country; tell me about the delivery of babies, where do they deliver babies; do the physicians assist delivery? Another question is on prenatal care; do they come down with depression? If so, why do they become depressed?
Dr. Isabelle Ellis
Thank you. This is a double-barreled question. Do you understand “double-barrel?” Two-in-one, okay? Yesterday, we talked about double whammy and today we are talking about double-barrel. So, I am a midwife as well as a remote area nurse, and we are having a big change in policy in Australia as we speak. It’s happening on the 1st of November where midwives will be able to practice more independently in Australia than they have before. We have a changing situation. But up till now, midwives are responsible for birthing for women, and only if the woman is experiencing a problem or a difficulty with the birth, would we call in a doctor. Normally, for most women, two midwives usually will assist the mother and that’s all. Maybe the father will be present or the woman's mother or aunty will be present.
We have a policy in Australia that women in very remote area do not have their babies in their community, because many of the communities do not have midwife resident in that community and we don’t have anyone to assist with the resuscitation of the baby, if needed. So, women are transferred to the regional hospital for birthing. This is a concern for a lot of women and it’s also concern for midwives, and we are trying to get women to have better services closer to home. So, that’s the first question. Can you repeat the second question?
Audience 2
When they were pregnant – maybe right after the delivery, do they become depressed? If they become depressed, tell me the reasons why they become depressed or what kind of advice or suggestions would you provide for the depressed mothers?
Dr. Isabelle Ellis
Okay. So, this was a very interesting question. Postnatal depression, as you know, is a universal phenomenon. Women around the world experience postnatal depression. It is experienced by women all cultures and we think there is on average about 10% of women who experience postnatal depression. Many aboriginal women experienced depression just like Japanese or Caucasian women. But there is another reason that people also have depression and that is because they've been away from their family for a long time. And so, they may have been in town if they have gestational diabetes, for example. They may have been far away from their family for many weeks before they have their baby and away from their children. So, they get quite depressed about that.
There is a cultural practice for most aboriginal women that older women will make a fire of a particular bush, a conkerberry bush, and smoke the mother to help with bringing the milk and also to help with the after-pains. This is a very important cultural activity. And if the woman has gone far away from her cultural group, say if she was quite unwell and had to go many thousands of kilometers to the urban center, she will not have access to other women who can provide that service for her, and so she may feel that she is not able to breastfeed properly or that her pain is worse than it would normally be, and so they get depressed and sometimes have a great deal of difficulty establishing breastfeeding because they feel that they haven’t experienced the right rituals.
Moderator
Thank you very much. Is there any other questions?
Audience 3
I have questions for both of you and also another question for Elizabeth, Dr. Ellis. I heard that you need to educate the local people when you work with them on the site. In Japan, we have a trainee system for medical doctors, but a system to train all staff members is not there as far as I know, at least I don’t know. How were you able to come down with that kind of system? Is there any factor that you have the system to train all the staff members? I believe that you had to follow certain steps or certain procedures. So, that’s my question for you, and another question for two of you.
In Japan as well as in Australia, in urban areas, we have students and also nursing practitioners who may not be willing to go to remote areas to practice nursing. So, how do you encourage people to work in remote areas? Dr. Ishigaki mentioned about the fundamental education or totality, which is the key. We have graduate school and also we have practical training on practices. How do you connect all this to different areas of education and also practice in nursing, so that they would be willing to go to remote areas as well?
Dr. Isabelle Ellis
Another double-barreled question, I’ll answer the first one first. We had a very big need in Australia. At first, the only people working permanently in remote areas were nurses, and then the nurses were joined by aboriginal health workers, and then eventually the doctors came and the allied health workers came. But what you find is when the doctors come, they want to take over and they deskill the people who are there. They don’t recognize their skill level or their scope of practice. And so, after a couple of communities were experiencing this, we’ll all work together, the medical association and the nursing association, to try and work a system where we could provide training that would be appropriate for medical practitioners, and nurses, and aboriginal health workers so they could learn in a team environment and the doctors then realized actually they had been deskilling the nurses when there was an emergency by taking over, and the nurses realized they had been deskilling the aboriginal health workers by taking over. This process then allowed people to actually open their eyes to each other’s scope of practice. In answer to the second question, I'll hand over to my colleague to speak first.
Dr. Kazuko Ishigaki
Thank you for the question. It is I guess very difficult to give you precise answers. However, today I think that Okinawa Prefecture is the best place because they have chances to receive practical trainings, but if you go to other regions in Japan, for example, it’s not easy to find an island to take some island nursing training. But, here in Okinawa it is available. However, I want them to feel that it is fun to work on islands as well as rewarding and I want them to experience island nursing when they are students before they graduate.
Dr. Isabelle Ellis
In Australia, we have some very specific strategies to encourage people to go and work in remote areas. We have the annual CRANAplus Conference every year and we give scholarships for undergraduate students to attend the conference, so they get an opportunity to meet remote area nurses and hear about remote area nursing practice. We also offer scholarships for students – undergraduate students – to go and do a placement, a community placement, in a remote area and that covers their airfare and stipend for accommodation, if they need that. Those are a couple of areas that we work on.
The other thing that we try and do is we have a student clubs in the universities. Students who are interested in rural nursing or remote area nursing will join the club, and we will do presentations and we will have some fun activities and we do additional skill development for those students, so they might learn plastering or suturing, and they may have be offered the opportunity to do the REC course. It’s really when people are students and they are concentrating on their studies and thinking about their future, that’s when we put our effort into encouraging them to go and think about remote area nursing as a career.
Moderator
I think our time is running out. So, with this I would like to wrap up this session – the third session of this symposium. Thank you all for coming.