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APPENDIX 4. Ethnographic Field StudyEthnographic field study of people’s perceptions of health, healthservices and chronic disease. Northern Territory.Kate Senior and Richard ChenhallMenzies School of Health ResearchIntroductionThe move from an acute care model of health service delivery to one that focuses on chronicdisease involves major cultural changes in the beliefs and practices of health centre staff and alsothe expectations and behaviours of the people accessing health services.This paper is designed to examine Indigenous client‟s perception and experiences regardinghealth care in general and chronic disease in particular. It draws on material from twocommunities in Arnhem Land as case studies for the implementation of the chronic diseasestrategy.This document was prepared for the NTDHCS review of the NT Chronic Disease strategy. Itdocuments the results of a pilot study of two communities undertaken with the aim of assessinghow the changes brought about by the chronic disease strategy are experienced by the clients ofthe strategy. This paper was funded by part of a grant for the development of an evaluationframework for the Chronic Disease Strategy and is intended to inform part of this development.Because the paper is intended as part of audit of the Chronic Disease strategy, and as a pilot todevelop future research questions, it has not gone through the ethics review process that is usualfor academic research. It is therefore not for publication, but is an internal document of theDHCS.Chronic disease and the importance of individual responsibilityA key concept which underpins the chronic disease strategy is the idea of individualresponsibility. Individuals must be informed about their disease or their disease risk and beactively involved in prevention, or if already diagnosed, management of their condition.“ medical care then must assure that persons with chronic disease have the confidenceand skills to manage their condition; the most appropriate treatments to assure optimaldisease control and prevention of complication; a mutually understood care plan; andcareful, continuous follow-up” (112) .Appendix 4: Ethnographic Field Study – Evaluation of the NT Preventable Chronic Disease Strategy 2007 118
An important background to this study is Senior‟s (2001, 2003) research in the Ngukurrcommunity which explores people‟s understandings of health and illness, their interactions withthe health centre and barriers to taking responsibility for their own health. (113, 114) She described acomplex interaction of factors which effectively prevented people from engaging in a positivehealth promoting way with their health services. These included people‟s understanding of thehealth centre as a place of sickness, rather than a place that a person would visit to enhancetheir health or prevent disease. Because people were reluctant to attend the clinic, except in thecase of a medical emergency, their perception was that it was a place of sickness and death:People don‟t want to know about sickness inside, if they find problems they‟ll go andchop you up and then you‟ll have sickness. As soon as you touch hospital you getsickness. Medicine that they give us, it kills us that‟s why we stay away from the clinic. Ifsomeone told me that my brother or sister has cancer then the whole family would besick with worry (113)People‟s beliefs about the causation of illness also affected the way that they interacted with thehealth centre and their perceived capacity to make changes to their lives that would improvetheir health and prevent the onset of illness. Sorcery is considered to be an important cause ofsickness and death in the community. Although sorcery is often used as a punishment for socialor ritual wrong doing, people also state that it can be used maliciously (motivated by jealousy orgreed) and that it can also be accidental (it may miss its mark, or it may be inflicted bymalevolent non human agents).A belief in sorcery, and its often accidental or arbitrary nature, means it is very difficult to arguethat changes in behaviour (i.e., giving up smoking) will have positive health benefits. A sense ofvulnerability and fatalism means that it may be preferential to retain habits that improve qualityof life in the short term, rather than make difficult changes which may in the end be ineffectual.The history of the community and especially the legacy of the Mission also influenced people‟sunderstanding of health and capacity to take responsibility for health. The missionaries enforcedgood health, but they did so by actively intervening in people‟s lives (i.e. ensuring the hygiene ofhouses, monitoring the care of babies, providing meals through a refectory). The response to thishas taken two paths. The first is of resistance, people actively oppose what they see as thevalues associated with non-Aboriginal life in general and the Mission in particular.For example one elderly woman who grew up during the Mission Era commented that her dailywork involved:Cleaning and scrubbing floors on my hands and knees, cleaning the louvers –Appendix 4: Ethnographic Field Study – Evaluation of the NT Preventable Chronic Disease Strategy 2007 119
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Pty LtdABN 82 147 637 101AN EVALUAT
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TABLE OF CONTENTSList of figuresLis
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6.6 Indigenous workforce 996.7 Prev
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List of AbbreviationsABCDACCHOsACIC
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ACKNOWLEDGEMENTSWe would like to ac
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However the extraordinary number of
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the establishment of the Sunrise He
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RECOMMENDATIONSGeneral recommendati
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Exploration of joint funding arrang
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CHAPTER 1. INTRODUCTION1.1 Backgrou
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Choosing the 5 chronic conditionsTh
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Table 1.1Key Result Areas + Best Bu
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prior to the launch of NTPCDS, such
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Year * Action Outcome1999 S NT Prev
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Year * Action Outcome2005 P Aborigi
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CHAPTER 2.EVALUATION METHODOLOGYThe
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2.2 Evaluation StagesThe NTPCDS eva
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chronic disease activities funded t
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internal project team. It was very
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Situation at Baseline1. The Guideli
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3.1.2 Patient information and recal
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Ferret Miwatj, Numbulwar, Marngarr,
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Medicare information is not for pub
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was in place in Central Australia i
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What orientation and ongoing traini
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programs focus on chronic disease p
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The information collected as part o
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Assessment against objectiveMost se
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career development, and retention i
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are. Indigenous employment is NTDH&
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NTDH&CS Programs that encourage Hea
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2002 Aboriginal and Torres Strait I
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delivering any prevention and healt
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The Community Services Division - A
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1 x AHW Central Australia 2001 S100
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One clinic stated it had no care pl
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Identifies priority practices to in
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There has been a significant growth
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about 25 per cent of the hospital b
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The level of funding provided by th
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Central Australia and two zones cur
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The diabetes education teams at HLN
Page 85 and 86: maintenance group for people with l
Page 87 and 88: Rebates for participating or arrang
Page 89 and 90: Use of Medicine Programmes. Althoug
Page 91 and 92: CHAPTER 4. CLINICAL OUTCOMES OF THE
Page 93 and 94: improvements have been made to serv
Page 95 and 96: A recent ten-year follow-up of a co
Page 97 and 98: The NTDH&CS also collect birthweigh
Page 99 and 100: Figure 5.3 Vaccination coverage for
Page 101 and 102: It is also important to note that k
Page 103 and 104: eported that 50 per cent of the Ind
Page 105 and 106: The current action plan identifies
Page 107 and 108: The availability and cost of health
Page 109 and 110: Hoy et al in 1995-2000 (100) , and
Page 111 and 112: 5.6 Best practice management5.6.1 P
Page 113 and 114: disease care in urban areas regardi
Page 115 and 116: PCIS was developed by NTDH&CS as th
Page 117 and 118: emote staff can access training and
Page 119 and 120: In the Top End there appeared to be
Page 121 and 122: APPENDIX 1EVALUATION OF THE NT PREV
Page 123 and 124: 2.10 Generally speaking, on a scale
Page 125 and 126: 4.4 Briefly recount any anecdotes y
Page 127 and 128: 5.9 Generally speaking, on a scale
Page 129 and 130: Section 8 • Summary questions8.1
Page 131 and 132: Preventable Chronic Disease Program
Page 133 and 134: Year Type Background What is it? /
Page 135: Year Type Background What is it? /
Page 139 and 140: New beliefs do not replace the old,
Page 141 and 142: Other services are provided to the
Page 143 and 144: ecame the main priority in many peo
Page 145 and 146: to be healthy, how to get rid of di
Page 147 and 148: (Draft Version - © August 2006 Jan
Page 149 and 150: References1. Dunham, H., Ministeria
Page 151 and 152: 35. Smith, J.D., Progress report fo
Page 153 and 154: Research Centre for Aboriginal Heal
Page 155: 114. Senior, K., 'A Gudbala Laif? h
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