tag:theconversation.com,2011:/us/topics/where-culture-meets-health-70226/articlesWhere culture meets health – The Conversation2019-06-13T02:10:16Ztag:theconversation.com,2011:article/1149172019-06-13T02:10:16Z2019-06-13T02:10:16ZOur culture affects the way we look after ourselves. It should shape the health care we receive, too<figure><img src="https://images.theconversation.com/files/277343/original/file-20190531-69055-yf9kqq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australia is a multicultural society, and our health services need to be designed accordingly.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p><em>This article is the final part in a series, <a href="https://theconversation.com/au/topics/where-culture-meets-health-70226">Where culture meets health</a>.</em></p>
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<p>For South Asians, there’s a distinct difference between “rice with curry” and “curry with rice”. When we spoke to <a href="https://www.sciencedirect.com/science/article/pii/S019566631730716X?via%3Dihub">Indian and Sri Lankan migrants</a> with type 2 diabetes and heart disease, they told us the advice they received on ways to reduce the quantity of staples like rice in their diet was difficult to implement. </p>
<p>This was because it doesn’t match with their perception of a “proper” meal – that is, a lot of rice and a little bit of curry. Receiving dietary advice not tailored to their cultural needs created a feeling that clinicians didn’t understand the social value they placed on traditional foods. </p>
<p>This acted as a barrier to effectively managing their diets, and in turn, their conditions.</p>
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Read more:
<a href="https://theconversation.com/australias-ethnic-face-is-changing-and-so-are-our-blood-types-113454">Australia’s ethnic face is changing, and so are our blood types</a>
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<p>While <a href="https://www.abs.gov.au/ausstats/abs@.nsf/lookup/Media%20Release3">Australia’s multiculturalism</a> enhances the fabric of society, the health outcomes of some of Australia’s culturally and linguistically diverse groups <a href="https://www.sciencedirect.com/science/article/pii/S019566631730716X?via%3Dihub">are poor in comparison</a> to the majority population. We looked at type 2 diabetes and heart disease partly because these conditions are experienced more commonly in migrant groups.</p>
<p>Importantly, people from culturally and linguistically diverse backgrounds tend to have <a href="https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features20June+2009">lower levels of health literacy</a> than people born in Australia. People with lower health literacy are <a href="https://journals.sagepub.com/doi/full/10.1177/0017896918792700">less likely to access health care</a>, and more likely to mismanage chronic health conditions (for example, by misinterpreting medical advice or medicine dosage instructions, or having a limited sense of severity of disease).</p>
<p>It’s imperative to consider cultural and language differences if we want to achieve the best health outcomes for our diverse population.</p>
<h2>Language is just the start</h2>
<p>Providing interpreting services in the patient’s language is important, but not the only consideration. Even when someone is well-versed in English, medical terminology or jargon can be hard to comprehend. </p>
<p>In addition, conceptualisations of health and illness and ways of expressing these vary across cultural and language groups.</p>
<p>For example, a common expression for psychosomatic symptoms (where there may be no disease, but physical symptoms such as nausea may be related to mental stress) in either Hindi or Punjabi, is <em>dil</em> (heart) <em>doob</em> (sinking) <em>raha hai</em> (is).</p>
<p>This <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80253/">implies generalised illness</a>, but its direct English translation would be “a sinking heart”. </p>
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Read more:
<a href="https://theconversation.com/nearly-1-in-4-of-us-arent-native-english-speakers-in-a-health-care-setting-interpreters-are-essential-115125">Nearly 1 in 4 of us aren't native English speakers. In a health-care setting, interpreters are essential</a>
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<p>Another example is the <a href="https://theconversation.com/when-treating-sports-injuries-does-the-west-do-it-best-90526">use of ice</a> on an acute injury. This is often seen as going against traditional Chinese medicine principles, upsetting the balance between Yin and Yang energies.</p>
<p>So the focus needs to go beyond language and include broader cultural considerations. For health professionals, this can be achieved by establishing trust with the patient and their family. It means being attuned, respectful and responsive to cultural differences in understandings of disease.</p>
<h2>Can someone really be trained to be ‘culturally competent’?</h2>
<p>Cultural competency is the ability to work effectively with culturally and linguistically diverse populations.</p>
<p>Many professionals – not only health professionals – should now be aware of the term, with the recent proliferation of <a href="https://www.sbs.com.au/learn/cultural-competence-program">cultural competency training packages</a>. These programs are designed to train staff to become more culturally competent by providing information about various cultures.</p>
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<img alt="" src="https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People from different cultural backgrounds have different understandings of health and illness.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>While these training packages are a good source of information, whether completing the package is enough to deem a person “culturally competent” is questionable. </p>
<p>Many such packages are delivered within a short time frame, leaving little scope for individual learners to reflect on their practices and develop practical strategies around how they can be more culturally responsive. </p>
<p>And these packages <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-99">rarely include any follow-up assessments</a> or evaluation to ascertain if their completion actually promotes more culturally responsive clinical practice.</p>
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<p>While mandating training is an efficient way to <a href="https://www.sciencedirect.com/science/article/pii/S147159530900047X?via%3Dihub">ensure practice improvement</a> and meet accreditation requirements, it can <a href="https://www.magonlinelibrary.com/doi/abs/10.12968/bjhc.2011.17.11.522">turn people away</a> from being engaged with the learning.</p>
<p>Instead of mandating training, the focus should be on facilitating staff engagement with diverse groups. This might include celebrating cultural diversity by perhaps holding a diversity day in the workplace, where people are encouraged to showcase their cultures through performances, food and traditional outfits. </p>
<p>People need to develop an interest in engaging with culturally and linguistically diverse groups before being motivated to complete training.</p>
<h2>Partnership and participation</h2>
<p>Apart from equipping staff with knowledge and skills, we need to create a safe and respectful environment where people from culturally and linguistically diverse communities feel empowered to voice their opinions.</p>
<p>Strong partnerships between government, organisations and communities should see a gradual improvement in the engagement of people from culturally and linguistically diverse communities in health-care activities.</p>
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Read more:
<a href="https://theconversation.com/aboriginal-australians-want-care-after-brain-injury-but-it-must-consider-their-cultural-needs-115128">Aboriginal Australians want care after brain injury. But it must consider their cultural needs</a>
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<p>While cultural competency implies a skill that can be perfected, <a href="http://iaha.com.au/wp-content/uploads/2015/08/2015-IAHA-Cultural-Responsiveness-Framework-WEB.pdf">cultural responsiveness</a> suggests provision of culturally appropriate care is an ongoing process involving self reflection and lifelong learning. </p>
<p>So rather than striving to be culturally competent, it may be more realistic to work towards the provision of culturally responsive health services.</p><img src="https://counter.theconversation.com/content/114917/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>By working together with culturally and linguistically diverse groups, health services can position themselves to deliver culturally responsive care to our multicultural population.Sabrina Gupta, Associate lecturer, School of Psychology and Public Health, La Trobe UniversityClarice Tang, Senior lecturer in Physiotherapy, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1149802019-05-30T19:50:13Z2019-05-30T19:50:13ZTraditional medicines must be integrated into health care for culturally diverse groups<figure><img src="https://images.theconversation.com/files/276758/original/file-20190528-42588-uc0t6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Traditional Chinese herbal remedies are today used in many countries.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p><em>This article is the fifth part in a series, <a href="https://theconversation.com/au/topics/where-culture-meets-health-70226">Where culture meets health</a>.</em></p>
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<p>Many people seek <a href="https://www.racgp.org.au/afp/2017/may/patterns-of-complementary-and-alternative-medicine-use-and-health-literacy-in-general-practice-patients-in-urban-and-regional-australia/">complementary treatments</a> for various ailments. Perhaps herbal remedies to cure a cold, or acupuncture to ease lower back pain. </p>
<p>“Complementary medicine” refers to practices outside Western medicine, adopted from other cultures, and often used in high-income countries.</p>
<p>But “traditional medicine” covers a range of practices and therapies indigenous to their practising population. Based on historical and cultural foundations, it operates outside of mainstream health care. </p>
<p>So for example, traditional Chinese medicine is indigenous to the Chinese and is therefore classified as a traditional medicine. But when it’s used by non-Chinese ethnicities, we’d call it a complementary medicine.</p>
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Read more:
<a href="https://theconversation.com/nearly-1-in-4-of-us-arent-native-english-speakers-in-a-health-care-setting-interpreters-are-essential-115125">Nearly 1 in 4 of us aren't native English speakers. In a health-care setting, interpreters are essential</a>
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<p>While many people use complementary medicines, traditional medicines form a particularly important influence on the way migrants look after their health.</p>
<p>This can present a challenge in the delivery of Western medical care to diverse communities in their destination countries.</p>
<p>But even where there’s little consensus around their efficacy, as we strive to achieve better health outcomes for culturally and linguistically diverse people, we must recognise traditional and complementary medicines as an essential component of their health care.</p>
<h2>A holistic approach</h2>
<p>Traditional and complementary medicines <a href="https://link.springer.com/article/10.1007%2Fs10903-018-0832-4">used among culturally and linguistically diverse populations</a> include herbal medicine, acupuncture, massage, traditional Chinese medicine, yoga, ayurveda, homeopathy, and tai chi. Different modalities are favoured in different communities.</p>
<p>Ayurveda is more than 5,000 years old and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ayurveda">native to India</a>. It combines lifestyle, diet, exercise and predominantly plant products as treatment options. Translating to “life science”, it aims to cleanse a person of disease-causing substances and restore balance in the body. </p>
<p>Ayurvedic practitioners believe this approach is effective in managing a number of acute and chronic conditions including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718571/">diabetes</a>, <a href="http://www.plantsjournal.com/archives/2017/vol5issue1/PartA/4-6-26-508.pdf">cancer</a>, <a href="http://www.ayurvedjournal.com/JAHM_201843_03.pdf">anxiety</a> and <a href="https://www.researchgate.net/profile/Rajkala_Patil/publication/319037230_Management_of_Rheumatoid_Arthritis_through_Ayurveda/links/598c2890a6fdcc58acb737ec/Management-of-Rheumatoid-Arthritis-through-Ayurveda.pdf">rheumatoid arthritis</a>.</p>
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Read more:
<a href="https://theconversation.com/does-traditional-chinese-medicine-have-a-place-in-the-health-system-6166">Does traditional Chinese medicine have a place in the health system?</a>
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<p>While some studies point to its efficacy – one found ayurvedic formulations <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Ayurvedic+medicine+offers+a+good+alternative+to+glucosamine">were comparable to conventional medicines</a> such as glucosamine to treat knee osteoarthritis – varied results and limited study designs make it difficult to draw firm conclusions.</p>
<p>Meanwhile, traditional Chinese medicine has evolved since it was first used more than 2,000 years ago. But it remains grounded in its aim to treat the whole body, rather than targeting the problem alone.</p>
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<img alt="" src="https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Traditional remedies often accompany migrants to their destination countries.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>Encompassing practices including tai chi, acupuncture, and a variety of herbal remedies, Chinese medicine is today used to prevent and treat many conditions.</p>
<p>Patients with <a href="https://www.ncbi.nlm.nih.gov/pubmed/19877092">knee osteoarthritis</a> who practised tai chi recorded significant improvements, while there have been positive results for acupuncture in relieving <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/413107">lower back pain</a> and nausea associated with chemotherapy. </p>
<p>Traditional Chinese medicine has also been used for the prevention of <a href="http://www.onlinejacc.org/content/69/24/2952?_ga=2.21281211.1216051978.1500588607-1243537711.1500588607&sso=1&sso_redirect_count=2&access_token=">heart disease and stroke</a>, and to improve quality of life for people with <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/227164">chronic heart failure</a>.</p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/28619197">recent review</a> found certain Chinese medicines may control some risk factors for heart disease, like diabetes and high blood pressure. But several studies were limited by small sample sizes and flawed research designs.</p>
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Read more:
<a href="https://theconversation.com/do-you-know-whats-in-the-herbal-medicine-youre-taking-72726">Do you know what's in the herbal medicine you're taking?</a>
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<p>Herbal remedies from Chinese medicine and beyond are employed to treat a range of conditions. St John’s wort has been used <a href="https://www.ncbi.nlm.nih.gov/pubmed/18843608">to treat mild depression</a>, Ginkgo Biloba for memory loss, and ginseng for musculoskeletal conditions. </p>
<p>Despite <a href="https://www.ncbi.nlm.nih.gov/pubmed/18843608">some promising results</a>, a substantial gap still exists between the strength of evidence supporting many of these practices and consumers’ use and acceptance of traditional and complementary medicines.</p>
<h2>If the evidence is limited, why should we pay attention?</h2>
<p>Some migrant communities experience poorer health than their host populations. For example, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-252">the rates of type 2 diabetes</a> are higher among migrants than in the wider Australian population.</p>
<p>It’s important to recognise that for minority groups, feeling as though a doctor doesn’t understand their cultural needs can be a barrier to help-seeking.</p>
<p>For instance, if a person doesn’t believe their doctor will approve of their use of traditional medicines, they may not disclose it. We know <a href="https://link.springer.com/article/10.1007%2Fs10903-018-0832-4">non-disclosure</a> of traditional and complementary medicine use is common among culturally diverse groups.</p>
<p>This can be dangerous, as some traditional and complementary medicines can <a href="https://europepmc.org/abstract/med/28762712">negatively interact</a> with other drugs.</p>
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Read more:
<a href="https://theconversation.com/going-to-the-naturopath-or-a-yoga-class-your-private-health-wont-cover-it-110699">Going to the naturopath or a yoga class? Your private health won't cover it</a>
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<p>Where patients feel their practitioners are non-judgemental or even accepting of their traditional medicine use, they are <a href="https://www.ncbi.nlm.nih.gov/pubmed/19273869?dopt=Abstract">more likely to disclose it</a>.</p>
<p>So medical providers may benefit from education around different types of traditional and complementary medicines, including culturally sensitive methods to enquire about their use.</p>
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<img alt="" src="https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Acupuncture, a popular complementary therapy, has its roots in Chinese medicine.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<h2>What does Australia need to do?</h2>
<p>The most mature integrative health care systems are evident in Asia. Countries like South Korea and India <a href="https://www.bmj.com/content/322/7279/164.extract">have regulated</a> traditional and complementary medicines into their national health policies.</p>
<p>To effectively tackle health inequities, our health systems need to consider and address the impact of cultural influences on patients’ health-care decisions. This is vital even when the treatments they value may not be grounded in evidence.</p>
<p>Investigating and considering these practices will ultimately help us to design and facilitate safe, effective, culturally sensitive and coordinated care for all patients and communities across Australia.</p>
<p><em>Professor Jon Adams contributed to this article.</em></p><img src="https://counter.theconversation.com/content/114980/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Josephine Agu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From herbal remedies to acupuncture, traditional therapies are valued particularly by ethnically diverse groups.Josephine Agu, PhD candidate, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1151282019-05-22T19:47:53Z2019-05-22T19:47:53ZAboriginal Australians want care after brain injury. But it must consider their cultural needs<figure><img src="https://images.theconversation.com/files/275068/original/file-20190517-69189-ps8p2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australia's first Aboriginal Brain Injury Coordinator, Rebecca Clinch, with brain injury survivor Justin Kickett.</span> <span class="attribution"><span class="source">Edith Cowan University</span>, <span class="license">Author provided</span></span></figcaption></figure><p><em>This article is the fourth part in a series, <a href="https://theconversation.com/au/topics/where-culture-meets-health-70226">Where culture meets health</a>.</em></p>
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<p>Aboriginal Australians continue to face serious health challenges. Life expectancy is about <a href="https://www.aihw.gov.au/getmedia/bbe476f3-a630-4a73-b79f-712aba55d643/aihw-ihw">10.7 years less</a> for Indigenous Australians than non-Indigenous Australians.</p>
<p>Brain injury occurs up to <a href="https://www.ncbi.nlm.nih.gov/pubmed/21493909">three times more often</a> in Aboriginal Australians than their non-Aboriginal counterparts. It also commonly occurs at a younger age, and is more likely among Aboriginal people living in <a href="https://journals.lww.com/headtraumarehab/fulltext/2018/11000/Missing_Voices___Profile,_Extent,_and_12_Month.7.aspx?casa_token=cAlzJJUcucoAAAAA:5Av23TAwiv2BjIQ6XiyOG31EuFzk3hu5NvW-aBUwLdt71Nb9X2g4SCdME3VZYfTes6gWqcqn1tr_UU3_OJDAZPg3BQ">rural and remote areas</a>.</p>
<p>Despite their greater need, Aboriginal people access rehabilitation services at <a href="https://particle.scitech.org.au/people/revitalising-rehab-for-aboriginal-brain-injury/">a lower rate</a> than the general population. </p>
<p>Barriers to accessing health services <a href="http://www.biomedcentral.com/1472-6963/13/460">can be related</a> to communication breakdowns, distance from facilities, and previous negative experiences with services.</p>
<p>Aboriginal people who have suffered brain injury are even more vulnerable to these barriers.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-traumatic-brain-injury-75546">Explainer: what is traumatic brain injury?</a>
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<p>Our research tells us the absence of Aboriginal people in rehabilitation services has often led largely non-Aboriginal practitioners to assume they don’t want therapy.</p>
<p>But based on our interviews with <a href="https://www.tandfonline.com/doi/abs/10.3109/09638288.2014.972581?casa_token=awEocv7M8BEAAAAA:_0YcC4_3oYP1WOSm8ChHKN70ph8-BHfipsJEZUGExH2nXh2DJeRscjvXkij-BnhwHfddiXoGKYvOzQ">Aboriginal brain injury survivors</a> in Western Australia, we’ve found they want more information and education about brain injury, and more practical support along their rehabilitation journey.</p>
<h2>Culturally secure health care</h2>
<p>The effects of colonisation, social exclusion, poverty and racism <a href="https://search.informit.com.au/documentSummary;dn=546572336923501;res=IELIND">continue to impact</a> many of our First Nations peoples today.</p>
<p>This is compounded by health services that may not have the tools to consistently recognise and respond to the cultural needs of Aboriginal people. </p>
<p>Aboriginal understandings of health and wellness, and how these understandings differ from Western biomedical models, need to be better reflected in practice.</p>
<p>The Aboriginal construct of health is a holistic model that perceives physical, psychological, spiritual, cultural, social, environmental and economic factors as affecting a person’s functioning.</p>
<p>Cultural security directly links understandings and actions. So providing culturally secure health care means all these factors are taken into account. Importantly, patients can practise their cultural norms and their care <a href="https://search.informit.com.au/documentSummary;dn=955665869609324;res=IELFSC">will not be compromised</a> as a result.</p>
<p>For example, under certain circumstances, interactions may only be considered culturally secure when conducted between people of the same gender, language group, or when aligned with kinship rules. Hospital limitations on the number of family members visiting at one time may lead to feelings of exclusion and infringement on family rights.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/indigenous-health-programs-require-more-than-just-good-ideas-20104">Indigenous health programs require more than just good ideas</a>
</strong>
</em>
</p>
<hr>
<h2>Our research</h2>
<p>We spoke to Aboriginal people who had <a href="https://www.tandfonline.com/doi/abs/10.3109/09638288.2014.972581?casa_token=awEocv7M8BEAAAAA:_0YcC4_3oYP1WOSm8ChHKN70ph8-BHfipsJEZUGExH2nXh2DJeRscjvXkij-BnhwHfddiXoGKYvOzQ">experienced brain injury</a> as a result of a stroke, or a traumatic injury such as a car accident, assault, or fall.</p>
<p>Our participants spoke frequently about poor communication with non-Aboriginal hospital staff. Many felt staff did not understand or empathise with their situation and the centrality of family and culture in their lives. Some expressed feeling vulnerable, alone and diminished in the hospital environment.</p>
<p>Several people reported being unable to understand technical explanations they were given regarding stroke, its treatment and recovery. Many Aboriginal stroke patients and families felt they received very little practical information about services available to them once they left hospital.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/words-from-arnhem-land-aboriginal-health-messages-need-to-be-made-with-us-rather-than-for-us-100655">Words from Arnhem land: Aboriginal health messages need to be made with us rather than for us</a>
</strong>
</em>
</p>
<hr>
<p>We also interviewed non-Aboriginal health service providers. They reported not feeling confident working with Aboriginal patients and families. </p>
<p>Reasons for this included a lack of skills in positively engaging and communicating with Aboriginal people, a fear of offending, and recognition that their largely Western knowledge base may not be appropriate when delivering medical care to Aboriginal patients.</p>
<h2>We need Aboriginal service providers on the ground</h2>
<p>The first point of contact after a brain injury is critical in determining the person’s ongoing rehabilitation journey. If information and support are made accessible from the outset, and cultural security guaranteed, follow-up and two-way engagement <a href="https://www.ncbi.nlm.nih.gov/pubmed/22530862">will be more likely</a>.</p>
<p>In our studies, patients often talked about feeling more comfortable with another Aboriginal person. Someone who understands their personal context including family, culture and community is uniquely placed to assist with the person’s journey to recovery.</p>
<p>As a result of our findings, the National Health and Medical Research Council funded <a href="https://www.ecu.edu.au/schools/medical-and-health-sciences/our-research/communication-disorders-research-group/projects/brain-injury-in-aboriginal-populations/healing-right-way-enhancing-rehabilitation-services-for-aboriginal-australians-after-brain-injury">Healing Right Way</a>, a project across Western Australia to improve the journey after brain injury for Aboriginal people and their families.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/275070/original/file-20190517-69186-1o7cndc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/275070/original/file-20190517-69186-1o7cndc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/275070/original/file-20190517-69186-1o7cndc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/275070/original/file-20190517-69186-1o7cndc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/275070/original/file-20190517-69186-1o7cndc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/275070/original/file-20190517-69186-1o7cndc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/275070/original/file-20190517-69186-1o7cndc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Aboriginal Brain Injury Coordinators provide education around brain injury and support patients during rehabilitation and recovery.</span>
<span class="attribution"><span class="source">Edith Cowan University</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Healing Right Way will employ eight Aboriginal Brain Injury Coordinators to support Aboriginal people for the first six months following their injury. These are the first such positions in Australia.</p>
<p>Typically nurses, the coordinators meet the patient and their family in hospital immediately after injury. They provide education around brain injury and subsequent rehabilitation and recovery, as well as psychological support. </p>
<p>They also liaise with other services and care providers such as GPs, specialists, and Aboriginal Community Controlled Health Services. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/indigenous-health-leaders-helped-give-us-a-plan-to-close-the-gap-and-we-must-back-it-54480">Indigenous health leaders helped give us a plan to close the gap, and we must back it</a>
</strong>
</em>
</p>
<hr>
<p>Meanwhile, the project is providing training for hospital staff to enhance their skills and knowledge in delivering culturally secure care for Aboriginal people with brain injury.</p>
<h2>There are success stories</h2>
<p>Our research has revealed stories of “successfully” <a href="https://www.tandfonline.com/doi/abs/10.3109/17549507.2011.663790?casa_token=HYZ73LG3M7cAAAAA:FzG6ySsMd4b7egYofsJTiiIqWLjtNzIHoCrLugmz0mFoCiSGXIfasEVoALIMVtIzwj4FTV69lVSD6Q">living with brain injury</a>. </p>
<p>One man who suffered a severe stroke looked to family and community groups to support his recovery. He resumed painting, travelling, and socialising over time, despite being partially paralysed and having virtually no speech. This was enabled by a strong will and help from his sister who organised taxi vouchers, train trips and other supports.</p>
<p>These stories provide a rich basis from which to explore alternative possibilities in the rehabilitation process. Learning from Aboriginal brain injury survivors about how to re-engage with community and return to regular activities offers insights that can be shared with brain injury survivors in the future, and, importantly, with rehabilitation service providers.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-art-of-healing-five-medicinal-plants-used-by-aboriginal-australians-97249">The art of healing: five medicinal plants used by Aboriginal Australians</a>
</strong>
</em>
</p>
<hr>
<p>The issues raised for Aboriginal people with brain injury are mirrored in First Nations people with a range of other conditions. </p>
<p>While examples of individual clinicians attempting to provide culturally secure services were evident in our research, system-wide practices doing the same were rare. </p>
<p>To build a more culturally secure approach for Aboriginal patients recovering from brain injury, there needs to be acknowledgement of patient experiences alongside a system willing to implement change.</p>
<p>The involvement and leadership of Aboriginal researchers, health professionals and consumers is essential.</p><img src="https://counter.theconversation.com/content/115128/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Beth Armstrong receives funding from National Health and Medical Research Council, Western Australian Department of Health, Royal Perth Hospital Medical Research Foundation, Australian Institute for Aboriginal and Torres Strait Islander Studies. </span></em></p><p class="fine-print"><em><span>Juli Coffin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The absence of Indigenous Australians in rehabilitation services has created the belief they don’t want therapy. The reality is they want services which better meet their cultural needs.Beth Armstrong, Foundation Chair in Speech Pathology, Edith Cowan UniversityJuli Coffin, Ellison Professor of Aboriginal Research, Telethon Kids InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1151252019-05-12T20:13:37Z2019-05-12T20:13:37ZNearly 1 in 4 of us aren’t native English speakers. In a health-care setting, interpreters are essential<figure><img src="https://images.theconversation.com/files/273712/original/file-20190509-183109-2wqvok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Interpreters enable patients to be fully informed about their health condition and options for treatment.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p><em>This article is the third part in a series, <a href="https://theconversation.com/au/topics/where-culture-meets-health-70226">Where culture meets health</a>.</em></p>
<hr>
<p>Almost <a href="http://www.abs.gov.au/ausstats/abs@.nsf/lookup/Media%20Release3">one quarter</a> of the Australian population speaks a language other than English at home. But health services in Australia are largely delivered in English only. </p>
<p>We know Australians from culturally and linguistically diverse backgrounds are <a href="https://www.tandfonline.com/doi/full/10.3109/09638288.2015.1062925?casa_token=6DPh6EAnh08AAAAA:40VGPHoQ40YQVjGxeOhSDd8iBfRK1LaWzygGoCaW-65BYWmZiM9mfHXuqySS7QmSZmQBdvu17q3GmBk">less likely to access health services</a>, which leads to poorer health outcomes. One major reason for this is the <a href="https://www.tandfonline.com/doi/full/10.3109/09638288.2015.1062925?casa_token=6DPh6EAnh08AAAAA:40VGPHoQ40YQVjGxeOhSDd8iBfRK1LaWzygGoCaW-65BYWmZiM9mfHXuqySS7QmSZmQBdvu17q3GmBk">language barrier</a> between health-care providers and consumers.</p>
<p>Access to interpreters in health care should be seen as a basic human right.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/translation-technology-is-useful-but-should-not-replace-learning-languages-85384">Translation technology is useful, but should not replace learning languages</a>
</strong>
</em>
</p>
<hr>
<h2>Interpreters benefit both patients and practitioners</h2>
<p>Interpreters are a vital bridge between health services and consumers. Interpreters enable consumers to be fully informed about their health condition and options for treatment.</p>
<p>They also give consumers a voice to express themselves freely in their dominant language. This means people can share exactly what they need to say to health-care professionals and can ask the questions they want answered. </p>
<p>Research has found the use of professional interpreters <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955368/">improves the experience</a> of medical care for patients with limited English proficiency.</p>
<p>The use of professional interpreters <a href="https://www.researchgate.net/profile/Glenn_Flores/publication/221713079_Errors_of_Medical_Interpretation_and_Their_Potential_Clinical_Consequences_A_Comparison_of_Professional_Versus_Ad_Hoc_Versus_No_Interpreters/links/59ef2344aca2721ca5e7b949/Errors-of-Medical-Interpretation-and-Their-Potential-Clinical-Consequences-A-Comparison-of-Professional-Versus-Ad-Hoc-Versus-No-Interpreters.pdf">significantly reduces the risk</a> of communication errors that can lead to <a href="http://www.mighealth.net/eu/images/6/61/Flores1.pdf">negative clinical consequences</a>. Errors could include gaps in information about patient allergies, and instructions around the use of prescription medicines being misconstrued.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/missed-something-the-doctor-said-recording-your-appointments-gives-you-a-chance-to-go-back-112302">Missed something the doctor said? Recording your appointments gives you a chance to go back</a>
</strong>
</em>
</p>
<hr>
<p>But failure to provide access to interpreters in health settings can <a href="http://fecca.org.au/wp-content/uploads/2015/06/FECCA-Mosaic-40_LR.pdf">literally be a matter of life or death</a>. </p>
<p>Particularly in an emergency, if a patient and their loved ones are unable to communicate details about the patient’s medical situation to the treating doctors, this may impact whether the patient receives appropriate and timely treatment. </p>
<p>In <a href="http://fecca.org.au/wp-content/uploads/2015/06/FECCA-Mosaic-40_LR.pdf">one case</a> in the United States, a hospital acted on advice provided by a Spanish-speaking family with limited English proficiency when admitting their son. A court found language confusion contributed to delayed diagnosis of a brain haemmorhage, which resulted in the patient becoming a paraplegic.</p>
<h2>But not everyone is given access to an interpreter</h2>
<p>Despite the benefits of using an interpreter, <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3135-5">a recent study in a Sydney hospital</a> found although interpreters were required in 15.7% of admissions, just 3.7% of patients were actually provided with an interpreter.</p>
<p>A person who needs an interpreter <a href="http://www.publish.csiro.au/PY/PY10075">may not get one</a> because they’re deemed not to require the service, because an interpreter can’t be sourced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284281/">within the required timeframe</a> (for example, in emergency situations), or because there’s no interpreter available in the language or dialect required by the patient.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Patients who need interpreters aren’t always able to access them.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>The use of interpreters in regional, rural and remote Australia may be even lower given the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1440-1584.2000.tb00354.x">lack of available interpreters in those areas</a>. </p>
<p>When health professionals and consumers don’t speak the same language, delivering health services without an interpreter raises a number of ethical issues. </p>
<p>For example, if a person is unable to understand what is being said to them by a health-care practitioner, <a href="http://www.publish.csiro.au/PY/PY10075">they can’t give their informed consent</a>. Proceeding with any treatment without informed consent is in breach of the <a href="https://www.medicalboard.gov.au/documents/default.aspx?record=WD10%2F1277&dbid=AP&chksum=eNjZ0Z%2FajN7oxjvHXDRQnQ%3D%3D">code of conduct</a> of all health professions in Australia. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-cultural-assumptions-behind-western-medicine-7533">The cultural assumptions behind Western medicine</a>
</strong>
</em>
</p>
<hr>
<h2>Family members as interpreters</h2>
<p>The Australian government funds the provision of professional interpreters in health-care settings <a href="http://fecca.org.au/wp-content/uploads/2015/06/FECCA-Mosaic-40_LR.pdf">free of charge</a>. But professional interpreters are not always on hand when they are needed. This often results in the use of <a href="http://www.publish.csiro.au/PY/pdf/PY10075">family members as interpreters</a>. </p>
<p>This practice is fraught with issues and in some instances this can do <a href="http://fecca.org.au/wp-content/uploads/2015/06/FECCA-Mosaic-40_LR.pdf">more harm than good</a> for both the interpreter and the patient. </p>
<p>Relatives don’t have <a href="https://pdfs.semanticscholar.org/45d8/0d2e4a5c90165aa97c4fe44840e51ddd5b81.pdf">formal training as interpreters</a> and may not be familiar with the medical terminology being used or how to translate it. </p>
<p>Family members <a href="https://www.researchgate.net/profile/Janette_Vardy/publication/51216567_Interpretation_in_Consultations_With_Immigrant_Patients_With_Cancer_How_Accurate_Is_It/links/56e98c5708ae25ede8309847.pdf">may add their own interpretation or opinion</a> in the delivery of the message, thereby not delivering the message intended by the health-care practitioner or the patient.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children and teenagers often act as translators for their older relatives.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>In many migrant families, <a href="https://www.jstor.org/stable/pdf/10.1525/sp.2003.50.4.505.pdf?casa_token=NPy--uoOIcUAAAAA:Oftz7TOvwhskv81y3ttj4qVP7gno8cbSCX_F9hNS4Xvsel3FYCjEFv6sI4ZRRV3Lv57gNo_JIqwu20gNBhVYPw1Fkwhxsz30KOchRr5Hl9XrkugZJYqbNA&seq=1#page_scan_tab_contents">children or young adults</a> have the best knowledge of English in the family and so are often called upon to be the interpreter. The use of underage interpreters raises further ethical issues as they are tasked with interpreting sensitive health information about a loved one. </p>
<p>So caution is needed when using family members as interpreters.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-ethnic-face-is-changing-and-so-are-our-blood-types-113454">Australia’s ethnic face is changing, and so are our blood types</a>
</strong>
</em>
</p>
<hr>
<h2>How can the use of interpreters be increased and improved?</h2>
<p>There are some key actions that should be taken to improve health-care experiences and outcomes for people with limited English proficiency.</p>
<p>First, training for both interpreters and health-care professionals is essential to develop skills for effective collaboration.</p>
<p>Second, there should be <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1460-6984.12112">additional time allocated for appointments</a> where interpreters are used. This is because each sentence must be said twice during the exchange of information and time is needed for <a href="https://www.bookdepository.com/Collaborating-with-Interpreters-Translators-Henriette-W-Langdon/9781888222760?ref=grid-view">briefing and debriefing about the session</a>.</p>
<p>Third, health services need to collect accurate information to determine whether an interpreter <a href="https://www.ceh.org.au/assessing-the-an-interpreter/">is needed</a>. A person may present with functional English <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3135-5">but still require an interpreter</a> for ease of communication given the complex terminology and the seriousness of medical conversations.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/between-health-and-faith-managing-type-2-diabetes-during-ramadan-115469">Between health and faith: managing type 2 diabetes during Ramadan</a>
</strong>
</em>
</p>
<hr>
<p>And finally, professionally trained interpreters must be available in the languages and dialects required. There are <a href="http://www.abs.gov.au/ausstats/abs@.nsf/lookup/Media%20Release3">more than 300 languages spoken in Australia</a> and many have multiple dialects.</p>
<p>Investment in interpreting services is essential to ensure the provision of equitable, high quality health care to all Australians. In a country where interpreters may improve care for one quarter of the population, we can’t afford not to.</p><img src="https://counter.theconversation.com/content/115125/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Verdon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Interpreters are essential in providing ethical and high quality health care to Australia’s culturally and linguistically diverse population.Sarah Verdon, Research Fellow and Senior Lecturer in Speech and Language Pathology, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1134542019-05-08T20:01:51Z2019-05-08T20:01:51ZAustralia’s ethnic face is changing, and so are our blood types<figure><img src="https://images.theconversation.com/files/273249/original/file-20190508-183103-1jusqev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">About one in three people living in Australia were born overseas.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p><em>This article is the second part in a series, <a href="https://theconversation.com/au/topics/where-culture-meets-health-70226">Where culture meets health</a>.</em></p>
<hr>
<p>It’s often said that no matter who we are, “we all bleed red”. But although our blood may be the same colour, we’re as individual on the inside as we are on the surface. Just like our background determines the way we look, where we come from is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595629/">one of the major factors</a> that influences the make up of our blood.</p>
<p>About <a href="http://www.abs.gov.au/ausstats/abs@.nsf/lookup/Media%20Release3">half of people</a> living in Australia today were either born overseas, or have a parent born overseas. This increase in the diversity of our population leads to a corresponding diversity in the people who need medical treatment – and their blood types.</p>
<p>We need a broad mix of ethnicities in our donor pool to meet the needs of patients with rare blood types. Providing the right blood and blood products for an ethnically diverse population presents an evolving challenge for blood collection agencies around the world, including here in Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/blood-groups-beyond-a-b-and-o-what-are-they-and-do-they-matter-75063">Blood groups beyond A, B and O: what are they and do they matter?</a>
</strong>
</em>
</p>
<hr>
<p>People from diverse backgrounds <a href="http://diversityhealthcare.imedpub.com/missing-minorities--a-survey-based-descriptionof-the-current-state-of-minority-blood-donorrecruitment-across-23-countries.php?aid=8326">tend to be underrepresented</a> in donor populations. While Australians born overseas account for <a href="http://www.abs.gov.au/ausstats/abs@.nsf/lookup/Media%20Release3">roughly one-third</a> of the population, they account for only one in five blood donors.</p>
<p>This limited diversity in our pool of donors creates challenges in identifying blood matches for transfusion to patients with rare blood types. </p>
<h2>The link between your blood group and where you come from</h2>
<p>Blood types consist not only of the commonly recognised groups such as A, B and O, but <a href="https://www.donateblood.com.au/blog/research/blood-types-and-donuts">also include</a> more than 300 other variants. Each of these variants is a marker on the surface of our red blood cells, and is known as an “antigen”.</p>
<p>Our blood type is inherited from our parents. Like other inherited characteristics such as skin and hair colour, the frequency of blood types in a population <a href="http://www.bloodjournal.org/content/115/23/4635?sso-checked=true">shift in response</a> to stresses in the environment (known as “selection pressure”).</p>
<p>For example, in parts of the world where malaria thrives, the proportion of the population with various blood types <a href="https://theconversation.com/how-our-red-blood-cells-keep-evolving-to-fight-malaria-96117">has altered over time</a> to make people less prone to infection.</p>
<p>So this effect has more to do with where you and your ancestors lived than your ethnic group. One blood type, known as <a href="https://www.ncbi.nlm.nih.gov/books/NBK2271/">Duffy null</a>, is much more frequent in Africans in Africa than in African-Americans, possibly because African Americans are no longer exposed to the malaria parasite.</p>
<p>In short, one reason we have different blood groups is to improve our chances of fighting disease.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-our-red-blood-cells-keep-evolving-to-fight-malaria-96117">How our red blood cells keep evolving to fight malaria</a>
</strong>
</em>
</p>
<hr>
<h2>Who needs specially matched blood?</h2>
<p>Most transfusions of red cells <a href="https://www.science.org.au/curious/people-medicine/why-are-some-blood-types-incompatible-others">are matched</a> for the commonly recognised ABO and Rh blood groups (the Rh group is the one that gives you the “positive” or “negative” in your blood type). </p>
<p>If someone receives a transfusion of blood that doesn’t match their own type, their body may recognise the transfused blood as foreign, and develop antibodies to try and destroy the “invader”. Their body will keep making these antibodies, which can then interfere with future transfusions.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/273254/original/file-20190508-183109-1r2rt4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273254/original/file-20190508-183109-1r2rt4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273254/original/file-20190508-183109-1r2rt4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273254/original/file-20190508-183109-1r2rt4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273254/original/file-20190508-183109-1r2rt4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273254/original/file-20190508-183109-1r2rt4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273254/original/file-20190508-183109-1r2rt4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Most healthy people are eligible to donate blood.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>Some patients need specially matched red cells for transfusion. This means on top of being matched by ABO and Rh type, the donor’s blood is matched to make sure it doesn’t contain blood group variants that aren’t present in the recipient’s blood. This is more difficult to achieve.</p>
<p>There are three groups of patients who need specially matched blood:</p>
<ol>
<li>patients who have already developed antibodies because they have had a transfusion of blood that is not fully matched in the past</li>
<li>patients who may have developed antibodies to blood group antigens, but other conditions or drug treatments make it hard for their doctors to test for antibodies </li>
<li>patients who need to have many transfusions throughout their life, so doctors want to avoid the development of blood group antibodies. </li>
</ol>
<p>Patients who may need to have multiple transfusions throughout their life include those with disorders affecting the blood such as sickle cell anaemia, thalassemia major and myelodysplasia. </p>
<p>Thalassemia is <a href="https://thalassemia.com/demographics.aspx#gsc.tab=0">most common</a> in people of African, Middle Eastern, Asian, Indian and Mediterranean descent. Sickle cell anaemia <a href="https://www.cdc.gov/ncbddd/sicklecell/data.html">affects these ethnic groups</a> and also people of Hispanic descent.</p>
<h2>Which groups are most in need in Australia at the moment?</h2>
<p>There are so many different blood group antigens, combinations of even the most common blood group types are found in only a small proportion of donors, making it difficult to provide blood fully matched for a particular patient. </p>
<p>In addition, as our patient population becomes more diverse, there is a greater need for blood types that are rare in a Caucasian population.</p>
<p>Ultimately, the distribution of blood groups that we collect from our donors should reflect the distribution of blood groups required by patients who need transfusion.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-whats-actually-in-our-blood-75066">Explainer: what's actually in our blood?</a>
</strong>
</em>
</p>
<hr>
<p>Blood centres in many countries have introduced a <a href="https://pdfs.semanticscholar.org/5ad0/1f8262f443562507c865323ebddd61d4b21c.pdf">variety of campaigns</a> to attract a broader donor group. </p>
<p>At the Australian Red Cross Blood Service, we are interviewing donors from diverse backgrounds to learn more about their experiences in donating blood. Our goal is to build a donor panel that represents the diversity of the broader Australian community. </p>
<p>The benefits are not only for the patients and the health system – research suggests participating in blood donation <a href="https://www.ncbi.nlm.nih.gov/pubmed/17319819">facilitates social inclusion among migrant communities</a>.</p>
<p><em>Dr Alison Gould, Scientific Communications Specialist for the Australian Red Cross Blood Service, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/113454/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tanya Davison is employed by the Australian Red Cross Blood Service as well as Swinburne University of Technology, and receives funding from NHMRC and ARC research grants. Australian governments fund the Australian Red Cross Blood Service for the provision of blood, blood products and services to the Australian community</span></em></p><p class="fine-print"><em><span>James Daly is employed by the Australian Red Cross Blood Service and holds an Adjunct appointment with QUT Schooll of Biomedical Science. Australian Governments fund the Australian Red Cross Blood Service for the provision of blood, blood products and services to the Australian Community</span></em></p><p class="fine-print"><em><span>Robert Flower is employed by the Australian Red Cross Blood Service as well an appointment at the University of Sydney. Australian governments fund the Australian Red Cross Blood Service for the provision of blood, blood products and services to the Australian community</span></em></p>Australia is a cultural melting pot, but our blood donors are less diverse. We need a broad mix of ethnicities in our donor pool to meet the needs of patients with rare blood types.Tanya Davison, Associate professor, Swinburne University of TechnologyJames Daly, Adjunct Associate Professor, Faculty of Health, School of Biomedical Sciences, Queensland University of TechnologyRobert Flower, Associate Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1154692019-05-02T20:14:05Z2019-05-02T20:14:05ZBetween health and faith: managing type 2 diabetes during Ramadan<figure><img src="https://images.theconversation.com/files/272141/original/file-20190502-117578-1pofj5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many Muslim Australians currently live with diabetes.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p><em>This article is the first part in a series, <a href="https://theconversation.com/au/topics/where-culture-meets-health-70226">Where culture meets health</a>.</em></p>
<hr>
<p>The holy month of Ramadan, which sees Muslims all over the world fast during daylight hours, begins this weekend. Does having type 2 diabetes exclude a person from fasting? Not necessarily. The decision belongs to the person, but getting some advice from health professionals can help.</p>
<p>Diabetes is the <a href="https://www.diabetesaustralia.com.au/diabetes-in-australia">fastest growing chronic condition</a> in Australia. About <a href="https://www.aihw.gov.au/reports/diabetes/diabetes-snapshot/contents/how-many-australians-have-diabetes">6% of Australian adults</a> report they have diabetes, although this is likely an underestimate of the true prevalence.</p>
<p>Type 2 diabetes, which constitutes the majority of diabetes cases, occurs when <a href="https://www.diabetesaustralia.com.au/type-2-diabetes">the body becomes resistant</a> to the actions of insulin, or loses the capacity to produce sufficient insulin from the pancreas. Insulin keeps the body’s blood glucose levels within a healthy range.</p>
<p>People with type 2 diabetes can manage the condition by maintaining a healthy lifestyle, including doing exercise and keeping a healthy diet. In more serious cases, people with type 2 diabetes may need to take medications such as metformin, sulfonylureas, or other glucose-lowering tablets, or self-administer insulin injections.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/271944/original/file-20190501-113867-14ckby1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/271944/original/file-20190501-113867-14ckby1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=350&fit=crop&dpr=1 600w, https://images.theconversation.com/files/271944/original/file-20190501-113867-14ckby1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=350&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/271944/original/file-20190501-113867-14ckby1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=350&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/271944/original/file-20190501-113867-14ckby1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=440&fit=crop&dpr=1 754w, https://images.theconversation.com/files/271944/original/file-20190501-113867-14ckby1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=440&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/271944/original/file-20190501-113867-14ckby1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=440&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Type 2 diabetes affects the body’s blood glucose, or blood sugar levels.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>Type 2 diabetes affects some ethnicities more than others. It’s more common in people of <a href="https://www.idf.org/our-activities/advocacy-awareness/resources-and-tools/134-idf-diabetes-atlas-8th-edition.html">Middle Eastern, north African and south/south-east Asian backgrounds</a>. Many <a href="https://apo.org.au/node/56353">Muslim Australians</a> are from these ethnic backgrounds.</p>
<p>Using <a href="http://www.unisa.edu.au/contentassets/4f85e84d01014997a99bb4f89ba32488/australian-muslims-final-report-web-nov-26.pdf">2016 census data</a>, and conservatively estimating an adult diabetes prevalence of 10% among people of Muslim background (the exact prevalence is unknown), as many as 40,000 Muslims may be living with diabetes in Australia. And this number is likely to be increasing.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-australians-die-cause-5-diabetes-57874">How Australians Die: cause #5 – diabetes</a>
</strong>
</em>
</p>
<hr>
<h2>We’re about to begin the month of Ramadan</h2>
<p>Dietary practices such as fasting, feasting, and consumption of special foods are an essential component of many religious and cultural celebrations. </p>
<p>For Muslims, fasting during the month of Ramadan is <a href="https://www.icv.org.au/about/about-islam-overview/ramadan/">obligatory for all healthy adults</a>, who must refrain from eating, drinking and taking oral medications between dawn and sunset.</p>
<p>During Ramadan, most people have two meals per day, at sunset and before sunrise. This can be risky for people with type 2 diabetes – particularly those who use insulin or certain oral diabetes medications – for a couple of reasons.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/271675/original/file-20190430-194606-yk0j6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/271675/original/file-20190430-194606-yk0j6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/271675/original/file-20190430-194606-yk0j6f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/271675/original/file-20190430-194606-yk0j6f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/271675/original/file-20190430-194606-yk0j6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/271675/original/file-20190430-194606-yk0j6f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/271675/original/file-20190430-194606-yk0j6f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The daytime fast is often broken with a communal meal, called Iftar.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>First, fasting during the day can <a href="http://care.diabetesjournals.org/content/27/10/2306">increase the risk of low blood glucose levels</a> in people who usually take insulin or <a href="https://www.ncbi.nlm.nih.gov/pubmed/21506631">other blood glucose-lowering medications</a>.</p>
<p>And conversely, the evening meal to break the fast, called “Iftar,” often involves eating large amounts of calorie-rich foods in a relatively short space of time. This can put people with diabetes at <a href="https://www.ncbi.nlm.nih.gov/pubmed/25497966">risk of high blood glucose levels</a> overnight.</p>
<p>Omission or changes in the timing of medications may also contribute to instability of blood glucose levels. </p>
<p>Low blood glucose levels can cause <a href="https://www.diabetesaustralia.com.au/hypoglycaemia">symptoms of sweating, shakiness and confusion</a>. If severe, they can lead to seizures, coma, or even death. High blood glucose levels make people feel <a href="https://www.diabetesaustralia.com.au/hyperglycaemia">tired and generally unwell</a> and can lead to dehydration and poor concentration. Extremely high levels are a medical emergency.</p>
<h2>There are guidelines</h2>
<p>According to Islamic teachings, the elderly, pregnant, or those with illnesses requiring regular medication – like diabetes – can be exempted from fasting on medical grounds. They do not need to seek special permission from a religious leader.</p>
<p>Certain groups of people with type 2 diabetes who do not use insulin or particular oral medications can safely fast during Ramadan under the guidance of their health-care professional. </p>
<p>But as diet, lifestyle and medication use are key factors in maintaining stable blood glucose levels and minimising diabetes complications, many people with type 2 diabetes can also be considered medically exempt from fasting.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/know-your-disease-education-is-key-to-living-well-with-diabetes-28665">Know your disease: education is key to living well with diabetes</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://www.idf.org/e-library/guidelines/87-diabetes-and-ramadan-practical-25">Practical guidelines</a> established by the International Diabetes Federation-Diabetes and Ramadan (<a href="https://www.daralliance.org/daralliance/">IDF-DAR</a>) International Alliance assist health professionals to assess patients’ level of risk.</p>
<p>Low risk patients can safely enjoy fasting, while those at moderate to high risk are advised against fasting. </p>
<p>These guidelines have been endorsed by religious authorities in Australia and overseas and are a valuable reference for health professionals and their Muslim patients.</p>
<h2>But it’s not quite that simple</h2>
<p>The month of Ramadan is a special time for Muslim people, where fasting and feasting are integral to religious life, social interaction and communal celebration.</p>
<p>Because fasting is one of the five pillars of Islam, there is a strong desire to participate, even among those who could be exempt for medical reasons. </p>
<p>Those who cannot fast for medical reasons may <a href="https://drc.bmj.com/content/5/1/e000365">feel alienated by their diabetes</a> and develop negative attitudes towards it, possibly resulting in impaired self-management of their condition.</p>
<p>Some people with diabetes may be reluctant to raise the topic themselves, fearing a <a href="https://drc.bmj.com/content/5/1/e000365">lack of understanding</a> from non-Muslim health providers. They may conceal their intentions to fast to avoid any perceived conflict with the health professional.</p>
<p>Understanding the spiritual significance of this month to Muslims as well as the practical aspects can put health practitioners in a much stronger position to gain patient trust and facilitate communication.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-will-intermittent-fasting-diets-help-you-lose-weight-51040">Health Check: will intermittent fasting diets help you lose weight?</a>
</strong>
</em>
</p>
<hr>
<h2>Culturally sensitive discussion allows people with diabetes to make informed choices</h2>
<p>The month of Ramadan is determined according to the Islamic lunar year and varies annually in the western calendar. Professionals caring for people who observe Ramadan should be aware of its timing and start the conversation in advance. </p>
<p>Muslims with diabetes wanting to observe Ramadan should be counselled on the risks of fasting. Drawing on the guidelines, health providers can reassure their patients that those who do not fast for medical reasons also receive spiritual rewards and should not feel guilty.</p>
<p>Health-care professionals may suggest donations of food or money to the poor could be considered as an alternative, if it’s within the person’s means.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/271678/original/file-20190430-194630-11s11jz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/271678/original/file-20190430-194630-11s11jz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/271678/original/file-20190430-194630-11s11jz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/271678/original/file-20190430-194630-11s11jz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/271678/original/file-20190430-194630-11s11jz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/271678/original/file-20190430-194630-11s11jz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/271678/original/file-20190430-194630-11s11jz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A person with diabetes may need to check their blood sugar more often if they’re fasting.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>Discussion about Ramadan must occur in a culturally sensitive and non-judgemental way, appreciating a person’s right to evaluate the risks and benefits of fasting – both spiritual and physical – for themselves, and determine from an individual perspective whether fasting is the right decision. </p>
<p>Doctors might also advise their patient to discuss any concerns with their local religious leader.</p>
<p>For those who choose to fast despite their exemption, discussions about glucose monitoring, nutrition, exercise and potential medication changes can ensure they fast as safely as possible. </p>
<p>The diabetes health care team (which can include GPs, endocrinologists, diabetes educators, dietitians and diabetes nurse practitioners) can also develop an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477147/">individualised Ramadan-specific management plan</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-how-western-attitudes-towards-islam-have-changed-111989">Friday essay: how Western attitudes towards Islam have changed</a>
</strong>
</em>
</p>
<hr>
<p>Understanding people’s different cultural backgrounds, lifestyles and religious practices <a href="https://www.sciencedirect.com/science/article/pii/S0168822716302522">plays an important role</a> in their health care. A lack of understanding might lead to poorer health outcomes and disengagement with health services, while research shows culturally appropriate diabetes education and prevention programs <a href="https://www.ncbi.nlm.nih.gov/pubmed/16410421">improve outcomes</a> for people from different backgrounds.</p>
<p>Health-care professionals should educate themselves about their cultural setting and local patient population to maintain effective therapeutic relationships and achieve the best patient-focused outcomes.</p><img src="https://counter.theconversation.com/content/115469/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ahmed Hussein is affiliated with the not-for-profit organisation Sydney Northwest Muslim Community as a Vice President.
</span></em></p><p class="fine-print"><em><span>Sue Lynn Lau does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The holy month of Ramadan begins on Sunday night. This can present a challenge for Muslim people with type 2 diabetes who want to fast but can’t necessarily do so safely.Sue Lynn Lau, Endocrinologist, Western Sydney UniversityAhmed Hussein, Endocrinologist and Associate lecturer, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.