Burns units need to cater for Indigenous kids

Aboriginal liaison workers in burn units, and greater cultural competence by clinicians in health services, are urgently needed for Aboriginal and Torres Strait Islander burns patients who have the highest burn injury rates of all Australians.

Researchers are calling for culturally safe and holistic care to be factored into hospital treatment and post-injury care for the large number of people from remote communities who present with serious burns, particularly children and their carers and parents.

In a major study funded by the Australian Government NHMRC, researchers at Flinders University are working with the George Institute for Global Health and UNSW Sydney to address these issues.

With burn injuries among Aboriginal and Torres Strait Islander children at least double the rate of other children in Australia, the researchers interviewed 76 clinicians in multidisciplinary burn teams around Australia about their burn care for their families.

The resulting findings, published in the journal Burns (Elsevier), conclude there are “clear opportunities to improve healthcare” for Aboriginal and Torres Strait Islander children.

 “Burns care for Aboriginal and Torres Strait Islander children and families in Australia is still predominantly informed by non-Indigenous concepts of health, healing and care delivery,” says lead author, Flinders University PhD candidate Sarah Fraser.

“The disjuncture between Western biomedical and Indigenous healthcare paradigms negatively impacts the delivery of care.”

Burns care is an important but not isolated example, Ms Fraser says.

“The current power imbalance in favour of the scientific approaches to burns care extenuates the issue and constructive action is required to address this inequity.”

Starting with care provisions in remote community clinics, the Coolamon project led by UNSW Professor Rebecca Ivers from the George Institute seeks to understand the gaps in care and bring better understandings of cultural and social requirements into major metropolitan burns units.

“Emergency and trauma settings, including burns units, are critical for provision of appropriate care for life-threatening injuries and rehabilitation afterwards,” she says.

“However, care delivered needs to be holistic, and better address the needs of Aboriginal and Torres Strait Islander children and their families”.

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Flinders University ARC Fellow Dr Tamara Mackean, who focuses on Australian healthcare delivery from an Indigenous perspective, says the research project is very important.

“Addressing these issues is a critical means by which acute care services can address broader issues of quality and safety for Aboriginal and Torres Strait Islander peoples and meet the national standards of care set by the Australian Commission on Safety and Quality in Health Care,” says Associate Professor Mackean. “Achievement of these standards will contribute to redressing health inequities in relation to childhood burn injuries.”

The latest paper, ‘What informs care? Descriptions by multidisciplinary teams about burns care for Aboriginal and Torres Strait Islander children’ by S Fraser, J Grant, T Mackean, K Hunter, N Keeler, K Clapham, WJ Teague, T Potokar and RQ Ivers, has been published in the journal Burns (Elsevier). The project is funded by the National Health and Medical Research Council (grant number APP1059038).

Background: While not comprehensively reported, Indigenous Australian children are disproportionally affected: they are more than twice as likely to be hospitalised for a burn injury as non-Indigenous children, and mortality is five times as high.

According to 2013-14 statistics, Aboriginal and Torres Strait Islander people accounted for 9% of hospitalised burn cases overall, with the 480 cases representing 58 cases per 100,000 population, compared to 22 cases per 100,000 for other Australians.

The highest rate of burn injury was in the youngest age range (0-4 years) for both Indigenous (174 cases per 100,000 population) and other Australians (56 cases per 100,000 people).

See also: H Möller, K Falster, R Ivers, K Clapham., L Harvey, and L Jorm (2017). ‘High rates of hospitalised burn injury in Indigenous children living in remote areas: a population data linkage study’. Australian and New Zealand Journal of Public Health

 

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