Past experiences enhance the future. Health care providers gaining expertise in creative thinking, traditional medicine, spirituality, and cultural sensitivity is an essential requirement for 21st century health care. We must stay mindful that poverty, isolation, and rural living may create new forms of social exclusion because of lack of communication and rapidly changing technology. Conversely, sensory overload resulting from a faster paced lifestyle and rapid enhancements in technology may cause increased tension and stress. This article reviews successes that may offer the reader ideas on coping with the provision of health care services in such a volatile changing environment, while honoring tradition and cultural competency.
University of New Mexico, Albuquerque, New Mexico; the Uniformed Services University of the Health Sciences, Bethesda, Maryland; the Northern Navajo Medical Center, Shiprock, New Mexico; the Mid-Columbia Medical Center, The Dalles, Oregon; the University of Texas Rio Grande Valley, Edinburg, Texas; the Alaska Native Medical Center, Anchorage, Alaska; the University of Mississippi Medical Center, Jackson, Mississippi; the Oregon Health and Science University, Portland, Oregon; and the American College of Obstetricians and Gynecologists, Washington, DC.
Since 1970, the American College of Obstetricians and Gynecologists' Committee on American Indian and Alaska Native Women's Health has partnered with the Indian Health Service and health care facilities serving Native American women to improve quality of care in both rural and urban settings. Needs assessments have included formal surveys, expert panels, consensus conferences, and onsite program reviews. Improved care has been achieved through continuing professional education, recruitment of volunteer obstetrician-gynecologists, advocacy, and close collaboration at the local and national levels. The inclusive and multifaceted approach of this program should provide an effective model for collaborations between specialty societies and health care professionals providing primary care services that can reduce health disparities in underserved populations.
To retrospectively examine the barriers faced and opportunities for improvement during the 2009 H1N1 pandemic response experienced by participants responsible for the delivery of health care services in 3 remote and isolated Subarctic First Nation communities of northern Ontario, Canada.
A qualitative community-based participatory approach.
Semi-directed interviews were conducted with adult key informants (n=13) using purposive sampling of participants representing the 3 main sectors responsible for health care services (i.e., federal health centres, provincial hospitals and Band Councils). Data were manually transcribed and coded using deductive and inductive thematic analysis.
Primary barriers reported were issues with overcrowding in houses, insufficient human resources and inadequate community awareness. Main areas for improvement included increasing human resources (i.e., nurses and trained health care professionals), funding for supplies and general community awareness regarding disease processes and prevention.
Government bodies should consider focusing efforts to provide more support in terms of human resources, monies and education. In addition, various government organizations should collaborate to improve housing conditions and timely access to resources. These recommendations should be addressed in future pandemic plans, so that remote western James Bay First Nation communities of Subarctic Ontario and other similar communities can be better prepared for the next public health emergency.
This paper summarises the recent RANZCOG Indigenous Women's Health Meeting with recommendations on how the College and its membership can act now to improve the health of Aboriginal and Torres Strait Islander women and infants.
In Thailand, where abortion is still illegal, abortion services (health services) outside Bangkok, and outside hospitals or clinics, are provided by non-physician practitioners. In the studies reported here, those practitioners were interviewed in 1978 and 1981 about their methods and the characteristics of their clients. The first study revealed that massage is the method most widely used by rural practitioners and that uterine injection with different solutions comes second. The second study was in agreement with these findings. The health consequences of these induced abortions were studied by interviewing the clients of the rural practitioners in 1980 and 1981. In Sweden, where abortion has been legal for quite a long time, all women who need an abortion have access to safe and convenient health services throughout the country.