“That Heart Sickness”: Young Aboriginal People’s Understanding of Rheumatic Fever

ABSTRACT

High rates of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Australia predominate in young Aboriginal people highlighting underlying racial and equity issues.  This article focuses on the perceptions of the disease among young Aboriginal people living in remote Australia. Participant understanding was constrained by clinicians’ use of language rooted in biomedicine and delivered through English, a second language for all participants. Clinicians’ communicative competency is a social determinant of Aboriginal health. We recommend that the use of Aboriginal languages be prioritized in health services caring for Aboriginal people and that biomedical dominance in the services be relinquished.

KEYWORDS:

• Aboriginal languages
• communicative competency
• medical dominance
• rheumatic fever
• rheumatic heart disease
• social determinants

Acknowledgments

We acknowledge and sincerely thank all study participants and, in particular, Aboriginal co-researchers. We thank Dr. Marilyn McLellan, a specialist in Australian Aboriginal languages, for linguistic oversight. Ethical approval was provided by the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research HREC-2012-1756. The trial was registered with the Australian New Zealand Clinical Trials Registry: ACTRN12613000223730.

Notes

1. Cass et al. (2002): research undertaken in a renal unit that explored the quality of communication between Aboriginal patients and clinicians. Pervasive miscommunication was found to be more entrenched than expected and shared understanding of renal disease and related health concepts was required for meaningful dialogue to occur.

2. Kriol is the name of a creole spoken in the cattle areas from the Gulf of Carpentaria in the NT, west to the Kimberly in Western Australia (Munro 2000).

Additional information

Funding

AGM was recipient of an Australian Postgraduate Award scholarship funded by the Australian Federal government. The trial was funded by the National Health & Medical Research Council project grant [1027040] and Telethon Kids Institute, University of Western Australia.

Notes on contributors

Alice G. Mitchell

Alice G. Mitchell is a PhD scholar in public health at Charles Darwin University and an applied linguist, specializing in community health media using people’s language and worldview.

Suzanne Belton

Suzanne Belton is an adjunct professor with Menzies School of Health Research and previously senior principal researcher with Rheumatic Heart Disease Australia. She is a medical anthropologist who studies cross-cultural health and a filmmaker focusing on health promotion.

Vanessa Johnston

Vanessa Johnston is a public health physician and associate professor at the Australian National University Medical School. Her research interests include exploring the determinants of health and well-being for Indigenous and refugee populations.

Wopurruwuy Gondarra

Wopurruwuy Gondarra is an experienced language and communication analyst as well as a cultural advisor for her Aboriginal group. She has worked in various capacities to improve Aboriginal health, including as a co-researcher in this article.

Anna P. Ralph

Anna P. Ralph is the director of Global and Tropical Health at Menzies School of Health Research in northern Australia. She is a research fellow supported by the National Health and Medical Research Council, and is the clinical director of Rheumatic Heart Disease Australia, as well as being a practicing medical specialist in General Medicine and Infectious Disease at Royal Darwin Hospital. Her main research interests are in the prevention of rheumatic fever and rheumatic heart disease and control of tuberculosis.