Barriers to care

Since working in Moose Factory, one thing that has really stood out has been the high no show rates. I am doing considerably more outpatient counselling here than in Nova Scotia, but the 50% show rate for appointments has been surprising. As a practitioner it is frustrating because you feel that people could benefit by seeing you, and it tends to be the most complicated cases that do not show. I was interested in exploring this further, as it occurs not just in dietetics but also in other outpatient services. There must be some barriers that overwhelm people’s desire or ability to attend.

Barriers to accessing health care differ from one person or population group to another, and what we may think of as routine, may in fact be an insurmountable barrier for another. It tends to be the most vulnerable populations that face these barriers, as health care services are not designed to meet their needs.

The SOGC journal, has an excellent policy statement on recognizing barriers to care in Aboriginal communities. They list potential categories of barriers including: attitudinal, values and beliefs, socioeconomic, and language and communication.

Attitudinal barriers include racism and prejudice, which can be subtle yet incredibly damaging. Differences in values or beliefs can cause people to feel alienated in an unfamiliar environment; First Nation governance was traditionally based on non-interference, this stands in stark contrast to Western medicine featuring an “expert” practitioner who makes a diagnosis and controls the care process. Socioeconomic barriers may include poverty, inadequate housing, low education, and substance abuse; all of which are correlated and contribute as barriers to access. Finally language and communication can become a barrier, not just because of the need for direct translation, but also for interpretation of content to be culturally appropriate.

As Ensor & Cooper (2004) suggest the usual strategy to increase accessibility to health care services has been to supply more health care professionals or increase the quality of care to vulnerable populations, but this may not be the best strategy. More attention needs to be made to the barriers that affect people’s desire to seek care, these include the cultural barriers that hinder the relationship between the community and health care services/practitioners.

Providing traditional native healing in health care institutions is one way to overcome some of these barriers, this is a service that does exist at the hospital here in Moose Factory. However, as my supervisor has mentioned, some people within the community are strongly opposed to this type of care, which puts a whole new spin on cultural appropriateness. Other barriers include the high turnover of health care professionals. In the 6 weeks I have been here I think I have met at least a dozen people that are moving to jobs elsewhere, this lack of continuity does little to improve the community’s relationship with the health care system.

 While many issues exist to increase accessibility, there are no simple solutions. The most important thing is to create open channels of communication between the community and health care services. Culturally appropriate care will need to balance traditional and modern health care, while allowing input from community members.