Australia prides itself on its multicultural chemistry, but it presents everyday challenges. Community pharmacy services can play their part by catering specifically for people from diverse backgrounds.
Every third or fourth patient you treat is likely to have been born overseas.1,2 In fact, almost half (49%) of all Australians were either born overseas or have at least one parent who was.1
It’s a statistic that’s very close to home for Veronica Nou, pharmacist and proprietor of Morris Care & Advice Pharmacy in St Mary’s in Sydney’s west. Her family fled Cambodia in 1981 when she was an infant. Ms Nou (pictured) speaks the Khmer (Cambodian) language and is often called upon to help ensure Cambodian immigrants with poor English skills are taking their medicines properly.
She recalls one home visit to a newly diagnosed insulin-dependent person with diabetes. When Ms Nou asked the elderly lady how she took her medicine, she received an unexpected response.
‘She got an orange, then she got her insulin, then she injected the insulin into the orange and ate the orange,’ says Ms Nou, ‘because that’s how the educator had done it in front of her a few weeks earlier. She didn’t understand the orange was meant to represent her.’
In many developing countries around the world, traditional herbal remedies are still regularly used by local populations. And thus, eating an insulin-injected orange doesn’t seem so ridiculous.
‘For so many people, Australian and western medicine is like a whole new world,’ explains Ms Nou. ‘The culture shock and the adjustment are huge. It’s not that people are stupid, it’s just that there’s a lot of adjustment to make.’
A different mindset
While over 250,000 Australians from culturally and linguistically diverse (CALD) backgrounds are estimated to experience some form of mental disorder in a 12-month period, a significant proportion of them do not seek help for their mental health problems, according to the Department of Health.3
Ms Nou explains that in many south-east Asian cultures, for example, mental health issues remain heavily stigmatised.
‘That means by the time someone comes to you saying they’ve had trouble sleeping due to a lot of stress at work, it’s probably taken them a lot more to get to that point than the next person,’ Ms Nou says. ‘Therefore, you have to put extra effort in to understand that, and make sure that their privacy is completely respected.’
Australian diversity 7 ways
Distrust of authority
Some immigrants can also have trouble trusting authority figures, adds Ms Nou.
‘Some people have a lot of trauma they need to overcome. They go through so many authority figures along the way to get here who don’t necessarily have their best interests at heart,’ she says. ‘So it can be very difficult to put your faith in someone who is standing there in a white coat behind the dispensary. It takes time to build up trust.’
Free translation service
One government service aimed at delivering better patient outcomes is the Department of Social Services’ (DSS) Free Interpreting Service (FIS).
Earlier this year the pharmacy category of the program was permanently expanded to support community pharmacists when providing general advice and delivering other general pharmacy services, from screening and risk assessment to providing leave certificates (see ‘Found in translation’, below).
‘By using the service you’re more likely to be confident your patients have understood you, and you’ve understood what their needs are,’ explains a representative from DSS.
‘Your patients will really appreciate it – they’re going to get a better quality of service from you and be more likely to return to your pharmacy.’
My Health Record
Another recent federal government initiative, My Health Record (MHR), aims to provide pharmacists with comprehensive health information about people from CALD backgrounds.
However, Ljubica Petrov, Manager at the Centre for Cultural Diversity in Ageing, warns it’s important for pharmacists not to over-rely on it as it may be incomplete.
‘As MHR may not contain the most up-to-date information about a person’s condition, it’s vital pharmacists still carry out the necessary screening and instruction-giving prior to providing medication to a person,’ she says.
Are budding pharmacists being adequately prepared to treat patients from CALD backgrounds? National President of the National Australian Pharmacy Students’ Association (NAPSA) Jessica (Han-Fang) Hsiao believes the current curriculum is falling short.
‘The majority of universities offering the pharmacy degree do not specifically deliver adequate education regarding interactions with patients from culturally diverse backgrounds,’ she says.
Ms Hsiao says a solution could be to develop tools similar to Mental Health First Aid training modules, which include online simulations of scenarios which may occur in pharmacy, but would instead apply to interactions with patients of different cultural backgrounds.
‘Students of select pharmacy schools may already be required to undertake training in cultural awareness for Aboriginal and Torres Strait Islander people. This could be expanded in the future to cover a wider range of cultures,’ Ms Hsiao says.
So what can pharmacies do to immediately start delivering higher quality service to people from CALD backgrounds?
Ms Petrov suggests management can endeavour to employ staff who speak languages that are spoken in the local community. And pharmacists should always use plain English, free of jargon.
‘Using complex terminology, technical terms, acronyms and grammatical structure can make it very difficult for people to understand,’ says Ms Petrov.
Key PSA resources
The PSA offers the following CPD education courses and resources to help pharmacists improve how they deal with patients from CALD backgrounds.
Customer service management (Group 2 course): Build the skills, abilities and experience to manage quality customer service. Learn how to understand customers and their pharmaceutical needs through sensational customer service as well as how to set service standards and train staff to meet and exceed those standards (1 CPD credit).
Emotional intelligence and workplace relationships (Group 2 course): Learn how to use emotional intelligence to increase self-awareness, self-management, social awareness and relationship management in the workplace. Also learn how to establish and manage processes and procedures to support workplace relationships taking into account the organisation’s values, goals and cultural diversity (1 CPD credit).
Develop and use emotional intelligence (Group 2 course): Develop and use emotional intelligence to increase self-awareness, self-management, social awareness and relationship management in the context of the workplace (12 CPD credits).
Providing Pharmacy Services to Aboriginal and Torres Strait Islander People (Resource): A Guide designed to assist pharmacists to deliver a consistently high quality of service to Aboriginal and Torres Strait Islander people, to communicate effectively and to be culturally responsive health professionals (2014).
Go to PSA CPD and Education portal at: my.psa.org.au/s
Go to PSA Resources portal at: psa.org.au
Another easy win for community pharmacies is to provide information and resources that have been translated. The SBS Diversity interactive web tool can provide a good breakdown of the cultural diversity in your suburb.4
‘The production and availability of high-quality translated material is vital in supporting your communication efforts with consumers who speak languages other than English,’ Ms Petrov says.
One recent innovative campaign is the Deakin University and BreastScreen Victoria funded Ophelia project, which aims to optimise engagement with breast screening in Melbourne’s west. Part of the project included pharmacy-based awareness campaigns in areas with a large Italian speaking population.5
Getting the message out
That said, if producing hard copy material is an unaffordable option, remember social media can be a free and effective way of highlighting that your pharmacy welcomes people from CALD backgrounds. For example, Ms Nou and husband Howard have used a pharmacy Facebook page to advocate for refugees and immigrants online – as highlighted in one of their recent Facebook posts:
‘Dear friends, occasionally we get asked, what’s up with all the charity and campaigns? Fam, the answer is because we’re all human.
‘People are people no matter where you go – we’re all in this together. Access to services like torture and trauma counselling, healthcare support and case management is way too important to be taken away from families that need help, just like ours once did.’
Found in translation
After an exchange like this one (above) it’s usually about the time Andrea Hales, Pharmacist Manager at Ramsay Pharmacy Coff s Central, NSW, knows she should pick up the phone and use the Federal Government’s Free Interpreting Service (FIS).
‘We get that a lot. And that’s when you go, “Okay, yep, no – we’re going to need to get a bit of help here”,’ Ms Hales says.
While 83% of the Coffs Harbour population was born in Australia, the area is also home to people born in more than 100 different nations, according to the SBS Diversity interactive web tool.4 Ms Hales says her pharmacy uses the FIS about once a week.
The biggest benefits the FIS provides are increased quality of care for patients, she says, as well as peace of mind for pharmacists.
‘I much prefer to be certain that they know what they’re doing with the medication than having that really uneasy feeling you get when somebody is walking away and you’re not entirely sure if they’ve understood how many times a day to take it,’ she says.
Ms Hales has also noticed an increase in return customers – and referrals from patients who have benefited from using the FIS.
‘Doctors will also tell people to come to us specifically because they know that we use the FIS,’ she says.
While the pharmacy uses the FIS predominantly for prescription medications, the front of shop staff will also use it for over-the-counter scenarios.
‘Another more specific example of when using the FIS comes in handy is when explaining how to use suppositories,’ she says. ‘That can be hard to describe sometimes.’
For more information visit: dss.gov.au/free-interpreting
- Australian Bureau of Statistics. Census reveals a fast changing, culturally diverse nation [Media Release]. 2017 Jun 27. Available from: abs.gov.au/ausstats/abs@.nsf/lookup/Media%20Release3
- Australian Bureau of Statistics. Over 28 per cent of Australians born overseas [Media Release]. 2017 Mar 30. Available from: abs.gov.au/ausstats/abs@.nsf/lookup/3412.0Media%20Release12015-16
- Australian Government Department of Health. Fact sheet: Mental health services for people of CALD backgrounds. 2018. Available from: health.gov.au/internet/main/publishing.nsf/content/03B02D60AA5F0376CA257BF0001C9624/$File/Webpage%20update%20MHiMA%20factsheet%20-2.pdf
- SBS Interactive: How diverse is my suburb? Compiled Australian Bureau of Statistics 2016 Census data. Available from: sbs.com.au/news/interactive/how-diverse-is-my-suburb
- Victoria Government Report in Multicultural Affairs 2016-17. Available from: multicultural.vic.gov.au/images/2018/Victorian-Government-Report-in- Multicultural-Affairs-201617.pdf
- Australian Government Australian Institute of Health and Welfare. Older Australia at a glance [Web Report]. 2018 Sep 10. Available from: aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/demographics-of-older-australians/australias-changing-cultural-linguistic-profile
- Carisbrooke P. SBS News. Exploring Clayton, Australia’s most diverse suburb [Internet]. 2016 Jun 22. Information compiled from Australian Bureau of Statistics 2016 Census data. Available from: sbs.com.au/news/exploring-clayton-australia-s-most-diverse-suburb