Aust Fam Physician
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Although all Australian healthcare providers are acutely aware of the health outcomes for Aboriginal and Torres Strait Islander peoples, many general practitioners may feel unprepared to take on the challenge of working in an Aboriginal medical service or in a remote Indigenous community. To highlight the immense rewards, without minimising the challenges, AFP invited Dr Lara Wieland, a GP with longstanding experience in the front-line of providing primary care for Aboriginal peoples, to share her thoughts.
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Given the health inequity faced by Aboriginal people, it is important that interactions with general practitioners (GPs) are effective and that GPs are aware of issues affecting culturally competent practice. ⋯ Respectful attitudes and good communication and consultation skills need to be combined with knowledge of the historical, cultural, social, medical and system factors that impact on healthcare delivery for Aboriginal patients. Access to cultural mentorship or support is important to promote culturally competent practice.
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Smoking is the most important preventable cause of adverse outcomes in pregnancy. However, most smokers who become pregnant continue to smoke and most of those who quit relapse after delivery. ⋯ Continuing to smoke during pregnancy is strongly associated with socioeconomic disadvantage, mental illness and Aboriginal and Torres Strait Islander populations. Quitting is more difficult for these groups and interventions assist only sixin every 100 pregnant smokers to quit. Behavioural counselling is the first-line treatment. Nicotine replacement therapy (NRT) can be offered if the smoker is unable to quit without it, although its efficacy is uncertain. Adequate doses of nicotine and good adherance may be required for the best results. The use of NRT in pregnancy is likely to be less harmful than continuing to smoke. Women should be encouraged to quit smoking before becoming pregnant.
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Skin infections are a cause of significant morbidity in Aboriginal and Torres Strait Islander populations. ⋯ Management should consist of treatment of the patient through medication and also general measures for the patient, their family and the community as a whole. There are significant health and socioeconomic burdens placed on communities as a result of the high rate of skin disease in some settings.