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(Culturally Responsive Clinical Practice: Working with People from Migrant and Refugee Backgrounds COMPETENCY STANDARDS FRAMEWORK for CLINICIANS, 2019)

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As a nursing student, competency standard 9.2 from Domain 5 informs my practice of delivering culturally sensitive care, ensuring I meet the unique needs of diverse patients. As a result, I feel more confident and capable in providing appropriate healthcare for my patients from different cultural backgrounds. I now understand why effective communication is essential, why cultural assessments are vital, why inclusive care plans are crucial, and why cultural differences should be respected.

Culturally Responsive Clinical Practice: Working with People from Migrant and Refugee Backgrounds COMPETENCY STANDARDS FRAMEWORK FOR CLINICIANS. (2019). https://culturaldiversityhealth.org.au/wp-content/uploads/2019/02/Culturally-responsive-clinical-practice-Working-with-people-from-migrant-and-refugee-backgrounds-Jan2019.pdf

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This image is a representation of my Journaling. 

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To me, health means prioritizing both my mental and physical well-being. It's not about strict diets but loving myself regardless of others' opinions and doing things that boosts my mental and physical health. Activities like walking and journaling help me feel refreshed.

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My sisters, two cousins and I wearing our cultural costume. The Tongan costume was made by our late grandma and other ladies from her village.

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The Teuaga Tau'olunga is a traditional Tongan costume made from fine mats, crafted by our elders. These mats symbolize respect, honour, and storytelling through painted patterns. They are worn during formal occasions and ceremonies as a mark of respect to elders and important figures. The communal effort in weaving Teuaga Tau'olunga fosters unity and preserves Tonga's cultural heritage and values.

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Ota Ika made by my aunty, with products from our local store Spudshed. 

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Ota Ika, meaning 'Raw Fish' is Tonga's famous dish, also popular in Samoa. Served at important events like weddings and Christmas. Making it with my late grandmother connected me to our ancestral culinary traditions. This dish, featuring raw fish and vegetables, aligns with Australian Dietary Guidelines.

Recipe:

2 Salmon: bite size pieces

3 tomatoes: diced

1 onion: diced

1 cucumber: diced

1 small red chili: diced

600 mL of Coconut cream

3 Lemons: Juice Squeezed

Salt and pepper: to taste

Method:

1. Marinate diced salmon in half the lemon juice and a pinch of salt for 15 minutes in the fridge.
2. Drain lemon juice, add the remaining juice.
3. Mix in cucumber, onion, and tomatoes.
4. Incorporate coconut cream, chili, salt, and pepper. Serve.

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My sisters and I had the privilege to perform our cultural dance for our older cousin's wedding. 

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The Tau'olugna is a graceful dance performed by young girls and women, closely related to the Teuaga Tau'olunga. It holds deep cultural significance, telling stories of our people or ancestors. When performed collectively, it symbolizes unity and harmony, adding visual and cultural richness to Tongan celebrations.

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In 2017, the Tongan NRL team made global headlines by defying expectations as underdogs in the competition. This historic moment held immense significance for Tongans as rugby represented more than just a game; it was to represent their people. As Jason Taumalolo quoted in his interview "Its more than winning" (Patrick Skene., 6 November, 2019). Despite doubts about their chances, Tonga faced New Zealand, and during the match, Tongan supports sang a meaningful hymn passed down through generations. The hymn inspired hope, and despite losing the first half, Tongan supporters kept singing and Tonga emerged victorious with a score of 28 to 22. This victory brought immense joy and unity to the Tongan community. It symbolized a triumph not only for Tonga but for all small Pacific nations.

The West Australian. (2019, June 12). Tonga name strong squad for showdown with New Zealand. The West Australian. https://thewest.com.au/sport/rugby-league/tonga-name-strong-squad-for-showdown-with-new-zealand-ng-50a3b81a48adbd280fd5e7d3975a14b3

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Impact of Social Determinants on Migrant/Refugees

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Impact of Social Determinants on Migrant/Refugees

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Social determinants such as unemployment, housing, and food insecurity have a huge impact on the health of migrants/refugees in Australia (World Health Organization, 2023). In high-income Australia, migrants and refugees, particularly those with low incomes or government assistance, often struggle to afford an adequate supply of food, highlighting the strong link between food insecurity and poverty (Coalition, 2021). Nutritional foods are essential for our lives, not being able to afford food will leave migrants and refugees in a state of stress mentally and physically. Migrants and refugees in Australia often struggle to find employment due to language barriers and differences in qualifications recognition. This high unemployment rate can severely affect their mental health, leading to distress and, in some cases suicidal thoughts (Ziersch et al., 2023). Migrants and refugees, especially those with low incomes or unemployed, experience mental distress and repression in Australia due to the high housing costs and living in overcrowding spaces (Ziersch et al., 2023).

World Health Organization. (2023). Social determinants of health. World Health Organization. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Ziersch, A., Miller, E., Walsh, M., Due, C., Callaghan, P., Howe, J., & Green, E. (2023). ‘I really want to work for me to feel good myself ‘: Health impacts of employment experiences for women from refugee backgrounds in Australia. SSM - Qualitative Research in Health, 3, 100209. https://doi.org/10.1016/j.ssmqr.2022.100209

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Lau Nonu, also known as Morinda Citrifolia, as a plant commonly used in Tongan culture to soothe children with fever, alleviate body aches through massage, and make a drink called 'Vai pala' for sore throats and clearing phlegm.

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South Sudan Flag Map and Meaning | Mappr. (2021, July 12). Www.mappr.co. https://www.mappr.co/flag-maps/south-sudan/

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Principle Health Issues Faced by Refugees

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Principle Health Issues Faced by Refugees

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South Sudan was listed number one amongst the top 10 poorest countries in the world in regards of GDP per capita Purchasing Power Parity (Ninrew, 2023). War, droughts, and famines have driven South Sudanese refugees to seek refuge in Australia. Sudanese often arrive with health concerns, like low vitamin D, schistosomiasis, and tuberculosis, which are also recognized in the Australian refugee health practice guide (Queensland Health Multicultural Services, 2011).

Vitamin D:
Vitamin D is a hormone that controls calcium levels in the blood. It is needed for strong bones and muscles (Vitamin D, 2012).  Treatments for low vitamin D is high/low dosage of vitamin D supplements and regular monitoring, sunlight exposure, and dietary changes ensuing that refugee patients eat foods rich in vitamin D (Paxton & Singleton, n.d.).

Schistosomiasis:
Schistosomiasis is an infectious disease caused by parasitic blood flukes belonging to the genus Schistosoma. It can manifest as both acute and chronic conditions (Davis et al., n.d.). For individuals who have lived in or travelled to Schistosomiasis-endemic regions like Africa or parts of Southeast Asia. If results are positive, praziquantel in two doses of 20 mg is prescribed to treat patients with Schistosomiasis (Davis et al., n.d.).

Tuberculosis:
Tuberculosis is a is an airborne disease caused by germs that primarily target the lungs but can also infect other body organs like the brain, kidneys or spine. If left untreated it can lead to death (CDC, 2020). Antibiotics are prescribed to help treat patients affected by tuberculosis and other medications that may be prescribed are isoniazid, pyrazinamide, and ethambutol. However, the listed medication is only administered under the supervision of a healthcare professional (Denholm et al., n.d.-a).

CDC. (2020, April 29). Fact Sheets | General | Tuberculosis: General Information | TB | CDC. Www.cdc.gov. https://www.cdc.gov/tb/publications/factsheets/general/tb.htm#:~:text=Tuberculosis%20(TB)%20is%20a%20disease

Davis, J., Philips, C., & Clifford, V. (n.d.). Schistosomiasis» Australian Refugee Health. Australian Refugee Health Practice Guide. https://refugeehealthguide.org.au/schistosomiasis/

Denholm, J., Bailes, M., & Francis, J. (n.d.). Tuberculosis (TB & LTBI)» Australian Refugee Health. Australian Refugee Health Practice Guide. https://refugeehealthguide.org.au/tuberculosis-tb/

Ninrew, C. (2023, August 18). South Sudan ranked world’s poorest by GDP per capita. Eye Radio. https://www.eyeradio.org/south-sudan-ranked-worlds-poorest-by-gdp-per-capita/#:~:text=In%20the%20Forbes%20report%2C%20South

Paxton, G., & Singleton, G. (n.d.). Low Vitamin D» Australian Refugee Health. Australian Refugee Health Practice Guide. https://refugeehealthguide.org.au/low-vitamin-d/

Queensland Health Multicultural Services. (2011). Community Profiles for Health Care Providers - Sudanese Profile. https://www.health.qld.gov.au/__data/assets/pdf_file/0031/157378/sudanese2011.pdf

South Sudan Flag Map and Meaning | Mappr. (2021, July 12). Www.mappr.co. https://www.mappr.co/flag-maps/south-sudan/

Vitamin D. (2012). Vic.gov.au. https://www.betterhealth.vic.gov.au/health/healthyliving/vitamin-d

WHO. (2019, April 17). Schistosomiasis. Who.int; World Health Organization: WHO. https://www.who.int/news-room/fact-sheets/detail/schistosomiasis

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This image above is a great example of how Religion (Christianity) brought us all together for a youth night to praise God. 

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Religion is a vital aspect of Tongan culture, introduced by Western missionaries (Scroope, 2018). It deeply influences traditions, laws, and daily life. For instance, on Sundays, businesses close as a sign of rest, echoing the biblical Sabbath. In social events, prayer and acknowledgment of God are customary, reflecting religion's profound impact. Overall, religion fosters unity and harmony among the Tongan people.

Scroope, C. (2018). Tongan Culture - Religion. Cultural Atlas. https://culturalatlas.sbs.com.au/tongan-culture/tongan-culture-religion