Communicating with Rural Aboriginals

I am currently on my cardiopulmonary placement, and have been allocated an older Aboriginal woman to treat. This woman was transferred to Perth from a small Aboriginal community east of Perth, for a surgical procedure.
As you would be aware, a pivotal component of treating a surgical/cardiopulmonary patient is ambulation. This acts to increase tidal volume to therefore increase secretion mobilisation, it positions the patient to best increase lung volumes to ensure adequate perfusion and prevent V/Q mismatch, it increases recruitment of lung units to help re-inflate atlectatic segments etc.
Initially, I found it very difficult to treat this patient. She refused to ambulate, was reluctant to take deep breaths, used offensive language, and would only intermittently answer questions. As nice as I tried to be to this patient and despite her limited English, I got the hint that she disliked physiotherapy when she kept telling me to “go away”, that I “talk too much”, and that I’m young- why don’t I walk instead of her. She was fast becoming a patient I wanted to avoid, however I still persisted with her.
I had treated Aboriginal patients prior to this experience, but no one had been from such a small community. I was aware of some cultural differences, such as they don’t make eye contact and the importance of family, but I was still vague on ways to treat this patient without causing cultural offense and the implications that these factors have upon emotions.
It wasn’t until a nurse came to the ward who had worked in an Aboriginal community that I feel my rapport with this patient began to build. This nurse told me the patient did not like being called by her name, but preferred being addressed as “nanna”. This nurse also educated me on key words from her Aboriginal dialect, such as “walk”, “foot”, and “pain”. I was also informed of additional cultural differences to take into consideration. For example, older Aboriginal woman generally sit most of the time and act as a storyteller, therefore they may not be used to walking long distances. Also, not making eye contact is not a sign of dislike but rather a sign of respect. There were also emotional considerations for this patient, such as a family funeral which she could not attend (due to her hospitalisation). Family is an integral part of Aboriginal life, and the fact that she could not participate in the process of mourning would have been very distressing. Also, this woman had not been visited by any family, which would have attributed to her frustration as she was used to being surrounded by her family. Furthermore, as she originated from a small community, she would not have been accustomed to being in the small confines of a hospital room and would be longing for her freedom.
Taking these factors into consideration has led to me develop a new understanding of this patient and resulted in better compliance from the patient. I now know that she is not trying to make my time difficult, but rather her attitudes are reflections of her frustrations. Now, I even occasionally get a “thank you” from this patient, and told that I am “a good woman”. She still does often refuse to ambulate and often uses offensive language towards me, but at least I know it’s not personal and that she must be longing to return home.
My suggestion is if there is someone on the ward who is experienced working with such individuals or within such communities, communicate with them and gain as much knowledge as you can. Not only will it help develop your own understanding, but also put the patient more so at ease. If there is no one on the ward to help, contact an Aboriginal Liaison Officer that works within the public health system, and enquire regarding optimal ways to communicate with the patient. Alternatively, see if the officer is able to visit the patient if they have not already done so. Also, if you see such a patient on the ward and you are not allocated to treat them, request to have them added to your patient list, as it is definitely a learning experience and should hopefully place you in good stead for your rural placement.