Academic journal article Outlines : Critical Practice Studies

Patient Participation in Healthcare Practice in Greenland: Local Challenges and Global Reflections

Academic journal article Outlines : Critical Practice Studies

Patient Participation in Healthcare Practice in Greenland: Local Challenges and Global Reflections

Article excerpt

Greenland as the Context of the Study

The current healthcare system in Greenland was established during the Danish colonization of the country (1721 - 1953). With the end of colony-status, Greenland was integrated as an administrative region within Denmark and underwent rapid modernization. In the span of a few generations the country went from being a largely nomadic hunter society to becoming partially industrialized on the model of Western societies. The population was concentrated in a number of towns with factories, administrative services and educational institutions, and in several smaller towns and settlements where production is low-tech and partly used for self-subsistence. Institutions based on economic rationality and individualism replaced the communal organization of social life, which had been necessary for survival in the hunter society. However, the practices, norms and values of the hunter society, dominant only a few generations ago, continue to influence the modes of thought and practice in contemporary Greenland, while some features of the postcolonial society are not quite overcome (Petersen, 1993).

The 56,000 inhabitants are spread in 17 towns and 54 settlements distributed along more than 2.000 km of coastline with no roads connecting them. Nuuk is by far the biggest town with 17.000 inhabitants. All transportation is by ship, flight or helicopter, which is exhausting, expensive and often time consuming. Internet and telephone communication are well functioning and accessible for most people.

The healthcare system holds doctors, therapists and nurses in regional hospitals in the five largest towns. In the smaller towns and settlements there are medical personnel with varying degrees of qualifications. Telemedicine is being established, but is not yet functioning everywhere. Lack of professionals and turnover by short-term professionals from Denmark is a current problem everywhere in the healthcare system. Thus, the availability of treatment depends on the competences of the current staff at any given time (Deloitte, 2010).

The situation with many professionals from outside Greenland causes communication problems between patients and professionals, who do not speak Greenlandic and are not familiar with Greenlandic culture and practice. Many Greenlanders, particularly elderly people from towns and settlements, are cautious and reserved in expressing their wishes and needs, having grown up in a time when this was seen as a virtue and a necessity for living in a small and isolated society (Elsass, Christensen, Falhof & Hvolby, 1994a, 1994b; Petersen, 1993; Lynge, 2000). The withdrawnness is often misunderstood by professionals coming from outside of Greenland. In addition to this, the official language of the healthcare system is Danish which many patients do not master.

The Status of 'Involvement' in Present Greenlandic Healthcare

Within the last three to four decades patient involvement in healthcare practice has been put on the agenda in most Western European and North American countries1 along with a development in disease patterns with larger numbers of populations living with chronic diseases due to better treatment, and longer duration of life. The agenda for involving patients during hospital care has many sources: WHO's human rights, various ethical demands, patients' legal rights, the development of professional practice related to quality, economic calculations, and more. There is a swarm of understandings of what interests 'involvement' of patients should serve in practice which inform different initiatives, from tools for patient involvement in professional decision making (e.g. European Commission, 2012; Stacey et al., 2014) to professional attempts to recognize patients' complex and diverse problems in everyday life with illness (e.g. Armstrong, Herbert, Aveling, DixonWoods, & Martin, 2013; Barello, Graffigna, & Vegni, 2012). It seems that the agenda tends to be set by the professionals and thereby be disease-oriented. …

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