Problem: Read the following story and identify the different determinants of health portrayed within the story. Discuss the ways in which each determinant of health impact has impacted on the individuals within this story.
Sam is a 52-year farmer from a remote town in southern New South Wales. The family has worked the farm for three generations. Sam and his partner Kylie have been married for 25 years and have three children - Jim 20 years old, Marla 15 years and Sally, 12 years old. Jim is at University in Canberra. Marla wants to leave school and start an apprenticeship as a motor mechanic, but her father says it is "not a career for a girl" and won't approve her leaving school early. Sally started high school at the beginning of the year.
The farm has not produced any income for the last two years because of floods, but the value of the farmland means that the family does not qualify for income support from the Government. At times the family has had to rely on charity from local Food Banks to survive. Jim works 40 hours a week, while continuing to study full time so he is not a burden on his parents. He is struggling to keep up with his university work and is on an "academic performance improvement plan" after failing three out of four courses last semester and will be excluded from University if he does not pass all his courses this semester. He is too ashamed and embarrassed to seek help from the University services and feels very isolated because he is never able to attend classes and does not have any friends. He has not talked to his parents about the situation.
Kylie started to work as a casual care assistant at the local aged care facility to help provide an income for the family a year ago, but she had to stop working three months ago. She is in Melbourne with Sally, who is being treated for leukaemia in the Royal Children's Hospital. Sally is having a bone marrow transplant and her treatment will take six months.
Sam is not coping well with his family away and being in constant conflict with Marla over her career choice. He feels depressed, but he does not want to see anyone because he feels ashamed and does not want anyone to know how he is feeling. The local doctor is his cousin, and the local pharmacist is his brother. There are no counselling or psychology services located within the town. There are some psychologists who consult using tele-health, but the internet service at the farm is very slow because they can't afford a satellite internet service. Sam drinks alcohol every evening until he passes out.
He needs some help on the farm, so he hires brothers Ali and Zaki to help. Ali and Zaki are refugees from Afghanistan and have recently moved into the town with their families. They have had a long journey to Australia since leaving Afghanistan 8 years ago and have spent time in immigration detention centres. They are the only members of the Afghani community in the town and feel very isolated. They are aware that some of the people in the town are not welcoming and are fearful of their religion. There is only one male doctor in town, and the women of the family do not feel comfortable consulting with him. Ali and Zaki can speak English, but both have difficulties reading English, and cannot read the health warnings on the agricultural chemicals. Ali uses a chemical without protection and is found unconscious by Sam in the shed. The nearest hospital is 50 km away.
Sam decides that the best option is to drive Ali into the hospital rather than wait for the ambulance volunteers. He puts Ali into a vehicle and starts the long drive into town along dirt roads. He drives too fast and misses a corner rolling the vehicle. Ali is not wearing a seatbelt and is thrown out of the vehicle. Sam bumps his head on the front window screen and briefly loses consciousness but is able to get out of the car and check on Ali, who is unconscious, but still breathing. Sam uses the two-way radio to get help. The volunteer ambulance officers arrive ninety minutes later, and find Ali's condition is stable, but Sam is drowsy and disoriented to time and place (which suggests a head injury). They stabilise both patients and take them into the local emergency department that is operated by the GP. The decision is made that both men will need to be transported to the city by air-ambulance.