SPECIAL EDITION
INDIGENOUS HEALTH AND UNION ISSUES
THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION SPECIAL EDITION
INSIDE
Prejudice impacts Aboriginal health Building trust in health The history of lock hospitals Remembering Wave Hill
CREATING POSITIVE CHANGE
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CATSINaM
Creating positive change Janine Mohamed, CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) talks to The Lamp about meeting the challenges facing Indigenous nurses, midwives and patients within our health system.
Q: WHAT ARE YOUR GOALS FOR CATSINaM? I am absolutely passionate about improving the health and wellbeing of Aboriginal and Torres Strait Islander people, and also about increasing the numbers of Aboriginal and Torres Strait Islander nurses and midwives in the health system, and improving their experiences in their workplaces. An important way to address all these goals is to improve the cultural safety of health professionals and health services. I also want the nursing and midwifery professions to think about how we might want to make a formal apology to Aboriginal and Torres Strait Islander people, following the example recently set by the Australian Psychological Society.
OUR COVER: JANINE MOHAMED PHOTOGRAPHED BY TATE NEEDHAM
Q: WHAT IS THE ROLE OF CATSINaM IN CLOSING THE GAP? Our main priority at CATSINaM is to increase the recruitment and retention of Aboriginal and Torres Strait Islander peoples into the nursing and midwifery professions. This is vital for improving the health and social and economic outcomes for our people. Aboriginal and Torres Strait Islander nurses and midwives account for only about one per cent of the total nursing workforce, which is far less than what we’d like to see, given Aboriginal and Torres Strait Islander people are three per cent of the Australian population. CATSINaM also wants to positively affect the education of non-Indigenous nurses and midwives, ensuring they receive a good grounding in what cultural safety and respect is, and that this is a lifelong journey. CATSINaM also works with its partners in Aboriginal Health to ensure we have a health system free of racism.
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Q: WHAT PARTICULAR ISSUES DO INDIGENOUS NURSES FACE AT WORK? Aboriginal and Torres Strait Islander nurses and midwives belong to the world’s oldest living cultures. We are resilient, strong and proud peoples. We have survived the horrors of colonisation and the oppression that continues across so many parts of society today. But often we are in workplaces that do not properly support us to undertake our cultural responsibilities. Often we are in workplaces where institutional racism is so embedded that it is not visible – except to those of us who are harmed by it. It is for these reasons that I am so determined to see cultural safety embedded across the health system; it is important for our members, as well as their patients.
Q: CAN YOU MENTION A COUPLE OF WAYS THAT INDIGENOUS NURSES AND MIDWIVES ARE STARTING TO TRANSFORM HEALTH OUTCOMES FOR THE INDIGENOUS COMMUNITY? Aboriginal and Torres Strait Islander people have been performing the roles of nursing and midwifery for tens of thousands of years. We have a long and proud history of caring for, and with, our people and our communities. It would be great to see nursing and midwifery informed by this history to have a shared history of nursing and midwifery in Australia. We have a very clear understanding that health services provision with the community, through the philosophies of self-determination, is key to improving health outcomes. Since colonisation began its devastating toll upon our country and our people, we have continued to provide this care.
CATSINaM
PHOTOGRAPHY BY TATE NEEDHAM
‘Aboriginal and Torres Strait Islanders have been performing the roles of nursing and midwifery for tens of thousands of years.’ — Janine Mohamed
May Yarrowick, who trained as an obstetric nurse in Sydney in 1903, may well be our first Indigenous nurse qualified in Western nursing. We need to be very clear that the achievements of Aboriginal and Torres Strait Islander nurses have a long history.
Q: HOW CAN EMPLOYERS ATTRACT AND SUPPORT THE INDIGENOUS NURSING WORKFORCE? Employers need to ensure that people at all levels of their organisations – from governance structures and senior executives to the clerical and reception staff – have the opportunity to meaningfully engage with cultural safety training. There needs to be an understanding that this is not a one-off, tick-the-box event, but a process that requires constant work and self-examination. These structures need to be examined to ensure they include Aboriginal and Torres Strait Islander people. Initiatives like cadetships, running cultural safety training within organisations, and modelling work that is successful, are some of the strategies employers can deploy to attract and retain our members. Another key idea is encouraging their Indigenous nursing and midwifery staff to join CATSINaM.
Q: HOW CAN NURSES AND MIDWIVES WORK BETTER WITH ABORIGINAL HEALTH WORKERS? If nurses and midwives do not have a sound understanding of cultural safety and respect and a commitment to continually work towards culturally safe practice, then their capacity for working with Aboriginal Health Workers will be compromised. There is also a very real possibility they will only add to the burden upon their Aboriginal Health Worker colleagues.
Q: WHAT ARE THE GOOD NEWS STORIES AND THE PROGRESS BEING MADE IN ABORIGINAL HEALTH? An achievement I believe we should all feel proud of is that we are beginning to talk about and name racism in our health system. The work we all have now is to eradicate it and not give this to our children to deal with. I am also really proud of what CATSINaM has achieved – for our resourcing, we punch way above our weight in the impact we have across so many spheres – from policy and program development to helping to grow the next generation of Aboriginal and Torres Strait Islander nurses and midwives. n
GIVE YOUR SUPPORT CATSINaM is urging NSWNMA members to support four critical initiatives: •A National Aboriginal and Torres Strait Islander Health Authority to lead development of national Aboriginal Health policy and be “the watchdog for all expenditure on Aboriginal health and matters impacting on Aboriginal health”. •A n amendment to the Health Practitioner Regulation National Law Act 2009, so it clearly identifies cultural safety as a priority. • A dedicated National Aboriginal and Torres Strait Islander Nursing Workforce Strategy to fast track workforce increases. •C ontinued funding for CATSINaM past June 30, 2018.
MORE INFORMATION A longer version of this interview can be found on the NSWNMA website nswnma.asn.au Visit the CATSINaM website catsinam.org.au
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ABORIGINAL HEALTH
Prejudice impacts Aboriginal health Teaching clinicians about ‘unconscious bias’ can lead to improved health outcomes for Indigenous patients, say experts.
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n April last year, the blind Aboriginal singer Gurrumul Yunupingu languished at the Royal Darwin hospital’s emergency rooms waiting to be treated while he bled internally for eight hours. Yunupingu’s manager and his private nurse had taken him to the hospital and had gone home confident that he would have immediate surgery to stop the bleeding. Mark Grose, Yunupingu’s manager, later told ABC radio he believed the hospital delayed the life-saving treatment because staff made an assumption that Gurrumul’s liver damage was a result of heavy alcohol use, and not the chronic hepatitis B infection he had since he was a child. While the hospital strongly refuted the claims, the case put a spotlight on the very real
Deakin University’s Dr Yin Paradies, an expert in the effects of racism on health, told The Lamp that numerous studies show discrimination is having real effects on Indigenous health. “More than a dozen Australian studies have found disparities in medical care experienced by Indigenous patients, compared to non-Indigenous patients, after adjusting for a range of medically appropriate factors such as age, sex, marital status, place of residence, etc. “These studies suggest that Indigenous patients are about a third less likely to receive the medical care that non-Indigenous patients receive for the same conditions.”
‘ Studies suggest that Indigenous patients are about a third less likely to receive the medical care that non-Indigenous patients receive for the same conditions.’ — Dr Yin Paradies problem of discrimination against Indigenous patients in the health care system.
A DISPARITY IN CARE BETWEEN INDIGENOUS AND NON-INDIGENOUS PATIENTS
In a study of 7,000 Indigenous people (published in the International Journal for Equity in Health in 2013), one third (32.4%) of Indigenous patients said they were discriminated against in a medical setting most or all of the time. The discrimination included being “treated rudely, as if they were inferior or with disrespect; [and being] ignored, insulted, harassed, stereotyped or discriminated against”, the study’s researchers wrote.
The disparity in care in some areas of health care is even higher, Dr Paradies notes. “For example, Indigenous patients were three times less likely to receive kidney transplants in one study.”
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Tackling discrimination against Indigenous patients in the health care system effectively requires “working across various parts of the system”, said Dr Paradies. “From changing implicit and explicit attitudes and beliefs of healthcare providers
ABORIGINAL HEALTH
32.4%
of Indigenous patients said they were discriminated against in a medical setting
33%
of Indigenous patients are less likely to receive the medical care that non-Indigenous patients receive for the same care
3 times less of all employed nurses and midwives are Indigenous
and other hospital staff, to ensuring processes are in place to support Indigenous patients during their hospital journeys. “In practice, this involves a range of cultural competency and anti-racism training, improving the quality of data on Indigenous patients in the system and having feedback mechanisms for Indigenous patients and their broader communities to ensure the health care system is free from discrimination and culturally appropriate.” Writing for The Conversation news site, Gregory Phillips, Associate Professor, Research Fellow in Aboriginal Health, Baker IDI Heart & Diabetes Institute, concurred. “Teaching health professionals about Indigenous health will effectively require teaching about unconscious bias and racism; one’s own culture, values and motivations. It requires training in ‘unlearning’ preconceptions; regular reflections on one’s own practices; as well as education about Aboriginal and Torres Strait Islander cultures,” he wrote.
WITH TIME AND PATIENCE, ATTITUDES CHANGE Dr Phillips singled out a program at the University of Western Australia for mention. Researchers assessing the program found “a key shift in understanding and
engagement occurred when fourth-year students on medical rotation were required to complete a comprehensive case history and discussion, including reflective comments, in relation to an Aboriginal person they have seen during that rotation”. Dr Phillips noted that educators have found “patiently moving Australian medical students who were initially hostile to Aboriginal Health curricula through their discomfort to reach the ‘a-ha’ moment, is a key teaching strategy in producing better prepared doctors”. But Dr Phillips added the proviso that cultural awareness training will only be truly effective when systemic factors are also addressed: “workplace culture, policies, power, funding and criteria on which decisions are made”. What is needed is something he describes as the “deeper transformational work of institutional decolonisation”. This means asking questions such as “how can power be shared? On whose terms are decisions made? Who owns institutions and services? Whose criteria are used to judge effectiveness?” The bottom line, according to Dr Phillips, “is that Aboriginal and Torres Strait Islander definitions and measurement tools of success are more likely to contribute to producing better outcomes than those where unconscious bias and racism is implicit”. n SPECIAL EDITION INDIGENOUS HEALTH AND UNION ISSUES | 5
INDIGENOUS WORKFORCE
More Indigenous nurses builds trust in health Aboriginal nursing and midwifery cadetships have transformed the lives of Indigenous nurses and patients alike.
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Leona left school when she was 14 and had children young; she didn’t think nursing was a realistic option for her to pursue.
‘ Our health is at third world standards. From a historical perspective, we know that indigenous people have gone in to health facilities and don’t come out’ — Leona McGrath
“Just one per cent of nurses and midwives are Indigenous, and we are three per cent of the population,” she says.
nursing and midwifery cadetships. Leona applied for and was accepted into both the degree and the cadetship program.
idwife Leona McGrath first had an inkling she might like to become a nurse when she was a young girl and saw her sister give birth to her niece. “I thought how wonderful to do something like that. But it didn’t seem like a reality because I didn’t think I was smart enough.”
Outside of seeing her sister give birth, Leona’s experience with the health care system as a young Indigenous girl growing up in Queensland had not been a very positive one. “Our health is at third world standards. From a historical perspective, we know that Indigenous people have gone in to health facilities and don’t come out.” “You have a lot of people who don’t trust the health care system for a lot of reasons.” Despite multiple barriers to a career in nursing, Leona’s life changed when she read about UTS’s bachelor of midwifery program in 2006, and at the same time she heard about a NSW Health program for Aboriginal 6 | SPECIAL EDITION INDIGENOUS HEALTH AND UNION ISSUES
The cadetship, which provides a scholarship and paid hospital placements to Indigenous trainees, “dramatically changed my life,” says Leona. She trained at the Royal Hospital for Women in Randwick, but she now works with the health department as the senior adviser for the Aboriginal Nursing and Midwifery Strategy. Leona now helps to run the cadetship scheme, which provides students with a study allowance for 40 weeks a year. Cadets are also required to undertake a paid work placement during the ten-week non-teaching period each year. Since the program commenced in 2004, 132 nursing and midwifery students have graduated in NSW.
INDIGENOUS WORKFORCE
Skye Parsons and Leona McGrath “There are now 68 Aboriginal cadets in the program across NSW,” Leona notes. Another 60 students are receiving financial scholarships, she says.
A NEED FOR CULTURAL SAFETY For Leona, the program is not just about giving Indigenous students career paths that otherwise might be closed to them, it’s also about addressing the Indigenous community’s needs for cultural safety. “Unfortunately the reality is that racism means that health services can be unsafe for a lot of Aboriginal people.” “I know that my pregnancy would have been a whole lot different if I had another black face. Aboriginal people have that connection with each other.” Skye Parsons, the project officer for the Aboriginal Nursing and Midwifery Strategy, has worked as a midwife at the RPA in ante-
natal health, seeing Aboriginal women a nd women having Aboriginal babies. “To see another black face there really puts people at ease,” Skye says. At RPA she offered a flexible service and appointment time. “Antenatal attendance was much earlier. People were booking in during the first trimester.” Having a program specifically designed for Aboriginal women had a positive impact on the community, she says: “People were having healthier babies.” The cadetship program is growing, Skye notes, with 15 nursing and midwifery students enrolled last year.
In 2015:
360,008 the total number of nurses and midwives in Australia
3,187
nurses and midwives employed in Australia identified as an Aboriginal of Torres Strait Islander
1.1%
of all employed nurses and midwives are Indigenous
“Working in a hospital they learn policy and procedure. Cadets are work ready when they graduate,” she notes. As Leona puts it: “It’s transforming lives.” n SPECIAL EDITION INDIGENOUS HEALTH AND UNION ISSUES | 7
NURSING HISTORY
The hidden history of medical incarceration Medical incarceration can be seen as an example of the role of health care professionals and systems in colonisation writes Melissa Sweet. Dorre Island lock hospital
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n the first decade of the 20th Century, a new medical scheme to remove Aboriginal people from across Western Australia to remote islands was described by government officials as a grand humanitarian venture. Between 1908 and 1919, several hundred Aboriginal people said to have the non-specific diagnosis of “venereal disease” were taken to Bernier and Dorre Islands, which lie about 30 nautical miles west of Carnarvon in Shark Bay. “Such a great undertaking of this kind has never before been attempted in any part of the Commonwealth, and it is an emphatic contradiction to the many charges made against the State Government of neglecting the welfare of the aborigines…,” the Chief Protector of Aborigines in WA, Charles Frederick Gale, wrote in 1908. The segregation of “these unfortunate people” was not only for their own sakes but “for the sake of the community at large”, Gale stated in the annual report of the Western Australia Aborigines Department. In a briefing note to government colleagues dated 17 September 1908, Gale urged the need for police involvement: “There may be some Natives who will voluntarily go to a distant land to be cured, but I very much doubt it. The only alternative is to treat them as prisoners, and force them to go; the end justifying the means… It is only by force and practically making them prisoners, that the end we have in view will be accomplished, and this can only be done by the police.” 8 | SPECIAL EDITION INDIGENOUS HEALTH AND UNION ISSUES
At least 162 people died at the Bernier and Dorre Island lock hospitals, although this is likely to be a significant under-estimate and also does not include those who died en-route, often on long, harsh journeys in chains, with periods in jail or other lock-ups.
THE LOCK HOSPITALS WERE RACIALLY BASED The concept of lock hospitals dates to their use in English garrison towns in the 1800s to protect the health of soldiers by confining women who were thought to be engaged in sex work and to have venereal disease. Abandoned in Britain following vocal opposition, lock hospitals were continued elsewhere in the British Empire in the 20th century. In Australia they were mainly used to incarcerate Aboriginal and Torres Strait Islander people under racially based laws (health authorities did not support lock hospitals for the general population on the grounds they would discourage people from seeking treatment for venereal diseases). In Queensland, more than 1,144 Aboriginal and Torres Strait Islander people were admitted to a lock hospital that operated from 1928 to 1945 on Fantome Island in the Palm Island group, 70 kilometres north-east of Townsville. A leprosarium also operated on Fantome Island from 1940 to 1973. The history of lock hospitals is closely intertwined with the history of the medical incarceration of Aboriginal and Torres Strait Islander people with leprosy at multiple sites between 1884 and 1986. These included Mud Island and Channel Island in the Northern Territory; Friday Island in the Torres Strait, Peel
From left clockwise: Bernier Island; a plaque remembering those who were imprisoned and who died on the islands; Dorre ruins; medical inmates. Island in Moreton Bay and Fantome Island in Queensland; and in Western Australia included islands near Cossack, and other sites at Derby, Broome and Beagle Bay. As with lock hospitals, some of these institutions housed children. In 1925, a Darwin newspaper recorded that a four-year-old Aboriginal girl was discharged from Mud Island lazaret after being examined by doctors and found free of any trace of leprosy. She had been an inmate since birth, her mother having had leprosy and since died. Whether people were being removed to lock hospitals or leprosy institutions, they often faced traumatic journeys as well as long periods in prisons or other lock-ups awaiting transport.
A NEED FOR ACKNOWLEDGEMENT In WA, people were transported from Derby and other places to Cossack, and shipped from Cossack, Derby and Beagle Bay to Darwin in the NT, and then some patients subsequently were returned on trucks to WA from Darwin. These episodes of medical incarceration can be seen as archetypal examples of the role of health care professionals and systems in colonisation, contributing to intergenerational trauma. While the situation for medical inmates varied within and between the various sites over time, some general themes can be identified from searches of the academic literature and archival and newspaper sources. These include the unreliable nature of diagnoses and record-keeping, the harmful nature of many interventions, high mortality rates, inadequate staffing, and
harsh living conditions. Although largely portrayed in public debate at the time as benevolent, humanitarian interventions, these episodes inflicted physical, mental, social, emotional, cultural and spiritual trauma over a period lasting almost a century. They led to the dislocation of multiple generations of Aboriginal and Torres Strait Islander people from their families, communities and country, and were part of a pattern of events and policies that interrupted people’s ability to care for country and to undertake cultural practices and responsibilities. This history of incarceration has ongoing consequences for the families, kin, communities and country of those taken away. Interviews with dozens of Aboriginal and Torres Strait Islander people have shown a strong wish for wider public acknowledgement of these histories, including by health systems and health professionals, and for healing projects. They also want stories relating to the histories of medical incarceration included in health and medical curricula, as well as wider curricula at all levels of the education system. n Melissa Sweet is a public health journalist and publisher of the social journalism project for health, Croakey. Her PhD is titled “Acknowledgement”: A social journalism research project relating to the history of lock hospitals and other forms of medical incarceration of Aboriginal and Torres Strait Islander people.
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Aboriginal and Torres Strait Islander readers are warned this article contains images of people who are now deceased.
NURSING HISTORY
EQUAL PAY AND LAND RIGHTS BORIGINAL HEALTH
Equal pay strike pioneered land rights Half a century ago, Aboriginal stockmen and their families in the Northern Territory took a historic stand in support of equal pay and land rights. Support from the Australian union movement was vital to their success. Gurindji elder Vincent Lingiari, who led his people in a walkout off Wave Hill cattle station in 1966.
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ifty years ago, in August 1966, a handful of union volunteers in Darwin loaded a small Bedford truck with food destined for a remote cattle station known as Wave Hill. The food was a donation from the North Australian Workers Union (NAWU) to Aboriginal stockmen and their families who were on strike demanding equal pay with white workers. The strike developed into a nine-year struggle by the Gurindji people to gain rights over their ancestral land. It had been occupied as a cattle farm by the family of British Lord Vestey since 1914. The Bedford truck belonged to waterside worker Brian Manning, who died in 2013. He was accompanied on the gruelling 750km drive by the NAWU’s Aboriginal organiser, Dexter Daniels, and another Aboriginal man, Robert
Tudawali, a former top football player who starred in Charles Chauvel’s pioneering 1955 film Jedda.
paid around 3 pounds 6 shillings ($7) when white workers were paid around 23 pounds ($46),” he said.
Manning drove the truck on about 15 trips to support what is now known in Australian history as the Wave Hill walk off.
“In addition, Aboriginal workers were to be fed in accordance with a schedule in the Wards Employment Ordinance, which provided for an adequate and varied nutritious diet. Daily fare in the Wave Hill stock camps consisted of dry salted beef, dry bread, tea and sugar.”
Manning said much of the road to Wave Hill was “a horror stretch consisting of a series of temporary, heavily corrugated diversions which could not be driven at great speed with my overloaded small truck. We crawled along most of the way between 15 and 20 mph.”
DENIED EQUAL WAGES In a 2002 speech, Manning explained how Aboriginal workers on white-owned stations were “arbitrarily bound to employers by a system of institutionalised poverty.” “For a seven-day week, working from sun-up to sun-down, Aboriginal pastoral workers in the NT were
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In March 1966, the Arbitration Commission ruled that Aborigines should be paid equal wages but not for almost three years, to allow station owners time to prepare for the change. The delay sparked widespread anger among Aboriginal workers. At one of the largest stations in the Northern Territory, Wave Hill, Gurindji leader Vincent Lingiari asked the station master for equal wages and was refused. The Gurindji and other Aboriginal
© COMMONWEALTH OF AUSTRALIA
PHOTO BRENDA L CROFT
Aboriginal and Torres Strait Islander readers are warned this article contains images of people who are now deceased.
EQUAL PAY AND LAND RIGHTS
Dexter Daniels – organiser for the North Australian Workers Union.
Brian Manning’s truck; Vincent Lingiari and Gough Whitlam.
‘ For a seven-day week, working from sun-up to sun-down, Aboriginal pastoral workers were paid around 3 pounds 6 shillings when white workers were paid around 23 pounds.’ — Brian Manning stockmen, domestic workers and their families collected their belongings and quietly walked away from Wave Hill station to camp at a dry river bed about 16km away. This event has become part of Gurindji folklore and is annually re-enacted as ‘Freedom Day’.
“RELIEF IN THE REALISATION THAT THEY WERE NO LONGER ON THEIR OWN” Manning remembered that the arrival of the Bedford truck at the strikers’ camp was greeted with “loud and excited cheers from a swelling
crowd... I could actually sense their relief in the realisation that they were no longer on their own.” Vincent Lingiari told Manning that all Aboriginal workers were on strike except the pumpers – maintenance workers who camped out at water bore sites where windmills and diesel motors continuously pumped water into troughs for the cattle. W hen Ma nning sug gested the pumpers should walk off too, “Vincent hastened to assure me that they wouldn’t call out the pumpers because they had to look after the cattle.”
Strike negotiations; Wave Hill workers; and the strikers’ campsite.
“Here was another insight into this quiet, unassuming and responsible leader who understood his priorities.” Unions sponsored Aboriginal strikers on trips to the southern states so people could hear their case first hand. Donations from union members provided the strikers’ campsite with a Toyota truck, fencing materials, a brick-making machine, roofing iron and a water pump. In October 1968, equal pay became law in the pastoral industry and the Gurindji struggle advanced beyond a claim for equal wages to a demand for their ancestral land. In August 1975, nine years after the walk off, Prime Minister Gough Whitlam presented the Gurindji with leasehold title over part of their land. And in 2016, the National Museum of Australia decided to acquire Brian Manning’s historic Bedford truck. n
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ABORIGINAL HEALTH
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