1 monash university department of rural & indigenous health [email protected]...
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Monash UniversityMonash UniversityDepartment of Rural &Department of Rural &
Indigenous HealthIndigenous Health
Indigenous Health Unit
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Indigenous Cultural Awareness / Cultural
Safety Trainingfor Health Professionals
Marlene Drysdale Isabel Ellender
February 2009
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ObjectivesTo explore culture & cultural competence,Examine why cultural competence is a desirable
skill for health professionals,Examine events & policies that lacked cultural
safety & now impact on Indigenous health, Reflect on your own values & perspectives to
become a culturally competent professional.
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Culture – why learn about it?• Each of us is part of some culture or
cultures.
• Sensitivity & curiosity to build competence skills
• To provide better health care delivery.
• Equity
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Culture…..
• Beliefs
• Behaviours
• Attitudes
• Practices
……… all learned, shared, and passed on by members of a group
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Culture shapes our…..
• experience of the world, • environment, • family life, • lifestyle, • work & play• life in our communities.
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Culture is adapted through…..
• ethnic/racial environment,
• language and education,
• gender, age, personality
• socio/economic status,
• spirituality/religion,
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Every culture -
defines health, determines disease aetiology, prescribes how distress is defined &
signalled, prescribes medical & social means of
treatment
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What is your culture?
Q How would your culture affect your service delivery?
Q How do your values and norms affect how you see the cultural practices of others?
Q How do culture & health interact?
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What is Aboriginal Cultural Awareness?• Aboriginal Cultural Awareness means
having knowledge and understanding of Aboriginal people’s histories, values, belief systems, experience and lifestyles.
• It is not about becoming an expert on Aboriginal culture.
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What is Cultural Safety?
• Cultural safety is the action that comes from cultural awareness.
• Leads to cultural security.
• Appreciating and understanding difference and accepting it.
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Definition of Aboriginality
An Aboriginal person is of Aboriginal descent who identifies as such and who is accepted by the Aboriginal community with which he or she is associated
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SESSION ONE Pre-European Settlement
• 60,000+ years Indigenous occupation• Strong traditional Indigenous societies• Complex and structured social organization• Self-sufficiency in tune with environment
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Dreaming
• Ungud - Ngarinyin People from NW Australia.
• Alcheringa - Aranda people• Tjukurpa - Pitjantjatjara People• Wongar - Murngin People NE Arnhem
Land.• Bugari - Broome Region of West Australia
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What the ‘Dreaming’ teaches us
• Our ‘dreaming stories’ are not myth and legend but are both our past and present.
• Teaches rules for living in the physical and spiritual worlds.
• Explains how the ‘spirit ancestors created the world
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• Teaches us about all aspects of life our social structure and relationships to one another
• Dreaming beliefs are passed on through story and ceremony
• Importance of sharing and caring for our environment
• Controls rules of marriage and behaviour
• The ‘Dreaming’ is creation, history, our bible and a blueprint for life .
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Indigenous Occupation• Kinship system• 500 different languages and complex sign
language • Highly complex and integrated spiritual belief
system• Conservation of land and environment to
guarantee food and other resources-continuity• Technology
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Kinship system
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Language
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Language (cont’d)
• In Victoria about 10 different languages• Over 30 dialect groups e.g. Kulin nation of
Melbourne and surrounding areas was made of of 5 dialect groups- Woiworung, Jajowrong and Taungurong.
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SESSION TWO
European Contact
• 1770 James Cook claims possession
• 1788 Captain Phillip raises Union Jack
• 1799 Aboriginal resistance – Parramatta
• 1835 Batman Treaty- estimated Aboriginal population =11,500
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European Contact (cont’d)
• 1837 British parliament receives report on genocide in the colonies
• 1838 First Aboriginal protectorate established
• 1841 Estimated Aboriginal population = 2000
• 1851 Colony of Victoria established
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European Control
• 1869 Act for protection and management of Aboriginal natives is passed in Victoria
• 1908 Pensions for all Australians Except Aborigines• 1912 Maternity allowance for all except Aborigines• 1938 Aborigines forced to “play” re-enactment of
invasion of 1788• 1941 Child endowment- no payments to nomadic or
“mission” dependent Aborigines
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Protection, removal, segregation
• Protection policies 1890-1937
• Assimilation policies –1938 1968
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Protection policies 1890-1937
What Happened?– Mixing together of groups– Start welfare dependency– Stringent control of Aboriginal life– Loss of land– Forbidden to practice culture & speak language– European food & clothing introduced– Massacres & diseases
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Protection policies 1890-1937 (cont’d)
Effects– Destruction of kinship system– Families separated – loss of roles– Loss of spirit– Loss of culture– Loss of way of life-self-sufficiency– Heavy death toll– Disease epidemics
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Assimilation policies – 1938 -1968
What Happened?
– Children taken away from families
– Institutionalized & trained for menial work
– Further breakdown of family and clan
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Assimilation policies – 1938 -1968
The Effects
– Confusion, fear, anger
– Cultural dispossession
– Further loss of connection
– Increased welfare dependency
– Provision of cheap labor
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Self-determination/self-management 1968-90
What happened?– 1957 Federal Council for The Advancement of
Aboriginals & Torres Strait Islanders established– Aborigines Advancement League established in
Victoria– Political activism-national level– Re-emergence of Aboriginal leaders
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1967 Referendum
– sec127 of Constitution to include Aborigines in the Census and
– sec 51 to enable the Federal Government pass laws for Aboriginal people nationally
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Self-determination/self-management (cont’d)
The Effects– Aboriginal people gain new hope– Improvement in some aspects of life– Aborigines get right to vote– Government commitment to improving
economic status of Aboriginal people– Department of Aboriginal Affairs
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Reconciliation 1990s onward
What Happened?• Royal Commission into Aboriginal deaths in
custody 1991• Council for Aboriginal Reconciliation established
1992• National Inquiry into the separation of Aboriginal
& Torres Strait Islander children from their families 1997
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Reconciliation 1990s onward
Effects• National & State programs to reduce deaths in
custody• National recognition of ‘Stolen Generations” of
Indigenous children• Howard refuses to say sorry• Community education programs introduced on
Indigenous culture & history• Ongoing collaboration between Indigenous and
non-indigenous people on reconciliation
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Aboriginal Health Status
• Life expectancy: 17 year less
• Infant Mortality: 3 times higher
• Diabetes: 20 -30 times higher
• Renal Failure: 15 times higher
• Birthweight: 209 grams less
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Health continued….
• Death by injury : 4 times greater
• Hospitalisation: rates 55% greater
• Cardiovascular Disease: 1 in 3 deaths
• Cancer: 70% higher death rates among Indigenous women
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Issues Today
• Health conditions equal to third world statistics
• 17 year less life expectancy
• No political power – no seats in Government
• No economic base to operate from
• High youth suicide etc.
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Continued…
• Domestic violence
• Child abuse
• Government neglect
• Loss of identity
• Powerlessness
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Many Indigenous health issues lie outside the health sector -* cultural, * social,
* spiritual * historical
* economic * physical environment.
If you don’t remove the cause,
you wont effect a cure!
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Good health requires -
• appropriate housing, • Suitable, sufficient diet, • clean drinking water and clean air• land free of pollution,• pest control and waste removal • health education, information, • communicable diseases control• leisure facilities.
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“Health is not just the physical well-being of the individual but the social, emotional and cultural well-being of the whole community”
(NAHS Working Party, 1989:x)
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The Intervention
• Howard government response
• To eliminate violent & sexual abuse of Aboriginal children & unacceptable living standards in remote communities.
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The $1 billon Intervention• 73 remote NT communities• acquired 99 year leases,• cancelled permit system• Enforced the alcohol legislation• Military taskforce• Quarantined 50% of all welfare payments.
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Pro Intervention
• 9000 child checks
• rise in school attendance
• drops in gambling, drinking & drug taking.
• expanded schools, public housing
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Anti Intervention
• On-going invasion!• Political manoeuvre• Land grab• Discriminatory • Broader issues neglected.• Undermined human rights.• Lacked consultation process
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Consider…….• All kids need protection!
• Accusing all remote Indigenous parents.
• Abuse in urban as well as remote.
• Opening up closed remote communities - Good or bad?
• Previously out of sight out of mind.
• A new assimilation and interference???
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The ApologyThe Stolen Generations
Children of mixed descent, forcibly removed from their families by government welfare or church agents & placed in institutional care or with non-Indigenous foster parents.
“Neglect” judged by presence of poverty, mobility, or having few possessions.
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Some say …………1. It’s too long ago! 2. I had nothing to do with it! 3. I didn’t know it was happening! 4. Why should I feel guilt & shame?5. Saying sorry wont deliver results! 6. Saying sorry wont change the past! But ……. Need an apology to move on.
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Bad things happen when good people are
silent!
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Lack of communication - the patient …Lack of dialogue with a health professional can lead to
– Compliance problems with prescribed treatment– Not understanding treatment purpose, side effects– Admitted to hospital without information– Lack of informed consent– Mistaken identity– Sent home with inadequate information.– Patients’ treatment at odds with their cultural beliefs.
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Lack of communication - the health professional
– Barrier to diagnosing patients’ complaints– Difficult to inform patients, & gain informed consent– Getting gender issues wrong– Getting authorities wrong– Getting religious protocols wrong (death & birth)– Barriers to timely health prevention measures– Barriers to evaluating overall problem and
developing culturally sensitive solutions
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Cultural differences in communication
Verbal Non-verbal Rules Etiquettetempo gestures prioritizing greeting
taboos body space avoidance respect
address touching consent interrupting
tone eye contact observing time acknowledging
slang silences decision making conduct
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Reminder
You do not have to bear the guilt for the actions of past practices but you have a responsibility to ensure such practices do not continue today
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British Japanese Aboriginal German American
Industrious
Gentle
Vicious
Artistic
Organised
Spiritual
Warlike
Passive
Aggressive
Intellectual
Narrow minded
Cultural ways???
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What is your culture?
Q How would your culture affect your service delivery?
Q How do your values and norms affect how you see the cultural practices of others?
Q How do culture & health interact?
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Your culture
♣ Describe your culture!♣ In your culture, what protocols are associated
with birth?♣ In your culture, what protocols are associated
with death, the dead body, disposal?♣ Describe the indigenous people in your
country of birth? ♣ Describe something about their health?
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Indigenous culture
Name a behaviour or words likely to offend an
– Indigenous patient?
– A Moslem patient?– A Jewish patient?
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Indigenous culture♣ Have you met an Indigenous Australian? ♣ What does it mean to be aware of another’s
culture? ♣ Why would it be important to you as a
professional? ♣ What skills do you acquire from being aware of
Indigenous peoples’ history and their culture?♣ What non-medical issues act as barriers to
Indigenous peoples’ use of mainstream health facilities?
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Questions♣ Proportion of Indigenous Australians in total
population? ♣ What is the life expectancy of a non-Indigenous
man? ♣ What is the life expectancy of an Indigenous
man? ♣ What is the life expectancy of a non-Indigenous
woman?♣ What is the life expectancy of an Indigenous
woman?
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Institutional culture - ‘a culture of no culture’???
What is the culture of the profession of Social Work?
How does it pass it on??
Truth of bio-medical knowledge - a real knowledge.
What is the culture of Monash?
How does it pass it on?
Science is concerned only with timeless truths.
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DVD Stranger in town issues, questions and model answers.
1.What support processes are in place for Colin Murka’s remote community when he gets sick?
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Q 1. Answers• Aboriginal Health Worker (AHW). Familiar person in the
community, speaks the language, knows the people.
• AHW takes message from Colin’s nephew, understands implications of message, acts on it.
• The clinic knows Colin.• Female nurse has male AHW when she talks to and
questions Colin.• The nurse gives Colin time to answer her questions.
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Colin in hospital
Q 2. What aspects of his hospital stay are unfamiliar and scary for Colin?
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Q 2. Answers • Clinical setting, confined situation, left alone in strange
environment for long periods.• Unfamiliar procedures, gadgets around him.• New faces, unfamiliar language.• Everyone in a hurry.• Wheelchair orderly shouts so he understands.• Female nurses attend to him.• Use of very direct approaches not his way.• Fear of getting into a lift for the first time.• Sleeps under stars not in formal bed in a clinical setting.
• Not told what’s happening next.
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Colin in hospital
Q 3. As a health professional in that hospital what would you have done to make Colin’s stay less scary?
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• Better communication.
• Appropriate explanations.
• Offer to contact hospital Indigenous liaison officer or local Indigenous community.
• Culturally competent approaches.
• Offer to connect a phone call to his family
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Colin in hospitalQ 4. What caused Colin’s stay to improve?
Why did these things work?
• Contact with local Indigenous community brought some familiarity and cultural safety.
• Contact person could liase with hospital staff
• A friendly face in a hostile environment.
• Speaking his language with a friend.
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