NACCHO Aboriginal Health Summary #ruralhealthconf : Indigenous health focus at 14th National Rural Health Conference

As we contemplate a culturally safe future from our current vantage point, let us reflect upon how each and every one of us can contribute to making this future that I’ve shared with you today a reality.

  • Embed cultural safety in your organisation’s strategic plan, and Reconciliation Action Plan.
  • Make anti-racism practice part of your everyday – whether you are at home or at work – and whether anyone is looking or not. Enact zero tolerance for racism.
  • Ensure your governance structures reflect the communities who you are serving. Privilege the voices and the wisdom of Aboriginal and Torres Strait Islander people and organisations.
  • Inform yourself about 18C and Constitutional Recognition.
  • Inform yourself about climate change and the actions you can take – and try to put aside non-Indigenous lenses when doing this. Learn from us about caring for country.
  • Practise trust, respect and reciprocity. Build and value your relationships with us

In 2037, let us look back on this conference – and this moment – as a time when we stood together, determined to make history and to create a better future.”

It’s no wonder the speech  ” Today is tomorrow’s history ”  from Janine Mohamed – CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) – sparked such a big response at the National Rural Health Conference in Cairns.

She imagined a strong, positive, future for Australia 20 years from now – and what it might take to get us there.

See full speech below thanks to Janine and Croakey Team

The improvement of Indigenous health outcomes in rural and remote areas was the focus of many of the sessions and keynote presentations at the 14th National Rural Health Conference in Cairns .

Dr Mark Wenitong, Senior Medical Advisor with the Apunipima Cape York Council, spoke on health and cultural competence.

Addressing matters such as clinicians bringing their own cultural biases into practices, DrWenitong stressed the need for individuals to learn more about their own cultures.

“Reflective practice is important so that people recognise their own bias,” he said, also pointing out that some of the simplest are the most effective.

“You need to treat people nicely and with respect to improve engagement.”

Download  Cultural competency in the delivery of health services for Indigenous people referenced by Dr Mark Wenitong ctgc-ip13

Another of the keynote presenters was Professor of Nursing and Midwifery at CQ University, Gracelyn Smallwood.

Professor Smallwood discussed the need to better understand history in order to aid reconciliation.

“Captain Cook didn’t discover Australia. People were here for thousands of years and one day discovered Captain Cook.”

Audience member Dr Lucas de Toca tweeted that Professor Smallwood was perceived as “Absolutely killing it delivering hard truths in her outstanding keynote on cultural competency at #ruralhealthconf.”

The Assistant Minister for Health, Dr David Gillespie was present for the conclusion of proceedings and to receive the priority recommendations for rural and remote health to emerge from the Conference as put forward by the attending delegates through the Sharing Shed.

See all recommendations here DOWNLOAD



Janine Mohamed: speech to the National Rural Health Conference

As published originally here thanks to Janine and Croakey Team

Good morning ladies and gentlemen, Elders, dignitaries and colleagues.

janineI would like to begin by paying my respects to the Traditional Custodians of this land, the Yirrganydji Gimyayg Yidinji people, and to Elders past and present, and future generations.

Thank you for your very warm welcome and for the invitation to talk to you today.

About two years ago I had the privilege of meeting Professor Moana Jackson, from Aeoteroa. He is truly an inspirational Maori leader, who challenged us at CATSINaM to ‘see beyond the mountain’, to vision our future at all costs, and to be brave because that is the way of our people.

He also reminded us that we are storytellers – Moana has inspired me to share our hopes for the future with you today.

So….hang on to your seats – we are going to be doing some time travel together!

Becoming advocates and agents of change

slide young JanineWhen I was a young girl I realised I wanted to become a nurse, after seeing my family members suffer traumatic experiences at the hands of the health system.

While I have worked in many different roles across the health system – clinically, in program development and delivery, academia and in policy –I am now very pleased to be leading the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, or CATSINaM since 2013.

I am proud to be an advocate for the unique and powerful roles that Aboriginal and Torres Strait Islander nurses have in the health system and their communities, as agents of change.

I like to begin my speeches by acknowledging May Yarrowick, who trained as an obstetric nurse in Sydney in 1903. She may well be our first Indigenous nurse qualified in Western nursing.

Let’s take a few moments to reflect upon the challenges that May must have overcome to train and work as a nurse in those times. Remember, this was just a few years after the new federation of Australia passed the Immigration Restriction Act of 1901.

This legislation enshrined the White Australia policy, embedding dominant culture worldviews and priorities into the very birth of the federation, and of course the exclusion of us from Australia’s birth certificate.

Some might say that to this day Australia has not yet grown up – or out of those views.

Too often, the limitations of these dominant culture worldviews stop non-Indigenous people from recognising the incredible strengths of our Aboriginal and Torres Strait Islander peoples and cultures.

Imagine this is now 2037….

Now, I’d like to invite you to cast your minds forward.

Imagine that we have travelled forward in time from May Yarrowick and 1903, all the way to 2037 – 20 years in the future from the time of this conference here in beautiful Cairns.

How old are you in 2037?

I am 62. – I think I look like I belong on the set of the Golden Girls – the Black Betty White. But I am not yet retired. Now that we all are living longer, the retirement age is now 70.

I am happy to still be working. In fact, I am happy to still be alive and in relatively good health.

When I think back to 2017, I remember that I was not at all sure this would be the case. In my early 40s I developed a chronic disease and worried about what it might mean for my future health. But my worries proved unfounded. As I grew older, I remained strong and well.

When I think back over the last few decades, I realise that what helped to keep me feeling good was the strength of my identity, my connection to community and country, and my mentors.

The health literacy that I developed through my nursing career also helped – just one of many ways that developing an Aboriginal and Torres Strait Islander health workforce helps to improve the health of our people.

At 62, I must admit that I am feeling pretty good about myself. My life has had – and continues to have – purpose and meaning, thanks to my passion for improving the health of my people.

So much of my work has been about re-writing national narratives that were once so detrimental to our well-being but are now a source of pride and strength in our identities as members of the world’s oldest living cultures.

One of the reasons I’m so happy is that I am now watching my grandchildren thrive.

I am seeing that their experiences at school and university are so different from my days , and even from those of my children – their parents.

My grandchildren are reading histories and textbooks that have been written by Aboriginal and Torres Strait Islander people.

My grannies are learning from Indigenous teachers and lecturers and television presenters. And they are proud and strong in their identities because of how and what they are learning.

It is such a far cry from when I was at school and university. Then our romanticised and exotic histories were being told by non-Indigenous people, who too often saw us through the overlapping lenses of deficit, unconscious bias and racism.

goodes pmMy grandchildren are learning about the tremendous achievements of our first Indigenous Prime Minister, Mr Adam Goodes.

From their classrooms, they scan in to hear the discussions from the First Nations Parliament.

Self-determination is not an aspiration or even a dream for my great grandchildren. It is their daily reality.

They grow up conscious of whose country they are on

In school, they learn about our many Indigenous health heroes — about people like Professor Tom Calma and Aunty Pat Anderson, & Aunty Gracelyn Smallwood…….

It is not only my grandchildren who are learning about the strengths and proud history of Aboriginal and Torres Strait Islander peoples  – so are their non-Indigenous classmates.

Together, they are learning a shared, true history of this place we call Australia.

My grandchildren and their non-Indigenous friends share in learning local language and they learn together about the importance of respecting and caring for country. They grow up knowing about whose country they were born on – because this is written on their birth certificates and is part of their identities from the day they are born.

slide signpostsThey grow up knowing to always be conscious of whose country they are on – the signs, GPS reminders and names on our maps and roads also remind them of this.

Thanks to the many outcomes of the Truth and Reconciliation Commission, when they go on fun school excursions, they visit fun exhibitions that are informed by our Indigenous knowledges and cultures.

They visit memorials that honour our First Nations people, including our brave Warriors and protectors of country such as Pemulway.

When they go on school excursions, the signage on the streets and highways is not only in English, but also honours the language and naming of the local First Nations peoples.

They grow up with intergenerational hope, not trauma

My grandchildren are growing up in a society that values them and their heritage. They are growing up with intergenerational hope, rather than intergenerational trauma.

They are relative strangers to the experiences of racism that were part of the daily experience of their ancestors over so many generations — including for me, my parents and my children.

The health professionals of the future are learning, from their earliest days, when they first set step into early childhood learning and development centres, about cultural safety. Not that they call it that any more.

Cultural safety has become so embedded into all systems that it has become the norm – rather than something exceptional that people have to learn when they start training to be a nurse or a doctor.

In 2037, cultural safety doesn’t begin in the health system; it begins in our homes and schools. It is evident in our private conversations, and our public debate and discourse.

In 2037, there is no longer a disconnect between public and political discourse – and the language used in the education and training of health professionals.

Politicians of ALL persuasions now understand – just as well as do ALL health professionals – that racism is an attack on people’s health and well-being, and our capacity to live productive, self-determining lives.

slide health careIn 2037, cultural safety has become a societal norm. The cultures, knowledges and practices of Aboriginal and Torres Strait Islander people are central to the national narrative; they are valued and respected.

We have fixed the “racism problem”. Embedding cultural safety into all aspects of society has helped us to transform Eurocentric systems and worldviews.

In 2037, I no longer feel the need to put on my heavy “armour” when I venture outside of my home. It’s a far cry from 20 years ago, when this armour was part of my defence system against the everyday insults of unconscious bias born of racism. Experiences such as deflecting or swallowing hard when I hear:

  • ‘You’ve done well for yourself’
  • ‘Aboriginal people get so much given to them’
  • ‘You’re too pretty to be Aboriginal’
  • ‘Yes, but you’re not like the rest of them, you’re different’
  • or ‘You’re not a real Aboriginal, you’re a half caste’
  • being asked to see my receipt at Woolworths self-serve because ‘they’ve had problems with my sort of people’.

In 2037, I know that when non-Indigenous people see me in the street or at work, their first reaction will not be of prejudice or fear, but of gratitude and pride.

This reflects their understanding of the profound value that Aboriginal and Torres Strait Islander peoples and cultures bring to Australian society.

We have closed the gap in health outcomes

In 2037, when my grandchildren get sick or need to go to the hospital, I no longer even think to worry about whether their care and treatment will be respectful.

No longer do my people leave seeing a doctor or visiting a hospital to the last possible moment because of the fear of being humiliated or traumatised.

The real-time reporting of national safety and quality healthcare data shows that cultural safety is now so embedded across all health systems that Aboriginal and Torres Strait Islander patients are as likely as any other Australians to have proper access to respectful and appropriate care.

The Health Barometer – which was established some years ago to measure our health outcomes, race relations and the cultural safety of health services, programs and policies – has become redundant.

The dual governance boards which Local Area Health Networks established to eradicate racism at the organisational and direct service delivery level are also no longer needed.

There is no longer a gap between the safety and quality of healthcare provided to Aboriginal and Torres Strat Islander people and that provided to other Australians. Our health status is now comparable with other Australians.

The health sector has long ago acknowledged its role in colonisation and such traumatic practices as removal of children and the medical incarceration of Aboriginal and Torres Strait Islander people. Nursing and midwifery now learn this history at the same time as learning about our founders, for example Florence Nightingale.

Health professions and systems have apologised and provided reparation and justice for harmful practices.

Over the past 20 years the sector learnt how to be part of healing, rather than causing harm.

The persistence, hard work and brilliance of our Indigenous health leaders paved the way for a sea change that became evident around the time this century celebrated its 21st birthday.

Climate change prompted a global sea change

I must admit that things were looking pretty grim in the years leading up to 2021. We were still dealing with the aftermath of President Trump, fake news, climate deniers, and the rise of nationalistic, xenophobic movements.

 But as the impacts of climate change started to hit – earlier and harder than expected – there was a profound sea change around the world.

People realised the limitations of the usual Western ways of doing business. Globally, Indigenous knowledges were not only legitimised, but valued and centred in responses to such complex problems as climate change; social and economic inequality; and the protection and management of land and water resources.

As new social and economic structures emerged in response to these challenges and in response to what was then called the Fourth Industrial Revolution, the voices of Indigenous peoples were heard – not only in Australia but also globally.

Our ways of doing business – informed by practices of respect, reciprocity, caring for country, and relationship-based ways of working – are now centred.

Power no longer rested in self-interested hierarchies but became de-centralised. People and organisations were valued for what they could do for the well-being of the community and the planet.

Just imagine what a wonderful difference this has made for rural and remote people and communities!

At the same time as these wider shifts were occurring in society, some fundamental shifts were occurring in health systems.

The health system changed its way of doing business

slide health planIt wasn’t just that the Aboriginal and Torres Strait Islander health plan was fully resourced and implemented – and that this became remembered as one of the landmark achievements of Minister Ken Wyatt, along with establishment of the National Aboriginal and Torres Strait Islander Health Authority.

It wasn’t just that the Rural Health Commissioner’s role was reformed – after some sustained, behind-the-scenes lobbying – to ensure that the Commissioner had a more wide-ranging and meaningful remit.

It wasn’t just that in the wake of the abolition of the Indigenous Advancement Strategy, the Goodes Government set up a Productivity Commission for Indigenous Health. This quarantined, money so that we were able to self-determine the way we invested in our health. And what a difference that made!

It wasn’t just that insurance laws were changed and health systems were reformed to enable women, both Aboriginal and Non- Indigenous women, to birth on country.

It wasn’t any one of these changes alone that led to us closing the gap in life expectancy and health outcomes – years earlier than we had hoped for in our wildest dreams.

It was these things, but it was more than this.

When I look back now, it seems incredible that most of our health dollars and efforts were once spent on centralised, institutional systems of care that contributed relatively little to health outcomes for the large investment they incurred.

It now seems unbelievable that we once invested so little effort and money into providing the conditions that empowered people and their families and communities to have to healthy, contributing lives.

Such a fundamental shift occurred. As Indigenous knowledges and practices were centred in wider systems, so too did the health system change its way of doing business.

.The mainstream health system learnt from the successes of the Aboriginal community controlled health sector. The mainstream re-oriented itself around our ways of doing business – to focus on primary health care, communities, prevention, social justice, and the social and cultural determinants of health.

Health services moved towards providing long-term contracts and seamless services addressing peoples’ needs for inclusion, housing, transport and integrated care.

For our members at CATSINaM, the changes have brought profound transformations to the way they work and how they are valued.

 Our members now work at their full scope of practice. They are involved in diagnosing and managing dental caries, for example, while dentists are incorporating population health strategies into their daily work. Their work has been funded for many years now by ….the sugar tax (dare I say this in Queensland?).

It is so thrilling too to see that the mainstream politic has learnt from the ingenuity of Aboriginal and Torres Strait Islander peoples. Creativity and innovation are not only valued — but properly funded and rewarded.

After its unpromising early years, visionary leadership transformed the NBN to provide equitable access to connectivity right across the country.

Aboriginal and Torres Strait Islander people capitalised on this opportunity, supporting our creativity, entrepreneurialism and innovation. We used the NBN to drive innovation in healthcare and health promotion, as well as to contribute to a better future for all.

We are all making history right now

twitter historyAs I stand before you in 2037, I am not only happy, but I am proud.

One of the highlights of my career has been working to use the virtual world  – cyberspace – to embed cultural safety, not only into the training and education of all who work in the health system – but also into wider societal systems. Along with my newly released cookbook, written in conjunction with the CWA of course.

As we contemplate this potential future together now from our present reality, in 2017, let us remember that history is not something that happens in the past.

It is happening right now. We are all making history right now.

Over the next few years, as we move to embedding cultural safety into our systems and services, supported by the forthcoming Version 2 of the National Safety and Quality Health Service Standards and CATSINaM’s current campaign to have Cultural Safety embedded into our Health Practitioners legislation, let us ensure that this brings meaningful improvement to rural and remote health services.

Let us remember that cultural safety is a philosophy of practice that is about how a health professional does something, not simply what they do. Its focus is on systemic and structural issues and on the social determinants of health.

Cultural safety is as important to quality care as clinical safety. It includes regard for the physical, mental, social, spiritual and cultural components of the patient and the community.

Cultural safety represents a key philosophical shift from providing care regardless of difference, to care that takes account of peoples’ unique needs – and to be regardful of difference.

For Aboriginal and Torres Strait Islander health, cultural safety provides a decolonising model of practice based on dialogue, communication, power sharing and negotiation, and the acknowledgment of white privilege.

These actions are a means to challenge racism at personal and institutional levels, and to establish trust in health care encounters.

Culturally safe and respectful practice therefore is not about learning about Aboriginal and Torres Strait Islander peoples – in fact you can never know this.

Cultural safety requires having knowledge of how one’s own culture, values, attitudes, assumptions and beliefs – influence interactions with patients or clients, their families and the community. Being aware of our racial orator.

As we contemplate a culturally safe future from our current vantage point, let us reflect upon how each and every one of us can contribute to making this future that I’ve shared with you today a reality.

I’d like to conclude this presentation by inviting you to journey with me into the future. I ask each and every one of you to think deeply about how you might contribute to creating this future.

How can YOU help to make history?

Here are some suggestions:

  • Embed cultural safety in your organisation’s strategic plan, and Reconciliation Action Plan.
  • Make anti-racism practice part of your everyday – whether you are at home or at work – and whether anyone is looking or not. Enact zero tolerance for racism.
  • Ensure your governance structures reflect the communities who you are serving. Privilege the voices and the wisdom of Aboriginal and Torres Strait Islander people and organisations.
  • Inform yourself about 18C and Constitutional Recognition.
  • Inform yourself about climate change and the actions you can take – and try to put aside non-Indigenous lenses when doing this. Learn from us about caring for country.
  • Practise trust, respect and reciprocity. Build and value your relationships with us.

In 2037, let us look back on this conference – and this moment – as a time when we stood together, determined to make history and to create a better future.

Because today is tomorrow’s history – be brave.

Thank you.

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