NACCHO Aboriginal Youth Health News @KenWyattMP launches Aboriginal Youth Health Strategy 2018-2023, Today’s young people, tomorrow’s leaders at @TheAHCWA

“ The youth workshops confirmed young people’s biggest concerns are often not about physical illness, they are issues around mental health and wellbeing, pride, strength and resilience, and ensuring they can make the most of their lives

Flexible learning and cultural and career mentoring for better education and jobs were highlighted, along with the importance of culturally comfortable health care services.

While dealing with immediate illness and disease is crucial, this strategy’s long-term vision is vital and shows great maturity from our young people.”

Federal Minister for Health and Aged Care Ken Wyatt, AM launched AHCWA’s Western Australia Aboriginal Youth Health Strategy 2018-2023, Today’s young people, tomorrow’s leaders at AHCWA’s 2018 State Sector Conference at the Esplanade Hotel in Fremantle. Read the Ministers full press release PART 2 Below

See Previous NACCHO Post

NACCHO Aboriginal Health @TheAHCWA pioneering new ways of working in Aboriginal Health :Our Culture Our Community Our Voice Our Knowledge

“If we are to make gains in the health of young Aboriginal people, we must allow their voices to be heard, their ideas listened to and their experiences acknowledged.

Effective, culturally secure health services are the key to unlocking the innate value of young Aboriginal people, as individuals and as strong young people, to become our future leaders.”

AHCWA Chairperson Vicki O’Donnell said good health was fundamental for young Aboriginal people to flourish in education, employment and to remain socially connected.

Download the PDF HERE

The Aboriginal Health Council of Western Australia (AHCWA) has this launched its new blueprint for addressing the health inequalities of young Aboriginal people.

“The Turnbull Government is proud to have supported this ground-breaking work and I congratulate everyone involved,” Minister Wyatt said.

“Young people are the future, and thinking harder and deeper about their needs and talking to them about how to meet them is the way forward.”

Developed with and on behalf of young Aboriginal people in WA, the strategy is the culmination of almost a decade of AHCWA’s commitment and strategic advocacy in Aboriginal youth health.

The strategy considered feedback from young Aboriginal people and health workers during 24 focus groups hosted by AHCWA across the Kimberley, Pilbara, Midwest-Gascoyne, Goldfields, South-West, Great Southern and Perth metropolitan areas last year.

In addition, two state-wide surveys were conducted for young people and service providers to garner their views about youth health in WA.

During the consultation, participants revealed obstacles to good health including boredom due to a lack of youth appropriate extracurricular activities, sporting programs and other avenues to improve social and emotional wellbeing.

Of major concern for some young Aboriginal people were systemic barriers of poverty, homelessness, and the lack of adequate food or water in their communities.

Significantly, young Aboriginal people shared experiences of how boredom was a factor contributing to violence, mental health problems, and alcohol and other drug use issues.

They also revealed that racism, bullying and discrimination had affected their health, with social media platforms used to mitigate boredom leading to issues of cyberbullying, peer pressure and personal violence and in turn, depression, trauma and social isolation.

Ms O’Donnell said the strategy cited a more joined-up service delivery method as a key priority, with the fragmentation and a lack of coordination in some areas making it difficult for young Aboriginal people to find and access services they need.

“The strategy provides an opportunity for community led solutions to repair service fragmentation, and open doors to improved navigation pathways for young Aboriginal people,” she said.

Ms O’Donnell said the strategy also recognised that culture was intrinsic to the health and wellbeing of young Aboriginal people.

“Recognition of and understanding about culture must be at the centre of the planning, development and implementation of health services and programs for young Aboriginal people,” she said.

“AHCWA has a long and proud tradition of leadership and advocacy in prioritising Aboriginal young people and placing their health needs at the forefront.”

Under the strategy, AHCWA will establish the Aboriginal Youth Health Program Outcomes Council and local community-based Aboriginal Youth Cultural Knowledge and Mentor Groups.

The strategy also mandates to work with key partners to help establish pathways and links for young Aboriginal people to transition from education to employment, support young Aboriginal people who have left school early or are at risk of disengaging from education; and work with local schools to implement education-to-employment plans.

More than 260 delegates from WA’s 22 Aboriginal Community Controlled Health Services are attending the two-day conference at the Esplanade Hotel Fremantle on April 11 and 12.

Over the two days, 15 workshops and keynote speeches will be held. AHCWA will present recommendations from the conference in a report to the state and federal governments to highlight the key issues about Aboriginal health in WA and determine future strategic actions.

The conference agenda can be found here: http://www.cvent.com/events/aboriginal-health-our-culture-our-communities-our-voice-our-knowledge/agenda-d4410dfc616942e9a30b0de5e8242043.aspx

Part 2 Ministers Press Release

A unique new youth strategy puts cultural and family strength, education, employment and leadership at the centre of First Nations people’s health and wellbeing.

Indigenous Health Minister Ken Wyatt AM today launched the landmark Western Australian Aboriginal Youth Health Strategy, which sets out a five-year program with the theme “Today’s young people, tomorrow’s leaders”.

“This is an inspiring but practical roadmap that includes a detailed action plan and a strong evaluation process to measure success,” Minister Wyatt said.

“It sets an example for other health services and other States and Territories but most importantly, it promises to help set thousands of WA young people on the right path for healthier and more fulfilling lives.”

Produced by the Aboriginal Health Council of WA (AHCWA) and based on State wide youth workshops and consultation, the strategy highlights five key health domains:

    • Strength in culture – capable and confident
    • Strength in family and healthy relationships
    • Educating to employ
    • Empowering future leaders
    • Healthy now, healthy future

Each domain includes priorities, actions and a “showcase initiative” that is already succeeding and could be replicated to spread the benefits further around the State.

Development of the strategy was supported by a $315,000 Turnbull Government grant, through the Indigenous Australians Health Program.

“I congratulate AHCWA and everyone involved because hearing the clear voices of these young Australians is so important for their development now and for future generations,” the Minister said.

NACCHO Aboriginal Health : Download @KenWyattMP speech to @CISOZ : The question of leadership and responsibility in Aboriginal health – addressing the Centre for Independent Studies

 ” Last year, we led a massive group listening program – the My Life My Lead consultations involved 600 people at 13 forums across Australia, plus more than 100 written submissions were received.

Seven priority areas were identified, and are informing the current Closing the Gap refresh agenda.

The priorities we heard from First Australians are:

  • Putting culture at the centre of change
  • Success and wellbeing for health through employment
  • Foundations for a healthy life
  • Environmental health
  • Healthy living and strong communities
  • Health service access, and
  • Health and opportunity through education

We need to be fully committed to sitting down and listening; hearing what’s being said, and continuing to invest in programs that do their work from the ground up.

Policies and services that reflect local voices and wisdom are more closely owned by the people they serve.”

Minister Ken Wyatt MP speaking at Centre for Independent Studies in Sydney yesterday

Download full address or read below

FINAL Wyatt CIS speech 10 April 2018

Family the key to Indigenous health, says Ken Wyatt

Executive summary from the The Australian Stephen Fitzpatrick 

Good parenting rather than increased funding for programs and services is key to improving Indigenous health, the federal minister responsible for the sector has ­declared.

Warning that “doing more of the same is an option we can no longer afford”,

Aboriginal Liberal MP Ken Wyatt said the successes and the failures in indigenous health demonstrated that “responsible parents and families provide the most consistent and enduring interventions”.

“Funding for health programs and services, from public or private sources, will only ever be part of the currency of change,” Mr Wyatt said at a speech to the Centre for Independent Studies in Sydney. “By far the greatest value will come from every mother, father, uncle, aunt and elder every day, taking responsibility for and contributing to better health.”

Calling for a declaration of “non-negotiable standards to be met from the bottom up”, Mr Wyatt said these standards must “reflect the pride of the oldest continuous culture on the planet” but should also extend “far beyond families, to health and community groups and organisations too”.

He said there had for too long been a “piecemeal approach” to indigenous health, with “inadequate accountability” for repeated programs and yet “every time there’s been a new issue or challenge, ­people say we need more money”.

Efforts to close the gap between indigenous and non-indigenous health outcomes would not succeed “until we eliminate the mindset that Aboriginal Australians could be, and even should be on occasions, dealt with differently”.

The current syphilis epidemic in northern Australian indigenous communities, which has prompted the Turnbull government to commit $8.8 million in an attempt to turn its tide seven years after it began, was a case in point.

“If this outbreak had occurred on Sydney’s north shore, in ­Cottesloe in Perth or Toorak in Melbourne — in any city or major town, in fact — there would have been a rapid response years ­earlier,” Mr Wyatt said.

However, he cautioned that there must also be a greater focus on strategies that clearly work, calling for governments and NGOs to “hear the voices of families, of mothers, fathers and community elders, not just the voices of those who are the strongest ­advocates for the establishment of organisations or services”.

He cited the work of Fitzroy Crossing women including Aboriginal and Torres Strait Islander Social Justice Commissioner June Oscar in curbing the spectre of ­fetal alcohol spectrum disorder, saying it had “turned the town around and you now see strong families there, bound by the glue of love and caring”.

He had ordered his department to overhaul a Medicare provision designed for indigenous Australians that provides physical, psychological and social wellbeing assessments as well as preventive healthcare, education and other options to improve health.

He said only 217,000 people ­accessed this provision last year but he wanted this number to rise because “what I want to see is all First Nations people accessing all relevant (Medicare) items in the same way other Australians do”.

He praised the growing number of indigenous health professionals at all levels, “as doctors and nurses, in allied health, administration and management (and) in policy planning and research”.

Mr Wyatt said this was likely to be the best hope for the future, with more than 40 per cent of the 720,000-strong indigenous population aged under 24, so that many of this group were “set to make a big impact across many fields that may help to close the gap”.

Full Speech Minister Ken Wyatt


Download FINAL Wyatt CIS speech 10 April 2018

Thank you Tom, [Switzer, Executive Director, Centre for Independent Studies] for your introduction.

In West Australian Noongar language, I say kaya wangju – hello and welcome.

At the same time, I acknowledge the traditional owners of the land on which we meet, the Gadigal people of the Eora Nation, and pay my respects to Elders past and present.

Today, I want to pose the question: “What is the currency of positive change for the health of First Nations people?”

Is it government or private investment; is it determination; is it personal motivation?

To begin, I’d like those of us who can remember, to think back to 1972.

Australia’s Helen Reddy was topping the international charts and we were getting out of Vietnam.

The Tent Embassy went up at Parliament House in Canberra on Australia Day that year, a symbolic foreign mission erected in the fight for land rights, after years of dashed hopes – an embassy that continues today in the fight for equality.

1972 was a potentially life-changing year for thousands of Aboriginal and Torres Strait Islander Australians.

Prime Minister Gough Whitlam established the Commonwealth Department of Aboriginal Affairs, ushering in an era of bold new promise, building on changes implemented by previous governments following the 1967 referendum.

Looking back – in so many different ways since then – we have come so far.

Yet, since 1972, we have not seen the broad, wholesale change that we would expect, especially given the significant funding and vast amount of good intentions that have been invested in Aboriginal affairs.

Yes, for the first time in several years, we are on track to reach three of the seven Closing the Gap targets – but what lies behind the statistics that still highlight health inequities today?

What have we got right – and wrong – since 1972?

As I travel our nation, I see and hear more and more inspiring stories of First People’s achievement and the journey to equality, from almost every corner of the country.

Perhaps I’m a bit old-fashioned, but I like to call these “jewels in the crown” – because they shine so brightly, and they exemplify the things that work.

One of these is a university college for Aboriginal students I recently launched in Perth.

Now doubling in size six years after it began, it boasts a 90 per cent retention rate, with almost 80 percent of students passing all their exams.

Head to remote communities in the Kimberley and the Pilbara and you’ll find the EON program, literally teaching children how to grow vegetables and good health.

This is especially close to my heart, because I approved the initial, modest, funding to help start the project 10 years ago.

Since then, EON’s employed scores of local Aboriginal people, worked with students and families to create dozens of school vegetable gardens and has run countless cooking classes, including bush tucker, too.

The compelling taste and health benefits of home grown food are one thing; but it’s the ownership, the healthy habits, the skills learned, and the pride that are also helping change young lives.

The EON program’s now in high demand, extending further south in WA and into the Northern Territory this year.

In the Western Desert, the Pintupi Luritja people saw the tragedy of kidney failure and decided it wasn’t going to be a one-way ticket off their beloved country, to being hooked up to dialysis in Alice Springs.

They took control, famously painted and sold precious artworks – and raised a million dollars to start realising their dream.

Eighteen years on, the Purple House project has treatment centres across their vast lands, a mobile dialysis truck and, just as important, a growing primary and preventive health care network.

Not surprisingly, the wraparound approach – from the ground and the street up – most often shows the common denominator of success.

This local impetus is being strongly supported, and replicated with careful community consultation, through significant Turnbull Government programs.

Better Start to Life and its care and family partnerships begin a child’s health journey before conception. We have funded 124 sites nationwide, and counting.

The results are showing fewer low birth weight babies, higher rates of breastfeeding and, in our Australian Nurse Family Partnership Program sites, 100 per cent immunisation rates, the highest in the nation.

At the same time, from Alice Springs to Port Augusta and from Doomadgee to Canberra, the Connected Beginnings program links parents, health care and education, so children are ready to start school, learn and grow into healthy teenagers and adults.

As Nelson Mandela rightly said: “There can be no keener revelation of a society’s soul than the way in which it treats its children.”

But sometimes, I go into communities and I meet with organisations that tell me they are meeting their health targets — the key performance indicators.

I then get permission from Elders to walk around and chat with locals.

On one particular occasion, in the Kimberley, I met a significant Aboriginal artist.

We were walking along and a friend was talking with this painter and I noticed that her eyes looked opaque, so I asked her: How much can you see?

She said: “I can’t see very much at all, I’m hoping for my cataract surgery.”

At that time, it had been a two-year wait – yet the health organisation’s KPIs were being met. How could this be?

In a country as rich and advanced as Australia, how can this happen?

This is not an isolated incident.

Improving overall Aboriginal and Torres Strait Islander health is, first and foremost, critical for the well-being and dignity of hundreds of thousands of First Australians.

But it is also fundamental to our nation’s commitment to equality, and our global health status.

The health of First Nations Australians is everyone’s business.

We must continually celebrate with Aboriginal communities and families the many milestones in health, education, careers and cultural achievement.

At the same time, it is crucial we look carefully at where poorer aspects of health and wellbeing remain.

In these cases, doing more of the same is an option we can no longer afford – the high cost in lives and lost futures is incalculable, and budgets are also under intense pressure.

First Nations knowledge is embedded in the memories of the living – knowledge that is imparted through teaching, storytelling, music, art and dance.

They are our living libraries and losing each individual means a precious book of knowledge is lost forever.

It is imperative that we enable people to be healthy and live longer.

For far too long in Aboriginal health there was a piecemeal approach; series upon series of programs, often with inadequate accountability.

Every time there’s been a new issue or challenge, people say we need more money.

Currently, there are two evaluations underway to identify opportunities to improve; access to quality and effective primary health care services; assess health gains; and identify the social returns and the broader economic benefits of the Indigenous Australians’ Health Program.

While Government investment in the program will continue to grow over the forward estimates, it is imperative – especially for those in greatest need – that we maximise the health value in every dollar.

To illustrate this point I want to look at the current challenges of Sexually Transmitted Infections and Blood Borne Viruses.

Recently, I was asked to approve significant special funding for a targeted program to tackle the increasing prevalence of STIs, particularly the alarming rise of syphilis in northern areas.

When I asked ‘What are the States and Territories doing about this?’ I was disturbed to find too little had been invested and too little done when the first warning signs appeared, almost seven years ago – certainly not to the extent I would have expected from the responsible jurisdictions.

There was still an overwhelming reliance on Commonwealth leadership and funding in order to address the spread of STIs across the Top End.

I committed $8.8 million dollars, to provide a surge approach that is currently ramping up, aiming to turn the tide of infection.

I also make the point that these First Nations people now struggling under the burden of this deadly disease are, first and foremost, citizens of Australia.

If this outbreak had occurred on Sydney’s North Shore, in Cottesloe in Perth, or Toorak in Melbourne – in any city or major town, in fact – there would have been a rapid response years earlier.

I believe there will not be complete success, in terms of Closing the Gap, until we eliminate the mindset that Aboriginal Australians could be, and even should be on occasions, dealt with differently.

Ensuring awareness and respect for First Nations people and culture throughout our health system may be critical to equality of access – but above all, there is a fundamental human right we must accord every one of our citizens, and that is the right to good health.

Picture this scenario.

A doctor based in Kintore – around 2,000 kilometres South-West of Darwin visited the community of Kiwirrkurra located in Western Australia’s sandhill country — the Gibson Desert.

This doctor reports meeting a group of nine nomadic Aboriginal people, and he says:

“…They were the most healthy people I have ever seen…They were literally glowing with health – not an ounce of superfluous fat. They were extremely fit…”

The year was 1984.

Today, we hear a different narrative too often: There is an alarming rise in obesity and diabetes, suicide levels are high, there is alcohol and drug misuse and the impacts of poverty leave many people with a sense of powerlessness.

Too often, First Nations people’s achievements are overshadowed by health and welfare stories of deep, and understandable, concern.

We’re seeing laudable improvements because of interventions, but they’re not always consistent enough, and they’re often not equivalent to results achieved by other sectors within multicultural Australia.

I’m strongly focussed on where we need to improve; on why – even after accounting for the social and environmental impacts on health – we’re still seeing better outcomes for non-Aboriginal people.

For almost 20 years now, the Medicare Benefits Schedule (MBS) has included Item number 715 – a health assessment especially designed to ensure Aboriginal and Torres Strait Islander people receive primary care matched to their needs.

A 715 looks at a patient’s health — physical, psychological and their social wellbeing.

It also assesses what preventative health care, education and other assistance should be offered to improve health and wellbeing.

It’s holistic. Not body part, by body part. The whole body.

Australia’s Aboriginal and Torres Strait Islander population is around 720,000.

Yet only 217,000 people in 2016-17 have been assessed under MBS Item 715.

At the same time, I see organisations such as the Institute for Urban Indigenous Health, that according to their 2016-17 Annual Report have over 33,000 active patients, of which approximately 60 per cent have had their 715 health check.

In 2016-17, the organisations Members’ Network of 19 Aboriginal Community Controlled Health Care Clinics generated more than $14.3 million in Medicare income, with all funds re-invested in the delivery of comprehensive health care for Aboriginal and Torres Strait Islander people in South East Queensland.

What I see here are significantly better results, through completion of a “cycle of care”, comprising the range of chronic disease and other MBS items.

The Institute has grown its clinics from 5 to 19 in the past nine years, with their 20th soon to open in the Moreton Bay region.

I’m excited by this work – the innovation and capacity to change, and the resolve not to accept the status quo of poorer health outcomes.

I look at some of the health disparities and think, why aren’t we as a nation case managing, fundamentally, 720,000 people in a way that would make a difference to so many chronic conditions?

I have asked my department for an overhaul of 715s – what I want to see is all First Nations people accessing all relevant MBS items in the same way that other Australians do.

A key Government focus is on the health of our children, from conception right through to their late teens, so they can grow into strong and healthy men and women who can be the best mentors for their own children.

With more than 1700 First Australians receiving kidney dialysis, and rheumatic heart disease affecting another 6,000 mainly younger people, this year I’ve also prioritised renal health and RHD, along with eye and ear health.

From four national roundtables, we’re now charting Australia’s first roadmaps to coordinate efforts to combat these debilitating and deadly conditions.

It’s absolutely intolerable that RHD among our First Nations people is happening at more than 50 times the rate of other groups in Australian society.

In parts of the Northern Territory, those horrific rates of RHD are doubled again.

And Aboriginal and Torres Strait Islander people under the age of 55 are starting dialysis at twice the rate of non-Aboriginal Australians, with many showing danger signs in their teens.

The unfinished business of today is disappointing because we should be celebrating more successes.

And are community-controlled health organisations and other community groups established to service great need, sitting down enough and asking families and individuals what they know, what they want and what they think would work best?

They must ask: Where is the continuity of service for anyone who requires an intervention to prolong their life or to circumvent an illness?

Minor ailments like skin sores or strep throats, if treated consistently and effectively, won’t develop into early onset renal failure or rheumatic heart disease.

In the same way, neither will ear infections become impaired hearing, that can stunt a child’s learning capacity and their chances of a good job, or any job at all.

There is a need for a holistic approach to the health of each individual.

Some of the benefits flowing from Australia’s recent mining boom have been great employment opportunities, close to country, for thousands of First Nations people.

But the job hopes of many were hampered by deafness contracted in childhood, much to the frustration of mining companies committed to hiring keen local staff.

Hearing and communication are fundamental to fulfilling our life’s potential.

They’re also two of the most valuable commodities for sustainable change in Aboriginal and Torres Strait Islander health.

Governments and non-government organisations across the board must listen to and hear the voices of families, of mothers, fathers and community Elders.

Not just the voices of those who are the strongest advocates for the establishment of organisations or services that, theoretically, should make a difference on the ground.

I say this with no political overtones – the Prime Minister and the Turnbull Government are committed to doing things with Aboriginal and Torres Strait Islander people, not to them.

Last year, we led a massive group listening program – the My Life My Lead consultations involved 600 people at 13 forums across Australia, plus more than 100 written submissions were received.

SEE NACCHO report

Seven priority areas were identified, and are informing the current Closing the Gap refresh agenda.

The priorities we heard from First Australians are:

Putting culture at the centre of change

Success and wellbeing for health through employment

Foundations for a healthy life

Environmental health

Healthy living and strong communities

Health service access, and

Health and opportunity through education

We need to be fully committed to sitting down and listening; hearing what’s being said, and continuing to invest in programs that do their work from the ground up.

Policies and services that reflect local voices and wisdom are more closely owned by the people they serve.

People are empowered, because they’ve been heard, and take responsibility because they’re respected and proud.

Around the nation there are many things that are working and I have seen programs and services where Aboriginal organisations, Aboriginal people and non-Aboriginal people are highly successful in the most difficult of circumstances.

I see June Oscar and her community’s work in Fitzroy Crossing, which has changed the whole dynamic of buying alcohol and curbed the local tragedy of Foetal Alcohol Spectrum Disorder.

Together, they have turned the town around and you now see strong families there, bound by the glue of love and caring.

Alcohol and the bad behaviour of a few no longer defines Fitzroy Crossing, the strength and the story of the community does.

When I think about the successes, as well as the failures, I know that responsible parents and families provide the most consistent and enduring interventions.

Funding for health programs and services, from public or private sources, will only ever be part of the currency of change.

By far the greatest value will come from every mother, father, uncle, aunt and Elder every day, taking responsibility for and contributing to better health.

For over 65,000 years, First Nations people survived and thrived without a plethora of organisations – individual families and communities pulled together, to ensure the health and wellbeing of all.

Working and walking together with local communities, we collectively need to declare non-negotiable standards to be met, from the bottom up.

Standards that also reflect the pride of the oldest continuous culture on the planet.

This individual responsibility extends far beyond families, to health and community groups and organisations, too.

Everyone working to close the gap in health equality must look at themselves and say: Together, we have outcomes to achieve – what difference are we really making today and how can we do better?

We must constantly walk around the communities we serve and look for patterns of disparity.

If that’s what we’re seeing, the question should be: Are we fighting our own people? Are we listening enough?

Fortunately for the future, increasing numbers of young First Nations people are hearing the call to lead the next wave of change.

With more than 40 per cent of our Aboriginal and Torres Strait Islander population aged under 24, large groups – like the undergraduates I met recently at the university college – are set to make a big impact across many fields that may help close the gap.

Through concerted programs around the country, there’s also a growing number of First Nations health professionals at all levels – as doctors and nurses; in allied health, administration and management; in policy, planning and research.

My message to them and to all Aboriginal and Torres Strait Islander people, in communities across this nation, is that we are proud descendants of those who came here at least 65,000 years ago.

We have proven incredibly resilient, and we’ll continue that tradition of resilience, and respect for our country and for all Australians.

But the strength of our cultural identity will always remain the basis for our health – and what we strive for and live for.

Thank you.

 

NACCHO Aboriginal Health and #CulturalSafety Debate : Media VS Health Sector : Should we have culturally appropriate spaces in hospitals ?

Once again the debate about cultural safety has escalated nationally thru News Ltd newspapers with the Daily Telegraph leading off on Tuesday (3 April ) with a front page “cultural safety expose “ and 4 hours nonstop coverage and commentary on SkyNews from the usual suspects Peta Credlin , Alan Jones , Andrew Bolt , Ben Fordham , Paul Murray, Troy Branston in addition to blanket radio coverage across Australia.

See 2 SkyNews Broadcasts below

The policy issue being heavily criticised by the media but not health authorities and experts is that the NSW Health has recommended its emergency departments to provide “culturally appropriate space’’ for the families of Aboriginal patients.

The new policy in NSW to provide a “culturally appropriate space’’ or “designated Aboriginal waiting room’’ was introduced after research found Indigenous patients were at least 1.5 times more likely to leave hospitals before emergency treatment.

In Victoria some hospitals and services have separate areas for Indigenous patients and their families to meet, rest or engage with specialist hospital staff.

See Part 1 Below for NSW Health policy extracts and download document

Above Editorial Daily Telegraph 3 April

Firstly those in favour of this cultural safety policy include

 ” Well, I think it’s good that issues like cultural safety are entering the popular narrative. We need to do better when it comes to delivering care to Aboriginal and Torres Strait Islander people, and I think we need to ask them what will and won’t work.

The truth is that health outcomes for Indigenous Australians are significantly worse than non-Indigenous Australians according to just about every possible metric.

The AMA strongly supports Aboriginal control when it comes to primary care and when it comes to Aboriginal and Torres Strait Islanders being in larger health facilities like our hospitals, I think we need to do everything we can to make them- the appropriate settings for them to seek care.

If that means spending a little bit of money on waiting areas, if that means making subtle changes to outpatient clinics or to inpatient wards to make Indigenous people feel more at home, I don’t think non-Indigenous people should find that threatening”

1.Dr Michael Gannon President AMA

For the Aboriginal and Torres Strait Islander population born in 2010–2012, life expectancy was estimated to be 10.6 years lower than that of the non-Indigenous population.

“Indigenous patients are over-represented in requiring public hospital services.

“In 2013-14, there were 392,142 public hospital emergency department presentations by Indigenous people, accounting for 5.4% of all such presentations.

As a doctor working in south western Sydney and at an Aboriginal Medical Service, I see every day the barriers to accessing healthcare faced by our Indigenous patients.

“Hospitals are complex, overwhelming places and care is too often fragmented.

“For this reason, everyone involved in healthcare has an obligation to break down the barriers to accessing care and to improve health outcomes.

2. AMA (NSW) President, Prof Brad Frankum

“ It isn’t mandatory in the sense they’ve got to do it, it’s mandatory in the sense you’ve got to think about what is culturally appropriate (and) what might help the local community,”

3.Health Minister Brad Hazzard­ said many hospitals had already decided to introduce a culturally appropriate­ space.

“Among other benefits, culturally competent care increases accurate and timely diagnosis and increases attendance rates at follow-up appointments

Positive results such as these worked to overcome reluctance to engage with mainstream healthcare services, as well as improving rates of self-discharge against medical advice.”

4.President Simon Judkins the Australasian College for Emergency Medicine said it believed emergency departments must move towards a place of respect and acknowledgment of Indigenous culture

The college also called for a focus on increasing the numbers of Aboriginal and Torres Strait Islander people working across all health professions, including emergency medicine.

“All healthcare providers need to consider the cultural dimension of the services they are providing, and embrace culturally safe care which is determined to be safe by Aboriginal and Torres Strait Islander patients and their families.

This includes making hospital waiting rooms a welcoming and supportive environment for Aboriginal and Torres Strait Islander people, which will help to build trust between them and their healthcare providers and enhance cultural sensitivity in medical treatment.

It is vitally important that these waiting areas are designed and implemented in close consultation with relevant local Aboriginal and Torres Strait Islander communities and Aboriginal Community Controlled Health Organisations.”

5.Carmen Parter, PHAA Vice-President (Aboriginal and Torres Strait Islander) affirmed PHAA’s support for such an initiative.

” The policy was about improving the health of Aboriginal people and people who are not Aboriginal should not be threatened by the fact we’re trying to look out for a very vulnerable part of our community ”

6.NSW Health deputy secretary Susan Pearce

” The policy is flexible, allowing local health districts to carry out initiatives in consultation with their local Aboriginal community to make their hospital settings more culturally inclusive, in ways that best suit the community,”

7.NSW Health spokeswoman .

“Within the hospital system Aboriginal and Torres Strait Islander people face racist barriers to gaining appropriate health care. Despite the increased burden of disease they carry, Aboriginal and Torres Strait Islander patients are only three-quarters (73%) as likely to undergo a procedure once admitted to hospital

Racism is a significant barrier to Aboriginal health improvement say Donna Ah Chee 2015 Read in full here or Part 4 Below

” Cultural safety requires embedding in not only course accreditation for each health profession — including measures to reduce resistance — but also in the standards governing clinical professionalism and quality, such as the Royal Australian College of General Practitioners Standards for general practices,19 and the Australian Commission on Safety and Quality in Health Care National safety and quality health service standards.20

Such commitment will need investment in clinician education and professional development, together with measures for accountability. The stewards of the National Aboriginal and Torres Strait Islander Health Plan5 (ie, the Department of Health and their expert implementation advisory group), accreditation bodies, and monitors of the existing frameworks of safety and quality standards in health care need to formally collaborate on a systematic revision of standards to embed culturally safe practice and develop health settings free of racism.”

Martin Laverty, Dennis R McDermott and Tom Calma see Part 5 Below

Part 1 NSW Policy

Download The Policy document in full

NSW Policy Doc

Local processes should be in place to monitor numbers of patients who ‘Did not Wait’ for treatment following triage, including rates for Aboriginal and non-Aboriginal patients.

Strategies to address issues identified should be implemented and evaluated

2.1.3 Considerations for Aboriginal patients

 Section 4.1 acknowledges the higher rates of Aboriginal patients who choose not to wait for treatment in ED when compared to non-Aboriginal patients.

An important contributor to this issue is Aboriginal patients feeling safe to stay and wait. The use of local Aboriginal art in ED waiting rooms can provide links to culture and community; advice should be sought on appropriate art from the local Aboriginal community.

If available in the hospital, relatives may access the designated Aboriginal waiting room for families and carers. If no room exists, a culturally appropriate space within the local hospital should be identified.

Patients identifying as Aboriginal people should be provided with information regarding access to Aboriginal Health Workers that may be available. Access to any of these services may

4.1 Monitoring of rates of patients who ‘Did not Wait’

 EDs should maintain a local auditing system to monitor trends in rates of DNW. Review of data should also be undertaken by Aboriginal and non-Aboriginal patients as there is significant evidence in the literature of higher rates of DNW among Aboriginal patients presenting to ED

Addressing this issue is in line with the Australian Commission on Safety and Quality in Healthcare’s guidance on Improving care for Aboriginal and Torres Strait Islander People.

Locally designed strategies to manage identified reasons for patients who DNW should be implemented with outcomes reviewed. Consideration may be given to follow up of patients who DNW who are considered to have high risk issues or are from a vulnerable patient group.

Part 2 AMA (NSW) President: culturally appropriate spaces in EDs are a welcome addition to NSW public hospitals

Access to healthcare is critical to the wellbeing of all Australians and removing barriers to it is important, AMA (NSW) President, Prof Brad Frankum, said.

“It is essential that hospitals and all healthcare facilities make an effort to provide safe and welcoming spaces to facilitate access to care.

“Public hospitals try to do this in a range of ways, including the design of spaces, the provision of information in different languages, access to translators and other services to ensure patients get the best from their healthcare.

“For this reason, AMA (NSW) applauds the NSW Government for encouraging hospitals to ensure that they consider the needs of Indigenous patients in creating a safe and welcoming environment in hospitals,” Prof Frankum said.

“Indigenous patients continue to suffer unacceptably poorer health outcomes compared to other Australians.

“For the Aboriginal and Torres Strait Islander population born in 2010–2012, life expectancy was estimated to be 10.6 years lower than that of the non-Indigenous population.

“Indigenous patients are over-represented in requiring public hospital services.

“In 2013-14, there were 392,142 public hospital emergency department presentations by Indigenous people, accounting for 5.4% of all such presentations,” Prof Frankum said.

“As a doctor working in south western Sydney and at an Aboriginal Medical Service, I see every day the barriers to accessing healthcare faced by our Indigenous patients.

“Hospitals are complex, overwhelming places and care is too often fragmented.

“For this reason, everyone involved in healthcare has an obligation to break down the barriers to accessing care and to improve health outcomes.

“It is disappointing to see those who clearly do not have the same personal experiences of navigating our healthcare system making inappropriate comments about such an important health policy,” Prof Frankum said

Part 3 : Culturally safe healthcare starts in the waiting room

The Public Health Association of Australia (PHAA) called for cultural safety in Aboriginal and Torres Strait Islander healthcare last week, along with a number of other leading health groups and medical practitioners.

As an extension of this, the PHAA supports all viable and suitable cultural safety measures in the provision of healthcare to Aboriginal and Torres Strait Islander people, including culturally appropriate waiting rooms.

Carmen Parter, PHAA Vice-President (Aboriginal and Torres Strait Islander) affirmed PHAA’s support for such an initiative, saying, “All healthcare providers need to consider the cultural dimension of the services they are providing, and embrace culturally safe care which is determined to be safe by Aboriginal and Torres Strait Islander patients and their families.”

 

“This includes making hospital waiting rooms a welcoming and supportive environment for Aboriginal and Torres Strait Islander people, which will help to build trust between them and their healthcare providers and enhance cultural sensitivity in medical treatment,” she said.

Ms Parter continued, “It is vitally important that these waiting areas are designed and implemented in close consultation with relevant local Aboriginal and Torres Strait Islander communities and Aboriginal Community Controlled Health Organisations.”

“The history of the stolen generations and the role that Australian hospitals held during these events has left a strong effect on Aboriginal and Torres Strait Islander people, and in order to overcome this and move toward Reconciliation we need to work together to ensure Australian hospitals are a safe space for all,” Ms Parter said.

Michael Moore, CEO of the PHAA supported Ms Parter’s statements, saying, “Evidence shows that healthcare has the best outcomes when the patient and provider can share knowledge and understanding in a respectful and welcoming environment.

We also know that Aboriginal and Torres Strait Islander patients are at least 1.5 times more likely to leave hospital before receiving treatment compared to non-Indigenous patients.”

“This resembles the gaps in health outcomes which Close the Gap campaigners are working hard to resolve, and a trial on the mid-north coast in NSW showed that culturally appropriate waiting rooms resulted in a 50% reduction in Aboriginal and Torres Strait Islander patients leaving before accessing treatment. This really demonstrates the strength of this type of cultural safety initiative in a tangible way,” Mr Moore said.

“We ensure that hospitals are safe environments for children, elderly people, disabled people, and other groups with certain needs, it’s now time we ensure that the cultural needs of patients are also taken into careful consideration,” Mr Moore said.

 

Part 4 Racism and the hospital system : Donna Ah Chee

 Read in full here

“Within the hospital system Aboriginal and Torres Strait Islander people face racist barriers to gaining appropriate health care. Despite the increased burden of disease they carry, Aboriginal and Torres Strait Islander patients are only three-quarters (73%) as likely to undergo a procedure once admitted to hospital (3).

This difference led one key study to conclude that ‘there may be systematic differences in the treatment of patients identified as Indigenous’ in Australia’s public hospitals (4), a conclusion supported by studies showing poorer survival rates for cancer for Indigenous people, due to their being less likely to have treatment, having to wait longer for surgery, and being referred later for specialist treatment (5). This is not good enough and we need to use the current spotlight on racism to look at these deeper issues as well”, she suggested.

“Such systemic differences in care provided by hospitals contribute to Aboriginal and Torres Strait Islander people’s low level of trust for hospitals as institutions – the 2008 National Aboriginal and Torres Strait Islander Social Survey found that little more than 60% of Aboriginal and Torres Strait Islander people said that they felt hospitals could be trusted (6).

This level of distrust is reflected in the fact that Aboriginal and Torres Strait Islander people are five times as likely to leave hospital against medical advice or be discharged at their own risk compared to other Australians (7).

“Addressing these institutional barriers to appropriate care is complex but possible and we can do it as a nation of we finally come to terms with the seriousness of the problem (8).

“It will take a strong commitment to action. There needs to be a greater awareness in the Australian community about the adverse health consequences of racism for Aboriginal people.

If any good is to come out of the racism shown towards Adam Goodes I hope it is an awareness of the harm this does to our people across the nation which is currently symbolised by the suffering of one man: Adam Goodes.

Racism is a serious problem that Australia is yet to properly address. It should never be trivialised. It needs to be dealt with”, she concluded.

References

  1. Paradies, Y., Harris, R. & Anderson, I. 2008, The Impact of Racism on Indigenous Health in Australia and Aotearoa: Towards a Research Agenda, Discussion Paper No. 4, Cooperative Research Centre for Aboriginal Health, Darwin.
  2. ANTaR website http://www.antar.org.au/node/2… accessed September 26 2011
  3. Australian Health Ministers Advisory Council (2012). Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report. AHMAC. Canberra. page 131
  4. Cunningham J (2002). “Diagnostic and therapeutic procedures among Australian hospital patients identified as Indigenous.” Medical Journal of Australia 176(2): 58-62
  5. Condon J R, Barnes T, et al. (2005). “Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory.” Medical Journal of Australia 182(6

 

 ” Cultural safety requires embedding in not only course accreditation for each health profession — including measures to reduce resistance — but also in the standards governing clinical professionalism and quality, such as the Royal Australian College of General Practitioners Standards for general practices,19 and the Australian Commission on Safety and Quality in Health Care National safety and quality health service standards.20

Such commitment will need investment in clinician education and professional development, together with measures for accountability. The stewards of the National Aboriginal and Torres Strait Islander Health Plan5 (ie, the Department of Health and their expert implementation advisory group), accreditation bodies, and monitors of the existing frameworks of safety and quality standards in health care need to formally collaborate on a systematic revision of standards to embed culturally safe practice and develop health settings free of racism.”

Martin Laverty, Dennis R McDermott and Tom Calma

Originally published by MJA here

Download a PDF of this Report Paper for references 1-20

MJA Cultural Safety

Read 20 + previous NACCHO articles Cultural Safety  

In Australia, the existing health safety and quality standards are insufficient to ensure culturally safe care for Indigenous patients in order to achieve optimum care outcomes.

Where “business as usual” health care is perceived as demeaning or disempowering — that is, deemed racist or culturally unsafe — it may significantly reduce treatment adherence or result in complete disengagement,1,2 even when this may be life-threatening.3

Peak Indigenous health bodies argue that boosting the likelihood of culturally safe clinical care may substantially contribute to Indigenous health improvement.4 It follows that a more specific embedding of cultural safety within mandatory standards for safe, quality-assured clinical care may strengthen the currently inadequate Closing the Gap mechanisms related to health care delivery.

The causes of inequitable health care are many. Western biomedical praxis differs from Indigenous foundational, holistic attention to the physical, emotional, mental and spiritual wellbeing of the person and the community.5 An article published in this issue of the MJA6 deals with the link between culture and language in improving communication in Indigenous health settings, a critical component of delivering cultural safety.

Integrating cultural safety in an active manner reconfigures health care to allow greater equity of realised access, rather than the assumption of full access, including procession to appropriate intervention.

As an example of the need to improve equity, a South Australian study found that Indigenous people presenting to emergency departments with acute coronary syndrome were half as likely as non-Indigenous patients to undergo angiography.7 More broadly, Indigenous people admitted to hospital are less likely to have a procedure for a condition than non-Indigenous people.8

Cardiovascular disease is the leading cause of death in Indigenous Australians.9 Cancer is the second biggest killer: the mortality rate for some cancers is three times higher for Indigenous than for non-Indigenous Australians.10 Clinical leaders in these two disease areas have identified the need for culturally safe health care to improve Indigenous health outcomes.

Cultural safety is an Indigenous-led model of care, with limited, but increasing, uptake, particularly in Australia, New Zealand and Canada. It acknowledges the barriers to clinical effectiveness arising from the inherent power imbalance between provider and patient,11 and moves to redress this dynamic by making the clinician’s cultural underpinning a critical focus for reflection.

Moreover, it invites practitioners to consider: “what do I bring to this encounter, what is going on for me?” Culturally safe care results where there is no inadvertent disempowering of the recipient, indeed where recipients are involved in the decision making and become part of a team effort to maximise the effectiveness of the care. The model pursues more effective practice through being aware of difference, decolonising, considering power relationships, implementing reflective practice, and by allowing the patient to determine what safety means.11

Along with an emphasis on provider praxis, cultural safety focuses on how institutional care is both envisaged and delivered.12 Literature on cultural safety in Australia is scant but growing.13 Where evidence is available, it identifies communication difficulties and racism as barriers not only to access but also to the receipt of indicated interventions or procedures.11

There is evidence of means to overcome these barriers. An Australian study undertaken across ten general practices tested the use of a cultural safety workshop, a health worker toolkit, and partnerships with mentors from Indigenous organisations and general practitioners.13 Cultural respect (significant improvements on cultural quotient score, along with Indigenous patient and cultural mentor rating), service (significant increase in Indigenous patients seen) and clinical measures (some significant increases in the recording of chronic disease factors) improved across the participating practices.

In addition, a 2010 study by Durey14 assessed the role of education, for both undergraduate students and health practitioners, in the delivery of culturally responsive health service, improving practice and reducing racism and disparities in health care between Indigenous and non-Indigenous Australians. The study found that cultural safety programs may lead to short term improvements to health practice, but that evidence of sustained change is more elusive because few programs have been subject to long term evaluation..

Newman and colleagues10 identified clinician reliance on stereotypical narratives of indigeneity in informing cancer care services. Redressing these taken-for-granted assumptions led to culturally engaged and more effective cancer care. In a similar manner, Ilton and colleagues15 addressed the importance of individual clinician cultural safety for optimising outcomes, noting that provider perceptions of Indigenous patient attributes may be biased toward conservative care.

The authors, however, went beyond the clinician–patient interaction to stress the outcome-enhancing power of change in the organisational and health setting. They proposed a management framework for acute coronary syndromes in Indigenous Australians.

This framework involved coordinated pathways of care, with roles for Indigenous cardiac coordinators and supported by clinical networks and Aboriginal liaison officers. It specified culturally appropriate warning information, appropriate treatment, individualised care plans, culturally appropriate tools within hospital education, inclusion of families and adequate follow-up.

Willis and colleagues16 also called for organisational change as an essential companion to individual practitioner development. Drawing on 12 studies involving continuous quality improvement (CQI) or CQI-like methods and short term interventions, they acknowledged evidence gaps, prescribing caution, and argued for such change to be undertaken in the service of long term controlled trials, as these would require 2–3 years to see any CQI-related changes.

Sjoberg and McDermott,17 however, noted the existence of barriers to change: the challenge (personal and professional) posed by Indigenous health and cultural safety training may not only lead to individual but also to institutional resistance.17 Dismantling individual resistance requires the development of a critical disposition — deemed central to professionalism and quality18 — but in a context of strengthened and legitimating accreditation specific to each discipline. The barriers thrown up by institutional resistance, manifesting as gatekeeping, marginalisation or underfunding, may require organisational change mandated by standards.

NACCHO Media Alerts : Top 10 Current Aboriginal Health News Stories to keep you up to date

1. Aboriginal sexual health: The Australian : Was the syphilis epidemic preventable ? NACCHO responds

2.Royal Flying Doctors Service extra 4-year funding $84 million Mental Health and Dental Services

3.Nurses PAQ continues political membership campaign spreading false and misleading information about our cultural safety

4.AMSANT has called for re-doubled efforts to implement the recommendations of the Royal Commission into the care and protection of children in partnership with NT Aboriginal leaders

5.Dialysis facilities worth $17 million are sitting padlocked, empty and unused in WA’s north

6.ALRC Report into Incarceration of Aboriginal and Torres Strait Islander People.

7. Minister Ken Wyatt : Listening to Indigenous Needs: Healthy Ears Program Extended with $29.4 commitment

8.Tangentyere Alice Springs Women’s Family Safety Group visits Canberra

9.Minister Ken Wyatt launches our NACCHO RACGP National Guide to a preventative health assessment for Aboriginal and Torres Strait Islander people

10. Your guide to a healthy Easter : #Eggs-actly  

 

1.Aboriginal sexual health: The Australian : Was the syphilis epidemic preventable ? NACCHO responds

“These (STIs) are preventable diseases and we need increased testing, treatment plans and a ­culturally appropriate health ­education campaign that focuses resources on promoting safe-sex messages delivered to at-risk ­communities by our trained Aboriginal workforce,”

Pat Turner, chief executive of peak body the National Aboriginal Community Controlled Health Organisation, is adamant about this.

Read full article in Easter Monday The Australian or Part B below

2.Royal Flying Doctors Service extra 4-year funding $84 million Mental Health and Dental Services

Read full press release here

 

3.Nurses PAQ continues political membership campaign spreading false and misleading information about cultural safety

SEE NACCHO Response

SEE an Indigenous Patients Response

See Nurses PAQ Misleading and false campaign

4. AMSANT  has called for re-doubled efforts to implement the recommendations of the Royal Commission into the care and protection of children in partnership with NT Aboriginal leaders

Read full AMSANT press Release

Listen to interview with Donna Ah Chee

Press Release @NACCHOChair calls on the Federal Government to work with us to keep our children safe

#WeHaveTheSolutions Plus comments from CEO’s @Anyinginyi @DanilaDilba

4.Dialysis facilities worth $17 million are sitting padlocked, empty and unused in WA’s north

Read full Story HERE

6.ALRC Report into Incarceration of Aboriginal and Torres Strait Islander People;

Read Download Full Transcript

Senator Patrick Dodson

Download the report from HERE

Community Groups Call For Action on Indigenous Incarceration Rates

7. Minister Ken Wyatt : Listening to Indigenous Needs: Healthy Ears Program Extended with $29.4 commitment

The Australian Government has committed $29.4 million to extend the Healthy Ears – Better Hearing, Better Listening Program, to help ensure tens of thousands more Indigenous children and young adults grow up with good hearing and the opportunities it brings.

Read Press Release HEAR

8.Tangentyere Alice Springs Women’s Family Safety Group visits Canberra

This week the Tangentyere Women’s Family Safety Group from Alice Springs were in Canberra. They shared with politicians, their own solutions for their own communities, and they are making an enormous difference.
Big thanks to all the Tangentyere women who made it to Canberra.

Read Download the Press Release

TANGENTYERE WOMEN’S FAMILY SAFETY GROUP (FED

9. Minister Ken Wyatt launches our NACCHO RACGP National Guide to a preventative health assessment for Aboriginal and Torres Strait Islander people

Read press releases and link to Download the National Guide

10. Your guide to a  healthy Easter : #Eggs-actly  

And finally hope you had a Happy Easter all you mob ! After you have enjoyed your chocolate eggs and hot cross buns , this is how much exercise you will require to work of those Easter treats .

For medical and nutrition advice please check with your ACCHO Doctor , Health Promotion / Lifestyle teams or one of our ACCHO nutritionists

 

Part B Full Text The Australian Article Easter Monday

There is no reason it should have happened, especially not in a first-world country like Australia, but it has: indigenous communities in the country’s north are in the grip of wholly treatable sexually transmitted diseases.

In the case of syphilis, it is an epidemic — West Australian Labor senator Patrick Dodson ­described it as such, in a fury, when health department bureaucrats mumbled during Senate estimates about having held a few “meetings” on the matter.

There have been about 2000 syphilis notifications — with at least 13 congenital cases, six of them fatal — since the outbreak began in northern Queensland in 2011, before spreading to the Northern Territory, Western Australia and, finally, South Australia.

What’s worse, it could have been stopped. James Ward, of the South Australian Health and Medical Research Institute, wrote in mid-2011 that there had been a “downward trend” over several years and it was likely at that point that the “elimination of syphilis is achievable within indigenous ­remote communities”.

But governments were slow to react, and Ward is now assisting in the design of an $8.8 million emergency “surge” treatment approach on the cusp of being rolled out in Cairns and Darwin, with sites in the two remaining affected states yet to be identified.

It will be an aggressive strategy — under previous guidelines, you had to have been identified during a health check as an active carrier of syphilis to be treated. Now, anyone who registers antibodies for the pathogen during a blood prick test, whether actively carrying syphilis or not, will receive an ­immediate penicillin injection in an attempt to halt the infection’s geographical spread.

This is key: the high mobility of indigenous people in northern and central Australia means pathogens cross jurisdictions with ­impunity. Australian Medical ­Association president Michael Gannon calls syphilis a “clever bacterium that will never go away”, warning that “bugs don’t respect state borders”.

Olga Havnen, one of the Northern Territory’s most respected public health experts, points out that many people “will have connections and relations from the Torres Strait through to the Kimberley and on to Broome — and it’s only a matter of seven or eight kilometres between PNG and the northernmost islands there in the Torres Strait”.

“This is probably something that’s not really understood by the broader Australian community,” Havnen says. “I suspect once you get a major outbreak of something like encephalitis or Dengue fever, any of those mosquito-borne diseases, and that starts to encroach onto the mainland, then people will start to get a bit worried.”

Olga Havnen, CEO of the Danila Dilba Health Service, says transmission is complex issue in Australia’s indigenous communities.
Olga Havnen, CEO of the Danila Dilba Health Service, says transmission is complex issue in Australia’s indigenous communities.

But it is not just syphilis — ­indeed, not even just STIs — that have infectious disease authorities concerned and the network of Aboriginal Community Controlled Health Organisations stretched.

Chlamydia, the nation’s most frequently diagnosed STI in 2016 based on figures from the Kirby Institute at the University of NSW, is three times more likely to be contracted by an indigenous Australian than a non-­indigenous one.

The rate was highest in the NT, at 1689.1 notifications per 100,000 indigenous people, compared with 607.9 per 100,000 non-indigenous Territorians. If you’re indigenous, you’re seven times more likely to contract gonorrhoea, spiking to 15 times more likely if only women are considered. Syphilis, five times more likely.

As the syphilis response gets under way, health services such as the one Havnen leads, the Darwin-based Danila Dilba, will be given extra resources to tackle it. “With proper resourcing, if you want to be doing outreach with those people who might be visitors to town living in the long grass, then we’re probably best placed to be able to do that,” she says.

But the extra focus comes with a warning. A spate of alleged sexual assaults on Aboriginal children, beginning with a two-year-old in Tennant Creek last month and followed by three more alleged ­attacks, has raised speculation of a link between high STI rates and evidence of child sexual assault.

After the first case, former NT children’s commissioner Howard Bath told this newspaper that STI rates were “a better indicator of background levels of abuse than reporting because so many of those cases don’t get reported to anyone, whereas kids with serious infections do tend to go to a ­doctor”. Others, including Alice Springs town councillor Jacinta Price and Aboriginal businessman Warren Mundine, raised the ­spectre of the need for removing more at-risk indigenous children from dangerous environments.

Children play AFL in Yeundumu. Picture: Jason Edwards
Children play AFL in Yeundumu. Picture: Jason Edwards

However, Sarah Giles, Danila Dilba’s clinical director and a medical practitioner of 20 years’ standing in northern Australia, warns this kind of response only exacerbates the problem. She is one of a range of public health authorities who, like Havnen, say connecting high STI figures to the very real scourge of child sex abuse simply makes no sense. They do not carry correlated data sets, the experts say.

“One of the things that’s really unhelpful about trying to manage STIs at a population level is to link it with child abuse and mandatory reporting, and for people to be fearful of STIs,” Giles says. “The problem is that when they’re conflated and when communities feel that they can’t get help ­because things might be misinterpreted or things might be reported, they’re less likely to present with symptoms. The majority of STIs are in adults and they’re sexually transmitted.”

Havnen says there is evidence of STIs being transmitted non-sexually, including to children, such as through poor hand ­hygiene, although Giles says that is “reasonably rare”. And while NT data shows five children under 12 contracted either chlamydia or gonorrhoea in 2016 (none had syphilis), and there were another five under 12 last year, Havnen points to the fact that over the past decade there has been no increasing trend in under 12s being affected. Where there has been a rise in the NT is in people aged between 13 and 19, with annual gonorrhoea notifications increasing from 64 cases in the 14-15-year-old ­female cohort in 2006 to 94 notifications in 2016.

In the 16-17-year-old female ­cohort the same figures were 96 and 141 and in the 12-13-year-old group it rose from 20 in 2006 to 33 in 2016. Overall, for both boys and girls under 16, annual gonorrhoea notifications rose from 109 in 2006 to 186 in 2016, according to figures provided to the royal ­commission into child detention by NT Health. Havnen describes the rise as “concerning but not, on its own, evidence of increasing ­levels of sexual abuse”.

Ward is more direct. Not all STIs are the result of sexual abuse, he warns, and not all sexual abuse results in an STI. If you’re a health professional trying to deal with an epidemiological wildfire, the distinction matters — the data and its correct interpretations can literally be a matter of life and death.

Indeed, in its own written cav­eats to the material it provided to the royal commission, the department warns that sexual health data is “very much subject to variations in testing” and warns against making “misleading assumptions about trends”. Ward says: “Most STIs notified in remote indigenous communities are ­assumed to be the result of sex ­between consenting adults — that is, 16 to 30-year-olds. Of the under 16s, the majority are 14 and 15-year-olds.” He says a historically high background prevalence of STIs in remote indigenous communities — along with a range of other ­infectious diseases long eradicated elsewhere — is to blame for their ongoing presence. Poor education, health services and hygiene contribute, and where drug and ­alcohol problems exist, sexually risky behaviour is more likely too. The lingering impact of colonisation and arrival of diseases then still common in broader ­society cannot be underestimated.

But Ward claims that an apparently high territory police figure of about 700 cases of “suspected child sexual offences” in the NT over the past five years may be misleading. He says a large number of these are likely to be the result of mandatory reporting, where someone under 16 is known to have a partner with an age gap of more than two years, or someone under 14 is known to be engaging in sexual activity. Ward points out that 15 is the nationwide ­median sexual debut age, an age he suggests is dropping. At any rate, he argues, child sex abuse is unlikely to be the main reason for that high rate of mandatory ­reporting in the NT.

Areyonga is a small Aboriginal community a few hours drive from Alice Springs.
Areyonga is a small Aboriginal community a few hours drive from Alice Springs.

Data matters, and so does how it is used. Chipping away at the perception of child sexual abuse in indigenous communities are the latest figures from the Australian Institute of Health and Welfare showing the rate of removals for that crime is actually higher in non-indigenous Australia.

According to a report this month from the AIHW, removals based on substantiated sex abuse cases in 2016-17 were starkly different for each cohort: 8.3 per cent for indigenous children, from a total of 13,749 removals, and 13.4 per cent for non-indigenous children, from 34,915 removals.

Havnen concedes there is a need for better reporting of child abuse and has called for a confidential helpline that would be free of charge and staffed around the clock by health professionals.

It’s based on a model already in use in Europe that she says deals with millions of calls a year — but it would require a comprehensive education and publicity campaign if it were to gain traction in remote Australia. And that means starting with the adults.

“If you’re going to do sex ­education in schools and you start to move into the area about sexual abuse and violence and so on, it’s really important that adults are ­educated first about what to do with that information,” she says. “Because too often if you just ­educate kids, and they come home and make a disclosure, they end up being told they’re liars.”

These challenges exist against the backdrop of a community already beset by a range of infectious diseases barely present elsewhere in the country, including the STIs that should be so easily treatable. It is, as Havnen is the first to admit, a complex matter.

Cheryl Jones, president of the Australasian Society for Infectious Diseases, says the answer is better primary treatment solutions and education, rather than trying to solve the problem after it has ­occurred. “For any of these public health infectious disease problems in ­remote and rural areas, we need to support basic infrastructure at the point of care and work alongside communities to come up with ­solutions,” she says.

Sisters play in the mud after a rare rain at Hoppy's 'town camp' on the outskirts of Alice Springs.
Sisters play in the mud after a rare rain at Hoppy’s ‘town camp’ on the outskirts of Alice Springs.

Pat Turner, chief executive of peak body the National Aboriginal Community Controlled Health Organisation, is adamant about this. “These (STIs) are preventable diseases and we need increased testing, treatment plans and a ­culturally appropriate health ­education campaign that focuses resources on promoting safe-sex messages delivered to at-risk ­communities by our trained Aboriginal workforce,” Turner says.

The Australian Medical ­Association has called for the formation of a national Centre for Disease Control, focusing on global surveillance and most likely based in the north, as being “urgently needed to provide national leadership and to co-ordinate rapid and effective public health responses to manage communicable diseases and outbreaks”.

“The current approach to disease threats, and control of infectious diseases, relies on disjointed state and commonwealth formal structures, informal networks, collaborations, and the goodwill of public health and infectious disease physicians,” the association warned in a submission to the Turnbull government last year.

However, the federal health ­department has rebuffed the CDC argument, telling the association that “our current arrangements are effective” and warning the suggestion could introduce “considerable overlap and duplication with existing functions”.

“I think it (the CDC) might have some merit, if it helps to ­advocate with government about what needs to happen,” Havnen says, “but if these things are going to be targeted at Aboriginal bodies, it needs to be a genuine partnership. It’s got to be informed by the realities on the ground and what we know. That information has to be fed up into the planning process.”

NACCHO #MediaWatch Aboriginal Health @DeSouzaRN busting 5 Myths about #CulturalSafety : Plus Transcript and View @ABCMediaWatch exposing the lies about #whitepriviledge repeated by #MSM Media

Graeme Haycroft told Media Watch he stands by his claims, and no doubt he’ll be encouraged to keep on repeating them by conservative commentators who’d love to believe they’re true.

But they are not.

And he should not be allowed to make the claims unchallenged.

Nurses are not required, forced or even encouraged to announce their white privilege to patients before treating them, or indeed at all.

Yet that crazy claim has been gathering strength for weeks.”

 Watch ABC TV Media watch broadcast HERE

 ” Cultural safety challenges nurses and midwives to work in partnership with people and communities but acknowledges that the system is weighted towards the interests of those who work in the system. We think we give the same care to everyone, but everyone experiences our care differently.

Once we understand ourselves and our health system as having a culture that privileges some people over others – whether we are conscious of it or not – we can get on with the real work of implementing better healthcare experiences for Aboriginal and Torres Strait Islander peoples and other marginalised groups.’

Dr Ruth De Souza Busting the 5 Myths of cultural safety See Part 2 Below

 Watch ABC TV Media watch broadcast HERE

Claims the new nursing code will force white nurses to declare ‘white privilege’ are incorrect

But now to a story that is almost as stupid. Here’s the promo for Friday night’s Today Tonight in Adelaide:

ANNOUNCER: Having to apologise for being white.

GRAEME HAYCROFT: I think it’s a disgrace.

ANNOUNCER: Nurses told to say sorry before treating Aborigines.

GRAEME HAYCROFT: You have real consequences.

ANNOUNCER: Politically correct or risk dismissal.

— Channel Seven, Today Tonight promo, 22 March, 2018

And those crazy claims weren’t just on Seven. The trusty Daily Mail had them the day before:

Racist to its core. Outrage as nurses are subject to a new code where they must announce their ‘white privilege’ before treating Aboriginal and Torres Strait Islander patients

— Daily Mail, 21 March, 2018

Is it April Fool’s Day, I hear you ask? No, that’s still a week away.

So where did it come from?

Take a bow Peta Credlin, Tony Abbott’s former chief of staff, who told her Sky News viewers on Wednesday it was a story she “almost can’t believe”.

At least she got that bit right. She then went on to ask her guest:

PETA CREDLIN: Please tell me I’m wrong. As I understand it, this new code of conduct for nurses in Queensland requires obviously white nurses to announce they’ve got white privilege before they can look after patients of an Indigenous or Torres Strait Islander background. Am I right there?

— Sky News, Credlin, 21 March, 2018

And back came the answer from Graeme Haycroft of Queensland nurses’ association the NPAQ:

GRAEME HAYCROFT: Yes, you are, except that it’s not just Queensland, Peta, it’s all of Australia, there’s 350,000 nurses and midwives Australia-wide and they’re all now subject to this new code.

— Sky News, Credlin, 21 March, 2018

So, is the story true? Well no. Although there is some basis to it.

There IS a new code for nurses and midwives, which came into effect this month, and it does talk about Indigenous patients, and the glossary does say this about white privilege:

GRAEME HAYCROFT: In relation to Aboriginal and Torres Strait Islander health, cultural safety provides a decolonising model of practice based on dialogue, communication, power sharing and negotiation, and the acknowledgement of white privilege.

— Sky News, Credlin, 21 March, 2018

Now you might think that is pretty barmy stuff. But, the glossary is not the code that nurses must adhere to.

And nurses are not required, forced or even encouraged to announce their white privilege to patients before treating them, or indeed at all.

Yet that crazy claim has been gathering strength for weeks. Ever since Cory Bernardi first made it in January in his, quote, “Weekly Dose of Common Sense”, where he dubbed it “medical Marxism” and claimed the code says:

Nurses must acknowledge white privilege and voice this acknowledgment if asked …

— Senator Cory Bernardi’s Weekly Dose of Common Sense, 31 January, 2018

True to form, The Daily Telegraph was first to seize on the story. Then, a few weeks later the Cairns Post cranked it up.

And last week the Daily Mail and News.com.au followed the Credlin interview by revving it up again.

At which point Andrew Bolt and Chris Smith joined the fun:

ANDREW BOLT: What about if they’re just within seconds of dying and the nurse has to fling themselves into action, but they have to stop, before, while they just announce their white privilege, oh too late.

CHRIS SMITH: Yeah.

ANDREW BOLT: Gone.

CHRIS SMITH : Please keep your heart beating for one more beat, because sir I need to talk to you about my white privilege.

— 2GB, The Chris Smith Show, 22 March, 2018

Hilarious, eh?

So, who is driving all this outrage?

Answer: Credlin’s interviewee, Graeme Haycroft, founder of the breakaway union, the Nurses Professional Association of Queensland, which represents around 2500 – yes, 2500 – of Australia’s 390,000 nurses and midwives.

Now Haycroft is not a nurse but a labour hire millionaire, who’s made his fortune busting unions. He’s also a former bigwig in the LNP, and a member of the fiercely anti-union HR Nicholls Society.

And he’s been spreading fear about the code to anyone who’ll listen, like the inimitable John Mackenzie, or Macca, on Cairns’ 4CA:

JOHN MACKENZIE: … When this issue emerged, everyone thought it was a practical joke. But it’s far from a practical joke, isn’t it?

GRAEME HAYCROFT: Well, yes, it’s worse than that. It’s an insidious form of racism and … it’s going to end up with a form of apartheid in the health system.

— Classic Hits 4CA, Mornings with John MacKenzie, 7 March, 2018

And a couple of weeks before that, Graeme Haycroft was getting 2GB’s Michael McLaren in Sydney equally riled up:

MICHAEL MCLAREN: This all sounds ridiculous to me. What the hell is cultural safety? No one’s ever heard of it.

— 2GB, Overnight with Michael McLaren, 13 March, 2018

So, what is cultural safety? Well, according to that new code from the Nursing and Midwifery Board of Australia:

Rather than saying ‘I provide the same care to everyone regardless of difference,’ cultural safety means providing care that takes into account Aboriginal and/or Torres Strait Islander peoples’ needs.

— Nursing & Midwifery Board of Australia code of conduct for nurses and code of conduct for midwives, March, 2018

Doesn’t sound too bad, you might think. But Haycroft – who’s using the issue to rally support for his union – claims the code will see nurses lose their jobs. And here is how:

GRAEME HAYCROFT: If you’ve got an Aboriginal or Indigenous patient and they don’t like the bedside manner of the nurse because the nurse is not acknowledging her white privilege, if she happens to be white, then a complaint can be lodged and there’s no defence.

— 2GB, Overnight with Michael McLaren, 13 March, 2018

So, is that true? Well, no again, at least according to the Nursing and Midwifery Board of Australia, who drew up the code:

MEDIA WATCH: Are nurses encouraged to announce their ‘white privilege’ before treating indigenous patients?

NMBA: No.

MEDIA WATCH: Is there any requirement to acknowledge or announce ‘white privilege’ before treating a patient?

NMBA: No.

MEDIA WATCH: Can a nurse be sacked for NOT declaring or addressing their ‘white privilege’ to a patient?

NMBA: No. The recent criticisms from Mr Haycroft are based on completely untrue statements.

— Nursing & Midwifery Board of Australia, 23 March, 2018

Graeme Haycroft told Media Watch he stands by his claims, and no doubt he’ll be encouraged to keep on repeating them by conservative commentators who’d love to believe they’re true.

But they are not.

And he should not be allowed to make the claims unchallenged.

Read a statement from the Nursing and Midwifery Board of Australia
Read a response to Media Watch from the Nursing and Midwifery Board of Australia

Part 2 Busting 5 myths about cultural safety

Dr Ruth De Souza is a nurse, writer, speaker and researcher with a passionate interest in culture and health. She has combined her academic career with governance and community involvement, talking and writing in popular and scholarly venues about mental health, maternal mental health, race, ethnicity, biculturalism, multiculturalism, settlement, refugee resettlement, and cultural safety.

She has serve on the editorial boards of the Journal of Transcultural NursingThe Women’s Studies Journal (The Women’s Studies Association, NZ) and The Australian College of Nursing (ACN)’s Hive publication

Published HERE 26 March

The new Codes of Conduct for Nurses and Midwives in Australia have made the news. The Nursing and Midwifery Board of Australia  (NMBA) have set expectations around culturally safe practice in the health system for nurses and midwives who comprise the largest workforce in healthcare.The incorporation of cultural safety into nursing in Australia has support from The Council of Deans of Nursing and Midwifery:

The Council of Deans of Nursing and Midwifery ANZ acknowledge Aboriginal & Torres Strait
Islander people as the First Nations people of Australia. The Council supports the
development and implementation of cultural safety in education programs, practice, and
research activities for nurses and midwives. It also recognises that the origins and context
informing the development of cultural safety arise from different historical, political, economic
social and ideological positions in Australia and New Zealand and therefore this will be
acknowledged separately

However, this explicitly anti-racist and equity informed strategy has not gone down well with The Nurses Professional Association of Queensland Inc (NPAQ). Run by union-buster Graeme Haycroft who calls the Codes ‘racist’,  the association brands itself as a non party political alternative to existing unions. Haycroft has garnered a deluge of support (despite not being political) and claims NPAQ members were not consulted and 50 per cent of NPAQ members are opposed to the Codes. Interviewed by Sky News host Peta Credlin, supporters like  Andrew Bolt have jumped into the fray with headlines screaming: Nurses forced to announce ‘white privilege’ is new racism. The hyperbole has been astounding:

What if… they’re within seconds of dying and the nurse has to fling themselves into action but they have to stop while they just announce their white privilege?

A clear early rebuttal came from The Queensland Nurses and Midwives’ Union (QNMU) Secretary Beth Mohle when Cory Bernardi first expressed indignation:

These codes were the subject of lengthy consultations with the professions of nursing and midwifery and other stakeholders including community representatives. This review was comprehensive and evidenced-based. Our union and our national body the Australian Nursing Midwifery Federation (ANMF) were active participants in these consultations.

The codes, written by nurses and midwives for nurses and midwives, seek to ensure the individual needs and backgrounds of each patient are taken into account during treatment.

There’s no doubt cultural factors, including how a patient feels while within the health system, can impact wellbeing. For example, culture and background often determine how a patient would prefer to give birth or pass away.

Every day, nurses and midwives consider a range of complex factors, including a patient’s background and culture to determine the best treatment. These codes simply articulate what is required to support safe nursing and midwifery practice for all.

Further rebuttals have entered the public sphere, including a joint statement from Nursing organisations including the Nursing and Midwifery Board of AustraliaAustralian College of Midwives (ACM); Australian College of Nursing (ACN); Congress of Aboriginal and Torres Strait Islander Nurses and Midwives and A/Federal Secretary Australian Nursing and Midwifery Federation which have also been supported by the Australian Healthcare and Hospitals Association, Public Health Association of Australia, Consumers Health Forum of Australia and National Rural Health Alliance.

As CEO of CATSINaM Janine Mohamed observes in a blog for Indigenous X “Australia is playing a game of ‘catch up’”. Indeed, cultural safety is an approach developed by indigenous Māori nurses that is embedded in the undergraduate national nursing curriculum, and broadly applied across marginalised groups in New Zealand. The Nursing Council of New Zealand introduced the concept into nursing and midwifery curricula in 1992, developing the expectation that nurses practise in a ‘culturally safe’ manner. It wasn’t without resistance, however.

As a nurse, academic and researcher, cultural safety has informed my professional practice. I completed a PhD which attempted to extend the theory and practice of cultural safety to both critique nursing’s Anglo-European knowledge base, and to extend the discipline’s intellectual and political mandate with the aim of providing effective support to diverse groups of mothers (Migrant Maternity).

I am pleased to contribute to the conversation about cultural safety and nursing. I wrote this piece called Busting five myths about cultural safety – please take note, Sky News et al for Croakey.

My appreciation to Melissa Sweet and Mitchell Ward from Rock Lily Design for the terrific infographic.

Myth 1

Cultural safety is creating racism, not eliminating it. It’s political correctness gone mad!

Correction: Race is a proven determinant of health. The Nursing and Midwifery Codes of Conduct acknowledge racism and attempt to reduce its impact on health.

Australia is a white settler society like the United States, Canada and New Zealand. In such settler societies, colonisation and racism have had devastating effects on Indigenous health and wellbeing. These include: the theft of land and economic resources; the deliberate marginalisation and erasure of cultural beliefs, practices and language; and the forced imposition of British models of health over systems of healing that had been in Australia for millennia.

Along with the systematic destruction of these basic tools for wellbeing, interpersonal racism has also contributed to a reduction in access to health promoting resources for Indigenous communities. Cultural safety was developed and led by Indigenous nurses in New Zealand to mitigate the harms of colonisation and improve health care quality and outcomes for Māori, and this has been extended by nurses in Australia, Canada and the US.

Evidence demonstrates that health system adaptations informed by a cultural safety approach have benefits for the broader community. For example, in New Zealand, the request by Māori to have family involved in care (whānau support) have led to a more family-oriented health care system for everyone.

Myth 2

I’m white but I’ve had a hard life, who is to say that I am privileged? Why am I being called racist for being white? That’s racist! I am a nurse, I’ve been abused, I am not privileged.  I fought hard for everything I have and have achieved today.

Correction: Whiteness and white privilege refers to a system, they are not an insult.

Scholar Aileen Moreton-Robinson points out that British invasion and colonisation institutionalised whiteness into every aspect of law and policy in Australia. One of the first actions of the newly formed Australian nation state in 1901 was to pass the Immigration Restriction Act restricting the entry of non-white people.

The White Australia policy ended in 1962, when some of our lawmakers today were adults. Unsurprisingly, politicians have reflected these assumptions as they have demonised successive groups of migrants and refugees.

This culture of whiteness confers dominance and privilege to those who are located as white, but is largely invisible to them, and very visible to those who are not white. Being white in a settler colony like Australia means that you can move through daily life in a world that has been designed by people who are white for people who are white.

Even accounting for class and poverty, people who are white experience privileges that are not available to people of colour. White people can’t actually be systematically oppressed on the basis of their race by Indigenous people or people of colour, because the colonial systems of governance are still in force.

As the comedian Aamer Rahman points out, so called “reverse racism” would only exist under circumstances where white people had been intergenerationally marginalised from the social and economic resources of the nation on the basis of their race. The way Graeme Haycroft from the Nurses Professional Association of Queensland Inc attempts to create equivalence between the inconvenience of having to think differently about health with generations of dispossession is farcical and insulting.

Myth 3

Why can’t we treat everyone with respect? Dividing people into categories of oppressors and victims isn’t helpful.  I respect each patient and their diversity as I respect all the nurses I work with and their cultural diversity.

Correction: No matter what individuals believe, entering the health system is not always a safe experience for cultural minorities. Providing tailored care where possible helps the health system work for everyone.

One size does not fit all. It’s not helpful to treat everybody the same or to say that one does not see colour. How one shows respect varies from one person to the next. Some things work for some people, while others don’t.

Many nurses and midwives already tailor health care to people’s bodies, genders, class and sexuality. For example, the grumpy old entitled man is a well-known “type” of patient that nurses have dealt with for generations, disrupting their own routines and responding to patient demands in order to get them to accept the care required.

Cultural safety promotes an understanding of the culture of health and asks nurses and midwives to be learn to be more responsive to the needs of the patient generally, and this only benefits patients.

Cultural safety asks caregivers to challenge biases and implicit assumptions in order to improve healthcare experiences for Aboriginal and Torres Strait Islander peoples. In the codes, cultural safety also applies to any person or group of people who may differ from the nurse/midwife due to race, disability, socioeconomic status, age, gender, sexuality, ethnicity, migrant/refugee status, religious belief or political beliefs.

In other words, where “business as usual” is designed for white people, cultural safety is for everyone.

Myth 4

Why is cultural safety being regarded in the new Codes of Conduct as equally important to the patient as clinical safety? Doesn’t that devalue clinical care?

Correction: Cultural safety enhances clinical safety.

People are more likely to use health services that are appropriate, accessible and acceptable. If people don’t use health services because they do not trust them or find them unsafe, then they are more likely to become very ill or die unnecessarily.

The health system is not accessed equally by all Australians who need it. For example, Aboriginal and Torres Strait Islander people access health services at less than half of their expected need. Safety and quality of care are also linked with culture and language. Research shows that people from minority cultural and language backgrounds are more at risk of experiencing preventable adverse events compared to white patients.

In Australia lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) people often receive inappropriate medical care, and experience health inequities compared to the general population around drug and alcohol use; sexual health and mental health issues.

Discrimination, transphobia, homophobia and a lack of cultural safety from health professionals discourage help seeking. Having services that are welcoming and safe would facilitate equitable health outcomes for all these groups.

Myth 5

There is no objective assessment of what constitutes “cultural safety”.

Correction: Only the person and/or their family can determine whether or not care is culturally safe and respectful.

The most transformative aspect of cultural safety is a patient centered care approach, which emphasises sharing decision-making, information, power and responsibility. It asks us as clinicians to demonstrate respect for the values and beliefs of the patient and their family; advocating for flexibility in health care delivery and moving beyond paternalistic models of care.

Patient-centred care is institutionalised in the Australian Charter of Health Care Rights (ACSQHC, 2007) and the Australian Safety and Quality Framework for Health Service Standards (2017) Partnering with consumers (Standard 2).

Cultural safety challenges nurses and midwives to work in partnership with people and communities but acknowledges that the system is weighted towards the interests of those who work in the system. We think we give the same care to everyone, but everyone experiences our care differently.

Once we understand ourselves and our health system as having a culture that privileges some people over others – whether we are conscious of it or not – we can get on with the real work of implementing better healthcare experiences for Aboriginal and Torres Strait Islander peoples and other marginalised groups.

 

NACCHO Aboriginal Health and #Cultural Safety Media Debate : The Truth behind the Nurses Code of Conduct and the false claims enforcing #WhitePriviledge “to apologise to #Indigenous clients for being white’

 

” National media outlets ( Including Peta Credlin on SkyNews and News Corp Newspapers see Part 5 below plus Today Tonight SA ) have aired wrongful claims that the codes would force white nurses to ‘apologise to Indigenous clients for being white’.

The codes do not say that – that idea was invented and then pushed on these media programs.

These stories were not based in facts, but seem to have been driven by the partisan politics of a fringe nursing group, and conservative politicians who have been approached to comment on the wrongful claims.

I am sure that some of our nursing and midwifery members and community will be hearing disturbing claims.

Let me be clear, nurses and midwives under the new code do not have to announce their ‘white privilege’ before treating Indigenous clients.

 I am really proud of these new codes, and not only because the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) contributed to their development, which included extensive consultation across nursing and midwifery and at the time no one opposed the inclusion of cultural safety “

Janine Mohamed CEO CATSINaM see IndigenousX  Part 1 below

Read over 90 NACCHO Aboriginal Health and Racism articles published last 6 Years

Read 30 NACCHO Aboriginal Health and Cultural Safety published last 6 years

” It is clear from the 2018 Closing the Gap Report tabled by Prime Minister Turnbull in February 2018 that Aboriginal and/or Torres Strait Islander Peoples still experience poorer health outcomes than non-Indigenous Australians.

It is well understood these inequities are a result of the colonisation process and the many discriminatory policies to which Aboriginal and/or Torres Strait Islander Australians were subjected to, and the ongoing experience of discrimination today.

All healthcare leaders and health professionals have a role to play in closing the gap.

The approach the NMBA has taken for nurses and midwives (the largest workforce in the healthcare system) by setting expectations around culturally safe practice, reflects the current expectations of governments to provide a culturally safe health system.

(For more information please see the COAG Health Council 4 August 2017 Communiqué).

Combined Press Release Nursing and Midwifery Board of Australia ,The Australian Nursing and Midwifery Federation, the Australian College of Nursing, the Australian College of Midwives and the Congress of Aboriginal and Torres Strait see in full Part 2 Below

 ” I was stunned to read businessman Graeme Haycroft’s comments regarding nurses and indigenous Australians on the weekend, as part of his criticism of the new NMBA Codes and the term cultural safety which is defined in a glossary connected to the codes.

These codes were the subject of lengthy consultations with the professions of nursing and midwifery and other stakeholders including community representatives.

This review was comprehensive and evidenced-based. Our union and our national body the Australian Nursing Midwifery Federation (ANMF) were active participants in these consultations.

The codes, written by nurses and midwives for nurses and midwives, seek to ensure the individual needs and backgrounds of each patient are taken into account during treatment.”

QNMU Secretary Beth Mohle issued a statement clarifying misleading comments in the media around the NMBA’s new Codes of Conduct for nurses and midwives: See in Full part 3 Below

And just to reinforce that point, the entire premise for the segment was false.

There is no requirement for nurses to apologise for being white, which would be very awkward for the more the more than 1500 Indigenous nurses across Australia, and the countless others who also aren’t white to begin with. But, even for the nurses who are – THERE IS NO REQUIREMENT FOR THEM TO APOLOGISE FOR BEING WHITE.

So, why on Earth would Today Tonight run such a story?

Why would they base a story off the demonstrably false allegations of this Graeme Haycroft person? “

The truth behind the Nursing Code of Conduct lie ; Indigenous X Article Read in full Part 4

Watch Today Tonight TV

If you thought nursing was about quality health care, think again.

According to the Nursing and Midwifery Board of Australia, “’cultural safety’ is as important to quality care as clinical safety”. And there’s no objective test of ‘cultural safety’; it’s determined, so the Board says, by the “recipient of care”. You see, it’s not just what the nurse does that matters but “how a health professional does something”.”

Nurses’ Code of Conduct undermines those who care

 

So who is this Graeme Haycroft

Businessman . Director of Queensland Association Services Group (QAS Group), Political activist , Anti Unionist

And according to peak Nurses groups Graeme has has no previous health experience or qualifications

From a recent BIO

Graeme has spent a lifetime working in industrial relations and was the man who set up Haycroft Workplace Solutions, leading provider of workplace consulting and management that has nearly 2000 workers on the payroll.

He is chair of the Liberal National Party’s labour market policy committee, active in the HR Nicholls Society, is a regular commentator on labour market issues, and has published his thoughts in such places as the IPA Review, Courier Mail and Online Opinion. But Graeme’s most important contributions have come through what he has done, not what he has written or said.

In the 1990s Graeme famously fought the Australian Workers’ Union to set up sub-contracting for shearers in Charleville, and went on to battle the CMFEU in helping to set up union-free high-rise construction sites. When the Howard government allowed Australian Workplace Agreements (AWAs), Graeme was instrumental in creating the most widely copied template in the country, and his business helped set up about 30,000 agreements.

Lately, Graeme has been working on a exciting new project with the potential to fundamentally change the role and power of unions in this country, while improving services for workers.

He is not waiting for politicians to act; he is changing the system himself… and after years of planning he is finally ready to show us how.

So who is this new Nurses Professional Association of Queensland ? 

Queensland Association Services Group QAS Group and Sajen Legal have established a new business model for Employee Associations Queensland Association Services Group (QAS Group), who are the contracted service providers for the  NPAQ, in conjunction with Sajen Legal have developed and set up a new association business  model.

Extract from NPAQ website

Working with a small group of dedicated and experienced nurses, they have built in a strict separation  between the money earned and spent on the one hand, and the control of the Association on the other.

To launch NPAQ, the  QAS Group , have backed the provision of services for ten years under contract. They have provided all of the seed funding for the administrative and legal services including the member  Professional Indemnity Insurance policy required of the Association..

Whilst it will be many years before all the seed funding is fully repaid, at the end of our second year, the membership income was sufficient to fund all the running expenses of the NPAQ

 ” And they quote no party politics

The NPAQ executive is resolute that there will be no party politics. Every cent of your NPAQ membership money is spent on nurse services and issues

When NACCHO pointed out that NursesPAQ was ”  using the definitions of two America right wing commentators to justify mounting a political membership campaign in which you sensationalise and falsely quote out of context  aspects of our Indigenous cultural safety in Australia ”

These videos were then removed from the NPAQ news page

http://www.npaq.com.au/news.php

Part 1 Janine Mohamed CEO CATSINaM

Originally Published Indigenous X

I rang my dad over the weekend. We’d hardly begun yarning before he asked me: “What’s this about white nurses having to apologise to us for being white?”

I could have just said, “Dad, you should know better than to believe what the mainstream media says about us.”

But instead I took the time to explain the truth behind recent misleading media reports on new codes of conduct for nurses and midwives.

Media outlets have aired wrongful claims that the codes would force white nurses to ‘apologise to Indigenous clients for being white’.

The codes do not say that – that idea was invented and then pushed on these media programs.

As Luke Pearson recently wrote for IndigenousX, these stories were not based in facts, but seem to have been driven by the partisan politics of a fringe nursing group, and conservative politicians who have been approached to comment on the wrongful claims.

I took the time to have the conversation with my Dad because it is important people understand how significant these new codes are for efforts to improve the care of our people, hence I thought it important to reach out to the readers of IndigenousX too.

I am sure that some of our nursing and midwifery members and community will be hearing disturbing claims.

Let me be clear, nurses and midwives under the new code do not have to announce their ‘white privilege’ before treating Indigenous clients.

I also had the conversation because, to be honest, I am really proud of these new codes, and not only because the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) contributed to their development, which included extensive consultation across nursing and midwifery and at the time no one opposed the inclusion of cultural safety.

We are delighted the Nursing and Midwifery Board of Australia (NMBA) listened to CATSINaM in developing these new codes, and took on board our advice that cultural safety should be recognised as an integral part of ethical and competent professional practice. Further, they cited some of our work at CATSINaM in materials supporting the code.

CATSINaM has been at the forefront of advocating for cultural safety training for health professionals at all levels of health systems in order to improve care for both Indigenous clients and their families. Improving the cultural safety of workplaces is also a vital strategy for improving the recruitment and retention of Indigenous health professionals and staff. We need more of our people in the health system.

Rather than being criticised by sensationalist, inaccurate reports, the NMBA deserves credit for showing leadership in the area of cultural safety. They have set a great example for other health professions and organisations. It wouldn’t be the first time that nurses and midwives have been at the forefront of leading change.

In fact, this is also not the first time this has happened. In many ways, Australia is playing a game of ‘catch up’.

In New Zealand, cultural safety is part of the nursing and midwifery code of conduct and also in the laws that nurses and midwives must follow to be registered to practice. This happened well over 10 years ago because many Maori nurses worked hard for many years to teach their non-Maori colleagues about cultural safety and gain their support so they could provide better care for their people. This is considered completely normal in New Zealand.

Under the new codes, which took effect on 1 March, nurses and midwives must take responsibility for improving the cultural safety of health services and systems for Aboriginal and Torres Strait Islander clients and colleagues.

They are required to provide care that is “holistic, free of bias and racism”, and to recognise the importance of family, community, partnership and collaboration in the healthcare decision-making of Aboriginal and/or Torres Strait Islander people.

The codes advocate for culturally safe and respectful practice and require nurses to understand how their own culture, values, attitudes, assumptions and beliefs influence their interactions with people and families, the community and colleagues (for more information on our position on Cultural Safety please visit our website).

As part of such reflexive practice, nurses and midwives are encouraged to consider issues, such as white privilege, and how this can affect the assumptions and practices they bring to the care of clients and how they interact with their families. It must be said that privilege has been discussed in Australia for some time – although we are more used to talk about class privilege in Australia – those who have more financial resources compared to those who don’t.

Over time we have recognised there different forms of privilege – men have male privilege in contrast to women. Able-bodied people have able-bodied privilege compared to people living with different types of disabilities. Heterosexual people have heterosexual privilege compared to people who are lesbian, gay, bisexual, transgender, intersex or queer. Not to mention what we have been socialised to believe is normal!

Many people have campaigned for decades to help us learn about these different forms of privilege and do something to change inequity they cause. This has involved education, advocacy, legislation, policies and professional codes of conduct. The acknowledgement of these different forms of privilege and the non-acceptance of biased treatment has resulted in improved circumstances for women, people living with disabilities and lesbian, gay, bisexual, transgender, intersex or queer people. But there is still a long way to go in all of these areas, and especially so where they intersect.

There has been considerable work over the last 20-30 years to talk about white privilege and address the inequity that many white Australians don’t see or realise is there, although Aboriginal and Torres Strait Islander Australians live this every day.

Cultural safety training does include examining how Indigenous people have been locked out of the opportunities that most white people take for granted by past policies and this has resulted in intergenerational exclusion and Indigenous disadvantage. This means that white privilege is one of the areas that people must explore and understand. This is what the codes are asking nurses and midwives to do – to think this through so they do not make incorrect and unhelpful assumptions based on their idea of what is normal for non-Indigenous Australians, particularly white Australians.

A glossary accompanying the new codes cites CATSINaM materials. It identifies that the concept of cultural safety was developed more than 20 years ago in a First Nations’ context (in New Zealand) and holds that the recipient of care – rather than the caregiver – determines whether care is culturally safe. That means you determine if the care you receive is culturally safe.

Instead of providing care regardless of difference, such as when people say ‘I treat everyone the same’, to providing care that takes account of peoples’ unique needs. This includes their cultural needs.

While this is important for Indigenous clients, it also has the potential to improve all clients’ care by encouraging health practitioners to be more reflexive and responsive to the needs of different clients.

Despite what recent headlines might have us believe, there is widespread support for cultural safety’s implementation across the health system.

The National Aboriginal and Torres Strait Islander Health Plan: 2013-2023 (2015) and its associated Implementation Plan (both available here) identify the importance of cultural safety in addressing racism in the health system, and many health services already provide cultural safety training for their staff.

The Australian Nursing and Midwifery Federation, the Australian College of Nursing, the Australian College of Midwives are united with CATSINaM in strongly supporting the guidance around cultural safety in the new codes of conduct.

The Council of Deans of Nursing and Midwifery also considers cultural safety an integral part of competencies for registered nurses and midwives. Providing culturally safe care that is free from racism should be a normal expectation. All health professionals learning about cultural safety and building it into their codes of conduct is a very important step to this becoming a reality. Hence nurses and midwives are currently required to study Aboriginal and Torres Strait Islander health, culture, history, and cultural safety as part of their study programs.

Cultural safety is talked about and implemented in other fields, including education, and family and community services, although people in these fields are still learning about it so it is not always standard practice yet. In fact, CATSINaM recommended cultural safety training for journalists in our submission to the recent Senate Inquiry into the future of public interest journalism, and the latest media fracas indicates just how sorely this is needed.

It is important that we continue these conversations about the importance of cultural safety for healthcare and other systems – they are potentially life-saving.

 

For readers who wish to contribute to the discussion, I suggest you read the joint statement from nursing and midwifery organisations and the codes of conduct, which can be downloaded here.

Part 2

In response to Graeme Haycroft’s recent comments, we welcome the opportunity to provide further information on how important cultural safety is for improving health outcomes and experiences for Aboriginal and Torres Strait Islander Peoples.

It is clear from the 2018 Closing the Gap Report tabled by Prime Minister Turnbull in February 2018 that Aboriginal and/or Torres Strait Islander Peoples still experience poorer health outcomes than non-Indigenous Australians. It is well understood these inequities are a result of the colonisation process and the many discriminatory policies to which Aboriginal and/or Torres Strait Islander Australians were subjected to, and the ongoing experience of discrimination today.

All healthcare leaders and health professionals have a role to play in closing the gap.

The approach the NMBA has taken for nurses and midwives (the largest workforce in the healthcare system) by setting expectations around culturally safe practice, reflects the current expectations of governments to provide a culturally safe health system. (For more information please see the COAG Health Council 4 August 2017 Communiqué).

Culturally safe and respectful practice is not a new concept. Nurses and midwives are expected to engage with all people as individuals in a culturally safe and respectful way, foster open, honest and compassionate professional relationships, and adhere to their obligations about privacy and confidentiality.

Many health services already provide cultural safety training for their staff. Cultural safety is about the person who is providing care reflecting on their own assumptions and culture in order to work in a genuine partnership with Aboriginal and Torres Strait Islander Peoples.

Nurses and midwives have always had a responsibility to provide care that contributes to the best possible outcome for the person/woman they are caring for. They need to work in partnership with that person/woman to do so. The principle of cultural safety in the new Code of conduct for nurses and Code of conduct for midwives (the codes) provides simple, common sense guidance on how to work in a partnership with Aboriginal and Torres Strait Islander Peoples. The codes do not require nurses or midwives to declare or apologise for white privilege.

The guidance around cultural safety in the codes sets out clearly the behaviours that are expected of nurses and midwives, and the standard of conduct that patients and their families can expect. It is vital guidance for improving health outcomes and experiences for Aboriginal and Torres Strait Islander Peoples.

The codes were developed through an evidence-based and extensive consultation process conducted over a two-year period. Their development included literature reviews to ensure they were based on the best available international and Australian evidence, as well as an analysis of complaints about the conduct of nurses and midwives to ensure they were meeting the public’s needs.

The consultation and input from the public and professions included working groups, focus groups and preliminary and public consultation. The public consultation phase included a campaign to encourage nurses and midwives to provide feedback.

The Australian Nursing and Midwifery Federation, the Australian College of Nursing, the Australian College of Midwives and the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives all participated in each stage of the development and consultation of the new codes. The organisations strongly support the guidance around cultural safety in the codes for nurses and midwives.

Lynette Cusack

Chair Nursing and Midwifery Board of Australia

Ann Kinnear

CEO
Australian College of Midwives (ACM)

Kylie Ward

CEO
Australian College of Nursing (ACN)

Janine Mohamed

CEO
Congress of Aboriginal and Torres Strait Islander Nurses
and Midwives

Annie Butler

A/Federal Secretary Australian Nursing and Midwifery
Federation

For more information:

Part 3 QNMU Secretary Beth Mohle has issued a statement clarifying misleading comments in the media over the weekend around the NMBA’s new Codes of Conduct for nurses and midwives.



I was stunned to read businessman Graeme Haycroft’s comments regarding nurses and indigenous Australians on the weekend, as part of his criticism of the new NMBA Codes and the term cultural safety which is defined in a glossary connected to the codes.

These codes were the subject of lengthy consultations with the professions of nursing and midwifery and other stakeholders including community representatives. This review was comprehensive and evidenced-based. Our union and our national body the Australian Nursing Midwifery Federation (ANMF) were active participants in these consultations.

The codes, written by nurses and midwives for nurses and midwives, seek to ensure the individual needs and backgrounds of each patient are taken into account during treatment.

There’s no doubt cultural factors, including how a patient feels while within the health system, can impact wellbeing. For example, culture and background often determine how a patient would prefer to give birth or pass away.

Every day, nurses and midwives consider a range of complex factors, including a patient’s background and culture to determine the best treatment. These codes simply articulate what is required to support safe nursing and midwifery practice for all.

Mr Haycroft stated that the new code “has been sponsored and supported by the QNU to promote its party political social policy.”

This statement is disturbing on a number of levels. The Queensland Nurses and Midwives’ Union (QNMU) has repeatedly refuted Mr Haycroft’s allegations we donate to political parties. We do not. Nor are we affiliated with any political party. Yet Mr Haycroft continues to repeat these claims.

Secondly, this statement demonstrates a failure to understand the basics. It is the Nursing and Midwifery Board of Australia (NMBA) that regulates the practice of nurses and midwives through its standards, codes and guidelines.

The QNMU actively participates in NMBA consultations and represents the interests of our members individually and collectively.  However, the new codes have not been “sponsored” by our union.

As a not-for-profit organisation run by nurses and midwives for nurses and midwives, the QNMU will remain steadfastly focused on advancing the values and interests of our members and the safety of those in their care.  We will not be diverted by the political or business agendas of others.

Author Luke Pearson Indigenous X

But first tonight, the contentious new code telling nurses to say “sorry for being white” when treating their Indigenous patients.

That’s how Today Tonight Adelaide began last night.

It continued:

“Now, it’s the latest in a string of politically correct changes for the health industry, but this one has led to calls for the Nursing Board boss to resign.”

It was followed by a five minute story with the new code being condemned by someone you’ve probably never heard of, Graeme Haycroft, explaining that:

“According to how the code is written, the white nurse would come in and say, ‘before I deal with you, I have to acknowledge to you that I have certain privileges that you don’t have” followed by Cory Bernardi calling it divisive.

It goes on in this vein for a full five minutes before it cuts back to the presenter, who finally says, “The Nursing and Midwifery Board has told us that the code was drafted in consultation with Aboriginal groups and has been taken out of context as it’s not a requirement for health workers to declare or apologise for white privilege”.

And just to reinforce that point, the entire premise for the segment was false. There is no requirement for nurses to apologise for being white, which would be very awkward for the more the more than 1500 Indigenous nurses across Australia, and the countless others who also aren’t white to begin with. But, even for the nurses who are – THERE IS NO REQUIREMENT FOR THEM TO APOLOGISE FOR BEING WHITE.

So, why on Earth would Today Tonight run such a story?

Why would they base a story off the demonstrably false allegations of this Graeme Haycroft person?

To answer that, it might useful to cut back to a 2005 Sydney Morning Herald story about Mr Haycroft:

“A member of the National Party and the H.R. Nicholls Society, he (Mr Haycroft) boasts that, because of a tussle he had with the Australian Workers Union 15 years ago, the union does not have a single member shearing sheep in south-western Queensland today.

Now he runs a labour hire firm with a thriving sideline in moving small-business employees off awards and collective agreements and onto the Federal Government’s preferred individual contracts, Australian Workplace Agreements.

…Mr Haycroft’s business stands out because he is targeting lower-skilled, lower-paid workers, often with poor English – the people unions say have much to fear from individual contracts.”

Cut back to 2018, and Graeme Haycroft now runs the Nurses Professional Association of Queensland, which promotes itself as an alternative to the Qld Nurses Union.

So, a man with a long history of fighting Unions, who ‘saved’ the mushroom farming business by showing businesses how to move “small-business employees off awards and collective agreements and onto the Federal Government’s preferred individual contracts, Australian Workplace Agreements.”

According to the 2005 article, “Mr Haycroft said workers had been more than happy to sign on, most with their penalty rates, holiday pay and other conditions being rolled into a flat rate.”

“However, [there is always a ‘however’], Mr Haycroft was stripped of his preferred provider status with the Office of the Employment Advocate on Thursday, after a Sydney picker, Carmen Walacz Vel Walewska, said she was sacked after she contacted the Australian Workers Union for advice on AWAs.”

With that track record, it’s hard to imagine why nurses would want to leave their current union in favour of his ‘professional association’.

It seems as though, once again, Indigenous people have become a political football and a convenient scapegoat for issues that have nothing to do with us.

Queensland has a long history of political success found through anti-Aboriginal sentiment, so what better way to undermine a Union and recruit new members to a professional association than to accuse the Union of ‘racism against white people’ and ‘political correctness gone made’ by spreading the blatantly false and misleading accusation that white nurses now have to apologise to Aboriginal people for being white?

And just like Dick Smith’s anti-immigration campaign, Blair Cottrell’s anti-African ‘community safety group’, and Prue McSween’s call for a new Stolen Generation, it seems Channel 7 is always more than happy to ignore the facts and sensationalise issues about race and racism.

There is always one more thing.

We, and others, will soon publish articles explaining what the Code of Conduct actually calls for, and explain why cultural competence and cultural safety are important (editor’s note: we did, here’s one of them), but I can’t help but be reminded of this quote from Toni Morrison:

“The function, the very serious function of racism is distraction. It keeps you from doing your work. It keeps you explaining, over and over again, your reason for being. Somebody says you have no language and you spend twenty years proving that you do. Somebody says your head isn’t shaped properly so you have scientists working on the fact that it is. Somebody says you have no art, so you dredge that up. Somebody says you have no kingdoms, so you dredge that up. None of this is necessary. There will always be one more thing.”

So, instead of working on the very real business of ensuring best practice within the nursing industry, our Indigenous experts in this area will have to take a few days away from this important work to explain that no one is asking for white nurses to apologise for being white.

Just like we have to explain that not all Aboriginal parents abuse their children, or that we don’t want to steal white people’s backyards, or that we had (and have) science, or that Australia wasn’t Terra Nullius, or, as Malcolm Turnbull suggested last year, that acknowledging Indigenous history and addressing the issue of colonial statues and place names across Australia is not a “Stalinist exercise of trying to wipe out or obliterate or blank out parts of our history”.

So long as Australian media and politics finds value, profit and opportunity in promoting racism, there will always be one more thing.

So, I might as well clear up a few others while I’m here, and empty a few more buckets out of the endless ocean of racist misinformation.

Child abuse isn’t a ‘cultural’ thing.

Police are not scared to arrest Aboriginal people out of fear of being called racist.

We don’t get free houses.

Aboriginal people using white ochre on their faces in dance and ceremony is not the same thing as white people dressing up in blackface.

We don’t get free university.

The Voice to Parliament is not a third chamber of parliament.

We are not the problem.

Anything else?

We aren’t vampires?

We don’t shoot laser beams out of our eyes?

We aren’t secretly developing a perpetual motion machine that runs on white tears?

I’m sure I, and countless others, will undoubtedly need to keep adding to this list because, as Toni Morrison tells us, there will always be one more thing.

If you thought nursing was about quality health care, think again.

According to the Nursing and Midwifery Board of Australia, “’cultural safety’ is as important to quality care as clinical safety”. And there’s no objective test of ‘cultural safety’; it’s determined, so the Board says, by the “recipient of care”. You see, it’s not just what the nurse does that matters but “how a health professional does something”.

According to the commissars at the Board, “’cultural safety’ represents a key philosophical shift from providing care regardless of difference, to care that takes account of peoples’ unique needs”.

Changes to the Code mark a philosophical shift in the industry. (Pic: supplied)

What this means is that nurses are no longer required to be colourblind; instead, they must see colour and treat patients differently because of it.

According to the Code, the Board declares, “cultural safety provides a decolonising model of practice based on dialogue, communication, power sharing and negotiation and the acknowledgment of white privilege” (no, I am not making this up — it’s on page 15 of the Code effective 1 March 2018).

The Board decrees that “non-indigenous nurses must address how they create a culturally safe work environment that is free of racism”. Now I know many nurses, including my sister who has spent 20 years working selflessly in indigenous communities, and the idea that they are subtly racist or even insensitive to their patients’ needs is as offensive as the leftist sanctimony that has infected their professional body.

The changes to the Code were endorsed by COAG. (Pic: iStock)

When a body representing some nurses had the temerity to complain about this, Board Chair Associate Professor Lynette Cusack disdainfully replied that it had been endorsed by COAG.

Well, I checked with the Federal health minister Greg Hunt and that’s not accurate. The Minister’s own advice from his Chief Nursing Officer and health department noted that “while the Commonwealth Department of Health provided feedback in the public consultation process, the final changes to cultural safety were made after (this) process. The Department did not see the final version until it was publicly released in March 2018.”

Greg Hunt is one of the smartest politicians I know; I didn’t think he would have let this get through, had he known about it, without a fight.

NACCHO Aboriginal Women’ Health #NWHS18 Read full Keynote Address Pat Turner CEO NACCHO @RANZCOG National Women’s Health Summit

RANZCOG National Women’s Health Summit

2 March 2018

Patricia Turner, CEO NACCHO

Keynote address “Aboriginal and Torres Strait Islander Women’s Health”

Read over 300 NACCHO Aboriginal Health Articles we have published over the past 6 years : SUBSCRIBE HERE

 

I begin by paying my respects to members of the Gadigal of the Eora Nation as the traditional custodians of this place we now call Sydney.

It is proper that I acknowledge the different Aboriginal groups when I travel to various parts of Australia because it should never be forgotten that our people have lived here for over 65,000 years. In those days Australia was a truly liveable place for our people.

So, thank you very much for the warm welcome Julia and to RANZCOG for inviting me to speak today.

It was important to hear from Minister Hunt, to listen to Professor Baum articulate the social determinants of women’s health and Professor Gannon discuss the economic impact of women’s health.

It is an honour to be asked to address an audience of 100 successful and influential women from the health care sector.

Today this summit is an opportunity to highlight health challenges facing Aboriginal women today. To help them live healthier, longer lives, supported by better, more targeted health services across the nation.

But first, I think this morning is an opportunity for all of us in this place to celebrate the contribution women make in our lives.

It is important to acknowledge how far we have all come together over the last 100 years.

The new medical technology now saves countless lives, the testing regimens are first rate, surgical care has been enhanced and women now have pathways to a multitude of careers and thrive in the health workforce. Some are even in positions of ‘real power’ to advocate for reforms.

Now let’s be clear that Australia has a world-class health system, but not for all of us! Yes, I could mention issues around pay, promotion, mentoring, bullying and harassment but that’s not why we are here today! So, let’s focus today on the fact that health outcomes for Aboriginal and Torres Strait Islander women in Australia are a long way from those of non-Indigenous women.

Whilst it is very flattering to be counted as one of the 100 influential women in this room.

It is important that you know how I became the person I did. I know that my experience was gained from and influenced by my mother.

She was the first medical person I knew. She cared for me and my family as a healer and she helped make me the woman I am today. Education just knocked off my rough edges!

Now, let’s not forget that Aboriginal people invented Bush Medicine which they still use today. They had ready access to bush tucker and led a healthy way of life before colonisation. We still have remnants of our past practice that continue today like using traditional healers and have access to very advanced Western medical models of health care.

I have had a long, varied and distinguished career in the Australian Public Service including as Deputy Secretary of Prime Minister and Cabinet, Centrelink and was the longest serving CEO of ATSIC. I was also the inaugural CEO of the National Indigenous Television (NITV). So, I know how to argue for a change in women’s health policy. I’ve had a lot of experience in dealing across bureaucracy, Ministers, budget cycles, developing public health initiatives and campaigns and essentially dealing with governments at every level in this country.

Now, NACCHO is the national peak body representing 144 Aboriginal Community Controlled Health Services in over 304 clinics and health settings. Our very first AMS started in Redfern and has 47 years of experience to draw upon.

We provide about three million episodes of care each year for about 350,000 people which is provided by almost 6,000 staff. In very remote areas, our services provided about one million episodes of care. Over 50 per cent of the workforce is Aboriginal and we are working at increasing that.

There are many gaps in our Aboriginal Community Controlled Health Services and their holistic approach in delivering comprehensive primary care to our people, no matter where they live. We are mapping those gaps. Our aim is to ensure full coverage for our people.

We are funded by the Australian Government to support improvements in Indigenous health through the Aboriginal Community Controlled Health Services network and to bring the voices of those services into health policy decisions in Canberra.

NACCHO is independent of, trusted by and offers a strong voice to the federal government for the provision of specific community sector health care needs for Aboriginal people that is controlled by Aboriginal people. This ensures a strong voice in policy work and participation in policy development and legislation advocating and dealing with the issues as they arise or as reforms are discussed.

I coordinate 25 staff who sit on some 60 national committees and bodies. Historically NACCHO has a proud tradition and has developed over the last 20 years a strong coalition of support with other NGO’s working across a diverse range of areas.

We offer an alternative point of view enhanced by years of dedicated experience. Aboriginal perspectives from our governing bodies and staff about culturally appropriate healthcare needs are admired and respected by government.

According to the Australian Bureau of Statistics Aboriginal and Torres Strait Islander peoples represented 2.8 per cent of the population counted in the 2016 Census or 649,200 people of whom 326,996 were females. The median age of an Aboriginal is 23 years and only one in ten reported speaking one of the 150 Australian Indigenous languages at home.

There were 18,560 births registered in Australia during 2016 (6% of all births) where at least one parent reported themselves as being an Aboriginal or about 2.12 babies per woman. Births to women aged under 30 years contributed three-quarters (73%) of the total fertility rate for Aboriginal women with the median age of 25.5 years when having their first child.

This is important, especially when you realise that our Aboriginal population will increase to one million people by 2030.

As many of you would know, the state of Aboriginal health continues to be cause for both national shame and requires national action. I’m still as frustrated as some of you are that we have not Closed the gap for Indigenous people, had meaningful reconciliation in this nation and enhanced Aboriginal women’s health.

I believe there is no agenda more critical to Australia than enabling Aboriginal people to live good quality lives while enjoying all their rights and fulfilling their responsibilities to themselves, their families and communities. Aboriginal people should feel safe in their strong cultural knowledge being freely practiced and acknowledged across the country. This should include the daily use of our languages, in connection with our lands and with ready access to resources.

Aboriginal people should feel free from racism, empowered as individuals and have educational opportunities, careers, and health services to meet their needs and overcome inequality, poverty and increase life expectancy.

Now the Australian Government’s 2007 commitment to close the gap between Indigenous and non-Indigenous life expectancy within a generation was welcome. But the Close the Gap agenda did not deliver on a fundamental change to the way governments work with Aboriginal people.

I want to be very clear that progress against the closing the gap targets is now stalling and, in many cases, is going backwards.

I am also concerned that the Government is now shifting the focus to ‘prosperity’ targets, when we don’t even have the basic targets on track.

The figures paint a staggering reality. The Australian Institute of Health and Welfare tells us that the mortality gaps are actually widening.

No government can preside over widening mortality gaps and maintain goals to improve life expectancy and child mortality rates. On average Indigenous men and women die 15 years earlier than other Australians. Indigenous people suffer chronic diseases that are entirely preventable and have virtually been eliminated in the non-Indigenous population: trachoma, rheumatic heart disease and congenital deaths as a direct result of the current Syphilis outbreak across Australia, are but three examples.

The Closing the Gap target to halve the gap in child mortality by 2018 is not on track. Our children are dying at almost three times the rate of non-Indigenous children and there is a clear disparity in birth outcomes for my people. So, we now all appreciate and understand that our services are on the frontlines of women’s healthcare every day.

But of course, it’s not all bad news, NACCHO, its affiliates and our hardworking member services have had recent success with various national health programs. As you know Alcohol consumption during pregnancy can result in birth defects and behavioural and neurodevelopmental abnormalities including Fetal Alcohol Spectrum Disorder (FASD).

NACCHO recently provided advice to mothers that included practical advice and assistance with breastfeeding, nutrition and parenting, monitoring of developmental milestones, immunisations status and infections controls in 85 health service sites in remote, regional and urban locations. The FASD Prevention and Health Promotion Resources worked and did help to reduce the impacts of FASD in Aboriginal and Torres Strait Islander communities. The information also provided an opportunity to engage our local communities about other health issues like tobacco smoking, substance misuse and improving diets.

On the ground, Through Better Start to Life campaign, our Northern Territory member Danila Dilba has recently begun offering home nurse visits, meaning Darwin children and families now have more culturally appropriate access to antenatal and postnatal care resulting in better pregnancy outcomes which is vital in the first 1,000 days of a child’s life.

We now know that Mums participating in this program have fewer low birth weight babies, higher rates of breastfeeding and very high infant immunisation rates. We are also seeing women accessing antenatal care earlier in their pregnancies.

As you are aware a key component of improving pregnancy outcomes is early and ongoing engagement in antenatal care through culturally appropriate and evidence based care suitable to the local community. Investment in the early years is the best way to improve disadvantage over the longer term.

RANZCOG and NACCHO members understand this, evaluations have shown success in improving uptake of care earlier in pregnancy, for the duration of the pregnancy and in post-natal care allows other opportunistic healthcare interventions, such as family planning, cervical screening and improving breastfeeding rates.

So, by wrapping services around families, locally focused programs like this are also important in helping guard against the development of chronic conditions in later life, such as rheumatic heart disease and kidney failure.

While in Alice Springs, the Central Australian Aboriginal Congress is targeting at-risk Indigenous children before they even start preschool. The Preschool Readiness Program has up to 10 places for children between the ages of three and four who have been identified as having developmental delays or come from challenging home environments.

The foundations for health are laid early in life and there is much to be done in the early years to give our kids the best chance of succeeding at school and throughout their life.

If services cater for their needs, Aboriginal women will use them. However, not all Aboriginal women have access to these programs and many still rely on mainstream services such as GPs and public hospital clinics. That’s why it’s so important that mainstream services embed cultural competence into health care delivery across the care continuum.

Aboriginal culture has many strengths that can provide a positive influence, such as a supportive extended family networks, connection to country, and language. This is where the community controlled health sector and Aboriginal Health Workers are uniquely placed.

Our services build ongoing relationships to give continuity of care so that chronic conditions are managed and preventative health care can be effectively targeted.

Studies have shown that Aboriginal community controlled health services are 23% better at attracting and retaining Aboriginal clients than mainstream providers. Through local engagement and a proven service delivery model, our clients ‘stick’.

The cultural safety in which we provide our services is a key factor of our success. They can help to create relationships and understanding between our women and healthcare providers, practical assistance for attending appointments and coordinating care.

Many frontline clinicians and policy makers feel it is beyond their role to deal with these issues, but understanding some of these concepts will lead to greater empathy in the interactions with Aboriginal women.

We must acknowledge that Closing the Gap is not only a technical policy matter, but is also a political issue. We are disadvantaged, we are marginalised, we are poor, we do not have the numbers to influence government to the extent that others do, but we keep on trying.

The statistical gaps arise from voicelessness, powerlessness and a historical and significant lack of resources.

Firstly, the funding myth must be confronted as it stands like a rock in the way of progress.

As my good friend Professor Ian Ring tells us the commonly held view that enormous amounts of money have been spent on Indigenous Affairs has led many to conclude that money is not the answer and a different focus is required.

The recent Productivity Commission Report found that per capita government spending on Aboriginal services was twice as high as for the rest of the population. But higher spending on Aboriginal people should hardly be a surprise. We are not surprised, for example, to find that per capita health spending on the elderly is higher than on the healthier young because the elderly have higher levels of illness.

Nor is it a surprise that welfare spending is higher for Indigenous people who lag considerably in education, employment and income and there would be something very wrong with the system if it were otherwise.

The key question in understanding the relativities of expenditure on Indigenous is equity of total expenditure, both public and private, in relation to need, but the Productivity Commission’s brief is simply to report on public expenditure. In relation to government expenditure on health services the picture is quite different. State and Territory governments spend on average $2.6 per capita on Indigenous people for every $1 spent on the rest of the population.

By contrast, the Australian Government spends $1.4 for every $1 spent on the rest of the population, notwithstanding that, on the most conservative assumptions, Indigenous people have at least twice the per capita need of the rest of the population because of much higher levels of illness. The Commonwealth, in particular, needs to do much more. This is massive market failure.

The health system serves the needs of the bulk of the population very well but the health system has failed to meet the needs of the Indigenous population. And the Australian Government knows this, that’s why, for over 40 years they have been funding ACCHSs because they know the evidence shows these services better meet those needs, but the coverage of these services is patchy and needs to be expanded.

Secondly, Aboriginal communities need to be properly resourced, and Aboriginal people need to be in control. Let’s put Aboriginal health in Aboriginal hands.

It is imperative that a person’s health be considered in the context of their social, emotional, spiritual and cultural wellbeing, and that of their community. We know that being able to better manage and control your own affairs is directly linked to improved wellbeing and mental health.

This is why Aboriginal Community Controlled Health Services are essential to closing the health gap. Often Aboriginal people are uncomfortable seeking medical help at hospitals or general practices and therefore are reluctant to obtain essential care.

For example, the policy of forcibly removing children from Aboriginal families until the 1960s may still engender distrust of the ‘system’ in Aboriginal mothers. Access to healthcare is extremely difficult due to either geographical isolation or lack of transportation.

Many Aboriginal people live below the poverty line so that services provided by practices that do not bulk bill are unattainable. The most well-intentioned mainstream services struggle to provide appropriate healthcare to Aboriginal patient’s due to significant cultural and language disparities. Aboriginal Community Controlled Health Services bridge these gaps.

Their focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people.

 And thirdly, greater access to education, employment and participation in the economy.

So, for those three reasons, NACCHO continues to call on the Australian Government to invest in the expansion of the Aboriginal Community Controlled Health Services, to reach more people living in isolated areas, and to provide more care options for women, including mental health and psychology services.

Recently NACCHO, RANZCOG and other college Presidents met with the Minister for Indigenous Health and other ministers in Canberra who are all determined to do everything possible to close the gap in health outcomes. Now your stated mission is in providing excellence in women’s health. Well let’s do that by including Aboriginal women with new practical measures advocated to government and policy makers.

By all means let us together develop new statements and guidelines, by contributing effectively to health policy debate, in providing representation on various external committees and advisory groups, and responding to requests for submissions with expert evidence-based opinion.

Together lets us continue to drive policy development for the betterment of all women’s health with a view to developing a set of policy imperatives that must be addressed by Governments. It is through Aboriginal community controlled health service delivery that we can best close the gap. But we need your assistance.

We need your help with community-developed programs, that accept our cultural beliefs and traditions about health issues like contraception, termination, or pregnancy.

Currently Sexually Transmitted Infections rates have increased; the current syphilis outbreak has now reached four states predominantly infecting 15-29-year old’s with 12 cases of congenital syphilis causing five deaths.

In this day and age this is unacceptable! NACCHO seeks your assistance to insist on regular STI testing, a national public STI education campaign, with enhanced and clear antenatal guidelines, supported by a workforce with mobile local team’s conducting health checks and testing for other STI’s like gonorrhoea, chlamydia, HIV, Hepatitis C and B. This is the best way for you as individuals and organisations to contribute to improved Aboriginal women’s health outcomes and wellbeing.

As a group of 100 pioneering passionate women I know we have all earnt the accolades, enjoyed the press coverage and have a certain status in life. Let’s make a difference by today by being outspoken advocates for Aboriginal women and inspiring the next generation of women to not ask but demand better access to health care. Aboriginal women are the best advocates and leaders for health and wellbeing in their own families and in the broader community.

Please help bring about change, please make a contribution to improving the lives of Aboriginal women by lobbying governments.

We need your capabilities and skill, the energy and drive to make an impact, your commitment of time to our cause, your ingenuity and passion. Help us by proving to be effective role models, mentors and influencers for the next generation of Aboriginal female leaders.

I hope that today is seen as an opportunity to reflect on these vital Aboriginal women’s health issues. I urge you to act and commit to real sustainable practical change.

Don’t wait for government, don’t wait for them to provide the solutions. Work it out ourselves and just move on. So, to all you people here today I invite you to get in touch with your local Aboriginal Controlled Health Services and our Aboriginal health workers and to all your policy makers you can call me at NACCHO.

I have lost count of the number of speeches I have given over the years on this subject regarding Aboriginal women’s health to numerous gatherings, meetings, conferences, roundtables and symposiums. I will continue to speak for up all of our sisters, aunties, mothers and grandmothers.

I don’t expect or desire any consensus today but I expect robust discussion leading to identify policy reform that can be implemented. We must advocate for more action, adopt new policy positions and increase investment in the Aboriginal community controlled sector.

I know that the fight for Aboriginal rights continues and that the future is looking brighter for our mob with your support.

Thank you again for having me here today and I welcome any questions that you may have.

NACCHO Aboriginal Health Workers @NATSIHWA NEWS : Download National Framework for Determining Scope of Practice and read 5 Top tips for making the most of the Aboriginal Health Worker and Practitioner workforce

 

” The National Aboriginal and Torres Strait Islander Health Workers Association (NATSIHWA) has today launched a supportive publication, the National Framework for Determining Scope of Practice for the Aboriginal and/or Torres Strait Islander Health Worker and Health Practitioner workforce.

The Framework is designed to support Employers and Managers to work with their Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners to establish and define their scope of practice.”

See Part 1 below to download

 ” All who work in Aboriginal and Torres Strait Islander health know about the vital role of Health Workers and Health Practitioners.

They are the link between the community and medical worlds. They are the faces of optimism and hope despite the challenges and burden of ill health.

They use language, cultural and social networks and knowledge to communicate effectively with clients. They are the providers and trainers in delivering culturally competent health care to community members and clients.

Enabling appropriate and culturally safe health care services for Aboriginal and Torres Strait Islander peoples is critical, and this means building an appropriate and capable workforce.

Currently, members of this unique workforce are found in a great diversity of health roles, including not only clinical service delivery of primary health care, but in preventive health, allied health and rehabilitation, public health, chronic disease management and palliative care.

So, what can we do to ensure these roles are nurtured, fostered, expanded and supported in health care settings?

Karl Briscoe is Chief Executive Officer for NATSIHWA and Alyson Wright is Policy Officer with NATSIHWA, and Researcher with National Centre for Epidemiology and Population Health at the Australian National University

See a few ideas Part 2 Below

Part 1 NATSIHWA encourages using a ‘Scope of Practice’ for Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners

The Framework is a practical tool that guides a discussion and documentation in the workplace around the Scope of Practice for individual or groups of Aboriginal and Torres Strait Islander Health Workers and Health Practitioners.

Download the NATSIHWA Framework HERE

NATSIHWA-Scope of Practice

“This Framework is about helping services and our workforce better define their practices. We are hoping that it assists in building more capable staff and services, defining roles and greater recognition of the role of Aboriginal and Torres Strait Islander Health Workers and Health Practitioners in health care”, said Mr Karl Briscoe, NATSIHWA CEO.

View Video HERE

The document provides a set of practical questions and template that need to be addressed when developing a Scope of Practice.

“We are aware that State and Territory legislation and regulation affects the work an Aboriginal and Torres Strait Islander Health Workers and Health Practitioners are allowed to undertake. This Framework helps to consider these, but also draws on the role and responsibilities, the service needs and an individual’s training and qualifications” said Mr Briscoe.

Ms Josslyn Tully, Chairperson of NATSIHWA said “Aboriginal and Torres Strait Islander Health Workers and Health Practitioners are vital to improving the health of our peoples. The Framework for developing a Scope of Practice will better enable and support these employees in health services to reach their potential and utilise their skills and capabilities. A Scope of Practice supports better service delivery and improves workforces”.

The NATSIHWA website will continue to be updated over time to feature best practice examples of the Framework being utilised by various health services.

To view our video on the Scope of Practice visit NATSIHWA’s Scope of Practice

MORE INFORMATION: https://www.natsihwa.org.au/content/what-we-do,

Part 2 Tips for making the most of the Aboriginal Health Worker and Practitioner workforce

Here are a few ideas for the health sector

1. Define the scope of practice for Health Workers or Health Practitioners in the workplace

Aboriginal Health Workers and Health Practitioners routinely exercise extended practices that reflect community and service needs, often informally developed while working alongside other practitioners.

A ‘formalised’ scope of practice establishes an individual’s practices, contributions and value adds in the workplace and reduces ambiguity about where the responsibility lies.

The scope of practice is defined by individual circumstances and is based on their training, qualifications, service requirements, supervision available and job responsibilities and role. It also is influenced by jurisdictional health care legislation and therefore should be a tailored document for an individual or group in the workplace.

NATSIHWA has recently launched a national framework to guide workplaces and services in developing Health Workers and Practitioners’ scope of practice.

The Framework describes key elements required to develop a scope of practice and provides practical steps and a template for Managers and Health Workers to work through in establishing their scope of practice.

Better definition of an employee’s scope of practice helps everyone in the workplace, and secures greater confidence and capabilities in the workforce. Staff at NATSIHWA can help people work through the development of a scope of practice.

2. Tap into NATSIHWA 2018 Regional Forums and October Professional Development Symposium

Opportunities to build and expand professional networks and develop skills and capabilities is recognised as important.

Every year NATSIHWA hosts regional forums across Australia to support and develop our workforce. Typically these forums are for members and other Health Workers and Health Practitioners, although others may be invited to participated or present.

These forums are developed based on local priorities and provide networking and professional development opportunities for Health Workers and Health Practitioners.

A 2018 calendar of forums is being finalised, so have a look at upcoming dates and locations, and register your interest in attending. If you have ideas or suggestions for these, please contact NATSIWHA now.

Further, planning has already started for the 2018 NATSIHWA Professional Development Symposium to be held in Alice Springs in October this year. This event is a not to be missed opportunity to brush up on your skills and expertise in key health care areas.

3. Encourage Health Workers and Health Practitioners to register on the NATSIHWA portal

For a health professional, building and maintain qualifications and skills set are mandatory, as is recording your continuing professional development (CPD) hours. NATSIHWA has created an online tool to help Health Workers and Health Practitioners keep a track the professional development activities.

The portal is online resource that helps Health Workers and Health Practitioners store professional development activities and accreditation details. It also updated regularly with training opportunities and relevant news. It allows Health Workers and Health Practitioners to keep track of CPD hours. All our members have the opportunity to register for the NATSIHWA portal.

4. Use models of care that embed Health Worker or Health Practitioners at the CORE

We have heard a lot over the past couple of years about the most appropriate model of care for the Aboriginal and Torres Strait Islander population. It necessary to have Aboriginal and Torres Strait Islander health workers and practitioners in core roles of delivering health care for culturally safe service provision.

Other issues to resolve this year

Finally, there are other administrative issues that Health Workers and Health Practitioners are also hoping will be resolved in 2018.

5 .These include:

A decision on the Health Worker/Practitioner new award. From 2015-16, NATSIHWA and other stakeholders have been involved in negotiations on Health Worker Award with the Australian Fairwork Commission. We are hoping the final decision will be announced over the next 12 months.

Greater allocation of resources and funding for more Health Workers and Health Practitioners across the health sector, including not only in the community-controlled sector but also hospitals, general practices and other health services.

Resourced action on social and cultural determinants of health.

We need Aboriginal and Torres Strait Islander Health Workers and Health Practitioners right across the health sector. Just as we need Indigenous doctors, Indigenous allied health staff, and Indigenous nurses in the sector.

Making, developing and defining their role in health services builds effectiveness and efficacy in services, better enables cultural safe care to be practiced and is more responsive to needs of clients.

 

 

 

NACCHO Aboriginal Health Leadership News : New @VACCHO_org CEO Has a Vision for a Culturally Confident Aboriginal Community

 

” Look it would be easy to say that we haven’t got anywhere, but the fact is with Aboriginal health, I look at this holistically.

So there’s health in the traditional notions of health, that is physical well-being and mental health well-being, and then there’s the broader concept of health which is the whole of the person’s life and all the things that impact on that.

I think we’re making gains, but given our starting point and where we’re coming from, things don’t change quickly. It will take a number of generations for us to get to what I’d call self-equity.

It’s taken us 200 years to get where we are now, so to turn it around and get on a level par with everybody else is going to take quite a while as well. So I think we are trending in the right direction, but it will require a sustained and increased effort over many years to come, to get us really on the path or to reach the point of health equity.”

Ian Hamm has just been appointed CEO of the Victorian Aboriginal Community Controlled Health Organisation (VACCHO), after more than 30 years’ experience working with the Indigenous community.

He is this week’s Changemaker

Job Vacancy  Manager Cultural Safety Training

• Be a part of the change you want to see in the world
• Take on a leadership role
• This is an Aboriginal and/or Torres Strait Islander identified position

VACCHO is the peak body for Aboriginal health in Victoria and champions community control and health equality for Aboriginal communities.

Apply HERE of see below Part 2

Hamm was appointed CEO of VACCHO for 18 months, while Jill Gallagher AO takes a leave of absence to commence as Victorian Treaty Advancement Commissioner from February.

He described himself as a proud Aboriginal man, who has extensive experience in the public service, including as executive director of Aboriginal Affairs Victoria.

Hamm currently serves as chair of the Koorie Heritage Trust, the First Nations Foundation and Connecting Home Ltd (Stolen Generations Service).

In this week’s Changemaker, Hamm speaks about his plans for VACCHO in the next 18 months, details his sister Cherie’s special connection to the organisation, and explains what keeps him motivated to serve the Indigenous community.

Have you been involved with the community sector before?

I’ve been in government for a bit over 31 years. So this is my first time working in the community sector itself, but I have worked closely with the community sector over that time. I’ve worked for federal and state governments, mostly around Indigenous community stuff. But I’ve also worked in education, in health justice economics and so forth.

What attracted you to work in the community sector?

I suppose it was the opportunity to get to work in the sector that I’d always worked with, if you like. So over the period of 31 years, I’ve worked across a range of different things to do with the Aboriginal community. I’ve worked closely with the sector. So when the opportunity came along to be CEO of one of the leading community organisations for 18 months, you get asked these things once and once only and you don’t say no.

What are your plans for VACCHO during your term as CEO?

At the moment there are a lot of developments going on in Victoria on Aboriginal matters. So quite clearly, the predominant one at the moment is the treaty discussions which are which are about to take off. The person whose role I’m taking, Jill Gallagher, is going to be the treaty commissioner for 18 months. So that’s the big piece of work in Victoria, in fact Australia to be honest.

Victoria is also doing work around self-determination and how do we bring self-determination to life. So those are two really big things going on. So clearly I want to make sure that VACCHO is well engaged in those two pieces of work and also continues to prosecute the efforts around improvement in Aboriginal health outcomes and also ensuring that our members are best practice organisations, in terms of their administration, their governance, their workforce development and all that kind of stuff as well. So there’s a fair bit I want to do and obviously looking at VACCHO itself, is there an opportunity for VACCHO to improve? I mean everywhere can improve over time and develop its operating and business models. So I want to look at VACCHO itself and how we work as an organisation.

How do you see a typical day going for you as CEO of the organisation?   

A lot of my background has been around [strategic] long-term outcome focus, around where we want to be in a number of years from now as opposed to where we are now. So my type of day as I see it, [will involve] a lot of time spent with an external focus, building up critical relationships and ensuring we’re well engaged with the members, because VACCHO exists by right of its membership. So ensuring that we have good and productive relationships with our members [is vital] and we’re supporting them in what they do.

I’ll obviously be having an oversight of the organisation but leaving the day-to-day operating, the daily grind as you might call it, to the people who are much better and much more skilled at that type of work than I am within the organisation. So a typical day for me will probably be in a number of meetings, making sure that at a higher level I’m across stuff around the operating of the organisation and probably talking to the chair of the organisation once a week or a fortnight just to make sure that the leader of the board is across stuff. So it’ll be a mixed bag of things that CEOs do, that you can never quite put your finger on when somebody asks you “what is it that you do exactly?”

You have spoken in the past about how your sister Cherie has a special connection to VACCHO, what does this mean to you?

My sister Cherie worked at VACCHO for many years, for 10 years if not longer. She not only was a worker there but she was part of the soul of the place. And she did a lot of work particularly around palliative care. She confronted the difficult issue of when Aboriginal people are passing and not just looking at health improvement, but dealing with the dreadful reality that people die.

She herself died of breast cancer in 2014. She was well loved by the VACCHO people, the VACCHO staff and the VACCHO community as a whole. So to be CEO of the organisation that she was such an intimate part of, not just in a work sense but in a soul sense, is an additional thing for me that was one of the reasons I took this job.

Amongst all the work that you do, how do you find time for yourself and what do you like to do in your spare time?

I learnt a new word in 2017. It’s called “no”, as in “no I cannot go onto another board, no I cannot do this”. I’m actually on seven boards in addition to being CEO of VACCHO now, and I do other stuff outside of that. So when I do find the time just to myself, I like to cook, and I still play cricket at the age of 53. So I’m still going around on a Saturday playing in a 4th XI as a wicketkeeper, which I should have given away many years ago, but I get to play cricket with a bunch of blokes who have no idea what I do for a living.

So there’s that kind of stuff. Obviously my pride and joy are my children Jasper and Isabel. I have a special relationship with my niece Narita, Cherie’s daughter, and she’s just had a little boy. So I enjoy being part of his life, [even though] he’s only about three months old. That’s the type of thing I do privately and is my little piece of paradise.

You’ve been advocating for Indigenous causes for a long time. How do you remain motivated and optimistic despite all the challenges that arise?

It’s just a fundamental thing inside me that I can’t stand inequity, I can’t stand people not being given the opportunity to be the best that they can be. I can’t actually describe it any deeper than that, but particularly with our own community, I have a deep commitment to us finding what I believe is our rightful place in the great Australian community. That to me is what drives me. It’s something that I find hard to describe. It just is. It’s just what makes me get out of bed in the morning.

It’s what makes me do work which is essentially really hard. But I wouldn’t do anything else. There are a lot easier ways to make more money than this, but for me and everyone else in this sector, it’s not just about job satisfaction or what you get out of it as a job. It’s a much deeper thing, this isn’t about me this is about everyone. So that’s what gets me out of bed in the morning and makes me do what I do.

What kind of future would you like to see for the Indigenous community in the years ahead?

One of the things which I’ve always had in my mind around what I try to do with anything [regarding] the Aboriginal community, is not just looking at what are the problems we have now and how do we fix them. If you just focus on that you never get ahead. I’ve always said in my mind, “What does Aboriginal Victoria look like in 20 years from now?” So if I jump forward a generation, Aboriginal Victoria will have equity on most things which we measure.

So economic equity, health equity, education equity etc. Most critically, Aboriginal community identity will be a confident one. It will be not only culturally strong, but culturally confident in itself and its place in the wider Victorian community. It will be universally respected and in fact, may even be the thing that the rest of the Victorian community aspires to. That is where I want to see Aboriginal Victoria as a whole 20 years from now.

Do you have any particular people that inspire the work that you do?

Oh there’s a number of people. So William Cooper, my great uncle, he inspires me. There’s Doug Nicholls, and Alf Bamblett who I knew quite well. Those three people inspire me. I went into government 30 years ago and decided to stay there to work for Aboriginal people. Charlie Perkins, he inspires me to no end. And he got sacked a couple of times, but he did what he thought was right for the Aboriginal community.

I got sacked once for doing what I thought was right for the Aboriginal community, and getting sacked from high profile positions is never fun, but you know what, I could sleep at night because I knew I had done the right thing. So those type of people inspire me and there’s a whole range of others. My own family inspire me, my aunty Claire, she’s one of those people who inspired me and there’s a whole range of people.

Part 2 Manager Cultural Safety Training job opportunity

• Be a part of the change you want to see in the world
• Take on a leadership role
• This is an Aboriginal and/or Torres Strait Islander identified position

VACCHO is the peak body for Aboriginal health in Victoria and champions community control and health equality for Aboriginal communities. We are a centre of expertise, policy advice, training, innovation and leadership in Aboriginal health. VACCHO advocates for the health equality and optimum health of all Aboriginal people in Victoria.

VACCHO’s cultural safety training incorporates cultural awareness training and builds on this learning to provide practical tips and skills that can be utilised to improve practice and behaviour, which assist in making Aboriginal people feel safe. In shifting the focus to health systems, our participants begin to learn how to strengthen relationships with Aboriginal people, communities and organisations so that access is improved.

We are looking for someone to provide leadership in the sustainability, development, coordination and delivery of our Cultural Safety training.

You will need to be comfortable presenting to other people, be good at networking and building relationships and have an understanding of cultural awareness issues as it relates to Aboriginal communities and individuals as well as experience in managing and leading a team.

You will be joining a great team and will be provided with guidance and support to learn the training packages.

If this sounds like the job you are looking for then you can download the Position Description and Application Form from our website http://www.vaccho.org.au/jobs.

To apply please email a copy of your resume and application form to employment@vaccho.org.au.

For queries about the position please contact Paula Jones-Hunt on 9411 9411 Applications close on Monday 12 February.

APPLY HERE


Luke Michael  |  Journalist |  @luke_michael96

Luke Michael is a journalist at Pro Bono News covering the social sector

NACCHO Alert : Download #NSQHSStandards Users Guide Aboriginal Health : National Safety and Quality Health Service Standards

 

 ” At the request of the National Aboriginal and Torres Strait Islander Health Standing Committee, the Commission undertook a project to improve the care provided to Aboriginal and Torres Strait Islander people in health service organisations, using the framework of the National Safety and Quality Health Service (NSQHS) Standards.”

Download National-Safety-and-Quality-Health-Service-Standards-User-Guide-for-Aboriginal-and-Torres-Strait-Islander-Health

See More Downloadable Resources below

Why have Aboriginal and Torres Strait Islander–specific actions?

The two compelling reasons to have specific actions that meet the needs of Aboriginal and Torres Strait Islander people are:

  1. The historical and contemporary context of Aboriginal and Torres Strait Islander health
  2. The unique and diverse cultures of Aboriginal and Torres Strait Islander people.

1.Historical and contemporary context of Aboriginal and Torres Strait Islander health Aboriginal and Torres Strait Islander people are among the most socially and economically disadvantaged groups in Australia.2

The current poor health and wellbeing of many Aboriginal and Torres Strait Islander people stems largely from the effects of colonial policies and their ongoing legacy. These policies have resulted in loss of land, family and community connections, and denial of free cultural expression and growth across generations. They affect the physical, emotional, social and spiritual dimensions of wellbeing for Aboriginal and Torres Strait Islander individuals and communities.

The continuing impacts on health and wellbeing are evident in the unacceptable gaps between Aboriginal and Torres Strait Islander people and other Australians in health outcomes, including infant and child mortality, disease burden, and life expectancy. Significant barriers to accessing effective and safe health care contribute to these gaps. Therefore, it is important that people experience safe and high-quality health care based on need.

Meaningful, lasting relationships with the Aboriginal and Torres Strait Islander community are integral to redressing past wrongs and moving towards an equitable healthcare system for all Australians.

The project considered the safety and quality issues typically affecting care provided to Aboriginal and Torres Strait Islander people in health services, and investigated how the NSQHS Standards could be used to leverage improvements in the safety and quality of care provided to Aboriginal and Torres Strait Islander people in mainstream health services.

We represent the oldest continuous culture in the world; we are also diverse and have managed to persevere despite the odds because of our adaptability, our survival skills and because we represent an evolving cultural spectrum inclusive of traditional and contemporary practices. At our best, we bring our traditional principles and practices – respect, generosity, collective benefit, collective ownership – to our daily expression of our identity and culture in a contemporary context. When we are empowered to do this, and where systems facilitate this reclamation, protection and promotion, we are healthy, well and successful, and our communities thrive. (Dr Ngaire Brown, New York, 20123)

Closing the Gap4 in Aboriginal and Torres Strait Islander disadvantage is a national priority that the Australian Government and all state and territory governments are committed to addressing. It is the responsibility of all health service organisations to consider and action their part in closing the gap in health disparities experienced by Aboriginal and Torres Strait Islander people.

2.Unique and diverse cultures of Aboriginal and Torres Strait Islander people

Aboriginal and Torres Strait Islander people have world views that differ from other Australians. Although language varies across the country, four core concepts are found consistently among Aboriginal and Torres Strait Islander communities. In the Arrernte (A), Warlpiri (W), Pitjantjatjara (P) and Luritja (L) language groups of South Australia and the Northern Territory, these concepts are:

  • Altyerre (A), Jukurrpa (W), Tjukurpa (P) or Tjukurrpa (L). The religious interpretations of the profound bonding of people to one another, to their country and to the species of animals and plants inhabiting it. It is continually renewed by its expression in song, dance, verbal narratives of creation stories and re-enacted continually in ceremonial journeys.

• Walytja (L, P) or Warlalja (W). The system of extended kinship; the organisational scaffolding for social roles and authority; the pathways of distribution and communication.

• Ngura (L, P) or Ngurra (W). Country to which people belong; which they may use; always subject to the obligations of looking after it and care …; including its celebration.

• Kanyini (L, P) or Mardarni (W). Which is to have, to hold [and] to care. Kanyini is a verb which reflects a commitment, a full engagement; vitalising again and again all that went before and all that will go after.5

Aboriginal and Torres Strait Islander people have a holistic view of health that is not adequately met by the biomedical model of health care. For Aboriginal and Torres Strait Islander people, health is:

… not just the physical wellbeing of an individual but refers to the social, emotional and cultural wellbeing of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their Community. It is a whole-of-life view and includes the cyclical concept of life–death–life.6

While there are similarities, there is also much diversity. There were more than 250 Aboriginal and Torres Strait Islander language groups across Australia, and it is estimated that 120 languages are still spoken today.5

It is important to note that each language group has its own unique values and belief systems. Therefore, if a health service organisation is to provide effective care to its local Aboriginal and Torres Strait Islander people, or the communities that regularly access care, it will need to understand the diverse cultures and values of the people in the organisation’s catchment and of the patients using its services.

The approach and results :

  • Consultation with a wide range stakeholders including individuals, leaders in Aboriginal and Torres Strait Islander health, policy makers, Aboriginal and Torres Strait Islander health organisations, managers, clinicians and members of the Aboriginal and Torres Strait Islander health workforce
  • Mapping the safety and quality issues for Aboriginal and Torres Strait Islander people to the NSQHS Standards
  • A literature review of relevant evidence based strategies to improve the safety and quality of care for Aboriginal and Torres Strait Islander people.

Based on the findings of this project:

  • Six Aboriginal and Torres Strait Islander specific actions have been included in draft version 2 of the NSQHS Standards
  • A series of guides to drive best practice care for Aboriginal and Torres Strait Islander people has been developed based on the NSQHS Standards.

The next stage of this project is now underway which builds on previous work and again aims to improve the safety and quality of health care provided to Aboriginal and Torres Strait Islander people in mainstream health service organisations using version 2 of NSQHS Standards.

The objectives of this project are to:

  • Raise awareness of the issues facing Aboriginal and Torres Strait Islander patients in mainstream health service organisations
  • Improve the safety and quality of care for Aboriginal and Torres Strait Islander patients by supporting mainstream organisations to implement the NSQHS Standards, using resources that contain effective, evidence-based strategies to address Aboriginal and Torres Strait Islander health issues
  • Improve the Aboriginal and Torres Strait Islander cultural awareness skills of the surveyor workforce whose members assess health service organisations to the NSQHS Standards.

Resources

The guides contain editable text boxes for those health service organisations who wish to include local content. Please contact the Commission’s Advice Centre on 1800 304 056 to discuss any additional changes

National Safety and Quality Health Service Standards User Guide for Aboriginal and Torres Strait Islander Health (PDF 2MB)

Overview: Guide to better care for Aboriginal and Torres Strait Islander Consumers (Word 503KB)

1. Setting safety and quality goals for Aboriginal and Torres Strait Islander people in health service organisations (Word 576KB)

2. Cultural competence in caring for Aboriginal and Torres Strait Islander consumers (Word 421KB)

3. Improving identification rates of Aboriginal and Torres Strait Islander consumers (Word 397KB)

4. Creating safe and welcoming environments for Aboriginal and Torres Strait Islander consumers (Word 408KB)

5. Effective and safe communication with Aboriginal and Torres Strait Islander consumers (Word 417KB)

6. Comprehensive care for Aboriginal and Torres Strait Islander consumers (Word 419KB)