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

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

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

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

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

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

See full speech below thanks to Janine and Croakey Team

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

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

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

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

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

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

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

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

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

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

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

See all recommendations here DOWNLOAD

Recommendations14NRHC

 

Janine Mohamed: speech to the National Rural Health Conference

As published originally here thanks to Janine and Croakey Team

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

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

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

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

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

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

Becoming advocates and agents of change

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

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

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

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

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

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

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

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

Imagine this is now 2037….

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

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

How old are you in 2037?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

They grow up conscious of whose country they are on

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

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

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

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

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

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

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

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

They grow up with intergenerational hope, not trauma

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

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

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

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

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

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

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

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

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

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

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

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

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

We have closed the gap in health outcomes

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

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

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

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

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

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

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

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

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

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

Climate change prompted a global sea change

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

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

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

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

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

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

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

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

The health system changed its way of doing business

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We are all making history right now

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How can YOU help to make history?

Here are some suggestions:

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

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

Because today is tomorrow’s history – be brave.

Thank you.

Aboriginal Health Canada and Australia : Cultural #Safety #Humility #Awareness #Sensitivity #Competence

 ” Supporting the health care system to be culturally safe for Indigenous people is one of our top priorities.

 All our programs and initiatives work toward inclusive health services and a health care system respectful of Indigenous people in Northern British Columbia Canada “

Cultural safety improves as proceed along this path of self-reflection and Learning

View Cultural Safety Video here or Below

 ” Cultural safety refers to the accumulation and application of knowledge of Aboriginal and Torres Strait Islander values, principles and norms.1

It is about overcoming the cultural power imbalances of places, people and policies to contribute to improvements in Aboriginal and Torres Strait Islander health and increasing numbers within, and support for, the Aboriginal and Torres Strait Islander medical workforce “

Download the AIDA Cultural Safety Factsheet HERE

AIDA Cultural-Safety-Factsheet1

 Download Other Australian Position papers

NACCHO CSTStandardsBackgroundPaper-NACCHO

CATSINAM cultural-safety-endorsed-march-2014-

Cultural Humility

Cultural humility is a lifelong journey of self-reflection and learning. It involves listening without judgement and being open to learning from and about others. It involves learning about our own culture and our biases. Cultural humility is a building block for cultural safety. It is an overarching principle that is threaded through our learning and acts as the process by which change can occur.

Cultural Awareness

The journey of cultural humility often starts with cultural awareness – recognizing that differences and similarities exist between cultures. Learning about the histories that impact Indigenous peoples in Canada is an important part of developing cultural awareness.

Cultural Sensitivity

Cultural sensitivity grows when we start to see the influences of our own culture and acknowledge that we have biases. This can be an eye-opening experience, and it may take courage and humility to walk this path. Cultural sensitivity is NOT about treating everyone the same.

With cultural awareness and sensitivity comes a responsibility to act respectfully.

Cultural Competence

We can increase our cultural competence by developing knowledge, skills and attitudes for working effectively and respectfully with diverse people. It’s about reducing the number of assumptions we make about people based on our biases. Cultural competency does not require us to become experts in cultures different from our own.

Cultural Safety

 The goal of cultural safety is for all people to feel respected and safe when they interact with the health care system. Culturally safe health care services are free of racism and discrimination. People are supported to draw strengths from their identity, culture and community.

Background Australia AIDA Cultural Safety Factsheet

This Cultural Safety Factsheet outlines some practical and achievable actions that can be implemented to strengthen cultural safety for Aboriginal and Torres Strait Islander people.

This Factsheet complements the Australian Indigenous Doctors’ Association (AIDA)

Cultural Safety for Aboriginal and Torres Strait Islander Doctors, Medical Students and Patients position paper available at http://www.aida.org.au/wp-content/uploads/2015/03/Cultural_Safety.pdf.

This paper provides guidance and outlines the parameters for AIDA in our work to advocate for a health system that is culturally safe, high quality, reflective of needs and respects and incorporates Aboriginal and Torres Strait Islander cultural values.

What is Cultural Safety?

Cultural safety refers to the accumulation and application of knowledge of Aboriginal and Torres Strait Islander values, principles and norms.1

It is about overcoming the cultural power imbalances of places, people and policies to contribute to improvements in Aboriginal and Torres Strait Islander health and increasing numbers within, and support for, the Aboriginal and Torres Strait Islander medical workforce.1

As outlined in our Cultural Safety for Aboriginal and Torres Strait Islander Doctors, Medical Students and Patients position paper,1 AIDA views cultural safety on a continuum of care with cultural awareness being the first step in the learning process and cultural safety being the final outcome.

This is a dynamic and multi-dimensional process where an individual’s place in the continuum of care can change depending on the setting.

For example, Aboriginal and Torres Strait Islander community-controlled health services, hospitals or communities.1

1 Australian Indigenous Doctors’ Association, 2013, Position Paper Cultural Safety for Aboriginal and Torres Strait Islander Doctors, Medical Students and Patients, AIDA, Canberra.

Why is Cultural Safety important for Aboriginal and Torres Strait Islander People?

Aboriginal and Torres Strait Islander people experience a disproportionate burden of illness and social disadvantage when compared with non-Indigenous Australians.

Additionally, Aboriginal and Torres Strait Islander people experience much higher levels of racism and discrimination.

AIDA recognises Aboriginal and Torres Strait Islander culture as a source of strength, resilience, happiness, identity and confidence, which has a positive impact on the health of Aboriginal and Torres Strait Islander people.

To improve health outcomes for Aboriginal and Torres Strait Islander people, health service provision needs to be responsive to cultural differences and the impacts of conscious and unconscious racism.

Aboriginal and Torres Strait Islander people are more likely to access and will experience better outcomes from services that are respectful and culturally safe places.

Likewise, Aboriginal and Torres Strait Islander medical students and doctors are more likely to stay and thrive in learning and working environments that consistently demonstrate cultural safety.1 Cultural Safety Factsheet Australian Indigenous Doctors’ Association

How can Cultural Safety be strengthened?

Some practical and achievable measures can be implemented to strengthen cultural safety. This includes but is not limited to:

  •  prominent displays of Aboriginal and Torres Strait Islander artwork;
  •  prominent displays of posters specifically aimed at Aboriginal and Torres Strait Islander people, including promotion of health messages;
  •  asking patients if they identify as being an Aboriginal and/or Torres Strait Islander person in a respectful manner;
  •  providing an explanation to patients about why the Aboriginal and Torres Strait Islander status of patients is being collected and how this information will inform better health care;
  •  collecting data on the Aboriginal and Torres Strait Islander status of new and existing patients (with the permission of patients);
  •  organising and participating in events that celebrate Aboriginal and Torres Strait Islander culture, such as NAIDOC and Reconciliation Australia events;
  •  practising Welcome to Country for official events;
  •  practising Acknowledgement of Country;
  •  displaying the Aboriginal and Torres Strait Islander flags in prominent positions;
  •  using Aboriginal and Torres Strait Islander languages in the naming of health services, buildings and programs;
  •  developing partnerships with Aboriginal and Torres Strait Islander individuals, communities and organisations;
  •  becoming a member of relevant peak Indigenous organisations;
  •  having appropriate support structures in place for Aboriginal and Torres Strait Islander people;
  •  including Aboriginal and Torres Strait Islander people on governance bodies;
  •  providing cultural safety training for all staff;
  •  developing and implementing a Reconciliation Action Plan;
  •  developing and implementing an Aboriginal and Torres Strait Islander employment strategy to promote an increase in the number of Indigenous employees; and championing Aboriginal and Torres Strait Islander health.

How does AIDA contribute to strengthening Cultural Safety?

Cultural safety is an overarching theme of AIDA’s Values and Code of Conduct and is a key principle in all of AIDA’s Collaboration Agreements.

The aim is to contribute to improved health and life outcomes for Aboriginal and Torres Strait islander people through growing the Indigenous medical workforce.

Much of our work is aimed at promoting culturally safe learning environments for Aboriginal and Torres Strait Islander students, doctors and service delivery to patients. Examples of our work in this area includes:

  •  development and implementation of the AIDA Cultural Safety for Aboriginal and Torres Strait Islander Doctors, Medical Students and Patients position paper;1
  •  participation in the development and implementation of a culturally inclusive Aboriginal and Torres Strait Islander health curriculum, known as the Committee of Deans of Australian Medical Schools Indigenous Health Curriculum Framework, available at

http://www.limenetwork.net.au/files/lime/cdamsframeworkreport.pdf;

Download the VACCHO Cultural Safety Enrolment Form

VACCHO-CS-ENROL-2017-WEB

What is cultural safety?

Cultural safety is about providing quality health care that fits within the familiar cultural values and norms of the person accessing the service that may differ from your own and/or the dominant culture.

How is cultural safety different to cultural awareness?

Cultural awareness focuses on raising individuals knowledge about cultural experiences that are different from their own. Cultural awareness training maintains an ‘other’ rather than clear self-focus for participants. Cultural awareness also tends to have an individual rather than systemic focus.

VACCHO’s cultural safety training encompasses some of the information that is often included in cultural awareness training. We do, however, build on cultural awareness training and provide practical tips and skills that can be utilised to improve practice and behaviour, which assist in making Aboriginal peoples 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.

What cultural safety training does VACCHO offer?

We currently offer four training options:

How was VACCHO’s cultural safety training developed?

Our cultural safety training was developed in accordance with the National Aboriginal Community Controlled Health Organisations (NACCHOs) Cultural Safety Training Standards.

During the design of our training, we consulted and collaborated with various key stakeholders, including:

  • the Victorian Aboriginal community
  • our Member organisations
  • mainstream health organisations
  • the Victorian Public Sector and Services

We asked Aboriginal people “what would you like non-Aboriginal people to know about you?” We also asked non-Aboriginal people “what information would help you work more effectively with Aboriginal people?”

We then trialed and tested our training with the Victorian Aboriginal community, including Elders, employees at VACCHO and our member organisations, health workers and other key stakeholders.

In June 2012, we began to deliver our training. Since then, we have delivered our training to more than 1,250 people across Victoria. We’re excited to think of the implications the completion of our training will have in program and policy design and the delivery of culturally safe services to Aboriginal people and communities. 

How is VACCHO’s cultural safety training delivered?

VACCHO’s cultural safety training is delivered in three stages:

Pre-training: during this stage, we will create and send a unique, online Pre-Workshop Self-Reflection Activity for all participants to complete. This assists us in ascertaining the knowledge that already exists within the room and gives participants the opportunity to note any existing questions they would like addressed in our training.

Training: during this stage, we will deliver our interactive training and provide each participant with relevant materials (including a training pack and our 60 page learner resource guide). At the end of the training, each participant will complete an evaluation.

Post-training: during this stage, we will provide each participant who successfully completes our training with a certificate of participation. Where we deliver to a group, we will also provide the booking agency with an evaluation summary for future reference and recommendations (this summary is the collated responses of each individual evaluation).

For more information, or to make a booking, please contact our Cultural Safety Team or on 03 9411 9411. 

 

NACCHO Aboriginal Health Workforce : @KenWyattMP meets medical colleges to boost Aboriginal health care

” Providing health care that was culturally appropriate for Indigenous people was crucial.

Ultimately, what I want to see is that Aboriginal people, if they come into a hospital, they take the full patient journey,

The procedures and treatment regimes are the same as any other Australian receives so that we push out life and we move to closing the gap.

Increasing the number of Aboriginal and Torres Strait Islander people working in health care will also be discussed.

If we don’t get our initial training and ongoing education right, we will never deliver a culturally safe health system,

The colleges are critical partners in getting this right with ideas on training and recruitment and retention initiatives.”

Indigenous Health Minister Ken Wyatt

Photo above : Danielle Dries  pictured above with the minister in an inspiring final-year Aboriginal medical student from the Australian National University was the recipient of the MDA National and Rural Doctors Association of Australia (RDAA) Rural Health Bursary for 2016. Read full Story here

NACCHO Background Info

Read NACCHO Articles Cultural Safety

Aboriginal Health ” managing two worlds ” : How Katherine Hospital, once Australia’s worst for Indigenous health, became one of the best

Senior representatives from Australia’s medical colleges are converging on Canberra today for a roundtable aimed at improving treatment for Aboriginal and Torres Strait Islander people.

As reported by ABC NEWS this morning

Indigenous Health Minister Ken Wyatt will host the 12 colleges at Parliament House in a bid to boost outcomes and access to health care over the next decade.

The powerful groups include the Royal Australasian College of Surgeons, the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners.

“[They’re] important for me to partner with if I’m going to close the gap,” Mr Wyatt told the ABC.

“I believe that they can make an incredible difference, it’s just we’ve never asked them to in this sense.”

Prime Minister Malcolm Turnbull’s Closing the Gap report to Parliament last month showed six of the seven targets were off track, including life expectancy and child mortality.

Mr Wyatt earlier this year became Australia’s first-ever Indigenous federal government minister.

 

Aboriginal Health ” managing two worlds ” : How Katherine Hospital, once Australia’s worst for Indigenous health, became one of the best

 

” Katherine Hospital in the Northern Territory has gone from one of the worst facilities in the country when it comes to Indigenous health care to one of the best.

Their secret: engaging with Indigenous patients and supporting doctors.”

Dr Quilty his high level of specialist training has meant that patients who would have had to be evacuated to Royal Darwin Hospital can now receive treatment in Katherine. Full Story below

Photo above : Gaye is a 50 year-old cancer patient from Mataranka in the NT. Supplied: Simon Quilty

NACCHO support INFO

Aboriginal Patient Journey Mapping Tools Project:

Communicating complexity

The Managing Two Worlds Together project aims to add to existing knowledge of what works well and what needs improvement in the system of care for Aboriginal patients from rural and remote areas of South Australia (and parts of the Northern Territory). It explores their complex patient journey.

The relationship between patients and health care providers is the foundation of care and requires communication across cultures, geography and life experiences. As a staff member in one rural Aboriginal Community Controlled Health Service put it: ‘It’s like managing two worlds together, it doesn’t always work’.

Download Stage 3 Study Managing Two World Study Report

NACCHO Aboriginal Health News Alert :

Do we need to close the gap on Aboriginal hospital experiences ?

How Katherine Hospital, once Australia’s worst for Indigenous health, became one of the best

As published ABC NEWS  By Hagar Cohen for Background Briefing

When physician Simon Quilty arrived at the hospital, it was going through a major crisis.

“What had happened in 2010 is that the hospital found itself in a situation where things were falling apart,” he says.

A number of doctors complained to the NT Medical Board about a lack of supervision and the impractical workload. The hospital was on the verge of shutting down.

More than one in four Indigenous patients left Katherine Hospital before completing treatment, often without informing staff, the worst rate in the nation. These “take own leave” cases are complex, but one factor is Indigenous patients’ perception of inadequate treatment.

It’s an issue plaguing the health system nationally: a 2014 Federal Health Department report found that racism contributes to the low rates of access to health services by Aboriginal people.

Similarly, the number of patients who “discharge against medical advice” is recorded and recognised by health departments as a key indicator for the quality of Aboriginal healthcare.

In the NT, 11 per cent of all Indigenous patients discharge themselves against medical advice.

“These people have very complex illnesses,” says Dr Quilty. “Many of them are highly likely, if not treated well, to resolve in significant injury or death. Hospitals in remote locations really need high expertise to deal with the very sick patients that turn up here.

“Thirteen and 15-year-olds are developing type 2 diabetes, they’ve got kidney impairment by the time they’re 22 and they’re on dialysis in their early 30s. It’s a bit terrifying really.”

Back from the brink

The NT Department of Health conducted an investigation into the staffing crisis at the Katherine Hospital. Its findings weren’t released publicly.

Background Briefing can reveal that the final report concluded that there were “significant deficiencies in nearly all the essential dimensions of safe clinical service provision”, adding that the “root cause is that the medical service model is unsustainable and becomes more unsustainable with each passing year”.

Six years ago, a new general manager and a group of new doctors arrived with an ambition to turn things around.

Katherine Hospital

They’ve brought highly trained specialist doctors who are invested in the community, interpreters are used regularly and families of Indigenous patients are consulted on complex treatment plans.

In the past, interpreters were available but rarely used. Families weren’t a part of the consultation process. Many of the doctors were junior, and staff turnover was high.

The new management has made huge inroads in the way the hospital cares for Aboriginal patients.

This year, only 4 per cent of the Indigenous patients “took own leave”, making Katherine one of the best performing hospitals in the nation when it comes to caring for Aboriginal patients.

Systematic use of interpreters

In 2006, when respected Indigenous lawman Peter Limbunya, from the remote community of Kalkarindji, stayed in the hospital for 10 days, he did not have access to an interpreter, despite not speaking English.

At the end of his treatment, Mr Limbunya, who was part of the legendary Wave Hill walk off in the 60s, was flown to a remote airstrip 5 kilometres away from his community.

His family wasn’t told he’d be back that day and nobody was there to meet him. He died of dehydration.

During the inquest into his death, the coroner found that interpreters were not in use at the hospital.

His cousin, lifetime activist and advocate for Aboriginal people Josie Crawshaw, remains outraged. She says her uncle would have known “absolutely nothing” about his treatment and what was going on.

But things have come along way since then. The hospital’s Aboriginal liaison officer, Theresa Haidle, says improving the way doctors communicate is the key to developing Indigenous patients’ trust in their treatment plans.

Regular use of interpreters has been an essential part of Ms Haidle’s work. She says they’ve been key in making sure patients understand their illnesses and treatment options.

“English isn’t their first language. It may not even be their second or third either. If there’s any doubt, we get interpreters in, or even on the phone.”

The systematic use of interpreters is a big change at Katherine Hospital.

Ms Haidle says the hospital has a lot further to go when it comes to providing a culturally safe environment, but overall, the relationship with the Aboriginal community is getting better all the time.

“It’s like a big learning process for everybody,” she says.

“We have to break it down as simple as we can,” she says. “There’s not an Aboriginal word that means cancer, so how do you explain those things?

“I remember one day a lady had this fungus, and there’s no words for those things on women’s bodies, or inside. So I heard the interpreter telling her: ‘You know, like mushrooms growing?’ They got her to stay and get it treated.”

Changing doctors’ attitudes

Pip Tallis, who is training to be a physician at Katherine Hospital, has worked in hospitals in Alice Springs and Darwin, where she says many of her Indigenous patients left before their treatment was complete.

“I found it really hard to understand why,” she says.

“It was frustrating as a doctor, and there was a lot of frustration among the staff and no-one really took the time to understand why people were taking their own leave, or really did anything to change it.

“I think, there was a bit of hands up in the air. ‘Whatever, what can we do about it? It’s their problem.'”

The NT town of Katherine, seen from the air

Dr Tallis says that her perspective has changed since coming to work at Katherine Hospital.

“I’ve spent six months working with the team here and observing how they engage with the patients, and I think that they do significant things to result in people not taking their own leave,” she says.

“Previously I was very inflexible. Now I spend a lot more time appreciating why people take their own leave.

“I’m also picking up the subtle signs on a patient who’s starting to not engage. I’ll sit down with them and explore their issues. And if they say they want to just go for a walk, you just say, ‘Would you like to take some medicine with you just in case you don’t come back?'”

Care plans to lower ‘take own leave’ rates

The introduction of weekly meetings to go over care plans for the Indigenous patients means everyone in the hospital can keep up with what’s happening with individual patients

These meetings are attended by social workers, doctors, nurses and admin staff.

At one such meeting, Dr Tallis mentions Jason, a 30-year-old patient from the remote community of Ngukurr, 330 kilometres south-east of Katherine.

Jason has tuberculosis, and has left the hospital during treatment once before. His family has convinced him to return. Dr Tallis explains at the meeting that Jason doesn’t like the hospital food, and that special food is being provided for him.

“We tried really hard to engage him,” she says. “We even got bacon and eggs for him in the mornings so he doesn’t complain about porridge, he’s got a DVD player, USB drive, he got pizza the other day. So we tried really hard to make it possible.”

But there’s still a cultural divide. At the end of the meeting, Jason explains to another doctor that he thinks “white fella” medicine is too slow.

“I want to go back to bush medicine,” he says. “It’s better and works fast because we learned it from old people.”

More support for staff

The hospital’s general manager, Angela Brannelly, says the 2010 investigation into the staffing crisis recommended major changes to the way the hospital operates, its level of staffing and supervision.

She says supporting the medical staff was one of her first priorities.

“We took it very seriously and made some really serious changes to the way that the medical team was supported here. It was around ensuring that someone’s got their back,” she says.

Dr Quilty, who joined the hospital in 2012, was the first physician to have ever been employed at the hospital. Last year he won the Royal Australian College of Physicians’ medal for clinical service in rural and remote areas.

A dark-skinned doll

His high level of specialist training has meant that patients who would have had to be evacuated to Royal Darwin Hospital can now receive treatment in Katherine. Since 2012, there has been a decrease of 43 per cent in the number of total aeromedical evacuations to Darwin.

Many Indigenous patients who live in remote communities don’t like going to Darwin to receive medical treatment because it’s far from family and the hospital is bigger and less personal.

Gaye, 50, a cancer patient who was transferred to Darwin for chemotherapy says she felt lonely in Darwin. “In Darwin I was always sad and crying a lot,” she says.

No-one in Darwin had realised that Gaye was deaf, which made communication with medical staff virtually impossible. In Katherine her deafness was recognised by the nurses and she was given a hearing aid, which she says made a huge difference to her mental health.

Katherine Hospital now employs two full-time physicians.

Still no Aboriginal doctors

Katherine Hospital employs 24 doctors but none of them are Indigenous.

Ms Brannelly admits the hospital hasn’t done enough to attract Aboriginal doctors.

“That’s good advice for us, and it’s probably where we need to go in that space around seeking out Aboriginal medical officers to come and work for us,” she says.

“I think we have some work to do there, absolutely.”

NACCHO #Aboriginal Health and #Racism #justjustice : The importance of teaching doctors and nurses about unconscious bias

aee

 “Australian universities, medical schools and health systems grappling with how to include Aboriginal and Torres Strait Islander people in their institutions as participants and staff – and how to produce equality of outcomes – need to deal with both overt and systemic factors of racism.

In Australia, the inability to deal with unconscious bias and racism has serious health effects on Aboriginal and Torres Strait Islander people. These include increased stress, mental ill-health and suicide, systemic racism in education, sports, justice and the public sector.

In a national survey of Aboriginal patients, 32.4% reported racial discrimination in medical settings most or all of the time. “

Gregory Phillips, Associate Professor and Research Fellow in Aboriginal Health at the Baker IDI Heart & Diabetes Institute, considers the coroner’s recommendations in light of Australia’s “inability to deal with unconscious bias and racism”, in and out of the health system. He says our responses must go far beyond cultural awareness training and its implicit judgements:

Image above : Equality can only work if everyone starts from the same place, whereas equity is about making sure people get access to the same opportunities. Interaction Institute for Social Change | Artist: Angus Maguire/madewithangus.com, CC BY

NACCHO Resources

Cultural awareness isn’t enough

 ” Teaching health professionals about Indigenous health will effectively require teaching about unconscious bias and racism; one’s own culture, values and motivations. It requires training in “unlearning” preconceptions, regular reflections on one’s own practices; as well as education about Aboriginal and Torres Strait Islander cultures.”  See Below

” The National Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 2016–2026 (the Framework) was recently launched by the Australian Health Ministers’ Advisory Council .

This ten year framework seeks to guide delivery of culturally safe, responsive, and quality health care to Aboriginal and Torres Strait Islander people and communities.

Download the COAG Cultural Respect Framework here :

cultural_respect_framework_1december2016_1

Ms Dhu coronial findings show importance of teaching doctors and nurses about unconscious bias

Originally published at The Conversation and then Croakey /JustJustice

In delivering her findings of the coronial inquest into the death of 22-year-old Ms Dhu during time spent in a Western Australian jail cell, state coroner Ros Fogliani was highly critical of some actions of police and medical staff.

She reportedly said Ms Dhu’s medical care in one instance was “deficient” and both police and hospital staff were influenced by preconceived notions about Aboriginal people.

Ms Dhu died on 4 August 2014 from staphylococcal septicaemia – a severe bacterial infection – and pneumonia, which were complicated by a previously obtained rib fracture. Released CCTV footage showed Ms Dhu moaning from pain, saying it was ten out of ten.

It was reported an emergency doctor considered her pain real but exaggerated for “behavioural gain”. Another doctor also noted Ms Dhu suffered from “behavioural issues” while a constable thought she was “faking” her suffering.

Ms Dhu’s case is not the first instance of mistreatment of an Aboriginal person in custody or a medical setting, nor is it likely the last. And while coroner Fogliani’s recommendations included mandatory, ongoing cultural competency training for police officers, to assist with health issues and other dealings with Aboriginal people, this isn’t enough.

For thirty years, Australian institutions have implemented cultural awareness programs. The thinking was if they taught staff about Aboriginal and Torres Strait Islander cultures, it would result in better lecturers, clinicians and policy-makers – and magically produce equity.

But this assumes Aboriginal culture is the problem. Like a deaf student in an all-hearing classroom, it is not the deaf student or their needs that are the problem, but a system that thinks an all-verbal and all-hearing teaching style is equal. The idea of equality itself entrenches systemic discrimination.

Unconscious bias

Singer Gurrumul Yunupingu has been suffering from chronic Hepatitis B since he was a child. ALAN PORRITT/AAP Image

 

 

 

In April, Darwin Hospital staff were under fire for allegedly leaving Aboriginal singer Gurrumul Yunupingu to bleed internally for eight hours. Media reported hospital staff noted Gurrumul’s liver damage was self-inflicted (a result of repeated heavy alcohol use) rather than being due to his chronic hepatitis B infection he had since he was a child.

We don’t know whether these allegations are true, but we do know unconscious bias exists in Australia. It refers to the instant judgements we make about other people and situations based on our own values, experiences and cultural and gender beliefs.

These judgements impact significantly on hiring and promotion decisions, how medical students make decisions, and in public discourse.

Regardless of merit or facts, research shows black or Indigenous people are more likely to be seen as less trustworthy; women to be risky prospects, and overweight people as irresponsible. Those with power and privilege judge those with less power for their inability to compete on terms set by the powerful.

So how is unconscious bias different to racism? Like an iceberg, unconscious bias is said to represent the beliefs, values and experiences (below water) that give rise to overt expressions of discrimination (above water).

There are two problems with these definitions, however. They don’t reveal how beliefs, values and experiences got into the subconscious in the first place. They may also imply it is not the responsibility of those with unconscious bias to change their implicit beliefs and explicit actions.

In Australia, the inability to deal with unconscious bias and racism has serious health effects on Aboriginal and Torres Strait Islander people. These include increased stress, mental ill-health and suicide, systemic racism in education, sports, justice and the public sector.

In a national survey of Aboriginal patients, 32.4% reported racial discrimination in medical settings most or all of the time. These people felt they had been treated unfairly (which included being treated rudely or with disrespect; being ignored, insulted, harassed, stereotyped or discriminated against) because they were Aboriginal or Torres Strait Islander.

Equality vs Equity

Public discussion about racism in Australia is often met with denial, discomfort and fragility. Some blame AFL player Adam Goodes for calling out racism – shooting the messenger is a common reaction.

Some stand with whistle blowers and defend their right to speak truth to power. Others completely deny racism’s existence, wishing it would go away because “we treat everyone the same”.

But the impulse to treat everyone the same confuses equality of inputs with equality of outcomes. As the below diagram shows, treating everyone with equal inputs (the same boxes) produces an inequality of outcomes (not everyone can access the game).

Alternatively, treating everyone differently, according to their needs and humanity is more likely to produce equality of outcomes where everyone can access the game. Equity deals not only with overt discrimination but the systemic factors that give rise to it.

Australian universities, medical schools and health systems grappling with how to include Aboriginal and Torres Strait Islander people in their institutions as participants and staff – and how to produce equality of outcomes – need to deal with both overt and systemic factors of racism.

Cultural awareness isn’t enough

Teaching health professionals about Indigenous health will effectively require teaching about unconscious bias and racism; one’s own culture, values and motivations. It requires training in “unlearning” preconceptions, regular reflections on one’s own practices; as well as education about Aboriginal and Torres Strait Islander cultures.

Most importantly, if the clinician cannot see themselves, their privilege and power as a potential problem, this will inadvertently re-establish racism and unconscious bias.

People had mixed reactions when Adam Goodes spoke out on racism in Australia. DEAN LEWINS/AAP Image

Educators have found patiently moving Australian medical students who were initially hostile to Aboriginal health curricula through their discomfort to reach the “a-ha” moment, is a key teaching strategy in producing better prepared doctors.

Further, cultural awareness training assumes that even if we could train every individual staff member in a hospital to be perfectly culturally competent, they would then go on to magically produce better health outcomes.

But the systemic factors – workplace culture, policies, power, funding and criteria on which decisions are made – are critical if we want a culturally equitable society.

Improving outcomes for Aboriginal and Torres Strait Islander people includes moving from a goal of equality to equity; teaching about racism and unconscious bias, not just culture; and making explicit the deeper transformational work of institutional decolonisation. We need to ask: how can power be shared? On whose terms are decisions made? Who owns institutions and services? Whose criteria are used to judge effectiveness?

The answer is that Aboriginal and Torres Strait Islander definitions and measurement tools of success are more likely to contribute to producing better outcomes than those where unconscious bias and racism is implicit. The work of admitting and addressing institutional racism remains.

croakey-new

How you can support #JustJustice

• Download, read and share the 2nd edition – HERE.

Buy a hard copy from Gleebooks in Sydney (ask them to order more copies if they run out of stock).

• Send copies of the book to politicians, policy makers and other opinion leaders.

• Encourage journals and other relevant publications to review #JustJustice.

• Encourage your local library to order a copy, whether the free e-version or a hard copy from Gleebooks.

• Follow Guardian Australia’s project, Breaking the Cycle.

Readers may also be interested in these articles:

NACCHO Aboriginal #SUDI Children’s Health : Queensland leads the way with #Pepi-Pods safe co-sleeping spaces

 pepi-pod-baby

” The Pēpi-Pod® Program, comprising a safe sleep enabler, safe sleeping parent education and safety briefing; and family commitment to share safe sleeping messages in social networks, was delivered to Aboriginal and Torres Strait Islander families with identified SUDI risks, recruited through Queensland maternal and child health services (n=10 services, 25 communities) across metropolitan, regional and rural/remote areas.”

From the Pepi-Pod Program Website

 ” Hundreds of Aboriginal and Torres Strait Islander newborns will be tucked safely into bed with funding for more safe co-sleeping spaces. 

Mothers in Aboriginal and Torres Strait Islander communities will be provided with a Pēpi-Pod for their babies to sleep safely in, as well as access to a safe sleeping education program in a bid to cut infant deaths.

The safe sleeping program is a partnership between the Department of Communities, Child Safety and Disability Services, Queensland Health, University of the Sunshine Coast, the Queensland Aboriginal and Islander Health Council, Rural Doctors Association for Queensland Foundation and Red Nose.”

Premier Annastacia Palaszczuk said the Queensland Government would provide $100,000 to continue the roll-out of a safe sleeping program in Indigenous communities, including 600 Pēpi-Pods for young mothers aged 15-25 years.

“Safe sleeping arrangements are absolutely vital and provide a starting point to keep babies and young children safe at home,” she said.

“Sudden Unexpected Death in Infancy (SUDI) is one of the leading causes of death amongst infants and in some cases may be preventable with the right education and support.

“Pēpi-Pods have made a real difference in helping reduce infant mortality in New Zealand by up to 30 per cent over the last four years, so I’m pleased that hundreds of young Indigenous mothers right here in Queensland will be able to use them, in conjunction with education and health support.”

Minister for Child Safety Shannon Fentiman said The Queensland Family and Child Commission 2015-16 report into Queensland child deaths found half of infants who died from sudden unexpected death were sleeping with one or more people at the time of death.

“We know co-sleeping can increase the risk of sudden unexpected death and fatal sleep accidents, especially for babies less than 12 weeks of age,” she said.

“The rates of sudden unexpected death are around four times higher among Indigenous infants than non-Indigenous infants,” she said.

“We know that co-sleeping can be a risk factor associated with sudden unexpected deaths in some circumstances, which is why we’re focusing this trial on the delivery of education and support for high-risk young women.”

Pēpi-Pod’s are a safe sleep enabler, which provides physical protection around a baby when they are asleep in places where the risk of suffocation is heightened, for example, on adult beds, couches or in makeshift beds.

The Pēpi-Pod Program is made up of a portable sleeping space designed for babies up to five months, which includes appropriate bedding, and is embedded in safe sleep education and a family commitment to spreading safe sleep messages within their own social network.

The program was first introduced in Queensland as a research trial led by Professor Jeanine Young from the University of the Sunshine Coast in collaboration with New Zealand’s Change of our Children social innovation organisation and Queensland Health in 2012.

Professor Young said babies thrive when they are kept close to their mothers.

“We have had strong support from health services participating in the study,” she said.

“This program is all about valuing and maintaining the cultural values of keeping babies close, but also ensuring baby has a safe place to sleep, particularly when there are other risk factors present.

“Safe sleeping advice needs to be evidence-based but also transferable in a way that is practical, acceptable and valuable for families caring for their babies.

“The Pēpi-Pod Program helps families move safe sleep advice to safe sleep action.”

Ms Fentiman said an education and awareness program, including antenatal workshops, will be rolled out in conjunction with the Pēpi-Pod Program through local community-controlled health networks.

“The Queensland Government and Family Matters are also working together to develop an action plan that lays the platform for our efforts to improve the lives of Indigenous people and ensure that their children are safe, healthy and have the same opportunities as other Queensland children,” she said.

Background

Co-sleeping is a culturally valued practice by many Indigenous families, however is associated with sudden unexpected death in infancy (SUDI) in hazardous circumstances. This study aimed to evaluate a safe sleep strategy in collaboration with Aboriginal and Torres Strait Islander families with high risk for SUDI.

A project team from USC have collaborated with Change for our Children Limited in New Zealand for the first trial of a safe sleep enabler in Australia. The Pēpi-Pod Safe Sleep Program was initiated in New Zealand by Change for our Children in 2011 as a public health response for babies at a higher risk of SUDI.

Methods

The Pēpi-Pod® Program, comprising a safe sleep enabler, safe sleeping parent education and safety briefing; and family commitment to share safe sleeping messages in social networks, was delivered to Aboriginal and Torres Strait Islander families with identified SUDI risks, recruited through Queensland maternal and child health services (n=10 services, 25 communities) across metropolitan, regional and rural/remote areas.

Results

Program acceptability and feasibility was established and raised awareness of safe sleeping in communities. Families reported benefits including safety, convenience and portability. Partnering health services reported that the program was feasible, flexible, sustainable, and built local workforce capacity with integration into current service models.

Awards

This project was recognised with two national awards in 2014:

  • Winner, HESTA Australian Nursing Awards – Team Innovation
  • National Winner, National Lead Clinicians Group Award for Excellence in Innovative Implementation of Clinical Practice (Indigenous Health Category).

Conclusion

This is the first evaluation of a safe sleep enabler in Australia. Evaluating innovative and culturally respectful strategies to reduce SUDI risk through enabling safe sleep environments, which support community ownership, develop multidisciplinary team skills, and reorient services from safe sleep advice to safe sleep action, will better inform the evidence-base used by educators, clinicians, researchers and policy makers in supporting parents and reducing infant deaths.

More information

Please contact Professor Jeanine Young, Chief Investigator, Australian Pepi-Pod® Program.

Recruitment information for partnering sites in the Pēpi-Pod® Program:

For more information about the New Zealand and Australian Pepi-Pod® Safe Sleep Program please see Introducing the Pepi-Pod Safe Sleep Program and Change for our Children website.

NACCHO Aboriginal Health : Five things wrong with government Aboriginal Cultural Safety and Security policies

mark-lock

 ” Australian organisations seeking to be culturally safe and secure would have little confidence in Australian Governments’ policy documents to provide them with high-quality evidence for restructuring organisational governance.

I have assessed the various current Australian policies (listed below) around Aboriginal cultural safety and security.

Why would organisations follow guidelines that have no underlying evidence base, are not endorsed by Aboriginal community organisations, and have no assessment of their effectiveness for improving Aboriginal cultural safety and security?”

Dr Mark Lock  is a researcher who studies committees professionally and he’s looking at ways Aboriginal people can make their voices heard. “In my research, covering 53 towns around Hunter New England Local Health District, currently I have 2,500 committees and about 3,500 people,” Mr Lock said. It’s a surprising statistic.

“Aboriginal people sit on many different committees and I want to know: Where is my voice? Where is Aboriginal voice? How do Aboriginal people influence decision-making processes through sitting on all these different types of committees? Contact

See the recent full ABC Meet the Mob interview below

Five things:

1) No endorsement from any peak Aboriginal organisation (except Victoria – Victorian Aboriginal Child Care Agency),

2) No detail about the developmental process, with statements such as “thanks to the many people who were involved in developing this framework”,

3) Limited evidence base for the long list of domains, strategies, and actions, 4) No key performance indicators for measurement, and

5) No evaluations to assess their effectiveness.

Those policies evaluated

  1. Cultural Respect Framework for ATSI Health 2016 – 2026 (AHMAC)
  2. Aboriginal Cultural Security Framework 2016-2026 (Northern Territory)
  3. Aboriginal and Torres Strait Islander Cultural Capability A Framework for Commonwealth Agencies (Australian Public Service Commission, 2015)
  4. Towards Culturally Appropriate and Inclusive Services 2014-2018 (Australian Capital Territory)
  5. A Framework for Working Effectively with Aboriginal People (Agency for Clinical Innovation, NSW Health, 2013)
  6. WA Health Aboriginal Cultural Learning Framework 2012-2016 (Western Australia)
  7. Respecting the Difference-An Aboriginal Cultural Training Framework for NSW Health (NSW Health, 2011)
  8. Queensland Health ATSI Cultural Capability Framework 2010-2033 (Queensland)
  9. Aboriginal Cultural Competence Framework (Victoria, 2008) and Matrix (2009)
  10. Aboriginal Cultural Respect Framework 2007-2012 (South Australia)

 NACCHO RESEARCH See our Cultural Safety posts

Download the Australian Indigenous Doctors Association FACT SHEET

cultural-safety-factsheet1

The National Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 2016–2026 (the Framework) was recently launched by the Australian Health Ministers’ Advisory Council .

This ten year framework seeks to guide delivery of culturally safe, responsive, and quality health care to Aboriginal and Torres Strait Islander people and communities.

Download the COAG Cultural Respect Framework here :

cultural_respect_framework_1december2016_1

The recent full ABC Meet the Mob interview 

“I got a cheque for three dollars when I was a little boy. I don’t know who did that but I really value that three dollars. It came through good committee processes about giving financial independence to Aboriginal people.”

Mark Lock is a researcher who studies committees professionally and he’s looking at ways Aboriginal people can make their voices heard.

“In my research, covering 53 towns around Hunter New England Local Health District, currently I have 2,500 committees and about 3,500 people,” Mr Lock said.

It’s a surprising statistic.

“Aboriginal people sit on many different committees and I want to know: Where is my voice? Where is Aboriginal voice? How do Aboriginal people influence decision-making processes through sitting on all these different types of committees?

“They’re all connected because the chairperson of one committee will be a member of another committee, and the chairperson of that committee will be a member of another committee. It’s a network perspective like a spider’s web of committees.”

Mr Lock is keen to find out how policy makers make decisions.

“How do they say, ‘Oh, Aboriginal priorities, close the gap, number one. There’s an Aboriginal voice coming from Boggabri. I need to give that priority over anybody else’s voice.’ I don’t know how it happens and that’s what I’m investigating,” he said.

“There’s many more committees out there operating in our communities and that’s a fantastic thing, but with a population with high needs and so few people, how can their voice be better heard in all the noise? That’s what I want to try and get to.”

Mr Lock’s journey into this unique field of research started with a humble trophy from his grandmother that still sits in his office at the Hunter Medical Research Institute.

“My grandmother, Marjorie Woodrow, gave this to me in 1978 when I got straight As as a little boy in Narromine. I grew up in the same class as Glenn McGrath, that’s my brush with fame. We played cricket together,” Mr Lock said.

“To me, a little boy at the time, I felt so proud that Nan acknowledged this and said, ‘Go and get educated like white fellas and do good for our mob.’ I am 46-years-old now and that was when I was 12-years-old. It’s propelled me to this point always.”

Being a blackfella is not straightforward for Mr Lock.

“I’ve always been challenged about blackness and I’m always being challenged about, ‘Am I good enough to be a blackfella because I don’t look like blackfella? It’s constantly a battle to maintain identity, but I’m very strong about it now,” he said.

“My mob is the Ngiyaampaa mob out from Murrin Bridge, and on my website profile, you’ll see I don’t identify as Aboriginal because Aboriginal is a Latin term imposed upon us by Europeans.

“I’ve got all these mixed ancestries; convict, Latvian, Ngiyaampaa. But my history is very strongly of growing up around my Aboriginal family in country New South Wales and all the stories around that.”

Mr Lock lives in Newcastle but he has lived in many different places.

“I moved 28 times by the time I was 21. We went all over, in caravans, tents on river banks, wherever we could live,” he said.

“It started out with Nan who was always moving around with her children because she didn’t want them taken away by the welfare agencies, and it just transferred on to how we lived. I actually thought it was quite normal.

“When I met my wife Steph in Newcastle 26 years ago I thought she was a weirdo because she had only ever lived in the one place. No. It turns out that my story is not normal – 28 moves by the time I was 21!

“Moving is common in Aboriginal communities. People just move around. I think it’s related to that history of not having a solid root, of a solid foundation where you grew up, where you sang songs, where you sat by the fire, where you went fishing.”

Mr Lock travelled the country as a child and travelled the world as an adult, living in far-east Russia with his wife.

“I wanted to send a really clear message that I’m going to support my wife and I support women in this country. She’s an engineer. I was a stay-at-home dad looking after the kids,” he said.

“She has lived in Gabon, China, all over the place. She’s a fantastic engineer and we made a decision together that her career was the most important career.

“I said okay. Not only that; it’s not a token thing but it’s a serious issue for me, to promote that positive bias towards women, I changed my last name too.”

So Mark Lutschini took his wife’s surname and became Mark Lock

Mark Lock applies his independent thinking to his research.

He employs two full-time social media experts to publish findings as an ongoing part of his research process, rather than leaving it all to be published at the end of the process.

“My social media researchers have Twitter, Facebook, LinkedIn, Google Plus and Pinterest because Aboriginal voice is expressed in different ways; images, video, writing in different forms,” Mr Lock said.

“We write many blogs. We tweet a lot. We also write journal articles. They capture as I gather the data for the study. I send it to them and then tweet about it to people who are interested in the study.”

Mr Lock would like to see committees take up social media to be more transparent.

“If you’re sitting down with a bunch of people around a table making decisions, why not write minutes, post them on a website so anyone in the community can access the minutes of the meeting?” he said.

And Mark’s personal experience on committees?

“I try to avoid committees. I was in the public service for 10 years and they were very debilitating. Dreadfully boring and often times you just want to go to sleep.”

Hosted by Jill Emberson, Mornings presenter on 1233 ABC Newcastle, Meet the Mob is a weekly profile of Aboriginal people in the Hunter region of New South Wales.

You can listen to each Meet the Mob interview by clicking on the audio player or you can download each interview as an mp3 by right clicking on the blue heading under the audio.

 

 

NACCHO Invites all health practitioners and staff to a webinar : Working collaboratively to support the social and emotional well-being of Aboriginal youth in crisis

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NACCHO invites all health practitioners and staff to the webinar: An all-Indigenous panel will explore youth suicide in Aboriginal and Torres Strait Islanders. The webinar is organised and produced by the Mental Health Professionals Network and will provide participants with the opportunity to identify:

  • Key principles in the early identification of youth experiencing psychological distress.
  • Appropriate referral pathways to prevent crises and provide early intervention.
  • Challenges, tips and strategies to implement a collaborative response to supporting Aboriginal and Torres Strait Islander youth in crisis.

Join hundreds of doctors, nurses and mental health professionals around the nation for an interdisciplinary panel discussion. The panellists with a range of professional experience are:

  • Dr Louis Peachey (Qld Rural Generalist)
  • Dr Marshall Watson (SA Psychiatrist)
  • Dr Jeff Nelson (Qld Psychologist)
  • Facilitator: Dr Mary Emeleus (Qld GP and Psychotherapist)

Read more about the panellists.

Working collaboratively to support the social and emotional well-being of Aboriginal and Torres Strait Islander youth in crisis.

Date:  Thursday 23rd February, 2017

Time: 7.15 – 8.30pm AEDT

REGISTER

No need to travel to benefit from this free PD opportunity. Simply register and log in anywhere you have a computer or tablet with high speed internet connection. CPD points awarded.

Learn more about the learning outcomes, other resources and register now.

For further information, contact MHPN on 1800 209 031 or email webinars@mhpn.org.au.

The Mental Health Professionals’ Network is a government-funded initiative that improves interdisciplinary collaborative mental health care practice in the primary health sector.  MHPN promotes interdisciplinary practice through two national platforms, local interdisciplinary networks and online professional development webinars.

 

 

 

 

 

 

NACCHO Aboriginal Health : Death by #racism: Is bigotry in the health system harming Indigenous patients ?

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” Death by racism should be a category on death certificates, because the racism in hospitals is hindering the recovery of many Aboriginal and Torres Strait Islander people.

Spend some time as a patient in a hospital and you soon find out that the medical profession is full of bigots and people who might not consider themselves racist, but have preconceived ideas on race and hold outdated beliefs in racial stereotypes.”

 We need cultural awareness programs on all levels of the system, writes Colleen Lavelle for IndigenousX : Our stories, our way” – each week, a new guest hosts the @IndigenousX Twitter account to discuss topics of interest to them as Aboriginal and/or Torres Strait Islander people. Produced with assistance of Guardian Australia staff.

NACCHO background info

Read previous 69 articles NACCHO Aboriginal health and racism

Read previous 10 articles NACCHO Aboriginal health / Cultural safety

 ” The National Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 2016–2026 (the Framework) was recently launched by the Australian Health Ministers’ Advisory Council .

This ten year framework seeks to guide delivery of culturally safe, responsive, and quality health care to Aboriginal and Torres Strait Islander people and communities.

Download the COAG Cultural Respect Framework here :

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I have been in and out of hospital for years with a brain tumour and have experienced the bigotry within the system first hand. I have also collected stories from Indigenous people around the country and a common thread is either: “Is it me or do they treat all of us like this?” or “Am I being overly sensitive?”

Indigenous cancer patients have even had pain relief denied to them. This might happen for a couple of reasons. First, because apparently some people think we Indigenous people can cope with more pain than our European counterparts. Let me state now that that ethnocentric view is not true. Another common view is that we are “faking it” to get drugs. Now, I don’t know about you, but if someone has cancer and is crying in pain, it’s pretty obvious they are not trying to get some cheap thrills.

A similar misconception is that we are drunk. I have even heard of cancer patients having their blood alcohol level tested before a doctor will see them. This assumption that we all take drugs or drink is outdated and just insulting.

Traditional people from remote communities have had to deal with their cultural mores being completely overlooked. Men have been shamed by having a young female nurse attend to them, when a male nurse is required. The same happens to our women too: a male attendant will try to do something that should only be done with or by a female. And when women ask to have another female in with them, they are quite often overlooked. I can’t understand why our cultural needs are overlooked when other peoples have their cultural rules respected.

The medical system seems so against us in so many ways, particularly if we are sent to a hospital away from home and English is not our first language. Good luck trying to find a translator to help! Governments, both at state and federal level can’t say they are doing all they can when our needs are not even considered important. All we hear are excuses like, “The cost is prohibitive for translators, patient transport, mobile medical units …”

We are the first people of this country and as such we shouldn’t be constantly overlooked. Perhaps fewer trips to the Gold Coast and a little bit more money into Indigenous health could help.

There are ways to make the road to good health better. For starters, no doctor or nurse should be allowed to work with Aboriginal people unless they have had cultural awareness training. It should be a requirement that all medical professionals do a cultural awareness course, with a refresher course after every year. Make it part of the accreditation process. It should be a part of the Close The Gap scheme that every general practice has to sign on to do cultural awareness. Even if it’s just one person in the practice doing it online. There could also be an incentive, such as the practice receives money for each Indigenous patient they see.

If every doctor and nurse across the country had this training and if hospitals and health executives spent quality time with Aboriginal and Torres Strait Islander patients, they might learn we are not so different. We might have some different needs, but they shouldn’t compromise the levels of compassion, caring and proper medial attention that we need.

NACCHO Aboriginal #Heart Health @HeartAust @AusHealthcare : Lighthouse Hospital project employment opportunities

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What is the Lighthouse hospital project?

  • The Lighthouse hospital project is a joint initiative of the Heart Foundation and the Australian Healthcare and Hospitals Association (AHHA).
  • The aim: to improve care and health outcomes for Aboriginal and Torres Strait Islander peoples experiencing coronary heart disease, the leading cause of death among this population.

Australia is a privileged nation by world standards. Despite this, not everyone is equal when it comes to heart health and Aboriginal and Torres Strait Islander people are the most disadvantaged. The reasons are complex and not only medical in nature. Aboriginal and Torres Strait Islander people have a troubled history with institutions of all kinds, including hospitals.

The Lighthouse Hospital project aims to change this experience by providing both a medically and culturally safe hospital environment. A culturally safe approach to healthcare respects, enhances and empowers the cultural identity and wellbeing of an individual.

This project matters because the facts are sobering. Cardiovascular disease occurs earlier, progresses faster and is associated with greater co-morbidities in Aboriginal and Torres Strait Islander peoples. They are admitted to hospital and suffer premature death more frequently compared with non-Indigenous Australians[1].

Major coronary events, such as heart attacks, occur at a rate three times that of the non- Indigenous population. Fatalities because of these events are 1.5 times more likely to occur, making it a leading contributor to the life expectancy gap [2].

Current employment opportunities

1.The National Project Manager – Lighthouse Hospital Project

Will manage the development, delivery and evaluation of the Lighthouse Hospital Project (Phase 3) across 18 hospital sites nationally. The role will lead project partnerships and oversee a national team of four to drive sustainable change in acute settings to improve cardiac care and outcomes for Aboriginal and Torres Strait Islander peoples. Regular interstate travel will be required.

Download job description

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2.The Lighthouse Hospital Project ( 3 ) Coordinators

Will manage the day to day support for the development, implementation and evaluation of the Lighthouse Hospital Project (Phase 3) in approximately six hospital sites each. The Coordinators will support the development of local and state-based project partnerships and work as part of a national project team of five to drive sustainable change in acute settings to improve cardiac care and outcomes for Aboriginal and Torres Strait Islander peoples. Regular interstate travel will be required.

Download job Description

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Contact:

Fiona Patterson, National Programs Manager,

fiona.patterson@heartfoundation.org.au, 03 9321 1591

Phase 1 (2012–2013)

Aim – To improve the care of Aboriginal and Torres Strait Islander peoples experiencing acute coronary syndrome (ACS).

We developed this project was developed in response to a 2006 report from the Australian Institute of Health and Welfare (AIHW).

The project first focused on providing culturally safe and positive consumer experiences, which were reviewed by 10 organisations known for providing exemplary care in the treatment of Aboriginal and Torres Strait Islander patients with acute coronary syndromes (ACS).

The project identified key elements that make a difference to ACS care:

  • expanding roles for Aboriginal Liaison Officers, Health Workers, Patient Pathway Officers and equivalent roles
  • better identification of Aboriginal and Torres Strait Islander patients
  • building strong partnerships and communication channels with local Aboriginal and Torres Strait Islander communities and other relevant organisations
  • fostering and supporting clinical champions
  • building capacity for patient-focused care
  • use of technology
  • use of an industry-based quality matrix.

Phase 2 (2013–2016)

Aim – To drive systemic change in acute care hospital settings to improve care for and the experience of Aboriginal and Torres Strait Islander peoples experiencing ACS.

In Phase two, the scope was to improve activities in eight public hospitals across Australia to improve clinical and cultural care for Aboriginal and Torres Strait Islander patients with ACS.

The toolkit

We developed a quality improvement toolkit, ‘Improving health outcomes for Aboriginal and Torres Strait Islander peoples with acute coronary syndrome’, to provide a framework to address health disparities.

The toolkit aimed to:

  • ensure care providers met minimum standards of care, cultural safety
  • identify practices and actions that can and/or should be improved
  • foster engagement
  • improve healthcare services for Aboriginal and Torres Strait Islander peoples with ACS.

The toolkit outlined four areas that were critical in providing holistic care for Aboriginal and Torres Strait Islander peoples and their families as they journeyed through the hospital system and return to their communities.

The four domains were:

  • governance
  • cultural competence
  • workforce
  • care pathways.

The pilot

Eight pilot hospitals participated in testing the toolkit:

  • Bairnsdale Regional Health Service, Victoria
  • Coffs Harbour Health Campus, New South Wales
  • Flinders Medical Centre, South Australia
  • Liverpool Hospital, New South Wales
  • Princess Alexandra Hospital, Queensland
  • Royal Perth Hospital, Western Australia
  • St Vincent’s Hospital, Victoria
  • Tamworth Rural Referral Hospital, New South Wales.

Each hospital developed an action plan that outlined the areas they would address and the quality improvement activities they would undertake during the pilot. The project outcomes were dependent on community engagement, capacity to embed change, project support and the governance structures at each site.

Key Phase 2 achievements

  • Improved relationships with Aboriginal and Torres Strait Islander patients
  • Strengthening relationships with the Aboriginal and Torres Strait Islander community and medical services
  • Creating culturally safe environments for Aboriginal and Torres Strait Islander patients
  • Increased self-identification among Aboriginal and Torres Strait Islander patients
  • Streamlining processes related to culturally appropriate clinical care of Aboriginal and Torres Strait Islander patients
  • Enhanced staff capacity to respond to the needs of Aboriginal and Torres Strait Islander patients

Phase 3

We are awaiting funding for Phase three of the Lighthouse Project.

This will aim to increase the reach and the critical mass of Aboriginal and Torres Strait Islander peoples experiencing an acute coronary syndrome who receive evidence based care in a culturally safe manner.

Within this phase there will be a focus on integration of health services and care coordination by enhancing the relationships between local community groups, hospitals, local Aboriginal Community Controlled Organisations and Primary Health Networks.

The implementation of this phase would enable hospitals to address the actions in the revised Australian Commission on Safety and Quality in Healthcare National Safety and Quality Health Service.

The Lighthouse hospital project is a joint initiative of the Heart Foundation and the Australian Healthcare and Hospitals Association and is funded by the Australian Government Department of Health.

Download the poster.

References

  1. Australian Health Ministers Advisory Council (AHMAC). Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report. Canberra: AHMAC, 2012.
  2.  Mathur S, Moon L, Leigh S. Aboriginal and Torres Strait Islander people with coronary heart disease: further perspectives on health status and treatment. Cardovascular disease series no. 25. Canberra: Australian Institute of Health and Welfare, 2006.