In today's Western dominant society, Aboriginal and Torres Strait Islander people continue to be a marginalised and socially disadvantaged minority group. Compared to other Australians, Aboriginal and Torres Strait Islander people experience significantly varied outcomes related to health, education, employment, and housing.
At Royal Darwin Hospital, in Australia’s Northern Territory, 60-90% of patients are Aboriginal, and 60% speak an Aboriginal language, but only approximately 17% access an interpreter. Recognising a need to improve cultural safety and communication for Aboriginal and Torres Strait Islander people, the NT Aboriginal Interpreter Service and Royal Darwin Hospital piloted a new research project to place interpreters in the hospital for 4 weeks in 2019.
After initially reporting feeling disempowered when forced to communicate in English, participants in the research reported feeling satisfied with their care and empowered by consistent access to trusted interpreters, who shared their culture and worldviews.
CPSN was impressed with the research project and reached out to Anna, one of the key researchers involved, and a Professor at the Menzies School of Health. We were able to get more in-depth insights from her, understand her passion for Indigenous health and see what we can learn from her.
Despite growing up in a white environment in southern Tasmania in the 1970s, Anna from an early age had been exposed to Aboriginal people from Arnhem land during the making of a film in 1979 about Tasmania’s horrific colonial past. This fuelled her desire to work in Aboriginal health and created a deep respect for First Nations peoples.
When deciding on career options, Anna initially focused on international medical aid work as she wanted to work with less privileged people. However, it became evident that she didn’t need to go overseas to do that. Anna said, “we have huge disparities in health in our own country, due to the ongoing impacts of colonisation.”
She has been working in Indigenous health on and off for 20 years now. Anna is encouraged by the improvements which are occurring but is still motivated to stay working in this space since we still have so far to go.
She shares with us five tips on how healthcare professionals can better support Indigenous communities to access their services in a culturally safe way.
1. Learning about history
Firstly, we need to educate ourselves about the historical factors that promote ongoing health inequities and poverty – colonisation, stolen generations, and disempowerment.
The negative impacts of racial and economic disadvantage and a series of past government policies, including segregation, displacement, and separation of families have contributed to the mistrust held by Aboriginal and Torres Strait Islander people towards government services and systems.
2. Understanding racism and different cultural belief systems
Secondly, we need to face up to racism and recognise it’s a natural human trait but one we each need to deal with. It’s natural to judge others against our cultural norms. As healthcare providers working in someone else’s country, we need to put aside our own judgments and learn from community members.
We’re constantly reminded that the Western approach of valuing structure and efficiency is often totally the wrong approach. Discrimination, racism, and lack of cultural understanding mean that Aboriginal and Torres Strait Islander people still experience inequality and social injustice.
People's cultural beliefs, values, and world-views influence thinking, behaviours, and interactions with others. Cultural awareness is recognising that differences and similarities exist between cultures. Learning about the histories that impact First Peoples’ health is crucial to this awareness.
3. Acknowledging the stages of grief in Aboriginal health
Thirdly, we need to acknowledge and work through the stages of ‘grieving’ that healthcare professionals go through on first encountering Aboriginal health. Working in Aboriginal health is confronting. People die young of preventable conditions. We need to work through the culture shock and grief and come out the other side seeing the positives, seeing how alive and strong traditional cultures are, otherwise you burn out along the way.
4. Developing cultural competence
Fourthly, we need to gain cultural competence (understanding Aboriginal cultural practices and structures) and practice with cultural safety (examining our own biases and providing healthcare that truly meets the needs of our clients). It is important to build relationships within the local community and learn suitable and generally accepted social interactions.
For example, avoidance of eye contact is customarily a gesture of respect. In Western society averting the gaze can be viewed as being dishonest, rude, or showing a lack of interest. Some (but not all) Aboriginal and Torres Strait Islander people may therefore be uncomfortable with direct eye contact. To make direct eye contact can be viewed as being rude, disrespectful, or even aggressive.
To convey polite respect, the appropriate approach for instance with older, remote community members you haven’t met before, might be to sit alongside them during conversation to avoid them feeling interrogated in a face-on confrontation.
However, during light-hearted conversation, eye contact might be totally fine. You can read the situation and tailor your body language and eye contact depending on the social cues.
A local Aboriginal and Torres Strait Islander may also be able to assist us with cultural knowledge and interpreting information. They may also advise us on the best ways of distributing information through the community.
5. Creating safe spaces
Finally, we need to make health systems less alienating and more welcoming not just through our practices, but by changing the structural barriers that might be in place – like requiring people to go somewhere for healthcare where their family member just died, which may be culturally unacceptable.
Everything from the architecture of the health service (are there enough ground floor and outdoor spaces?) to the décor (are there design elements like Aboriginal artwork or flags to help people feel welcome?) to the behaviour of the security and cleaning staff towards First Nations peoples, it all impacts on the experience of healthcare. If that experience is better, then engagement is better, and healthcare outcomes can improve.
Anna’s last point is that providing health care across a cultural divide is not that much different from providing healthcare for anyone. Be kind. Being sick in the health system is a horrible experience – it’s our task to try to make that a little bit better, through kindness and consideration.
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