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Monash University Department of Rural & Indigenous Health. Indigenous Health Unit. Indigenous Cultural Awareness / Cultural Safety Training for Health Professionals Marlene Drysdale Isabel Ellender February 2009. Objectives.

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monash university department of rural indigenous health

Monash UniversityDepartment of Rural &Indigenous Health

Indigenous Health Unit


Indigenous Cultural Awareness / Cultural Safety Trainingfor Health ProfessionalsMarlene Drysdale Isabel EllenderFebruary 2009


To explore culture & cultural competence,

Examine why cultural competence is a desirable skill for health professionals,

Examine events & policies that lacked cultural safety & now impact on Indigenous health,

Reflect on your own values & perspectives to become a culturally competent professional.


culture why learn about it
Culture – why learn about it?
  • Each of us is part of some culture or cultures.
  • Sensitivity & curiosity to build competence skills
  • To provide better health care delivery.
  • Equity





……… all learned, shared, and passed on by members of a group


culture shapes our
Culture shapes our…..

experience of the world,


family life,


work & play

life in our communities.


culture is adapted through
Culture is adapted through…..

ethnic/racial environment,

language and education,

gender, age, personality

socio/economic status,



every culture
Every culture -

defines health,

determines disease aetiology,

prescribes how distress is defined & signalled,

prescribes medical & social means of treatment


what is your culture
What is your culture?

Q How would your culture affect your service delivery?

Q How do your values and norms affect how you see the cultural practices of others?

Q How do culture & health interact?

what is aboriginal cultural awareness
What is Aboriginal Cultural Awareness?
  • Aboriginal Cultural Awareness means having knowledge and understanding of Aboriginal people’s histories, values, belief systems, experience and lifestyles.
  • It is not about becoming an expert on Aboriginal culture.
what is cultural safety
What is Cultural Safety?
  • Cultural safety is the action that comes from cultural awareness.
  • Leads to cultural security.
  • Appreciating and understanding difference and accepting it.
definition of aboriginality
Definition of Aboriginality

An Aboriginal person is of Aboriginal descent who identifies as such and who is accepted by the Aboriginal community with which he or she is associated

session one pre european settlement
SESSION ONEPre-European Settlement
  • 60,000+ years Indigenous occupation
  • Strong traditional Indigenous societies
  • Complex and structured social organization
  • Self-sufficiency in tune with environment
  • Ungud - Ngarinyin People from NW Australia.
  • Alcheringa - Aranda people
  • Tjukurpa - Pitjantjatjara People
  • Wongar - Murngin People NE Arnhem Land.
  • Bugari - Broome Region of West Australia
what the dreaming teaches us
What the ‘Dreaming’ teaches us
  • Our ‘dreaming stories’ are not myth and legend but are both our past and present.
  • Teaches rules for living in the physical and spiritual worlds.
  • Explains how the ‘spirit ancestors created the world
Teaches us about all aspects of life our social structure and relationships to one another
  • Dreaming beliefs are passed on through story and ceremony
  • Importance of sharing and caring for our environment
  • Controls rules of marriage and behaviour
  • The ‘Dreaming’ is creation, history, our bible and a blueprint for life .
indigenous occupation
Indigenous Occupation
  • Kinship system
  • 500 different languages and complex sign language
  • Highly complex and integrated spiritual belief system
  • Conservation of land and environment to guarantee food and other resources-continuity
  • Technology
language cont d
Language (cont’d)
  • In Victoria about 10 different languages
  • Over 30 dialect groups e.g. Kulin nation of Melbourne and surrounding areas was made of of 5 dialect groups- Woiworung, Jajowrong and Taungurong.
session two european contact
SESSION TWOEuropean Contact
  • 1770 James Cook claims possession
  • 1788 Captain Phillip raises Union Jack
  • 1799 Aboriginal resistance – Parramatta
  • 1835 Batman Treaty- estimated Aboriginal population =11,500
european contact cont d
European Contact (cont’d)
  • 1837 British parliament receives report on genocide in the colonies
  • 1838 First Aboriginal protectorate established
  • 1841 Estimated Aboriginal population = 2000
  • 1851 Colony of Victoria established
european control
European Control
  • 1869 Act for protection and management of Aboriginal natives is passed in Victoria
  • 1908 Pensions for all Australians Except Aborigines
  • 1912 Maternity allowance for all except Aborigines
  • 1938 Aborigines forced to “play” re-enactment of invasion of 1788
  • 1941 Child endowment- no payments to nomadic or “mission” dependent Aborigines
protection removal segregation
Protection, removal, segregation
  • Protection policies 1890-1937
  • Assimilation policies –1938 1968
protection policies 1890 1937
Protection policies 1890-1937

What Happened?

  • Mixing together of groups
  • Start welfare dependency
  • Stringent control of Aboriginal life
  • Loss of land
  • Forbidden to practice culture & speak language
  • European food & clothing introduced
  • Massacres & diseases
protection policies 1890 1937 cont d
Protection policies 1890-1937(cont’d)


  • Destruction of kinship system
  • Families separated – loss of roles
  • Loss of spirit
  • Loss of culture
  • Loss of way of life-self-sufficiency
  • Heavy death toll
  • Disease epidemics
assimilation policies 1938 1968
Assimilation policies – 1938 -1968

What Happened?

  • Children taken away from families
  • Institutionalized & trained for menial work
  • Further breakdown of family and clan
assimilation policies 1938 19681
Assimilation policies – 1938 -1968

The Effects

  • Confusion, fear, anger
  • Cultural dispossession
  • Further loss of connection
  • Increased welfare dependency
  • Provision of cheap labor
self determination self management 1968 90
Self-determination/self-management 1968-90

What happened?

  • 1957 Federal Council for The Advancement of Aboriginals & Torres Strait Islanders established
  • Aborigines Advancement League established in Victoria
  • Political activism-national level
  • Re-emergence of Aboriginal leaders
1967 referendum
1967 Referendum
  • sec127 of Constitution to include Aborigines in the Census and
  • sec 51 to enable the Federal Government pass laws for Aboriginal people nationally
self determination self management cont d
Self-determination/self-management (cont’d)

The Effects

  • Aboriginal people gain new hope
  • Improvement in some aspects of life
  • Aborigines get right to vote
  • Government commitment to improving economic status of Aboriginal people
  • Department of Aboriginal Affairs
reconciliation 1990s onward
Reconciliation 1990s onward

What Happened?

  • Royal Commission into Aboriginal deaths in custody 1991
  • Council for Aboriginal Reconciliation established 1992
  • National Inquiry into the separation of Aboriginal & Torres Strait Islander children from their families 1997
reconciliation 1990s onward1
Reconciliation 1990s onward


  • National & State programs to reduce deaths in custody
  • National recognition of ‘Stolen Generations” of Indigenous children
  • Howard refuses to say sorry
  • Community education programs introduced on Indigenous culture & history
  • Ongoing collaboration between Indigenous and non-indigenous people on reconciliation
aboriginal health status
Aboriginal Health Status
  • Life expectancy: 17 year less
  • Infant Mortality: 3 times higher
  • Diabetes: 20 -30 times higher
  • Renal Failure: 15 times higher
  • Birthweight: 209 grams less
health c ontinued
Health continued….
  • Death by injury : 4 times greater
  • Hospitalisation: rates 55% greater
  • Cardiovascular Disease: 1 in 3 deaths
  • Cancer: 70% higher death rates among Indigenous women
issues today
Issues Today
  • Health conditions equal to third world statistics
  • 17 year less life expectancy
  • No political power – no seats in Government
  • No economic base to operate from
  • High youth suicide etc.
  • Domestic violence
  • Child abuse
  • Government neglect
  • Loss of identity
  • Powerlessness
many indigenous health issues lie outside the health sector
Many Indigenous health issues lie outside the health sector -

* cultural, * social,

* spiritual * historical

* economic * physical environment.

If you don’t remove the cause,

you wont effect a cure!

good health requires
Good health requires -
  • appropriate housing,
  • Suitable, sufficient diet,
  • clean drinking water and clean air
  • land free of pollution,
  • pest control and waste removal
  • health education, information,
  • communicable diseases control
  • leisure facilities.
“Health is not just the physical well-being of the individual but the social, emotional and cultural well-being of the whole community”

(NAHS Working Party, 1989:x)

the intervention
The Intervention

Howard government response

To eliminate violent & sexual abuse of Aboriginal children & unacceptable living standards in remote communities.


the 1 billon intervention
The $1 billon Intervention

73 remote NT communities

acquired 99 year leases,

cancelled permit system

Enforced the alcohol legislation

Military taskforce

Quarantined 50% of all welfare payments.


pro intervention
Pro Intervention

9000 child checks

rise in school attendance

drops in gambling, drinking & drug taking.

expanded schools, public housing


anti intervention
Anti Intervention

On-going invasion!

Political manoeuvre

Land grab


Broader issues neglected.

Undermined human rights.

Lacked consultation process



All kids need protection!

Accusing all remote Indigenous parents.

Abuse in urban as well as remote.

Opening up closed remote communities - Good or bad?

Previously out of sight out of mind.

A new assimilation and interference???


the apology
The Apology

The Stolen Generations

Children of mixed descent, forcibly removed from their families by government welfare or church agents & placed in institutional care or with non-Indigenous foster parents.

“Neglect” judged by presence of poverty, mobility, or having few possessions.


some say
Some say …………

1. It’s too long ago!

2. I had nothing to do with it!

3. I didn’t know it was happening!

4. Why should I feel guilt & shame?

5.Saying sorry wont deliver results!

6. Saying sorry wont change the past!

But …….

Need an apology to move on.


Bad things happen

when good people are silent!


lack of communication the patient
Lack of communication-the patient …

Lack of dialogue with a health professional can lead to

Compliance problems with prescribed treatment

Not understanding treatment purpose, side effects

Admitted to hospital without information

Lack of informed consent

Mistaken identity

Sent home with inadequate information.

Patients’ treatment at odds with their cultural beliefs.


lack of communication the health professional
Lack of communication - the health professional

Barrier to diagnosing patients’ complaints

Difficult to inform patients, & gain informed consent

Getting gender issues wrong

Getting authorities wrong

Getting religious protocols wrong (death & birth)

Barriers to timely health prevention measures

Barriers to evaluating overall problem and developing culturally sensitive solutions


cultural differences in communication
Cultural differences in communication

Verbal Non-verbal Rules Etiquette

tempo gestures prioritizing greeting

taboos body space avoidance respect

address touching consent interrupting

tone eye contact observing time acknowledging

slang silences decision making conduct



You do not have to bear the guilt for the actions of past practices but you have a responsibility to ensure such practices do not continue today

thank you
Thank you

what is your culture1
What is your culture?

Q How would your culture affect your service delivery?

Q How do your values and norms affect how you see the cultural practices of others?

Q How do culture & health interact?

your culture
Your culture

♣Describe your culture!

♣ In your culture, what protocols are associated with birth?

♣ In your culture, what protocols are associated with death, the dead body, disposal?

♣ Describe the indigenous people in your country of birth?

♣ Describe something about their health?


indigenous culture
Indigenous culture

Name a behaviour or words likely to offend an

Indigenous patient?

A Moslem patient?

A Jewish patient?


indigenous culture1
Indigenous culture

♣ Have you met an Indigenous Australian?

♣ What does it mean to be aware of another’s culture?

♣ Why would it be important to you as a professional?

♣ What skills do you acquire from being aware of Indigenous peoples’ history and their culture?

♣ What non-medical issues act as barriers to Indigenous peoples’ use of mainstream health facilities?



♣ Proportion of Indigenous Australians in total population?

♣ What is the life expectancy of a non-Indigenous man?

♣ What is the life expectancy of an Indigenous man?

♣ What is the life expectancy of a non-Indigenous woman?

♣ What is the life expectancy of an Indigenous woman?


institutional culture a culture of no culture
Institutional culture - ‘a culture of no culture’???

What is the culture of the profession of Social Work?

How does it pass it on??

Truth of bio-medical knowledge - a real knowledge.

What is the culture of Monash?

How does it pass it on?

Science is concerned only with timeless truths.


dvd stranger in town issues questions and model answers
DVD Stranger in town issues, questions and model answers.
  • What support processes are in place for Colin Murka’s remote community when he gets sick?
q 1 answers
Q 1. Answers
  • Aboriginal Health Worker (AHW). Familiar person in the community, speaks the language, knows the people.
  • AHW takes message from Colin’s nephew, understands implications of message, acts on it.
  • The clinic knows Colin.
  • Female nurse has male AHW when she talks to and questions Colin.
  • The nurse gives Colin time to answer her questions.
colin in hospital
Colin in hospital

Q 2. What aspects of his hospital stay are unfamiliar and scary for Colin?

Q 2. Answers
  • Clinical setting, confined situation, left alone in strange environment for long periods.
  • Unfamiliar procedures, gadgets around him.
  • New faces, unfamiliar language.
  • Everyone in a hurry.
  • Wheelchair orderly shouts so he understands.
  • Female nurses attend to him.
  • Use of very direct approaches not his way.
  • Fear of getting into a lift for the first time.
  • Sleeps under stars not in formal bed in a clinical setting.
  • Not told what’s happening next.
colin in hospital1
Colin in hospital

Q 3. As a health professional in that hospital what would you have done to make Colin’s stay less scary?


  Better communication.

  • Appropriate explanations.
  • Offer to contact hospital Indigenous liaison officer or local Indigenous community.
  • Culturally competent approaches.
  • Offer to connect a phone call to his family
colin in hospital2
Colin in hospital

Q 4. What caused Colin’s stay to improve? Why did these things work?

  •  Contact with local Indigenous community brought some familiarity and cultural safety.
  • Contact person could liase with hospital staff
  • A friendly face in a hostile environment.
  • Speaking his language with a friend.