Monash University Department of Rural & Indigenous Health

1. Monash UniversityDepartment of Rural &Indigenous Health Indigenous Health Unit www.med.monash.edu.aurural.health@med.monash.edu.au

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

3. Objectives 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. 3

4. 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

5. Culture….. Beliefs Behaviours Attitudes Practices ……… all learned, shared, and passed on by members of a group 5

6. Culture shapes our….. experience of the world, environment, family life, lifestyle, work & play life in our communities. 6

7. Culture is adapted through….. ethnic/racial environment, language and education, gender, age, personality socio/economic status, spirituality/religion, 7

8. Every culture - defines health, determines disease aetiology, prescribes how distress is defined & signalled, prescribes medical & social means of treatment 8

9. 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?

10. 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.

11. 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.

14. 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

15. SESSION ONEPre-European Settlement • 60,000+ years Indigenous occupation • Strong traditional Indigenous societies • Complex and structured social organization • Self-sufficiency in tune with environment

17. Dreaming • Ungud - Ngarinyin People from NW Australia. • Alcheringa - Aranda people • Tjukurpa - Pitjantjatjara People • Wongar - Murngin People NE Arnhem Land. • Bugari - Broome Region of West Australia

18. 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

19. 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 .

20. 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

21. Kinship system

22. Language

23. 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.

24. 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

25. 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

26. 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

27. Protection, removal, segregation • Protection policies 1890-1937 • Assimilation policies –1938 1968

28. 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

29. Protection policies 1890-1937(cont’d) Effects • 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

30. Assimilation policies – 1938 -1968 What Happened? • Children taken away from families • Institutionalized & trained for menial work • Further breakdown of family and clan

31. Assimilation policies – 1938 -1968 The Effects • Confusion, fear, anger • Cultural dispossession • Further loss of connection • Increased welfare dependency • Provision of cheap labor

32. 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

33. 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

34. 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

35. 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

36. Reconciliation 1990s onward Effects • 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

37. 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

38. 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

39. 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.

40. Continued… • Domestic violence • Child abuse • Government neglect • Loss of identity • Powerlessness

41. 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!

42. 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.

43. “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)

44. The Intervention Howard government response To eliminate violent & sexual abuse of Aboriginal children & unacceptable living standards in remote communities. 44

45. 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. 45

46. Pro Intervention 9000 child checks rise in school attendance drops in gambling, drinking & drug taking. expanded schools, public housing 46

47. Anti Intervention On-going invasion! Political manoeuvre Land grab Discriminatory Broader issues neglected. Undermined human rights. Lacked consultation process 47

48. Consider……. 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??? 48

49. 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. 49

50. 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. 50