Australian governments have to stop the waste and dismantle barriers in their approaches to Aboriginal and Torres Strait Islander health, says Janine Mohamed, CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM).
In her speech last week at the National Press Club in Canberra, Mohamed called on government to make the most of the great asset that is the Indigenous health workforce and stop the “obscene” waste of time and effort involved in arguing for renewed funding.
Calling for greater cultural competency and respect in health care in Australia, she describes the case of an expectant mother in a remote community who was threatened with having child protection brought in because she wanted to delay her departure from home by a week.
And she describes a personal experience of true culturally safe and respectful practice that sparked her healthcare career.
This is the fourth story in a Croakey mini-series on Fixing Rural and Remote Health, following the launch of the National Rural Health Alliance’s five key priorities for ‘Fixing Rural and Remote Health’. Read the others:
- Fixing rural, remote health: time to go beyond tokenistic “Akubra & moleskins’ responses
- One size doesn’t fit all in rural health; 7 million people and kids like Max deserve better
- Rural Health Commissioner’s KPI: “end acceptance, complacency on health disparities between city and bush”
Janine Mohamed’s speech:
“We can only ever travel at the speed of trust”
I am a proud Nurrunga Kaurna woman, which means I am from the Yorke Peninsula in South Australia, more specifically Point Pearce mission. I’d like to start with a personal story about how I decided to became a nurse.
When I was a young girl growing up in a country town in South Australia, we lived next door to the director of nursing from our local hospital. In our home we always had more than our fair share of sick people, and Mr Brad Walker often came over to help us. He built the health literacy in our home.
He wasn’t an Aboriginal man. He saw colour, he respected our difference and he didn’t judge us. Our family often enjoyed a laugh with him and we built a relationship founded on mutual respect and trust. We can only ever travel at the speed of trust.
When I look back, I recognise that he embodied culturally safe and respectful practice, long before the term had even been invented. He supported us to make the best use of our family’s human resources without bias.
When I was seven years old, he told me I would make a good nurse, because I was smart, and kind. He didn’t underestimate me. He encouraged me to see beyond the mountain, to see what I could be.
What he gave me was the capacity to make sure I didn’t waste the resources that I had, to make the best use of them.
And that’s the message, I would like governments to take on board today: stop the waste and barriers. Make use of a great asset – the Aboriginal and Torres Strait Islander nurses, midwives and all of our other health professionals.
The life-changing work of an Indigenous health workforce
I often like to begin my speeches by speaking about a great pioneering Aboriginal nurse – May Yarrowick.
May trained in obstetric nursing in Sydney in 1903. Imagine an Aboriginal nurse treating and caring for both Aboriginal and non-Aboriginal peoples in this era. And she may well be our first Aboriginal woman qualified in western nursing.
We now have over 3,000 Aboriginal and Torres Strait Islander nurses and midwives working across this great country.
When I think of May, I am reminded of the incredible service that our health professionals provide to people living in rural, remote and regional Australia. It’s a service built on the knowledge of our people, who undertook the roles of health professionals for thousands of years before the first formal health school was ever set up.
The importance of our workforce in closing the gap in health must not be under-estimated. Evidence shows that our people respond best when they are treated and supported by Aboriginal and Torres Strait Islander health professionals.
A strong and growing Aboriginal and Torres Strait Islander health workforce not only provides better quality of care and role modelling for our people. But it also provides life-changing jobs for our people in rural, remote and regional communities and improves health literacy for families and communities.
“Obscene” waste arguing for funding
Unfortunately, continued waste and short-term vision of government bureaucracy sadly contributes to the lack of progress in “Closing the Gap”.
Each year, our sector invests an obscene amount of time and effort arguing for the renewal of funding contracts. This diverts frontline staff from their jobs and I can tell you is a killer for job satisfaction. It also sends a terrible message to our workforce about their own job security and value.
So policies that help grow and support the Aboriginal and Torres Strait Islander health workforce, less bureaucracy and, longer-term funding arrangements for our organisations are the low hanging fruit of what can be done to close the gap.
Lagging behind on cultural competence
But these aren’t the only answers. While we are growing our own workforce we need to make sure that all health professionals operate in a culturally safe way with Aboriginal and Torres Strait Islander people
We need health professionals like Mr Walker – who see colour, see our culture, see our difference and respect it. Health professionals who understand the impact of racism, poverty and dispossession on health outcomes. Health professionals capable of addressing their own bias and the bias that underlies the system in which they work.
In New Zealand, legislation requires all health professionals to be trained in and demonstrate culturally safe and respectful practices. We are lagging behind to do the same in our country.
Let me give you another area where our health system fails to support our rural, remote and regional families – when support is most necessary: when a new baby arrives.
The birth of a baby is a special time and the birthing period is also critical for forming life-long trajectories in health.
That’s why, together with the Australian College of Midwives and CRANAplus, we have been calling on governments to support women to give birth on country – in the communities where they live, surrounded by their loved ones.
A woman I am so proud to call my friend Ms Djapirri Mununggirritj articulated the meaning of Birthing on Country to be:
‘…a metaphor for the best start in life for Aboriginal and Torres Strait Islander babies and their families – which provides an appropriate transition to motherhood and parenting…’.
There is no cookie cutter approach to the term birthing on country, but what is common is for everyone being with family, being on country and having birthing choices respected.
In some places, Aboriginal and Torres Strait Islander women are virtually forced to leave their communities towards the end of their pregnancies.
Respected Brisbane based researcher, Professor Sue Kildea recently told me of an expectant mother in a remote community who said she wanted to delay her departure from her community by a week. The health providers threatened her and told her that if she did not get on that plane to be taken to the closest hospital, they would report her to child protection services.
This level of coercion being used on expectant Aboriginal mothers is shocking and reminiscent of what Australians would have hoped was a bygone era.
Professor Kildea told me another distressing story. Of a hospital that discharged a new mother, without telling her family and they put her on the long bus-ride home. So when this new mother arrived in town at 3am, there was no-one there to meet her and she had no means of contacting anyone to pick her up. What could she do? At 3am? She walked for an hour, with her new baby, to get home.
Calling for change that sees ‘beyond the mountain’
If services are not culturally safe, if they are not providing health care that meets the needs of OUR people, then what value are we getting for our investment?
Our nation requires champions for action on the wider determinants of health. Aboriginal people make up 3 per cent of the population. We need the other 97 per cent to champion this with us.
I trust the new Commissioner for Rural Health will be a champion of change and see beyond the mountain just like my childhood neighbour Mr Walker. I trust the Commissioner will be a champion for improving health systems and services while recognising the need to address key areas like: poverty, inequality, racism and prejudice.
It is these wider issues that continue to plague and burden the health of Aboriginal and Torres Strait Islander people.
Let us make the best use of the extraordinary Aboriginal and Torres Strait Islander community controlled health sector and workforce. Let us make the best use of the wealth of Indigenous knowledge that has helped sustain us for thousands of years. Let us utilise these valuable assets to improve the health of our nation.
I look forward to meeting the new Commissioner for Rural Health and working together to do just this.