Health And Wellbeing Community Assessment Of Indigenous Australians

Reporting

Historical legislation and government policies have impacted the health and well-being of Indigenous Australians. Since the landing of the First fleet in 1788, the Australian government employed institutional racism in the form of laws and regulations. Such policies were executed throughout the colonial frontier, segregation, ‘protection’, and assimilation eras (Hampton & Toombs, 2013). Cassie’s Story has been used as an example to correlate past and present implications of the assimilation policy (CSU, 2011). Polices were primarily enforced through the use of missions and government reserves in an attempt to ‘civilise the savages’ (Eckermann, 2010). As a future health care professional, strengths and weaknesses of cultural competence will be critically reflected in this journal. Researching the true violence that occurred in Australia’s shared history has been a confronting introduction towards my cultural competence journey.

In 1937, the Australian government introduced the assimilation policy. The aim of the assimilation policy was to absorb the ‘half-caste’ Indigenous population into the ‘white’ community. With the protectorate experiment failing, governments were viewing the Indigenous population as a nuisance. The idea of absorption agreed that all efforts of the government should be directed at integrating children that were from mixed blood decent into the non-indigenous community. Consequently, individual racism and prejudices have been transmitted throughout generations (Hampton & Tooms, 2013). It was evident during my studies that the protection and assimilation polices overlap considerably. Indigenous children were forcibly removed from their families during both these eras of government control. I experienced feelings of disbelief and sadness watching footage of the children that had been taken. The stories that have been shared in the Bringing them home report are appalling. “The wailing at night used to disturb the spirits” as quoted in Cassie’s story reminded me of a tragic scene in the movie Rabbit Proof Fence and is an unsettling description of the events that took place. It was heartbreaking to learn that there were an estimate of 100,000 children taken and not all were reconnected with family members. I cannot fathom the intense heartbreak the families would feel then and now. This has created an understanding of why trauma is carried throughout the generations. Not only is there a strong history of violence, killing and dispossession there are children still missing that have never returned home. The dehumanising term “herded” is used frequently in literature and is mentioned in Cassie’s story. It further demonstrates that the Indigenous people were transported and treated like animals (Australian Human Rights Commission, 2017). The general theme of Cassie’s story relates to the forcible removal of Indigenous Australians and the assimilation policy. My interpretation of Cassie’s story clarifies that Indigenous communities were never asked and the government has controlled most aspects of their lives (CSU, 2011).

I have explored specific impacts on the health and well-being of Indigenous Australians throughout Cassie’s story. The negative outcomes that I have deciphered are dispossession, destruction of kinship groups, intergenerational trauma and psychological impacts. These impacts can be evidenced with the destruction of the community centre, destruction of the safe house for mums and the eviction of Indigenous families from their homes. Cassie is further burdened with the worry of her families physical and mental health. These worries can radiate broadly throughout the community kinship groups. Mental health concerns and the suicide of a family member are cited in Cassie’s story. The estimated suicide rate of Aboriginal and Torres Strait Islander peoples is 2.6 times the rate for non-Indigenous Australians (Australian Government Department of Health, 2013). I live in a small rural community that has frequently experienced the loss of young Indigenous people to suicide. There are many Indigenous Australians caught in the vicious cycle of poverty and incarceration in my local community and right across the continent as illustrated in Cassie’s story. Psychological impacts of trauma and dispossession are highly relevant in today’s society as these issues are still prevalent. Racial discrimination directly contributes to inequality in health and wellbeing outcomes (Eckermann, 2010).

Relating

Reflecting on personal and professional experiences has changed dramatically since commencing this subject. I am able to recall various events throughout my life and healthcare profession that relate to aspects of the assimilation policy. Throughout the protection and assimilation eras Indigenous people were seen as primitive and it was thought that they would die out as a matter of evolution. To some extent this thinking is still prevalent today. In the past I have heard people being asked “how much aboriginal do you have in you?”. This type of racial thinking is linked to assimilation with the belief that Indigenous blood could be bred out throughout generations and children were better off raised in white families (Chesterman & Douglas, 2004). I unknowingly believed that someone could have “less” Indigenous in them due to the colour of their skin and their percentage. How I came to believe that I will never know. It is a shameful assumption that I now understand to be highly inaccurate and was a belief that I mistakenly carried (Claeys, 2000). This is prime example of how racial thinking can be carried throughout generations unintentionally and the importance of cultural competence.

Until recently, I had been working for the past 6 years as an Assistant Nurse in the Aged Care industry. I remember observing the Diversional Therapist handing out several different colouring in pages to a group of elderly residents for an activity. There were pictures of machinery, flora, fauna, buildings and beautiful landscapes. The residents were all seated in a large dining room. Each person was seated in their particular seat. Lord help you if you accidently sat ‘Mavis’ in ‘Beryl’s’ chair before Bingo. The centre table sat a dozen people and a there were two smaller tables on the side. Two of the Indigenous male residents always sat off to the side together. I look back now and wonder if this was a personal choice or they felt uncomfortable and removed. Colouring sheets were always handed out to residents based on their likes and preferences. For example an old farmer preferred to colour in the machinery and thought it was too ‘feminine’ to colour in the butterflies. Brightly coloured pencils were placed around the table in decorated jars. I watched as the Diversional Therapist did not ask their preference and only ever selected pages of native Australian flora and fauna for the two males. Their jar of pencils only consisted of three colours red, black and yellow. Having researched assimilation in Australian I would now have the confidence to explain to that staff member how this behaviour can contribute to feelings of seclusion and dispossession. There is a clear relationship between the impacts of the assimilation policy and everyday Indigenous life. Concepts of historical government control can resurface in many every day activities. I would feel comfortable to ask why those men were excluded from the group and why they were not given the same choices to express themselves.

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Reasoning

Cultural competence from my understanding is the ability of a healthcare professional to have the awareness, knowledge and sensitivity towards various cultures in order to provide holistic care to our patient’s. There are many aspects of cultural competence that can help individuals improve their delivery of healthcare to Indigenous Australians. The main aspects of cultural competence are awareness, attitude, cultural knowledge and cultural skills. Healthcare professionals must have the ability to interact and communicate effectively with people across different cultures (Wells, 2000). Throughout my recent study of Indigenous culture and histories I have been able to uncover, reflect and challenge my own cultural bias’s. I discovered that my previous subconscious beliefs may have possibly affected my perception and attitude towards Indigenous patient’s. I’ve lived in a small rural community for my entire life. 30 years on, I am beginning to understand the Indigenous population I have shared my community with. Prior to commencing this subject I believe I was moving through life with a set of blinkers on. There are models of cultural development that I have viewed in literature which I can use to assist with my journey from cultural awareness right through to cultural proficiency (Wells, 2000).

Dispossession, destruction of kinship groups, intergenerational trauma and psychological effects can be reduced through the application of cultural competent healthcare. Cultural awareness, attitudes, knowledge and skills can be used to reduce the impacts of the health and well-being of Indigenous Australians. As discussed in Reporting and Relating there are concepts of the assimilation policy that arise in today’s society. Indigenous Australians are still experiencing the impacts of historical legislations. The negative events I have explained from Cassie’s story could be alleviated if the communities culture, values, beliefs and practices are acknowledged (Editorial Team, 2019). In my example from a professional experience, I mentioned that two Indigenous male residents were secluded from a group. They were not asked or given the same choices to complete an activity. If the Diversional Therapist was culturally competent she may have taken the time to sit and talk with the residents to understand them. Cassie stated that “they never ask us” perhaps we begin by asking how we can help a community or kinship rather than assuming and deciding on their behalf (CSU, 2011). Through the aspect of culturally appropriate communication I will be able to establish a respectful therapeutic relationship towards our Indigenous communities. Additionally, if I am ever in doubt I can simply ask our patients if they have any religious or cultural practices that affect the way they wish to be cared for.

Reconstructing

To prevent misunderstandings, miscommunication, and culturally-unsafe care it is essential that nurses continue their development of cultural competence (Levett-Jones, 2016). To improve in cultural competence I have chosen relevant, realistic and achievable goals. Firstly I identified and examined my own underlying beliefs and values in comparison to Indigenous culture. I have acknowledged a weakness in the assumption of Indigenous blood lines. With this understanding, I will initially focus on my misconception of Indigenous blood line percentages and research deeper into that area of assimilation. By acknowledging and challenge possible assumptions I can help to break the cycle of intergenerational racism. I can use self-reflection to identify any other gaps in cultural understanding as I progress through my studies. Charles Sturt University has access to 1000s of resources that I can access through the student portal for further self-education.

Secondly, it is widely understood that nursing assessment underpins safe-practice. Nurses and healthcare professionals are routinely conducting all types of assessments in the healthcare setting. A cultural assessment is equally important but most often forgotten. I have investigated a mnemonic called the ‘ABCDE’ of cultural assessment. By familiarising myself with this form of assessment I can improve the delivery of safe person-centred care to all people regardless of their race, ethnicity, culture or language. The mnemonic stands for attitudes, beliefs, context, decision making and environment (Levett-Jones, 2016). I will endeavour to learn and understand how to conduct this cultural assessment correctly so that I can utilise it in the workplace.

Thirdly, I currently work in Hospice and aspire to specialise in the Palliative health care sector. The Australian Indigenous Health Info net website provides a range of educational opportunities. There are hundreds of resources that I can use to continue my learning throughout my career. The time surrounding the end of someone’s life is precious and needs to be respected and approached in a safe and culturally appropriate manner. The Palliative care and end-of-life portal in the website is designed to assist health care professional to provide culturally coordinated care. I aim to undertake the learning resources that are focused on culturally appropriate palliative care, grief and bereavement and advanced care planning.

Finally, as a nurse I must be able to understand what cultural competency is and how to apply it in practice. The Nursing and Midwifery Board of Australia have outlined in the Code of Conduct specific standards which all nurses are expected to practice. It is vital that I examine the Code of Conduct and Professional standards to maintain my nursing competence throughout my career. There are sections that specifically focus on the acknowledgment of the social, economic, cultural, historic and behavioural factors influencing health, both at the individual, community and population levels (Nursing and Midwifery Board of Australia, 2018).