How Australia’s Indigenous people are positioned within health service sites by our presence and by our absence

De Certeau (1984) constructs the notion of belonging as a sentiment which develops over time through the everyday activities. He explains that simple everyday activities are part of the process of appropriation and territorialisation and suggests that over time belonging and attachment are established and built on memory, knowledge and the experiences of everyday activities. Based on the work of de Certeau, non-Indigenous Australians have developed attachment and belonging to places based on the dispossession of Aboriginal people and on their everyday practices over the past two hundred years. During this time non-Indigenous people have marked their appropriation and territorialisation with signs, symbols, representations and images. In marking their attachment, they also define how they position Australia’s Indigenous people by both our presence and our absence. This paper will explore signs and symbols within spaces and places in health services and showcase how they reflect the historical, political, cultural, social and economic values, and power relations of broader society. It will draw on the voices of Aboriginal women to demonstrate their everyday experiences of such sites. It will conclude by highlighting how Aboriginal people assert their identities and un-ceded sovereignty within such health sites and actively resist on-going white epistemological notions of us and the logic of patriarchal white sovereignty.

Collaborative voices: Ongoing reflections on cultural competency and the health care of Australian Indigenous people

The issue of cultural competency in health care continues to be a priority in Australia for health and human services professionals. Cultural competence in caring for Aboriginal and Torres Strait Islander peoples is of increasing interest, and is a priority in closing the gap in health disparities between Indigenous and non-Indigenous Australians. Through a collaborative conversation, the authors draw on a case study, personal experience and the literature to highlight some of the issues associated with employing culturally appropriate, culturally safe and culturally competent approaches when caring for Aboriginal and Torres Strait Islander peoples. The intent of this article is to encourage discussion on the topic of cultural competency, and to challenge health professionals and academics to think and act on racism, colonialism, historical circumstances and the political, social, economic, and geographical realms in which we live and work, and which all impact on cultural competency.

Developing a model of care to improve the health and well-being for Indigenous people receiving renal dialysis treatment

The high levels of end-stage renal disease among Indigenous Australians, particularly in remote areas of the country, are a serious public health concern. The magnitude of the problem is reflected in figures from the Australian and New Zealand Transplant and Dialysis Registry that show that Indigenous Australians experience end-stage renal disease at a rate almost 9–10 times higher than other non-Indigenous Australians. A majority of Indigenous Australians have to relocate to receive appropriate renal dialysis treatment. In some Australian states, renal treatment is based on self-care dialysis which allows those Indigenous Australians to be treated back in their community. Evidence clearly shows that reuniting renal patients with community and family improves overall health and well-being for those Indigenous Australians. With the appropriate resources, training, and support, self-care management of renal dialysis treatment is an effective way for Indigenous people with end-stage renal failure to be treated at home. In this context, the study was used to gain insight and further understanding of the impact that end-stage renal disease and renal dialysis treatment has had on the lives of Indigenous community members. The study findings are from 14 individually interviewed people from South East Queensland. Data from the interviews were analysed using a combination of thematic and content analysis. The study methodology was based on qualitative data principles where the Indigenous community members were able to share their experiences and journeys living with end-stage renal disease. Many of the experiences and understanding closely relate to the renal disease pattern and the treatment with other outside influences, such as social, cultural, and environmental influences, all having an equal impact. Each community member’s experience with end-stage renal disease is unique; some manage with family and medical support, while others try to manage independently. From the study, community members who managed their renal dialysis treatment independently were much more aware of their renal health status. The study provides recommendations towards a model of care to improve the health and well-being is based on self-care and self-determination principles.

Researching the 'reception' of indigenous affairs in Australia

The Reporting and Reception of Indigenous Issues in the Australian Media was a three year project financed by the Australian government through its Australian Research Council Large Grants Scheme and run by Professor John Hartley (of Murdoch and then Edith Cowan University, Western Australia). The purpose of the research was to map the ways in which indigeneity was constructed and circulated in Australia's mediasphere. The analysis of the 'reporting' element of the project was almost straightforward: a mixture of content analysis of a large number of items in the media, and detailed textual analysis of a smaller number of key texts. The discoveries were interesting - that when analysis approaches the media as a whole, rather than focussing exclusively on news or serious drama genres, then representation of indigeneity is not nearly as homogenous as has previously been assumed. And if researchers do not explicitly set out to uncover racism in every text, it is by no means guaranteed they will find it1. The question of how to approach the 'reception' of these issues - and particularly reception by indigenous Australians - proved to be a far more challenging one. In attempting to research this area, Hartley and I (working as a research assistant on the project) often found ourselves hampered by the axioms that underlie much media research. Traditionally, the 'reception' of media by indigenous people in Australia has been researched in ethnographic ways. This research repeatedly discovers that indigenous people in Australia are powerless in the face of new forms of media. Indigenous populations are represented as victims of aggressive and powerful intrusions: ‘What happens when a remote community is suddenly inundated by broadcast TV?’; ‘Overnight they will go from having no radio and television to being bombarded by three TV channels’; ‘The influence of film in an isolated, traditionally oriented Aboriginal community’2. This language of ‘influence’, ‘bombarded’, and ‘inundated’, presents metaphors not just of war but of a war being lost. It tells of an unequal struggle, of a more powerful force impinging upon a weaker one. What else could be the relationship of an Aboriginal audience to something which is ‘bombarding’ them? Or by which they are ‘inundated’? This attitude might best be summed up by the title of an article by Elihu Katz: ‘Can authentic cultures survive new media?’3. In such writing, there is little sense that what is being addressed might be seen as a series of discursive encounters, negotiations and acts of meaning-making in which indigenous people — communities and audiences —might be productive. Certainly, the points of concern in this type of writing are important. The question of what happens when a new communication medium is summarily introduced to a culture is certainly an important one. But the language used to describe this interaction is a misleading one. And it is noticeable that such writing is fascinated with the relationship of only traditionally-oriented Aboriginal communities to the media of mass communication.

Closing the gap between policy and 'Law' : Indigenous homelands and a working future

The Northern Territory Government's Working Future: Outstations/Homelands (2009) policy statement gives effect to the Council of Australian Government's Closing the Gap policy on Indigenous housing and remote service delivery. These policies mark a radical shift in public policy that winds back the outstations and homelands movement that began in the 1970's. This paper examines Indigenous homelands policy and considers whether these policies are consistent with the Indigenous human rights and in particular the United Nations Declaration on the Rights of Indigenous Peoples (2007), which Australia endorsed in 2009. The author argues that the current homelands policy breaches a number of Indigenous human rights and promotes assimiliation by forcing Indigenous Australians to relocate to access basic services such as health, housing and education. As a consequence these policies are counter-intuitive to the overall Closing the Gap goals of improving Indigenous health outcomes because they fail to take into account the importance of country and culture to Indigenous wellbeing. She concludes that Australian governments need to formulate a homelands policy that is consistent with Indigenous human rights and in particular the right of self determination, enjoyment of culture and protection against forced assimilation.

Indigenous Voice : a work-integrated learning case study in journalism education

The continuing stereotypical coverage of Inigenous affairs in the Australian media suggests that journalists are still finding it difficult to come to terms with more effective ways ofm reporting such issues. The many hundreds of students who graduate from journalism programs across Australia represent an opportunity to at least challenge the predominant methods and strategies. But how prepared are journalism graduates for working with Indigenous issues? This paper explores the processas involved in an intensive reporting practices course held at the University of Queensland mid-2009. The course aimed to raise journalism student's awareness of some of the issues involved as well as enabling them to interact and work with personnel from the Brisbane Indigenous Media Community, 98.9 fm, the National Indigenous Radio Service, SBS and the ABC. The findings suggest that such structured programs have a significant impact on changing student's perceptions of, and approaches to, their role and journalists.

Empowerment as a framework for Indigenous workforce development and organisational change

Relative powerlessness resulting from colonial dispossession and associated passive welfare policies has long been recognised as a critical factor influencing the health and wellbeing of Indigenous Australians, yet it is hard to find well-evaluated health and social interventions that take an explicit empowerment approach. This paper presents the findings of a Family Wellbeing Empowerment programme pilot delivered to Cairns Region Department of Families Indigenous youth workers and family and community workers in 2003/2004. The aim of the pilot was to build the capacity of these workers to address personal and professional issues as a basis for providing better support for their clients. The pilot demonstrated the effectiveness of the programme as a tool for worker empowerment and, to a lesser degree, organisational change.

Improving Indigenous women’s wellness through action research

Today in Australia, 75% of all Indigenous Australians reside in urban and peri-urban areas. In Brisbane, Indigenous Australians now number just over 45,000, and this number is rapidly increasing. Undertaking research with urban based Indigenous Australians is a relatively new phenomenon. Most past research with Indigenous people has been carried out in remote and regional areas. This paper focuses on a Participation Action Research project undertaken with Indigenous women in the highly urbanised area of North Brisbane. The project takes on the challenge of undertaking urban based Indigenous research. It opts not to centre on poor Indigenous women’s health statistics but instead centres on Indigenous women’s wellness and ways to talk about and work towards wellness. Through the cycles of dialogue with Indigenous women these concepts were teased out and manifested in two highly successful Women’s Wellness Summits. This paper will outline aspects of this project.

Languages of Communication : Indigenous language and/or English?

My interest in producing this paper on Indigenous languages was borne out of conversations with and learnings from community members in the Torres Straits and those connected to the ‘Dream Circle’. Nakata (2003, p. 12) laments the situation whereby ‘teachers are transitionary and take their hard-earned knowledge with them when they leave’. I am thus responding to the call to add to the conversation in a productive albeit culturally loaded way. To re-iterate, I am neither Indigenous nor am I experienced in teaching and learning in these contexts. As problematic as these two points are, I am in many ways typical of the raft of inexperienced white Australian teachers assigned to positions in school contexts where Indigenous students are enrolled or in mainstream contexts with substantial populations of Indigenous students. By penning this article, it is neither my intention to contribute to the silencing of Indigenous educators or Indigenous communities. My intention is to articulate my teacherly reflections as they apply to the topic under discussion. The remainder of this paper is presented in three sections. The next section provides a brief overview of the number of Indigenous people and Indigenous languages in Australia and the role of English as a language of communication. The section which follows draws on theorisations from second/additional language acquisition to overview three different schools of thought about the consequences of English in the lives of Indigenous Australians. The paper concludes by considering the tensions for inexperienced white Australian teachers caught up in the fray.

The development of a supportive care needs assessment tool for Indigenous people with cancer

Background: Little is known about the supportive care needs of Indigenous people with cancer and to date, existing needs assessment tools have not considered cultural issues for this population. We aimed to adapt an existing supportive care needs assessment tool for use with Indigenous Australians with cancer. Methods: Face-to-face interviews with Indigenous cancer patients (n = 29) and five focus groups with Indigenous key-informants (n = 23) were conducted to assess the face and content validity, cultural acceptability, utility and relevance of the Supportive Care Needs Survey - Short Form 34 (SCNS-SF34) for use with Indigenous patients with cancer. Results: All items from the SCNS-SF34 were shortened and changed to use more appropriate language (e.g. the word 'anxiety' was substituted with 'worry'). Seven questions were omitted (e.g. items on death and future considerations) as they were deemed culturally inappropriate or irrelevant and 12 items were added (e.g. accessible transport). Optional instructions were added before the sexual items. The design and response format of the SCNS-SF34 was modified to make it easier to use for Indigenous cancer patients. Given the extensive modifications to the SCNS-SF34 and the liklihood of a different factor structure we consider this tool to be a new tool rather than a modification. The Supportive care needs assessment tool for Indigenous people (SCNAT-IP) shows promising face and content validity and will be useful in informing services where they need to direct their attention for these patients. Conclusions: Indigenous people with cancer have language, customs and specific needs that are not accommodated within the standard SCNS-SF34. Our SCNAT-IP improves acceptability, relevance and face validity for Indigenous-specific concerns. Our SCNAT-IP will allow screening for supportive care needs that are specific to Indigenous cancer patients' and greatly inform targeted policy development and practice.

“We eat more than kangaroo tail or dugong you know…” : recent indigenous Australian cookbooks

This paper focuses on a series of cookbooks published by Indigenous Australian groups. These cookbooks are typically produced with government funding, and are developed by nutritionists, dieticians, and health workers in consultation with local communities. They are designed to teach Indigenous Australians to cook healthy, nutritious, low-cost meals. In this paper, Fredericks and Anderson identify the value of these cookbooks as low-cost, public health interventions. However, they note that their value as health interventions has not been tested. Fredericks and Anderson question the value of these cookbooks within the broader context of the health disadvantage faced by Indigenous Australians. They argue that the cookbooks are developed from a Western perspective of health and nutrition that fails to recognise the value of traditional Indigenous foodways. They suggest that incorporating more Indigenous food knowledge and food-related traditions into cookbooks may be one way of improving health among Indigenous peoples and revitalising Indigenous knowledge.

Aboriginal and Torres Strait Islander cookbooks : promoting Indigenous foodways or reinforcing Western traditions?

This article examines the recent emergence of cookbooks written for Aboriginal and Torres Strait Islander people in Australia. The cookbooks are health promotion initiatives, developed through a desire to improve the health status of Indigenous Australians. They focus on nutritious, family meals that can be cooked on a low budget. In this article, the authors argue that the cookbooks designed for Aboriginal and Torres Strait Islander people are developed within a Western paradigm of health and nutrition that subtly reinforces Western approaches to food and disregards traditional diets. While the authors recognize the value of the cookbooks as health promotion tools, they suggest that cookbooks centred around Indigenous foodways – with a focus on traditional ingredients and traditional cooking methods – may be more appropriate for improving the health of Indigenous people and helping Indigenous cultures to thrive. They advocate for a decolonizing approach to food and nutrition, that specifically promotes Indigenous traditions and culture, and incorporates traditional foodways into modern recipes.

Using participatory action research for heart self care amongst indigenous patients

This paper describes the initial phases of the Fluid Watchers Pacific Rim project: a participatory action research project that involves developing and trialling an iPad app to provide monitoring and self-care for Indigenous Australians with heart failure. The development phase involved working with health experts, an IT team and Indigenous heart-failure patients through three cycles of development and critical reflection. This was followed by a small pilot study to examine the app’s effectiveness. In this paper, the researchers explain why IT-supported health education can be successful in decreasing re-hospitalisation and improving self-management skills. They describe the steps they took to ensure community participation and ownership of the project and present the findings of their pilot study. This pilot project suggests that an iPad app may be a practical and successful way to provide health-care support for Indigenous Australian heart-failure patients.

What are the offence and offender risk factors for Indigenous repeat drink drivers in Queensland?

In Australia and internationally, there is scant information about Indigenous repeat drink drivers. The aim was to identify the risk factors associated with repeat offending. De-identified data on drink driving convictions by offenders identifying as Indigenous in Queensland between 2006 and 2010 were examined. A range of univariate analyses were used to compare first time and repeat offenders on gender, age, court location and region (based on the accessibility/remoteness index of Australia), blood alcohol concentration and sentencing severity. Multivariate logistic regression adjusted for confounding variables. Convictions for repeat offenders were more likely from locations other than ‘major cities’ with the association strongest for courts in the ‘very remote’ region (OR=2.75, 2.06-3.76, p<.001). Indigenous offenders 40 years or older were found to be at reduced risk in comparison to offenders aged 15-24 years (OR=0.68, 0.54-0.86, p=0.01). After controlling for confounding factors, gender, sentencing severity and blood alcohol concentration levels were not significantly associated with recidivism. The association of recidivism and remoteness is consistent with higher rates of alcohol-related transport accidents involving Indigenous Australians in isolated areas. This study provides a platform for future research and allows for early attempts to address the need for intervention to reduce Indigenous drink driving recidivism.