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.

Weaving yarns : the lived experience of Indigenous Australians with adult-onset disability in Brisbane

Indigenous Australians have lower levels of health than mainstream Australians and (as far as statistics are able to indicate) higher levels of disability, yet there is little information on Indigenous social and cultural constructions of disability or the Indigenous experience of disability. This research seeks to address these gaps by using an ethnographic approach, couched within a critical medical anthropology (CMA) framework and using the “three bodies” approach, to study the lived experience of urban Indigenous people with an adult-onset disability. The research approach takes account of the debate about the legitimacy of research into Indigenous Australians, Foucault‟s governmentality, and the arguments for different models of disability. The possibility of a cultural model of disability is raised. After a series of initial interviews with contacts who were primarily service providers, more detailed ethnographic research was conducted with three Indigenous women in their homes and with four groups of Indigenous women and men at an Indigenous respite centre. The research involved multiple visits over a period extending more than two years, and the establishment of relationships with all participants. An iterative inductive approach utilising constant comparison (i.e. a form of grounded theory) was adopted, enabling the generation and testing of working hypotheses. The findings point to the lack of an Indigenous construct of disability, related to the holistic construction of health among Indigenous Australians. Shame emerges as a factor which affects the way that Indigenous Australians respond to disability, and which operates in apparent contradiction to expectations of community support. Aspects of shame relate to governmentality, suggesting that self-disciplinary mechanisms have been taken up and support the more obvious exertion of government power. A key finding is the strength of Indigenous identity above and beyond other forms of identification, e.g. as a person with a disability, expressed in forms of resistance by individuals and service providers to the categories and procedures of the mainstream. The implications of a holistic construction of health are discussed in relation to the use of CMA, the interpretation of the “three bodies”, governmentality and resistance. The explanatory value of the concept of sympatricity is discussed, as is the potential value of a cultural model of disability which takes into account the cultural politics of a defiant Indigenous identity.

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.

‘Universities are not the safe places we would like to think they are, but they are getting safer’: Indigenous women academics in higher education

This paper outlines some of the experiences of Indigenous women academics in higher education. The author offers these experiences, not to position Indigenous women academics as victims, but to expose the problematic nature of racism, systemic marginalisation, white race privilege and radicalised subjectivity played out within Australian higher education institutions. By utilising the experiences and examples she seeks to bring the theoretical into the everyday world of being Indigenous within academe. In analysing these examples, the author reveals the relationships between oppression, white race privilege, institutional privilege and the epistemology that maintains them. She argues that, in moving from a position of being silent to speaking about what she has witnessed and experienced, she is able to move from the position of object to subject and gain a form of liberated voice (hooks 1989: 9) for herself and other Indigenous women. She seeks to challenge the practices within universities that continue to subjugate Indigenous women academics.

Indigenous research and broader issues in the Academy

The Rudd Labour Government rode to power in Australia on the education promise of 'an education revolution'. The term 'education revolution' carries all the obligatory marketing metaphors that an aspirant government might want recognised by the general public on the eve government came to power however in revolutionary terms it fades into insignificance in comparison to the real revolution in Australian education. This revolution simply put is to elevate Indigenous Knowledge Systems, in Australian Universities. In the forty three years since the nation setting Referendum of 1967 a generation has made a beach head on the educational landscape. Now a further generation who having made it into the field of higher degrees yearn for the ways and means to authentically marshal Indigenous knowledge? The Institute of Koorie Education at Deakin has for over twenty years not only witnessed the transition but is also a leader in the field. With the appointment of two Chairs of Indigenous Knowledge Systems to build on to its already established research profile the Institute moved towards what is the 'real revolution' in education – the elevation of Indigenous Knowledge as a legitimate knowledge system. This paper lays out the Institute of Koorie Education‘s Research Plan and the basis of an argument put to the academy that will be the driver for this pursuit.

Using the semantic grid to build bridges between museums and indigenous communities

In this paper we describe a Semantic Grid application designed to enable museums and indigenous communities in distributed locations, to collaboratively discuss, describe and annotate digital objects and documents in museums that originally belonged to or are of cultural or historical significance to indigenous groups. By extending and refining an existing application, Vannotea, we enable users on access grid nodes to collaboratively attach descriptive, rights and tribal care metadata and annotations to digital images, video or 3D representations. The aim is to deploy the software within museums to enable the traditional owners to describe and contextualize museum content in their own words and from their own perspectives. This sharing and exchange of knowledge will hopefully revitalize cultures eroded through colonization and globalization and repair and strengthen relationships between museums and indigenous communities.

From Jindabyne to 'Jindabyne' : immigrant and indigenous specters

This paper reads Ray Lawrence's film Jindabyne (2006) in order to consider how "Australian" connotes as "immigrant" or "Indigenous" in contemporary Australia. Although the film is an adaptation of an American short story, it exploits an existing grammar of place in Australian cultural production in order to interrogate this very culture. If questions of race, gender, and class have haunted post-settlement Australia, Lawrence's film simultaneously stages these spectres and gestures towards the necessary failure of any attempt to exorcise them in a place where indigeneity is invisible. Thus, the location of Jindabyne, the town drowned in the name of progress, offers an exemplary visual metaphor for the failed project of identity formation in a place where forgetting is a survival tool.

Life on the edge : housing experiences in three remote Australian indigenous settlements

This analysis of housing experiences and aspirations in three remote Indigenous settlements in Australia (Mimili, Maningrida and Palm Island) reveals extreme liveability problems directly related to the scale and form of housing provision. Based upon field visits to each of the settlements and extensive interviews with residents and local housing and community officers, the paper analyses two aspects of living in such housing conditions at two spatial scales, the layout of the settlement and the design of individual houses. The failings at both scales are shown to be the fault of a dysfunctional housing system that is only recently been addressed.

Culture-fair assessment : challenging Indigenous students through effortful mathematics teaching

This paper reports on a mathematics education research project centred on teachers’ pedagogical practices and capacity to assess Indigenous Australian students in a culture-fair manner. The project has been funded by the Australian Research Council Linkage program and is being conducted in seven Catholic and Independent primary schools in north Queensland. Our Industry Partners are Catholic Education and the Association of Independent Schools, Queensland. The study aims to provide greater understanding about how to build more equitable assessment practices to address the issue of underperforming Aboriginal and Torres Strait Islander (ATSI) students in regional and remote Australia. The goal is to identify ways forward by attending to culture-fair assessment practice. The research is exploring the attitudes, beliefs and responses of Indigenous students to assessment in the context of mathematics learning with particular focus on teacher knowledge in these educational settings in relation to the design of assessment tasks that are authentic and engaging for these students in an accountability context. This approach highlights how teachers need to distinguish the ‘funds of knowledge’ (González, Moll, Floyd Tenery, Rivera, Rendón, Gonzales & Amanti, 2008) that Indigenous students draw on and how teachers need to be culturally responsive in their pedagogy to open up curriculum and assessment practice to allow for different ways of knowing and being

Differences in Treatment and Management of Indigenous and Non-Indigenous Patients Presenting with Chest Pain: Results of the Heart Protection Partnership (HPP) Study

BACKGROUND: Indigenous patients with acute coronary syndromes represent a high-risk group. There are however few contemporary datasets addressing differences in the presentation and management of Indigenous and non-Indigenous patients with chest pain. METHODS: The Heart Protection Project, is a multicentre retrospective audit of consecutive medical records from patients presenting with chest pain. Patients were identified as Indigenous or non-Indigenous, and time to presentation and cardiac investigations as well as rates of cardiac investigations and procedures were compared between the two groups. RESULTS: Of the 2380 patients included, 199 (8.4%) identified as Indigenous, and 2174 (91.6%) as non-Indigenous. Indigenous patients were younger, had higher rates hyperlipidaemia, diabetes, smoking, known coronary artery disease and a lower rate of prior PCI; and were significantly less likely to have private health insurance, be admitted to an interventional facility or to have a cardiologist as primary physician. Following adjustment for difference in baseline characteristics, Indigenous patients had comparable rates of cardiac investigations and delay times to presentation and investigations. CONCLUSIONS: Although the Indigenous population was identified as a high-risk group, in this analysis of selected Australian hospitals there were no significant differences in treatment or management of Indigenous patients in comparison to non-Indigenous.

Psychometric validation of the growth and empowerment measure (GEM) applied with Indigenous Australians

Objective: Empowerment is a complex process of psychological, social, organizational and structural change. It allows individuals and groups to achieve positive growth and effectively address the social and psychological impacts of historical oppression, marginalization and disadvantage. The Growth and Empowerment Measure (GEM) was developed to measure change in dimensions of empowerment as defi ned and described by Aboriginal Australians who participated in the Family Well Being programme.---------- Method: The GEM has two components: a 14-item Emotional Empowerment Scale (EES14) and 12 Scenarios (12S). It is accompanied by the Kessler 6 Psychological Distress Scale (K6), supplemented by two questions assessing frequency of happy and angry feelings. For validation, the measure was applied with 184 Indigenous Australian participants involved in personal and/or organizational social health activities.---------- Results: Psychometric analyses of the new instruments support their validity and reliability and indicate two-component structures for both the EES (Self-capacity; Inner peace) and the 12S (Healing and enabling growth, Connection and purpose). Strong correlations were observed across the scales and subscales. Participants who scored higher on the newly developed scales showed lower distress on the K6, particularly when the two additional questions were included. However, exploratory factor analyses demonstrated that GEM subscales are separable from the Kessler distress measure.---------- Conclusion: The GEM shows promise in enabling measurement and enhancing understanding of both process and outcome of psychological and social empowerment within an Australian Indigenous context.