Introduction by Croakey: The #BackToTheFire conference series hosted by the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) across Australia during 2021 finished where its spark was first lit, in Canberra on Ngunnawal and Ngambri Country.
The final event heard timely calls for restorative healthcare with a focus on family and community to help address high rates of removal of Aboriginal and Torres Strait Islander children from their families, child and adult incarceration, and the health impacts of intergenerational trauma and dispossession.
The calls come amid warnings this week from the 2021 Family Matters report that the already devastatingly high number of Aboriginal and Torres Strait Islander children in out-of-home care could rise by more than 50 percent this decade.
Marie McInerney writes:
On Ngunnawal Country in Canberra, Elders have been working to strengthen the cultural connections of community members who have been grappling with stresses and health concerns.
Aunty Roslyn Brown is a founding member of the United Ngunnawal Elders Council, who have worked over many years to establish the Ngunnawal Bush Healing Farm, a place of healing for community members managing with alcohol, drugs, mental health or other issues.
An important part of its work is “to instil culture back into those who have lost culture or strengthen culture in those who still know about it”, she told the recent Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) #BackToTheFire ACT event.
“I think all people need to belong,” she said.
The Elders are guided by the United Ngunnawal Elders Charter, which Brown gifted to CATSINaM, inviting Aboriginal and Torres Strait Islander nurses and midwives to join a “journey of healing”.
The Charter declares:
It takes courage to do work for the greater good.
We need to learn how to solve problems, include not isolate, to listen with our hearts and speak from our souls. In being courageous, we are a direct link back to the Dream time. This is the essence of Aboriginality, as is our relationship to land.”
Brown is Elder in Residence at the University of Canberra, where she is strongly involved in research and cultural safety issues, supporting Aboriginal and Torres Strait Islander students and in helping to reawaken the Ngunnawal language.
She presented at the #BackToTheFire event with Dr Holly Northam, head of nursing at the University of Canberra, and a founding member of Muliyan, a collaboration of researchers and practitioners led by CATSINaM that aims to decolonise health, particularly nursing and midwifery.
Urging a new social contract in healthcare — Ngura, a Ngunnawal word meaning ‘a place of belonging’, they talked about the work on restorative health practices to give voice, accountability and healing for Aboriginal and Torres Strait Islander families and communities in health services, putting family and community at the heart of healing.
The aim of Ngura is to present a vision of reconciliation in action so non-Indigenous Australians can act on the National Apology and build trusting relationships between Indigenous and non-Indigenous Australians.
Critically, they said, these approaches to ‘just relationships’ can address high rates of removal of Aboriginal and Torres Strait Islander children from their families, child and adult incarceration, and the health impacts of intergenerational trauma and dispossession that contribute to equity gaps.
The removal of children from their families is a significant concern in the ACT now, as well as nationally.
While Commonwealth, state and territory governments are committed to Closing the Gap targets to reduce the over-representation of Aboriginal and Torres Strait Islander children in out-of-home care by 45 percent by 2031, a new report this week projects that, without urgent action, their numbers will instead rise by 54 percent in that timeline.
The Family Matters Report 2021 found that Aboriginal and Torres Strait Islander children continue to be separated from their families, communities and cultures “at devastatingly high rates” — 21,523 are in out-of-home care – one in every 16, “making our children 10 times more likely to be in out-of-home care than non-Indigenous children”, it said.
Releasing the report, Family Matters Co-Chair Paul Gray, a Wiradjuri man and Associate Professor at the Jumbunna Institute for Indigenous Education and Research, UTS, said there had been no shortage of commitments from governments, “but not nearly enough action”.
Recent changes in child protection measures had been framed as solutions but only entrenched many of the problems children and families face, he said.
Northam told the CATSINaM conference that rising rates of child removal have intergenerational impacts on health and wellbeing and raise critical issues for the role of nurses and midwifery.
She outlined the growing crisis in the ACT, where child protection placements have risen over the past decade by 87 percent for Aboriginal and Torres Strait Islander children, who are 16 times more likely than non-Indigenous children to be removed from family.
Yet, she said, there are very low levels of investment in prevention, despite the success of pilot programs. She warned that a health system that does not provide culturally safe services for pregnant women and their families is “actually creating harm”.
“These are critical problems because we all know from the social determinants of health that early childhood is the greatest predictor of the future health of a person,” she said.
“We need to look forward to a new social contract so that everyone can feel as though they have a sense of belonging when they come to a hospital and in need of healthcare – if they’re pregnant, that they can feel safe, which is actually about belonging,” Northam said.
Focus on family, community
Northam and Brown told the event about their 2017 visit, with other Ngunnawal Elders and University of Canberra researchers, to the Whanganui District Health Board in Aotearoa New Zealand.
It was part of their investigations into restorative healthcare, which, they said, “places respectful relationships at the heart of every interaction” and is grounded in beliefs about the equality, dignity and potential of all people and about just structures and systems.
Northam said a major lesson from Te Hau Ranga Ora Māori health services team was the focus on family, “where the health of an individual is only as good as the health of their whole family”.
That contrasts with the Australian mainstream health context that talks about person-centred approaches, autonomy and the individual, “but we forget about the family, which is so often where the care sits”, she said.
Northam said nurses and midwives also should be thinking and working on Aboriginal and Torres Strait Islander holistic understandings of health, a whole-of-life view focused on the social, emotional and cultural wellbeing of the whole community.
“We should be seeing healthy communities as being central to us having healthy people who come in seeking help from us as nurses and midwives,” she said.
With Northam and others, Brown guided a recent cardiac rehabilitation program — ‘Yeddung Gauar’, Ngunnawal for ‘Good Heart’, which looked to make a non-Indigenous service space culturally safer for Aboriginal and Torres Strait Islander women, part of a strategy to recognise and reduce institutional racism and its contribution to poor healthcare outcomes for Indigenous people.
Their paper talks about restorative healthcare as being also about “hearing vulnerable voices, acknowledging past harms, recognising and respecting culture, and applying ideas of cultural and academic reciprocity”.
It also critiques its own methodology, warning against traditional colonised and hierarchical approaches to research and health systems that do not take fully into account the cultural connection to Country, and respect and leadership power that Elders hold in their community.
Need for accountability
From her non-Indigenous perspective, Northam urged acknowledgement of the harm, suffering and pain inflicted knowingly and unknowingly by non-Indigenous nurses, midwives, and institutions on Aboriginal and Torres Strait Islander people in the past and present.
“As nurses and midwives, we are all accountable,” she said, backing CATSINaM’s calls for an apology and encouraging non-Indigenous nurses and midwives to keep “front of mind” the unified #BlackLivesMatter call to action led by Bwgcolman nursing leader Dr Lynore Geia last year.
Reinforcing CATSINaM’s #BackToTheFire focus on place, Northam also urged nurses and midwives to connect at the local level with the history and trauma of Aboriginal and Torres Strait Islander peoples in their communities and care, highlighting a recent article on ‘the importance of local history for nurses’.
The researchers, who include CATSINaM founding member Professor Aunty Kerrie Doyle, say nurses are of course better able to understand their patients if, for example, they know the local community has been through droughts, floods, or earthquakes in the past.
“Similarly, being familiar with local history is equally important for nurses who work with communities who have been historically subjected to racial or political oppression, such as Aboriginal Australians,” they wrote.
They also highlight the need for the profession to know that nurses commonly worked in and supported segregated hospital care for Aboriginal and Torres Strait Islander people and that many were “enthusiastic agents” of government policy on removals of children from family.
Leadership and Eldership
The COVID-19 pandemic may have forced CATSINaM’s final three #BackToTheFire events online, but Dr Roianne West found resonance in how the journey ended.
“Canberra was back where we started #BackToTheFire,” West said, reflecting on how the ambitious place-based national events were set in motion by the gift of a coolamon and a blessing from Ngunnawal Elder Auntie Matilda House near the Tent Embassy in Canberra in late 2020.
“We were always adamant about getting back to our roots — not only of the organisation, but of our culture, and Indigenous knowledge, leadership and Eldership,” West told Croakey after the online ACT event ended.
Across the country, as the tweets at the bottom of this post show, #BackToTheFire events have paid deep respects to Traditional Owners on Yirrganydji and Yidinji Country in Cairns, Larrakia land in Darwin, Kaurna Country in Adelaide, in nipaluna/Hobart and Melbourne/Naarm, before meeting online for the remaining events in New South Wales, Western Australia and the ACT.
West said the events also showcased and celebrated the cultural authority and depth brought to its discussions from founding CATSINaM members — Dulcie Flower, Lynda Holden, Jane Jones, Kerrie Doyle, Dr Lynore Geia, and Professor Juanita Sherwood, who came together in Sydney in 1997 to create the organisation.
Dismantle the social contract
#BackToTheFire has focused strongly on place at each of its events, as well as on big structural and systemic issues, including workforce, improving the standard of Aboriginal health education and cultural safety training in nursing and midwifery schools, and addressing racism in health care.
In the closing session of the event, West revisited her address to the University of Sydney to mark the 2021 International Day of the World’s Indigenous Peoples and its call for a new social contract across the globe, aimed at “Leaving No-one Behind’.
West talked about the importance of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) — which Australia, and fellow settler/colonial states Canada, New Zealand and the United States refused initially to ratify, and questioned to what extent its principles have been taken up by the World Health Organization and the International Council of Nurses.
Accepting it would not happen overnight or perhaps in her lifetime, she also issued a call to action to nursing and midwifery in Australia, “for us dismantling and re-mantling the nursing and midwifery social contracts based on the United Nations Declaration on the Rights of Indigenous Peoples, inclusive of Aboriginal and Torres Strait Islander voices”.
“My vision for my grandchildren and their children is that they are not at risk when they visit a hospital or when they undertake a Bachelor of Nursing or Midwifery and to uphold the legacy left for me by my grandmother and mother,” she said.
“It was also for Aboriginal and Torres Strait Islander safety in education to be given the same level of consideration that has been given to all other areas of nursing and midwifery education, and that it occurs because the profession recognises it as a priority and aligns policy education and practice accordingly,” she said.
See these Twitter threads from the #BackToTheFire ACT event:
Thread 1: Welcome, Pat Turner (NACCHO), Aunty Roslyn Brown, Dr Holly Northam
Thread 2: Dr Lynore Geia, Dr Karen Martin, ACT Chief Nurse and Midwifery Officer Anthony Dombkins, Paul Spurr, Dr Roianne West
“Let it torment you, let it wake you at 3am”
Dr Karen Martin, a Noonuccal woman from Minjerripah (North Stradbroke Island – South East Queensland) with connections to the Bidjara people (central Queensland), presented at multiple #BackToTheFire events on cultural safety.
She has been leading the development of CATSINaM’s Murra Mullangari cultural safety training to be launched in early 2022. Here is a snapshot from her final presentation.