Back to the Fire was a fitting theme for Aboriginal and Torres Strait Islander nurses and midwives in nipaluna/Hobart this week as they gathered under the snow-capped mountain of kunanyi/Mount Wellington.
Delegates to the latest event in the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) national conference series were told of the urgent need to remove barriers to the wider implementation of Birthing on Country and to grow the Aboriginal health workforce, reports Nicole Mackee for the Croakey Conference News Service.
The Healing Foundation also revealed plans for a national campaign to “Make Healing Happen”, to be launched on 2 June.
Nicole MacKee writes:
A dusting of snow on kunanyi/Mount Wellington welcomed delegates to the southern-most session of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) National Conference Series in lutruwita/Tasmania/ this week.
This powerful landscape provided a fitting backdrop for the CATSINaM conference theme: ‘Back To The Fire: Unity and Strength Through Caring’. Nipaluna is the fourth destination for the coolamon, which originated at the Tent Embassy in Canberra, and is travelling the country with the conference series.
In her address to the conference, CATSINaM president Marni Tuala called for a national solution to the indemnity insurance limitations that were a key barrier to birth-on-country models of care.
Tuala, of the Moorung Moobar Goodjinburra and Bundjalung nations, told Croakey that professional indemnity insurance for midwives was revoked in 2000-2001.
“We still have private practice midwives, but it’s quite an expensive ordeal with insurance, etc, and there are also barriers with that in terms of visiting rights and continuity of care,” she said.
“Aboriginal Community Controlled Health Services are the best place to facilitate birth-on-country models of care but are unable currently to purchase an insurance product to allow midwives to work the full scope of practice. They can do antenatal and postnatal care, but they can’t do the birth and intrapartum care, so there is an immense limitation there.”
Workforce issues were a further barrier to birth-on-country models of care, Tuala said, adding that there were still only 230 Aboriginal and Torres Strait Islander midwives nationally.
“If we were to aim for population parity, we would need about 1,096-1,100 midwives today and that doesn’t take into account our higher birth rate being about 2.4 times higher, so we are a long way off the mark.”
Support through education
Palawa woman Dr Tanya Schramm – a GP and Senior Lecturer in Aboriginal and Torres Strat Islander Health at the University of Tasmania – also presented at the conference.
Reflecting on the conference theme of ‘Back to the Fire: Unity and Strength through Caring’, Schramm said it was crucial for Aboriginal and Torres Strait Islander doctors and nurses to support each other through academia and into the workforce.
Schramm said lutruwita had some catching up to do when it came to growing a thriving Aboriginal and Torres Strait Islander health workforce.
“Sadly, a lot of our community have ventured interstate to get their degrees and as a result, many end up staying in those other states,” said Schramm, who is also president of the Australian Indigenous Doctors Association.
“So, it’s really important for our community here that we look at recruiting our local students through the university system. There is definitely interest in those caring roles – whether it be working as a nurse, doctor or allied health professions among our community.”
CATSINaM president Marni Tuala pointed to a chasm between the national graduation rates of Aboriginal and Torres Strait Islander nursing and midwifery students and other students.
“The likelihood of an Aboriginal or Torres Strait Islander person graduating from their Bachelor of Nursing of Bachelor of Midwifery is 27 percent,” she said, adding that the graduation rate for non-Aboriginal nursing/midwifery student graduating is 75 percent.
“We are a long way off the mark. So, we need to start to look at systemic reform around what’s going on in our education system, we need to look at curricula reform, we need to look at accreditation, and CATSINaM needs to lead that work.”
Workforce retention was another challenge, Tuala said.
“We are 20 years on from the ‘gettin em n keepin em’ report and we haven’t improved at all in our retention rates in Aboriginal and Torres Strait Islander nursing and midwifery students,” Tuala said.
“Our recruitment has gone up 300-400 percent, so we don’t have any problems getting Aboriginal and Torres Strait Islander people to enrol in nursing and midwifery – it’s in the bloodlines, we have been doing it for 60,000 years – but the retention rates remain the same.”
‘You cannot be what you cannot see’
Schramm said that it was important for universities to make space for Aboriginal and Torres Strait Islander people in health courses, and to provide sustained support throughout their education.
“It’s really important that we try to get members of our community into those courses, and we do everything that we can to support them in that space to make sure that they graduate at the end,” Schramm said.
“Whether it is in a clinical setting, or those of us who might go into medical education and work in the university, we need to work together and support each other as we grow our workforce.
“For our mob, there are a lot of challenges coming into that space. We are very few in numbers, so you don’t have that communal support so it’s really important that we try to provide that by providing access to other students who may be further along in their course, or having an Aboriginal academic present in the space, someone that student can relate to.”
Schramm said the benefits of a robust Aboriginal and Torres Strait Islander health workforce were many.
Once they have graduated, Schramm said Aboriginal and Torres Strait Islander nurses and midwives could be a dynamic force in challenging the healthcare system to offer better, culturally safe care.
“It’s standing together in a collaborative group, saying ‘this is what we want, this is how we are going to drive that change forward’, and challenging the health systems to do a better job, because we are part of it,” she said.
“You can’t be what you can’t see’ and when there is one Aboriginal nurse within the hospital system, other people within the community will start to see, ‘wow, that’s something that I can do’.”
“So not only do you get the benefit of better, more culturally safe health care … they are also going to encourage more Aboriginal and Torres Strait Islander people to take that journey into those caring and health-related roles. This will drive and develop our workforce – employment, education, all of those things that directly improve the social determinants of health for Aboriginal and Torres Strait Islander people, which overall will help to lead to better health outcomes and to close that gap.”
The CATSINaM conference theme ‘Back to the Fire’ may be expressed as ‘Milaythina tunapri patrula’ (Country understands/knows fire) in palawa kani, said Theresa Sainty, a Pakana woman and palawa kani language speaker.
‘I did not grow up speaking my language, and nor did my mother, or her mother, or her mother – in fact, nobody in my community has grown up speaking their language,’ said Sainty, who is a Senior Indigenous Scholar at the University of Tasmania.
Now, Sainty texts her daughter in language.
Sainty has been a part of a dedicated team – led by the Tasmanian Aboriginal Centre – who have worked tirelessly over the past 30 years to revive the “sleeping language” of lutruwita.
Palawa kani – which translates as ‘Tasmanian Aboriginal people talk/speak’ in English – has been retrieved by drawing upon the records of white people, who made note of some Aboriginal words and place names, names of people and tribes as told to them by Aboriginal guides and interpreters, and on community memory.
“Our people have memory of language and so maybe it’s single words, or phrases or parts of songs,” she said. “It’s a mix of looking at the journals of white people and the memory of our community.”
Sainty described the revival of the palawa kani language as “another piece in the puzzle” in rebuilding a culture devastated by colonisation.
“Language is a part of our heritage, it’s a part of our identity and our culture an all that has come before,” she said. “It is so important to the health and wellbeing of our community as individuals, as families, and as a collective community.”
Sainty added, however, that people did not need to speak language to be authentic within themselves and to know who they are and their culture.
“Even though we didn’t grow up speaking language, we grew up knowing who we are, where we are from, where our ancestral homelands are and aspects of our culture that have continued uninterrupted,” she said. “Unfortunately, language wasn’t one of those aspects.”
Reviving language puts another piece of the puzzle back together, she said.
“We weren’t allowed to speak language and we were discouraged from practising culture. That’s what the victors do when they invade; that’s colonisation,” she said. “But we were able to put some of those pieces back together and fill in the gaps. Language was one of the gaps, but it isn’t any longer.”
Kristy Cooper, a nurse practitioner and Palawa woman, was part of the Aboriginal Leadership Panel at the conference. The panel discussed the importance of amplifying First Nation’s voices and creating culturally safe workplaces to increase workforce retention and rates.
Speaking to Croakey, Cooper said she welcomed the opportunity to participate in a forum in which there was “safety to have our identity expressed and acknowledged in the ways in which we aspire to sustain”.
Cooper added that this was particularly the case in Tasmania, where there the ongoing existence of Aboriginal people had been denied.
“It’s not uncommon in healthcare systems and processes to not acknowledge the ongoing existence of Aboriginal people, so we do have a lot of work to do in having our contributions to nursing and midwifery recognised,” said Cooper, who has recently returned to her home Country, after spending 12 years studying and working interstate.
She said there was continuing work needed to advance practice approaches that were more aligned with cultural aspirations, challenging health care providers to be more culturally aware and responsive.
For example, she said, group-based, outdoor therapies may be preferred to the conventional healthcare practices in the Western biomedical framework.
“More group-based, outdoor therapy has the potential to gain social connection but also to sustain cultural practices and knowledge systems,” Cooper told Croakey.
Cooper said this was an exciting time to be a Palawa nurse practitioner.
“There is a strong sense among Palawa/Pakana nurses and midwives working in Tasmania that this is a powerful time in history to come together and reclaim our identities in this space,” she said.
“We can also learn from other nations and continue to build on CATSINaM’s several decades of work and thinking about how we embody these culturally sound ways of practising that can lead to better quality and safety in health care provision.”
A Palawa mother’s story
For Bronwyn Dillon, the experience of having her son born at just under 24 weeks’ gestation brought into sharp focus the critical importance of cultural connection.
Dillon, a Palawa woman and cultural practitioner, said an infection in her placenta resulted in an early labour and her son, Ochre-Rain, being born at just 700g. He spent the first 120 days of his life in the Neonatal Intensive Care Unit.
“I look back at this time in our lives and often wonder how we got through it,” she told Croakey. “The answer always comes back to community support and ancestor guidance.”
Dillon – who was scheduled to speak at the CATSINaM conference but had to withdraw due to illness – told Croakey that connection to culture was ‘everything’ as she and her partner AJ (Anthony King) negotiated this challenging experience.
“We spent as much time as we could lighting fires and connecting with our old people through the smoke,” she said. “We would try not to wear shoes when we could, so we were in touch with our Mother Earth.”
Outpouring of support
An “absolute outpouring of community support from individuals and organisations” helped to sustain the family through this difficult time.
This included the Karadi Aboriginal Corporation, which “went above and beyond” and bought Christmas presents for the couple’s other children, and dropped off healthy snacks and drinks to the hospital.
Cultural gifts were left at the family’s home and funds to support the family through this time were raised.
“A community artist auctioned off a beautiful painting raising money for us. [It was sold] on the provision that the painting is to be gifted back to Ochre-Rain on his 18th birthday,” Dillon said.
“The person who bought it agreed. This thought, and provision, was so touching to us and filled us with hope that he would have an 18th birthday.”
While Dillon said no Aboriginal and Torres Strait Islander nurses or midwives were involved in Ochre-Rain’s intensive care, the hospital staff were open and accepting of the family’s culture.
“Breastfeeding, for example. I was ready to feed him straight away. And I pushed and pushed to get him out as early as possible to feed him,” Dillon said. “They were absolutely amazing, respecting my cultural need to feed and connect to my baby.”
Still, Dillon said, she was disappointed when she had to shift her care from the Aboriginal Health Services to the public system when her pregnancy became high risk.
“I hated going from having my community look after me and my pregnancy to having to go the public system for high-risk pregnancy. They don’t know us. And they don’t know Aboriginal culture. You can train them as much as you like but we are still just patients, not their community,” Dillon said. “We need blackfullas in there. Blackfullas looking after blackfullas.”
For this reason, Dillon said, having a strong Aboriginal and Torres Strait Islander health workforce is “not just important, it’s paramount”.
Ochre-Rain is now an energetic two-year-old who weighs 14kg.
“He has now caught up and even exceeded some of his milestone,” Dillon said. “He is the most loving, caring, kindest child and he is so loved, not just by us but by his whole community.”
Ochre-Rain’s father AJ conducted the Closing Smoking Ceremony for the conference.
Tuala said it had been fascinating to see the different approaches to smoking ceremonies as the CATSINaM conference series moves around the country.
“They used black peppermint, white peppermint and dogwood for the medicinal and healing properties, it was just incredible.”
Tuala wrapped up the conference with a note of thanks: “On behalf of the CATSINaM board, we thank the Tasmanian Aboriginal community for having us on Country and for sharing with us their culture and their stories.”
Croakey acknowledges and thanks David Nardoo and CATSINaM for these photos below.
Read our previous articles from the #BackToTheFire conference series here.