Introduction by Croakey: Delegates to the latest event in the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) national conference series experienced the importance of cultural governance and leadership, reports Linda Doherty for the Croakey Conference News Service.
The coolamon travelling between the 10 cities and regional centres hosting CATSINaM conference events under the theme #BackToTheFire was hosted by the Bunurong Boon Wurrung and Wurundjeri Woi Wurring Peoples in Naarm (Melbourne).
The next generation of nurses and midwives was celebrated during the conference at the inaugural Victorian First Nations Nurses and Midwives Graduation Ceremony.
See all of the conference coverage to date.
Aboriginal and Torres Strait Islander peoples are advised this article contains the name of a person who has passed away.
Linda Doherty writes:
Truth-telling was an important focus of #BackToTheFire in Naarm (Melbourne), starting with the Welcome to Country by Sue-Anne Hunter, a Commissioner for the newly established Yoo-rrook Justice Commission, which will investigate historical and ongoing injustices committed against Aboriginal Victorians since colonisation.
Yoo-rrook, the Wemba Wemba/Wamba Wamba word for truth, is Australia’s first truth-telling body and will inform Treaty negotiations with the Victorian Government.
Hunter, of the Wurundjeri and Ngurai illum wurrung peoples, is a leader in trauma and healing practices and told ABC Radio the Commission would ensure that “culture is used as a protective factor for our mob telling their story”.
Social and emotional expertise
Speaking on the day before National Sorry Day, Associate Professor Catherine Chamberlain told the conference that midwives and nurses played a critical role in building up social and emotional expertise in healthcare systems to close the gap in the continuing removal of Aboriginal and Torres Strait Islander babies.
“As midwives we’ve been doing this for millennia, supporting parents through the transition to parenthood. We’ve always had sophisticated systems of mentoring and training, combined with emotional expertise and wisdom,” Chamberlain, a member of the Trawlwoolway people, told Croakey.
She said a new model of care, like a “wise council” was urgently needed to support at-risk pregnant mothers and their families. This multidisciplinary team, including midwives and Indigenous community members, would make decisions collectively and provide cultural, practical and socio-emotional support.
“The problem is the system, not the people,” Chamberlain said. “Most Aboriginal parents are doing a fantastic job but we do have this compounding intergenerational trauma that is impacting a higher number of our parents and they need a more therapeutic model of care.”
“Increasing numbers of Aboriginal babies are being removed after birth. We’re supposed to be closing the gap to reduce the number of children being removed to out-of-home care by 45 percent by 2031 but the gap is actually increasing”.
“We can care for babies that are born weighing less than a pound of butter, we can deal with all sorts of medical complexity but when it comes to social and emotional complexity it’s put in the too-hard basket and referred out to child protection services, which do not have the expertise to deal with this high level of complexity.”
Chamberlain is a midwife, nurse and Associate Professor and NHMRC Career Development Fellow at the Judith Lumley Centre at La Trobe University. In February Chamberlain and concerned colleagues established ‘SAFeST Start: Supporting Aboriginal and Torres Strait Islander Families to Stay Together from the Start’ to raise awareness of the “catastrophic” impact on children and families and to lobby for the enshrinement of the Secretariat of National Aboriginal and Islander Child Care’s (SNAICC) child placement principles.
“Midwives have a really important role under the child placement principles, in particular with ‘prevention’ and ‘participation’. All parents should have access to community-led, culturally responsive, trauma-integrated care,” Chamberlain said.
A new report by the Australian Institute of Health and Welfare said there were 18,862 Aboriginal and Torres Strait Islander children in out-of-home care at June 2020, 11 times the rate for non-Indigenous children. One in five Indigenous children removed from their parents is aged under 12 months, Chamberlain said.
Child protection risk assessment guidelines were driving increased notifications from health services. These include pregnant women who had prior contact with child protection services as a child or adult, mental health concerns, substance abuse, family violence and homelessness.
“There’s no transparency; this is all happening in the shadows and these notifications act as a barrier to people asking for help. If somebody’s homeless, that’s not a reason to take their child from them; it’s a reason to give them a home,” Chamberlain said.
Cultural wellbeing
For almost a decade Aboriginal women living on Wadawurring Country have been planting their babies’ placentas in a tranquility garden that has become a special sanctuary.
Former Koorie Maternity Services midwife Mandy Miller and Aboriginal health worker Renee Owens conceived the garden after they met Indigenous women from Gove on Cape York who had to travel hundreds of kilometres to Darwin to birth their babies but brought the placentas back home to connect their children with their culture and country.
The Women’s Tranquility Garden at Wathaurong Aboriginal Cooperative in Geelong took a few years to gain approval but during that time Miller, a non-Aboriginal midwife, and Owens, a Yorta Yorta and Taungurung woman, stored the individually labelled placentas in a freezer. By the time the first planting occurred in 2011 there were 40 placentas.
Miller, who is now a midwife at Geelong Hospital, discussed the placenta garden at the CATSINaM conference. She said it was a peaceful and respected place that was also used by women just wanting a quiet moment, and sometimes for counselling.
“It feels special when you walk in there. Birds nest in there and sometimes there’s blue-tongue lizards,” she told Croakey. “People know that many placentas are buried in there, and they take pride in that.”
Owens, now a program manager, Aboriginal health for Barwon Health, related the story of the garden opening to Monash University Professor Karen Adams, who edited a research paper called The Wathaurong Aboriginal Cooperative Placenta Garden and Ceremony: Cultural Revival for Wellbeing.
The paper recounts:
At the first ceremony all the mums, the little people, their nanas, aunties and dear friends were invited to attend. All the mums had the names on the placentas that were wrapped in paper.
We called each of them forward one at a time and they placed their placentas in the earth, the bubbas all got special certificates. Afterwards, we all joined in some morning tea together and had a good old chinwag.”
Owens said the garden gave “a sense of culture and identity and belonging for the kids that were born in this community”. It was also a way of providing a permanent connection to Country in a region with a high transient population, many survivors of the Stolen Generations and large numbers of children in out-of-home care.
The garden connects families and the community. The placentas of siblings and cousins lie side by side and Miller said it was an important part of the healing process for some families who had lost premature or stillbirth babies.
More than 180 placentas have been planted since 2011, usually within days of birth. The ceremony revolves around the deciduous ‘birth tree’ planted when the garden was first developed to symbolise how lives are always changing, and includes a welcome to the baby:
“The placenta we are planting today has nourished and grown this beautiful bubba and now it will nourish our birth tree. We would like to welcome baby to the Wathaurong community. Our hopes and dreams for baby is to grow up healthy and strong and well connected to Country and Culture.”
Going back to our roots
The conference theme “Back to the Fire” resonates deeply with Uncle David ‘Tarnda’ Copley, Chair of CATSINaM’s Elders Advisory Council, established by the Board of CATSINaM in July last year.
“Back to the Fire means we’re going back to our roots to stay connected with our cultural framework in a world that’s more technologically advanced,” he said.
The Elders Council advises the Board and CEO Professor Roianne West on fulfilling their responsibilities to CATSINaM members on matters relating to cultural governance and leadership.
Copley, who chaired the Elders and Leaders Panel at the conference, said the Elders Council was committed to supporting Aboriginal and Torres Strait Islander nursing and midwifery students who were “the leaders of the future” and, in particular providing cultural support to improve their retention through university.
Copley said he remembered 20 years ago at the original incarnation of CATSINaM, the conference could fit “the entire membership in the one room”. The Indigenous nursing and midwife workforce now sits at around 5,500 people.
“But it’s not just about numbers; it’s about [university] retention and putting infrastructure in place so there are welcoming spaces and support staff with appropriate training,” he said.
Copley, a descendant of the Kaurna and Peramangku peoples, is the Indigenous Academic Advisor at La Trobe University’s Rural Health faculty. He said barriers to student completion at university included racism, pressure from families, being homesick, a lack of community and cultural connection, and infrastructure such as accommodation and internet access.
“These students are often the first in their families to finish school and go to university and there can be pressure initially to come home and help the family, and then when they’re close to finishing there can be the expectation and pressure of ‘so you’re going to be famous’,” he said.
Cultural safety and anti-racism
But once students are at university, what are they actually learning about cultural safety and anti-racism?
That was the question posed at the conference in a presentation by Wiradjuri woman Professor Karen Adams, Director of the Gukwonderuk Faculty of Medicine Nursing and Health Sciences Indigenous Engagement Unit at Monash University.
Adams told Croakey her work in educational research in Indigenous health across all education settings – schools, tertiary education and workplace professional development – was a relatively new field and “the more we dig, the more complex we find the area”.
“When we look at how we are doing, what are students actually learning about cultural safety and anti-racism, and is it making any difference, it certainly seems like we’re not having great inroads at the moment,” she said.
Research was showing that students taught about cultural safety improved their knowledge and skills in the short-term but not in the long-term, because there was no sequential link to cultural safety as they transitioned into their profession.
Anti-racism educational research, largely from the United States, was showing the lack of coordination between what was taught at university and in clinical settings made it “very hard for students to keep that progression going, because what you’re teaching in the classroom is not what they’re seeing in the work environment”.
Adams recommended the approach taken by American writer Ibram X. Kendi in How to be an Antiracist because “if everyone’s not on the same page then you make very little impact”.
“People need constant reinforcement and that’s the same about learning anything, like handwashing for example. If it’s not reinforced then the knowledge drops off and people don’t do it. It’s the same with cultural safety and anti-racism if it’s not reinforced in workplaces.”
Partnership for Justice in Health
Far too many lives of Aboriginal and Torres Strait Islander peoples have been cut short by racism, Lowitja Institute CEO Dr Janine Mohamed told the conference.
“We hear a lot — though still not enough — about Aboriginal deaths in custody, but not enough about the harm caused by racism in the health system,” she said, noting that mainstream health services were still often not safe or welcoming for Indigenous Australians.
Mohamed said the Partnership for Justice in Health, which she co-chairs with Karl Briscoe, was formed after the preventable death of Naomi Williams, a 27-year-old Wiradjuri woman, who was 22 weeks’ pregnant with her son when she died of septicaemia at Tumut Hospital in 2016. A coronial inquiry found she went to hospital at least 18 times in the months before she passed away without receiving a referral to an expert.
The Partnership is an alliance of self-determining Aboriginal and Torres Strait Islander academics, legal experts, and national peak health and justice organisations, including CATSINaM, working to improve Indigenous health and justice outcomes by eliminating racism.
The Lowitja Institute recently launched a new discussion paper on Race, Racism and the Australian Health System, written by Associate Professor Chelsea Watego, Dr David Singh and Dr Alissa Macoun.
“It makes the point that time is not on our side; that our people are dying at the hands of the state in numbers that should shame,” Mohamed said.
“And that 30 years after the Royal Commission into Aboriginal Deaths in Custody the health and justice systems that are meant to protect and keep our people safe are failing.”
• The Djubuguli (Sydney) Gadigal Country ‘Back to the Fire” that was to be held in Sydney on 2-3 June has been postponed to 6-7 July due to the current COVID outbreak in Melbourne, to ensure the safety and wellbeing of all attendees.
Disclaimer: Linda Doherty does casual speechwriting for the Lowitja Institute and contributed to Dr Mohamed’s CATSINaM Naarm speech.
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Professor Roianne West
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Photo gallery
Croakey acknowledges and thanks CATSINaM and photographer Michael Torres, Jalaru Photography, for the opportunity to publish these photographs of conference delegates and presenters.