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Leading Indigenous health researchers share some courageous conversations

A standout session at the recent 6th annual National Health and Medical Research Council symposium on Indigenous health research translation, co-hosted by the Lowitja Institute, was a panel discussion on Courageous Conversations.

As Dr Megan Williams, Senior Lecturer in Aboriginal Health and Wellbeing at the Graduate School of Health at the University of Technology Sydney and a Croakey contributing editor, said:

It provided a rare window to the leadership of Aboriginal people in ethical research featuring community engagement – which governments are increasingly calling for – as well as the challenges to stimulate other researchers to conduct their work properly.”

The discussion also revealed the added layers of personal and professional pressures for Aboriginal and Torres Strait Islander researchers, academics and clinicians, including having to deal with racial stereotypes and slurs and systems that cause harm for their communities.

The panel featured Dr Jaquelyne Hughes, Dr Ray Lovett, Professor Alex Brown, Dr Chelsea Bond and Dr Cass Hunter. In a wide-ranging discussion, they talked about the added and often unsafe burdens in their work that include:

  • being expected to speak on behalf of all Indigenous people
  • having to deliver worst case scenarios to individual patients and front-line communities
  • being regarded as suspect because of your deep links to community, and
  • having to worry about white people’s emotional comfort when it comes to conversations about race and racism.

You can watch the full one-hour discussion, chaired by Professor Juli Coffin, Head of Campus and Director of the University of Notre Dame Australia in Broome, via this link.

In the story below, Marie McInerney reports on the discussion and you can also watch this interview by Croakey contributing editor Summer May Finlay with three of the panelists, Professor Alex Brown, Dr Ray Lovett and Dr Chelsea Bond.

See also the full one-hour panel discussion on leadership, chaired by Associate Professor Gregory Phillips here (with some tweet reports at the end of this post, together with the Twitter analytics).


Marie McInerney reports:

The need to “centre white people’s feelings” in conversations about race is holding back efforts urgently needed to address the impact of racism upon Aboriginal and Torres Strait Islander people, according to leading Indigenous academic and researcher Dr Chelsea Bond.

Bond is an Aboriginal (Munanjahli) and South Sea Islander Australian and a Senior Lecturer with the Aboriginal and Torres Strait Islander Studies Unit at the University of Queensland.

She was recently awarded an Australia Research Council (ARC) Discovery Early Career Researcher Award (DECRA) to advance understanding of the importance of race in contemporary Indigenous public health discourse and practice.

She told the panel discussion there is a long tradition in Australia of “black people having to service white people – economically, physically, emotionally in all kinds of ways”.

So, she said, when it comes to conversations about race, there is an expectation that black people will continue to service white people’s needs, in ways that would never happen in other debates about equity or oppression.

She drew two comparisons:

As a woman, if I was to talk about gender equity, it would be absurd to suggest I should (do so) in a way that makes men feel safe.

If I was to talk about class as a power structure, it would be ridiculous to suggest the poorest talked about poverty in a way that makes wealthy people feel good about their circumstance.

We wouldn’t do that but when it comes to race, we insist that blackfellas talk about it in a way that makes white people feel really comfortable.

I think that requirement… maintains the power of race and the production of racial inequities.

Bond lamented a “lack of critical race scholarship” in Australia, which is hindering the country’s ability to engage intellectually on race and racism, and where culture “tends to be the default and the decoy away from talking about race”.

“We need to read, we need to learn, we need to teach about race, not just have it as something we talk about in the hallway,” she said. “It’s an important field of scholarly inquiry.”

Bond also urged other Aboriginal and Torres Strait Islander people working in Indigenous health and health research not to disparage their specialist knowledge about race, saying that growing up with a black father and a white mother had given her deep insights. She said:

I know how race works, I saw it every day… Many of us who know how it works have been told to ignore it, dismiss it, downplay it, be ten times better, outperform, overcome it.

No.

We need to study it, understand how it works so we can undermine it.”

Inspired by Professor Lester–Irabinna Rigney’s Indigenist research framework, Bond also urged Indigenous health professionals to “embrace the notion of non-compliance, both clinically and politically” and to have “disciplinary deviance in our work”.

In a brutal system, in health as well as justice systems, it should not be seen as courageous for health researchers to call out harm and the imperative to act.

“Our communities are waiting for us to do better, our people are dying,” she said.

Asked for solutions to conversations about race that don’t centre white people’s feelings, Bond offered three steps:

1.       Stop saying ‘the R word’ as if it is on a par with ‘the N’ word. “It’s not, it’s different. We have to name race and racism,” she said.
2.       Emphasise and foster intellectual engagement with race conversations, not people’s emotional responses to race conversations.
3.       Focus on the outcomes for Indigenous health, not aspirations or intentions.

“Sick to death of the sickness and death”

Professor Alex Brown told the conference there are a few key questions that invariably and frequently herald difficult conversations for him as an Aboriginal person, doctor and public health researcher.

They include: “How Aboriginal are you?”, “Who do you think you are?” and – from patients – “Will I live to see my children start school?”

All are signposts to difficult, often hurtful and insulting conversations about race, identity, and authenticity, or to manifestations of discrimination and disadvantage that are an added and very personal burden for Aboriginal and Torres Strait Islander researchers, he said.

Head of the Aboriginal Research Unit at the South Australian Health and Medical Research Institute (SAHMRI), Brown talked about the emotional toll of being both a clinician and fellow community member to patients with a poor prognosis and as a researcher investigating the disproportionate burden of disease borne by Indigenous people.

“It’s not hard to get sick to death of all the sickness and death we record because we are the scribes of that reality, and we’ve got skin in the game, it’s our family, it’s each other, it’s the people we worked with last week,” he said.

Another big struggle, he said, is being on the front-line to try to improve health outcomes for Aboriginal and Torres Strait Islander people but with little power to make that happen. He said:

We work really hard at translating our work, there’s no doubt that it’s a central requirement to everything we do…. but the challenge is that most of the levers for change are outside our control.

They’re in departments, in funding mechanisms, outside our ability as Aboriginal people, organisations and community to change.

We’re expected to solve the riddle of the sphinx with nothing to solve it with, beyond our brains and hearts and spirits and our connection.”

And then there are the everyday racial slurs that are both personal and professional.

They come from colleagues or others in the clinical environment, after he’s observed poor treatment of Aboriginal people in the health care system.

In such cases he will often end up saying, “you know I’m Aboriginal, right?”, to be met with, “how Aboriginal are you?”, and then, “well, you’re not like them”.

He said: “The reality is I am really like them, because they are me, we are us, and to deal with, obviously as a very light skinned (Aboriginal person), obviously my own issues of identity notwithstanding…it’s a challenge, we get asked these questions all the time, these are difficult conversations to have and I’ve really struggled with them.”

Another frequent question – “who do you think you are?” – can be posed aggressively or with kindness, but more often than not is “hard and difficult and painful”, particularly when it comes from other Indigenous people.

“I don’t mind hearing that from non-Indigenous people in our field – we hear it a lot – but it really hurts when we hear it from our mob and that’s probably the difficult stuff we don’t talk about enough, (about) how willing we are at times, because of the pain and suffering we’ve endured ourselves, to bring down people around us, rather than build each other up.”

Damaging expectations

Australian National University researcher Dr Ray Lovett talked about his experience of being “the only Aboriginal person” in a research unit, constantly expected to be the font of all Indigenous wisdom, whether on welcome to country protocols through to how best to engage with a community.

“I speak for me, I don’t speak for everyone,” said Lovett, a Wongaibon/Ngiyampaa man from New South Wales who is the Program Leader for Aboriginal and Torres Strait Islander Health at the National Centre for Epidemiology and Population Health at the ANU.

But he said that to tell that to colleagues or the institution and to suggest instead how they should go about speaking to the right Indigenous person or community on the particular issue they want help with “leads to decision paralysis”.

Brown agreed, saying later in an interview with Croakey:

“We’re expected to know everything about everything Aboriginal, expected to speak on behalf of everyone, expected to know all of the policy imperatives, there to solve every Aboriginal problem that the institution or organisation has…. to lead them to Nirvana on all Aboriginal fronts and then try to balance the realities of what our communities and families expect of us as well.”

Lovett told the conference he also faces issues around authenticity, not just within the institution or his discipline, but across to community and even family, particularly around policy work. He said:

Those questions about how authentic I am as an Aboriginal person are raised on a daily basis, because I don’t speak the right way in certain contexts or dress the right way…. or people have perceptions about where I’ve come from and how I’ve grown up when they’re meeting me for the first time.

I definitely have a sense sometimes that I don’t fit in the Aboriginal world and definitely at others …that I don’t fit in the academic world.

That’s a really hard space to be in when community members say to you ‘you’re different, you’re more of a whitefella’, or conversely, when the university is a bit suspicious of you because you align yourself very much with community.”

Lovett highlighted the impact too for Indigenous researchers, who understand context and different knowledge systems, amid the fierce competition for funding, rather than collaboration, particularly where greater status is given to quantitative research.

“The paradigm in unis and academia about what is evidence or which evidence is privileged, it’s a huge problem we have to deal with,” he said.

“The numbers sure give us that hit in the face about what’s going on but the qualitative component really contextualises and tells us what that story means.”

Climate conversations

Some of the hardest conversations for Dr Cass Hunter come when she has to talk to communities about the impacts of environmental and climate change.

Hunter is a Kuku Yalanji and Torres Strait Islander woman, working as an Indigenous social ecological research scientist with CSIRO Oceans and Atmosphere, with a focus on the resilience of communities in the Torres Strait.

Because those communities are on the frontline of climate change, there’s a risk that talking about ‘uninhabitable homes’ and ‘displacement’ causes distress and starts to work against their wellbeing and to break down connections to island life, she said.

“As a researcher, I have to be very mindful of that, about that distress, about ‘worst case scenarios’,” she said. “We’ve got to allow communities to handle conversations around that in their own way.”

It was a message that resonated across the two-day symposium – of making sure that communities are not only fully engaged in, but lead research.

“People are looking for that golden lever to pull down, but it’s a bit of an illusion,” Hunter said. “Often you need to focus on solutions that are empowering, put communities in the driving seat.”

Alex Brown also had some practical advice, “largely for whitefellas in the audience”, including that trust is critical. He said:

One of the reasons Aboriginal and Torres Strait Islander research takes so long is we’re building capital in trust and relationships that take a lot of time to build and a second to screw up.

This is a very difficult balance for us to maintain constantly, that’s why we’ll always defer to looking after our communities rather than institutions.

Communities should be able to have as much time as they need to decide whether your new world saving project is worth their support.”

And all of this shows the need for a research framework to be developed by an organisation like the NHMRC, according to Dr Jaqui Hughes, Australia’s only Aboriginal and Torres Strait Islander nephrologist and an NHMRC Early Career Research Fellow at Menzies School of Health Research in Darwin. (See this article about her work: Listen to Indigenous patient experts to transform renal care).

Hughes told the symposium she was tired of non-Indigenous colleagues “expecting me to go and do that engagement for them”.

She later told Croakey: “We need to create the research framework that supports researchers to go and do community engagement properly, so you can’t say this is a suggestion.”

It needs, she said, to ask: “‘have you done it, where do you demonstrate that, is it more than a cup of tea or a nod in the street? … what are you delivering back to the community that benefits the community now and not just to you as a researcher or to a research institution.”

Leadership dimensions

The symposium also hosted a panel discussion on leadership, led by Associate Professor Gregory Phillips, that can be viewed in full here.

Among the highlights was a discussion between Professor Gail Garvey, Senior Principal Research Fellow at the Menzies School of Health Research, and her colleague and mentee Dr Lisa Whop, who is a research fellow at Menzies School of Health Research, working on the National Indigenous Cervical Screening Project.

Key points were:

  • the importance of trust – not just in each other’s work and research, but intentions: “Trusting that Gail’s intentions are for my own personal growth not for her CV,” Whop said.
  • making space – Whop quoted an Oprah Winfrey interview with US basketballer Michael Jordan’s coach who said “a leader has to create a space for other people to step forward and lead”.
  • letting go – Garvey said at one stage she had encouraged Whop to follow her dream to work elsewhere (though she was glad she came back) – “I didn’t try to hang on to her… it’s hard to train and develop your staff and let them go, but it’s most important they have a broad depth of experience to have the most impact, and that may or may not be in your team.”

Watch this interview