National Reconciliation Week: ‘In this together’

‘In any situation, you can’t move on and reconcile unless you’ve acknowledged the hurt or things that have happened in the past.
 
‘It all comes down to acknowledgment and acceptance of the historical context of this country.’
 
That is Dr Ngaree Blow, a Yorta-Yorta and Noonuccal, Goreng-Goreng woman, and Director of First Nations Health for medical education at the University of Melbourne.
 
She is referring to historical acceptance, one of Reconciliation Australia’s five dimensions of moving towards a reconciled nation.
 
National Reconciliation Week runs from 27 May to 3 June. This year’s theme, ‘In this together’, is one that resonates more than anticipated, given the current COVID-19 climate.
 
Since the movement started, there has been greater acknowledgement of Aboriginal and Torres Strait Islander land rights and understanding around the impact of government policies and frontier conflicts, as well as embracing of stories of their success and contribution.
 
But the 12th Closing the Gap report shows there is still a way to go, with only two of seven targets met in efforts to close Australia’s healthcare, education and employment gaps.
 
While there has been a focus on raising cultural awareness and competency, Dr Tanya Schramm, a Palawa woman, told newsGP the spotlight now needs to focus on cultural safety – and, in doing so, tackling unconscious bias.
 
‘Up until now there hasn’t been that push for people to reflect on their own unconscious bias. It’s a new space that we’re moving into,’ she said.
 
‘Hopefully there will be a bit of recognition that I really need to learn about myself first before I can go off and treat others from different cultural backgrounds; I need to know what my bias is and what I bring to the table when involved in a consult with somebody from a different background.
 
‘Have you been brought up with all those stereotyped ideas of Aboriginal people?’
 
While the issue is systemic, if individual healthcare professionals do not consider their own position Dr Blow says racism and, as a result, negative health outcomes will continue.
 
‘That is what we’re trying to avoid,’ Dr Blow said.
 
Among the efforts to call out this racism is The Final Quarter, a documentary from director Ian Darling focusing on the last three years of Aboriginal AFL player – and 2014 Australian of the Year – Adam Goodes’ on-field career, during which he was the target of repeated booing, particularly in 2015.
 
Produced using solely contemporaneous media footage, the film’s education director Alex Shain told newsGP the aim was to give viewers a chance to reflect on what happened, what was said, and to examine own views through a process of ‘truth telling’.
 
‘The only thing that made the issue “go away” was the devastating circumstances in which Adam Goodes retired. So, yet again, the persecuted person is the one that has to resolve the issue,’ Mr Shain said.
 
‘But it wasn’t resolved and we thought the best way that you could investigate that is through using archival footage which is, in some ways, a process of truth telling. We often think truth telling refers to atrocities that occurred 250 years ago but, actually, truth telling of contemporary stories is just as important for modern day society.
 
‘Putting it out there and letting people then consider the truth is a really powerful way of helping us as a nation move forward and think perhaps a bit differently about our own identity and who we all are.’

Mr Shain says this process is in no way about putting guilt on current generations, but rather reminding people of their responsibility towards reconciliation.
 
‘It is not about making you, as an individual person, somehow feel responsible for everything that’s happened before because it’s not your responsibility. What is your responsibility is to actually talk about that and to understand the truth,’ he said.
 
‘Really we can’t move on until we understand what we’re moving on from, which might have been a massacre in the community that you’re working and living in right now, and that might have happened in 1850 and no one ever talks about it.
 
‘We don’t actually teach or understand what happened here. If we don’t teach that in schools, then we’ve got no chance in some ways of ever moving forward as a nation.’


Aboriginal AFL player – and 2014 Australian of the Year – Adam Goodes experienced significant crowd booing over the last three years of his playing career. (Image: AAP)
 
The impacts of colonialism are experienced to this day, a severe consequence seen among the devastating, preventable deaths. Among them, Tanya Day, a Yorta Yorta woman, who suffered a fatal injury in police custody, while Naomi Williams, a Wiradjuri woman, was pregnant when she died of septicaemia after failure to receive adequate care.
 
Dr Schramm says both cases highlight the deadly impact of not addressing unconscious bias.
 
‘If Tanya Day hadn’t been Aboriginal, would the same outcome have happened at the end of the day? I think there’s a lot of things that are still happening within the health service that really reflect that we haven’t addressed unconscious bias and cultural safety,’ she said.
 
Part of the discussion, Dr Schramm says, is the need to recognise that Australia’s health system was originally set up to suit the needs of the majority at the time – white, Anglo Saxon. This in itself can create barriers just for people getting through the door.
 
‘It’s all the barriers that they had to jump to get into your surgery to start with that are still there,’ she explains.
 
‘So it’s about decolonising the health system itself, and we haven’t really got there at all.’
 
Dr Blow believes part of the issue is the lack of understanding regarding the social and cultural determinants of health, and the importance of Aboriginal and Torres Strait Islander people being able to self-determine their own health and lives.
 
‘A lot of the Western medicine does actually come from Indigenous knowledge, which hasn’t been acknowledged. We are starting to see a real shift to a holistic concept of health, which is essentially the original concepts of health from First Peoples here,’ she said.
 
‘Aboriginal and Torres Strait Islander people have been here for over 60,000 years and have been looking after their own health in their own way for thousands of generations – [we need to] acknowledge and respect that Indigenous knowledge as well.’
 
Dr Blow says incorporating more of this knowledge into medical education at every level – not just university, but official training pathways – would be mutually beneficial.
 
‘This is something that I’ve been trying to do more of with medical students at the university, actively ensuring that they hear from Indigenous voices,’ she said.
 
‘And the feedback we’ve got from students is that it actually is a really significant learning for them.’
 
Without this cultural understanding, Dr Schramm says one patient’s negative experience with a health professional can have a flow-on effect to the rest of the community.
 
‘You’ve got to remember that that person’s going to take that message home with them to the family. “That GP refused to do these tests” or “that GP refused to acknowledge what I had to say”,’ Dr Schramm said.
 
‘“You don’t get good care up there” will be the message.
 
‘That’s only going to add to their own health burden because now it’s not just that one patient [who’s] not coming back, it’s that whole family that’s not coming back. Then that family is going to put that out in and around the community.’
 
Dr Blow’s key advice to healthcare professionals is to listen.
 
‘It seems quite simple, but it can be a really hard thing to do when we as doctors and other healthcare professionals have limited time with patients,’ she said. ‘And so it can seem like a barrier, but actually we’re seeing a lot better health outcomes when there is a lot more listening and that effort to understand the patient in front of you.’
 
Dr Blow urges clinicians to be mindful of the population approach. While important to acknowledge the statistics, she highlights the need to tailor management for individuals.
 
‘Remember that you’re working with a heterogeneous group of people who are from multiple nations, who have multiple different cultures, languages, ways of seeing the world,’ she said.
 
‘So being collaborative in that approach by truly deep listening and understanding the holistic view of health that our people have, and realising that health isn’t just a treatment for a disease or an illness – it’s about looking at the whole context of that person in terms of their family and their community in regards to their health, their home life, their education, their employment, and all the other social and cultural determinants of health while, you’re also working on a treatment plan.’
 
In order for GPs to ensure they are creating a culturally safe environment, Dr Schramm suggests asking patients directly.
 
‘It’s not something that we are usually open to. People seem to be coming back, so you think “yep, I’m doing a great job”. But the only way to know if you’re being culturally safe is to actually ask the patient,’ she said. 
 
‘For a lot of GPs that’s a really hard thing to put themselves out there to ask patients “Where am I falling down? What needs to be fixed? And how do I go about it?” But that’s what this is going to take for health professionals.
 
‘It’s only by getting that feedback that you can properly change the way you go about doing things.’
 
This approach is in line with the 2020 Reconciliation Week theme ‘In this together’, and something that has been highlighted more than ever during the COVID-19 pandemic.
 
Dr Blow, who is currently working as part of the Department of Health and Human Resources’ (DHHS) COVID-19 response team, says it has been good to see Aboriginal and Torres Strait Islander communities at the forefront of engaging with government to prevent the spread of the virus.
 
‘That is a really strong example of self-determination and of Indigenous peoples ensuring that we’re protecting our own communities,’ she said.
 
‘Actually, a lot of the resources and health promotional materials that Aboriginal organisations like the Australian Indigenous Doctors Association have come up with are being brought into the mainstream as well and into non-Indigenous communities.’
 
The RACGP is asking staff across Australia to contribute their own commitments this National Reconciliation Week, to be incorporated into its Reconciliation Action Plan (RAP). Marking the 10th anniversary of RACGP Aboriginal and Torres Strait Islander Health, the college is currently working to update its RAP and planning to launch its formal commitments later in the year.
 
For tools and resources to support GPs and practice teams to provide effective, culturally safe primary healthcare, visit the RACGP website.
 
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