Galiwin’ku, an Aboriginal community in the Northern Territory, has just been hit by 2 cyclones. Cyclone Lam on the 15th of February. Then Cyclone Nathan on 22nd March. Both came at night time which makes them much more frightening.
These cyclones are devastating enough as pictures linked can show you. (Click here for links.)
But there’s a weapon more dangerous than cyclones that affects remote Aboriginal communities and people every day. No-one died or was badly injured in the category 4 and 2 cyclones above, but Yolŋu and other Aboriginal people across the nation are traumatised over and over again by interactions with mainstream English-speaking people unprepared and untrained in how to engage with the gross assumptions they carry about Aboriginal people and their communities.
This morning I was going to work with Dianne Gondarra. Some of you will be familiar with Dianne from the work she is doing on the Hope for Health program. Dianne’s health story is incredible. She dramatically transformed her own health, going from a wheelchair to regularly walking around the community, and she is now working to help others do the same.
When she rang me today she mentioned that after we finished work she should go to the clinic and get checked for the chest pains that she was experiencing. Of course I said to her, “There’s no way you are working this morning, go straight to the clinic”.
The next phone call I received from her was very upsetting. My sister Dianne is usually a fairly quiet person but she was so angry that she could hardly put words together. I desperately tried to calm her down and understand why she was so angry. It was a good 5 minutes before she calmed down enough for me to even understand what she was saying and find out what happened.
Apparently she had presented at the clinic with the chest pains and they immediately took her to casualty where they started the process of putting on the ECG leads and inserting a cannula so they could take bloods etc. The ECG was being done by a male Yolŋu health worker, a situation that already put her on edge. But due to the emergency situation it is understandable that sometimes male health workers may need to do a procedure that a female health worker should be doing.
Strangely enough her sister, who is also a very experienced health worker, was in the clinic at the time . Most medical services know that male and female health in Aboriginal communities should be kept clearly within the male and female divide. So often the impact of undermining a person’s cultural safety, and how it should be managed when the line must be crossed, is not understood.
But that in itself was not the main problem. A male Registered Nurse (RN) came in with Dianne’s medical records in hand and started abusing her, accusing her of being non-compliant, not following through with her cardiologist appointments and apparently “walking out of Darwin Hospital”. He clearly thought he had identified another compulsive non-compliant Aboriginal person who was at fault for her own illness and he was going to set her straight – whilst she was seeking medical attention for chest pain!
This man had never met Dianne before and he had not sought to understand anything about her personal situation or her medical conditions and their current management. Aside from it being highly irrelevant to dealing with her current emergency situation, he didn’t stop to hear her side of the story, he just assumed what was written there was correct, because it fits the assumptions and the pattern of blame that unfortunately has become part of his culture while working with Aboriginal patients.
The incident he was referring to from her chart was in November 2013 when I had actually attended the Royal Darwin Hospital with Dianne in an attempt to see a cardiologist. This was just a follow-up check from a time when she had had a mild heart attack a year or so before. So it was not critical and she felt quite okay. We had waited for hours and in the end they told us that the only way she would see a cardiologist was to stay in hospital overnight. However, Dianne was to facilitate with me the next day at a Bridging the Gap Seminar. She was feeling well and had felt well for a number of months and so decided that she would wait for the clinic back home to organise her appointment with the next visiting cardiologist. The next visit at Galiwin’ku was on 15 December 2013. Dianne was ready to attend but the cardiologist did not show up.
The RN in attacking Dianne was abusing a person who has gone through a health revival, as many would know in the Hope for Health Program, and was active in improving and understanding her health conditions; the very reason why she was promptly presenting to the clinic. Despite this she gets abused by a male registered nurse who has not been in her community very long and seemingly has had no cultural competency or special communication training to work with Aboriginal people. This is despite the fact that the clinic is an Aboriginal Health clinic run by an Aboriginal Health Board.
Which medical person in their right mind would attack any person who walked in to a clinic with chest pains – a potentially life threatening condition? The answer is that this happens quite often, only the specifics change.
Yes sadly it is not an isolated event. Trauma from interactions with angry, insulting and careless mainstream personnel are experienced regularly by Aboriginal people.
Predetermined cultural assumptions
Why does this happen? Because when anyone is dealing with people of another race, especially in stressful work environments, often our unconscious mind takes control and encourages us to respond to people of the other culture, not as people, but objects who are defined by our culturally predetermined set of assumptions. In this case the generalisation that Aboriginal people are non-compliant took control.
These assumptions drive mainstream culture staff towards a tendency to blame Aboriginal people. In medical services, who deal with the worst outcomes of the crisis in Aboriginal communities, this can manifest as the idea that Aboriginal people are sick because they are too lazy, careless or unintelligent to take responsibility for themselves or their family. So Aboriginal people are blamed for their own illness.
This jumping to assumptions occurs because the dominant culture person is out of their (conscious) mind set and are acting on their sub-conscious cultural assumptions; assumptions absorbed from their upbringing in their own culture in relation to Aboriginal people.
Dianne was so upset this morning that she pulled the ECG leads off her half naked body, dressed herself and walked out of the clinic. As she did so the RN called after her “There you go doing it again, walking out”. Of course the RN wrote in the notes, “She walked out of the clinic”. Just another non-compliant Aboriginal person! And so the stereotype and blame is maintained. We know this because our other workers took the female doctor to see Dianne to get her treated appropriately. Would she have gotten the lifesaving treatment she needs if we weren’t there?
I could guess that this registered nurse not only has had no proper training to work in a cross-cultural situation but is carrying a whole lot of negative stereotypes which can kill or maim just like a cyclone. Imagine the impact if Dianne was truly on the edge of a heart attack. This kind of assault could create enough stress to bring on a full blown attack leading to death.
To prevent the attitude that ultimately causes people to be treated as objects, competency in cross-cultural interactions is essential. Workers need more than just to understand that Aboriginal culture is different but need to develop a deep awareness that will stop them operating using dangerous cultural assumptions. This is what good cross-cultural training does, it teaches you how to understand and identify these patterns, in yourself and co-workers – so we do not objectify others and keep coming from a place of assumptions and stereotypes.
But as it stands right now, it seems Aboriginal controlled Health Boards, the Federal and Northern Territory governments can keep people safe through cyclones but do very little to give medical and other personnel the type of training and skills that are necessary to keep Australian citizens safe during medical interactions or in other points of service provision.
Let’s be clear; there’s a lot of really good medical people in the medical system, and in Galiwin’ku, who work their guts out to make sure that Aboriginal and other people are safe and cared for. This is not about good and bad people. It’s about making real change and admitting that the kind of abuse that Dianne faced this morning is an endemic problem. The gross assumptions that staff make about their Aboriginal clients is actually one of the biggest reasons for non-compliance. A lot of Yolŋu just do not want to go to the clinic and face abuse and embarrassment.
Unfortunately this poor untrained RN picked on the wrong Yolŋu lady this morning, just as I was sitting down to write this editorial for our latest Why Warriors news. Usually I would try to mediate conflicts like this, as this is what we do all the time. However I think it is about time that we made an issue out of some of the things that happen continuously on Aboriginal Communities and that Aboriginal people have to put up with. Things that do not get into the mainstream media just because it happens on the other side of the cultural/language divide.
As I write this I sit and think if this happened to Dianne this morning at Galiwin’ku it is also happening in many other places across Australia as we speak. We need to do things better. For our part, Dianne, Witiyana and I will continue to roll out Bridging the Gap Seminars despite the fact that they cost us more than we make out of them. We will do this because we believe this training is just so essential, life-saving and also has the potential to save the government tens of millions of dollars if they would only use it.
This is not just a problem in the medical arena. All agencies in Aboriginal communities across the Northern Territory and Australia create the same sort of disaster when we do not recognise that good appropriate cross-cultural communication and skilling are essentials tools for all mainstream workers who come to Aboriginal communities.
When I arrived in North Australia in 1973 I was forced, yes forced, to learn an Original Australian Language and I was also forced to attend Community Development and Cross Cultural courses. I am so glad that was the policy of the day. Because of it I am still here working with Yolŋu people.
It also should be the policy of today, in a contemporary democratic free society. Just as we have Cyclone and disaster preparedness, we need preparedness to prevent the disasters that come from acting out of our untrained cultural minds.
Come on Australia we can do better!
PS. Dianne is safe for another day.