Aboriginal Health and cultural respect case studies

“This case study is such a notable example of how incorporating cultural respect expectations in a funding agreement creates growth and development in this area.”

– Public Health Services funding agreement content advisor

Working with their PHS Funding Agreement content advisor, AOT agreed to specific measures in their Agreement which focussed on engagement with Tasmanian Aboriginal organisations to do health promotion activities. Aware of the need to improve communication and engagement strategies and realign services to be more culturally safe and responsive, AOT made the effort to provide health education in a way that empowered more Tasmanian Aboriginal people to be active participants in their own health and musculoskeletal healthcare.

AOT’s Health Educator made personal approaches to reconnect with Tasmanian Aboriginal Community organisations offering to work in partnership to provide increased education support for their community in whatever manner they saw fit.

Partnering with Karadi Aboriginal Corporation (Karadi), AOT successfully delivered three health promotion workshops, Spring Yarns for Elders, and community members on site. Karadi’s three key health program coordinators each consulted with their groups regarding topic selection before working with the AOT Health Educator to help with the design and delivery plan of each individual session.

On the advice of Karadi, ‘yarn style’ talks were determined to be the most effective mode of delivering the information and ensuring that every participant had enough time for telling their story if they wished, receiving information, and asking lots of questions to ensure that everyone understood the concepts, evidence and strategies being discussed.

The AOT Health Educator was invited and agreed to stay on to join the groups for lunch, providing a chance to get to know each other better, build trust and allow for individuals to have their questions answered in a private manner.

Storytelling to illustrate and convey key knowledge; visual display aids including diagrams, photos, and a collection of examples of assistive aids for daily living, were employed at each session. In addition, every participant received an information pack to take home.

In the case study provided to PHS as evidence of how well they met the KPIs and whether anyone was better off, AOT reported:

“All three sessions were well attended and received. Lively conversation ensued with lots of questions and sessions running over time at the request of the groups. Elders were happy to share their knowledge with our Health Educator in an exchange of cultural learning.”

Karadi Coordinators were pleased with the outcomes of all three of the sessions reporting community members expressed satisfaction and found the talks interesting and engaging:

“As a result of their participation, several members had followed up post session to avail themselves of the opportunity to book appointments with their health providers to seek further individual guidance and support to implement self-management strategies. A positive, collaborative relationship has been established because of this initiative. Karadi have expressed interest in continuing to work with AOT.”

The Maternity Cultural Artwork was officially unveiled at the new Maternity Unit (K7) in October 2021.

The artwork brings important elements of Country, nature, and Tasmanian Aboriginal culture into the public spaces on the Maternity unit. These images are now treasures for every Tasmanian to recognise, share, and enjoy together.

The art project is in honour of the thousands of years of birthing on Country by Tasmanian Aboriginal people and is symbolic of the ongoing intention to ensure recognition and support for cultural safety whenever birthing or visiting the Royal Hobart Hospital Maternity Unit.

pulingina pakata ngayapi mapali / Welcome to all the babies born.

Like all good things, the Maternity Cultural Art Collaboration Project started with an open, relaxed and honest yarn.

• How can we do better? How do we let Aboriginal families know that the new K7 Maternity unit is a welcoming safe space?
• How can we honour and acknowledge the rich and thriving Aboriginal culture in nipaluna / Hobart and throughout lutruwita / Tasmania, that is here today, as it has been forever, with strong connection to Country?
• How do we tell a story that brings everyone a sense of place, recognition, pride and belonging?
• How do we start somewhere that feels good, feels right and starts us on a journey of healing and becomes a journey for healing?

The value of Aboriginal Health Liaison Officers (AHLOs) being connected to Community and the “everyday business” of the RHH Maternity Service, cannot be underestimated. From working with families directly, to guiding staff to consider a cultural lens and bring Aboriginal voice and direction to Maternity staff ’s work and professional development, both for physical health care and beyond, highlights the importance and value of AHLOs being present and integrated as important partners of the broader health team.

Everything starts with building real and honest relationships.

The relationship with the AHLOs and external Aboriginal Health Services and broader community has been developing for some time and is equally very much in its early ‘building trust’ days. We have time.

Maternity staff are authentically seeking ongoing ways to improve access, quality of care and ensure the lived experiences of Aboriginal women and their families whilst being cared for through the Maternity Services, is as positive and culturally appropriate as possible.

This includes going slowly where necessary, knowing this is for the long time. It’s not a “to do list”, it’s a “to be list”, a “deep listening, genuine learning/growing/welcoming/ inviting and ensuring a place is always at the table and an openness to being led.”

Other background external influences and inspiration for starting this project included:

• The Australian College of Midwives Birthing on Country project 2017-2019.
• Midwifery staff attending TAC cultural awareness training on the recommendation of the RHH AHLO and with support from RHH management.
• The updating of NSQHS standards in 2018. The RHH Women’s and Children’s service completed a gap analysis and action plan, identifying work needed in Standard 2 (Partnering with Consumers) and Standard 6 (Communicating for Safety) including partnering with Aboriginal families and community to create safe, culturally sensitive and welcoming environments for Aboriginal people.

The LGH and RHH AHLO’s connected the RHH Maternity Clinical Midwife Consultant to meet and work with Luana Towney, a Tasmanian Aboriginal Artist, who had also birthed with RHH Maternity. This was a perfect partnership for bringing culture, Country, current and ancient birthing connections to K7 Maternity, through Luana’s artwork and storytelling.

This yarn then evolved into a collaborative art project, with thanks to the support of time and funding from the Queen Alexandra Auxiliary (QAA) Group, who engaged Digital Ink Graphic Artist to work closely with Luana, to transform her works into the beautiful wall murals. The murals were completed and installed in September 2021, for the public spaces on K7 Maternity for all to enjoy, for many years to come.

This project is just the beginning for the many ways in which healing, partnership and shared governance will hopefully continue to be walked onward together. Ensuring every Aboriginal family feels genuinely culturally safe, respected, heard, and celebrated within our health services is of great importance for the healing of Country and in turn, Country healing us.

The image of larapuna / Bay of Fires with soft overlays of a whale and grasses was the image chosen by maternity staff to help create a space of calm, relaxation, and recharge during breaks. The healing influences of nature, beauty, and colours are well known to have an impact on the parasympathetic nervous system. The QAA wanted to ensure those looking after mothers and babies also felt looked after.

Established in 2004, the program is a key DoH initiative in support of the Tasmanian Government Aboriginal Employment Strategy 2019-2022. It provides financial support for tertiary and vocational study in recognition of the under representation of Aboriginal people in health professions in Tasmania.

Each year the Office of the Chief Nurse and Midwifery Officer (OCNMO) works closely with a West family member throughout the scholarship advertising, selection and awarding processes.

Scholarship funds help students in many ways. Students can buy textbooks, computers, clinical equipment and uniforms. The scholarship helps with living costs for attendance at rural clinical experience placements. During COVID-19 some students found the loss of income eased by the scholarship. Being able to pay for childcare costs helped others with studying at home. Students can focus on their studies and connect with their local community without the pressures of financial stress. All say the extra financial support is critical to students completing their studies.

In 2020 nine applications were received. The three available scholarships were awarded to MaKenzie Adams (Bachelor of Nursing), Emma Shanahan (Bachelor of Nursing) and Claire Whiteway (Bachelor of Medicine and Bachelor of Surgery).

In 2021 there were 11 applicants with Emma Shanahan (Bachelor of Nursing), Claire Griffith (nee Whiteway) (Bachelor of Medicine and Bachelor of Surgery) and Jaimi-Lee Armstrong (Bachelor of Medicine and Bachelor of Surgery) being awarded the three available scholarships.

For the next four years (2022 to 2025) there will be 10 Ida West scholarships available each year.

Having a yarn with Emma, scholarship recipient for 2020 and 2021

The DoH’s Aboriginal Health Policy Officer (AHPO) Nikki Kivi recently interviewed Ida West scholarship recipient Emma Shanahan.

Who lives with you?

Husband Ian, Ezra our six-year-old son, along with one horse, one dalmatian, one cat, 39 chickens, four sheep and some fish.

Where do you currently work?

I work at the Aboriginal Health Service in Hobart. I love working for the Health Service as we get the time to really work out what someone’s needs are and support them through their whole health journey.

Being an Ida West Aboriginal Health Scholarship recipient enabled me to …?

I had been an Enrolled Nurse for over 10 years before I found out about the Scholarship. With a mortgage, child, and full-time employment I could not see a financially stable path for me to undertake a Bachelor of Nursing.

I applied for one of the three scholarships and was successful! I was able to confidently reduce my hours at work to commence studies and now I am looking forward to the end of the year when I complete my degree and graduate.

Ida West Legacy

Receiving the Scholarship has been an honour and I am determined to carry on Aunty Ida’s legacy of supporting Community and being a role model for other Aboriginal people interested in the health field.

What does the future hold for you career wise?

Nothing is set in concrete yet, there are many avenues that open when you become a Registered Nurse. You will have to wait and see.

Actions since the group’s inception:

• Developing a THS North ‘First Nation Peoples’ health needs protocol and a cultural capability checklist.
• Reinstating the Aboriginal flag at LGH. The flag, together with the Australian and Tasmanian flags will fly continuously, with lighting at night. The flags were reinstated with a ceremony attended by the Health Minister and members of rana rrala payngana rrala.
• In 2021 a significant body of work was undertaken in developing posters, about asking the question ‘Are you Aboriginal or Torres Strait Islander? ’ The design, content and colours were chosen by members of rana rrala payngana rrala, reflecting their connections to the land and sea. Each poster features members of rana rrala payngana rrala and their families. These resources will be launched in 2022.

Feedback from rana rrala payngana rrala members:

“The journey has been enjoyable, working with other community members, Aboriginal and non-Aboriginal.”

“Worthwhile health outcomes are being achieved for Aboriginal people.”

“It is a positive step forward in recognition of the health needs of Aboriginal and Torres Strait Islander people.”

Plans for 2023:

• Launch of asking the question ‘Are you Aboriginal or Torres Strait Islander?’ resources including dissemination and information sessions to LGH and District Hospitals North.
• Progress Aboriginal artwork for two major entry transit points in and through the LGH and also in the NICS area.
• Support for celebration of NAIDOC week.
• Acknowledgement Plaque for front entrance of the LGH designed by members. Clyde Mansell pictured with the 'Asking the Question' poster designed by the group which features local families and depicts connections to land and sea.
   

kutalayna Health Service, run by the Tasmanian Aboriginal Centre and kutalayna Learners (a team of Department of Education Aboriginal Educators) are key partners in the collective.

Informed by the voice of the community they are both working with OHST to improve oral health outcomes for Aboriginal children under 5 and their families. Their guidance forms positive and culturally appropriate experiences for Aboriginal children and their families.

What we know:

• Although nearly entirely preventable early childhood decay is the most common childhood disease and the top reason for hospitalisation in this age group. It is strongly linked to family behaviours and practices.
• Local families do not currently have the information on how to prevent early childhood decay.
• Numbers of local families accessing dental clinics needs to be increased.

What we do together:

• We have a shared and agreed purpose with kutalayna Learners and other partners to actively work together to break down barriers for families reluctant, or find it difficult to access, dental care or preventive messages or interventions.

We did this by:

• Building the oral health knowledge and understanding of the eight kutalayna Learners.
• Supporting kutalayna Learners to share information on how to prevent early childhood decay.
• Supporting kutalayna Learners to develop healthy mukwi healthy me resources that support parents to make healthy oral behaviour choices at home.
• Participating in Community for Children’s Health Day in Children’s Week. We provide a safe and respectful space for families to take part in fun activities.
• Forward planning the promotion of OHST into local schools and supporting local families to access the service.
• Working with kutalayna Health and kutalayna Learners to improve (warm) referral pathways. A ‘warm referral’ uses the support of safe relationships that families have with other Aboriginal organisations and community to provide families with the confidence to access services.

“The Team enjoyed the informal way that the information was delivered and how it was Community based information. It will be easy to make it part of our every-day work”

– kutalayna learner

“Leanne, one of the kutalayna Learners developed the backdrop artwork to represent the river. This artwork formed the background for the memory cards, toothbrushing calendar and Wendy Roo story book for the 60 outreach bags.”

– kutalayna learner

What we will do next:

• Implement our planned activities into Launching into Learning programs in schools via the kutalayna Learners team.
• Continue to support kutalayna Learners through regular professional learning opportunities with OHST.
• Continue to support a warm or supported approach to help Aboriginal families attend our service.
• Local dental team members will take part in Cultural Awareness training.
• Compare data from previous year to monitor our approach.

“We do soft and supported referrals to enable us to meet the needs of our Community. In our area, families are hesitant to attend any service without some form of intro and have an historical dislike/negative experience with many services (government in particular). This type of approach is working better for our people, and we are seeing more families attending the different services because of this.”

– kutalayna learner