I’m doing a presentation!

  • Date and Time: Wednesday 20th April
  • Time: 3pm – 4pm
  • Location: VTMH Seminar Room,  St Vincent’s Hospital,  Level 1, Bolte Wing (Enter Via Nicholson Street).

Book here.

Abstract

Cultural safety was developed by Indigenous nurses in Aotearoa New Zealand as a mechanism for considering and equalizing power relationships between client and practitioner.

An ethical framework for practice derived from postcolonial and critical theory, cultural safety proposes that practitioners reflect on how their status as culture bearers impacts on care, with care being deemed culturally safe by the consumer or recipient of care.

The question remains: how does the practitioner come to understand “culture” outside a media environment of “culturalism”, that persistently makes those outside the dominant culture a victim of their culture, while dominant groups exist in a “culture of no culture”, and get to choose whether or not to participate in “culture”?

In this presentation, I examine the dominant cultural discourses that shape the knowledge, skills and values of healthcare providers toward migrant mothers, and show how discourse analysis can help understand how culture is represented and how it comes to distribute power.

Bio

Our speaker, Dr Ruth DeSouza, leads the research program at the Centre for Culture, Ethnicity and Health.  Ruth has worked as a mental health nurse, therapist, educator and researcher. Ruth has written extensively about cultural safety, mental health, maternity and migration.

 

The Hive cover

Health professionals from migrant backgrounds bring new ways of seeing and doing that can innovate practice, but differences are often framed as a deficit rather than a strength. The 2016 Autumn edition of the Hive (the Australian College of Nursing’s quarterly publication) focuses on indigenous and multicultural health.The wonderful Janine Mohammed, Chief Executive Officer of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) has written a commentary on Indigenous health and I invited some great health professionals from different backgrounds to reflect on what their cultural background and life experiences bring to the world of health.  I’ve also written a commentary on the multicultural aspects of contemporary health care practice. You can download a pdf version of Embracing uncertain ground or keep reading!

Reproduced with permission: cite as DeSouza, R. (Autumn, 2016). The Hive (Australian College of Nursing), 13 (13).

 

The word ‘translation’ comes, etymologically, from the Latin for ‘bearing across’. Having been borne across the world, we are translated men. It is normally supposed that something always gets lost in translation; I cling, obstinately to the notion that something can also be gained – Salman Rushdie, Imaginary Homelands: Essays and Criticism 1981-1991.

Salman Rushdie writes in Imaginary Homelands about being a migrant and the uncertain and shifting territory that accompanies it, making one’s identity both polar and partial. Sometimes one straddles both the country of origin and the new country comfortably, and at other times falls in the space between (1992, p.13). Rushdie challenges the notion that migration only represents loss, and suggests that the uncertainty of migration and settlement can reinvigorate new spaces. The migrant is changed by migration, but the migrant also changes the worlds they enter.

The uncertainty that accompanies the migrant is also processed by the receiving society. Here, however, uncertainty and unpredictability are often viewed as a loss and threat, rather than as spaces of possibility. My own work in cultural safety has advocated for those who are already at home to foster uncertainty. To effectively work cross-culturally requires engaging with our own cultural beliefs as well as those of others, and to consider culture as contingent, contested, negotiated and open-ended. A constructive and conscious examination of the culture of the health system that sees seemingly xed constructions as variable can yield new practices, resources, metaphors and practical strategies (De Souza, 2013). This special feature focuses on practitioners who are both translators and translated, who bring other ways of seeing things, and whose arrival has the potential to invigorate new thinking and practices.

Contemporary health care is no longer a single national culture. In 2014, there were 610,148 registered health practitioners. Over half of whom (352,838) were nurses or midwives – over three times the size of the next largest group, medical practitioners (AIHW, 2014). More than half of general practitioners (56%), just under half of specialists (47%) and one third (33%) of nurses in Australia were born overseas in 2011 (The Australia Bureau of Statistics, 2013). Nearly 20% of nurses born overseas and one fth of general practitioners and specialists (both 19%) had arrived in the preceding ve years. Their countries of origin have also changed, where once the United Kingdom (UK) overwhelmingly dominated as a source country, an increasing proportion of overseas born nurses and medical practitioners come from outside Europe.

In this new dynamic, the health system is transitioning from a command-and-control colonial institution to a responsive, agile and networked set of practices. Demands from consumers, carers, families and communities have required the health system to reorientate itself from being system-focused to be more patient and family centred. The changes in response to these demands are backed by evidence that doing so enhances effectiveness and quality. I served on the board of a large health organisation in New Zealand that emphasised the idea of the Triple Aim – enhancing patient experience, improving population health, and reducing costs – as a way of optimising health system performance. More recently, the three goals have been expanded to include a fourth aim to improve the work life of health care providers, as evidence shows that doing so also enhances the patient experience. This is particularly important as the toll a complex system exacts on the physical, emotional and mental health of workers is high, as seen in the levels of burnout.

Australia’s health system, like those of other settler societies, was based on a colonial model of care exported from the metropole to the colony. Hospitals are recognisable wherever you are in the world, and have been imposed over indigenous modes of healing and wellness in the interests of modernisation. This modern movement was informed by the imbrication of Western scienti c and industrial knowledge, focused on ef ciency and effectiveness. In this factory model, people are moved through the universal health system as standard units of personhood and treated similarly in order to reach an identical outcome that assumed a homogeneous monoculture.

In Victoria today, the most culturally diverse state in Australia, a quarter of our population were born overseas, originate from more than 230 countries, speak over 200 languages and follow more than 135 different faiths. The shift to patient-centredness in this context requires a broader range of skills. Professionals from culturally and linguistically diverse (CALD) backgrounds bring new ways of seeing and doing health that allow those of us working in health care to expand who we imagine the ideal user of health care to be. They bring different ways of knowing that are assets and which can help innovate the health system. The health leaders pro led in the following pages bring commitments to equity and social justice, a wonderful range of life experiences, and innovative ways of providing health care. Their inspiring work creates opportunities for the health system to consider new and innovative ways of ensuring the needs of diverse people are met.

If you could have a superpower, what would it be?

Fearless speech or parrhesia.

Favourite food?

I have to say Goan food. It represents connection to my ancestral homeland, as well as to my family. It has sustained me through multiple migrations and immediately evokes comfort and nurturance.

What do you think is an important feminist issue in Australia at the moment?

The policies of detention and deterrence that are being invoked in the state management of asylum seekers

Why are you a member of AWGSA?

As a relative newcomer to Australia, I want to be involved in the inter-disciplinary conversations happening in feminist spaces. I attended the conference in Melbourne two years ago and made some great new friends. As a nurse socialised into a very gendered hierarchy, I have a unique contribution to makes as a feminist woman of colour, but I don’t want to be limited to conversations only within my discipline.

If you could have been at one historical event, which one would it have been?

Being a diasporic Goan I would have been interested in being at the liberation/Invasion of Goa by the Indian government.

Who are your academic/feminist heroes?

Octavia Butler (overcoming shyness, having self-belief and being committed to her writing), Audre Lorde (for living with illness, for her writing), Angela Davis (for her activism).

Where would you like to live?
Exactly where I live now, South Gippsland.

What do you appreciate most about your friends?

I’d have to say conversations that are energising, learning, rich and which mean that the friendship continues to deepen and has potential for depth and transformation.

Favourite book?

Too many to count but I’ve just been reading Jhumpa Lahiri’s short stories and am awed by her ability to draw you into her character’s worlds. Another favourite was Americanah by the Nigerian author Chimamanda Ngozi Adichie.

A goal?

To learn more about the Aboriginal history of Australia and Aboriginal feminists. Not in an appropriative way but to be a better ally.

On 15 February 2016, I spoke on 612 ABC Brisbane Afternoons with Kelly Higgins-Devine about cultural appropriation and privilege. Our discussion was followed by discussion with guests: Andie Fox – a feminist and writer; Carol Vale a Dunghutti woman; and Indigenous artist, Tony Albert. I’ve used the questions asked during the interview as a base for this blog with thanks to Amanda Dell (producer).

Why has it taken so long for the debate to escape academia to be something we see in the opinion pages of publications now?

Social media and online activism have catapulted questions about identities and politics into our screen lives. Where television allowed us to switch the channel, or the topic skilfully changed at awkward moments in work or family conversations, our devices hold us captive. Simply scrolling through our social media feeds can encourage, enrage or mobilise us into fury or despair. Whether we like it or not, as users of social media we are being interpolated into the complex terrain of identity politics. Merely sharing a link on your social media feed locates you and your politics, in ways that you might never reveal in real time social conversations. ‘Sharing’ can have wide ranging consequences, a casual tweet before a flight resulted in Justine Sacco moving from witty interlocutor to pariah in a matter of hours. The merging of ‘private’ and public lives never being more evident.

How long has the term privilege been around?

The concept of privilege originally developed in relation to analyses of race and gender but has expanded to include social class, ability level, sexuality and other aspects of identity. Interestingly, Jon Greenberg points out that although people of color have fought racism since its inception, the best known White Privilege educators are white (Peggy McIntosh, Tim Wise and Robin DiAngelo). McIntosh’s 1988 paper White Privilege and Male Privilege: A Personal Account of Coming to See Correspondences through Work in Women’s Studies extended a feminist analysis of patriarchal oppression of women to that of people of color in the United States. This was later shortened into the essay White Privilege: Unpacking the Invisible Knapsack (pdf), which has been used extensively in a a range of settings because of it’s helpful list format .

Many people have really strong reactions to these concepts – why is that?

Robin DiAngelo, professor of multicultural education and author of What Does it Mean to Be White? Developing White Racial Literacy developed the term ‘white fragility’ to identify:

a state in which even a minimum amount of racial stress becomes intolerable, triggering a range of defensive moves. These moves include outward display of emotions such as anger, fear and guilt, and behaviors such as argumentation, silence and leaving the stress-inducing situation

DiAngelo suggests that for white people, racism or oppression are viewed as something that bad or immoral people do. The racist is the person who is verbally abusive toward people of color on public transport, or a former racist state like apartheid South Africa. If you see yourself as a ‘good’ person then it is painful to be ‘called out’, and see yourself as a bad person. Iris Marion Young’s work useful. She conceptualises oppression in the Foucauldian sense as:

the disadvantage and injustice some people suffer not because of a tyrannical power coerces them but because of the everyday practices of a well-intentioned liberal society…

Young points out the actions of many people going about their daily lives contribute to the maintenance and reproduction of oppression, even as few would view themselves as agents of oppression. We cannot avoid oppression, as it is structural and woven throughout the system, rather than reflecting a few people’s choices or policies. Its causes are embedded in the unquestioned norms, habits, symbols and assumptions underlying institutional rules and the collective consequences of following those rules (Young, 1990). Seeing oppression as the practices of a well intentioned liberal society removes the focus from individual acts that might repress the actions of others to acknowledging that “powerful norms and hierarchies of both privilege and injustice are built into our everyday practices” (Henderson & Waterstone, 2008, p.52). These hierarchies call for structural rather than individual remedies.

We probably need to start with privilege – what does that term mean?

McIntosh identified how she had obtained unearned privileges in society just by being White and defined white privilege as:

an invisible package of unearned assets which I can count on cashing in each day, but about which I am meant to remain oblivious (p. 1).

Her essay prompted understanding of how one’s success is largely attributable to one’s arbitrarily assigned social location in society, rather than the outcome of individual effort.

“I got myself where I am today. Honestly, it’s not that hard. I think some people are just afraid of a little hard work and standing on their own two feet, on a seashell, on a dolphin, on a nymph-queen that are all holding them up.”

“I got myself where I am today. Honestly, it’s not that hard. I think some people are just afraid of a little hard work and standing on their own two feet, on a seashell, on a dolphin, on a nymph-queen that are all holding them up.”

From: The Birth of Venus: Pulling Yourself Out Of The Sea By Your Own Bootstraps by Mallory Ortberg 

McIntosh suggested that white people benefit from historical and contemporary forms of racism (the inequitable distribution and exercise of power among ethnic groups) and that these discriminate or disadvantage people of color.

How does privilege relate to racism, sexism? Are they the same thing?

It’s useful to view the ‘isms’ in the context of institutional power, a point illustrated by Sian Ferguson:

In a patriarchal society, women do not have institutional power (at least, not based on their gender). In a white supremacist society, people of color don’t have race-based institutional power.

Australian race scholars Paradies and Williams (2008) note that:

The phenomenon of oppression is also intrinsically linked to that of privilege. In addition to disadvantaging minority racial groups in society, racism also results in groups (such as Whites) being privileged and accruing social power. (6)

Consequently, health and social disparities evident in white settler societies such as New Zealand and Australia (also this post about Closing the gap) are individualised or culturalised rather than contextualised historically or socio-economically. Without context  white people are socialized to remain oblivious to their unearned advantages and view them as earned through merit. Increasingly the term privilege is being used outside of social justice settings to the arts. In a critique of the Hottest 100 list in Australia Erin Riley points out that the dominance of straight, white male voices which crowds out women, Indigenous Australians, immigrants and people of diverse sexual and gender identities. These groups are marginalised and the centrality of white men maintained, reducing the opportunity for empathy towards people with other experiences.

Do we all have some sort of privilege?

Yes, depending on the context. The concept of intersectionality by Kimberlé Crenshaw is useful, it suggests that people can be privileged in some ways and not others. For example as a migrant and a woman of color I experience certain disadvantages but as a middle class cis-gendered, able-bodied woman with a PhD and without an accent (only a Kiwi one which is indulged) I experience other advantages that ease my passage through the world You can read more in the essay Explaining White Privilege to a Broke White Person.

How does an awareness of privilege change the way a society works?

Dogs and Lizards: A Parable of Privilege by Sindelókë is a helpful way of trying to understand how easy it is not to see your own privilege and be blind to others’ disadvantages. You might have also seen or heard the phrase ‘check your privilege’ which is a way of asking someone to think about their own privilege and how they might monitor it in a social setting. Exposing color blindness and challenging the assumption of race-neutrality is one mechanism for addressing the issue of privilege and its obverse oppression.  Increasingly in health and social care, emphasis is being placed on critiquing how our own positions contribute to inequality (see my chapter on cultural safety), and developing ethical and moral commitments to addressing racism so that equality and justice can be made possible. As Christine Emba notes “There’s no way to level the playing field unless we first can all see how uneven it is.” One of the ways this can be done is through experiencing exercises like the Privilege Walk which you can watch on video. Jenn Sutherland-Miller in Medium reflects on her experience of it and proposes that:

Instead of privilege being the thing that gives me a leg up, it becomes the thing I use to give others a leg up. Privilege becomes a way create equality and inclusion, to right old wrongs, to demand justice on a daily basis and to create the dialogue that will grow our society forward.

Is privilege something we can change?

If we move beyond guilt and paralysis we can use our privilege to build solidarity and challenge oppression.  Audra Williams points out that a genuine display of solidarity can require making a personal sacrifice. Citing the example of Aziz Ansari’s Master of None, where in challenging the director of a commercial about the lack of women with speaking roles, he ends up not being in the commercial at all when it is re-written with speaking roles for women. Ultimately privilege does not gets undone through “confession” but through collective work to dismantle oppressive systems as Andrea Smith writes.

Cultural appropriation is a different concept, but an understanding of privilege is important, what is cultural appropriation?

Cultural appropriation is when somebody adopts aspects of a culture that is not their own (Nadra Kareem Little). Usually it is a charge levelled at people from the dominant culture to signal power dynamic, where elements have been taken from a culture of people who have been systematically oppressed by the dominant group. Most critics of the concept are white (see white fragility). Kimberly Chabot Davis proposes that white co-optation or cultural consumption and commodification, can be cross-cultural encounters that can foster empathy and lead to working against privilege among white people. However, an Australian example of bringing diverse people together through appropriation backfired, when the term walkabout was used for a psychedelic dance party. Using a deeply significant word for initiation rites, for a dance party was seen as disrespectful. The bewildered organiser was accused via social media of cultural appropriation and changed the name to Lets Go Walkaround. So, I think that it is always important to ask permission and talk to people from that culture first rather than assuming it is okay to use.

What is the line between cultural appropriation and cultural appreciation?

Maisha Z. Johnson cultural appreciation  or exchange  where mutual sharing is involved.

Can someone from a less privileged culture appropriate from the more privileged culture?

No, marginalized people often have to adopt elements of the dominant culture in order to survive conditions that make life more of a struggle if they don’t.

Does an object or symbol have to have some religious or special cultural significance to be appropriated? 

Appropriation is harmful for a number of reasons including making things ‘cool’ for White people that would be denigrated in People of Color. For example Fatima Farha observes that when Hindu women in the United States wear the bindi, they are often made fun of, or seen as traditional or backward but when someone from the dominant culture wears such items they are called exotic and beautiful. The critique of appropriation extends from clothing to events Nadya Agrawal critiques The Color Run™ where you can:

run with your friends, come together as a community, get showered in colored powder and not have to deal with all that annoying culture that would come if you went to a Holi celebration. There are no prayers for spring or messages of rejuvenation before these runs. You won’t have to drink chai or try Indian food afterward. There is absolutely no way you’ll have to even think about the ancient traditions and culture this brand new craze is derived from. Come uncultured, leave uncultured, that’s the Color Run, promise.

The race ends with something called a “Color Festival” but does not acknowledge Holi. This white-washing (pun intended) eradicates everything Indian from the run including  Holi, Krishna and spring. In essence as Ijeoma Oluo points out cultural appropriation is a symptom, not the cause, of an oppressive and exploitative world order which involves stealing the work of those less privileged. Really valuing people involves valuing their culture and taking the time to acknowledge its historical and social context. Valuing isn’t just appreciation but also considering whether the appropriation of intellectual property results in economic benefits for the people who created it. Kareem Abdul-Jabbar suggests that it is often one way:

One very legitimate point is economic. In general, when blacks create something that is later adopted by white culture, white people tend to make a lot more money from it… It feels an awful lot like slavery to have others profit from your efforts.

 

Loving burritos doesn’t make someone less racist against Latinos. Lusting after Bo Derek in 10 doesn’t make anyone appreciate black culture more… Appreciating an individual item from a culture doesn’t translate into accepting the whole people. While high-priced cornrows on a white celebrity on the red carper at the Oscars is chic, those same cornrows on the little black girl in Watts, Los Angeles, are a symbol of her ghetto lifestyle. A white person looking black gets a fashion spread in a glossy magazine; a black person wearing the same thing gets pulled over by the police. One can understand the frustration.

The appropriative process is also selective, as Greg Tate observes in Everything but the burden, where African American cultural properties including music, food, fashion, hairstyles, dances are sold as American to the rest of the world but with the black presence erased from it. The only thing not stolen is the burden of the denial of human rights and economic opportunity. Appropriation can be ambivalent, as seen in the desire to simultaneously possess and erase black culture. However, in the case of the appropriation of the indigenous in the United States, Andrea Smith declares (somewhat ironically), that the desire to be “Indian” often precludes struggles against genocide, or demands for treaty rights. It does not require being accountable to Indian communities, who might demand an end to the appropriation of spiritual practices.

Go West – Black: Random Coachella attendee, 2014. Red: Bison skull pile, South Dakota, 1870’s.

Go West – Black: Random Coachella attendee, 2014. Red: Bison skull pile, South Dakota, 1870’s by Roger Peet.

Some people believe the cuisines of other cultures have been appropriated – is this an extreme example, or is it something we should consider?

The world of food can be such a potent site of transformation for social justice. I am a committed foodie (“somebody with a strong interest in learning about and eating good food who is not directly employed in the food industry” (Johnston and Baumann, 2010: 61). I am also interested in the politics of food. I live in Melbourne, where food culture has been made vibrant by the waves of migrants who have put pressure on public institutions, to expand and diversify their gastronomic offerings for a wider range of people. However, our consumption can naturalise and make invisible colonial and racialised relations. Thus the violent histories of invasion and starvation by the first white settlers, the convicts whose theft of food had them sent to Australia and absorbed into the cruel colonial project of poisoning, starving and rationing indigenous people remain hidden from view. So although we might love the food we might not care about the cooks at all as Rhoda Roberts Director of the Aboriginal Dreaming festival observed in Elspeth Probyn’s excellent book Carnal Appetites:

In Australia, food and culinary delights are always accepted before the differences and backgrounds of the origin of the aroma are.

Lee’s Ghee is an interesting example of appropriation, she developed an ‘artisanal’ ghee product, something that has been made for centuries in South Asia.

Lee Dares was taking the fashion world by storm working as a model in New York when she realized her real passion was elsewhere. So, she made the courageous decision to quit her glamorous job and take some time to explore what she really wanted to do with her life. Her revelation came after she spent some time learning to make clarified butter, or ghee, on a farm in Northern India. Inspired, she turned to Futurpreneur Canada to help her start her own business, Lee’s Ghee, producing unique and modern flavours of this traditional staple of Southeast Asian cuisine and Ayurvedic medicine.

The saying “We are what we eat” is about not only the nutrients we consume but also to beliefs about our morality. Similarly ‘we’ are also what we don’t eat, so our food practices mark us out as belonging or not belonging to a group.So, food has an exclusionary and inclusionary role with affective consequences that range from curiosity, delight to disgust. For the migrant for example, identity cannot be taken for granted, it must be worked at to be nurtured and maintained. It becomes an active, performative and processual project enacted through consumption. With with every taste, an imagined diasporic group identity is produced, maintained and reinforced. Food preparation represents continuity through the techniques and equipment that are used which affirm family life, and in sharing this food hospitality, love, generosity and appreciation can be expresssed. However, the food that is a salve for the dislocated, lonely, isolated migrant also sets her apart, making her stand out as visibly, gustatorily or olfactorily different. The resource for her well being also marks her as different and a risk. If her food is seen as smelly, distasteful, foreign, violent or abnormal, these characteristics can be transposed to her body and to those bodies that resemble her. Dares attempt to reproduce food that is made in many households and available for sale in many ‘ethnic’ shops and selling it as artisanal, led to accusations of ‘colombusing’ — a term used to describe when white people  claim they have discovered or made something that has a long history in another culture. Also see the critique by Navneet Alang in Hazlitt:

The ethnic—the collective traditions and practices of the world’s majority—thus works as an undiscovered country, full of resources to be mined. Rather than sugar or coffee or oil, however, the ore of the ethnic is raw material for performance and self-definition: refine this rough, crude tradition, bottle it in pretty jars, and display both it and yourself as ideals of contemporary cosmopolitanism. But each act of cultural appropriation, in which some facet of a non-Western culture is columbused, accepted into the mainstream, and commodified, reasserts the white and Western as norm—the end of a timeline toward which the whole world is moving.

If this is the first time someone has heard these concepts, and they’re feeling confused, or a bit defensive, what can they do to understand more about it?

Here are some resources that might help, videos, illustrations, reading and more.

White privilege

Cultural appropriation

This is a longer version of a review of Damien Riggs & Clare Bartholomaeus’ paper published in the Journal of Research in Nursing: Australian mental health nurses and transgender clients: Attitudes and knowledge. Cite as: De Souza, R. (2016). Review: Australian mental health nurses and transgender clients: Attitudes and knowledge. Journal of Research in Nursing, 0(0) 1–2. DOI: 10.1177/1744987115625008

I have never forgotten her face, her body, even though more than twenty years have passed. She was not much older than me and she desperately wanted to be a he. I had no idea how to respond to her depression and her recent self-harm attempt in the context of her desire to change gender. There was nothing in my nursing education that had prepared me for how I might be therapeutic and there was no one and nothing in the acute psychiatric inpatient unit that could resource me. I feel embarrassed now that I had no professional understanding and experience to guide me to help me provide effective mental health care to my client. I was an empathic kind listener, but I had been immersed in a biologically deterministic (one’s sex at birth determines ones’ gender) and binary view of gender despite my own diverse cultural background which I had been socialized to see as separate from my mainly white nursing education. I had not been educated to critically consider discourses of sex and gender, to provide competent safe care to someone who wanted to change her gender and express her gender differently from normative gender categories (Merryfeather & Bruce, 2014). My work has since led me to consider the ways in which “differences” are produced culturally, politically, and epistemologically specifically in terms of categories including “race”, ethnicity, nationality, class, and more recently sexuality and gender.

Four critiques of biomedicine as a dominant framework for understanding ‘problems with living’ have inspired transformation of the mental health system. Firstly, the emphasis on participation and inclusion through consumer-led and recovery-oriented practice has profoundly changed the role of consumers from passive recipients of care to being more informed and empowered decision-makers whose lay knowledge and personal experience of mental illness are a resource (McCann and Sharek, 2014). This reconceptualisation has been formalised in the ‘recovery’ model, which has critiqued the stigmatising judgements of medico-psychiatric discourse about deviance and their accompanying social exclusion and disadvantage (Masterson and Owen, 2006). The third has been the recognition of cultural diversity and a critique of the limits of universalism. Finally, gender activism has exposed fractures in the sex/gender system and has led to a greater awareness of diversity, with regard to gender and sexual orientation.

Of these critiques, gender activism has received the least attention in mental health nursing; which is a concern, given the negative effects of heteronormativity and cisgenderism. Mental health nurses must continue to challenge or trouble the dominant binary views of gender and the discourse of biological determinism, the notion that the sex that one is assigned at birth determines ones’ gender (Merryfeather and Bruce, 2014). There is growing evidence of negative attitudes, a lack of knowledge, and a lack of sensitivity toward people whom are expressing diverse genders and sexualities. This discrimination creates barriers to the patients’ health gain and creates disparity (Chapman et al., 2012; McCann and Sharek, 2014).

The reviewed article on the attitudes of mental health nurses towards transgender people is therefore timely, given the relative invisibility of issues of gender identity within nursing theory, practice and research. As Fish (2010) wrote previously in this journal, the culture, norms and values of social institutions can inhibit access to healthcare and reinforce disparities in health outcomes. Cisgenderism (the alignment of one’s assigned sex at birth and one’s gender identity and gender expression with societal expectations) suffuses every aspect of clinical access to and through services, from written materials including mission statements, forms, posters and pamphlets; the built environment such as gender-specific washrooms; and interactions with both health professionals and allied staff, all of which reinforce a message of exclusion of transgender people (Baker and Beagan, 2014; Rager Zuzelo, 2014). In turn, these exclusionary practices are shaped through a dearth of policies and procedures, and scant educational preparation at the undergraduate and graduate levels (Eliason et al., 2010; Fish, 2010).

Nurses have a professional responsibility to challenge structural constraints and social policies, rather than passively accepting them. This paper provided compelling evidence for how nursing as a discipline and mental health nursing as a unique speciality can critically reflect on discourses regarding sex and gender; and on how these influence practice and consequently, can develop safer, ethical, effective and high-quality care for people whom either change their sex or express their gender differently from the standard culturally determined gender categories (Merryfeather and Bruce, 2014). Furthermore, this paper challenges mental health nurses to challenge heterosexism and cisgenderism; to speak out about social determinants of health that contribute to health inequities and health disparities, such as transphobia; and to address discrimination against transgender people. These challenges must be embedded into processes at the organizational, regulatory and political level (DeSouza, 2015).

References
Baker K and Beagan B (2014) Making assumptions, making space: An anthropological critique of cultural competency and its relevance to queer patients. Medical Anthropology Quarterly 28(4): 578–598. doi:10.1111/maq.1212.
Chapman R, Watkins R, Zappia T, et al. (2012) Nursing and medical students’ attitude, knowledge and beliefs regarding lesbian, gay, bisexual and transgender parents seeking health care for their children. Journal of Clinical Nursing 21(7,8): 938–945. doi:10.1111/j.1365-2702.2011.03892.
De Souza R (2015) Navigating the ethics in cultural safety. In: Wepa D (ed.) Cultural safety. Port Melbourne, Australia: Cambridge University Press, pp. 111–124.
Eliason MJ, Dibble S and Dejoseph J (2010) Nursing’s silence on lesbian, gay, bisexual and transgender issues: The need for emancipatory efforts. Advances in Nursing Science 33(3): 206–218. doi:10.1097/ANS.0b013e3181e63e4.
McCann E and Sharek D (2014) Challenges to and opportunities for improving mental health services for lesbian, gay, bisexual and transgender people in Ireland: A narrative account. International Journal of Mental Health Nursing 23(6): 525–533. doi:10.1111/inm.12081.
Masterson S and Owen S (2006) Mental health service user’s social and individual empowerment: Using theories of power to elucidate far-reaching strategies. Journal of Mental Health 15(1): 19–34. doi:10.1080/0963823050051271.
Merryfeather L and Bruce A (2014) The invisibility of gender diversity: Understanding transgender and transsexuality in nursing literature. Nursing forum 49(2): 110–123.
Rager Zuzelo P (2014) Improving nursing care for lesbian, bisexual and transgender women. Journal of Obstetric, Gynecologic and Neonatal Nursing 43(4): 520–530. doi:10.1111/1552-6909.1247.

December 18th marks the anniversary of the signing of the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families by the United Nations in 1990. Lobbying from Filipino and other Asian migrant organisations in 1997, led to December18th being promoted as an International Day of Solidarity with Migrants. The day recognises the contributions of migrants to both the economies of their receiving and home countries, and promotes respect for their human rights. However, as of 2015, the Convention has only been signed by a quarter of UN member states.

2015 has seen the unprecedented displacement of people globally with tragic consequences. UNHCR’s annual Global Trends report shows a massive increase in the number of people forced to flee their homes. 59.5 million people were forcibly displaced at the end of 2014 compared to 51.2 million a year earlier and 37.5 million a decade ago.

Politicians and media have a pivotal role in agenda setting and shaping public opinion around migrants, refugees and asylum seekers. A 100-page report, Moving Stories, released for International Migrants Day reviews media coverage of migration across the European Union and 14 countries across the world. The report acknowledges the vulnerability of refugees and migrants and the propensity for them to be politically scapegoated for society’s ills and has five key recommendations, briefly (p.8):

  1. Ethical context: that the following five core principles of journalism are adhered to:
    accuracy, independence, impartiality, humanity and accountability;
  2. Newsroom practice: have diversity in the newsroom, journalists with specialist knowledge, provide detailed information on the background of migrants and refugees and the consequences of migration;
  3. Engage with communities: Refugee groups, activists and NGOs can be briefed
    on how best to communicate with journalists;
  4. Challenge hate speech.
  5. Demand access to information: When access to information is restricted, media and civil society groups should press the national and international governments to be more transparent.

Much remains to be done, but it is heartening to see Canadian Prime Minister Justin Trudeau’s response to the arrival of thousands of Syrian refugees: 

You are home…Welcome home…

Tonight they step off the plane as refugees, but they walk out of this terminal as permanent residents of Canada. With social insurance numbers. With health cards and with an opportunity to become full Canadians

Trudeau’s response sharply contrasts with that of the United States, where many politicians have responded to Islamophobic constituencies with restrictions or bans on receiving refugees. The welcome from Indigenous Canadians to newly arrived refugees has also been generous and inclusive, considering that refugees and migrants are implicated in the ongoing colonial practices of the state. These practices can maintain Indigenous disadvantage while economic, social and political advantage accrue to settlers. It is encouraging that Trudeau’s welcome coincided with an acknowledgement of the multiple harms Canada has imposed on Indigenous people since colonisation. 

Alarmingly, the center-right Danish government’s bill currently before the Danish Parliament on asylum policy, allows for immigration authorities to seize jewellery and other valuables from refugees in order to recoup costs. The capacity to remove personal valuables from people seeking sanctuary is expected to be effective from February 2016 and has a chilling precedent in Europe, as Dylan Matthews notes in Vox:

Denmark was occupied by Nazi Germany for five years, from 1940 to 1945, during which time Germany confiscated assets from Jewish Danes, just as it did to Jews across Europe. Danish Jews saw less seized than most nations under Nazi occupation; the Danish government successfully prevented most confiscations until 1943, and Danes who survived the concentration camps generally returned to find their homes as they had left them, as their neighbors prevented Nazis from looting them too thoroughly. But Nazi confiscations still loom large in European historical memory more generally.

The UN, the Parliamentary Assembly of the Council of Europe (PACE) and the International Organization for Migration (IOM) have advocated for the development of regional and longer term responses. Statements echoed by Ban Ki-moon which proposed better cooperation and responsibility sharing between countries and the upholding of the human rights of migrants regardless of their status (Australia take note). He proposes that we:

must expand safe channels for regular migration, including for family reunification, labour mobility at all skill levels, greater resettlement opportunities, and education opportunities for children and adults.

On International Migrants Day, let us commit to coherent, comprehensive and human-rights-based responses guided by international law and standards and a shared resolve to leave no one behind.

What does this all mean for Australia and New Zealand? I’ve written elsewhere about the contradiction between the consumptive celebrations of multiculturalism and the increasing brutality and punitiveness of policies in both countries; the concerns of Australia’s key professional nursing and midwifery bodies about the secrecy provisions in the Australian Border Force Act 2015 and the ways in which New Zealand is emulating a punitive and dehumanising Australian asylum seeker policy.

It is appropriate then in this season of goodwill and peace to write an updated Christmas wish list, but with a migration focus. As a child growing up in Nairobi, one of my pleasures around Christmas time was drawing up such a list. I was so captivated with this activity that I used to drag our Hindu landlord’s children into it. This was kind of unfair as I don’t think they received any of the gifts on their list. For those who aren’t in the know, a wish list is a list of goods or services that are wanted and then distributed to family and friends, so that they know what to purchase for the would-be recipient. The idea of a list is somewhat manipulative as it is designed around the desires of the recipient rather than the financial and emotional capacity of the giver. Now that I’ve grown up a little, I’ve eschewed the consumptive, labour exploitative, commercial and land-filling aspects of Christmas in favour of spending time with family, as George Monbiot notes in his essay The Gift of Death:

They seem amusing on the first day of Christmas, daft on the second, embarrassing on the third. By the twelfth they’re in landfill. For thirty seconds of dubious entertainment, or a hedonic stimulus that lasts no longer than a nicotine hit, we commission the use of materials whose impacts will ramify for generations.

So, this list focuses on International Day of Solidarity with Migrants. All I want for Christmas is that ‘we’:

  1. End the Australian Government policy of turning back people seeking asylum by boat ie “unauthorised maritime arrivals”. 
  2. Stop punishing the courageous and legitimate right to seek asylum with the uniquely cruel policy of mandatory indefinite detention and offshore processing. Mandatory detention must end. It is highly distressing and has long-term consequences.
  3. Remove children and adolescents from mandatory detention. Children, make up half of all asylum seekers in the industrialized world. Australia, The United States, the United Kingdom, Germany and Italy directly contradict The Convention on the Rights of the Child (UNCRC).
  4. Engage in regional co-operation to effectively and efficiently process refugee claims and provide safe interim places. Ensure solutions that uphold people’s human rights and dignity, see this piece about the Calais “Jungle”.
  5. End the use of asylum-seeker, refugee and migrant bodies for political gain.
  6. Demand more ethical reporting by having news media: appoint specialist migration reporters; improve training of journalists on migration issues and problems of hate-speech; create better links with migrant and refugee groups; and employ journalists from ethnic minority communities, see Moving Stories.
  7. Follow the money. Is our money enabling corporate complicity in detention? Support divestment campaigns, see X Border Operational matters. Support pledges that challenge the outsourcing of misery for example No Business in Abuse (NBIA) who have partnered with GetUp.
  8. Support the many actions by Indigenous peoples to welcome refugees. Indigenous demands for sovereignty and migrant inclusion are both characterised as threats to social cohesion in settler-colonial societies.
  9. Challenge further racial injustice through social and economic exclusion and violence that often face people from migrantnd refugee backgrounds.
  10. Ask ourselves these questions:‘What are my borders?’ ‘Who do I/my community exile?’ ’How and where does my body act as a border?’ and ‘What kind of borders exist in my spaces?’ The questions are from a wonderful piece by Farzana Khan.
Seppo Leinonen, a cartoonist and illustrator from Finland

Seppo Leinonen, a cartoonist and illustrator from Finland

This was first published in the Spring 2015 edition (Issue 41) of the Federation of Ethnic Councils of Australia (FECCA) national magazine, Australian Mosaic. Cite as: DeSouza, R. (2015). Medical pluralism: Supporting co-existing diverse therapeutic traditions in mental health. Australian Mosaic (FECCA). 41, 34-36.

Decades afterward, I still recall the frequent waking, getting out of bed and moving around our Nairobi house in the dark. Sometimes I moved pots and pans, re-arranged furniture, but mostly I caused a disturbance. My parents decided to address my distressing behaviour by taking me to an older woman from our Goan community who chanted
prayers and anointed me with chilli and garlic. Her incantations arrested the nocturnal disturbances, which never perturbed me again. The evil eye was diagnosed, the somnambulism caused by envy, inflicted on me with a look. I later learned that the
evil eye is seen as the cause of many problems and illnesses globally with a multitude of rituals and remedies to either prevent or cure it.

Charm- Niall Corbet on Flickr

My own experience of being a multiple migrant and then a clinician, led me to consider many possible antecedents to mental illness. The dominance of biomedicine to manage health and illness, assumes cross-cultural universals. Yet, mental health is a contested specialty with problematic treatments. Culturally derived norms and values from a specific location impose labels on behaviour from another context, which drive treatments, or management that flattens those contexts. Psychiatry and counseling are often viewed skeptically by people from refugee and migrant backgrounds who instead turn first to informal sources outside the health system including self-help, family, community, social networks, various forms of spirituality, religion and church. Increasingly, clinicians are appreciating the part these sources of support play.

Once mental health services are accessed, if staff focus on mental illness without understanding the cultural context or without realising that clients and their families might integrate both biomedical and more “traditional” beliefs, quality psychiatric assessment can be impaired and the potential for inaccurate diagnosis and inappropriate treatment and care can occur. Incorrectly identifying culturally appropriate behaviour or experiences as psychopathology is problematic, just as assuming that something is cultural rather than psychopathology or symptoms. However, every culture has frameworks for understanding health and illness and how these are demarcated.

In Aotearoa New Zealand, where I have spent most of my life, Maori psychiatrist Mason Durie has conceptualised Maori health as encompassing mental (hinengaro), physical (tinana), family/social (whänau), and spiritual (wairua) dimensions. In Australia, the National Aboriginal Health Strategy (1989) views wellbeing through a communal lens, broadening the concept of well-being beyond the to the social, emotional and cultural well-being of the whole community. Situating Aboriginal and Torres Strait Islander mental health within a framework of social and emotional wellbeing emphasise wellness, harmony and balance rather than illness and symptom reduction (AIHW 2012). Connection to land, culture, spirituality, ancestry, family and community, interdependence between families, communities, land, sea and spirit are also seen as necessary for health. The Ways Forward National Aboriginal and Islander Mental Health Policy Report 3 (pp19-20) adapted from Swan and Raphael also prioritises holism, self-determination, the need for cultural understanding, the impact of history in trauma and loss, human rights, acknowledges the impact of racism and stigma, kinship, cultural diversity and Aboriginal strengths.

Contemporary neoliberal health discourses have co-opted patient rights movements and positioned patients as consumers ­­-active partners in health who are responsible for their own health. Consumer engagement and health literacy form a suite of strategies for inducing medical citizenship, so that individuals can participate and become knowledgeable consumers. Some would argue these are assimilatory processes. However, in order for medical citizenship to be a two way process, one’s own beliefs about the causes of illness and the corresponding treatments must also be considered. Health literate organisations must also be open to a multiplicity of illness explanations and to those locations from which such beliefs are derived. As Beijers and de Freitas (p.245), note:

Health care is transforming social suffering into illnesses and diagnoses, while often denying the social and moral origins and implications of the suffering

David Ingleby suggests that two perspectives are available for thinking about culture and mental illness. A technical perspective assumes mainstream frameworks and treatments can be universalised to all patients/clients and that more sensitivity and overcoming linguistic and cultural barriers will assist therapeutic efforts. With a technical approach to mental health, the goal of care is to deliver it efficiently and increase utilization (efficacy). Strategies can include access to language matched information and professional interpreting services, or improving mental health literacy and awareness, supporting community resilience and coping strategies. However, technical approaches do not ask questions about power imbalances between groups.

On the other hand when care is given through a critical lens (equity), the questions become what is going on when interventions developed for one population are applied to another? What are the underlying power relations? Whose interests are being served? Is there a covert attempt to impose the values and perspectives of the dominant group? Ingelby suggests that becoming a user of Western health care involves accepting its underlying philosophy and values and “acquiring health literacy”.

It is important that collaborations between traditional healing mechanisms and western practice are made possible, however within professional discourses traditional healing is frequently viewed as primitive and unprofessional, yet people often utilize different health beliefs simultaneously in their search for optimal treatment. Furthermore, assimilation and acculturation into the dominant culture are thought to negatively impact on migrant health status and to contribute to migrant ill health and disparities as the healthy migrant advantage that people arrive with reduces after a year. Developing collaborative models that combine traditional and Western health knowledges and combining health literacy and consumer participation with better access and quality of staff can indeed facilitate better health outcomes.

As an educator, I am interested in how I can do my part to increase the awareness and openness to pluralism, so that the next generation of nurses can be effective and therapeutic. There is guidance available from The Cultural Diversity Plan for Victoria’s Specialist Mental Health Services. There is an emphasis on being respectful and having non-judgmental curiosity about other cultures. Mental health workers are encouraged to seek cultural knowledge in an appropriate way, tolerate ambiguity and develop the ability to handle the stress of ambiguous situations. In addition, developing a family-sensitive practice, where family and community resources are viewed as partners in recovery as appropriate allow syncretism and innovation to take place. There are significant institutional barriers remaining to this in mental particularly the emphases on privacy, independence and the one-to-one relationship between consumer and professional.

600-Mangere Arts Centre Ext 1 sm (1)

I was honored to be invited to write a catalogue piece for an exhibition which opened during Mental Health Awareness Week 2015 at Mangere Arts Centre – Nga tohu o Uenuku and which closes on 22nd November. Lotus in Bloom is an exhibition of works by artist members of the Tufunga Arts Trust, whose visual arts programme enables artists living with mental illness to develop their art practice and the Trust supports artists by providing opportunities to exhibit their work.

Tufuga Arts Trust exhibition

Art makes visible experiences, hopes, ideas; it is a reflective space and socially it brings something new into the world—it contributes to knowledge and understanding. In so doing it is intrinsically political (O’Neill, 2008)

“Lotus in Bloom” an exhibition at Mangere Arts Centre of 80 works by thirty artists with experience of mental ill health makes visible their experiences and hopes, while simultaneously bringing new knowledge and understanding to the broader community. Tufuga – Creative hands, mind and spirit is a charitable trust that supports people with experience of mental ill health to lead their own recovery. Set up in May 2004 in Counties Manukau, South Auckland it aims to “enable access to art and creative experiences in an environment that nurtures cultural well-being”. In using arts as a medium, people with experience of mental ill health are supported to engage in creative expression and meaningful activity, countering experiences of social exclusion. Lasting impact was the second exhibition of their artwork.

The notion of recovery permeates contemporary mental health services inspiring a transition from symptom amelioration to supporting people experiencing mental ill health to ‘live well’ on their own terms. Recovery approaches and mental health promotion challenge the confining language of psychiatric symptomatology and endemic “therapeutic pessimism” in biomedical models, which contribute to stigma and discrimination and compound social exclusion. Mental health promotion refers to:

the process of enhancing the capacity of individuals and communities to take control over their lives and improve their mental health. Mental health promotion uses strategies that foster supportive environments while showing respect for culture, equity, social justice and personal dignity. (Joubert and Raeburn, p.19).

Most powerfully, recovery approaches promote a philosophical shift from a medical model of mental illness to a social model. The possibility of recovery despite illness is invoked through offering hope and enabling self-determination, by resourcing people with experience of mental ill health to pursue their own goals. These philosophical changes in mental health care provision have instigated a shift in power relations, challenging mental health professionals, policy makers and service providers to consider the adequacy of expert knowledge and in doing so dismantling a hierarchy where expert driven practices are valued above client and family knowledge. The client’s lived experience of illness and their needs have become more central to the mental health support offered. However, these changes go beyond inclusion in the therapeutic encounter, requiring that communities support participation and inclusion. The Like Minds Like Mine social marketing programme in New Zealand is one example of a stigma countering initiative that has helped to both educate and build public support.

Photo by James Pinker

The arts hold promise for meeting inclusion and recovery agendas. Participation in community arts can further public health imperatives for reducing social and health inequalities and facilitating social inclusion by enhancing social capital. Having one’s experiences refracted through an asset and strengths based lens rather than as a dependent consumer of services, can help an artist with an experience of mental ill health to develop a more positive self-image. Being recognised as having an ability, whether as an artist or teacher can counter pathology and illness laden representations. The safety and mutual support in arts environments for the recovery journeys of participants can extend beyond feeling good to opening up opportunities for artists to generate income and work.

My sincere hope is that this exciting exhibition incites the broader community to support the aspirations of artists who experience mental ill health; to examine the ways in which “we” can make our world less disabling and in the process create worlds where we can all have lives that are worth living.

An edited quote from this essay printed on vinyl and exhibited on the wall of Mangere Arts Centre

An edited quote from this essay printed on vinyl and exhibited on the wall of Mangere Arts Centre. Photo by James Pinker.

References
Joubert, N. & Raeburn, J. (1998). Mental health promotion: People, power and passion. International Journal of Mental Health Promotion, 1 (1), 15–22.
O’Neill, Maggie (2008). Transnational Refugees: The Transformative Role of
Art? [53 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative
Social Research, 9(2), Art. 59, http://nbn- resolving.de/urn:nbn:de:0114-fqs0802590.
Stickley, T. (2008). Promoting mental health through an inner city community arts programme: A narrative inquiry. PhD diss, University of Nottingham, United Kingdom.

World Refugee Day in June acknowledges the courage, resilience and contributions of refugees. On this day, I acknowledge those caught in geopolitical situations that aren’t of their own making. I acknowledge those who risk life and limb for a better life. I acknowledge those who create new lives despite horror, profound loss and hardship. I acknowledge those who fight for a better world. I mourn for the loss of life, the loss of potential, the loss of innocence, the loss of family, the loss of dignity, hope, freedom. I burn fiercely with rage for those who dehumanise, destroy, lay waste to, ignore, collude and contribute to the reason people flee. For all those who have survived, I salute your courageous hearts and spirits, your resilience in the face of unspeakable atrocity. 

The many celebrations, performances, speeches representing individual and community acts of welcome in both New Zealand and Australia, disguise the increasing brutality and punitiveness of policies in both countries. Policy refers to “a course or principle of action adopted or proposed by a government, party, business or individual” (Australian Concise Oxford Dictionary). Policy not only references content, it points to the kinds of values and beliefs held in a society. Consider the passing of the second reading of the Immigration Amendment Bill by the New Zealand Parliament which will allow the imprisonment of asylum seekers arriving boat, following in Australia’s footsteps of penalising maritime arrivals. Consider the persecution of refugees who arrive by sea, the removal to offshore facilities of babies and children, the payment of “people smugglers” to “turn back the boats” in Australia. For health professionals the secrecy provisions in Section 42 of the Australian Border Force Act 2015 threaten jail for up to two years for professionals who disclose information about the conditions in immigration Detention Centres. These policies are often cited as grounds for moral superiority by New Zealand, but Australia has a larger refugee quota per capita than New Zealand does, which is more often being seen as “a heartless country and a bad global citizen” (see Dr Bryce Edwards excellent summation).

So what “we” are to do with these contradictory aspects of celebration and deterrence that are present in World Refugee Day? RISE: Refugees, Survivors and Ex-Detainees is the first and only refugee and asylum seeker welfare and advocacy organisation in Australia, entirely governed by refugees, asylum seekers, and ex-detainees. RISE have made a powerful statement for World Refugee Week:

The world has forcibly displaced over 57 million people, the highest number since World War II. Most of the displaced refugees are hosted by non-signatory refugee countries, yet most people who celebrate Refugee week are signatories of the refugee convention. There has been no coordinated effort to create more places for resettlement nor other long-term humanitarian solutions for refugees other than lucrative “border security” that feeds the military industrial and detention industrial complex at the expense of our lives. Presently, most refugee signatory countries are trying to block borders and decrease refugee intake, so what is left for us to celebrate here? The death and torture of refugees? Thus far, we have not witnessed safe passage for asylum seekers and refugees across borders.

Questioning the performance aspects of the many activities organised for this week and especially today, they state:

Basically we are remembered once a year as entertainers, visible once a year but voiceless and too incompetent to provide solutions to address our own community’s needs for the rest of the year.

UNHCR’s new annual Global Trends report shows a massive increase in the number of people forced to flee their homes. 59.5 million people were forcibly displaced at the end of 2014 compared to 51.2 million a year earlier and 37.5 million a decade ago. Over half the world’s refugees are children. How can those of us who are disturbed by the scale of displacement and trauma influence governments to influence policy? Murdoch Stevens’ work is a great example. He set up Doing Our Bit in New Zealand and has spearheaded a campaign since 2013 supported by the New Zealand Greens, World Vision, Amnesty International and the New Zealand Race Relations Commissioner Susan DeVoy asking for the New Zealand Refugee Quota to be doubled (you can sign a petition at Action Station). On Wednesday 17th June a private members bill was launched by Denise Roche of the Green Party to increase the refugee quota from 750 to 1000 places.

Tracey Barnett a journalist has responded to the backlash from calls to increase the quota in New Zealand by developing a series of one minute videos to counter misconceptions about refugees : Can New Zealand Get a Refugee Boat Arrival?Define a refugee, an asylum seeker and an economic migrant?Are boat arrivals really jumping the UN queue? :

As families risk their lives at sea rather than die in the war that has engulfed them, New Zealand has quietly just shrugged. It’s not our crisis. It’s so far away. We’re missing the boat entirely. We are every bit a part of the problem. New Zealand has very quietly closed the door to refugees from long-term neglect.

In Australia, The Royal Australasian College of Physicians (RACP) released a new Refugee and Asylum Seeker Health Policy and Position Statement which outlines the deleterious health impacts of detention and sets out the RACP’s Policy relating to Refugee and Asylum Seeker health. The Position Statement outlines four key aspects influencing health for people seeking asylum in Australia and New Zealand: an end to immigration detention, good access to health services in the community, rigorous health assessments, and promotion of long-term health in the community. There is also a video. The Australian College of Midwives, The Australian College of Mental Health Nurses and The Australian College of Nurses, Australia’s key professional nursing and midwifery bodies have expressed serious concern about the secrecy provisions in the Australian Border Force Act 2015, arguing that the threat of imprisonment for nurses or midwives that disclose any protected information acquired while working in immigration detention centres, places them at odds with obligations under the Australian Codes of Professional Conduct and Codes of Ethics:

This law actively prohibits nurses and midwives from fulfilling their duty under their respective Code of Professional Conduct and Code of Ethics which set the minimum standards for practice a nurse or midwife is expected to uphold. Under their respective Codes of Professional Conduct both nurses and midwives are required, where they have made a report of unlawful or otherwise unacceptable conduct to their employers and that report fails to produce an appropriate response from the employers, to take the matter to an appropriate external authority. However, restrictions imposed by the Australian Border Force Act prohibit nurses and midwives from doing so.

 

The nursing and midwifery bodies endorsing this statement are of the strong view that the Australian Border Force Act 2015 requires urgent amendments. These amendments must ensure that all health professionals and all contractors can advocate freely for best practice health care and against conditions or practices that are harmful to detainees’ health or that otherwise violate their human rights.
As organisations representing Australia’s nurses and midwives, we consider it inconceivable that the Government should seek to place us at odds with our obligations under the Australian Health Practitioner Regulation Agency when delivering health care to people in immigration detention. The Australian Border Force Act requires immediate amendment so nurses and midwives working in immigration detention centres can comply with their professional requirements.”

These examples highlight how activists, professionals and citizens can advocate and influence policy and politics. We can influence politics meaning discussions of how resources are allocated and we can influence policy meaning the distribution of resources. Furthermore, we can engage in politics in the context of how conflict is expressed in the public sphere with regard to values (Mason, Leavitt, Chaffee, 2014). Teanau Tuiono (Ngāpuhi, Ngāi Takoto, Atiu) advocates for Māori values of manaakitanga and whanaungatanga and a respect of Indigenous Peoples guide the criteria of who can stay. It would do us all well to remember which values are embedded in the actions of our political leaders and policy makers and whether these values reflect our own. As Rachel Smalley asks, what is more frightening?

There is nothing frightening about a refugee, nothing at all.  But there is everything to fear about an ignorant and xenophobic society which increasingly shuts the door on humanity

Leunig July 1 2015: 40 current and former workers at Australia’s detention centres on Nauru and Manus Island challenge Tony Abbott and Peter Dutton to prosecute them under new secrecy laws for speaking out over human rights abuses in this open letter.

 

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