Blog – Page 7 – ruthdesouza-dreamhosters

Australia, Cultural safety, Inequalities, Migration, Multiculturalism, Racism, Research, Writing

Knowledge and action, developing evidence for an equity agenda

Speech given at the launch of a partnership between Monash University and Centre for Culture, Ethnicity and Health (CEH) April 29th 2015 and the celebration of CEH’s 21st birthday.

I would like to show my respect and acknowledge the traditional custodians of this land on which this launch takes place, the Wurundjeri-willam people of the Kulin Nation, their elders past and present. I’d also like to acknowledge our special guests: The Honorable Robin Scott – Minister for Multicultural Affairs/Minister for Finance, Phillip Vlahogiannis the Mayor of the City of Yarra, Chris Atlis the Deputy Chair of North Richmond Community Health (NRCH), Councillor Misha Coleman and Baraka Emmy, Youth Ambassador for Multicultural Health and Support Services. I’d also like to acknowledge: Professor Wendy Cross; CEO of the Centre for Culture Ethnicity and Health (CEH) Demos Krouskos; General Manager of CEH Michal Morris, representatives from the Department of Health and Human Services and other government departments, healthcare service partners, clients, NRCH and CEH staff and community members.

It’s an honour to take up this joint appointment between the Centre for Culture Ethnicity and Health (CEH) and Monash School of Nursing and Midwifery, there are some wonderful synergies which allow both organisations to jointly advance a shared goal of equity and quality in health care for our communities, and in particular for people from refugee and migrant background communities. As most of you know, Victoria is the most culturally diverse state in Australia, with almost a quarter of our population born overseas. Victorians come from over 230 countries, speak over 200 languages and follow more than 135 different faiths. This role is an acknowledgement of this diversity, and the need for health and social services that are equitable, culturally responsive and evidence based.

The gap this role addresses

Monash takes its name from Sir John Monash: an Australian, well known for being both a scholar and a man of action. He is quoted as having said “…equip yourself for life, not solely for your own benefit but for the benefit of the whole community.” I am excited about the ways in which this new role can both strengthen CEH’s leadership and expertise in culture and health; and strengthen Monash’s position as a provider of dynamic and collaborative research-led education. In thinking about the world of the university and the world of practice, the words of Abu Bakr resonate: “Without knowledge, action is useless and knowledge without action is futile.”

What we have in common

I believe this relationship combines knowledge and action which will benefit both organisations and their staff, but even more importantly the communities that we are all here to serve. Key to this partnership success is the generous and collaborative spirit with which the leadership of both organisations have come together and which bodes well for the future. What we have in common as organisations is:

Firstly, a commitment to responsive clinical models of care that consider social determinants of health. In a world where health is increasingly industrialised and individualised, both Monash and CEH affirm the importance of communities in a healthy society
Secondly, both organisations aim to develop a health and social workforce that can work effectively and safely with our communities. CEH and NRCH know how to work with communities, having expertise in advocacy and community-building roles advocacy and community-building roles to contribute to healthier social and physical environments. Monash know how to educate and inspire practitioners to link their practical knowledge to the centuries of research and scholarship that universities are custodians of around the world.
Thirdly, the two organisations aim to keep clients and their families at the centre of care, to recognise that despite all our professional expertise it is the recipient of care who ultimately determines successful outcomes.
Fourthly, the organisations seek a system of care that is both just and equitable – just as the university seeks truths that are universal while we research in the here and now, so too we need more than ever to maintain our ideal of a healthy society for all.

Dr Ruth De Souza, Professor Wendy Cross, Michal Morris, The Hon Robin Scott – Minister for Multicultural Affairs/Minister for Finance.

Benefits of the relationship

I forsee a number of benefits for both organisations from this role. CEH has a distinguished track record in supporting health and social practitioners to respond sensitively and effectively to the issues faced by people people from refugee and migrant backgrounds , and this will be of benefit to students and staff at Monash as we prepare a rapidly changing workforce for a rapidly changing workplace.

Monash has an international reputation for high quality and research and education, and CEH will use this expertise to advocate and campaign for change. CEH will be exposed to the university’s dynamic intellectual environment and its knowledge of global currents in cultural research and health research, strengthening its expertise in cultural competence and giving the organisation a platform to lead a much needed translational research agenda.

There have been enormous amounts of work undertaken internationally in my own research areas of cultural safety and cultural competence. Yet there is still so much more to be known about what works and how institutions and practitioners can respond to our changing world. The relationship with Monash will provide both organisations with an opportunity for research output that is grounded, that can be disseminated both in academic settings such as conferences, academic books and journals, into the sphere of practice and to a range of audiences. The relationship allows for a reciprocal re- examination of priorities and practices about equity in health in research, teaching, and service delivery. I am excited to be working in this dynamic partnership and look forward to helping the partners in their quest for an innovative, resilient and responsive health system for our changing world.

To conclude, I am grateful to the leadership that has made this role and partnership happen, my profound thanks go to the CEO of CEH Demos Krouskous, GM Michal Morris, Professor Wendy Cross, all the magnificent staff here at Monash and at CEH who have made me so very very welcome and lastly to all of you here who have made time to provide your presence and support.

May 5, 2015/by ruth

Aotearoa New Zealand, Cultural safety, Inequalities, Migration, Multiculturalism, Nursing, Power relations, Racism, Refugees, Te Tiriti o Waitangi/Treaty of Waitangi, Writing

Cultural safety in Aotearoa New Zealand 2nd Edition

Very excited about the 2nd Edition of Cultural safety in Aotearoa New Zealand being published by Cambridge Press in December 2015.

I’ve contributed two chapters and I have excerpted the introduction of each chapter below:

8. Navigating the ethical in cultural safety

Caring is an ethical activity with a deep moral commitment that relies on a trusting relationship (Holstein & Mitzen, 2001). Health professionals are expected to be caring, skilful, and knowledgeable providers of appropriate and effective care to vulnerable people. Through universal services they are expected to meet the needs of both individual clients and broader communities, which are activities requiring sensitivity and responsiveness. In an increasingly complex globalised world, ethical reflection is required so that practitioners can recognise plurality: in illness explanations; in treatment systems; in the varying roles of family/whanau or community in decision making; and in the range of values around interventions and outcomes. To work effectively in multiple contexts, practitioners must be able to morally locate their practice in both historical legacies of their institutional world and the diversifying community environment. This chapter examines the frameworks that health professionals can use for cross-cultural interactions.I then explore how they can select the most appropriate one depending on the person or group being cared for.

13. Culturally safe care for ethnically and religiously diverse communities

Cultural safety is borne from a specific challenge from indigenous nurses to Western healthcare systems.It is increasingly being developed by scholars and practitioners as a methodological imperative toward universal health care in a culturally diverse world. The extension of cultural safety, outside an indigenous context, reflects two issues: a theoretical concern with the culture of healthcare systems and the pragmatic challenges of competently caring for ethnically and religiously diverse communities. As discussed throughout this book, the term ‘culture’ covers an enormous domain and a precise definition is not straightforward. For the Nursing Council of New Zealand (‘the Nursing Council’) (2009), for example, ‘culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability’.

In an attempt at a precise two-page definition, Gayatri Chakravorty Spivak (2006, p. 359), captures the reflexive orientation required to grasp how the term ‘culture’ works:

Every definition or description of culture comes from the cultural assumptions of the investigator. Euro-US academic culture… is so widespread and powerful that it is thought of as transparent and capable of reporting on all cultures. […] Cultural information should be received proactively, as always open-ended, always susceptible to a changed understanding. […] Culture is a package of largely unacknowledged assumptions, loosely held by a loosely outlined group of people, mapping negotiations between the sacred and the profane, and the relationship between the sexes.

Spivak’s discussion of the sacred and the profane links culture to the more formal institution of religion, which has historically provided the main discourse for discussion of cultural difference. Particularly important for cultural safety is her discussion of Euro-US academic culture, a ‘culture of no culture’, which has a specific lineage in the sciences of European Protestantantism. Through much of the 19th century, for example, compatibility with Christianity was largely assumed and required in scientific and medical knowledge, even as scientists began to remove explicit Christian references from their literature. This historical perspective helps us see how the technoscientific world of the healthcare system, and those of us in secular education, are working in the legacy of white Christian ideals, where the presence of other cultures becomes a ‘problem’ requiring ‘solutions’. Cultural safety, however, attempts to locate the problem where change can be achieved in the healthcare system itself.

Other contributors include: Irihapeti Ramsden, Liz Banks, Maureen Kelly, Elaine Papps, Rachel Vernon, Denise Wilson, Riripeti Haretuku, Deb Spence, Robin Kearns, Isabel Dyck, Ruth Crawford, Fran Richardson, Rosemary McEldowney, Thelma Puckey, Katarina Jean Te Huia, Liz Kiata, Ngaire Kerse, Sallie Greenwood and Huhana Hickey.

Book cover

April 7, 2015/by ruth

Australia, Carceral society, Colonialism, Cultural safety, Indigenous, Inequalities, Nursing, Racism, Writing

The closure of remote Aboriginal communities: What is the role of nurses in Indigenous disadvantage?

The view expressed by Tony Abbott (Prime Minister and the Minister for Indigenous Affairs), that taxpayers shouldn’t be expected to fund the “lifestyle choices” of Aboriginal people living in remote regions in support of Colin Barnett’s (West Australian Premier) decision to close 150 remote Aboriginal communities in Western Australia reflects the repetition of the colonial project and Aboriginal dispossession. One of the mythologies of a white settler society is that white people are the first to arrive and develop the land, with colonisation a benign force (rather than one enacted through the processes of conquest and genocide and displacing the indigenous (Razack, 2002)). Closing the community draws attention away from governmental failures to ‘Close the Gap’ and instead displaces the blame on the supposed inadequacies and problems of Aboriginal communities (Amy McQuire) thereby individualising socio-political inequalities rather than revealing them as historic and structural. The paternalism of closing the communities “for their own good” and for the common good, appears benign but hides the brutality of forced removal and in doing so denies the significance of indigeneity as Mick Dodson notes:

It is not a “lifestyle choice” to be be born in and live in a remote Aboriginal community. It is more a decision to value connection to country, to look after family, to foster language and celebrate our culture. There are significant social, environmental and cultural benefits for the entire nation that flow from those decisions.

The protests against this cruel action have resounded around the world and have resonated in Aotearoa where I have lived for most of my life although I now live in the lands of the Kulin Nations in Gippsland as a migrant. As a nurse educator and researcher I am shaped by colonialism’s continuing effects in the white settler nation of Australia.

Nurses have often played an important part in social justice. Recently nursing professional bodies made a stand against violent state practices with the Australian College of Nursing (ACN) and Maternal Child and Family Health Nurses Australia (MCaFHNA) supporting The Forgotten Children report by the Australian Human Rights Commission against detaining children in immigration detention centres. Others like Chris Wilson wrote in Crikey about the many limitations of the Northern Territory Intervention:

I am saddened that the intervention has wasted so many resources, given so little support or recognition to the workers on the ground, paid so little attention to years of reports and above all involved absolutely no consultation with anyone, especially community members. The insidious effect of highlighting child abuse over all the other known problems in Aboriginal health is destructive to male health, mental health and community health, is unfounded in fact and is based in the inherent ignorance of this racist approach.

It has made me think about how nurses and midwives don’t often problematise our locations and consider our responsibilities within a social context of the discursive and material legacies of colonialism, neoliberalism, austerity and ‘othering’ (of Muslims, of refugees of Indigenous people) and “the ways in which we are complicitous in the subordination of others” (Razack, 1998, p.159). As Razack notes, groups that see themselves as apolitical must call into question their roles as “innocent subjects, standing outside of hierarchical social relations, who are not accountable for the past or implicated in the future” (Razack, 1998, p.10).

Colonisation and racism have been unkind to Indigenous people (term often used to refer to both Aboriginal and Torres Strait Islander peoples) with the health status of Indigenous people often compared to that of a developing country as I have pointed out elsewhere. The Overcoming Indigenous Disadvantage 2014 report measures the wellbeing of Australia’s Indigenous peoples. Briefly, Indigenous people:

Experience social and health inequalities (Australian Institute of Health and Welfare, 2004).
Are over represented and experience a higher burden of disease and higher mortality at younger ages than non-Indigenous Australians (Australian Institute of Health and Welfare, 2012b).

So, the question for me as a researcher and educator are what responsibility do nurses and the discipline of nursing have to Aboriginal health?

1) Recognise colonisation as a determinant of health

Indigenous people enjoyed better health in 1788 than people in Europe, they had autonomy over their lives, (ceremonies, spiritual practices, medicine, social relationships, management of land, law, and economic activities), but also didn’t suffer from illnesses that were endemic in18th century Europe. They didn’t have smallpox, measles, influenza, tuberculosis, scarlet fever, venereal syphilis and gonorrhoea. However, they were known to have suffered from; hepatitis B; some bacterial infections; some intestinal parasites; trauma; anaemia; arthritis; periodontal disease; and tooth attrition.

What’s often difficult for many nurses and students to imagine is that the past could have anything to do with the present, however, research in other settler colonial societies shows a clear relationship between social disadvantages experienced by Indigenous people and current health status. Colonisation and the spread of non-Indigenous peoples saw the introduction of illness (eg smallpox); the devaluing of culture; the destruction of traditional food base; separation from families; dispossession of whole communities. Furthermore, the ensuing loss of autonomy undermined social vitality, reduced resilience and created dispossession, demoralisation and poor health.

The negative impacts of colonisation on Indigenous led colonial authorities to try to ‘protect’ remaining Indigenous peoples, which saw the establishment of Aboriginal ‘protection’ boards (the first established in Victoria by the Aboriginal Protection Act of 18690. However, ‘protection’ imposed enormous restrictions eg living in settlements; forced separation of Indigenous children from their families. With between one-in-three and one-in-ten Indigenous children forcibly removed from their families and communities from 1910 until 1970. The result was irrevocable harm as one of the Stolen Generations stated:

We may go home, but we cannot relive our childhoods. We may reunite with our mothers, fathers, sisters, brothers, aunties, uncles, communities, but we cannot relive the 20, 30, 40 years that we spent without their love and care, and they cannot undo the grief and mourning they felt when we were separated from them

The Redfern Speech from December 1992 (Paul Keating Australian Prime Minister publicly acknowledging to Indigenous Australians that European settlers were responsible for difficulties Australian Aboriginal communities face).
The Bring them home report: Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families 1997 recommended that the Prime Minister apologise to the Stolen Generations, however John Howard refused to do so. Sorry Day evolved as a result.
It was only on February 13th, 2008 that Kevin Rudd issued the National Apology Speech, some of which is excerpted below:

For the pain, suffering and hurt of these Stolen Generations, their descendants and for their families left behind, we say sorry. To the mothers and the fathers, the brothers and the sisters, for the breaking up of families and communities, we say sorry. And for the indignity and degradation thus inflicted on a proud people and a proud culture, we say sorry.

Also watch Babakiueria which uses role reversal to satirise and critique Australia’s treatment of its Indigenous peoples. Aboriginal actors play the colonisers, while white actors play the indigenous Babakiuerians.

2) Recognise continuing colonial practices

This blog started with the news of the closures of 150 remote Aboriginal communities in WA. Only one example of continuing colonial practices. Mick Dodson suggests that the closure of the 150 WA communities reflects an inability of the descendants of settlers to:

negotiate in a considered way the right of Aboriginal people to live as Aboriginal peoples in our own lands and seas, while also participating in every aspect of life as contemporary Australian citizens.

You can also read about proposed alternatives to the closure by Rebecca Mitchell.

3) Develop an understanding of racism as a determinant of health

Racism (racial discrimination) is linked with colonisation and oppression and is a social determinant of health. Nancy Krieger (2001) defines it as a process by which members of a socially defined racial group are treated unfairly because of membership of that group. Too often racism is seen as individual actions rather than as structural and embedded as this video shows. We know that racism damages health and in the health sector health systems and service providers can perpetuate Aboriginal health care disparities through attitudes and practices (Durey).

Anti-racist scholars suggest that there are three levels of racism in health.

Institutional: Practices, policies or processes experienced in everyday life which maintain and reproduce avoidable and unfair inequalities across ethnic/racial groups (also called systemic racism);
Interpersonal, in interactions between individuals either within their institutional roles or as private individuals;
Internalised, where an individual internalises attitudes, beliefs or ideologies about the inferiority of their own group.

Krieger and others have written extensively about how racism affects health. People who experience racism experience the following:

Inequitable and reduced access to the resources required for health;
Inequitable exposure to risk factors associated with ill-health;
Stress and negative emotional/cognitive reactions which have negative impacts on mental health as well as affecting the immune, endocrine, cardiovascular and other physiological systems;
Engagement in unhealthy activities and disengagement from healthy activities

1 in 3 Aboriginal Victorians experienced racism in a health care setting according to a VicHealth survey. The respondents reported:

Poorer health status;
Lower perceived quality of care;
Under-utilisation of health services;
Delays in seeking care;
Failure to follow recommendations;
Societal distrust;
interruptions in care;
Mistrust of providers;
Avoidance of health care systems.

This video on understanding the impact of racism on Indigenous child health by Dr Naomi Priest is well worth a look.

4) Develop a collective understanding of health and the importance of cultural determinants of health

Health is defined in the National Aboriginal Health Strategy (1989) as:

Not just the physical well-being of the individual but the social, emotional and cultural well-being of the whole community. This is a whole of life view and it also includes the cyclical concept of life-death-life

It is important that in considering the issues of colonisation, racism and inter-generational trauma that the diverse cultures and histories of indigenous people are not viewed through a deficit lens. So often mainstream media reinforce the myth that responsibility for poor health (whether it’s about people who drink, are obese or smoke) is an individual and group one rather than linked with social determinants including colonisation, economic restructuring or the devastating social consequences of state neoliberal policies. As Professor Ngiare Brown notes, there are significant cultural determinants of health which should be supported including:

Self-determination; Freedom from discrimination;
Individual and collective rights;
Freedom from assimilation and destruction of culture;
Protection from removal/relocation;
Connection to, custodianship, and utilisation of country and traditional lands;
Reclamation, revitalisation, preservation and promotion of language and cultural practices;
Protection and promotion of Traditional Knowledge and Indigenous Intellectual Property; and
Understanding of lore, law and traditional roles and responsibilities.

5) Develop an understanding of the organisations, policies, levers and strategies that are available to support Indigenous wellbeing

Aboriginal Community Controlled Health Services (ACCHSs), which are primary health care services operated by local Aboriginal communities to deliver holistic, comprehensive, and culturally appropriate health care. There are over 150 ACCHSs in urban, regional and remote Australia.
Close the gap campaign targets (also see a recent blogpost) developed by a consortium of 40 of Australia’s leading Indigenous and non-Indigenous health peak bodies and human rights organisations, which calls on Australian governments to commit to achieving Indigenous health equality within 25 years.
2007 United Nations Declaration on the Rights of Indigenous Peoples, Article 24 of which points out that Indigenous people have the right “to access, without any discrimination, [to] all social and health services” and “have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively full realisation of this right”.
Become familiar with the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.
Support the WHO Closing the gap in a generation, which recommends three actions for improving the world’s health:

Improve the conditions of daily life – the circumstances in which people are born, grow, live, work, and age.
Tackle the inequitable distribution of power, money, and resources – the structural drivers of those conditions of daily life – globally, nationally, and locally.
Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.

Support the Australian Nursing Code of Ethics statement:

In recognising the linkages and operational relationships that exist between health and human rights, the nursing profession respects the human rights of Australia’s Aboriginal and Torres Strait Islander peoples as the traditional owners of this land, who have ownership of and live a distinct and viable culture that shapes their world view and influences their daily decision making. Nurses recognise that the process of reconciliation between Aboriginal and Torres Strait Islander and non-indigenous Australians is rightly shared and owned across the Australian community. For Aboriginal and Torres Strait Islander people, while physical, emotional, spiritual and cultural wellbeing are distinct, they also form the expected whole of the Aboriginal and Torres Strait Islander model of care

6) Becoming a critical, reflexive, knowledgeable nurse who legitimates the cultural rights, values and expectations of Aboriginal people

More than ever, social justice provides a valuable lens for nursing practice (see Sir Michael Marmot’s speech). Cultural competence and safety directly reduce health disparities experienced by Indigenous Australians (Lee et al., 2006; Durey, 2010). It makes sense that the safer the health care system and its workers are, the more likely Indigenous people are to engage and use the services available. Early engagement in the health care system results in early health intervention strategies, prevention of illness and improved overall health outcomes for Indigenous Australians. The key features of cultural competence identified in the Cultural diversity plan for Victoria’s specialist mental health services 2006-2010 are:

Respectful and non-judgemental curiosity about other cultures, and the ability to seek cultural knowledge in an appropriate way;
Tolerance of ambiguity and ability to handle the stress of ambiguous situations;
Readiness to adapt behaviours and communicative conventions for intercultural communication.

Nurses have a role in improving health outcomes, but this requires an understanding of the reasons why there are higher morbidity and mortality rates in Indigenous populations than in the general population. It requires that nurses engage in reflection and interrogate the existing social order and how it reproduces discriminatory practices in structural systems such as health care, in institutions and in health professionals (Durey, 2010). It’s important that as nurses we focus on our own behaviour, practice and skills both as professionals and individuals working in the health system.

I think this statement about Cultural security from the Department of Health, Western Australian Health (2003) Aboriginal Cultural Security: A background paper, page 10. is a valuable philosophy of practice:

Commitment to the principle that the construct and provision of services offered by the health system will not compromise the legitimate cultural rights, values and expectations of Aboriginal people. It is a recognition, appreciation and response to the impact of cultural diversity on the utilisation and provision of effective clinical care, public health and health system administration

To conclude, I leave the last words to Professor Ngiare Brown:

We represent the oldest continuous culture in the world, we are also diverse and have managed to persevere despite the odds because of our adaptability, our survival skills and because we represent an evolving cultural spectrum inclusive of traditional and contemporary practices. At our best, we bring our traditional principles and practices – respect, generosity, collective benefit, collective ownership- to our daily expression of our identity and culture in a contemporary context. When we are empowered to do this, and where systems facilitate this reclamation, protection and promotion, we are healthy, well and successful and our communities thrive.

References

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April 5, 2015/by ruth

Australia, Cultural safety, Media, Mental health, Migration, Multiculturalism, Racism, Writing

Learning to listen: Mental health and migration for CALD communities

In Victoria the goal of the Victorian Mental Health Reform Strategy 2009-2019 is to achieve better social and economic outcomes for people with mental illness, their families, carers and friends. Specifically Reform Area 6 outlines areas for reducing inequalities. The Cultural Diversity Plan for Victoria’s Specialist Mental Health Services, 2006-2010 suggests that achieving more culturally responsive services for culturally and linguistically diverse (CALD) and refugee communities is a clear priority given that:

Victoria has a diverse population with 24 per cent of Victorians being born overseas.
A third of this group come from non-English speaking countries.
Culturally and linguistically diverse (CALD) groups often have poorer mental health outcomes compared to Australian-born people, because they tend to present to services when their illness is more severe and therefore are also likely to experience higher rates of involuntary treatment.
There are sub-groups articularly refugees and older people who are at risk of developing a mental health problem.
Each year Victoria accepts over 3,500 humanitarian entrants (refugees and asylum seekers).
Victoria’s CALD population is increasingly being dispersed across the state. in regional and rural areas which requires primary health and mental health services provide culturally appropriate care.
Almost half of all CALD Victorians report having experienced some type of discrimination based on their ethnicity or nationality.
Experiences of discrimination are associated with depression, stress, anxiety and problematic substance use.

Better mental health outcomes for people of CALD backgrounds must include:

Strategies to promote social inclusion;
Acceptance of cultural diversity;
Workforce development ie develop work practices and cultures in mental health services that support high quality, effective, consumer-focused and carer-inclusive care;
Improving access to culturally competent mental health care at earlier stages of illness;
Enhancing the capacity of primary health services and workers in CALD community settings to identify, respond earlier to, and refer people with emerging mental health problems;
Enhancing mental health literacy and reduce stigma among refugee and asylum seeker groups;
Provide mental health literacy training to multicultural, ethno-specific and refugee agencies to improve their understanding of mental illness, so that workers in these agencies can better navigate the mental health service system on behalf of CALD consumers and;
Encourage practical partnerships between these agencies and specialist mental health services to facilitate culturally-specific input into clinical treatment and psychosocial rehabilitation plans;
Address language needs of CALD clients in specialist mental health services and address supply of interpreters and promote client and carer awareness of language services;
Build on the work of Victorian Transcultural Mental Health and the Action on Disability within Ethnic Communities (ADEC) to improve training.

In the last week of March 2015 I was honoured to be one of six panelists ranging from consumers, carers, filmmakers, and mental health practitioners to be part of a panel at an event called Migrating Minds: A forum on mental health within Culturally and Linguistically Diverse (CALD) migrant communities.The panel was organised by Colourfest in partnership with Victorian Transcultural Mental Health and held at the State Library of Victoria (SLV). Colourfest celebrates films about diaspora and migrant experiences and shares them with the broader community through free events, professional development/training, distributing films and producing resources.

What was especially wonderful about Colourfest was that consumers and carers were central to the event and got to tell their own stories in the films at the start and in the panel discussion at the end. The event began with seven short films which were stories told by people with a personal experience of mental health issues and perspectives of relatives/carers. Five of the short films were produced by Multicultural Mental Health Australia (MHiMA) and Victorian Transcultural Mental Health. There was also an international short film produced by a second-generation Vietnamese-American who shares their experiences with Depression and Post-Traumatic Stress Disorder.

These fabulous examples of cross-sectoral collaboration were evident in the partnership between Mental Health in Multicultural Australia (MHiMA) in conjunction with the Australian Centre for the Moving Image (ACMI) to produce Finding our way. This unique project focused on migrant and refugee stories where the personal stories of people living with emotional and mental health issues who were negotiating migrancy. Managed by Victorian Transcultural Mental Health (VTMH), St Vincent’s Hospital, Melbourne and the Global and Cultural Mental Health Unit at the University of Melbourne. Erminia Colucci & Susan McDonough coordinated the project for MHiMA. We watched The Visual Conductor by Maria. A story about family expectations, taking charge and staying well involving art, personal goals and play. We also viewed Dear Self by Akeemi, which was about childhood memories, moving to a new country, feelings of isolation and efforts to connect including original drawings and paintings. Both Maria Dimopoulos and Akeemi from the Finding Our Way film project were also on the panel.

The Our Voices project told the stories of carers from refugee and migrant backgrounds through five short films, showing a poignant insight into the lives of carers from migrant and refugee backgrounds. At the Colourfest panel we were fortunate to view Kevser‘s story. Kevser arrived from Turkey in the late 60’s with her husband and is the primary carer for her daughter. What was extraordinary about this film and the other four (from Afghani, Egyptian, Somali and Vietnamese communities) were the common challenges they faced in finding culturally sensitive and culturally-responsive mental health care and support. The aim of the forum was to help healthcare practitioners, community workers and the general population to understand some of the needs of the CALD community and the films were a powerful mechanism for leading the audience to empathise with the experiences of families. Leyla Altinkaya spoke on behalf of her mother, Kevser on the panel. Our other panelists were Munira Yusuf , a young person speaking from a youth perspective on their lived experiences with mental health issues and David Belasic: A psychologist based at Drummond Street Services. He has a strong interest in community psychology and queer mental health.

Me answering a question from Pham Phu Thanh Hang Colourfest Melbourne Coordinator. Also in the shot from left to right, fellow panellists Akeemi, Maria Dimopoulos, Munira Yusuf and David Belasic.

One of the priorities of The Framework for Mental Health in Multicultural Australia: Towards culturally inclusive service delivery is that services evaluate their cultural responsiveness and develop action plans to enhance their delivery of services to CALD communities as part of core business. Central to this responsiveness is having processes where consumers, carers and family members can have a say in the planning, development, delivery and evaluation of services. Particularly important given that CALD consumer and carer participation lags behind mainstream participation. Hence, the importance of this event which placed the experiences of consumers and carers at the forefront.

Cultural competence in mental health emphasises the attributes of the service provider and outcomes of the cross-cultural encounter rather than the unfamiliar culture of the consumer/carer. I love the key elements of cultural competence identified in the Cultural diversity plan for Victoria’s specialist mental health services 2006-2010:

Respectful and non-judgemental curiosity about other cultures, and the ability to seek cultural knowledge in an appropriate way;
Tolerance of ambiguity and ability to handle the stress of ambiguous situations;
Readiness to adapt behaviours and communicative conventions for intercultural communication.

What’s lovely about this list is that it does not constitute a recipe or tick box that can be memorised and then deployed in every intercultural encounter. These qualities are about how we developing a capacity for being in relationship with other people when we cannot assume common ground (which is really kinda always). I believe that watching the films provided a way to facilitate the beginnings of such a journey..

I am grateful to all those who made the films happen and for making visible the experiences of CALD consumers and carers. A grateful thanks to Gary Paramanathan and Pham Phu Thanh Hang Colourfest Melbourne Coordinator for the opportunity to be part of this wonderful panel.

Note that the Victorian Mental Health Reform Strategy 2009-2019 defines Cultural and linguistic diversity as:

the diversity of society in terms of cultural identity, nationality, ethnicity, language, and increasingly faith. Individuals from a CALD background are those who identify as having a specific cultural or linguistic affiliation by virtue of their place of birth, ancestry, ethnic origin, religion, preferred language, language(s) spoken at home, or because of their parents’ identification on a similar basis. CALD does not refer to an homogenous group of people, but rather to a range of cultural and language group communities.

April 5, 2015/by ruth

News, Personal

A small gallery

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January 24, 2015/0 Comments/by danny

Writing

Passion and knowledge: The craft of being a mental health nurse

I was honoured to contribute a foreword to the final edition of the Hive (the Australian College of Nursing’s quarterly publication showcasing member’s experiences) for 2014. The issue focuses on mental health, both on the importance of nurses looking after their own mental health and profiling the work of mental health nurses. I’m particularly interested in the issues of epistemology and ontology in psychiatry and mental health; the social determinants of mental health and care including gendered and cultural aspects (more about my background in the bio at the bottom), and the ethical and political including peer support and family involvement.

Reproduced with permission: cite as DeSouza, R. (Summer2014/15). Passion and knowledge: The craft of being a mental health nurse. The Hive (Australian College of Nursing), 8(10-11).

Mental health nursing has a colourful and somewhat contentious history. Attendants, coercion, abuse, stigma and asylum are words associated with the field of psychiatric nursing. The re-branding to mental health nursing and focus on recovery provides opportunities to respond more creatively and therapeutically to the person experiencing mental ill health. Philip and Poppy Barker advocate for a “craft of caring”, where the mental health practitioner integrates both the aesthetics and knowledge of nursing to meet the needs and expectations of clients and their own aesthetic and technical desires (Barker & Barkin 2011). The Barkers suggest that caring takes diligence, time and effort combined with creativity and resourcefulness.

Carrington hospital Auckland, photo by Te Ara.

This brings me to the stories of the nurses that are contained in this issue. Nurses need these stories for several reasons. Many nurses feel anxious and unprepared for working effectively with people experiencing mental health issues. This gap, combined with stigmatising and hostile views, impact on the quality of care provided. This is concerning given the high prevalence of mental health issues in the general population and the disempowerment that often accompanies a change in health status. However, mental health nursing is a marginal career choice for students entering a Bachelor of Nursing degree. Frequently, they are dissuaded from choosing it as a career option with classmates, faculty and family members not viewing it as ‘real’ nursing and many students are afraid of people experiencing mental illness (Happell et al. 2013). This is why I was so heartened to read Meg’s story. Meg has just completed her final year of her Bachelor of Nursing and is about to embark on a career as a mental health nurse. Her enthusiasm and passion offer great hope that we are already reversing these barriers. I hope that more early career nurses, like Meg, choose the career path so many of us mental health nurses have embraced, through engaging with high quality theory and having positive clinical experiences.

Barming – Oakwood Hospital, via Kent History Forum

Karen’s passion for mental health nursing is evident in her belief that “… it is crucial that mental health nursing education remains clearly identified within undergraduate curricula in stand-alone units and is delivered by academics that are specialists within this field”. Here is where future mental health nurses have their seeds of interest sown,
nurtured and grown, then reinforced through clinical practice. Although nurses are implicated in psychiatric care, treatment and processes that valorize vigilance and surveillance to minimise risk, nurses like Christopher deftly work within psychiatry’s reductive gaze while attending to the unique lived experience of the person who
is experiencing “problems of living” (Barker). Christopher carefully manages the ethical dilemmas of care and control, by remaining client focussed, using the family as a model of care, he tries to create a more equitable world despite nursing in a context of community fear. This attempt to cultivate an ethical disposition and maintain hope and trust in themselves and in their clients requires that mental health nurses address their own psychological wellbeing amidst an environment of “moral distress” (Barker 2011, Barkin 2011). Barbara’s story shows how, in order to promote good mental health, her relationship with colleagues is fundamental for support but equally her relationship with herself also requires nurturing in the form of self-care. What’s important about these stories is that they show how central passionate people are to entry to the profession. Edy began her career in orthopaedics but became inspired by passionate educators when undertaking further study. She found herself in an environment where she saw mental health nursing being valued and came to consider it as a career option. “Being fascinated” provided the spark for her to take up mental health nursing which has resulted in her being versatile, enjoying herself and learning to deal with what is.

The rewards of crafting are evident in Brett’s story, both in being inspired to take up an apprenticeship in mental health nursing and being inspired by highly skilled practitioners, and in the ways he pits his skills against levels of acuity and risk. The lifetime apprenticeship is also evident in Barbara’s story; her work with people at various parts of the lifespan, in different contexts and settings brings richness to her craft. Entrepreneurship and new paths are evident in both Barbara and Christopher’s stories, offering further autonomy and creativity. Whether the passion for mental health nursing starts in the blood like it did for some or appears later in their career for others, what is a resounding theme in these stories is the desire to help others to get the most out of life using innovation and creativity. The caring part is important too; although caring is a human activity, what makes the care that mental health nurses give different is that it happens in the context of competing demands, with people who might have been forsaken by others or difficult to care for (Barker 2008). Importantly, caring must occur by learning about yourself, countering stigma, being a leader and a role model, recognising that mental distress impacts on all aspects of life.

These stories have a common vision of mental health nursing practice as both art and science. Moving beyond a medically dominated view of mental health, these exemplary nurses articulate a philosophy of practice that sees people in the context of their culture, family and society. Motivated by a philosophy and practice of compassion and advocacy in the context of complexity, their narratives reveal mental health nursing to be a craft that is challenging, rewarding and innovative.

References

Barker 2008, Psychiatric and Mental Health Nursing: The
craft of caring, CRC Press, Boca Raton, FL.
Barker & Barkin 2011, ‘Promoting critical perspectives in
mental health nursing education’, Journal of psychiatric and
mental health nursing, vol. 21, no. 2, pp. 128-137.
Happell, B., & Gaskin, C. J. 2013, ‘The attitudes of undergraduate
nursing students towards mental health nursing: a
systematic review’, Journal of Clinical Nursing, vol. 22, no. 1,
pp. 148-158

Bio

For those of you who don’t know, I’ve worked in a range of mental health settings in New Zealand and England. I started my career in the addiction field, then worked in acute mental health in-patient units; community mental health services, regional hospitals and developed a new Maternal Mental Health Service. I am also a therapist having completed a Graduate Diploma in Counselling. I developed the content (with Andy Williamson) for the New Zealand Mental Health Foundation’s Postnatal Depression brochure. I am also advisor to Perinatal Mental Health NZ.

I have been actively involved in the development of the New Zealand mental health workforce through leading and developing all seven of the courses making up the National Certificate in Mental Health Support Work (Treaty of Waitangi, Relationships, Communication/Code of rights, Demonstrating knowledge and theory, Challenging incidents/Legal implications, Community and lifestyle planning, Concepts of health, Integrating knowledge) and co-ordinating the Graduate Certificates in Forensic Mental health; Child and Adolescent Mental health and Dual Diagnosis. I am a former Auckland branch Chair of the College of Mental Health Nurses and was seconded to the New Zealand Committee. I was also the Co-ordinator of the Master of Health Practice in Nursing (Mental Health) at AUT University.

I am a former co-ordinator of the Auckland Central Mental Health Forum and served as a Board Member and Deputy Chair of the West Auckland Living Skills Homes Trust Inc (WALSH Trust) who offer support services that promote recovery for people whose lives have been affected by an experience of mental ill health. More recently I’ve had strategic roles in mental health including the NZ Mental Health Literacy Programme Reference Group and National service specifications for specialist mental health and addictions- Asian and Refugee services. I have contributed to workforce and strategic planning through my roles on the Waitemata DHB mental health strategic workforce development plan steering committee; Waitemata DHB District Mental Health Addictions Plan – Asian Chapter Development and Counties Manukau DHB Mental Health and Addiction Network Committee. I co-ordinated NUR2207 – Mental Health Clinical Practice in Semester 2 of 2014 at Monash University, School of Nursing and Midwifery Berwick.

Recent mental health publications

Wood, P., Bradley, P., & De Souza, R. (2012). Mental Health in Australia and New Zealand. In R. Elder, K. Evans & D. Nizette (Eds.), Practical perspectives in psychiatric and mental health nursing (Third edition). New South Wales: Mosby, Elsevier Australia.
•DeSouza, R (2012). Power dynamics in communication. In S. Shaw , A. Haxell and T. Weblemoe (Eds.), Lifespan development and commmunication. Auckland: Oxford University Press.
•McNeill, H., Paterson, J., Sundborn, G., DeSouza, R., Weblemoe, T., McKinney, C., et al. (2009). Culture health and wellbeing. In S. Shaw & B. Deed (Eds.), Health and environment in Aotearoa/New Zealand (pp. 95-124). Auckland: Oxford University Press.
•O’Brien, T., Morrison-Ngatai, E., & De Souza, R. (2009). Providing culturally safe care In P. Barker (Ed.), Psychiatric and mental health nursing: The craft of caring (Second ed., pp. 635-643). London: Arnold.
•Wood, P., Bradley, P., & De Souza, R. (2008). Mental Health in Australia and New Zealand. In R. Elder, K. Evans & D. Nizette (Eds.), Practical perspectives in psychiatric and mental health nursing (Second ed., pp. 86-107). New South Wales: Mosby, Elsevier Australia.
•Pavagada, R., DeSouza, R. (2007). Culture and mental health care in New Zealand: indigenous and non-indigenous people. In K. Bhui & D. Bhugra (Eds.), Culture and mental health (pp. 245-260). London: Hodder Arnold.
•DeSouza, R. (Jan, 2007). Multicultural relationships in supervision. In D. Wepa (Ed), Clinical supervision in the health professions: The New Zealand experience. Auckland: Pearson Education.
•DeSouza, R. (2006). Sailing in a new direction: Multicultural mental health in New Zealand. Australian e-Journal for the Advancement of Mental Health 5(2).
•DeSouza, R. (2005). Postnatal mental health. In A. Hodren (Ed.), Royal New Zealand Plunket Society National Resource Manual. (pp. 99-113) Wellington: Royal New Zealand Plunket Society.
•Wood, P., Bradley, P., & De Souza, R. (2004). Mental Health in Australia and New Zealand. In R. Elder, K. Evans & D. Nizette (Eds.), Practical perspectives in psychiatric and mental health nursing (pp. 80-98). New South Wales: Elsevier Australia.

January 12, 2015/by ruth

Australia, Carceral society, Colonialism, Islamophobia, language, Media, Racism, Writing

To surveil and marginalise or to keep our hearts open? The aftermath of public violence.

Last week I visited the Tasman Peninsula in Tasmania, which was the country of the Pydairrerme band of the Oyster Bay tribe, before being invaded and settled by Europeans. As a a recent arrival in Australia (from New Zealand in 2013), I see it as my responsibility to develop a local nuanced understanding of settler-colonialism, the dispossession of indigenous Aboriginal people and the colonial carceral system. Port Arthur, a convict settlement for the former colony of Van Diemen’s Land on the Tasman Peninsula was on my itinerary. Maria M. Tumarkin points out that places like Port Arthur with their material remnants allow us to engage with events (like the trauma of convictism) and to experience the hardship and suffering endured by convicts without actually putting ourselves on the line. People that visit sites of trauma or traumascapes as Tumarkin calls them (also known as dark tourism (Philip Stone), thanatourism (A.V. Seaton), trauma tourism (Laurie Beth Clark) are not either “voyeuristic tourists” or “earnest pilgrims” but can also have mixed motives, some unknown to them. I wanted to better understand the colonial and convict history of my adopted homeland, especially because my partner is Australian born and has an ancestral convict history.

Port Arthur has a history of prison tourism and its sandstone, pink brick and weatherboard buildings along a beautiful cove, belie it’s disciplinary role for convicts from 1830-1877. Prior to 1840, convicts were used as colonial labour for settlers, after 1840 convicts undertook a trial period of labour in a government gang, and if this was satisfactory could then be hired out to the private sector. This partnership with the private sector transferred costs of rations, clothing and accommodation from the colonial government to private masters who did not pay wages (sound familiar?). Thus, Van Diemen’s Land was a panopticon without walls rather than a prison. More about panopticons later! For people that “abused” this “open” punishment or for whom a suitable assignment could not be found, a place of secondary punishment was needed. Hence the development of the penal station of Port Arthur to house those who could not be assigned and where labour could be extracted and the recalcitrant punished as Professor Hamish Maxwell-Stewart notes. After the closure of the penal station, decline and damage to the carceral buildings of Port Arthur ensued. Renewed interest in the late 1920s, saw restoration work begin so that the tourism potential of the site could be maximised. In the 1980s Port Arthur became Australia’s most famous open-air museum, and the 1996 killing of innocent people by an armed gunman did not diminish its role as a tourist site. A memorial garden now houses the Broad Arrow cafe where twenty of the thirty five victims were shot which represents a cathartic location -triggering powerful emotions.

The carceral buildings at Port Arthur including the Penitentiary and the Separate Prison in use nineteenth-century ideas about how adult deviants could be treated in order to transform them into skilled and docile members of society. Foucault used the metaphor of the panopticon designed by the philosopher Jeremy Bentham to talk about the change in society from a “culture of spectacle” (public displays of torture etc) to a “carceral culture.” where punishment and discipline became internalized. The panopticon was a prison designed so that a central observation tower could potentially view every cell and every prisoner. However, the prisoners could not view observers or guards, so prisoners could not tell if or when they were being observed. Consequently, they came to believe that they might be always being observed, and disciplined themselves into model prisoners. Port Arthur’s prison was shaped like a cross with exercise yards at each corner and prisoner wings connected to the surveillance core of the Prison from where each wing could be clearly seen, although individual cells could not (thus differing from the theory of the panopticon). Panopticism or the ever-present threat of potential or continual surveillance is a mechanism for translating technologies of disciplinary control into an individual’s everyday practices.

Reinforcing Islam and Muslims as ‘others’

This brings me to the key concern of this blog post, the events of December 15th when a single armed man took people hostage inside the Lindt Chocolate cafe in Sydney. His actions ultimately led to the death of two innocent people and overshadowed scrutiny of the mid-year budget update (which includes cuts to Foreign Aid and the Australian Human Rights Commission). The gunman had significant social and inter-personal problems but the media were quick to label the siege a terrorist attack (it was a Muslim person brandishing a flag after all) which also helped to justify future and recent past legislation limiting the movement of some groups of people. Only last week New Zealand politicians hastily passed anti-terror laws through Parliament. In the United Kingdom, PM David Cameron pointed out:

It demonstrates the challenge that we face of Islamist extremist violence all over the world. This is on the other side of the world (in Sydney) but it’s the sort of thing that could just as well happen here in the UK or in Europe.

Many media sources and other commentators were quick to jump to conclusions with The Daily Telegraph front page screaming “Death cult CBD attack” and anti Muslim scare mongering from shock jocks like Rad Hadley.

Interestingly the reportage focused on the religion of the gunman and brought out racist and inflammatory commentary from people on Twitter and Facebook. What was especially interesting was the way in which misinformation spread far and wide as Alex McKinnon carefully pointed out:

But the families of the people involved, and the broader public, have a right to information that is accurate and correct. Spreading rumours on something as potentially serious as this is not innocuous: it is actively harmful. Your best course of action is to refrain from commenting or spreading unchecked information, online or otherwise, until the facts are known, the situation is better understood and our collective emotions aren’t running so high.

In a critique of media coverage Bernard Keane of Crikey interrogated the language and phrases that proliferated in coverage:

The assumptions loaded into such “lost its innocence” statements merit entire theses; indeed, many have doubtless already been written. That Australia, established as a prison colony and forged in dispossession, genocide and gleeful participation in the long wars of imperialism throughout the 20th century, could be “innocent”; that it is such a fragile culture that a single moment of violence, however atypical, could comprehensively alter its very nature.

New Matilda predicted that there would be spike in violence against Muslims and mosques:

Just as Christian churches all over the nation were attacked in the immediate aftermath of the 1996 Port Arthur siege, Mosques around Australia will be vandalized. Because, naturally, if the siege is in fact being perpetrated by Muslim extremists, then all Muslims (and all symbols of Islam) are fair game.

Bernard Keane also predicted that media identities and journalists would:

disgrace themselves and their profession by reporting wild speculation as fact. When you’re reporting a big story on a 24 hours news cycle, and you have no idea what’s going on, you need to fill the gaps. Anything that moves is news, and if it doesn’t move, give it a push.

With the media finding:

some lone nut Muslim extremist somewhere to say something short of condemning the violence, and then portray that as the view of the broader Muslim population. Eventually, Australian media will start demanding that all Muslim leaders everywhere condemn the violence… even though Muslim leaders everywhere will have already condemned the violence.

This was an accurate prediction as in no time at all, the Australian Muslim community denounced the act:

However, Randa Abdel-Fattah problematised this gesture in the context of broader insatiable community demands:

Muslim organisations – weary, under-resourced, under pressure – were ready to condemn, to distance, to reassure because after 13 years of condemning, distancing, and reassuring, the Australian public seems to still be in doubt about Islam’s position on terrorism.

Australian responses give me hope…

As people gather to pay their respects in a very public way. I’d like to think that there’s an opportunity for healing rather than fomenting further hate and powerlessness. I agree with Tasmanian and Booker Prize winner Richard Flanagan’s observations of people:

I think evil, murder, hate… these things are as deeply buried within us as love, kindness, goodness and perhaps they are far more closely entwined than we would care to admit… And the face of evil is never the other, it’s always our face.

So with that in mind, I’d like to talk about the outpouring of grace, dignity, compassion and thoughtful analysis that I’ve also seen in abundance.

Clover Moore Lord Mayor of Sydney:

Victoria Rollison challenged media representations of the gunman and the framing of the siege as a Muslim issue:

“I was a teenager when the Port Arthur massacre happened, and I don’t recall there being a backlash at the time against white people with blonde hair. I’m a white person with blonde hair, and no one has ever heaped me into the ‘possibly a mass murderer’ bucket along with Martin Bryant. Or more recently, Norwegian Anders Breivik, who apparently killed 69 young political activists because he didn’t like their party’s immigration stance which he saw as too open to Islamic immigrants. In fact, in neither case do I recall the word ‘terrorist’ even being used to describe the mass murders of innocent people.”

Clementine Ford similarly pointed out that Christianity has not come under the same scrutiny in other violent incidents, both in Australia and Norway, while also addressing the issue of violence against women:

Almost without fail, non-Muslim white men who behave as he did are given the benefit of individual autonomy. When Rodney Clavell staged a 13 hour siege at an Adelaide brothel in June of this year, his reported Christianity barely made any of the news reports. Where it did, it was in articles which spent a good proportion of time talking about how much of a good bloke he was. Norway’s Andres Breivik – a right wing Christian who murdered 77 people in 2011 – was frequently described as ‘a lone wolf’. His actions were certainly not treated as a defining characteristic of members of the Christian faith, nor did Christians have to fear backlash once his affiliation was revealed.

Max Fisher responded:

This expectation we place on Muslims, to be absolutely clear, is Islamophobic and bigoted. The denunciation is a form of apology: an apology for Islam and for Muslims. The implication is that every Muslim is under suspicion of being sympathetic to terrorism unless he or she explicitly says otherwise. The implication is also that any crime committed by a Muslim is the responsibility of all Muslims simply by virtue of their shared religion. This sort of thinking — blaming an entire group for the actions of a few individuals, assuming the worst about a person just because of their identity — is the very definition of bigotry.

The hashtag #illridewithyou (but also note Beyondblue’s national anti-discrimination campaign in 2014 which highlights the impact of discrimination on the social and emotional well-being of Aboriginal people which has not had the same flurry of support). Also some interesting critique from Eugenia Flynn who asks What happens when the ride Is over?
Interfaith action from mosques, synagogues and churches inviting the public to gather for unity, and against violence, fear and hatred.
Social media sharing guidelines from Alex McKinnon:

When in doubt, wait. When you are not in full possession of the facts, remain silent so that more informed voices can be heard

Good to see some thought about the people who survived the siege and their recovery.
Lastly, it’s great to see some critique of mass media practice from John Birmingham in the Canberra Times and Bernard Keane in Crikey.

Ending with a reflection

Thinking with sadness of all the people traumatized by yesterday’s events, the innocent people that lost their lives and all their loved ones in Sydney. Thinking also of people who live with and are caught up in acts of power, control and violence which are not of their own making globally. Thinking of the ways in which ‘our’ institutions serve ‘us’ and how responsibly they exercise their power and influence (police, media, politicians), whether their role creates calm, understanding, light or heat, marginalising and stereotyping. Whether the creation of an ‘other’ is necessary and what future it holds open for ‘others’ who experience heightened vigilance, policing and surveillance. Thinking of those who work for peace, who work to address injustice. Thinking of the need to not conclude too quickly, to not judge too harshly before understanding. Mostly today sending love, prayers and hope into the world in this season of peace and goodwill.

December 16, 2014/by ruth

Australia, Indigenous, Inequalities, Islamophobia, language, Media, Migration, Multiculturalism, Racism, Writing

Ethnic migrant media: Weaving ourselves a home

Exploring the role, benefits, challenges & potential of ethnic media in NZ.

Paper presented at the Ethnic Migrant Media Forum, Unitec Institute of Technology, Auckland, New Zealand. Also available as pdf from conference proceedings DeSouza keynote.

Tena koutou, tena koutou, tena koutou katoa, it’s an honour to be invited to speak at this forum where we are gathered to talk about ethnic media and the possibilities it offers for our communities. I wish to acknowledge this magnificent whare whakairo (carved meeting house) ‘Ngākau Māhaki’, built and designed by Dr Lyonel Grant which I think is the most beautiful building in the entire world. Kia ora to matua Hare Paniora for the whaikōrero, whaea Lynda Toki for the karanga and this pōwhiri. I acknowledge Ngāti Whātua as mana whenua of Unitec and Te Noho Kotahitanga marae. I acknowledge the organisers of this forum, Unitec’s Department of Communication Studies and Niche Media & Ethnic Media Information NZ, in particular Associate Professor Evangelia Papoutsaki, Dr Elena Kolesova, Lisa Engledew and Dr Jocelyn Williams and all the participants gathered here today.

As a migrant to Aotearoa and now Australia, there are a few places that I call home. Tamaki makau rau and Unitec specifically would be one of those places. This whenua has been central to my own growth and development. I love these grounds, I walked them when I was a student nurse at Oakley hospital in 1986 and then worked in Building 1 or as it was known then Ward 12 at Carrington Psychiatric Hospital in 1987. I also worked here at Unitec as a nursing lecturer from 1998-2004. I have this beautiful Whaariki (woven mat) made from Harakeke (NZ Flax) grown, dyed and woven at Unitec that has accompanied me for over three house moves since I left Unitec and more recently across the Tasman.

Whaariki from Unitec, gifted to Ruth DeSouza

It is this being at home that interests me as a migrant. Home is the safe space where I can be myself and where there are other people like me. It’s a place where I can be nurtured and supported, where I can thrive in my similarities and in my differences. Where I can see my norms and values reflected around me. I believe that the media can have a special place in helping us to see ourselves as woven through like this exquisite mat as belonging to something larger than ourselves. I believe that it can contribute to helping us feel at home, through it we can feel embraced and included, we can be part of a conversation that can see us in all our glory. However, too often it is also a site where if we are already marginalised, we can be further marginalised.

Advert in the Australian 2013

Today, I am going to briefly talk about the limitations of mainstream media, review some key functions of ethnic media and conclude with some challenges and opportunities for ethnic media. As you’ll see from my bio, I co-founded the Aotearoa Ethnic Network, an email list and journal in 2006 to provide a communication channel for the growing number of people in the “ethnic” category. I’ve been passionately interested in the role of media practices in intercultural relations in health, and also on the relations between settlers, migrants and indigenous peoples in Aotearoa New Zealand. I have been actively involved in ethnic community issues, governance, research and education in New Zealand and Australia.

This hui is timely, given discussions about: biculturalism and multiculturalism; the Maori media renaissance, the growth of Pacific and Asian owned or run media including radio, newspapers, online media; television, web based news services; the underrepresentation of Maori, Pacific and Ethnic in media and journalism; the growth of blogs through early 2000s and the growth in social media (FB, Twitter) in the last decade. It’s also part of a longer conversation, I’m thinking about the forum we had in 2005 organised by the Auckland City Council and Human Rights Commission after the Danish cartoon fiasco, where I talked about the role of media in terms of “fixing” difference or supporting complexity; the role of media in making society more cohesive or divisive or exclusive and the relevance of New Zealand media relevant in the context of growing diasporic media. In that forum I suggested that there was a need for: ethnic media but also adequate representation in mainstream media; the showing of complex multicultural relationships not just ethnic enclaves and ways for people of ethnic backgrounds to be included in national and international conversations. Me and others have also taken mainstream media to task over representations of Asians (Asian Angst story by Debra Coddington);Paul Brennan’s Islamophobic comments on National Radio and Paul Henry’s comments about then Governor General Anand Satyanand. An editorial in the AEN Journal also examines the role of mainstream media in inter-cultural exchange and promoting inter-cultural awareness and understanding. I also challenged media representations of Maori and Pacific people as evidenced in cartoons by Al Nisbet, which were printed in New Zealand media. More recently, I’ve written with colleagues Nairn, Moewaka Barnes, Rankine, Borell, and McCreanor about the role and implications of media news practices for those committed to social justice and health equity.

Let me start by introducing a fairly binary definition of ethnic media that I am going to use as referring to media created for/by immigrants, ethnic and language minority groups and indigenous groups (Matsaganis et al., 2011). In contrast, media that produces content about and for the mainstream is known as the mainstream media. However, as most of you will know there’s a lot of blurriness and consumers consume both. I also want to preface this talk by introducing two key words which I am going to use as a lens for this keynote. I believe that these lenses are more important than ever in an era where critique is becoming censured for those in academia and in the context of corporate governance of media. Foucault’s notion of critique which is

“..a critique is not a matter of saying that things are not right as they are. It is a matter of pointing out on what kinds of assumptions, what kinds of familiar, unchallenged, unconsidered modes of thought the practices we accept rest” (Foucault, 1988, p.154).

and Stuart Hall’s definition of ideology:

Ideology: “The mental frameworks – the language, concepts, categories, imagery of thought and system of representation – which different classes and social groups deploy in order to make sense of, define, figure out and render intelligible the way society works” (Hall, 1996 p. 26).

It’s in the spirit of critique that I want to talk about the mainstream media’s role in co-option and converting audiences into seeing “like the media”. As Augie Fleras observes, media messages reflect and advance dominant discourses which are expertly concealed and normalised so as to appear without bias or perspective. The integrative role of mainstream media reflects and amplifies the concerns of particular groupings of power so that attention is drawn to norms and values that are considered appropriate within society. In this way attitudes are created and reinforced, opinions and understandings are managed and cultures are constructed and reinvented. The headline below shows the ways in which language is used to create an “other”, the picture out of focus, the beard a stand in for evil and fear, a threat to national security.

Sponsor a jihad

Thus mainstream media’s main function becomes commercial, selling by pooling groups together for the purposes of advertising and marketing and in so doing must appeal to a large audience. It can’t be too controversial (unless it’s also supporting larger official agendas such as guarding against the insider Islamic threat or deterring the hordes of maritime arrivals through forcibly turning back the boats) and it cannot segment its audiences with any kind of nuance. I think this meme floating around Facebook captures this idea of communicating some kind of national identity and values well.

Consequently social media, the internet and ethnic media are seen as able to service more specific audiences. In the case of social media, there’s some great opportunities for connecting beyond the nation state:

As the internet surpasses the nation-state limitations and usually the legislative limitations that bind other media, it opens up new possibilities for sustaining diasporic community relations and even for reinventing diasporic relations and communication that were either weak or non- existent in the past (Georgiou 2002: 25).

Moving on to ethnic media, I see several functions or imperatives loosely using the typology by Viswanath & Arora (2000): Ethnic media as form of cultural transmission, community booster, sentinel, assimilator, information provider and one lesser mentioned in the literature, as having a professional development function.

The most obvious role of ethnic media is to provide information for the community, events both local and from the homeland are paid attention to. In the break I was talking to a journalist from Radio Torana who is flying to Brisbane for the G20 summit and to cover Modi’s visit to Australia. Through him I found out about the Modi express. For the first time ever, a train service is running under the name of an Indian Prime Minister from Melbourne to Sydney carrying some 200 passengers who are planning to attend Prime Minister Narendra Modi’s public address in Sydney during his visit to Australia, the first by an Indian premier in 28 years (Rajiv Gandhi was the last, he met with Bob Hawke in 1986). The organisers have arranged for music and dance troupes to entertain the passengers along with free Gujarati specialties like ‘Modi Dhokla’ and ‘Modi Fafda’ (Fafda is crunchy snack made from chick pea flour and served with hot fried chillis or chutney and Dhokla is snack item made from a fermented batter of chickpeas accompanied with green chutney and tamarind chutney).

Photo from India2Australia.com

In its role as cultural transmitter, it has a distributive function to publish or broadcast information that is important to the ethnic community, so information about events and celebrations comes to the fore. This in turn sustains and fosters a sense of belonging to an imagined community, that feels coherent, united and connected to a homeland. However, rarely in that role does it also act as a critic of community institutions or powerful groups within that community.

A second role of ethnic media is as a community booster. In this role the media presents the community as doing well, being successful and achieving. The communities served by the media expect that a positive image is reflected both to its own members and outside the community. Typically close links are fostered between local reporters and editors and the community elite. Stories consist of human interest features, profiles of successful members, particularly those that are volunteers or contribute. There many be a reluctance to feature more radical or critical voices or critical stories as these many adversely affect the community image and the commercial imperative.

A third role is the ethnic media as a sentinel or watch dog. There’s very little about this in the literature but in fulfilling this role, the ethnic media produce stories on issues that could affect the rights of communities, crime against immigrants and so on.

A more common function is that of assimilation, where ethnic media play a part in assisting their community members to be more successful; through learning the ropes of the system. Ethnic media coverage then focuses on the role of the community in local politics and fostering positive relations and feelings between that of the ethnic group’s homeland and adopted country.

Another crucial function which is rarely articulated in this literature, but has been pivotal to my development is that of the ethnic media as space for professional development. Through engagement in ethnic media, members of ethnic communities develop transferrable skills and the capacity to write, broadcast and present. This one is very personally relevant. Through writing for the Migrant News and Global Indian, I refined my writing skills. Through talking on ethnic radio stations like Samut Sari and Planet FM I developed and refined my own capacity to articulate thoughts and ideas. Being featured in stories on Asia Downunder I realised my own ability to speak on television. These opportunities led to developing the confidence to develop my own online journal, the Aotearoa Ethnic Network Journal and write peer reviewed publications and feature on commercial radio and television. This would never have happened without the support of those ethnic media pioneers. I acknowledge them all.

However, ethnic media is on rapidly shifting terrain. Increasingly consumers are negotiating the availability of media from their place of origin via the internet. Ethnic media are having to consider their roles and business models in the context of neoliberalism and the withdrawal of the state from cultural funding.

The end of the charter. Picture via Against the Current

Recently Television New Zealand the public service broadcaster announced that it intended to outsource production of Māori programmes (Marae, Waka Huia) and Pacific (Fresh and Tagata Pasifika) programmes. A depressing move given the unrelenting negative representations of people in these communities who are socially and culturally marginalised in New Zealand mainstream media (see my blog post on how blame for the disparities in health is attributed to individuals and communities rather than neoliberal and austerity policies). This very manoeuvre was used to outsource Asia Downunder a programme which ran from 1994-2011 for Asians in New Zealand and featured the activities of Asians in New Zealand and New Zealand Asians abroad gutted Asian institutional knowledge and capacity within TVNZ when it was replaced with Neighbourhood. Asia Downunder was a casualty of the loss of the Television New Zealand Charter which was introduced in 2003 by the Labour government and removed in 2011 by the National government on the basis that meeting its public service obligations were a barrier to its commercial obligations. The Charter encouraged TVNZ to show programmes that reflect New Zealand’s identity and provided funding. You can read more about its history and gestation and what has been lost in The End of an Error? The Death of the TVNZ Charter and its implications for broadcasting policy in New Zealand by Peter A. Thompson, Senior Lecturer, Media Studies Programme, Victoria University of Wellington.

In this context, I end with several questions. Given that ethnic media institutions help their audiences to reimage or sustain themselves and their place in the cultural and socio-political milieu of their new home (Gentles-Peart):

What is the relationship between ethnic media and the ‘mainstream ideological apparatus of power? (Shi, 2009: 599)
What is the relevance of ethnic media in terms of the next generation?
What is the relationship between ethnic media and indigenous media?
How do ethnic media import or reinforce or critique the power structures of immigrants’ homelands including gender, class and sexuality?
Are there opportunities for ethnic media to lobby and advocate for their communities?
What opportunities and possibilities are available for inter-ethnic media work?

I look forward to summing up the korero at the end of our forum, to report back to the roopu about the strands we’ve woven together and to enjoying the robust and dynamic discussions that I know are going to happen today. No reira me mihi nui kia koutou katoa ano, tena koutou tena koutou, tena ra koutou katoa.

Update: 12th March 2017: the curated conference proceedings of the Ethnic Migrant Media Forum are now available. Edited by Evangelia Papoutsaki & Elena Kolesova with Laura Stephenson.

November 16, 2014/by ruth

Feminism, Food, Inequalities, Maternity, Migration, Multiculturalism, Nursing, Power relations, Women, Writing

“Kiwi food is okay for Kiwis, but it isn’t okay for us”: Special food in the perinatal period for migrant mothers

I attended the 5th International Conference on Nutrition and Nurture in Infancy and Childhood: Relational, Bio-cultural and Spatial Perspectives from Wednesday, 5 November 2014 – Friday, 7 November 2014.

Those who know me or follow my work will know that I am deeply interested in eating and thinking about food. I’m interested in how food structures our days and our lives,it nourishes and sustains us, reminds us of people, events, history, all in a mouthful.

A special birthday cake, made for a surfer on his special birthday.

I’ve written elsewhere about how migrants perform identity through food preparation and consumption. I’ve also written about consumptive multiculturalism. I’m also interested in the provision of food in (monocultural) institutional contexts such as health where people are racialised by the foods that they eat and how the processes of hospitalisation strip people of their cultural and social identities and often lead people into being unable to access culturally appropriate food. This presentation brings those ideas together.

Abstract

Food, its preparation and ingestion, constitutes a source of physical, emotional, spiritual and cultural nourishment. Food structures both daily life and major life transitions, including the transition to parenthood, where food is prepared and consumed that recognises the unique status of the mother. However, the reductive focus of hospitals where efficiency, economy and a focus on nutrients dominate and where birth is viewed as a normal event can mean that there is a mismatch between the cultural and religious dietary needs of migrant mothers with the food that is available from Western instititutional environments. In this paper I outline a research study, which examined the transition to parenthood among new migrant groups in New Zealand. Based on a number of focus groups with mothers and fathers, the data were analysed using a postcolonial feminist lens and drew upon Foucauldian concepts to examine the transition to parenthood. The findings show that Asian new migrant parents construct the postnatal body as vulnerable, requiring specific kinds of foods to facilitate recovery from the trials of pregnancy and delivery and optimize long term recovery from pregnancy. This discourse of risk contrasts with the dominant discourse of birth as normal, and signals the limitations of a universal diet for all postnatal mothers, where consuming the wrong food can pose a threat to good maternal health. Paying attention to what nutrition and nurturing might mean for different cultural groups during the perinatal period can contribute to long term maternal well-being and cultural safety. Health practitioners need to understand the meanings and significance attached to specific foods and eating practices in the perinatal period. I propose that institutional arrangements become responsive to dietary needs and practices by providing facilities and resources to facilitate food preparation.

I’m hoping that the written form of the paper becomes part of an edited book about mothers and food. Fingers crossed, it’s under review at the moment.

November 6, 2014/by ruth

Colonialism, Cultural safety, Indigenous, Inequalities, language, Media, Nursing, Racism, Te Tiriti o Waitangi/Treaty of Waitangi, Writing

Nursing in media-saturated societies: implications for cultural safety in nursing practice

Nairn, DeSouza, Moewaka Barnes, Rankine, Borell, and McCreanor (2014). Nursing in media-saturated societies: implications for cultural safety in nursing practice in Aotearoa New Zealand. Journal of Research in Nursing September 19: 477-487,doi:10.1177/1744987114546724

Great to be published in the Journal of Research in Nursing September 2014 issue on ‘Race’, Ethnicity and Nursing, Edited by: Lorraine Culley. I had the pleasure of being included in a previous issue in 2007, so it’s great to be in this one.

Abstract

This educational piece seeks to apprise nurses and other health professionals of mass media news practices that distort social and health policy development. It focuses on two media discourses evident in White settler societies, primarily Australia, Canada, New Zealand and the United States, drawing out implications of these media practices for those committed to social justice and health equity. The first discourse masks the dominant culture, ensuring it is not readily recognised as a culture, naturalising the dominant values, practices and institutions, and rendering their cultural foundations invisible. The second discourse represents indigenous peoples and minority ethnic groups as ‘raced’ – portrayed in ways that marginalise their culture and disparage them as peoples. Grounded in media research from different societies, the paper focuses on the implications for New Zealand nurses and their ability to practise in a culturally safe manner as an exemplary case. It is imperative that these findings are elaborated for New Zealand and that nurses and other health professionals extend the work in relation to practice in their own society.

One of my favourite pieces of the article proposes some ways in which nurses can engage in critical assessment of mass media, by asking questions like:

From whose point of view is this story told?
Who is present?
How are they named and/or described?
Who, of those present, is allowed to give their interpretation of the matter?
Who is absent?
Whose interests are served by telling the story this way?

One of the things that I love about this journal is that they ask for commentaries from a reviewer. My former colleague Denise Wilson (Professor, Māori Health Taupua Waiora Centre for Māori Health Research/School of Public Health & Psychosocial Studies, National Institute of Public Health and Mental Health Research, Auckland University of Technology, New Zealand), has reviewed our paper and says:

I would urge nurses to read this paper and reflect on how the media influences their own practice and engagement with minority and marginalised groups. Media portrayals of minority groups often reflect negatively geared dominant cultural sentiments, becoming ‘accepted’ fact within our communities. Nurses need to be aware that their efforts to be culturally safe in their practice can be undermined by the normalisation and acceptance of what is portrayed in the media. Therefore, nurses are encouraged by the authors to come together and question the ‘taken-for-granted’ dominant cultural media portrayals to create a stronger platform for culturally safe practice.

September 8, 2014/by ruth