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All I want for Christmas is… On International Day of Solidarity with Migrants 2015

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

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Medical pluralism: Supporting co-existing diverse therapeutic traditions in mental health

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.

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Politics and policies reflect values: Border Force Act 2015 and the Immigration Amendment Bill (NZ)

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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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.

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.

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

Jeanie Govan

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.

Hamilton action

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

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.

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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.

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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.

  1. 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);
  2. Interpersonal, in interactions between individuals either within their institutional roles or as private individuals;
  3. 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.

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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.

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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:
  1. Improve the conditions of daily life – the circumstances in which people are born, grow, live, work, and age.
  2. Tackle the inequitable distribution of power, money, and resources – the structural drivers of those conditions of daily life – globally, nationally, and locally.
  3. 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.

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

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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.

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References

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Chapman, R., Smith, T., & Martin, C. (2014). Qualitative exploration of the perceived barriers and enablers to Aboriginal and Torres Strait Islander people accessing healthcare through one victorian emergency department. Contemporary Nurse.
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Kelly, J., West, R., Gamble, J., Sidebotham, M., Carson, V., & Duffy, E. (2014). ‘She knows how we feel’: Australian Aboriginal and Torres Strait Islander childbearing women’s experience of continuity of care with an Australian Aboriginal and Torres Strait Islander midwifery student. Women and Birth : Journal of the Australian College of Midwives, 27(3), 157-62. doi:10.1016/j.wombi.2014.06.002
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Larson, A., Gillies, M., Howard, P. J., & Coffin, J. (2007). It’s enough to make you sick: The impact of racism on the health of Aboriginal Australians. Australian and New Zealand Journal of Public Health, 31(4), 322-329.
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Paradies, Y., & Cunningham, J. (2009). Experiences of racism among urban indigenous Australians: Findings from the DRUID study. Ethnic and Racial Studies, 32(3), 548-573. doi:10.1080/01419870802065234
Paradies, Y., Harris, R., & Anderson, I. (2008). The impact of racism on indigenous health in Australia and aotearoa: Towards a research agenda. Cooperative Research Centre for Aboriginal Health Darwin.
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Pedersen, A., Dudgeon, P., Watt, S., & Griffiths, B. (2006). Attitudes toward indigenous Australians: The issue of special treatment. Australian Psychologist, 41(2), 85-94. Pijl-Zieber, E. M., & Hagen, B. (2011). Towards culturally relevant nursing education for Aboriginal students. Nurse Education Today, 31(6), 595-600. doi:10.1016/j.nedt.2010.10.014Prior, D. (2009). The meaning of cancer for Australian Aboriginal women; changing the focus of cancer nursing. European Journal of Oncology Nursing : The Official Journal of European Oncology Nursing Society, 13(4), 280-6. doi:10.1016/j.ejon.2009.02.005
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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.

Migrating minds

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.

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.
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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

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.

Port Arthur2

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.

Tele-front-page

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:

Australiam

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…

John Donegan ABC Sydney

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:

Clover Moore

 

  • 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.

 

 

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

Breaking news comsumers handbook

  • 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.

Heartlight

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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

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

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

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.

team australia

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

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

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.

 

 

 

 

 

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Mind the gap: Cultural safety in Australia

In August 2014 there was a wonderful story of how “people power” had freed a man in Perth, whose leg had become caught in the gap between a platform and train on his morning commute. You can watch the video here. What struck me about this story was that people taking part in their “regular” commute noticed something out of the ordinary and used their combined energy to free the man. Someone alerted the driver to make sure that the train didn’t move, staff then asked passengers to help and in tandem they rocked the train backwards from the platform so it tilted and his leg could be freed. It made me think about the gaps people are stuck in, that exist all around us, that have become so routine, that we are habituated to, and fail to notice.

One of the biggest gaps is in the health outcomes between Indigenous and non-indigenous people in settler nations. Oxfam notes that Australia equals Nepal for the world’s greatest life expectancy gap between Indigenous and non-Indigenous people. This is despite Australians enjoying one of the highest life expectancies of any country in the world. Indigenous Australians (who numbered 669,900 people in 2011, ie 3% of the total population) live 10-17 years less than other Australians. In the 35–44 age group, Indigenous people die at about 5 times the rate of non-Indigenous people. Babies born to Aboriginal mothers die at more than twice the rate of other Australian babies, and Aboriginal and Torres Strait Islander people experience higher rates of preventable illness such as heart disease, kidney disease and diabetes.

One of the most galvanising visions for addressing the health and social disparities between Indigenous and non-indigenous people is  The Close the Gap campaign aiming to close the health and life expectancy gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians within a generation. By 2030 any Aboriginal or Torres Strait Islander child born in Australia will have the same opportunity as other Australian children to live a long, healthy and happy life.

Mind the gap

 

Nurses play an important role in creating a more equitable society and have  been forerunners in the field of cultural safety and competence. For the gap to close, nurses need an understanding of health that includes social, economic, environmental and historical relations. Cultural safety from Aotearoa New Zealand has been an invaluable tool for me as nurse for analysing this set of relations. However, as a newcomer to Australia, I have a lot to learn about what cultural competency means here and how I fulfil my responsibilities as a nurse educator to Aboriginal and Torres Strait Islander peoples. To that end, this blog piece focuses on some of the frameworks in nursing that might enable nurses to close the gap. I am particularly interested in frameworks that enable nurses to widen the lens of care beyond the individual and consider service users in the context of their families and communities and broader social and structural inequities. I’m also interested in policy frameworks that can support practice.

Gosford Anglican church

A social determinants of health approach takes into account “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics” (WHO, 2010). A health equity lens has also been invaluable to my own practice, it refers to the absence of systematic disparities in health (or in the major social determinants of health) between groups with different social advantage/disadvantage. Social inequalities refer to “relatively long-lasting differences among individuals or groups of people that have implications for individual lives” (McMullin, 2010, p.7). While an inequity, refers to an unjust distribution of resources and services. “equity means social justice” (see, Braverman 2003). The term “social and structural inequities,” refers to unfair and avoidable ways in which members of different groups in society are treated and/or their ability to access services.

Equality justice

Principle Four of the New Zealand Nursing Council: Guidelines for Cultural safety in Nursing and Midwifery Education (2011) pay great attention to the issue of power:

PRINCIPLE FOUR Cultural safety has a close focus on:

 

4.1 understanding the impact of the nurse as a bearer of his/her own culture, history, attitudes and life experiences and the response other people make to these factors

4.2 challenging nurses to examine their practice carefully, recognising the power relationship in nursing is biased toward the provider of the health and disability service

4.3 balancing the power relationships in the practice of nursing so that every consumer receives an effective service

4.4 preparing nurses to resolve any tension between the cultures of nursing and the people using the services

4.5 understanding that such power imbalances can be examined, negotiated and changed to provide equitable, effective, efficient and acceptable service delivery, which minimises risk to people who might otherwise be alienated from the service.

The Australian Code of Ethics for nurses and midwives in Australia also pays attention to the role of nurses in having a moral responsibility to protect and safe guard human rights as means to improving health outcomes and having concern for the structural and historical:

The nursing profession recognises the universal human rights of people and the moral responsibility to safeguard the inherent dignity and equal worth of everyone. This includes recognising, respecting and, where possible, protecting the wide range of civil, cultural, economic, political and social rights that apply to all human beings.

 

The nursing profession acknowledges and accepts the critical relationship between health and human rights and ‘the powerful contribution that human rights can make in improving health outcomes’. Accordingly, the profession recognises that accepting the principles and standards of human rights in health care domains involves recognising, respecting, actively promoting and safeguarding the right of all people to the highest attainable standard of health as a fundamental human right, and that ‘violations or lack of attention to human rights can have serious health consequences’.

 

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.

The Code stops short of using words like colonisation and racism, but the National Aboriginal Community Controlled Health Organisation background paper “Creating the Cultural Safety Training Standards and Assessment Paper” (2011, p. 9) points out that awareness and sensitivity training, result in individuals becoming more aware of cultural, social and historical factors and engaging in self-reflection however if there isn’t an institutional response and the responsibilities for institutional racism remain individualised:

Even if racism is named, the focus is on individual acts of racial prejudice and racial discrimination. While historic overviews may be provided, the focus is again on the individual impact of colonization in this country, rather than the inherent embedding of colonizing practices in contemporary health and human service institutions

The focus is on the individual and personal, rather than the historical and institutional nature of such individual and personal contexts.

Cultural Respect
The concept of cultural respect (Aboriginal Cultural Security: Background Paper, Health Department of Western Australia) comes the closest to embedding the health care system with policies and practices to help improve the health care outcomes of Aboriginal and Torres Strait Islander peoples. Having a cultural respect framework means that there is an acknowledgement that:

the health and cultural wellbeing of Aboriginal and Torres Strait Islander peoples within mainstream health care settings warrant special attention.   Cultural Respect is the:  recognition, protection and continual advancement of the inherent rights, cultures and tradition of Aboriginal and Torres Strait Islander Peoples. ….   [it] is about shared respect ….[and] is achieved when the health system is a safe environment for Aboriginal and Torres Strait Islander peoples and where cultural differences are respected. It is commitment to the principle that the construct and provision of services offered by the Australian health care system will not compromise the legitimate cultural rights, values and expectations of Aboriginal and Torres Strait Islander peoples. The goal is to uphold the rights of Aboriginal and Torres Strait Islander peoples to maintain, protect and develop their culture and achieve equitable health outcomes.

The framework includes the following dimensions:
Knowledge and awareness, where the focus is on understandings and awareness of  history, experience, cultures and rights of Aboriginal and Torres Strait Islander peoples.
A focus on changed behaviour and practice to that which is culturally appropriate. Education and training and robust performance management processes are strategies to encourage good practice and culturally appropriate behavior.
Strong relationships between Aboriginal and Torres Strait Islander peoples and communities, and the health agencies providing services to them. Here the focus is on the business practices of the organization to ensure they uphold and secure the cultural rights of Aboriginal and Torres Strait Islander peoples.
Equity of outcomes for individuals and communities. Strategies include ensuring feedback on relevant key performance indicators and targets at all levels.
What I like about this framework is that it goes beyond attitudes and knowledge-based to also demand changed behaviour and action that leads to culturally safe healthcare for Aboriginal and Torres Strait Islander peoples. Central to cultural respect is the need for organisations to engage with and seek advice from local Aboriginal or Torres Strait Islander communities.
Cultural Security
Another new term is the notion of cultural security (developed by the Department of Health, Western Australian Health, 2003, Aboriginal Cultural Security: A background paper, page 10) which focuses on behavior: the practice, skills and behaviour of both professionals as individuals and the health system:

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

Cultural Responsiveness
Defined by the Victorian Health Department as: The capacity to respond to the healthcare issues of diverse communities. This term broadly considers diversity rather than the unique needs of Aboriginal and Torres Strait Islander peoples which are a consequence of colonialism and racism.
Cultural Competence

The term ‘Cultural competence’ originates from Transcultural Nursing developed by Madeleine Leininger. Borrowing from anthropology, the aim was to develop a model that encouraged nurses to study and understand cultures other than their own. You can read my paper on the complementariness of cultural safety and competence here. Wellness for all: the possibilities of cultural safety and cultural competence in New Zealand. Betancourt, et al., 2002, p. v define it as:

the ability of systems to provide care to patients with diverse values, beliefs and behaviours, including tailoring delivery to meet patients’ social, cultural and linguistic needs

The Australian National Health and Medical Research Council (NHMRC)’s  Cultural Competency in Health: A guide for policy, partnerships and participation supports the notion of the capacity of the health system to improve health and wellbeing by integrating culture into the delivery of health services, but the scope of the document does not extend to cultural competency as applied to Aboriginal and Torres Strait Islander health care.
Government interventions to address health inequities are being deployed in tandem with neoliberalism and economic globalisation, which push back responsibility to individuals. Now, more than ever, attention needs to be paid to power relations and structures that contribute to inequality in society and injustice within nursing, using approaches that consider equity and the social determinants of health. I personally am looking forward to the day when we don’t need this sign, because there isn’t a gap.
Mind-the-Gap
What you can do:
Support the Close the Gap campaign
Dr Tom Calma’s (Aboriginal and Torres Strait Islander Commissioner )  Social Justice Report 2005 instigated a human rights-based approach Campaign to close the gap in life expectancy between Indigenous and non-Indigenous Australians (up to 17 years less than other Australians at the time). This report called on all Australian governments to commit to achieving equality of health status and life expectancy within a generation (by 2030).
A coalition drawn from Indigenous and non-Indigenous health and human rights organisations formed the Close the Gap Campaign, which was launched in April 2007 by Catherine Freeman and Ian Thorpe, the Campaign’s Patrons.  The CTG Campaign is currently Co-Chaired by the Aboriginal and Torres Strait Islander Social Justice Commissioner Mick Gooda and Co- Chair of the National Congress of Australia’s First Peoples, Kirstie Parker. The Campaign Steering Committee is comprised of 32 health and human rights organisations. The members of the Campaign Steering Committee have worked collaboratively for approximately nine years to address Aboriginal and Torres Strait Islander health inequality through two primary mechanisms: attempting to gain public support of the issue and demanding government action to address it.
Some useful videos
Aboriginal and Torres Strait Islander health videos:
http://blogs.crikey.com.au/croakey/2013/08/04/youtube-an-excellent-resource-for-aboriginal-and-torres-strait-islander-health/Cultural competence video:
https://www.youtube.com/watch?v=JpzLzgeL2sADr Tom Calma – Cultural Competency
https://www.youtube.com/watch?v=tnYuTY0fn3s
White privilege: Unpacking the invisible knapsack
http://amptoons.com/blog/files/mcintosh.htmlWhat kind of Asian are you?
https://www.youtube.com/watch?v=DWynJkN5HbQReverse racism, Aamer Rahman:
https://www.youtube.com/watch?v=dw_mRaIHb-M
Terminology
Aboriginal and Torres Strait Islander peoples are the first inhabitants of Australia.  Aboriginal people are extremely heterogenous groups differing in language and tradition. Torres Strait Islander peoples come from the islands of the Torres Strait, between the tip of Cape York in Queensland and Papua New Guinea but who may live on mainland Australia. The term ‘Indigenous’ is often used to refer to both Aboriginal and Torres Strait Islander peoples. In the spirit of being both relational and political then I’d like to share with you my learning about cultural competency and Aboriginal and Torres Strait Islander health care.
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Babies on board: Families in detention

The rather time-worn yellow sign “Baby on Board” seen in the back window of vehicles is meant to encourage safe driving, but also is a public announcement of one’s new status as a parent (It’s also a pun referring to pregnant women commuters in London, as an incitement for commuters to offer their seats to pregnant women). In Australia, when I think of “Babies on Board” there is a poignancy and a deep and overwhelming sadness, because it evokes images of people seeking asylum via boat. The official term is “unauthorised maritime arrivals”, a dehumanising and bureaucratic term rather like the hardline policies of deterrence and detention. Abbott’s cruel “stop-the-boats” strategy ensures that maternity and infancy cannot be the celebrations they are in every culture. Mothers, babies, children and families will encounter the opposite of tender loving care at the hands of the Australian Government who will send them to detention centres in remote locations run by global companies including G4S, Serco and Transfield (See Cathy Alexanders Crikey post for more details). This outsourcing of misery costs the Australian taxpayer a load of money ($2.97 billion has been budgeted by the Federal Government (2013-2014) for detention-related services and offshore asylum seeker management while $19.3 million is  allocated ($65.8 million over four years) for regional solutions).

baby-on-board-2

Consistent with other responses to asylum seekers in western countries, Australia has developed policies of deterrence and detention for boat arrivals without a valid visa. Australia’s Migration Act 1958 requires all “unlawful non-citizens” (people who are not Australian citizens and do not have permission to be in the country) to be detained, until they are granted a visa or leave the country. This detention policy was introduced in 1992 and continues until today. What makes Australia’s response to a legitimate right to seek asylum is the uniquely cruel policy of mandatory, indefinite detention and offshore processing. Without an age exemption it means that detainees can include families and unaccompanied children with processing taking months or years. A range of international literature shows that detention is highly distressing for both adults and children with long-term consequences. The majority of asylum seekers are found to be refugees under the 1951 Convention.

Everyone has the right to seek and enjoy in other countries asylum from persecution. Article 14, Universal Declaration of Human Rights (signed by member countries in 1948, including Australia).

The child shall have the right to adequate nutrition, housing, recreation and medical services. Principle 4. United Nations Declaration of the Rights of the Child. Proclaimed by General Assembly resolution 1386(XIV) of 20 November 1959.

I am horrified that many new babies and new parents will be starting their lives in detention, the latter having already navigated treacherous borders, war strife and dangerous seas but now officialdom to meet the needs of their babies. Most of my professional career has involved supporting new parents. Aside from working on a postnatal ward, I helped to set up a service for women with postnatal depression in Auckland in the mid-nineties, my colleagues and I offered assessment, consultation and therapy to women. Aside from the hundreds of women I met I also heard many stories in the weekly support group I facilitated for depressed women for three years. My Master’s research considered the experiences of new migrant mothers and the challenges of establishing a new life without support and access to cultural rituals. In my PhD research I looked at the “the politics of the womb” and the role of maternity in projects of capitalism, nation building, imperialism and globalisation. See my other blog posts on supporting migrant fathering, ‘good’ mothering, pronatalist and antinatalist policies (including Australia’s forcible removal of Aboriginal – and some Torres Strait Islander – children). I’ve also researched and written about the experiences of Refugee women in New Zealand, Korean migrant mothers and the discursive repertoires of Plunket Nurses. I have spent decades educating organisations and professionals about the needs of new mothers and I developed a brochure about Postnatal depression for the New Zealand Mental Health Foundation with the help of consumer organisations and many new parents and professionals. So you could say I know a little about what new mothers and babies might need to help them thrive.

Parenting and mothering are not easy. The transition is challenging emotionally, physically and socially. That’s why so many cultures have rituals for protecting and nurturing new mothers, whether it’s special foods, attention or ceremonies. The mother has experienced a massive transition requiring time to recoup, hence postpartum rest and loving attentive care are provided to women. Maternity professionals have a unique role in supporting the health and wellbeing of new migrant and refugee families, as they have privileged access to women at a time that is culturally and spiritually important to a woman and her family. However, women’s experiences of maternity services that are designed to meet their needs, can lead them to feel isolated, disrespected and invisible (and that’s when they aren’t in detention). 

Detention centres have been called factories for mental illness. The conditions in immigration detention are not conducive to establishing or maintaining family life, let alone helping families thrive. For asylum seekers who may have experienced torture or trauma, there is a vulnerable to experiencing mental health problems even before they reach countries of resettlement. The conditions of detention are demanding and difficult without the resources and support of family and friends, community and culture, no direct access to services and support. This situation is exacerbated by the unknown length for which people will be detained and to where they might be sent. It is further compounded by the punitive and coercive ways in which people are treated in detention. Existing trauma is only exacerbated while in prolonged detention which has an impact not only on the individuals in a family, but families themselves with the role of parent being undermined. Imagine powerless parents in unpredictable, hostile and degrading surroundings who cannot ensure their children’s safety or comfort. Yes, Australian policies of detention and deterrence are contributing to long term mental ill health for children and their families. Detention facilities have been criticised for the “culture of punishment, humiliating treatment of detainees, including children, and a failure to provide appropriate psychological support for high-risk populations”.

Children in detention

 In all actions concerning children … the best interests of the child shall be a primary consideration. UN Convention on the Rights of the Child (1989)  – Article 3.

.. a child who is seeking refugee status … whether unaccompanied or accompanied … [shall] receive appropriate protection and humanitarian assistance.

UN Convention on the Rights of the Child  (1989) – Article 22 .

 

No child shall be deprived of his or her liberty unlawfully or arbitrarily. The arrest, detention or imprisonment of a child shall be in conformity with the law and shall be used only as a measure of last resort and for the shortest appropriate period of time.

UN Convention on the Rights of the Child  (1989) – Article 37 (b).

 

Children subjected to abuse, torture or armed conflicts should recover in an environment which fosters the health, self-respect and dignity of the child.

UN Convention on the Rights of the Child (1989) Article 39.

Children, accompanied or on their own, account for as up to half of all asylum seekers in the industrialized world. Australia is not the only country to detain children, The United States, the United Kingdom, Germany and Italy also directly contradict The Convention on the Rights of the Child (UNCRC), which stresses that detention of children should only be a last resort and for the shortest appropriate period of time. In Australia up till 1994 there was a 273-day time limit on detention, however, after this time indefinite detention became the norm with no exemptions made for children or unaccompanied minors. A Human Rights Commission National Inquiry into Children in Immigration Detention in 2001 noted that (CRC)  requires the detention of children to be ‘a measure of last resort’, but Australia’s detention laws make detention of unauthorised arrival children ‘the first, and only, resort’. Mandatory detention overrides the rights and protections of child asylum seekers as enshrined in other international and regional conventions and declarations the European Convention on Human Rights, the Geneva Convention, the International Covenant on Civil and Political Rights, and the International Covenant on Economic, Social and Cultural Rights. 

Source: Department of Immigration and Citizenship, 13 September 2013. Adapted by the Australian Human Rights Commission.

Source: Department of Immigration and Citizenship, 13 September 2013. Adapted by the Australian Human Rights Commission.

The Australian Department of Immigration and Border Protection (DIBP) statistics (2014) show that:

  • 1106 children are held in Australia’s secure immigration detention facilities,
  • 356 on Christmas Island and 177 of the children in Nauru
  • 1579 are detained in the community under residence determinations.
  • 1816 children live in the community on Bridging Visas (their parents have no work rights and limited access to Government support).

Research shows that even “brief” detention is detrimental to children. Prior to 2008, all children seeking asylum In Australia were faced with mandatory detention for an average of two years. In a summary of the impacts on children’s physical and mental health, Kronick, Rousseau, & Cleveland (2011) noted all manner of behvioural problems including disruptive conduct, nighttime bedwetting, separation anxiety, sleep disturbance, nightmares and impaired cognitive development. More severe symptoms includied mutism, stereotypic behaviours, and refusal to eat and drink. Mental health problems such as post-traumatic stress disorder, major depression, self harm and suicidal ideation were common. Younger children experienced developmental delays, attachment and behavioural problems Parents self-reported a decrease in the capacity to parent while in detention, and detention can trigger memories of previous trauma, humiliation and hopelessness. United Kingdom research has also found behavioural difficulties, developmental delay, weight loss, difficulty breast-feeding in infants, food refusal and loss of previously obtained developmental milestones. The neurodevelopmental vulnerability of infants means that they are highly sensitive to their socio-cultural environments. The Australian Human Rights Commission is conducting an inquiry into children in immigration detention. You can read powerful testimonials from children themselves, educators and health professionals including this account from Paediatrician Karen Zwi who visited Christmas Island:

Babies are unable to crawl because the ground is so rough and the only playground is unusable during the day due to the extreme heat.New mothers are forced to queue up for strictly rationed nappies, baby wipes and powdered milk, with staff telling them constantly they will never be resettled in Australia.

Parenting in detention

Changes to the Migration Act since July 19, 2013 mean that pregnant asylum seekers in offshore detention (classed as “unauthorised maritime arrivals”) can be removed offshore. Recently babies have been sent from Darwin to Nauru and Greens Senator Sarah Hanson-Young plans to introduce a bill banning the removal of Australian-born babies to offshore detention centres to Parliament in May. She says:

‘‘We are, by incarcerating these newborn babies, creating the next damaged generation . . . we know the damage the detention of children has (on them),’’ she said. ‘‘If we allow this to continue, we are knowingly destroying them,’’ she said. ‘‘I don’t think that’s a political issue, it’s a moral issue.’’

(Note that Section 21(8) of the Australian Citizenship Act makes clear that a baby, born in Australia, who is stateless, is eligible to apply for Australian citizenship).

Louise Newman (see reference below) has worked extensively with women asylum seekers and notes that they have unique health and mental health needs related to pregnancy and delivery which can be exacerbated by limited antenatal care or screening. Their histories can include sexual trauma and abuse and perinatal loss. Receiving perinatal “care” in a detention facility means that professionals are balancing competing priorities and subject to varying forms of regulation and administration which put complex demands on their time. There may be ambiguity about how to respond to the needs of pregnant or postpartum women who they might be ill-equipped or resourced to support as reports have indicated.

In a detention context, women are isolated from their cultural traditions and supports and sometimes physical isolation begins weeks prior to delivery. This cultural isolation compounded with a lack of access to interpreters during delivery can increased fear and distress and is implicated in the high rates of postnatal depression and anxiety and attachment difficulties with infants seen in women in detention. Newman notes that research in the United Kingdom would resonate with women’s experiences and clinician observations in Australia. Where women expressed high levels of of distress and reported poor care. The context also impacted on their capacity to parent with women feeling isolated, incompetent, ashamed and guilty for delivering a baby in detention. Consequently, a highly anticipated, magnificent, sacred and profound time in a woman and her family’s life becomes one that is painful. In a powerful article describing his visit to Christmas Island, acting for some 26 babies born in detention Jacob Varghese notes how cruel asylum seeker policy is for new parents:

…what it is like being a new parent in a remote prison, with no control over your circumstances, every daily routine determined for you by guards and bureaucrats.

 

How the Australian government reports on conditions in detention differs from the reality. In an article for Crikey, Caroline de Costa, Professor of Obstetrics and Gynaecology and Director of the Clinical School at James Cook University School of Medicine, Cairns Campus in North Queensland notes:

We were told that there is 24/7 access to a nursing triage service, with a doctor on call, for asylum seekers (male and female, adults and children) in all three camps.  We were also told that there are regular playgroups and ‘Mums and Bubs’ sessions held in all three camps for pregnant women and new mothers. Meeting individual asylum seekers, in the visitors’ rooms of all three facilities, in the two days following our formal visit, we heard stories quite different from the official accounts. We observed in many parts of the camps that asylum seekers including children and women are routinely listed, dealt with and addressed by the numbers given to them on arrival by boat in Australia, rather than by their names.

Caroline de Costa also “unequivocally” states that neither Manus nor Nauru are suitable places for the detention of very young babies and their families. She suggests that:

the greatest and most pervasive risk is to the mental health of children and their families. The fact of ongoing uncertain detention is bad enough; adding to it with an extremely isolated hot and crowded environment with few diversions within the detention facility and none outside is demonstrably contributing to very high levels of psychiatric presentations among asylum seekers, well documented by many of my colleagues in recent weeks. My own observations of recent mothers I met in Darwin is of a high level of postnatal depression that is continuing on well past the postnatal period…

The Australian Immigration Minister’s (Scott Morrison) office says:

the Government’s policy is to transfer illegal boat arrivals to offshore processing centres and families are transferred to Nauru. The statement says creating exemptions for offshore processing will only create dangerous incentives for people smugglers to fill boats with women and children.

Cartoon by Oslo Davis Source: Museum Victoria

Cartoon by Oslo Davis
Source: Museum Victoria

So what can we do?

The good news is that there is plenty of resistance both professionally, in the community and among refugee advocacy organisations. DASSAN (Darwin Asylum Seekers Support and Advocacy Network) believe that families should not be detained and babies should not be born into detention. They advocate for policy change but have also been providing practical help and support including: making welcome packs for new babies; sewing gifts: and collecting clothes for babies and women in detention on Christmas Island. They observe:

At a time when families should be focused on preparing for the joy of welcoming new life, they are instead dealing with the trauma of having fled from their home, the great anxiety of being told they will be sent to Nauru or Manus Island, and the daily despair of being kept locked up.

(Note, if you’d like to support their work there are details on the DASSAN site). Chilout (Children out of immigration detention) have worked tirelessly to lobby for children aged from zero to eighteen. I recommend reading their Factsheet and accessing the extensive range of resources and reports on their website.

The use of prolonged detention for pregnant women and mothers with young children inflicts physical and psychological harm disproportionate to the policy aim of immigration control and should be stopped immediately .

 

The Royal Australasian College of Physicians (RACP) made a passionate plea on World  Refugee Day for the Australian Government to end the mandatory detention of children and adolescents seeking asylum in Australia and in offshore centres. Their Position Statement Towards better health for refugee children and young people in Australia and New Zealand advocates for the abolition of  Australian legislation that allows children to be housed in detention centres and they propose that the Australian Government  immediately place detained children in the community with their families where they can be provided with appropriate health and social support. There is a Paediatrics & Child Health advocacy campaign for health and well-being of children in detention/refugees which was launched on 7 June 2013. Information and template letters addressed to Government Ministers can be used to advocate for health of children in detention. These are just a few of the national and local responses to mothers, children and families in detention.
There is also a National Inquiry into Children in Immigration Detention 2014: Discussion Paper. The the Australian Human Rights Commission (HRC) is investigating the ways in which life in immigration detention affects the health, well-being and development of children and inviting people previously detained as children in closed immigration detention and assessing the current circumstances and responses of children to immigration detention. A follow up to their report ten years ago A last resort? the report of the National Inquiry into Children in Immigration Detention (National Inquiry). After the National Inquiry positive developments including the removal of children from high security Immigration Detention Centres, the creation of the Community Detention system and the use of bridging visas for asylum seekers who arrive by boat. However, there are still around 1,000 children in closed immigration detention, a higher number than the last inquiry, and the Commission’s monitoring work reveals that key concerns remain. Their aim is to discover if there have been any changes in the ten years since the last investigation, and whether Australia is meeting its obligations under the Convention on the Rights of the Child (CRC). You can read the inquiry discussion paper and make a submission that addresses the inquiry terms of reference. This inquiry is focused on closed detention facilities (not community) and the impact of detention on children under 18 years. You can also read about their work on alternatives to closed detention The last words really belong to Murray Watt who in an article Why is an Australian baby locked up in detention? says:

 

It’s not fair that children – or anyone for that matter – should be locked up for years on end, without any consideration of their claims to protection.   It’s not fair that the conditions in offshore detention camps, overseen by our own government, are dangerous, inhumane and deliberately designed to break people’s spirit.   And it’s not fair that Australia – ranked by the IMF as the 10th richest country in the world – should pass our refugee “problem” on to countries that are far poorer and less safe than many of the countries from which refugees come in the first place.   Australia can do better than this. Over our history, we have led the world in protecting others in distress, and in improving the rights and living conditions of our citizens and those across the world. We should live up to our history.

References

  • Kronick, Rachel, Rousseau, Cécile, & Cleveland, Janet. (2011). Mandatory detention of refugee children: A public health issue? Paediatrics & child health, 16(8), e65.
  • Mares, Newman, Dudley, & Gale, (2002). Seeking Refuge, Losing Hope: Parents and Children in Immigration Detention. Australasian Psychiatry, 10(2), 91-96. doi: 10.1046/j.1440-1665.2002.00414.x)
  • Newman, Louise K, & Steel, Zachary. (2008). The child asylum seeker: psychological and developmental impact of immigration detention. Child and adolescent psychiatric clinics of North America, 17(3), 665-683.
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