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Cultural safety in Aotearoa New Zealand 2nd Edition

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

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

8. Navigating the ethical in cultural safety

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

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13. Culturally safe care for ethnically and religiously diverse communities

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

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

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

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

 

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

Book cover

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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.

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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

Universities of Australia. (2011). National best practice framework for indigenous cultural competency in Australian Universities.
Awofeso, N. (2011). Racism: A major impediment to optimal indigenous health and health care in Australia. Australian Indigenous Health Bulletin, 11(3), 1-8.
Best, O., & Stuart, L. (2014). An Aboriginal nurse-led working model for success in graduating indigenous Australian nurses. Contemporary Nurse, 4082-4101.
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.
Christou, A., & Thompson, S. C. (2012). Colorectal cancer screening knowledge, attitudes and behavioural intention among indigenous western Australians. BMC Public Health, 12, 528. doi:10.1186/1471-2458-12-528
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Durey, A. (2010). Reducing racism in Aboriginal health care in Australia: Where does cultural education fit? Australian and New Zealand Journal of Public Health, 34 Suppl 1, S87-92. doi:10.1111/j.1753-6405.2010.00560.x
Durey, A., Lin, I., & Thompson, D. (2013). It’s a different world out there: Improving how academics prepare health science students for rural and indigenous practice in Australia. Higher Education Research & Development, 32(5), 722-733.
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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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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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Nursing in media-saturated societies: implications for cultural safety in nursing practice

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

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

Abstract

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

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

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

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

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

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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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Korean migrant mothers on giving birth in Aotearoa New Zealand

Cite as: DeSouza, Ruth. (2014). One woman’s empowerment is another’s oppression: Korean migrant mothers on giving birth in Aotearoa New Zealand. Journal of Transcultural Nursing. doi: 10.1177/1043659614523472.  Download pdf (262KB) DeSouza J Transcult Nurs-2014.

Published online before print on February 28, 2014.

Abstract

Purpose: To critically analyze the power relations underpinning New Zealand maternity, through analysis of discourses used by Korean migrant mothers. Design: Data from a focus group with Korean new mothers was subjected to a secondary analysis using a discourse analysis drawing on postcolonial feminist and Foucauldian theoretical ideas. Results: Korean mothers in the study framed the maternal body as an at-risk body, which meant that they struggled to fit into the local discursive landscape of maternity as empowering. They described feeling silenced, unrecognized, and uncared for. Discussion and Conclusions: The Korean mothers’ culturally different beliefs and practices were not incorporated into their care. They were interpellated into understanding themselves as problematic and othered, evidenced in their take up of marginalized discourses. Implications for practice: Providing culturally safe services in maternity requires considering their affects on culturally different women and expanding the discourses that are available.

Keywords: focus group interview, cultural safety, Korean women, maternal, postcolonial, Foucault.

Introduction

A feature of contemporary maternity is the notion that birth can be empowering for women if they take charge of the experience by being informed consumers. However, maternity is not necessarily empowering for all mothers. In this article, I suggest that the discourses of the Pākehā maternity system discipline and normalize culturally different women by rendering their mothering practices as deviant and patho- logical. Using the example of Korean migrant mothers, I begin the article by contextualizing maternity care in New Zealand and outlining Korean migration to New Zealand. The research project is then detailed, followed by the findings, which show the ways in which Korean mothers are interpellated as others in maternity services in New Zealand. I conclude the article with a brief discussion on the implications for nursing and midwifery with a particular focus on cultural safety.

You can read the rest at: Journal of Transcultural Nursing or download DeSouza TCN proof.

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From bystander to ally: Can small acts help?

I’m interested in what moves us from being bystanders and witnesses to injustice to being moved to act. This has been prompted by several incidents since I arrived in Australia and a few days ago, the savage beating to death of a transgender woman of colour. In our increasingly surveilled and fear based society, there seem to be more effective structures and mechanisms for contributing to injustice than remedying it. In many cases our political leadership promulgate fear and distrust in a bid to retain or increase voters, hate which is then fanned and fuelled by the media. Take the invitation to police our neighbours in the form of immigration policy in both the United Kingdom and Australia. The Immigration Dob-in Service on the website of the Australian Government’s Department of Immigration and Citizenship (DIAC) being a prime example of how with a few clicks and some information “the community” are encouraged to “dob in” people. Similarly the The UK Home Office had vans warning illegal immigrants to “go home” which demonstrated how easily the government could ignore and breach its responsibilities under the Equalities Act (eliminating discrimination and harassment based on race and religion, fostering good relations between people from different racial and religious groups).

Go home van

Photograph: Rick Findler

Luckily the racist vans were subverted with civil liberties group Liberty organising an alternative message. Other advocacy groups such as Amnesty, Refugee Action and Freedom from Torture claimed in a letter to the Guardian:

As organisations with expertise in supporting people who are seeking protection in the UK, we deplore the highly controversial advertising campaign delivered on the side of vans driven through selected London boroughs

The ‘illegal immigrants go home campaign’ is cynical and giving rise to a climate of fear. The heavy-handed ‘stop and search’ activity outside London tube stations harks back to a period before the Lawrence inquiry and raises questions about racial profiling in immigration control

Van

But what if you are an individual who would like to respond to racism but feel overwhelmed and powerless? A recent study by VicHealth (with the University of Melbourne and the Social Research Centre) investigated the role of bystanders and racist incidents by sampling 601 Victorians and asking them whether racism was acceptable in various scenarios in social settings, workplaces and sports clubs; what they would do if they witnessed racism in these scenarios and what they did the last time they witnessed a racist incident. You might have heard about the many incidents of racist violence and abuse on public transport and in sport.

The purpose of the study was to consider whether reducing racist incidents or the impact of incidents could prevent distress and illnesses in Victorian people from Aboriginal and culturally and linguistically diverse backgrounds. People from Aboriginal and culturally and linguistically diverse backgrounds experience the highest volumes of racism and record the most severe psychological distress, which places them at higher risk than others of mental illnesses (Ferdinand, Paradies & Kelaher, 2013a; 2013b). The VicHealth study found that individuals’ coping strategies provided insufficient protection from harm, and therefore broader community and organisational efforts were needed to stop racism from occurring and that the role of bystanders was a particularly important one.

Encouragingly the study found that 83% of participants felt that more could be done to address race-based discrimination in settings such as workplaces and sporting clubs such as education, promoting cultures of respect and taking action when racist incidents occurred. 84% claimed they would take action against racism with 30 per cent willing to act on every occasion. However, 13 per cent to 34 per cent (approximately one in four people across the sample) claimed they would feel uncomfortable if they witnessed racism, but would not do anything. I agree with the authors that this group of people hold the potential for a new, powerful wave of action. Take this lovely example of an intervention in a supermarket from Upworthy: One Easy Thing All White People Could Do That Would Make The World A Better Place.

That action was a powerful one, but not all bystanders would be willing to act. Imagine though if all bystanders could be moved to act in small ways in their own workplace or social setting and their efforts were co-ordinated. That’s one of the reasons I love the New Zealand Diversity Action Programme, facilitated by the Human Rights Commission who hold their annual forum this week. The programme brings together organisations taking practical initiatives to:

recognise and celebrate the cultural diversity of our society (diverse) promote the equal enjoyment by everyone of their civil, political, economic, social and cultural rights, regardless of race, colour, religion, ethnicity or national origin (equal)foster harmonious relations between diverse peoples (harmonious)fulfill the promise of the Treaty of Waitangi (Treaty-based)

Any organisation that supports the vision of an Aotearoa New Zealand that is “culturally diverse, equal and harmonious” can take part. All they need to do is to commit on an annual basis to taking practical steps to making this vision happen and these steps can be big, small or celebratory.

In the spirit of the Diversity Action Programme, this story about Mariam Issa a former refugee is delightful. Mariam transformed her backyard into a public garden, complete with chooks. She runs regular storytelling sessions bringing women from her middle-class suburb together with former refugees to share stories and better understand each other. Her story inspired me to think how food and conversations might also help us to to shift from bystander to ally and address unequal power relations and racism. I wonder if her new middle-class friends have made that transition?

I loved Mariam’s story because it made me think that the domestic worlds of food and garden can be such potent sites of transformation for social justice. I am a committed foodie (“somebody with a strong interest in learning about and eating good food who is not directly employed in the food industry” (Johnston and Baumann, 2010: 61), who is also interested in the politics of food. My partner and I moved to Victoria, Australia this year near Melbourne, a foodie paradise. Melbourne’s food culture has been made vibrant by the waves of migrants who have put pressure on public institutions, to expand and diversify their gastronomic offerings for a wider range of people. However, our consumption can naturalise and make invisible colonial and racialised relations. Thus the violent histories of invasion and starvation by the first white settlers, the convicts whose theft of food had them sent to Australia and absorbed into the cruel colonial project of poisoning, starving and rationing indigenous people remain hidden from view. So although we might love the food we might not care about the cooks at all as Rhoda Roberts points out:

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

Imagining an alternative Australian future, David Liddle asks if instead of clearing the land and its people and replacing them with cattle, the new settlers had eaten with Aboriginal people a new form of co-existence might have come into play. As a newcomer to Australia I am only just beginning to grasp this history and I know I have a lot to learn.

Which brings me to the crux of this post, can the consumption of food move us from being passive consumers, bystanders if you like, to being engaged allies in the face of racism? The example of the Conflict Kitchen, a restaurant in Pittsburgh which prepares food exclusively from countries currently in conflict with the U.S makes me think it’s possible. Highlighted in a piece in Take Part, the idea is that by eating food from such a country, “the enemy” is humanised and the consumer has an opportunity to deepen their appreciation of cultural difference. Not only is a meal provided but insight into political conflicts and world affairs through performances, discussions and stories about that country is part of the whole experience. Their website says:

…Conflict Kitchen uses the social relations of food and economic exchange to engage the general public in discussions about countries, cultures, and people that they might know little about outside of the polarizing rhetoric of governmental politics and the narrow lens of media headlines.

Closer to my new home is the wonderful initiative by the Asylum Seeker Resource Centre (ASRC), which has a Hot Potato travelling van rolling out across Australia and challenging Australia to 10 million conversations in the lead up to the federal election. The idea is to take the heat out of the asylum seeker conversation and debunk the myths—given that everyone in Australia has an opinion, the ASRC’s aim is to attempt to cool a highly politicised debate with facts. The ASRC claims this Australian political Hot Potato, has been manipulated and passed from one politician to another and heated up by the media.

Drowning

Unless you’ve been sleeping under a rock, you will know that Australia’s Humanitarian Program has made the news for all the wrong reasons, namely it’s harsh treatment of asylum seekers arriving by boat (Irregular Maritime Arrivals). There’s a huge drive to deter people arriving in this way (you can watch the videos on the DIAC webpage called “Don’t be sorry” which features prominent sportsmen). Australia has been roundly criticised for its migration policy of August 2012 which instigated offshore processing of protection (asylum) claims in Nauru and Papua New Guinea.

Settled in Australia

What I love about the hot potato venture are two things. First of all, food is an expression of generosity and hospitality. So these folk aren’t charging anyone for the food. Secondly, the consumption of the food moves away from the foodie zone which:

operate[s] as a field of distinction, marking boundaries of status through the display of taste … The professional and managerial classes are thronging to ethnic cuisine restaurants, while poor, working class, older, provincial people are not. Familiarity with ethnic cuisine is a mark of refinement. (Warde and Martens 2000: 226)3

So anyone can go and have a conversation with the hot potato van regardless of income.

Hot potatoI’ve always thought that eating food from other cultures offered a bridge to empathy and affection for different people as a starting point, and potentially a non-threatening way of developing an ongoing engagement, even ultimately world peace. I mean imagine if instead of bombing and fighting, we had cook offs? Perhaps if we all do a little something, whether it is food and conversation, we might have a chance of realising a vision of a world without racism.

Going back to the VicHealth study, the characteristics of allies (or as they call them active bystanders) were that they were more likely to recognise race-based discrimination, understand the harm it caused, feel a responsibility to intervene, and feel confident to intervene. They were more likely to act in work or social settings if they were supported by their organisations (via policies, culture etc) peers and colleagues. If we are to do our part to reduce or eliminate the harms of racism it will take all of us.

If you want to know where to start, here are some resources:

  1. A terrific video of Dr. Omi Osun Joni L. Jones’ keynote speech from September 2010 at a lThe Seventeenth Annual Emerging Scholarship In Women’s and Gender Studies Conference UT Austin, where gives 6 rules for allies (cross race/gender/sexuality/nationality/religion etc).
  2. Read this terrific blog from SMARTASSJEN about being a trans ally.
  3. AWEA (Auckland Workers Educational Association) is a not-for-profit organisation that supports groups and runs community education related projects. Their core aim is to promote a just and equitable society in accordance with Te Tiriti o Waitangi. They have many useful links and resources for social justice in particular the role of non-indigenous supporters of indigenous justice struggles.

  4. A new book, Working as Allies: supporters of indigenous justice reflect written by Jen Margaret is now available.

 

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