This post is prompted by a recent blog I read on Racism. It is an assignment written by myself whilst studying, and in some ways gives a perspective on how past racism can affect the actions and thoughts of the present and future.
Sir Willian Dean (Couzos & Murray 1999.) said that ‘The past is never fully gone. It is absorbed into the present and future’. Discuss this in relation to the state of Indigenous Health in the 21st Century and include the implications for nursing and midwifery practice.
The state of Indigenous health in the 21st century is undoubtedly influenced by the events of the past. This paper will discuss those events in our history that are pertinent to the current status of Aboriginal Health. Moreover, from this historical perspective there will inevitably be implications on the nursing and midwifery practices of today.
The atrocities faced by Indigenous Australians in the past have almost certainly had some influence on the 17 year life expectancy gap between Indigenous and Non-indigenous people, but steps are being made in the fact that we can recognise that things need to be done to change this.
However, there is no denying that the causes of this inequality are complex and almost definitely linked to the historical actions during the late 19th and 20th century. It is hard to deny that had there been no European influences on modern Aboriginal lifestyle, Indigenous people would not have been exposed to risks that they were simply not prepared for. The risks Indigenous people were exposed to were European diseases, alcohol, tobacco, drugs and even diet, and were things that our culture had adapted to over time, but caused depopulation and social disruption amongst the Indigenous population (Mitchell, 2007.)
Since 1788 when Australia was first colonised, there has been a deep misunderstanding between the Indigenous people of Australia and the Colonialists. In the first instance, the Colonials held the egocentric belief that Indigenous Australians were not worthy of the land upon which they lived (Eckermann et al, 2006.) This view was based on the belief that Aboriginal Australians had failed to make effective use of the land in a manner consistent with European ideals (Eckermann et al, 2006.) As such the land was declared ‘Terra Nullis’, which conveniently made it acceptable for Western settlement and lawful possession (Eckermann et al, 2006.)
Furthermore, Aboriginal people were regarded as the lowest state of social existence and to be genetically inferior (Grant et al, 2008.) An article in 1888 stated that because of their perceived neo-lithic status that it would in fact not be detrimental if their race disappeared and as such all that could be expected of Colonials was to free them from misery for the duration of their ‘last days’ (Grant et al, 2008.)
It was not until the 1940s that attention was actually paid to the health status of Indigenous Australians, and it is considered that this only occurred because White soldiers became concerned that they would become ill if the health of Indigenous soldiers they were fighting alongside was not maintained (Eckermann et al, 2006.)
The first policies from the new European Government were based on the Western belief that Aboriginal people had no morality or humanity, which resulted in the loss of their land and genocide in the form of hunting and poisoning and was centred on humanizing the savages (Anderson, 2002.) This meant the construction of missions and reserves, and was the beginning of the separation of many children from their parents (Eckermann et al, 2004.)
This loss of land had a devastating effect on the Aboriginal population due to the spiritual significance it holds, causing a loss of a core entity in Aboriginal culture. This gave birth to a sense of hopelessness and insecurity, leaving them living in a world they did not and do not understand, creating a limbo in which they can no longer move forwards or back (Randall, 2004.)
This also left Aboriginal people homeless and pushed into missions and reserves in which the environment left much to be desired (Grant et al, 2008.) These environments fostered the spread of diseases because of proximity, unsanitary conditions and relocation stress.
Mental health issues in the Indigenous population also have roots in the past policies. The policy of removing children from the families in order to assimilate them into White society had detrimental psychological effects (Zeldenryk and Yalmambirra, 2006.) Family and community are a valuable aspect of Indigenous culture, and the removal of children from these environments promoted loss of security, and as a result caused significant pain, and in some cases post traumatic stress disorders (Zeldenryk and Yalmambirra, 2006.) In situations like this it is no surprise that Indigenous people have turned to substance abuse, perhaps as a form of escape.
The National Enquiry into the Separation of Aboriginal and Torres Strain Islander Children from their families (1997) illustrated that the removal of children from their families and communities had serious effects on them (Eckermann et al, 2006.) This action resulted in identity problems, the inability to form strong attachments, lack of trust, resentment, and externalization of blame, alcohol abuse and depression (Hunter, 2003.)
This then causes a vicious cycle of familial abuse, as many children were unable to become good parents as they had no role models to learn from. The abuse and neglect that occurred in missions and children’s homes nurtured distrust and the inability to be open and loving (Eckermann et al, 2006.)
In addition, this removal of children was not only ripping families and communities apart, but it was destroying core values of Aboriginal culture. These included kinship, their fundamental links to the land, culture, beliefs and language (Van Holst Pellekaan & Clague, 2005.)
The banned ability to speak their own language prevented communication amongst families and communities, and also impacted on the loss of culture, kinship, an emphasised the degradation that Aboriginal people were subjected to. This had a significant bearing on mental health, emphasising any stressors and isolation, but it also aggravated the feelings of distrust and loneliness, making the ability to escape through alcohol and substance abuse eve more attractive (Brown, 2001.)
Such losses that Aboriginal people experienced also mean that they had become dependant on Europeans, this included their diet and welfare system (Burns and Irvine, 2003.) The Aboriginal lifestyle was that of hunter-gatherer and relied on natural plant life and animal life, and also encouraged a nomadic lifestyle, whereby groups of Indigenous people moved where there was enough food and water to provide sustenance (Burns and Irvine, 2003.)
The traditional diet was high in protein, had very little sugar and a lot of complex carbohydrates and micronutrients (Burns and Irvine, 2003.) However, when the Europeans arrived they brought with them alcohol and foods never before seen and this hunter-gatherer lifestyle began to disappear, along with its nutrition (Burns and Irvine, 2003.) This diet was highly processed in order to make them edible having travelled vast distances, leaving little of the kind of nutrition that Indigenous people were used to (Burns and Irvine, 2003.)
The reliance on western foods not only led to illnesses such as diabetes due to high sugar content, but also led to increased inability of women to manage foods economically and thus feed their children causing malnutrition, and decreased physical activity because there was no longer the need to hunt and forage for food (Burns and Irvine, 2003.) This rapid change in diet made Indigenous Australians much more vulnerable to obesity and diet-related diseases (Burns and Irvine, 2003.)
Poverty also became a major risk factor for Indigenous health (Water and Saggers, 2007.) The poverty cycle commenced when Indigenous Australians were evicted from their land, but was also influenced by being forced to accept hand outs from the Government, and to adapt to a system they could not understand (Randall, 2008.)
Between 1900 and 1970 many Aboriginal people were forced to pay millions of dollars into Government trust funds, but this money was never returned (Nicholls, 2004, 2006.) It is occurences like this that have caused such a vicious cycle of poverty experienced by many Aboriginal people, which can impair health through poor nutrition, poor sanitary conditions, increased levels of stress and inability to access health services because of the cost (Nelson, Allison and Copely, 2007.)
When providing care to Indigenous people we need to accept that their culture and beliefs are very different from our own, and thus a lot of aspects of their life need to be looked at and dealt with differently – health included. The question is have we opened our minds and learnt enough from our past mistakes to do this?
Van Holst Pellekaan and Clague (2007) have suggested that the MBS and PBS figures spent on Indigenous people illustrate that perhaps not, since in comparison to the $601 spent per Non-indigenous person in 1998-9, only $224 was spent on each Indigenous individual. However, surely the fact that such research exists alone suggests that we are acknowledging the mistakes we have made, and trying to make amends.
The Australian Nursing and Midwifery Council are trying to encourage the incorporation of Indigenous studies into the training of more nurses and midwives in Australia (Dragon, 2007.) This suggestion was supported by Turale and Miller (2007), who state that the past abuse suffered by Indigenous Australians has had a detrimental effect on the current health status, and that in order to improve our nurses need to work in a more culturally safe environment. But, a culturally safe environment, whilst making health care more accessible does not negate the damage done by the past.
However, it is not only indirect influences on health that have guaranteed the inequality seen today, but also direct factors. The past events have had massive implications for Indigenous health, and as such have massive implications on nursing and midwifery practice. It is reasonable to expect a lot of suspicion about the Western Health Care system on the part of Indigenous people, after all, how did White culture help them in the past? In order to try to counter act this we need to acknowledge that Indigenous people have values, beliefs and health practices that are different from our own. We need to validate them, acknowledging them as equal to our own, and showing that just because Indigenous people don’t hold our beliefs and practices, it does not make them ‘savages’.
In order to alleviate suspicion and distrust that can only afford greater inequalities in health, both nurses and midwives, need to work in a culturally safe and non judgemental fashion, and acknowledging that the concerns of Indigenous people around out health system are just and valid.
As Keating said in his apology in 1993:
“It begins, I think, with the act of recognition. Recognition that it was we who did the dispossesing. We took the traditional lands and smashed the traditional way of life. We brought the disasters. The alcohol. We committed the murders. We took the children from their mothers. We practiced discrimination and exclusion.”
It is important to recognise the damage done by past actions and to begin to make Indigenous patients feel accepted and that their concerns and beliefs are valid. That they are citizens in their own country.