December 13, 2024

First Nations health

‘When you have a voice, you make greater progress. When you don’t have a voice, you’re easily exploited’

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There are echoes of trade unionism in what Aboriginal and 
Torres Strait Islanders are asking for in the Voice to Parliament.

The upcoming referendum for a Voice to Parliament has come about after Aboriginal and Torres Strait Islander peoples held an extensive series of 13 regional dialogues that culminated in 250 representatives developing the Uluru Statement from the Heart in 2017.

Thomas Mayo, one of the Uluru Statement’s signatories and Assistant National Secretary of the Maritime Union of Australia, compared the consensus work in the dialogues by First Nations people from across the country 
and at Uluru, to union delegates working together.

“When you have a voice, you make greater progress. When you don’t have a voice, you’re easily exploited and ignored,” Mayo told the NSWNMA Annual Conference.

“So, we decided, looking at the history, when Indigenous people have had a voice, we made great progress. And when it’s taken away, the gap widens in life expectancy and all those other measures that we have failed to close.”

Throughout Australian history, groups such as the Australian Aboriginal Progressive Association in the 1920s and the Australian Aborigines’ League in the 1930s made progress for Indigenous people, “but what is in common is that they were all silenced”, said Mayo, a Kaurareg Aboriginal and Kalkalgal, Erubamle Torres Strait Islander.

Later governments formed Indigenous bodies that were constantly dissolved and replaced by new organisations: the Whitlam government established the National Aboriginal Consultative Committee, which was then abolished by Malcolm Fraser, who formed the National Aboriginal Conference (NAC), which in turn was replaced by Bob Hawke with the Aboriginal and Torres Strait Islander Commission.

“Howard came in and got rid of that one, and that’s when we saw the gap widening,” Mayo said. “We couldn’t ignore those lessons from the past. Our voice is always taken away. So, we must enshrine it in the Constitution to see that 
it can consistently improve 
policies, programs and laws that affect our lives.”

Past government approaches have failed

Speaking alongside Mayo at the conference was Kerry O’Brien, journalist and former adviser to Gough Whitlam. With Mayo, he is co-author of the bestselling The Voice to Parliament Handbook.

O’Brien said the failures of past government approaches to Indigenous communities have been the result of “fly-in fly-out bureaucrats” who “would drop in, like cargo cultists from the sky”.

“They would have their pens, and they’d write copious notes. And they’d ask very learned questions, and they’d nod a lot. And they might even make some promises, and then they’d go away, in many cases, never to be heard from again, or when the policy outcome came back, it had nothing to do with the advice that was given to them.”

In contrast, O’Brien said, establishing a Voice will involve Indigenous representatives from around the country who will consult with their communities about policy that affects them and take their views to Canberra. Their advice would go to the relevant departments and Ministers to be considered by the cabinet.

But the Voice won’t have the power to “dictate to the Parliament or government”, O’Brien added. The Voice’s power will come from “the strength and the quality and the integrity of their arguments. But they will also have the moral and political authority that will be vested in them, by us with this referendum”.

O’Brien said referendums don’t happen often, but we shouldn’t “build a kind of mystique” around the Constitution as an unchangeable document.

The Constitution “has immense significance to us as a nation because it is the rulebook by which our democracy is framed through legislation in Parliament”, he said.

O’Brien pointed out that if the proposition is approved, future parliaments will have the power to legislate how the Voice is assembled and details such as the number of delegates and how often it meets.

There is much is at stake with this vote, Thomas Mayo says.

“If we can’t take this important proposal forward, it will be devastating. We won’t be closing the gap because nothing else has worked.

“The whole world will look at us and wonder what a backward country we are.”

Indigenous members seek representation

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The NSWNMA has embarked on a path towards representation and leadership for Aboriginal and Torres Strait Islander members within the Association.

Our annual conference will consider a NSWNMA Council proposal to support the formation of a statewide Aboriginal and Torres Strait Islander branch of the union.

The Council also proposed creating two dedicated Aboriginal and Torres Strait Islander positions on Council, one each for a nurse and a midwife.

Both proposals will be put to a vote at the union’s annual conference in August.

The proposals came from the first meeting of Aboriginal and Torres Strait Islander members of the Association in February.

Aboriginal and Torres Strait Islander members at the meeting included Jo Burton, a primary healthcare nurse practitioner for Justice Health.

She said the inaugural meeting of Indigenous members was initiated by General Secretary, Shaye Candish, and Assistant General Secretary, Michael Whaites, after they took over leadership of the union in mid-2022.

“The new leadership team wanted to find out what we wanted and how they could help us achieve it,” Jo said.

“Our group came up with some important ideas on developing the leadership skills of Aboriginal and Torres Strait Islander members.

“We agreed the best format would be to create a branch for Indigenous members with similar interests and needs to discuss issues separate from those a normal branch would deal with.”

Overcoming prejudice

She said Indigenous members “carry an extra load taking on responsibility for Aboriginal and Torres Strait Islander patients and the health and wellbeing of our community”.

“First Nations members have a unique experience of the systemic, entrenched racism in society that occurs on a daily basis.

“It’s not necessarily malicious, and a lot of non-Indigenous people would not even recognise or understand it.

“However, as an Indigenous workforce we need to address it.

“We need a forum to discuss and act on issues specific to the experiences of First Nations nurses and midwives.

“By having a platform within the union, we will be able to represent First Nations members in a way that reflects their cultural needs.” – Jo Burton, primary healthcare nurse practitioner for Justice Health. 

As an example, Jo cited the need for industrial awards to recognise ‘sorry business’ – Indigenous cultural practices and obligations associated with grief and mourning.

“Our award allows for family leave but not necessarily in the context that First Nations people define and experience family.

“It is cultural practice for many Aboriginal people to be raised by their grandmother or auntie – but if they die, nurses and midwives can’t normally get bereavement leave.”

Jo said the existence of a formal network for Indigenous members would make the union “more relatable and relevant” to Indigenous nurses and midwives.

“I think a lot of members joined the union before they had the option of identifying as Aboriginal or Torres Strait Islander on the membership form.

“A formal network specifically for Indigenous members will give people an opportunity to identify and embrace their culture in a more supported way.”

On the agenda

Issues discussed at the inaugural meeting of Aboriginal and Torres Strait Islander NSWNMA members included:

  • cultural safety
  • creating opportunities for members to identify as Aboriginal or Torres Strait Islander
  • empowering Aboriginal and Torres Strait Islander members
  • advocating for better health outcomes for Aboriginal and Torres Strait Islander patients
  • staffing issues
  • industrial entitlements around culturally specific issues such as “sorry business” and the Yes for Voice campaign.

Closing the gap on infant mortality

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Birthing on Country programs aim to engage Aboriginal and Torres Strait Islander women in effective antenatal care.

Infant mortality rates among Indigenous Australians are almost double those of other Australian children.

Indigenous babies also have higher rates of low birth weight, with maternal smoking a major contributing factor.

The Birthing on Country (BoC) movement has arisen over recent years with the aim of reducing these and other health disparities.

BoC services aim to be community-based and governed, and are developed by, or with, Indigenous Australians.

They aim to incorporate traditional practice, value Indigenous and non-Indigenous knowledge and practice, be culturally competent and adopt a holistic definition of health.

Southern Cross University (SCU) has secured a $3.6 million federal government grant to design a BoC program in collaboration with three Aboriginal community-controlled health organisations.

Dr Marilyn Clarke, who graduated as Australia’s first Aboriginal obstetrician and gynaecologist in 1997, is jointly leading the SCU project.

She grew up in Port Stephens near Newcastle and credits her mother, Grace Kinsella, a Worimi woman and passionate community nurse, for inspiring her to become a doctor.

‘Historical and inter-generational trauma has led Aboriginal women often to have a negative view of hospitals.’

Culturally safe care

Dr Clarke said the essence of BoC is “providing culturally safe care where the woman is feeling safe and empowered in her pregnancy journey. It is also about providing holistic care that incorporates social supports and meets the woman’s cultural needs as well.

“Historical and inter-generational trauma has often led Aboriginal women to have a negative view of hospitals,” she said.

“Also, the hospital system is very focused on acute management. Hospital settings are not designed to connect with Aboriginal people in their communities and there’s often no continuity of midwifery care.

“Having a known and trusted carer is important to all women and Indigenous women in particular, because it provides a sense of safety.”

Dr Clarke said there is still a disparity in rates of perinatal mortality, maternal mortality, and medical conditions such as preeclampsia and gestational diabetes.

BoC programs aim to reduce these inequities by engaging Aboriginal and Torres Strait Islander women in effective antenatal care, and ensuring mums and their pregnancies are as healthy as possible.

Dr Clarke added that a Birthing in Our Community service implemented at Mater Mothers Public Hospital in Brisbane achieved a significant reduction in preterm births.

The service also costs less than standard care due to fewer interventions and procedures in birth and fewer neonatal admissions.

Quit smoking scheme

Maternal smoking has a strong association with low birth weights and the SCU BoC project will tailor a quit-smoking program to the needs of partner communities.

Dr Clarke said smoking rates among Indigenous women are slowly coming down, but at 44 per cent it is still almost quadruple the non-Indigenous rate of 12 per cent.

SCU has a midwifery program at its Coffs Harbour and Gold Coast campuses, with the provision of culturally appropriate care part of the curriculum.

Scholarships for midwives

The SCU BoC project aims to boost the number of graduating Aboriginal midwives through an increase in scholarships and opportunities.

“Having an Aboriginal midwife can make a massive difference to Indigenous mothers, yet they are a tiny part of the overall midwifery workforce,” Dr Clarke said.

“The federal government grant includes scholarships for Aboriginal people to do the midwifery course and have placements out in the communities we are going to partner with.”

She believes the involvement of Aboriginal communities in the design of maternity programs is vital to their success.

“In designing our project, we will go out to our partner communities and involve them from the ground up.

“We want them to be co-designers of how BoC would look for their communities, how smoking cessation training can be adapted to their needs, and how Aboriginal midwives can be incorporated into the model of care.”

A Voice at the table

Aboriginal obstetrician and gynaecologist Dr Marilyn Clarke is a supporter of the proposed Aboriginal and Torres Strait Islander Voice to parliament and government.

“As an Aboriginal person who has worked in Aboriginal health for my entire career and been a consumer of Aboriginal health services for myself and my family, I’m a witness to the importance of having an Aboriginal voice at the table when things are being designed and implemented,” she said.

“If the referendum is successful, the Voice will give us an input at the national level into programs and policies that are going to directly affect us.

“Without such an input, programs and services for Indigenous people will not be as effective. That’s been proven in Australia time and time again.”

Voice will help close the gap

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The Public Health Association of Australia (PHAA) says a constitutionally enshrined Voice to Parliament will “provide a path for Aboriginal and Torres Strait Islander voices to be heard and respected, after being ignored or sidelined for many years”.

“A fundamental building block for addressing Aboriginal and Torres Strait Islander health challenges is addressing equity,” said PHAA President, Adjunct Professor Tarun Weeramanthri AM.

“We cannot close the most glaring health equity gap in Australia if we continue to ignore its roots in our society.”

‘We cannot close the most glaring health equity gap in Australia if we continue to ignore its roots in our society.’ — Tarun Weeramanthri AM, Public Health Association

A Voice for Aboriginal and Torres Strait Islanders within the NSWNMA

The Association proposes creating a path towards increasing voice, representation and leadership of Aboriginal and Torres Strait Islander nurses and midwives within the union.

The NSWNMA Council supports two member-driven initiatives:

  • formation of a statewide Aboriginal and Torres Strait Islander NSWNMA Branch and
  • creating two dedicated Aboriginal and Torres Strait Islander positions on NSWNMA Council, one each for a nurse and a midwife.

Both proposals will be put to NSWNMA Annual Conference in August this year.

‘Nothing about us without us’

The Australian Stroke Alliance says a Voice to Parliament will help Indigenous voices to be heard in the design and delivery of health care.

Associate Professor Luke Burchill, from the Alliance’s Aboriginal and Torres Strait Islander Leadership Council, says inability to access culturally safe healthcare services is a major problem.

“Unfortunately, not feeling safe is a major reason why Aboriginal people are more likely to present late and sometimes critically unwell – and we see much higher rates of death and disability for First Nation peoples in Australia,” said Burchill, who is Australia’s first Indigenous cardiologist.

He told ABC NewsRadio, “We need to be seen, we need to be heard. And when it comes to the framing of data about us, we would come back to the thing that we’ve been saying for decades – nothing about us without us.”

Aboriginal and Torres Strait Islander peoples have a stroke incidence rate 2–3 times that of non-Indigenous Australians. Those under 55 have a rate 6–9 times greater.

‘Not feeling safe is a major reason why Aboriginal people are more likely to present late and sometimes critically unwell.’ — Luke Burchill, Australian Stroke Alliance

Get involved

Follow this link to learn more about the Yes campaign and to get involved:

 

Birthing on Country gets a boost

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The success of a Birthing on Country project for Aboriginal women and their families at Nowra has led the federal health department to fund a dedicated Birthing on Country Centre of Excellence at the NSW South Coast town.

The $22.5 million birthing centre to be built at Nowra will provide “culturally safe care and wraparound support services” for First Nations families during pregnancy, birth and beyond.

The aim is to allow Indigenous women to give birth on their ancestral country with Indigenous midwives in a dedicated facility.

It will be run by Waminda Women’s Health and Welfare Aboriginal Corporation and Charles Darwin University and will open in 2025–26.

Waminda has operated a Birthing on Country program in Nowra since 2018.

Senior midwife at the Waminda centre, Mel Briggs, is an NSWNMA member and a long-time advocate for culturally safe maternity care for Aboriginal and Torres Strait Islander women and for Birthing on Country.

In June 2020, Mel became the first endorsed Aboriginal midwife in NSW and only the second in Australia.

First Nations mothers are 3–5 times more likely than other mothers to experience maternal mortality, while babies are 2–3 times more likely to be born preterm, with low birth weight, or not to survive their first year, a recent study shows.

Mel told Australian Associated Press that the birthing centre will help to close the child mortality gap by providing ongoing holistic support to mothers from when they fall pregnant until after they give birth.

“Our women are judged, our women are stereotyped, our women do not feel comfortable walking into those (hospital) doors,” she said.

“If that is a problem for them to access, then they won’t go.

“These are the determining factors as to why babies are born prematurely, because it’s a systemic problem and what we’ve had to do to is adapt to ensure our own model that our women are having better health outcomes.”

The health consequences of indiscriminate gas extraction 

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On 4 November, other NSWNMA members and I joined a trade union contingent of activists and travelled to Coonabarabran to see first-hand both the beauty of the Pilliga region but also the devastation caused by fossil fuel extraction.

We were shown the incredible underground river systems, told of the diversity of plant and animal life sustained in this region, learned about the connection to country for the Gomeroi people and the ceremonial significance of this land.

We also learnt about the proposal for 850-plus gas wells that are being planned in this area – which would be blasted through into the Great Artesian Basin, creating toxic salt by-products that no-one – including the government and the mining companies – knows how to dispose of safely.

The Gomeroi people have voted overwhelmingly AGAINST the proposed gas wells, and in response Santos has taken the Gomeroi Nation to the Native Title Tribunal to try to ultimately dispossess them of their land. Of the 180 disputes taken to the Native Title Tribunal – only three have ever been decided in favour of First Nations people. The verdict in this current case is still to be decided, but this is a rigged and racist system that perpetuates the harms of colonisation and continues the destruction of the land.

This is our battle. We know that dispossession of First Nations people from their land has caused catastrophic health outcomes across this nation – and as nurses it’s our business to be aware of this.

We know that fuelling further global warming will cause catastrophic health outcomes across the world. Australia, our patients, and our families will not be excluded from this.

So as nurses and midwives, we must lend our support and commit to act when required to by the Gomeroi people. It is a commitment we must make if we are serious as a union about standing with our First Nation brothers and sisters to fight for a fair and equitable future.

Let us be the follow-through … let us not be another empty promise. Let us stand proudly with our brothers and sisters across the union movement in condemning Santos’s project and stopping it in its tracks.

Let us commit to fighting for the health of our country, the health of the Gomeroi nation and against the ongoing harmful dispossession of First Nations people from their lands.

Damien Davis Frank, RN

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