What does the “third space” mean to you as a health professional?

1. What does the “third space” mean to you as a health professional? Eileen Tan Lisa Molony Kate Brazzale

2. Acknowledgment of country We respectfully acknowledge the past and present traditional owners of this land on which we are meeting, the Noongar people. It is a privilege to be standing on Noongar country.

3. Introduction • Why should health professionals be aware of the "third space"? • What should health professionals take into account when looking after Aboriginal and Torres Strait Islander patients? • Why are cultural implications important for health professionals to take into consideration?

4. Importance of identity • What does it mean to be Aboriginal? • "An Aboriginal or Torres Strait Islander is a person: • of Aboriginal or Torres Strait Islander descent • who identifies as an Aboriginal or Torres Strait Islander and • is accepted as such by the community in which he (she) lives.“ • What does your identity mean to you?

5. Culture shock • Culture shock: the tension and anxiety, combined with feelings of isolation, sensations of loss, confusion and powerlessness, associated with entering a new culture.

6. Aboriginal terms of reference • A way to determine Indigenous viewpoints on issues within an Indigenous context. • Core values include: • The worth and validity of contemporary Indigenous cultures • The right of expression of Indigenous realities • Self-determination and self-management • Positive social change • Social justice • The recognition and acceptance of Indigenous diversity • Reconciliation of contending issues between Indigenous people • The worth of the group

7. the third space

8. How third space applies to the health industry? • “WA Health Is dedicated to working with the Australian Department of Health and Aboriginal communities in building new partnership for services provided; developing culturally appropriate Health services and providing safe, high equality and accountable Health service to the Aboriginal community” (Health Reform Implementation taskforce, 2007). • Indigenous and Health professions has a variety of differences that are met and respected together as one. • Cultural belief • Views and Values • Expectations • Traditions • Historical factors • Family structure

9. Conceptual framework that includes the four dimension

10. How third space applies to the health industry? • It is the space for the four dimensions to be met between the Aboriginal and non- aboriginal domain. • Experiences • Concentrates on the experience of Aboriginals in relation to the issue under discussion. • Aspiration • Concentrates on what the critical reference group wants to achieve in relation to the issue. • Understanding • Focuses on the persons understanding of the issue • Cultural element • It draws on cultural differences and traditions which includes current culture practices.

11. Challenges for health professionals • Communicating among the aboriginals • Understanding their traditions and beliefs • Traditional healing • Not being able to achieve the outcome until a certain level of trust has been created • Obtaining informed consent for treatment • Explaining diagnosis and treatment to patients (Ngyuen, 2008, p.990-992)

12. health professions and aboriginal may clash in a health environment • Communication and language issues • Poor cultural understanding • Racism and prejudice • Values and beliefs • Mistrust of the system (Aboriginal Health issue committee, n.d., A guide for Health Professionals working with Aboriginal people)

13. Operating within the third space Advantages Disadvantages • assumptions or stereotypes may still happen within the third space about an individual based on their racial or ethnic background. • Access to higher quality services • Culturally secure services that will improve health outcome for Aboriginal people • Improve customer satisfaction • Provide opportunity to improve the broader determinants of health

14. Aboriginal Health Statistics Life expectancies of Indigenous versus Non-Indigenous Males and Females. • On average • Indigenous Men die 11 years earlier then Non- Indigenous Males • Indigenous Females die 9 years earlier then Non-Indigenous Females. Data from the Australian Bureau of Statistics 2005-2007 data surveys.

15. Aboriginal Health Statistics

16. Aboriginal Health Statistics

17. Aboriginal Health Statistics Selected Chronic Conditions: Ratio of Indigenous Australian’s to Non-Indigenous Australians — 2004–05

18. Aboriginal Health Statistics • Diabetes Comparison between Indigenous and Non Indigenous 2005 • Cardiovascular Comparison between Indigenous and Non Indigenous 2005

19. Aboriginal Health Statistics

20. Implications for Health Professionals • Third Space • “A place where Indigenous and Non-Indigenous people can come and work together without fear of prejudice from ‘baggage’.” • An area of mutual respect between Indigenous and Non-Indigenous people where they can work collaboratively. • Health Professionals need • Knowledge. • Of where the other comes from; their “space” • Understanding • Of roles and responsibilities • Empathy • Towards both sides • Willingness to be open • Accepting of differences • Avoid stereotyping

21. Implications for Health Professionals • Aboriginal and Torres Strait Islanders are not the same. • Discontinue use of out-dated, derogatory terminology. • Half-caste, full-blood, quadroon, etc. • Always use the terms Aboriginal Man/Woman/People or Torres Strait Islander Man/Woman/People. • Aboriginal people mistrust people who offer services related to “protection” and “intervention. • European colonisation. • Government Policies post colonisation. • The “Stolen Generation”. Government policy til 1969. • “Keep your word.” • Changes made. • e.g. Kevin Rudd’s “Apology”. NSW Department of Community Services 2009 & National Disability Services WA 2009

22. Implications for Health Professionals • Sensitive issues due to past Government policies have contributed to: • Dispossession of land • Family fragmentation • Mental health issues • Social and emotional wellbeing issues • Grief and loss issues • Self-harm and intentional injury • Over-representation of Suicide rates • Family and domestic violence issues • Loss of country • Loss of identity • Poverty • Racism • Unemployment • Poor health outcomes • Poor education outcomes • Below standard literacy and numeracy rates • Alcohol and substance abuse/misuse • Over-representation in the juvenile and criminal justice system NSW Department of Community Services 2009 & National Disability Services WA 2009

23. Implications for Health Professionals • Respect • Elders, • The Land, • Animals, • Ancestors. • “Sorry Business” • Kinship • Defines roles and responsibilities within the family. • Ensure that extended family is included in important meetings or when making decisions. • Gender responsibilities. • Men’s Business – issues which have a male perspective within aboriginal culture. • Women’s Business – issues which have a female perspective within aboriginal culture. NSW Department of Community Services 2009 & National Disability Services WA 2009

24. Implications for Health Professionals • Language • Originally 300 nations speaking 250 languages with up to 600 dialects. • Nonverbal cues • Eye contact. • Hand and facial gestures. • Silence • Progression of Conversation. • Semantic Ambiguity • Swearing • Communication Techniques • Use uncomplicated language, Not “jargon”. • Be wary of comprehension NSW Department of Community Services 2009 & National Disability Services WA 2009

25. Close the Gap Campaign • Australia’s largest Campaign to improve Indigenous Health. • Aimed at reduced the Life Expectancy Gap between Indigenous and Non Indigenous Australians to 0 years by 2031. • OXFAM is campaigning to: • Increase Aboriginal and Torres Strait Islanders’ access to health services • Address critical social issues such as poor housing, nutrition, employment and education • Build Indigenous control and participation in the delivery of health and other services • Get governments at state and national level to work in partnership with Indigenous communities, health organisations and experts to develop and monitor a plan to tackle the Indigenous health crisis • Promote real and meaningful partnerships between Indigenous COAG, 2011 and OXFAM 2006

26. Need for Education • To understand the needs of our Aboriginal or Torres Strait Islander Patients • The majority of Aboriginal people access health care from Non-Aboriginal services. • Downing and Kowal 2011 • Majority of Nurses interviewed felt that didn’t receive enough cultural training to look after Aboriginal and Torres Strait Islander patients • They felt that they weren't giving them the level of care the needed and deserved. • Canada’s Approach • Kilpatrick, 2004 • Looked at the need for Aboriginal Education.

27. Focus Question.

28. References • Aboriginal Health issue committee (n.d.) A guide for Health Professionals working with Aboriginal people Retrieved February, 2001, fromwww.sogc.org/guidelines/public/100e-ps4-february2001.pdfNgyuen, H. (2008). Patient centred care. Cultural safety in Indigenous health, 37(12),p990- 992. Retrieved December,2008, from Theme Indigenous health site at www.racgp.org.au/afp/200812/200812nguyen1.pdf