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. 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?

3. 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?

4. 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.

5. 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

6. the third space

7. How third space 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

8. Conceptual framework that includes the four dimension

9. 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; as well as judging if further explanation is needed. • Cultural element • It draws on cultural differences and traditions which includes current culture practices.

10. Challenges for health professionals • Communicating among the aboriginals • Understanding their traditions and beliefs • Traditional healing where some professions might disagree on • 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

11. 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

12. Operating within the third space Advantages Disadvantages • 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

13. 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.

14. Aboriginal Health Statistics

15. Aboriginal Health Statistics

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

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

18. Aboriginal Health Statistics

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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.

26. Focus Question.

27. References