Podsocs - podcasts for social workers

Transcription Podsocs 68: Aboriginal Health: In Conversation with Richard (Rick) Shipp and Victoria Jones

[Thank you to James Attard for this transcription]

(Musical introduction from 00:00 - 00:10)

Hello and welcome to Podsocs, the podcast for social workers on the run – brought to you by a bunch of social workers from Griffith University, in Australia. I’m Tricia Fronek, one of that bunch, and we’re just basically really glad you found us. So, happy listening.

Tricia: This morning on Podcsocs were speaking with Victoria Jones and Richard Shipp, welcome to Podsocs both of you.

Rick: Thank you

Victoria: Thank you Tricia

Tricia: Now this morning we are going to talk about Aboriginal health, maybe if we start if you guys tell us a bit about you.

Rick: Okay, um, I’m Rick ship, um I am the Aboriginal Health Team Leader for Southern New South Wales LHD.

Victoria: I’m Victoria Jones and I am the Psycho-Oncology Service Development Social Worker for Southern New South Wales and Murrumbidgee Local Health District.

Tricia: Now you guys have been doing a lot of work in Aboriginal Health, both in practice and research, is that right?

Victoria: Yes, more in practice than in research, but it is studying through research, yes.

Tricia: So, what is the state of Aboriginal health? Big question.

Rick: Uh, yeah it is a huge question, you know there is a lot of um, disparities between Aboriginal and non-Aboriginal people, as far a health goes,

Victoria: And one of the things that we notice particularly around cancer which is my area, is that Aboriginal people get cancer at the same rates as non-Aboriginal people, but their outcomes are still very different – there is about 20-year difference in the, in the, you know, in the outcomes for the Aboriginal people.

Tricia: So, so there is still quite a significant gap?

Victoria: Absolutely yes, and that’s something that we’ve really wanted to address.

Tricia: So, what are you seeing in practice, why is this happening?

Rick: Oh uh, I guess it is uh, various reasons and some of those is access, education…

Tricia: Is it our health system? How sensitive are we to Aboriginal and Torres Strait Islander people?

Rick: Oh, I think very insensitive at times

Victoria: Yeah, I think, I think it would vary, I think there would be pockets of health services, which would be really culturally sensitive, but I think broadly speaking that that is not Aboriginal and Torres Strait Islander People’s experience usually either.

Rick: Mmm

Victoria: I, I think that it is quite daunting for people to feel comfortable for historical and current reasons

Tricia: So, what are some of those barriers?

Rick: Some of the barriers are, you know past culture, past experiences, what’s happened at hospitals in the past and then keep continuing and one of the culture is, you know once something has happened, everyone just relates that to – ok that’s what is going to happen in the future.

Tricia: Now, Richard, you’re an Aboriginal health practitioner, does that make a difference? Having Aboriginal people within organisations?

Rick: I think it does, I think it does, like you know, Aboriginal people to work in Aboriginal positions, and you know they actually have that connection with the community and they actually have that knowledge and have that experience, before they, you know, come to work with health, so they’ve got that kind of knowledge before they actually start. And It’s kind of like a natural way to relate you know?

Tricia: In my experience, Richard, when we do have Aboriginal health practitioners, we tend to overload them, and anything remotely related to Aboriginal people is automatically sent to the Aboriginal health worker whether it is within their job description or not and I’ve seen people get terribly overloaded, so is Aboriginal health everybody’s business?

Rick: It is, it is everybody’s business and I think a lot of um, non-indigenous staff fall into that trap of um referring everything and passing kind of that buck over to the Aboriginal Liaison Officer or Education Officer, you know they, you know we should be involved but that doesn’t mean that we have to do everything and we’re not specialist in every particular field, so it is everybody’s business and everyone has their specialisations in their own little fields.

Tricia: Victoria what’s, what’s your experience as a white woman working in this area?

Victoria: Yes, I mean I, I think, I would like to pick up in answering that on a couple of things that Rick has said and that’s about people passing everything over to Aboriginal workers and I think as non-indigenous workers that happens for some, several reason one is because we feel unconfident about doing the right thing or because it’s too hard or because, we just think that’s what we should do.

Rick: Mmm

Victoria: So, my experience as a white woman working in this area is the need to understand the importance of conversation and talking about what our roles are, what our knowledge, what our skills are, so for me a really critical step is if Rick and I are working in an area together, that we talk about what we each offer and we talk about what are the kinds of things that need to come to you Rick.

Rick: Mmm

Victoria: When there’s, an Aboriginal person in the health system that needs support and what are things that I can confidently do? And how do we keep talking about that? And how do we work together with an Aboriginal family or community? So, I think my experience as a white woman is two things. One to be really clear of what my own expertise is and to be confident in that, but at the same time, be really humble about how that expertise can be useful for Aboriginal people and part of that humility is to learn from and with my colleagues, about where those two things come together.

Rick: I think sometimes non-indigenous workers, like I think start to panic as well, like oh, oh I’ve got an Aboriginal client , I’m just gonna have to contact the Aboriginal Hospital Liaison Officer or the Aboriginal Health Education Officer, um because I don’t know how to deal with this or its gonna be easier, when really, it’s not, it’s not rocket science

Tricia: And there’s two things I’m picking up in that, the first thing is “humble” and that is a tension in a way in health where, we’re really taught that we’re experts in health, so there is a tension in there, isn’t there?

Rick: Yeah, there’s tension, yeah definitely, and you know I hear it all the time the comment they say, we treat all our clients the same, which I, you know, it always bugs me, because different people are, different, you know everyone’s different, we’re not all the same, you need to treat people differently, like you know?

Tricia: Mmm, and we need to be in the learner position and know that we really don’t understand.

Rick: Mmm

Tricia: And the other tension, I think, is the increasingly busy and pressured environment within health to actually take time to have these conversations.

Rick: Yeah

Tricia: With each other and with clients, because that’s how we’re going to connect isn’t it?

Rick: Yep, and I think that’s, I mean that’s another thing too, time is crucial you know, for our Aboriginal and Torres Strait Islander clients because they appreciate the time you actually, you know, that we as Aboriginal health workers, you know, spend with them. They know that our time is important and they’ve got X amount of clients but they actually appreciate the time we spend with them and devote to them, whereas I feel the non-indigenous clients, uh non-indigenous workers, some of harm don’t want to put in that extra effort because they think, well I’m not doing it for anyone else, why should I do it for Aboriginal people?

Victoria: Mmm

Rick: But um just the respect there, like it’s really, it’s valued you know.

Victoria: And I think that’s one of the things I really wanted to pick up on Tricia because one of the crucial things that I have learned, is about time and taking time. And it takes a long time and takes time to build relationships and I think as social workers we actually know about the importance of building relationships in all the work that we do. But, I think organisations need to understand that staff need to be allowed to take time.

Rick: Mmm

Victoria: And organisations need to take the time because that’s part of respect and I think the biggest change will come, when we actually acknowledge that we need to build respectful relationships and that’s at all levels of the organisation, it’s staff on the ground, its management its, its everybody.

Tricia: How will we achieve that?

Rick: Well, I think there needs to be they at the time, is so important. You know, but Ok the stats don’t look fantastic, it’s been six months, why haven’t you got people through the door? Well you know, you need to be a bit more flexible.

Tricia: And even though someone might not understand it, if something isn’t working, it is time to maybe do it differently.

Rick: Mmm

Victoria: Mmm

Tricia: So how is this working in cancer?

Victoria: Rick and I have been involved in specific projects, but Aboriginal Health and Cancer Services working together and that’s a result of the funding from the Cancer Institute New South Wales and Cancer Australia, so that has, in a way, given us time to build relationships and what we’ve worked to do over a period of probably going on for 5 years, is to aim to improve access to cancer services for Aboriginal and Torres Strait Islander people.

And we’ve done that through a number of steps. The first is actually consultation with communities, so we actually went, Aboriginal and non-Aboriginal staff together, went to local communities across the two local health districts, to talk with them about what needed to happen in order for people to feel more comfortable by accessing cancer services.

I mean you could say health services in general, but we were there to talk about cancer services and I think there’s some crucial things around consultation, you know, it’s an overused word I think, in health and other organisations these days, consultation has to have negotiation and agreement coming out of it, it’s not just about consulting people and then going away and doing their own things separately. So, this is all the critical part…

Tricia: It actually has to change something, doesn’t it, Victoria?

Victoria: Yes, yes, yes and it’s not just in terms of hard concrete actions, it also about the way we relate to each other and the way we engage with people and share control about the way decisions are made and what actually is going to happen and I think that’s a huge thing for professional staff in organisations to actually, really take on board. We can take it on board intellectually, but actually doing it I think is really challenging, and I think there are huge successes can come out of that, but it’s difficult, it’s difficult because we each have to struggle with our way of looking at things and what’s important and making time to deal with these difficult issues.

So, we were then talking um in our project, we then and each community has had different ways of us responding to them, so it’s also about not seeing all Aboriginal people as needing the same thing. Actually, things have worked quite differently in different communities, although the same principles have been applied, they’ve been applied differently. So, having done the consultation, negotiation and agreement, we’d then done some outreach in the community whereby cancer services staff whether they’re actually from the health service or from other voluntary organisations, have gone out in the community to talk with them and share ideas about how we can improve access in their local community.

We’ve also had a program of cancer awareness training for Aboriginal Health workers and Rick might want to speak about that in a moment and then cultural awareness training for cancer or health services staff, so that what we’re trying to do is create confidence on, for everybody around working in this area.

So, it’s also been important to find ways of talking with communities about why it matter to be diagnosed early, to go to your doctor early, so we’ve had a number of projects around that, some of which have been specifically gender focused, men’s and women’s business, and then finally we’ve been researching what is the meaning of collaboration because all of, the whole project was really about collaboration and again there is some sort of assumptions made about collaboration so we’ve been at the same time doing some qualitative research about the meaning and experiences of collaboration in this project.

Tricia: Can you give us an example?

Victoria: In terms of community education, there have been two particular aspects, um and Rick will talk about one, which is our focus on Aboriginal men because one of the things the community told us, right at the beginning was that they were concerned about everybody, they were particularly concerned about Aboriginal men and their health.

Tricia: Mmm

Victoria: And the other has been um, a Day in the Park, that we have for Aboriginal women, in the New South Wales country town, but I’ll let Rick talk more about the focus on Aboriginal men first of all

Rick: Mmm, so, across the LHD or the Liaison office, to help workers, the male ones, we regularly got together to discuss issues, what our issues were around cancer like as far as what our clients have said to us and why they weren’t accessing and things like that and the education they wanted to know, um and it was hard for our health workers to offer support and education because they didn’t know themselves.

Victoria: Mmm

Rick: So, we um organised some training for our health workers surrounding cancer

Tricia: So, what are some of the issues for Aboriginal men? Is it similar to other men? “Cause men are notoriously bad for going to doctors and looking after their health anyway.

Rick: Yeah

Tricia: Are they the same with some additional layers?

Rick: I think so, like there’s, you know, a whole big thing about shame and um, you know yeah going to the doctor and getting checked and all those kind of things which is something we wanted to highlight through the DVD that we actually produced.

Tricia: Mhmm

Rick: But um you know that was the process of us both getting together and then you know really formulating a plan of what was going to be in DVD, because there aren’t, there wasn’t one um existing.

Tricia: We’ll have to put the details of that DVD up and where people can get hold of it.

Victoria: Yeah, the DVD is called uh, ‘Early Screening Keeps You Dreaming’

Tricia: Mmm

Victoria: Uh and that particularly targeted Aboriginal men and followed a hypothetical um process of an Aboriginal man being uh diagnosed with cancer.

Tricia: And, and how about the work with women?

Victoria: So, this is a really good example of how different communities respond differently um so for outreach in Narrandera, in Murrumbidgee Local Health District, we were talking there with the Aboriginal health workers, people from Aboriginal communities locally and the cancer workers about what we would do next and the Aboriginal worker said what we need is an education day and out of this came the most fantastic day in the park and it was called “Out in the Open’. So, it was held out in the open and it was about bringing conversations about cancer out into the open and we held the day in the Narrandera park and the, the whole layers of the importance of this.

So it was about bringing together Aboriginal women for the day in the park where we had speakers around a whole range of topics around cancer but it was done in a really relaxed sort of picnic like environment. So, the two critical parts of this, one is in providing education to Aboriginal people in culturally appropriate ways, so we’re out in the park. It is a relaxed atmosphere where Aboriginal women felt comfortable to come and it was also the process of, of, developing the day which involve a vast array of Aboriginal and non-Aboriginal Health Community Workers coming together to do this.

So it involved local council who were just fantastic, the Medicare local, the local hospital and health service, organisations like Lions Club, Rotary Soroptimists, all came and played a part in, in that, community organisations for Aboriginal and non-Aboriginal people. So, it, that’s another way of building relationships, and one of the, the feedback we got was that people really learned, uh the Aboriginal women really learned a whole load of information about cancer that they haven’t understood before. That they enjoyed the day and it gives confidence to the, particularly to the non-Aboriginal workers, about ways of working together appropriately.

Tricia: So it’s really about, having the time, but it’s about making those connections and building those relationships and being open to learning and listening and really having that humility position to learn from Aboriginal people, and not assume that they’re all the same, so that Aboriginal people can then, can in turn, feel safe to learn from health workers.

Victoria: Yes, yes, you just summed it up well.

Tricia: Mmm, so have there been measurable changes yet, in your project?

Victoria: One of the things that has stood out clearly is the increasing number of eligible Aboriginal women in accessing breast screening.

Tricia: So, there’s been a jump in the numbers?

Victoria: Absolutely, because one of the things that happened earlier on in the project was the result of, the Director of Breast Screening Services in our area and the Manager for Aboriginal Health, having a conversation and getting involved with this project and beginning a process, whereby whenever the mobile breast screening unit goes out into a community, that the Aboriginal Health Workers in that community are informed, I think a week or whatever, in advance, so that they can go to their community and encourage the women to come in and support them to come in and that alone has increased the number of Aboriginal women accessing breast screening services.

Tricia: Mmm

Victoria: And it’s, on one level, such a simple thing to do, on another level, it’s about doing it.

Tricia: And Rick, have, have men responded in the same way?

Rick: Uh, it’s hard to, hard to um report on I think because we haven’t had any…

Tricia: Enough time?

Rick: Yeah, yep.

Tricia: Mmm

Victoria: One of the things that we have had reported, is particularly in result of that open day, and I think it would be true also, we’ve had yarn-ups in other areas of our local health district, is that cancer is being talked about much more in communities, that if, when we first did the consultations people told us that cancer is a death sentence and around that was the whole taboo around talking about cancer because it was so frightening um and what we’re now being told is that people in community are talking about cancer. So, I’m not sure that we can yet measure.

Rick: Mmm

Victoria: Other than for breast screening but this therefore means that people’s health is really good, but is about taking a step-by-step process. If people are talking about cancer now, there much more likely to begin to talk about whether they need to go see their GP at an early stage, what happens then, in treatment, who is around to support you? And uh, and most of all I guess, is that if you go early, your outcomes, your survival is much more likely to be better, than if you don’t.

Rick: Mmm, and I guess from our point of view like from the men’s point of view, we’ve been tied up with the you know planning process of the DVD and production of that, and that’s where the focus has been um but now that the DVD is in its production stage and then we’re gonna roll it out you know, I’d assume that once that DVD is out and we’re rolling it, you know, that we’ll actually see some outcomes as a result of that.

Tricia: And it reminded me of the education that was happening 20 years ago in the white community that cancer is not a death sentence, so it really is that 20 year gap.

Rick: Mmm

Tricia: For both groups, so it’s not going to change overnight either is it?

Rick: No.

Tricia: So, it’s going to be a slow process and in the general community.

Victoria: That’s absolutely right Tricia, and I think one of the things that organisations need to have faith in, is that if you put the right processes in place, things will change, but the process is part of the outcome.

Tricia: And there’s a different emphasis on importance because in heath it’s all about outcomes and producing measurable outcomes, but in this work, there really has to be a greater emphasis on the process in order to eventually reach those outcomes.

Victoria: Yes.

Rick: Yeah, I think so because most definitely with our health worker you know, that have been involved with you know that planning process, you know they’ve gained valuable skills on the way, so you know that’s building you know.

Tricia: And it is everybody’s business.

Victoria: Yes, that’s right.

Rick: Mmm

Tricia: Well we’re almost out of time guys, that’s gone very quickly, things that we haven’t said that are important to this discussion?

Victoria: I think, the thing I’d like to add is around cancer awareness, sorry cultural awareness training or cultural responsiveness is the importance of non-Aboriginal people understanding white privilege and that is actually a part of the whole process as well.

At last it is important for us as non-Aboriginal workers to understand about colonisation, local history, the whole issue of racism and how that might look and how to deal with it and turn the lens on ourselves and say “What is about the way we look at the world, that actually affects the way we relate to Aboriginal people and to what part we play in either working really appropriately with people or perpetuating colonising practices”, so…

Tricia: Because everybody says that they’re not racist and they’re open, but what we have is a blindness to our own privilege, isn’t it?

Victoria: Absolutely.

Rick: Oh yeah without a doubt!

Victoria: To be white is not to notice that your white.

Tricia: Yes exactly.

Victoria: But everybody knows if somebody is black.

Tricia: Mm, so we can be very self-delusioned, Mary, we can delude ourselves quite significantly in that area.

Victoria: I’m just wondering, whether there are particular things you noticed Rick, when, when we’re blind to our own perspective? When white people make assumptions, that are not necessarily shared by Aboriginal people.

Rick: So, I guess one of the assumptions is, um and some of the attitudes, is at the beginning of the process they say ‘oh, I’ve known the person for so long’ is that because I’m a galah, I’m really out there you know?” And the kind of attitude behind that was you know was really slack, and I think over time we have built it to say well that’s not really the issue, the issue is why, why aren’t they active, not how come they don’t have X amount you know 10 people or…

Tricia: Or what is it about me? That they’re not coming to me?

Rick: Yeah you know what is the service doing that isn’t meeting the need?

Tricia: Yeah … Anything else?

Victoria: Well, I suppose the only thing I’d like to do is invite Rick to say what difference does it make when the processes work through really well, in terms of collaboration, shared control of the way things happen and so on, I was just wondering if you’ve got any comments to make about that?

Rick: I think it make a huge difference, you know I think we can get lost in the fact that the project has gone on for in, what seems to be a long time, and if you just quickly glance at it, you can say oh that’s not the outcome, but really when you delve into it, there has been a lot of outcomes but it’s been building along the way.

Victoria: And you were talking about some of those earlier Rick, as to what difference has been made, and I think you were talking about it actually makes a difference outside the cancer.

Rick: Yeah, yeah and I think Victoria and Joe, like in the early stages, really took on what the health workers were saying and that were saying you know that we need time, we need to do it in our own time, we need to consult, we need to consult this way um and you guys need to be patient, and we don’t really know a lot about caner, but we want to know, and you know all those kinds of things that we started off with, by saying in the very beginning were listened to and respected so…yeah.

Tricia: Fantastic work, thank you guys and I think, I think the biggest message is that we all need to learn about this and we all need to be open to addressing these issues and influencing institutions with our work, thank you so much for being on Podsocs.

Rick: Thank you!

Victoria: Thank you Tricia!

[Musical outro 27:36 to End]

[Interview Ends 28:10]