Many allied health university curricula integrate information about working with Aboriginal and Torres Strait Islander peoples. Some degrees also ensure students have ‘cultural awareness training’ prior to going on placement. However, clinical educators report that students often have insufficient understanding of health issues and culture before they start a placement.
Students can also feel under-prepared for these placements. In the report, 'I Wish I Knew Then What I Know Now', students reflect on their clinical education experiences in Aboriginal and Torres Strait Islander settings, and suggest ways that the universities could more adequately prepare them for placement. The report also provides some simple and practical suggestions for students preparing for clinical placement in this type of setting.
We all interpret situations through our own ‘cultural lens’. We can find it difficult to understand and respect cultures that are not familiar or that appear to reflect different beliefs to our own. We need to recognise our own underlying values and assumptions before we can apply an ‘Indigenous lens’ (Mungabareena Aboriginal Corporation and Women's Health Goulburn North East, 2008). Family, kinship, community, connections to the land and spirituality are fundamental and complex realities for most Aboriginal and Torres Strait Islander people (Royal Australian College of General Practitioners, 2012). However, ‘Aboriginal and Torres Strait Islander culture’ is not homogenous. Urban communities and remote communities are different. Each community and each language group is different.
In this video, the significance of understanding the individual context of each person is explored.
It might be useful to ask your students to reflect on their own upbringing and values, and how these might impact on their involvement with Aboriginal and Torres Strait Islander clients. For example, you could encourage students to produce their own version of ‘My Story’ in which they reflect upon the following aspects of their life:
- Educational opportunities
- Family situation
- Cultural practices
- Assumptions about First Peoples
- How do I feel about the history of Aboriginal and Torres Strait Islander peoples? Why?
- How might this impact on my practice as a health care provider?
In this video, the use of the 'My Story' reflection tool is explained. And, this example student’s ‘My Story’ shows how effective this reflection process can be.
Cultural training programs for students and professionals working with Aboriginal and Torres Strait Islander peoples usually aim to develop awareness of the cultural, social and historical factors significant to Aboriginal and Torres Strait Islander peoples. Participants reflect on their own culture, assumptions and attitudes. This ‘cultural awareness’ training can help develop recognition and understanding of the factors that affect the ‘cultural safety’ of Aboriginal and Torres Strait Islander peoples and help develop appropriate skills to interact with ‘cultural competence’.
Cultural awareness training may be risky: it may create a ‘false perception that there is a unified entity called ‘indigenous culture’ that can be described, taught and understood … [and that training might] reinforce stereotypical and even negative understanding of what ‘culture’ is, what it means for Australia's First Peoples and how it will be an ‘issue’ in the health care setting.’ (The evidence for the effectiveness of cultural training programs in Australia is poor and has been described and evaluated in Downing, Kowal & Paradies, 2011). However, as a first step in raising awareness and signposting the factors that might be important, cultural awareness programs are often useful.
Your workplace might have a cultural training program. If so, ask if it is possible for your students to participate in it or you could establish your own cultural awareness program. For example, all students on placement with the Mount Isa Centre for Rural and Remote Health must also attend a one-day cultural awareness course as part of their orientation to the service.
Alternatively, a number of online programs and downloadable resources are available and you could choose one of these and require students to complete this either prior to placement, during the first few days or as ongoing, more in-depth training throughout the placement. An overview of some of the useful resources is presented below:
Australia's First Peoples Health E-learning Initiative - Griffith Health
Australia's First Peoples Health E-learning initiative - Griffith Health has been developed specifically for students about to undertake clinical placements working with Aboriginal and Torres Strait Islander peoples. The portal aims to help students develop the confidence and knowledge to provide culturally sensitive health services and care. Students who visit the portal undertake a ‘cultural awareness journey’. They have a ‘cultural passport’ that is stamped when they have worked through each section of the portal. The portal includes information, videos, quizzes and links to other resources. The information is also available in a downloadable portable document format (pdf) for students to take with them on placement.
Australian Indigenous Health InfoNet - Cultural Safety for Health Professionals
The Cultural Safety for Health Professionals portal aims to support teaching health professionals to critically reflect on the concept of cultural safety and to deliver safe, accessible and responsive care. For a variety of allied health professions you will find available links to resources and publications in relation to the Aboriginal and Torres Strait Islander Health Curriculum Framework.
Health Professionals Working with remote Indigenous Communities - Remote Area Health Corps
Remote Area Health Corps provides a range of free eLearning modules designed to increase awareness about the various considerations when working with remote Aboriginal and Torres Strait Islander communities. There are a variety of modules available, and access to the modules is free
Cultural Safety Learning Module - Services for Australian Rural and Remote Allied Health
Services For Australian Rural and Remote Allied Health (SARRAH) provide a Cultural Safety Learning Package using case studies and interactive exercises to assist health workers to reflect critically on their work practices and to develop culturally safe services for Aboriginal and Torres Strait Islander clients. The module is free to access and takes about 20 minutes to complete. SARRAH resources support allied health professionals starting remote and rural practice.
An introduction to Aboriginal and Torres Strait Islander health cultural protocols and perspectives - Royal Australian College of General Practitioners
'An Introduction to Aboriginal and Torres Strait Islander health, cultural protocols and perspectives' is a free downloadable resource to provide background information and guidance on Aboriginal and Torres Strait Islander perspectives, along with an understanding of important protocols and other relevant cultural issues. Useful chapters in this resource explain the historical context surrounding Indigenous health issues and suggest important principles and protocols:
- Aboriginal and Torres Strait Islander history and why it matters (p.6)
- Core principles for working with Aboriginal and Torres Strait Islander peoples (p.20)
- Protocols for culturally respectful engagement with Aboriginal and Torres Strait Islander peoples (p.25)
You’re in New Country is a downloadable booklet developed specifically to support people starting to work with First Peoples within an early childhood context. In this resource, First Peoples share their personal stories of work and learning with people who come from outside their communities. They highlight the ways non-Indigenous people have supported them to succeed but they also reflect on some of the equally important things that non-Indigenous people struggle with when they begin to work in remote communities. This resource is their answer to the key question – “What is important for non-Indigenous people to learn to help them support your early childhood work and learning?”
- Learn about family rules and kinship
- Learn our ways with our kids
- Family comes first
- Strong Relationships are everything
- Communication - It’s critical
- Community life can be hard sometimes
The Torres Strait Regional Authority (TSRA) website provides useful information about Torres Strait Islander peoples and includes community profiles. The Cultural Protocols Guide has been developed to help people engage with all the communities of the Torres Strait.
Many resources focus on rural and remote Indigenous people. However, as Scrimgeour and Scrimgeour (2007) described in Health Care Access for Aboriginal and Torres Strait Islander People Living in Urban Areas, a significant majority of the total population of Aboriginal and Torres Strait Islander people live in urban areas. Additional resources that explore health determinants in urban populations can be found by typing in 'urban' to the Lowitja's Institute Resource page.
Health services for urban Aboriginal and Torres Strait Islander people includes contextual issues for urban Indigenous people in a powerpoint presentation, and explores themes for student orientation to a placement setting in the urban context with the Institute for Urban Indigenous Health.
Introduction to Remote Health Practice Program is an online orientation and learning program for health professionals. The Remote Area Health Corps (RAHC) developed this program to better equip workers for the provision of clinical services within remote Indigenous communities. Four of the modules are specifically recommended for allied health are:
- Introduction to Aboriginal and Torres Strait Islander Health
- Communication and Education
- Chronic Conditions Management
- Mental Health
The modules are thorough and can take up to two hours each to complete. The program is free to access. It requires participants to login and provides certificates of completion.
RAHC have also produced a Cultural Orientation Handbook that could provide an effective introduction to working with Aboriginal and Torres Strait Islander peoples (NB. This Handbook was developed specifically for people working in the Northern Territory). This handbook could also be used as a model for workplaces planning to develop their own resource.
- Coffin, J., Drysdale, M., Hermeston, W., Sherwood, J and Edwards, T. (2008). Ways forward in Indigenous health. In S. Liaw & S. Kilpatrick (Eds.) A textbook of Australian rural health. (pp.141-150). Canberra, Australian Rural Health Education Network.
- Downing, R, Kowal, E., & Paradies, A. (2011). Indigenous cultural training for health workers in Australia. International Journal for Quality in Health Care, 23(3), 247–257. doi: 10.1093/intqhc/mzr008
- Mungabareena Aboriginal Corporation and Women's Health Goulburn North East. (2008) Using a health promotion framework with an ‘Aboriginal lens'. Part of Making two worlds work: building the capacity of the health and community sector to work effectively and respectfully with our Aboriginal community.
- Royal Australian College of General Practitioners. (2012). An introduction to Aboriginal and Torres Strait Islander health cultural protocols and perspectives. Melbourne.
- Scrimgeour, M. & Scrimgeour, D. (2007). Health Care Access for Aboriginal and Torres Strait Islander People Living in Urban Areas, and Related Research Issues: A Review of the Literature. Cooperative Research Centre for Aboriginal Health, Darwin.