Cultural Orientation Handbook

Funded by the Australian Government Photographs used in this handbook were taken in the Northern Territory communities of Ampilatwatja, Ti Tree, Imanpa and Galiwin’ku. Permission was sought from these communities and from all individuals or guardians of individuals, before photography commenced. All photographs are copyright of the Remote Area Health Corps. © Copyright - Remote Area Health Corps, RAHC, 2013 Contents

Welcome ...... 4 Working within the Dying, death and kinship network...... 27 sorry business ...... 35 Introduction to this handbook ...... 5 The kinship network Dying Roles and responsibilities Death Your first days...... 7 Avoidance and Poison relationships Sorry business Permits Where do you fit in? Other cultural considerations Forbidden areas and sacred sites When offered a skin name relating to treatment ...... 39 Alcohol Working with the right members Blame and payback Introductions of the kinship network Curses Adjusting to your role Reciprocity — sharing Traditional healers Working with Elders Working within the Use of ochre Aboriginal community ...... 11 Birth and childhood ...... 33 Treatment arising from The Aboriginal community Birth ceremonial activity Factionalism and politics Childhood Hair and clothing Engaging with the community Men’s and Women’s business

Personal presentation Treatment compliance ...... 43 and conduct ...... 17 Medication Attitude Informed consent Conduct Travel for treatment Safety References ...... 45 What to wear What to take with you Useful resources ...... 46 Greeting and addressing people Communication Where can I walk? Buying artwork Taking photographs

Remote Area Health Corps | Cultural Orientation Handbook | 3 Welcome to the Remote Area Health Corps (RAHC)

Thank you for your interest and willingness to experience the rewards and challenges of working in remote communities. The opportunity to provide service, work with teams of dedicated health professionals and contribute to improving health outcomes for Aboriginal Australians should be fulfilling and beneficial to you and the community you will work with. At RAHC we recognise that for this to happen we must provide information and training that will prepare you for the unique challenges and opportunities that lie ahead and importantly, for achieving a successful placement as a health professional. This RAHC Cultural Orientation Handbook is the first part of the training and orientation program you will undertake. It aims to provide an introduction to working with and living in remote Aboriginal communities and to the cultural issues you will need to be aware of in providing health services. Critical issues such as the role of the Aboriginal Health Practitioner and working among kinship networks are discussed in order to help you work effectively and safely as a health professional. However, we must also emphasise that it is impossible to cover these and similar issues completely and you should always be open and alert to the situations that are unique to the community you are working in. We recommend you regularly seek the advice of colleagues including Aboriginal Health Practitioners and your Health Centre Manager. RAHC would like to acknowledge and express gratitude to the Aboriginal people of the Northern Territory, who have so generously shared aspects of their culture and great wisdom for use in this handbook and in other RAHC training materials. The first versions of this handbook were prepared for RAHC by The Echidna Group and we acknowledge and thank Dr Terri Farrelly and Ms Bronwyn Lumby for their contribution. RAHC also acknowledges the contribution of Mr Don Christophersen whose local knowledge and years of experience in working on cultural orientation have enriched the handbook. For later editions we have drawn upon feedback and suggestions from staff of the Aboriginal Medical Services Alliance Northern Territory (AMSANT) and Katherine West Health Board. As you read and work with this handbook, go on to participate in other RAHC training programs and most importantly, experience work and life in remote communities, we encourage you to provide feedback and advice on how we can continue to develop and strengthen our orientation and training programs. We look forward to hearing from you and wish you the best in your RAHC experience.

Philip Roberts General Manager

4 | Remote Area Health Corps | Cultural Orientation Handbook Introduction to this handbook

The information has been compiled • Franks C. and Curr B. (1996), This handbook provides through a review of available literature Keeping company — an intercultural and consultations with members of conversation, Wollongong, NSW: you with information Aboriginal communities in the Northern University of Wollongong. specific to working Territory. Two existing texts were of Both these texts are now available in particular use: revised editions — details are provided at within an Aboriginal • Eckermann A., Dowd T., Martin the end of this handbook. community such as M., Nixon L., Gray R. and Chong E. (1992), Binan Goonj: bridging cultures personal conduct, in Aboriginal health. Armidale, NSW: appropriate methods University of New England Press. of communication and cultural factors you need to consider when providing healthcare.

Remote Area Health Corps | Cultural Orientation Handbook | 5 Remember: there are no hard and fast rules. Every cultural group and community is different. Your first days

The key to being culturally competent and being able to deliver a culturally Forbidden areas and Alcohol appropriate health service in Aboriginal sacred sites Many Aboriginal communities and bush communities, is to: camps are dry — alcohol is prohibited. The very first thing you should do on • be respectful These laws are typically enforced strictly. arrival is determine where you can and • be observant and willing to learn cannot go in the community or bush camp Some communities may have a permit system where residents can apply to • ask for advice. area — don’t wander about until this has been confirmed, because there may be have a nominated amount of alcohol numerous forbidden areas or sacred sites with them in the community area. Other Even other Aboriginal people who travel in and around the community or camp. communities may have restrictions on to different regions have to be aware of availability of takeaway alcohol from clubs These forbidden areas are vital spiritual the cultural protocols that apply to the and pubs. particular community they are in. and cultural places which link Aboriginal people to their cultural traditions and It is strongly recommended that you Your first days within an Aboriginal the land. They may be places linked to do not bring alcohol with you into the community as a health professional are ceremonial activity, such as men’s and community to ensure you do not breach important, as this is where first impressions women’s business, or to spiritual beliefs. any laws that may be in place. Once you are made. These first impressions can They may or may not be sign-posted. have arrived and are familiar with the determine both your satisfaction in particular restrictions applicable in that Accidentally or intentionally entering your role and placement, as well as the area you can then act accordingly. satisfaction of the communities and camps such areas will offend Aboriginal people you are working with and ultimately in the area and may even result in your impact on their health outcomes. immediate removal from the community or camp. Even other Aboriginal Please respect the wishes of the Permits traditional owners by avoiding and people who travel to respecting these areas. If you want to visit or work on Aboriginal different regions have land in the Northern Territory, you must To learn more about sacred sites, go by law have a permit to do so. to the Northern Territory Aboriginal to be aware of the Areas Protection Authority website at You should already have a permit www.aapant.org.au. cultural protocols. organised for you by the health service where you will be working, however it is important that you understand it is likely this permit will only allow you to be in a specific area. It is also important to note that it is likely your permit won’t allow you to fish or camp at any time during the job — this will require additional permits. If you wish to venture to other areas, you will need to apply for additional permits via the relevant NT Aboriginal Land Council.

Remote Area Health Corps | Cultural Orientation Handbook | 7 Introductions Adjusting to your role

As a health professional, it’s vital that You must at all times remember that you spend your first few days being you are there to do a particular job. You introduced to members of the community must also be aware of your position as and, where appropriate, bush camps. a newcomer to the community. You This includes being introduced to the may encounter situations where you Board of Directors of the health service wish to intervene, change or control (where applicable) and other Aboriginal matters, or take particular actions as you organisations in the area. would normally do in non-Aboriginal Sometimes if Aboriginal people have environments. It is important that you not been introduced to new health step back and consider the factors of professionals working in their community the situation that are directly related to they may visit the clinic but may choose Aboriginal cultural beliefs and protocols not to speak or interact with them. and the implications your actions may have on the community as a whole. You can overcome some of these issues by taking steps to ensure you are introduced Aboriginal people are typically wary about to members of the community and bush being judged and betrayed. How you react camps. Ideally, introductions should and respond to particular situations that be conducted by an Aboriginal Health are either beyond their direct control Practitioner or other well-respected local (living conditions, environment, poverty), Aboriginal person. or related to cultural beliefs and protocols (sorry business such as cutting and payback) may result in members of the community feeling you are judging them or betraying their trust in you. This Cultural Orientation Handbook includes examples of situations that you may find difficult and your usual responses and courses of action may not be appropriate in this context. You will have to consider the implications your actions may have on the community as a whole given the unique circumstances. Remember to respect the community’s decisions and activities as much as possible and take care not to deliberately or inadvertently judge or betray.

8 | Remote Area Health Corps | Cultural Orientation Handbook Remote Area Health Corps | Cultural Orientation Handbook | 9 10 | Remote Area Health Corps | Cultural Orientation Handbook Working within the Aboriginal community

It is easy to have an idealised notion of Many Aboriginal communities across The Aboriginal Aboriginal communities that includes Australia were historically displaced community (Australian viewing community members as being from their traditional lands and often united in purpose and action and sharing resettled in new communities as a result cultural diversity) a common culture. Peters-Little (2000) of past governmental policies. Some new Imagine if a handout on ‘Understanding characterises popularised notions and communities were an amalgamation of Australian Culture’ had to be produced assumptions of the Aboriginal community different peoples who are traditional for Aboriginal health professionals about as the following: enemies. They then experienced forced segregation on missions and reserves. to start working in Canberra with non- • members are caring and generous in Aboriginal people. How complex and all matters Later government policies of self- diverse would this document need to be management and self-determination • disadvantage and adversity is resulted in such missions and reserves to take into account all aspects of Western inevitable and even acceptable culture and the new multicultural society being granted a freedom of sorts, with that is Australia today. • materialistic values are unnecessary limited autonomy. In this way, they were forced to become communities in name, Imagine also if you lived in a community • independence and individuality is despite the lack of voluntary association of 2000 people, many of whom were your rejected if not in the common interest among members. In many cases, when family by blood and marriage. You also of the larger population the artificial infrastructure provided had a kinship relationship with the other • external assistance is revoked and by legislation, regulations and religious people in the community and could call solutions only exist within the evangelism was removed, nothing was every Aboriginal person in the community community substituted in its place. family. At every level of communication and interaction, you would be dealing • there is a communal sharing of Understanding this as the basis of many with your family, 24 hours a day, 365 days socio-economic and cultural opinions, Aboriginal communities will help you a year. experiences and expectations. understand why certain situations have evolved and why certain issues seem Understanding cultural issues will Such views have been referred to extremely difficult to resolve. help with your work in an Aboriginal as the type you can afford to have community. To understand the people when you don’t have to live in the you’ll be working with and the community community. These notions however fail members who will be your clients, you to accommodate the true origin and will need to have empathy. All people are establishment of such communities. complex, all cultural groups are complex and culture is not the only answer or explanation for some of the issues and personalities you will encounter.

Remote Area Health Corps | Cultural Orientation Handbook | 11 Factionalism and politics Rather than being set up by the government of Aboriginal Health the day, the Aboriginal Medical Service was born Organisations While some of the family groupings of the Aboriginal community’s consciousness within a typical Aboriginal community of the need for the provision of more accessible and appropriate healthcare to the people. Its One of the goals of Aboriginal may be aligned, others may be long- Community Controlled Health standing antagonists, often resulting in establishment and initial survival was achieved by local people and depended on the active support Organisations is to recruit as many factionalism. Factionalism is characteristic Aboriginal staff as possible. This is based of many Aboriginal communities and is of the community. From the beginning it was a medical service operating along lines dictated on international evidence showing that often not negotiable or remediable. Aboriginal health services are most This impedes interpersonal relationships by Aboriginal people (Fagan, 1984, cited in Eckermann et al, 1992, p.180). effective when delivered by Aboriginal and interferes with a community’s health professionals. In terms of Australian socio-economic progress. Aboriginal health and wellbeing, this Other examples of Aboriginal Community is problematic as Aboriginal people Factions will not be readily identified by a Controlled Organisations include women’s newcomer, however factionalism is common comprise a relatively small percentage of centres, family violence prevention and the total Australian population. The wide within community organisations and can be intervention services and youth groups. complicated by the intended or unintended socio-economic disadvantage experienced Many of these organisations, despite not by Aboriginal people has resulted in an involvement of outsiders. A common being Aboriginal Medical Services, will scenario is for factions controlling one under-representation of Aboriginal people often have a health focus given the holistic in all health disciplines. As a result the community organisation (for example, the view of Aboriginal health and wellbeing. health service) to be in conflict with factions majority of health professionals in these controlling another community-controlled Aboriginal Community Controlled services are non-Aboriginal. organisation, even where both organisations Organisations are typically established However, the development of the are supposed to work closely with one in the following manner. An Aboriginal role and qualification of Aboriginal another. Keep your eyes and ears open and corporation is set up (for example, an Health Practitioner has enabled the make discreet enquiries of your colleagues to Aboriginal Medical Service Corporation) employment of Aboriginal people in ensure you are aware of any such situation. and Aboriginal community members health roles that can effectively act as register as members of the corporation. To work effectively within the community, intermediaries between the Aboriginal Annual general meetings are held client and the non-Aboriginal health take care not to be perceived as taking sides where members of the Aboriginal or affiliating yourself with one or more of professional, as well as perform many corporation elect board members who clinical tasks independently. Thus, in a these factions, thereby putting yourself will be responsible for the corporation’s at odds with others. Providing particular typical Aboriginal Community Controlled governance. The board members are usually Health Organisation, management, services, funds or resources for one faction Aboriginal members of the community and and not for others and inadvertently being administration and Aboriginal Health corporation. In this respect, the organisation Practitioner positions are occupied by seen as supporting certain activities and not is described as being community controlled others (even if unintentional), can result Aboriginal people and health professional because it is the community members who positions (for example, doctors) are in community members assuming you are ultimately control its management through favouring a certain faction. largely occupied by non-Aboriginal people their involvement and election of the board in the absence of available qualified of management. Aboriginal Community Aboriginal people. Controlled Organisations

Aboriginal Community Controlled Organisations came into being in the early 1970s amid a growing determination by Aboriginal people and communities to take control of their destinies. A common example of an Aboriginal Community Controlled Organisation is the Aboriginal Medical Service found in many Aboriginal communities across Australia. The following statement provided by a doctor working in such a service explains their conception and purpose:

12 | Remote Area Health Corps | Cultural Orientation Handbook Working with Aboriginal Indeed, some may have 20 or more years The community’s expectations of service as a health professional in the Health Practitioners same clinic and as such they are critical for of you maintaining stability and cultural security Aboriginal people prefer to be cared for for the whole health team. The community expects you to perform by other Aboriginal people. However, appropriately in your role as a health given the shortages of Aboriginal doctors Aboriginal Health Practitioners may professional. This includes dressing, and nurses, the role of the Aboriginal have particular kinship relationships speaking and generally conducting Health Practitioner has become critical. and obligations to members of their yourself in a manner in keeping with Consequently it is essential for all health community. This can result in Aboriginal the role and having the knowledge and professionals to support and work Health Practitioners: expertise expected of your profession. effectively with these Practitioners. • feeling obligated to work with clients You are also expected to be sensitive and Aboriginal Health Practitioners may out-of-hours if they are part of their empathetic and to recognise, honour have qualifications that vary from TAFE community or kinship group and respect the vibrancy of Aboriginal certificates to university degrees and • feeling obligated to share their cultures. The values detailed below have the level of clinical experience may resources with family members been endorsed by the National Health vary greatly. The essential role of the and Medical Research Council (2003) for Aboriginal Health Practitioner is twofold: • perceiving clients in a holistic way conducting ethical research in Aboriginal (without many of the functional health contexts. These values also serve 1. to provide basic healthcare to boundaries of Western culture) Aboriginal clients as a sound guide for cross-cultural • being unable to assist certain communication: 2. to act as a bridge between Aboriginal community members due to avoidance • Spirit and integrity — a respect for clients and the community, the non- relationships and factionalism Aboriginal health professional and the spirit and integrity of all cultures, mainstream health system. • being exposed to high levels of stress communities and individuals resulting from the fact that potentially Aboriginal Health Practitioners may • Reciprocity — full recognition of all the clients seen by the service who the involvement and contributions work in a variety of positions in both may be experiencing very distressing Aboriginal Community Controlled Health of stakeholders, a dedication to the situations are well-known, if not feedback of meaningful results and Organisations (for example, Aboriginal related or closely connected to them Medical Services or women’s centres) and the assurance that outcomes must be mainstream services. • being under immense pressure as a of equitable value to the communities result of community expectations, and individuals involved Aboriginal Health Practitioners can be which in certain situations may be • Respect — acknowledgement and caught in a conflict between the two impossible to deliver on distinct definitions of their role. While affirmation of the inherent diversity the benefits of a clinical background and • being the target for blame if that exists within cultures and knowledge are recognised, they can also something goes wrong with the communities and a commitment to be criticised. This is because the social treatment of an Aboriginal client extensive consultation and involvement value of their role as a catalyst within • needing to be away from the clinic to • Equality — the promotion of the community, talking to people and attend funerals — this is part of their distributive fairness and justice, encouraging their attendance for health job description, not just taking time affirming the right of individuals, checks, often results in two roles — clinical off. Attending funerals is a cultural communities and cultures to be and social — that can be in conflict. expectation and failure to do so results different It is important to remember that for many in cultural repercussions such as shame. • Responsibility — to ensure that all Aboriginal Health Practitioners: It’s important to appreciate that practice is transparent and accountable and will result in no harm to the • English may be a second or third Aboriginal Health Practitioners have to language (this is a positive for a regularly find ways to work around clashes individuals and communities involved. community clinic) between their professional and cultural ethics due to the family and kinship issues • talking to a non-Aboriginal doctor or within their culture — never an easy task. nurse may be intimidating Aboriginal Health Practitioners in the • many clinical situations may be foreign Northern Territory are also among the due to a lack of training. most highly trained in Australia. By understanding this, you will be in a better position to appreciate and access the expertise of Aboriginal Health Practitioners.

Remote Area Health Corps | Cultural Orientation Handbook | 13 The community also expects you to work Living in a small community Aboriginal kinship may be defined as existing with them in partnership. Franks and Curr in two formats — traditional and urban. (1996) provide the following summary Some of the issues you may find hard to advice on the ideal approach a non- deal with may in fact be more related to Traditional Aboriginal kinship system Aboriginal health professional can adopt rural culture, as opposed to Aboriginal The traditional format of kinship is in building and working in partnership: culture. Remote and rural Aboriginal commonly based on 16 names. All • I want to work with Aboriginal ways communities have the usual characteristics Aboriginal and some non-Aboriginal — show me. of small towns — community concerns people have these names, which give and gossip run rife. However, in Aboriginal every individual a relationship with every • I want to cooperate with Aboriginal communities these characteristics are other person in the community. These ways — educate me. magnified as the spotlight is on all outsiders. relationships link you together and • I want to understand Aboriginal ways Every action, whether private or public, is provide a set of rules for you to conduct — help me. the topic of community conversation. the processes and tasks in your daily life.

• The clinic belongs to the community Urban Aboriginal kinship system and I am here to work in a way that Understanding how to work will suit everyone. within the kinship network Many Aboriginal children were systematically taken from their families • We all work together and learn from You need to gain an understanding throughout the history of the Northern each other how to do this the best Territory (the ‘Stolen Generation’) and possible way. of Aboriginal kinship networks and relationships and how you can work many members of the Stolen Generation appropriately within these networks. This established themselves in the urban is because every relationship you have in townships of the Northern Territory. Engaging with the the community and much of the work Other Aboriginal people settled in urban community you do while there will be affected by townships through circumstance, such as kinship networks. work or marriage. These urban Aboriginal Engaging appropriately and successfully people created a different and simplified version of the traditional kinship system with your host community involves taking All people in all cultures have some form of the time to learn how to present and and the extended family that included kinship system that governs their lives. It is the blood and marriage, but also friends. conduct yourself. This handbook provides changing world and exposure to other cultures some tips and further detail can be sought and world views that influences people and from your colleagues in the community, therefore changes our own understanding of Understanding cultural particularly Aboriginal Health Practitioners family and how we connect to each other. factors and how they impact and Aboriginal Community Workers. Issues you should think about and be Kinship encompasses the norms, roles, on treatment aware of include: institutions and cognitive processes referring to Develop a basic understanding of how to • general attitudes and conduct all of the social relationships that people are born into or create later in life and that are expressed respond appropriately to cultural factors • what you wear through, but not limited to, a biological idiom. such as how birth and death are viewed and dealt with in the community. Some • greeting and addressing people Dousset (2005) grasp of ceremonial issues and beliefs • communication Kinship is the recognition of a relationship relating to the causes of disease and • learning where you can walk and visit between persons based on descent or marriage. illness and traditional cures and healing, If the relationship between one person and is imperative. Some basic information • reciprocity and sharing another is considered by them to involve descent, is provided in this handbook, however These issues will be explored in the the two are consanguines (“blood”) relatives. If further direction should always be following sections. the relationship has been established through sought from your colleagues, particularly marriage, it is affinal. Stone (1997) Aboriginal Health Practitioners.

14 | Remote Area Health Corps | Cultural Orientation Handbook Getting to know your local Aboriginal community events You are also expected Aboriginal community and initiatives to be sensitive and Take the time to read and learn about the Attending, participating in and supporting Aboriginal community you are working community events can help increase your empathetic and to in — the language groups, cultural groups, familiarity with community members, historical factors, demographics, services establish trust and credibility and help you recognise, honour and and organisations and current issues within get to know the community and what’s respect the vibrancy of the region. Your colleagues, particularly going on. Always check first with someone the Aboriginal Health Practitioners and such as an Aboriginal Health Practitioner Aboriginal cultures. other Aboriginal staff, can be a source or other colleague to ensure your presence of great knowledge about the local at particular events will be appropriate and community. Work towards establishing importantly, that it will not be unwittingly trust and credibility — go out regularly offensive, or align you too closely with and have contact with community particular factions within the community. members so people get to know you. Keep promises and always ask permission Building relationships before branching out in any way or doing something you are not sure about. While it’s important to build effective inter-cultural relationships, remember Asking for advice and using it not everyone will be your friend and conflict will inevitably arise even within Always ask for advice in any situation the best of relationships. Healthy where you are not confident regarding relationships tolerate difference and the appropriate methods for proceeding. negotiate consensus and are able to cope Simple questions such as ‘what is the with conflict because these relationships best way for me to do this?’ can help you provide an environment that allow it to ascertain the appropriate ways of going safely occur. What is important is how you about particular activities, whether they respond to and resolve conflict, not the are related to clinical practice or everyday details of the conflict itself. life. Others within the community will always be happy to teach you. Return the Addressing the priorities of the favour by ensuring you listen to the advice and put it into practice. community When in doubt about anything — no It is important that as part of the matter how small or insignificant it relationship and partnership you are seems to you — ask someone such as an building with the community, you are Aboriginal Health Practitioner, Elder or willing to give attention to the issues the other Aboriginal community member. community sees as a priority, rather than They can advise you or direct you to trying to simply address the issues. someone who will know what is best. What may seem insignificant to you may be of substantial significance to others in the community.

Remote Area Health Corps | Cultural Orientation Handbook | 15 16 | Remote Area Health Corps | Cultural Orientation Handbook Personal presentation and conduct

To be adaptable, you need to be in touch Attitude with your own feelings, beliefs and needs In a word, it is all about being adaptable. and this can be achieved by spending time every day orienting yourself in time and Adaptation does not mean giving up space. By focusing your thoughts on who your own culture, but rather being willing and where you are, your reasons for taking to accommodate new and different on the position and taking the time to circumstances, reflecting on your journey care for your own health and wellbeing, and learning from it. you will learn to become part of the Franks and Curr (1996, p.109) provide environment, rather than reacting to it. the following strategies essential to being To be adaptable you also need to be adaptable in this context: able to accept community structures and • give up perceived power positions characteristics for what they are. You that are inherent in a dominant need to work within these structures culture and characteristics, rather than battling to change what may have been well- • listen and absorb new knowledge to entrenched over many generations. apply in future intercultural contact Franks and Curr (1996) note that this • learn to stand back and observe what includes avoiding ‘shoulds’ and ‘oughts’. is happening without overlaying the For example, ‘the mothers ought to look situation with your cultural baggage after their children better’, ‘the fathers should control their sons’, or ‘they should pick up the • have the humility to appreciate rubbish’. Your energy will be wasted trying another cultural viewpoint to control situations that for the most part • dare to give something of yourself you are taking at face value from your first at each contact — that is not to be impressions. What is needed is time to the enigmatic, all-seeing, all-knowing let these first impressions sit until you are professional able to see what lies beneath them and gain an understanding of how better to • assume equivalence of status within every working/social relationship. work with them rather than against them.

Remote Area Health Corps | Cultural Orientation Handbook | 17 Conduct DO Safety

Conduct can also be summed up in one • treat people gently, both physically • always take your personal safety and word — respect. and emotionally security as seriously as you would Respect should be an inherent part of • greet people respectfully and speak anywhere else your interaction with everybody within the softly • ask for advice on safe routes and community. Being disrespectful is seen as • act politely and demonstrate an places to walk ignorant and selfish. interest in people and the community • be careful of dogs, but also be In Aboriginal communities, you need through recognition — a smile, a wave, respectful of dogs as they are often an to carefully consider how you behave. a small sign integral part of family life Get to know people and their habits • conduct your private life in a discreet • be careful moving around the before taking up invitations to go to manner community at night, due to the lack the social events. Among many non- of light Aboriginal groups, it is acceptable for • observe others when communicating men and women to mix freely on social and take their lead, particularly • always let other people know where and professional levels. Such mixing is regarding shaking hands and eye you are going. not always acceptable in an Aboriginal contact context where women tend to mix • ask for advice in any given situation with women and men tend to mix where you are unsure of what to do with men. For example, while it may be or how to act — people will always be quite acceptable for a non-Aboriginal happy to teach you female health professional to treat male • not be impatient or raise your voice Aboriginal clients, it may not be proper with anybody — particularly older for her to interact socially with such men people or children. unless accompanied by a chaperone. To do otherwise could leave the health professional open to community gossip DO NOT and shaming, which does not help establish relationships of mutual respect. • speak harshly to someone that is drunk — speak to them in the same A lot of health professionals socialise manner you would a sober person among the community, but the wise hands do it in a gradual way. One of • badmouth or enter into gossip about the difficulties with outside health anyone in the community professionals coming and going from • swear around anyone in the Aboriginal communities is that often they community break social rules. Yet they may not be there long enough to learn any differently, • drink alcohol in alcohol-free (dry) or even find out they have offended areas others, socially or professionally. The • take illegal drugs best way to start to socialise is by joining • eat in front of others if they are not people for a cup of tea. eating Some general tips on conduct include: • assume that you know everything. Aboriginal people are not fond of people who talk too much about their assumed knowledge and try to ‘big note’ themselves, particularly in regard to assumed knowledge about Aboriginal peoples and cultures.

18 | Remote Area Health Corps | Cultural Orientation Handbook Respect should be an inherent part of your interaction with everybody within the community. Before packing for your Northern What to wear What to take with you Territory journey here are a few tips: The community may have certain RAHC staff will assist you with information • as well as talking to RAHC staff, try to expectations about the way you should about the accommodation and shopping speak to the health centre staff about dress. As a health professional, they may facilities in the community you will be local accommodation. RAHC will assist reasonably expect you will dress in a way working in. Generally, most communities in linking you with the health centre that reflects this role. The dress code is have their own local store that is as they will have more knowledge particularly important when meeting or stocked with all essential food items, about whether you should bring your treating older members of the community although these can be quite expensive own linen or not, where you can wash and in company of members of the due to transport costs and the range is your clothes and what appliances are opposite sex. To dress inappropriately generally limited. However, while it may available to you can cause offence and shame, resulting in be necessary to buy certain non-essential • be prepared for weather extremes. community members passing comments items from Alice Springs or Darwin Even though the Northern Territory behind your back and avoiding contact. before heading out to the community is renowned for hot sunny weather — for instance specific food, cleaning or most of the time, Central Australia Acceptable personal products — remember that by can have very cold overnight shopping locally you are also supporting temperatures and a jacket or tracksuit • skirts and dresses (below the knee, the local economy. Also be aware that can come in handy if you are on call not above) some of the aircraft you may need to during the night travel on to reach a remote community • blouses, shirts and tops with sleeves will have luggage weight restrictions, so • take note of the guidelines in this • loose trousers it’s a good idea to bring only the extra handbook about what to wear above items that you really need. If possible, seek and pack appropriate clothing for the • loose-fitting uniform advice on weight limitations when you are community and region you will be • comfortable, enclosed shoes. issued with your itinerary. working in • do not take non-essential valuable Unacceptable items with you. Security of your valuables is your responsibility and • short skirts (above the knee) RAHC is not liable. • singlets Essential items to pack: • sleeveless tops • appropriate clothing and footwear • tops showing midriffs — enough to last for the duration of • tight-fitting shorts your journey • tight-fitting or very casual jeans • personal toiletries • thongs or flip-flops. • power cords for any appliances you are taking with you, such as a mobile It can also be appropriate to wear clothes phone charger and jewellery that have been designed • money for your groceries and and produced by the community, or that personal needs. Most communities is reflective and supportive of Aboriginal have ATMs and credit card facilities culture. This can demonstrate your but try to check the specific details respect and willingness to participate in for the community where you will be the community. However, it is a good idea located before you travel. to check with your colleagues, particularly Aboriginal Health Practitioners, regarding what is appropriate and when it is appropriate to wear it. Wearing such items may not be seen to be appropriate for the clinic, but welcomed outside the clinic in daily community life and at community events.

20 | Remote Area Health Corps | Cultural Orientation Handbook Old people and Elders (people who have Be aware of personal space Greeting and addressing earned status within that community for people their knowledge and experience) should Distancing yourself or getting too close not be addressed by their first names, may be misinterpreted as coldness, such as ‘Harry’. They may be called by inappropriately intimate or pushy. The Take the lead from others their skin names, or ‘aunty’ or ‘uncle’. It gender of the person is an important is best to ask what is most appropriate factor in how personal space is used. Always observe others and follow their rather than simply assuming what they lead, particularly in regard to shaking would like to be called. Touching on the head and hair is hands and eye contact. These protocols inappropriate in some Aboriginal cultures, differ among cultural groups and even particularly in regard to Elders and babies. Aboriginal people visiting other regions Shaking hands and touching Always seek advice from your colleagues, are not always aware of the correct particularly an Aboriginal Health In some communities, shaking hands protocol. Instead, they watch and learn Practitioner or an Elder, if you need to is inappropriate for general greeting as from others. touch a person’s head. it has a specific meaning in traditional life, notably used during sorry business. Greetings To shake hands as a general greeting Eye contact can shame an Aboriginal person. It is Always greet people respectfully and important to note that some Aboriginal In some communities eye contact may be speak softly but clearly. people will offer their hand despite it inappropriate and avoiding eye contact being inappropriate, as they may feel it can be a sign of respect. This is often Terms of address is expected of them. Remember many misinterpreted by non-Aboriginal people Aboriginal people feel intimidated in in authority as inattentiveness. Lack of Take note of appropriate terms of address dealings with non-Aboriginal people, eye contact may also be about power or for people. This includes skin names and particularly those in positions of authority lack of power and due to factors such as terms of reference for Elders. If you are such as health professionals. personality, guilt and distrust, rather than unsure, ask for advice. just being put down to culture. Touching someone in a comforting You may address people as Mr or Mrs and manner is appropriate and this may use their family name only. This is seen as involve a gentle pat on the shoulder being very respectful and will not cause or a stroke on the arm. However, you the issues that using a first name can. For should be aware that it may not be example, the first name may be the same appropriate for a female to touch a male, as a recently deceased person. particularly an older male. It may also In some communities, the name of a be inappropriate for a male to touch a deceased person and even others who share female. In such situations, it is best to the same name, is not to be spoken for a seek advice from an Aboriginal Health certain period of time after their passing. Practitioner or Elder. In some communities, it may be expected that you call people by their skin names as opposed to their first names. This may particularly be the case with Elders. If you are unable to identify a person, you need to ask for advice. It is not appropriate to refer to anyone using terms such as ‘that old man’ or ‘that old woman’. Ask by using various associations that are more respectful, for example ‘who is the person who was here this morning?’

Remote Area Health Corps | Cultural Orientation Handbook | 21 Communication

Northern Territory Aboriginal languages

A large number of Aboriginal languages are currently spoken in the Northern Territory. The Northern Territory Aboriginal Interpreter Service works with over 50 Aboriginal languages (see Box 1). Box 1: Aboriginal languages for which the Northern Territory Aboriginal Interpreter Service is able to offer support.

Region Languages Alice Springs (Central) and Alyawarre, Anmatyerre, Central Arrente, Eastern Arrente, Jingili, kaititj, Mudbarra, Luritja, Ngaanyatjarra, Tennant Creek (Barkly) Ngaatjatjarra, Pintupi, Pitjantjatjara, Southern Arrernte Wambaya, Warlpiri, Warnmanpa, Warumungu, Western Arrernte, Yankunytjatjara, Wuriaki

Borroloola Yanyuwa

Darwin Larrakia

North Eastern Arnhem Yolngu languages: Dhay’yi – Djarrwark, Dhalwangu Dhangu – Golumala, rirratjinu, Galpu, Wangurri Dhuwala – Gupapuyngu, Gumatj, Manggalili Dhuwala – Wubulkarra, Madarrpa Dhuwal – Djambarrpuyngu, Liyagalawumirr, Datiwuy Dhuwal – Marrangu, Djapu Djangu – Warramiri, Mandatja Djinang – Murrungun, Mildjingi, Wulagi

Groote Eylandt Alawa, Anindilyakwa, kriol, Nunggubuyu

Katherine Gurrindji, Jawoyn, kriol, Mayali, Ngaringman, Walpiri, Nunggubuyu

Kunbarllanjanja (Oenpelli), Jabiru Burarra, kunwinjku

Litchfield (Batchelor) Madinarl, Mariamu

Nauiyu Nambiyu (Daly River), kriol, Ngangikurrungurr, Ngangiwumirri, Marithiel Peppimenarti

Maningrida Burarra, Djambarrpuyngu, Djinang, Guninggu, Gurrgoni, kriol, Nakkara, Ndjebbana, Rembarrnga, Yanyangu

Ngukurr kriol, Marra

Tiwi Islands Tiwi

Wadeye (Port Keats) Mari-Jarran, Murrinh-Patha, Nungu Jamidi

Warruwi (Goulburn Island) Maung, Walang, Iwaidja

22 | Remote Area Health Corps | Cultural Orientation Handbook Language According to Australian Bureau of Statistics data Non-verbal communication (2011) most Indigenous people (about 83%) You may notice that while many spoke only English at home, which is similar The unspoken messages given and Aboriginal people speak English, it is to the figure for non-Indigenous Australians. received in Aboriginal cultures often Kriol or a dialect rather than a About one in eight Indigenous Australians (11%) probably have the greatest impact on standard form of English. You may find reported that they spoke an Aboriginal or Torres communication and the potential for that even when the language is known, Strait Island (Australian Indigenous) language rapport between health professionals tonal differences, colloquialisms and other at home. Indigenous languages were much more and clients. You will find that Aboriginal factors obscure the meaning, which can likely to be reported by Aboriginal and Torres Health Practitioners are particularly adept block your access to important cues for Strait Islander people living in geographically at interpreting non-verbal messages from responding appropriately. remote areas. Over half the Indigenous people Aboriginal clients. Reading between the living in very remote areas (55%) reported using You should also remember that lines is not difficult to learn but it does an Indigenous language, compared with 1% of require time. Aboriginal people may have difficulty those in major cities and inner regional areas understanding you and conveying the Aboriginal and Torres Strait Islander people Silence message they are trying to get across. aged 25 to 44 years reported the highest rate of There is no simple solution to this. It speaking English well or very well (91%). requires your willingness to make the For many Aboriginal people, silence is situation as comfortable as possible for Arrente and Warlpiri, from Central Australia and used as part of communication styles and your Aboriginal clients and taking the Dhuwal-Dhuwal, from Eastern Arnhem Land, varies depending upon which community time to learn to interpret such cues. Make were the most commonly spoken Indigenous you are in. For example, silence can be use of interpreter services (both face- languages. Kriol is a commonly understood used as a form of respect, contemplation, to-face and telephone), speak in simple language from Western Queensland and across disagreement, or to allow time to reflect language and take the time to explain. the northern half of the Northern Territory to and consider. Aboriginal people may not Western Australia. speak up and therefore their concerns may not be seen as urgent. People may be quite happy to sit and, aside from the occasional comment, there is no obligation to keep the conversation flowing. For those used to interactions which have a particular social or professional focus, being able to relax and accept such silences can prove difficult and even stressful. The best way to deal with this is to sit back and listen, learn to relax with silences and tune into the speech patterns and idioms of the community.

Remote Area Health Corps | Cultural Orientation Handbook | 23 Questioning Go with the flow — allow a Building good relationships takes a lot circular, time-rich process of time, energy and effort. Culturally, Conversational style, idiom and etiquette Aboriginal people work with process, whereas Western culture has become differ between language groups. Direct Exact timing and meeting deadlines are questioning is not very common (or outcome-oriented. Many Aboriginal less of a priority in traditional Aboriginal people find the usual practice of the polite) in Aboriginal conversation and cultures. Everything done needs to be questions are usually simple. health professional asking, ‘What seems in tune with cultural responsibilities and to be the problem?’ or ‘What is wrong Franks and Curr (1996) note that as a obligations. If requests to do something with you?’ very affronting. This is because health professional you often need to ask fit into this order, then it will be done. If Aboriginal ways of helping include questions, so consider the way in which there is no meaning or purpose, then the allowing for a circular, time-rich process you do so. Ask only one question at a time chances are a person will neither turn up of yarning and storytelling (Lynn, Thorpe and try not to ask compound questions for a meeting nor carry out their duty and Miles, 1998). (e.g. ‘Is it this way, that way or the other statement as it is described. Franks and way?’). Curr (1996, p.67) state: Time needs to be spent allowing the client to talk about other topics — often Be aware that silence in response to The skill in working inter-culturally is to completely unrelated to their health and a question may mean that the person identify what the task is and then adjust wellbeing — until they feel sufficiently does not understand the question, does the circumstance under which it is to be comfortable to then introduce the not know the answer, or may know but done so as to not compromise Aboriginal problem or issue. If you as a health is lacking the confidence to reply. Try priorities. This is not to say Aboriginal professional can enable this circular and reframing the question in a different way, people cannot adapt to a contemporary time-rich process to occur, the client making it more specific as opposed to lifestyle — that they can and do is obvious is then free to determine the content, general. Or if it was a compound question, in any community — the adaptation must direction and pace of the interaction break it up. have meaning and significance in relation between themself and you. This helps to traditional values. build rapport and trust. Take care to look for other meanings

As a result of past experiences with racism and discrimination, as well as experiencing a marginalised position in Australian society, Aboriginal people may sometimes act in a way that they feel is expected of them. Of course, this may not be indicative of their true feelings, needs or wishes. Take care to make the person feel as comfortable and confident as possible.

24 | Remote Area Health Corps | Cultural Orientation Handbook Discussion of sensitive issues Where can I walk? Taking photographs

Sometimes there may be a need to discuss Every part of Aboriginal land is a place of It is fine to travel with your personal a sensitive issue, initiated either by you significance and is an intrinsic component camera or video recorder, but there are or by the client. It is more appropriate to of cultural life. For this reason, there can a few things to be aware of before you discuss other general, comfortable issues be places, even in communities, where start filming in an Aboriginal community. first and work your way gently to the you are not able to walk or visit. One of Be courteous and always check with the issue, rather than to start the conversation your first questions needs to be, ‘Where person you are intending to photograph by directly addressing the sensitive issue. can I walk?’. before taking a photo. Just as you Discussions are best held in situations where wouldn’t like someone coming into your there is enough time to ensure that the home and taking photos of your family conversation can initially be non-directed Buying artwork and your belongings without permission, and to allow for sharing and ‘going with the it is the same for Aboriginal people. flow’. Importantly, you need to ensure that Within many Aboriginal communities, Speak with your health centre colleagues you talk plainly and simply and that your many community members are artists. approach is non-shaming. about the use of cameras in the They may have arrangements with community. If there is an issue with the galleries to sell their works, however many use of photographic equipment, then you Dealing with issues and may also sell their works privately, as is must respect this rule. You will find that conflict their right. once you become more familiar with the Purchasing artwork from members of the community your opportunities for taking Typical non-Aboriginal approaches to community is also your right. However, photos will greatly improve. dealing with conflict include: be aware that while it can be seen as Be aware of sacred sites around the • confrontation being supportive of the community, some community that will be off limits to you. community members may be wary of Taking photographs of these sites without • discussion your intentions as non-Aboriginal people permission will be strictly forbidden. • professional networking frequently take advantage of low prices when buying direct from artists and stock- Taking photographs of children will require • meetings (formal and informal) up on Aboriginal art pieces to later sell the permission of their parents or guardians. • socialising on for profit. This behaviour is obviously Avoid walking around the community • industrial action seen by many community members as taking random happy snaps of everything unethical and inappropriate. If you intend you see. Always ask permission before you • grievance procedures to buy from a gallery, ensure the gallery take photographs of homes or campsites. • arbitration, mediation, negotiation. owners have a good reputation among the community and look after their artists Typical Aboriginal approaches to dealing rather than exploiting them. Aboriginal people with conflict include: may have difficulty • discussions with families • allowing space and time understanding you and • consultation with Elders in the conveying the message community they are trying to get • avoidance • belief that relationships are more across. important than the issues • open discussion • talking circles to explore the issues • sharing stories • factionalism.

Remote Area Health Corps | Cultural Orientation Handbook | 25 26 | Remote Area Health Corps | Cultural Orientation Handbook Working within the kinship network

• even when Aboriginal people come The kinship system has continued to evolve The kinship network into major centres they still follow and adapt as part of Aboriginal culture, Kinship relationships in Aboriginal kinship rules with Aboriginal families in urban, rural and remote areas still exhibiting kinship communities are both biological and • members are constantly making — through marrying correctly — non- connections with people to confirm structures that provide psychological and biological. However, kinship encompasses family and relationships physical support and security. much more than this. It is about all Every language group has its own version • when people die, the relationships the relationships that are professional, between the living family members of kinship. What you are taught about personal and family, that you will have may change. kinship in North Eastern Arnhem Land throughout your life. may not be exactly the same in North Having a basic understanding of the Western Arnhem Land. Kinship looms large in all the tasks, kinship network and the roles and communications and processes of every responsibilities of people within this Language and kinship are like all other day activities. Kinship is social order, network can help you greatly in your own components of culture — they are always governance, world view and it is the role as a health professional within the evolving. Aboriginal people are constantly preferred way of doing things. Kinship is Aboriginal community. adjusting their culture to fit within the culture, which is not static. It is evolving dominant culture and to fit within the and compromising to the world we now Western society is strongly individualistic, great diversity of other Aboriginal cultures live in. while Aboriginal society emphasises in the Northern Territory. membership of a group and the Kinship is a life-long learning process and Aboriginal kinship systems of obligations and responsibilities of individuals to meet the expectations to fully grasp and understand all the rules the Northern Territory of others. For many Aboriginal people, and concepts people must apply it in their family and community are of central daily routines. • Aboriginal people think differently significance and group interests and needs Do not be discouraged by the complexity about family and extended family are a fundamental part of an individual’s of kinship. Just be aware of it and how it compared with non-Aboriginal people identity and self-fulfillment. Personal is used. Understanding family and how • in every Aboriginal community in the identity and self-esteem is expressed kinship is applied to the processes and Northern Territory members are using in places of belonging and one’s place tasks of Aboriginal people living in both kinship within the extended family, rather remote urban communities, is enough. than individualistic characteristics or • there is biological (straight or full) achievements. family and there is kinship family Traditional Aboriginal societies functioned • Aboriginal people have many by means of kinship networks, which mothers, fathers, aunties, uncles, sons, formed the basis of social relationships daughters, nieces and nephews and maintained social order. Kinship • kinship, clans and language influence relationships go beyond the extended how a majority of the Northern family and include unions without blood Territory communities operate on a or marital ties. daily basis • there are double relationship names, such as cousin — brother or niece — daughter

Remote Area Health Corps | Cultural Orientation Handbook | 27 Kinship relationships are commonly governed by a set of 16 ‘skin names’. You get your skin name from your mother — it is predetermined and follows a cycle. All Aboriginal people in the community have one of these 16 names. The names are all your biological family, marriage partner and in-laws. Every task you do will be in compliance with the rules and norms of kinship. Kinship is 24 hours a day, 365 days a year, in the shop, school, clinic, every house and workplace. Every person in the community can draw on this set of 16 names to make a kinship (family) relationship. Some examples, according to language group, are as follows. Language group: Iwaidja — Minjilang and Cobourg Peninsula Skin names

Male Skin Names Female Skin Names Nawulanj Ngalulanj

Nangarrij Ngalngarrij

Nawmut Ngalamut

Namarrang Ngalamarrang

Nangila Ngalangila

Nawagaj Ngalawaj

Nawuyug Ngalwuyug

Nawangari Ngalwangari

Language group: Warlpiri — Central Desert Skin names

Male Skin Names Female Skin Names Japaljarri Napaljarri

Japangardi Napangardi

Jakamarra Nakamarra

Jampijinpa Nampijinpa

Jungarrayi Nungarrayi

Japanangka Napanangka

Jupurrula Napurrula

Jangala Nangala

28 | Remote Area Health Corps | Cultural Orientation Handbook Roles and Fathers Uncle The father(s) have the same The role of uncle(s) is linked to the responsibilities responsibilities and obligations to the son various developmental stage of the as the paternal grandfather(s). nieces’ and nephews’ growth. That is, the There are many aspects to the kinship roles change according to age. From the network: who can be spoken to, who Mother time the children are small, the uncles has to be avoided, who has specific are responsible for the discipline of their responsibilities and obligations, who guides, A mother’s primary role is one of nurture. nephews and nieces. As young men who teaches, who marries whom and who She feeds, clothes and loves her child. Other separate from their mothers, the uncles attends to passing away ceremonies. These members of the kinship network perform assume the nurturing of the young men. are all contained in the guidelines laid the more rigorous duties of discipline and Their role with their nieces, although down within the kinship protocols. teaching. If the mother steps outside her defined boundaries, she is chastised by caring, becomes more formal as they Franks and Curr (1996, p.38-39) provide those whose responsibility it is to perform grow up. They provide support during the following description of the roles of the duties. Mother and daughter participate sorry business for their sisters, nephews different members of the kinship group as and support each other during ceremonies and nieces. relevant to Central Australia: and sorry business. Aunt Within a ‘family’ unit, all the father’s brothers are fathers and all the mother’s Son Their role is one of strict ceremonial sisters are mothers. A father’s sister is an A son has responsibilities and obligations protocol. The significance of niece/aunt aunt and a mother’s brother is an uncle. to both his father and grandfathers. These relationships cannot be emphasised enough; include a caring role and ceremonial it encompasses every aspect of living. Grandfathers responsibilities to any father or grandfather There is utmost respect between these two The paternal grandfather(s) guides the within the kinship system. people. It is personally special, as an aunt young man through land, culture and provides a unique friendship combined with kinship knowledge, back into the previous Daughter teaching, formality, humour and support. generations. This can be thought of There is a loving relationship between as a companionable relationship, with mother and daughter. A daughter’s role A basic rule of thumb is physical, mental and spiritual dimensions. is both to look after her mother’s social The maternal grandfather(s) teaches the needs and participate and support her to think of the way you grandson ceremonies and understanding during ceremonies and sorry. of his mother’s [relationship to country]: would like to be treated the grandfather can speak on the mother’s behalf. This relationship is an instructional in any of your own close one and is more formal than the paternal relationships. grandfather(s).

Grandmothers The mother’s mother has a particularly close relationship with her granddaughter. It is that of friend, supporter, confidante, ceremonial partner and comforter. This is a relationship of unconditional acceptance, identifiable by the level of trust and enjoyment derived from each other. The father’s mother has a more formal relationship with her grandchildren.

Remote Area Health Corps | Cultural Orientation Handbook | 29 Avoidance and Poison Avoidance in names Where do you fit in? relationships Some people may not be able to say As noted, the kinship system is a major another’s name due to avoidance but foundation of Aboriginal existence and Within the kinship network there are people can say the initial of the person’s way of viewing the world. Aboriginal also avoidance relationships between name or use the names of those people’s people like to identify themselves by their people that are lifelong. Some of these are children to identify them. For example, family relationships. For example, upon public knowledge and some are private. a woman cannot say the name of her meeting, Aboriginal people will often Franks and Curr (1996, p.68) provide the brother James, so she identifies him as question each other about where they following description of public knowledge ‘my brother starting with J’. She could are from, who they are related to and avoidance relationships: also have identified her brother as David’s who they know. They are often looking These avoidance relationships are about father as James has a son named David. for some common ground and kinship respecting your family and are not about Brothers and sisters should never: system which will determine how they disrespect. The term ‘poison’ is also used to will relate to each other. It may be useful describe avoidance, this term is meant with • touch each other (ever) for you as a non-Aboriginal to share respect. You do not touch or go near poison. • give anything to each other personal information about yourself (use another person) upon meeting others, including where Mother-in-law/son-in-law you come from and other Aboriginal and • talk to each other directly Torres Strait Islander communities where Always ‘no room’ — this avoidance (use another person) relationship is practised throughout you may have worked. • say each other’s names Central Australia. Franks and Curr (1996, p.68) state: (gender specific) Paradoxical relationships • be in the same room together Friendship for Aboriginal people is a relationship Sometimes ‘no room’ — these relationships (at any time) within the kinship network. There is a designated are complex and sometimes appear • attend each other’s funeral. role attached to friendship which has its contradictory, hence the term ‘paradoxical’. accompanying obligations and responsibilities. As well as an avoidance component, Right skin relationships For a person outside the kinship network, other aspects of these relationships relationships remain at an acquaintance level include friendship, protector, third choice of intimacy. Even when a person is fitted into You may hear the term ‘right skin’ being partner and grandparent. The avoidance the kinship network, the obligations and the used in conversation. This term relates component is related to ceremonial responsibilities have to be fully acknowledged and to the people who can marry each other protocols. accepted in order for true intimacy and trust to and their siblings. These people call develop. Clearly this is a different concept from each other right skin and want to work Daughter-in-law/father-in-law contemporary Western friendships, which have together and help each other. Aboriginal other less formal protocols attached to them. Formal ‘room’ — this is a formal Health Practitioners constantly have relationship which involves no eye to compromise their professional and contact, sitting sideways from one cultural ethics due to the avoidance issues another, sitting a fair distance apart and within their culture. involves the daughter-in-law having special duties of care. These avoidance rules will vary throughout the Northern Territory. Very young children are not affected by avoidance protocol. You need to be aware that such relationships exist and may explain why the Aboriginal Health Practitioner is unable to work with certain clients, or why particular people are unable to attend the same meeting together.

30 | Remote Area Health Corps | Cultural Orientation Handbook To decline the offer of a skin name may A basic rule of thumb is to think of the When offered a skin cause offence, but be as open as you can way you would like to be treated in any name about any misgivings you may have in of your own close relationships. To be terms of your lack of cultural awareness. placed within the kinship network means If a non-Aboriginal person is around an In some cases non-Aboriginal people have sharing in the same way that you would in Aboriginal culture for an extended period, been referred to as ‘brother’ or ‘sister’ in any other intimate relationship. Any good they may be given an opportunity to be the community, which may be a better relationship occasionally entails doing adopted into the kinship network. This option and again is an acknowledgement things you would rather not do. However, would not strictly be an adoption in the of your acceptance in the community but all relationships have boundaries and Western sense, but the assignment of does not entail the complex kinship system. friendships within the kinship network a skin name so that the individual has a are no exception. It is alright to say ‘no’. skin group and may interact with people Everyone’s boundaries are different and it in the proper way, knowing who to avoid Working with the right will be necessary for you to define yours and what relationships and obligations are while living in an Aboriginal community. held in regard to others. members of the kinship Being given a skin name does not mean network you have been initiated but it does Working with Elders provide you with a place within the When caring for Aboriginal clients, you kinship network. It is also a significant will often need to involve and inform Elders are people within the Aboriginal mark of respect and will only be offered members of their family regarding details community who have earned status after much consideration and discussion of their condition and care. It’s important within that community for their among Elders. It is highly unlikely that a to make sure you are involving and knowledge and experience. Elders are to health professional with only a short-term informing the right person within the be shown total respect. connection to an Aboriginal community family, or kinship network, to ensure Old age is considered to be the time would be offered a skin name. that the right story can be passed on. for wisdom. Children often go to older Information might not be shared or Aboriginal people also understand that, people for advice, comfort, affection, or communicated fully if the Aboriginal story telling. Elders have a very important despite having a skin name, most non- people consulted with are not in the Aboriginal people do not have the same role in traditional and contemporary right relationship to the client. The best Aboriginal families. They are often the key kinship obligations and responsibilities as way is to ask around about who is best to other community members. However, in decision makers. They teach important talk to in the context of what is needed traditional skills and customs, pass on the event that you are offered a skin name, for the client. it is important to be aware of at least some knowledge and share personal stories. of the complex interplay of relationships Particularly in the case of palliative care, When working with Elders it is important and expectations. For example: it is important not to talk to just one to dress appropriately and use respectful person but to as many family members as terms of reference. • your new skin name may mean you possible. Family meetings may be the best are now considered husband/wife to method of achieving this. As a health professional, it is helpful for particular members of the community you to have contact with Elders in the or in a similar relationship community, as they can provide you with • your new kinship relationships may Reciprocity — sharing useful advice and guidance in many matters. mean it becomes problematic to treat or communicate with certain Functional Aboriginal culture has a basic members of the community due to commitment to sharing. It occurs within avoidance relationships the kinship network and is typically seen in • there may be certain obligations child rearing, food distribution, ceremonial and commitments that you are now obligations and housing arrangements. No expected to honour and these may one can be denied access to sharing. Each include ceremony obligations person reciprocates so no one has the full responsibility to provide all needs. • you may have inadvertently taken a side in community politics/ Sharing brings with it associated relationships which will again impact obligations and responsibilities. It’s most on your role as a health professional. important for you to act naturally and adapt the protocols and etiquette you know from your own culture.

Remote Area Health Corps | Cultural Orientation Handbook | 31 32 | Remote Area Health Corps | Cultural Orientation Handbook Birth and childhood

practice in the community you are working For example, although the mother is Birth with. Again, ask the Aboriginal Health responsible for feeding and nurturing Traditionally, birth occurred at a specific Practitioner or an Elder for guidance her child and keeping them contented, birthing place, with the woman attended regarding birth and pregnancy protocols others within the kinship network often by specific female skin relatives from the specific to that community, particularly if have responsibility for guidance, teaching kinship network. you are a male health professional. Further and ceremonial life (this could include advice should also be sought from the taking responsibility when a child is sick). Today, while many Aboriginal births occur female client themselves and their sisters, This makes it difficult for the mother to in hospital, there have been a number grandmother, cousins or aunts. perform certain activities, for example of developments in terms of providing After the birth the mother and baby administering medicine, as this would more traditional practices within a medical cause distress to the child and herself environment. There can be some tension return to the community where both may attend a smoking ceremony for strength, and she would be criticised by others for regarding the decision to either have making the child unhappy. This is noted the baby in hospital or at home in the health and spiritual celebration. Often the mother returns to routine life when in the following excerpt from Franks and community. High infant mortality rates Curr (1996, p.136) lead to calls for hospital births, while the child’s umbilical cord has dropped off. Babies are identified by their skin name, within the community there can be For the first time I began to see the impact of pressures for children to be born at home which identifies their place within the kinship network. This ensures that there skin relationships and how to get the right person in order to firmly establish their birth- to achieve a desired response. Instead of getting rights for the future. are people within the network who have a special interest in the child’s welfare, frustrated with mothers who would not bring Pregnancy and birth are generally not as well as others who have particular their babies back for a full course of needles, I to be discussed with the male partner responsibilities and obligations in regard could ask the aunt or grandmother and it would of a female client. In the event of a to the child’s upbringing. more often than not get done. medical emergency that may involve a woman being evacuated to hospital, A baby’s hair is not to be cut — check with the family in regard to touching a baby on Therefore, you should consider other the medical condition can be discussed, members of the child’s extended family but not the actual pregnancy. Ask the the head or if there is a medical reason for cutting the hair. to be as involved and influential as the Aboriginal Health Practitioner either to mother and father would be. contact the relevant females within the kinship network, or advise you on what Affection is an essential ingredient of child is acceptable procedure. If available, the Childhood discipline. Intervention by adults outside sister, grandmother, cousin or aunt is a defined kin group is rarely accepted. the best person to provide you with the A child is a gift to the entire kinship network Teaching is done by demonstration and necessary guidance and advice. and is highly valued. Children are given participation rather than instruction. constant affection and child-rearing is If there is a serious life-threatening shared by all those who have a responsibility event, protocols can be breached and to the child within the kinship network. professional services given. Each of these people has their specific role As a matter of course, Aboriginal women essential to healthy child rearing. Gaining a should be attended by female midwives. basic understanding of these roles can help A male health professional should offer you in your clinical practice. assistance and then wait until asked for help. Traditionally, men are never present at the birth of a child. This may still be the

Remote Area Health Corps | Cultural Orientation Handbook | 33 34 | Remote Area Health Corps | Cultural Orientation Handbook Dying, death and sorry business

treatment, Aboriginal people are more A smoking ceremony may be held within a Dying likely to accept the explanation of cancer. place where someone has died to cleanse If the cancer is detected at the end stage all the spirits from the house and area. In Diagnosis, information and when the only treatment available is some cultures, the family of a relative who palliative, these people are still commonly has died in the family home will move out support said to have been cursed by black of the house and may even go to another magic. This indicates the need for more community. This makes it easy to lose the Giving a diagnosis of a serious, terminal education and information about cancer. house to others who move in, which can illness can be difficult in situations potentially result in homelessness. involving Aboriginal clients and their Try to ensure you give the client and families. Health professionals have family enough time and opportunity for reported difficulties including Aboriginal the information to be understood and for Cultural issues relating to care understanding of terminal illness and them to consider and discuss it. reluctance on behalf of the client and McGrath and Holewa (2006) note that: their family to find out bad news. Place of death • an Aboriginal person who is dying Many avoid seeking palliative support. and receiving palliative care may wish Aboriginal Health Practitioners may find Many Aboriginal people feel strongly to go out to communities and touch it difficult to talk to a client about the fact about their place of death and who cares base with country — this may be that they are dying. As the non-Aboriginal for them. Many Aboriginal people prefer essential for their spiritual wellbeing health professional, you need to talk to go home to die rather than die in • many Aboriginal people have honestly and firmly with the client and hospital. Christian as well as traditional beliefs their family about what is happening and For clients who have to be relocated — this translates into mixed beliefs ensure the information is understood. for respite, it is essential that an This also includes information about the • in some cultures it may not be escort accompany them. Help families effects and side effects of treatment. appropriate for certain family members understand that it is important to choose to be present when blood is being There do not appear to be any Aboriginal the right escort as they will need to be taken from the person who is dying words for cancer and it is an issue that is making serious end-of-life decisions. It (for example, it may be inappropriate surrounded by a lot of fear and relatively may also be desirable for another person for the husband to be present when little community awareness. There may be to support the escort. Ensure that escorts blood is taken from his wife) many misconceptions regarding cancer, have contacts for support people such such as that non-Aboriginal people are as Aboriginal liaison officers who are • elders may require carers to be of a not susceptible to it and regarding its employed to work with mainstream health particular gender causes and treatment. services such as hospitals and whose role • it may be inappropriate for others to In relation to cancer, research by McGrath essentially serves as a bridge between the look at an Elder’s face when they are and Holewa (2006) found that in health system and the Aboriginal client dying — even when coming into the room, outstations, people still hold strong faiths and their community. The Aboriginal people may have to shield their face related to the use of bush medicine and liaison officer is able to advocate for the Aboriginal client and their family • particular ceremonies may apply in bush tucker, rather than the Western the situation of an Aboriginal person beliefs associated with cancer diagnosis and can also provide much needed information, including explaining details who is dying — this may involve and treatment. The idea of cancer is singing special songs typically understood from notions of such as accommodation and directions black magic and spirits. But increasingly, to hospital, as well as assist with finances. • when an Aboriginal person is dying, if the person who has died has been pre- Escorts should have a contact person many people will want to visit and pay diagnosed with cancer and undergone within the hospital framework. their respects.

Remote Area Health Corps | Cultural Orientation Handbook | 35 Making decisions Family and friends may gather in the Death house of the person closest to the one One important factor affecting decision- When a death occurs in an Aboriginal who died. While everyone is clearly making, particularly relating to ending community, the person is generally grieving, it is also often a time to divert curative treatment and relying on referred to as having passed away. Passing the pain of the loss through humour and palliative care, is that of payback. The away conveys the images of going through, tales of special memories — the love, person who makes the decision for not to return and going on a journey. jokes, adventures and trials they shared. the dying person regarding particular Many Aboriginal people will travel great interventions and medication may later The name of the deceased is now not to be used. The name can be written down distances to attend funerals and will be subject to blame and payback. This be expected to do so even for deaths includes Aboriginal Health Practitioners, but not spoken. To refer to the deceased person to other family members you could outside their immediate network. Not to who may be subject to blame and payback do so would be disrespectful and result for administering medication which if say ‘your father’, ‘your brother’, ‘your uncle’, or whatever the relationship may in shame. Often many members of the close to the time of death, may be seen as community will attend the funeral, which the cause of death. be. Deceased people may be identified by their children’s names (‘Ricky’s father’). may mean that many activities within the It is essential that end-of-life decisions community, including services, will be are made by a person who has respect In the Top End of the Northern Territory, cancelled, postponed or closed for that because of their relationship to the dying smoking ceremonies take place at the day. Economic problems commonly occur person and who is well supported by the deceased’s house, workplace, shop, clinic, in relation to the cost of funerals and the community in making these decisions. ambulance and other community vehicles, cost of travel to attend funerals. one, two, or three weeks leading up to the funeral. An ochre band will also be lined Before the funeral, grieving relatives are Family meetings around buildings and vehicles. supported by the community to ensure those most affected are looked after with It is important that you find the The right people need to handle the body, enough to eat and enough sleep. After the appropriate person to care and make including collecting the body and bringing funeral, a similar network of support and decisions for the person who is dying. it back to the community. It is important comfort is provided. Large groups may This person (or people) needs to have that health professionals understand this gather to look after those who are grieving the right relationships to the dying and enable this to happen. to divert them from becoming too person. It is also important that the whole In both coronial and non-coronial cases, distressed and to ensure they have what family and community is involved when the post-mortem needs to be discussed they need to cope in the times ahead. providing information regarding the sensitively with the family members of the There may also be other ceremonies after client’s condition and planning care. The deceased, providing as much information a person has died. For example, a further involvement of the Aboriginal Health as possible and taking the time to ensure ceremony may be held a year later. This Practitioner is crucial, however there may everything is understood. In regard to may involve a smoking ceremony and the be situations where the worker is unable to post-mortems, it is appropriate to respect distribution of clothes. act effectively and may need the support Aboriginal culture, however still treat and assistance of other suitable members people as individuals by offering the In general, it is appropriate for you to of the community. Interpreter services family of the deceased the same range of quietly acknowledge the loss for the family should also be used where necessary. choices as anyone else. involved and express your sympathy. It is important that family meetings are held before starting any interventions and that they are regular enough to enable the discussion of the client’s progress. The family needs to be given time to plan for the end of life, obtain money for burial and make initial plans regarding where the person will be buried.

36 | Remote Area Health Corps | Cultural Orientation Handbook • there may be disputes among the Any communication with an Aboriginal Sorry business family of the deceased about how and person in sorry must be done through the Sorry business is the time of mourning why the person died and where the kinship network. An Aboriginal Health following the death of an Aboriginal person should be buried Practitioner can assist you with this and find an appropriate intermediary for you. person. The term ‘sorry business’ is • those who are mourning may cut frequently connected to a death in the themselves — Sorry cuts can be a Self-inflicted sorry cuts may be part of Aboriginal community but is also used to symbolic recognition attached to the the traditional mourning process and describe other events such as the forcible sharing of blood as both a means of as a health professional you must be removal of Aboriginal children from their sorrow and washing away of sorrow. respectful, stand back and not offer families and communities. The degree To show your own blood is to show advice or assistance. However, if a person and intensity of mourning ceremonies how much respect and love you had voluntarily presents for treatment, then are in direct proportion to the esteem for the deceased. it is acceptable for you to carry out the person was held in by the community The signs of sorry (grief and mourning) in whatever treatment is necessary. and the level of responsibility that person a community may include: If in your opinion, a sorry wound is life had. The mourning process is designed to threatening, then the kinship network is the remember, let go of the memory and heal • firstly a scream, secondly hitting or cutting oneself means by which the relevant person can the grief of the community. be approached to mediate with the person Sorry can vary in time from days to • women may remove their tops to needing the treatment. Consideration may months, or in exceptional circumstances, show their grief also be given to changing clinic hours when years. During this time, sign language is • some upper clothes or all clothes are there are sorry camps, so treatment can be often used as a means of communication removed given in a culturally appropriate manner between those grieving and the wider during this time. A clinic can be conducted community. In some communities, the • a sorry camp may be established at the camp, after consultation with the name of the deceased is never mentioned in the community away from the relevant people. again. In others, it is not mentioned for customary living area a certain period of time. This may also • hair cutting, which is conducted in the extend to others still living who share sorry camp. Often the head is covered It is important that the same name. Images of the deceased when going about the community, family meetings are may no longer be shown. In other with a scarf or t-shirt communities, it is important to remember held before starting any the person frequently and to talk about • extensive use of sign language. their contribution to the community. Any person is welcomed into a sorry interventions and that Franks and Curr (1996) note that some camp to pay respect and comfort. This they are regular enough common Aboriginal responses to grief can be done by shaking hands, embracing may include: or slight shaking of the head with eyes averted. As a sign of respect towards to enable the discussion • crying and wailing — showing sadness the members of the community who of the client’s progress. as a means of showing respect are in sorry, you are encouraged to wear • ceremony singing, which involves dark-coloured clothing. You may even certain songs and ceremony for the be asked to wear a black t-shirt or arm passing of an Elder (family members) band. The Aboriginal Health Practitioner can advise you on any other particular • talking with family members, telling protocols in regard to the community’s stories wishes. This is a time for quiet and little • continuing normal/satisfying activities spoken conversation, which recognises the such as painting and fishing need to be seen to be sorry. There may be times when daily activities within the • moving to a different community or community are stopped, such as playing area and receiving love from different music. This should also apply to music not family and friends being played in the clinic and vehicles. • carers may be blamed for not looking after the dying person properly — blaming can complicate grief

Remote Area Health Corps | Cultural Orientation Handbook | 37 38 | Remote Area Health Corps | Cultural Orientation Handbook Other cultural considerations relating to treatment

Blame and payback Curses Use of ochre

Aboriginal cultural beliefs often vary from Many Aboriginal cultures have belief Ochre is a soft rock found in specific areas Western medical knowledge regarding systems that include curses — ‘pointing in the Northern Territory. Ochre has been causes, explanations and management the bone’, being ‘sung’ — as a cause of traded between language groups in the of disease. Blame can often be directed illness and death. In such cases, health past and is still considered a valuable gift at the carer, or other culturally perceived professionals are encouraged to facilitate to someone. cause of illness or death. Blame can result the client’s access to a traditional healer The use of ochre painted on the skin in traditional punishment — sometimes (see below) in the community, through and hair has ceremonial significance and referred to as payback. the assistance of the Aboriginal Health can also be used as a sunscreen, to give a A fear of blame and payback can impact Practitioner or an Elder. person a sense of safekeeping, for healing on the ability and willingness of carers purposes and as an art medium. to effectively care for those who are ill, Traditional healers Different coloured ochres have different particularly those with a terminal illness. meanings. Yellow and red ochres often This obviously includes Aboriginal Health have connections to the land and life. Practitioners and their role in treating clients. A traditional healer, such as the ‘Ngangkari’ of Central Australia, is generally a person White ochre is technically not an ochre In regard to giving medicine to terminally who has a recognised skill of healing. This but is derived from several sources, such ill clients who are close to death, it is skill is often recognised at birth or during as friable limestone and pipeclay. White preferable if the nurse or doctor does so, to childhood. Their skills are developed by an ochre is generally the symbol of mourning make it less likely that the Aboriginal Health older healer, resulting in them becoming and is synonymous with sorry business — Practitioner will be blamed for the death. a fully accredited healer in their own it represents the breaking of a link with This also highlights the importance of right. The role is honoured and respected someone within the kinship network. Black providing the larger kinship network with by community members. There is no ochre is invariably charcoal and is often as much information as necessary when condition — spiritual, emotional, mental symbolic of Aboriginal people themselves. a client requires an intervention of any or physical — that cannot be referred to a Respect should particularly be shown to sort such as surgery, so the likelihood of traditional healer. senior people in the community wearing someone being blamed is reduced. The healing power of the traditional ochre. If you see a person covered in If an Aboriginal person requires treatment healer should not be underestimated in white ochre, you can show respect to the for injuries relating to payback, you the treatment of an Aboriginal client. mourning protocol by not commenting should consult with the Aboriginal Health The Aboriginal Health Practitioner will be on this. Practitioner, or in their absence an Elder, aware of the traditional healers associated If a client is covered in ochre, it is important before providing treatment. with the community. You are encouraged that you have respect for their culture to use the services of these traditional and not shame them. Ochre has been healers wherever possible to complement successfully used as a healing agent for a Western treatment. This approach will long time. You will need to look past the give the client comprehensive treatment appearance and assess what is being done. which uses both contemporary Western medical expertise and traditional knowledge. This can in turn bring spiritual wholeness and healing, which consequently validates functional contemporary Aboriginal life.

Remote Area Health Corps | Cultural Orientation Handbook | 39 Ochre should never be wiped or washed off a client requiring treatment. Where Hair and clothing Men’s and Women’s a person is injured and perhaps requires Hair has many meanings and purposes business suturing, ask that they wash only the that are sacred, secret and private Within Aboriginal cultural groups some injured area. If there is an infected area knowledge. For these reasons, hair cannot knowledge is segregated to specific requiring medical attention, clean only be cut without the permission of the genders and is commonly referred to as that area after obtaining their permission. family and cannot be thrown out. If the person has a high fever, do not ‘men’s business’ and ‘women’s business’. sponge the ochre off. When there has A senior man or woman must not be This knowledge may include stories, been an accident or other life-threatening touched on the head. In some Aboriginal ceremonies and rituals. Examples include event, you can remove the ochre for cultures, it is also inappropriate to touch birth, initiation rituals and ceremonies for theatre or other treatment. The decision babies on the head. If treatment requires male and female youth. this, then permission should be sought. to remove ochre should be discussed with In certain circumstances, it may not be Consult with the Aboriginal Health the family as soon as possible. appropriate for you to deal with clients Practitioner or an Elder. of the opposite gender, or to discuss If a person presents with nits, hair can be particular matters with other members of Treatment arising from washed with preparations and combed. It their family or community. For example, ceremonial activity cannot be cut without permission. in some cases it may not be appropriate When there is a head injury, permission for a female health professional to speak Certain injuries, particularly infections, must be sought from the person for any with a male carer or member of a client’s can occur as a result of ceremonial activity hair to be shaved or cut. If the person family. It may not be appropriate for male (see also the discussion of Men’s and is unconscious or no family is present, health professionals to discuss pregnancy, Women’s business following). cut the hair and wrap it securely to be birth or breastfeeding issues. It may not returned to the family as soon as possible. be appropriate for either a male or female Treatment of any males should ideally be health professional to discuss pregnancy carried out by male health professionals It must not be thrown out or destroyed. It must not be given to anyone other than or birth with the male partner of a female in consultation with the male Aboriginal client. Health Practitioner. the family. Again, you are best to take the lead and Female nurses and doctors are not Seek permission if a senior man’s beard needs to be cut. ask for advice from your colleagues, allowed to look on the initiate or deal with particularly an Aboriginal Health any infections in sensitive areas. However, Hair may also be cut as a cultural response Practitioner or, if they are unavailable, if there is a male Aboriginal Health to an event in the community, such as a consult with an Elder. Practitioner to act as an intermediary, death. Never comment on a person’s cut then this can occur under their guidance. hair, or when a person wears a scarf. It is important that there be no In the event of death, the clothing of the questioning about how the injury person must be returned to the family as occurred, although this can be a natural soon as possible, particularly if there is to response. Again, consult with the male be a post-mortem. Aboriginal Health Practitioner in these circumstances. There can be difficulties when the male Aboriginal Health Practitioner has a father/son relationship with the initiate requiring attention. In this case, the Aboriginal Health Practitioner may be unable to approach him at the initiation camp to ascertain need for treatment, or provide treatment. In such situations, consult with an Elder.

40 | Remote Area Health Corps | Cultural Orientation Handbook Remote Area Health Corps | Cultural Orientation Handbook | 41 42 | Remote Area Health Corps | Cultural Orientation Handbook Treatment compliance

Medication Informed consent Travel for treatment

All matters regarding medication, Informed consent is a difficult concept as The Northern Territory runs a Patient including the effects and side effects, need the Western way of looking at health is Assistance Travel Scheme (PATS) for to be explained in language understood very different to the Aboriginal way. people living in rural and remote regions by the Aboriginal client or carer. Many It can be difficult to get authentic who require specialist services not Aboriginal people, particularly men, will informed consent, particularly in hospitals. available in their local area. For more not report pain. Issues include: information, see the Resources section on As a result of their use in palliative care, p.45 of this handbook. • Aboriginal clients may feel intimidated syringe drivers are associated in many Aboriginal communities with death. • Aboriginal clients may say ‘yes’ All matters regarding because they think this is what the Many Aboriginal people have an intense doctor wants them to say fear of euthanasia. People may be scared medication, including of medicine in drips, especially morphine. • families can become angry, especially the effects and side Many have a fear of medication because it when an Aboriginal person dies — makes the person sleepy. they may be unsure what they have effects, need to be previously given consent for Many members of the community, explained in language including Aboriginal Health Practitioners • interpreters need to be able to providing palliative care to clients translate the concept from one understood by the who are close to death, have a fear of culture to another — the meaning administering medication to others. They behind the words Aboriginal client or may fear negative outcomes that could • quite often, Aboriginal people do not result in blaming and payback. understand what they are giving their carer. Many Aboriginal people are apprehensive consent for. about injections. They prefer to use The best way to overcome these issues patches or administer medication orally. is to ensure the client and their family Be aware of literacy problems and ensure has been consulted and given as much that medication instructions account for information as they require to gain a good illiteracy and language barriers. understanding of all the facts. Hearing loss is also very common in In the case of an emergency, always notify Aboriginal communities and may be the family as soon as possible of decisions another reason why a patient is not made regarding interventions, otherwise complying with medical advice. there may be anger over not being adequately informed. It may be inappropriate for a mother to give her child medication because of the different roles and responsibilities within the kinship network. In such situations, it may be more effective and appropriate to pursue the issue with other members of the child’s kinship network such as a grandmother or aunt.

Remote Area Health Corps | Cultural Orientation Handbook | 43 References

Australian Bureau of Statistics (2011), Franks C. and Curr B. (1996), Keeping National Health and Medical Research Census of Population and Housing: company — an intercultural conversation, Council (2003), Guidelines for Ethical Characteristics of Aboriginal and Torres Wollongong, NSW: University of Conduct in Aboriginal and Torres Strait Strait Islander Australians, 2011(2076.0) Wollongong. Islander Health Research. Endorsed by Dousset L. (2005), Assimilating Identities: Lynn R., Thorpe R. and Miles D. (1998), Council at its 148th Session on 5 June Social Networks and the Diffusion Murri way: Aborigines and Torres Strait 2003, Canberra. of Sections. Oceania Monograph, 57. Islanders reconstruct social welfare Peters-Little F. (2000), The community University of Sydney. practice, Centre for Social and Welfare game: Aboriginal self definition at Eckermann, A., Dowd.T, Chong. E., Nixon. Research, James Cook University of North the local level, Australian Institute of L., Gray.R. and Sally Margaret Johnson Queensland, Townsville. Aboriginal and Torres Strait Islanders (2010), Binan Goonj: Bridging cultures McGrath P. and Holewa H. (2006), Studies Discussion Paper Series, No. 10. in Aboriginal Health. (3rd Ed), Churchill- Exploring Aboriginal peoples’ experience Stone L. (2000), Kinship and gender: an Livingston, Chatswood, NSW. of relocation for treatment during end-of- introduction.(2nd Ed) Boulder: Westview Eckermann A., Dowd T., Martin M., Nixon life care, International Journal of Palliative Press. L., Gray R. and Chong E. (1992), Binan Nursing, 12,2:75-82. MA Healthcare Ltd, Goonj: bridging cultures in Aboriginal London, United Kingdom. health. Armidale, NSW: University of New England Press.

44 | Remote Area Health Corps | Cultural Orientation Handbook Useful resources

Aboriginal Interpreter Service (AIS) Aboriginal primary healthcare: an evi- contacting the Council of Remote Area www.dlghs.nt.gov.au/ais dence-based approach (third edition) Nurses of Australia on 08 8959 1111 or from www.crana.org.au. Northern Territory Department of Editors Couzos S. and Murray R. (2008), Local Government and Housing Central Kimberley Aboriginal Medical Services Bush Support Service Council, Oxford Press, Australia booking service 08 8999 8353 Darwin. 1800 805 391 (free call) Alice Springs - Tel. 08 8951 5576 This text is a definitive guide to best- practice management of the major A 24-hour confidential telephone AIS helps to alleviate the language barriers health problems facing Aboriginal debriefing and support for multi- faced by Aboriginal people throughout people and Torres Strait Islanders. It disciplinary rural and remote health the Northern Territory, particularly in helps health practitioners, policy-makers practitioners and their families. relation to health and legal issues. The and communities to influence health service was established in April 2000 and determinants, advocate for and overcome Central Australian Rural Practitioners maintains and uses a register of Aboriginal inertia to change and strengthen Association interpreters and languages in the healthcare provision within a human rights PO Box 8143 Northern Territory. It provides a service context. Alice Springs NT 0871 for government and non-government agencies that require on-site Aboriginal Avoiding burn-out in remote areas: Ph: 08 8951 4700 language interpreters. The AIS provides surviving the day-to-day hassles Fax: 08 8951 4777 a 24-hour, seven-days-a-week central Council of Remote Area Nurses of Publications include: booking service. Clients must provide the Australia (2000). following information when booking an • CARPA standard treatment manual interpreter: This text is a guide for health practitioners (th edition) 5th ed, 2009 going to work in remote areas. It can be • The Medicines Book for Aboriginal • name of the organisation/section ordered at www.crana.org.au. requesting service Health Practitioners • The CARPA manual reference book • name, skin name, age and gender of Binan Goonj: bridging cultures in Aboriginal person requiring service Aboriginal health (3rd edition) • CARPA newsletter. • Aboriginal language required (AIS can Eckermann A., Dowd T., Martin M., Nixon Clinical procedures manual (2009) 2nd assist with determining the correct L., Gray R. and Chong E. (2005) 2010 ed, Women’s business manual, (2008) language) Eckermann A., Dowd T., Chong E., Nixon 4th ed. L., Gray R. and Sally Margaret Johnson • location, date and time the service is (2010), Binan Goonj: Bridging cultures needed in Aboriginal Health. (3rd Ed), Churchill- • topic of assignment. Livingston, Chatswood, NSW. Bookings need to allow time for travel Binan Goonj means ‘hearing but and accommodation arrangements to be not listening’. This text provides a made. Fees apply, however the Northern comprehensive introduction to the Territory Government has allocated historical and socio-political context additional funding to the AIS to enable of Aboriginal health and continuing non-government organisations to access Aboriginal disadvantage and the service at no cost to the organisation. marginalisation. The book is primarily aimed at non-Aboriginal healthcare providers. It can be purchased by

Remote Area Health Corps | Cultural Orientation Handbook | 45 Keeping company — an intercultural The Public Health Bush Book ‘Towards an understanding of why the conversation Northern Territory Department of Health Aboriginal people of Arnhem Land face (2nd edition) and Community Services the greatest crisis in health and education since European contact’. Franks C. and Curr B. (2007). 2nd Ed, PO Box 40596 Whyalla, S. Aust. : Spencer Gulf Rural Casuarina NT 0811 Carson B., Dunbar T., Chenhall R. and Health School, Australia Ph: 08 8985 8019 Bailie R. (2007). Social determinants Fax: 08 8985 8016 of Indigenous Health. Alen and Unwin, This text was written in partnership Australia with traditional Aboriginal authors from The Public Health Bush Book is a valuable central Australia. It explores the structure resource of two volumes for those who Shifting the focus from individual and complexity of the Aboriginal kinship work in remote Aboriginal communities behaviour, to the social and political network and protocols and the concept in the Northern Territory. It is written circumstances that influence people’s of true reconciliation. It can be ordered by those who have worked in and with lives and ultimately their health, helps us from the University of South Australia’s remote community healthcare teams. to understand the origins of poor health. Department of Rural Health by phoning The book can be ordered in hard copy, or It can also guide action to bring about 08 8647 6036, faxing 08 8647 6164 or downloaded from www.health.nt.gov. au/ change. emailing [email protected]. Health_Promotion/Bush_Book/index. Social Determinants of Indigenous aspx. Murri Way! Aborigines and Torres Strait Health offers a systematic overview of Islanders reconstruct social welfare Sharing the True Stories: Improving the relationship between the social and practice communication between health staff and political environment and health. Lynn R., Thorpe R. and Miles D. (1998). Aboriginal patients Taylor, K. and Guerin, P. (2010). Health Care and Indigenous Australians: Cultural This report details findings from a Coulehan K., Brown I., Christie M., Gorham G., Lowell A., Marrnganyin B. and safety in practice. Palgrave MacMillan, research project into Aboriginal and Victoria, Australia Torres Strait Islander helping in a social Patel B. welfare context. This report comes in two volumes, A book that focuses on the healthcare covering each stage of a two-stage professional and what they can do to The living model: a resource manual for research project designed to identify contribute to improving the health Indigenous palliative care service delivery strategies to improve communication outcomes of Indigenous Australians. The book uses a cultural safety approach for McGrath P. and Holewa H. (2006). between health staff and Aboriginal patients – a key determinant in improving health students or professionals wanting This report presents a flexible, detailed health outcomes for Aboriginal people. to improve their practice. With 14 and unique model for appropriate Originally funded by the Cooperative Chapters that include activities, critical Indigenous palliative care service delivery. Research Centre for Aboriginal Health, thinking questions, poems, ‘making it local’ activities and case scenarios, It has been developed from a two-year both volumes are available in hard copy from the Lowitja Institute or can be readers will find that the material provides National Health and Medical Research opportunities to think in new ways about Council funded study exploring palliative downloaded from www.lowitja.org.au/ lowitja-publishing. Indigenous health and about their practice care service delivery within Aboriginal more generally. communities of the Northern Territory. It is available from the Central University of Do not move the furniture and other ad- Queensland by phoning 07 4930 9886. vice for new remote area nurses (RANs) These are just a few. Lenthall S., Gordon V., Knight S., Aitken R. and Ivanhoe T., 2012 There are many others Published by Australian Journal of Rural out there including local Health (2012) 20(1), 44-45 or specific people or Trudgeon, R (2000), Why Warriors lie down and die: Djambatj Mala, Aboriginal Resource country-orientated and Development Services, Darwin NT. new ones continually being produced so keep your eyes open!

46 | Remote Area Health Corps | Cultural Orientation Handbook

Canberra Office Suite 17J, Level 1, 2 King St, Deakin ACT 2600 T 02 6203 9588 F 02 6203 9598 Darwin Office rahc.com.au Level 4, Darwin Central Offices, 21 Knuckey Street, Darwin NT 0800 1300 697 242 T 08 8942 1650 F 08 8942 1676