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Fellow in focus: learning how to listen

30 Aug 2021

Cross-cultural nursing, and certainly Remote Area Nursing (RAN), were basically unheard of in Australia when Registered Nurse Toni Dowd began practising in the late 1970s.

Even though I had com­plet­ed a five-year pilot Com­bined Uni­ver­si­ty and Gen­er­al Nurs­ing Pro­gram in NSW (I was in one of the ear­ly Uni­ver­si­ty-trained cohort) there was very lit­tle focus on nurs­ing peo­ple from a cul­ture dif­fer­ent to your own.”

After grad­u­at­ing Toni did sev­er­al months of relief emer­gency nurs­ing in Syd­ney before going west to Cobar.

That was before the days of CRANA and a time when Cobar hos­pi­tal was in cri­sis. It was my first expe­ri­ence of work­ing remote with­out much support.”

Ear­ly in her career Toni went into quar­an­tine at North Heads to nurse chil­dren who were evac­u­at­ed from Vietnam.

This expe­ri­ence brought home to me how people’s basic needs of food, shel­ter and sleep can be neglect­ed if their pre­ferred ways of meet­ing these needs are not clear­ly understood.”

Alice Springs in the 1970s is where Toni met Abo­rig­i­nal peo­ple from remote areas and lis­tened to some of their expe­ri­ences at the hos­pi­tal and the heartache of leav­ing their home communities.

I was fair­ly young and look­ing to do things dif­fer­ent­ly. I went bush – lit­tle did I know how unpre­pared I was – naive­ly pop­ping in and out of var­i­ous remote com­mu­ni­ties as a relief nurse,” she says.

And it was in Papun­ya and lat­er in Elliott up the Stu­art High­way where she relieved Barb Lowen, a very expe­ri­enced and high­ly-respect­ed RAN, who was in need of a well over­due break”.

In Elliott, Toni began to see first­hand the com­plex­i­ties of Abo­rig­i­nal health and the impact that var­i­ous gov­ern­ment poli­cies and prac­tices had on Abo­rig­i­nal people’s every­day lives.

She reflects, It was quite con­fronting – all I can tell you is, thank good­ness for the Abo­rig­i­nal Health Work­ers – they had the least pow­er in the sys­tem but they knew it and their com­mu­ni­ty like the back of their hand. Besides the fact that for a long time they were not allowed to use the radio or phone, they were more than capa­ble of run­ning the clin­ic. With­out their guid­ance and sup­port I don’t think I would have survived”.

In those days, Toni explains, most com­mu­ni­ca­tion with col­leagues and med­ical ser­vices was by radio.

…more than once in a cri­sis I was relieved to hear the voice of anoth­er RAN – like Pat Kemp at Dock­er Creek or Wendy Dow at Ulu­ru or clos­er at Ali Curung. They were life savers!”

Whilst liv­ing in Elliott Toni under­took a Grad­u­ate Diplo­ma in Edu­ca­tion (Abo­rig­i­nal Stud­ies) by dis­tance from Armi­dale. At the time there was lit­tle on offer in the ter­tiary sec­tor rel­e­vant to remote health or Remote Area Nursing.

It was at res­i­den­tial schools that I first heard the true his­to­ry of Aus­tralia. I met and became good friends with Abo­rig­i­nal stu­dents who were under­tak­ing the same pro­gram. They would yarn into the ear­ly hours of the morn­ing shar­ing per­son­al and fam­i­ly sto­ries that made me realise how the past wasn’t just some­thing that we could ignore.”

Toni under­took a Kel­logg Nurs­ing Schol­ar­ship (1983 – 1985) in the US, achiev­ing a Mas­ters in Nurs­ing – Cross Cul­tur­al & Inter­na­tion­al Health, suc­cess­ful­ly nego­ti­at­ing to do her field work with Abo­rig­i­nal fam­i­lies involved in the health sys­tem on the Cen­tral Coast in NSW.

In 1988, Toni received an NHM­RC Fel­low­ship to eval­u­ate the Queens­land Abo­rig­i­nal Health Pro­gram, becom­ing one of the first RANs to com­plete a PhD.

Toni served on the Exec­u­tive (what we now call the Board) of CRANA from 1985 to 2005, and was invit­ed to join the elite group of foun­da­tion Fel­lows of CRANAplus in 2010.

Her exper­tise has been sought after by the Roy­al Col­lege of Nurs­ing Aus­tralia, the Aus­tralian Nurs­es’ Fed­er­a­tion and CRANAplus to review research sub­mis­sions, posi­tion state­ments and pol­i­cy direction.

She has made numer­ous sub­mis­sions to state and fed­er­al gov­ern­ments that have informed strate­gic direc­tion in rela­tion to many areas, includ­ing Indige­nous health, human rights and rural/​remote area health.

She co-ordi­nat­ed, through CRANA, the Aus­tralian Health Min­is­ters Advi­so­ry Coun­cil Work­ing Par­ty on the roles, respon­si­bil­i­ties, and inter- rela­tion­ships of RANs, Abo­rig­i­nal and Tor­res Strait Islander Health Work­ers and doc­tors which laid the foun­da­tion for nation­al Abo­rig­i­nal and Tor­res Strait Islander Health Work­er accred­i­ta­tion and registration.

In the late 1990s Toni worked close­ly with RANs through­out Aus­tralia to devel­op the first Nation­al RAN Com­pe­ten­cies pre­sent­ed at the CRANA Con­fer­ence in Broome in 1998 and to the Com­mon­wealth in 2001.

That was a major CRANA mile­stone and a ground- break­ing piece of work that many RANs work­ing in the high­ly dis­persed and diverse remote loca­tions through­out Aus­tralia made happen.”

In the ear­ly 1990s, Toni also col­lab­o­rat­ed with Abo­rig­i­nal and non-Abo­rig­i­nal col­leagues Ena Chong, Roy Gray and Lynette Nixon, Mary Mar­tin along with CRANAplus Life Mem­ber Sal­ly John­son (AM) and UNE aca­d­e­m­ic Anne Eck­er­mann, to devel­op the sem­i­nal cross- cul­tur­al edu­ca­tion mod­el called Binang Goonj.

It start­ed out as a dis­tance edu­ca­tion pack­age to famil­iarise non-Abo­rig­i­nal health work­ers, includ­ing doc­tors and nurs­es, with the dis­tinc­tive needs and aspi­ra­tions of Abo­rig­i­nal peo­ple liv­ing in rural/​urban Aus­tralia.

This pack­age which was pub­lished as a book in 1992 was endorsed by CRANA and the Nation­al Abo­rig­i­nal Com­mu­ni­ty Con­trolled Health Organ­i­sa­tion. After requests, par­tic­u­lar­ly from Abo­rig­i­nal health and oth­er com­mu­ni­ty work­ers, the con­cepts and prin­ci­ples of Binang Goonj were work­shopped to sup­port local com­mu­ni­ties and organ­i­sa­tions to devel­op their own cul­tur­al aware­ness and ori­en­ta­tion pro­grams and deliv­ered at CRANA con­fer­ences for many years.

The book was updat­ed in 1994 and reprint­ed in 2006 and 2010. It has been adopt­ed and adapt­ed by diverse cul­tur­al groups through­out the coun­try and ben­e­fit­ed a vari­ety of com­mu­ni­ty organ­i­sa­tions and pro­fes­sions beyond nurs­ing, includ­ing doc­tors, ambu­lance offi­cers, police, and teachers.

Fur­ther teach­ing mate­ri­als, includ­ing videos, were devel­oped in 1993 to train cross-cul­tur­al facil­i­ta­tors by work­ing in part­ner­ship with Abo­rig­i­nal peo­ple from rur­al and remote Aus­tralia and CRANA. Many CRANA lead­ers became facil­i­ta­tors along the way. It was used and adapt­ed by peo­ple in Cen­tral and North­ern Aus­tralia, as well as the Tor­res Strait dur­ing the mid 1990s and has influ­enced cul­tur­al aware­ness train­ing across Aus­tralia.

The phrase Binang Goonj – from the Bid­jara Abo­rig­i­nal lan­guage in South West Queens­land mean­ing you hear but don’t lis­ten’ – is as rel­e­vant today as ever. First Nations Peo­ple in the Ulu­ru State­ment from the Heart state that in 1967 we were count­ed, in 2017 we seek to be heard.”

Toni, who has notched up 40 years as a pro­fes­sion­al in the health and com­mu­ni­ty edu­ca­tion are­na, reflects that before too much more time escapes us, we all, espe­cial­ly those in pow­er who make deci­sions on our behalf, still need to learn to lis­ten with our hearts and our minds if we are to be involved in con­struc­tive, open dia­logue and truth-telling about our history.

Binang Goonj pro­vid­ed a lens to exam­ine, with Abo­rig­i­nal peo­ple, struc­tur­al and sys­temic fac­tors that impact on their lives and well­be­ing. It invit­ed an open, hon­est two-way exchange and chal­lenged all of us, whether we were Abo­rig­i­nal or non-Abo­rig­i­nal, to reflect on our own indi­vid­ual bias­es and prejudices.

The work­shops also pro­vid­ed a forum to high­light the patience, resilience, and cul­tur­al vital­i­ty of many Abo­rig­i­nal com­mu­ni­ties through­out Australia.

We still have to come to grips with our true his­to­ry i.e., Australia’s colo­nial his­to­ry.”

We have to face the fact that, along with that his­to­ry, there is also a mind­set that we
need to over­come,” says Toni. This is the basis of truth telling. It will begin the process of heal­ing for all of us and, rather than divid­ing us, will serve as a mea­sure of the matu­ri­ty of our nation.

No doubt, there will always be peo­ple who believe that Aus­tralia was peace­ful­ly set­tled and that today’s Indige­nous socio/​economic and polit­i­cal prob­lems, all of which impact on health, have noth­ing to do with us’.

Any analy­sis of the oppor­tu­ni­ties we have in life, our posi­tion in our soci­ety, our lev­el of eco­nom­ic secu­ri­ty and access to edu­ca­tion and ser­vices, demon­strates the influ­ences of the his­toric, socio/​economic and polit­i­cal process­es in our coun­try. That’s where we find the roots of dis­crim­i­na­tion and dis­re­gard.

A big les­son I’ve learnt over the years is that build­ing under­stand­ing between cul­tures is part of an on- going jour­ney. It’s more about under­stand­ing our own cul­ture from the point of view of some­one else.”

Change is inevitable. We don’t know what is and will be need­ed in the future and there are dif­fer­ent and alter­na­tive ways to get the answers. How­ev­er, we do know that the process must be inclu­sive and that the foun­da­tion for change must be truth telling, hon­esty and empathy.”

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