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A selection of stories from our CRANApulse magazine written by remote health professionals or students during their clinical placement
Fellow in focus: learning how to listen
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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