Podcast: Baggarrook Midwifery with Aunty Gina Bundle and Alexandrea Burton

Episode: 43
Guest: Aunty Gina Bundle, Alexandrea Burton and special guest co-host Tessa Moriarty
Duration: 43:58
Tags: Aboriginal and Torres Strait Islander, NAIDOC week, Cultural Safety, Baggarrook midwifery
Soundcloud: Listen to Episode 43

Aboriginal Liaison Officer Aunty Gina Bundle, a Djiringanj, Walbunja woman and midwife Alexandrea Burton, a Waradjuri woman join the podcast to discuss how the Baggarrook midwifery service at The Royal Women’s Hospital is improving Culturally Safe care for First Nations patients and colleagues. 

Aunty Gina explains why programs like Baggarrook are so crucial to improving outcomes for Aboriginal and Torres Strait mothers and babies: 

“Like any other organisation, public or government, you get that ‘Them blackfellas, here they go again ....’ It's not about that. It's about providing a service to community, communities that never used to have these services. 20 years is relatively new, having a KMS [Koori Maternity Service]. But to have a Baggarrook caseload within a public hospital is even newer, and creating these services for Aboriginal people. Historically, we've created them because we didn't have them. We weren't allowed to have them, or it was really hard to get them. So we created our own.”

Learn more about this award-winning midwifery program: Woman’s Journey: Baggarrook Yurrongi, Nurragh Manma Buliana.

Aunty Gina was recently awarded a Medal of the Order of Australia in recognition of her service to Victoria’s Indigenous community. We thank her for her dedication to improving care for First Nations patients and workers! 

This podcast is part of our special NAIDOC week newsletter, Edition 21 — Supporting Aboriginal and Torres Strait Islander nurses and midwives. The newsletter also features podcasts with the first Aboriginal Nurse Practitioner Lesley Salem and CATSINaM CEO Dr Ali Drummond.

If you need to talk, Nurse & Midwife Support is here to support you: 1800 667 877 or by email.

Aunty Gina Bundle

Gina Bundle is a Djiringanj, Walbunja Woman and Program Coordinator / Aboriginal Hospital Liaison Officer – of Badjurr-Bulok Wilam – meaning ‘Home of many women’ in the Woiwurrung language of the Wurundjeri Peoples – at the Royal Women’s Hospital.

Gina is a member/author of the research team that created the award winning Baggarrook Yurrongi caseload programs since the beginning 2017 that provides high-quality maternity care and patient liaison, which give pregnant Aboriginal and Torres Strait Islander women and Non-Aboriginal and Torres Strait Islander women having Aboriginal and/or Torres Strait Islander babies greater access to gold standard maternity care.

Gina is as a member of the Cultural Council for Reconciliation Victoria, Stolen Generations Reparations Steering Committee Member and Board member of the Victorian Aboriginal Corporation for Languages Inc. and an inductee into the Victorian Governments Women’s Honour Roll for service to her Community.

Gina’s Art and Cultural Practice is in Possum Skin Cloaks which saw her facilitate the making of the Victorian Treaty Commission Possum Skin Cloak which she says is a ‘Historical Document’ in its Own Right. This 72-Possum-Skin cloak now sits with the First Peoples Assembly, and more recently the making of a large 40-Possum-Skin Cloak for the Yoorrook Justice Commission and many Magistrates Courts Cloaks across Victoria.
 

Alexandrea Burton

Alexandrea says: 

“My name is Alexandrea Burton

I am a proud Waradjuri woman my land is around Wagga Wagga.

I come from a family of 12, 6 biological siblings then 4 foster siblings.

I went grew up in a Rural and remote town called Finley. I then moved to Melbourne after finishing high school and went to Latrobe University and studied a bachelor of nursing. During this I was supported by The Rotary Club and received a scholarship which without I wouldn’t have been able to finish degree.

I then after graduating started my Registered Nursing Career at the Royal Womens Hospital on the NICU ward and Gynaecology and oncology ward. After 2 years I went back to study and did a post graduate diploma of midwifery at Latrobe but placements at the Mercy Hospital for Women. I then did 4 years of nursing an midwifery there and worked in all areas of that hospital, consolidating my skills. I then moved back to the Royal Womens Hospital and applied for a job in the Baggarrook Caseload program. Here I work with Indigenous women/people and or women/people who are birthing Indigenous babies. I am very passionate about closing the gap for Indigenous as an Aboriginal person myself. My Background gives me a unique insight in to the challenges that my people face meaning I’m better equipped to help deal with challenges that may arise.”
 

Elle Brown  [0:12] Welcome to the Nurse & Midwife Support podcast: Your Health Matters. My name is Elle Brown, the podcast co-host today with Tessa Moriarty. I'm a Stakeholder Engagement Coordinator with Nurse & Midwife Support, and I'm a registered nurse. Nurse & Midwife Support is the national support service for nurses, midwives and students. It is anonymous, confidential and free. You can call anytime you need support on 1800-667-877, or contact us via the website, nmsupport.org.au.  

I would like to begin by acknowledging the traditional custodians of the land on which each of us are listening on. I pay my respects to First Nations elders, past and present. I extend that respect to Aboriginal and Torres Strait Islander people both contributing and listening today. Sovereignty was never ceded. 

Today Tessa and I are speaking with the Royal Women's Hospital Badjurr-Bulok Wilam and research team member for the Baggarook caseload, Aunty Gina Bundle, and one of the Baggarook midwives, Alexandria Burton. Welcome Gina.

Aunty Gina Bundle   [1:13] Thank you, Elle.

Tessa Moriarty  [1:14] It's a good morning from me too, Aunty Gina. If you don't mind, I will continue to call you Aunty Gina. Could we start this podcast by you telling us, rightly so, about your professional background, and then we could lead into your work with the Women's services. Thank you.

Aunty Gina Bundle   [1:31] Oh, right! It's a long and varied road to get where I am today. Like I said, I'm the program coordinator of Badjurr-Bulok Wilam, which means in Wurundjeri Woi Wurrung language, 'home of many women,' here at the Royal Women's Hospital. We're the Aboriginal Liaison Unit. But part of my role is to partner with, be involved in community initiatives. One of those initiatives, way back in 2017, was to create a caseload, Aboriginal and Torres Strait Islander specific caseload for the Women's Hospital. There were three other hospitals involved, but I'll only speak about the Women's as I wasn't involved in the others, only in the research. 

We created a unit of originally four midwives, and of those midwives in the beginning, they were non-Aboriginal. I'm happy to say that we have three Aboriginal midwives now within that group. The reputation of this group has grown out of sight. The number of women being seen here at the Women's because of this unit, Baggarrook caseload, has grown out of sight. We've had people coming back now having their third babies with us. Of course, they bring their sisters, aunties and cousins, and everybody else with them when they're pregnant, as well. We've become too successful for our own good in some instances, which is wonderful, because we're growing. We've just employed, or are in the process of employing a fifth midwife. 

We're also in the process of employing another ALO because the ALO and Baggarrook midwives work so closely together. It's a team that should have always existed, but it did in another context, as prior to Baggarrook, we had KMS, which is Koori Maternity Services, which is an individual, one-on-one midwife. The majority of those midwives are also non-Aboriginal. But along with those midwives comes the Aboriginal Health workers. So they're a team that worked together as well. That Aboriginal support has always been there in the context of the KMS service. We're the same. As in, we're not Aboriginal Health Workers, but we're Aboriginal Liaison Officers, wordings can change the context of the job description, I guess. But neither one of those positions, the health workers or the liaison officers are clinical, one of our wonderful young ... Alex has just arrived!

Alexandria Burton  [3:58] [inaudible]

Aunty Gina Bundle  [4:03] I was just telling them that babies don't wait for nobody! 

Part of my role there in community, a long time ago, is because the KMS service is 21-22 years old now, Baggarrook in its content, or in its form, is relatively new. It's a few years old, since 2017, as part of that research program, but it's an award-winning (in 2019) program of its own standing now. It's autonomous within the hospital, part of the other caseloads, but I like to call it 'specialist midwives in a specialist team inside a specialist hospital,' because the Royal Women's is a tertiary hospital. 

It's an award-winning program. We were lucky enough to win that for the state of Victoria in 2019, I believe. The context of having midwives historically were Aboriginal Aunties. Due to colonisation, those practices were put a stop to. So what we've tried to do over the years is recreate those old practices in a contemporary setting. Hence now we have Aboriginal nurses and midwives in this hospital, but in the context of a caseload team, which is a five star one, these girls offer five star treatment.

Tessa Moriarty  [5:25] That's so wonderful to hear, Aunty Gina. So you've been with the Baggarrook caseload since its inception 

Aunty Gina Bundle   [5:34] 2017. 

Tessa Moriarty  [5:36] Okay. And good morning, Alexandria. Lovely to meet you. Before we ask you about your own background, Alexandria ... Aunty Gina, could you then just say a little bit about ...

Aunty Gina Bundle   [5:48] Me? 

Tessa Moriarty  [5:48] Yes. Who you are and what brought you to the Baggarrook caseload?

Aunty Gina Bundle   [5:54] Yes. I guess I could start off with me being a Djiringanj Walbunja woman from up near Bermagui, Yuin Country in New South Wales. Brought up, or grown up, in Orbost in Far-East Gippsland. Starting off there, as a young girl leaving high school in year 11 ... and my first ever job was a traineeship with Centrelink at the time. I think they were called something else then, I can't remember. Getting old already! 

This is my journey into the health field, because it was a 12 month traineeship in a pathology lab in the Traralgon Hospital, when the old Traralgon Hospital was there. It's no longer there anymore, but can you imagine even getting a traineeship in a hospital, let alone a pathology lab? So my journey into the health of our people started way back then, in high school. I was just coming out of high school because it was my first job and seeing the other side of health, not just the physical being that you see with your eyes, but the insight, more or less of what can actually go wrong, because I learned to produce microscopic slides. I saved them in the wax and sliced them really thin. I learned how to do that. I learned how to take bloods, I learned how to read reports. I did my little stint in each section, including the mortuary, in that traineeship. 

It really gave me a good insight in what could go wrong for Aboriginal people's health in general. Then you get in the front of that, in front of house where I am now basically. That actually stood me in good stead way back then, on my journey into the health field. I did do my training, as the second ... well, Div Two, with TAFE, 100 years ago. I began that, I didn't complete it, though, because it was like, do I want to do nursing? [Or] do I want to do the admin side, because I like the talking. I'm a talker. So my clinical is probably not as good as my talking. And so I chose to just not complete my Div Two Nursing, and I wasn't very far off. I kick myself now as to why I didn't keep going. But anyway, that's another story. 

After coming from there, I've done all sorts of jobs in New South Wales, and in Victoria, in regards to Aboriginal women and children's health. I was the Women's Health Worker for the Liverpool Women's Health Service at one stage, in New South Wales. I've done audiology training with GEGAC, a lot of my training was done with GEGAC, in regards to women's health. I've run a women's shelter in Bairnsdale. 

The physical and the medical side of Aboriginal children and women's health has always been a big part of me because the context of health is as wide as, the mental health, physical health and the medical inside jargon of what goes on in the blood tests and x-rays and all of that. Learning those skills, to be able to explain to people what's happening to them as a liaison officer, is a job I just love. Creating atmosphere in a place like this is one of my most important roles, I believe, creating safe places, culturally safe and physically safe places for our girls to do their job. So I'm the big baddie!

Alexandria Burton  [9:10] It's good to have somebody on your side.

Aunty Gina Bundle   [9:12] It's really important that young ones have someone to come to to say, "Look, this is what's happening, Aunt, and I don't know what to do about that." Thank goodness the hospital is really good and they allow me the authority to bring problems to the people that need to hear them. That's worked well, the hospital's been really amazing in allowing and making change compared to how things used to be. 

Like I was saying before, the hospital is aware of its past. They've actually made a community and public apology in regards to their actions and their input in removing Aboriginal children on behalf of the government. Together now we work really hard to make sure Aboriginal women and non-Aboriginal women having Aboriginal babies, that those babies go home with their mothers and their families. One of our goals ... that's the goal. Healthy pregnancy, make sure problems, if they any arise, fix them if we can. But the goal is to have a healthy baby born alive, and then that baby goes home with their parents. Their mother in particular. 

The hospital plays a real role in that because the move at the moment is Birthing on Country and the concepts around that, we're doing that but we're doing that inside of a hospital. We're not there yet, to be able to create ... almost, Waminda in New South Wales, a Women's Health Service has received quite a large funding grant to create something like that. We're all looking really closely at that, waiting and watching. But what we're doing here inside the hospital is we're creating, because we need to remember, land was never ceded. So people are still birthing on Country, it may not be their own Country, but they're still birthing on Country, and we're on Wurundjeri Country. What we try and do is to create that atmosphere that you're welcome here, you can birth safely here. If Child Protection does become involved, for whatever reason, our girls put their armour on and off they go. Very rarely do babies leave this hospital with Child Protection. It does happen, but not in the numbers that it used to.

Tessa Moriarty  [11:26] Aunty Gina, before we go too much more into the Baggarrook caseload and how you work as a team in a service ... Alexandria, could you tell us a bit about yourself, your background, and what brought you to both midwifery, but also to the Women's?

Alexandria Burton   [11:43] Yeah, so I am Alexandria. I am a proud Wiradjuri woman. My Country is Wagga Wagga way. That's where most people know! I come from a family of 10 children. Six of them are my biological brothers and sisters, and then there's four foster children. I love being around big family. 

What brought me to nursing ... there's a photo of me as a two year old reading a 'Mother and Me' book. What brought me to nursing is that I've always been drawn to childbirth and always wanted to do my Midwifery but got into the single degree instead of the double degree, so decided to do nursing first. Got my basis at the Royal Women's. I did gynae-oncology and then I did NICU, so special care and high dependency in [inaudible]. 

After, I decided, right, I've got this, I want to go study my Midwifery, I did my Midwifery at the Mercy Hospital. I did the postgraduate there, which was a really good learning experience. I got my foundations down pat, and then I came back to the Women's Hospital as I found the culture really safe, inviting and welcoming. 

So I came back to the Royal Women's Hospital, and as an Indigenous woman, I really wanted to give something back to my community, because I feel like I've been given such opportunities in my life that I felt like I need to go give something back to my community. I went and applied for the Baggarrook job and got it. I've been doing Baggarrook for six months now. Yeah, it's really cool.

Tessa Moriarty  [13:25] That's wonderful. I was just about to add, six months and loving it!

Alexandria Burton   [13:32] Yeah, definitely. I've just delivered a beautiful baby just probably two hours ago, if that. An hour and a half.

Tessa Moriarty  [13:40] You've been doing all the aftermath! Tell us more about delivering babies in the specialist service, specialist team, specialist hospital, and the specialist way that you do it as a team. 

Alexandria Burton  [13:56] We have an all-risk caseload, that's what I call it. It means that no one is excluded due to comorbidities. That's really important due to being Indigenous, there are higher comorbidities in our health group. Regardless of what's happening in your health, you're accepted within the group, as long as we have got a space available, because we're very popular! 

We see them, all people, from about 16 weeks. We first see them and do a booking visit at 16 weeks. Sometimes some ladies have their booking visit already done, and are identified through the hospital system that way, but generally we get referrals from all different organisations and our external organisations will book somebody in to be seen at 16 weeks. 

Then we do a 20 week morphology, around 20-21 week morphology appointment, where we review the ultrasound. After that, we see [them] at about 28 weeks for the glucose tolerance test and review appointment. After that, 32, 34, 36, 38 and 40 weeks, but we tailor the care to the ladies. For instance, I had a person who needed a 13 week appointment, an 18 week appointment, a 22 week appointment, a 24 week appointment and a 28 week. We have the capabilities of tailoring care that's individualised, that's really important, to deal with, say, different access for mental health, or possibly they need to be seen more because they're obstetrically high-risk as well. 

Another good thing about being in Baggarrook means that we go with the ladies to their doctor's appointment. We provide that continuity so that there's trust already built within the organisation. We attend the doctor's appointments with the patients, because obviously, all our ladies are over different groups over the hospital. So we have some in diabetes, and some in foetal medicine, and some in maternal medicine and all sorts of different groups. It means that we get to go with the ladies, provide culturally safe care, make sure that anything that the patient doesn't understand [gets explained]. Say, if the doctors use jargon that's not appropriate by mistake, then we can help to debrief, and make sure that the patient fully understands what's happening.

Tessa Moriarty  [16:32] Can I just say: that sounds really amazing that you provide that close support at that appointment. That sort of wraparound, that's beautiful support. Women must really appreciate that. 

Alexandria Burton  [16:46] Yeah. I really appreciate providing the care. Yeah! We also work very closely with one specific obstetrician, Vicki Carson. If we have any things that are just a little outside of our scope, say, we send all our blood tests off to Vicki. I might need an iron transfusion, so I'll get Vicki to book it. Or I've got a lady who's previously had a foetal growth-restricted baby. So I'll get them to see an obstetrician once during their pregnancy, or more, depending on what they need. But we have a really, really good relationship with a very culturally safe doctor, which is so important. I can vouch that it's okay, we'll go to this appointment together and at the appointment they feel really safe with Vicki and really comfortable.

Tessa Moriarty  [17:37] That's beautiful, beautiful. Tell us about how you work. We've got a sense of it already. But how you work as a team, including the way you two work together.

Alexandria Burton  [17:47] Our team of four midwives--soon to be five--we have advertised and done some interviews for a fifth midwife in our caseload. We're a growing caseload, so that's really exciting. How we work together is we have work phones, so that we have access to the hospital system EPIC online. We can send secure, private messages to each other when we're at home or we're on call, but we're not having access to a computer at the hospital. That's really important, that we have access to each other. 

We also have the pager system. We get our patients to page us if they need any assistance outside of their clinic days. Say, they've got abdominal pain, or reduced foetal movements, or bleeding, or they might have clearly broken their waters. Or, I don't know if mayo's safe to eat in pregnancy! Anything they want, they have access to us 24/7. We roster each of our days so that there's always someone on call.

How we divide the caseload is each year, I'll see 40 ladies at a full-time rate, so it's roughly three to four ladies a month that I take on to my caseload. If I'm on a day off, then my ladies are covered by whoever in the team is 'on'. Whoever in the team is on is always over any updates or things in their care because we keep a good close connection, and everyone is up to date.

Tessa Moriarty  [19:31] And you come together with Aunty Gina on a regular basis for discussion and review, etc?

Aunty Gina Bundle  [19:38] Yeah. One of the issues in the hospital at the moment is space. There's not enough space for us all, and that's okay. So the girls actually live in our office, at this moment in time. They're getting their own office really soon, because we're getting another ALO. If there are any two groups of staff in this hospital that should be in the same room, it's us. Aboriginal Liaisons and the midwives, especially young Cinnamon, she's over the back from me, but she's not here at the moment, [she] works very closely with the Baggarrook midwives. 

The knowledge together, to create that wraparound service with social work, WADS ... and unfortunately, sometimes when we have babies passed, we have pastoral care. We create ceremony for people as well. We create items, possum skins, we discuss how ceremony can be created with them and their families, around getting baby's spirit to go home with them. Taking placentas home, we talk about what can happen for burials, we do all of that together, because we are a happy hospital, generally, because we're a maternity hospital. But there are some sad things that happen within these walls. 

Together we really work not only to help our patients, but also to protect one another, to help one another. Because, you know, emotionally, we're very attached to our women, even though we only have that short period and window that we're involved with them, it's such an important time of their lives. Sometimes we need to take care of one another. That's the beauty of us working together, our ALOs and the Baggarrooks working together, because we deal with a specific group of people that we're closely connected to in all sorts of ways. The rapport-building that the Baggarrook midwives and ourselves create with our patients is over and above any other staff member in the hospital. We're a specialist team, as well, inside a specialist hospital, and we do that job together. 

Like Alex was saying, we're actually creating a clinic at the moment. We've got our doctor Vicki, and we pull these experts from around the hospital to create this team. Hopefully, when our clinic is up and running, these people will be in our clinic, because we're not a clinic as such, at this moment in time, [inaudible], but we're creating a clinic to include these people [that] will be inside of our clinic. We will be a department in our own right. 

Tessa Moriarty  [22:08] Still within the hospital?

Aunty Gina Bundle  [22:08] Within the hospital, yes. Not only will that create funds for us, but it will offer protection as well, I believe. I mean, we're very well-protected in the hospital, don't get me wrong, we have a wonderful executive who really supports us in doing what we do. At one stage, I was here by myself. The help and support that our executive gave me to get what we have now, you can't fault it, because I'm working in the [inaudible]. Because I'm coming to the end of my working career, sort of, and to have all these beautiful young women following in my footsteps, I couldn't ask for anything better. The hospital has helped in creating what we have now. 

We have a wonderful RAP committee team, all of our staff sits within that. All the deliverables that we want, we put in there, we ask there. Then we create. We work from the RAP committee down to create more staff, more positions. I sit on all the employment panels, and I'm involved in the recruitment of Aboriginal staff in the hospital. So I'm allowed to have my finger in all sorts of pies because of our RAP. That wasn't here when I first came. There are people on the RAP from the top down, so they're involved in everything that we do, and they're supportive of everything we're doing.

Tessa Moriarty [23:27] That's amazing. That's a real testimony of the commitment of the organisation. One last question about the service itself, because I noticed in that lovely brochure that's on the website about your caseload work, [that] you have our outreach capacity. So could you provide support to your mums and bubs once they've gone home?

Alexandria Burton  [23:48] Yeah, full service. We see them in clinic, I'm on call for their birth, then I'd go do their birth. After I'll visit you on the hospital ward, on the postnatal ward and attend education, do some baby bath, help with breastfeeding, help with postpartum recovery. Checking the stitches ...

Tessa Moriarty  [24:10] If there's any!

Alexandria Burton  [24:10] Agreed! I've got some good rates. Making sure that they're really recovering well, and setting them up really well for going home. Then we visit them at home, and that may be two or three, depending on what's happening. Are they a multi, are they a primip, have they had children before, how are they coping? Is their milk in, do they need help with breastfeeding? 

What's really good is I found, coming in new, only six months to this position ... there have been a lot of really good relationships built within the hospital with our Allied Health Services. I've got a mum just the other day who was having some trouble with breastfeeding. They had already been discharged from the hospital, but not discharged from Baggarrook, because I was providing domiciliary services. They had issues with their breastfeeding, so I rang up the lactation consultant. They said, "Oh, you're a Baggarrook woman, I've got an appointment. Bring her in today."

We've got all of these expectations all set up really well within the hospital, well, not expectations, relationships set up really well within the hospital so that our ladies can be prioritised. It's very important. Like with physio, if I have problems with any of the physio appointments made, I know the ward clerk by name, so I just run around there, and they go in, adjust the appointment, tailor to what the patient needs. Yeah, it's really good.

Tessa Moriarty  [25:43] You really highlight to us the importance of relationship and connection, how you really develop and build those relationships, and the relationship that you have with your women and their families. It's all about developing relationship, isn't it?

Alexandria Burton  [25:59] It's vital to any healthcare, you need to be able to build rapport, and you need to build rapport really quickly. 

Aunty Gina Bundle  [26:08] It's really important to remember we also have wonderful shared care arrangements with community. With VAHS, in particular, Victorian Aboriginal community Health Services, but also through VACCHO, all the KMS services, the majority of them sit within organisations across the state. We're actually connected in there, the hospital is part of the training with VACCHO who train/provide the education services to the KMS, and the Aboriginal health services. I do education with them, it's part of my role. Like I say, we all have our fingers in different pies across the state. Even though we're centrally located in Melbourne, as a tertiary hospital, we do a lot of educating around. My job's got [me wearing] many hats on my head. Sometimes I feel like I got lots of heads and not enough hats! 

It's really important that all that background work allows Alex and the rest of the team to really focus on the women here, knowing that when their time is finished with us, they're going to be fully supported in the community.

Tessa Moriarty  [27:12] Yeah, it's really comprehensive. It's got such longevity and vision. Can you tell us about some of the challenges that you've both faced and your service and team has faced?

Aunty Gina Bundle  [27:22] I'll go first with that one. When we were building, after we had Baggarrook, I think the success of Baggarrook took us all by surprise. I don't think we were ready for the amount of women that we were going to see, because prior to that hardly any woman had caseload, Aboriginal women. All of a sudden people in the hundreds are turning up. It was like, "Oh, my gosh!" I don't think we were prepared for the success in the way we should have been, or could have been. But we certainly have got our eyes open now, and hence the creation of other positions. 

But that was one of the things that jumped out at us after a very short period of time. In that sense, when that was happening, burnout for our girls was a real thing. 

Alexandria Burton  [28:06] Yeah.

Aunty Gina Bundle   [28:06] Well, we really had to take stock of that, and I think we've handled that quite well. But like I said, I don't think none of us were prepared for the actual amount of women that the Baggarrook girls were seeing. We've actually lowered the amount of people, well we will be lowering the amount of people that they're going to see every caseload, every year, and I think a full-time one will go down to 38.

Alexandria Burton  [28:28] 35.

Aunty Gina Bundle  [28:29] 35. Because a lot of our patients are ... and that was the other thing, we didn't realise how complex some of our women are. We get women from the Northern Territory as well, and that's another feather in this hospital's cap. They used to go to Adelaide for some reason, but all of a sudden they started coming here. We have long-term patients, some patients have to come here months before baby's born, in case baby comes too early. Then months after, they're still here. We're involved, the ALO roles then really come into play. We're involved with those patients from the beginning to the end, and some of them could be a long time.

Tessa Moriarty  [29:07] Alex, tell us about some of the challenges you had as a midwife.

Alexandria Burton  [29:11] I was going to mention burnout, due to the complexities of case with treating all-risk ladies. It means that they're very complex ladies sometimes. Sometimes they're not, sometimes they're low-risk, but the majority of our patients are high-risk ladies. That means that there's a lot to be over, and there's a lot to follow up on. It does have a cumulative weight sometimes. 

How I've managed to deal with it is making sure that we have leave, booked and planned throughout the year appropriately. But also I work in a very flexible team. If I'm having a tough day, any of the midwives in my team, I just have to let them know and the slack is picked up. So it's really, really good in that way.

Tessa Moriarty  [30:00] As you know, given that it's such a very special year ... and as Elle said, before we started this conversation, this yarn ... the importance of stamping out racism, and calling out racism. So we are interested in your experiences and challenges in relation to that.

Aunty Gina Bundle   [30:29] I'll just answer that, before Alex came on board, I think there was a little bit around, "Why are they getting special treatment?" That was from other hospital staff, earlier on. It's that not knowing what the go was, really, because nurses work in caseload. Doctors, midwives, work in caseload. The majority of women that come to this hospital is in caseload of some sort. Not all, but some sort. So when we created our own, they didn't know didn't quite understand why Aboriginal women. It's the same old story all over the place. Why do Aboriginal people get special preference? And that's because people don't understand the history of how Aboriginal people became disadvantaged in the first place, and that that disadvantage continues right to this day. A lot of people don't understand that history [there are some] preconceptions about what we are and why we do what we do. Then, as we all worked together and progressed, and they see the importance ... it's important to know that we've been Closing the Gap here. Our breastfeeding rates are up, low birth weights are lower. Babies are being born at good birth weights, we're doing things that are Closing the Gap. I's really important that that's known. 

Like any other organisation, public or government, you get that "Them blackfellas, here they go again ...." It's not about that. It's about providing a service to community, communities that never used to have these services. 20 years is relatively new, having a [inaudible] KMS. But to have a Baggarrook caseload within a public hospital is even newer, and creating these services for Aboriginal people. Historically, we've created them because we didn't have them. We weren't allowed to have them, or it was really hard to get them. So we created our own. 

We're doing that again, here in this particular instance, because the high risk to our women is higher than most, simply because of all the horrendous statistics that happened to Aboriginal people in general, let alone pregnant Aboriginal women. The history around that sort of knowledge, a lot of people still don't know that, as bizarre as that sounds in today's age. A lot of people still don't know how we became so disadvantaged, and the offshoots of that, of early death, early imprisonment, prison rates for women especially, worst in the world per capita. The removal of children are higher now than they've ever been before, before the Bringing them Home report. It's like, what is that? How did that happen? Because that report was supposed to lower taking children and removing them. The hospital works really hard to make sure that what we do inside these walls contributes to babies going home.

Tessa Moriarty  [33:24] Leaning into a question around the research, then. Clearly, what you're doing is Closing the Gap. 

Aunty Gina Bundle   [33:30] Yes.

Tessa Moriarty  [33:33] We've kind of moved away from some of the challenges ...

Aunty Gina Bundle  [33:35] Sorry, I didn't let Alex finish, because it was talking about the barriers that they face here. That was just what happened in the early beginning. You don't see that as much anymore. You still see it, but it's not as prevalent as it used to be.

Is some of that because of the work that you've all done?

Alexandria Burton  [33:53] I feel the cultural burnout a bit more. That's one of the hardships that I've faced. Just having the understanding of where these ladies are coming from, and possibly myself. I find it a little bit challenging.

Aunty Gina Bundle   [34:13] Given that people work differently, one of the bigger issues that I've seen--because I've been with all of the girls since the beginning--is work/life balance. Trying to be your own person as well. You're not just a Baggarrook midwife. You're actually Alex Burton, daughter, girlfriend, sister, big sister, you know? It's trying to keep that balance. It's really hard when you have to work within these [parameters], you're on call, or you're on holidays, but you're always thinking about ... you're not on today, [but] you're still thinking about "What am I going to do tomorrow when I got to come back on?" 

Alexandria Burton  [34:46] Yeah.

Aunty Gina Bundle  [34:46] It's that never-ending sort of stuff. We try and keep that [from] the girls. If they're here when they shouldn't be here, I tell them to get home. It's really hard to get that life balance. Like I said, the girls are on call, they do all those different shifts, they help one another out, unless they actually go on leave, actually go on holiday somewhere, I just get dragged into all of this stuff. But it's wonderful stuff. 

I have no degree whatsoever. But you do a lot of background work to try and create something that's good. What we've created is something very, very good. I hope the hospital's seeing this, which they will. I hope they continue supporting us, because we're doing a wonderful job. We're Closing the Gap that they've signed up for, they signed up to Close the Gap, well, we're doing it. The girls work really hard, and young Cinnamon behind me, I don't work as hard as the girls, because I'm old and raggy. But together, together we make a formidable team. And we're doing it. I'm really, really proud of the girls, young Cinnamon, we're getting another ALO, we're getting another midwife. We're growing, we're hopefully creating a clinic, and together, we're an unbeatable team. I just love it because people are still learning. I think once we get that life balancey stuff right, you won't be able to stop us, I don't think.

Alexandria Burton  [36:11] From the research, the thing that gets me excited the most is the fact that you can have such an input on the birth weight of babies by providing continuity of care. So, early intervention. We can do more monitoring and scans when needed, if appropriate, not unnecessarily. But just having a safe, secure mother can provide a huge output on that baby's life, thinking about what a lower birth weight does, it influences on the rest of the comorbidities of that baby's life, is predisposed to different diseases, and all sorts of stuff. I think it's awesome that we can do that.

Aunty Gina Bundle  [36:51] You know, the girls ... and this is just in conversation, and anecdotally, no records here. But I think we've lowered the amount of c-sections. The girls pay attention to episiotomies. Do you need one or do you not need one? Because that's life-changing stuff. Every time you cut someone's body, that's life-changing stuff. The girls pay real attention to that, and I don't think we have as many c-sections in our community as we used to, because we don't need to.

Tessa Moriarty  [37:19] Yes. As a collective, how do we support Aboriginal and Torres Strait Islander nurses and midwives better than we have been?

Alexandria Burton  [37:28] I think it's got to do with education. To know where one person has come from really impacts on where somebody can go. To understand history, and to know some of the things that have happened in the past. It's really important, acknowledging and moving forward, like the hospital has done. That's really important. 

Possibly other hospitals could have a go at that. What else is really important for moving forward is education. Maybe making it mandatory to have cultural safety training, instead of making it voluntary? I think that would be really important. In welcome packs, when new employees start, making a mandatory decision, do cultural safety training. I think that would really impact on change. 

Aunty Gina Bundle  [38:18] And people's behaviour.

Alexandria Burton   [38:18] Yeah, and people's behaviour. 

Aunty Gina Bundle  [38:21] There's also another bow to this violin, I guess ... when people go to university, because once upon a time, I used to be a Liaison Student Support Officer, at what used to be Monash Gippsland which now is Federation University Gippsland. We had a really good, large nursing and midwifery intake at Monash Gippsland. All the time, there was lots of Aboriginal students that became nurses and a couple that did the double degree. One of those students that was there way back then, it was 2019, I believe, 18 or 19, [was] Midwife of the Year. I know Tracy, she was one of the girls that was in our little cohort, and it was so exciting. 

It was actually creating strength and self-reliance in people while they're studying, and [they'd] be able to hold their own when they came into a place like this. Hopefully there are places like our little Liaison Unit, our Badjurr-Bulok Wilam, that is here to grab them when they come through the door, too. Because I do a lot, and young Cinnamon behind me does a lot with our grads when they come in. Undergrads, postgrads, our cadets, graduate cadets, we work with them. 

There's lots of bows to the violin that allow us to create strength, resilience and pride in the Aboriginal nursing and midwifery staff that come through our door. We have a bunch of nursing and RUSON cadetships, we've actually decided we're going to have all RUSONs because RUSONS get to do more than a nursing cadet does. 

When we realised the difference, especially when I realised the difference, it was like, why are we doing this? Why can't we have all RUSONs and give their nurses that opportunity to have a little bit more hands-on stuff, because the goal of that is to ensure that people learn, and then pass their exams. That's our role, is to help them pass their exams to become fully-fledged nurses and midwives. The more opportunity we give them in those cadetship phases to get the experience and the knowledge so that their studies makes sense to them [the better]. 

But sometimes if study doesn't make sense to you, there's no way you're going to be able to pass, unless you get really lucky. But if we can offer the right type of learning in their cadetships, it will make it easier for them to know what they're talking about and what the studies are talking about, because they've actually done it. They're not standing off in the corner, folding sheets, or cleaning the cupboard or something. They're actually in there, doing stuff as RUSONs. It's so important in how people learn, because people learn in all sorts of different ways. We need to move with the times and teach them in all sorts of different ways.

Tessa Moriarty  [41:06] Yes, spot on, Aunty Gina. My last question, I certainly have one, my last question would be if I was a young nurse or midwife for that matter, looking to start out my career [as] a young Aboriginal nurse or midwife, what kind of wisdom or advice would both of you, or either of you, have for me?

Aunty Gina Bundle  [41:30] For me, it would be, especially if you're already at university, touch base with your Liaison Officers, your student supports, because they have a whole wealth of information and different doors they can open for you to learn in different ways. Having that relationship, they also have people in community they can connect you to, because the hardest part of being an Aboriginal person trying to get into community or into services like this is--especially if they come from the country into the city--is not knowing anybody. 

You'll find that a lot of the country universities have connections to all the Aboriginal services in the city. They'll have connections to introduce people to, but also once they get into the hospitals, go find your Aboriginal Liaison Unit because they're there in just about every hospital in the country now. There might be a few small hospitals that don't have us, but they'll have something around. Connect yourself with Liaison Units, because they do, like we do, all sorts of stuff inside the hospital that we can help you with.

Tessa Moriarty  [42:29] Yep, thank you. Alex, and yourself, what advice would you give me, being a young budding midwife?

Alexandria Burton  [42:37] To not say no to any opportunities, even if you're scared of them. To ask for help where help is needed. Don't feel afraid that there's any silly question. There's never any silly question. There's just questions that haven't been asked before. To give everything a go, and to put your hand up even if you're feeling uncomfortable. Yeah.

Aunty Gina Bundle  [42:58] Did we answer everything that needed to be answered?

Elle Brown  [43:01] Yeah. Thank you so much, Aunty Gina and Alex, for your time today. We've really appreciated your insights. We've got further information about supporting Aboriginal and Torres Strait Islander nurses, midwives and students, which is invaluable. 

Aunty Gina Bundle  [43:18] Aw, that's good.

Alexandria Burton   [43:19] My pleasure. 

Elle Brown  [43:20] I just want to say that if anyone has any issues that they'd like to speak about, you're welcome to call Nurse & Midwife Support, a 24 hour, seven day a week service for nurses, midwives and students. You can call us on 1800-667-877, or contact us via the website on nmsupport.org.au Thank you.