Podcast: Cultural Safety with Dr Ali Drummond

Episode: 42
Guest: Dr Ali Drummond, special guest co-host Tessa Moriarty
Duration: 40:08
Tags: Aboriginal and Torres Strait Islander, NAIDOC week, racism, Cultural Safety, CATSINaM
Soundcloud: Listen to Episode 42
 

Dr Ali Drummond is the new CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM). He is a Meriam and Erubam man of Zenadh Kes (Torres Straits) and Wuthathi man from Far North Queensland. Dr Drummond joins us on the podcast to share his experiences as a nurse and academic, and why it’s so important to embed Cultural Safety and Cultural Humility training in academia and education. 

Dr Drummond says: 

“Understanding when Aboriginal and Torres Strait Islander people in (the workplace) are being disempowered, are being treated like crap for no other reason but for them being Indigenous, that is very challenging. I think nurses and midwives can better support Aboriginal and Torres Strait Islander nurses, midwives and students by doing training like Murra Mullingari, to understand cultural safety. Understand those different manifestations of racism. Learn in other programs, you learn language to address these things. It's far safer for a non-Indigenous nurse, midwife or student to actually step up and say, "Actually, that's inappropriate." This is why. Don't expect the Aboriginal person or the person who's being targeted with this racism to do it themselves. That's an important role.  

I think [the role that] nurses and midwives can play is stepping up.”

When we recorded this podcast, Dr Drummond was Acting CEO of CATSINaM, but he has recently been permanently appointed to the role. Congratulations Dr Drummond, and thank you for joining us to share your expertise! 

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 Lesley Salem, the first Aboriginal Nurse Practitioner, and Aunty Gina Bundle and Alexandrea Burton of the Baggarrook midwifery program. 

If you’re challenged by issues related to Cultural Safety and need to talk, Nurse & Midwife Support is here to support you: 1800 667 877 or by email.
 

Dr Ali Drummond is a Meriam and Erubam man of Zenadh Kes (Torres Straits) and Wuthathi man from far north Queensland. He was recently appointed to the role of Chief Executive Officer with the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM). A highly experienced leader in the sector, Dr Drummond has more than two decades of professional experience in Aboriginal and Torres Strait Islander health, clinical practice, policy, research, and teaching and learning.

Throughout his career, Dr Drummond has continued to focus on health workforce development to ensure a culturally safe health system. For several years, he has also innovated nursing education in his role with Queensland University of Technology (QUT’s) School of Nursing and as inaugural co-Director of Indigenous Health within QUT’s Faculty of Health

Ali holds a Bachelor of Nursing Science and a Master of International Public Health. His recent PhD research critically examines how Australian nursing academics collaborate with Indigenous peoples in developing, delivering and evaluating nursing curricula concerning Indigenous peoples’ health and wellbeing.

Dr Drummond is a Fellow of the Higher Education Academy, an active member of CATSINaM and the Torres Strait Islander Nurses Indigenous Corporation, and the Lowitja Institute Research Committee Chairperson.
 

Elle Brown [0:11] 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 will be speaking with Dr. Ali Drummond, acting CEO of CATSINaM, the Congress of Aboriginal and Torres Strait Islander nurses and midwives. It's a nursing and midwifery organisation that has supported and advocated for Aboriginal and Torres Strait Islander nurses, midwives and students for over 25 years. Ali, would you mind telling us a little bit about yourself and your career in nursing please?

Ali Drummond [1:46] Thank you for having me. So a little bit about myself. I am a Meriam and Erubam man from the Torres Strait on my mother's side, and my father's side, Wuthathi man from Cape York. I grew up on Waibene, or Thursday island, or TI, with my seven siblings, many cousins and broader extended family. Went away for boarding school, went back when I finished boarding school and did my nursing degree through James Cook University, they had a little campus on Thursday Island. It's not there anymore, but I was one of the three inaugural graduates from the JCU's Thursday Island campus.  

During the time I was studying my Bachelor of Nursing degree I worked as a Torres Strait Island health worker in the primary health care service up there for Queensland Health, as well as Assistant in Nursing at the Thursday Island nursing home known as Star of the Sea. 

So just as I'm talking about my entry into health and into nursing, I really want to bring that to the fore because that really grounded my practice in Primary Health Care but also in caring for my mum. Clinically as a nurse I've worked in many different areas. I eventually made it into agency nursing. So I've worked in many different areas, particularly in Brisbane, but I did my grad year in orthopaedics and really enjoyed that and stayed there for about three years at The Princess Alexandra Hospital. It's a great place, I think, to learn a broad range of skills and expand on knowledge, particularly around surgical nursing. 

My clinical experience is mostly, I think, in orthopaedics, in primary health care. I've also worked in policy areas. I've worked for two of Queensland's Chief Nursing and Midwifery Officers in a role that focused on Aboriginal and Torres Strait Islander Nursing and Midwifery. I was the Indigenous Nurse Advisor and Assistant Director of Nursing, so I oversaw a number of statewide policy and program work, and looked at increasing Aboriginal and Torres Strait Islander nurses and midwives, looked at improving practice, so improving the cultural safety of nursing midwifery practice in Queensland, and also supported a number of Aboriginal and Torres Strait Islander nurses and midwives to advance into advanced roles within Queensland Health. 

I soon left there after a few years, and started work at Queensland University of Technology as an academic. In that role, I taught in the undergraduate and postgraduate Nursing program across the board, but had a focus obviously on cultural safety and Aboriginal and Torres Strait Islander health. I had a keen interest in ensuring scaffolded learning from first year all the way to postgrad, so developing courses and teaching courses for the Masters of Nurse Practitioners. 

That's where I expanded my interest in looking at how we can continue to sophisticate what we teach nurses and midwives, nurses in particular because the QUT unit offered nursing, but to offer sophisticated nursing education. So continue to build upon your foundational stuff that wasn't taught in first year nursing, to more advanced-level teaching about how nurse practitioners can learn about the policy frameworks that exist around Closing the Gap. Learn about what opportunities exist for taking advantage of things like funding that comes through Medicare, as well as how they develop and design models of care, leveraging of resources and incentives, like Medicare that exist. 

I think it was important for me at that time to really support nurses coming through that education. To understand it's not just a one-off training that you do, or the one-off unit that you do in your undergraduate program. That your knowledge, skills, and experience, can further develop and be enhanced, to better support Aboriginal and Torres Strait Islander people to that Master's level where nursing leaders, clinical leaders, can actually design programs with Aboriginal and Torres Strait Islander communities, with what leverages were available.

Tessa Moriarty [5:49] Can I ask you a question there? What sort of response did you get from those you were training? Like you said, it's so critical.

Ali Drummond [5:56] A bit of a mix. I think largely a lot of the students appreciated the learning. I think it can be quite challenging learning, particularly when taken, I think, to undergraduate education first. I think when the majority of the program is targeted at clinical practice, which isn't a bad thing, but I think students get a sense for that. Anything else that isn't so focused on clinical practice, when you're looking at, you know, the theory of cultural safety, when you're looking at the therapeutic relationships, the power dynamics between care recipient, care provider. That can seem less sexy and attractive, and less 'nursing,' because everything else is so proximal to clinical practice, where learning about cultural safety, and learning about the history, the historical context of Aboriginal and Torres Strait Islander health, the social context and cultural context. 

Particularly when it comes to challenging concepts like racism, I've found [in] my experience with students [they] can feel very uncomfortable with that and very easily and quickly can be seen as non-nursing knowledge and skills. But I've also had experiences of students really excelling in undergraduate education, where we're giving them cultural safety as a tool of understanding the world in a much more critical way, understanding our practice in a much more critical way. 

I think if learning is scaffolded well, students can see the tools and then apply it. It can be confronting, I think, understanding racism, and then seeing it for the first time, because we see it in our social circles, in our families and our friends. There's grief that comes with that, the different stages of denial and anger. There's a bit of that in teaching Aboriginal and Torres Strait Islander health and cultural safety as well. 

As a contemporary educator in that space, you have to understand that journey, and create a learning experience that can support students along the way. Not all students will take the journey, but many do. Once you get a collection of students on board, they support each other through that journey. That's what you see in the tutorial activities. If you get it right, you can really support that collective knowledge, and develop trust in each other to walk that path.

Tessa Moriarty [8:13] That's so right. One thing I'm learning and doing the Murra Mullangari course is that the nursing practice is critical. But nurses also have to step outside practice to be leaders and to be changemakers, and to really, as you said, understand the system, the biggest system, the history, racism itself. There's a disarming process in that, but that's what also requires change. So it's great to hear you talk about that. 

Ali Drummond [8:43] Absolutely. I think there's an assumption that nursing and midwifery are apolitical. Nothing is apolitical, we all live in a social, cultural space, there's politics everywhere. If you're not actively engaging, just being aware of it, and understanding whether you are condoning a certain ideology, or certain approach, or certain direction ... just claiming an apolitical space is a bit of a cop out. Yeah, I think acknowledge that and understand that our disciplines aren't apolitical, we've never been. We've always pushed for what's best for our patients, for the community. But what's best for our patients and community can be quite complicated. So we have to go to the next step then, and understand the complexity. Cultural safety really helps us understand.

Elle Brown [9:32] Ali, can you tell us about being the acting CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, please?

Ali Drummond [9:41] Yes, well, being the acting CEO of any organisation is tough work! Lots of responsibility on your shoulders to feel the aspirations of the board. I have a board of directors that I report to, that supervise me, they're my employer. We're also a membership organisation. So our members, largely Aboriginal Torres Strait Islander nurses, midwives and students, they vote the board. So there's some structures above me that keep me accountable for my role. 

My role is fulfilling the strategic plan, the strategic agenda set by the board. That's a huge responsibility. As you said before, CATSINaM is a membership organisation, we have almost 2000 Aboriginal Torres Strait Islander nursing, midwifery, and student members, and another 700 non-Indigenous members. There's all sorts of aspirations and needs from our membership as well. 

It's balancing all those requirements of you with what resources you have. My role is to do that. When it comes to priority areas for CATSINaM, my focus from the board is around ... the first one is around leadership and advocacy. That's ensuring that CATSINaM has a seat at the table for all those big national and sometimes jurisdictional--so state and territory--strategic discussions when it comes to nursing, midwifery and Indigenous Health. CATSINaM's invited to a lot of those tables to have a say, and it's not just turning up, it's ensuring that we're across the intersections of what the gathering is about and how it impacts on CATSINaM, its members, and its interests. 

Advocacy, we do a lot of work from the organisation lobbying, so we do provide a lot of feedback on big national consultations and inquiries. We provide that lens, that Aboriginal and Torres Strait Islander nursing and midwifery lens. We do try to stick in our lane because there is so much work out there that we could do, but we want to make sure that we are delivering for Aboriginal and Torres Strait Islander nurses and midwives and largely the nursing midwifery workforce, particularly around Aboriginal and Torres Strait Islander health. 

Since we've been established, 25-26 years ago now, we've always had an interest in workforce development and growth, our second priority area. We've always been interested and keen to lobby and support increases in Aboriginal and Torres Strait Islander people's participation in nursing and midwifery programs, and of course, in the disciplines themselves. 26 years on from the birth of our organisation, we now are very keen to advocate and promote Aboriginal Torres Strait Islander leadership within health services. That isn't just replacing non-Indigenous people with Aboriginal and Torres Strait Islander people in leadership roles. It's also promoting and advocating for the value of Aboriginal and Torres Strait Islander knowledges and Ways of Doing. 

Some of your listeners might be familiar with or might have worked in Aboriginal community-controlled health services. I know some of these health services really engage in different ways of approaching health and wellbeing. Their role has required them to think about what nursing looks like, or midwifery looks like, in these models. I think a lot of people are getting behind [this], but models around Birthing on Country or birthing in community ... these are harnessing Aboriginal and Torres Strait Islander Ways of Knowing, knowledges. Different ways of engaging with communities, with families, that is making them change the way that they practise to fit what the needs are, different approaches. 

Our role at CATSINaM is to support that. It isn't just about building capacity anymore. It's about ensuring that we're getting the health service, health systems, even the university systems that value Indigenous knowledge as Ways of Knowing. 

Lastly we'll just have that last priority area, the last strategic pillar is partnership and engagement. That's evident in all the things I've mentioned before. CATSINaM can't do this work alone. As I mentioned before, we have quite a number of allies that have joined organisations, and we're ensuring that we are providing support to them as well. Their learning of cultural safety, or their learning of racism and their role in it. But also supporting specific areas too. We have a program called Leaders in Nursing and Midwifery Education Network, and that's a network of nurse and midwife educators and academics who teach Aboriginal and Torres Strait Islander health and cultural safety. 

A large amount of that program membership is non-Indigenous nurses and midwives. We know that we can't do all that teaching, so it's supporting them to develop their practice, their knowledge, their confidence, and teaching cultural safety. Ensuring that we are developing that community of practice. 

When we're thinking about my role in all of that, it's ensuring that the ship's moving forward. We offer all these different programs and work within the organisation, ensuring that we're not taking on too much, we are staying afloat. But we're focused on those key areas that are important for the organisation that's supporting Aboriginal and Torres Strait Islander nurses and midwives, but also supporting our allies, because we know that's a very important part of our success as well. 

Yeah. So the acting role has been interesting in the sense that it's also 'acting,' that we're in transition between CEOs, so it's ensuring that we maintain momentum. My predecessor, Professor Roianne West established a lot of your seminal pieces of work for CATSINaM and [inaudible] 'gettin em n keepin em n growing em,' report. So ensuring that continues to mobilise into implementation has also been key on my agenda. It's been a busy time, I've been in the role for a few months now, but it's been a rewarding experience.

Tessa Moriarty [15:29] It's beautiful to hear. Like you said, there's a lot of work you do. There's a lot of work to do. Reiterating how important, as you say, those partnerships are, because CATSINaM can't do all of the work. Within your membership, do you have working groups, working parties as well?

Ali Drummond [15:48] That's something that we want to expand upon. I mentioned LINMEN before. It grew quite big several years ago, but since COVID it's been a bit dormant. It's really difficult to get people together and have face-to-face workshops. So we're trying to reignite that fire again for LINMEN. We have a collection of Aboriginal and Torres Strait Islander academics, who form a collective called Muliyan, and Muliyan's focus is research at the moment, research around Aboriginal and Torres Strait Islander health education and cultural safety education. 

It was a group that was funded by a Lowitja Institute grant. Lowitja Institute is an Aboriginal and Torres Strait Islander controlled Research Institute. It funded the establishment of this group, that funding has since ceased, and we're actually looking at expanding that program, Muliyan, to look at all the different priority areas for CATSINaM. So, as I mentioned before, workforce advocacy.

We have that research element behind us, we are looking at expanding in a way that we have temporary working groups for different priority areas. We know that projects and programs that were engaged in tenders, for example, or advisor groups, [inaudible] groups that were set up by the federal government, they have a short timeframe, but they're an opportunity for us to engage our members. 

Since starting the role in November, we've been engaged by the department to bring together our Nurse Practitioner members to advise on a Nurse Practitioner plan, bring together a number of our members from the university sector, provide advice in an official submission for the university cord, which is the government planning the next couple of decades of the university sector. We're trying to be a lot more agile around how we function, and also create opportunities for our members to actually share with us their knowledge and experience and us making the connection between them, and these big national projects and opportunities for us to make influence. 

It's a lot of work coordinating members, but it's an important part of our work. Because, you know, the knowledge doesn't sit with one person who's in the Acting CEO role. It's actually within the collective. So a big part of my role--sorry, going back to that previous question--is facilitating that.

Tessa Moriarty [18:06] Yes, absolutely. [That] CATSINaM have always been in the capital, in Canberra, kind of makes sense. Is that a strategic thing, as well, so that you're close to government?

Ali Drummond [18:17] Yeah, CATSINaM started on Bribie island. So Dr. Sally Gould, she's the one that instigated the CATSIN. Congress of Aboriginal and Torres Strait Islander Nurses, initially. She did her Master's on the participation rates of Aboriginal and Torres Strait Islander nurses, and from that Master's she brought together a whole heap of Aboriginal and Torres Strait Islander nurses and midwives to talk about the need for a national organisation. 

When it first started, it was based on Bribie Island, that's where she lived. It was just her and, when I first started in 2002, I think she may have had two staff members, but that's it. So it started as a small operation on Bribie Island, and it wasn't until I think 2009 or 2010 that it moved to Canberra. That's when Janine Mohamed, now the CEO of Lowitja Institute, she became CEO of CATSIN, that then became CATSINaM, and yeah, it's sort of been in Canberra ever since. It now has the bigger office in Brisbane, and we still have a small office here in Canberra, and it is strategically placed so we can be close to government, be close to the department, and key stakeholders. We are mostly government-funded, and work alongside the other Aboriginal and Torres Strait Islander health peaks. AIDA, the Australian Indigenous Doctor Association, the IAHA or allied health associations and NAATSIHWP, the National Association of Aboriginal and Torres Strait Islander Health Workers and Health Practitioners. They're all based here as well. 

So there is strategy around us also working together, ensuring that we're on the same page when we are negotiating the bigger things with government. I think government appreciates that too, that we are aligned with our approach, particularly around cultural safety, around addressing racism, around increasing Aboriginal and Torres Strait Islander health professionals within health services.

Tessa Moriarty [20:11] Our next question is, Ali, what does the future hold for Aboriginal and Torres Strait Islander nurses, midwives and students?

Ali Drummond [20:18] I'm just going to go back a little and mention one more thing around important functions, because I've talked a lot about how we provide advice and guidance. But I think for me, the most important part of CATSINaM is that CATSINaM is the collective. It's not just a building. It's the collective of Aboriginal and Torres Strait Islander nurses, midwives and students, and so our most important function is maintaining that community. 

Our conferences have always been a highlight for me as a member. There's been times when I've not been as close to CATSINaM because work's been busy, but knowing that there is always that annual conference to come back, to re-engage with mob from the other side of the continent I haven't seen for a long time. Even mob from the same city, we haven't seen each other because it's just been so busy. It's that coming together, sharing experiences, lessons, more strategizing, or how we've dealt with racism the last year, how we've pushed for more things within our workplace. So celebrating the blue sky moments as individuals, but also as collectives. I think that's so important for us as practising nurses and midwives. But it's also important learnings for students coming through, because they're learning about how to be resilient in the space because of the racism that they encounter. 

When it comes to what the future holds for us, I think we are keen to build upon that community and make it more active, provide more opportunities for people to get together. We're currently in a political landscape where we have very supportive federal government, have quite a number of Aboriginal and Torres Strait Islander ministers, including an Assistant Minister of Indigenous Health, who has been very supportive of CATSINaM, particularly the 'gettin em n keepin em n growin em' report. So they're across our work. 

The very supportive Commonwealth Chief Nursing and Midwifery officer as well, I meet with Alison regularly and she's really keen and interested to learn about the work that CATSINaM is doing. There's a lot of synergies that are happening nationally, and [we're working out] how we can leverage off the big national pieces of work and the Nurse Practitioner Plan is one of those we're able to strategize around. Okay, how do we get First Nations Nurse Practitioner voices, but also elevate First Nations Health within there? 

I think it's been important learning for me in the last few months, by hitting the ground running around getting those opportunities. I think the time is ripe right now more than ever, for advancing. Especially with the more challenging conversations around the need for addressing racism, and the need for us to be more culturally safe in our practice. We've been a lot bolder in our discussions, particularly with key stakeholders, like the Nursing and Midwifery Board of Australia, like the Australian Nursing, Midwifery Accreditation Council, and the very many Nursing Midwifery organisations that exist. 

To our surprise, and in a very respectful way, the organisations and leaders have been very receptive to learning to sitting and yarning about what the problem is, what can be done about it, and where does CATSINaM fit in the space, knowing that CATSINaM can't do all things, can't be everything to everyone. But we can certainly advise, guide and provide that critical friend, to provide that honest advice and guidance. 

I think what lies ahead is [that] CATSINaM is investing in those relationships. We're going down the pathway of establishing partnership agreements with our key stakeholders, and the intentions of the partnership agreements for CATSINaM to set forth its expectation of what it means to be partners with us. We want mature partnerships. We don't want to be the advisory group on projects that we've been brought in last minute. We actually want to co-develop things, and we want to co-implement. We also want to evaluate in partnership, and have those very robust and honest conversations about what didn't go well, and what could be done better. 

We know that an environment like this doesn't last forever, but we want to make hay while the sun shines, so we want to establish those relationships and do some really good work with our key partners, and I've already mentioned a few of them. We're very excited, and an important part of that is CATSINaM getting ready for those relationships. We're only a small organisation, there's only 12 of us, so we're also trying to build our capacity internally to ensure that we're not overcommitting and what we commit to we can certainly achieve for our members.

Tessa Moriarty [24:46] Yes. I've had some experience with primary health networks and the federal government programs that are funded specifically for Aboriginal and Torres Strait Islander peoples. I really think that there's a lot of work in those partnerships that can still be done on the development of programs that are much more suited to your people rather than programs that are being adapted, that you actually have a stake in the development of [them] from the get go, rather than adapt them. Because I've seen the opposite of that.

Ali Drummond [25:23] Absolutely. I guess that's why the Closing the Gap National Reform Agreement take two, the current one, the new one, has that as part of its key reform areas, about co-development, co-design, that accountability, transparency back to Aboriginal and Torres Strait Islander people. The people that we should be serving, in the context of Aboriginal and Torres Strait Islander Health, is Aboriginal and Torres Strait Islander people. So it makes sense for the people that should be served to provide that feedback, to provide that leadership, because we have to be held accountable to those people. That aligns with cultural safety. 

This is why cultural safety is about the care recipient determining what's safe for them in any given moment. This is why that partnership is so important, that relationship is so important. They feel safe telling us, "No, I want it this way." Of course we can't always provide care that these requests [are fulfilled]. I'm just thinking about my time in clinical nursing, there was a request around smoking of the room, it was very difficult to smoke rooms within the hospital because of the fire alarm system that was set up. It's difficult just to isolate one particular room or one particular section, so it was impossible to do. 

There's some limitations, obviously, to that. But in saying that, there are opportunities when we are developing and designing new hospital health services, that we keep those things in mind, that maybe we need to factor that some people would like their room smoked after the passing of a loved one. So it's not entirely impossible, but this is why the relationships are so important. We negotiate what's possible, within the parameters that we have, to ensure care is as safe as possible.

Tessa Moriarty [26:59] Absolutely. I've got one question. How can nurses and midwives better support Aboriginal and Torres Strait Islander nurses, midwives and students?

Ali Drummond [27:09] Yeah, that's a really good question. I think that, and I guess I've raised it a few times, but it comes back to commitment to continuously learning, developing an understanding of cultural safety. The theory itself, but it's also its application to Nursing and Midwifery practice. This learning can be uncomfortable. Research that I've read so far talks about the need for it to be uncomfortable, because it's supposed to interrupt what we see as normal. So: persevere through that discomfort. If you're not uncomfortable, perhaps you're not going deep enough. Revisit the theory, revisit the learning, get a little bit uncomfortable, that's fine. 

As individuals we can feel guilty or angry about being complicit, whether directly or indirectly, of poor treatment of Aboriginal and Torres Strait Islander people, and of other people as well. I should put that up front. Cultural safety is a really important tool for all our patients, all the people that we care for, and we focus on cultural safety for Aboriginal and Torres Strait Islander people, because the experience of racism by Aboriginal and Torres Strait Islander people is very significant. We've seen this in so many reports. I mean, we don't talk enough about how the gap that exists between Aboriginal and Torres Strait Islander people's life expectancy, and burden of diseases. We don't talk about how much racism impacts on that. We talk about how people discharge prior to their care being complete, or discharged against medical advice. But we never talk about how unsafe health service is, the reason why people leave. 

Aboriginal and Torres Strait Islander people are six times more likely to leave before their care is complete. That's telling us the health service out there that's supposed to help them is unsafe, and they would rather go home, continue being sick, risk getting worse, risk death, than to stay in that health service. We don't spend enough time looking at how unsafe our health service, and so that's why I think the focus for cultural safety for Aboriginal and Torres Strait Islander people has been so focused on racism.

Tessa Moriarty [29:06] It's shocking, actually, that is shocking that that happens. It's so important that you say that, that we remember that, that we hear that.

Ali Drummond [29:15] And learning about that, I think. Learning about the cultural safety and the operations of racism, how they operate. How a joke about Aboriginal and Torres Strait Islander people is sort of laughed at, or laughed along with by people, or people are sort of encouraged or ... no one says anything. They know it's bad and don't say anything. That's just one small example of racism, it can take many forms. Learning about cultural safety and learning about how racism can manifest is really important. Because racism can manifest and disempower people through jokes, not giving them the shifts that they want, and a trend starts to happen that Indigenous nurses or particularly Indigenous nurses, are given that particular shift. Then being allocated Aboriginal and Torres Strait Islander people, nurses, midwives being allocated certain patients.  

Just recently, last year, we had an Aboriginal and Torres Strait Islander midwife in New South Wales being allocated Aboriginal and Torres Strait Islander women, which wasn't a bad thing. When we think about cultural safety, it might be safer, but how it was written on the roster ... there was a derogatory term that was used to identify this particular midwife. The Nurse Unit Manager was informed but didn't do anything; I'm just talking from what I read in the media. There was no action from seniority within the ward. That behaviour was condoned, was supported, and seen as fine. The Aboriginal and Torres Strait midwife was seen as the one that had the problem, that they were being too sensitive. This was just last year.  

This is something that has happened over the years, I've experienced it myself. So it has many different forms. Understanding when Aboriginal and Torres Strait Islander people in this context are being disempowered, are being treated like crap for no other reason but for them being Indigenous, that is very challenging. I think nurses and midwives can better support Aboriginal and Torres Strait Islander nurses, midwives and students by doing training like Murra Mullingari, to understand cultural safety. Understand those different manifestations of racism. Learn in other programs, you learn language to address these things. It's far safer for a non-Indigenous nurse, midwife or student to actually step up and say, "Actually, that's inappropriate." This is why. Don't expect the Aboriginal person or the person who's being targeted with this racism to do it themselves. That's an important role.  

I think [the role that] nurses and midwives can play is stepping up. We see that [in] other campaigns, other racism campaigns, gender equality, we see that also in equality for LGBTIQ+ people as well. It's really extending that advocacy, that activism, that ally role to prevent them experiencing discrimination within the workplace. I must say, I think that addressing racism is going to be harder than those other forms of discrimination, because there's something very foundational to racism here, where we are on Aboriginal land.  

I was on Torres Strait Islander land, last weekend, when I was visiting home. These are all unceded sovereign lands. The existence of the nation state, the existence of Australia is based on us being on sovereign Aboriginal and Torres Strait Islander land. So there is a tension there that never really gets talked about. I think we're seeing it being talked about now that we've had the Uluru Statement presented. It talked very clearly about how the Crown's claim to the lands and waters of Australia cannot supersede Aboriginal and Torres Strait Islander people, because their sovereignty has never been ceded. The Uluru Statement speaks to that pivotal cornerstone we haven't really dealt with yet for our nation-state.  

When we acknowledge that, we can also see that these manifestations of racism are based on that tension, based on this sort of notion that, you know, Aboriginal and Torres Strait Islander people aren't human enough to be the sovereign people. This is why terra nullius was seen as viable because Aboriginal and Torres Strait Islander people weren't seen as human, lands belonging to no human, to no one. There's still that logic that exists, even though no one talks about it, if you unwind back, these manifestations of racism, it comes back to this tension around who's the sovereign owners of these lands and countries. Aboriginal and Torres Strait Islander people are a constant reminder of that. We disrupt a room when they walk in, because we're a constant reminder of that.  

That's why we are targeted with racist vile attacks, sometimes. It's telling us we don't belong in those spaces, we're not worthy enough to be in those spaces. In thinking about what nurses and midwives can do in that space, it's being more aware. Learning about cultural safety, again, [how to deal with] manifestations of racism. But in addition to that, understanding this big push now, this request from Aboriginal and Torres Strait Islander people in the Uluru Statement, and around having that voice to Parliament. Having the difficult conversations, the truth-telling about how to join history together. It isn't just Aboriginal and Torres Strait Islander history, our joint history. What's happened since colonisation, and the conversations around agreement making, because of those tensions, I've talked about that go back to the centre, that push us back to those racialized logics that then manifest as racism against Aboriginal and Torres Strait Islander people.  

Being aware of those conversations on a deep level as well and not just seeing them as rhetoric. Also acknowledge, as you take these learnings on board, acknowledge that Aboriginal and Torres Strait Islander people have always been that proverbial football, political football. All and any government has used Aboriginal and Torres Strait Islander peoples in different ways to get ahead, to get votes. Of course, we see this now and we have both sides taking different sides of the Uluru Statement. 

Unfortunately, it can get quite violent for Aboriginal and Torres Strait Islander people. All of a sudden, we just get pushed in front of cameras and microphones to speak on which side you take. All of a sudden, you have to condense this very complex matter into a 15 second grab. It's very violent, because it's very complex. So learning about cultural safety helps you understand how those power dynamics work, how Aboriginal and Torres Strait Islander people are kept disempowered, even in a political context that's supposed to be supportive of us. It's become quite unsafe. 

Tessa Moriarty [35:41] Yes. It's both humbling and inspiring to listen to you. To be in that space of not knowing, not having understood, but wanting to, and wanting to say something in itself can be quite anxiety-provoking because I don't want to say the wrong thing. But I want to say something. I'd rather be there than not be there. I'd rather be here. 

Ali Drummond [36:05] Absolutely. I guess that's why it's important for us to have space for our non-Indigenous allies, and create space for them to have those conversations. Communities of Practice are important for that. I think if listeners out there also are thinking about the same thing, it's finding like-minded people. When I say like-minded, it's people who are interested in having communities where they can have robust conversations that are informed by evidence, that are also compassionate. Not finding people that will just stay in the silo with you. These complex matters require different perspectives. I think you're better prepared, then, to disarm others who are out there to just cause harm, or to spread ill-informed information or rhetoric, as we're seeing at the moment in the current political landscape. 

It can be very challenging when you want to say the right thing, and you don't want to condone the wrong thing. I know that some spaces where people can come and get together, it's mostly for Aboriginal and Torres Strait Islander people to talk, and others to listen. I think they're spaces that can work well too, where it is about listening and learning from the interactions. From what's being said, the theorising that happens ... you know, Professor Chelsea Watego talks about how Aboriginal and Torres Strait Islander people have been disempowered for so long, put at the bottom rung for so long, and reminded that that's where they belong. But it's from those places where Aboriginal and Torres Strait Islander people have learned about the worst of racism, and so understand how it operates within the systems. She calls them 'vantage points,' where we learn about how racism operates, and then strategize against those things. 

I think in those spaces, you can learn a lot from Aboriginal and Torres Strait Islander people, this is why our voices are so important. It's why we should have a voice at the table, because we know how the system hasn't been designed for us, we know the pattern of those systems and processes. We can anticipate those. We can also advise on different ways of disarming those systems and processes. That's why our voices are important. 

That's why I think those spaces are really nice, when non-Indigenous people can sit and listen. But I think there's also room for critical spaces for non-Indigenous people to have those robust conversations amongst themselves. Because these are systems and processes designed largely by non-Indigenous people for non-Indigenous people expecting everyone else to fit the mould. So I think there are important, robust conversations to be had there. 

It's not about saving Aboriginal and Torres Strait Islander people, because what we find, particularly when we look at the examples of Aboriginal and Torres Strait Islander health organisations, is that when Aboriginal and Torres Strait Islander people design different things that meet the needs of Aboriginal and Torres Strait Islander people, it actually meets the needs of the broader population as well. Having worked in the community for a health service in Brisbane, I've seen non-Indigenous people come in because the GP service that they've been going to was limited in its way to actually engage with Allied Health, engage with broader social determinants of health as well, so asking questions beyond that, found value in that. 

So I think systems that are better suited to and designed for Aboriginal and Torres Strait Islander people can actually better serve the broader community. So there's lots that we can learn from Aboriginal and Torres Strait Islander people as well. 

Tessa Moriarty [39:25] Beautiful. Wonderful answer, wonderful conversation. There's so many learnings in what you're saying.

Elle Brown [39:31] Thank you, Ali. That was a wonderful yarn.

Ali Drummond [39:36] Thanks. Thank you both. Really enjoyed that.

Elle Brown [39:39] That's all for today's podcast. Please remember, support is available whenever you need it. Nurse & Midwife Support, you can call on 1800-667-877. This service is anonymous, confidential and free, and you can call 24/7, or contact us via the website, nmsupport.org.au. Your Health Matters.