Cultural safety can only occur when differences in culture are recognised and respected and these differences are incorporated into health service delivery.[79] Cultural safety requires the health practitioner to explore their own cultural make up. Based on attitude change, cultural safety training aims to educate the practitioner to become open minded and non-judgemental. Not blaming the victims of historical and social processes for their current situation is integral to cultural safety training. Cultural safety encourages nurses and midwives to have a thorough understanding of poverty and its impact on people.[83]
Anecdotally, there are many remote area practitioners who have had limited or no formal cultural training prior to working in remote Aboriginal communities. Most will learn from the Aboriginal health workers who are an integral part of the health team and have many responsibilities in their positions. Many government reports and departments recommend cultural training courses be attended by all practitioners who are working with Aboriginal people. This is particularly important in the Northern Territory where 30% of the population are Aboriginal, increasing up to 100% in remote communities. Yet still today there are many practitioners working in these areas that have had no specific cultural awareness training.
In our cross cultural training there was absolutely nothing mentioned about birthing. It wasn't even health orientated. (Remote Area Doctor)
I've worked for several different communities and have never had cross cultural training. (Remote Area Nurse Midwife)
The one we did in Darwin was all general - nothing health related. Most people that did it were people working for the Public Service. And even then it sounded better than the one that one of the doctors did. They said they were taught by people who were based in Sydney. (Remote Area Nurse)
One report in the NT found community members were frustrated that the health service providers lack social and cultural knowledge of the community and have suggested that regular sharing of information and community based engagement by the service providers are strategies that would improve health outcomes.[80] The lack of (or limited) cultural awareness training, and not knowing how to access resources and knowledge already present in remote Aboriginal communities mean the health service providers are not always working collaboratively with community members. Lack of knowledge rather than lack of motivation may result in poorly directed effort, misunderstanding, frustration and ‘burn out’.
I can still remember things that happened when I was new in a community you sort of flounder a lot, luckily we had a lot of health workers, but still I’m sure we made these huge faux pas all the time, but you just don’t know. You slowly start to have that picture when you first go to the community but if there was something written down some sort of general guide it would help. It was so frightening to know that I’ve done the wrong thing and said the wrong thing, no one tells you. You just go around putting your foot in your mouth all the time until eventually one day you go… ah ah and it clicks… I should be doing something else. (Remote Area Nurse Midwife)
There is such a variety between each individual as well. What you say to one individual won’t work with the other one so there is a lot of muck ups. Cause you might have to not say some things to some people whereas other people you can be up front and say things. (Remote Area Nurse Midwife)
You don’t know, because you can’t know everything. I just find it easier if I ask some of the people that are there. Sometimes you get that feeling, you think maybe there is something going on, you don’t really know, but you are aware that there might be cultural business happening. (Remote Area Nurse Midwife)
Listed below are some of the examples that the Maningrida women gave when talking about culture.
There are many resources available for people who want to learn more about the Aboriginal culture. These are just a few examples of things that were highlighted during our talks.
Learning all the rules – from way back – from our great, great grandfathers. (Molly)
Culture is still very important. If a baby is born to the wrong skin then there can be problems - they might be deaf, dumb, or anything can happen, death as well. (Margaret)
My father told me the right way to go and how to follow the rules but these days those young girls don’t listen to parents anymore. (Sharon)
When the young ones ask the older ones for money they can’t really say no, we share all the time, even if the old people end up with no money, that's just our way. (Molly)
When you have funny feelings in different parts of your body it might mean that there is something wrong with someone in your family. Different parts of your body refer to different relatives, this is used for sign language too. (Molly)
Have you ever been out in the community looking for someone and just been ignored when you call out that persons name? You might be talking to their poison cousin and putting them in a difficult position. There will be times that AHW's are not able to see someone who is sick, depending on their relationship with that person. These are the avoidance rules which are an important part of the kinship system.
You can’t talk to your poison cousin maybe you can talk to the girl one (but you shouldn't really) but not the boy one. And with the boys – they can talk to their poison cousin boy (but you shouldn't really) but not girl one – you can’t go near them.
Who is responsible for looking after the older people?It is the role of the first grandchild to look after the grandmother. (Molly)
The ceremonies are still very important for our culture and it’s important the midwives know about the ceremonies. There are some ceremonies that children are not involved in. One of the important ceremonies is the young mans' ceremony and another is the funeral ceremony. (Alice, Sonia, Charlie, Molly and Nellie)
During the young mans ceremony my brother in law rubbed my hair with the blood from that ceremony. That was what made my hair go white. It can happen that way - like if you drink the water from Daly River - that can make it go white too. (Molly)
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| Marie and Mary collecting white clay |
The funeral ceremony can go for weeks.
It depends on your relationship to the dead person as to whether or not you can see the body.
Often we use white clay for painting the skin.
White clay has many uses - see below under bush medicine.
We still have the ceremony for the widows and they wear a special necklace around their neck. They never take it off, not till it breaks off.
We also have a funeral ceremony for the babies if they die. These days if a little baby dies it just gets buried, by itself, not with other family members, but in a special place. All the families talk about it and they decide where it should be buried.
To non-Aboriginal people the kinship / skin system is very complex and yet to Aboriginal people it is second nature. The skin system is a way of knowing your relationship to other individuals and the roles and responsibilities you have to these people. Amongst other things it includes who you are able to talk to and to marry. It is not something anyone can learn about quickly.
It’s too difficult to learn as soon as you come. You need to take time I think. I’ve been out here for just over twelve months, maybe I’m a little bit slow but it’s taken me that long sort of to get my mind around all the different tribal groups, knowing who comes from where and that sort of thing. It takes a while to work out which family of people belong to which tribal group. (Remote Area Nurse Midwife)
The diagram below illustrates the skin terms and relationships for several
of the language groups in the Maningrida region. It was produced in 1993 by
Murry Garde, Research Office, Maningrida Arts and Culture.
It is very important to marry someone who is the right skin. It is best if the young girls marry their promised husband first as then there is no trouble. Then after he dies it is all right to go with their boyfriend. But not everyone marries his or her promised husband anymore. (Wendy)
There is big shame about having babies like that, they have babies with the wrong skin names and it is complicated who is the real father and which is the right skin for that baby. I don’t know what is going to happen, it is their decision, it is their problem, they go around with the boyfriends with wrong skins and families start to get worried and they start arguing and fighting. (Alice)
Some girls you know they go like really right skin but the wrong side. It doesn’t matter so much for the young girls but I think it does for the older women, for them it is still important. (Sonia)
These days it is not like before, we married right skin but now new generation they getting married wrong skin. Now they just go for love you know, doesn’t matter what kind of skin they are anymore. Any skin, it’s up to them, if they choose their boyfriends let it go. I don’t like it but it’s alright. So if boyfriend and girlfriend are wrong skin and they have a baby that baby can’t go to the business camp. Never able to go, not even young man’s ceremony, they can’t do it, they tell them to get out, the older men, like really old men with white hair tell them, don’t you come into my area, you’ve got to go because you have the wrong side skin. That baby might be able to go to the business camps if it stays with the father, but not with the mother. (Dorothy, Joy, Dora, Tinica, Nancy, Rosie, Phyllis and Molly)
This side, the Bululkarduru side, they say that skin groups are still very important and everyone marries the right skin. The young girls are all still going with promised husbands. (Nellie and Lena)
Talking about recruiting Health Workers to work in the Health Centre....
I think it’s really important to have senior Aboriginal health workers to learn from, you just can't work without them. (Remote Area Nurse Midwife)
They don't like to work in that clinic because they get jealous for their husbands. Or maybe the men might get jealous to that girl. But if the husband and the wife both work in the health clinic, that might be better. If there is a Health Board meeting then if we get word from them and we go to the Health Centre and tell them who should work there. There should be one from each of the seven groups in the community, if one of them works in that clinic then it should be both of them, girlfriend and boyfriend. That is the best way. (Dora, Joy, Verity, Rosie, Molly)
This is something we might have to talk to the landowners about. They might get jealous, if all the Burarra (different language group to the landowners) go and work in the clinic the landowners get jealous and talk about it and they say 'why does this lady from there come and work here?'. (Alice)
Lena and Laurie started to ask the boys and girls to go and work even the men – but in this community all men and women sitting down with their own money and playing cards with sitting down money and the clinic doesn’t do anything – they get money for pension people and they spend that. The clinic should do something like keep old peoples money in their bank – and if the old people ask the nurses or the bank owner – then they can get the money for them. (Alice)
Some women are not allowed to work as their husbands get jealous. (Molly)
During the seventies and eighties we had two trucks and we had trouble - fighting over keys, who was going to take it home, who will look after the keys, who will go to which outstations. They only wanted to go for a health visit if it was their country. Even today the trucks cause trouble. When we ask around for health workers they say 'we don't know we have to think about it'. Some girls they say it is too much humbug. (Margaret)
The change in lifestyle has brought with it and increase in diseases such as obesity, hypertension and diabetes. The traditional life of hunting and gathering with plenty of exercise and eating bush food with a small amount of store bought food, meant that mothers were lean and healthy. These days many people ‘hunt’ at the many food outlets and frequently make bad choices of food and do not get enough exercise. Consequently there has been a large increase in the numbers of people with lifestyle diseases. Whilst some people listen, many don’t and only take notice when their health is declining. (Hellen Matthews RAN/RM)
If women had any trauma from birth they would use bush medicine to assist with healing. They would collect the stems from the ‘aspirin tree’ called the Midadima tree, it has little red berries on it, but it is the roots and stems that are used. They strip the bark from it and then they boil it. The fluid can be used for scabies, headache or a cough. The roots go all soft and they can be used as a poultice for healing after childbirth. (Theresa, Marie, Nancy and Mary)
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| The leaf of the 'aspirin tree'
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| Marie preparing the stems
and the next day, after boiling, it is placed in the
bottle. |
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As they do in many countries:
They would use breast milk for the babies eyes if they were sore. (Molly)
They would use bush plums and put them all over them as well as eat them (bush plums are very rich in Vitamin C). (Barbara)
White clay has many uses...
The white clay makes the bodies and skin lovely. It can be used on boils and it helps to stop diarrhoea, it might help them to fall pregnant too. People eat it to stop being hungry when they don't have much food available. When they go hunting and they get thirsty for water they eat the white clay and it makes them wet. You shouldn't eat the white clay if you are pregnant, it can make the baby weak inside and could cause a miscarriage. (Mary, Marie, Nancy, Molly and Dorothy)
I'm eating white clay to stop the hunger, I'm on CDEP and only got paid $62 last fortnight as my son is going through 'young mans' ceremony and I could not go to work.
Elizabeth here knows about bush medicine, for sores or anything. Like that gum tree there, they take that bark and they burn it and the smoke from the bark will make them better. They make that medicine for kids when they are getting too skinny and their eyes are getting sunken from the diarrhoea. (Molly, Deborah and Elizabeth)
Traditional healers are also called bush doctors, medicine men, witch doctors and Ngangkari (in the Centre of Australia), too name a few. In the Kuninjku language the word 'Mankordang' refers to the power to heal, with 'nakordang' being a man with this power and 'ngalkordang' being a women with this power. Many people continue to use traditional healers, often before they go to the health centre. Many remote area nurses have stories to tell about working together with these practitioners. Often working together will improve the outcome for the person who is seeking help, as it ensures a more holistic approach to health care. Their skills are complimentary to the care offered in the Health Centre and cannot be replaced by it. More information about traditional healers can be found in the article Traditional Aboriginal Medicine Practice in the Northern Territory by Dr D Devanesan.
There are still traditional healers out bush, both men and women. They learn that business, they are not born with it. One lady, she lost her power because she drank hot water. Many people go to the traditional healers before they go to the clinic, they do special things with their hands to make them better. They go for flu, diarrhoea or anything. You have to pay the medicine man if you see them. (Phyllis)
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| Charlie is showing how they used
to use paperbark for carrying water |
After the baby is born, if a woman didn’t want any more babies, the baby bag goes together with the green plum, with the skin off, and they both get given to the green ants to eat. That can stop the babies for that woman. If she wants to have more babies they put it in another place, somewhere else. But it is up to the men how many more babies she has, he decides. (Charlie - Traditional Healer)
People come to me for bush medicine, I can help them get better. Sometimes I have to tell them to go to the Health Centre for that strong medicine and sometimes when someone is sick I work with the Health Centre to make them better. (Charlie - Traditional Healer)
People do still go to the bush doctor but never the pregnant women. (Theresa)
People still go the the traditional healers, all the time. They might suck the blood or mucous out to make the headache or chest better. But they might say you have to go the the clinic to get strong medicine. But they still use lots of bush medicine. Lots of bush medicine plants are now growing at the clinic. (Margaret)
We think it would be a good idea to take the new nurses on a women’s camp so they can learn from the older women. We should go around and get all the woman so we can go far away. Like one of the strong nurses from the clinic and go and explain to them at the bush somewhere, like in a bush shed or somewhere like a creek or good territory where we can take them, all the sisters, like you know, so we can explain to all the young nurses and talk to them. (Ruby, Esther, Dora, Rosie)
Smoking Marijuana (Gunga) and drinking Kava (from the root of the Kava tree) were problems that were identified by the women as influencing health.
When they run out of money and he starts to bargain with his wife and if she has the gunga they start fighting with each other about who should have the gunga. That gunga should be stopped. Just as they start to run out they get really angry, the husband starts breaking things up and its really sad. (Alice)
But grog, not many people drink at the moment – everyone smokes gunga instead. They might go mad in the head as that gunga is working really hard – yes it is making them really cranky. Then they are too lazy to take them hunting so the grandmother has to take them hunting. (Alice)
That gunga drug comes out in the breast milk, that’s why those babies will be really small too, their eyes. (Sonia)
Some women are smoking gunga and drinking Kava, even when they are pregnant and after the baby is born. This means the grandmother or father has to look after the baby. You can tell who drinks Kava as their skin gets dry and they get skinny. (Wendy)
Sometimes they spend too much money on the gunga and also they make a problem too, for parents. It’s the young guys and some of the young girls too and the young boys they come round and ask for money. They like smoking all day and night and if you don’t give them that money they turn around and make problem for you, it’s causing some of the fighting in town over the gunga and the money. Lots of money is going to the dealers in this community. (Deborah, Sonia, Sharon, Janet, Janice)
They can smoke any time of day until it is all gone. Even some pregnant women or women with small babies they are smoking too. Some people, like they need more money for gunga they waste lots of money - $100, $150. At my place when the young people smoke gunga they come around asking for meat and food everyday. Cause the gunga does that to them you know it makes people hungry. But when they are smoking you feel like it doesn’t make them want to go hunting. Because they get weak. They don’t go to school. Last week some of the men they asked some boys to go in to that ceremony but the young boy said no we don’t like to go and stay there without smoke. In their brain they think gunga all the time. (Deborah, Sonia, Sharon, Janet, Janice)
Even when they are eleven, twelve, fourteen, fifteen right up to old people they will use that gunga. When they are pregnant or their baby is outside they smoke whatever they call it that one there with water in it (a bong). When they play cards and they win they go and get the gunga they don’t buy their food they just smoke everything even all the women they are loosing their petticoats because they are getting too skinny from the gunga. (Molly)
Cause they spend all their money on gunga and they can’t afford food, they don’t buy food even baby food. So the kids aren’t getting fed properly. We should stop it altogether, that is my idea, they probably have fifty million dollars from this area. We see the truck coming in all the time – we all know when it comes in. They get a very small amount for $50, but even though it is banned it is still coming in from Darwin, they have it and here we have it. It is getting better because they are trying to stop it. (Molly and Dora)
There is a ceremony for dogs and young boys. The dog is very important for the dreaming, it is in the culture for us one of my granddaughters, that is her dreaming now – the dog. They should stop if they hit a dog with their car. When dogs are sick you shouldn’t do anything until they die themselves, unless they ask permission then it is OK to give them that sleeping injection, we used to get the vet to do it when they visited. (Alice)
For years Aboriginal women have been saying that women's business must be attended by women and men's business by men. I wondered if this was changing with the 'new generation'. However I did not talk to anyone that felt this was changing, women of all ages felt strongly about this.
No it is not OK to see men for women’s business, not even the young girls, its a shame job. The young girls are too shy, they do not want a man to check them up. Women should never see white men for women’s business, many of them are frightened and shamed, it is not the Aboriginal way and their husbands can get jealous. (Joy, Rosie, Verity, Amanda, Sonia, Molly, Wendy)
You need the men for men's business, but not for women's business.
If a baby is born with a handicap what can they do, if they wanted that baby they would keep that baby. The women don’t want to know about a handicap, they will just wait till that baby is born, they don’t want to loose that child. Even if there something like handicap or something even if it is a very bad handicap they still want to keep that baby. That child was coming up from the water and when the women went past that area then that baby just got into her body, the handicap is the dreaming for that child. They will want to keep that child, it doesn’t matter. You know that handicap child, the mother got pregnant with her and she saw her, then the father saw her and the rest of the family saw her and they knew that she was from that dreaming place. (Mary, Theresa)
Some babies are just born with a problem – not from the dreaming. (Joy)
They should not eat turtle when they are pregnant, some they’ve got little noses, some they’ve got big head and big nose, but the small one really turtle it got small nose like you know one little girl who was crippled her mother ate it when she was a little girl in her tummy. (Dorothy and Molly)
Molly told a story about her husband….
It is very important to die on your own land. When my husband was dying he was very weak and they wanted him to go into Darwin to have a blood transfusion to make him feel stronger. He didn’t want to go because he wanted to die on his own land, but they made him go. He had that blood and was OK but then he got sick and died while he was still in Darwin. This was the worst thing that could have happened to him.