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‘Big systems’ create challenges for Indigenous health

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Australia’s diverse healthcare system has won accolades around the globe. But navigating its sheer size and complexity can be difficult, not least for Australia’s Indigenous community, says Curtin alumna Melanie Robinson.

This is why spreading the message of ‘cultural safety is so vital, according to Robinson, CEO for the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM).

Robinson, a Curtin nursing graduate from the Ngallagunda community, was appointed to the prestigious role earlier this year.

“‘Cultural safety’ is about recognising difference,” Robinson explains. “The nurse or clinician should allow the patient to feel safe to be who they are.

“It’s the patient who determines if the practitioner or health service is ‘culturally safe’, if they feel comfortable and treated with respect.”

Robinson says many Indigenous people struggle with ‘big systems’ like hospitals and find them a scary and confusing experience.

“Empathy and compassion are critical,” she emphasises. “Sadly, our ‘big systems’ don’t seem to make room for people’s individual needs. For example, when making an appointment, clinics will tell everyone to turn up at 8:30am and then make you wait for hours.

“‘Big systems’ don’t care that you may have young children, that you can’t afford the train or bus fare, or have to drive a long way to get there.

“If the patient doesn’t attend the appointment, they are blamed. Nobody stops to consider there may be other circumstances at play.”

The concept of ‘cultural safety’ originated with the work of Irahapeti Ramsden in New Zealand in the late 1990s and has been adopted extensively by the Australian healthcare sector.

According to Aboriginal and Torres Strait Islander representative body, CATSINaM, cultural safety’ provides a ‘decolonising model of practice based on dialogue, communication, power sharing and negotiation.’

Melanie Robinson, CEO of CATSINaM

The effects of inter-generational trauma on Aboriginal and Torres Strait Islander children and families have been well documented.

The 1997 Bringing Them Home report investigated the impact of Australia’s former policy to forcibly remove Aboriginal and Torres Strait Islander children from their families. The children were taken from their homes from the turn of the twentieth century until the practice was abolished in 1967. Today, these children are known as the Stolen Generations.

Robinson’s own grandmother was a child of the Stolen Generations, taken from her home at Lamboo Station near Halls Creek to Beagle Bay mission, north of Broome.

Robinson and her family were adopted by the Ngallagunda community.

“To be accepted as Aboriginal or Torres Strait Islander you must be identified, be recognised, and accepted by an Aboriginal community,” Robinson explains. “I was lucky to grow up in a strong and proud community that taught us their ways and adopted us as their own. To this day, they tell us: ‘This is your home, your place and you belong here.’”

Robinson describes an idyllic childhood on a remote cattle station in the Kimberley region, surrounded by Aboriginal elders. She talks about the incomparable freedom, swimming in breathtaking gorges and exploring the country.

“I grew up surrounded by family,” she recalls. “My cousins, brother and sister were my playmates and my friends. We also met other children our age at School of the Air camps.”

As a student of School of the Air, Robinson received lessons via two-way radio from her teachers, and her schoolwork arrived on a mail plane once a fortnight. However, communication would be cut off during the annual wet season from November to February. Heavy rains and flooding closed Gibb River Road and isolated the community for months at a time. Not even the mail plane could land.

It was during this period, at the tender age of seven, that Robinson decided to become a nurse.

“I loved caring for my brother and sister and helping others and knew nursing would be right for me,” she says.

After graduating high school, Robinson enrolled in a Bachelor of Nursing at Curtin and said she loved the course from day one.

“I loved studying at Curtin,” she reminisces. “It was the place I felt that I belonged. I had a great network of friends who were mature age students and already enrolled nurses. We created study groups and they taught me about nursing and shared all their stories. We helped each other get through university. Everyone was so friendly and helpful. I still see my old lecturers from time to time.”

However, Robinson struggled with feelings of isolation and missing her family.

“Having grown up in an Aboriginal community and having lived around Aboriginal people all my life, it was weird to not see another Aboriginal person,” she recalls. “I was the only Aboriginal student in my year and I never met another Aboriginal nurse until I graduated.”

Upon graduation, Robinson returned home to the Kimberley and accepted a placement at Derby Hospital.

“I loved working at Derby Hospital,” Robinson smiles. “I learned a lot of skills and translated theoretical knowledge into practice. I developed my love of paediatrics and aged care in Derby. I also went to Fitzroy Crossing for six weeks where I learned to take x-rays and bloods. Often it was only me and a midwife on duty.”

However, at times, Robinson’s deep connections with the community left her feeling conflicted.

“The hardest part was belonging to the community and feeling torn when other clinicians made rude or disrespectful comments about a patient and you knew them and their family. It was personal and I had to speak up.”

Despite these concerns, Robinson found her nursing work deeply rewarding and satisfying.

“When an Aboriginal patient or family saw me come in the room, or on the ward, they were so happy to see me,” she recalls with pleasure. “You already have a connection so they automatically trust you and they always wanted to share their experiences or worries with you. They knew I would advocate for them.”

Over the next few years, Robinson worked in London and Dublin before accepting a position at Princess Margaret Hospital, where she worked for the next decade in oncology, hematology and intensive care.

“It was very challenging and specialised, but I loved working with children and their families and creating such strong bonds with them throughout their care.”

As well as working in major metropolitan hospitals, Robinson’s wide-ranging career has led her to support local Aboriginal communities as a nurse educator and seen her rise the ranks of government to become Director Aboriginal Health in WA’s Child and Adolescent Health Service.

Today, as CEO for CATSINaM, Robinson is passionate about supporting and growing the number of Aboriginal and Torres Strait Islander nurses and midwives across Australia.

“I always tell students and young people that nursing is a great career and it can take you to many places around the world,” Robinson enthuses. “It can help you get roles in places you wouldn’t even imagine, like education, policy and leadership.”

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