Cultural safety: Hearing from other health professions

"There is beauty and strength in culture. Knowing, being and doing. This new experience is furthering my journey in cultural safety and understanding. Even as an Aboriginal woman myself, I am still on a journey," Chastina said.

See also:

• Why LIPPE? What will it do? A yarn with Faye McMillan
• What pharmacy academics say about cultural safety curriculum design

IAHA survey

IAHA represents First Nations people working in Allied Health disciplines. Mr Paul Gibson, IAHA, shared survey findings on their experiences regarding cultural safety, racism, and lateral violence within education, clinical placement, training, and employment. More than 100 IAHA members across a diverse range of sectors had responded to the open survey in 2022.

Findings:

• Racism is still prevalent within systems.
• Nearly 30% of student respondents said they did not always feel culturally safe within a university setting.
• One-third of respondents have experienced racism within the past 12 months.
• 40% of respondents felt the need to justify their position and culture within their education and training.
• Of those who experienced racism, it was not just public-facing. It was most commonly through their peers and educators and was more common within a clinical placement setting.
• It's important to have Aboriginal and Torres Strait Islander representation and visibility within universities, having peers to share learnings with, and the representation of Indigenous knowledge within curriculum.
• Leadership at all levels to ensure that things are done differently and to lead transformational change is important.
• But many respondents were unsure if their leaders were committed to cultural safety and the health and wellness of Aboriginal and Torres Strait Islander people.

Lessons learned: Systemic, structural and policy change

Anna Tiatia Fa’atoese Latu has a gift of sharing great learnings through beautiful lived experiences. She reflected on institutional systems and structures after a 5 day stint at the hospital for a family member.

"I saw lots of my students that I taught in medical school years back, who are now beautiful doctors, but not one of them said Kia Ora."

After teaching them everything about building relationships with patients, she was disappointed to experience a lack of engagement with her around her family. To which her husband responded with, 'The institution is still the same.'

"That was a really good lesson for me in that moment. We're so passionate about making a difference. I carry it everywhere I go. How can I shift those stats? How can I make a difference for my people? And I know that my colleagues are just as passionate.

"But until the institutions, systems, structures, and policies change, we're still going to be hitting our heads against a brick wall," Anna said.

"I hope we're inspiring people here to stretch, to change, to want to learn more, and say 'I’m going to make a difference in my lifetime'. Because the sooner we get more people onboard making small or big changes, the sooner we're going to see those statistics shift.

Strengths Based Approach

A challenge known to educators in the pharmacy space is changing the way that previously a very western institution and perspective of health was put forward and taught.

"Much of the time it was statistics about Indigenous versus Non-Indigenous rates of disease without any other real opportunity for context or discussion, and that's often what we talk about when we say a deficit discourse narrative," Chastina said.

Chastina emphasised the complexity of understanding deficit models and that it takes intentional research and practice to understand what we're doing that may not be best serving First Nations peoples.

What a Strengths Based Approach looks like

A Strengths Based Approach may look like:

1. Focussing on resilience, protective factors, empowerment, importance of wellbeing, decolonisation methodology, and cultural appropriateness.
2. Explaining social determinants of health. If someone does not have access to a refrigerator because of where they live, this part of the story needs to be told for safe medication management and minimising the use of our internal assumptions and bias. Whilst some people may not think of people living in an urban setting as experiencing disadvantage, it is very different to a context within a very remote healthcare context.

"It is not about minimising the disparity or ignoring the lived experience, reality and truth. It's just not the only story that should be told," Chastina said.

Understanding your journey

Acknowledging that NAIDOC Week had recently passed, Chastina asked us to reflect on the pledges we made in the first webinar, and the actions we had taken since.

In our break out rooms we responded to three questions:

1. What are the existing strengths, assets, and things that you have access to that can support you to take action?
2. What might be the first step in the journey for you?
3. What are the things you can commit to doing today, this week, next month, and beyond?

Key highlights from the breakout rooms:

• Have commitment across a department so that responsibility is not with one main advocate.
• Place value on the time and resources that are required to do things properly.
• Think about strengths and assets that we can build on and actions that we can take to put us on the journey.
• Reflect on things that are holding us back or that need to be overcome – may need to put ourselves out there a bit more to get started on the journey.
• Understand the role of relationships.
• Be able to learn from others and your own experience.
• Support and seek feedback.
• Cultural safety should be viewed as a lifelong journey.
• Reflect on the role of cultural training in experience and journey.
• Acknowledge where you are on your journey.
• Understand that it is okay to be afraid to make mistakes.

"The benefits of these sorts of networks is you can influence change across your profession. Having a group of people who are looking to take action within your own spheres of influences at individual, community, and institutional levels is a powerful thing," said Paul Gibson.

“As Indigenous people, we know who we are. We are those people every day. We do our healthcare business and we’d love you to be able to do it with us as well,” Chastina said.

"There is beauty and strength in culture. Knowing, being and doing."

The LIPPE at Noon webinars aim to bring together like-minded people wanting to see Indigenous voices in the delivery of pharmacy education. It's where we build the LIPPE Network!