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Summary of Concurrent Sessions

Leading in Allied Health Research

One of the early highlights of the 2018 Forum was a panel discussion on Leading in Allied Health Research. Facilitated by Mr Romlie Mokak, Chief Executive Officer of the Lowitja Institute. The panel featured a range of Indigenous perspectives through a high-quality panel featuring Dr Teah Carlson, Massey University, Aotearoa; Associate Professor James Charles, Deakin University; Katherine Burke, University of Hawaii; and Dr Evan Adams, First Nations Health Authority, Canada

Reflecting on their experiences as Indigenous researchers and working with Indigenous communities, the panel developed and expanded on themes recurring throughout the day. Indigenous peoples worldwide have been heavily researched, but often without the benefits for Indigenous people that should come from the research. The discus­sion highlighted the need for allied health research that is ethical, action-oriented, decolonising, and participatory and which is of direct benefit to Indigenous peoples and owned by community. In Australia, IAHA members will have an important and ongoing role as the Aboriginal and Torres Strait Islander allied health workforce in the conduct of high-quality, translational research that is conducted with community to meet their needs. As Associate Professor James Charles said, “allied health has a lot to offer to professional service and in research”. Below are some high­lights from the work presented by the panel.

Dr Teah Carlson – Indigenous Gaze: Value in Worldview 
Dr Carlson is a kaupapa M?ori researcher and evaluator at SHORE and Whariki Research Centre, Massey University. Dr Carlson spoke of the effects of colonisation of M?ori health and wellbeing and that research and evaluation must be ethical, action-oriented, restorative, transformative, decolonising, and participatory.

“Our power as M?ori is innately relational, {it) depends on the gathering of networks, recognising the entitlements of individuals that are exercised within the wellbeing of the collective.” 

Dr Carlson’s research is about transforming health literacy and advancing an Indigenous health literacy, communication, connection, skills, abilities, environment (access).

“Ways of ‘knowing’ begins with narratives – embodied through our connections to place, time and histories. These narratives are interwoven and engage with, and are a product of, our experiences. Experience involved lived experi­ences, testing and evaluating narratives to our own context, including interactions with and between people. Our ex­periences then informed our Practice, encompassing our attitudes, skills, abilities and ultimately knowledge.”

Dr Evan Adams shared his experience as the Chief Medical Officer for the First Nations Health Authority (FNHA) in British Columbia. FHNA is the first province-wide health authority of its kind in Canada.

In 2013, the FNHA assumed the programs, services & responsibilities formerly handled by Health Canada’s First Nations Inuit Health Branch – Pacific Region. This provided the opportunity for the FHNA to reform the way health care is delivered to British Columbia First Nations peoples, to close gaps in health disparities and improve health and wellbeing.

Dr Evans addressed the issues that FHNA are now addressing through the provision of health and wellbeing services, such as the legacy of trauma and health and social inequities which is the result of colonial policies, legislation and systems, and human rights violations against Indigenous children via the residential school system, the Sixties’ Scoop, Indian Hospitals, the Indian Act, and the Indian Reservation System.

First Nations people continue to be impacted by the ongoing legacy of colonisation and oppression as well as present-day systemic and internalized racism. These factors continue to affect the health and wellbeing of British Columbia Fist Nations people today. The FHNA tells us that in their work, they aim to shift the paradigm by following a strength-based, wellness-focused approach.

Associate Professor James Charles discussed his podiatry research on biomechanics including conditions like Equinus and ‘Flatfeet’ and collating data within Aboriginal communities.

Associate Professor Charles has been instrumental in demonstrating the relationship between ankle equinus, bare-foot plantar pressures and diabetic neuropathy in Aboriginal Australians. Aboriginal people have high incidence of musculoskeletal injuries, however there was no research that investigated the impact of musculoskeletal injury on weight gain, treatment, quality of life, and social and emotional wellbeing.

An Aboriginal Musculoskeletal Injury Questionnaire (AMIQ) has been developed from a modified Bristol Foot Score (BFS). The AM IQ can assess the impact of foot, ankle, knee and back injuries on quality of life in the Aboriginal community. As there was no conclusive way to measure ankle joint range of movement for accurate diagnosis, a new device for measuring ankle joint dorsiflexion developed and has had increasing success in determining the right course of treatment.

Katherine Burke addressed the social and cultural determinants of health in Hawaii and described health equity as a ‘wicked problem’ for a complex health system and the need for a social justice curriculum and framework to address the determinants of health.

Research identified the need to move away from a siloed approach and from that a Native Hawaiian Health Consortium has been developed that will systematically change the way health services are viewed and delivered in Hawaii.

The panel discussed the need for reciprocity in giving of yourself as a practitioner or researcher, the centrality of culture, and the importance of growing the Indigenous health workforce as best placed to provide culturally safe and responsive care to Indigenous peoples. This is best captured in the words of Dr Evan Adams, who said he came to the realisation during his career ‘that I was the best clinician to look after my people. We are the best clinicians for our people”.

The Power of an Inter-professional Workforce

Facilitator, Associate Professor Greg Phillips, along with Dr Chris Bourke, Australian Healthcare and Hospitals Asso­ciation, Professor Kerry Arabena, University of Melbourne, Krystal Harrison, Nga Pou Mana and Drew St. Laurent, University of British Columbia, led us through a rich session about the need to reframe and reclaim how we think about practice and embedding a central focus of good health with patients and communities. From tangible and practical examples of how to practice health well as part of a team, whatever your professional expertise, to fundamentally shift the paradigm: how we speak about, understand, teach and work together in supporting people to achieve their health aspirations. In a session full of positive 11how to’s”, the panel recognised the value of much of mainstream health practice, but that to be effective for Indigenous people it must sit within a paradigm that is consistent with Indigenous culture and notions of health and wellbeing. As Kerry Arabena said, “wicked problems can’t be solved with the same thinking that created them”. 

Krystal Harrison explained the differences of the inter, intra and multidisciplinary teams, highlighting the key idea that good teams are based on principles of respect, value of diversity of knowledge, skills and experience, acknowledging your own professional lens, and sharing within safe spaces and places. Krystal shared examples of local area coordination to demonstrate the importance of putting the power back into the hands of those accessing the service, further stating ‘as Indigenous peoples and treaty partners the M?ori should always be in the front of the conversation”.

Dr Chris Bourke discussed the connections between oral health and dentistry in the treatment, management and prevention of other illnesses such as stroke, diabetes, heart disease and kidney disease. In demonstrating this, Dr Bourke highlighted the importance of inter-professional practice between dentists and a range of other health professions including; Aboriginal health workers, radiographers, dieticians, pharmacists, physiotherapists and doctors, in order to provide culturally safe and holistic health care. He described how, over decades of practice, two-way communication and information sharing is important to the health of patients but has been too rare. Dr Bourke highlighted the crucial need to recognise and address structural and systemic racism in the health care system. Systems that result in markedly different health outcomes for people identifiable through race and culture do not provide equitable access and health care. The evidence is in the outcomes. Structures and processes that continue to produce these results may appear benign, but they need to be assessed in terms of the impact on people’s health.

Culturally Safe and Responsive Practice

In the afternoon, a panel facilitated by IAHA Patron, Professor Tom Cal ma AO with George Kingi, Community Action on Youth and Drugs, Aotearoa; Janene Erickson, First Nations Health Authority, British Columbia; Jamie Newman, CEO, Orange Aboriginal Medical Service, NSW; and Corrine Butler, Co-founder of the National Aboriginal and Torres Strait Islander Occupational Therapy Network expanded upon Dr Adams’ earlier comment and discussed culturally safe and responsive practice.

Jamie Newman opened by discussing the development of a cultural safety framework that sits under the Western NSW Primary Health Network (PHN) led by their Aboriginal Health Council.

As a member of the PHN the Orange AMS implemented the framework into their core business and have laid out what the organisation deems as culturally safe care. Jamie stressed the importance of Aboriginal and Torres Strait Islander organisations embedding cultural safety and responsiveness into their practice and not assuming that, as Indigenous organisations, they are culturally safe. “The normal values of an organisation are: leadership, self-determination, innovation, empowerment, ownership, trust. If we want our organisations or employers to be real about safety and responsiveness, then why shouldn’t their values be or include ‘safety, acceptance, dignity, shared experience, sharing and caring, love, relationships, person centred and community driven’.”

Janene Erickson spoke of the value of collaboration with all First Nation’s communities and shared the FHNA’s common foundation and seven directives:

1. Community driven, nation based
2. lncrease First Nations decision making
3. lmprove services
4. Foster meaningful collaboration and partnerships
5. Develop human and economic capacity
6. Be without prejudice to First Nations interest
7. Function at a high operational standard

Janene spoke about the approaches the FHNA are taking regarding First Nations decision making and that, first and foremost, as a collaborative their approach is one of “nothing for us without us”. Janene also quoted Chief Ian Campbell of the Squamish Nation in recognising the opportunity to work better:

“We are at a pivotal moment in our collective history, one where we have a unique opportunity to mature as a society. We are now entering a post-colonial era. This country is founded and built on a very solid foundation of Indigenous people. We will no longer be invisible in our own land.” 

Corinne Butler discussed her work with the Deadly Ears Program which is Queensland Health’s State-wide Aboriginal and Torres Strait Islander Ear Health Program. Deadly Ears is a specialised service that delivers clinical and non-clinical services across the state and is leading systemic changes in health care delivery by working with various agencies and departments.

Corrine highlighted her vision for a health workforce with the appropriate skills and capabilities to deliver health services in a culturally safe and responsive way and values the importance of Aboriginal and Torres Strait Islander people actively engaged and participating in decisions around their own health. Corrine linked this to her work as an OT where her role is to enable people to do what they want to do and need to do.

Corrine stated that having meaningful and effective partnerships with Aboriginal and Torres Strait Islander people and organisations wi II support the delivery of culturally safe and responsive healthcare services.

George Kingi provided a strong testimony of the importance of culture in his own personal journey. George shared how he occupies spaces, particularly in his current role as one of the few M?ori males in his current workplace and the only M?ori in his team. George summarised his presentation by sharing the Whakapapa of Karakia.

The session focussed on practical examples of how to make health services more culturally safe and accessible; community ownership of services and accountability to First Nation Peoples; and the need for non-Indigenous health professionals to take responsibility for their role in creating a more culturally safe health care system.

Jamie Newman highlighted the need for organisations to develop and adopt policies to address lateral violence to ensure that community-controlled services are culturally safe places for all Aboriginal and Torres Strait Islander people, ending by encouraging those in attendance to create a world in which ‘our ceiling becomes the floor for the next generation”. 

Culturally Safe Allied Health Curricula

Associate Professor Greg Phillips facilitated a very full session with Roxanne Waru, Nga Pou Mana, Professor Roianne West, Griffith University, Stephanie Armstrong, Weenthunga Health Network, and Dr Alexandra King, University of Saskatchewan, Canada. The presenters gave their perspectives on why and how cultural content and approaches lead to more capable health professional who respect, connect and work with patients and communities. Culture more than informs – it underpins – capability, service and care quality and quality of health and wellbeing. Each with their own stories and experiences, our presenters from British Columbia, Aotearoa and Australia, provided examples of how to connect allied health students with community and culture and build insight in to their role in shaping attitudes, access and quality of care.

Professor West provided a comprehensive background on her work in Inter Professional (IPL) care in Indigenous health contexts, its value, and the reasons why a targeted Indigenous IPL strategy is necessary. Professor West highlighted that many health professionals already work in collaborative teams with the recognition that no one single profession has all the answers.

Dr King discussed the need for transcendence and collaboration for a culturally transformative health workforce, opening by sharing the history and demographics of the Saskatchewan region, including the different Indigenous and First Nations peoples. Dr King shared the multiple co-existing health systems in the region, with the Indigenous Nehiyawak, Denesuline, Nakata, Dakota, Lakota and Nakawe health systems, and mainstream health system. Dr King closed by observing that reconciliation equals decolonisation plus lndigenisation, with an Indigenous health curriculum grounded in both western and Indigenous paradigms and locally contextualised.

Roxanne Waru argued that culturally safe curricula is important given there being no substantial improvement in the health status of Indigenous Peoples and to address a system which continues to “do to” Indigenous peoples rather than with Indigenous peoples and based solely on western ideologies. Roxanne states that the conversation needs to be changed from “what’s wrong with you?” to a strengths-based approach, in which Indigenous nations have autonomy and self-determination. Roxanne posed a number of critical questions for delegates to consider: Is enough being done in allied health curricula? What world-view are our teachings coming from? Is the Indigenous worldview weaved throughout the curriculum? If you do not have indigenous knowledge, do you know where to go and seek it? Who have you designed the curriculum for?