WHAT DOES THE “THIRD SPACE” MEAN TO YOU AS A

HEALTH PROFESSIONAL?

Eileen Tan

Lisa Molony

Kate Brazzale

ACKNOWLEDGMENT OF COUNTRY

We respectfully acknowledge the past and present traditional owners of this

land on which we are meeting, the Noongar people. It is a privilege to be

standing on Noongar country.

INTRODUCTION

Why should health professionals be aware of the "third space"?

What should health professionals take into account when looking after Aboriginal and Torres Strait Islander patients?

Why are cultural implications important for health professionals to take into consideration?

IMPORTANCE OF IDENTITY

What does it mean to be Aboriginal?

"An Aboriginal or Torres Strait Islander is a person: of Aboriginal or Torres Strait Islander descent who identifies as an Aboriginal or Torres Strait

Islander and is accepted as such by the community in which

he (she) lives.“

What does your identity mean to you?

CULTURE SHOCK

Culture shock: the tension and anxiety, combined with feelings of isolation, sensations of loss, confusion and powerlessness, associated with entering a new culture.

ABORIGINAL TERMS OF REFERENCE

A way to determine Indigenous viewpoints on issues within an Indigenous context.

Core values include: The worth and validity of contemporary Indigenous cultures The right of expression of Indigenous realities Self-determination and self-management Positive social change Social justice The recognition and acceptance of Indigenous

diversity Reconciliation of contending issues between

Indigenous people The worth of the group

THE THIRD SPACE

HOW THIRD SPACE APPLIES TO THE HEALTH INDUSTRY? “WA Health Is dedicated to working with the Australian

Department of Health and Aboriginal communities in building new partnership for services provided; developing culturally appropriate Health services and providing safe, high equality and accountable Health service to the Aboriginal community” (Health Reform Implementation taskforce, 2007).

• Indigenous and Health professions has a variety of differences that are met and respected together as one.• Cultural belief• Views and Values • Expectations• Traditions• Historical factors• Family structure

CONCEPTUAL FRAMEWORK THAT INCLUDES THE FOUR DIMENSION

HOW THIRD SPACE APPLIES TO THE HEALTH INDUSTRY?

o It is the space for the four dimensions to be met between the Aboriginal and non- aboriginal domain.• Experiences

• Concentrates on the experience of Aboriginals in relation to the issue under discussion.

• Aspiration• Concentrates on what the critical reference group

wants to achieve in relation to the issue.

• Understanding• Focuses on the persons understanding of the issue

• Cultural element• It draws on cultural differences and traditions which

includes current culture practices.

CHALLENGES FOR HEALTH PROFESSIONALS

o Communicating among the aboriginalso Understanding their traditions and beliefso Traditional healing o Not being able to achieve the outcome until a

certain level of trust has been createdo Obtaining informed consent for treatmento Explaining diagnosis and treatment to patients

(Ngyuen, 2008, p.990-992)

HEALTH PROFESSIONS AND ABORIGINAL MAY CLASH IN A HEALTH ENVIRONMENT

o Communication and language issueso Poor cultural understandingo Racism and prejudiceo Values and beliefso Mistrust of the system

(Aboriginal Health issue committee, n.d., A guide for Health Professionals working with Aboriginal people)

OPERATING WITHIN THE THIRD SPACE

assumptions or stereotypes may still happen within the third space about an individual based on their racial or ethnic background.

Advantages Disadvantages

Access to higher quality services

Culturally secure services that will improve health outcome for Aboriginal people

Improve customer satisfaction

Provide opportunity to improve the broader determinants of health

ABORIGINAL HEALTH STATISTICS

Males Females0

10

20

30

40

50

60

70

80

90

62.7

72.9

78.5

82.6

IndigenousNon - Indigenous

Life expectancies of Indigenous versus Non-Indigenous Males and Females.

On average Indigenous Men die 11

years earlier then Non- Indigenous Males

Indigenous Females die 9 years earlier then Non-Indigenous Females.

Data from the Australian Bureau of Statistics 2005-2007 data surveys.

ABORIGINAL HEALTH STATISTICSHealth

complicationComparative

incidence rateComment

Circulatory system 2 to 10-fold

5 to 10-fold increase in rheumatic heart disease and hypertensive disease, 2-fold increase in other heart disease, 3-fold increase in death from circulatory system disorders. Circulatory system diseases account for 24% deaths.

Renal failure 2 to 3-fold

2 to 3-fold increase in listing on the dialysis and transplant registry, up to 30-fold increase in end stage renal disease, 8-fold increase in death rates from renal failure, 2.5% of total deaths.

Communicable 10 to 70-fold

10-fold increase in tuberculosis, Hepatitis B and Hepatitis C virus, 20-fold increase in Chlamydia, 40-fold increase in Shigellosis and Syphilis, 70-fold increase in Gonococcal infections.

Diabetes 3 to 4-fold11% incidence of Type 2 Diabetes in Indigenous Australians, 3% in non-Indigenous population. 18% of total deaths.

Cot death 2 to 3-fold

Over the period 1999–2003, in Queensland, Western Australia, South Australia and the Northern Territory, the national cot death rate for infants was three times the rate of Non-Indigenous.

Mental health 2 to 5-fold5-fold increase in drug-induced mental disorders, 2-fold increase in diseases such as schizophrenia, 2 to 3-fold increase in suicide.

Optometry/ Ophthalmology

2-fold A 2-fold increase in cataracts.

Neoplasms (Tumour)

60% increase in death rate

60% increased death rate from neoplasms. In 1999–2003, neoplasms accounted for 17% of all deaths.

Respiratory 3 to 4-fold3 to 4-fold increased death rate from respiratory disease accounting for 8% of total deaths.

ABORIGINAL HEALTH STATISTICS

ABORIGINAL HEALTH STATISTICSSelected Chronic Conditions: Ratio of Indigenous

Australian’s to Non-Indigenous Australians — 2004–05

ABORIGINAL HEALTH STATISTICS

Diabetes Comparison between Indigenous and Non Indigenous 2005

Cardiovascular Comparison between Indigenous and Non Indigenous 2005

ABORIGINAL HEALTH STATISTICS

IMPLICATIONS FOR HEALTH PROFESSIONALS Third Space

“A place where Indigenous and Non-Indigenous people can come and work together without fear of prejudice from ‘baggage’.”

An area of mutual respect between Indigenous and Non-Indigenous people where they can work collaboratively.

Health Professionals need Knowledge.

Of where the other comes from; their “space” Understanding

Of roles and responsibilities Empathy

Towards both sides Willingness to be open

Accepting of differences Avoid stereotyping

IMPLICATIONS FOR HEALTH PROFESSIONALS Aboriginal and Torres Strait Islanders are not the same.

Discontinue use of out-dated, derogatory terminology. Half-caste, full-blood, quadroon, etc. Always use the terms Aboriginal Man/Woman/People or Torres

Strait Islander Man/Woman/People.

Aboriginal people mistrust people who offer services related to “protection” and “intervention. European colonisation. Government Policies post colonisation. The “Stolen Generation”. Government policy til 1969.

“Keep your word.” Changes made.

e.g. Kevin Rudd’s “Apology”.

NSW Department of Community Services 2009 & National Disability Services WA 2009

IMPLICATIONS FOR HEALTH PROFESSIONALS Sensitive issues due to past Government policies have contributed

to:• Dispossession of land• Family fragmentation• Mental health issues• Social and emotional wellbeing issues• Grief and loss issues

• Self-harm and intentional injury• Over-representation of Suicide rates • Family and domestic violence issues• Loss of country• Loss of identity

• Poverty• Racism• Unemployment• Poor health outcomes• Poor education outcomes• Below standard literacy and numeracy rates• Alcohol and substance abuse/misuse• Over-representation in the juvenile and criminal justice system

NSW Department of Community Services 2009 & National Disability Services WA 2009

IMPLICATIONS FOR HEALTH PROFESSIONALS Respect

Elders, The Land, Animals, Ancestors. “Sorry Business”

Kinship Defines roles and responsibilities within the family. Ensure that extended family is included in important meetings or when

making decisions.

Gender responsibilities. Men’s Business – issues which have a male perspective within aboriginal

culture. Women’s Business – issues which have a female perspective within

aboriginal culture.

NSW Department of Community Services 2009 & National Disability Services WA 2009

IMPLICATIONS FOR HEALTH PROFESSIONALS Language

Originally 300 nations speaking 250 languages with up to 600

dialects. Nonverbal cues

Eye contact. Hand and facial gestures. Silence Progression of Conversation.

Semantic Ambiguity Swearing

Communication Techniques Use uncomplicated language, Not “jargon”. Be wary of comprehension

NSW Department of Community Services 2009 & National Disability Services WA 2009

CLOSE THE GAP CAMPAIGN Australia’s largest Campaign to improve Indigenous Health.

Aimed at reduced the Life Expectancy Gap between Indigenous and Non Indigenous Australians to 0 years by 2031.

OXFAM is campaigning to: Increase Aboriginal and Torres Strait Islanders’ access to health

services Address critical social issues such as poor housing, nutrition,

employment and education Build Indigenous control and participation in the delivery of health

and other services Get governments at state and national level to work in partnership

with Indigenous communities, health organisations and experts to develop and monitor a plan to tackle the Indigenous health crisis

Promote real and meaningful partnerships between Indigenous

COAG, 2011 and OXFAM 2006

NEED FOR EDUCATION To understand the needs of our Aboriginal or Torres Strait

Islander Patients The majority of Aboriginal people access health care from Non-

Aboriginal services.

Downing and Kowal 2011 Majority of Nurses interviewed felt that didn’t receive enough

cultural training to look after Aboriginal and Torres Strait Islander patients

They felt that they weren't giving them the level of care the needed and deserved.

Canada’s Approach Kilpatrick, 2004

Looked at the need for Aboriginal Education.

FOCUS QUESTION.

REFERENCES

Aboriginal Health issue committee (n.d.) A guide for Health Professionals working with Aboriginal people Retrieved February, 2001, fromwww.sogc.org/guidelines/public/100e-ps4-february2001.pdf

Ngyuen, H. (2008). Patient centred care. Cultural safety in Indigenous health, 37(12),p990- 992. Retrieved December,2008, from Theme Indigenous health site at www.racgp.org.au/afp/200812/200812nguyen1.pdf