Cultural safety, cultural competence, higher morbidity and mortality rates, lower life expectancy, closing the gap.
These are the words which buzz around the room of the NURS6033 Aboriginal and Torres Strait Islander Health unit, a mandatory final year nursing class.
Throughout my nursing degree, I have heard healthcare students continually express that issues relating to Aboriginal and Torres Strait Islander health are often taught tokenistically — that although they are aware of what cultural competency is, defined by The University of Sydney as “the ability to participate ethically and effectively in personal and intercultural settings and… collaborate across cultural boundaries,” students feel confused and discouraged to implement it. They feel that they will fail before they have a chance to practice these concepts, due to an inadequate education that is stiffened and enshrouded by the exclusive sandstone University environment.
The University is an institution which is failing to include First Nations people. Only 360 students in 2019, out of over 60,000, identified as Aboriginal or Torres Strait Islander in 2019, and only 1.02% of the staff across 15 faculties. In fact, The University of Sydney’s 2019 Annual Report showed a decrease of 8% in students who identified as Aboriginal or Torres Strait Islanders compared to the year before.
In all my classes, First Nations people have been discussed at length, but there has not been representation of even one student in the room to advocate for themselves. Amongst students within this exclusionary environment, despite the ‘best’ efforts of tutors, there is likely some guilt, shame, and possibly bewilderment as a result of this lack of genuine consultation.
Indigenous health topics at USyd are taught through a narrative of lack and disadvantage — our perceptions of First Nations people are shaped to highlight lower life expectancy, chronic illnesses, and exclusion under oppressive government policies. Meanwhile, First Nations’ different ways of healthcare, meanings of wellness, mental health and health practices are brushed over. Students are thus only taught how to be culturally competent if First Nations people interact with the NSW healthcare system, a system which has and continues to neglect First Nations people, and told to be culturally competent whilst not affording weight to First Nations cultures, and ways of practicing and maintaining health, wellness and mental health which is not dependent on the Australian healthcare system. The result is an uncomfortable settling of dust that no one is equipped to wipe off. In the case of university health subjects, the emphasis on First Nations peoples’ illness, and how healthcare professionals are only taught to “be culturally competent” within the hospital environment, relegates First Nations people not only to the sick role with a lack of agency, but as only valid through interaction with dominant institutions which have been, and continue to be, insensitive to First Nations cultures. The unit seems to be a tacked-on afterthought rather than something which is truly incorporated into every aspect of ways of understanding health. Students have also criticised the First Nations healthcare subjects as generalistic and uninformed, with some students even criticising staff for using prejudicial language, and perpetuating colonial narratives and racism, such as by insinuating that the Aboriginal Medical Service is based off the public health model, rather than predating it.
Whilst it should not fall upon any person to have to represent an entire population with a diversity of ways of being, knowing, and practicing cultures, the lack of First Nations people in the room is reminiscent of ‘Closing the Gap’ government policies, which have also denied leadership to Indigenous communities. This denial of participation in decisions meant to foster autonomy has contrastingly created policies whose objectives are only equitable for First Nations people found to be participating within socio-cultural standards set by white Australian, ‘default’ culture.
Indigenous health subjects at University unfortunately remain insular and are held to no accountability other than the complaints of a few non-First Nations students. Even this article is struggling to go beyond the breadths of there being something unsettlingly, deeply and institutionally skewed. It begs the question of who these units are meant to empower, and whether they serve any purpose other than a badge of lip service by the institutions who run it.