16. Communicating with indigenous peoples
CHAPTER OBJECTIVES
• Appreciate the importance of using terms appropriately when communicating with indigenous peoples
• Apply the general principles of effective communication when communicating with indigenous peoples
• Analyse and recognise the importance of cultural identity
• Analyse the relevance of the pre- and post-contact states of indigenous peoples
• Appreciate and synthesise the factors affecting the establishment of cultural safety when working with indigenous peoples
• Apply specific communication principles relevant to indigenous peoples
• Recognise potential barriers to effective communication when communicating with indigenous peoples.
Note regarding terminology: It is not possible to be an expert in all the cultural practices of others. The author is not an expert and nor is this chapter able to make experts of the readers. However, it can begin the exploration of what it might be like to work with and assist those who have different practices to oneself, whether because of individual, family or cultural differences.
This chapter will begin the journey for some and continue it for others in understanding and embracing the communication needs of people who were the original inhabitants of a region or country, that is, indigenous peoples.
Correct use of terms
History and attitudes dominate relationships with indigenous groups around the world. This often means that non-indigenous colonists and their descendants demonstrate attitudes and use terms that are discriminatory and offensive to the relevant indigenous peoples. It is important then that health professionals avoid causing offence by ensuring they understand the current terms that are appropriate when relating to indigenous peoples. While this is not always true of every country, in Australia the terms used to describe Aboriginal and Torres Strait Islander Peoples evolve constantly (NSW Department of Health 2004). This provides a challenge for every Australian health professional to know the most current descriptive terms, as the appropriate use of terms is essential for the development of therapeutic relationships and family/community-centred practice. Using the current terms also contributes to positive experiences that will ensure indigenous peoples continue to seek assistance from health services.
GROUP DISCUSSION
How might a health professional ensure appropriate use of terms and avoid offending an indigenous person when communicating with them?
There is no definitive formula for relating to indigenous peoples. Recognition and application of the general purpose of health professionals when communicating will assist in achieving effective communication and positive outcomes. Also, there are specific principles useful in all communicative circumstances that will therefore be beneficial when communicating with indigenous peoples. Before exploring these principles, it is important to consider the reality of cultural identity.
The complexity of cultural identity
Cultural identity is complex because each individual is a member of many different groups that have a unique culture. In each of these groups, every individual has a particular identity that is unique to that group (Holliday et al 2006; see Ch 15). The nationality of the individual provides a particular cultural identity that comes with values, traditions, beliefs and expectations (of self and others) specific to that nation. Membership of other groups – families, clans (in New Zealand iwi = tribe and hapu = sub-tribe), communities, sporting groups, religious groups, educational groups, employment groups, and political groups – creates additional cultural identities that relate to and affect the national and/or cultural identity of each person. Membership of each group provides a connection through common experiences and expectations that are unique to the group. This phenomenon means that each individual has a unique cultural identity based upon national identity and moulded by membership of multiple groups.
Indigenous persons are no different. They each have a unique identity that reflects their original group or nation. Their connection to the values, beliefs, traditions and expectations of that group influences their cultural identity and their appreciation of that identity. Levels of identity and connection vary for many indigenous persons. If an individual has lived their entire life with their kinship group at a traditional birthplace, their cultural identity will strongly reflect their national group. Traditional knowledge and customs will guide the daily life of that individual. If an individual was separated from their birthplace and kinship group at some point, their cultural identity may reflect other influences as well as the influence of their national origin. An indigenous person who lives in a large metropolis may or may not take pride in their cultural identity. They may have only vague expectations of adhering to cultural traditions and customs, although they may acknowledge particular spiritual and relational values and beliefs. In Australia, although the cultures of Aboriginal and Torres Strait Islander Peoples are different, there are common core values shared across the country. These values include family and kinship, caring and sharing, and a spiritual connection with and love of the land (Country). While Maori have less variation in their distinctive groups, they share a sense of connection to space and belonging. This is reflected in Tūrangawaewae – a place to stand, a place to belong to, a seat or location of identity.
In most countries there is a broad range of connection with and adherence to traditions among indigenous peoples. In Australia, for example, many rural Aboriginal and Torres Strait Islander Peoples have replaced walking with horses or motorised forms of transport. However, the same people continue to value the land (Country) and their traditional ceremonies and singing. In New Zealand, many Maori have absorbed ‘ways’ from the dominating culture of the colonists. However, they still believe in and use traditional remedies to augment or replace the health practices of the dominant culture. In the Pacific, various indigenous peoples may use modern equipment to fulfil the traditional occupation of fishing. However, the same people continue to make traditional mats for use in their houses and for particular occasions. In many places in Asia, indigenous peoples use mobile phones to communicate but still plough their fields using buffalo. In many places in northern Canada, the skidoo has replaced the traditional use of the dog sled for transport and sometimes even hunting. However, the same people still create unique clothing that reflects membership of their particular kinship group. It is important to remember that the culture of all indigenous peoples is neither static nor uniform. Each culture and individual within that culture is continually changing and adapting to the influences upon themselves or their community.
The complexity of cultural identity means it is important that health professionals recognise the factors influencing that identity. It is also essential that health professionals acknowledge there are variations within indigenous peoples that prohibit the stereotypical labelling of any individual because of their nationality. Aboriginal and Torres Strait Islander Peoples clearly exemplify this fact, as they are two distinct groupings. The Torres Strait Islander Peoples have an origin, culture and identity distinct from the many Aboriginal groups that originated in the mainland and Tasmania. These many Aboriginal groups also have languages, cultures and identities that are distinct from each other and from those of the Torres Strait Islander Peoples.
There is a long history of stereotyping of many indigenous peoples. Indigenous peoples may also stereotype non-indigenous people and sometimes even other indigenous individuals or groups. It is the responsibility of the health professional to consider their own tendency to stereotype and adjust their knowledge and attitudes to avoid stereotyping any indigenous person. It is also important that the health professional behaves in a manner that will reduce the tendency of some indigenous peoples to stereotype non-indigenous health professionals.
Principles of practice for health professionals when working with indigenous peoples
Creating cultural safety for indigenous peoples
Understanding the concept of cultural safety is essential when relating to indigenous peoples from any country. Practice that respects, supports and empowers the cultural identity and wellbeing of an individual produces cultural safety (Nursing Council of New Zealand 2002). Such practice is more than mere awareness or sensitivity. It requires action that results from critical reflection about personal values (Stein-Parbury 2006) and evaluation of the attitudes and beliefs of the individual health professional. Culturally safe practice also requires awareness of and reflection about the culture and values of the particular health service. It is important that the health professional evaluates how their values, attitudes and beliefs affect the indigenous peoples they assist (Fenwick 2001). It is equally important for health professionals to evaluate the quality and outcomes of the assistance indigenous peoples receive from their health service. Such evaluation requires awareness and appreciation of the lives and perceptions of indigenous peoples, their kinship groups and their communities. These perceptions develop while receiving assistance, whether past or present, and should contribute to any evaluation of a health service. The histories of the relationship of indigenous peoples with the Europeans who have colonised their country also affect these perceptions. The result of such reflection and evaluation should be the achievement of cultural safety for indigenous peoples because of adjustments and improvements in the health service and the practice of the health professional (Fried 2000).
In contrast, lack of cultural safety exists when any individual behaves in a manner that diminishes, demeans or disempowers the cultural identity and wellbeing of any individual within a health service (Nursing Council of New Zealand 2002).
CASE STUDY
Emily is a 5-year-old Australian girl with blonde hair and blue eyes who has come to you for assistance. You have developed a good relationship, based on respect, trust and rapport, with her mother, Jillian. Your assessment of Emily indicates the choice of school will be significant and could affect her learning and thus her future.
Her mother feels safe and comfortable with you and discusses the pros and cons of the local schools with you. She indicates that one school, a distance away, has extra funding for children with an Indigenous background. You are unsure of the meaning of this comment – you have not noticed any indication of Emily’s heritage on her record/file and, looking at Jillian and her three children, you assume there is no Indigenous background. You assume Jillian is concerned that if Emily attends that school she will not have the assistance she requires because of the presence of an Indigenous cohort. You say it would not be good for Emily to experience reverse discrimination because of her ethnicity (i.e. to miss out because she does not have an Indigenous background).
Jillian bristles and coldly explains that she was taken from her family post-contact with Europeans and did not know she had an Aboriginal heritage until recently. She states that she was raised by a family that was discriminatory against people with her background and thus she now has to adjust to the fact that she is one of the people about whom she previously thought negatively. While her husband, who married her before she discovered this fact, says it makes no difference to him, she struggles to establish her identity and often avoids disclosing her heritage. This makes her reticent to place Emily at the school that has specific funding for children with an Aboriginal background, despite her eligibility.
You are generally an accepting person and have good friends who have an Indigenous background. You regret your assumptions and offensive comment. You are aware that you could have been assisting Jillian to resolve her struggle, experience acceptance and establish her cultural identity.
REFLECTION
• What will you do now to retrieve the relationship and encourage her to continue bringing Emily for assistance?
Note: When treating children it is essential that the health professional assists the family, not just the individual child, because it is the context of the family that usually dominates the development of the child. In addition, it is the parents who know the child better than anyone and are invaluable in providing a true picture of the child and their abilities.
There are a number of factors contributing to the creation of cultural safety for indigenous peoples that require examination.
The importance of history
Awareness and understanding of pre- and post-contact history is a factor that contributes to the creation of cultural safety. For many indigenous peoples (particularly those who are older) it is highly significant, because historical factors have created negative perceptions and mistrust of non-indigenous or mainstream health systems (Australian Government Department of Health and Ageing 2004). Thus, pre- and post-contact history requires close consideration.
Pre-contact history
Pre-contact with Europeans, many indigenous groups in various places around the world existed in harmony with their spiritual and physical environments and in varying levels of harmony with each other for generations upon generations. Each group had their own traditional languages; culture; specific identity including dress; spiritual explanation of their existence; rules of behaviour including expectations of the individual and the group; kinship rules; remedies; methods of artistic expression; methods of providing food and water; and laws governing their everyday lives. The groups had designated leaders or groups of leaders who understood their values, traditions and laws. As protectors of these values, traditions and laws, these leaders had particular levels of wisdom and understanding and, thus, were often the decision-makers for the group and the individuals within the group.
In Australia pre-contact there were around two-hundred-and-fifty distinct groups of Aboriginal and Torres Strait Islander Peoples with their own language, culture, identity, kinship rules, boundaries and laws for relating to other groups (Australian Government Department of Health and Ageing 2004). Aboriginal groups had inhabited Australia for approximately 50,000 years pre-contact. These groups did not always relate well to each other and some still experience tension today.
In New Zealand pre-contact there was one Maori language. However, more than one group existed and these groups did not always experience harmonious relations. The Maori inhabited New Zealand for approximately 300 years before the arrival of Europeans. While there was a treaty (te Tiriti O Waitangi: The Treaty of Waitangi) in 1840 between the Maori and particular non-indigenous people, that treaty was not ratified by the non-indigenous colonial government of the time. This meant that the rights of the Maori were not recognised, although their organised existence became impossible to ignore. This resulted in post-contact stress that in many ways results in inequality today.
Post-contact history
In many cases, when European contact occurred with the indigenous peoples of a region or country, the indigenous groups were not structured or organised in ways recognisable to the non-indigenous people. In many places ‘contact’ resulted in violence, devastation through introduced diseases or deliberate attempts to kill and/or control these groups. This control often placed members of ‘non-compatible’ groups together in reserves or missions. Lack of understanding, multiple incorrect assumptions and misplaced social theories (Harms 2007, Smith 2001) by non-indigenous people post-contact often resulted in histories that established negative expectations in the minds of the affected indigenous peoples. For example, in Australia there was deliberate segregation in society that also occurred in hospitals. Hospital staff often placed Aboriginal and Torres Strait Islander Peoples on the verandah or in unneeded areas of the hospital to keep them separate from non-indigenous people. Many older Aboriginal and Torres Strait Islander Peoples still remember such actions, which contribute to current negative expectations. These expectations continue in many places today because of continued discriminatory attitudes and behaviour by many non-indigenous people. In many sectors of Australian society, however, there has been a slow awakening and recognition of the social, emotional, spiritual and cultural damage caused post-contact to Aboriginal and Torres Strait Islander Peoples. In New Zealand there has been a similar awakening reflected in the Treaty of Waitangi Act 1975, which recognises the effects of colonisation on the Maori and has resulted in various changes for the benefit of the Maori.
Knowledge and understanding of pre- and post-contact history is important in the creation of cultural safety. However, genuine synthesis of the history and an appropriate response (including awareness of the personal bias of the health professional) to this history is essential when communicating with indigenous peoples.
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