Bronwyn Fredericks

Australian Aboriginal Women's Health: Reflecting on the Past and Present

Aboriginal women collectively have the poorest health of any other group of women in Australian society. We live this day-to-day reality and understand that we are not the remnants of part of our history but the sum of our history. This article presents, in a case study format, an in-depth interview of an Aboriginal woman's experiences of the health system, past and present. Kay's words resonate some of the experiences of the other nineteen Aboriginal women who participated in a research project involving in-depth, semi-structured, face-to-face interviews in a participatory-action research process. Kay's words offer an understanding of the sociology and psychology of the health system in the historical context and its on-going impact on everyday life.

When I think about my own health issues, you're hitting that statistic now, it could be good-bye anytime, we are all reminded of that all the time, 'cause our mates are passing away, and you think, well, they were the same age as me, I am forty-six, and I am coming up to the time which tells us most black fellas don't make it after this ... it is something that when you reach forty, this is, hit the hump and start heading down hill and white people hit sixty and think they hit the hump (Kay).

Kay's words give us an understanding of the reality for many Aboriginal women. Her words outline how this reality can become internalised, and how, as Aboriginal women, we come to know ourselves and what we face within our lives. Kay's words also outline that Aboriginal women know how we compare when we look at the health statistics of non-Aboriginal people. Moreover, she expresses an understanding of the reality of ageing and health as it relates to non-Indigenous people. This reality, this knowing ourselves, and knowing how our health is part of this reality, is central to life and is explored in this paper.

Several Aboriginal women, including Kay, living within the Rockhampton area of Central Queensland, were interviewed as part of a research project exploring 'how the relationship between health services and Aboriginal women can be more empowering from the viewpoints of Aboriginal women.'¹ The assumption underpinning this study, 'Us Speaking about Women's Health: Aboriginal Women's Perceptions and Experiences of Health, Wellbeing, Identity, Body and Health Services,'² was that empowering and re-empowering practices for Aboriginal women can lead to improved health outcomes. The focus of the study arose from discussions with Aboriginal women in the community as to what they wanted me, another Aboriginal woman, to investigate as part of a formal research project. The terms 'empowering' and 're-empowering' were raised throughout these early exploratory discussions. They were later discussed during the interviews. Re-empowerment was discussed from the viewpoint that Aboriginal women were once empowered as sovereign women who had control of all aspects of their lives. Aboriginal women became disempowered as a result of colonisation and thus the term 're-empowering' was discussed and agreed upon.

The ethics process included presentations before an Indigenous inter-agency meeting of more than fifty representatives from community organisations and Indigenous work units, an Aboriginal women's meeting, and an individual organisation that was recognised as having specific responsibility for women's issues. This was in addition to the ethics process at Central Queensland University, through which the study was conducted. A panel of supervisors oversaw the project, including an Aboriginal woman recognised for her long-term involvement in Aboriginal women's activism. She was nominated by other Aboriginal women in the community as the appropriate person to be a cultural supervisor and to assist in any cultural dilemmas. She worked with the other two supervisors who also provided specific research roles within the university environment. Twenty Aboriginal women participated in in-depth, semi-structured, face-to-face interviews in a participatory-action research process, which incorporated the principles of an Indigenous methodology as put forward by Rigney,³ and decolonising concepts asserted by Smith.⁴ In addition, the process drew heavily from the field of ethnography.⁵ Ethnographic data collection, as understood from the writings of Creswell,⁶ can include documents, observations and interviewing. These were all tasks that were undertaken in this project. The benefits of ethnography allow for interviewees to provide 'rich and quotable material' and 'enable them to give their opinions in full on more complex topics.'⁷ Moreover, it allows for concepts of reciprocity and reactivity to be enacted within the research process and for the researcher to be immersed in the day-to-day lives of the members of the research group.⁸ For me, as a member of the Rockhampton Aboriginal and Torres Strait Islander community, this was imperative.

It is important to note that this research process was developed in consultation with Aboriginal women in the community and through discussion with other Indigenous researchers in Australia and overseas.⁹ Research processes were sought and discussed that would not only allow for academic rigour, but would not further perpetuate the disempowerment and marginalisation of the Aboriginal women involved and Aboriginal women in the community. The interviews that resulted presented a powerful insight into the lives of Aboriginal women, past and present. This insight and the information gained are valuable in contributing to a deeper understanding of the past and present interactions between Aboriginal women and health services. One of those interviews is presented in this paper.

A background of Aboriginal women's health past and present is presented before the interview with Kay to provide a backdrop to the changes within Aboriginal women's lives. The interview with Kay provides us with a clear picture of the present-day reality faced by many Aboriginal women as a result of history. Her story demonstrates how colonisation, discrimination and racism have been enacted at the coalface of everyday life. Furthermore, it demonstrates that life today for many Aboriginal women is lived as colonised peoples who continue to be subjected to racism and kept impoverished by policies and behaviours that have their origins in history.

Aboriginal women's health: The past

Prior to 1788, Aboriginal Australian women had, in general, a relatively good lifestyle and good health.¹⁰ Thomson claims that when the British invaded Australia, Aboriginal Australians were 'physically, socially and emotionally healthier than most Europeans of that time.'¹¹ This is also stated in other sources.¹² The information related to the pre-invasion health of Aboriginal peoples, based on historical records and observations made by European explorers, presents a consistent picture regarding the health of Aboriginal peoples. Captain Cook, said to have 'discovered Australia' in non-Aboriginal historical accounts, outlined on several occasions the status of the Aboriginal peoples he observed: 'of middle Stature straight bodied slender-limb'd the Colour of Wood soot or of dark chocolate ... Their features are far from disagreeable.'¹³ The observations of Arthur Phillip, Australia's first governor, as outlined in Stone,¹⁴ are similar to those of Edward Eyre, a European explorer writing on the Murray River area, who described the Aboriginal people he encountered as 'almost free from diseases and well-shaped in body and limb.'¹⁵ There are many other similar accounts from historical records.¹⁶

The National Aboriginal and Torres Strait Islander Health Council (NATSIHC),¹⁷ as well as Franklin and White,¹⁸ report that there were probably high rates of infant and child mortality at this time, as there were in European cultures. Prior to invasion, Aboriginal peoples managed health through traditional healing practices and healing practitioners. These practices were embedded within the cultural and spiritual values of Aboriginal peoples.¹⁹

Colonisation had a profound impact on the Aboriginal women of Australia, who were of generally good health prior to 1788. The invasion, with the establishment of the British penal colony at Botany Bay, began the destruction of Aboriginal lifestyles and cultures through colonising practices such as killings and massacres, dispossession of peoples and sequestration of lands, the removal of children to missions, the separation of families, and other interventions.²⁰ Past government policies and practices were focused on denying rights—the right of 'Aboriginal peoples being Aboriginal peoples,' that is, the right to live as Aboriginal peoples, practice culture as Aboriginal peoples, to be Aboriginal. Such policies were premised on assumptions of Aboriginal peoples as 'heathen,' 'uncivilised,' 'primitive' and 'immoral.'²¹ It was thought that separating children from their families and giving them to white families, white missionaries and white institutions would make them white.²² Documents from the early twentieth century reveal specific government belief embodied in policy that Australian Aboriginal peoples would be exterminated or assimilated as time went by²³ and that these policies were in everyone's (including Aboriginal peoples') best interests.

The NATSIHC report states that

the ill health of Aboriginal and Torres Strait Islander peoples exceeds that of any other sector of Australian society and the causes can be partly attributed to the impact of colonisation on the health of Aboriginal and Torres Strait Islander peoples.²⁴

It further states that,

[the] Acts of dispossession, introduced diseases, loss of traditional foods and lifestyle, forced resettlement, loss of social cohesion, separation of children and the actions of health and welfare services reflect this impact.²⁵

The destruction that began in 1788 continues to impact on Aboriginal peoples' lives, cultures, and health and wellbeing. Aboriginal peoples also know the impact that the history of colonisation has had on them and what it means in terms of health status. As is evident from Kay's statement, Aboriginal women know what this health status means in terms of the lived reality.

Aboriginal women's health: Present

The National Health and Medical Research Council (NHMRC) stated in 1996 that hospital admission rates were 50 per cent higher for Aboriginal women than for other Australians and that this was 'a substantial underestimate.'²⁶ The chronic diseases of asthma, diabetes, ear infections, kidney infections, trachoma and circulatory conditions are experienced by Indigenous Australians at higher rates than among the population as a whole.²⁷ Public health, mental health and the impact of communicable diseases, including HIV/AIDS, have added to these alarming statistics. The Australian House of Representatives Standing Committee on Family and Community Affairs²⁸ outlines that three out of every four deaths among Indigenous Australians now result from either diseases of the circulatory system (heart attacks and strokes), injury and poisoning (road accidents, suicide and murder), respiratory diseases (pneumonia, asthma and emphysema), neoplasms (cancers), and endocrine, nutritional and metabolic disorders (diabetes).

How do these statistics compare with other Australians, in particular women? Indigenous women are twice as likely to have cardiovascular disease than non-Indigenous women and 1.7 times more likely to get coronary heart disease. They are thirteen times more likely to get rheumatic fever,²⁹ which can have long-term effects on the heart muscle leading to heart problems in adult life. Indigenous hospitalisation rates due to respiratory disease are twice that of non-Indigenous people, and respiratory disease is the second most frequent cause of hospitalisation for Indigenous women, after pregnancy-related admissions.³⁰ Injury is the third most frequent cause of death among Indigenous women and, within this attribute, suicide rates are 1.4 times higher and homicides seven times more likely than for non-Indigenous women.³¹ Aboriginal and Torres Strait Islander women are dramatically less healthy than their Australian counterparts.

The 1994 National Aboriginal and Torres Strait Islander Survey showed that Aboriginal maternal and infant mortality rates were still higher than for non-Indigenous Australians. Although infant mortality rates have generally declined for all Australians in the past twenty-five years, the Aboriginal rates of hospitalisation are still three to four times that of non-Aboriginal Australians.³² What is alarming for Aboriginal women is that there are still higher rates of stillbirth, neo-natal and post-natal deaths, and low birth weights of their children.³³ In 2000, the Australian Indigenous HealthInfoNet showed that 'the Indigenous mortality rate of 13.6 infant deaths per 1,000 live births was 3.0 times the non-Indigenous rate of 4.6.'³⁴ The average birth weight for an Aboriginal child is 3140g compared with an Australian average of 3349g.³⁵

While Aboriginal babies do not fare very well, what of the mothers? According to the HealthInfoNet the situation is no better: 'for direct maternal deaths, the ratio for Indigenous women was 13.0 compared with 5.1 for non-Indigenous women' (per 100,000).'³⁶ While these are significant findings, few midwifery or obstetrics programs contain curriculum content that specifically addresses Aboriginal issues of birthing. Aboriginal women are more likely to die as a result of childbirth than non-Indigenous women and their babies are more likely to have low birth weights and die before or after birth. Some programs have been established specifically to address this issue, for example, the Ngua Gundi birthing program in Rockhampton (the site of the Aboriginal women's study), which focuses on education for young pregnant women and girls and provides support during pregnancy, birthing and after the new baby is born.³⁷

Historically, the causes of excess mortality were a result of acute infections and communicable diseases. The leading causes of mortality are significantly different to what they were some twenty or fifty years ago.³⁸ In its 2004 Health Determinants Queensland report, Queensland Health lists higher death and hospitalisation rates due to all causes with higher death and/or hospitalisation rates due to: injuries, especially due to interpersonal violence, particularly women; diabetes; respiratory disease; lung cancer; cervical cancer; coronary heart disease; and suicide and self-harm.³⁹ The same report also discusses life expectancy.⁴⁰ The HealthInfoNet suggests that based on Census estimates and projection,

Indigenous males born in 1998–2000 could be expected to live to 56.0 years, almost 21 years less than the 76.6 years expected for all males. The expectation of life at birth of 62.7 years for Indigenous females was more than 19 years less than the expectation of 82.0 years for all Australian females.⁴¹

This is the projected life expectancy for Aboriginal and Torres Strait Islander peoples born between 1998 and 2000. The 2004 report details life expectancy as twenty years lower than that of non-Indigenous Australians. The Aboriginal women who participated in the study in Rockhampton were conscious of the reality of a shortened life expectancy in comparison to non-Indigenous women.

What can be ascertained is that Australian Aboriginal women experience greater incidence and levels of illness throughout their lifetimes, and that this continues despite government attempts to make progress on our health status. At times, it is difficult to believe that this will change and to envisage a time when this will not be the case; with some health issues the statistics may become worse. The Australian Indigenous HealthInfoNet suggests that, 'the disparity between Indigenous and non-Indigenous health, at least measured by mortality, has widened in recent years.'⁴²

Kay's story: Lived experiences

Kay is an Aboriginal woman who, at the time of the interview, was forty-six years old. She moved to the Rockhampton area in 1995. She has two sons, has been married and divorced, and has a partner. Kay has lived in a range of places: as a child she was removed from her Aboriginal mother and raised by non-Indigenous people. Kay wasn't always able to name who she belongs to in terms of her Aboriginal nationhood and clan affiliations. In 1998 she met members of her family for the first time and they were able to tell her more about her Aboriginal heritage. She now talks to others about her adoption and her life's journey. Kay has studied at university, works part-time and she and her partner have been buying their home for the past six years.

I have selected parts of Kay's story, in a case-study approach, to demonstrate a range of issues connected with Aboriginal women's health past and present. During her interview Kay shared openly, demonstrating the complexity of her life. Kay's life mirrors the aspects of other Aboriginal women's lives and how they try to deal with historical and present-day issues, and how they might choose to move to a position of empowerment. Kay told me at the time of interview that she was still continuing this journey. From this perspective Kay offers us learning and insight.

Significant events in Kay's life

Kay experienced a lot of sickness as a child and as an adult. When reflecting on her past health experiences she recalled two significant events that occurred in her twenties. In the first, she experienced a lot of pain and found it difficult to get medical treatment. She said that 'everyone thought I was imagining it, [but] I had gallstones ... 201 stones, they were amazed that I made it as long as I did.' She ended up being admitted to hospital and having the stones and her gallbladder removed. She recounts the process:

I was the youngest one in the hospital. I thought I would have a tiny mark. I didn't know what questions to ask. I got big dog stitches. I was in my mid-twenties. I got the dog clips. I was the only one who got the apprentices [possibly interns/new registrars]. I was really upset. Just because I hadn't asked about the scar didn't mean I wanted to be the ugliest. Aboriginal people we mark when we scar, that kind of scarring [shows me], if I hadn't been so sick ... I felt it was discrimination. How come all those old [white] women got the clamping situation and I got the old dog stitches. I felt really ashamed then ... I felt it was because of the colour of my skin.

The second significant event was when she was about to deliver her first child and went to the hospital. 'That doctor said, good, she's right, she is obviously having her second or third child.' The doctor made an assumption about Kay that became a barrier to her asking questions about her birthing process. How Aboriginal women present to doctors, does not always reveal what is actually happening with them, as Kay explains:

On the exterior I've got it together and on the inside I am so scared. I am so ashamed how fearful I am, how I am ignorant, never touched a baby in my life, never had any one who had a baby in my life. I didn't know what was happening with the baby, like, I didn't know that we even bleed after you have a baby ... it's hard to believe now, but that's how it was ... another assumption that people make about us.

Not knowing what to do and what happens is a barrier in addressing health issues and carrying out healthy practices. As Kay identified, she was frightened and she wasn't really in a position to ask. She felt the staff assumed that she knew what to do because on the outside she 'had it together'; maybe she showed outward signs that she was confident, but she wasn't. Kay, in reflecting on this experience, said 'looking back ... as a pregnant woman I was treated in a way that white women weren't, you knew you were part of something a little bit different but you don't know why ...'

Kay shared a few more examples and stated that:

It has never made any sense to me that people could treat me different because of the colour of my skin ... now I look back I recognise it was racism that I didn't want to face ... I wasn't given equal treatment.

It is when Kay looks back on the events of the past that she can analyse them more thoroughly and interrogate what happened or the treatment she received. She talked about this retrospection and the importance of this reflection in self-growth and becoming stronger as an Aboriginal woman. The two experiences of Kay's that I have outlined above occurred only twenty years ago. Some may say that things have changed. However, more recent experiences shared with me by Kay and the other Aboriginal women I interviewed, as well as my reading of the literature, leads me to conclude that there are still issues of discrimination based on skin colour and Aboriginality.

Trauma connected to the medical system

Kay's experiences still have an impact on her life, 'because the trauma of my life is connected with the medical system and government, I fear [the] government as much as I do the medical system.' Kay also revealed during the interview that it was a medical doctor who was responsible for 'stealing me from my mum.' Aboriginal people and non-Indigenous Australians are aware that, in a range of different situations, police, government officials, welfare workers, religious congregations and others including doctors and nurses, were responsible for orchestrating child removals and adoption of Aboriginal children. Phillips explains that a range of people, including health professionals, carried out questionable practices and 'operated in concert to suppress local Aboriginal sovereignty, steal their lands, and destroy their languages, cultures and social cohesion.'⁴³ These practices are broadly documented.⁴⁴ Phillips states that not only did 'colonisation produce situational traumatisation, such as seeing relatives shot or taken away, but it also produced cumulative trauma as a result of shame and self-hate, and intergenerational trauma as a result of unresolved and unaddressed grief and loss.'⁴⁵ The medical practitioner's removal of the six-year-old Kay from her mother produced such trauma, and has left her with unresolved issues. Kay has what could be described as 'soul wounds.'⁴⁶ It is worth noting that many younger health professionals may not even be aware that older members of their professions were engaged in these practices.

The policies of the past, including child removals, have undoubtedly impacted on the health and wellbeing of Aboriginal peoples. For Kay, her long-term illnesses, the many sicknesses she has experienced, and her removal as a child from her mother, have all impacted on her overall health and wellbeing for most of her life. She still feels their impact as demonstrated by the following statement:

Even though, as a dynamic woman, who is very motivated and empowered in most areas, I feel like I'm a little girl when I'm, when it comes about health but I haven't let that put me off, I go off and have my pap smear tests, and now my mammograms.

In accessing services, Kay says:

I still put myself there even though ... [and] I still get really scared when I have to go to other doctors [referring to doctors outside of the Aboriginal community health service she presently uses], the blood people, non-Indigenous female doctors. I felt totally disempowered, I felt really angry.

Kay discussed that how she presents to people, including the health system, can often lead to a misinterpretation of both her and her needs at the time: 'I know that I present, I try to present to the community as a woman whose got it together. I try not to come from a place of victim.'

She stated several times during the interview that she doesn't want to be a victim or be seen as a victim: this was important to her. Kay explained that she wants people to understand that

even on the outside if we look like we have got it together, that mightn't be what's happening underneath and that we as Aboriginal peoples can be disempowered in different ways, when that has happened continually, you work up strategies.

Health services that Kay presents to may perceive her to be OK and strong enough to handle the reason why she presented, when, in fact, it may be that at that point in time she is not OK. This may be happening with other Aboriginal people too, and could create situations where extra attention or care is given to those who present as more vulnerable and as a 'victim,' to use Kay's words.

Kay and I had a discussion in the process of the interview about how she believed that no one ever thought she was traumatised through all her illnesses and diseases or her removal from her mother. Kay believed that the medical staff only ever looked at the physical sickness that she presented with at the time. She accessed counselling through the Aboriginal community health service for two years and felt comfortable doing that, stating: 'I never hear anything about my life' in the community. Concerns about confidentiality were stressed by Kay, as they were by the other women interviewed. For Kay it was important, as she was conscious of not wanting to be a victim and also of her privacy. The counselling Kay undertook assisted her to work through many of her issues including those related to her health. Through counselling she was able to draw links between incidences in her life and her health issues. It was this counselling and support that has led her to a deeper analysis of her own situation and the situation of other Aboriginal women. Kay was able to tease out what had happened in past situations and to look at the ways she had experienced trauma and re-traumatisation. Kay's story facilitates an understanding that Aboriginal people cannot just get over the past, or just 'move on.' Past events and experiences are powerfully active in Kay's life as they are in the lives of other Aboriginal people. The past is ever-present in interactions with other Aboriginal people, and with the way non-Indigenous people interact and interpret Aboriginal people.

Reflections on the health system and reality of life

In her discussion around health services, Kay described how she accessed some of the Aboriginal-specific services. She outlined how she assesses a health service location as to whether 'I'm just going to be sitting on the fringes as I have all my life, I don't want to be, I want to find places where I can be part of the centre.' She identified the Aboriginal and Torres Strait Islander health service as a place where Aboriginality is part of the centre, part of the thinking of the place and where she wasn't going to be left on the fringe as an Aboriginal woman. Kay argued that part of the difficulty with the health system, and with the broader system, was the ideology and foundation on which they are based. She articulated that:

I want the white system to understand that we are not part of the white centre, we are on the fringe, we have not been included into that centre, and we won't until the white system sees that.

Throughout her interview, Kay referred to the ancestors, linking the past to the present and future. She revealed that she is very aware of her life-span issues and her past health problems:

I am real proud of myself that I make sure my sons visit the doctors to have a check up, I try not to show them any of my fear. I don't want to be sick. I don't have grandchildren yet ... I want to be around to see a couple of grandchildren at least ... I ask the ancestors all the time to gift me that I can live.

Kay also demonstrated that she was very much aware of her reality in terms of the health status disparity between Aboriginal and non-Indigenous people. The quote I used from Kay at the beginning of this paper is evidence of her awareness and her sense of reality. I am not suggesting here that Kay or any of the other Aboriginal women who were interviewed as part of the research project are living self-fulfilling prophecies; rather, that this reality is demonstrated through what the Aboriginal women have shared. All the women I interviewed have a sense of the realities of their lives in relation to other Aboriginal women, Aboriginal peoples and the broader population. When I asked each one of them if they thought that other Aboriginal women had similar issues, they articulated that some did. They additionally had a sense of the collective issues that Aboriginal people of past and future generations have and will experience. The women were very much in tune with their positioning and their lives at the time the interviews were conducted: for example, Kay's quote at the beginning of this paper in which she compares herself and her life expectancy to that of non-Indigenous people. A number of the women in the study stated their aspiration of becoming grannies (grandmothers) and of watching their children and grandchildren grow.

Women-centred health services

In undertaking the study,⁴⁷ which questioned how the relationship between health services and Aboriginal women can be more empowering for the women, I asked my interviewees about women-centred services. The study found that Aboriginal women had requirements of health services that related to the cultural comfort of the health service environment; that Aboriginal women did not access one health provider for all their health needs, but rather 'shopped around' to meet their general health and specific women's health needs, and relationship and privacy requirements; that Aboriginal women's health is impacted upon by stereotypes held by health professionals around skin colour and Aboriginality; and that Aboriginal women have an understanding of what is required to improve the interactions between them and the health service providers. In exploring women's health it needs to be recognised that women-specific services have historically evolved through advocacy and strategic action by women, along with government policies.⁴⁸ It should not be assumed, however, that Aboriginal women have been part of that long-term advocacy, strategic action, design and operation or have been clients of women-centred health spaces, merely due to being the same gender.⁴⁹ Kay's words in relation to a specific women's service show a disconnection from the place and service that is specifically designed for 'women.'

I go there but I never feel comfortable there, I don't go there as a client. I really do like women's spaces but this space doesn't make me feel like it is for me, it is a woman's space I feel that, it's not an Aboriginal woman's space, the design of the space, it is a totally white designed space. There is nothing that identifies me to that place ... I just won't go there as a client because I don't feel they cater for me as a black woman.

She came back to the point later in her interview when she was discussing notions of place, in reference to that particular service:

there was no Aboriginality around the place, I didn't see black people, I didn't see black workers, I didn't see any posters either ... that kind of says its not a place for me, maybe that's an assumption but all of the things ... that's how I gauge whether it wants me to be part of its centre or if I'm just going to be sitting on the fringes as I have done all my life.

Kay's expression of whether she feels included or not as part of the core is evident. She feels she is not.

Kay raised some powerful concepts and a high level of analysis when discussing women who are employed as workers within women's spaces or health environments. She said:

I always like female workers in the health area, but then again they don't always make me feel comfortable, a lot of them are kind of cultural voyeurs, it's like they take anything from anybody's culture, but they kind of put it on the exterior ... cultural tourist ... too many cultural tourists in women's spaces.

I asked Kay when she meant by the term cultural tourist. 'Cultural tourist, it's where everything is on the external.' She outlined that they, the cultural tourists, have bits and pieces of clothing or jewellery they may wear and may sometimes even have a number of cultures reflected on the exterior of their bodies. She said it also involved them talking about concepts that might be drawn from a range of cultures. She told me that she asks them a question about something they have on, or something they are talking about, and that 'that question can locate for you' whether that person is a cultural tourist or not. From her question/s she determines whether that person takes the culture from the exterior of their body to the interior, if that happens 'then that person is not a cultural tourist.' They take the 'culture from the exterior into the interior ... building it as part of them' as part of their ideology. Kay saw how it could become part of how they live, when they are able to be reflective of other people's cultures from within. When Kay explained this to me I could understand the concept and even picture some people as cultural tourists within a range of health arenas. One needs to wonder if this is a remnant of the cultural tourism that Europeans used to take part in when they visited the colonies years ago. It is also known that there were medical practitioners, medical anthropologists and other health professionals who additionally undertook such activities.

Kay talked further about the concept of cultural tourists and whether she believed they could empower Aboriginal women. She stated that:

They are like leeches and suck people dry, they need to keep taking they don't give ... it is the same way they become a cultural tourist ... it's not just one culture on their sleeve. They con me up quite quickly, they are nice and friendly on the top surface, exchange, locate where you are from, then it's like they have known you forever, and then they put it out there ... it's totally disempowering ... sometimes in the first instance you can think that you'd like to get to know this person, they have some deep and meaningfuls that you can exchange but you soon learn that you are the only one giving ... they work in health a lot, comes into this thing where it is just you and them, when it is a client [relationship they have with you, you are the only one giving, they do not disclose anything about themselves. This is even the case when you may have known them outside the site of service provision], and they, get on to the one on one now, outside the room they wanted all this from you, and all of a sudden you realise you don't have any rights to ask questions anymore, they don't freely give you the information ... even those people in the women's health places ... even when you feel you have had a good relationship ... friendships go out the door and that person gives you the energy that they have your power [power in the sense that the service provider now has all the information about you, can get you referrals or not, seek further help for you or not, continue to see you or not] and that you have to bend and stretch.

Kay describes how she sees power and control being maintained. The staff in health services need to be adequately trained, so that they can create Aboriginal-friendly environments that will enable Aboriginal women to gain and feel a sense of control in person-to-person interactions and other forms of communication. Added to this the staff need to reflect on how the dominant culture maintains its stronghold on all aspects of the health communication process, a process of control to which historically held stereotypes contribute.

Kirsten Roger's study is useful to draw on at this point. In her interviews with white women in the helping professions in Canada (psychotherapists) she details how they have gained increasing levels of status and authority through their dominance in the helping professions; for example, nursing, counselling, health care.⁵⁰ Throughout the narratives of the women she interviewed were cultural characteristics that marked the almost total presence of white, Anglo-Saxon, Anglo-Celtic, Canadian culture. In this she showed that many of these professionals managed and incorporated 'whiteness' within their practice as social service providers.⁵¹

What can be understood from Roger's study is that there is a need for a historical analysis of racism and colonisation in order to provide a greater sense of how non-Indigenous women in the helping professions might be better able to work with Aboriginal women. This would enable non-Indigenous women helping professionals to become aware of how race, gender and class are constructed, and encourage them to examine their own social status and position in relation to Aboriginal women. This may assist in addressing the issues Kay raises of cultural tourists working in women's services. Assumptions could also be drawn from the explanations that these issues are not limited to women-centred services, but that they cut across all health services. Both male and female health professionals, as well as health services that cater to the broader population in Australia, have developed from the same historical context in relation to Aboriginal peoples.

Conclusion

The arrival of the colonists, and the subsequent removal and dispossession of Aboriginal women from their traditional lands, where relationships would be maintained and responsibilities carried out, has had a disastrous effect on Aboriginal women's health over the years. Through invasion and colonisation, Aboriginal women have experienced different forms of ethnocide and genocide that have attempted to assimilate and exterminate them. We know through these processes that Aboriginal women's lives were disrupted to varying degrees, depending on the level of penetration of the colonising dominant society.

What can be ascertained is that the roles of Australian Aboriginal women, men and children, family life and community life were forever changed in most communities. It is not non-Indigenous anthropologists who can tell the story from the lived experience, from the personal or from within the knowledge base of Aboriginality, but Aboriginal people themselves. It is Aboriginal women who understand what has happened from the position of being, of having lived the experiences, having heard the stories and having seen and felt the pain as Aboriginal women. It is through the lives of Aboriginal women such as Kay that we are able to gain an understanding about the workings of white society in order to survive as Aboriginal women. It is Aboriginal women who have been required to gain meaning from and re-interpret the dominant culture, to be able to live within it as Aboriginal women. It is from women such as Kay that we are able to gain an understanding of the sociology and psychology of the health system in the historical context, and effect change within that system.

Monash University and
the Queensland and Islander Health Council

Notes

^1. Bronwyn Fredericks, "Us Speaking about Women's Health: Aboriginal Women's Perceptions and Experiences of Health, Wellbeing, Identity, Body and Health Services" (PhD thesis, Central Queensland University, 2003).

^2. Fredericks, "Us Speaking about Women's Health."

^3. Lester-Irabinna Rigney, "A First Perspective of Indigenous Australian Participation in Science: Framing Indigenous Research towards Indigenous Australian Intellectual Sovereignty," Kaurna Higher Education Journal, vol. 7 (2001): 1–13.

^4. Linda Tuhiwai Smith, Decolonising Methodologies Research and Indigenous Peoples (London: Zed Books, 1999).

^5. Ann Bowling, Research Methods in Health: Investigating Health and Health Services (Buckingham, UK: Open University Press, 1997); John Creswell, Qualitative Inquiry and Research Design (London: Sage Publications, 1998).

^6. John Creswell, Research Design Qualitative & Quantitative Approaches (London: Sage Publications, 1994).

^7. Bowling, 231.

^8. Creswell, 58.

^9. Consultation with Indigenous postgraduates and researchers took place at national and international forums from 1995–98 while I was the National Indigenous Officer, Vice-President and President of the Council of Australian Postgraduate Association Inc. (CAPA), via attendance at National Indigenous Researchers Forums, the Indigenous Postgraduate Summer Institute and other such events along with connection on an individual basis.

^10. Sherry Saggers and Dennis Gray, Aboriginal Health and Society: The Traditional and Contemporary Aboriginal Struggle for Better Health (Sydney, NSW: Allen & Unwin, 1991), 59.

^11. Neil Thomson, "Australian Aboriginal Health and Health-care," Social Science & Medicine, vol. 18 (1984): 939.

^12. Information regarding the health status of English people from the nineteenth century can be found in the work of Freidrich Engles. See Chapter 3, "The Great Towns," in The Condition of the Working Class in England in 1844, translated by W. O. Henderson and W. H. Chaloner, first published in 1845 (1958). The first two paragraphs are the conclusion of Chapter 2, "The Industrial Proletariat" and provide eyewitness accounts describing conditions in 1844 when Engels (1820–1895) had been living in England, chiefly in Manchester. The book was first translated into English in 1892, available at www.cis.vt.edu/modernworld/d/Engels.htm. Also the work of Sherry Saggers and Dennis Gray, Aboriginal Health and Society: The Traditional and Contemporary Aboriginal Struggle for Better Health (Sydney, NSW: Allen & Unwin, 1991), and others support this view.

^13. Manning Clark, Sources of Australian History (New York: Mentor, 1966), 51.

^14. Sharman Stone (ed.), Aborigines in White Australia: A Documentary History of the Attitudes Affecting Official Policy and the Australian Aborigine 1697–1973 (Melbourne, Vic.: Heinemann Educational Books, 1974), 20.

^15. Eyre quoted in John Burton Cleland, "Disease amongst the Australian Aborigines," Journal of Tropical Medicine and Hygiene, vol. 31 (1928): 53–70, 125–30, 141–5, 157–60, 173–7, 196–8, 202–6, 216–20, 232–5, 262–6, 281–2, 290–4, 307–13, 326–30 (series of articles across same volume).

^16. John Elphinstone, "The Health of Australian Aborigines with no Previous Association with Europeans," Medical Journal of Australia, vol. 2 (1971), 295; Dampier in Andrew Arthur Abbie, The Original Australians (Sydney, NSW: Rigby, 1976), 5.

^17. National Aboriginal and Torres Strait Islander Health Council (NATSIHC), National Aboriginal and Torres Strait Islander Health Strategy, Consultation Draft (Canberra, ACT: NATSIHC, 2001), 3.

^18. Margaret-Ann Franklin and Isobel White, The History and Politics of Aboriginal Health (Sydney, NSW: Harcourt Brace Jovanovich, 1991), 3.

^19. NATSIHC, 5.

^20. Geoffrey Blainey, Triumph of the Nomads: A History of Ancient Australia (Melbourne, Vic.: Macmillan, 1994); Raymond Evans, K. Cronin, and Kay Saunders (eds.), Exclusion, Exploitation and Extermination: Race Relations in Colonial Queensland (Sydney, NSW: Australia and New Zealand Book Company, 1975); Lorna Lippmann, Generations of Resistance Mabo and Justice (Melbourne, Vic.: Longman Cheshire, third edition, 1994); Stuart Rintoul, The Wailing: A National Black Oral History (Melbourne, Vic.: William Heinemann, 1993); Rosser Bill, Dreamtime Nightmares: Biographies of Aborigines under the Aborigines Act (Canberra, ACT: Australian Institute of Aboriginal Studies, 1985).

^21. James Sa'ke'j Youngblood Henderson, "Challenges of Respecting Indigenous World Views in Eurocentric Education," in Voice of the Drum: Indigenous Education and Culture, edited by R. Neil (Brandon, Manitoba: Kingfisher Publications, 2000), 59–80.

^22. Peter Read, A Rape of the Soul so Profound: The Return of the Stolen Generations (Sydney, NSW: Allen & Unwin, 1999); Rintoul, Human Rights and Equal Opportunity Commission (HREOC), Bringing Them Home: A Guide to the Findings and Recommendations of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families (Canberra, ACT: HREOC, 1997) provides an account of these practices and effects. In Canada, similar processes occurred through the removal of Aboriginal children from their communities and placing them in residential schools as in Suzanne Fournier and Ernie Crey, Stolen from Our Embrace: The Abduction of First Nations Children and the Restoration of Aboriginal Communities (Vancouver, BC: Douglas and McIntyre, 1997).

^23. Kidd Rosalind, The Way We Civilise (Brisbane, Qld: University of Queensland Press, 1997).

^24. NATSIHC, 5.

^25.Ibid.

^26. National Health and Medical Research Council (NHMRC), The Health Australia Project: A Review of Infrastructure Supports for Aboriginal and Torres Strait Islander Health Advancement, Discussion Paper (Canberra, ACT: NHMRC, 1996), 20.

^27. NHMRC, 20; Australian Bureau of Statistics (ABS), The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples (Canberra, ACT: Australian Government Publishing Service, 2001), 4.

^28. Australian House of Representatives Standing Committee on Family and Youth Affairs, Health is Life Report on the Inquiry into Indigenous Health (Canberra, ACT: Australian Government Publishing Service, 2000), 4.

^29. Australian Indigenous HealthInfoNet, "Summary of Indigenous health status," accessed 30 May 2002 at http://www.healthinfonet.ecu.edu.au/html/html_keyfacts/keyfacts_summary.htm, 7.

^30.Ibid, 8.

^31.Ibid, 8. The increasing levels of family violence and injury caused by violence (within Queensland) is addressed in the Aboriginal and Torres Strait Islander Women's Task Force on Violence Report by the Aboriginal and Torres Strait Islander Women's Task Force on Violence (Brisbane, Qld: Department of Aboriginal and Torres Strait Islander Policy and Development, Queensland Government, 1999).

^32. Australian Bureau of Statistics (ABS), National Aboriginal and Torres Strait Islander Survey (Canberra, ACT: Australian Government Publishing Service, 1995); NHMRC.

^33. ABS 1995; NHMRC; Australian Indigenous HealthInfoNet, 4.

^34. Australian Bureau of Statistics (ABS), The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples (Canberra, ACT: Australian Government Publishing Service, 1997); Australian House of Representatives Standing Committee on Family and Community Affairs, Health is Life.

^35. Commonwealth of Australia, The National Aboriginal Health Strategy: An Evaluation (Canberra, ACT: Australian Government Publishing Service, 1995), 6.

^36. Australian Indigenous HealthInfoNet, 6.

^37. Rhonda Dorman, "Ngua Gundi (Mother and Child) Program," Aboriginal and Islander Health Worker Journal, vol. 21, no. 5 (1997): 2–6.

^38. Saggers and Gray; Neil Thomson, "A Review of Aboriginal Health Status," in The Health of Aboriginal Australia, edited by Jan Reid and Peggy Trompf (Sydney, NSW: Harcourt Brace Jovanovich, 1991), 37–79; Australian House of Representatives Standing Committee on Family & Community Affairs, Health is Life, 4.

^39. Queensland Health, Health Determinants Queensland 2004 (Brisbane, Qld: Queensland Health, (2004), 22.

^40.Ibid.

^41. Australian Indigenous HealthInfoNet, 12.

^42.Ibid.

^43. Gregory Phillips, Addictions and Healing in Aboriginal Country (Canberra, ACT; Aboriginal Studies Press, 2003), 93.

^44. See Rosalind Kidd, 1997; Robert Manne, "In Denial: The Stolen Generation and the Right," Australian Quarterly Essay, vol. 1 (2001): 1–113; Robert Manne (ed.), Whitewash: On Keith Windschuttle's Fabrication of Aboriginal History (Sydney, NSW: Macmillan Education Australia, 2003); Read, 1999; Henry Reynolds (ed.), Race Relations in North Queensland (Townsville, Qld: Department of History and Politics, James Cook University, 1993); Rintoul, 1993.

^45. Phillips, Addictions, 23.

^46. Eduardo Duran, Bonnie Duran, Maria Yellow Horse Brave Heart and Sandra Yellow Horse-Davis, "Healing the American Indian Soul Wound," in International Handbook of Multigenerational Legacies of Trauma, edited by Yael Danieli (New York: Planum Press, 1998), 341–354.

^47. Fredericks, "Us Speaking about Women's Health."

^48. Commonwealth of Australia, National Women's Health Policy: Advancing Women's Health in Australia (Canberra, ACT: Australian Government Publishing Service, 1989); Dorothy Broom, Damned if We Do: Contradictions in Women's Health Care (Sydney, NSW: Allen & Unwin, 1991); Teresa Moore, "Radical to Conservative: An Analysis of the Establishment of a Women's Health Centre in Queensland" (Honours thesis, Central Queensland University, 1999); Queensland Health, Towards A Queensland Women's Health Policy—Social Justice for Women (Brisbane, Qld: Queensland Health, 1992).

^49. Jackie Huggins, "A Contemporary View of Aboriginal Women's Relationship to the White Women's Movement," in Australian Women and Contemporary Feminist Thought, edited by Norma Grieve and Ailsa Burns (Melbourne, Vic.: Oxford University Press, 1994), 70–79; Jackie Huggins, "Black Women and Women's Liberation," Hecate, vol. 13, no. 1 (1987): 77–82; Jackie Huggins and T. Blake, "Protection or Persecution: Gender Relations in the Era of Racial Segregation," in Gender Relations in Australia, edited by Kay Saunders and Raymond Evans (Sydney, NSW: Harcourt and Brace Janovich, 1992), 42–57; Aileen Moreton-Robinson, Talkin' Up to the White Women Indigenous Women and Feminism (Brisbane, Qld: University of Queensland Press, 2000); Pat O'Shane, "Aboriginal Women and the Women's Movement," Refracting Voices, Feminist Perspectives, (Sydney, NSW: Southward Press, 1993), 69–75; Pat O'Shane, "Is There Any Relevance in the Women's Movement for Aboriginal Women?," Refractory Girl, September (1976), 12.

^50. Whiteness in this context is used to refer to the cultural construct of Anglo-settler culture. It is not used as a biological reference. Parallels can be drawn between Australia and Canada in relation to Anglo-settlement and cultural development and the colonisation of Indigenous peoples. Kirsten Roger, "'Fairy Fictions': White Women as Helping Professionals" (PhD thesis, University of Toronto, 1998).

^51. Links can be made here to numerous health and human service professions.

Content in the History Cooperative database is intended for personal, noncommercial use only. You may not reproduce, publish, distribute, transmit, participate in the transfer or sale of, modify, create derivative works from, display, or in any way exploit the History Cooperative database in whole or in part without the written permission of the copyright holder.