Questions- Cultural Safety

Copyright \C'~ eContent Management Pt.v Ltd. Contemporary )\'urse (2007) 24: 33--44.

Accepted 12 September 2006Received 14 March 2006

The Jocus ~f this paper is stories by, and about (mainly non-Aboriginal)

Registered Nurses working in hospitals and clinics in remote areas ~rAustralia

.from the early 1900s to the 1980s as they came into contact with, or caredfor,

Aboriginal people. Government policies that controlled and regulated

Aboriginal Australians provide the contextfor these stories. Memoirs and other

contemporary sources reveal the ways in which government policies in different

eras influenced nurse's attitudes and clinical practice in relation to Aboriginal

people, and helped uistitutionalise racism in health care. Up until the 1970s,

most nurses in this study unquestioningly accepted firstly segregation, then

assimilation policies and their underlying paternalistic ideologies, and

incorporated them into their practice. The quite marked politicisation ~f

Aboriginal issues in the 1970s in Australia and the move towards seif-

determination for Aboriginal people politicised many - but not all - nurses.

For the first time, many nurses engaged in a robust critique cif'government

policies and what this meantlor their practice andfor Aboriginal health. Other

nurses, however, continued as they had bifore - neither questioning prevailing

policy nor its ~ffects on their practice. It is argued that only by understanding

and confronting the historical roots ~f institutional racism, and by speaking out

against such practices, can discrimination and racism be abolis~eafrOfn nursing

practice and health care. This is essential for tiursinq's c

pr~fessional development andfor better health for Aboriginal

SUE FORSYTH

Senior Lecturer

Nursing History

Research Unit

Faculty of Nursing

& Midwifery University of Sydney

Camperdown NSW,

Australia

INTRODUCTION

Ind ige no us people (Aboriginal and Torres StraitIslanders) comprise 2.4% of the Australian population (AIHW 2006), and their appalling

health and severe socio-economic disadvantage

(low incomes and educational levels, high un-

employment, poor housing etc) continue to be a

national disgrace. Life expectancy for Indige-

nous males is 59 years and for Indigenous

Volume 24, Issue 1, February 2007 C:J( 33

Copyright of Full Text rests with the original copyright owner and, except as permitted under the Copyright Act 1968, Copyright this copyright material is prohibited without the permission of the owner or

its exclusive licensee or agent or by way of a license from Copyright Agency Limited. For information about such licences contact Copyright Agency Limited on (02) 93947600 (ph) or (02) 93947601 (fax)

Sue Forsvth

females is 65 years. This is approximately 20

years less than for other Australians, with about

70% dying before the age of 65 years. This is in

stark contrast to the non-Indigenous popula-

tion, where the corresponding proportion is

21 %. Indigenous death rates for circulatory dis-

eases are three times higher than other Aus-

tralians, diseases of the digestive system five

times, and endocrine, nutritional and metabolic

diseases are eight times higher. Indigenous

infants and children have death rates three times

higher than non-Indigenous Australians (AIHW

2006). This situation is not new. The very poor

state of Aboriginal health was widely known by

the early 1970s (Saggers & Gray 1991) and little

has changed in the intervening years.

The health problems and severe disadvantage

suffered by Indigenous Australians is similar to

that of other Indigenous peoples worldwide

and, according to the International Council of

Nurses (1999), a matter of concern for nursing

(see Willis, Smye & Rameka 2006). Also of con-

cern is the wav health care services are dcliv- j

ered, including the behaviour of health care

providers with respect to Indigenous peoples

(ICN 1999). Australian nurses share these con-

cerns (Armstrong 2004; van Holst Pellekaan &

Clague 2005), but few point to the link

between past government policies and current

nursing practice. One who does is Sally Goold,

Executive Director of the Congress of Aborigi-

nal and Torres Strait Islander Nurses. She

believes that racism, prejudice and discrimina-

tory practices are alive and well in nursing and

in the Australian health care system today pre-

cisely because of 200 years of colonization and

the implementation of paternalistic and racist

policies. Such policies denied Aboriginal people

control over their own affairs, restricted their

movement, and forbade them to speak their lan-

guage and perform their ceremonies (Goold

2001). Goold provides compelling evidence

of contemporary nurses ignoring Indigenous

patients, treating them as 'nonpersons, invisible,

unseen and unheard' (Goold 2001: 96). As the

34 C:JV Volume 24, Issue 1, February 2007

former Governor General of Australia, Sir Wil-

liam Deane, quite rightly explains:

the past is never fully gone. It is absorbed

into the present and the future. It stays to

shape what we are and what we do.

(Cited in Stephens 1999)

Goold is not alone in believing that racism has

become 'institutionalised' into contemporary

health care services in Australia. Institutional

racism can be defined as the wavs in which

'racist beliefs and values have been built into the

operations of social institutions in such a way

as to discriminate against, control and oppress

various minority groups' (Henry, Houston &

Mooney 2004: 517). Henry et al. (2004) consid-

er institutional racism has been an almost con-

stant feature of Australia's history, and that

health care services are no exception. But they

caution this has not always been deliberate. Very

often institutional racism is covert and relatively

subtle, unintentional and unrecognized even by

those involved in it. Unquestioned adherence

(by nurses) to dominant group norms, for ins-

tance, is one way of institutional ising racism.

The purpose of this paper is to explore the

link between past government policies con-

cerned with Aboriginal people and nursing

practice as a way of understanding how racism

became institutionalised into nursing and health

care in Australia today. Such an examination is, I

believe, crucial for contemporary nurses. His-

torical knowledge is a powerful tool for alerting

nurses to the insidious and often covert nature

of racism, for understanding how the past influ-

ences the present, and it underpins the abolition

of racist practices, attitudes and behaviours in

nursing and health care. As Jackson, Brady and

Stein (1999) argue, confronting nursing's past

and reflecting on the role nurses may have had

in contributing to the oppression of Australia's

Aboriginal people is essential for nursing's pro-

fessional maturity, for the successful delivery of

health services to this most disadvantaged popu-

lation, and an important step towards reconcili-

l\' urses, politics and Aboriginal Australians, circa 1900-1980s C:;v

ation. Overcoming institutional racism, Henry

et al. (2004) claim, is also the key to improving

the health of Aboriginal and Torres Strait

Islander peoples.

Registered Nurses have a long history of

coming into contact with, and caring for,

Aboriginal Australians, particularly those non-

Aboriginal nurses who combined their clinical

practice with missionary work in rural and

remote areas of Australia from the early 20th

century. It has been suggested that these nurses

were amongst the first to recognise the dreadful

state of Aboriginal health precisely because of

their close contact with this population (Grif-

fiths 2000). This paper explores stories told by,

and about (mostly non-Aboriginal) Registered

Nurses and their professional relationships with

Aboriginal people from the early 1900s to the

1980s in the context of government policies

that regulated and controlled Australia's Aborig-

inal population. As Commissioner Elliot John-

ston pointed out in the Royal Commission into

Aboriginal Deaths in Custody:

every turn in the policy of government and

the practice of the non-Aboriginal communi-

ty was postulated on the inferiority of the

Aboriginal people.

(Cited in GrifIin 1995: 285)

Stories in this paper are drawn from the mem-

oirs and contemporary accounts of mainly (but

not exclusively) non-Aboriginal hospital and

clinic Registered Nurses who worked in rural

and remote areas of Australia, from Aboriginal

people themselves, and from other sources of

the period. They are snapshots by individuals of

particular places at particular moments in time.

The stories have been grouped into three dis-

tinct historical eras broadly defined by policy:

segregation and protection, 18 90s-19 50s; as-

similation and integration, 1950s-1972; and

self-determination and self-management, from

1972 (Ecker mann et al. 2006). This examina-

tion finishes in the 1980s as the policies have

changed little (Eckerrnann et al. 2006), and it is

the historical connections between government

policies and nursing practice that is of interest

here for what it can tell nurses today. These

stories reveal that paternalism is an enduring

feature throughout these eras, and a major

factor in shaping nurses' attitudes and clinical

practice in relation to Aboriginal Australians. In

the current health care arena where policies of

paternalism remain on the political agenda (Ab-

bott 2006), such an exploration has profound

implications for nursing practice today.

ETHICAL CONSIDERATIONS Ethical considerations are of major concern in

Aboriginal research. In line with the require-

ments of the National Health and Medical

Research Council (2003) guidelines on con-

ducting research on, or about, Aboriginal peo-

ple and Aboriginal issues, this paper has been

discussed at length with Vicki Bradford and Kath

Howey, Indigenous lecturers at the Faculty of

Nursing and Midwifery, University of Sydney,

Australia. Changes they have sought have been

incorporated into the paper.

A note of caution. This paper refers to per-

sons who are deceased. However, as the paper

draws on published works and publicly available

material, including memoirs, identifying details

of deceased persons have not been removed. In

addition, when quoting, the language used in

the documents of the day is used. This may

cause offense to some people.

SEGREGATION AND PROTECTION: 19005-19505 The official, legally sanctioned policies from the

1890s to the 1950s were those of protection

and segregation. Government reserves and

Christian missions were established across Aus-

tralia (generally on land that Europeans did not

want) supposedly to protect Aboriginal people

until they died out. Paternalism was the under-

lying philosophy of protection policies, rein-

forced by prevailing attitudes that Aboriginal

Volume 24, Issue 1, February 2007 C:;v 35

Sue Forsvth

people were childlike, dependent, and 'a race

apart' (Griffiths 2000).

While each state of Australia had its own leg-

islation that governed and severely circum-

scribed Aboriginal people's lives, protection

policies were fairly uniformly applied through-

out the country (Eckermann ct al. 2001: 24). In

New South Wales, for instance, Aboriginal peo-

ple were defined by an Act of Parliament and

every aspect of their lives was governed, regu-

lated and controlled by the Aborigines Protection

Act (1909) administered by the Aboriginal Pro-

tection Board. This Act prohibited Aboriginal

people from drinking alcohol, voting or cohab-

iting with non- Aboriginal people, from owning

property, and authorized their forcible reloca-

tion from any station, camp or reserve as the

Board directed. The Board retained custody and

control of all Aboriginal children, excluded

them from state schools, and, at its discretion,

removed them from their families and sent

them to children's homes or to service with

white families (Aborigines Protection Act 1909).

Other states had similar Acts and Boards.

Very little was done for the health of Aborigi-

nal people in the early 20th century, despite

compelling evidence of their disintegrating

health, as it was widely believed they were a

dying race that would soon be extinct (NSW

Department of Aboriginal Affairs 1998). Those

Aboriginal people who lived in fringe-camps on

the outskirts of larger towns in Western Aus-

tralia in the early 1900s, for instance, suffered

high rates of blindness and crippling bone

diseases, high rates of infectious (influenza,

whooping cough, leprosy) and sexually trans-

mitted diseases that caused sterility, kidney fail-

ure and dementia, and endemic infections

arising from living in dirty and polluted camps.

Those living on properties in Western Australia

and Queensland often fared little better in

terms of their health and suffered high rates

of poor health and disability (Briscoe 2003). At

the government settlement at Cherbourg in

Queensland, semi-starvation, disease (hook-

36 C:JV Volume 24, Issue 1, February 2007

wor m , influenza, syphilis) and misery were rife

- largely the result of overcrowding, poor sani-

tation and poor diet and malnourishment (Blake

2001). The provision of medical care to Aborigi-

nal people remained in the hands of private

medical practitioners, who tried (often unsuc-

cessfully) to recoup their costs from the Chief

Protector, or district hospitals where segrega-

tion of Aboriginal patients was widespread

(Briscoe 2003).

The memoirs of nurse Ann Stafford Garnsey

are especially telling about prevailing attitudes

during this period of segregation and protection

and the dreadful living conditions of one group

of Aboriginal people in Queensland. Writing of

her experiences as a nurse from the early

1900s, Garnsey came into contact with a group

of fringe dwelling Aboriginal people who lived

near Rockhampton Hospital where she worked.

She wrote with a mixture of unhelpful sympa-

thy, paternalism, curiosity and unquestioning

acceptance of the lot of these Aboriginal people.

Garnsey was clearly intrigued by them, and fre-

quently went down to 'the blacks' camp' in her

off duty time from the hospital to indulge her

hobby of sketching. She described the camp as a

'collection of scrub humpies , patched up with

bits of tin and other rubbish. There was some

shelter from the sun' , she continued, 'but not

much from the rain'. While she found it dis-

tressing that human beings should live in this

dreadful state, she never questioned why. Yet, in

spite of their appalling living conditions, Garn-

sey wrote 'they all looked well-fed and cheerful'

(Garnsey n.d.: 36-37). But from her own

account it is obvious they were neither. On one

of her frequent visits to the camp one man, she

reported, 'looked angrily at me and said in a

whining voice, 'You, go 'way, whitefella. You

take all my country. This camp belonga black-

Iella ' (Garnsey n.d.: 37). Garnsey's reaction, like that of other whites at the time, was to buy

the confidence of Aboriginal people with tea,

sugar and tobacco. She lured children (with

sweets) into posing for her sketches, having a

:\Iurscs, politics and Aboriginal Australians, circa 1900--1980s C:J'(

self proclaimed fascination for 'piccaninnics ...

especially the darling, dusky babies with their

fuzzy heads' (Garnsey n.d.: 37).

Garnsey unquestioningly accepted the policy

of removing Aboriginal children from their fam-

ilies, but was, nevertheless, sympathetic to the

plight of the poor mothers. On one occasion

she approached a 'gin' asking to look at the 'pic-

caninnv ' she carried and was met with a

resounding 'N-a-a! N-a-a! this one belonga me,

vou no stcalcm ': As Garnsey commented:

The poor things had good cause to be very

suspicious of any advances made by 'whites' .

Too often babies have been stolen from their

mothers and carried off by people in carts to

be a plaything for a while. And then what?

And the poor mother left sad, and with no

redress. (Garnsey n.d.: 37)

While Garnsey provides no evidence of having

removed Aboriginal children from their families

herself, there is evidence that other nurses dicl.

In evidence to the National Inquiry into the

Stolen Generations, for instance, one Aboriginal

woman recounted how in the 1940s her mother

gave birth to twins. She was told one twin had

died and shown the empty cot. The woman,

however, had recently learned that the twin

her older brother - had not, in fact, died. The

nursing sister had taken him (National Inquiry

into the Separation of Aboriginal and Torres

Islander Children from their Families 1997).

This was not an isolated incident and Aboriginal

people were quite rightly suspicious of nurses

and hospitals (Eckcrrnann et al. 2006).

Particularly telling of the paternalism that is a

feature of this period is Garnsey's story of what

she called 'the act of grace' by the Queensland

and Western Australian Governments in supply-

ing Aboriginal people with 'nice, warm, grey

blankets' on the first of May every year. She

considered it 'amusing to see them lining up' for

their blankets, 'they are so childlike' (Garnsey

n.d.:42).

Some nurses in this era, however, were more

insightful into the plight of Aboriginal people in

their writing, but no less blind to the underlying

policies. Australian Inland Mission Sister, Jean

Williamson, of remote Oodnadatta Hospital,

for instance, wrote in 1919:

There is a need for [white] people to be

made aware of their life. Thev are not the

degraded people some seem to class them

[as]. They could not have managed to exist if

thev had bad laws ... The white man has, upset a lot of their ways by introducing vices

and infections they had no immunity for.

(Griffiths 2000: 19)

Segregation for Aboriginal people was not only

confined to the conditions under which thcv, lived; there was widespread use of segregation

in hospitals. Aboriginal patients were often allo-

cated to separate, inferior wards or areas in hos-

pitals, a practice favoured by many nurses.

Garnsey, for instance, considered segregated

wards benefited all concerned. The 'small canvas

wards' reserved 'solely for the use of [A]borig-

ines", she wrote, were put up 'at smell-proof

distance' from the other hospital wards. The fact

that the Aboriginal wards were 'rarely empty'

Garnsey claimed was a measure of 'how much

they liked them'. Such a claim, though, flew in

the face of her own recognition that Aboriginal

people feared and distrusted white people and

hospitals (Garnsey n.d.: 53). On the question of

the health problems of the hospital's Aboriginal

patients, however, Garnsey is silent.

Missionary nurses working for the Australian

Inland Mission (AIM) in some of the most

remote locations generally considered segregat-

ed 'native wards' a necessity (Griffiths 2000:

11 5). In his history of the nurses of the AIM,

Max Griffiths argues that one of the problems

for these nurses was that negative community

attitudes towards Aboriginal people made it dif-

ficult for nurses in hospitals to admit them into

wards with white people, Whites feared catch-

ing the diseases that ran rampant through Abo-

riginal communities and objected to their being

Volume 24, Issue 1, February 2007 C:J'( 37

Sue Forsvth

treated in hospitals (Griffiths 2000). However,

there is no indication that at this time the AIM

nurses themselves objected to segregated wards

or other separate accommodation for Aboriginal

people. According to AIM nurses working in the

remote town of Innamincka in the far north-

east of South Australia in 1931, a police cell

provided 'a comfortable and convenient bed-

room for our sick blacks' (Griffiths 2000). For

another desperately ill Aboriginal woman in Esperance in Western Australia in the 1940s seg-

regation meant being admitted to the mortuary

(Griffiths 2000).

Aboriginal people, on the other hand, found

these segregated wards far less satisfactory. In

her memoirs, Aboriginal artist, Mabel Edmund,

recounts how she experienced her first real

hurts of racism on going to hospital to give

birth. The maternity hospital at Rockhampton

had a separate ward for black mothers that con-

sisted of a small room at the end of the back

verandah well away from the white wards. It

contained three beds and three cots, and dou-

bled as the labour ward for Aboriginal mothers.

When Edmund was there this room also had

bars on the windows (Edmund 1992). Well

known Aboriginal Elder and activist, Mum

Shirl, recounts in her memoirs the shock of

finding segregated and poor quality verandah

accommodation for Aboriginal women at

Kempsey Hospital (Mum Shirl 1987). For

another Aboriginal mother, the room on the

verandah was 'very, very cold ... in August'

(Eckermann et al. 1992: 160).

In a particularly telling episode, Edmund

describes taking her dying father to a nursing

home for old people, thinking this a better

alternative than the local hospital. It is unclear when this occurred, but the prevailing attitudes

are abundantly clear. On arrival at the nursing

home with her dying father in the car, Edmund

was confronted by the sister in charge whose

first question was 'Is your father as dark as you?'

When Edmund said 'yes', the nurse replied 'We

don't take black people here'. As Edmund

38 C:J( Volume 24, Issue 1, February 2007

recounts the story, the nurse 'went out to the

car to check how black mv dad was. She came

back and said, 'Your father is dying.' I said I

knew he was, that was why I wanted profession-

al care for him. But [the nurse] still didn't take

him, because he was black' . The nurse claimed

that though she wasn't prejudiced, the other

patients were, and she did not want to upset

them. Edmund, however, was profoundly upset

by this episode (Edmund 1992: 70-71).

Segregated wards are one striking example

whereby nurses were called upon to be the in-

struments of discriminatory policies that institu-

tionalized racism into their practice and the

delivery of health care. For Aboriginal patients,

separate facilities in hospitals reminded them of

social norms that overtly promoted, approved and

institutionalised racism (Ec kermann et al. 1992).

ASSIMILATION AND INTEGRATION: 1950s-1972 When it became clear that the Aboriginal popu-

lation was not dying out as previously assumed,

policies of protection were replaced by those

of assimilation and integration. This called for

Aboriginal people to attain a similar manner of

living as other Australians, have the same rights,

privileges and responsibilities, and to be sub-

sumed into the wider Australian community

(Eckerrnann et al. 2006). This policy was prem-

ised on the belief that breeding out Aboriginali-

tv was the onlv wav to achieve harmonious , "

coexistence (Saggers & Gray 1991).

The problem was that Aboriginal people did

not have the same rights, were not considered

Australian citizens (until the 1967 referendum),

and the policies themselves were contentious.

Aboriginal people were not enthusiastic to col-

laborate with their white conquerors for what

they saw as their physical and cultural extinc-

tion, and whites were concerned that complete

mergence of Aboriginal people into the general

community was not possible without some

detriment to Australia's white inhabitants

(Franklin & White 1991). It was one thing to

Nurses, politics and Aboriginal Australians, circa 1900- 1980s C:J(

attempt to change policy, but quite another to

change attitudes, behaviours and practices. For

example, at this time the Queensland govern-

ment encouraged the 'independence' of Aborig-

inal workers as a way of reducing costs on

settlements, and introduced further repressive

and paternalistic measures such as forced deten-

tion on reserves, controlled marriages and cen-

soring their mail. While some Aboriginal

workers continued to provide unpaid compulso-

ry labour, others faced discriminatory wages,

and most had their savings controlled and man-

aged by the government (Kidd 2000: 238-9).

And their health continued to suffer.

By the 1950s and 60s there was mounting

evidence of the continued poor state ofAborigi-

nal health. Doctors, for instance, wrote letters

to the editor of the Medical Journal ~rAustrafja on

Aboriginal health, a topic previously ignored

(Thomas 2004). Nurses reported on the in-

tractability of the health of Aboriginal people

and their unhealthy living conditions, but there

is no evidence they questioned why this state of

affairs occurred or why it was allowed to con-

tinue. One missionary nurse working at the

remote location of Fitzroy Crossing, for ins-

tance, wrote:

God, the conditions in that [Aboriginal] camp

are criminal. Every time I get called out

there I could scream. I just get fed up with

treating the same diseases week after week.

You treat them, they go back to the camp and

the next thing they're in here again. It's hope-

less. (Griffiths 2000: 105)

Despite the move to policies of assimilation and

integration, the paternalistic policies of protec-

tion and segregation continued to dominate the

delivery of health care in this period. Aboriginal

people were largely excluded from both the

decision-making processes and the delivery of

health care, even in relation to services specifi-

cally designed for them. Separate wards for

Aboriginal people in many hospitals continued

well into the 1960s, often despite official sane-

tions and threats that they would lose their gov-

ernment subsidy (Franklin & White 1995). As

the matron of a VI/estern Australian hospital at

this time argued, 'it is all very well to talk about

the rights of natives, but I do not think that

people who talk in this way would like to be in

the next bed to one' (cited in Saggers & Gray

1991:124).

In remembering her time in the mid 1950s as

the first Aboriginal nursing sister in the small,

remote, 'somewhat racist town' of Leonora,

Sadie Canning recounts how disturbed she was

on finding the Aboriginal patients in the hospital

segregated in a small tin shed away from the

general wards. On becoming matron, and in the

face of opposition, Canning ended the practice

of segregated wards at the hospital, proudly

proclaiming this as her greatest achievement

(Canning 2005: 6--7). At Darwin Hospital in the

late 1950s, however, segregation continued,

though it was not always clear who should be

sent to the 'native' or 'full-blood ward'. Those

of mixed ancestry were supposed to be sent to

the regular wards, to assimilate. In reality, how- ever, Aboriginal nurse MarvAnn Bin-Sallik con-

tends hospital personnel sent many people to

the 'native' ward 'on the basis of their dark

complexions' (Bin-Sallik 2005: 29).

For Bin-Sallik what was equally as disturbing

was the treatment of Aboriginal patients at the

hospital. She reports that Aboriginal women,

particularly those who could not speak English,

were sterilized after giving birth without their

consent. This was based on the paternalistic atti-

tude that their previous children had died of

gastroenteritis, a not surprising state of affairs

given their appalling living conditions. But, as

Bin-Sallik (2005) points out, these same living

conditions were provided by the government.

Aboriginal patients at this time were routine-

ly treated differently from their non-Aboriginal

counterparts, and excluded from decisions

about their care. In her memoirs, Pat Keating, a

non-Aboriginal teacher working on an Aborigi-

nal government reserve in the 1960s, describes

Volume 24, Issue 1, February 2007 C:J( 39

Sue Forsvth

how her two vear old son was mistakenlv admit-, , ted to the Aboriginal section of the nearby hos-

pital after drinking kerosene. The nurses had

wrongly assumed that because Keating gave her

address as the Aboriginal rcser vc , that both she

and the child were Aboriginal. As a result, the

nurses refused Keating permission to visit her

son, arguing it 'would serve no purpose and

would most likely disturb the child unnecessari-

ly'. Even the matron assured Keating that the

child was' quite well and happy' , and that she

would be informed when he was ready to come

home. When the mistaken racial identity of the

child was finally realized more than a week

later, it was made clear that the only reason for

his prolonged hospitalisation was because 'the

child had been admitted as an Aborigine and as

such was considered in need of extra attention' .

The ward sister apologized to Keating, saying

'everything would have been different if they

had known Christopher was a white child' - he

would have been discharged after two days

(Keating 1994: 35).

Admitting Aboriginal children to hospital and

keeping them there for as long as possible was

widely practiced by nurses. It was considered

preferable to sending them back to their fami-

lies and their dreadful living conditions. In her

memoirs of working for the Bush Church Aid

Society of Australia, missionary nurse Audrey

Aspeling recounts how, in the early 1970s in the

remote town of Laverton in Western Australia,

matron insisted that all sick Aboriginal children

be admitted, as she felt 'their parents would be

unable to care for them satisfactorily' (Aspeling

2000: 58). Aboriginal children there were

recurrently hospitalised with sores, ear and

chest infections, and were nearly always infect-

ed with scabies and lice. Aspeling noted, though

did not question or comment further, 'no one

ever suggested repairing their severely ruptured

eardrums' (Aspc1ing 2000: 57).

Though Aspeling's memoirs were written in

2000, her attitudes are indicative of the times

about which she wrote rather than present day

40 C:J( Volume 24, Issue 1, February 2007

sensibilities. She was not surprised at the chron-

ic health problems of the Aboriginal communi-

ty, for the houses in which they lived on the

government reserve at the edge of town were

'dilapidated and dirty'. From her point of view

the problem was simple: Lavcr tons 'native peo-

ple' were 'still quite tribal'. Their houses had

been built (by the government) 'with the best of

intentions' , but the Aboriginal people were 'not

used to living in any kind of house' . They 'slept

with their dogs' and used their meager welfare

payments to buy 'very low quality foods from

the shops in town' (Aspeling 2000: 57-58).

But, concerned as much with spreading Chris-

tianity as ministering to the sick, Aspeling could

joyfully report that these same Aboriginal peo-

ple were 'keen to talk about God and to assimi-

late Him into their own religion', their faith in

Christ being' one of the most beautiful things

about them' (Aspeling 2000: 59 & 63).

SELF-DETERMINATION AND 5ELF- MANAGEMENT: 1972-19805 The election of the Whitlam Labor Government

in 1972 heralded a marked politicisation of

Aboriginal affairs in the wider community, and

a new era of policies aimed at self-determina-

tion and self-management for Indigenous Aus-

tralians. A nationwide referendum in 1967 had

given Aboriginal people full citizenship, and

they were now recognised as a distinctive cul-

tural group with a right to determine their own

future. The appalling state of Aboriginal health

was also recognised (Saggers & Gray 1991) and

federal funds were now poured into health and

housing for Aboriginal people to bring them

into line with standards enjoyed by other Aus-

tralians. It appears, however, that the money was not always wisely spent. In Queensland, for

example, federal grants financed new amenities

(hospitals, dental clinics) but not the highly

qualified health personnel upon which their suc-

cess depended (Kidd 2000: 261). The reality

was that policies to self-determination and self-

management were never fully implemented. A

Nurses, politics and Aboriginal Australians, circa 1900-1980s C:;v

largc percentage of programs aimed at sclf-

determination for Aboriginal people continued

to be controlled, regulated and directed by non-

Aboriginal people, and the Federal Minister for

Aboriginal Affairs retained the final say on all

rnatters and absolute control mer the purse

strings (Eckermann et al. 2006).

By the 1970s, nurses too were increasingly

politicised about, and interested in, Aboriginal

matters. A special Indigenous edition of the Aus-

tralasian Nurses Journal became an annual event

from the mid 1970s, with articles by Aboriginal

and Torres Strait Islander people, nurses, politi-

cians, anthropologists and others concerned

with Indigenous health, housing, culture, land

rights etc. The Editor, Edna Davis, considerecl

the time for burying our collective heacls in the

sand 'like the proverbial ostrich' in relation to

past injustices to Australia's Indigenous people,

was over (Davis 1977).

In tune with the politicisation of Aboriginal

issues and the change in government policy,

many nurses experienced in working in Aborigi-

nal communities now considered self-determi-

nation as the most effective way to improve

Aboriginal health. Sister Dinnell from the Abo-

riginal Health Unit, Norwood, for example,

pointed out in 1976 that 'feelings of helplessness

and dependency' engendered in Aboriginal peo-

ple over the past 200 years would exist as long

as the money for Aboriginal health was con-

trolled by others (Dinnell 1976). Lindsey Harri-

son, a nurse who had worked at a small

government run Aboriginal community on

Cape York, was more forthright in her claims in

1978 that there would be 'little real improve-

ment' in Aboriginal health until Aboriginal peo-

ple were given 'full responsibility' for their own

health care (Harrison 1978). Other nurses,

however, were far less insightful. In 1979, Gwen

Coster, community health nurse for the East

Gippsland Aboriginal Medical Service, just

wished Aboriginal people had 'more confidence'

in their ability 'to cope with the white society in

which they find themselves' (Coster 1979: 4).

Remote area nurses who worked extr emelv

hard under very difficult conditions to improve

Aboriginal health, were often severely con-

strained by, and becoming increasingly critical

of, government inaction. In her memoirs of

working in a clinic in the remote community of

Port Keats in the mid 1980s, Registered Nurse

Tracey Leonard expressed more than frustration

at what she called the 'bureaucratic merry-go-

round' that left the local Aboriginal community

with broken sewerage pipes, inadequate garbage

disposal, and poor and overcrowded housing.

She angrily stated that 'we heroically treat all ...

conditions with the best that modern medicine

can provide, but unfortunately this makes little

impression in the long run'. Leonard consid-

ered that the lack of government resources for

Aboriginal communities, and, it would seem,

political will, continued to exact an enormous

toll on Aboriginal health (Leonard 1999: 235).

But the paternalistic attitudes and racism of

past eras were not easily shed. In her reminis-

cences of her time working in Aboriginal com-

munities in Western Australia in the late 1970s

and early 1980s, English nurse, Diana Camp-

bell, found Aboriginal people and their ways

'highly entertaining'. She claims never to have

met 'such a marvelously patient race', saying

they would wait all day to see the doctor or

nurse at the hospital and never complain

(Campbell 1982: 2019). But Campbell never

questioned why they were forced to wait all day

for medical attention. Nor did she question why

Aboriginal communities often had no toilet,

running water or shelter, preferring instead to

interpret this as them having 'different standards

of hygiene'. Most telling about Campbell's

paternalism is her story of one particular Abor-

iginal woman:

One day in outpatients, Ida Jam, pigeon-toed

and untidy, staggered through the door. She

was covered in scabs and sores and had been

in a fight. She descended upon the treatment

room ... calling' Sista, Sista!' She is battered

Volume 24, Issue 1, February 2007 C:;v 41

Sue For svth

and abused and is a regular. She' 11 never be

made better. Ida comes and goes as she pleas-

es. She's totally free and I wouldn't change

her for the world. (Campbell 1982: 2022)

Racism in the delivery of health care, and by

nurses in particular, was increasingly questioned

by nurses. Nurse Mary Samisoni, for instance,

surveyed Aboriginal and Torres Strait Islander

people in Brisbane in the mid 1970s about their

experience of being hospitalised. For her the

most troubling comments referred to 'the rude-

ness and abrupt manner' of nursing staff, and

the failure of the nursing staff to provide' ade-

quate comfort and personal cleanliness' at a

time when patients were most vulnerable and

dependent, such as when they were bedridden

or following surgery. She also noted that, in

many cases, 'there was a feeling of prejudice and

bias' experienced by the Indigenous patients

(Samisoni 1977: 46). Doctors and administra-

tors did not fare well in this survey either. Little

wonder the Indigenous population was reluctant

to seek help from Brisbane's hospitals.

According to Jane Salvage, racism was also

characteristic of the broader Australian commu-

nity at this time. Reporting on her travels

around Australia in the Nursing Times in 1982,

Salvage claimed that wherever she went white

Australians would ask what she thought of 'the

coons'. Her replies that Aboriginal people

seemed to have a poor deal, she contends, were

met with claims she was a 'nigger lover', that

they were really 'lazy, good-for-nothing,

scrounging drunkards'. Most shocking about

this racism, reported Salvage, was the 'lack of

knowledge and imagination about Aboriginal

ways' (Salvage 1982: 2018).

Lack of knowledge about Aboriginal ways

was also seen as increasingly problematic for

nurses working in remote areas, with many ill-

equipped to assume duties in Aboriginal com-

munities. The isolated community of Edward

River was a case in point. In the late 1970s,

John Taylor argued that the nurses at Edward

42 C:Jf Volume 24, Issue 1, February 2007

River knew vcr;" little about traditional Aborigi-

nal medicine or culture, and that this caused

contlict and confusion. Nurses, he claimed,

became annoyed when Aboriginal people

claimed illness for social rather than physical

reasons, when they discontinued antibiotics and

other drugs when the symptoms disappeared,

or when they brought their children in late at

night for treatment when the child had obvious-

ly been unwell for much of the day. It was hard-

er for nurses to understand or excuse those

who came into hospital to have their wounds

tended having been involved in a fIght. While

such fights were an organised way of resolving

disputes, Taylor explained, the nurses described

such behaviour as 'savage' and 'barbaric'. Misun-

derstandings about the causes of illness, such as

whether an illness was caused by sorcery or bac-

teria, and aggressive western medical treat-

ments such as intubation and intravenous

therapies, were commonplace and often result-

ed in nurses being assaulted or threatened with

physical violence. Such misunderstandings, Tay-

lor (1978) argued, compounded the problem of

poor health in the community.

Pam Nathan also considered nurses working

in Aboriginal communities required a substan-

tial understanding of Aboriginal beliefs, prac-

tices, social organisation and law. She argued

that simply imposing Western medical beliefs

and practices on an alien culture was both 'arro-

gant and harmful' (Nathan 1983). For Merilyn

Spratling, the imposition of western medicine in

these settings was more than arrogant. She con-

sidered it constituted institutionalised racism. In

her reminiscences as a community nurse in a

small remote Aboriginal community in the

Northern Territory, Spratling argued that insti-

tutionalised racism permeated the health care

system despite the fact that government policies

promoted the principle of self-determination

and encouraged community control. For her,

institutionalised racism was evident in the frag-

mentation of services between different bodies

and levels of government, the imposition of a

Nurses, politics and Aboriginal Australians, circa 1900-1980s C:J'(

western model of health care without incorpo-

rating traditional practices, and the lack of con-

trol the Aboriginal community had over the

clinic in which she worked. Office hours at the

clinic conformed to government office hours,

and the language used was English, though the

majority of residents spoke other languages.

Spratling found this situation made her ext-

remely uncomfortable, that it limited her prac-

tice, and left the local Aboriginal community

feeling dissatisfied (Spratling 1995).

By the end of the 1980s, nurses were even

more critical about the cruel legacies of an

imposed western medical system for Aboriginal

peoples. Jennifer Cramer, Health Services Co-

ordinator for the Kimberley Aboriginal Medical

Service's Council in Broome, for instance,

argued that the relationship between medicine

and the well-being of Aboriginal people consti-

tuted a paradox - well-meaning western health

services were simultaneously part of the process

that lead to cultural destruction (Cramer 1989).

CONCLUSION Institutional racism in nursing and health care is

not a thing of the past. Stories by and about

Registered Nurses as they came into contact

with, or cared for, Aboriginal people in hospi-

tals and clinics in rural and isolated areas of Aus-

tralia throughout much of the 20th century

reveal the ways in which government policies,

and their underlying ideologies, shaped nurses'

attitudes and clinical practice to this least pow-

erful group in Australia. Reflecting on these sto-

ries helps us understand the role nurses have

had, often unwittingly through unquestioning

compliance, in contributing to the oppression of

Australia's Aboriginal people. Confronting and

understanding the historical roots of institution-

al racism alerts nurses to it, and empowers

them to speak out and refuse to engage in such

practices today. Only then can discrimination

and racism be abolished from nursing practice

and from the delivery of health care. This is

essential for nursing's current and future profes-

sional development and for better health for

Aboriginal Australians.

Acknowledgments I am indebted to Vicki Bradford and Kath

Howey, Indigenous lecturers, and Emeritus Pro-

fessor R. Lynette Russell, Director of the Nurs-

ing History Research Unit, Faculty of Nursing

and Midwifery, University of Sydney, for their

helpful and insightful comments on this paper.

Presentation This article is based on a paper presented at the

Beyond Professionalism: Towards a History of. , Practice Conference, The University of Mel-

bourne,August 2005.

References AbbottT (2006) 'Misplaced tact stands in the way

of help', Sydney Morning Herald, June 21.

Aborigines Protection Act (1909) New South Wales Govcrmncnr: Government Printer.

Armstrong F (2004) 'Deadly: Indigenous health today' Australian Nurses Journal 12(5): 16-19.

Aspeling A (2000) There are Flowers in the Desert: A Story of Nursing in the Outback Ringwood East:

Aspeling.

Australian Institute of Health and Welfare (2006) Australia's Health 2006: The Tenth Biennial Health Report of the Australian Institute of Health andWeljare,

Canberra: AIHW

Bin-Sallik MA (2005) 'Beyond expectations: from nursing to academia' in Goold S & Liddle K (eds.) In Our Own Right: Black Australian Nurses' Stories,

Maleny QLD: eContent Management.

Blake T (2001) A Dumping Ground: A History of the Cherbourg Settlement, St Lucia: University of Queensland Press.

Briscoe G (2003) Counting, Health and Identity: A History ofAboriginal Health and Demography in

Western Australia and Queensland, 1900-1940,

Canberra: Australian Institute of Aboriginal and Torres Strait Islander Studies.

Campbell D (1982) 'Nursing the Aborigines' Nursing Times 1: 2019-22.

Canning S (2005) 'My story: the beginning, child- hood, ambitions and achievements' in Goold S & Liddle K (cds.) In Our Own Right: Black Australian

Volume 24, Issue 1, February 2007 C:J'( 43

Sue Forsvth

Nurses' Stories, Malcny QL1): e-Contcnt

Management.

Coster G (1979) 'East Gippsland Aboriginal Medical Centre' The Australasian Surses Journal, Nmcmber: 4-6.

Cramer J (J 989) 'Remote area nurses in Australia: a 'mantle of safety 'J' thc Australian Journal or Advanced Nursing 7(1): 23 30.

Davis E (1977) 'Editorial: Identity' Anstralasian Nurses

journal 7(2): 3.

Dinnell G (1976)' Aboriginal health' Australasian Nursesjournal, November: 31.

Eckermann A, DowelT, Chong E, Nixon L, Gray R & Johnson S (2006) BinL1l1 Goon}: Bridging Cultures in

Aboriginal Health 2nd edn, Sydney: Elsevier.

Eckermann A, Dowd T, Martin M, Nixon L, Gray R & Chong E (1992) Binan Gooni: Bridging Cultures in Aboriginal Health, Armidale: The University of New England Press.

Edmund M (1992) No Regrets, St Lucia: University of Queensland Press,

Franklin M & White I (1991) 'The history and politics of Aboriginal health' in Reid J & 'lrompf P (cds) The Health ofAboriginal Australia, Marrickville: Harcourt Brace Jovanovich,

Garnsey A (no date) Scarlet Pillows: An Australian Nurse's

Tales c:fLongAgo, Facsimile edition (1984), Carlisle (WA): Hesperian Press.

Griffin S (1995) 'A crossroad of care' in Gray G & Pratt R (cds) Issues in Australian Nursing 4, South Melbourne: Churchill Livingstone.

Goold S (2001) 'Transcultural nursing: can we meet the challenge of caring for the Australian Indigen- ous person?' journal c:fTranseultural Nursing 12(2): 94-99.

Griffiths M (2000) Straightfrom the Heart: Tales of

Tragec£v and Triumphfrom the Nurses of the Australian Outback, Sydney: Kangaroo Press.

Harrison L (1978) 'Nursing on Cape York' Australasian Nurses journal, August: 28-29.

Henry B, Houston S & Mooney G (2004) 'Institu- tional racism in Australian healthcare: a plea for decency' Medicaljournal c:fAustralia, 17 May, 180: 517-520.

International Council of Nursing (1999) 'The health of Indigenous Peoples: a concern for nursing', Nursing Matters, www.icn.ch/matters_indigenous .htm [accessed 7 September 2006].

Jackson D, Brady W & Stein I (1999) 'Towards (rc )conciliation: (re )constructing relationships between indigenous health workers and nurses' , Journal <ifAdvanced Nursing, 29(1): 97~103.

44 C:J( Volume 24, Issue 1, February 2007

Keating P (1994) [lcnlcls .[parl: Ide on all Ibol'lgllJu! Mission, Marrickvilk-: Hale & Iremonger.

Kidd R (2000) Thdlcl)f!c Cirilile, St Lucia: Uni\lTsity of Queensland Press.

Leonard T (1999) The Full Catastrophe, Sydney: Hodder.

Mum Shirl (1987) Mum Shirl: An Autohiogmphy with the assistance orBohbi Sykes, Svdncv: Heinemann Educational Australia.

Nathan P (1983) 'Nurses and health business ill Central Australia' The Australian Nursesjournal, 12( 10): 38-40.

National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families

(1997) Bringing Them Home, Canberra: Sterling Press.

National Health and Medical Research Council (2003) 1alues and Ethics:Guidelines on Ethical Conduct in Aboriginal and Torres Strait Islander Research, Commonwealth of Australia.

New South Wales Department of Aboriginal Affairs (1998) Securing the Truth: NSW Government Submis-

sion to the Human Rights and Equal Opportunity

Commission InqUiry into the Separation <ifAboriginal and Torres Strait Islander Childrenfrom their Families,

Sydney: NSW Government. Saggers S & Gray 0 (1991) Aboriginal Health &.-Society:

The Traditional and Contemporary Aboriginal StTllggle for Better Health, North Sydney: Allen & Unwin.

Salvage J (1982) 'Caught between cultures' Nursing Times, December 1:2017 18.

Samisoni M (1977) 'Aboriginal and Islander attitudes to public health care institutions' The Australian Nurscs lournal, 7(5): 45-48.

Stephens T (1999) 'Waiting for the dinosaurs to die'

Sydney Morning Herald 24 July: 47. Spratling M (1995) 'Aboriginal community health

nursing: reflections, responses and rewards' in Gray G & Pratt R (eds) Issues in Australian Nursing 4, South Melbourne: Churchill Livingstone.

Taylor J (1978) 'Murri doctor or nursing sister: the nurse's point of view' Aboriginal Health Worker, March, 2: 37--46.

Thomas D (2004) 'The upsurge of interest in Indigen- ous health in the 1950s and 1960s' MedicalJournal ofAustralia, 180, 17 May: 521-23.

Van Holst Pellekaan S & Clague L (2005) 'Toward health and wellbeing for indigenous Australians' , Postgraduate MedicalJournal, 81: 618-624 .

Willis E, Smye V & Rameka M (eds) (2006) Advances in Indigenous Ilealth Care - a special issue of Contemporary Nurse (vol. 22:2). Maleny QLD: eContent Management.