Domain – Aboriginal and Torres Strait Islander health (guiding topics)

Developing Cultural Humility and Holistic Healthcare

• Openness to Learning:
  • Cultivate a genuine desire to learn about Aboriginal and Torres Strait Islander health.
  • Approach learning with cultural humility, recognizing the value of diverse perspectives.
• Holistic Healthcare:
  • Incorporate social, emotional, physical, spiritual, and cultural aspects into healthcare.
  • Understand the interconnectedness of these aspects in Aboriginal and Torres Strait Islander health.
• Respect for Cultural Mentors:
  • Show respect and willingness to learn from cultural mentors and educators.
  • Engage with Aboriginal and Torres Strait Islander knowledge holders and community leaders.
• Self-Awareness:
  • Develop an understanding of your own cultural identity, lens, and worldview.
  • Reflect on your beliefs, values, behaviors, and communication styles.
  • Recognize how your cultural identity impacts consultations and relationships.
• Understanding Western Healthcare:
  • Understand the culture and worldview of Western healthcare systems.
  • Recognize the impact of Western healthcare systems on Aboriginal and Torres Strait Islander peoples’ experiences and access to healthcare.

Practising Anti-Racism in Healthcare

• Examine Biases:
  • Reflect on and examine your own conscious and unconscious biases and prejudices.
  • Actively work to transform these biases to improve healthcare delivery.
• Impact of Stereotyping:
  • Describe the negative impact of stereotyping on therapeutic relationships.
  • Recognize how stereotypes affect Aboriginal and Torres Strait Islander health outcomes.
• Responding to Discrimination:
  • Recognize and act in response to witnessed interpersonal discrimination.
  • Address systemic discrimination within general practice and healthcare systems.
• Mitigating Privilege:
  • Recognize and commit to mitigating your own privilege as a non-Indigenous person.
  • Address power imbalances inherent within the patient–doctor relationship.

Population Health Considerations

• Screening Guidelines:
  • Understand relevant screening guidelines for preventive health assessments.
  • Tailor preventive health measures to Aboriginal and Torres Strait Islander patients.
• Health Risks:
  • Acknowledge the increased relative risks of certain health conditions within the community.
  • Recognize the increased risk of chronic disease at younger ages and multimorbidity.
• Colonial Determinants of Health:
  • Understand the colonial determinants of health, including systemic and interpersonal racism.
  • Recognize exclusion and marginalization from socioeconomic opportunities, disempowerment, lack of self-determination, forced removal of children, intergenerational trauma, forced loss of language and cultural practices, and disproportionate incarceration rates.
• Socioeconomic Determinants of Health:
  • Identify housing pressures, income and employment issues, and educational barriers.
• Local Barriers:
  • Understand local barriers to accessing healthcare (e.g., transport, geography, availability of Aboriginal and Torres Strait Islander-specific healthcare services, cultural safety of local primary healthcare and social services).
  • Describe approaches to mitigating these factors.

Strengths-Based Approach in Healthcare

• Cultural Determinants of Health:
  • Appreciate cultural determinants such as family, kinship, traditional languages, cultural practices, connection to Country, and resilience.
  • Recognize the benefit of these determinants in enhancing and maintaining health and wellbeing.

Cultural Safety

• Barriers to Healthcare:
  • Understand how a lack of cultural safety at individual and systemic levels acts as a significant barrier to healthcare access.
• Improving Cultural Safety:
  • Implement measures in general practice and primary healthcare to improve cultural safety:
    • Creating a welcoming environment
    • Giving an Acknowledgement of Country
    • Providing cultural safety training for all staff
    • Ensuring the use of relevant Aboriginal and Torres Strait Islander clinical and preventive health guidelines
    • Registering the clinic for the Practice Incentives Program – Indigenous Health Incentive (PIP IHI)
    • Accurately recording Aboriginal and Torres Strait Islander identity in patient records
    • Offering access to Aboriginal and Torres Strait Islander-specific MBS and PBS items

Effective Communication

• Asking About Identity:
  • Respectfully ask all patients about their Aboriginal and Torres Strait Islander identity.
  • Explain why this information is important.
• Building Trust:
  • Develop trust and rapport with Aboriginal and Torres Strait Islander patients.
  • Understand that building trust takes time and skill.
• Using Appropriate Terminology:
  • Use appropriate terminology in reference to Aboriginal and Torres Strait Islander peoples.
  • Respect community preferences for naming protocols for local language/tribe/group/nation.
• Local Knowledge:
  • Know the name of the Traditional Owner group(s) of the land on which you live and work.
  • Learn about local Aboriginal and Torres Strait Islander language and words in common use.
• Tailoring Communication:
  • Tailor communication to the local context, including verbal and non-verbal cues.
  • Use health promotion materials appropriate for the local community.
• Working with Interpreters:
  • Work with Indigenous language interpreters when necessary.
  • Recognize challenges such as lack of access to trained interpreters and difficulty translating medical concepts.
• Respecting Diversity:
  • Appreciate the diversity of health beliefs and traditional medicines.
  • Navigate the impact of this diversity on presentation, diagnosis, and management plans.
• Cultural Protocols:
  • Understand and respect local cultural protocols, including gender considerations, death and dying, kinship structures, and family obligations.
• Incorporating Sociocultural Context:
  • Incorporate sociocultural context into history-taking, assessment, and shared management plans.
  • Respond appropriately to patient preferences, priorities, and needs.
• Avoiding Miscommunication:
  • Recognize the impact of miscommunication on health outcomes.

Importance of Partnerships

• Collaborative Relationships:
  • Develop effective working relationships with Aboriginal community controlled health organisations (ACCHOs) and Aboriginal medical services (AMS).
  • Collaborate with Aboriginal and Torres Strait Islander liaison officers, health practitioners, and health workers.
  • Utilize Indigenous language interpreters.
• Referral Pathways:
  • Know appropriate local referral pathways for patients to access primary and allied healthcare and social services specific to Aboriginal and Torres Strait Islander communities.
• Family-Centered Care:
  • Incorporate family-centered care into practice where appropriate.
• Engaging with Peak Organizations:
  • Understand the role of peak Aboriginal and Torres Strait Islander health organizations:
    • National Aboriginal Community Controlled Health Organisation (NACCHO) and state and territory affiliates
    • Australian Indigenous Doctors’ Association (AIDA)
    • Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINAM)
    • Indigenous Allied Health Australia (IAHA)
    • National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP)
    • Indigenous General Practice Registrar Network (IGPRN)

Advocacy for Aboriginal and Torres Strait Islander Peoples

• Historical and Contemporary Policies:
  • Understand the impact of local and national historical events and contemporary policies on local community self-determination and wellbeing.
  • Recognize the flow-on effects on engagement with healthcare services.
• Promoting Health Equity:
  • Support and promote self-determination, community involvement, self-governance, and local Aboriginal and Torres Strait Islander models of primary healthcare.
  • Advocate for health equity and social justice.
• Community Engagement:
  • Engage with and support community initiatives.
  • Participate in days of national importance (e.g., Sorry Day, NAIDOC Week, Close the Gap Day, Reconciliation Week).
• Workforce Parity:
  • Understand the importance of workforce parity for Aboriginal and Torres Strait Islander doctors, nurses, allied health, and ancillary staff.
  • Commit to providing culturally safe workplaces for Aboriginal and Torres Strait Islander colleagues.

Research Considerations

• Historical Research Harm:
  • Acknowledge the historical research harm done to Aboriginal and Torres Strait Islander communities.
  • Understand the ongoing impact of these harms on contemporary research.
• Ethical Research Practices:
  • Adhere to the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) Code of Ethics for Aboriginal and Torres Strait Islander Research.

Words of Wisdom for Working in Aboriginal and Torres Strait Islander Health

• Rewarding Experience:
  • Opportunities to learn about different cultures.
  • Build valued relationships with Aboriginal and Torres Strait Islander patients and communities.
  • Develop expertise from skilled Aboriginal and Torres Strait Islander health practitioners.
  • Contribute to improving significant health needs in Australia.
  • Skills developed will enhance care for all patients.
• Lifelong Learning:
  • Continuous, ongoing process.
  • Self-reflection, cultural humility, and genuine interest are essential.
  • Openness to unlearning and relearning.
  • Patients determine if care is culturally safe—gather feedback.
• Diversity:
  • No stereotypical Aboriginal or Torres Strait Islander person.
  • Significant diversity based on geography, culture, language, history, and life experiences.
  • Commonalities may exist (e.g., experiences of colonisation, connection to Country and family).
  • Interactions with one person may differ from another.
• Bias and Racism:
  • Common experiences of interpersonal and systemic racism.
  • Recognize and address your biases from inaccurate media, colonial assumptions, and social narratives.
  • Actively work to change biases.
  • Identify, speak out, and act against racism, both interpersonal and systemic.
• Strengths-Based Approach:
  • Recognize resilience in Aboriginal and Torres Strait Islander communities.
  • Culture, Country, and kinship as positive drivers of wellbeing.
  • Reflect on strengths when considering health disparities and socioeconomic determinants.
  • Understand that colonisation, discrimination, and marginalisation impact health outcomes.
  • Acknowledge survival and ongoing efforts to build health and wellbeing from cultural strength.
• Rural and Remote Healthcare:
  • Most healthcare occurs in metropolitan areas.
  • Additional learning needs for rural and remote areas.
  • Cultural and linguistic differences can be profound.
  • Familiarize with medical conditions more common in these regions.
  • Challenges of geography and healthcare access.
  • Seek specific induction and training.
• Overcoming Overwhelm:
  • It’s normal to feel unsure where to begin.
  • Learning about Aboriginal and Torres Strait Islander health is relevant, even if not immediately apparent.
  • Don’t fear mistakes or causing offence—take steps to learn.
  • Simple activities (reading, workshops, movies) can lead to further learning and reflection.
  • Each step reveals the next.