WHAT DOES THE “THIRD SPACE” MEAN TO YOU AS A

HEALTH PROFESSIONAL?

Eileen TanLisa Molony

Kate Brazzale

INTRODUCTION

DEFINITION OF THIRD SPACE

ABORIGINAL TERMS OF REFERENCE – THIRD SPACE

Link with Identity Their Perceptual View/Way of Life How they deal with things – eg Community

involvement.

ABORIGINAL IDENTITY IN RELATION TO THE THIRD SPACE

Family Community Land Importance

ABORIGINAL HEALTH STATISTICS

Males Females0

10

20

30

40

50

60

70

80

90

62.7

72.978.5

82.6

IndigenousNon - Indigenous

Life expectancies of Indigenous versus Non-Indigenous Males and Females.

On average Indigenous Men die 11

years earlier then Non- Indigenous Males

Indigenous Females die 9 years earlier then Non-Indigenous Females.

Data from the Australian Bureau of Statistics 2005-2007 data surveys.

ABORIGINAL HEALTH STATISTICSHealth

complicationComparative

incidence rate Comment

Circulatory system 2 to 10-fold

5 to 10-fold increase in rheumatic heart disease and hypertensive disease, 2-fold increase in other heart disease, 3-fold increase in death from circulatory system disorders. Circulatory system diseases account for 24% deaths.

Renal failure 2 to 3-fold2 to 3-fold increase in listing on the dialysis and transplant registry, up to 30-fold increase in end stage renal disease, 8-fold increase in death rates from renal failure, 2.5% of total deaths.

Communicable 10 to 70-fold10-fold increase in tuberculosis, Hepatitis B and Hepatitis C virus, 20-fold increase in Chlamydia, 40-fold increase in Shigellosis and Syphilis, 70-fold increase in Gonococcal infections.

Diabetes 3 to 4-fold 11% incidence of Type 2 Diabetes in Indigenous Australians, 3% in non-Indigenous population. 18% of total deaths.

Cot death 2 to 3-foldOver the period 1999–2003, in Queensland, Western Australia, South Australia and the Northern Territory, the national cot death rate for infants was three times the rate of Non-Indigenous.

Mental health 2 to 5-fold5-fold increase in drug-induced mental disorders, 2-fold increase in diseases such as schizophrenia, 2 to 3-fold increase in suicide.

Optometry/ Ophthalmology 2-fold A 2-fold increase in cataracts.Neoplasms (Tumour)

60% increase in death rate

60% increased death rate from neoplasms. In 1999–2003, neoplasms accounted for 17% of all deaths.

Respiratory 3 to 4-fold 3 to 4-fold increased death rate from respiratory disease accounting for 8% of total deaths.

ABORIGINAL HEALTH STATISTICS

ABORIGINAL HEALTH STATISTICSSelected Chronic Conditions: Ratio of Indigenous

Australian’s to Non-Indigenous Australians — 2004–05

ABORIGINAL HEALTH STATISTICS Diabetes Comparison

between Indigenous and Non Indigenous 2005

Cardiovascular Comparison between Indigenous and Non Indigenous 2005

ABORIGINAL HEALTH STATISTICS

IMPLICATIONS FOR HEALTH PROFESSIONALS Third Space

“A place where Indigenous and Non-Indigenous people can come and work together without fear of prejudice from ‘baggage’.”

An area of mutual respect between Indigenous and Non-Indigenous people where they can work collaboratively.

Health Professionals need Knowledge.

Of where the other comes from; their “space” Understanding

Of roles and responsibilities Empathy

Towards both sides Willingness to be open

Accepting of differences Avoid stereotyping

IMPLICATIONS FOR HEALTH PROFESSIONALS Aboriginal and Torres Strait Islanders are not the same.

Discontinue use of out-dated, derogatory terminology. Half-caste, full-blood, quadroon, etc. Always use the terms Aboriginal Man/Woman/People or Torres Strait

Islander Man/Woman/People.

Aboriginal people mistrust people who offer services related to “protection” and “intervention. European colonisation. Government Policies post colonisation. The “Stolen Generation”. Government policy til 1969.

“Keep your word.” Changes made.

e.g. Kevin Rudd’s “Apology”.

NSW Department of Community Services 2009 & National Disability Services WA 2009

IMPLICATIONS FOR HEALTH PROFESSIONALS Sensitive issues due to past Government policies have contributed to:

• Dispossession of land• Family fragmentation• Mental health issues• Social and emotional wellbeing issues• Grief and loss issues

• Self-harm and intentional injury• Over-representation of Suicide rates • Family and domestic violence issues• Loss of country• Loss of identity

• Poverty• Racism• Unemployment• Poor health outcomes• Poor education outcomes• Below standard literacy and numeracy rates• Alcohol and substance abuse/misuse• Over-representation in the juvenile and criminal justice system

NSW Department of Community Services 2009 & National Disability Services WA 2009

IMPLICATIONS FOR HEALTH PROFESSIONALS Respect

Elders, The Land, Animals, Ancestors. “Sorry Business”

Kinship Defines roles and responsibilities within the family. Ensure that extended family is included in important meetings or when

making decisions.

Gender responsibilities. Men’s Business – issues which have a male perspective within aboriginal

culture. Women’s Business – issues which have a female perspective within aboriginal

culture.

NSW Department of Community Services 2009 & National Disability Services WA 2009

IMPLICATIONS FOR HEALTH PROFESSIONALS Language

Originally 300 nations speaking 250 languages with up to 600 dialects.

Nonverbal cues Eye contact. Hand and facial gestures. Silence Progression of Conversation.

Semantic Ambiguity Swearing

Communication Techniques Use uncomplicated language, Not “jargon”. Be wary of comprehension

NSW Department of Community Services 2009 & National Disability Services WA 2009

CLOSE THE GAP CAMPAIGN Australia’s largest Campaign to improve Indigenous Health.

Aimed at reduced the Life Expectancy Gap between Indigenous and Non Indigenous Australians to 0 years by 2031.

OXFAM is campaigning to: Increase Aboriginal and Torres Strait Islanders’ access to health

services Address critical social issues such as poor housing, nutrition,

employment and education Build Indigenous control and participation in the delivery of health

and other services Get governments at state and national level to work in partnership

with Indigenous communities, health organisations and experts to develop and monitor a plan to tackle the Indigenous health crisis

Promote real and meaningful partnerships between Indigenous

COAG, 2011 and OXFAM 2006

NEED FOR EDUCATION To understand the needs of our Aboriginal or Torres Strait

Islander Patients The majority of Aboriginal people access health care from Non-

Aboriginal services.

Downing and Kowal 2011 Majority of Nurses interviewed felt that didn’t receive enough

cultural training to look after Aboriginal and Torres Strait Islander patients

They felt that they weren't giving them the level of care the needed and deserved.

Canada’s Approach Kilpatrick, 2004

Looked at the need for Aboriginal Education.

FOCUS QUESTION.

REFERENCES