Knowledge sharing for health and wellbeing

CHRIS HATZIS
Eavesdrop on Experts, a podcast about stories of inspiration and insights. It’s where expert types obsess, confess and profess. I’m Chris Hatzis, let’s eavesdrop on experts changing the world - one lecture, one experiment, one interview at a time.

Gwenda Freeman is a Yorta Yorta woman and Associate Lecturer in Aboriginal Health Education, at the University of Melbourne’s Department of Rural Health, based in Shepparton, Victoria. Her role supports local Aboriginal students who are studying health subjects, and lectures in Aboriginal health, particularly to the rurally-based medical students.

Gwenda is passionate about good Aboriginal healthcare, especially due to the hesitancy around western medicine and anxiety about racism that might prevent Aboriginal people from seeking out basic health services.

Gwenda will also be MC at the 5th annual Ngar-wu Wanyarra and Torres Strait Islander Health Conference, a one-day conference held in Shepparton, Victoria, on Wednesday 16 October 2019. The conference aims to facilitate the exchange of information on key issues in Aboriginal and Torres Strait Islander peoples’ health and wellbeing and provides a forum for the presentation of cutting-edge program initiatives and research findings by Aboriginal and Torres Strait Islander health practitioners.

Andi Horvath sat down to chat with Gwenda Freeman about her work.

ANDI HORVATH
As a Yorta Yorta woman, Gwenda, what drew you towards the health industry?


GWENDA FREEMAN
I think I’ve always been interested in health and wellbeing, anyway. From an Aboriginal perspective, health is probably a bit more all embracing than we’re used to speaking of it - you know, according to sort of more mainstream services. But I really - and I’m really motivated, I guess, in the areas of health promotion, preventable diseases, things like that because Aboriginal health has tended to be worse - have worse outcomes in terms of disability, years of life lost due to chronic health illnesses and also early death. It just seemed to be a really important area to work in.

ANDI HORVATH
Were there particular events that made you think, this needs my attention?


GWENDA FREEMAN

I guess just the awareness that for a lot of Aboriginal people, we don’t necessarily have the same kind of background - and it’s because of history and it’s because of trauma - so that Aboriginal people are often at a disadvantage from the very first point. Whereas you might have been brought up that if you’re not well, you go to the doctor. For Aboriginal people, that might be a much bigger issue. There might be issues of racism, there might be history of difficulties, there might be hesitancy about western medicine and all sorts of cost and other anxieties that often prevent people from being able to access what we would consider basic health services.

ANDI HORVATH
Can you explain some of the misconceptions you’ve encountered that you’ve heard from various communities, white or Indigenous, about Aboriginal health care?


GWENDA FREEMAN
I think it - probably the most glaring one is the number of people in mainstream health services - so non-Indigenous people who are - might be wonderful nurses and doctors and so on, but who just say, look, if Aboriginal people want health services, they can come in here, same as anyone else - not realising the extra barriers that people have. I think a lot of health services have started understanding more about it now and are becoming a bit more culturally sensitive to - because the reality is, you do have to alter things to cater for all sorts of different types of people, including Aboriginal people. The other thing, of course, is that in - I mean, Australia is huge and there’s a lot of communities who have always been, and still are, in remote areas, or we in the towns might call remote.

To the Aboriginal people there, it’s their home, it’s their stories, it’s their history and it’s really the business of the health services to ensure that people are covered there, just as they ensure people are covered in Melbourne, or Wangaratta, or where ever.

ANDI HORVATH
You’ve been involved in Aboriginal health care for a long time, tell us some things that have pleasantly surprised you, or some successes that you’ve rejoiced in.


GWENDA FREEMAN

Look, I think the one that’s made the biggest impact is the changes that I’ve seen in my lifetime. Having been brought up at a time that Aboriginal people weren’t recognised legally as part of the Australian population, to a time when people are being - well, are graduating as doctors, nurses and so on. I mean, it’s just wonderful to see because that’s going to work a whole lot better.

ANDI HORVATH
If there’s something that you’d like to change right now and wave a magic wand, what would it be?

GWENDA FREEMAN
That’s a hard one because every approach to better health is complex or - and that’s kind of obvious or it would have been done before. But the sorts of things that really help are health promotion programs that the Aboriginal community has input into. In fact, is in charge of, wherever possible, because Aboriginal people in a community will know what will work best and how something will work well. Whereas, just dumping a program that happened to work for white people in Melbourne onto a rural or remote Aboriginal community can be - it’s an - it can be alien, that’s just not necessarily the most appropriate way to go.

ANDI HORVATH
For those of us who are unfamiliar with the Aboriginal communities in remote areas, draw a picture for us about how it’s different and what, if we enter the field, we need to make sure we pay attention to.


GWENDA FREEMAN
Well, I guess if I talk about Shepparton which is where I’m based at the moment with the Department of Rural Health, there’s quite a big population. There’s more Aboriginal people per capita than in Melbourne, for example, or in the whole of Victoria. There’s a rural area and that tends to happen along the river and where Aboriginal people have made their home. There’s more Aboriginal people around so there’s more need for user-friendly services. Many of the people have a background where only two generations ago, they’re - that’s their current grandparents or grandparents who have recently passed away, were not regarded as citizens, may have come from the reserves. For Shepparton, that would be Cummeragunja which is just over the border. One of the difficulties being that many of the tribal groups from along the river were on both sides of the river. The river was central.

Trying to cope with one part being Victoria and the other part being New South Wales is really hard. Then if you go particularly further into western New South Wales and Queensland and the Northern Territory - and I’ve spent some years there - some of the communities are so remote that the people living there would rarely see a big town. They might not have a doctor available every day. They might not even have a nurse available every day. They might have someone fly in every now and then. There’s considerations like that where it can be really difficult.

If you compare that to where I live in rural Victoria, which is a little town called Avoca. It has every bit of infrastructure and facility. I’m not saying it’s perfect in its number of doctors there, for example, but doctors and medical services are in easy reach, there’s easy access to television and advertising, for example - the health promotions being advertised over the radio or on TV. To compare that then with some of the remote communities, you can’t help asking yourself, so, how come there’s all the infrastructure and services here and not there? Because really, before colonisation, there was no particular concept of rural or remote. People were just living on their land, as they had for thousands and thousands of years, wherever that might be in Australia. For many people, it’s very important that they continue living there because that’s their heritage and their stories.

ANDI HORVATH
The connection to the land.


GWENDA FREEMAN
That’s right, yep.

ANDI HORVATH
Now, some formal structures at the University of Melbourne are assisting you in setting up a course. Tell us about that.

GWENDA FREEMAN
Yeah, that’s right. We had been supporting local people, in the Shepparton area, to do the Master of Public Health. That’s been amazing because there’s, at this very moment, five local people who hold a Master of Public Health, three doing a PhD, we’ve got two more on the way - will graduate shortly. That means that there’s local Aboriginal people there who have the knowledge and understanding of the health system, the health sector, health issues right at their fingertips - which is fantastic. Some of those people did feed back how much they appreciated the support that we were able to give them, but that a lot of it was a big challenge, just because of it being the unknown. Some of the people coming in had years and years of work experience, but may not have had an undergraduate degree.

What we’ve developed now is a course that goes for one year - it’s a specialist certificate. It’s made up of two subjects and by the time people do those subjects, they will hopefully be ready to walk in to other subjects in the Master of Public Health, or anything that they decide to do, and kind of be ready for it. Have a good understanding of what’s expected, how to do it and therefore, successful at doing it. I think that the intensive support is sometimes really needed, in that people don’t have a kind of background family and knowledge of how the - how academia works. It’s a different language, it’s - has its own unique ways about it and yet, at the same time, it’s the way to such great qualifications that can help Aboriginal people be absolutely at the table in organising things for their own community.

ANDI HORVATH
So, there’s a reaching out from the University and from the community, coming together to finally get this right?


GWENDA FREEMAN
That’s right.

ANDI HORVATH
These are good times.


GWENDA FREEMAN

Well, it’s fantastic to see and as I said before, it’s just been amazing to see some of the changes happening in my lifetime. It’s still slow, it’s still not enough. There’s still too many people who lack understanding about how to cater for the Indigenous population a whole lot better, not only in the health system, but in education and in other areas too.

ANDI HORVATH
What’s one of the cultural things that you’d like white people to learn in how to interact with various Indigenous communities?


GWENDA FREEMAN
That’s a hard one because it’s probably complex. But I guess stepping back and listening is always really helpful. Some of the health services now are running cultural awareness training, they’re looking at making things a bit more culturally friendly around the hospital or the health service or whatever it is and there’s lots of things can be done there. I guess the people who say, look, Aboriginal people can come here, I treat everyone the same - I guess, that’s not right. You don’t treat everyone the same. You treat men and women differently. You get interpreters in for people who can’t speak English. You have to cater the service to the people who are coming in. If they vary, then you need to know there’s different ways of relating in the best way possible.

ANDI HORVATH
So, we need to customise to diversity?


GWENDA FREEMAN
Absolutely.

ANDI HORVATH
It makes complete sense. We celebrate differences but we cater to them and in that sense, we kind of unify what we can provide.


GWENDA FREEMAN
Yeah, yeah that’s right and it’s a very generalist sort of approach. We really do need to customise. You’re right. But there’s some wonderful Aboriginal people who are running cultural training and then - I mean, the next step after that is to see and get to know the Aboriginal people on the land where you are. There’s kind of generic training you can do, but there’s also localised training that gives you an understanding of the local people, the local language and names, what people would like or expect. Because the reality is there were so many different Aboriginal units, language groups, tribes, whatever you want to call them. Countries is really probably the best name. Best estimates are that there were 250 to 300 separate groups, each with their own language and culture, in Australia at the time of colonisation.

ANDI HORVATH
Can you share some language with us? Perhaps something that allows us to communicate in Indigenous language that wishes one well?

GWENDA FREEMAN
I can only tell you some Yorta Yorta, which I’ve been absolutely thrilled to be learning. I’m able to because even though when people were on Cummeragunja Reserve, they were forbidden to speak language - it was lost, virtually in a generation, as I understand it - some wonderful people have been reconstructing it. In the late nineties, they produced a dictionary which is a fantastic start for learning some words. If I wanted to say, hey - the equivalent would be "de".

ANDI HORVATH
"De"?


GWENDA FREEMAN
"De". If I wanted to say, are you healthy? I would be saying, "yorta itjumatj"? Because Yorta means no and itjumatj means sick. The idea of healthy as per English is kind of, not sick. But bear in mind that that sick - that’s a broad term that covers a lot of issues, even further than the physical and mental health that the western system is used to. For example, not having homes, not having people to contact, not having your country - all of those things contribute to you not being well. The ideal is that the community is well, on country and people will have a lot better chance of better health. That’s hard, of course, for a lot of places because they’ve been broken up and, in some ways, there’s no going back.

But of course, we modernise, the same as anyone does. I think that the newer generations now are aware of both the need for that sense of belonging to culture and country for their own wellbeing and likewise, the opportunities that are available these days for travel, different education. There’s been a lovely coming together recently of traditional healers - traditional Aboriginal healers and what you might call western medicine. I know the Ngangkari - the Pitjantjatjara people from South Australia - the South Australian Health Department has recruited some of the Ngangkari to actually work in the hospitals and health services in Adelaide, along with the mainstream medicine there. They’re very happy to because Aboriginal people can see that western medicine offers some things that traditional medicine doesn’t. But also, that traditional medicine covers things that western medicine neglects. So, it’s a good coming together.

ANDI HORVATH
That’s lovely. That’s sort of adding to the spirit of individuals.


GWENDA FREEMAN
That’s right, yeah.

ANDI HORVATH
Yorta itjumatj?


GWENDA FREEMAN

Itjumatj.

ANDI HORVATH
Itjumatj?


GWENDA FREEMAN
Yep.

ANDI HORVATH
Yorta itjumatj. Thank you.


GWENDA FREEMAN
Well done.

ANDI HORVATH
Gwenda Freeman, navigate us through the conference that’s coming up real soon.

GWENDA FREEMAN
Okay, the conference is an Aboriginal health conference. It’s called Ngar-Wu Wanyarra. That’s local language in Shepparton. This is the fifth year it’s run and it’s going to be run as a one-day conference. There will be heaps of topics. People will have a chance of choosing topics. They’ll all be Aboriginal health, all presentations on different aspects of programs, research and so on that’s happening in Australia. We’ll have local speakers. We’ll have speakers from afar. We’ve got guest speakers coming. Pat Anderson is our keynote speaker. You might know of Pat. She was involved in running one of the early Aboriginal medical services in the Northern Territory. She’s going to be inspirational. She’s involved with Lowitja Research at the moment.

For the rest of it, there’s a day of intense presentations, being able to mix with all sorts of different people with interests in Aboriginal health. There’s a dinner in the evening and that will be absolutely wonderful. Our guest at the dinner is Archie Roach which is fantastic to have.

ANDI HORVATH
I’m absolutely fascinated by Indigenous healing methods that are done in conjunction with western science.

GWENDA FREEMAN
I think that that translation happens the best where you are able to recruit Aboriginal people to run the program because they will have knowledge, they’ll be in touch with the local community and they’ll be able to help translate it. The value of having Aboriginal staff is incredible. Some of those programs might be anything from checking peoples’ eyesight, educating about diabetes and the complications, might be talking about how to become a health professional yourself, learning about some of the ways that people are able to get into and navigate the education system. It won’t be all the answers - we haven’t got those. But there will be some wonderful ideas there and some wonderful examples of projects that are happening and working.

ANDI HORVATH
Colonisation globally has never been good for Indigenous communities. Tell us about Australia.


GWENDA FREEMAN
Yeah, I mean, if you look at history, certainly the history that I learned at school, colonisation was really around taking over as much of the world as possible, usually more for the resources and the power, rather than anything good for the people. Therefore, Indigenous populations all over the world have suffered hugely from that process. But certainly, for our Aboriginal population here in Australia today, most have ancestors who were killed or died tragically. Most have grandparents, great grandparents who suffered and probably overcame great obstacles to participate in life today. Of course, there are other casualties of that kind of trauma and that was followed then by taking the children away. Lots of mums who were happy and proud of their kids, the kids were taken away.

It was assumed, by the English, to be for the good of the children, but in a way, that was a terrible assumption to make because it was on the basis that Aboriginal women wouldn’t have known how to parent properly, or wouldn’t have given their children the skills they need. If you can imagine the grief for any mother, any family of having children taken away like that and that grief is lingering and is now probably dominated more by the stolen generation people themselves who are asking questions and saying, so what happened to my family? Who are they? Where do I come from? That’s a really hard one. I remember an interview in the stolen generations film that was done a while back and the woman being interviewed said that she was brought up in a home where everything was done by the whistle, as it were, or by the clock. She said, I had my kids and I didn’t know how to look after them, I had no role models, I had no examples of how to look after my children.

That’s one of the biggest tragedies, I think, for Aboriginal people, is that kind of dislocation from home, family, country, everything like that. Therefore, for most Aboriginal people, that kind of trauma is there in much greater proportion than is trauma in the wider population.

ANDI HORVATH
Gwenda Freeman, you’re heralding in re-learning and healing. Thank you so much for speaking to us today.


GWENDA FREEMAN
Yeah, thank you for having me.

CHRIS HATZIS
Thank you to Gwenda Freeman, Associate Lecturer in Aboriginal Health Education, Department of Rural Health, University of Melbourne. And thanks to our reporter Dr Andi Horvath. The Ngar-wu Wanyarra Aboriginal and Torres Strait Islander Health Conference will be held in Shepparton, Victoria, on Wednesday 16 October 2019.

Eavesdrop on Experts - stories of inspiration and insights - was made possible by the University of Melbourne. This episode was recorded on October 7, 2019. You’ll find a full transcript on the Pursuit website. Audio engineering by me, Chris Hatzis. Co-production - Silvi Vann-Wall and Dr Andi Horvath. Eavesdrop on Experts is licensed under Creative Commons, Copyright 2019, The University of Melbourne. If you enjoyed this episode, review us on Apple Podcasts and check out the rest of the Eavesdrop episodes in our archive. I’m Chris Hatzis, producer and editor. Join us again next time for another Eavesdrop on Experts.