Transcript of Wingara Aboriginal Health Series: Seminar 1.

Reorienting our approach to Aboriginal health: Embracing the voice of Aboriginal people in leading change

Geraldine Wilson-Matenga, Executive Director, Centre for Aboriginal Health: I just wanted to welcome Uncle Chicka here to welcome us to country this morning. I will hand over to Uncle Chicka. Thank you. Thank you.

Uncle Charles Madden, Eora Elder, Metropolitan Local Aboriginal Land Council: Good morning folks. My name is Charles Madden but known in the City of Sydney as Chicka. Now that's a nickname that I got many many years ago going to Redfern Public School which is now NCIE, the National Centre For Indigenous Excellence.

Folks, I'm from Gadigal land, Aboriginal land. That's just across the bay. Here they're acknowledged as the Cameraygul but the Gadigal and the Cameraygul are two of fourty nine clans that make up the Eora nation and the Eora nation is bordered by three distinctive landmarks. We have Hawksbury River to the North.

[coughs]

That's the damper! Sorry about that Folks.

Everyone: [Laughs]

Uncle Charles Madden: The Nepean, Western. And the Georges River to the south. Those three rivers form the boundaries of the Eora nation.

Folks for many many years I've lived and worked around the City of Sydney. I've been involved with many a different Aboriginal organisations over the years. I've been a director with the Aboriginal Medical Service at Redfern for over 40 years. Also a director with the Redfern Aboriginal Housing Company, Aboriginal Hostels Australia and the Metropolitan Local Aboriginal Land Council, where I am still a very active member. I gotta mention it folks, I'm also a life member of the Redfern All Blacks rugby league football club. Folks, for many many years I've lived and worked around the City of Sydney.

I'd like to take this opportunity this afternoon to extend a warm and sincere welcome to any of my Aboriginal brothers and sisters, non-Aboriginal brothers and sisters. If we have any brothers and sisters here from the Torres Strait or further afar across the seas, welcome. Welcome to the land of the Eora. Folks, if you travel across this great city of ours today, the state, or this great country, welcome. Enjoy your stay, have a safe and trouble-free trip home. Once again welcome, welcome, welcome. Thank you. Enjoy the day folks. Thank you.

Geraldine Wilson-Matenga: Thank you Uncle Chicka for your warm welcome. I too would like to start by acknowledging the traditional custodians of the land that we meet on today, the Cameraygul people of the great Eora Nation, pay my respects to elder's past and present and future leaders, and extend my respects to Aboriginal colleagues in the room today and all colleagues here. It gives me great pleasure to welcome everyone here today to the first Wingara Aboriginal health seminar series.

The Centres' very excited to be hosting these series throughout the year, this is the first of probably four that we have have planned throughout the year and these seminars are being led by the Center, and our role is really about the working in partnership with everybody; not just in this room but across the system to encourage a whole of system approach to building a culturally safe and responsive health system; where Aboriginal people have the same health outcomes as not Aboriginal people. A key focus of the Centre is supporting the health system to better engage and listen to the needs and aspirations of Aboriginal people. 'Wingara' is a Cameraygul word for learning and thinking and I hope this seminar will assist with your learning and thinking about how we can better listen and respond to the health needs of our people. so today's theme is about reorienting our approach to Aboriginal health and to do that we need to embrace the voice of Aboriginal people in leading change.

We're very lucky to have with us today Romlie Mokak and Leila Smith from the Lowitja institute. Romley is a Djugun man of the Yawuru people. He has been the CEO of the Lowitja Institute Australia's National Institute for Aboriginal and Torres Strait Islander research since 2014. Leila is a Wiradjuri woman and is the Knowledge Translation Manager at the Lowitja Institute. So I'll now hand over to both Leila and Romlie to take you through today's discussion. Thank you.

Romlie Mokak: Thank you Geri. So we'd also like to acknowledge the work we're here today on Aboriginal land and as we respect and honor those ancestors and those ah elders today, we look forward to the futures that our young people have, in being the custodians of this place into the future. As Geri mentioned I've been with the Lowitja Institute now for about three and a half years and prior to that the Indigenous Doctors Association for almost a decade and had my time in the public sector as well and for a very short period of time was actually in the Department of Health here in this jurisdiction. So it's great to come back today and catch up with some of our my brother's here Ian and Morris and you know just to see people in for the long haul is fantastic and wherever we are and whatever we do we know that we're working for the empowerment of our people so it's great to see everyone today.

Leila Smith: Thanks everyone for coming today. My name is Leila Smith. I'd like to acknowledge the traditional owners of the land that we made upon today. I'm the Knowledge Translation Manager at the Lowitja Institute. My family is from Cowra in central New South Wales if anyone knows the Coe's and the Williams' that's my family. I'm gonna let Rom introduce first and he's gonna set the scene for a bit and then I'm gonna set up a bit of a framework for us to give us some different concepts to think about and then rom and I gonna talk a bit about where we are today but I'll just kick off with Rom first and then we're just gonna tag-team through it today and if you have any questions we'd really love to have a conversation about it at the end.

Romlie Mokak: Thanks LeIla. Another person I'd like to introduce is Jessie. Jessie Motley if you want to just... Jessie's on our team as well the research team and you know what we're really proud of at the Lowitja Institute is that we have a strong Indigenous cohort working within so over the three and a half years that I've been there we've gone from about 30% of our very small FTE of about 15 or 16 now to I think 60, 60% are Aboriginal or Torres Strait Islander with two phd's the only Aboriginal geneticists in the country and a Torres Strait Islander woman whose PhD is in health systems. So this is what we're trying to do and I'm hoping that this will emerge over the next half hour or so in terms of us sharing the way that we do business at the Lowitja Institute.

We had some conversations with Geri late last year about engaging with the Ministry and while that didn't come to fruition when when Geri said that that the Wingara Series was something that they wanted to do I thought yeah we'll get behind this because we really are, at the Lowitja Institute, about not only thinking and learning, but the doing is important as well and I hope that some of that will come through. We understand that the objectives for today are things like better understanding what success looks like and it goes without saying that we are very clear that defining success is the business of Aboriginal people and I'll use Aboriginal to include Torres Strait Islander as well.

So we have to define success for ourselves and work with others who want to work with us. That's pretty clear in our mind. To consider and think about current approaches, we'll talk a bit about leadership but also governance which is critical and then think about some practical strategies around taking things forward. So let's start here which gets the question of defining success so what do we want to see for our mob. This is a starting point in in any endeavor and it's Aboriginal and Torres Strait Islander people who will define what we want to see for our mob and this is the part of the the great struggle and I'll speak to some of that in in a little bit about how Aboriginal people have been the entrepreneurs, the innovators in this world but not if not a lot of that is recognised. So what do we want to see for our mob and what do we want to be?

[Getting slides ready]

Actually that photo, sorry Leila, was of our from our first international conference the Lowitja Institute, Indigenous health and wellbeing conference of 2016. The man in the middle, Rob Bamblett's from a strong Aboriginal family in Victoria and their his two boys. So they gave a welcome and a dance and some cultural offerings to this international conference with amazing keynote speakers from all over the world. What was very clear we the conference was about identity about knowledge and about strength. It was really about how do we grow these two young fellows up to be the strongest that they can be and not only for the family but what's our collective purpose and action in all of that, and how do we connect with our Indigenous brothers and sisters their cousins from across the world. The conference was unapologetically an Indigenous space and some of those of you who might have been at the Research Translation Symposium that we co-hosted with the NHMRC late last year, you might have got that feel as well.

But these things don't happen routinely or by chance so these are the very issues that need to be negotiated with systems to relinquish the long-held power and we have to be really clear and really firm about that as Indigenous peoples. it's not often and frequent that power will be given away by by institutions and systems; we have to create those strong black spaces. So we thought we'd have a bit of a look at the context here, so you have an Aboriginal Health Plan here, a number of elements in that plan. Local partnerships based on trust, programs implemented based on what works. There might be some contention around who decides what works, that, is it just about being in the literature or is it what our communities know, and is it about Indigenous knowledge and knowing what of what have worked for our people for thousands of years. Planning and services will be integrated. Workforce is always always something we should be concerned about. culturally safe environments and performance monitoring evaluation. So all of that's really important.

Just by as a comparator, the our research principles at the Lowitja Institute, and I'll just run through those, the very first one is really critical. That our research is led by Aboriginal people, Torres Strait Islander people. So we don't respond to investigator driven research coming to us with a predetermined idea. It's our mob who determine what the question is and without question, the framing of that question, is always strengths based. It's never at a deficit. So we're at a different starting point immediately. The research has to act for the benefit of our people. That's non-negotiable. If it doesn't deliver benefit for our people then it's not worth doing. Some of this stuff gets a bit tricky when you're thinking about blue sky research or discovery research as you might think what's the immediate and can they connect to the benefit. We always have to have that front of mind. And this can rub researchers up the wrong way in that they're always in pursuit of the next research question. But if you put a question around benefit behind that, it changes the conversations.

Now those principles can be applied to policy as well, they're not just about research and delivery. End-users are engaged. And increasingly, 'end-users' is a bit of a term around research, but increasingly what we're saying is that Aboriginal people, Aboriginal communities have to be engaged right from the start all the way through. We're very clear about building a research workforce and in our discussion later I'm happy to speak about my time with AIDA; at the Indigenous Doctors Association. We want to do the same with higher degree by research capability in this country, we want to build a strong Aboriginal and Torres Strait Islander research workforce and we're really getting there but we can we can amplify that a whole lot more. And not dissimilar to your monitoring performance, we will know what the impact looks like. And you can't have a have a conversation about impact unless Aboriginal people are telling you what that looks like. So this requires a different way of measuring things ultimately into the future.

So these are pretty much in parallel. The only thing that I thought I would be really interrogating would be this question of leadership. We're clear about it at our research agenda needing to be black-led, Aboriginal and Torres Strait Islander lead, but is it enough that partnerships can deliver that for New South Wales Health. These are questions. Where does Aboriginal leadership sit and what are the sub structures; the super structures and the sub structures that are required to to give it the best shot. So the question about our partnership and leadership and and clearly they're not the same thing.

Leila Smith: So earlier I mentioned that I want to introduce a toolkit with some different words and concepts to put to all of this. We've already mentioned words like engagement, partnership, leadership. This this kinds of puts ... it puts these words on a on a spectrum and it's really useful to think about these different ways of engaging with Aboriginal and Torres Strait Islander people and organisations as being on a spectrum, because there are some ways of embracing the voice of Aboriginal and Torres Strait Islander leadership that that are more powerful than others.

So we've got on the lowest end of the spectrum, in terms of influence, which is Inform, and that's about providing information and assist assisting people to understand something. That's basically saying to people 'we're going to keep you informed about what's happening here' and then you move to Consult, and that's more about getting feedback from people and what the particular program or policy or service might be, and then you're ramping it up again as you're going to Involve which is about not just stepping in and getting some feedback at one point in time but doing that consulting and feedback process throughout the whole the whole conception through to delivery and evaluation stage. Then we start getting to words like partnership. Partnership, collaborating and that's about working together to agree on things and it says that we're together we'll implement and incorporate your advice to the maximum extent possible. So there are always boundaries and parameters around partnerships, and that's usually the point where partnerships become less convenient and they start entering a point where it becomes more difficult to engage with each other. That's because somebody needs to make a decision at one point and that will always happen with partnerships.

That that finally one, Empower, that's about leadership and that's one way of thinking about the difference between partnership and leadership; to place the final decision making in the and Aboriginal and Torres Strait Islander people or organisations, we will implement what you decide and we will support and complement your actions. Later today when we get to the how section, we're going to talk about what that might look like in a process or a policy and different ways, and we'll talk about how we do about at the Lowitja Institute as well, but that sweet spot between Collaborate and Empower if there's a government agency you could find a way to move within those spaces that's where we can really start getting some results, because most of our processes when we ask Aboriginal and Torres Islander communities what they want, it's that other end of the spectrum. It's it's certainly not the Inform and Consult and I know we have time frames and budgets that influence these processes, but just having that toolkit of being aware of where you are and where you could be, I think that is really useful. So just keep that in mind as we go through the rest of the the content for the seminar today and we'll come back to it later with practical strategies.

Romlie Mokak: I might just pick up on the question the the last column. Actually we'll do that later, Leila. I've just been in New Zealand for ten days, got back Saturday night back to Melbourne and then up on a plane this morning, so if I'm appearing to be a bit bit fuzzy that's the reason. They've got great food, wine, ice cream in New Zealand but I'll catch up with you then.

So where are we at now. In in this part what I'll do is talk a bit about where I think we we need to center ourselves as Indigenous peoples within a global context. So you would all be aware of the United Nations Declaration on the Rights of Indigenous Peoples. Now this Declaration took more than two decades of drafting, through a you know United Nations process. A lot of our leaders Aboriginal Torres Strait Islander people, along with Indigenous peoples of the world being in that process. Finally it was ratified by the General Assembly in 2007. There were four countries that abstained Australia being one of them. The others were Canada the U.S. New Zealand. So that's an interesting kind of interesting construct. The fact that our our country couldn't sign up, to it even after 20 plus years of of drafting. The the Australian Government eventually signed on in 2009, two years later.

What we should understand for Indigenous peoples, is that underpinning the Declaration is the right to self-determination. Now how that plays out in different nation states is very different and we'll provide you with some links to resources, but the Lowitja Institute and the Lancet had a collaboration and looked at half of the world's Indigenous populations. Some of the biggest issues are around identification of Indigenous peoples and how nation states for will will stand in the way of Indigenous peoples self-identification or the ways in which we identify ourselves.

Article 24 of the United Nations Declaration is about health and there are two elements to it. One is about traditional health traditional medicine and the other is the the requirement that nation states should act to deliver the best possible health to Indigenous peoples, and that that should be progressively realised so we need to establish a target, a place where we want to be. So this is again a very live conversation right now is the the Closing the Gap Refresh so called is being negotiated. So what's the destination point you know how do we as Indigenous peoples define what success looks like; what do we want to be. So it's shift in the United Nations Declaration that Australia has signed onto, this notion of progressive realisation.

So where do we want to land and how do we progressively realise that. This is where monitoring performance monitoring is is so critical; you don't just set a target, you measure how you're going as you progressively realise that target. And putting aside you know the politics of Closing the Gap and you know there's a fair chunk of work to happen there.

Going back to the campaign, the Close the Gap campaign that emerged out of Social Justice Commissioner Calma's report, that was for the first time establishing a very clear framework which was a rights based framework. We certainly had the NARS National Aboriginal Health Strategy, that's our foundational document, but in terms of securing multi-jurisdictional support, the Close the Gap campaign were very strident in ensuring that we had a rights-based approach to health. So these are the things that we've got to think about as well. And they're not abstract. This is not abstract thought. It's where do we want to get to, how we're going to get there and how we're going to be accountable for that progress. And you can't, we cannot have frameworks where non Indigenous peoples dictate to us where the destination point is. So this is a negotiated process throughout.

So the other piece of work that was undertaken last year, a really critical piece of work, that I should declare that Pat Anderson who was the Referendum Council Co-Chair, is also the Chair of the Lowitja Institute, that in no way influences what we're doing here today. But what I want to highlight is we've we had the Uluru Statement of statement from the Heart, a deliberative process, regional dialogues sought by the Australian Parliament through the government of the day, bipartisan support through Labour, a process that landed at the convention in Uluru, with one really and key significant recommendation, which was, so we're talking about the voice the importance of voices at the table, so we that was what was put forward. Quite simply, a voice to Parliament. Constitutionally recognised. Not dissimilar at all to many other nations.

Five years ago I was at the Sami Parliament in northern Norway a place called Kiruna. They have a constitutionally mandated Parliament that the Norwegian Parliament has to consult with, has to negotiate with on development of policy and other things. This is not a this is not a threat to the Australian democracy. But we saw in in in large measure, the the political response to that. So the fear mongering, the notion that this would be a third chamber of Parliament, the the threat to the Westminster system etc without having given it really any consideration at all. So these are the things that Aboriginal and Torres Strait Islander people bring forward as solutions. This is the stuff that we're defining; the voice. And not all Aboriginal people going to agree on that but through that deliberative process that was where it landed, only to be swatted away. And we hear and see and experience so many of these things continuously. So for me, it really is a question of taking those words. And it may not be this generation that ends up landing. It may not be I mean it might be you know, Jess and Leila's kids perhaps, that end up campaigning and delivering on that. So we've got to take the words as we do have to take the policy words and think about the how; the action. And this is this is really the point that I'm making. Even when Aboriginal people design a strategy, develop something very tangible, how easily it is to have that not even considered with the respect that it deserves.

Leila Smith: So this follows on from that last that last table about different levels of influence and engagement. so with that 'Inform' it's very kind of static documents around fact sheets and media releases and then it starts to get more interactive as you move in to 'Consult' with surveys. Then you get start getting forums around 'Involve'. 'Collaborate' looks like reference groups, multi-stakeholder initiatives and partnerships. And 'Empower' which is the one I want to talk about now. That's when you integrate the stakeholders into your governance structure, and that's when you start putting them on particular committees and things like that as well. And also it part of that is enabling and equipping people to have the skills to make those decisions and the resources to make those decisions too which is important to point out here.

The way we do this at the Lowitja Institute. I might begin with the way that we we fund our research. We have 41 research projects that we're funding at the moment. The way that we came up with the questions or themes to fund those research projects, was we held a workshop or a roundtable with different stakeholders, particular community members, members of government agencies, researchers. And we bring them together and we start talking about what the key issues are, what should the research questions be, what should their research priorities be, what really needs to happen in this space. Based on what happens on those round tables and what comes out of it, some research questions come out of the day. They are then approved and considered by our Program Committees - and Roms going to talk to them more later - which are made up of Aboriginal and Torres Strait Islander people who are experts in that area. So they then review the research questions. Then that goes out in a call for applications for research questions, so we have nothing to do with it. While me and Jesse and Rom we're part of the process of supporting that, the priority setting does not come from us.

So all of our 41 research projects that we have at the moment, they're based on priorities that have been assessed within these consultation processes. And part of that is also building and strengthening the capacity of the community and policymakers to engage in research. Research questions are really hard to come up with. And engaging people in that process from the very beginning, also helps with the end stage when it comes to communicating the findings, because you've got people on the at the community level and in governments who know that the research is happening and they already have an interest and a invested interest in that process, so that's part of that an empowerment process. We're equipping people with the skills to engage with research, we're bringing them in to be part of that governance and decision-making process.

Out of those research projects that we have, seventy six percent of those Chief Investigators are Aboriginal or Torres Strait Islander. That is amazing. When you have projects that are led by Aboriginal and Torres Islander people, you get different results and you look at different things. Because we're not making a whole lot of progress with closing the gap, this is really important to think about.

One of the things that that we're doing which a lot of other areas aren't, is looking at the role of Aboriginal and Torres Strait Islander young men, this is one example, from a strengths-based perspective. As Rom mentioned earlier, a lot of our focus is on the strengths. What role do Aboriginal and Torres Strait Islander men play in different communities around Australia? What are their lives like? What were their triggers to change their lives? How do they hold each other? How do they bring up young men? This was what they said they wanted to talk about, and and that's not to take away from the important role of women and children and Elders, but it's about including a focus on young men too. This is not happening anywhere else. They are very largely absent from government policy and narratives, but when we talk to communities and researchers they say our men are invisible and we want to make them visible because they're fantastic and they have an important role to play. We've recently put a call for research questions out, and signing the contracts for those research projects at the moment through that process that I mentioned earlier.

One other example is around disability. So we had a roundtable last year with the Disability Commissioner, First People's Disability Network, Aboriginal and Torres Strait Islander people with a disability and researchers. They had never been in the same room before, let alone to discuss what sort of research needs to happen. As well as people from government agencies as well. When you bring people in from the beginning, you can have real conversations because everyone's in on the same equal terms. They'd never been in the same space. Again, like the value in young men, those contracts are being signed right now for really interesting research projects. And you know what? They weren't all about the NDIS. They weren't all about the NDIS. We have this behemoth of a once-in-a-generation policy reform happening and yes that was part of the conversations but there are a whole lot of other things that people wanted to talk about. And one of them was empowerment.

And finally I might finish on another another thing that's interesting when you do this process, is a project by Therese Kearns which is currently in the draft report stage, but she did an evaluation of anaemia management up in Northern Territory. And the things that she found, it has been able to change and inform the clinical guidelines around anemia management for children. This this work could not have been funded elsewhere but not only that it's now she's now getting a lot of larger grants to test and confirm her findings elsewhere. So that is so common; we're always seeding projects and giving projects a run where they're not given a run anywhere else.

We can list plenty of those examples actually and the anemia management is one of them changing the clinical guidelines but where it's because where we're looking it's not it's not it's out of the box because we're bringing everyone in the room together, and we're working through that process, and we're looking at power structures and we're breaking through them. And that's one example of that.

Romlie Mokak So Leila talked about empower empowerment. and I mean empowerment is one of those words isn't it that we often hear non-Aboriginal people say, you know, 'we want to empower Aboriginal people'. Now you can see the the you know the oxymoron, the the untruth in that. I mean, it's Aboriginal people who are empowered and need to empower ourselves even further. It's not for others to tell us, you know, how to do that.

So in terms of the Institute, the model that we have currently have and it's a little bit kind of it's it's challenging in that we run a Cooperative Research Center, so the CRC's are funded through the Department of Industry innovation and Science. we have 22 partners in that including a number of governments, medical research institutes, university's, Aboriginal organisations. So that's a cooperative model; we develop a research agenda and Leila's just explained how we go about the business. Now that CRC model is not a sustainable model for us, so in parallel I'm also leading the development of a new approach to maintaining the Institute going forward beyond this periodic, cyclical, competitive process.

Historically the CRC and the one that on I guess I'm CEO of the Lowitja Institute, CEO of the CRC, historically we've had a non-Indigenous research lead and an Indigenous co-lead, co program leads and that model has worked to a point. But typically the research lead non Indigenous was much more senior than the Aboriginal co-leads. So you've immediately got this this sort of imbalance. And so for this current CRC we took an approach which was to to advertise, and certainly not racialise the advertisement for members of our program committees as well as Chairs. I sought to get really senior people on the panel that I chaired, to assess those committee applications. Senior Research Alex Brown from South Australian Health and Medical Research Institute, Wendy Ah Chin, who was the Head of Aboriginal health in the territory and John Singer who's currently the the NACCHO chair, so really high caliber people. As we assess the the applications, you know there was this sort of moment, where we thought we don't actually need non-Indigenous people to be leading these processes. The time has come now. where we have our own talent at senior levels and our committees and members of the committee's some of them developing, others who are there.

So all of our Committees are all Indigenous. Our Social Cultural Determinants Committee is chaired by a woman called Kerry Arabena; she's a Torres Strait Islander woman with a PhD in Human Ecology. We've got Cindy Shannon, a professor from Queensland covering our Workforce Committee, our Systems and Policy Committee is Dr Mark Wenitong an Aboriginal clinician/public health practitioner. So this is a sort of talent that we've got and we've got a bunch of people in those committee structures you know, coming on and up and through, which is about how do we really strengthen the hand for the next generation. You know this generation are going to pick up the Uluru Statement again and really take it take it home. And how do we do that in a way that is strengthening rather than competitive.

So that's the model that the Lowitja Institute. Pat Anderson is the Chair. I was very grateful the fact that June Oscar, upon becoming social justice Commissioner, said that she would retain several commitments, and one was to stay on our Board at the Lowitja Institute. Fiona Stanley; Fiona's a pediatrician, a researcher. You know, the breakthrough on on folate and you know, Fiona has just been a champion. Peter Buckskin, who's the head of the National Aboriginal and Torres Strait Islander Higher Education Consortium so these are all black fullas in higher and if we think working in Aboriginal health and Aboriginal Affairs is a tough game, I really feel for a lot of our colleagues working in the higher ed sector. I mean that's just that it's brutal. so we've got Peter who chairs that Committee on our Board, so a number of fantastic people. My leadership team, the Executive Team we have five ... three of those are Aboriginal, and this is the stuff that we were on about.

And I can go on and on about where we want to take the Institute, but the important thing here is leadership. You've got to have a Black leadership if you're dealing with Aboriginal Affairs, otherwise it's just a continued contest. And you have to have governance structures that enable that to happen, rather than disabled. Now how that works, you know, is is often very difficult, how do we negotiate our way through systems. For for about three or four years I was the Chair of the Aboriginal Staff Network in the Health Department. The Secretary I worked with, two Secretaries; one Andrew Podger and the other Jane Holton. Andrews, as we set up the network, Andrews gave a directive to his Head of Corporate, you know the people management, the the the Corporate Division Head, was and I didn't know about this until much later, he told Andrew Wood his name was, really cool guy that he was not to say no to me. Now what a simple instruction. He was not to say, the starting point was not to say no, but to be in the conversation.

And so Andrew Podger, the Secretary and I would meet every six months for our catch ups, Andrew Wood was invited in, but all the stuff had been dealt with and negotiated on that simple directive to not say no. Now that's just not giving away to black fellas and saying okay whatever you want you'll get, it was negotiated, but the Secretary had the confidence that his senior corporate person was up to that. And so that the relationship was very different and the outcomes are very different. So it's it is incumbent on leadership and right at the top of the tree I mean I've worked in small Aboriginal organisations but I'm very clear that as a CEO for nearly the last 15 years, you know, if I'm not walking the talk, then there's a problem there. And I would put the same requirement on any institutional leader. If they're not walking the talk, not accountable to our mob, to our communities, then what are they doing for us? Where's the benefit question being addressed? And that's that's not at all meant to kind of diminish people's intent, but we know that intent will never deliver for us. Ultimately actions will deliver.

I've kind of gone off a bit on a tangent there Geri, shoulda have pulled me up.

So I'm hoping that what we've done today has provided you with a bit of insight into the way that Lowitja Institute does its business. Emphasising the point that that leadership is critical governance, is critical setting those goals or targets or whatever by Aboriginal and Torres Strait Islander people is fundamental. Measuring your efforts and progress to get there is critical; it gets to the question of accountability. But what it does is it grows really ambitious teams. You know if you can start ticking off the results, this this notion of complexity always being with us, and and being drowned by complexity, is a heavy burden. If you can start taking things off you can you realise that you can chunk these things down, and you can actually make good progress. And I'm happy to talk about the Indigenous doctor stuff later.

But if I can just finish up going back to that earlier image of Rob Bamblet with his two sons and it was, as it always should be about our contribution to our future generations. If you jump onto the Lowitja Institute Conference 2016 website we've we've got our Statement, we've got a Lowitja Statement there. And I just thought I'd take an extract out of that borrowed from a good friend and colleague Karina Walters who's a Cherokee woman from from the US. And it comes from one of their ancestral teachings and we borrowed it. And it goes along the lines of in our Statement 'We honor our ancestors resilience, strength and wisdom, so in this moment in time which was then but now equally, our obligations is to our future generation, our obligation is to our future generations, and there are three questions that are posed there: one is 'what kind of ancestor did my own ancestors want me to be?', 'What kind of ancestor do I want to be?,' 'And what kind of ancestor do I want my children to be?' And this is not a uniquely proprietary Indigenous question or three questions. This is a question for all of us you know, what what did our ancestors have in mind for us, what do we have in mind for us, so and what do we want to leave you know to the future generations. So we might leave it on that one Geri if that's all right.

Audience member: Hello my name's Kiel. So I've worked in the public service now for about 11 years. I've worked at the Federal level and State. What I've been challenged with, is shifting the decision making about our relationship, around the spectrum of engagement. My experiences around trying to shift that power and around is that decisionmaking is, often, when you bring up issues around racism, white priviledge with non Aboriginal Senior Executives and decision making in organisations, ah, issues around white fragility, an organisation might start that commitment but then maybe, some of the responses are around diluting their use of language, challenging racism, or you can't tackle issues around racism... personalising...But also around organisational responsibility around, putting barriers program decision-making. So, you might start off with a commitment but the end product has taken its first steps backwards. Positions around priviledge and racism can be very confronting. I guess my question is from your experience over the years, what are some tips that you give to senior non Aboriginal people around decision-making that can support them through that process, that can support their Aboriginal colleagues, and themselves and other Aboriginal colleagues to, not personalise, but meet the outcome we all want to achieve together?

Romlie Mokak: Yeah look I thought I'd go back to that question of leadership, so the very top of the agency has to be on board and expect results from their Executive. You know that um, little vignette about Andrew Podger, the Secretary saying to his Head of Corporate 'you're not to say no as a first response', opens up that kind of dialogue. You can go a lot deeper with with discussions about racism and other things if you establish that right from the very start at the very top.

I think racism, we're doing a lot of work in racism. We've got some research that shows the ubiquity of racism. In Victoria alone. It happens everywhere, across all settings, and you know government departments are no, are not immune from that. So the first thing is to own up to the fact that it exists, so people who are in denial or in denial, and that's where white privilege comes through in in bucket loads. So Aboriginal people telling non-Aboriginal people is not necessarily the means by which it will work, it needs to be a systemic approach.

The I mean there's some interesting conversations that were having around racism. We fought very hard with the Labor, not not hard in a bad way, but we were willing to walk from the table when Labor was in government if they didn't understand the impact of racism in the National plan. So the National Plan has a has a vision for the health system which is the health system free of racism. So any health leader in any system who denies that racism exists is kidding themselves. The National Plan, albeit the Commonwealth's plan, basically says racism exists otherwise why would we need to have a health system free of racism. So we then take it to the next level and what does that look like, how do we how do we identify and measure it, and what are the things that need to be put in play.

The other non-negotiable was culture. Culture is the bedrock. So those, the combination of those two things, were non-negotiable in our work with with Labor. Nicola Roxon, Warren Snowden and the Coalition adopted that Plan directly when when they were in government. So at a policy level you know, it's it's acknowledged. The hard stuff is getting it implemented. And to the second point that you raise around how to how do we support non-Indigenous people in those conversations. The ... I mean it will vary for different people. There's are a number of us who say our focus, we're continually feeling the need to create safe spaces for non-Indigenous people to talk about their own lack of efforts around tackling racism. We're focused on keeping our mob strong.

Non-Indigenous people need to do some work for themselves as well. Which I mean it sounds that quite brutal and blunt, but where we've got, where we've sort of stretched in all sorts of ways, it then it changes that the discourse then, which is about you know, really understanding white privilege not as an individual thing but as institutionalised and systemic, and then how do non-Indigenous peoples get a better understanding themselves that and work with us. And I think it's very difficult. I've you know I've got beautiful, strong, deadly white colleagues and they're feeling it as you know as heavily as we do sometimes. My wife is from New Zealand she's Pakeha. She feels that even more than I do when judgments are made about our children for example. So this this gets played out in personal spaces as well as institutional spaces, but it does require efforts and different efforts I think on the part of different actors and players.

Leila Smith: I might just back that up with a case study.

Before I started at Lowitja Institute I was a Management Consultant and I was brought in to do a job for a government agency who wanted me to have a chat to their Aboriginal and Torres Islander staff about what they were experiencing. That was the extent of the brief; just have a chat with them and then we'll do an action plan based on what you found. Spoke to 150 Aboriginal and Torres Islander staff for that agency, and there was a lot of instances of racism. It was pretty horrendous there was some some focus groups where people were just crying and comforting each other. It was real pain that people are experiencing when they come into work every day. So we presented these findings to the head of the agency and they said the middle management needs to hear this. I want you to present this to to all all the middle management.

So we had a big day and they all came in, presented the findings and I was a nervous wreck because I had to present all of these stories and somehow summarise all of this pain that they had felt and explained to the middle management, most of whom were not Indigenous that you guys have got a problem and there's racism here and it's being experienced. By the end of the presentation, the head of the agency stood up people where people were crying in the room and he said 'This stops now. We will not tolerate any of this.'

So first, we had to present the evidence that it actually existed and unfortunately that is a terrible thing to have need to do to convince people that racism exists. But after that to have him stand up and say this stops now and for everyone to feel it in their hearts and in their heads, is what it took. But as you're saying Kiel, we need to go forward, because once you unpack that you cannot walk away from it. That is almost worse once you acknowledge that there's racism there and you don't carry through.

So my advice would be: once there's the clear case and acceptance that there is racism, once it's called out from the highest leadership structures that it is not acceptable, the most critical point is to run with that momentum and run with it because this very busy, complex world that we live in and if that's not a priority other things will jump on top of it. So just run with the momentum otherwise you will go three steps back.

And one other thing my favorite quote from that research translation symposium that Rom was talking about that we hosted last year with NHMRC, was Chelsea Bond who does a lot of work around racism she says 'We need to stop saying the R word like its equivalent with the n-word'. It's so true, we just need to call it racism it's and once you do that, then we can move forward together and and just get past that different space about comfortability because we've got much more important things to do.

Geraldine Wilson-Matenga: Thank you everyone for coming today. If there are not other questions today I'd really like to thank Romli and Leila for today, a very thought-provoking discussion and I certainly learned something new today and, in terms of I suppose you know I found I found the toolkit really really interesting and it's very practical and that we can apply to everyday work practices and something that really resonates as opposed to the work that we're doing in the Center around collaboration and empowerment and what that looks like in it from an Aboriginal perspective and what the leadership you know, we want in terms of Aboriginal health and you know the Aboriginal leadership space. I think that can never be underestimated and alot of the discussion was going on both that Leila and Romlie have talked about and in the national space about you know working within an Aboriginal health or within an Aboriginal perspecitve and Aboriginal world views and on Aboriginal terms of reference. And the more that we are principled about doing that and the way that we work, that there are the outcomes will be into the future. And certainly the work of the Center is about enabling the system and working with you all so that we can get there together. And I feel really positive about the work that we're doing at the moment and we do have really great leadership in this building at the moment who are very supportive, that was having some different conversations, having the brave conversations, talking about the R word quite openly, and that is a task that Elizabeth has set for us; to really look at racism and and how we approach that both within the Ministry and across the system for Aboriginal people, as well as governance and looking at Aboriginal leadership and really growing that and making it very strong so that we do have we do have a legacy to leave for in the future. But I really like to thank you for today.

If you have feedback or you've got other questions please email the Centre for Aboriginal Health inbox and we'll get back to you as soon as we can. But we do as I said, we've future seminars planned throughout the year. We'll be emailing out those invitations shortly. So thanks for your time spending your lunch time with us, hope you enjoyed the yarn today and yeah have a great afternoon thank you.

[Applause]

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Page Updated: Thursday 5 September 2019
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