7th National Aboriginal and Torres Strait Islander Environmental Health Conference Kalgoorlie, WA

Environmental Health Officer, Community Engagement Training and Survey

Page last updated: December 2010

Thaddeus Nagas, Greater Western Area Health Service, Helen Ptolemy & Bob Allen Sydney West Area Health, NSW

Firstly I would like to thank the traditional owners, the Wongatha people for allowing me to speak today.

As part of the traineeship program we have been able to work alongside quite a few ‘housing for health’ projects. I’m from Broken Hill which is out in the wild west of NSW. I cover quite a few towns. Just to let you all know I’m not of Aboriginal descent, I’m a Torres Strait Islander fella working on Aboriginal Lands, amongst Aboriginal people nothing wrong with that; I’m having a good time and a lot of people made me feel very welcome.

What this project is about is that a past graduate of the traineeship program Greg. Highlighted during one of our regular trainee meetings that there has been a need because there is only a minor number of trainees within the health system and it’s not a sustainable training package by that I mean we have no guarantee of employment at the end of it. We have guarantee of excellent training. It’s good for us not only to absorb the information from the learned people that we work alongside but also pass on some cultural knowledge to our colleagues to give them some greater understanding what living ‘black’ is all about and learning to engage with our people our people, our communities and not just rely on government people above them that they can be proactive at their local level; including local government and from within their own public health units. So basically we came up with a plan about how we were going to go about training some of these EHOs; there had to be a more formal process and as usual people wanted data. So we had to jump through the normal hoops we have 51 qualified EHOs working in public health units across NSW so for us to develop a training package we had to first show that there was a need to have it.

I am going to play a video clip and whilst this clip is on some of us older people in the room will be aware of this short video clip I want you all to think about your communication style whilst watching this video clip; not only with Indigenous people but everyone you are involved with during your working life.

Refer to video clip located on the CD

You may have just noticed that is the correct way to spell BBQ.

We conducted a survey late in 2008 to collect information hopefully form all EHA working in public health units in NSW Health so that we could evaluate if there was a need for this project convince the people working above us i.e. directors and those above them that there was a need for this training component. Other people that worked on the project were Robert Barnett who presented the ‘Mister Germ’ program, a senior EHO in Sydney by the name of Bob Allen and Helen Ptolemy, another EHO in NSW Health. We needed to basically get the message across that EHO work was not supposed to be left up to Aboriginal trainee EHO’s, that it was everybody’s business it was up to all EHO’s, don’t just leave it up to some of us younger people or less knowledgeable people to engage in communities and get the message across that environmental health in Aboriginal Communities was everybody’s business. The existing training is very limited across all health services with cultural awareness training it’s basically a broad brush type effect across NSW which doesn’t really highlight some of the issues in local areas which someone might live and work in. Say you started to work in NSW Health in Sydney and then you were transferred out to ‘back of Bourke’. You were considered as having appropriate cultural awareness training and not being aware of the issues locally that you were about to be confronted with in work environment. Even down to the point where you wouldn’t know the of the language group, name of the local people, names of the reserves or local missions and the history in those communities.

Our training needs should be focussed on the items highlighted on the slides. Culturally appropriate communication you may have seen the way some people may want to talk a bit slower like they have problems but we still have a brain you don’t have to talk slow and dumb everything down to us we will catch on if we don’t catch on we will ask. Sometimes you feel like that we don’t speak the same language as everyone else. Sometimes you can be offended but most times we have a bit of a laugh and a joke about it and a lot of times we play on it a bit too, just to make us feel a bit more uncomfortable.

A lot of work has already been done. EHOs have identified through our survey that project success have been improving. We asked people and basically the improvement has come about since the inception of the traineeship program for Aboriginal and Torres Strait Islander EHOs. Prior to that they said that could not get such successful figures of implementation. I am sure that all the Indigenous EHWs in this room will understand that there is a lot of community pressures and work pressures put on us to deliver these services in our communities and what we are trying to do in this trainee package is to alleviate some of this pressure from ourselves and share the burden across the workforce.

We hope to do lot of work in rules of engagement in communities to achieve better project outcomes through the following points as listed. This is proven to work and we have two areas where a lot of community based work is showing a lot of positive outcomes already in NSW one is being put together by a former Indigenous trainee who is now a Senior EHO; Glenn Pearce I’m very proud of that brother. Where he basically goes and starts at a community level, engages stakeholders and they sit down on a regular basis and plan and focus on what services are required within that community. That the community has interest in what they want delivered from that aspect they then go about trying to source funding so there is no double dipping. They talk to relevant stakeholders about coming to positive outcomes for those issues. It also happens out in the wild wild west where we call it now the Aboriginal Health and Housing Forum; houses have been attached onto it in the last 18 months. Some of you may be aware of the ‘healthy housing program’ which was trialled out there, it’s a real trial area out there, and sometimes it is a trial working out there. Everybody wants to have a play out there because there are a lot of remote communities that they can play with and it’s only a day’s flight from Sydney. We get people coming into community quite often and we sit down in a similar process out there and basically get FaHCSIA, DAA, AHO Health and all of us together and try and plan and implement service delivery in Indigenous communities. Why do we need to do the training; well as in local Indigenous communities where there is a high turnover of staff there is going to be quite a high turnover rate of us trainees as well. Also people come to country areas to get a start after Uni and then move on for promotion so in the end we need to build that capacity in not just have that knowledge absorbed and then taken somewhere else maybe to a useless place like a city. Most people only get a job straight out of Uni; I know this successful person who I used to go to Uni with and she is going to start work up in Derby very soon. I am sure there will be similar places and people have had first year trainee EHOs out in Indigenous communities; we don’t want to lose that knowledge.

Some of the key recommendations that we will want to put into this training package will be:

  • Recognition is Aboriginal environmental health as a priority function of all EHO staff I mentioned that previous because of these reasons
  • For further specialised training to be conducted and maintaining sustainable partnerships in collaboration with Indigenous communities focussing on their level of health needs. Plus also building in the ownership of the local level of the component; getting local people interested a lot will hang around a bit longer and nobody cares about us more than us and it’s our kids getting sick on the land.
We hope to put this training package together. You have seen a map of NSW it is very spread out the area health services are divided up into 8 health areas I think. We plan to go to 5 difference regions and deliver these packages together. So that we can bring all the EHOs in those areas together into one unit so we are also speaking the same language and it will also give the capacity to let people in that whole area know about local Indigenous history and who the contacts are within community in that whole area. This would be a nightmare for a new person trying to start off in health anywhere and within any state health service. I would have no idea about working in Western Australian. I know a little about Queensland but I have no idea about community contacts. Half the battle is getting a start of knowing where to go.

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Cultural competence to allow participants to develop an understanding of themselves first and what they think and believe themselves of what culture is. I have sat in recent job interviews and given people jobs in DAA and that’s the best question I have heard in my life when I have got people that ; Mary G eluded to it in one of her jokes last night – “don’t worry about those people, there weren’t even black when they were young!” A lot of people as they get older start identifying as Indigenous. I went to school with people used that used to make racist remarks to me then later on came along in later life and asked me to be a job referee for those people because now they are claiming to be Aboriginal or Torres Strait Island people. It is very difficult. The question was in that job interview “What does Aboriginal mean to you?” and it was quite interested to see people stutter and stammer and have no idea even at the point where people were saying “that’s a good question, I don’t know” and yet they had applied for an identified position within a government department to work with our people.

Some of the levels of cultural competence.
  • Cultural aversion to overtly racist people.
  • Cultural incompetence; the people that are opportunistic and just want to work our people to get their first job or can’t get a job anywhere else – are they really interested in solving the health problems of our people?
  • Cultural blindness makes and organisations look useless for our people it seriously does. Do they really care about us?
  • Cultural pre-competence; access to information the best practice options.
  • Cultural competence again; knowledge of community and clients.
  • Cultural proficiency; working with everyone, community and in an advocacy role at all times.
It will basically cover a broad historical background of Indigenous history and then be taken back down to local people; people that you will be working with and engaging with. There will be a component of a role reversal as seen in a previous video clip; where we will sit down and ask those people a lot of questions about their history and some quiet personal questions to get them to get a feel of what it’s like to be living black and people coming into your community. For example if a team of people in say ‘Housing for Health’ and don’t think I’m knocking ‘Housing for Health’ I’m a great advocate for it, turned up at your place and knocked on the door with a team of 6 people and just started walking though and you had no idea what it was all about. They start to pull things apart and fixing things sometimes that what’s happened to our people in the past and unfortunately it still happens the present day.

You need to be very well prepared before approaching a community. Sometimes unfortunately you may be aware it doesn’t happen in your area. We need to make sure it doesn’t happen in NSW. This is something that EHO’s will be made aware of from the training package. I am sure a lot of people in the room will be aware of the benefits both for the associations and the organisations they work with about using Indigenous people to help them implement services in their communities. We to have found ‘ we can get into these communities a lot easier if we use black fellas we will only train them up a little but, we will only pay the a little bit and we will get our job done and we will get out of there.

I mentioned earlier that there needs to be a bit more sustainable component; don’t just rape and pillage our knowledge and take it away so that you can get your job done and move along with your career – put a bit back including the money into that local community. All Aboriginal health workers face the same challenges. We live and work and play together. Other people have mentioned previously so I will reiterate it – we never knock off! I don’t have a phone at home - I have one in my pocket I can turn it off. People ring me up at 3am. I live in Broken Hill which maybe long way away but you become identified in the area as the bloke to talk to. I had to push and request for a mobile phone because I was sick of people ringing me up at home. I don’t mind talking to my mob just not at 3am in the morning because that’s when they have their problem and they know you and they know you will talk to them and they know you have been though area and will come back.

There is an important point there under ‘trainee’ which I touched on earlier. Being of Aboriginal descent does not also guarantee cultural competence as I pointed out earlier I’m Torres Strait Islander decent working ion Aboriginal communities.

In conclusion we are all aware that there are no easy answers. In the past there has been introduced along range of solutions. That time hasn’t finished there are more solutions; there are better ways. We need to develop more culturally appropriate interventions sorry to use the work interventions – it is not a joke. Minimum standards of cultural competence must be achieved at all levels; personal, system organisational, professional and individual.

Once again some of the older people in this room will recognise these words. It’s been a long time, round about the same time as I heard this song and the words of this song for the first time as a very young child. I didn’t realise the significance of it. My father took me along, it was winter time, and it was on Aboriginal health what he was doing because we would pull up in the Holden, open the boot and hand out Vitamin C tablets in the middle of winter. It is just as cold in Broken Hill and the outlining areas as it is here in the winter time. That was Aboriginal health. Whilst we were there, there was a big deal about someone turning on a tap in a place I thought was a rubbish dump because I grew up in Broken Hill in a mainly white society. It wasn’t a rubbish dump they were humpies and it’s where my people were living and I had the privilege of seeing the first chlorinated water supply being turned on. I was 7 years old and now I’m 44 and we haven’t done enough. To many brothers and sister, aunties and uncles are passing away.

There are copies of these words, they are not my words but I believe in them. Thank you for your attention.

Statement: Clayton Abreu: I am glad that NSW Health has done this project, this awareness. We are doing it in our service it’s a need it’s given other staff within the service a different perspective on how to work in Indigenous communities and in Qld Health we have started to do that. With the VET workshop we had with AMMRIC in Qld we did a similar program of how to work in Indigenous communities in Qld so we have that starting up in our service as well. But I see it as a need across all services not just environmental health.

Thaddeus: I will just highlight some of the issues I have faced since I started my traineeship. One day I was working a long way from home. I was at Uni and I got a phone call just before my Chemistry exam. The phone call was my son; my daughter had cut her wrists. I sat that exam and I couldn’t get home in a hurry. I got home to talk to my boy. I went home and I tried to talk to my Director three times to tell him I needed to take some time off to be with my family. They were too busy to talk to me. I’m old and wiry and I find a way to get around things so I thought I’ll make them talk to me. I took the work car home; I didn’t drive it all round the place, just took it home and parked it in the driveway. My priority was looking after my kid. I thought that sooner or later they would realise that I took the car because you have to sign for it and they would come looking for it. Three days later they came looking for me. My Director knocked on the door and asked me if he could have the car back and I said “Yes, but I want to talk to you about something first mate” So I went through the issues. I had my daughter sitting outside talking about taking her back to country to make her strong. I said to my Director, I need a few days off. He was very supportive once he knew.

I took six weeks off work. In my absence, I apologise if anyone has lost a member of their family to suicide, a colleague that was asked to work with me for me to pass my knowledge onto him was making jokes “I wonder where Thad is, I wonder if we will find him hanging in a wardrobe” I raised this issue with quite a few people in the working environment who said that he was only joking. It was bloody serious to me! And it’s serious to my people. I had to keep working with this bloke. I couldn’t look him in the eye I had to face my back to him and give him a cultural history lesson about some of the plights faced by Indigenous people. He was one of the fly-by-nighters that come in get paid very well and yes he eventually left. He had also upset me previously because I had been maintaining and documenting all the changes since about 1950 in my local area of Council EHO’s, State EHO’s and they still made me work with this bloke, I still went on projects with this bloke and pass in the information on because it was helping my mob. I put my mob before I put me, all I wanted to do was to get physical but I am too old to break heads. But we need this sort of stuff to change these things happening. I’m sorry I got personal but it’s just to highlight some things that some of us go though in our work place environments.

For more information

Thaddeus Nagas
Trainee Environmental Health Officer Greater Western Area Health Service PO Box 457, Broken Hill, NSW 2880
Ph: 08 80801503 Email: TNagas@gwahs.health.nsw.gov.au