1. What does the “third space” mean to you as a health professional?
Eileen Tan
Lisa Molony
Kate Brazzale

2. Acknowledgment of country
We respectfully acknowledge the past and present traditional owners of this land on which we are meeting, the Noongar people. It is a privilege to be standing on Noongar country.

3. Introduction
Why should health professionals be aware of the "third space"?
What should health professionals take into account when looking after Aboriginal and Torres Strait Islander patients?
Why are cultural implications important for health professionals to take into consideration?
Introduce group
Introduce topic
Introduce focus questions

4. Importance of identity
What does it mean to be Aboriginal?
"An Aboriginal or Torres Strait Islander is a person:
of Aboriginal or Torres Strait Islander descent
who identifies as an Aboriginal or Torres Strait Islander and
is accepted as such by the community in which he (she) lives.“
What does your identity mean to you?
This is called the 'three-part' definition of Aboriginal identity and is used by all Commonwealth departments [2]. And is a the ‘white authority’ way of identifying Aboriginal people.
“The very fabric of what it means to be Aboriginal [is] that being, living and breathing the journey, walking the land as proud Aboriginal people, knowing the importance of being respectful within our community and wanting with all your heart and ability to make positive change”. —Paul Ralph, CEO KARI Aboriginal Resources Inc [38]

5. Culture shock
Culture shock: the tension and anxiety, combined with feelings of isolation, sensations of loss, confusion and powerlessness, associated with entering a new culture.
When we move to a new culture, we take with us the values, beliefs, customs and behaviours of our old culture. Depending on how similar this new culture is to our own, our beliefs, customs, values and behaviours may clash with those encountered in the new environment. A loss of familiar signs and symbols, such as words, gestures, facial expressions, customs or norms, can result in confusion, disorientation, misunderstandings, stress and anxiety.
For example giving the thumbs up in Australia generally means ‘job well done’, giving the thumbs up in the middle east is the equivelant of raising the middle finger, meaning ‘sit on it and swivel’. Likewise, if you were talking to someone and they turned their head away from you, you would think they were being rather rude. However in some cultures, people turn their eyes away from you so that their ‘best ear’ is facing you…which makes more sense when you think about it.
- Culture shock can be very destructive and undermines the ability of dominant culture to satisfactorily perform their professional tasks. The Aboriginal community is left to cope with the fall-out from the culture shock suffered by the dominant culture.

6. Aboriginal terms of reference
A way to determine Indigenous viewpoints on issues within an Indigenous context.
Core values include:
The worth and validity of contemporary Indigenous cultures
The right of expression of Indigenous realities
Self-determination and self-management
Positive social change
Social justice
The recognition and acceptance of Indigenous diversity
Reconciliation of contending issues between Indigenous people
The worth of the group

7. the third space

8. How third space to the health industry?
“WA Health Is dedicated to working with the Australian Department of Health and Aboriginal communities in building new partnership for services provided; developing culturally appropriate Health services and providing safe, high equality and accountable Health service to the Aboriginal community” (Health Reform Implementation taskforce, 2007).
Indigenous and Health professions has a variety of differences that are met and respected together as one.
Cultural belief
Views and Values
Expectations
Traditions
Historical factors
Family structure

9. Conceptual framework that includes the four dimension

10. How third space applies to the health industry?
It is the space for the four dimensions to be met between the Aboriginal and non- aboriginal domain.
Experiences
Concentrates on the experience of Aboriginals in relation to the issue under discussion.
Aspiration
Concentrates on what the critical reference group wants to achieve in relation to the issue.
Understanding
Focuses on the persons understanding of the issue; as well as judging if further explanation is needed.
Cultural element
It draws on cultural differences and traditions which includes current culture practices.

11. Challenges for health professionals
Communicating among the aboriginals
Understanding their traditions and beliefs
Traditional healing where some professions might disagree on
Not being able to achieve the outcome until a certain level of trust has been created
Obtaining informed consent for treatment
Explaining diagnosis and treatment to patients

12. health professions and aboriginal may clash in a health environment
Communication and language issues
Poor cultural understanding
Racism and prejudice
Values and beliefs
Mistrust of the system

13. Operating within the third space
Advantages
Disadvantages
Access to higher quality services
Culturally secure services that will improve health outcome for Aboriginal people
Improve customer satisfaction
Provide opportunity to improve the broader determinants of health

14. Aboriginal Health Statistics
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 data surveys.

15. Aboriginal Health Statistics
Health complication
Comparative 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-fold
2 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-fold
10-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
Over 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-fold
5-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 increased death rate from respiratory disease accounting for 8% of total deaths.

16. Aboriginal Health Statistics

17. Aboriginal Health Statistics
Selected Chronic Conditions: Ratio of Indigenous Australian’s to Non-Indigenous Australians — 2004–05

18. Aboriginal Health Statistics
Diabetes Comparison between Indigenous and Non Indigenous 2005
Cardiovascular Comparison between Indigenous and Non Indigenous 2005

19. Aboriginal Health Statistics

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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.

27. Focus Question.

28. References