WHAT DOES THE “THIRD SPACE”
MEAN TO YOU AS A HEALTH
PROFESSIONAL?
Eileen Tan
Lisa Molony
Kate Brazzale
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?
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?
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.
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
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THE THIRD SPACE
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
CONCEPTUAL FRAMEWORK THAT
INCLUDES THE FOUR DIMENSION
HOW THIRD SPACE APPLIES TO THE
HEALTH INDUSTRY?
o
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.
CHALLENGES FOR HEALTH
PROFESSIONALS
o
o
o
o
o
o
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
HEALTH PROFESSIONS AND ABORIGINAL
MAY CLASH IN A HEALTH ENVIRONMENT
o
o
o
o
o
Communication and language issues
Poor cultural understanding
Racism and prejudice
Values and beliefs
Mistrust of the system
OPERATING WITHIN THE THIRD SPACE
Advantages




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
Disadvantages
ABORIGINAL HEALTH STATISTICS
Life expectancies of
Indigenous versus NonIndigenous Males and
Females.
90
82.6
78.5
80
72.9
70
62.7
60

On average
Indigenous Men die 11
years earlier then NonIndigenous Males
 Indigenous Females die 9
years earlier then NonIndigenous Females.

Data from the Australian Bureau of
Statistics 2005-2007 data surveys.
50
Indigenous
Non - Indigenous
40
30
20
10
0
Males
Females
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
2 to 3-fold
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.
2-fold
A 2-fold increase in cataracts.
60% increase in
death rate
60% increased death rate from neoplasms. In 1999–2003, neoplasms
accounted for 17% of all deaths.
3 to 4-fold
3 to 4-fold increased death rate from respiratory disease accounting
for 8% of total deaths.
Optometry/
Ophthalmology
Neoplasms
(Tumour)
Respiratory
ABORIGINAL HEALTH STATISTICS
ABORIGINAL HEALTH STATISTICS
Selected Chronic Conditions: Ratio of Indigenous
Australian’s to Non-Indigenous Australians — 2004–05
ABORIGINAL HEALTH STATISTICS


Diabetes Comparison
between Indigenous and
Non Indigenous 2005
Cardiovascular Comparison
between Indigenous and
Non Indigenous 2005
ABORIGINAL HEALTH STATISTICS
IMPLICATIONS FOR HEALTH
PROFESSIONALS

Third Space
“A place where Indigenous and Non-Indigenous people can come and
work together without fear of prejudice from ‘baggage’.”
 An area of mutual respect between Indigenous and Non-Indigenous
people where they can work collaboratively.

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Health Professionals need

Knowledge.


Understanding

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Towards both sides
Willingness to be open

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Of roles and responsibilities
Empathy


Of where the other comes from; their “space”
Accepting of differences
Avoid stereotyping
IMPLICATIONS FOR HEALTH
PROFESSIONALS

Aboriginal and Torres Strait Islanders are not the same.

Discontinue use of out-dated, derogatory terminology.
Half-caste, full-blood, quadroon, etc.
 Always use the terms Aboriginal Man/Woman/People or Torres Strait
Islander Man/Woman/People.


Aboriginal people mistrust people who offer services related to
“protection” and “intervention.
European colonisation.
 Government Policies post colonisation.
 The “Stolen Generation”. Government policy til 1969.
 “Keep your word.”
 Changes made.
 e.g. Kevin Rudd’s “Apology”.

NSW Department of Community Services 2009 & National Disability Services WA 2009
IMPLICATIONS FOR HEALTH
PROFESSIONALS

Sensitive issues due to past Government policies have contributed
to:
•
•
•
•
•
•
•
•
•
•
•
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Dispossession of land
Family fragmentation
Mental health issues
Social and emotional wellbeing issues
Grief and loss issues
• Self-harm and intentional injury
• Over-representation of Suicide rates
• Family and domestic violence issues
• Loss of country
• Loss of identity
Poverty
Racism
Unemployment
Poor health outcomes
Poor education outcomes
Below standard literacy and numeracy rates
Alcohol and substance abuse/misuse
Over-representation in the juvenile and criminal justice system
NSW Department of Community Services 2009 & National Disability Services WA 2009
IMPLICATIONS FOR HEALTH
PROFESSIONALS
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Respect

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Kinship

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Elders,
The Land,
Animals,
Ancestors.
“Sorry Business”
Defines roles and responsibilities within the family.
Ensure that extended family is included in important meetings or
when making decisions.
Gender responsibilities.
Men’s Business – issues which have a male perspective within
aboriginal culture.
 Women’s Business – issues which have a female perspective within
aboriginal culture.

NSW Department of Community Services 2009 & National Disability Services WA 2009
IMPLICATIONS FOR HEALTH
PROFESSIONALS

Language

Originally 300 nations speaking 250 languages with up to 600
dialects.

Nonverbal cues

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Eye contact.
Hand and facial gestures.
Silence
Progression of Conversation.
Semantic Ambiguity
 Swearing
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Communication Techniques

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Use uncomplicated language, Not “jargon”.
Be wary of comprehension
NSW Department of Community Services 2009 & National Disability Services WA 2009
CLOSE THE GAP CAMPAIGN

Australia’s largest Campaign to improve Indigenous Health.

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Aimed at reduced the Life Expectancy Gap between Indigenous and
Non Indigenous Australians to 0 years by 2031.
OXFAM is campaigning to:

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Increase Aboriginal and Torres Strait Islanders’ access to health
services
Address critical social issues such as poor housing, nutrition,
employment and education
Build Indigenous control and participation in the delivery of health
and other services
Get governments at state and national level to work in partnership
with Indigenous communities, health organisations and experts to
develop and monitor a plan to tackle the Indigenous health crisis
Promote real and meaningful partnerships between Indigenous
COAG, 2011 and OXFAM 2006
NEED FOR EDUCATION

To understand the needs of our Aboriginal or Torres Strait
Islander Patients

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Downing and Kowal 2011
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The majority of Aboriginal people access health care from NonAboriginal services.
Majority of Nurses interviewed felt that didn’t receive enough cultural
training to look after Aboriginal and Torres Strait Islander patients
They felt that they weren't giving them the level of care the needed and
deserved.
Canada’s Approach

Kilpatrick, 2004

Looked at the need for Aboriginal Education.
FOCUS QUESTION.
REFERENCES