In Episode 4 of our Race in Society series, Associate Professor Alana Lentin and I spoke with three health experts to unpack how racist ableism drives the management of lockdown and healthcare during the pandemic. Ableism is the discrimination of disabled people, based on the belief that able-bodied people (people without disability) are superior, and the taken-for-granted assumptions that able-bodied experiences are “natural,” “normal” and universal. Racist ableism describes how ableism intersects with racial discrimination (unfair treatment and lack of opportunities, due to ascribed racial markers such as skin colour or other perceived physical features, ancestry, national or ethnic origin, or immigrant status).
In “Lockdown, Healthcare and Racist Ableism,” we explore the ways in which Aboriginal and Torres Strait Islander people living with disabilities can be better supported in the health system, how to establish cultural safety during the pandemic, and what an anti-racist response to healthcare might look like.
First, we spoke with June Riemer, the Deputy Chief Executive Officer of the First Peoples Disability Network. She discussed the Network’s advocacy on the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, and the impact of COVID-19 on Aboriginal people with disability. Second, Associate Professor Lilon Bandler is a Principal Research Fellow for Leaders in Indigenous Medical Education Network. She spoke about cultural safety and the imposition of heavier restrictions on racial minorities during lockdown. Finally, Dr. Chris Lemoh is an infectious disease expert and general physician at Monash University Health. He discussed his advice to the Victorian Department of Health and Human Services, after the Department put nine social housing towers in Melbourne under heavily armed police lockdown. The majority of these residents were migrants and refugees. No other neighbourhood was policed in Melbourne in the same way.
These patterns are now being repeated in Sydney. Eight multicultural suburbs have been put into a “hard lockdown,” including visits by police and military personnel. To see how our guests’ work still resonates in the current context, watch our video, and read a summary below.
June Reimer on disability
On our Race in Society panel, June Reimer discusses how the First Peoples Disability Network (FPDN) published an ethics paper early in the pandemic, to address the health needs of Aboriginal and Torres Strait Islander people living with disability. The Network highlighted the “double disadvantage” they experience:
“COVID for us just highlighted those elements of poverty, disadvantage, remoteness, homelessness, overcrowding, lack of utilities, lack of clean fresh drinking water, lack of support with PPEs [personal protective equipment]. These are just normal everyday occurrences for a lot of our mob in particular regions across Australia. So it wasn’t nothing new to us.”
Supermarkets in remote communities ran out of food early in the pandemic, impacting people on “Basics cards”. The FPDN partnered with an international not-for-profit, the Al-Ihsan Foundation, to distribute emergency food packs to regional and remote areas, to help Aboriginal and Torres Strait Islander community living with disability. These regions were already affected by bushfires from late 2020, and struggled further when the pandemic spread.
June notes that Aboriginal organisations pre-emptively went into lockdown to protect their communities before Australia formally responded to the pandemic. This includes the APY Women’s Council, and other communities in the Wreck Bay in the Shoalhaven Region, the Menindee, and Brewarrina:
“First and foremost, they wanted to keep their elders safe… Our elders are the national library of this country, and our Government couldn’t even recognise that.”
Along with the FPDN’s CEO, Damian Griffis, June gave evidence at the Royal Commission about the impact COVID-19. Remote communities already struggle with lack of access to fresh, clean drinking water and hand sanitisers. June notes that self-isolation was difficult, as families live in overcrowded conditions:
“When we’re asked people to self isolate, there isn’t anywhere to self isolate for a lot of our communities.”
The FPDN continue to address institutionalisation of Aboriginal people living with disability.
“We had 200 years to learn to be isolated and put back into the extremities of society… we always had to be second class. And that goes to that intergenerational racism and trauma, and the things that Aboriginal and Torres Strait Islander people live with every day. So when COVID-19 came along, I think our mob’s survived this really well, and are still surviving this very well.”
Lilon Bandler on cultural safety
Associate Professor Lilon Bandler discussed the evolution and practice of cultural safety. This term grew out of work by Maori nurses in New Zealand, especially the work of Irihapeti Ramsden and her colleagues throughout the 1990s. Lilon says nurses are often the first health professional most people meet, and so their attitudes, especially blame, criticism, or unfounded assumptions, can lead to poor delivery of healthcare.
“Cultural safety assumes that each healthcare relationship between a professional and a consumer is unique, is power-laden, and culturally two-sided. And from that perspective, whenever two people in healthcare interact, it inevitably involves a convergence of two cultures… with different colonial histories, ethnicities, and different levels of material advantage.”
Lilon demonstrates that confronting systemic racism in healthcare “is hard work every single day.” Under a cultural safety framework, healthcare professionals and their organisations examine the potential impact of their own culture on clinical interactions and healthcare service delivery. Healthcare professionals are taught how to examine their attitudes and behaviours. Curriculum and services must also be changed. The aim is, ultimately, to empower consumers to make better decisions. She cites the mismanagement of the nine towers in Melbourne as an example that lacked cultural safety.
“Overwhelming people and using the police force to enact a public health measure really fails to recognise the opportunity to engage and involve people in their own health and safety. And this saw a tremendous police presence, as though power differences weren’t already apparent. But it also failed to recognise that it was a real opportunity to do things differently and to think about the political, the social, the cultural context of people.”
Chris Lemoh on anti-racism
Dr Chris Lemoh was previously seconded from a public hospital to work within the Victorian health department’s management of the nine housing towers placed under hard lockdown in Melbourne in 2020. He became “furious” about the way residents were treated by police.
Chris describes the relationship between government, the health system and the population as one laden by unequal power relations. He says healthcare professionals don’t recognise that discrimination is inherent in the way they’re trained to think and practise medicine. Chris says that, before the second wave of infection in Melbourne, most non-Indigenous people had “a Ramsey street kind of picture” of the pandemic. That is, typified by “a very white middle class suburban” experience. Chris notes that Australia hasn’t experienced the same COVID-19 devastation as other countries. However, in Victoria, the second wave proportionately affected people from migrant backgrounds, particularly from Africa, South Asia and Southern Eastern Europe. But these aren’t the groups in public health messages, which still focus on white middle class suburban people.
Chris notes that better data collection, more equitable allocation of resources, and other structural changes need to happen. Sending out uniformed officers, or cold calling people without cultural or linguistic awareness, are routine mistakes still being made.
Racial justice in health
We ended by asking our guests to discuss how society might ensure racial justice in health during the pandemic, and into the future.
June says that healthcare workers shouldn’t assume they know what’s best for Aboriginal and Torres Strait Islander communities. Instead, they should have conversations with minority communities:
“Let’s open a new page on our books and go, how can we walk alongside you? How can we support you to be the best person you are? Whether that’s a person with disability, whether it’s our elders or whether it’s our new arrivals, what do you need to support you in your life for greater health and wellbeing?”
Lilon says health policies need to move away from ideas about efficiency and scaling up healthcare initiatives. Instead, health professionals should engage every segment of the community, and develop meaningful partnerships with disability services, land councils, Aboriginal community controlled organisations, and hospitals.
“It’s no good boasting of our multiculturalism if we don’t actually engage with the multiple cultures. And that means thinking about versions of a solution that suit different people, at different times, in different contexts.”
Chris says there needs to be better evidence informing health decisions in the pandemic, as well as transparent processes that demonstrate how governments are linking with communities. Pandemic planning needs to go beyond “window dressing tokenism” and instead involve people are most impacted:
“What decisions are made, who makes those decisions, and who gets held accountable for the decisions they make and the outcomes.”
References
Davey, M. (2020, August 14). Police presence at Melbourne towers was “dehumanising”, infectious disease doctor says. The Guardian. https://www.theguardian.com/australia-news/2020/aug/14/police-presence-at-melbourne-towers-was-dehumanising-infectious-disease-doctor-says
First Peoples Disability Network (2020, April 28). COVID-19: Ethical decision-making for First Peoples living with disability. First Peoples Disability Network Australia. https://fpdn.org.au/covid-19-ethical-decision-making-for-first-peoples-living-with-disability/
First Peoples Disability Network. (2020, July 23). Opening Statement to the Senate Inquiry into Australian Goverment Response to the Covid-19 Pandemic . FPDN. https://fpdn.org.au/opening-statement-to-the-senate-inquiry-into-australian-government-response-to-the-covid-19-pandemic/
Ramsden, I. (1993). Cultural safety in nursing education in Aotearoa (New Zealand). Nursing Praxis in New Zealand, 8(3), 19–25. https://trc.org.nz/sites/trc.org.nz/files/digital library/Cultural safety in nursing education in Aotearoa.pdf
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