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Professor Roianne West is a Kalkadoon and Djaku-nde woman hailing from her grandmother’s ancestral lands near Mount Isa. She is Foundation Professor of First Peoples Health and Director of the First Peoples Health Unit at Griffith University.
Professor West began her career as a health worker in an Aboriginal Community Controlled Health Service in her hometown prior to completing a Bachelor of Nursing, followed by a Masters of Mental Health Nursing, and finally a PhD, gaining her Doctor of Philosophy in the School of Nursing, Midwifery & Nutrition at James Cook University. Her drive to improve Aboriginal and Torres Strait Islander health is part of a long family tradition with the occupation of nursing spanning four generations of her family.
Professor West is the winner of the 2020 Lowitja Institute Cranlana Award. In this Q&A with the Lowitja Institute, she talks about her personal and professional journey, including the importance of culture and community, how she approaches leadership, and what challenges lay ahead in providing culturally safe health care and health workforces for Aboriginal and Torres Strait Islander people.
** Q1: Can you talk about your background and career trajectory?
My people are the Kalkadoon people from North West of Queensland, I was fortunate enough to have been born on Country in Cloncurry and raised for the first 20 years of my life on my grandmother’s ancestral lands.
My mother has been a health worker for 45 years -- she only retired this year at the age of nearly 75. My grandmother was a staunch lifelong advocate for Aboriginal affairs, and my twin sister and brother also went into nursing. So my career didn’t start with my education, it builds on a family legacy.
University wasn't something that was front of mind for us, it was actually getting through year 12 that was a massive achievement for us at that point.
When I started my nursing program, I had three children: four month old twins, a four-year old, and I was in a domestic violence situation. For me, my bachelor's degree was my lifeline out and it's one of the many reasons why I'm so passionate about university level education for our people, especially for women, because I know how much it transformed my life, and in turn transformed the lives of my children and now my grandchildren.
Q2. What motivated you in your early career?
What drove me in my early years and continues to drive me today was the foundation of being born and raised in community. Coming from a big Aboriginal family certainly keeps you very grounded. I like going home because there I’m not Professor, I’m not Doctor, I’m just Roianne. It’s impossible for you to get too big for your boots. You’re accountable to community and I like that, a lot.
Another big driver was nursing Aboriginal patients and walking into the room and seeing the sense of relief and pride, even though they didn't know you, but they knew you were Aboriginal and the way in which you were connected with them. There was such a sense of anxiety reduced and pride. It really made the challenging things worth it, to be a bit of a role model.
But what really drove me was wanting to make a difference. Once I learned that I had a gift, I wanted to use it as best I could to make a difference to my community. It’s all about community, it's about culture, it's about respect for each other, respect for family, and respect for Country. And I really get inspired by seeing Aboriginal and Torres Strait Islander people be self-determining and empowered. If I can be a part of facilitating that, that’s the bit that makes my heart sing.
Q3: What led you to academic leadership?
I had left academia in 2002 (after getting my Bachelor of Nursing), thinking it was too far removed from community. I wanted to really see much quicker impacts than were to be seen in that ‘theory practice gap’, where it is generally five years before research has its impact. I felt it was too long, we were losing too many people and had too much sadness in that five years for that to be able to go on. So I wanted to work much closer to the ground.
But what ultimately led me to do my Master’s, and to work in cultural safety, was when I was working as the only Aboriginal nurse in Australia’s first regional forensic mental health unit in Townsville. It had 32 beds, and 30 of the patients were Indigenous males. When I was in the ward, there was never a takedown, assault, or a seclusion. But when I wasn’t, there was always an incident.
I observed there was some type of respectful interaction that was taking place between the Indigenous clients in that unit and me, and I started to ask ‘what did I do that was different to non-Indigenous nurses?’. I realised that when I did a mental status assessment, my interpretation of symptoms was very different to theirs, so there were clinical implications. When I did a suicide risk assessment, the outcome of that assessment was very different than if it was done by a non-Indigenous nurse because of what I knew, culturally. For example, a non-Indigenous nurse might assess an Aboriginal patient as being low risk, where I would know that in that patient's family or community, there had been a cluster of suicides, so that would be justification for me to raise that assessment to a medium or high (risk).
But what I realised was that, despite that unit being 90 per cent Indigenous, non-Indigenous nurses did not place a value on Aboriginal health education because it wasn’t part of their undergraduate degree. So reluctantly I thought I need to go back into university to help make that happen.
Q4. What’s helped advance your work?
I have had a lot of enablers: a good strong family, but also a lot of non-Indigenous mentors. I think a really grounding experience was that I didn't start work in a non-Indigenous construct or philosophy of nursing. I started in a grassroots Aboriginal Health Worker role, Certificate 3. It makes a big different, that grounding, it informs those cultural frameworks. When you get into big mainstream systems, you can sometimes drift away because those other frameworks are so dominating. But if you've been raised in a strong cultural framework, it doesn’t take you long to feel off-centre if you deviate from them and realise that you need to re-navigate.
Having all the letters after my name has also helped. There is no way when I was a little girl that I thought ‘I want to be a Professor when I get older’, but once I had that Bachelor of Nursing, I realised how much more people listen to you. And then when I had my Masters, they listened a little bit more. And when I had the PhD, they listened a little bit more again. It’s never about the titles, the letters that come after your name or the salary. But it’s about having the tools to be able to influence change.
Q5. What have been barriers?
Sometimes your passion is a barrier. I want to move fast, and I want to move quick and sometimes the systems are cumbersome and not as agile, and that can be frustrating.
Racism in the beginning was a barrier, but you need to learn how to deal with that in order to be able to address it. Racism is a reality of the space that we are working now, and I think we've got multiple mechanisms that are in place now where we're starting to deal with that. It’s not unspoken anymore, like it was. It's on the table. We need to know how to deal with it, including how to take whatever emotions it conjures up in you, which in the beginning for me was anger, frustration, and sadness, and work out how to redirect them so they don't stop us from achieving. Because that's the impact of racism, the oppressive behaviors that mean we don't then achieve in the areas that we want.
Black Lives Matter has put it on the map, and I’ve witnessed some great shifts from that. We’ve got good work happening at a higher level, though we need much more leadership from the Prime Minister – all the Ministers need to be talking about racism, not commenting that slavery didn’t occur here.
Q.6 What career achievements are you proud of?
One of the highlights for me is that I have had a career of being a first timer in roles. I was the first Aboriginal nurse in an identified role in the forensic mental health unit, the first Aboriginal liaison officer for the Royal Flying Doctor Service, the first Aboriginal academic in the School of Nursing and Midwifery at James Cook University, and then the first nursing director in an Australian tertiary hospital with a dedicated portfolio of Indigenous health, and Australia’s first Professor of Indigenous Health in a joint appointment between a hospital and a university. A lot of my work has been in establishing positions and the success of those positions has been evident because they went from being contract positions to continuing positions.
My most exciting role has been my last five years at Griffith University (where she has overseen the establishment of the First Peoples Health Unit, and overhauled the Indigenous health course to align with the new national Aboriginal and Torres Strait Islander health curriculum framework, which she was involved in developing). I’m in disbelief at what we’ve been able to achieve over the past five years at a course level, at a program level, at a school level, at a faculty level, and at the university level.
I think it was only a few years ago that I came to terms with the fact that I'm a leader, because it is something that's quite daunting. I said to myself, ‘you can keep bumbling your way through this or you can make a decision to be a leader and do it consciously’. And part of that, learning about complex decision making and leadership capabilities, is not only important for the way that you work, but for yourself to be able to make sense of some stuff that often doesn't make sense.
Q.7 What works for you in bringing about change?
Through all my work, including the privilege of being able to work with ATSIC (the former Aboriginal and Torres Strait Islander Commission) and in the Department of Health in Canberra and now in higher education, I’ve learnt that ‘a system is a system is a system’. I’m good with frameworks and processes, and I think once you’ve got those things worked out, you can bring the same thinking to a different context.
Q.8. What needs to happen now for cultural safety in health care?
We’ve got a National Aboriginal and Torres Strait Islander Health Plan that, for the very first time, calls for a health system free of racism, but we’ve got to enact that. It’s all well and good to have it as a vision as part of that plan, but what does it then look like through the system?
We are starting to see traction within the health professions through the Ahpra work (she is a member of the Ahpra Aboriginal and Torres Strait Islander Strategy Group and co-lead of the recently successful Ahpra Cultural Safety Education Project).
(Lowitja Institute CEO) Janine Mohamed led a phenomenal piece of work in recent years (as then CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives) to get racism embedded within the nursing codes.
But even when that’s embedded, there’s still an issue of teaching about racism in nursing schools, and we still face significant resistance from students. And even though we've had the Aboriginal Health curriculum in higher education faculties since 2015, it's still sporadic, it’s not consistent across the 39 faculties at this point and then there’s a whole suite of health professionals who graduated before the curriculum framework as well.
So, we’ve got pockets of really great work and some that aren't – to get the genuine system change, it needs to be happening at all levels, with a lot of people being a part of that movement as well.
Q.9 What is upmost on your agenda?
To be bold.
‘What's your legacy? What do you want to hand over?’ They’re the questions that are always in my mind. Certainly, in the beginning of my career, my mother was saying ‘Bub, we were having these discussions 20 years ago’. I don’t want to be saying that to my kids and grandkids in another 20 years. So, I say for all leadership in Australia, for all health departments in universities: What is your legacy? What type of Australia do you want to hand over to the next generation?
Q.10. What does winning the 2020 Lowitja Institute Cranlana Award mean to you?
It means such a lot to be recognised by Australia's only Aboriginal and Torres Strait Islander Research Institute, working within the legacy of Lowitja O'Donoghue, and having played a role, on the Research Advisory Committee, in its shift to be a community controlled organization where its research is much more aligned with community and community research. I’ve worked over many years with Janine (Mohamed), so to win this award at a time, with Janine as CEO and particularly when the Lowitja Institute is going through such a transformation, is an honour and a privilege.
I’m really excited too about what comes with the award (a fully funded position at the six day Cranlana Centre for Ethical Leadership’s Executive Colloquium) because, if every health professional in Australia was working to their Code of Ethics, there wouldn’t be racism in Australia’s health system, including in nursing and midwifery. So I'm really interested in exploring the ethics and the morals of leadership -- the multiple layers and having the frameworks to be able to navigate those layers, as well as staying true to your morals and ethics as an Aboriginal person in our own Indigenous knowledges. I’m interested to know about what they bring of Indigenous ethics in this training. So I'm not naïve, and I know that I'll learn a lot from this, but I also think that they'll learn a lot from me.
It’s taken me a long time to consider myself as a researcher, perhaps because Indigenous research isn’t seen in mainstream academic circles as the “gold standard” that clinical research is. Yet it’s truly the Indigenous research that’s going to have the most impact – it’s 60,000 years old and the way in which we do things is much more aligned with human values.