The focus of this paper is stories by, and about (mainly non-Aboriginal) Registered Nurses working in hospitals and clinics in remote areas of Australia from the early 1900s to the 1980s as they came into contact with, or cared for, Aboriginal people. Government policies that controlled and regulated Aboriginal Australians provide the context for these stories. Memoirs and other contemporary sources reveal the ways in which government policies in different eras influenced nurse's attitudes and clinical practice in relation to Aboriginal people, and helped institutionalise racism in health care. Up until the 1970s, most nurses in this study unquestioningly accepted firstly segregation, then assimilation policies and their underlying paternalistic ideologies, and incorporated them into their practice. The quite marked politicisation of Aboriginal issues in the 1970s in Australia and the move towards self-determination for Aboriginal people politicised many - but not all nurses. For the first time, many nurses engaged in a robust critique of government policies and what this meant for their practice and for Aboriginal health. Other nurses, however, continued as they had before neither questioning prevailing policy nor its effects on their practice. It is argued that only by understanding and confronting the historical roots of institutional racism, and by speaking out against such practices, can discrimination and racism be abolished from nursing practice and health care. This is essential for nursing's current and future professional development and for better health for Aboriginal Australians.
Received 14 March 2006 Accepted 12 September 2006
Aboriginal health; institutional racism; government policies; nursing practice; memoirs; paternalism
Indigenous people (Aboriginal and Torres Strait Islanders) comprise 2.4% of the Australian population (AIHW 2006), and their appalling health and severe socio-economic disadvantage (low incomes and educational levels, high unemployment, poor housing etc) continue to be a national disgrace. Life expectancy for Indigenous males is 59 years and for Indigenous females is 65 years. This is approximately 20 years less than for other Australians, with about 70% dying before the age of 65 years. This is in stark contrast to the non-Indigenous population, where the corresponding proportion is 21%. Indigenous death rates for circulatory diseases are three times higher than other Australians, diseases of the digestive system five times, and endocrine, nutritional and metabolic diseases are eight times higher. Indigenous infants and children have death rates three times higher than non-Indigenous Australians (AIHW 2006). This situation is not new. The very poor state of Aboriginal health was widely known by the early 1970s (Saggers & Gray 1991) and little has changed in the intervening years.
The health problems and severe disadvantage suffered by Indigenous Australians is similar to that of other Indigenous peoples worldwide and, according to the International Council of Nurses (1999), a matter of concern for nursing (see Willis, Smye & Rameka 2006). Also of concern is the way health care services are delivered, including the behaviour of health care providers with respect to Indigenous peoples (ICN 1999). Australian nurses share these concerns (Armstrong 2004; van Holst Pellekaan & Clague 2005), but few point to the link between past government policies and current nursing practice. One who does is Sally Goold, Executive Director of the Congress of Aboriginal and Torres Strait Islander Nurses. She believes that racism, prejudice and discriminatory practices are alive and well in nursing and in the Australian health care system today precisely because of 200 years of colonization and the implementation of paternalistic and racist policies. Such policies denied Aboriginal people control over their own affairs, restricted their movement, and forbade them to speak their language and perform their ceremonies (Goold 2001). …