Copyright © eContent Management Pty Ltd. Contemporary Nurse (2007) 24: 33–44.

Telling stories: Nurses, politics and Aboriginal Australians, circa 1900–1980s
ABSTRACT
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 selfdetermination 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

Key Words
Aboriginal health; institutional racism; government policies; nursing practice; memoirs; paternalism

INTRODUCTION
SUE FORSYTH
Senior Lecturer Nursing History Research Unit Faculty of Nursing & Midwifery University of Sydney Camperdown NSW, Australia

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ndigenous 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

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Sue Forsyth former Governor General of Australia, Sir William Deane, quite rightly explains: the past is never fully gone. It is absorbed into the present and the future. It stays to shape what we are and what we do. (Cited in Stephens 1999) Goold is not alone in believing that racism has become ‘institutionalised’ into contemporary health care services in Australia. Institutional racism can be defined as the ways in which ‘racist beliefs and values have been built into the operations of social institutions in such a way as to discriminate against, control and oppress various minority groups’ (Henry, Houston & Mooney 2004: 517). Henry et al. (2004) consider institutional racism has been an almost constant feature of Australia’s history, and that health care services are no exception. But they caution this has not always been deliberate.Very often institutional racism is covert and relatively subtle, unintentional and unrecognized even by those involved in it. Unquestioned adherence (by nurses) to dominant group norms, for instance, is one way of institutionalising racism. The purpose of this paper is to explore the link between past government policies concerned with Aboriginal people and nursing practice as a way of understanding how racism became institutionalised into nursing and health care in Australia today. Such an examination is, I believe, crucial for contemporary nurses. Historical knowledge is a powerful tool for alerting nurses to the insidious and often covert nature of racism, for understanding how the past influences the present, and it underpins the abolition of racist practices, attitudes and behaviours in nursing and health care. As Jackson, Brady and Stein (1999) argue, confronting nursing’s past and reflecting on the role nurses may have had in contributing to the oppression of Australia’s Aboriginal people is essential for nursing’s professional maturity, for the successful delivery of health services to this most disadvantaged population, and an important step towards reconcili-

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). Goold provides compelling evidence of contemporary nurses ignoring Indigenous patients, treating them as ‘nonpersons, invisible, unseen and unheard’ (Goold 2001: 96). As the
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Nurses, politics and Aboriginal Australians, circa 1900–1980s ation. Overcoming institutional racism, Henry et al. (2004) claim, is also the key to improving the health of Aboriginal and Torres Strait Islander peoples. Registered Nurses have a long history of coming into contact with, and caring for, Aboriginal Australians, particularly those nonAboriginal nurses who combined their clinical practice with missionary work in rural and remote areas of Australia from the early 20th century. It has been suggested that these nurses were amongst the first to recognise the dreadful state of Aboriginal health precisely because of their close contact with this population (Griffiths 2000).This paper explores stories told by, and about (mostly non-Aboriginal) Registered Nurses and their professional relationships with Aboriginal people from the early 1900s to the 1980s in the context of government policies that regulated and controlled Australia’s Aboriginal population. As Commissioner Elliot Johnston pointed out in the Royal Commission into Aboriginal Deaths in Custody: every turn in the policy of government and the practice of the non-Aboriginal community was postulated on the inferiority of the Aboriginal people. (Cited in Griffin 1995: 285) Stories in this paper are drawn from the memoirs and contemporary accounts of mainly (but not exclusively) non-Aboriginal hospital and clinic Registered Nurses who worked in rural and remote areas of Australia, from Aboriginal people themselves, and from other sources of the period.They are snapshots by individuals of particular places at particular moments in time. The stories have been grouped into three distinct historical eras broadly defined by policy: segregation and protection, 1890s–1950s; assimilation and integration, 1950s–1972; and self-determination and self-management, from 1972 (Eckermann et al. 2006). This examination finishes in the 1980s as the policies have changed little (Eckermann et al. 2006), and it is

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the historical connections between government policies and nursing practice that is of interest here for what it can tell nurses today. These stories reveal that paternalism is an enduring feature throughout these eras, and a major factor in shaping nurses’ attitudes and clinical practice in relation to Aboriginal Australians. In the current health care arena where policies of paternalism remain on the political agenda (Abbott 2006), such an exploration has profound implications for nursing practice today.

ETHICAL CONSIDERATIONS
Ethical considerations are of major concern in Aboriginal research. In line with the requirements of the National Health and Medical Research Council (2003) guidelines on conducting research on, or about, Aboriginal people and Aboriginal issues, this paper has been discussed at length with Vicki Bradford and Kath Howey, Indigenous lecturers at the Faculty of Nursing and Midwifery, University of Sydney, Australia. Changes they have sought have been incorporated into the paper. A note of caution. This paper refers to persons who are deceased. However, as the paper draws on published works and publicly available material, including memoirs, identifying details of deceased persons have not been removed. In addition, when quoting, the language used in the documents of the day is used. This may cause offense to some people.

SEGREGATION AND PROTECTION: 1900S–1950S
The official, legally sanctioned policies from the 1890s to the 1950s were those of protection and segregation. Government reserves and Christian missions were established across Australia (generally on land that Europeans did not want) supposedly to protect Aboriginal people until they died out. Paternalism was the underlying philosophy of protection policies, reinforced by prevailing attitudes that Aboriginal

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Sue Forsyth worm, influenza, syphilis) and misery were rife – largely the result of overcrowding, poor sanitation and poor diet and malnourishment (Blake 2001).The provision of medical care to Aboriginal people remained in the hands of private medical practitioners, who tried (often unsuccessfully) to recoup their costs from the Chief Protector, or district hospitals where segregation of Aboriginal patients was widespread (Briscoe 2003). The memoirs of nurse Ann Stafford Garnsey are especially telling about prevailing attitudes during this period of segregation and protection and the dreadful living conditions of one group of Aboriginal people in Queensland.Writing of her experiences as a nurse from the early 1900s, Garnsey came into contact with a group of fringe dwelling Aboriginal people who lived near Rockhampton Hospital where she worked. She wrote with a mixture of unhelpful sympathy, paternalism, curiosity and unquestioning acceptance of the lot of these Aboriginal people. Garnsey was clearly intrigued by them, and frequently went down to ‘the blacks’ camp’ in her off duty time from the hospital to indulge her hobby of sketching. She described the camp as a ‘collection of scrub humpies, patched up with bits of tin and other rubbish. There was some shelter from the sun’, she continued, ‘but not much from the rain’. While she found it distressing that human beings should live in this dreadful state, she never questioned why.Yet, in spite of their appalling living conditions, Garnsey wrote ‘they all looked well-fed and cheerful’ (Garnsey n.d.: 36–37). But from her own account it is obvious they were neither. On one of her frequent visits to the camp one man, she reported, ‘looked angrily at me and said in a whining voice, ‘You, go ‘way, whitefella. You take all my country. This camp belonga blackfella’ (Garnsey n.d.: 37). Garnsey’s reaction, like that of other whites at the time, was to buy the confidence of Aboriginal people with tea, sugar and tobacco. She lured children (with sweets) into posing for her sketches, having a

people were childlike, dependent, and ‘a race apart’ (Griffiths 2000). While each state of Australia had its own legislation that governed and severely circumscribed Aboriginal people’s lives, protection policies were fairly uniformly applied throughout the country (Eckermann et al. 2001: 24). In New South Wales, for instance, Aboriginal people were defined by an Act of Parliament and every aspect of their lives was governed, regulated and controlled by the Aborigines Protection Act (1909) administered by the Aboriginal Protection Board. This Act prohibited Aboriginal people from drinking alcohol, voting or cohabiting with non-Aboriginal people, from owning property, and authorized their forcible relocation from any station, camp or reserve as the Board directed.The Board retained custody and control of all Aboriginal children, excluded them from state schools, and, at its discretion, removed them from their families and sent them to children’s homes or to service with white families (Aborigines Protection Act 1909). Other states had similar Acts and Boards. Very little was done for the health of Aboriginal people in the early 20th century, despite compelling evidence of their disintegrating health, as it was widely believed they were a dying race that would soon be extinct (NSW Department of Aboriginal Affairs 1998).Those Aboriginal people who lived in fringe-camps on the outskirts of larger towns in Western Australia in the early 1900s, for instance, suffered high rates of blindness and crippling bone diseases, high rates of infectious (influenza, whooping cough, leprosy) and sexually transmitted diseases that caused sterility, kidney failure and dementia, and endemic infections arising from living in dirty and polluted camps. Those living on properties in Western Australia and Queensland often fared little better in terms of their health and suffered high rates of poor health and disability (Briscoe 2003). At the government settlement at Cherbourg in Queensland, semi-starvation, disease (hook36

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Nurses, politics and Aboriginal Australians, circa 1900–1980s self proclaimed fascination for ‘piccaninnies … especially the darling, dusky babies with their fuzzy heads’ (Garnsey n.d.: 37). Garnsey unquestioningly accepted the policy of removing Aboriginal children from their families, but was, nevertheless, sympathetic to the plight of the poor mothers. On one occasion she approached a ‘gin’ asking to look at the ‘piccaninny’ she carried and was met with a resounding ‘N-a-a! N-a-a! this one belonga me, you no stealem’. As Garnsey commented: The poor things had good cause to be very suspicious of any advances made by ‘whites’. Too often babies have been stolen from their mothers and carried off by people in carts to be a plaything for a while. And then what? And the poor mother left sad, and with no redress. (Garnsey n.d.:37) While Garnsey provides no evidence of having removed Aboriginal children from their families herself, there is evidence that other nurses did. In evidence to the National Inquiry into the Stolen Generations, for instance, one Aboriginal woman recounted how in the 1940s her mother gave birth to twins. She was told one twin had died and shown the empty cot. The woman, however, had recently learned that the twin – her older brother – had not, in fact, died. The nursing sister had taken him (National Inquiry into the Separation of Aboriginal and Torres Islander Children from their Families 1997). This was not an isolated incident and Aboriginal people were quite rightly suspicious of nurses and hospitals (Eckermann et al. 2006). Particularly telling of the paternalism that is a feature of this period is Garnsey’s story of what she called ‘the act of grace’ by the Queensland and Western Australian Governments in supplying Aboriginal people with ‘nice, warm, grey blankets’ on the first of May every year. She considered it ‘amusing to see them lining up’ for their blankets, ‘they are so childlike’(Garnsey n.d.: 42). Some nurses in this era, however, were more

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insightful into the plight of Aboriginal people in their writing, but no less blind to the underlying policies. Australian Inland Mission Sister, Jean Williamson, of remote Oodnadatta Hospital, for instance, wrote in 1919: There is a need for [white] people to be made aware of their life. They are not the degraded people some seem to class them [as].They could not have managed to exist if they had bad laws … The white man has upset a lot of their ways by introducing vices and infections they had no immunity for. (Griffiths 2000: 19) Segregation for Aboriginal people was not only confined to the conditions under which they lived; there was widespread use of segregation in hospitals. Aboriginal patients were often allocated to separate, inferior wards or areas in hospitals, a practice favoured by many nurses. Garnsey, for instance, considered segregated wards benefited all concerned.The ‘small canvas wards’ reserved ‘solely for the use of [A]borigines’, she wrote, were put up ‘at smell-proof distance’ from the other hospital wards.The fact that the Aboriginal wards were ‘rarely empty’ Garnsey claimed was a measure of ‘how much they liked them’. Such a claim, though, flew in the face of her own recognition that Aboriginal people feared and distrusted white people and hospitals (Garnsey n.d.: 53). On the question of the health problems of the hospital’s Aboriginal patients, however, Garnsey is silent. Missionary nurses working for the Australian Inland Mission (AIM) in some of the most remote locations generally considered segregated ‘native wards’ a necessity (Griffiths 2000: 115). In his history of the nurses of the AIM, Max Griffiths argues that one of the problems for these nurses was that negative community attitudes towards Aboriginal people made it difficult for nurses in hospitals to admit them into wards with white people.Whites feared catching the diseases that ran rampant through Aboriginal communities and objected to their being

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Sue Forsyth recounts the story, the nurse ‘went out to the car to check how black my dad was. She came back and said, ‘Your father is dying.’ I said I knew he was, that was why I wanted professional care for him. But [the nurse] still didn’t take him, because he was black’. The nurse claimed that though she wasn’t prejudiced, the other patients were, and she did not want to upset them. Edmund, however, was profoundly upset by this episode (Edmund 1992: 70–71). Segregated wards are one striking example whereby nurses were called upon to be the instruments of discriminatory policies that institutionalized racism into their practice and the delivery of health care. For Aboriginal patients, separate facilities in hospitals reminded them of social norms that overtly promoted, approved and institutionalised racism (Eckermann et al. 1992).

treated in hospitals (Griffiths 2000). However, there is no indication that at this time the AIM nurses themselves objected to segregated wards or other separate accommodation for Aboriginal people. According to AIM nurses working in the remote town of Innamincka in the far northeast of South Australia in 1931, a police cell provided ‘a comfortable and convenient bedroom for our sick blacks’ (Griffiths 2000). For another desperately ill Aboriginal woman in Esperance in Western Australia in the 1940s segregation meant being admitted to the mortuary (Griffiths 2000). Aboriginal people, on the other hand, found these segregated wards far less satisfactory. In her memoirs, Aboriginal artist, Mabel Edmund, recounts how she experienced her first real hurts of racism on going to hospital to give birth. The maternity hospital at Rockhampton had a separate ward for black mothers that consisted of a small room at the end of the back verandah well away from the white wards. It contained three beds and three cots, and doubled as the labour ward for Aboriginal mothers. When Edmund was there this room also had bars on the windows (Edmund 1992). Well known Aboriginal Elder and activist, Mum Shirl, recounts in her memoirs the shock of finding segregated and poor quality verandah accommodation for Aboriginal women at Kempsey Hospital (Mum Shirl 1987). For another Aboriginal mother, the room on the verandah was ‘very, very cold … in August’ (Eckermann et al. 1992: 160). In a particularly telling episode, Edmund describes taking her dying father to a nursing home for old people, thinking this a better alternative than the local hospital. It is unclear when this occurred, but the prevailing attitudes are abundantly clear. On arrival at the nursing home with her dying father in the car, Edmund was confronted by the sister in charge whose first question was ‘Is your father as dark as you?’ When Edmund said ‘yes’, the nurse replied ‘We don’t take black people here’. As Edmund
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ASSIMILATION AND INTEGRATION: 1950S–1972
When it became clear that the Aboriginal population was not dying out as previously assumed, policies of protection were replaced by those of assimilation and integration. This called for Aboriginal people to attain a similar manner of living as other Australians, have the same rights, privileges and responsibilities, and to be subsumed into the wider Australian community (Eckermann et al. 2006).This policy was premised on the belief that breeding out Aboriginality was the only way to achieve harmonious coexistence (Saggers & Gray 1991). The problem was that Aboriginal people did not have the same rights, were not considered Australian citizens (until the 1967 referendum), and the policies themselves were contentious. Aboriginal people were not enthusiastic to collaborate with their white conquerors for what they saw as their physical and cultural extinction, and whites were concerned that complete mergence of Aboriginal people into the general community was not possible without some detriment to Australia’s white inhabitants (Franklin & White 1991). It was one thing to

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Nurses, politics and Aboriginal Australians, circa 1900–1980s attempt to change policy, but quite another to change attitudes, behaviours and practices. For example, at this time the Queensland government encouraged the ‘independence’ of Aboriginal workers as a way of reducing costs on settlements, and introduced further repressive and paternalistic measures such as forced detention on reserves, controlled marriages and censoring their mail. While some Aboriginal workers continued to provide unpaid compulsory labour, others faced discriminatory wages, and most had their savings controlled and managed by the government (Kidd 2000: 238–9). And their health continued to suffer. By the 1950s and 60s there was mounting evidence of the continued poor state of Aboriginal health. Doctors, for instance, wrote letters to the editor of the Medical Journal of Australia on Aboriginal health, a topic previously ignored (Thomas 2004). Nurses reported on the intractability of the health of Aboriginal people and their unhealthy living conditions, but there is no evidence they questioned why this state of affairs occurred or why it was allowed to continue. One missionary nurse working at the remote location of Fitzroy Crossing, for instance, wrote: God, the conditions in that [Aboriginal] camp are criminal. Every time I get called out there I could scream. I just get fed up with treating the same diseases week after week. You treat them, they go back to the camp and the next thing they’re in here again. It’s hopeless. (Griffiths 2000: 105) Despite the move to policies of assimilation and integration, the paternalistic policies of protection and segregation continued to dominate the delivery of health care in this period. Aboriginal people were largely excluded from both the decision-making processes and the delivery of health care, even in relation to services specifically designed for them. Separate wards for Aboriginal people in many hospitals continued well into the 1960s, often despite official sanc-

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tions and threats that they would lose their government subsidy (Franklin & White 1995). As the matron of a Western Australian hospital at this time argued, ‘it is all very well to talk about the rights of natives, but I do not think that people who talk in this way would like to be in the next bed to one’ (cited in Saggers & Gray 1991: 124). In remembering her time in the mid 1950s as the first Aboriginal nursing sister in the small, remote, ‘somewhat racist town’ of Leonora, Sadie Canning recounts how disturbed she was on finding the Aboriginal patients in the hospital segregated in a small tin shed away from the general wards. On becoming matron, and in the face of opposition, Canning ended the practice of segregated wards at the hospital, proudly proclaiming this as her greatest achievement (Canning 2005: 6–7). At Darwin Hospital in the late 1950s, however, segregation continued, though it was not always clear who should be sent to the ‘native’ or ‘full-blood ward’. Those of mixed ancestry were supposed to be sent to the regular wards, to assimilate. In reality, however, Aboriginal nurse MaryAnn Bin-Sallik contends hospital personnel sent many people to the ‘native’ ward ‘on the basis of their dark complexions’ (Bin-Sallik 2005: 29). For Bin-Sallik what was equally as disturbing was the treatment of Aboriginal patients at the hospital. She reports that Aboriginal women, particularly those who could not speak English, were sterilized after giving birth without their consent.This was based on the paternalistic attitude that their previous children had died of gastroenteritis, a not surprising state of affairs given their appalling living conditions. But, as Bin-Sallik (2005) points out, these same living conditions were provided by the government. Aboriginal patients at this time were routinely treated differently from their non-Aboriginal counterparts, and excluded from decisions about their care. In her memoirs, Pat Keating, a non-Aboriginal teacher working on an Aboriginal government reserve in the 1960s, describes

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Sue Forsyth sensibilities. She was not surprised at the chronic health problems of the Aboriginal community, for the houses in which they lived on the government reserve at the edge of town were ‘dilapidated and dirty’. From her point of view the problem was simple: Laverton’s ‘native people’ were ‘still quite tribal’. Their houses had been built (by the government) ‘with the best of intentions’, but the Aboriginal people were ‘not used to living in any kind of house’.They ‘slept with their dogs’ and used their meager welfare payments to buy ‘very low quality foods from the shops in town’ (Aspeling 2000: 57–58). But, concerned as much with spreading Christianity as ministering to the sick, Aspeling could joyfully report that these same Aboriginal people were ‘keen to talk about God and to assimilate Him into their own religion’, their faith in Christ being ‘one of the most beautiful things about them’(Aspeling 2000: 59 & 63).

how her two year old son was mistakenly admitted to the Aboriginal section of the nearby hospital after drinking kerosene. The nurses had wrongly assumed that because Keating gave her address as the Aboriginal reserve, that both she and the child were Aboriginal. As a result, the nurses refused Keating permission to visit her son, arguing it ‘would serve no purpose and would most likely disturb the child unnecessarily’. Even the matron assured Keating that the child was ‘quite well and happy’, and that she would be informed when he was ready to come home.When the mistaken racial identity of the child was finally realized more than a week later, it was made clear that the only reason for his prolonged hospitalisation was because ‘the child had been admitted as an Aborigine and as such was considered in need of extra attention’. The ward sister apologized to Keating, saying ‘everything would have been different if they had known Christopher was a white child’ – he would have been discharged after two days (Keating 1994: 35). Admitting Aboriginal children to hospital and keeping them there for as long as possible was widely practiced by nurses. It was considered preferable to sending them back to their families and their dreadful living conditions. In her memoirs of working for the Bush Church Aid Society of Australia, missionary nurse Audrey Aspeling recounts how, in the early 1970s in the remote town of Laverton in Western Australia, matron insisted that all sick Aboriginal children be admitted, as she felt ‘their parents would be unable to care for them satisfactorily’ (Aspeling 2000: 58). Aboriginal children there were recurrently hospitalised with sores, ear and chest infections, and were nearly always infected with scabies and lice. Aspeling noted, though did not question or comment further, ‘no one ever suggested repairing their severely ruptured eardrums’ (Aspeling 2000: 57). Though Aspeling’s memoirs were written in 2000, her attitudes are indicative of the times about which she wrote rather than present day
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SELF-DETERMINATION AND SELFMANAGEMENT: 1972–1980S
The election of the Whitlam Labor Government in 1972 heralded a marked politicisation of Aboriginal affairs in the wider community, and a new era of policies aimed at self-determination and self-management for Indigenous Australians. A nationwide referendum in 1967 had given Aboriginal people full citizenship, and they were now recognised as a distinctive cultural group with a right to determine their own future. The appalling state of Aboriginal health was also recognised (Saggers & Gray 1991) and federal funds were now poured into health and housing for Aboriginal people to bring them into line with standards enjoyed by other Australians. It appears, however, that the money was not always wisely spent. In Queensland, for example, federal grants financed new amenities (hospitals, dental clinics) but not the highly qualified health personnel upon which their success depended (Kidd 2000: 261). The reality was that policies to self-determination and selfmanagement were never fully implemented. A

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Nurses, politics and Aboriginal Australians, circa 1900–1980s large percentage of programs aimed at selfdetermination for Aboriginal people continued to be controlled, regulated and directed by nonAboriginal people, and the Federal Minister for Aboriginal Affairs retained the final say on all matters and absolute control over the purse strings (Eckermann et al. 2006). By the1970s, nurses too were increasingly politicised about, and interested in, Aboriginal matters. A special Indigenous edition of the Australasian Nurses Journal became an annual event from the mid 1970s, with articles by Aboriginal and Torres Strait Islander people, nurses, politicians, anthropologists and others concerned with Indigenous health, housing, culture, land rights etc. The Editor, Edna Davis, considered the time for burying our collective heads in the sand ‘like the proverbial ostrich’ in relation to past injustices to Australia’s Indigenous people, was over (Davis 1977). In tune with the politicisation of Aboriginal issues and the change in government policy, many nurses experienced in working in Aboriginal communities now considered self-determination as the most effective way to improve Aboriginal health. Sister Dinnell from the Aboriginal Health Unit, Norwood, for example, pointed out in 1976 that ‘feelings of helplessness and dependency’ engendered in Aboriginal people over the past 200 years would exist as long as the money for Aboriginal health was controlled by others (Dinnell 1976). Lindsey Harrison, a nurse who had worked at a small government run Aboriginal community on Cape York, was more forthright in her claims in 1978 that there would be ‘little real improvement’ in Aboriginal health until Aboriginal people were given ‘full responsibility’ for their own health care (Harrison 1978). Other nurses, however, were far less insightful. In 1979, Gwen Coster, community health nurse for the East Gippsland Aboriginal Medical Service, just wished Aboriginal people had ‘more confidence’ in their ability ‘to cope with the white society in which they find themselves’ (Coster 1979: 4).

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Remote area nurses who worked extremely hard under very difficult conditions to improve Aboriginal health, were often severely constrained by, and becoming increasingly critical of, government inaction. In her memoirs of working in a clinic in the remote community of Port Keats in the mid 1980s, Registered Nurse Tracey Leonard expressed more than frustration at what she called the ‘bureaucratic merry-goround’ that left the local Aboriginal community with broken sewerage pipes, inadequate garbage disposal, and poor and overcrowded housing. She angrily stated that ‘we heroically treat all … conditions with the best that modern medicine can provide, but unfortunately this makes little impression in the long run’. Leonard considered that the lack of government resources for Aboriginal communities, and, it would seem, political will, continued to exact an enormous toll on Aboriginal health (Leonard 1999: 235). But the paternalistic attitudes and racism of past eras were not easily shed. In her reminiscences of her time working in Aboriginal communities in Western Australia in the late 1970s and early 1980s, English nurse, Diana Campbell, found Aboriginal people and their ways ‘highly entertaining’. She claims never to have met ‘such a marvelously patient race’, saying they would wait all day to see the doctor or nurse at the hospital and never complain (Campbell 1982: 2019). But Campbell never questioned why they were forced to wait all day for medical attention. Nor did she question why Aboriginal communities often had no toilet, running water or shelter, preferring instead to interpret this as them having ‘different standards of hygiene’. Most telling about Campbell’s paternalism is her story of one particular Aboriginal woman: One day in outpatients, Ida Jam, pigeon-toed and untidy, staggered through the door. She was covered in scabs and sores and had been in a fight. She descended upon the treatment room … calling ‘Sista, Sista!’ She is battered

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Sue Forsyth and abused and is a regular. She’ll never be made better. Ida comes and goes as she pleases. She’s totally free and I wouldn’t change her for the world. (Campbell 1982: 2022) River knew very little about traditional Aboriginal medicine or culture, and that this caused conflict and confusion. Nurses, he claimed, became annoyed when Aboriginal people claimed illness for social rather than physical reasons, when they discontinued antibiotics and other drugs when the symptoms disappeared, or when they brought their children in late at night for treatment when the child had obviously been unwell for much of the day. It was harder for nurses to understand or excuse those who came into hospital to have their wounds tended having been involved in a fight. While such fights were an organised way of resolving disputes,Taylor explained, the nurses described such behaviour as ‘savage’ and ‘barbaric’. Misunderstandings about the causes of illness, such as whether an illness was caused by sorcery or bacteria, and aggressive western medical treatments such as intubation and intravenous therapies, were commonplace and often resulted in nurses being assaulted or threatened with physical violence. Such misunderstandings,Taylor (1978) argued, compounded the problem of poor health in the community. Pam Nathan also considered nurses working in Aboriginal communities required a substantial understanding of Aboriginal beliefs, practices, social organisation and law. She argued that simply imposing Western medical beliefs and practices on an alien culture was both ‘arrogant and harmful’ (Nathan 1983). For Merilyn Spratling, the imposition of western medicine in these settings was more than arrogant. She considered it constituted institutionalised racism. In her reminiscences as a community nurse in a small remote Aboriginal community in the Northern Territory, Spratling argued that institutionalised racism permeated the health care system despite the fact that government policies promoted the principle of self-determination and encouraged community control. For her, institutionalised racism was evident in the fragmentation of services between different bodies and levels of government, the imposition of a

Racism in the delivery of health care, and by nurses in particular, was increasingly questioned by nurses. Nurse Mary Samisoni, for instance, surveyed Aboriginal and Torres Strait Islander people in Brisbane in the mid 1970s about their experience of being hospitalised. For her the most troubling comments referred to ‘the rudeness and abrupt manner’ of nursing staff, and the failure of the nursing staff to provide ‘adequate comfort and personal cleanliness’ at a time when patients were most vulnerable and dependent, such as when they were bedridden or following surgery. She also noted that, in many cases,‘there was a feeling of prejudice and bias’ experienced by the Indigenous patients (Samisoni 1977: 46). Doctors and administrators did not fare well in this survey either. Little wonder the Indigenous population was reluctant to seek help from Brisbane’s hospitals. According to Jane Salvage, racism was also characteristic of the broader Australian community at this time. Reporting on her travels around Australia in the Nursing Times in 1982, Salvage claimed that wherever she went white Australians would ask what she thought of ‘the coons’. Her replies that Aboriginal people seemed to have a poor deal, she contends, were met with claims she was a ‘nigger lover’, that they were really ‘lazy, good-for-nothing, scrounging drunkards’. Most shocking about this racism, reported Salvage, was the ‘lack of knowledge and imagination about Aboriginal ways’ (Salvage 1982: 2018). Lack of knowledge about Aboriginal ways was also seen as increasingly problematic for nurses working in remote areas, with many illequipped to assume duties in Aboriginal communities. The isolated community of Edward River was a case in point. In the late 1970s, John Taylor argued that the nurses at Edward
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Nurses, politics and Aboriginal Australians, circa 1900–1980s western model of health care without incorporating traditional practices, and the lack of control the Aboriginal community had over the clinic in which she worked. Office hours at the clinic conformed to government office hours, and the language used was English, though the majority of residents spoke other languages. Spratling found this situation made her extremely uncomfortable, that it limited her practice, and left the local Aboriginal community feeling dissatisfied (Spratling 1995). By the end of the 1980s, nurses were even more critical about the cruel legacies of an imposed western medical system for Aboriginal peoples. Jennifer Cramer, Health Services Coordinator for the Kimberley Aboriginal Medical Service’s Council in Broome, for instance, argued that the relationship between medicine and the well-being of Aboriginal people constituted a paradox – well-meaning western health services were simultaneously part of the process that lead to cultural destruction (Cramer 1989).

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sional development and for better health for Aboriginal Australians.

Acknowledgments I am indebted to Vicki Bradford and Kath Howey, Indigenous lecturers, and Emeritus Professor R. Lynette Russell, Director of the Nursing History Research Unit, Faculty of Nursing and Midwifery, University of Sydney, for their helpful and insightful comments on this paper. Presentation This article is based on a paper presented at the Beyond Professionalism: Towards a History of Practice Conference, The University of Melbourne, August 2005. References
Abbott T (2006) ‘Misplaced tact stands in the way of help’, Sydney Morning Herald, June 21. Aborigines Protection Act (1909) New South Wales Government: Government Printer. Armstrong F (2004) ‘Deadly: Indigenous health today’ Australian Nurses Journal 12(5): 16–19. Aspeling A (2000) There are Flowers in the Desert: A Story of Nursing in the Outback Ringwood East: Aspeling. Australian Institute of Health and Welfare (2006) Australia’s Health 2006:The Tenth Biennial Health Report of the Australian Institute of Health andWelfare, Canberra: AIHW. Bin-Sallik MA (2005) ‘Beyond expectations: from nursing to academia’ in Goold S & Liddle K (eds.) In Our Own Right: Black Australian Nurses’ Stories, Maleny QLD: eContent Management. Blake T (2001) A Dumping Ground: A History of the Cherbourg Settlement, St Lucia: University of Queensland Press. Briscoe G (2003) Counting, Health and Identity: A History of Aboriginal Health and Demography in Western Australia and Queensland, 1900–1940, Canberra: Australian Institute of Aboriginal and Torres Strait Islander Studies. Campbell D (1982) ‘Nursing the Aborigines’ Nursing Times 1: 2019–22. Canning S (2005) ‘My story: the beginning, childhood, ambitions and achievements’ in Goold S & Liddle K (eds.) In Our Own Right: Black Australian

CONCLUSION
Institutional racism in nursing and health care is not a thing of the past. Stories by and about Registered Nurses as they came into contact with, or cared for, Aboriginal people in hospitals and clinics in rural and isolated areas of Australia throughout much of the 20th century reveal the ways in which government policies, and their underlying ideologies, shaped nurses’ attitudes and clinical practice to this least powerful group in Australia. Reflecting on these stories helps us understand the role nurses have had, often unwittingly through unquestioning compliance, in contributing to the oppression of Australia’s Aboriginal people. Confronting and understanding the historical roots of institutional racism alerts nurses to it, and empowers them to speak out and refuse to engage in such practices today. Only then can discrimination and racism be abolished from nursing practice and from the delivery of health care. This is essential for nursing’s current and future profes-

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Keating P (1994) Worlds Apart: Life on an Aboriginal Mission, Marrickville: Hale & Iremonger. Kidd R (2000) TheWayWe Civilise, St Lucia: University of Queensland Press. Leonard T (1999) The Full Catastrophe, Sydney: Hodder. Mum Shirl (1987) Mum Shirl:An Autobiography with the assistance of Bobbi Sykes, Sydney: Heinemann Educational Australia. Nathan P (1983) ‘Nurses and health business in Central Australia’ The Australian Nurses Journal, 12(10): 38–40. National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families (1997) Bringing Them Home, Canberra: Sterling Press. National Health and Medical Research Council (2003) Values and Ethics: Guidelines on Ethical Conduct in Aboriginal and Torres Strait Islander Research, Commonwealth of Australia. New South Wales Department of Aboriginal Affairs (1998) Securing the Truth: NSW Government Submission to the Human Rights and Equal Opportunity Commission Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families, Sydney: NSW Government. Saggers S & Gray D (1991) Aboriginal Health & Society: The Traditional and Contemporary Aboriginal Struggle for Better Health, North Sydney: Allen & Unwin. Salvage J (1982) ‘Caught between cultures’ Nursing Times, December 1: 2017–18. Samisoni M (1977) ‘Aboriginal and Islander attitudes to public health care institutions’ The Australian Nurses Journal, 7(5): 45–48. Stephens T (1999) ‘Waiting for the dinosaurs to die’ Sydney Morning Herald 24 July: 47. Spratling M (1995) ‘Aboriginal community health nursing: reflections, responses and rewards’ in Gray G & Pratt R (eds) Issues in Australian Nursing 4, South Melbourne: Churchill Livingstone. Taylor J (1978) ‘Murri doctor or nursing sister: the nurse’s point of view’ Aboriginal HealthWorker, March, 2: 37–46. Thomas D (2004) ‘The upsurge of interest in Indigenous health in the 1950s and 1960s’ Medical Journal of Australia, 180, 17 May: 521–23. Van Holst Pellekaan S & Clague L (2005) ‘Toward health and wellbeing for indigenous Australians’, Postgraduate Medical Journal, 81: 618–624. Willis E, Smye V & Rameka M (eds) (2006) Advances in Indigenous Health Care – a special issue of Contemporary Nurse (vol. 22:2). Maleny QLD: eContent Management.

Nurses’ Stories, Maleny QLD: eContent Management. Coster G (1979) ‘East Gippsland Aboriginal Medical Centre’ The Australasian Nurses Journal, November: 4–6. Cramer J (1989) ‘Remote area nurses in Australia: a ‘mantle of safety’?’ The Australian Journal of Advanced Nursing 7(1): 23–30. Davis E (1977) ‘Editorial: Identity’ Australasian Nurses Journal 7(2): 3. Dinnell G (1976) ‘Aboriginal health’ Australasian Nurses Journal, November: 31. Eckermann A, Dowd T, Chong E, Nixon L, Gray R & Johnson S (2006) Binan Goonj: Bridging Cultures in Aboriginal Health 2nd edn, Sydney: Elsevier. Eckermann A, Dowd T, Martin M, Nixon L, Gray R & Chong E (1992) Binan Goonj: Bridging Cultures in Aboriginal Health, Armidale:The University of New England Press. Edmund M (1992) No Regrets, St Lucia: University of Queensland Press. Franklin M & White I (1991) ‘The history and politics of Aboriginal health’ in Reid J & Trompf P (eds)The Health of Aboriginal Australia, Marrickville: Harcourt Brace Jovanovich. Garnsey A (no date) Scarlet Pillows:An Australian Nurse’s Tales of Long Ago, Facsimile edition (1984), Carlisle (WA): Hesperian Press. Griffin S (1995) ‘A crossroad of care’ in Gray G & Pratt R (eds) Issues in Australian Nursing 4, South Melbourne: Churchill Livingstone. Goold S (2001) ‘Transcultural nursing: can we meet the challenge of caring for the Australian Indigenous person?’ Journal of Transcultural Nursing 12(2): 94–99. Griffiths M (2000) Straight from the Heart: Tales of Tragedy and Triumph from the Nurses of the Australian Outback, Sydney: Kangaroo Press. Harrison L (1978) ‘Nursing on Cape York’ Australasian Nurses Journal, August: 28–29. Henry B, Houston S & Mooney G (2004) ‘Institutional racism in Australian healthcare: a plea for decency’ Medical Journal of Australia, 17 May, 180: 517–520. International Council of Nursing (1999) ‘The health of Indigenous Peoples: a concern for nursing’, Nursing Matters, www.icn.ch/matters_indigenous .htm [accessed 7 September 2006]. Jackson D, Brady W & Stein I (1999) ‘Towards (re)conciliation: (re)constructing relationships between indigenous health workers and nurses’, Journal of Advanced Nursing, 29(1): 97–103.
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