Introduction by Croakey: At a medical radiation sciences conference last week, Māori and Aboriginal and Torres Strait Islander experts in cancer care highlighted examples of policy and practice shifts aimed at addressing inequity and they also shared lived experience that has driven their work.
Marie McInerney reports on their successes and concerns, as well as some calls to action to the medical radiation community on cultural safety and to voters at the forthcoming Australian election.
Her article is part of continuing coverage of the Australian Society of Medical Imaging and Radiation Therapy’s 19th National Conference held in conjunction with the New Zealand Institute of Medical Radiation Technology (NZIMRT) in Adelaide on Kaurna country.
Marie McInerney writes:
Full funding of the Australian Cancer Plan, action to address inequities in the vital Patient Assistance Transport Scheme (PATS), and growing the number of Aboriginal and Torres Strait Islander people working in cancer care and research and medical radiation services more broadly.
They are key asks from Aboriginal cancer experts Adjunct Professor Jacinta Elston and registered nurse Kelly Trudgen, both consultants to Cancer Australia, ahead of the upcoming federal election.
“Seeing the [workforce] numbers increase over the next decade is critical,” Elston told Croakey at the Australian Society of Medical Imaging and Radiation Therapy’s (ASMIRT) 19th National Conference, held last week in conjunction with the New Zealand Institute of Medical Radiation Technology (NZIMRT) in Adelaide, on Kaurna Country.
Elston had a simple message for Australian voters at the upcoming federal election, amid its big focus on the cost of living.
“Yes, [rising costs] can be tough but some are doing it tougher,” she told Croakey.
She urged voters to apply the question: “Are the people you’re voting for really going to support those in need?”
Elston said Australia also needs to respond to the gap left by the devastating defeat of the 2023 Voice referendum, particularly on health issues.
“Australian people said no to the Voice, but that then doesn’t take away the problems that we as Aboriginal and Torres Strait Islander people were trying to see addressed by it,” she said.
The people who really needed the Voice are those in rural, regional and remote areas who have very significant health challenges due to “a lack of services and a lack of care in all sorts of different environments”.
“Where we sit now as a country, and where we’re going to be in five years’ time, or 10 years’ time will be a critical thing, given the tensions that we’ve got across the world,” she said.
Change the system
Elston was speaking in an interview with Croakey following a dedicated conference session on culturally safe care. Indigenous speakers from Australia and Aotearoa/New Zealand agreed on the need to dramatically grow the number of Māori and Aboriginal and Torres Strait Islander people working in medical imaging and radiation therapy to help improve cultural safety and address inequity in cancer screening and outcomes.
“We need to focus on how we can change the system and services, rather than trying to change the women,” said Māori health leader Lisa Te Paiho, talking about barriers to breast screening.
A radiation therapist, Te Paiho spoke at the conference in two capacities: as national program manager of BreastScreen Aotearoa and as co-chair of MiRO (Māori in Radiation Oncology).
Māori and Aboriginal and Torres Strait Islander people have faced significant national setbacks in recent years, including the defeat of the Voice referendum in Australia and the abolition of the Māori Health Authority by the Luxon National Government in 2023 in Aotearoa/New Zealand, which is seeing efforts to wind back important rights gained through Te Tiriti o Waitangi – the Treaty of Waitangi.
If the Coalition wins the 3 May Australian election, there are concerns of significant policy harm for Aboriginal and Torres Strait Islander people. The likely Minister for Indigenous Australians in a Dutton Government, Jacinta Nampijinpa Price, famously said during the referendum campaign that there are no negative ongoing impacts of colonisation on Aboriginal and Torres Strait Islander people.
Despite those concerns, the focus from the Indigenous speakers at the conference was on efforts to bridge cancer inequity, highlighting programs, policies and networks that are making a difference.
Reciprocity is key
Te Paiho (Te Aitanga a Mahaki, Ngāpuhi, Ngāti Maniapoto) is a strong believer in the transformational power of personal stories in the effort to achieve equity in breast screening participation and cancer mortality among Māori people.
She’s seen non-Māori health professionals moved to tears when they’ve heard what it is like for someone with difficulty in accessing healthcare, and the impact of learning that what they think is culturally normal and comfortable is abnormal and uncomfortable for someone else.
“If you can try and put yourself in that other person’s shoes, then I think you will do a better job at caring for them,” she told Croakey in an interview.
Speaking at a mammography session, she told delegates that her advice is relevant for any imaging technologist or radiation therapist, because “culturally responsive care goes right across health”.
Te Paiho said there is a 10 percent equity gap in breast screening rates between Māori and non-Māori women in Aotearoa/New Zealand, and a 15 percent gap for Aboriginal and Torres Strait Islander women.
That’s due to a range of barriers, including distance to screening sites, lack of transport, financial issues, work and family commitments, “that mean that many people are not able to prioritise their wellbeing”.
“Therefore, we need to provide equitable resources, more for some, less for others, to have the same outcomes,” she told the session.
Te Paiho shared feedback from Māori women, service providers and government officials for a new framework to support priority groups that was developed following a 2021 national evaluation of breast and cervical screening support services in Aotearoa/New Zealand.
Their comments showed the importance of funded support, service flexibility, listening to community, co-design and the need for professionals and services to reflect “with humility” on the values and biases they bring to their work.
Work with community strengths
During her first year at BreastScreen Aotearoa, some of Te Paiho’s priorities have been to develop culturally responsive education, so Māori women aren’t so shocked or embarrassed by the screening process that they never come back.
She’s also introduced more flexibility in appointment times, including to enable walk-ins, to address complaints that services ‘run around the service’, rather than being centred on the patient or family.
She says breast screening services have suffered in the past because they failed to partner properly with local communities. BreastScreen Aotearoa is working to “truly” partner with Māori and fund new ways of working with women holistically.
“Reciprocity is really important so we say ‘yes, you’ve come to do your screen, now what could we help you with in the rest of your life or your family’s?’”
Te Paiho had some advice for non-Indigenous people in medical imaging and radiation therapy, saying Māori people rely on allies, who “sometimes can say and do things we can’t as Indigenous people”.
As well as examining their own beliefs, values and biases, she urged them to learn about the Indigenous community in their care – “in a positive way”.
“There’s a lot of negative information out there about different groups and how participation rates aren’t as good, or cancer outcomes,” she said.
“What you need to do is go and find out what the strengths of that community are, and then work with those strengths …to try and make a difference.”
Watch this interview with Lisa Te Paiho:
Shifting mindsets
Te Paiho and Māori in Radiation Oncology co-chair Jamaine Fraser (Nō Ngāti Rangiwewehi) also told the conference about the foundational shifts they are seeking through the organisation.
It is a “volunteer not-for-profit action oriented collective of Māori movers and shakers working in radiation oncology”, aimed at “shifting mindsets across the sector”.
They talked first about three Māori leaders who have brought about profound change:
- Dame Whina Cooper, the first president of the powerful Māori Women’s Welfare League, who as a 79-year-old led the 1,100 kilometre Māori land march in 1975.
- Sir Mason Durie, who developed the Whare Tapa Whā Māori health model based on the concepts of whānau (family), tinana (physical), hinengaro (mental) and wairua (spiritual) health.
- Dame Rangimarie Naida Glavish, known as the ‘Kia Ora lady’ for her courageous stand on Māori language. She is known for saying: “My language is who I am. It’s in my blood, my bones and my genealogy.” And “My mother taught me, if you ever see something wrong in front of you, that you must fix it.”
Te Paiho and Fraser said the legacy of such leaders helped inspire Māori in Radiation Oncology, which began in 2021 out of the need to have a voice for Māori patients, families and members of the radiation oncology workforce, aiming to achieve equity for Māori receiving radiation therapy and for Māori working in radiation oncology, including to increase the number of Māori in the professions.
Māori are currently 20 percent more likely than non-Māori to get cancer, and nearly twice as likely to die from it. Aotearoa’s Cancer Action plan aims to achieve survival equity by 2030.
Fraser said Māori in Radiation Oncology has made big steps to date, including a research project at Otago University looking at the outcomes and benefits of a Māori radiation specialist, and acceptance from the university and national cancer groups as the Māori voice in radiation oncology.
Other programs and initiatives include culturally safe mentoring for Māori students, cultural safety advice for other disciplines, membership of key regulation bodies and overseeing the implementation of the Waitangi Treaty into the medical radiation sciences curriculum.
Driving forces
Powerful personal stories of cancer have also driven the work of Elston and Trudgen, they told the conference.
Trudgen’s father died of pancreatic cancer in 2015 less than a month after being diagnosed. He had delayed seeking medical attention because, like so many Indigenous people, he had “a fear of the health system”, she said.
Elston, who comes from a “very large Queensland Murri family” and is deputy chair of the Breast Cancer Network of Australia has had a tough personal journey with cancer.
She was diagnosed with breast cancer at the age of 33, having delayed reporting a lump because, with a demanding job in Indigenous health at James Cook University in Townsville and a new baby, she was “too busy”. (See more here in this 2024 interview with Elston at the World Indigenous Cancer Conference in Melbourne/Naarm.)
However, because of working at a senior level in health, she ultimately received strong support and medical intervention.
“People showed me the system in a way that didn’t happen for the average person in regional Queensland, let alone an Aboriginal woman in regional Queensland,” she said.
“That became a driving force for me.”
She urged more recognition in the sector that, while Australia does pretty well for cancer control, diagnosis and screening, particular groups miss out. (see pic below)
“We have to think about the disadvantage within each of these,” she said.
Elston and Trudgen highlighted the significant focus on Aboriginal and Torres Strait Islander people in the ten-year Australian Cancer Plan, and the aligned Aboriginal and Torres Strait Islander Cancer Plan, developed by the National Aboriginal Community Controlled Health Organisation (NACCHO).
They encouraged delegates to interact with the Australian Comprehensive Cancer Network (ACCN), an integrated national network that connects cancer services all across Australia and is open to clinicians, cancer survivors and families, and community members.
“If you’ve got a burning question about treating Aboriginal and Torres Strait Islander people, you can interact with people across Australia,” Trudgen said.
Asked what small change delegates could make in their practice to help drive equity, she said it was critical to put cultural competence training into action, not just for it to be a box to be ticked.
“If you can’t actually look at the individual in a holistic way then I have to question why you would be in a health profession at all,” she said.
Elston advised the sector to involve Aboriginal and Torres Strait Islander communities and organisations, rather than just individuals.
“It is getting community around the table that makes the difference,” she said. Aboriginal Health Workers are also critical. “People trust them,” she said.
Watch this interview with Adjunct Prof Elston and Kelly Trudgen
Other takeaways
The most remote visit for Breastscreen SA’s mobile service is to Marla, in the Aṉangu Pitjantjatjara Yankunytjatjara (APY) lands. It is more than 1,000 kilometres north of Adelaide, where there are a variety of barriers to screening, including language, weather, other pressing health demands, and mistrust of the health system.
Despite that, many women make a three day round trip from other communities for screening.
Dr Susan Calvert from NZ Medical Radiation Technologists Board talked about what the Treaty of Waitangi means for a regulator, saying the Board took on additional responsibilities in 2019 in relation to Māori people regarding cultural competence, equity and addressing institutional racism.
“The challenge for regulation is to work out what it means to incorporate an Indigenous world view into a Western regulatory framework,” she said.
The Board’s strategies include:
- being guided by a Māori Kaumatua (Elder) and a practitioner advisory group to support/inform work
- ensuring its own house is in order in incorporating Te Tiriti o Waitangi into its work
- upskilling the workforce.
Non-Indigenous radiation therapist Emily Hearnden won the public choice presentation award at the conference for her presentation on providing culturally safe cancer care in Nhulunbuy, in East Arnhem land.
Her work includes seeking better access to cancer treatment for the community by providing radiation therapy education and cancer-specific allied health screening on-Country, prior to patients travelling to Darwin for treatment.
Check these threads via X from the Cultural Considerations and Mammography sessions.
Croakey readers may be interested in a webinar on Wednesday 9 April at 8am-9:30am NZST as part of Global Public Health Week (hosted by World Federation of Public Health Associations). WFPHA President Emma Rawson Te Patu will be on a panel to discuss this year’s theme “Redefining equity: Decolonising Public Health for a Healthier World”.
Register here: https://events.humanitix.com/decolonising-public-health-globally-progress-and-possibilities-iwg-wfpha.
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