"It's about Rights": The Bunya Project's Indigenous Australian Voices on Health Care Curricula and Practice

Abstract

Indigenous community-controlled health care organizations provide timely, sustained, and culturally safe care. However, their expertise is often excluded from health professional education. This limits the transfer of knowledges and protocols to future practitioners—those positioned to shape health care systems and practices that could achieve the health rights of Indigenous people and reduce health and social inequities. In Australia, despite national government commitments to transforming curricula, services, and systems related to Indigenous health, health care training organizations such as universities generally have low numbers of Indigenous staff and few strategies to engage Indigenous experts. The authors of this paper are part of the Bunya Project, an Indigenous-led participatory action research effort designed to support non-Indigenous university staff and curriculum development through partnerships with Indigenous community-controlled organizations. We conducted 24 interviews with Indigenous individuals to ascertain recommendations for health care curricula. Three themes emerged: (1) role-modeling and leadership of Indigenous-controlled health organizations; (2) specific learnings for health professionals; and (3) achieving human rights in practice. Interviews also highlighted the need for health professionals’ extension beyond clinical caregiving, and staff and students’ development of knowledge, skills, and actions regarding client self-determination in order to promote clients’ rights across all aspects of their health care. Critical self-reflection by health professionals is a foundational individual-level skill necessary for cultural safety.

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Health and Human Rights Journal
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JUNE 2024 VOLUME 26 NUMBER 1 87
Health and Human Rights Journal
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“It’s about Rights”: e Bunya Project’s Indigenous
Australian Voices on Health Care Curricula and
Practice
 ,  ,   
Abstract
Indigenous community-controlled health care organizations provide timely, sustained, and culturally
safe care. However, their expertise is oen excluded from health professional education. is limits
the transfer of knowledges and protocols to future practitioners—those positioned to shape health care
systems and practices that could achieve the health rights of Indigenous people and reduce health and
social inequities. In Australia, despite national government commitments to transforming curricula,
services, and systems related to Indigenous health, health care training organizations such as universities
generally have low numbers of Indigenous sta and few strategies to engage Indigenous experts. e
authors of this paper are part of the Bunya Project, an Indigenous-led participatory action research
eort designed to support non-Indigenous university sta and curriculum development through
partnerships with Indigenous community-controlled organizations. We conducted  interviews with
Indigenous individuals to ascertain recommendations for health care curricula. ree themes emerged:
() role-modeling and leadership of Indigenous-controlled health organizations; () specic learnings
for health professionals; and () achieving human rights in practice. Interviews also highlighted the
need for health professionals’ extension beyond clinical caregiving, and sta and students’ development
of knowledge, skills, and actions regarding client self-determination in order to promote clients’ rights
across all aspects of their health care. Critical self-reection by health professionals is a foundational
individual-level skill necessary for cultural safety.
D M is a PhD candidate and senior lecturer in Indigenous teaching and learning at the University of Technology Sydney, Australia.
M W, PhD, is a professor of Indigenous health at the University of Technology Sydney, Australia.
A H, PhD, is a professor of biostatistics at the University of Technology Sydney, Australia.
Please address correspondence to Danielle Manton. Email: Danielle.Manton@uts.edu.au.
Competing interests: None declared.
Copyright © 2024 Manton, Williams, and Hayen. is is an open access article distributed under the terms of the Creative Commons Attribution
Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and
reproduction in any medium, provided the original author and source are credited.

d. manton, m. williams, and a. hayen / general papers, 87-99
88 JUNE 2024 VOLUME 26 NUMBER 1 Health and Human Rights Journal
Introduction
e right to health and Indigenous rights
Indigenous peoples’ right to health is armed in
international conventions and declarations per tain-
ing to health, human rights, and the specic rights
of Indigenous peoples. e United Nations Declara-
tion on the Rights of Indigenous Peoples identies
conditions necessary to achieve the right to health
and social justice, including self-determination,
maintaining traditional health practices, protec-
tion from vulnerabilities, and improved social
conditions and determinants of health. e right
to culturally appropriate health care is armed in
General Comment  of the United Nations Com-
mittee on Economic, Social and Cultural Rights,
and cultural dimensions of health are recognizable
in the Declaration on the Rights of Indigenous Peo-
ples’ provisions on the right to maintain traditional
knowledge, including medicines and knowledge of
the properties of fauna and ora.
Indigenous peoples’ right to health is armed
in legal and policy documents in the local jurisdic-
tions of Indigenous peoples across the world. ese
documents highlight the key principles of cultural
safety in health care, access to land and resources,
and accountability through legal recourse when
violations of the right to health occur.
Statements in legal and policy documents fre-
quently reect the holistic worldview of Indigenous
people—that health is not just physical well-being
but also social, emotional, spiritual, mental, and
environmental well-being. ese dimensions of
health are aected and inuenced by experiences
across generations, particularly the inuences of
colonization, colonialism, racism, and multitudi-
nous forms of social exclusion.
Self-determination
Self-determination in health care is articulated in
human rights instruments. Indigenous peoples
have the right to self-determination, including in
health care. Nonetheless, many health care sys-
tems have been identied as structurally racist,
with clear examples of interpersonal racism in
health care settings. In Australia, the health care
system and processes are seen as an instrument of
colonization that continues to suppress Aborigi-
nal and Torres Strait Islander peoples. e recent
framework to address health inequity in Australia,
entitled Closing the Gap, involves federal, state,
and local governments. e framework was rst
developed in  with minimal consultation with
Indigenous peoples or organizations; a majority of
the inequities to be addressed worsened over the
following decade. A policy refresh occurred in
 with input from Aboriginal and Torres Strait
Islander peoples and organizations, and in 
the Australian government formed a partnership
with the Coalition of Aboriginal and Torres Strait
Islander Peak Organisations to shi the approach
to include self-determination.
Working in partnership with Indigenous
communities is a key strategy for improving
self-determination, health care quality, and the
potential for cultural safety. Health professionals
receive little training on how to work in part-
nership with Indigenous communities or on key
concepts of cultural safety, Indigenous rights, and
specic Indigenous content underlying general ev-
idence-based practices. Overwhelmingly, health
care education focuses on the ill health of Indige-
nous peoples, with limited exposure to Indigenous
perspectives on holistic health care models. With-
out this knowledge, health care providers risk
continuing to devalue Indigenous models of health
care by rendering them invisible.
Cultural safety
Culturally safe practice is dened by the Australia
Health Practitioner Regulation Agency and Na-
tional Boards as “the ongoing critical reection
of health practitioner knowledge, skills, attitudes,
practicing behaviours and power dierentials in
delivering safe, accessible and responsive health
care free from racism.”
ere is growing pressure in the Australian
health sector to demonstrate culturally safe prac-
tice. Indeed, cultural safety is one of the objectives
of the Australian Health Practitioner Regulation
National Law.

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JUNE 2024 VOLUME 26 NUMBER 1 Health and Human Rights Journal 89
However, there have been too few strategies
to teach cultural safety in practice. In , the
Australian government developed the Aboriginal
and Torres Strait Islander Health Curriculum
Framework consisting of nine capabilities, includ-
ing respect, relationships, and partnerships. ese
capabilities are oen not well modeled at the uni-
versity level. Additionally, capabilities valued by
Indigenous peoples—such as respect, communica-
tion, advocacy, and reection—are rarely explicitly
developed or measured.
Aboriginal community-controlled health
organizations workforce and leadership
e -plus Aboriginal community-controlled
health organizations (ACCHOs) in Australia
demonstrate leadership in delivering culturally
safe holistic health care. ACCHOs are the largest
employers of the Indigenous workforce in Austra-
lia. eir sta enter a health care career wanting
to achieve systemic change and positive outcomes
for their families and communities. ACCHOs are
well placed to facilitate partnerships with universi-
ties to build the Indigenous workforce.
Education
Universities play a key role in perpetuating and re-
inforcing structures of inequality and oppression.
ey have very few partnerships with ACCHOs to
develop curricula or strategies to work with Indig-
enous peoples.
Graduates are typically underprepared to
work with Indigenous peoples and have little un-
derstanding of the burden of colonial contexts,
histories, and ongoing trauma. Coupled with
assumptions, stereotyping, and lack of reective
insight, this perpetuates an inequitable power
dynamic.
Inclusion in health care education is limited to
observation about Indigenous peoples rather than
with Indigenous peoples. Indigenous Australians
frequently report experiences of racism as part of
their daily life and in the health system.
Universities produce graduates who im-
mediately have positions of power in relation to
Indigenous peoples. Recent graduates play an
important role in how Indigenous patients engage
with the health care system. If recent graduates
are equipped with the appropriate knowledge,
skills, and strategies, they can become proactive
agents in promoting and providing space for Indig-
enous leadership and in identifying and addressing
racism.
Health curricula oen include rst-person
accounts of lived experience to bridge theory and
practice in health care. e Indigenous-led partic-
ipatory action research project, the Bunya Project,
was designed to support non-Indigenous univer-
sity sta and curriculum development through
partnerships with Indigenous community-con-
trolled organizations and strategic opportunities
to share rsthand accounts of health needs and
recommendations.
Methodology
e Bunya Project is centered in an Aboriginal
worldview, recognizing the value of the knowledge
held with Indigenous peoples for millennia and its
importance and relevance in today’s context. is
project is grounded in the centering and privileging
of Indigenous ways of knowing (epistemologies),
being (ontology), and doing (axiology). e design
of the Bunya Project has been described in full
elsewhere; here, we provide only a short overview
and a focus on the qualitative research component
pertaining to this paper.
Methods
e qualitative research conducted as part of the
Bunya Project aimed to develop, implement, and
evaluate Indigenous health curricula and resources
in New South Wales, Australia, from  to .
Data collection involved focus group discussions.
e focus group discussions were followed by in-
terviews, with the interviews exploring concepts
raised in the focus groups.
Interviews, conducted in a relaxed setting
known as Kapati Time, emphasized storytelling
and knowledge sharing, reecting the project’s cen-

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90 JUNE 2024 VOLUME 26 NUMBER 1 Health and Human Rights Journal
trality of Indigenous expertise and methodologies.
e structured interviews focused on Indig-
enous self-determination in health care education
and asking participants what they thought main-
stream health students should incorporate into
their professional practice.
While the interviews were semi-structured,
based on Kapati Time and yarning principles,
guiding questions were provided to all invited par-
ticipants. e interview duration ranged from  to
 minutes and was determined by the participants
and the conversation.
Ethical approval
e Bunya Project adhered to the ethical guidelines
of Australia’s National Health and Medical Rese arch
Council, ensuring free and informed consent from
participants and respecting their ownership of all
collected data, including videos, audio recordings,
and transcripts. e project was approved by the
University of Technology Sydney Human Research
Ethics Committee (ETH-) and the Aborigi-
nal Health and Medical Research Council of New
South Wales Human Research Ethics Committee
(/). We used participant-selected pseudonyms
to maintain condentiality while honoring
their Indigenous identities and roles within the
community.
Recruitment
e convenience sample for the study consisted
primarily of Indigenous sta and community
members from the four partner organizations, with
a total of  participants evenly distributed across
genders and age groups. All participants identied
as Aboriginal peoples and resided in New South
Wales, with interviews conducted between 
and , mostly in person but some via Zoom due
to the COVID- pandemic.
Analysis
e rst author conducted all interviews, collect-
ing rsthand data, including context, non-verbal
behaviors, and participants’ voices. Aer reading
all transcripts without annotation, we created codes
from emerging themes through active coding, lead-
ing to the identication of overarching themes. We
then rened these themes, emphasizing rights as a
driver of analysis, through focused coding, resulting
in three key ndings with  subthemes. Feedback
from participating organizations and individuals
ensured the reective nature of the ndings.
Findings
Accessing Indigenous voices is crucial for integrat-
ing Indigenous perspectives into curricula. e
diverse stories gathered in the Bunya Project, while
varied, share common themes, such as Indigenous
people feeling unsafe in health services, being
blamed, and feeling responsible for accessing ser-
vices rather than services prioritizing accessibility
for them. e common message is the aspiration
that health care practices in Australia will meet
their basic human rights.
“What we show you”: Self-determination of
Indigenous-controlled health organizations to
create culturally safe health care
e participants conveyed that Aboriginal peo-
ples have immense expertise and experience that
mainstream health services could learn from—not
only with regard to cultural knowledge but also
concerning exible and multifaceted ways to make
health care accessible.Access to health services and
the right to the highest attainable standard of health
are fundamental human rights, as is Indigenous
people’s right to self-determine programs and ser-
vices that aect their well-being. For Aunty Ivy,
a respected Gamillaroi Elder, culturally safe access
to health care services meant an understanding of
indigeneity:
I use an Aboriginal Medical Service because I don’t
have to explain.
When Aboriginal people use Aboriginal services or
see Aboriginal health care providers, they oen do
not have to explain the experiences that Aboriginal
people have with, for example, colonization, racism,
and complex family and community relationships,

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JUNE 2024 VOLUME 26 NUMBER 1 Health and Human Rights Journal 91
which non-Indigenous people tend not to know
about. One participant, Kaurna Elder Aunty Lily-
Jo, outlined the benet of removing barriers such as
anxiety related to attending appointments with set
times. In her words:
At the Aboriginal Medical Service, I just did a walk-
in, they have that on Mondays and Tuesdays where
you can just get a quick script and go. So that was
accessible, and I found that really helpful.
Unlike mainstream health organizations and hos-
pitals, ACCHOs oer preventive health care. ey
also address the needs of the whole community
across the lifespan and proactively develop rela-
tionships within the community. Aunty Lily-Jo
continued:
So, I think they work. I’ve seen it in early years,
high school and then the Aboriginal health days for
community are really good.
e approaches implemented by ACCHOs demon-
strate leadership in understanding the needs within
the local context.
Advocacy and empowerment. Alinta, a Biripi
woman in her mid-s, spoke of the importance
of advocacy within the health care environment,
empowering her to the benet of herself and her
community. Indigenous people globally have con-
nected individually and collectively to become
active in advocating for human rights. As Alinta
explained:
Being able to stand up and actually have a voice
for them within their health is something that has
made me stronger and being able to help myself but
also be able to stand up and be a voice for the ladies
that we help as well.
Kahi, a Saltwater man in his early s, spoke of the
condence he has when accessing eye health care,
self-advocating:
I don’t know if it’s me as a person who establishes
those boundaries and I have that willpower and I
guess that condence to say, “is is where I’m at.
You need to tell me the point of dierence. You need
to tell me what I need to do.” But they were willing to
listen and learn from what I needed for my eyecare.
“What you need to know”: Health care free
from discrimination, and learnings for health
professionals
Mainstream health care professionals and educa-
tion providers have much to learn about how to work
with Indigenous peoples. In Australia, policies
and regulations are beginning to hold health care
practitioners and education providers accountable
to this learning, but there is still much ambiguity
about how to approach learning and what curric-
ulum content should be. e participants in this
study identied points that they felt were important
for health care practitioners to understand when
working with Aboriginal peoples. ese reect
the United Nations’ work on health professional
education from a human rights-based approach,
which includes providing information and skills to
address and prevent bias and discrimination.
Legacy of colonization. e interviews suggest the
importance of understanding the ongoing legacy
of colonization and how past policies and power
relations continue to impact Aboriginal peoples.
Exclusionary practices—especially assumptions,
stereotyping, and oppression—are in the fabric
and culture of Australian health care systems and
structures.
Uncle Rex, a Gandangara man, reected on
this through his own experiences and journey:
Something that I’m working now to nd out, about
the history and everything of my culture, and
especially my history of my family. Aboriginal people
don’t have a great history in the past, especially
medical inuences, because they haven’t been able
to get the access that everyone else has had.
Alinta recognized the ongoing impact of colo-
nization and the continued negative impact of
introduced food sources:
I know the high risk that is involved with my people
and culturally, health wise, what we’ve been through
with colonization and things like sugar, how much
it’s aected our diet and diabetes.

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92 JUNE 2024 VOLUME 26 NUMBER 1 Health and Human Rights Journal
Health practitioners play a vital role in recognizing
the ongoing impact of colonization on health and
health care. Aunty Joy, a Kuku Yalanji and Kuku
aypan Elder, shared her story interacting with
health professionals:
If you don’t really know who your parents are. See,
that’s what happened in my case because I thought
somebody else was my father and I didn’t know the
history of the other side.
Riley spoke of a similar experience featuring a con-
stant expectation and pressure to know ancestorial
medical details:
Yeah. Just not assuming that everyone has just that
nuclear family structure. I know, even just going
back to mum, because she was adopted, she used
to get a lot of questions when she was pregnant
with my brothers and I, from the doctors of what’s
her medical history and everything. She couldn’t
provide that, at that time.
e ongoing legacy of colonization is extremely
personal, and sometimes traumatic, for many
people. is legacy aects how Aboriginal peoples
engage in the health system and oen how the
health system engages with Aboriginal peoples.
Racism and distrust. Many Indigenous peoples
face racism as a daily reality, despite racism being
illegal in many nations, including Australia, and
a breach of human rights. Aboriginal peoples
experience frequent racism in health settings, lead-
ing to a profound distrust of the system. Nulla, a
Gamilaraay woman in her early s, spoke of her
experience with interpersonal racism, being told
that
“You don’t look Aboriginal. You’re white.” And I was
like, I am, but I am also Aboriginal.
Uncle Jim, a respected Wiradjuri Elder, spoke of
his experience with his daughter, rst to justify her
Aboriginality based on her “white” appearance and
then to challenge stereotyping and assumptions—
devoid of clinical reasoning—based on her cultural
identity. Uncle Jim described the experience:
And all along that way I had to justify her
Aboriginality and them saying, well she’s not really
Aboriginal, she doesn’t look Aboriginal. But because
her Aboriginality, she had these medical histories,
and they weren’t listened to. And that’s happened
to me as well in emergency situations where they
stereotype Aboriginal people and they don’t relate
that to our medical histories.
Aunty Ivy, a respected Gamillaroi Elder, shared a
similar experience where conclusions were drawn
without any clinical diagnostics:
So that convinced them that I was a drug addict.
ey did no obs [clinical observation] on me in
triage in the casualty.
As a result of these experiences, participants noted
that they felt distrust and apprehension toward
accessing health services and working with non-
Indigenous health professionals.
Tidam, an Aboriginal man from the east coast
of Australia in his mid-s, spoke of wanting to
know specic information about the health care
professional who was treating him:
I’d want to know about their history and how long
they’ve been in the profession, success rate and
things like that.
Jarrah, an Aboriginal and Māori man in his
mid-s, spoke of the legacy of the past and how
it continues to inuence Indigenous peoples’ atti-
tudes and approaches to health care:
I think a lot of us are scared to go to the doctor’s, I
think that’s been passed down. You only sort of go
to the doctor’s if you’re going to die if something bad
used to happen.
A health system that is responsive to the health care
of all Australians should not rely on the ability of
the parent to navigate the system to ensure a posi-
tive outcome for their child. Aunty Ivy recalled:
at could have been a very dierent pathway for

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JUNE 2024 VOLUME 26 NUMBER 1 Health and Human Rights Journal 93
her if her parents didn’t have the skills to be able to
navigate through that system.
Cultural load. Cultural load refers to the extra
responsibility placed on Indigenous individuals in
personal and professional settings whereby these
individuals are expected to educate, provide in-
sight, and oer support on topics perceived as
“Indigenous.” In Australia, it is against the law to
discriminate against someone based on race or cul-
ture, and operating in ways that lead one’s culture
to result in dierential practices is discriminatory.
Nulla, a Gamilaraay woman in her early s,
described an example where she was required to
explain a federal pharmaceutical benets scheme
(related to Closing the Gap) to a pharmacist. is
knowledge should be foundational among pharma-
cists in Australia. Nulla described the encounter:
“Oh, what’s CTG [Closing the Gap]?” en you are
the one who has got to educate them.
Nulla continued:
I’ve never hated being Aboriginal, but I hate having
to educate and inform people.
Stereotypes and assumptions. Stereotyping and
assumptions relate to power, race, and positionality.
Monti, a Noongar man in his mid-s, warned:
Just because someone’s from that community, you
don’t want to label them as everyone’s got the same
problem, as well.
Nulla reected on her experiences where health
professionals made assumptions based on ste-
reotyping rather than clinical reasoning and
diagnostic testing:
“Are you Indigenous? Do you have diabetes?”
Aunty Tahnee, a respected Wonnarua Elder, spoke
of a similar experience in which health profession-
als made assumptions without clinical reasoning or
diagnostic testing:
But because I’ve got that tick of being Aboriginal,
they assumed I’d come in there to get drugs o them.
Interview participants noted that some health care
professionals believe that all Aboriginal patients
should primarily be attended to by Indigenous sta
members, such as the Aboriginal liaison ocer.
However, oen these sta members cannot see
patients without the clinical input of a health care
professional.
Nulla described the reality of this:
And it’s like, oh, okay. ere, if they’re Aboriginal
or Torres Strait Islander, they will just like, oh,
Aboriginal liaison ocer. But that Aboriginal
liaison ocer doesn’t necessarily have any health
care experience, so it’s not like they’re putting a nurse
in there or a psychologist or a speech [pathologist].
at’s just what I see.
Uncle Jim identied the potent inuence of bias
and assumptions about indigeneity, as well as the
importance of critical self-reection to challenge
them:
And of course, they come with preconceived notions
of what an Aboriginal person is, have sort of
stereotypical ideas and they never question those
ideas, so they don’t question themselves, they’re
always right. So they need to understand that
they cannot always be right, they can be wrong
sometimes.
Ed, a Noongar man in his s, emphasized the
signicance of critical self-reection, urging health
practitioners to engage in community-centered
work and understand the issues aecting all com-
munity members, recognizing their strengths, to
challenge preconceived assumptions. He provided
clear advice:
I think knowing that community and knowing the
problems in the community. I think also people in
general, especially non-Aboriginal people, they
paint a picture of Aboriginal people are very sick
people. And I know a lot of Aboriginal people are
very, very much switched on into their health and
looking aer themselves quite well. I think just

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94 JUNE 2024 VOLUME 26 NUMBER 1 Health and Human Rights Journal
knowing the problems in the community maybe
and trying to change that, it can help, but if you
going for work research, I think it’s a good idea, to
know what those problems are, as well.
Assumptions can lead to fatal outcomes in the
immediate and long term; this fear was reected in
many participants’ comments above, and further
below.
“What you need to show us”: Quality health
services and human rights in practice
Interview participants described many foundation-
al skills and concepts that health care practitioners
should demonstrate when working with Indige-
nous peoples.Cultural safety is now legislated for
in Australia, as discussed below.
Cultural safety. Participants were able to remem-
ber health practitioners who had demonstrated
culturally safe practice.
Sarah, a Worimi and Kuku Yalanji woman in
her late s, appreciated the opportunity to self-de-
termine and direct her own health care:
She respected what I wanted to do, I asked for it. She
followed through with what I wanted to do.
Kahi shared an experience of working with a fam-
ily where a child required health care treatment,
highlighting the practitioner’s skill in fostering a
culturally safe environment by involving the child’s
family:
I was just so, I guess, relieved and elated at the same
time that she was able to consider the implications
of this young kid’s issues within the family setting
and the role that each and everyone in that family
had to play to support this young person’s motor
skills and their movement so they could eat, so they
could communicate. It was a really great experience.
Jiemba, an Aboriginal, Irish, and Scottish man in
his mid-s, identied how the people and the cul-
ture at the facility he attended created a safe space
where he felt comfortable staying longer. As a result,
they were able to perform thorough diagnostics:
ey found a lot of things that were underlying
with me. And they were very good with our people
and culture and that there. ey’ve got a good
understanding. ey were actually pretty good
there.
Participants’ comments generally demonstrated
that cultural safety principles do occur in practice
and can be replicated.
Security of person and relationships. When
Indigenous peoples require health care, they of-
ten nd themselves in vulnerable positions—for
several reasons outlined above and because they
must navigate uneven power dynamics—which can
compromise their rights to physical and mental in-
tegrity, as well as security of person. Establishing
relationships is crucial in addressing these power
dynamics and fostering feelings of safety, which are
core components of cultural safety. is involves
practitioners prioritizing communication, respect,
and the creation of safe relationships that value
each client as a person.
In Kahi’s words:
Relationships are key. It’s not always about the
service that you can provide to make someone feel
better through their medical concerns. It’s really
about grounding yourself in understanding their
walk of life, understanding where they’ve come from
to get to where they are when you rst meet them.
And sustaining those relationships with either them,
themselves, their family, or even their community
that matters.
Aunty Lily-Jo added to this concept by describing
aspirations for her own health care:
I would like to ensure that I have an accessible,
trusting, respectful relationship, especially with our
non-Aboriginal sta health sta.
Uncle Jim provided insight and direction about
how to begin forming relationships:
Forming that relationship, the same as what we do,
who we are, where we’re from, which breaks down
a lot of barriers. I think, those rst initial barriers.

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JUNE 2024 VOLUME 26 NUMBER 1 Health and Human Rights Journal 95
Aunty Ivy provided an example from her own ex-
perience when a health practitioner understood the
importance of relationships:
And he was excellent and very much wanting
to know more about Aboriginal culture and he
actually had a lot of Aboriginal clients and they
were being referred to him from the Aboriginal
Medical Service. So it was very good relationship.
While developing relationships takes time, it is an
investment in the ongoing care of the patient.
Communication. Communication in health care
is a fundamental quality standard in patient and
workforce safety and a fundamental human right
(the right to be able to seek, receive, and impart in-
formation). Uncle Rex identied the importance
of communication in establishing relationships and
trust:
I believe that if you communicate well and show
that we’ve got an open mind when it comes down to
meeting dierent people even the rst time. I think
it’s important.
Yindi, a Wiradjuri woman in her early s,
discussed how the language used by health prac-
titioners can create distance between them and the
patient. While acknowledging the importance of
understanding clinical language, Yindi emphasized
the need for practitioners to scaold this process
and recognize that each person’s story is unique:
I think language is a really big thing. e rst thing
that I can think of is, I don’t know, the more clinical
you are, the more detached I feel from a health
worker. If you can speak to me like a human and try
to have that connection, I think is really important.
So language and the way that you’re speaking to
Aboriginal peoples.
Monti provided an example of when he felt that the
practitioner implemented communication skills
to work with him, and together they were able to
challenge him to achieve a better outcome:
ey were great in the way that they worked with
me, understood my limitations physically and then
even pushed the boundary to where mentally I was
like, “Oh, I can’t do this, I can’t do this.” But they
knew better than I did in terms of my physical. So
they really supported me physically and mentally
through that.
Ed pointed out that communication is more than
what is said; it includes the importance of listening:
But I think it’s important, to know that you’re there
even just to listen to what they are saying.
Sarah developed this point further, recognizing that
communication includes a non-verbal dimension:
I think it’s their body language, their tone in
their voice. You could be like talking nicely, at the
same you can feel they’re not really interested.
Acknowledging in just a handshake or whatever, all
those things. Don’t rush it.
Steven, a Noongar, Worimi, and Kuku Yalanji man
in his early s, identied the broader implications
of communication:
Because I believe everyone should have the chance
to be part of community, and communication is
an important part of developing relationships and
belonging in community.
Steven’s broader reections also explain his per-
spective that communication is foundational to
relationships in communities and that health
care providers’ willingness and ability to develop
relationships in the community helps Indigenous
people feel more comfortable accessing and com-
plying with health care.
Interpersonal skills. Interpersonal skills such as
communication style are oen subjective, hard to
articulate, and dicult to teach and assess. ese
skills, however, can have a benecial impact on
patients, oen leading to a positive experience and
improved adherence and outcomes. e inter-
personal skills of a health professional support all
peoples’ right to access health services, as well as
the right to maintain the highest attainable stan-
dard of health.

d. manton, m. williams, and a. hayen / general papers, 87-99
96 JUNE 2024 VOLUME 26 NUMBER 1 Health and Human Rights Journal
Monti, who lives in regional New South Wales,
spoke fondly of the interpersonal skills of a local
pharmacist:
He always remembers my name. We have a yarn.
He doesn’t—probably seen me kids once or twice,
but, how’s the wife and kids? What grade are they
in school now? Talks about [town]— what’s the
weather like in [town]? Because he knows I live here
now, and yeah.
e ongoing impact of colonization, oppression,
and racism compels Indigenous peoples to adopt
defensive mechanisms, which increases the need
for strong interpersonal skills among health pro-
fessionals. Uncle Warrin, a Worimi man, issued a
warning for current and future health care practi-
tioners working with Aboriginal people:
I think Kooris are very good at reading people.
And if there’s bullshit in the health professional, the
Kooris would react with a wall. Or just be nice, but
wary.
Annabelle, a Worimi and Kuku Yalanji woman in
her mid-s, built on this:
Learn a person’s story, not just treat a symptom.
Find out more about the person as much as you can
in the small timeframe you have. Listen, don’t just
go and judge. Understand cultural and historical
traumas as well as the strength that that culture
has, because the white way isn’t always the right
way. ere is always a dierent side and a dierent
lens and a dierent view that you could explore.
But that takes time, practice, and patience on your
behalf to do that. And you’re going to want to have
to learn it.
Riley spoke about the dierence between com-
munity experiences and expectations, on the one
hand, and practitioners’ experiences and expecta-
tions, on the other. He reected that it is important
for health practitioners to know that dierence is
not wrong. Riley emphasized the importance of
respect as a demonstration of authenticity and the
need for practitioners to understand the complexi-
ties of the local context and be respectful. He said:
Not to judge people, they look to understand the
area you live in and to also show that you are
respectful to them.
When considering what is important for health
practitioners to know when working with Aborigi-
nal peoples, Jarli, Aboriginal ancestry unknown, in
his late s, named salient points:
It’s just having respect. Respect and education.
Discussion
is research among  Aboriginal people explored
their health care experiences, uncovering positive
and negative examples within mainstream and
Indigenous-led services. Participants provided
recommendations for university health care cur-
riculum development, in keeping with the Bunya
Project’s purpose to positively inuence university
sta, support them in transforming and evaluating
their curricula, and in training health students
to be more culturally appropriate and respect the
rights of Indigenous peoples. e health care cur-
riculum is only a starting point, and as participants
explained, practitioners also benet from learning
within and from Aboriginal communities during
and aer graduation. Participants highlighted the
importance of educators equipping future health
professionals with the skills and knowledge need-
ed to promote human rights, emphasizing active
listening, respect, trust-based relationships, and
empowering Indigenous people to self-determine
solutions to complex health issues. ey called
on health professionals to understand the social
context, particularly of the local Aboriginal com-
munities, because it inuences health, well-being,
and rights; Aboriginal community life is a cultural
determinant of health.
Participants in the Bunya Project consistently
emphasized the importance of human rights and
Indigenous rights in health care practices and cur-
riculum development. However, there is a notable
lack of professional development opportunities for
academic sta, many of whom lack experience en-
gaging with Indigenous communities.

d. manton, m. williams, and a. hayen / general papers, 87-99
JUNE 2024 VOLUME 26 NUMBER 1 Health and Human Rights Journal 97
Subjugation embedded in the health care
system perpetuates systemic racism, necessitat-
ing critical reection to shi the narrative from
blaming Indigenous peoples to recognizing sys-
temic problems. By equipping health students with
skills to become culturally capable clinicians, the
burden on Indigenous peoples as educators can be
reduced. Partnering with ACCHOs oers universi-
ties opportunities to improve health curricula and
practices collaboratively and respectfully.
Conclusion
Australia’s health sector has the largest Indigenous
workforce of all sectors, largely because this is a
priority area where Indigenous people feel they
can make the most impact to the benet of their
communities. By partnering with Indigenous
community-controlled organizations, universities
can develop health curricula that involve Indig-
enous health care providers and users. rough
these partnerships, universities can also feasibly
and valuably contribute to Indigenous communi-
ties and engage more deeply with local cultures.
Finally, including Indigenous knowledges and
community members in the teaching of health
care practice creates potential for intergenerational
change—not only among Indigenous people but
among health care providers and educators—and
for fullling human rights.
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