Two Way Abuse in Aboriginal Communities

Last week we heard the news that a nursing sister was killed in the small community of Fregon. A young man has been charged and we are yet to hear the full story. This is truly a tragic situation for all concerned.

I first remember hearing about the community of Kaltjiti/Fregon in the 1960s when John and Gwen Fletcher told me about this place in central Australia where they had set up a sheep station. John spent a number of years working with the Pitjantjatjara people 30 miles south of the main mission station called Ernabella. It was south of Uluru, across the border from Northern Territory into South Australia. At the time I couldn’t imagine how anybody could ever live in such harsh desert conditions.

Then in the late 1970s when I was working at Ramingining as a community development worker I met Margaret Bain who was helping the Pitjantjatjara people of Kaltjiti with many issues, including taking control of the local pub so they could combat alcohol abuse in their own community.

I remember at the time being taken aback by both these people’s incredible knowledge of the local people they worked with.

Things were different in those days

Things were different in those days. Many people in authority back then knew that if mainstream Australians going to these remote communities didn’t learn the language and culture of the people then things would go belly up – for them and the people. John never spoke much of the language but had a very good understanding of Aboriginal culture. Margaret though had learnt both the language and the culture extremely well. Both John and Margaret were what we call culturally competent people [see “Cultural Competency”].

Today nurses, teachers, and other mainstream Australian workers are sent to remote Aboriginal communities with little or no training. Back in the “bad old days” even many missionaries attended anthropological and linguistic training for six months before they were sent to work in the field. Government patrol officers from the Welfare Department, like Ted Egan, were required to do similar training.

Today people walk out of capital cities and into Aboriginal Communities with more instructions about how to get on and off the plane, or fill out the department’s paperwork, than how to work and live productively with the Aboriginal people they go to work with.

Vulnerable people on both sides

The present ill-conceived system and practices leave broken and vulnerable people on both sides of the cultural divide.

Mainstream Australians arriving in these communities can suffer immensely. And the people they come to work with also suffer emotional and psychological abuse from the culturally incompetent interactions they experience.


How could this possibly be?

The problem is simple. Mainstream Australians who come to work with Aboriginal people usually bring with them a background of European culture. The Original Australian culture (Aboriginal culture) is more Asian than it is European and so is very different from mainstream Australian culture. And the reality is that many mainstream Australians know very little about Asian or Aboriginal culture.

In fact mainstream Australians understanding of Aboriginal culture has become clouded and confused by the stereotypes, of Aboriginal people and culture, which were developed at the colonial interface by the English-speaking “Australians”. Sadly these are very one sided stereotypical names and assumptions that are now accepted across Australia as “Aboriginal culture”. But these stereotypes are inaccurate and in themselves are offensive to Aboriginal people who still hold to their original culture.


Vulnerable outsiders

The people who arrive to live and work in communities can become vulnerable because many times their actions and words are misinterpreted. This is because they have little understanding of appropriate standards and manners that are central to the people’s ways. Therefore some of the ways of communicating and interacting with people are seen as rude and even abusive.

This makes them look morally corrupt and lawless in the eyes of the community and may lead to conflict and could also lead to personal, physical or verbal abuse. Many times it also results in the mainstream Australian worker being very unproductive and unable to help the community in the way they originally intended.


The people become vulnerable

Aboriginal people also become vulnerable as they suffer from the naive abusive words and actions of the mainstream Australians. They then also suffer from reaching the wrong conclusions about the people who have come to work in their community.


Nothing new here

There is nothing new or strange about what I’m saying here. When tourists travel to other countries around the world they are given some good basic advice on how to dress and interact with the local people so that their actions are not misunderstood.

Why is this advice also not made available to nursing sisters, teachers, and others who leave the safety of their culture and home environment to go and work with Aboriginal people who clearly operate within a different cultural context?

Is it just because bureaucrats find it easier to budget massive amounts of money for recruiting nurses and teachers than to put some money in the same budgets to train those they recruit? This seems to be the case and so people are employed and sent at great cost to communities only to fail in many cases. I’m not saying that there are not good mainstream Australian people doing some great work in Aboriginal communities. There are. But this is despite a flawed system that put them there in the first place. However the revolving recruitment door is very well oiled with large sums of public money moving many people in and out of communities, resulting in the retention of only a few.

It seems the system is designed this way so that public servants can say when asked, “Are all positions filled”? They can answer, “Yes”.

The cost of recruiting just one position could pay for the cultural competency training of between 15 and 20 staff members. Imagine savings to government if even only 10% or 20% of those people became effective and remained in their position more than one average staff rotation.

So nurses, teachers, and other expatriate workers are being placed in harm’s way due to the lack of foresight and understanding of the people who control the purse strings.

And people who these mainstream Australians are sent to work with are also placed in harm’s way, while the “Gap” just gets wider around all the key statistics.


Three decades of trying to get change

I have been talking about the need for this training for at least three decades now. Training that would save tens of millions of dollars in recruitment as mainstream Australian professionals come to Aboriginal communities, experience failure, psychological breakdown and leave as broken people, some so badly damaged they leave their chosen profession.

While back in the major centres the public servants blame these very same professionals for “failing in their job”. So they just recruit another group of green, untrained, unprepared, mainstream Australians to go and do the same thing all over again.

This is at a time when Australia is talking about National Reconciliation, “Closing the Gap” for Aboriginal people and finding savings in scarce public funds.


We want change

Here at Why Warriors we want to make a difference so I’ve decided to start sharing more training material that will help mainstream Australians learn some of the Original Australian culture. This will give some tools to people travelling and working in Aboriginal communities and stop some of the abuse that is inadvertently being carried out every day towards Aboriginal adults and their children.


Please see the first of this series; “The Beckoning Finger”. Help us to make a difference in the lives of Aboriginal people and share this with your friends and networks.


For more information see the “Grey Zone”. and “What is Cultural Competency”.


Richard Trudgen © April 2016

About Richard Trudgen

Richard was born in Orange NSW and trained as a fitter and turner. He moved to Arnhem Land in the NT in 1973 and became a community worker, learning to speak Djambarrpuyŋu. Has now worked with Yolŋu people for over 45 years. He was the CEO of Aboriginal Resource and Development Services (ARDS) for 10 years during which time he developed discovery education methodology with Rev Dr Djiniyini Gondarra OAM and also established Yolŋu Radio in 2003. He is the author of Why Warriors Lie Down and Die and facilitated ‘Bridging the Gap’ seminars, and delivered corporate training across Australia. He is currently the CEO of Why Warriors Pty Ltd, a community development social enterprise organisation working with Yolngu people. He spends his day writing, producing podcasts and building online learning platforms, producing videos and working face to face with Yolngu. He is also involved in building online cross-cultural training material to build understanding between Indigenous peoples and the Dominant Culture.


Add your comment:

  1. RICHARD Trudgen

    And Rob I need to be fairly general my response. This is a massive subject. I don’t know if you’ve read my book Why Warriors Lie Down and Die. It starts to explain how in the last 200 years the English mainstream culture in Australia has taken so much from Aboriginal people. I’m trying to write a series of five books about it at the moment. And we have just launched a cross-cultural learning site (see Cultural Courses above) that will help people like yourself see some of the mistakes we made.

    We are dealing with two very different groups of people. First Nations Aboriginal People have a culture and language that sustained them for over 40,000 years. Unfortunately, this unique culture is just been brushed aside. Replaced by mainstream Australian culture that has its roots in Europe. That mainstream culture brought with it things like alcohol which has had a devastating effect on Indigenous people right across the world. It’s a mainstream Australian Holy Cow and it leads to massive breakdown of law and order and even family morals. Anyone who would rape another person or force themselves sexually upon another person is less than human. But it happens mainly when people are out of control due to drugs or alcohol. In traditional times anybody who did that faced capital punishment.

    I myself come from a family who had an alcoholic father. He was a good hard-working man, fought in the second world war, did time in a German prison camp, and tried to work hard to provide for his family. Sadly he was addicted to alcohol and mainstream western society has done little to deal with this out-of-control addiction. In the Northern Territory we just continue to open up more and more access and even force it in on to Aboriginal communities.

    In Arnhem land all the communities are dry communities except the one community around the mining town of Nhulunbuy. Again it is the mainstream Australian needs and culture that is determining the future of Aboriginal people, even on their own land. And this is having a devastating effect on the Yolngu people around Nhulunbuy. Some clans will become extinct because of it.

    But as I said before this is a big subject. You can read another document on our site here called Breaking of a People.
    Many Aboriginal people have lost the purpose to live, due to Australian mainstream ignorance about where people are coming from.

    Before I wrote this, this morning, I was talking to middle-aged Yolngu lady who was helping me build a video on chronic disease at the moment. Whether it’s a conversation with her or many of the other Yolngu people from north-east Arnhem Land that I talk to. It comes down to the same confusion they have around how the mainstream dominant Australian culture operates. Yet we still struggle to be able to get money to do education needed to answer their questions and give them back purpose where they can control their own life again.

    Please continue to look for answers by getting as much information as you can. However, that will require you to also understand a lot more about the original Australian culture that has been denied and decimated by continuous government and mainstream community decisions. Progress will only occur when people from both sites join together to understand each other and come together in a common purpose of trying to find the best way forward for all people in Australia no matter what their cultural or language background is.

    Like, for example just one issue. No government in Australia for 200 years has provided an open-source English learning program for any Aboriginal language group in Australia. Aboriginal people want to learn English because they know it is the only way for them to get access to modern information. But the government just doesn’t get it. After billions of dollars spent to try and Close the Gap it just doesn’t close because the fundamental underlying information the people need access to is just not there for them, in a language they can understand, an original Australian language.

    I know I have been answered your question, but it’s a big one.
    Happy to continue the conversation. Thanks Richard Trudgen

  2. Robert

    Hi Richard. After travelling around Australia for a couple of years I am keen to find out more as I was very disappointed with what I saw in the northern half of Australia.

    This is my take and I don’t mind if you challenge my thoughts. I want to learn more about this. I am being very general here.

    Aboriginals worked on cattle stations as ringers and were competent horse-men. They had a purpose in life while still living on Country. Most of these situations started or were continued with malevolent missionary zeal. For some reason, whether TB or government/bureaucrat interference the missionary support ended, and communities set up with education, housing, schools etc. With no purpose in life, not really living off the land anymore, boredom took over and alcohol became their friend. Government aid and funding has continued at the same time some of these communities have spiralled out of control. I believe in order to address the problem, it will take a lot more than just cross cultural training for staff in the communities. For example, someone doesn’t rape many women because of a misunderstanding. Whether black, white or brindle, a man will take advantage of a powerful position over a woman and usually through sexual force to satisfy certain urges and hide weaknesses.
    Richard, what is your take please. Am I way off the mark here. I want to understand why we have these problems now in remote communities, but very few in the past.

  3. Lucas

    That nurse who was raped and murdered in Fregon had been working on the APY lands for a long time. Her tragic story should be used to highlight the lack of safety for remote nurses working in these locations. It should not be vaguely connected with the lack of cultural competency occurring… not sure what the connection is really? None the less I 100% agree with the premise of the article. Thanks for your great work

    • Richard Trudgen

      Lucas; thanks for your support. But sorry I have to disagree with you in the strongest possible terms. If I walk into a boxing ring throwing punches rather than walking around with my hands behind my back, like the referee, then I will likely get punched. In the boxing ring, I need to be culturally competent to give out and receive the right messages and responses. And it is the same with people living in cultures that are foreign to them.

      I originally lived in a Yolŋu community for over a decade, and I was still culturally incompetent at the end of it. It’s only when I started teaching cultural competency and cross-cultural and communication skills that many of my Yolŋu colleagues started to really straighten me out. Yes, I’d learnt a lot in that decade, but I still had a lot to learn. See when it comes to cross-cultural issues a person doesn’t know what they don’t know. And the level of cultural competency has little to do with how long those mainstream Australian personnel have lived in an Aboriginal community.

      In that time I worked in a community development office that dealt with many issues of conflict between mainstream Australian (Balanda) staff and the Yolŋu people. In all these cases it was the lack of cultural competency on both sides that led to issues of conflict and abuse, including attempted rape. Lack of good cultural competency skills means mixed messages are given and received all the time.

      Also having been involved in rape cases, as an expert witness and advisor to one or other of the lawyers, I have seen too many cases where the victim unwittingly sent the culturally wrong messages and got themselves in trouble because of it.

      If these culturally mixed messages are received by rational, sane individuals, within any culture, it will probably not be too much of a problem.

      Like the time I was reprimanded by a middle-aged Yolŋu woman for saying to her, “See you later”, in English. Despite this phrase now being seen by most Yolŋu as meaning goodbye, it was once seen as a very clear attempt, from the Yolŋu perspective, to hook up later on. That middle-aged lady, let me know in very clear terms that she was not interested and I would not be seeing her later on.

      The traditional way of saying goodbye is “Djututj” or “Djututj-nha”. Which means “keep moving” or “move on”. But the Balanda ways always win out, and now people say, “Nhäma yalala” – (see later). This is a Balanda construction because it doesn’t even seem to be grammatically correct and it still has those overtones of connecting up later on. Where with “Djututj-nha” there is no confusion.

      However, we are no longer just dealing with sane, rational people in many Aboriginal communities these days. Unfortunately more and more we are dealing with alcohol and drug affected people with some suffering from different forms of mental illness. In other words, we have a cocktail of human existence where if the cross-cultural wrong messages are given then certain individuals will become extremely exposed to physical harm. And this is why I wrote the original article above.

      For years I have been trying to lift the bar to a high standard were all mainstream Australian personnel going into Aboriginal communities get trained in the cultural competency and cross-cultural communication skills that will create real safety for themselves and the people have gone to serve. Unfortunately, things have gone backwards in this area, and most Balanda receive almost no training whatsoever leaving themselves open to being misunderstood and abused, and Aboriginal people also abused because of culturally unsafe, sometimes very rude mixed message.

      Have a look at the video called “The beckoning finger”, under the latest video’s on this site. Female teachers and medical people using the beckoning finger in that way will be seen as very loose women. Not only are they putting themselves at risk, they are also sexually assaulting the Yolŋu children and adults they use this gesture towards. And it would be the same for people in most Asian cultures. Doctors, teachers and registered nurses are being sent into communities with no basic training whatsoever in how to be culturally safe. They need cultural competency training and training in basic cross-cultural communication skills. This is the real situation, so I will not be changing my message, just turning up the volume on it.

      You are right to suggest we do not know the particular circumstances of this unfortunate tragic event. But I, more than most people know that it could have been initiated by poor cross-cultural communication. The sad part about it though; the courts and those involved in this particular case, and all those working in medical committees looking at safety for nursing staff in remote communities, probably won’t even look into this critical factor as it is a massive blind-spot for the mainstream dominant Australian culture. And unfortunately, it is this mainstream dominant culture blind-spot that is now the standard in organisations that work in Aboriginal communities and including in many Aboriginal organisations. Cultural incompetency is the major underlying, two-way, safety issue that is not being addressed in 2017. Whether it had anything to do with the above tragic case, we will probably never know.

      However, I know for sure that the teaching of good cultural competency and cross cultural communication skills will deliver greater cultural safety for medical staff in remote communities and for their Aboriginal clients all over the country. And if I can stop tragic experiences as in the Fregon story above I think that is my responsibility to do so. Let’s keep up the conversation as it is badly needed.

      • Lucas

        Most of what you say is true. Some of it just doesn’t relate to this incident. It’s just poor journalism. Her story should not be used to piggy back these issues. I can tell you the community feels deep shame from what happened. There is a lot more to the story then what you know. Many of the community has left in response to this incident. If you want to tie this womans tragic story to something else then it should be to lack of safety for remote nurses. Respect the dead.

        Furthermore did you know Gayle Woodford ? Do you know her story, Do you know the Yankunytjnatjara and Pitjantjatjara people of Kaltjiti ? Do you know what they think about what happened? Have you spoken to them to see their side of the story? Have they said that the reason this woman was raped was become she ‘sent the wrong message’ or something else like that. This woman should be honoured and respected and remembered for all that she gave not used as a trojan horse for issues that don’t specifically relate to her as an individual. The only issue that should be attached to Gayles story is the lack of safety for remote nurses. Yes cultural competencies is very important but I think if you look harder you will find that this was not the case in this incident. Do you know that nurse drive sometimes hundred of kilometres in the night by themselves to provide medical attention to people in need? Because thats what Gayle did.

  4. Karen Burnes

    Very impressed with your patient calm & helpful replies to comments about your article Richard. Thank you for this article. It is timely & that is why it is so important to be talking about now. There needs to be more dialogue about this – for both communities.

    • Richard Trudgen

      Thank you for your support we need to grow this support to get away from the past colonial set stranded; which has created the massive gap that exists for first nation Australians and move to a really true innovation intuitive approach which is not rocket science.
      That is give people real access to knowledge, training and skills so they can work more safely and productively with original Australian citizens. We need to stop the community violence that is occurring at a massive rate towards Aboriginal people which by the way is another silent subject that we need to talk about.
      Thanks again,
      Richard Trudgen

  5. Anonymous

    Hi I am an international student studying Nursing at Edith Cowan Univesity. Eversimce I hve read about Coober Pedy as a child, I have always been curious about Aboriginal and always wonder why there is not enough literature out there about their culture, customs, tradition and history. I would like to learn more. If there would be seminars I am interested to join.

    • Richard Trudgen

      Thank you for your interest into the original Australian culture, there is so much to learn and that is what makes it exciting.
      We have 2 Bridging The Gap seminars coming up one is in Darwin on the 27th and 28th of April and there is one in Nhulunbuy on the 17th and 18th of May, we would love to see you there.
      For more information on our Seminars and ticket information please see the “Bridging The Gap” page on our website. or feel free to send through any questions Via our Email
      Thank you for your comment,
      Richard Trudgen

  6. Sharon

    As far as I’m aware, every nursing course from AIN, EEN and through to RN has Aboriginal Awareness Studies and Cultural Awareness Studies. There is no specific training in Italian, Greek, African, Chinese, Japanese, etc studies/awareness, but the majority of these nationalities don’t constantly abuse the nursing staff verbally and physically. The article is very poorly timed with Gayle’s death/murder, being so recent.

    • Richard Trudgen

      Sharon, thank you for your comment
      What we are talking about is Cultural Competency, This is very different from usually very simplistic Cultural awareness courses, please see What is Cultural competency Blog.
      This has a strong emphasis on the awareness needed (Mindfulness) along with the knowledge, Cross Cultural Cross Language and communication skills.
      As you have mentioned there seems to be less violence coming from some of the other countries this is because Many Aboriginal Languages in the NT and English have a less than a 80 years working relationship; whereas Pacific Island languages have 180, Japanese/Chinese have 400, and other European languages have at least a 2000 year relationship. English for most Aboriginal people is extremely different in its syllabic phonics, grammar, and worldview construction, yet the language-mapping history is extremely brief and no complete inter-language resources exist.
      Consequently most Aboriginal people’s integration into the mainstream Australian community has remains slow, leading to significant suffering, including high unemployment, massive morbidity and mortality experiences and extremely high imprisonment rates. Aboriginal people have been left to sink or swim in an English speaking world. Therefore there confusion and frustration levels at times are right through the roof. You try and think of what it would like to try and communicate in a different language when life or death situations are happening to yourself or your loved ones.imagine being in a hospital in Indonesia or china and You haven’t got a clue what is happening. This is a daily reality for many Aboriginal people across Australia. And we call this the “Lucky Country”,.. lucky for some.
      I think people need special training not just “Aboriginal Awareness courses” and without it it is creating a very unsafe work environment for all.
      Many thanks for your comments,
      Richard Trudgen

  7. Sue

    can you please tell me if the black card gives the basics where can we get moe education in culture and language ( when there are so many dialects)

    • Richard Trudgen

      Hi Sue,
      Not to sure what you mean by “The black card”
      See Why learn an Aboriginal language
      Yes there are many dialects, 3 things from my experience
      1. Non Aborigional people need to stop being “Nomads” and choose a area to work in.
      2. If you learn a Aboriginal language you will find the grammar structure syllabic phonics similar to other Aboriginal languages
      3. When Aboriginal people know you speak Aboriginal language from another region they know that you have put in the time and will be much more interest in working with you to learn there language because they know you are going to be serious. So give it a go you will find it will change your life plus, and there is more you will be speaking Australian for the first time!!
      Thanks for your Time,
      Richard Trudgen

  8. Fiona

    Really disappointed in this – cultural sensitivity gone wrong here, how about respecting Gayle Woodford, allowing the truth to come out about this brutal murder (in due time) and not riding on the back of this devastating situation for your own purposes. Yes, absolutely, enhancing cross cultural communication is vital, but to blame the deceased is offensive and I’m quite shocked you’ve done this.

    • Richard Trudgen

      Fiona in my opening sentance i said, “Last week we heard the news that a nursing sister was killed in the small community of Fregon. A young man has been charged and we are yet to hear the full story.” I’m could not be more clear than that, saying that we haven’t got the full story yet. And no way am I suggesting that Gayle Woodford was culturally incompetent. I didn’t know her personally so I would not suggest that one way or another.

      But the facts are clear as stated in the article, that professionals from different disciplines are being sent into communities without any real basic training. From hundreds if not many hundreds of stories I’ve heard from both registered nurses and teachers this is a basic truth. Secondly I know that most of the violence that occurs in clinics and in classrooms occurs around miscommunication and people on both sides drawing the wrong conclusions. Many times Aboriginal people draw the wrong conclussions about European communication mores Which can lead to devastating effects for Aboriginal patients and disastrous interactions towards registered nurses..

      So there is a two way confusion which can lead, and does lead to much of the two-way violence that we see on Aboriginal communities. So I am not apologetic about raising an issue which many people and I’m sure the deceased mention would be happy that this tragic interface and interplay comes to an end.

      From some stories i have heard it could be that the perpetrator is just a bad man, whatever is races, we don’t know and it would be better if we all wait for the full process of law to be worked through.

      However I have been trying to get this issue in front of the bureaucrats and the media for over 30 years and it seems that the only time people listen is when unfortunate horrific events like this occur.

      What we need is more people who will join us and create a chorus of conversation back to those who are responsible for sending people out untrained and with little skills to work effectively with Aboriginal people in a more culturally competent way. If this means I need to be a little bit insensitive towards the dominant culture form time to time, as it is the mainstream dominante culture that is calling all the shots then so be it. Thanking you very much for your comments, as you were game enough to state your views.
      Your Faithfully
      Richard Trudgen

      • Patrick Woods

        If you weren’t suggesting Gail was culturally incompetent, why mention it at all? If there was there another context outside your article that made that reference relevant, I must have missed it.

        • Richard Trudgen

          My reference to the incident in Fregon was due to having a strong association with the community through the two people I mention. When I heard of the incident I was strongly guilt struck that I have not publicly said more in this area before. My thoughts were clearly for the family and the community as one knowing that many of the incidents that do occur like this are usually driven by the same forces of confusion and miss understanding.
          I consider myself (even after 40 years) to be still culturally incompetent and make mistakes every day with the Aboriginal people I speak with on the phone and associate with.
          Culture/our habits of youth and our habits of youth/culture are so strong that it leads us into making mistakes with people from other cultures constantly, the big difference is if we recognize and can apologize when we make cultural mistakes.
          Having said all this we do not know what happened in this case. But I will repeat, I was angry at myself when I heard about this as I have not addressed the issues publicly enough in the past and I am afraid it takes issues like this to get the people who are responsible to start looking at the real training needs we are talking about here.
          Ps. Can you please give me some heads-up on what other issues we can use to get this subject discussed. I have even tried to get ABC journalist to do programs on the teachers that leave community “broken” and the many incidents of assault that do occur on Aboriginal patients and Medical professionals. The silence is deafening over these many years. I would love to hear some ideas.

          Thanks Richard Trudgen

  9. Gaye Shepherd

    Very true great article. I read Why Worriors Lay Down and Die prior to my first placement as a RAN in Arhnam Land, it helped tremendously with my understanding and communication with the beautiful Yolngu people. I love what you are doing a true hero and wish you all the best with it.

  10. Elizabeth Lenoble

    I totally agree with this article. I have worked on communities for eight years and have found that there is lacking of true understanding of this culture. I believe we are still a long way off.

    • Richard Trudgen

      Thanks guys for your comments.. i do not understand why this training is so hard to sell. the book its self and the material that we teach through the Bridging the Gap Seminars, plus the other material that we want to get out there could really do wonders at CLOSE THE GAP and save the goverment 10s of Millions of dollars while we deliver better services to Yolngu and other Aboriginal people. we need pressure to come from you guys/gals at the coal face because they do not listern to me. So share as wide as you can please as i for one am tired of see Yolngu and other Aboriginal people suffer. thanks RT

  11. Jacquelibe manibs

    Great a nurse workibf more rural. But worjed akice springs/ alcohol unit mt isa . Darwin etc . Articke is so true!!!! Very interesting.. im a kiwi so have been quite shocked at lack ofindiginous culture and input in hospitals