'Believe in me and I will believe in myself', a rural Australian health service learns how to mangan dunguludja ngatan (build strong employment) for Aboriginal and Torres Strait Islander people: a qualitative study.

backgroundAustralian Aboriginal people have higher rates of unemployment and poorer health than non-Aboriginal Australians. Historical segregation policies that spanned 60 years negatively impacted workforce inclusion. A Victorian regional health service recently developed an Aboriginal Employment Plan (AEP) targeted to reach 2% employment of Aboriginal people by 2020. This study aimed to identify strategies that will build strong Aboriginal employment. METHODOLOGY: A qualitative research protocol was designed. Purposive recruitment of people with a vested interest in the growth of Aboriginal employment at the health service participated in focus groups and individual interviews.

resultsTwenty-four people including local Elders, past and present Aboriginal employees, key community stakeholders and health service executives participated. Learnings from the past, the present and strategies for the future emerged from two important stories: (1) the story of a strong group of local Aboriginal people who successfully approached the matron of the hospital in the early 1960s for employment. (2) The story of the 'verandah babies'. DISCUSSION: The history of the health service in question demonstrated the power of the possible with a self-determined group of Aboriginal people, who, in the face of cultural inequity, achieved employment at the health service. The opportunity for healing and a new start was illustrated by the story of women who gave birth on the verandahs due to their exclusion from the main hospital. Today, the 'verandahs' have been replaced with a modern hospital decorated with Aboriginal art, expressing cultural safety and inclusion, presenting fertile ground for strengthening and sustaining Aboriginal employment.

conclusionEleven strategies have emerged from three themes; safety, equity and pathway, offering mainstream health services insight into how to mangan dunguludja ngatan (build strong employment). Cultural safety can be achieved through acknowledging the past and reconciling that through engaging, partnering and collaborating with the Aboriginal community. Visual representations of culture and participation in celebratory activities engender awareness and understanding. The development of local, flexible career development pathways for Aboriginal people facilitates a 'sense of belonging' to the health service and a dual 'sense of pride' within the community: whereby the Aboriginal person feels proud to represent their community and the community is proud to be represented. Cultural equity is facilitated through mutual learning and reciprocal understanding of difference.