Elevating the Voices of Aboriginal and Torres Strait Islander Women

A Western Sydney University team is working on research that aims to understand the needs and priorities of Aboriginal and Torres Strait Islander women living with traumatic brain injury caused by family violence. The project lead, Dr Michelle Fitts, was involved in earlier work on understanding the experiences of Aboriginal and Torres Strait Islander people transitioning from hospital to community and Country after a traumatic brain injury. After review of hospital records, the earlier project found a significant subset of women arriving at hospital with head injuries as a result of assault, including Aboriginal and Torres Strait Islander women.  

Fitts — who is a Senior Research Fellow at the Institute for Culture and Society at Western Sydney University — turned to the literature to understand the phenomenon, but found that little had been published about Aboriginal and Torres Strait Islander women who experience traumatic brain injury in Australia.  

Traumatic brain injury can have significant long-term consequences, and yet Fitts and her colleagues realised during this current research project that for many Aboriginal and Torres Strait Islander women, it was an invisible injury — not well understood by Aboriginal and Torres Strait Islander women that experienced it or by many frontline community-based services.  

For Elaine Wills — who is a Warumungu woman and Research Associate at the Institute for Culture and Society, the timing for help is critical. "Providing immediate support at the time of the injury is critical for long-term recovery," says Wills.  

From listening to the stories and information shared by Aboriginal and Torres Strait Islander women with experience of traumatic brain injury from family violence, as well as community-based services, the research team learned that the barriers to safe and supportive assistance were complex and considerable. The research team found that Aboriginal and Torres Strait Islander women were fearful of accessing hospital care or social supports or otherwise reporting their injuries because of the threat that their children would be removed by child protection systems. Aboriginal and Torres Strait Islander womens’ fears were also linked to the effects of historical assimilation policies. People of all cultural backgrounds, including non-Indigenous men, were responsible for the violence Aboriginal and Torres Strait Islander women experience. 

They reported competing priorities, too. Aboriginal and Torres Strait Islander women were often primary carers for children and other family members, Fitts says. So, they prioritised the needs and wellbeing of other family members over their own. "Aboriginal and Torres Strait Islander women will manage symptoms on their own," she explains. "It’s often only when those symptoms become unmanageable and when they felt it was safe to do so, that they will attend the hospital or their local clinic."  

There was also a significant knowledge gap about traumatic brain injury in regional and remote towns and communities. In meetings, community members told the research team that they hadn’t known that brain injury could result from family violence or that it could cause long lasting impacts. There was education around other forms of acquired brain injury but there were few education resources that raised awareness about the connection between repeated concussions, family violence and long-term changes that can occur in the brain, Fitts says.  

Other factors made it harder for Aboriginal and Torres Strait Islander women to receive the help they needed. For instance, in some remote locations, the local clinic may not have enough health staff to open the clinic. A number of Aboriginal and Torres Strait Islander women were also in contact with the court and prison systems. But because their traumatic brain injury had not previously been reported, it was not in their medical record, so when they appeared in court, "they didn’t have medical records or a diagnosis that could be considered at sentencing," Wills says.  

Another barrier that can prevent referrals to support is the lack of training for frontline community-based services to identify traumatic brain injury. Sometimes frontline services associated symptoms with mental health conditions, trauma or long-term drug and alcohol use, with traumatic brain injury not considered. They can look similar and they can coexist, says Fitts, but not considering traumatic brain injury in that context meant that critical information and referrals were not provided for traumatic brain injury. Lack of training on traumatic brain injury is not unique to regional and remote services involved in the project, with the same being reported by services in other countries such as Canada and the United States, Fitts says. 

"Help isn’t just a matter of diagnosis," says Wills. In fact, diagnosis is a western concept and cognitive assessments are largely developed for non-Indigenous people, she explained. Further, there is not an equivalent word for ‘disability’ within Aboriginal and Torres Strait Islander languages. For many women, disability is connected with stigma and further vulnerability.  

Cultural responsiveness is key. The conversation must begin with the roles women play in their community and families as aunties, mothers, and grandmothers. "That is a source of identity and pride," says Wills. "It’s something that’s valued by all the women that we speak to."

For the research team, responsiveness includes the way the research itself is done. They view the traditional research pathway as rigid and linear. Fitts and her colleagues have sought to dismantle it in this research program, for example, by holding traumatic brain injury education workshops with Synapse Australia prior to data collection, rather than afterward.

As Fitts says, this was so "communities and services had the understanding, awareness and language to feel confident to participate in the project as well as support the development of deeper understandings of traumatic brain injury." The research team also commissioned artwork from local Aboriginal and Torres Strait Islander artists to reflect and celebrate the powerful presence and influence of women in families and communities. 

The research team recognises the women that walk alongside them to complete this study and raise the voices of Aboriginal and Torres Strait Islander women with traumatic brain injury from family violence. "It has been a two-way learning journey," says Wills.