Defeating the twin issues of racism and discrimination: aboriginal nursing pioneer Sally Goold has spent her life helping to break down barriers for Aboriginal and Torres Strait Islander people wanting to become nurses. It has often been a lonely road.

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Pioneering Aboriginal nurse Sally Goold is driven by one overarching vision: to see an increase in indigenous Australian registered nurses (RNs) to reflect the indigenous Australian population, and for all nurses in Australia to be able to work together without the twin issues of racism and discrimination.

Goold, who is founder and executive director of the Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN) and was the first Aboriginal RN in New South Wales (NSW), made this vision clear in a brief address at the South Pacific Nurses Forum in Fiji in October. She reminded attendees that while Aboriginal and Torres Strait Islander people make up 2.4 percent of the Australian population, RNs from these communities only account for .05 percent of the total number of RNs in Australia.

"A small number of Aboriginal and Torres Strait Islander nurses have been the trailblazers; they have broken through the barriers that had excluded them from undertaking nurse training. Bur we must remember that several Aboriginal women from Western and South Australia were excluded from undertaking nurse training because they were "black': Our history has been one of exclusion, discrimination and racism."

Goold is a Wiradjuri woman, born at Narrandera, on the banks of the Murrumbidgee River, in south-western NSW. Her father, Archie George Bamblett, was born on Warangesda Mission at Darlington Point, while her Aboriginal mother Eva Lilly Scott was born at Forbes NSW.

The Warangesda Mission was closed in 1924, with the "half-caste" people ordered off the mission land to fend for themselves. But wherever they tried to settle, they were moved on by the authorities because no-one wanted "blacks" in their area. They finally settled in an area of land that no-one wanted in Narrandera, an area between the town rubbish tip and the sewage works.

Goold's family moved to Sydney when she was young and they lived in the inner Sydney suburb of St Peter's. They were the only Aboriginal family in the area and certainly the only Aboriginal children to attend St Peter's Public school.

"I was the youngest of seven children," said Goold. "Like most people in the area, and certainly all the Aboriginal people that we knew, both in Sydney and Narrandera, we were poor. At primary school my two brothers and I were the victims of a lot of racism by other school kids. I was often bashed after school and had my clothes ripped when my two brothers were not there to protect me.

"Like many Aboriginal children, I had been hospitalised several times with various problems. I suppose as a result of this, I thought nurses were wonderful women, even though some of the language and actions of the day were a bit hard for a little Aboriginal kid to understand. For as long as I can remember, I had wanted to be a nurse.

"When I was 16 and applying to undertake my nursing training, I was really stunned to hear people, both black and white, say I wouldn't be able to do it. When I asked why, the reply was always 'because you are Aboriginal'. Of course, I didn't believe them. I was young and strongly believed that if you wanted to do something, you did it. I did not know at that time, that many people in other states, and also perhaps NSW, were excluded from undertaking nursing because they were Aboriginal."

Goold applied to her local hospital, the Royal Prince Alfred Hospital For her family, it was just amazing she had been accepted and was going to 'do something"

"The day after my 17th birthday, I lined up in a group with 41 other prospective nurses, feeling very strange and alone and, I am sure, standing out like the proverbial sore thumb. I felt very isolated and alone there, with separate rooms and no family warmth and companionship. I was very obviously Aboriginal, but I was so happy to be nursing that I didn't take too much notice of this, and I just let any comments that may have been made go over my head.

A strong desire to succeed

"As the first Aboriginal nurse at the hospital and the first of my family to have been given the opportunity to 'do something', to fail would have been disastrous, and would have brought such 'shame' on us all. The pressure was very difficult and the load was heavy. I didn't go out very often in the early years of my training because the desire to succeed was so very strong."

After her graduation, Goold applied to do midwifery at King George V Memorial Hospital. On completion of this course, she became a staff nurse at the Royal Prince Alfred Hospital She then gained a staff position at King George V Memorial Hospital and was promoted to sister in charge of one of the wards soon after.

"My professional life progressed very well. However, I did find it interesting and somewhat distressing, that it appeared okay to be an Aboriginal RN, so long as you didn't really assert yourself too much and if you were fairly compliant. If you did all that, then you were tolerated.

"I have always found the invisibility of Aboriginal nurses very difficult to accept. There are very few, if any, in senior administrative positions in mainstream health care settings. My experience, which was later confirmed by my master's study, was that many non-Aboriginal nurses guard against or perhaps even actively prevent the entry of black women into positions of authority (or even non-authority) in nursing. If the Aboriginal woman is perceived to be 'getting above herself', there are very swift and effective measures initiated to close the ranks to keep her out."

In 1971, Goold helped establish the Aboriginal Medical Service in Sydney's Redfern suburb. Working with and for her people, and alongside the ophthalmologist Fred Hollows and the other doctors who worked there on a voluntary basis, was a great privilege, she said. However, it took some time for her to be accepted by the community and to get over her reputation as a "flash black".

After Goold, her husband and son moved to Brisbane, she eventually gained a job at Queensland University of Technology's (QUT) School of Nursing, lecturing there for six years. While there, she organised community placement visits for the students' clinical practicum, to increase their awareness of cultural issues, safety and respect. "The students and I would live, for two weeks, on Aboriginal communities. The students found this a truly educational, worthwhile experience. However, when I called for expressions of interest from students to undertake this community clinical practicum, I had no applications from the Aboriginal and/or Torres Strait Islander students. This was interesting and also disappointing."

While at QUT, she was seconded to the Queensland Health Department as co-ordinator of nursing services, Aboriginal health programme, and then as acting director of that area.

The title for her master's thesis in 1995 was Why are there so few Aboriginal Registered Nurses? "I found many reasons for this, mainly, student-to-student and academic-to-student racism and discrimination, as well as inadequate, or no support systems for students. Not only do very few Aboriginal and Torres Strait Islander people choose nursing as a career option, many of those who begin training programmes do not complete them. Over a ten-year period, 1983-1993, nursing schools in seven states had an intake of 143 students among them. Only 36 of them graduated, the majority from NSW."

A voice for Aboriginal nurses

At a forum in 1997 in Sydney, attended by 28 indigenous RNs and supported by the Australian Nursing Federation, the Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN) was born. This was an historic moment for Australian Aboriginal nurses. Its major aims were, and continue to be, to increase the recruitment and retention of Aboriginal and Torres Strait Islander people into the nursing profession, and to bring about change in the nursing curriculum to include units on Aboriginal and Torres Strait Islander history, health and culture.

"CATSIN's voice is being heard and changes are occurring," she said. "We are the experts in our own health and believe our experience and world view challenges western nursing models and practice. Non-indigenous nurses can learn and benefit from our experience."

Over the last 30 years, Goold has received numerous awards and much recognition for her services to nursing: in 1985, the Order of Australia Medal for service to Nursing Education and Aboriginal Health; in 2000, the Royal College of Nursing (Queensland Chapter) Distinguished Nursing Award; in 2002, a Doctorate of Nursing, Honoris Causa, from the Royal Melbourne Institute of Technology (RMIT), for service to the community and to the profession; and in 2006, she was named Queensland Senior Australian of the Year. She continues to sit on many government and non-government committees, promoting nursing and/or indigenous Australian health.

"I have loved being a nurse and living my dream. Nursing has been very good to me bur nothing worth doing is ever easy. Aboriginal and Torres Strait Islander nurses have to work that bit harder for what we achieve. We have to walk the extra mile, to prove ourselves and to help bring about change in attitudes and behaviours. I would like to think that I am in some way helping to break down barriers and that perhaps a very weak light is coming through.

"Unfortunately, however, there continues to be difficulties in obtaining appropriate, particularly culturally appropriate, culturally safe, health care. Most Aboriginal people may not have the confidence or knowledge to seek assistance within mainstream health care systems and when they do, they may be confronted with judgmental or racist attitudes. I believe that nurses are not prepared to care for Australia's indigenous people, because there is a dearth of information on indigenous issues, particularly history, health and culture in nursing curricula. I also believe that racism, prejudice and discriminatory practices are alive and well in nursing and the health care system in general."

Indigenous Australians continue to have higher rates of socio-economic disadvantage than other Australians, she says. Their life expectancy is much lower, with on average, men dying 20 years younger and women 17 years younger than the wider population. Indigenous infants die at more than twice the rate of other Australian infants.

"Over many decades, there have been numerous reports, inquiries, well intentioned or misdirected government policies and practices, and millions of dollars expended. However, the desired effect on indigenous health and disadvantage is yet to be seen. Many Indigenous Australians are often reluctant to use predominantly western health care and they access treatment at much lower rates than other Australians. They perceive western medicine and health services to be culturally inappropriate or unwelcoming and why would one go where one is not made to feel welcome?"

Despite all of this, Goold remains hopeful that changes can be made and are being made, though much too slowly. "I believe that with increased numbers of Indigenous Australians in the nursing profession, we can truly knock down the twin barriers of racism and we will be able to walk and work together to achieve improved care for the most disadvantaged group in this country."

Information for this article has been largely drawn from "Is that a light I see over yonder? Or am I still dreaming?" by Sally Goold from In our own right: Black Australian nurses" stories, edited by Sally Goold and Kerrynne Liddle and published in association with CATSIN in 2005.