Indigenous children

Indigenous education in Australia has not been successful for two main reasons. First, there has not been a close and respectful relationship established between schools and their local Indigenous communities so that the purpose, process and outcomes of schooling can be constantly discussed and refined. Second, the white curriculum has found it extremely difficult to incorporate Indigenous knowledge, history and culture so that school subjects can relate to daily community life. Both problems stem from a highly conservative view of schooling and society. Australian Indigenous peoples make up only a very small proportion of the population and many schools will only have a small number of Indigenous students enrolled, if at all. Teachers may feel that they lack appropriate background knowledge when working with Indigenous children and may be uncertain of how to transform the white curriculum so that it is more culturally inclusive. This chapter describes the development of narrative curriculum and the identification of exemplars of knowledge so that the regular programs offered by neighbourhood schools can be respectful of Indigenous knowledge and ways of knowing, It suggests community learning circles as the main organisational

education with its focus on language development in its broadest sense, active learning and the care of young children engages Indigenous children to a much greater extent than what occurs at the secondary level. In the latter case, predetermined knowledge is broken into separate parts generally without linkages and the approach to learning is often teacher-centred and passive. This is particularly so in the senior years with considerable pressure being exerted by universities regarding subject content and selection procedures. Under these circumstances, it is quite understandable that there is a high dropout rate of Indigenous students around the age of 15 or 16 when the contradictions between the socio-cultural ways of knowing become very acute. An obvious first step at rectification is to restructure secondary schools along primary school lines, with knowledge being investigated in holistic and integrative domains.

Geogenic dusts contain a range of pro-inflammatory compounds and bioactive metals [13]. Iron-laden particles, which are prevalent in geogenic dusts [13], are associated with an increased risk of hospitalisation for respiratory infections in children [14] and hospitalisation for respiratory conditions [15]. This is supported by our experimental studies showing that geogenic particles can cause lung inflammation [13], impair lung function [16] and exacerbate existing respiratory infections [17]. Our previous ecological analysis of survey data conducted in 234 remote Indigenous communities showed that high levels of dust were associated with greater community concerns regarding respiratory conditions, hearing and eyesight [18]. This study extends on this prior work [18] by using individual-level data linked to objective measures of health in order to examine the associations between reported dust levels and the prevalence of, and hospitalisation for, infectious disease in Indigenous children. We supplemented this analysis by exploring the effect of community sampled geogenic particles from these regions on in vitro cell responses to the most important pathogen for respiratory [19] and ear infections [20] in these communities—non-typeable Haemophilus influenzae (NTHi).

studies, given that the pathotype is also isolated from asymptomatic adult and child carriers [12] [13]. EAEC is a pathotype of recognized variability, exhibiting elevated genetic and antigenic diversity. Though a great diversity of adhesins, toxins and proteins are possibly involved in the pathogenesis of EAEC, the pre- valence of these associated factors or genes is highly variable and is not found in all the isolates, which has hampered diagnostic accuracy for this pathotype [9] [12] [13] [31]. The virulence properties of the pathotype that are associated with symptoms of diarrhea include the production of biofilm and of diverse entero- toxins, such as thermo-stable enteroaggregative toxin (EAST-1), the Pet cyto- toxin and the anti-aggregative protein known as dispersin [9] [12] [13] [32] [33] [34]. EAST-1 is codified by the astA gene, located in a transposon, and has high homology with the amino-acid sequence of the thermo-stable entertoxin (ST) of ETEC. In our study, the astA gene was the most frequent genetic marker in EAEC isolates, obtained from acute diarrhea, suggesting the possible role of EAST-1 in the manifestation of the indigenous clinical status. As well as toxins, EAEC strains may exhibit diverse adhesins such as the Pic protein, associated or not, with other virulence factors of the pathotype [33]. In our study, the pic gene was only detected among EAEC obtained from asymptomatic children. In these E . coli isolates, no other EAEC virulence associated markers were observed sug- gesting that colonization can require additional factors for the efficiency of the infection. Despite the genotypic differences detected in EAEC, all the isolates originating both from asymptomatic and diarrheal indigenous children were classified as typical (tEAEC) due to presence of the aggR gene, which codes for the transcriptional activator AggR [13] [33] [34]. Typical EAEC has closely asso- ciated with the expression of the typical

Within Brazil, indigenous children in the North region (which largely coincides with the Amazon region) present the highest prevalence rates of low height-for-age as com- pared to the country’s other regions [20,21]. Highlighting the comprehensive influence of socioeconomic and envir- onmental conditions on child nutrition, indigenous chil- dren in the North also present higher prevalence rates of other nutritional deficit indicators, such as anemia, and are exposed to poorer sanitation and socioeconomic con- ditions (e.g., access to clean drinking water and precarious living conditions) [20], which are strictly associated with chronic undernutrition. The growing body of literature on nutritional profiles of indigenous populations in the Amazon region show the frequencies of chronic undernu- trition in children < 5 years of age to vary markedly from 10-20% to 50-60% in association with diverse sociocul- tural, economic, and environmental variables [14,22-24]. Recent diachronic studies in the Amazon demonstrate that improved socioeconomic conditions and access to sanitation and health services resulted in substantial re- ductions over time in the prevalence rates of chronic un- dernutrition among indigenous children. For example, among the Amazonian Suruí, the prevalence of undernu- trition in children < 5 years of age decreased from 46.3% to 26.7% in a period of less than two decades [15].

She goes on to say that such relationships can be sometimes regarded by her non-Indigenous colleagues as too informal and ‘familiar’ and inappropriate for teacher-student relationships. However, the notion of what is considered ‘respectful’ and ‘appropriate’ is a matter of culture, values and beliefs. The relationships between adults and children in Indigenous communities are different from those in non-Indigenous communities. Furthermore, from an early age, Indigenous children are generally encouraged to make their own decisions and to take greater responsibility for themselves and for younger siblings than is the case for non- Indigenous children (Nelson & Allison, 2000; Saggers & Sims, 2005). This can lead to strong autonomy and independence; characteristics that can be interpreted by non-Indigenous teachers as disrespectful and disobedient. Such behaviours, according to Partington, can ‘lead mainstream teachers to impose more controlling behaviours on them than non- Indigenous students’ (2003, p. 41).

But analyses have found considerable scope for improvement in PHC mental healthcare pathways for Indigenous children. We know little about how Indigenous children access mental healthcare access because of significant gaps in the availability of health information, but a general lack of appropriate and engaging mental health services is documented for Indigenous children from all CANZUS countries (Boksa, Joober, & Kirmayer, 2015; Oakley Browne et al., 2006). For example, only 17% of Indigenous Australian adolescents (10 – 24 years) from 114 Australian PHC's were screened for social and emotional wellbeing (SEWB); of those screened, concerns were identified for 21% (Langham et al., 2017). Audits of these PHC's found deficiencies in client records and health summaries, recording of risk factors and brief interventions, treatments, hospitalisation and discharge, investigations, follow-up of abnormal results, and health centres. The poorest scoring of the these components (considered as critical to best practice) was the enhance- ment of links with community, other health services and other services and resources (Bailie et al., 2015). In Norway, Sami youth with conduct problems had a lower probability of using a psychologist/psychiatrist than non-Sami youth with conduct problems (Bals et al., 2010). In Canada, New Zealand and the United States, mental health service utilization rates for Indigenous youth are low (Boksa et al., 2015; Oakley Browne et al., 2006; Substance Abuse and Mental Health Services Administration, 2016) The evidence suggests that because of a combination of factors, including stigmatization of mental health, lack of culturally trained providers, and lack of available primary healthcare services many Indigenous children either cope without service inter- vention or utilize schools (mainly through guidance counsellors), spe- cialist mental health services (particularly for more serious diagnoses), child welfare (also for more serious diagnoses) and juvenile justice services (Burns et al., 1995; Labonte, 1999). Those most at risk often use multiple services (Burns et al., 1995; Ungar et al., 2013).

Although publications in the field of Indigenous health have increased in number in recent decades, their impact remains inadequate (1, 2). This is partially attributable to the continued reliance on descriptive studies (1, 3, 4) and the underrepresentation of urban environments in research. The Longitudinal Study of Indigenous Children (LSIC), administered by the Department of Family and Housing Community Services and

Otitis media (OM) describes a spectrum of pathologies that involve inflammation and/or infection in the middle ear. This spectrum encompasses a continuum from acute to chronic disease that is clinically characterized by fluid in the middle ear [1–4]. OM is highly prevalent in indigenous populations globally, particularly when compared to non-indigenous peers [5, 6], and often oc- curs earlier, more frequently and in more severe forms [4, 5, 7]. Prevalence data reports that up to one third of Greenlandic and Alaskan Inuit, Native American, and Australian Indigenous children suffer from chronic sup- purative OM (CSOM) [6, 8–11]. The World Health Organization considers CSOM prevalence of ≥ 4% indi- cative of a public health problem serious enough to re- quire urgent attention [12]. OM-related complications result in approximately 21,000 deaths each year world- wide [13]. OM-associated hearing loss can impact sig- nificantly on language and social skills development, school attendance and educational outcomes, and down- stream effects such as greater contact with the criminal justice system later in life [4, 14, 15]. Medical interven- tions including liberal antibiotic prescription and vaccin- ation programs have limited effectiveness in indigenous populations [16–18]; thus, new treatment avenues need to be considered.

3. If there are two non-consecutive sets of decreases in height or weight within the four data points (e.g. a decrease in height between wave 1 and wave 2, an increase in height between wave 2 and wave 3, and a decrease in height between wave 3 and wave 4), exclude all four data points because it is difficult to infer which data points are most likely to be in error. As the exclusion method was based on z-scores, the validity of measurements for children missing height, weight or age could not be assessed (since z-scores could not be calculated). Thus, children missing data for any of these variables were not included in analyses. After the exclusion processes, the final sample included around 1000 BMI z-score measurements in each wave, representing 81–95% of all the BMI z-score measurements originally recorded.

One area where different indigenous cultures share a common approach is about the nature of reality. The Hodenosaunee, a member of the group of Native American peoples, has a teaching which states that “we are all a part of the land beneath us, the sky above us, and all that surrounds us” (STYRES, 2011, p. 718). Such belief maintains that every entity in the earth, both animate and inanimate, are all parts of a greater Being, a Reality from which everything emanated. This is a common assumption about the world found in almost all indigenous beliefs. Indigenous peoples do not adhere to a dualistic conception of reality where things and concepts are placed in conceptual categories and hierarchies. This non-dualistic view does not make any unnecessary distinctions between the mind and the body, between the good and bad, or between human beings and the world. Rather, it embraces the complexity immanent in the universe and believes that all beings proceed from the same source. It likewise affirms the intrinsic interconnectedness among all beings, while at the same time celebrating differences and individuality. The seeming oppositions among diverse beings and things are not denied but are balanced and oriented towards harmony. Such worldview, therefore, sees reality in “a spectrum, rather than being made up of absolute wholes” (VAN DER VELDEN , 2018 ). This kind of epistemology is characterized as a circularity representing “wholeness and interconnectedness that brings all of creation together in a circle of interdependent relationships grounded in land and under the Great Mystery” (STYRES, p. 718). Seen as a creative life force, this Great Mystery 5 , she adds, “finds expression through land

Table 1: Well-being indicators for Indigenous childrenin care Headline indicators Strategic change indicators Social · Cultural Spiritual · · · · · · · · Appropriate social skills Approp[r]

NSP frequently colonize Indigenous Australian children. In our studies with young Indigenous children, NSP were de- tected in up to 18% of nasopharyngeal swab specimens. In a recent cross-sectional carriage study, NSP were the 3rd most common pneumococcal serotype (unpublished data from ref- erence 16). It is also likely that we underestimate NSP carriage rates because of their morphological differences from their capsular counterparts; NSP tend to be smaller and dryer than capsular pneumococci, and the dimple is less conspicuous. The purpose of this study was to characterize NSP carriage isolates collected from Indigenous children after the introduction of PCV7. Our aim was to understand the potential importance of this population, particularly with regard to the presence of the capsule genes and antibiotic resistance. Importantly, we re- quire evidence to guide reporting of NSP carriage and resis- * Corresponding author. Mailing address: Menzies School of Health

This study demonstrates that undernutrition, in particular linear growth deficit, is a notable health issue for Xavante children. Low height-for-age was associated with house- hold composition in the youngest age group analyzed (< 2 years of age) and with household wealth in the oldest age group ( ≥ 5 and < 10). These data reaffirm the relevance of undernutrition, particularly as indicated by linear growth deficit, in characterizing the nutritional profile of indigen- ous children in Brazil. The frequencies of undernutrition observed in Xavante children from Pimentel Barbosa vil- lage, which were substantially higher than the averages reported for the Brazilian national population, call atten- tion to the persistent health disparities that exist between indigenous and non-indigenous people in the country. In this context, the continual monitoring of physical growth should be considered a strategic tool for evaluating the health conditions of indigenous children, as well as for assessing the possible determinants of child nutritional status. Its inclusion in the routine of local health services would contribute to the advancement of nutritional inter- ventions in this segment of the population known to be particularly vulnerable to health effects of food insecurity and poor sanitation.

In 2013, remote Indigenous communities participating in ear and nasopharyngeal carriage surveillance found that around 50% of young children (mean age 13 months) had otitis media with effusion (OME), 37% had acute otitis media (AOM without perforation), and 12% had chronic suppurative otitis media (CSOM). [1] CSOM is one of the most significant health problems affecting young Aboriginal children in Australia today [2, 3] having compounding effects on hearing, behaviour and learning. It was not that long ago that children with pus draining from their ears were a common sight in remote communities with more than 50% of young children in some re- mote communities having long term CSOM. [4, 5] Although the rates of CSOM have decreased, the NT hearing service reported that 53% of young Aboriginal children living in remote NT communities still have some form of hearing loss. [6, 7] Of all forms of ear disease, children diagnosed with CSOM had the high- est levels of hearing loss. It should be noted that chil- dren with dry perforations and wet perforations (or CSOM) may be interchangeable, depending on the season and the child’s upper respiratory infection sta- tus. Combined rates of wet and dry perforation be- tween 2007 and 2011 were 26% (15 and 11%) in 0–5 year olds, 26% (10 and 16%) in 6–11 year olds, and 37% (12 and 25%) in 12+ year olds respectively [7]. While effective timely treatment of acute otitis media with perforation (AOMwiP) aims to prevent CSOM, the challenges involved in delivering appropriate treat- ment in remote settings mean that a large group of children develop chronic severe ear disease [8]. The early age of onset, the severity of the hearing loss, and the persistence of this infection, means that im- proving medical management for this condition is a priority. Once CSOM has become established, it is extremely difficult to treat. Ear discharge failed to re- solve at the end of topical antibiotic therapy in 70% Indigenous children in our previous randomised trial. [9] While topical antibiotics have been shown to be more effective than oral antibiotics and topical anti- septics, it is unclear whether there are any benefits of combining these treatments [9–11]. Other treatment options, such as prolonged antibiotic intravenous treatment in hospital have not been used (or ac- cepted) in the management of children from remote Aboriginal communities [12, 13]. Topical quinolone antibiotics (e.g. ciprofloxacin) are currently the rec- ommended first line treatment for CSOM and are theoretically more active against the bacteria com- monly associated with CSOM (Pseudomonas aerugi- nosa), but have failed to eradicate all pathogens involved (particularly Staphylococcus aureus). Our

underestimate of difference as, unlike the national data, we were unable to include ‘ fruit drink ’ (as different from ‘ fruit juice ’ ) in our calculations of sugary drinks. The higher consumption levels among Aboriginal and Torres Strait Islander children (about 1 4/5 cups/day) compared with non-Indigenous children (about 1 to 1 1/5 cups/ day) shown in this study are concerning. This is particu- larly so given the significant association between high intakes (1 to 2 cups/day) of sugary drinks and the devel- opment of metabolic syndrome and Type 2 diabetes in adults [49], both of which occur at much higher rates in Australian Aboriginal and Torres Strait Islander than non-Indigenous communities [3]. The lower consump- tion levels of sweet biscuits/cakes/muffins by Aboriginal and Torres Strait Islander children may be due to differ- ences in disposable income and/or preference.

In this article, we present the results of three research experiences articulated around the analysis of Ch’ol Indigenous children and their relationship with nature in two communities of Chiapas. Two of these experiences are part of a collaborative project carried out over more than 15 years with children and their families. 1 The third experience involves children who participate in a small community library in one of these villages where the authors participate with the maintenance of the space and the promotion of activities with cultural relevance. In this experience, children made an artisanal hand-bound cardboard book called “Libro Cartonero.” This book is a compilation of drawings made by the children and bound in cardboard covers that were hand-illustrated by the children themselves. The instructions given to children at different time during the research were to draw about their home, school, community and nature. These three experiences have in common the interest in the use of drawings and interviews as methodological devices (Agamben, 2011, Medina and Martínez 2016) that can trigger a dialogical research process (Alejos, 2012). Our work was also based on horizontal methodologies (Corona, Berkin and Kaltmeir, 2012) and participatory drawing (Literat, 2013). The total number of children interviewed for this project was 29 (16 boys and 13 girls) from 5 to 12 years of age.

the Araucanía region) attend urban boarding schools (Silva-Peña, Moya, & Salgado, 2011). Many Mapuche families live in remote rural areas without secondary schools and the government is attempting to fulfill its obligation of making education universally accessible (clearly education is also one of the children’s rights according to the United Nations Convention). Nevertheless, in this particular case the right to an education conflicts with the right to enjoy indigenous culture, language, and religion freely as contact with family and culture is even further reduced when adolescents attend boarding schools (history has shown that the systematic implementation of boarding schools for indigenous children accelerated cultural genocide). Further, the native language Mapudungun was prohibited in schools until 1994 with the excuse that it would endanger the assimilation of indigenous people into Chilean culture (Pfefferle, 2015). Only in 2009 was the Supreme Decree No 280 issued, stating that it is obligatory to teach four hours of Mapudungun weekly in schools where more than 50% of the student body are indigenous. This effort seems to be “too little - too late” to save Mapudungun from the verge of extinction, but it provides a starting point, as it at least recognizes the importance of language preservation. In recent years some childcare centers and preschools also started to provide intercultural classes about indigenous culture and language once a week. In sum, few tentative attempts have been made to promote diversity in Chile, but they seem utterly insufficient to sustainably preserve what is left of Mapuche culture and language. In the south of Chile it is currently debated how to approach the topic of the education of indigenous children in a Western school context. Many Mapuche communities claim their right for more freedom and autonomy in the education of their offspring, yet so far no mutually satisfying solution has been found. Interestingly, a recent public opinion survey showed that 95% of the participating Chileans thought it is important that Mapuche children learn their language and almost 75% of the participants even believed it is important that Mapudungun is taught in school to some degree to all Chilean children regardless of their ancestry (Pfefferle, 2015). So even public voices are becoming louder in support of the native population of their shared homeland.

The top three ranked locations although the same in each of the populations were statistically different with Indigenous drowning less frequent in pools and more frequent in baths. These findings are consistent with earl- ier research from the 1970’s [30–32] and also the unique drowning pattern found in the Northern Territory where lower pool drowning rates were found in Indigenous children 0-4 years than in Non-Indigenous children the same age [25, 26]. The authors attributed this over- representation of Non-Indigenous children to lifestyle af- fluence and access to pools. Interestingly, findings in this study agree with pool drowning being connected to more advantaged residences [12], but that Indigenous children also have access (54 %) to such pools as well, and conse- quently share the drowning risk. Better supervisor and lifeguard vigilance at public pools could potentially re- duce the 27 % of drowning events at those locations for Indigenous children. All other Indigenous drowning loca- tions were in areas at the most disadvantaged end of the scale pointing to a need for prevention education for this demographic.

Together, all the reports reveal the profound damage inflicted on the most vulnerable in our society by government, institutions and individuals. These reports inform us that policy, supported by the legal and social system, contributed to the appalling treatment of children – both Indigenous and non-Indigenous. Children, already defenceless, underprivileged or marginalised, were placed into situations of neglect, abuse and exploitation ostensibly for their benefit. Not all children suffered; and some had positive institutional or out of home care experiences. But the reports reveal the underlying misconception of the policy of removing children from their families and placing them in care. Children suffered greatly: loss of identity, loss of love and trust, harsh conditions, basic or no education, physical cruelty, sexual abuse and exploitation of their labour. Indigenous Australian children, who were further marginalised because of their race, suffered compounded hurt – the denial of their culture.