During APASC25, Cam Edwards—chair of the APA Aboriginal and Torres Strait Islander Health Committee and a proud Kamilaroi man—sat down to chat with Samoan-Tongan physiotherapist Dr Oka Sanerivi about the role cultural safety takes in improving patient outcomes.

‘It’s a bit funny that there’s not an agreed upon national definition within Australia about what cultural safety really means but inherently, as First Nations people, we kind of understand what it feels like,’ Cam says.

According to Oka, cultural safety is critical in healthcare. 

‘There is no healthcare without trust, without relationships, without confidence.’

Physiotherapy treatment requires a certain level of vulnerability and trust. 

‘That trust is cultivated in social ways and culture,’ Oka says. 

‘I think there’s an increasing recognition that every interaction is cultured in some way; there is no such thing as… not having a culture.’

Their discussion highlighted a fundamental tension in Australian healthcare; although the concept of cultural safety is widely discussed, its importance and practical application are often misunderstood.

Much of Cam and Oka’s work as physiotherapists and advocates has focused on re-centring the voices of their people. 

‘Physio was born out of England in the 19th century and it’s successfully preserved that language, that way of thinking, looking at our body as a machine, looking at sort of separate entities, not talking about spirituality, whereas our peoples are deeply spiritual,’ Oka explains. 

‘We’re deeply connected to the cosmos, to land, to other life forms.’

This reimagining of physiotherapy challenges deeply embedded Western medical thinking. 

By questioning the profession’s foundation, Cam and Oka are advocating for a more inclusive model that validates Indigenous and Pacific knowledge systems alongside conventional practice.

‘Cultural safety is ultimately about upholding the dignity of the people before us that seek our services… it’s determined by them,’ says Oka. 

‘The ultimate aim of cultural safety is equitable health outcomes, so health equity. 

'And health equity recognises that people have different needs.’

‘If [mob has] a positive or a negative experience with a healthcare professional, institution, clinic, whatever it might be, mob talks.

'And if it’s a negative experience, no-one is going to come there,’ Cam says. 

‘I think that’s where we’ve actually experienced a lot of the healthcare gap that exists for First Nations people in Australia is because those institutions previously were the ones stealing children, were the ones making birthing mothers stay outside rather than come into the wards for care.

‘This immense racism has an intergenerational trauma effect where words are passed down for generations; words are passed down and become cultural ideals or understandings of us versus them in some cases. 

'But there are very many instances that I’m aware of where that trust has been rebuilt by healthcare professionals or institutions and it comes through that posturing.’

Creating a safe environment means taking into account not only a patient’s ethnic background but also their gender, sexuality, disability and religious status. 

Oka says that these factors form a person’s view of what physiotherapy is and what services a physiotherapist may be delivering.

This intersectional approach reflects a growing understanding within allied health that cultural safety cannot be reduced to a single dimension of identity. It also involves some self-reflection.

‘The critical piece, which is often overlooked, is that it starts with ourselves, you know, as practitioners and that critical reflection of: what do I bring to the interaction? What’s my culture? How does it dominate this interaction? How does it influence who holds the power?’ Oka says. 

‘The more experienced I’ve become, the more I recognise that I need to remain flexible and open-minded and teachable by our patients from our communities.’

However, it should not only be Indigenous physiotherapists who are leading the charge.

‘When someone does genuinely come with the posture and the reciprocity and the love that [Oka’s] spoken about, how welcome they are into [our] communities,’ Cam says.

‘My ask for our physio profession is that we need your allyship,’ Oka says. 

‘We need our allies there to be the voice when we can’t be in the room. To pose the questions. 

'Also to give us the opportunities to speak for our peoples and our needs… this benefits all of us. This enriches the physiotherapy profession globally.’

Listen here to Cam and Oka’s episode, ‘Exploring Indigenous cultural protocols’, and other episodes from APASC25.