Conversations on Tangata Whenua and Asian solidarity

I moved to Australia seven years ago from Aotearoa New Zealand. I’m pleased that old friends remember me despite the Tasman sea (Te Tai-o-Rēhua) between us (a so called “marginal sea” of the Pacific Ocean (Te Moana-nui-a-Kiwa). I was chuffed to accept the invitation from Asians Supporting Tino Rangatiratanga to be on a panel: Conversations on Tangata Whenua and Asian solidarity with Tze Ming Mok, Aaryn Hulme-Niuapu, Sue Gee, Arama Rata, me and Sina Brown-Davis.

This session will be an exploration of the experiences of tangata whenua and Asian activists who are working toward decolonisation and how we can strengthen cross-cultural solidarity against colonialism and racism. We will reflect on learnings of the past and imagine ways that we can move forward together to a just future.

As part of a phenomenal four day program in the fifth Social Movements, Resistance, and Social Change Conference: Activating Collectivity: Aroha and Power hosted online and in Te Whanganui-a-Tara (Wellington).

It engages with the ongoing question of how we honour Indigenous knowledges, learn from the spirit and tikanga animating struggles, and work in genuine togetherness for the deep structural change that our planet and people urgently need. This year’s theme also provides space for responding to social issues and movements as they continue to unfold around us. In response to the Black Lives Matter movement, for instance, ‘Activating Collectivity: Aroha and Power’ also engages with questions of how we situate ourselves as allies and accomplices, confront racism within and between our communities, and expand our networks and solidarities. Our theme asks how our imaginings of collectivity, aroha, and power have been activated and constrained, and how we can extend them as a basis for liberation.

Photo taken at march on Queen St, Auckland, 2012.

One of the questions we engaged in as a panel was about our entry point into this kaupapa of Tangata Whenua and Asian solidarity. This took me down memory lane. It began with helping fund raise for the Hoani Waititi Marae in the late seventies when my family moved to West Auckland from Nairobi, Kenya.

Photo of the Maori cookbook I sold to help fundraise for an urban marae.

Most of my experiences with tangata whenua were through Pākehā institutions. In the eighties when I was doing my nursing education at AUT, I joined a trip to the Ureweras and enjoyed regular noho marae at Hato Petera school for boys, across the road from the Akoranga campus. However, most of my experiences didn’t really help me make sense of my place in the colonial sandwich (Avtar Brah). It’s only when I started reading Xicana feminism like This Bridge called my back, Black feminists like Audre Lorde and bell hooks, that I started developing a vocabulary for my own experiences. Thank goodness for theory. In 2004 I set up the Aotearoa Ethnic Network email list and then a journal with the brilliant artistic and design talents of Andy Williamson as a way of problematising the unique to New Zealand term to describe people who are neither Maori, Pākehā or Tangata Pasifika. As Tze Ming quipped in the webinar “before we had a group for ethnics”. From this network, we also developed a journal and you can see some of the covers from the issues below. I’m going to revamp my website soon so will share the archive and contents in full.

Back in the day (2012) Philipa K Smith used a case study from AEN in her PhD and a subsequent publication: New Zealanders on the Net: Discourses of National Identities in Cyberspace. Smith used a discourse-historical approach of critical discourse analysis, emphasising the role of power and ideology in the construction of identities.

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I also helped develop the Tangata Tiriti interactive workbook in 2006 which has accurate information about the Treaty of Waitangi in plain English for migrants. I’ve also written an essay for for the Are we there yet? series, a prelude to the election in November 2011, with a focus on the ‘wish list’ of Generation Xers; their hopes, dreams, aspirations and vision for New Zealand society. I wrote:

I began this piece by talking about my family’s welcome to New Zealand through consumer capitalism at Foodtown. On reflection, the supermarket is an apt metaphor for migration, both for the visibility and promise of its products and for the invisibility of its processes. Neoliberal narratives of individualism and ‘choice’ render invisible both the dispossession of the local and Indigenous and the economic imbalance necessary for the movement of goods and people to the West in order for capitalism to flourish. Yet if these two aspects of migration were made visible, in the same way that more ethical consumptive practices are becoming a feature of contemporary life then other kinds of relationships might be made possible. In the case of ethnic communities, direct negotiation with Maori for a space where Indigenous Maori claims for tino rangatiratanga, sovereignty and authority are supported while the mana of newcomers to Aotearoa is upheld hold promise.

Thanks friends Menghzu Fu and Kirsty the chance to do some walking down memory lane and also to consider what kind of future I might be able to contribute to both in Aotearoa where my family still live and here on the unceded lands of the people of the Kulin Nation.

Women of Colour ‘in’ academia: Political creativity and (im)possibilities of solidarity

This week has been a biggie with lots of zoom presentations, all of which were marvellous. The fabulous and thoughtful Lutfiye Ali gathered Shakira Hussein, Denise Chapman, Torika Bolatagici, Jesica S. Fernández and I together to talk solidarities in academia.


Expressions of embodied political creativity and radical being of and for solidarities of resistance have been long described by African American, Global South, decolonial, Indigenous and other women of colour scholar activists (e.g., Hill Collins, 2002; hooks, 2000; Grande, 2000; Lorde, 1984; Lugones, 1987; Moraga, 1983; Smith, 1999; Wynter, 2003;). Gloria Anzaldua (1990) writes:

A woman-of-color who writes poetry or paints or dances or makes movies knows there is no escape from race or gender when she is writing or painting. She can’t take of her color and sex and leave them at the door of her study or studio. Nor can she leave behind her history. Art is about identity, among other things, and her creativity is political.

As Women of Colour, this way of thinking about identity and knowledge inspires us to ask how we see our own positions in the academy. How do (neo)liberal institutions receive the voices and knowledges of racialized women? How do we co-create safe and enabling spaces for embodied knowledge production that is inherently political? What are ways in which we resist, disrupt, and transform intersecting vectors of inequality? Through these conversations, we will not only name heteropatriarchial and institutionalized racism through which the women of Colour and their labour are tokenised, appropriated, co-opted and silenced in academia, we will also identify the moments for forging and fostering solidarities of resistance, belonging and social change. We seek new spaces of knowledge production that are agentic, productive, disruptive while driving change for and with the communities through which we each engage our work. This discussion panel offers a way to think about ‘political creativity’ and generative possibilities for forging solidarities of resistance and belonging.

Screenshot of the panellists on a computer screen.
The panellists: Screenshot by Torika Bolatagici.

2020 International Conference of Community Psychology at Victoria University had as its theme celebrating and interrogating “how solidarities are fostered and sustained within community contexts, across borders and boundaries, digital and non-digital spaces, and through process of knowledge production. Importantly the conference aimed to provide a critical platform for ideas and work emerging from coalitions with practitioners, artists, educators, activists, and diverse communities.

On the limits of empathy

Every week during November 2020, the indomitable Mary Freer has put together an amazing online program as part of the Compassion Revolution. It was a privilege to be in conversation with Katerina Bryant (writer and PhD student whose first book, Hysteria: A Memoir of Illness, Strength and Women’s Stories Throughout History (NewSouth) is out now; Dr Summer May Finlay (Yorta Yorta woman, public health professional and academic at the University of Wollongong) who played a pivotal part in shaping our discussion). Our session: Beyond empathy: stories that change practice was beautifully chaired by Dr Kate Bowles (Associate Dean International at the University of Wollongong Australia).

The stories of patients and those with lived experience of our health and social care systems are vital to improving the quality of our services and building our awareness and empathy. How do we challenge ourselves to go further than listening? How can we honour the stories that are so generously shared and take the lessons back to our practice?

T Shirt merchandise from the online conference. The logo says: You've got this and we've got you.

An interview with nurse and multi-disciplinary researcher Dr Ruth De Souza

I had a chat with Ben Rodin from The Australian Nursing and Midwifery Journal . I said a few things. You can read more

“All bodies are not treated the same and we’re not affected by the virus in the same way… how we do healthcare actually matters… There’s some arguments that the failure to care, and poor quality [of care], are actually embedded in the structures and processes of the healthcare system.”

How inclusive is craftivism?

I was invited by Hayley Singer convenor of the Environmental Arts & Humanities Network at the University of Melbourne to be a respondent to one of their seminars, exploring the COVID 19 Global Quilt Project co-instigated by artists, activists, and academics Kate Just and Tal Fitzpatrick. The @covid19quilt project started in April 2020 and the Instagram account invites people to digitally submit a textile square and a small written text about life during the COVID-19 pandemic.

The seminar series explores how environmental arts and humanities practices can help societies process social, cultural and environmental complexities by asking environmental arts, humanities scholars, artists and storytellers to reflect on ways environmental arts and humanities can provoke deep engagement, nuanced understanding, and support robust community discussion about the multiple and overlapping environmental and cultural crises of our times. Each seminar hosts an invited interdisciplinary scholar to provide a response to the primary presentation (this was me). You can listen to the webinar.

Images below are a couple of screenshots from my laptop.

What does meaningful participation look like in Citizen Science?

On October 7th 2020 I was invited to be a keynote in The Australian Citizen Science Association (ACSA) CitSciOzOnline Early-Mid Career Researcher (EMCR) 1/2 day symposium. The aim of the symposium was to unite citizen science-aligned researchers in Australia to interrogate and explore research and practice in citizen science across the country. It featured keynotes, lightning talks, Q&A, interactive sessions, and networking opportunities, to build a community of practice in citizen science research.

Photo of frog on a banana, to illustrate  a project called FrogID, which used citizen scientists to map the decline in Sydney of the iconic Australian Green Tree Frog (Litoria caerulea).

My abstract
Research can change the world, but how it is undertaken is not always beneficial. First Nations critiques of Western science have suggested that many aspects of research resemble colonial processes and are extractive, taking raw contextualised material from people, and making them abstract and universal for the benefit of researchers or institutions. Building on participatory action research and community-based participatory research (CBPR) methods, where researchers collaborate with community partners to investigate issues, citizen science offers a new iteration of co-producing knowledge and participating in the scientific archive outside the university. However, there are also concerns that a participatory agenda is the outcome of reduced funding, and that underfunded research institutions are using unpaid labour to produce knowledge for no cost. This presentation covers principles for working with community partners in authentic, collaborative, sensitive and culturally safe ways.

Virtually Racist: Anti-racist work in the time of Zoom.

In our continued presence, blackfullas are the uncomfortable truth that this nation must reconcile itself with. We are the most courageous when it comes to conversations about race having copped the full brunt of its violence but also because we have nothing else left to lose – literally.Chelsea Bond

Courage and racial literacy are urgently required to reconcile with uncomfortable truths in the time of COVID19 and Black Lives Matter (BLM). However, reckoning with racism is optional for some as Chelsea Bond notes, but for Aboriginal and Torres Strait Islander peoples, racism is profoundly imbricated in all the systems and structures encountered, requiring continual exhausting negotiation (see Bronwyn Fredericks, Debbie Bargallie and Bronwyn Carlson). The luxury of not having to think about racism is not available to Black people, and people of color. The aim of this blog is to facilitate discussion and share my own learning about how “we” might be more critical and reflexive in our online gatherings. I will be deliberately vague about protagonists in the spirit of using my painful experiences to educate and call in rather than shame and blame. But, yes, you know I see you!

The racialised nature of the pandemic and of police brutality, and deaths in custody, have become more perceivable for white people, some of whom are engaging in reflection and discussion on race in new ways. Gary Yonge quips that Britain has discovered racism in the same way that teenagers discover sex. Reading groups have flourished as have a proliferation of book lists. My favorite Melbourne book store Readings has a list of Books to help you understand & fight white supremacy. However, whether we can read ourselves out of racism when we did not read our way into it remains in question. The contaminated barrel needs a systemic solution not the removal of a few bad apples.

For children of empire or people of color (this term and terms like BIPOC and BAME are contentious and complicated, and are a whole other blog post), it seems an incredible opportunity to be heard and to be believed. Hanif Kureishi calls it:

our #MeToo moment, a paradigm shift, with some significant acknowledgement of how unalike the experiences of black and white people are, and of how traumatic the infliction of racism is.

Virtual meetings are par for the course, and processes that we either never imagined or thought were too difficult to replicate online have become ubiquitous. I never thought I’d do an exercise class with parents that live in another country or State, but twice a week I do Yoga for seniors on Zoom. A couple of months ago, my partner and I hosted a thirteen hour online eightieth birthday for my Mother with a hundred people in New Zealand, Canada, the US, England, Lebanon, Myanmar, India, and elsewhere. Virtual care, virtual parties, and family gatherings have seemingly seamlessly moved from real life to virtual platforms. There’s now etiquette available to help us manage conversations on a screen with multiple others. But what I am curious about is how things that were difficult face to face are possibly made even more complex and difficult in a virtual environment. Things like anti-racist work. Here I see a gap. Where’s the manual about how to create anti-oppressive spaces that do not reinscribe social relations or that center whiteness? How do people from non-dominant groups working at the interstices of social justice and pedagogical spaces look after ourselves? How can we adequately intervene in online power relations?

In my recent Zoom experiences, the invitation has been for me as a person of color (I use this term to externalise somewhat, remembering that identities are both socially constructed and individually determined) to provide counselling, forgiveness, praise or absolution. Rather like a confessional, the interlocutor wanted to recount their own experiences of witnessing racism. This is despite being the prime beneficiary of the structural arrangements in a white settler-colonial nation, and as an identity which already occupies a lot of space. This centering is an Occupational Health and Safety issue for those of us who have made it our lives work to challenge oppression wherever the miasma of institutional racism lingers. While there are a plethora of memes about the Karen and Becky’s of the world, there’s also the ‘concern troll’ who feigns concern so that they can do this very thing – distract from the process and put the focus on themselves…stalling all the work. Often, they are a loudly professed “ally” who is all about themselves and their career ambitions as the ultimate savior of, advocate for, and “scholar-activist” on behalf of “vulnerable” [black] peoples (Kati Teaiwa). Taking up space, instead of making a commitment of allyship or being an accomplice willing to undo the mechanisms that allow for the continuation of racism (Ruth Herd).


“racism is not mine, it is yours. What you do is not called “help” when it is your mess we are cleaning.” Catherine Pugh Esq (2020)

So I have polled my Facebook pals and come up with some strategies for when as a person of color you get derailed on Zoom.

Tell the speaker to drink a cup of “shut up” juice* and move on

  • Ignore the speaker. Shut that down immediately and unequivocally, then avoid like COVID19 thereafter (erect walls with razor wire & border patrol much). Time spent on this BS is wasted.

Name the behaviour

  • “That’s an interesting anecdote. But the issues we need to focus on are …” (Tahu Kukutai).
  • “When you say things like X, it means other people can’t talk about Y (the reason everyone is here) and the meeting becomes about you instead. This makes people feel coopted/ exhausted/ resentful/ distracted. I can suggest somewhere you can go for a one-on-one conversation where it’s ok for it to be all about you (eg a counsellor) if you’d like?” (Alison Young).
  • “Thanks for being so prepared to be open and share your experiences. What we also need to work on is moving away from centering white experience. That something that we should all do in our own time. What we want to focus on here is …”
  • Say how you feel: “I’m tired. I deal with this every day. Please look after yourself. Bye”
  • Name it clearly and simply: “I feel that you take up too much space and need to leave room for others in the conversation. And I also feel like you want me to talk to you about race all the time and it’s exhausting for me.” If that doesn’t work – or you feel it’s too much to do alone – ask the moderator to help.

Use as a teachable moment

  • Time and energy pie-diagram. Time and energy are where power lies. Ask them about how much time and energy space they are taking. Ask them if it’s proportionate, compassionate, and aware. Ask them to ask other White people to carry some of this stuff for them, supportively, it’s their load (Karlo Mila).
  • Suggest a person to do the work and undertake a personal journey (in their own time. “Thank you for your contribution but this is taking a lot of important time from the class”.
  • Take the comment and run with it, asking a series of questions that expose the problematic effects of the comment. They will get hurt/embarrassed but the set up will mean they run to others for absolution.
  • Invite them to sit with their discomfort, in silence (also put this in the group agreement).

Create brave collective spaces

  • When acknowledging country at the start of the session, also develop group agreements that outline the purpose of the meeting.
  • Develop a process for people to handle their discomfort. I suggest people “lean into” their discomfort. Megan McPherson in her Acknowledgment of Country: adds “In this session, we may cover issues that may make you feel uncomfortable. I ask you to sit with this discomfort-this session is not about your discomfort, rather it is about reflecting upon your privilege and thinking about the ways you can activate your privilege and capacities, to live in Australia in better ways. I ask you this as a non-Indigenous person at XXX. It is not my Indigenous colleagues’ job to fix your discomfort about racism in Australia”.
  • Stay on purpose. This might mean, stressing the importance of putting off-topic issues into ‘the parking lot’ for people to pick up for themselves after the session.
  • Name the behaviors in the group agreement and the need for white allies to intervene and not allow it space. Revise before every meeting and participants agree before joining and revise subsequently.
  • Use a ‘microcosm exercise’ and ask the group to actively reflect on the how the very dynamics of the conversation in the room are a microcosm of how it works in the world, so to think about who talks, who is taking up space/time/resources, who is silent, who is doing the labor.
  • Invite another white person to practice solidarity, a colleague who has the competency to sit this person down and tell them that they are performing a type of aggression against you and to help them think about the impact their stories are having on people of color (Shiranthi Fonseka).

Manage questions or interactions

  • Provide time for people to discuss their questions and have them peer-reviewed as Eve Tuck suggests. Tuck’s twitter thread is the best thing ever written about managing Q and A sessions in ways that attend to power differentials.
  • Frame question and comment time in a way that asks people not to privilege their angst (Carol D’Cruz).
  • Have a person facilitate the Q & A (and triage the questions).
  • KaeLyn from Autostraddle has some great ideas including using a progressive stack to centre marginalized voices or people who are directly impacted by the issues you’re discussing. Marginalized folx could include people whose voices often don’t get heard first; people who do not share the dominant language in the room etc.
  • For the questioner, here is an amazing flowchart by Dani Rabaiotti, and a list of Do’s and Don’ts.
Academic etiquette: Tips on conducting yourself at an academic conference

Suspend engagement for repeat offenders

  • “If the first three sets of engagement with such people do not yield some movement of a shared understanding then I don’t engage. Almost always these individuals bombard you with their attention-seeking behavior at every opportunity that is made available to them. I have learned, that if I have made the initial effort and know that this person is not there to challenge themselves then holding back on giving them airtime is the best way to preserve your own energy” Tayyaba Khan.

Take care of yourself

  • Set parameters for yourself to maintain your own peace and energy. Also see Reni Eddo-Lodge‘s book, reference below.
  • Nice long hot bath & chocolates (Tee Peters).

After the event

  • Invite white allies to have an “after-party” where allies can support the person who feels uncomfortable (Shandra Shears Bombay).

For future events

  • Set boundaries for your own well-being before the event.
  • Create a structure where marginalized people will be given space first
  • Prime the moderator.
  • Provide the group with reading before the event.
  • Set boundaries about what’s appropriate and what’s not at the start.

It takes a lot of effort to make the future. One or even several demonstrations will not achieve that. The effect will be cumulative. Some things are now impossible, and other things have become possible. And so this moment of economic breakdown and capitalistic stagnation, when neo-liberalism is destroying the very ground on which it is built, is an opportunity Hanif Kureishi

Further reading

  • Arao, B., & Clemens, K. (2013). From safe spaces to brave spaces: a new way to frame dialogue around diversity and social justice. In L. Landreman (Ed.), The art of effective facilitation. (pp. 135-150). Sterling, VA: Stylus

Deepest thanks to the following for their friendship and input into writing this piece.

Alex Bhathal, Sandra Shears Bombay, Esther Cowley-Malcolm, Sarah Craig, Shiranthi Fonseka, Bianca Hester, Tayyaba Khan, Tahu Kukutai, Jade Lillie, Debbi Long, Leah Manaema, Chris McBride, Rebecca McIntosh, Moata McNamara, Megan McPherson, Rebecca Monson, Laura Quin Ogle, Kat Poi, Zaky Shah, Kati Teaiwa, Nelly Thomas.

What do the Citizen’s Amendment Act (CAA) and the National Register of Citizens (NRC) mean for diasporic Indians?

Folks at Southern Crossings, a collective who aim to create space within the “Australian national imaginary and mediascape” for South Asian voices, invited Indian Australian writers to respond to the Citizen’s Amendment Act (CAA) passed on December 12, 2019 and the National Register of Citizens (NRC) in India as diasporic Indians in the context of living in Australia. These responses have been published as one statement to mirror in online form the idea of a “morcha”, a gathering of people to protest for a cause. I’ve added my thoughts below.

Australia and India are magnificent, beautiful, complicated countries that have powerfully shaped me. Goa in India is my ancestral homeland and I live as an uninvited guest on Boonwurrung country in Victoria, Australia. Although distant geographically, both countries share in the escalation of ethnonationalism and border securitisation in response to imagined threats to the culture of the nation. Australia is a British settler-colonial society that 250 years ago invaded Indigenous lands. It has relied on migration for building its nation, yet it invented and imposes the particularly cruel policy of indefinite, mandatory offshore detention. It also perpetrates colonial practices against First Nations peoples while it “celebrates” multiculturalism, and increasingly militarises its police. India suspended Article 370 of the constitution in August 2019, erasing the autonomy of Kashmir, India’s only Muslim-majority state, brutally suppressing a population of eight million people. More recently the Citizen’s Amendment Act (CAA) passed on December 12, 2019 and the National Register of Citizens (NRC) have instituted Hindu supremacy into the legislature.

The writer at the New Zealanders Against Indian Citizenship Amendment Act 2019 protest at Aotea Centre on 21 December 2019.

That two politically and militarily powerful nation states who pride themselves on secularism and the capacity to be inclusive, multicultural and multifaith are so paranoid about identity and security, and anxious about “outsiders” such as “maritime arrivals” and Muslims is breathtaking.

As we approach celebrations of Australia Day and Indian Independence day, I believe that international pressure must be put on the Indian government for its violent treatment of citizens in Kashmir; its brutality against peacefully protesting students and communities exercising their democratic right to dissent; and its discrimination against Muslims and other minority groups. I also believe that non-Indigenous Australians and the Australian government must give pause on this purportedly “national day” to consider the damage and harm to First Nations people from the violence of continuing settler colonialism, and to close the camps and resolve claims for asylum speedily in accordance with our international obligations. Here in Australia, amidst the smoke haze and a burning continent, there does not seem much to celebrate.

Photo taken by the author in the aftermath of a bushfire 2019

Cultural safety in the arts

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Robyn Higgins and I wrote a chapter about cultural safety in the arts in an exciting new book about community engaged arts practice The Relationship is the Project edited by Jade Lillie with Kate Larsen, Cara Kirkwood and Jax Jacki Brown.

Image from the cover of the book The Relationship is the Project. The book is on a wooden table.

It is exciting to be in such a fabulous line up with folks like Genevieve Grieves about working in First Nations contexts; Caroline Bowditch on access and disability; Dianne Jones, Odette Kelada and Lilly Brown on racial literacy; and other contributors including: Esther Anatolitis, Adolfo Aranjuez, Paschal Berry, Lenine Bourke, Tania Cañas, Rosie Dennis, Alia Gabres, Eleanor Jackson, Samuel Kanaan-Oringo, Fotis Kapetopoulos, Kate Larsen, Lia Pa’apa’a, Anna Reece, Daniel Santangeli, and Jade Lillie.

Table of contents from the book The Relationship is the Project

Here’s a tiny excerpt from our chapter to whet your appetite.

Why do we need cultural safety?
Australia is a white settler colony in which British invasion and colonisation have institutionalised whiteness. Like other sectors, this history is strongly reflected in the arts, including the ways our practitioners, organisations and institutions develop and deliver projects in collaboration with artists and communities.
Arts organisations often prioritise and centre whiteness. For people and communities who are not white, these organisations may not be seen as appropriate, accessible or acceptable, which can prevent participation and engagement.

Since I wrote this post the chapter has been edited and reprinted twice:

Artshub: Taking action for cultural safety and in The Arts Wellbeing Collective in their publication: Spotlight: The Arts Wellbeing Collective magazine – Edition 2 




The potential and pitfalls of AI.

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I wrote a piece for the Australian College of Nursing’s (ACN) quarterly publication. Cite as: DeSouza, R. (Summer 2019/20 edition). The potential and pitfalls of AI. The Hive (Australian College of Nursing), 28(10-11).

Many thanks to Gemma Lea Saravanos for the photo.

The biggest opportunity that Artificial Intelligence (AI) presents is not the elimination of errors or the streamlining of workload, but paradoxically the return to caring in health. In eliminating the need for health professionals to be brilliant, as machines will be better at diagnosis and other aspects of care, the need for emotional intelligence will become more pressing.

In his book Deep medicine, he recounts how he grew up with a chronic condition, osteochondritis dissecans which was disabling. At 62, a knee replacement surgery went badly wrong, followed by an intense physical protocol which led to devastating pain and distress leaving him screaming in agony. Topol tried everything to get relief and his orthopaedic surgeon advised him to take antidepressants. Luckily his wife found a book called Arthrofibrosis, which explained why he was suffering a rare complication of inflammation affecting 2-3% of people after a knee replacement. His surgeon could only offer him future surgery, but a physiotherapist with experience of working with people with osteochondritis dissecans (OCD), offered a gentler approach that helped him recover. AI could have helped him by creating a bespoke protocol which took into account his history which the doctor did not. The problems of health care won’t be fixed by technology, but the paradox is that AI could help animate care, in the case of the robotic health professionals he had to deal with in the quest of recovery.

The three D’s

Nursing practice is being radically transformed by new ways of knowing including Artificial Intelligence (AI), algorithms, big data, genomics and more, bringing moral and clinical implications (Peirce et al., 2019). On one hand, these developments have massive benefits for people, but they also raise important ethical questions for nurses whose remit is to care for patients (Peirce et al., 2019). In order for nurses to align themselves to their values and remain patient centred they need to understand the implications of what Topol calls the three D’s: the digitisation of human beings through technological developments such as sensors and sequencing are digitally transforming health care; the democratising of medicine as patient’s knowledge of themselves becomes their possession rather than that of the health system and lastly, deep learning, which involves pattern recognition and machine learning.

Data is fundamental to AI

The massive amounts of data being collected -from apps, wearable devices, medical grade devices, electronic health records, high resolution images and whole genome sequences- allows for increased capability in computing to enable the effective analysis and interpretation of such data, and therefore, making predictions.

Artificial Intelligence (AI) includes a range of technologies which can work on data to make predictions out of patterns. Alan Turing, who is thought to be the founding father of AI, defined it as the science of making computers intelligent; in health AI uses algorithms and software to help computers analyse data (Loh, 2018).

Applications of AI
Data are transforming health in two key ways:

Assisting with enhancing patient care – from improving decision making and making diagnosis more effective and accurate to recommending treatment.
Systemising onerous tasks to make systems more effective for health care professionals and administrators.

Applications are emerging including automated diagnosis from medical imaging (Liu et al., 2019), surgical robots (Hodson, 2019), trying to predict intensive care unit (ICU) mortality and 30-day psychiatric readmission from unstructured clinical and psychiatric notes (Chen, Szolovits, & Ghassemi, 2019), skin cancer diagnosis; heart rhythm abnormalities, interpreting medical scans and pathology slides, diagnosing diseases, and predicting suicide using pattern recognition, having been trained on millions of examples.

These systems overcome the disadvantages of being a human for example being tired or distracted. And from a knowledge translation point of view, rather than waiting for knowledge to trickle down from research into practice over decades, steps could be automated and more personalised (Chen et al., 2019).

AI can also be used to better serve populations who are marginalised. For example, we know that not everyone is included in the gold standard of evidence: randomised trials. This means that they are not representative of entire populations, so therapies and treatments may not be tailored to marginalised populations (Chen et al., 2019; Perez, 2019).

Potential for algorithmic bias in health
However, large annotated data sets on which machine learning tasks are trained aren’t necessarily inclusive. For example image classification through deep neural networks may be trained on ImageNet,which has 14 million labelled images. Natural language processing requires that algorithms are trained on data sets scraped from websites that are usually annotated by graduate students or via crowdsourcing which then unintentionally produce data which embeds gender, ethnic and cultural biases. (Zou & Schiebinger, 2018).

This is because the workforce that designs, codes, engineers and programs AI may not be from diverse backgrounds and the future workforce are a concern also as gender and ethnic minorities are poorly represented in schools or Universities (Dillon & Collett, 2019).

Zou & Schiebinger (2018) cite three examples of where AI applications systematically discriminate against specific populations- the gender biases in the ways google translate converts Spanish language items into English; software in Nikon cameras that alert people when their subject is blinking, identify “Asians “as always blinking and word embedding, an algorithm for processing and analysing natural-language data, identifies European American names as “pleasant” and African American ones as “unpleasant”.

Other similar contexts include crime and policing technologies and financial sector technologies (Eubanks, 2018; Noble, 2018; O’Neill, 2016). Also see (Buolamwini & Gebru, 2018). But, how does one counter these biases? As Kate Crawford (2016) points out “Regardless, algorithmic flaws aren’t easily discoverable: How would a woman know to apply for a job she never saw advertised? How might a black community learn that it were being overpoliced by software?”.

Biased decision-making in a systematic way might happen with individual clinicians but they also rely on clinical judgement, reflection, past experience and evidence.

Digital literacies for an ageing workforce
We have a crisis in healthcare, and in nursing. Our technocratic business models with changes from above are contributing to “callous indifference” (Francis, 2013). Calls to reinstate empathy and compassion in health care, and ensure care is patient-centered, reflect that these features are absent from care.

In the meantime, we have had Royal Commissions into aged care, disability and mental health. For AI to be useful, it’s important that nurses understand how technology is going to change practice. Nurses already experience high demands and complexity in their work, so technological innovations that are driven from the top down risk alienating them and further burning them out (Jedwab, et al. 2019). We are also going to have to develop new models of care that are patient centred and codesigning these innovations with diverse populations is going to become increasingly important.

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