Reflections on culturally competent practice with Mthobeli Ngcanga
Narrator [00:00:02] Welcome to the Emerging Minds podcast.
Chris Dolman [00:00:08] Hello, my name’s Chris Dolman, and today we’ll be hearing from Mtho Mgcanga, who is originally from South Africa, and Xhosa Tribe. Mtho has worked extensively with children and families from refugee communities here in Australia. In today’s episode, we’ll be hearing about some of the practices he draws on in his work with children to support their mental health and social emotional wellbeing in ways that reflect both cultural competency as well as curiosity.
[00:00:37] So thanks again Mtho for your time and generosity today. As I mentioned, we’re really interested in hearing about your work with children and families. Mtho if you could tell us a bit about your service and your role there as a starting point?
Mthobeli Ngcanga [00:00:53] Yeah. So I work for STTARS, which is Survivors of Torture and Trauma and Rehabilitation Services. We support people from a refugee background, people who have experienced torture and trauma. My role is specifically with children and families. So I look after two programs, which is the Child and Youth Program and the Intensive Family Program. So within the child and youth program, we have four counsellors who are doing work in schools and we also do home visits, also do some counselling as well in their offices. So we also do group programs at school, in schools and we do school holidays programs as well.
Chris Dolman [00:01:41] How do these families, children and families find their way to your service?
Mthobeli Ngcanga [00:01:46] So for us, we get referrals from schools. From other services, like other practitioners, and sometimes we get referrals from youth justice. So we get a variety of referrals.
Chris Dolman [00:02:02] Could you speak a bit about how you begin to work with children and so you get a referral from from a school? How does it happen from there with your services?
Mthobeli Ngcanga [00:02:11] So we have two approaches. One, we have a program that we call In School Residence. So we have a counsellor that would be in a school and what they do in school, they list I mean, they would have maybe a caseload of three young people from the school and they would work with the school to process any referrals that are within their school. They also serve as a consultant of some sort within the school where if a teacher, for example, is finding it difficult to work with this young person or they don’t know how to respond to a ceratin behaviour, then they can consult with our counsellor. That is one stream of dealing with referrals. And then the second one is where the schools or the doctors on youth justice, they send us referrals via our intake co-ordinator. We will have an assessment done, so we will distribute their names to counsellors and then we going to assessments. So how we do an assessment is we do it in two folds, one with a young person and secondly with a family. The idea is that we want to understand the context holistically and to see also if the parents have an understanding of what is actually happening with their child. And if sometimes they do have an understanding to also understand their understanding as to whether is it the same understanding that the young person has about what is actually happening with them. And also from the child’s perspective as well, we try to make sure that we understand the child that understands the situation from their perspective, and also find out if they have a perception of their parents perspective of the situation. Then that gives us a broad understanding of the situation when we think of the child. And then on top of that, we also consult with their school, if the school made the referral. And to see their understanding of the situation for the young person.
Chris Dolman [00:04:15] How do you begin to, you know, in those first conversations with children. How do you begin to engage with them you and your team? How does that work?
Mthobeli Ngcanga [00:04:27] Most often young people, because we work with young people from 5 to 25, the youngest children may not understand fully what it means to come from counselling, but they will understand that ‘we have someone who is gonna to support me’. So what we normally do is start off by creating a rapport with them by doing some drawings. Now those drawings, we can get to see what is happening in their world through drawings.
Chris Dolman [00:04:54] Do you prompt them in terms of what you ask them to draw?
Mthobeli Ngcanga [00:04:58] No, for the first time we just let them draw. Just for the fun of trying, and then that helps us understand how comfortable are they with certain things. And why are there things that are interesting for them, and then we can work from there.
Chris Dolman [00:05:13] When you say work from there, what what do you mean? How do you use those drawings?
Mthobeli Ngcanga [00:05:16] For example, if we see that a child is drawing graphic material, then we. That raises questions for us. And then we can start thinking about. Okay, is there any situation that is linked with these drawings or have you had an experience that you can say ‘these drawings refer to or relate to’? And then the child may say, yes. I’ll give you an example. When I saw tweens from Nepal. So the teens drew a church and a cross and then they drew some kind of ghosty things, that kind of drew my attention. I said ‘oh what is actually happening here? Can you tell me more about what’s happening here?’ He said ‘oh, when I was back home, I saw a lot of bodies, dead bodies going along the creek. And we would always have times where we see people going to the church for the funeral’. And then he also said ‘with these dead bodies that went along the river, some of them we didn’t know what happened with them. And then I also tried to find them’. So when do you get these? Why is this important? He said, ‘Oh when I’m asleep, sometimes I’m awake because of these pictures’. So then that led me to understand what is actually happening. So when I thought of nightmares, then I can see what has actually happened and what led to that.
[00:06:52] For example, in this situation, it was easy to find out what happened with the child. But at the same time, I had some more questions to ask, which led me to understand why they were getting those nightmares. It dawned as I ask more questions that these kids were watching horror movies. And with those horror movies, then when they go to bed, what the brain remembers is what they were scared off back home. And then when they present here with nightmares and stuff like that, it presented something that happened in the past, not necessarily what they watched on the movie. That was interesting for me. We responded I mean, I responded by suggesting that maybe, mum, let’s look at reducing their screen time and the content of the screen and see if we can see some changes. And within two weeks, there were changes yeah. Kids stopped having problems with nightmares and being scared to go to the toilet at night.
Chris Dolman [00:07:52] So this was a conversation that it kind of continued with the parents, with the mother of these twins?
Mthobeli Ngcanga [00:07:57] Once the kids told me I mean, once I saw the picture and had a conversation with the kids, the next step was to talk to the parents. I also involved the class teacher because the class teacher, I was going to help us to give them books that were relevant, age relevant for them, so that when we say take away screen, we don’t just take our screen in a punitive way. We replace it with something that is full of fun as well. So they are not losing in the process.
Chris Dolman [00:08:25] What would you say you’re kind of listening for in those early conversations?
Mthobeli Ngcanga [00:08:28] What I’m looking for in the early conversation is what is important in the child in relation to what I’ve been told about the situation about the child. Because I want to hear the child’s understanding of what is actually happening with them.
Chris Dolman [00:08:44] Why is that important for you to really seek that out Mtho?
Mthobeli Ngcanga [00:08:47] Because when we look at situations, most of the time we are informed by what we think about what the situation might be and sometimes not informed by the person’s perspective. So when we get the person’s perspective, it helps us to come up with a proper and more relevant approach to deal with the situation. Because its their experience, as much as we have an understanding of what could be happening.
Chris Dolman [00:09:17] Are there ways you found helpful to kind of bring what you are understanding from the child into that conversation with the parent?
Mthobeli Ngcanga [00:09:24] As I’ve said with a child, we want to understand the situation from their perspective. We also want to get the parents perspective. But on top of it, we also want to see the parent’s skills in dealing with the situation, because that is important. Most often you find that parents see that there are behaviours that they don’t like about children, and they understand that this has to do with probably what happened in the past. And then the approach would be, ‘look, you have to forget this, this is not helping you’. So that approach wouldn’t be the best for the kid. So you want to make sure that you have an understanding of the parents’ understanding of the situation, and their perspective on how to deal with that situation. And then from there you get to learn what the parents know about the situation and how they probably have dealt with these things in their culture. And then you can then work from there. So this approach maybe it worked well for certain situations. Let’s see if it works for this situation. And then let’s maybe add some more things that might build on what you are doing, so that we can make sure that we give the best for the child.
Chris Dolman [00:10:45] Is that an important position for you to take, a sense of building on what the parent’s doing? Is it in that sense?
Mthobeli Ngcanga [00:10:51] Yeah, it is important because in as much as I might come with some understanding that is what we call expertise. The wisdom of the parents is significant because they’ll be with those children every day. I will only see the child once a week. So building on their wisdom will help them to have confidence in this new information. If you do away with their wisdom, then the bridge will be so wide and then it’ll be very hard for the parents to adjust to this new information. But if you build on what they have already, that helps them to move. And also, to own it. They own it and feel like ‘I’m growing instead of being cut off from my child’s experience’.
Chris Dolman [00:11:41] When you think about this concept of the parent’s wisdom, how do you think about that when working with parents from a cultural background different to your own? Does that a evoke for you lots of different things?
Mthobeli Ngcanga [00:11:53] Yes. I come from a culture where we we look at things differently. Like, for example, I was talking to my colleagues this week about how in English you talk about an uncle. And an uncle in English means your mum’s brother or your dad’s brother. Whereas in my cousin, yet in my language specifically, we have a different way, a name for my uncle from my mother’s side and a different name for my uncle from my father’s side, and that informs the culture as well. For example, I might say to my colleagues at work ‘oh look, you work as if you are in your uncle’s place’. What I mean by that, if you were in your mother’s brother’s place, you would be spoilt. Whereas if I were to say it general in English, what does that mean? Whereas in my culture it has some richness about it, because your mum’s brother is expected to spoil the sister’s children. Not spoil in a negative way but they must feel like ‘there is a safe space for me at my uncle’s place’. Whereas with my father’s brothers that expectation is not that high culturally. So when it comes to the wisdom of the parents then, I always have that in mind. That culture is deep, and people do things because of their cultural background. For example, the approach that the parent might use here. It might have worked well where they come from because of the support system that they might have there, that is culturally informed. Whereas when they come into an individualistic society, that approach might not work well. Hence, it’s important to acknowledge their wisdom, but at the same time acknowledge that there might be some limitations of that wisdom in this situation without discrediting their wisdom.
Chris Dolman [00:13:46] You said before culture is deep Mtho. I was wondering if you could say a bit more about that concept of culture being deep?
Mthobeli Ngcanga [00:13:55] Yes, it’s deep in the sense that there are certain things that we take for granted in culture. For example, for a person to speak in their language, it is important. In the sense that it opens the areas off their thinking that they otherwise wouldn’t be able to open. When you give them that opportunity to go back into their culture. For example, if I were to talk about something that happens to me in my language when I look at my language, there are aspects of nature that helps me to say things in my language, which in English I cannot say. For example, I can talk about something that has a certain tree. And when I think about that from my language that connects me with a certain part of my life and a certain time in my life. So when I talk about that, it takes me away from here. But at the same time, it keeps me here so that I own what is happening in my life. So it’s deep in that sense that it’s not just something that needs to be taken light. I think that is very important, that when you deal with someone, you allow them to get to where they would feel comfortable and that could be language.
[00:15:13] For example, I am working with a young person now. On my assessment I went to see him at school and I also saw mum, but I first saw mum before I saw him. So when I was talking to mom I said, ‘mum, I’m happy to organise an interpreter for you’. And she said, ‘Oh, can you hear me?’ And I said, ‘Yeah, I can hear you perfectly’. She said, ‘Oh’, and she smiled. She was happy about that. And I thought, this is significant. So I said, ‘OK, I would like you to talk to me in English because I can hear you. I don’t hear anything. I mean, I don’t I don’t see any problem with your speaking. However, when you feel like you don’t understand me or you feel like you can’t express yourself fully, you feel like you can express yourself broader than what you are doing in English, let me know and we’ll get’. And she said, ‘Ok that’s good’. You could see that she was so happy that her ability to speak English was acknowledged to me that was important. I was willing to get an interpreter for her because that is a rule for our organisation that we make sure that people get interpreted. But in that situation, it was important for me to allow her to own the situation.
[00:16:29] So up to now, when I speak with her, she speaks in English. And I always ask. Did you understand everything? If you want, I can get a telephone interpreter to explain this. She said ‘No, no. I got you. I got you’. So to me, it’s important to acknowledge it. That’s culture again, because experience of leaving her home country and coming to a new country is full of many things. One of the things is the lost of the country. Loss of being known as someone in their country. And she was a teacher by profession. So when I heard her saying, ‘Oh, can you hear my English?’ To me that I was important, meaning that somewhere she was told that we couldn’t hear you. So for her to hear, to be heard and to feel like she can do this. It was important. I thought, let’s give her the right to do so.
Chris Dolman [00:17:23] In that situation or in others that you’ve spoken about, where you’re meeting with the child or with a parent from a different cultural background to your own, to what extent is it important to understand something about that culture prior to meeting with the person? Do you have a position or a view on that?
Mthobeli Ngcanga [00:17:44] I do have a broad position about it. It is important to know because when you know, when you know something about someone, it helps them to feel that it’s not about what you hear about, but it’s about them that you are concerned. Because we come, when we come as practitioners, we come kind of in business terms. So the feeling of being a client sometimes is not what people come for when they come for a service. They come for a relationship that will help her to deal with things that are happening in her life. And I think that’s very much important. At the same time, it is important not to think too much about the culture when you first see the person, even though you know about the person’s culture. Give the person a room to afford. For example, if you meet someone for the first time, it’s important to hear from them. For example, if they are from Iran, it could be that this person is not necessarily from Iran, but they ran and they escaped to Iran. And then when they got to Iran, they were ill treated there. Now, when you assume that because they in your referral, they say they are from Iran and then you start to talk positively about Iran when their experience was negative. That is not a good thing to experience.
Chris Dolman [00:19:08] So rather than assuming what would you say you do as part of your practise?
Mthobeli Ngcanga [00:19:12] So what I do I would always tell the person that this is the information I have and then I would like to hear from them. And then when I hear from them, the knowledge I have about whatever contact I have, then I can share it to show that. For example, if I meet someone who’s from Afghanistan and they came from Iran. When they talk about that to me, I’ll say, ‘Yeah and I’ve heard that’. For example, often they’ve told me and I say ‘yeah, it’s been a journey for you. And I understand that some people tend to talk about negative experience about Iran. And I hope that was not the case for you. Let’s see how we can work together from here going forward’.
Chris Dolman [00:19:56] What’s your intention in saying that sort of thing to them? What is it you’re wanting them to understand or experience from you speaking in those terms?
Mthobeli Ngcanga [00:20:04] It’s important for people to know that they are not. I mean, as I’ve said before, that business relationship can interfere with what that person is comfortable. So it’s important for them to understand that we are not only here to hear about the best stories. But when our understanding of their stories, we are interested in them for the benefit of what is going to happen going forward. And that is crucial. It’s not just kind of a gossip thing, where want to hear about you. But our understanding of what happened it’s well known and we kind of sympathize with you.
Chris Dolman [00:20:46] What suggestions might it give practitioners who are not so familiar with working with families from a cultural background different to their own?
Mthobeli Ngcanga [00:20:54] First point I would suggest is that get to know yourself as a practitioner and what informs your practise. In the sense that if for example, you are informed by the passion for human rights. Also, be aware as to what informs that. And that’s the first thing. Knowing yourself, and then secondly, knowing about other people because of their culture, it’s significant. However, what informs you about that knowledge as well it’s so significant. So you have to have layers and layers of thinking about it and then also be aware of your education, because if you bring your education at the expense of acknowledging the wisdom that the people that you are working with have some knowledge and wisdom that they can teach you, you might miss the point. Because you can come as someone who’s high up and because they’re too low to you, you might not get to them. So it’s very much important.
Chris Dolman [00:22:04] Is it part of what you meant by getting to know yourself as well?
Mthobeli Ngcanga [00:22:07] Yes. I think that’s key to know yourself and and know what drives you to do this. For example, for me, what makes me passionate about young people it’s my experience as a young person. I had a conflict with my dad and when I look back, I can say if there was someone who could talk to me at that point in time, because when I look at that and say I wanted to be a doctor and my dad wanted me to go and get the cattle and sheep. So those two conflicting worlds could have been worked out well if there was a mediator of some sort. And that’s what I see as my role in working with families. I don’t come as someone who has knowledge, but I get the people to see their wisdom and find ways of making it work for them. So that is the knowledge of yourself and your reasons behind doing what you are doing. It’s highly significant and you don’t have to have huge experience or terrible experience in life. But knowing what motivates you in what you are doing, it’s highly significant.
Chris Dolman [00:23:11] Thank you Mtho. Besides this concept of cultural competency. What else do you think makes it possible for services to respond well to families from diverse cultural backgrounds?
Mthobeli Ngcanga [00:23:24] Cultural competence is one of them. But I think the organisational culture itself, it’s highly significant. For example, if we have an organisation that looks at people from the human rights perspective, I think for that to be effective, it needs to be experienced within our generation. The organisation has to own it and live it and strive to live it. I must say, because there is no situation where everything is perfect, but striving towards living the values that you aspire to share or deliver to the people that you are working with. I think that is highly significant.
Chris Dolman [00:24:10] In our conversation today, you’ve put an emphasis, among other things, on being sure to ask the child or the family about things. How important is this curious stance to you in your work Mtho?
Mthobeli Ngcanga [00:24:23] It is important because when you come as a practitioner that you have this knowledge that you have, which is informed by education most often. However, I think learning from the young person is the key to support them better. Because if you come with all the knowledge that you bring to the counselling room, it might be what you want, what you know, what you’ve learned as a practitioner, but not what the young person might be able to cope with. So building on what they know about themselves, it’s kind of like when you build a house. You can’t just come in, put a brick in the air and hope that the structure is going to be solid. So building from what is there, it helps. Like for example, with the one young person that I am working with, he had nightmares that were always waking him up. So I’ve worked with young people who have nightmares. But with this young person, I’ve learned that he had some strategies that he’s using and also what informs the nightmares for him. So knowing what he does when the nightmares come, help me to better support him, because we started from what he was doing and acknowledge that the approach that he was taking. For example, he would wake up and go straight to check if his parents were safe. So to me, that was a strength that we have to focus on and say, ‘look, in as much as this situation is terrible, it looks like to me you have a heart for your family and that’s a starting point’. And then we go back as to how then you can best do this in a way that is supportive of your well-being in the end. Instead of focussing one thing ‘oh nightmares, when you have nightmares, the thing about breathing exercise and all that stuff’. Breathing exercise and all the modalities that we can use to do that are significant, but they must be owned by the young person. So starting from what they know, it’s highly significant.
Chris Dolman [00:26:31] Great. Thank you. So maybe we could have a conversation in future about some other aspects of your work. I think I’d really love to to hear more. It’s been really significant for us to be hearing some about you or your knowledge in this area.
Mthobeli Ngcanga [00:26:47] Yes. Thank you to you, too.
Narrator [00:26:50] Visit our Web site at www.emergingminds.com.au to access a range of resources to assist your practise brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds and delivered in partnership with the Australian Institute of Family Studies, the Australian National University, the Parenting Research Centre, and the Royal Australian College of General Practitioners. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.