Marie McInerney reports:
Current and future Aboriginal and Torres Strait Islander doctors and medical scientists have been urged to ensure their “two worlds” of Indigenous knowledge and Western science converge across their professional lives, from high level research through to community health care.
Leading public health researcher Professor Sandra Eades – a Nyungar woman from regional Western Australia who last year won Best Research Publication from the Medical Journal of Australia – said she had grown up with people who would not be recognised as scientists, but who were highly skilled in botany, meteorology and other scientific understanding.
“I think part of my love of science and thinking about systems and the way things hold together has come from growing up with scientists, people who deeply understood the ecology of the world they came from and the transition they made by beginning to hold two worlds together,” she told the 2014 Australian Indigenous Doctors’ Association (AIDA) conference.
“What we usually do is we keep those worlds separate,” she said. “We go to one set of meetings and talk that language and mostly at home or in our communities we speak another language. We don’t often find our places, meetings where can bring the worlds together. “
Eades was one of a number of keynote speakers to address the conference theme: Science and Traditional Knowledge: Foundations for a Strong Future.
Australia’s first Indigenous doctor, Professor Helen Milroy told nearly 300 delegates, who included many of Australia’s first Indigenous doctors and current medical students and interns, that they should not see Indigenous Knowledge and Western science as an “either or” choice.
“We still have a third space which I think is misunderstanding of what Indigenous Knowledge and Indigenous people and Western science are all about, and in it we put a mile of rubbish: myth, legend, stereotype, racism, discrimination.
“There clearly is something missing: the combination of an Indigenous knowledge base with a Western science perspective. “
“Increasingly science points to importance of spirituality to health, of cultural value systems, these powerful allies in recovery, particularly for things like grief and trauma,” she said.
Milroy looked at the myriad of Aboriginal and Torres Strait Islander understandings and practices that are now being backed up by modern science and practice, including:
- Caring for country, with a focus on custodianship rather than ownership.
- A tradition of oral history that required the development of very extensive neural networks as young children: “When you think about some of the neurosciences associated with that, that was actually pretty good practice”.
- Kin and skin groups that promoted a good genetic pool.
- Models of care or ‘wise practice’ that was inclusive, collaborative, multi-dimensional, adaptive, and relationship-based. “It’s interesting that services are increasingly adopting our ways of working: they may not call it that, they may call it ‘family-centred’, but that’s not new from our perspective.”
- Use of ‘yarning’ as an early form of narrative therapy.
- Child rearing practices including lengthy breastfeeding, a focus on early omnipotence and mastery, early autonomy and decision-making, and a focus on kinship that developed obligation, reciprocity and taught children to care for others.
She said: “There was no concept of an orphan in Indigenous society which means our attachment systems were in fact very safe. Parenting was about responding to children’s cues, that’s how it’s now taught. Neuroscience now supports what we have always done”.
She cited the best practice and best evidence elements of the Wharerata declaration on the development of indigenous leaders in mental health:
- Cultural and clinical perspectives have cumulative gains that outweigh the benefits from a single track.
- A combined approach that explores the biological and psychological functioning of individuals and at the same time locates the individual in an ecological context which is at the heart of an indigenous contribution to best practice.
- Where an intervention is based on western science, scientific measurement is appropriate.
- Where an intervention is based on indigenous knowledge and custom, another set of measures is necessary.
She said: “Wise practice is about old and new, clinical and cultural, being outcome focused on a variety of measures that don’t just look at health indices, and an understanding and meaning that provides the opportunity for personal and professional commitment.”
Indigenous doctors have to lead the way
Adjunct Associate Professor Mark Wenitong said it was a critical time in the health system for Indigenous doctors and medical scientists to not only think about the role of Indigenous knowledge in their practice and in the ways they influence the rest of the health system, but to take a leadership role on behalf of those who have less power.
“Whether you like it or not, you have intuitive values that are Indigenous knowledge, that’s your frame of reference,” he said.
“Quite often we practise within a system that doesn’t allow us to actually really fulfil a lot of things we know we should be doing, and this hits the road a lot more significantly for people like Aboriginal health workers who are much less empowered in the whole system.”
It was too easy, he said, “to keep our colonised minds. What’s driving the narrative also drives the policies. It’s really important that we take ownership of the narrative so we get policies that really do work for us.
“We need that balanced view that validates both the medical science and the cultural approach. We’ve got to get the narrative right and map that great methodology with what we know as Indigenous people a lot more, we’ve got to publish a lot more.’
- Professor Alex Brown and his work: Kurunpa [Spirit]: Exploring the Psychosocial Determinants of Coronary Heart Disease among Indigenous men in Central Australia. “He talked to traditional healers and lawmen and really worked it from their perspective, as opposed to just from academic literature. He thought it would take 3 months, it took 3 years but he did it properly, an immensely valuable piece of work”.
- Adjunct Professor Mick Adams and his 2007 (unpublished) PhD on Sexual and reproductive health problems among Aboriginal and Torres Strait Islander men. “He went and talked to guys in riverbeds through to academics, and guys opened up to him about their sexual abuse. Noone else would have ever got that information”.
- Professor Martin Nakata on Anger and Indigenous Men: http://www.federationpress.com.au/bookstore/book.asp?isbn=9781862876859
Wenitong said the Apunimpima Cape York Health Council, where he is Senior Medical Officer, had established an Indigenous Leaders Group to ensure the service (which has 150 staff, 70 of whom are Aboriginal and Torres Strait Islander people) “really is community controlled”. It was documenting its work to share with other organisations.
He’d been surprised that the organisation was not “hitting it” as well as it should, and that even some internal policies and processes “stop staff from doing their black stuff”.
Some health workers reported that they felt they had to “leave our culture at the front door”.
It was not just that cultural knowledge was not being valued by other staff, it was themselves thinking it was not valuable, he said. “That’s a colonised mind.”
Below are grabs from his slides on: “Our role as black scientists”.
- Nurturing IK (Indigenous Knowledge) in our students – don’t expect the institutions to do this – this is AIDA business and blackfella business, the “Indigenous Academy”.
- Understanding we can be both IK and western knowledge holders – not THE holders, inherent community stuff, not personal agenda.
- Believing in our knowledge – “experts”
- Balancing the role – “you speak different when you with black-fullas”, “act different around aunty”
- Translating at multiple levels IK into policy, programs, practice – parents and education, a different narrative = a different policy
- Pick bullsh*t when you hear it
- Re-translate “colonised data” etc
- Supporting less empowered Indigenous groups re validate IK
- Relational community aspects (how socio-cultural stuff happens)
- Remembering who we are in our careers
Two worlds co-exist
One place where the two worlds of knowledge converge is in the remote Ngaanyatjarra, Pitjantjatjara and Yankunytjatjar (NPY) lands, where the Women’s Council runs the only funded Ngangkari traditional healing program in Australia.
Five of the Ngangkari – Maringka Burton, Josephine Mick, Toby Baker, Clem Dalby, and Tinpulya Mervyn – delivered a keynote at the AIDA conference, describing (through translator Linda Rive) how they worked with Aboriginal communities across Australia and with mainstream health clinics among their own people.
Here are some of their insights:
“In our community we have a lot of ill-health: sometimes the people who may be the sickest are the quietest. We keep a close eye on them. We look after everybody, not just everybody who asks.”
“We really take care of children, especially when they get injuries when they play. We use puuni, the blowing breath treatment, it does immediate good as pain relief. The treatment we give never opens the skin. Once we’ve done the treatment, we take them to the clinic.:
“Our work is to put people right by harmonising their Kurunpa (spirit). I have many grandchildren and great grandchildren…some of them are showing great promise to be Ngangkari in the future, ensuring Ngangkari have a future.”
“It’s the first time in history for a program where the Ngangkari are paid to work. It is working. We have become a very strong team and our work is very diverse. We have recently been focusing a lot of attention on mental health problems.
“We find, as you do, that mental health problems affect the whole familyy so we work with the whole family. Sometimes the mother and father will be at their wits end with children who have mental health problems. It’s often a very lovely thing to do: we take parents and children into the bush, in a beautiful setting, and work together, often with the puuni.”
“Ngangkari have very powerful hands….to dissipate headaches, reduce swelling, take the pain away. We’ve got healing hands.”
“We are very valued in clinics. Doctor, nurses like what we do, makes their work easier, more effective, reduces the number of people who have to come in. We often get referrals to go to Adelaide, Alice Springs, Coober Pedy, Port Augusta.”
“We are very happy to be among you doctors. We are all Ngangkari. We are all healers.”
• You can track Croakey’s coverage of the conference here.