‘The Apology by the Prime Minister to Aboriginal and Torres Strait Islander peoples of Australia in February 2008 was the first step in a significant healing journey.
Importantly, it was the commencement of a healing process rather than an end in itself. The Apology created a climate of hope and a sense that the government may be open to taking a different approach to Indigenous health and Indigenous affairs generally.
This year, the Prime Minister marked the first anniversary of the Apology by announcing the establishment of a Healing Foundation to address trauma and healing in Indigenous communities. It is therefore timely to generate wide-ranging discourse about healing and what it means for Aboriginal and Torres Strait Islander health.
A healing journey will not only deliver better lives for Aboriginal and Torres Strait Islander peoples, but is essential for the wellbeing of Australia as a nation.
Healing means different things to different people. Within medical science, healing has specific meanings related to the pathophysiology of wound closure, organ repair and system function. The process of cell turnover occurs in the body to ensure health through the renewing of red blood cells, the sloughing and replacement of various epithelia, and bone remodelling. Throughout our daily work as doctors, we see the body’s “enthusiasm for life”.
For Aboriginal and Torres Strait Islander doctors, healing goes beyond treating the disease. It is about working towards reclaiming a sense of balance and harmony in the physical, psychological, social, cultural and spiritual lives of our people, and practising our profession in a manner that upholds these multiple dimensions of Indigenous health.
In essence, it is “Moving forward in our journey with hope for the future, with renewed energy, strength and enthusiasm for life.” Specific and holistic concepts of healing are not dissimilar, however, particularly if the foundational concept is that of “renewal”.
Healing needs to occur at various levels - from cells, organs and systems to individuals, families and communities. A number of different modalities may be used to ensure healing is meaningful to different people and different communities.
For example, this could mean Western-trained doctors working alongside Ngangkaris (traditional healers from Central Australia) to deliver an optimal health service that facilitates physical repair, psychological buffering, social nurturing, cultural reclamation and spiritual maintenance.
Indigenous healing services need to be culturally meaningful and must focus on why people are at risk of succumbing to physical disease and to using drugs and alcohol, as well as the ways in which restoring cultural norms and repairing the social fabric can mitigate these negative disruptions. Health professionals must be culturally competent and need to understand the cultural and spiritual elements of health.
The national effort to improve the health of Indigenous Australians is vital and must continue apace, with the driving principle of a holistic view of Indigenous health as being:
Not just the physical well-being of the individual but the social, emotional, and cultural well-being of the whole community. This is a whole-of-life view and it also includes the cyclical concept of life-death-life.
Having a state of health (however defined) assumes an individual has access to all levels of health care services and is able to negotiate the health system successfully. It also assumes access to nutritious food; the ability to have a good night’s sleep and feel safe; the capacity for motivation and the facility to undertake regular exercise or recreation; and the presence of sound relationships with family, community and society.
It assumes that an individual is protected by reasonable health infrastructure. Many of these issues have been tackled in recent health reviews and initiatives, Council of Australian Governments announcements, and the national effort to “close the gap” in life expectancy. These initiatives are to be applauded, although they are well overdue. If implemented effectively, they can go some way towards healing.
These efforts need to occur in parallel with a national discussion on the issues that are a little more confronting and yet are known to have an impact on health, such as the effects of cultural dislocation, dispossession, loss of autonomy, social exclusion, racism, and marginalisation.
Unless Aboriginal and Torres Strait Islander peoples are able to take action to restore balance to their lives and to experience the strength that comes from regaining that balance — and unless the rest of society facilitates, supports and nurtures this action — we will be forever addressing the symptoms rather than the root causes. Until these issues can be resolved, healing cannot occur at a community level or at a national level.
How can the medical profession further contribute to Australia becoming a healed nation?
As a collective, we can promote understanding of the multiple determinants of Indigenous health - the physical, psychological, social, cultural and spiritual aspects of wellbeing; ensure this understanding informs clinical interactions as well as policy and resource allocation; advocate for and practise culturally appropriate health service provision across the care spectrum; encourage sectors such as housing, education and justice to work with the health sector to create reform; and advance an appreciation of the healing strengths of reconnecting with family, culture and Country.
Clearly healing is a complex issue, and I hope this article raises questions and possibilities as to how healing might occur, and helps to explore the frameworks within which it can occur.
The fundamental aim of healing is to provide a better future for our children and to create a world in which Aboriginal and Torres Strait Islander peoples and culture thrive. As a profession working towards this end, we can truly show leadership in guiding change and generating a sustainable vision of health for all Australians into the future.’
Wonderful article Tamara, thank you for your insights!