Despite the fact that only 3.8% of Australians identify as Aboriginal and Torres Strait Islander, both the RACGP and ACRRM place a disproportionate weight on this topic. It will come up on every exam cycle, so you need to know something about it.
For reference 34.8 percent of Aboriginal and Torres Strait Islander people live in major cities, 43.8 percent live in regional areas, 7.7 percent live in remote areas, and 13.7 percent live in very remote areas.
The context of the ATSI questions usually relates to ATSI people in remote and very remote areas. Given these people represent < 1% of the Australian population, it is unsurprising that most doctors have 0% personal exposure to this area. As a doctor who was a DMO (District Medical Officer) in Katherine in the early 2000s, looking after 35 remote clinics and performing both booked clinics and emergency aero-medical retrievals this material is based on first hand experience.
This section contains common stuff that happens commonly – both real world and exam world. It is designed to provide just enough information to answer the likely exam questions without making any pretence of being complete or comprehensive. Let’s start with the party line, vis a vis what the RACGP says. Here is a short summary of the full RACGP document below says.
Respect for culture
Aboriginal and Torres Strait Islander world views, languages, lifestyles and customary laws are respected in all settings. The diversity and richness of Indigenous cultures is acknowledged and respected.
Respect for community
The importance to Aboriginal and Torres Strait Islander people of immediate and extended family, kinship structures and community is respected.
Consultation, communication and consent
Aboriginal and Torres Strait Islander people are consulted on the way in which they and their history, community, lives and families are represented and used, in all aspects of College and general practice business.
Involvement and engagement
Initiatives involving Aboriginal and Torres Strait Islander communities are based on genuine engagement and partnership, based on the concept of ‘with, not for’.
‘It’s a long road we have come and it’s a long road we can go. We have to walk together and talk together. If you never listen to me, I will never listen to you. If you walk in front of me, I will not follow you. Walk side by side and let’s get there.’
Conrad Ratara, an Arrente Elder from Hermannsburg
Recognising the social, emotional and environmental determinants of health
Effectively working to improve the health of Aboriginal and Torres Strait Islander people requires ‘an understanding of the social and emotional factors that influence health and wellbeing. In Aboriginal and Torres Strait Islander cultures these include the connection to land, culture, spirituality, ancestry, family and community. They also include issues arising from unresolved grief and loss, trauma and abuse, removal from family, substance misuse, family breakdown, cultural dislocation, racism and discrimination, and social disadvantage’.
Holistic view of health
An understanding and appreciation of a holistic view of health is essential in order for health professionals to work with Aboriginal and Torres Strait Islander individuals and communities on health and health-related matters. The National Aboriginal Community Controlled Health Organisation (NACCHO) definition of Aboriginal and Torres Strait Islander health is:
‘“Aboriginal health” means not just the physical wellbeing of an individual but refers to the social, emotional and cultural wellbeing of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total wellbeing of their Community. It is a whole of life view and includes the cyclical concept of life-death-life.’
The National Aboriginal Community Controlled Health Organisation (NACCHO)
Self-determination and community control
Aboriginal and Torres Strait Islander peoples have the right to self-determination in their cultural and health affairs. Self-determination is expressed most strongly in Aboriginal Community Controlled Health Services, where:
‘Community Control is a process which allows the local Aboriginal community to be involved in its affairs in accordance with whatever protocols or procedures are determined by the Community.’
Aboriginal Community Controlled Health Services
Aboriginal and Torres Strait Islander people are consulted concerning the integrity and authenticity of the ways in which history, community, interviews, lives and families are represented, and are consulted concerning the integrity and authenticity of the representation of their cultural and intellectual property.
Acceptance of complexity
While the medical knowledge required to work in Aboriginal and Torres Strait Islander health is not necessarily complicated, the factors contributing to poor health outcomes are often multiple, complex and interconnected. Keeping an open mind, being self-reflective, understanding the context of current health circumstances and having a desire to learn and understand are important qualities for people working in every area of Aboriginal and Torres Strait Islander health.
‘The medical knowledge is easy; its delivery is the complex part. The doctors I know who have mastered the art of Indigenous health have combined excellent communication skills with a drive to engage their patients. Doctor patient trust is the key, and nowhere else in medicine does it open more doors. I believe Aboriginal and Torres Strait Islanders have a particularly keen sense when it comes to detecting lack of respect, perhaps honed by two centuries of frequent practice. But, if you are prepared to listen and learn, and to make genuine efforts at communication, the work becomes immensely satisfying.’
Dr Justin Coleman, Senior VMO at Inala Indigenous Health Service
The culture and belief systems of local communities are also complex, and understanding their implications for the development of culturally sensitive behaviours and processes takes time. While participating in cultural awareness education and locally delivered cultural safety training is vital, continued engagement with, and learning from, local communities and individuals is essential. A ‘cultural mistake’ made by a non-Indigenous person may be easily tolerated by Aboriginal and Torres Strait Islander people, provided goodwill and the desire to keep learning is evident.
Pages 20-31 of this document is the core part.
The Concept of Country
The Aboriginal and Torres Strait Islander (ATSI) concept of “Country” is a foundational element of Indigenous Australian cultures, embodying a rich, complex understanding of the land that goes far beyond the Western notion of geography or environment. It encapsulates an intricate relationship that Indigenous Australians have with their land, water, sky, and all living things, intertwined with culture, spirituality, identity, and law. Here are key aspects that illuminate the depth of the concept of Country in ATSI cultures:
Holistic Connection
- Interconnectedness:
- Country is not just a place on a map; it is a living, breathing entity that encompasses land, water bodies, flora, fauna, the air, and spiritual ancestors. This holistic connection signifies that the well-being of an individual and the community is directly related to the well-being of the Country.
- Ancestral Ties:
- Country is deeply connected to the ancestral beings who created the land and its laws during the Dreaming (also known as the Dreamtime), a time of creation that is both the distant past and an ongoing reality. These ancestral spirits continue to inhabit the land, giving it life and sacred significance.
Cultural Identity and Belonging
- Identity:
- For ATSI peoples, Country is a critical part of personal and communal identity. It informs who they are, their responsibilities to care for their land, and how they relate to other beings and communities. Being separated from Country can have profound impacts on identity and well-being.
- Belonging:
- The concept of Country encompasses a sense of belonging and custodianship rather than ownership. Indigenous Australians see themselves as part of the Country, with a duty to look after it and maintain the balance of life as passed down through generations.
Stewardship and Care
- Caring for Country:
- This principle involves sustainable management and care for the land, water, and all living things, based on traditional ecological knowledge and practices. It includes activities like controlled burning, hunting, and fishing practices that ensure species’ sustainability and the protection of sacred sites.
- Cultural Practices:
- Connection to Country is maintained and strengthened through cultural practices such as storytelling, ceremonies, art, dance, and songlines (paths across the land created by ancestral beings during the Dreaming). These practices pass on knowledge about the land, its history, and how to care for it.
Rights and Recognition
- Land Rights and Native Title:
- The struggle for land rights and recognition of Native Title in Australia is a critical aspect of acknowledging the deep connection between Indigenous peoples and their Country. Legal recognition of Native Title rights affirms the enduring relationship between Indigenous peoples and their ancestral lands.
- Collaborative Management:
- There are increasing examples of collaborative land management, where ATSI communities work with government and other organizations to care for national parks and protected areas, applying traditional knowledge to contemporary conservation efforts.
The concept of Country is central to understanding the worldviews, cultural practices, and social structures of Aboriginal and Torres Strait Islander peoples. It underscores the need for respectful engagement and policies that recognize the importance of land, culture, and spirituality in the health, well-being, and rights of Indigenous Australians.
Men’s Business and Women’s Business
In Aboriginal and Torres Strait Islander (ATSI) cultures, the concepts of “Men’s Business” and “Women’s Business” are fundamental to the social and cultural practices, responsibilities, and teachings that are distinctly gendered. These concepts are deeply rooted in ATSI societies and are crucial for maintaining cultural traditions, transmitting knowledge, and performing ceremonies.
Men’s Business
Men’s Business refers to the activities, ceremonies, and knowledge that are exclusively for the participation and learning of Indigenous men. This can include:
- Initiation ceremonies:
- Significant rites of passage that mark the transition from boyhood to manhood.
- Lore and law teaching:
- The transmission of traditional laws, stories, and practices that are essential for the survival and integrity of the community.
- Management of land and resources:
- Responsibilities related to hunting, fishing, and the stewardship of sacred sites.
- Spiritual and healing practices:
- Including the use of traditional medicines and the conduct of ceremonies to communicate with ancestral spirits.
Women’s Business
Women’s Business, on the other hand, encompasses the activities, ceremonies, and knowledge exclusive to Indigenous women, involving:
- Birthing and fertility ceremonies:
- Rituals and practices surrounding childbirth, fertility, and women’s health.
- Gathering and food preparation:
- The collection and preparation of plant-based foods, medicines, and the teaching of these skills to younger women.
- Lore and law teaching:
- Similar to men’s business, this includes the transmission of knowledge, stories, and laws, but from a female perspective and often focusing on family and community wellbeing.
- Cultural crafts and art:
- The creation of textiles, weaving, painting, and other crafts that often have both practical and ceremonial use.
Significance
Both Men’s Business and Women’s Business are essential for the preservation of cultural identity, the teaching of life skills, and the maintenance of social order within ATSI communities. These practices ensure that knowledge is passed down through generations in a way that respects the gender roles traditionally held in these cultures.
The customs and practices within men’s and women’s businesses are strict, with harsh penalties and punishments if the rules are broken. Men are not to know what happens in women’s business, and women cannot know what happens in men’s business
Sorry Bussiness
Death and mourning practices among Aboriginal and Torres Strait Islander (ATSI) peoples are deeply embedded in their rich cultural traditions, reflecting a profound respect for the deceased, their families, and the continuity of spiritual and community bonds. These practices are diverse and vary significantly across different communities and language groups within Australia, each with its unique customs, beliefs, and rituals. Here are some key aspects that highlight the depth and complexity of death and mourning in ATSI cultures:
Spiritual Beliefs
- Continuity of Life and Spirit:
- Many ATSI cultures believe in the continuity of life after death, where the deceased’s spirit continues to exist in another realm or within the landscape. This belief underscores the importance of proper funeral rites to ensure the safe passage of the spirit and maintain harmony within the community.
- Connection to Country:
- The concept of ‘Country’—a term that encompasses land, waterways, sky, flora, fauna, and ancestral beings—is central to Indigenous spirituality. The death and mourning practices often emphasize the deceased’s connection to their Country, ensuring that their spirit returns to it or is at peace within it.
Mourning Practices
- Sorry Business:
- Often referred to as “Sorry Business,” mourning involves not just immediate family but can extend to the wider community. Sorry Business is a time for expressing grief, sharing memories of the deceased, and performing rituals that honor their life and passage to the spirit world. It can involve ceremonies, storytelling, singing, dancing, and the wearing of mourning symbols.
- Mourning Period:
- The length and nature of the mourning period can vary, with some communities observing extended periods of mourning. During this time, certain cultural protocols are followed, and normal community life may be altered to respect the process of grief.
- Avoidance of Names:
- In some Indigenous cultures, mentioning the name of the deceased or displaying their photographs is avoided after their death to respect their spirit’s journey. This practice also helps protect the bereaved from the pain of direct reminders of their loss.
- Cleansing and Healing:
- Rituals may include practices intended to cleanse and heal the community following a death, ensuring that the spirit of the deceased does not remain to potentially cause distress. These rituals also support the living in their grieving process.
Respect for Diversity
It is important to acknowledge the vast diversity within ATSI communities, meaning that practices, beliefs, and traditions can differ markedly from one group to another. This diversity reflects the rich cultural heritage and the adaptability of Indigenous cultures to their specific environmental, social, and spiritual landscapes.
Contemporary Contexts
In contemporary settings, Indigenous Australians may blend traditional practices with those of broader Australian funeral and mourning customs. This synthesis respects traditional beliefs while navigating the realities of modern life, including geographic dispersion of families and the influences of other cultures.
Understanding and respecting these practices is crucial for non-Indigenous Australians and others engaging with ATSI communities, especially in contexts of healthcare, education, and community services. It’s a fundamental aspect of recognizing and honoring the cultural sovereignty and resilience of Aboriginal and Torres Strait Islander peoples.