A Christian Aboriginal Rural Doctor’s Viewpoint
15 MINUTE READ
Culture is complex. To quote the Cambridge Dictionary, culture is “the way of life, especially the general customs and beliefs, of a particular group of people at a particular time: the attitudes, behaviour, opinions, etc. of a particular group of people within society.”1
Tom Verghese in his book The Invisible Elephant speaks about the broadness of culture, that it encompasses (amongst other things) attitudes, judgements, values, belief systems, morals, needs, wants and desires, identities, ideas about who ‘we’ are and about who ‘they’ are.2
Given this broadness and complexity I will not even attempt to dissect the whole of Aboriginal culture in this article. Traditional Australian Aboriginal culture is a well-refined, intricate and complex machine woven with different strands over thousands of years.
There are many (mostly unwritten) guidelines, rules, customs and behaviours – where your land is, whom you can marry, who grows up (raises) your children, where the paths to different places lie, how to catch food and find water. No few words can truly encompass these intricacies.
Furthermore, Aboriginal people are not one. There were and are many. Tribes and language groups in Australia and their cultures are not homogenous. Also, culture changes over time. The culture of the nomadic tribe 300 years ago and that of the Aboriginal teenager walking the streets of my town today listening to American rap music are not the same.
Cultures are not stagnant – they evolve and adapt over time. Certainly, Aboriginal people have experienced enough historically significant events to impact and change their culture. Different generations and subgroups definitely have different cultures. Senior Aboriginal people are different to their youth, with the academic Aboriginals being different again. Just like individual Christians in their theology and behaviour, Aboriginal people are individuals. However, there are commonalities. I ask the reader to consider the gross homogenisation and narrowing that has occurred so that some points can be drawn out.
As Christians whenever we look at culture we should do so through the lens of faith. Christians view culture differently from the secular world. 1 Corinthians 1:18-25 tells us that the wisdom of the world is foolishness and that Christ whom we preach is foolishness to the world.3
In John 17:14-18, Jesus, in his prayer, talks about his disciples being hated by the world for having God’s word, not being part of the world but being in the world.4 We, as Christians, “Do not conform to the pattern of this world,” and so when we analyse culture we do so in reference to God’s word.5
“Some aspects of culture are good, pure and right according to God’s standard; other parts are objectively evil and wrong; and most of it is neutral and may be performed in either a sinful or God-serving manner as most actions in life.”
Some aspects of culture are good, pure and right according to God’s standard; other parts are objectively evil and wrong; and most of it is neutral and may be performed in either a sinful or God-serving manner as most actions in life.6,7
When all is said and done, in heaven we will be “a great multitude that no one could count, from every nation, tribe, people and language, standing before the throne and before the Lamb” crying out, “Salvation belongs to our God, who sits on the throne, and to the Lamb.”8 We will be unified in faith, while parts of our culture and identities will be melded and will create the heterogenous beauty that is the Christian people praising their God. This is important to understand when considering any culture.
Considering this, then, I will use a model of culture by Tom Varghese from The Invisible Elephant and we will look at Aboriginal culture in nine dimensions and then look at how these may interact with health.2
- Relationships versus Task. This refers to the importance placed on relationships and social connections versus achieving specific goals and tasks.2 In traditional Aboriginal culture relationships are important and it is important to develop relationship before trying to achieve a task.2,9,10 Traditional ‘Western’ culture, by comparison, tends to value task-orientated behaviour and achievement at the expense of building strong relationships.2
- Harmony vs. Control. This refers to people’s relationship to the external environment, including nature.2 Aboriginal culture traditionally values harmony with nature.9–12 This can be seen in traditional spiritual beliefs and traditional way of life, both of which are tied to the land.9–12 Aboriginal Australians see themselves as caretakers of the land and believe that they have a responsibility to care for it.9–12 Western culture, however, is more focused on control and domination of the natural environment by controlling it, damming waterways, planting specifically bred crops, and fighting death with medicine. The focus is more on development and progress than using natural resources and environmental degradation.2,9–12
- Shame versus Guilt: This refers to the degree to which a culture relies on external societal pressure to regulate behaviour (shame) versus an internal pressure compass (guilt).2 In shame-based cultures such as Aboriginal culture, individuals are taught to have an acute social sensitivity towards others in their group, whilst in Western culture individuals are taught to be internally driven and therefore regulated by internal guilt.2,9–10
- Collectivism versus Individualism. Individualistic cultures views individuals by their personal characteristics, education, experiences and value free will, self-determination and individual welfare. By contrast, collectivist cultures view individuals based on family, relationships or social class and value sacrifice of personal interest and welfare for the collective interest and harmony of the group.2 Aboriginal culture is collectivist and values both family and kinship relationships over the individual, whereas Western culture heavily values the independent individual.2,9–10 This collectivism can be seen in things like community child rearing and resource sharing.9,10,13
- Religious versus Secular: This refers to the degree to which a culture is influenced by religion and spiritual beliefs. Religious cultures have religious beliefs as part of everyday life, they discussed in every setting, there is no separation of church and state.2 Aboriginal culture traditionally has a strong spiritual dimension, with a connection to the land and the natural world intertwined into everyday life.14,15 Due to the influence of missionaries and missions, a large percentage (54%) of Aboriginal people identify as Christians and less than 1% identify with traditional Aboriginal spiritual beliefs.16 Talking to most Aboriginal people about spirituality is very different from other Australians. There is no resistance to talking about the spiritual, and strong acknowledgement of the unseen power of God, the presence of other spirits and the role of both in terms of real-world events. In comparison, Western culture is largely secular and a majority of Australians state religious affiliation is more of a personal belief rather than something that impacts daily life.17,18
- Hierarchical versus Equality: This refers to the degree to which a culture values equality or authoritarian hierarchy.2 Some cultures have titles, class and authority figures with assumed right to power and authority, where as others value minimising levels of power and status.2 Aboriginal culture traditionally has both aspects of hierarchy and egalitarianism. Though groups do not have a single leader, elders hold a lot of power. Elders are respectfully addressed, given food and resources and cared for, though this is changing over time with the breakdown of respect for elders.19 Traditionally, if an elder was disrespected, punishment was dispensed.19 The hierarchy can be seen in traditional law which could be harsh and brutal, with punishment such as spearing occurring.20 The authority is also seen in customary law governing social interactions such as marriage which were often arranged and had to be between specific skin groups.10,21,22 Men and women also have different areas of authority and obligations.10,22 Western culture values hierarchy less and tends toward egalitarianism with historical events such as the Magna Carta, the French Revolution, the American Revolutionary War showing the tenuous relationship with authority in the west.2 It can also be seen with how society often aims for democracy and how elected leaders have limited respect in the population, how leaders in society and the workplace are often called by their first or nicknames rather than full name and/or title.2
- Polychronic vs Monochronic time orientation. Monochromic time orientation refers to cultures that are linear, short-term orientated, with plans, appointments and strict schedules for achieving tasks that are seen as absolute.2 Polychromic cultures with a more relaxed attitude to time with more value on relationships than task completion.2 Time is seen as more circular and multiple unfinished tasks are worked on as the importance to the community and individual fluctuates.2,10,23 Western culture is largely monochronic, with a focus on punctuality, scheduling, and efficiency.2 Time is seen as a limited resource to be managed and optimised.2 Aboriginal culture traditionally has a more polychronic view of time, as activities and events are often organized around seasonal cycles and communal gatherings.10,23,24 Time is lived through rather than dictating life.10,23,24
- High versus Low Context Form of Communication. This refers to the degree to which a culture relies on non-verbal cues and shared cultural knowledge (high context) versus explicit verbal communication (low context) to convey meaning.2 Low context cultures tend to be task focused.2 Australian culture tends to be low, what is said is what is meant, and all the meaning is in the words.2 Aboriginal culture traditionally relies heavily on non-verbal communication, including gestures, facial expressions, the direction of gaze, and storytelling, to communicate.10,24,25 Yes doesn’t necessarily mean yes, meaning is found in between what is said.10,24,25
- Femininity versus Masculinity. Masculine cultures have strict gender roles and value aggression, decisiveness, and competitiveness.2 Conflict is resolved by fighting (verbally or physically).2 Feminine cultures are rare, they have overlapping gender roles and value nurturing and harmony. Conflict is settled by negotiation and compromise.2 Western and traditional Aboriginal culture are mostly masculine in nature.2,9,26 Aboriginal culture has strict gender roles and the aggression of males in hunting large game with weapons and protection was valued and law and punishment was and is harsh.9,10,26,27 Feminine characteristics such as discussion and consultation, however, were and are also valued.9,10,26,27
Collectivism, a focus on relationships, hierarchy, masculinity and shame interact in a way that again has strengths and weaknesses. The value of relationships and strong hierarchy mean that if a relationship exists between health providers and a community, then sometimes health interventions can be rapidly and successfully implemented. When one Aboriginal community got behind the local clinic in organising covid vaccination with the help of one of our trusted, long serving doctors, 76% of the community were vaccinated in a short period of time.28 However this also means that if a health objective doesn’t have community and elder support, either through lack of involvement by government or non-profit organisations or lack of engagement by the community and elders, projects fail and if the relationships are not pre-existing they can take a long time to develop.29
Strong relationships, both in direct family and kinship relationships in the community are known to provide direct health benefits in terms of mortality.30,31 The complex law and relationships of traditional Aboriginal culture also provide meaning and purpose for individuals within the society, which also is significantly associated with lower mortality rates.32,33 Strong relationships, both familial, kinship and otherwise, can lead to strong resilience, especially in the face of trauma.34 Reciprocity, resource and responsibility sharing seen in child rearing, food distribution, and housing can also directly provide for individuals, allowing for better wellbeing.9,10,13
However, strong relationships and resource sharing can create obligations to share resources, time, money, housing, transport which can have flow on negative effects on health through overcrowding, malnutrition, poverty, loss of employment, loss of transport, missing health appointments, and discharging against medical advice amongst others.35–37
Stronger social networks can also create more pressure to engage in risky behaviour such as smoking, drinking, and drug use, and encourage family and sexual violence when these are normalised within certain social circles.38-41
Across all of Australia, smoking, risky alcohol use (more than monthly), cannabis and amphetamine use occurs more in the Aboriginal vs non-Aboriginal population (27% vs 10.8%, 35% vs 26%, 15% vs 12%, 3.1 vs 1.3%).42,43 These rates are even higher in Aboriginal people in remote communities such as mine, with potentially 54% smoking and 56% undertaking risky alcohol consumption.43
Through providing antenatal care locally, I gain unique insight into the normalisation of alcohol in my community. Anecdotally, up to 50% of the Aboriginal women I care for engage in alcohol use when knowingly pregnant. In one clinic, after the removal of the mandatory Basics card (Centrelink income management card) in October last year, all of the women who were to attend my antenatal clinic were intoxicated when the driver went to pick them up.
“In the emergency department, as you take a history you will hear of the social activity of binge drinking of dozens of cartons of beer or numerous bottles of wine being undertaken by family groups.”
In the emergency department, as you take a history you will hear of the social activity of binge drinking of dozens of cartons of beer or numerous bottles of wine being undertaken by family groups. Even outside of work, you can witness it in the street. The problems associated with alcohol, violence, child abuse and neglect and youth crime amongst others are the reason for restrictions being in place in these communities.44-46
Strong relationships, masculinity and strong hierarchy also create the potential for the normalisation of violence, which is often unmasked with alcohol.47,48 In the emergency department of my small town of only a few thousand people, not a day goes by without a presentation (or multiple) related to family or other violence by Aboriginal people against each other. Family violence occurs at much higher rates in the Aboriginal population in Australia with Aboriginal people being 32 times more likely to be hospitalised.49
If an Aboriginal person is assaulted in the Northern Territory there is a 74% chance it was a family member, and a 30% chance it was associated with alcohol.49 33% of all Aboriginal incarcerations are due to acts intended to cause injury vs 17% in the non-Aboriginal prison population. Aboriginal people are vastly overrepresented in prison populations.50
95% of young Aboriginal people report witnessing violence between Aboriginal people.51 87% of all Aboriginal women report being a victim of sexual, physical or emotional abuse or combinations of them.52
Aboriginal people are twice as likely to be sexually assaulted and eleven times more likely to be hospitalised for it with 64% of assaults occurring at home, and the perpetrators being known in the majority of cases.53 As Jacinta Price stated “If we can, in fact, reduce family violence, which I believe is possible if we take a unified approach, we will see fewer of our women dying, fewer of our men incarcerated, and more of our children educated.”47
“If we can, in fact, reduce family violence, which I believe is possible if we take a unified approach, we will see fewer of our women dying, fewer of our men incarcerated, and more of our children educated.”
The negative facets of the evolution of modern Aboriginal culture have devastating impacts on the health and well-being of the community. Unfortunately, it can’t be discussed openly in this political climate without fear of repercussions such as job loss.47 We can influence this issue if we talk about it and address the practical issues in front of us. A program for Aboriginal domestic violence in the Northern Territory called NO MORE focuses on the placement of responsibility for reducing domestic and family violence (including lateral violence) on Aboriginal men and elders. This has had outstanding successes.48,54 Uncle Alfred Men’s Group Local Drug Action Team in Townsville utilises similar principles in delivering a 98% success rate with their Aboriginal attendees with alcohol, drug and domestic violence issues.55 Culture can be utilised to harness strong relationships, masculinity, shame, and hierarchy for improvement.48
Aboriginal culture is broad, complex and complicated and its interactions with health reflect this. Culture is neither outright good nor bad but can cause both good and bad effects on society and individuals. Discernment is required for teasing out the strands of influence in outcomes and behaviours stemming from culture. This is as true for Aboriginal culture as for any other. I hope that this exploration of problems facing the Aboriginal community, especially where I practice, have helped provoke thought. I trust that it has also motivated you as a Christian health professional to harness cultural strengths in order to improve Aboriginal health.
Dr Joseph* is a Christian, Aboriginal, Husband, Father, and Rural Generalist Obstetrician, who grew up and works in remote Australia. Dr Joseph disagrees with the premise that only Aboriginal people should talk about Aboriginal issues and believes more open and honest discussion is required to bring healing to Aboriginal culture.
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