7. Perspectives on health and well-being

This is Ask the Specialist. I'm Vicki Kerrigan. We're at the final episode of this series, and my co-host Stuart McGraw is in the driver's seat. All right, let's wrap it up. This is a big one though. Topic, different world views. There are absolutely different world views. Yeah. People need to educate themselves up. It's not the responsibility of the Aboriginal people to make sure the doctors understand. The doctors need to get off their ass and go learn. So some tough love there from Larry Kerrigan at Auntie Billa Whirlig. Yeah, it's understandable frustrations, years of frustrations coming out. Ask the specialist, a podcast where doctors from Royal Darwin Hospital ask a team of specialists to answer the questions they have about working with Aboriginal patients. My name is Billa Whirlig Lee. Billa Whirlig means the red tumbler cook too. I'm an elder of the Larry Kerrigan nation. My name is Brawae Nghi, Oriental Ameri. I'm a Teewee elder. And my name is Ratio Melanie Hirdman and I am from Irelandland. The specialists are Larry Kerrigan, Teewee and your moon leaders, who have all had personal experiences in hospital in the Northern Territory of Australia. Back in our very first week, Teewee elder Peirou Nghi Pwerentata Mary used the term farana to refer to any non-indigenous person. For an indigenous person, Aboriginal person to hear a farana say a word or two to that means a lot. That really stuck with me. It made me realise that I'm a farana in Australia and so I should behave as I do when I travel overseas. I should be doing everything I can to fit in with the culture that was here way before my ancestors arrived. If you were going into a Muslim country and you were going to be a doctor there, you would certainly figure out the rules because if you don't, you're going to get into a lot of trouble. So it's the same with Aboriginal cultures and it's cultures, not culture. Get an awareness that people are looking at themselves and their body and their illnesses from a different perspective. You're going to hear a lot from Larry Kerrigan, your elder, Auntie Billowarali in this podcast. She's written a book called Healing from the Daily Bag. Auntie Billowar is a spiritual healer and in her book, she shares her knowledge about Aboriginal perspectives on what it means to live a healthy life and also ancient healing rituals, some of which she and others still practice today. And as usual, the doctors questions a voice by our friend Richard Margaretson. The real issue is that we have no idea of the expectations of some of our patients because we don't ask them. The patient's expectations is low. The self-esteem is very low. At times, they will not engage, but for the doctors, it's hard. So all they can come in is with what they've been trying to do. They're in the box, so to speak. So the doctors are always in the box. They have to get outside the box to get effective communication with the patients. Yeah, yeah, and I agree with that. And really importantly, as a doctor, you've got to know the intergenerational trauma that the communities in the territory have gone through. Over the success of generations of politicians and rules and policies that have dictated our life and has caused so much scarring. I honestly believe that the intergenerational trauma, which does now, they've told us, even though we've always known, transferred from mother to baby, is the absolute spiritual root cause of chronic diseases, suicide, drug and alcohol. Yeah, mental health. And mental health, but they don't treat the intergenerational trauma and the spiritual healing that needs to happen. It's the Western way of treating the symptoms, not the cause. You throw drugs at it. It might make it a little better if they work with proper identified healers, Aboriginal healers. They have a chapel and a chaplain, because I've met him. They have Muslim prayer rooms and people coming in. But no Aboriginal healers, we do go in and out as friends and family, but the actual spiritual practice is not permitted. That would make we're all down in hospital and much safer plays if one they worked with healers and that we can do some of our practices, particularly the smoking ceremony. As a cultural educator, Auntie Billowara has done heaps of workshops over the years with doctors and other health professionals in the top end. And because of her unique skill set and her knowledge, she can share some information with us about healers and sorcerers. I've done many workshops with surgeons. There are a couple of issues. One, it's the sorcerer of bad persons that cut you up. So a surgeon's role is to cut. So it's difficult when you're prescribing, having a limb removed, because they sometimes will say no. They want to say no, but a railrode it into, because the doctor knows this is what you should have happened. This is what's going to save your life. You've got to lose your leg. So in here, and they aren't given the opportunity to object and say no, no, I don't want to do that for spiritual reasons. In your book, you give some really interesting advice on amputations. Do you want to explain that? Oh my goodness. As I said, I'm a spiritual healer, so I look at the spiritual journey of somebody. Maybe not so much the young now, but the older generation, when you pass away, if your body is not complete, your spiritual journey is stuffed, bugged, can't go on. So for somebody to lose a limb or a digit is quite a serious issue. It's not like a Western person who, oh yeah, I take the limb and we'll get on with it and whatever. And what happened with the lady was that she had to have her leg amputated because she hadn't followed her treatment for her diabetes very well. And she basically said, no, no, not going to lose the leg. I'm going to go home and I'm going to die. Now, she was only in her 40s, so she had a long life ahead of her and she had children. And so it wasn't until if she agreed to the operation that one, she could either have the limb and send it back to where she was going to be buried, or two, it would be kept preserved until she passed. So there were the alternatives and once she realized that physically her remains would be whole, she was happy to go ahead and lived quite a long time. But it's all comes back to the importance in our world view on health and well-being is the spirit before body and mind. And that is the critical difference. Does that ring true for you, the spirit before the body and mind? It's pretty much abrogenality, you know, spirituality. If you don't have that intact then you don't exist in this world. So I have my moments where I feel like I'm losing myself. So I'll go back to my country and live there, hunt, perform ceremonies. And that's what gets me recharged and I come back to city. Yeah. So that's part of my well-being. People call it spirituality, I call it every unity. So that's my charm. Yeah, I don't know if that's real, but that's what I call it. The other thing that's really important to remember, patients, particularly from remote communities, will have huge anxiety and issues around what is happening with any of their body fluids, with everything from vomit to feces, but particularly around blood because to get somebody's blood, you can do the most unbelievable spiritual stuff. What I taught the young medical students who have all gone on to become doctors to say, to go through the illnesses, the symptoms and to explain as clearly as possible the importance of taking her life fluid to do testing on and they promise somebody goes with her blood sample till it is tested and then they promise to make sure to dispose of it. So nobody can get access because she will know enough to know that if you leave her blood lying around somebody can come along and swipe a bit and then sing her to death. The alternative is to have a traditional healer there and I've done it for people up there to explain the importance and how nobody was going to get access to their blood because the blood is the most powerful energy, spiritual energy in your body. I don't think we get any insights into their health model and why they think they're sick. Sometimes I think we're explaining what we think is the disease model and talking about germ theory and telling them why they're in hospital, but they might have a completely different idea and I understand that they often do. Someone might have stolen some of your hair or something and ground it into the dust and that's why you're sick and people will put curses on you and that's why you're sick or you missed some sorry business and so there's a curse on you and that's why you're sick. That's real and we don't have any idea of that. Sometimes I believe if the person's talking about it then talk to them about it. If they haven't mentioned it don't talk about it because sometimes that scares them, that someone else that is not Indigenous and knows about it and then they're like, "Wait, who told you? Are you a part of them?" Then there's a conspiracy theory that doctors are helping to perform whatever you want to call a black magic or sorcery or whatever it is. If people are talking about it, join in the conversation and obviously ask your questions there because if they're talking about it they want you to know that they believe that this is contributed and if you think that illness that they have is curable and you have a plan for them to be cured then you could say, "Well, we have medicines that can help you." So, you know, you're identifying, acknowledging that their belief is that they have been, you know, cursed or whatever but what then you could add on is that, "Okay, we want to help you make this illness go away and don't use the word curse or anything because then you are sort of bringing that with you." It happens to, a lot doesn't matter where you're from, from the centre, particularly up here in the territory, Northern territory, I mean, these things are for real. Unfortunately, the doctors can't do anything about it. Just to be mindful and be considered about that, you know, and respect that belief, I guess, don't just stop talking silly, you know. That's how we shut down. That's why people switch off because they don't listen to what that patient is saying and it's important. Let's do the paper round on different world views. There are many Aboriginal cultures and a diversity of world views. Remember what Auntie Billowara said. It's culture, it's not culture. Recognise the impact of intergenerational trauma and colonisation. Your patient may have been treated by an Aboriginal healer or may wish to be treated by an Aboriginal healer. Some patients fear treatments being proposed for reasons you don't know. If your patient's open to talking about their beliefs, be respectful and open and remember not to use the word curse or any kind of negative associations. But also, respect that your patient might not want to talk to you about this stuff. Next time I want to ask the specialist, I think this is going to be the first part. This is going to be that initial, you know, relationship building and then hopefully that this can show that there needs to be more work and have like basic Q&A. You throw all the questions and have a couple of people fly me in from Gove so I can have a decent message but I can provide that guess for your, you know, benefit. So now it's over to you. Learning how to work in a culturally safe way, it's a constant journey. You know that. I know that I've learnt heaps from listening to these stories and the stories have often challenged me to reflect on how I think, why I think what I think. As Rachi Roy said, listening to these podcasts, it's just the beginning. This isn't a ticker box exercise. Now the real work begins. Who can you talk to about the needs of your Aboriginal and Torres Strait Islander patients? How are you going to keep challenging your own world views and the practices of your workplace? What can you do to make sure you deliver culturally safe health care? My name's Vicky Carrigan and I want to thank again, Auntie Billowaralu, Piro Wangi, Porantata Mary and Rachi Roy Melanie Hurtman for being so very generous with their time and for sharing their knowledge and also their personal experiences. And a massive thank you to Stuart Uart McGraw for being such a legend and for working so closely with me to develop these podcasts for you. And finally, to you, the one who has listened to these stories. Thanks for listening and please let us know what you think.