Academic journal article Australian Aboriginal Studies

Shifting Expectations of Treatment: From 'Patient as Individual' to 'Patient as Social Person'

Academic journal article Australian Aboriginal Studies

Shifting Expectations of Treatment: From 'Patient as Individual' to 'Patient as Social Person'

Article excerpt

Abstract: With focus on an all-Aboriginal community in rural central-western New South Wales, and developing the notion of treatment as ' a site of negotiation', I illustrate the socially and culturally distinctive understandings of what it means to be 'a healthy Aboriginal person'. In this community, it is not necessarily understandings of 'health' that diverge from what appears to be a miscommunication between Aboriginal patients and health care professionals; disjunctures can emerge from expectations of treatment regimes. By analysing mainstream health practices in the context of the socialising paradigms inherent in Aboriginal peoples' practices, I propose that the emphases of treatment be shifted in order to better integrate Aboriginal understandings of 'health', which entails preserving 'cultural security' for Aboriginal persons in their dealings with the health system. Aboriginal persons who participated in my research indicated that the quality of their immediate social life, as expressed in their relationships to others (patient as 'social person'), is of greater value than the biophysical needs of their sick bodies (patient as 'individual'). I examine the implications of these relationships for bodily health.

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Kunitz (1994:187) wrote:

   ... failure to at least acknowledge the possibility that
   it is not simply poverty and oppression--real as these
   may be--but one's own culture that may contribute to
   some of the problems that confront so many communities
   may limit the likelihood of growth and positive
   change.

It has been widely discussed that Australian Aboriginal health is a politicised and contested area. While the evidence comparing Aboriginal and non-Aboriginal morbidity and mortality rates seems to provide clear messages, stakeholders and representatives of the apparent health inequalities often disagree about their ways of presenting the data. Approximately since the middle of the twentieth century, discourses on Aboriginal health have been nourished and sustained by Aboriginal and non-Aboriginal voices exploring the topic by drawing links to notions of 'racism' (Anderson 1997), 'essentialism' (Mitchell 1996), 'cultural appropriateness' (Eckermann et al. 1992) and, more recently, 'cultural security' (Henry et al. 2004; Houston 1998; Wilkes et al. 2002).

Often, these notions have become a focus in addressing Aboriginal health outcomes generally. Such emphases are not useful. Over time, they have contributed to sustaining the idea that providing solutions to any one of these issues is sufficient efficiently and effectively to address the complex dynamics of Aboriginal health, its constituent factors and related causes. By drawing a comparative link to what I gloss as 'Western' understandings of health and illness, some commentators have made references to the cultural inappropriateness of health-care provision for Aboriginal patients and the 'clinical nature' of encounters between health-care personnel and patients, including recommended treatment practices (Brady 1995; Gordon 1988; Larsen 1978; Mobbs 1986; Sykes 1978).

Taking into consideration the clinical focus of encounters between health-care providers and patients, and expressed concerns by personnel engaged in these encounters (Eisenberg & Kleinman 1981; Good & Good 1982; Gordon 1988; Johnson 1987; Lock & Gordon 1988), I argue that a majority of these debates perpetuate an essentialism that pits a dehumanising biomedical world against a benign Aboriginal cultural world. This notion of 'a cultural world', as I demonstrate, refers to a 'holistically-oriented' approach that includes legitimate concerns about health while situating them in a broad context, including cultural, social, historical, economic and political factors. In contrast, I will use the expression 'treatment as a site of negotiation' as a way of contributing to debates that aim to overcome some of these established dichotomies between healthcare providers and patients, between the mainstream health system and Aboriginal patients' responses to it. …

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