Academic journal article Oceania

Conflicting Traditions, Concurrent Treatment: Medical Pluralism in Remote Aboriginal Australia

Academic journal article Oceania

Conflicting Traditions, Concurrent Treatment: Medical Pluralism in Remote Aboriginal Australia

Article excerpt

Aboriginal people suffer from significantly higher rates of mortality and morbidity than do non-Aboriginal residents of Australia. For the past several years there has been a gap of slightly less than twenty years between the life expectancy of Aboriginal and non-Aboriginal people in the Northern Territory (Department of Health and Community Services 2004:24). Aboriginal deaths from respiratory diseases are six times higher than non-Aboriginal deaths; from diabetes, eight times higher; from renal failure, eleven times higher; from homicide, six times higher; and from child infection, fifteen times higher (Territory Health Services 1996:21). Aboriginal Territorians have both a burden of disease (Zhao et al. 2004) and a hospitalisation rate (Department of Health and Community Services 2004:31) that is 2.5 times higher than that of non-Aboriginal Territorians. As a result, over half of the Northern Territory health budget is spent on Aboriginal people, who make up approximately one third of the population (Department of Health and Community Services 2004:35). What these statistics do not reflect is that Aboriginal people consider themselves vulnerable to a wide variety of diseases, some of which are not considered to be the domain of biomedicine, such as illness caused by sorcery.

In remote Aboriginal communities in Australia two healing traditions--Aboriginal and Western/biomedical--are often considered to exist. Researchers writing from the different perspectives of health care practitioners (Devanesen 1985; Gray 1979; Maher 1999), anthropologists (Mobbs 1991; Reid 1983), and political advocacy (Nathan and Leichleitner 1983; Saggers and Gray 1991) support this distinction. Despite the varying approaches employed by these authors to understand and propose methods of combating poor Aboriginal health, which range from encouraging greater rates of Aboriginal treatment at government clinics to arguing for independent Aboriginal health services, there is a general agreement that fundamental differences between Aboriginal and biomedical approaches to health exist. Each tradition is considered to have its own history, ethos, aetiology, and treatment options. In many instances both Aboriginal healing beliefs and biomedicine are essentialised and reified, with much of the variation within both of these approaches being forgotten. For instance, biomedicine at Harvard Medical School is different from biomedicine in a remote area clinic in Central Australia. Likewise, there is a wide range of Aboriginal ideas regarding health and well being across the continent, making it difficult if not impossible to accurately simplify this complexity.

Nevertheless, many researchers attempt to typify the essential characteristics of both biomedicine and Aboriginal healing beliefs. The Aboriginal medical system is often cast as holistic, personal and social (Morgan et al. 1997:598; Nathan and Leichleitner 1983:91). It 'seeks to provide a meaningful explanation for illness and to respond to the personal, family and community issues surrounding illness' (Devanesen 1985:33). The link between health and social relations is often stressed (Devanesen 1985; Mobbs 1991; Morgan et al. 1997; Nathan and Leichleitner 1983; Reid 1983) and illness is characterised by 'social and spiritual dysfunction' (Maher 1999:230). In contrast, biomedicine is cast as 'particularistic, biophysical and mechanistic' (Nathan and Leichleitner 1983:91). Biomedicine is considered to view the body as a machine and illness as a malfunction of this machine (Fabrega and Silver 1973:218-223; Kirmayer 1988:57-60; Kleinman 1980:108). It is also common to portray the biomedical approach as casting disease as the result of physical and environmental factors, not social ones (Devanesen 1985: 33; Morgan et al. 1997:589; Nathan and Leichleither 1983:91).

Aboriginal and biomedical health systems are believed to be 'vastly different in philosophy and practice' (Nathan and Leichleitner 1983:72), and are compared in terms of a 'stark contrast' (Mobbs 1991:302) and a 'cultural gap' (Eastwell 1973:1012). …

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