Household/family members
Reasons for use of bush medicine amongst cancer patients or their family members were
recorded in a study based in Western Australia [23]. The qualitative analysis was by way of individual in-depth interviews, observations
and field notes. Results were analysed thematically into reasons why or why not bush
medicine was used demonstrating both the role and use of TM. Consent was given from
the Aboriginal reference group involved and this group was consulted throughout the
study period. Thirty seven in-depth open-ended interviews were conducted in English,
including one rural and two remote participants whilst the remainder resided in urban
Perth, Western Australia. Out of these 11 types of cancer were identified and only
11 of the 37 interviews were used as the focus for the paper. The results of the study
found that bush medicine played a role in symptom relief from chemotherapy or stress
associated with the situation. In some cases people chose TM over western medicines
and vice versa depending on their situation and beliefs surrounding chemotherapy and
TM. Such situations were likely to be concern over leaving family to come for chemotherapy
treatment, adverse reactions from chemotherapy, limited access and knowledge of bush
medicines, and uncertainty about bush medicine interactions with cancer medicine [23]. As one participant reported
‘I tried [bush medicine], but, yeah, I think it reacts with all my tablets I’m taking.’
This study gives us a valid indication that TM plays an important role in cancer and
its use depends on cultural knowledge, access to TM, concerns about integrative healthcare,
and location, however a bigger sample size would have given this study more reliability.
Discussion
It is evident that there is a gap in literature that seeks to examine specifically
the role of TMP for PHC rather than the philosophy or description of Aboriginal TM.
Although evidence exists for the use of TMP in primary health care, either alone or
in combination with biomedicine, reliable and valid research is lacking. Specifically,
there is a paucity of literature that seeks to examine the role of traditional treatment
modalities of ceremony and healing songs, instead the focus is on traditional healers
or bush medicines. Saying this, the literature found does give us an indication that
TMP exists and this enables a discussion about its role in PHC.
Examining the role of TMP
The role of TMP can be analysed quantitatively and qualitatively. Quantitatively the
OATSIH report is the best example. The percentages of overall service provision serves
as a useful tool to examine the extent of TMP. Combining both THs and bush medicine
gives us a figure of 32.1% of Aboriginal primary health care services across Australia
that offered some form of traditional medicine practice in the year 2010–2011 (excluding
bush tucker programmes), that is 76 out of 236 services [9]. Considering that prior to colonisation 100% of primary health care would have been
with TM, this tells us that the current extent of TMP is relatively low. Quantitatively
this report gives us no indication for reasons and extent of use of these services
within an individual clinic, such as how often or what type of illness. More questions
need to be designed into the report if these reasons are to be identified and examined.
Qualitatively, the role of TMP can be described as sequential (i.e. in sequence),
compartmental (i.e. treatment chosen is based on illness type) or concurrent (i.e.
at the same time) [24]. The ethnographic research conducted [21,22] show that people within the relevant communities studied exhibit all 3 types of health
behaviour for using THs. The understanding of disease cause was identified by both
these authors to underpin the choice of treatment, that is the ‘why and what’ of TM
use. Desert people believed that ‘new’ diseases such as diabetes and cancer lay outside
the powers of the THs, whereas illnesses believed to be caused by spirit resulted
in people seeking traditional healing methods [21]. This was reinforced by observations from the second author that illnesses thought
to result from contact and colonisation were considered ‘white’ illnesses including
diabetes and that ngangkari cannot help [22]. These types of health behaviour were not limited to the household/community. THs
were reported to visit the clinic at request [10,11,21], however it is unclear from these reports how this fits in to the sequential/concurrent
or compartmental behaviour model. The ngangkari account from the NPY women’s council described in the review exhibits both sequential
and concurrent health behaviour of a client. This behaviour could be affected by the
residency or employment status of the TH within the health services. The NPY Women’s
council state clearly that THs are employed for health services, whilst other accounts
do not mention employment status. It is reported that THs were employed in Australia
by the Northern Territory Department of Health in the early 1970s, however a training
course to teach traditional healers about western medical practices was soon replaced
by the training program for AHWs [24]. Despite this, Trudgen [25] describes (2000) that he does not know of one marrŋgitj (traditional doctor) employed in a health clinic, knows only one herbalist who is
employed as a cleaner and one AHW who has learned both traditional healing and western
medicine in Arnhem land.
Medical pluralism
Medical pluralism is essentially the adoption and integration of biomedical healthcare
with TMP, or ‘concurrent’ treatment as described above. With reference to integration,
Chan in her speech at the WHO Congress on Traditional Medicine [26] comments that;
‘The two systems of traditional and western medicine need not clash. Within the context of primary health care, they can blend together in a beneficial harmony, using the best features of each system, and compensating for certain weaknesses in each.’
Concern over interactions between pharmaceutical medicines and bush medicines was
identified within the study on cancer and bush medicine as a reason for not wanting
to use bush medicines [23]. While not articulated in any of the research, the area of uncertainty for drug-plant
interactions should be considered from the other perspective also – that is non-compliance
of pharmaceutical medicine due to a desire to use bush medicine and not wanting to
mix the two.
In the 1970s the concept of ‘two ways’ was introduced in the Northern Territory of
Australia, incorporating both traditional healthcare and biomedical healthcare, however
was dismissed by the late 1990s for reasons unknown [22]. Ivanitz [27] also reports in 1999 that individuals will often visit both a traditional healer
and the biomedical health clinic, which is confirmed in more recent times by the observational
and anecdotal accounts of Mccoy [21], Saethre [22] and the NPY Women’s Council [20]. As one Yolngu member puts it [28];
‘when we put [western medicine and traditional Yolngu healing] together, we strong – both feet strong. We can see with a clear mind. Stand strong together.’
From these accounts, integration can be viewed as not only the combination of pharmaceutical
and plant medicine but also the combination of traditional healers and western medical
doctors. Integration of both systems requires an understanding of the social and cultural
constructions of each medical system and the complexity of the whole.
Association with culture
The association or lack of association with culture was shown to underpin the choice
of using TM in the study on cancer patients and their use of bush medicines in Western
Australia [23], where one participant reports that
‘we didn’t use traditional medicine or anything like that. Because we are not traditional Aboriginal, and our family was Christian based, and so…We put our trust on God.’
It is clear from the interviews with elders from both Balgo [15] and the Akyulerre Healing centre [14] that they believe using TM keeps culture strong. As is described in one article [12];
‘using bush medicine…raises the self-esteem and makes aboriginal people more self-reliant since they all have access to the trees.’
On the flipside, a lack of understanding about social constructions of western medical
systems and associated culture by Aboriginal and Torres Strait Islander peoples who
are traditionally oriented, could mean that there is a perceived failure of biomedical
treatment. A perceived failure of treatment would then impact on the role and health-seeking
behaviour of people, especially for illnesses where pharmaceutical medicine is being
used to treat in a preventative role, such as the prevention of micro- and macro-vascular
complications of diabetes type 2.
Another influence that has been identified in the above review is that of gender.
The Maparn THs in the Kutjungka were reported to be generally male, although there
are some female Maparn. Conversely, it is traditional for the women and children to
collect and prepare bush medicines and become the ‘household healer’ [21]. A study performed in the Amazon in Brazil [29] researched the different roles of gender in TM and highlighted power struggles within
biomedical system for those women who had traditional plant medicine knowledge and
known as the ‘household healers’ who felt disempowered by the system. The resultant
effect was for these women to not access the biomedical healthcare and treat their
children at home with TM. This highlights the importance to incorporate gender roles
within research for TMP.
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