Sharing of knowledge
It is acknowledged that a limitation of this review is the lack of written documentation
for TM as traditional documentation of medicinal plants is by way of paintings [30] and passing down of knowledge through generations by story and songs. Another limitation
is the reluctance to share knowledge with outsiders. This may be due to cultural reasons
or mistrust regarding the way that this information will be used. A lack of building
appropriate trust relationships and respect for the worldview of Aboriginal people
from researchers con contribute to the potential for an unwillingness to disclose
knowledge. The authors of the questionnaire survey at the Aurukun Health Clinic also
came across difficulties for sharing of knowledge. Reasons cited were that bush medicine
is ‘secret business’, that respondents thought that it might offend clinic staff if
they knew they were also using ‘opar’ (bush medicine) [18]. Within the study of Aboriginal people and cancer one patient did not want to share
information on the bush medicine used, highlighting ‘the tension between what is allowed
to be public knowledge by Aboriginal people and what remains private.’ [23]. The WHO Traditional Medicine Strategy [31] outlines that protection of this knowledge is important and needs to be considered
as a different system than the current intellectual property rights agreement. The
strategy clearly states that traditional knowledge is ‘owned by the community and
is to be used for its benefit’. Permission therefore to document and use this knowledge
must be sought in a way that is reciprocal with and reflective of the will of the
community.
Governance
It is one thing for TM to be practiced in traditional ways at a local level and another
for it to be recognised as part of a national healthcare strategy. In Australia there
are no national government organisations for Aboriginal TMP. There is one national
non-government organisation currently in operation. The recently formed Indigenous
NGO Aboriginal and Torres Strait Islander Healing Foundation Ltd [32] have supported new projects for Indigenous healing such as the ‘Angangkere Healing
Project’, which is for THs and being run out of the Akyulerre healing centre in Alice
Springs, and the ‘Rumbulara Traditional Healing Centre’ in Victoria run under as part
of the Rumbulara Aboriginal Co-operative Ltd which will be established separate to
the current medical service PHC clinic. In contrast New Zealand hosts a National Board
of Maori Traditional Healers and in 1999 the Ministry of Health published a set of
standards for traditional Maori healing [33], whilst in the US in 2002 the previously formed Association of American Indian Physicians
approved a resolution acknowledging and supporting Native American traditional healing
and medicine as part of the spectrum of health care appropriate for Native Americans
[34]. The latest response to the development of a National Aboriginal and Torres Strait
Islander health plan was for an increased recognition and inclusion of Aboriginal
traditional medicine within the health plan [35]. Ivanitz [27] also recommends that ‘policies need to be developed and implemented that ....address
the use of traditional medicine alongside mainstream medicine’. Regulated governance
structures can potentially improve the quality of TMP including the reduction or removal
of quackery by practitioners.
Conclusions
It is evident that good research design that takes into account Aboriginal worldviews,
reciprocity and cultural sensitivities is paramount to reliable outcomes for research
within this field, and there are very few well-designed research articles examining
the role of TMP in PHC within Aboriginal Australia. Whilst there is a paucity of research
identified, the existing literature identified establishes reasons underpinning the
use of TM and when it is used, alone or combination with biomedicine. These reasons
are identified as association with culture, access to bush medicines and THs and health
beliefs about disease causation, such as using THs for perceived spiritual or sorcery
causes of illness and bush medicines for symptom relief of physical causes of disease
for a range of ailments including colds and flus, wounds, headaches, aching muscles
and skin rashes. It is also clear that health seeking behaviour is complex and medical
pluralism exists, and more focus on integration of TM with conventional medicine is
warranted. It is clear that there is willingness amongst some communities to strengthen
TMP and keep culture strong, however changes to and support for integrative and governance
models for TMP need to be made and support increased to reduce the risk of the loss
of knowledge as generations shift. Australia could benefit by looking to other nations
to improve this support and strengthen governance for traditional Aboriginal medicine.
Understanding more clearly the role of TMP by improving the quality and quantity of
research within Aboriginal Australia could potentially improve primary health care
outcomes for Aboriginal and Torres Strait Islander Australians.
http://www.ethnobiomed.com/content/9/1/46
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