BROWN: I think they’re an extraordinary opportunity for us to all be able to come together to share knowledge, to share culture, to share experiences. So we’re all trained in a so-called western model of medical practice and in clinical treatment, but there’s so much more that we can actually bring to the profession. So we have doctors and students, we have health workers from a range of countries, and other health professionals, both indigenous and non-indigenous. We also have very senior people, and other traditional practitioners that come to share their experience with us so that we’re enriching our practice, our understanding of identity, and how we actually contribute to medical practice, the service delivery, to research into medical education as indigenous practitioners and as indigenous peoples and not just as doctors.

 

COUTTS: And do they cohabit well, are they on parallel paths or can they be integrated the traditional forms of medicine with the western brand of medicine?

 

BROWN: It’s a really interesting question and we know that our indigenous senior healers, these are knowledges that have been passed down for tens of thousands of years. So obviously there was something there that works. There had been a movement away from that kind of traditional practice, just I think through lack of understanding and/or respect of those practices and how they had maintained community health and wellbeing for so long. And what we’re trying to do is sort of re-establish those connections and respect the knowledges and integrate those practices into the way that we do things. Communities still rely on traditional practices, on traditional medicines, and there’s certainly an increased movement. So if we look at some of the traditional practices, even from Southeast Asia, we have many of our own, and so we’re really integrating those into the way that we provide clinical care and services, not just in community but in hospitals, in Aboriginal medical services, in other comprehensive primary care environments. So we’re wanting to respect and maintain that. And I think that connection means that indigenous peoples will be more likely, hopefully more willing to then engage with services so that we’re not waiting until people are so unwell that they have to go to straight through ED or to intensive care or that their chronic disease is so well established that we can only just maintain a certain sense of health. But we’re actually creating and maintain health and wellbeing, so we’re healthy, we’re staying healthy, we’re making good decisions about our health. We’re respecting where we’ve come from and we’re carrying that forward and preserving it.

 

COUTTS: Now with colonisation of course there are many aspects that came with it, one of it of course is the white illnesses that weren’t known or suffered by the indigenous population of Australia. Can the indigenous culture, practices and medicines deal with those white illnesses?

 

BROWN: I think we’re dealing with it generally quite poorly for everybody, because the levels of morbidity and mortality are almost overwhelming. Within a system, and this is a broad comment as well as for Aboriginal communities, but within systems that I think that are under-resourced to be able to deal with those levels of ill health, does that make sense?

 

COUTTS: Yeah.

 

BROWN: So the more we have our practitioners clinically but also culturally competent and understanding communities and perspectives, so that they’re different from the mainstream sort of western model, the better able we will deal with these issues. So if we’re understanding the social and cultural context within which we are engaging and treating patients, it will mean better outcomes.

 

So there’s an aspect of it that’s very much about the systems and the resourcing, and where we have numbers and staffing and money for programs that are appropriate for local as well as regional state and federal priorities, but part of it’s also our medical and professional education and development and how we’re dealing with that.

 

So all of our doctors and nurses and dentists and health workers should be equipped to understand and be able to deal with Aboriginal and Torres Strait Islander health issues, and indigenous issues in our region. So it’s a mixture of not just resourcing, but professional education and development, clinical and cultural competence, and certainly from an indigenous perspective when we’re training our doctors and our students, and the kinds of role models and mentors we’re providing for our communities and for our young people.

 

It’s about the relevance of the opportunity, it’s about identity and how that actually builds resilience so that we can have better outcomes in terms of health and wellbeing. Multiple complex threads, but if we’re given the space we can draw those together and actually create better outcomes.

 

COUTTS: The focus as I said in the introduction or one of the focuses is to promote culturally safe research and clinical practices. Is there a suggestion that somewhere along the line that hasn’t been safe?

 

BROWN: I would say absolutely. And no that’s not necessarily because of any ill-will for example. But there’s often been quite divergent perspectives on what is important in terms of research or what that research then actually means for example. So rather than being community driven or orientated or initiated in the first instance because a local priority might be youth suicide, or it might be immunisation rates or it might be ear disease or respiratory infections for example.

 

It’s often researcher driven, so it might be a particular interest for a research project or for an institutional interest, and so it’s been very difficult to be able to bring those divergent perspectives and interests together. So if we have better relationships with communities in the first instance, and they take time and investment in those relationships, and many institutions have done this quite well, they’re not perfect but they’re progressing those relationships.

 

If you’re able to negotiate a research agenda that’s looking not only at local priorities and community engagement in the process of developing that research project, but the utility of the knowledge, so the sustainability and transfer ability of what we learn and the benefit sharing from that and the translation back into clinical service delivery and on the ground change, we can actually make sure there are extraordinary impacts.

 

And … has lacked that in many ways to date, but we’re getting back, we’re actually influencing through our Aboriginal and Torres Strait Islander peak bodies and our practitioners, influencing research process in Australia.

 

We’re contributing to say the NHMRC, into the ARC for example, and we’re able to provide leadership in this sector so that we’re looking for better outcomes for everybody, both indigenous and non-indigenous.