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168 P R I N C I P L E S A N D P R A C T I C E O F C R I T I C A L C A R E

health and wellness, are restricted spiritually and practi- and Torres Strait Islander people lived in tribes, clan, skin
cally (through rituals) by the concept of tapu (sacred or and language groups. Contemporary Aboriginal society
restricted). 121,123 Breaches of tapu, while spiritual in lives in a mixture of communities and families; some still
nature, often manifest in physical forms such as illness. live in old mission sites and homes and others live a
Often illness is seen as a failure to observe tikanga traditional life.
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(custom) and tapu, and is known as makatu (a spell or Aboriginal and Torres Strait Islander people of Australia
curse) or mate Māori (sickness or death). Traditional suffer a greater burden of social disadvantage and poor
healers and healing practices (such as the use of rongoa health than other groups of the Australian population.
[medicine] and karakia [ritual chant or prayer]) play an There is a well-documented gap in life expectancy between
important role in healing someone who is ill. Accessing Aboriginal and Torres Strait Islander people of Australia
traditional healers, such as a tohunga (expert), may be an and other Australians. This gap is mainly due to diseases
important part of the critically ill person’s recovery or that are preventable, for example heart disease is three
dying process. However, cultural expressions of spiritual- times more prevalent in the Aboriginal and Torres Strait
ity differ among Māori, and for some, traditional cultural Islander population than in the broad Australian popula-
approaches may not be acceptable. The critical care nurse tion. 125 As a result of this poor health status, many critical
needs to identify the beliefs and practices related to well- care nurses will come into contact with Aboriginal and
being and illness.
Torres Strait Islander people. Critical care nurses are
There are some things that are done in one culture that placed in an ideal situation where the experiences of
are perceived to be offensive in another, and thus disrupt Aboriginal and Torres Strait Islander people and their
the formation of relationships. The concept of tapu families who are critically ill or dying can be positive
(sacred or restricted), mentioned above, is also associated whilst maintaining their cultural integrity.
with the concept of noa (common), or to make ordinary.
Thus, a person’s body, body fluids and body parts are Aboriginal view of health and health beliefs
considered tapu, whereas food is often used to make Aboriginal people of Australia have a different view of
something ordinary. In practical terms this means that health from the dominant Western view. This view incor-
food should be kept separate from the person’s body and porates notions of body, spirit, family and community. 126
body fluids. For example, do not put urine in urinals or The patient-centred model described by Espezel and
collecting chambers for faeces in pans on surfaces where Canam fits nicely with the Aboriginal view of health.
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food will be put. Body tissue and body parts and their Described as far back as 1989 in the National Aboriginal
disposal is a major consideration in the care of Māori. For Health Strategy, 124 the Aboriginal view of health is a holis-
some Māori, having their body parts and any tissues tic view in which the sense of family is integral to the
removed returned to them so they can bury them is spiri- sense of oneself, which is in turn essential to health. 127
tually important: they are returning these to Papatuanuku
(the Earth Mother). However, again it is important to The Aboriginal view of health and how Aboriginal people
identify what is important for each patient and their relate to the healthcare system influences the care given.
whānau, as some Māori may not want their body tissue The following are specific beliefs Aboriginal people have
or parts returned to them. about health and medicine:
● The use of traditional or bush medicine is
WORKING WITH ABORIGINAL AND TORRES important.
STRAIT ISLANDER PEOPLE OF AUSTRALIA ● Access to their own ‘medicine man’ or traditional
healers is important.
Aboriginal and Torres Strait Islander peoples make up ● Health problems are attributed to higher spiritual
about 2.3% of the total population of Australia, although beings, such as pointing the bone or ‘payback’.
it is important to recognise that they are two distinct ● Hospitals are places where you go to die.
Indigenous groups each with their own cultural identity. ● White man’s medicine can make you sick.
Of the total population 90% identify as Aboriginal while
6% identify as Torres Strait Islander, and 4% identify as These are important points for nurses to understand, as
both Aboriginal and Torres Strait Islander. Aboriginal these health beliefs may influence people’s perceptions
124
and Torres Strait Islander people live throughout Austra- and may be mistaken for non-compliance with medica-
lia – some live in discrete communities in remote areas tions, or feelings of doom and not wanting to get better.
whilst others live in rural or urban areas. Aboriginal and It is important to explore how traditional Aboriginal
Torres Strait Islander people were forced off their tradi- medicine and health beliefs can be used complementarily
tional lands during colonisation and some have never with Western medicine – a particularly important point
returned. There are also the Stolen Generations who were for the palliative care of Aboriginal people.
removed from families and sent to missions often in
other states or overseas. Importance of family, community and land
Aboriginal and Torres Strait Islander people of Australia Aboriginal people have a strong connection to family,
have some of the oldest living cultures in the world. Their community and the land they live on. Some Aboriginal
culture is as dynamic and diverse as the areas in which people have a number of communities: the one they
they live. Their culture today is based on their rich spiri- were born into, the one they move to, and the one they
tual connection to the land and to each other. Aboriginal work in. There are a number of Aboriginal people who