A significant barrier to accessing palliative care for Australian Indigenous peoples is the Western ‘medicalisation’ of dying and death. Many people would prefer to avoid healthcare institutions, particularly hospitals, during the end-stages of life due to the lack of consideration given to cultural practices, customs and Lore regarding the end-of-life journey by non-Indigenous healthcare professionals.
Only a few decades ago, many Aboriginal and/or Torres Strait Islander people considered the end-of-life journey to be sacred business and would not speak of dying or death outside of their communities. The mismatch between Australian Indigenous peoples’ beliefs and the Western / medical understanding means that there is a reluctance to trust non-Indigenous healthcare staff with what is considered a sacred or spiritual time.1
The building of trust through consistent, long-term relationships between healthcare services and communities, that are inclusive and respectful of Australian Indigenous peoples’ cultural practices is an essential requirement for providing quality palliative care.2
Key Video Resource – PCC4U/IPEPA Yarn: Cultures, beliefs and the end-of-life journey (5:34)
This video excerpt (also part of Activity 4) provides a perspective on the diversity of cultures and beliefs around the end-of-life journey for Australian Indigenous peoples.3
Check the thinking points below for some questions to consider with regard to this video.
Learning resources
Learning about cultural considerations is important for all health professionals. There are many resources available that can support learning in this area.
An outline of the various learning resources and the key content they cover is provided in the ‘Related Links’ section below.
| Booklets and Guides: |
| Cultural considerations – providing end-of-life care for Aboriginal peoples and Torres Strait Islander peoples (IPEPA)4
Sad News, Sorry Business: guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying (Qld Health)5 |
| eLearning Modules: |
| Gwandalan Palliative Care eLearning Modules:6 |
Traditional healing
Traditional healers, also called Ngangkari (Central Australia) or Maparn (Kimberley region) may also be involved in the care of some Aboriginal and/or Torres Strait Islander people, particularly at the end-of-life. The skills of traditional healers come from a lifetime of being immersed in cultural ways of being, with knowledge being handed down from one generation to the next. Their role and influence cannot be easily translated into the Western medical understanding of health and wellbeing. Traditional healers use techniques such as observing, listening and touch / massage. They may also use bush medicines and ointments made from local plants.7 Further information about the role of traditional healers is available in the video, ‘Where traditional and modern medicine meet‘.
Returning to Country
Returning to Country may be complicated if a person is on intensive therapy, such as dialysis or receiving specialist palliative care. The desire to return to Country may be more important to the person than the treatment of their disease. Working in partnership with primary healthcare services, the family and community is important at this time to investigate possibilities.5For many Australian Indigenous peoples, the need to return to Country or Island at the end of life is of great importance. Remember that the person’s Country can be in a city, a rural town or a remote area. Spiritual and cultural beliefs around life as a continuum – Life-Death-Life (as discussed in Section 2) are common; at the time of death, the spirit leaves the body and returns to the Ancestors’ Country.
Even if a physical return is not possible, being connected to Country at the time of death is very important for many people. Experienced health professionals who care for Aboriginal and/or Torres Strait Islander people during their end-of-life journeys, report a range of ways that they ‘bring Country to people’ if a physical return to Country is not possible. These include:
- Use of technology to brings the sights and sounds of Country to the care facility (eg, campfire, running water, ocean / waves, images of the land, waters, sky/stars etc.)
- Having family bring in soil, rocks or leaves from the person’s Country and keeping it in a jar beside their bed
- Using videoconferencing to allow people to see and speak with family who are on Country.1
PRACTICE POINT
It is important to note that many Aboriginal and Torres Strait Islander people do not live on traditional Country. This does not diminish their cultural and spiritual connection to Country. It is helpful to ask if a return to Country is something that is an important part of the person and family’s end-of-life journey.7
Key Video Resource – ‘Passing On’: ECU Scenario (4:54)
This scenario, inspired by the real stories and experiences of Indigenous people, shows the experience of an Aboriginal family whose father is dying in hospital. The interactions they have with the nurse provide important points for reflection.8
Check the thinking points below for some questions to consider with regard to this video.
Thinking Points
- Review the video, ‘Passing On’ and reflect on the following points:
- What is most important to the patient’s daughter at this time?
- How does this differ from what is important to the nurse in the scenario?
- How could the nurse have improved her communication?
- In an ideal world, how should the healthcare team have dealt with this situation?
- What changes could be made to the health service to better care for both Aboriginal and/or Torres Strait Islander people who are at the end of life? Consider both physical changes as well as policy changes.
- Look at the list of resources introduced in this section to help health professionals learn about cultural considerations for Australian Indigenous peoples receiving palliative care. Choose one resource to review and make some notes about what you learn and discuss your experience with a friend / colleague.
References
- Palliative Care Australia. Final Footprints: My Culture, My Kinship, My Country. 2021; Available from: https://palliativecare.org.au/final-footprints-my-culture-my-kinship-my-country/.
- Australian Government Department of Health, Exploratory Analysis of Barriers to Palliative Care: Issues Report on Aboriginal and Torres Strait Islander Peoples. 2020.
- Palliative Care Curriculum for Undergraduates. PCC4U / IPEPA Yarning about palliative care for Aboriginal and Torres Strait Islander peoples (Playlist). 2021; Available from: https://www.youtube.com/playlist?list=PLnpkhbKx-6fWV1GrOi0bpHENJcnaG4S1D.
- PEPA Project Team, Cultural Considerations: Providing end-of-life care for Aboriginal peoples and Torres Strait Islander peoples. 2020, Program of Experience in the Palliative Approach.
- Aboriginal and Torres Strait Islander Cultural Capability Team: Queensland Health, Sad News Sorry Business: Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying. 2015.
- Gwandalan National Palliative Care Project. eLearning Modules. 2021; Available from: https://gwandalanpalliativecare.com.au/elearning-modules/.
- Indigenous Program of Experience in the Palliative Approach (IPEPA) Project Team, IPEPA Culturally-responsive care workshop presentation. 2020, QUT.
- Australian Learning and Teaching Council. Creating cultural empathy and challenging attitudes through Indigenous narratives. 2012; Available from: https://altc-betterhealth.ecu.edu.au/index.php.