ATSI – spiritual and cultural beliefs

1. Connection to Land and Nature

• Belief: Aboriginal and Torres Strait Islander peoples have a deep spiritual connection to the land, often referred to as “Country.” Land is not just a physical place but a source of identity, wellbeing, and spiritual significance.
• Healthcare Impact: Many Indigenous patients may feel uncomfortable or disconnected in large, sterile, urban hospitals that are far from nature or “grounded” environments. The separation from nature in these environments can cause distress. For example:
  • Hospitals and Big Buildings: ATSI patients may feel uneasy or reluctant to enter large buildings like hospitals because they are high above the ground and disconnect them from the earth, which they believe is essential for spiritual and physical healing.
  • Walking Barefoot: Some Indigenous patients prefer to walk barefoot because it allows them to stay connected to the earth, which they believe promotes grounding and a sense of spiritual balance.

Aspect	Connection to Land and Nature	Impact on Healthcare (Western Medicine)
Healing from the Land	Land provides physical and spiritual healing; time on Country restores balance and wellbeing.	Preference for outdoor settings in healthcare; preference for bush medicine alongside or instead of pharmaceuticals.
Walking on Country	Walking barefoot connects individuals to the earth, promoting grounding and spiritual balance.	Discomfort in shoes or indoor settings; desire to return to Country for healing and recovery.
Sacred Sites and Healing	Certain areas of land are sacred and possess spiritual healing properties.	Indigenous patients may seek healing at sacred sites, avoid healthcare facilities built on spiritually significant land, or express reluctance to enter certain areas.
Nature as Part of Spiritual Wellbeing	Natural elements (plants, animals, water) are integral to spiritual and physical health.	Environmental damage can cause spiritual distress. Access to natural settings, like rivers, can enhance healing, but absence may cause discomfort.
Respect for Animals and Ecosystems	Animals and ecosystems are spiritually significant, often serving as totems or spiritual guides.	Symbolic presence of animals may influence perceptions of health. Traditional practices like hunting are considered part of maintaining health.
Seasonal and Cyclical Connection	Health decisions and lifestyle practices align with natural cycles and seasons, considered essential for balance.	Indigenous patients may prefer to time medical interventions with natural cycles, which may conflict with standard treatment schedules.
Returning to Country for Healing/Death	Returning to ancestral lands is essential for spiritual peace, especially at end of life.	Indigenous patients may wish to leave hospitals for end-of-life care at home, fearing spiritual harm if they die away from Country.
Use of Bush Medicine	The land provides traditional healing remedies (bush medicine), passed down through generations.	Preference for natural remedies over or alongside prescribed medications. May combine traditional and Western medicine.
Sacred Trees and Places for Reflection	Certain trees and landmarks serve as places for spiritual reflection and mourning, aiding emotional healing.	Hospitals away from sacred or natural sites may feel isolating. Indigenous patients may seek time in nature for emotional or spiritual healing.

2. Concept of Health and Holistic Wellbeing

• Belief: In many Indigenous cultures, health is seen as a holistic concept. It encompasses not only the physical body but also the spiritual, emotional, and social aspects of life. Wellbeing is closely tied to family, community, and the environment.
• Healthcare Impact: This broader view of health may not align with Western medicine’s focus on treating specific illnesses or symptoms. Indigenous patients may seek treatment for spiritual or emotional imbalances, such as grief, trauma, or disruption of relationships, which are not always recognized in Western medical models. For instance:
  • A person may describe feeling unwell due to a spiritual imbalance, such as a disconnection from their land or ancestors, which Western medicine might not address.

3. Fear of Death and Spirits

• Belief: Many Aboriginal and Torres Strait Islander people hold specific beliefs about spirits and the afterlife, which influence how they perceive hospitals and death.
• Healthcare Impact: Hospitals, particularly Western hospitals, may be seen as places where people go to die, leading to a fear of these environments. Some Indigenous people believe that the spirits of those who die in hospitals may not be able to return to their ancestral lands, causing great distress.
  • Dying in Hospital: Many ATSI patients and their families prefer to return home to die rather than staying in a hospital because they believe the spirit must return to Country (ancestral land) for peace.
  • Avoidance of Death-related Discussions: In some communities, talking about death is taboo and considered to invite bad luck. Western medicine often involves detailed discussions about prognosis, terminal illness, and end-of-life care, which may make Indigenous patients uncomfortable or anxious.

4. Kinship and Community

• Belief: Kinship and strong family ties are central to the health and wellbeing of Indigenous peoples. Decisions about health are often made collectively, involving the broader family or community.
• Healthcare Impact: Western medicine typically focuses on the individual and encourages personal responsibility for health. However, Indigenous patients may feel that health decisions must be made with the input of family, elders, and community members.
  • Group Decision Making: Indigenous patients might not make quick decisions about treatment without consulting family members, which can be seen as a delay in Western medical practice.
  • Presence of Family: Large family gatherings in hospitals, including extended family, can occur, as many feel the need to support the patient and ensure culturally appropriate care. This may be challenging in hospital settings with visitor restrictions or limited space.

5. Spiritual Healing and Traditional Healers

• Belief: Traditional healing practices are important for many Aboriginal and Torres Strait Islander people. Traditional healers (e.g., Ngangkari in some communities) play a key role in maintaining spiritual and physical health through the use of natural remedies, rituals, and spiritual guidance.
• Healthcare Impact: Indigenous patients may seek out both Western medical treatments and traditional healing practices. They may rely on bush medicine or the intervention of a traditional healer before or alongside seeking Western medical care.
  • Use of Traditional Medicine: Indigenous patients may prefer or trust traditional medicines and remedies (e.g., bush plants) over pharmaceuticals. In some cases, there may be reluctance to use prescribed medications because of these preferences.
  • Combination of Healing Approaches: Some patients may choose to see both a doctor and a traditional healer, and they may expect the healthcare system to respect and incorporate their traditional practices.

6. Fear of Removal and Historical Trauma

• Belief: Many Aboriginal and Torres Strait Islander peoples carry the trauma of historical policies such as the Stolen Generations, where Indigenous children were forcibly removed from their families.
• Healthcare Impact: This historical trauma can manifest as a mistrust of healthcare institutions and government services, leading to delayed healthcare-seeking behavior.
  • Fear of Child Removal: Indigenous parents may fear that hospitals or healthcare services could result in their children being taken away, a fear rooted in past practices. This may lead to avoidance of hospitals or medical services, especially in cases involving child health.
  • Mistrust of Healthcare Providers: Some Indigenous patients may be hesitant to engage with healthcare providers due to a perceived lack of understanding of their cultural needs or fear of discrimination.

7. Spiritual Healing through Ceremony

• Belief: Ceremonies, including smoking ceremonies or cleansing rituals, are an important part of healing and maintaining spiritual wellbeing for many Indigenous Australians.
• Healthcare Impact: These ceremonies may be performed before or after a significant event like surgery, illness, or death. However, such practices may not always be accommodated or understood in Western medical settings.
  • Smoking Ceremonies: These involve burning native plants to cleanse a space or person spiritually. Patients may request permission to perform a smoking ceremony before undergoing a medical procedure or upon leaving a hospital.

8. Belief in “Sorry Business”

• Belief: “Sorry Business” refers to the Indigenous mourning and funeral practices, which are deeply significant and involve extended periods of grieving, often involving the entire community.
• Healthcare Impact: Western medical systems may not fully recognize the importance of “Sorry Business,” leading to potential conflicts when Indigenous patients need time off work, leave from school, or an extended stay away from healthcare facilities.
  • Prioritization of Mourning: Family members may prioritize participation in “Sorry Business” over medical appointments or treatments, which can be misunderstood by healthcare providers as non-compliance or neglect of health.

Type of Business	Meaning	Significance	Cultural Considerations	Health Implications
Sorry Business	Mourning practices and ceremonies after a death	Brings the community together for grieving and support	Avoidance of certain names/images of the deceased suspension of work/routines during the mourning period	Emotional and mental health impacts, including grief and stress. Long mourning periods can affect mental well-being, social participation, and access to healthcare.
Men’s and Women’s Business	Gender-specific cultural knowledge and ceremonies	Involves initiation rites and passing down of cultural roles and knowledge	Sacred and secretive; strictly limited to the respective gender groups	Restricted access to gender-specific healthcare if cultural boundaries are not respected. Gender-sensitive care is crucial.
Ceremonial Business	Ceremonies marking life events (e.g., initiation, marriage)	Central to maintaining cultural traditions and spiritual beliefs	Deeply spiritual, involving song, dance, and rituals; sacred in nature	Physical and emotional well-being may be influenced positively through community support but also through potential stress or physical strain during lengthy ceremonies.
Kinship and Family Business	Business involving family gatherings, dispute resolution, and kinship ties	Fundamental to social structure, influencing relationships and responsibilities	Complex obligations that are governed by traditional kinship rules	Family and community responsibilities may lead to stress or mental health challenges, especially if there is conflict or high expectations.
Cultural Business	Preservation and sharing of traditional knowledge (language, art, spirituality)	Vital for maintaining cultural identity and traditions	Involves storytelling, oral histories, and respect for Elders who hold the knowledge	Positive impact on mental and emotional well-being due to a sense of belonging and cultural continuity. However, loss of cultural knowledge may lead to feelings of isolation or identity issues.

9. Different Interpretations of Health Symptoms

• Belief: Some symptoms may be interpreted as signs of spiritual distress rather than physical illness. For instance, feeling unwell could be attributed to a spiritual cause, such as a curse or breach of cultural law.
• Healthcare Impact: Indigenous patients may describe symptoms differently, emphasizing the spiritual or emotional aspects of their illness rather than physical symptoms, which can lead to misunderstandings with healthcare providers focused on physical diagnoses.