On asking the clinically-relevant questions

There's a question out there in medical land that apparently asks whether you are racist or not. The question is: "Do you identify as of Aboriginal and/or Torres Strait Islander background?" Now, the response to this question  – which in Australia IS of clinical relevance – is not what matters, but the fact that some people are unwilling to ask this question in this first place for fear of "offending" a person who isn't of this background.

Fear of offending a racist person is the reason some people give as to why they feel uncomfortable asking the question. They imagine they may encounter a racist person who'll take offense at not clearly being identified as non-indigenous. More specifically, though, they fear that they'll meet a non-indigenous person who they will offend by implying the negative stereotypes associated with people of Aboriginal and/or Torres Strait Islander backgrounds. But who's given this question that connotation? The racist person who holds those prejudices – and that is the person fearing to ask the question! You don't know the strangers mind that you'll be asking, only that you imagine it may believe what you (either consciously or subconsciously) believe yourself.

And briefly before I leave this topic, let me explain why I say that it is clinically relevant to know whether a person is of Aboriginal and/or Torres Strait Islander background. In Australia, there is difference in the life expectancy, the mortality rate, and the burden from disease between indigenous and non-indigenous Australians. This difference is commonly referred to as “the gap” between indigenous and non-indigenous Australians. Clinically, a person may be more likely to suffer from one or another illness (e.g. diabetes mellitus) if he comes from an indigenous background than if he doesn’t, and his/her symptoms may be more likely to be caused by a disease that is more prevalent in those of indigenous background than those that aren’t. This is turn is relevant to both the adequate diagnosis and treatment of this person’s illness. Further to that, the government may have incentive programs aimed at “closing the gap” in the health of indigenous and non-indigenous Australians, some of which can be quite helpful in allowing indigenous persons to overcome some other indirect/social difficulties in accessing adequate health care. So, asking whether a person is of Aboriginal and/or Torres Strait Islander background needs to remain a relevant clinical history-taking question, and one devoid of prejudice from the person who has been tasked with the job of looking after the health of a community consisting of people of all types of backgrounds. And perhaps we should stop fearing to encounter a racist person if it will only make us become the racist one ourselves.

On racism in Australia

Dr. Charlie Teo, an Australian-born neurosurgeon of Asian descent, recently gave a speech on being Australian. He addressed the common denial of certain politicians, and in fact of a large segment of Australia’s population, that there is in fact a lot of racism in Australia. He pointed out that you cannot believably state that there is no racism in Australian unless you are of Indian or Arab appearance. I would add to that list Asian or African or Indigenous appearance at the very least too. That is because people of these backgrounds, with phenotypically prominent features in their face, skin colour, clothing, etc. are the ones that are often the recipients of the racism that occurs in Australia. But Australians in general aren’t racist, are they? Australians in general think they can make “non-racist” racist remarks by prefacing a racist statement by the words “I’m not being racist, but…” then following that up with an overgeneralisation or stereotype about a cultural group of people. It is such a common phrase in Australian parlance, really, but the preface doesn’t exonerate the content of the message.

The population of El Salvador is said to be over 99% ‘mestizo’, that is to say there are less than 1% “indigenous” Salvadorians or Mayan and/or pipils. Who in El Salvador does this matter to? No one! Because almost completely the people of El Salvador consider themselves Salvadorians rather than part Mayan with part Spanish ancestry – yet all of us, in varying proportions, are exactly that. You see it in the skin colour and physical features of the people. In terms of identity and culture, however, they call themselves Salvadorians only. Isn’t that a better method?... And yet maybe it isn’t about one method being better or another being worse, but perhaps it’s a cultural thing to think this way.

I remember when I was in Peru for the first time with some Australian-born girls and they were surprised by the way people describe each other in Latin American countries: skin colour, stature, hair colour, eye colours, nose length, personality, and other physical features – mostly in that exact same order! We were often trying to find people within a local hospital we were undertaking a medical school elective in. The oncologist was the white, tall guy, a bit chubby, with black hair, brown eyes, big nose, and was such a lovely man. The gynaecologist was the dark, short guy, who was overweight, had black hair and eyes, and was an arrogant prick. Found these guys in no time with those descriptions! Maybe our culture hasn’t been too marred by “political-correctness” and that’s why we can communicate so freely, but what else is the point of communicating if not to get a clear message across? I don’t know.

A few months ago I attended an indigenous culture awareness course, of which I’ve written about before. Before us non-Australian-indigenous folk was a man of Australian Aboriginal descent teaching us things about the differences between certain aspects of indigenous and non-indigenous culture. One of the rules of the course was that there were no “stupid” or “offensive” questions; all discussion and questions were allowed. As tends to happen in these kind of conversations, people soon start talking about “them” and “us”. The speaker at the front kept speaking about “us”, so a student of the course asked him a question: does he consider himself Australian at all? The question was based on the fact that we all, the speaker included, were living in Australia and sharing the experience of what living in Australia is. The speaker answered, “I consider myself an Aboriginal man”. Well, yes, but did he identify as both Australian and as an Australian-Aboriginal? The speaker laughed mockingly and said, “There is no Australian culture! What is Australian culture? Eating sausages and drinking beer?” There was an all-round “Ooh!” heard from around the room… I guess no-one likes to be stereotyped.

Is racism rife in Australia? Probably. Is this surprising? No; why should it be? Because suddenly it’s no longer acceptable to acknowledge flaws of the past (or present). What this reminds me of is of certain oppressive governments that seek to rewrite the history books that retell of their defeats or of their gross inhumane mistreatment of masses of people. If those histories or those actions are so reprehensible, then the wisest thing may not be to deny its existence, but to admit it and accept it as a challenge, to set it as the target away from which we must aim our future. If we are lucky enough not be part of a minority group, then what we can do is to personally not discriminate minority groups. But if we are part of a minority group, we must recognise also that this does not entitle us to be racist in return to “the oppressor”. We may not be able to change Australia, a whole country, but if we each make a commitment to change… 

On courageous conversations

Last week I attended an education session on Aboriginal and Torres Strait Islander cultural awareness. The intent was to help health professionals engage better with this subset of the Australian population, and as such “close the gap” between the health of non-indigenous and indigenous peoples (who fair terribly worse in morbidity and mortality). The session was run by a man who identified himself as an aboriginal man and he explained various aspects of what is culture from a psychosocial and semantic perspective. It was interesting and he spoke of a thing called “courageous conversations” – you know, all those touchy subjects on elements of our society which if we comment on we’ll be called racist or bigoted or misogynist or otherwise prejudiced. Racism and the history of Australia (or the U.S.A or South Africa or so many other nations) is one of those touchy subjects. So we all listened to the discussion he presented and he played Professor Michael McDaniel’sreconciliation speech and made passing reference to Kevin Rudd’s “Sorry”speech. The things spoken by these two men are along the same vein, but stated quite differently.

On the 13th of February, 2008, Kevin Rudd, the then Prime Minister of Australia gave a speech to acknowledge the past evils that had been afflicted systematically on the indigenous peoples of this nation. The other purpose of the speech was to apologize to aboriginal peoples of past, present, and future who had been (or will be) disadvantaged or hurt as a consequence of the shameful government policies that existed to purposely suppress aboriginal peoples. The speech was symbolic and groundbreaking, intent on paving the way to improving things in future and learning from past mistakes. This very loud gesture was meant to benefit not only the Australian indigenous people who for decades had had their history and rights suppressed, but also of benefit non-indigenous peoples by empowering them with knowledge and freeing them from the guilt of knowing that their ancestors had done something wrong but they now had the chance to right their wrongs. It was by all accounts a very admirable gesture by the leader of a nation.

Professor Michael McDaniel, an aboriginal man who is also Dean of Indigenous education at the University of Western Sydney, also gave a speech related to the reconciliation process that was occurring in Australia. He told one story of a non-indigenous solicitor who met some elders of an indigenous community and tried to tell them that he was aware of the unfairness and mistreatment indigenous peoples had suffered and he had a plan to propose some “reconciliation”, in this case something akin to acknowledging the land rights of the indigenous first occupants of that land. The aboriginal elders when he had finished his courteous and respectful talk, retold him the history of the Aboriginal people. They told him how his ancestors had raped, stolen, killed, desecrated, abused, and hurt their people in previous generations and how the current generation of their people is still suffering because of his people. The young solicitor was taken aback, surprised, and feeling blamed! What do you say to that? You say sorry. And when you say sorry the better man forgives, right? Right. That’s what we do in our culture, but not everyone’s culture is apparently the same in this respect.

Now, I have varying notions of what a sense of responsibility is, but for a while you have to consider yourself in the young solicitor’s shoes also. Prof. McDaniel explains that to the elders they were simply telling their story in their way, that they needed to do this, to vent, if you will. And at that second when the elders meet this young successful non-indigenous man, “For that moment you are Captain Cook. You are Arthur Phillip. You are the Mission Manager. You are the representative of everyone who did those things”. But you may wonder, why should he be designated the “representative of everyone who did these things”? The logic goes that it is because it is as an acknowledgement that the system and society we currently live in was built to ensure the success, exactly as he has, of a non-indigenous person like him and not of an indigenous person like the elders. So is he at fault because he is successful? Prof. McDaniel doesn’t state it quite like this, but he states that the systems that exist are at fault, they’re the “bad” ones. And yet in the middle of all this is a young man trying to do the right thing given what he has. Prof. McDaniel states he just has to “cop it, because it’s part of the healing process”. I know, I was outraged at his logic too. But you know what? Apparently it's hard for us to understand, he says, because (and I am paraphrasing here) ‘as a young non-Indigenous person, we’ve never had a sense of belonging to a society. We’ve never had “a collective sense of responsibility”’.

Honestly, I liked Kevin Rudd’s speech better. I liked it better for two reasons. As a Christian I always remember that scripture in Ezekiel 18:20 that says, “The one who sins is the one who will die. The child will not share the guilt of the parent, nor will the parent share the guilt of the child. The righteousness of the righteous will be credited to them, and the wickedness of the wicked will be charged against them”. Acknowledging our ancestors sins is one thing, we can even apologize for them and regret it on their behalf, but as for being “punished” or held accountable for it, I believe is a bit rich. My second reason can be summarised in this quote by Antoine de Saint-Exupery: “To be a man is to be responsible. It is to feel shame at the sight of what seems to be unmerited misery. It is to take pride in a victory won by one's comrades. It is to feel, when setting one's stone, that one is contributing to the building of the world”. Guilt is a useless thing unless it motivates forward action. It is honourable to take responsibility for righting wrongs even if they weren’t committed by us. It is not honourable to use punishment unless your aim is for retraining. If your camel is already walking to where you want it to go, it is only cruel to continue to beat it.

On god, nature, and spirituality

Recently I was doing a bit of reading about Australian indigenous identity, and one of the things I found very interesting is this culture's view of spirituality. In fact, the interesting thing is that a lot of indigenous cultures from vastly different places seem to have a similar belief system: sharing a deep spiritual connection to the land.

Now, I live in Australia, a westernized and largely Christian (if not by majority agnostic or atheist) country. To say that a culture has a deep connection to the land conjures up images of politics, of land ownership laws, and of a broad concept we’ll called ‘justice’. No, no, what I’m trying to discuss here is not those socio-political issues, but rather one of spirituality and culture. I admit that this new understanding is only new to me as a result of my natural curiosity and some research I had to do as part of coursework for a developmental psychology class. I would, however, like to share what I have come to comprehend from this – which may in fact be completely off track - but is probably closer to the true track to understanding these concepts.

I, like a lot of Judaeo-Christian adherents, couldn't understand before much about how a connection to the land equalled a spiritual connection. And in the Andes region, for the Incas for example, connection to the mountains meant a spiritual connection. The conclusion I’ve reached as to the reason it's hard for the traditional Jewish/Christian person to understand a connection to a land and equate it to a connection to God is because our tradition teaches us that God is in heaven, or “out there”.

So a common belief in Western culture is that God, who is creator of man and earth and everything, is in heaven, above us, in the sky somewhere. When we worship we direct our spiritual attention to this ether out there where God is. Now, the aboriginal man, for example, believes that all life comes from the earth, the soil and the ground on which we're all dependent on. And science will tell you that this is true: life on this planet requires air, water, sunlight, and nutrient and sustenance from the ground. Eukaryotic life, of which mammals and other animals like us are, depend on plants for nutrients. Plants emanate from the earth. Therefore it’s not a huge leap to assume that what keeps us alive is in the earth, or IS the earth. This is not a new observation, thousands of years ago, before pastoral times, and before mass colonization, the indigenous peoples of the land saw this basic relationship. He would see the plants and trees grow out of the soil, which fed the animals, which fed us, which kept us alive.

Keeping this in mind, consider now the human concept of god or creation. Until very recently, most traditional cultures had a basic belief that life, the universe, human beings and every other thing above, on, and below the earth, including the substance that is earth, was created by one if not many other external being/s or forces. For brevity, let’s call these beings or forces God. Extrapolate the line of thinking previously established, that if all life essentially originates from the earth, and God is creator of everything, then earth must be this being we decided to call God. It is now also easier to understand why so many native cultures speak of a 'Mother Earth' or Pachamama.

Now, the most common Judeo/Christian/Islamic traditions are monotheist and believe in a god that created the universe and everything in it, and who we in turn worship or have a spiritual connection or relationship with. To worship a creator is mostly a sign of gratitude and sustaining interconnectedness between ourselves and others (including wildlife, the earth, space, etc. as our specific faith dictates). To worship god or gods, a creator or co-creators, is a very ancient concept common to most cultures. Now consider the aboriginal man to whom God is or is in the earth. For an aboriginal man to worship God is to worship the land, to cherish and honour it, to direct his prayers and rituals to it. Christians, Jews, Islamists, etc. do the same: we pay respect to the place we think God inhabits, the heavens. We direct our prayers to this place. As an example of just this concept we have the very old traditional Christian cathedrals with high arched ceilings, ceilings decorated with images of heavenly creatures and the sun, the skies, etc. Going to the temples and cathedrals to offer our prayers and sacrifices we'd contemplate the heavens, conjure them up in mind and spirit to give our worship to God. The indigenous man does the same thing, except he believes God is in the earth. So making physical/skin contact with the soil is very important. The earth is what connects one man to God, and that which connects him to other men and all other creatures in this planet.

When Judaeo-Christians meet in their churches and synagogues and temples, etc, they also seek not only to connect and share with their god but also those whom they consider their spiritual brothers and sisters, co-worshippers in a common belief, people and creatures with whom they believe they share a common origin. It is the same also with the indigenous man, worshipping with those who are related to him via God, Mother Nature, earth. To worship together means often to worship in a specific place on earth, not just with specific people or within a specific but man-made structure such as a temple.

The indigenous man also shares a deep connection with other creatures, animals that also walk or otherwise inhabit the earth, not only with his fellow humans. That's why when the indigenous man speaks of the wolf or the kangaroo he calls him his brother, sharing a common origin and connection with the land. That's why killing animals for nutrition, especially to the aboriginal man who is not of a pastoral nature but hunts only what he will consume and absolutely needs that day, is a sacrifice and a spiritually-filled occasion, as it would be if a person of a Western culture would eat his siblings or friends. In times of crises, humans from non-traditionally cannibalistic cultures have had to do exactly this for survival, and they will tell you of their suffering in making these decisions and going through with them. You could say the indigenous man does this a little less freely, consuming his brother animals because he has acknowledged the sacrifice and has certain rituals by which these activities take place and they are often so ingrained that they are incorporated into the cultural practice itself rather than as a distinct spiritual ceremony.

Western culture’s spiritual worship rituals and our belief as to the location of God, in heaven or some other intangible place, is exactly what (I believe) makes it difficult for so many of us to understand the spiritual connection many indigenous peoples, not just native Australians, have with the land. But understanding this also helps to understand why place and movement, physical relocation, to aboriginal peoples is so important. Imagine it being like kicking someone out of a temple or cathedral, out to the cold and unknown, and asking them to continue about their lives, including their worship, without the places and things they believe to be sacred and secure.