Aboriginal Hands on Healing Program – Teaching and learning using two worlds (Aboriginal and non-Aboriginal) methodologies

Authors: Dein Vindigni and Paul Callaghan

Importance

It has long been acknowledged that Indigenous Australians experience widespread, and greater, socioeconomic disadvantage and health inequality than non-Indigenous Australians (Australian Institute of Health and Welfare, 2017).

Self-determination, a critical element in addressing this disadvantage, is an ongoing process of choice to ensure that Aboriginal and/or Torres Strait Islander people can meet their social, cultural and economic needs. Without self-determination it is not possible for Aboriginal and Torres Strait Islander people to fully overcome the legacy of colonisation and dispossession (Victoria Public Sector Commission, 2022).

In January 2016, a member of the government-appointed Referendum Council, Megan Davis stated that “Australia has rejected self-determination – freedom, agency, choice, autonomy, dignity – as being fundamental to Indigenous humanness and development” (Davis, 2016).

Universities have an important role to play in supporting self-determination; however, Leroy-Dyer (2018) posits that Aboriginal pedagogy is tied to the forced domination of colonial structures and that the academic world has not been welcoming to Aboriginal ways of thinking, understanding and approaching knowledge, partly as these approaches are not considered to belong to existing theory.

The eleven principles of the Gentle Academic have a critical role to play in changing the pedagogical approach to supporting Aboriginal self-determination and wellbeing. Principle 8: “Include underrepresented voices and perspectives that have historically been left out of the academy” is of particular importance, as is demonstrated in this case study.

Although this case study is by nature, centred on an Aboriginal Community, it is important to highlight that the approach outlined can be used to improve the delivery of culturally embedded health services in Indigenous Community contexts around the world.

Scenario

In 1998, a small number of Aboriginal and non-Aboriginal people gathered in Brewarrina, a small town in western New South Wales (NSW), Australia, to seek cultural guidance from Uncle Paul Gordon, a senior Ngemba Elder recognised for his cultural knowledge and expertise. The focus of discussion was about how this group might address inequities in access to ambulatory healthcare (healthcare services outside of the hospital setting) that Aboriginal people faced. Uncle Paul Gordon’s advice focused on learning about, understanding and sharing knowledge of Aboriginal ways of knowing, being and doing.

From those beginnings, Uncle Paul Gordon encouraged interested health professionals to learn more about the richness of traditional Aboriginal approaches to healing and the importance of active collaboration in understanding and managing the pain and suffering endured by the Community.

In 2001, the continued learning and effort was formed into a project titled ‘The Aboriginal Hands-on Healing Project.’ An important part of this project was the establishment of a Community Advisory Group (CAG) to:

• inform the design and delivery of a prevalence study to assess the risk factors contributing to the musculoskeletal pain and associated disability in the Community; and
• inform the design and delivery of teaching and learning to targeted stakeholders to help address the identified health conditions.

Step one of the project included the conduct of a literature review to support the development of a revised model for minimum level methodological considerations for conducting musculoskeletal prevalence studies and associated good practice guidelines in Communities.

Step two of the project involved the development and implementation of a preliminary Community-based course titled the Aboriginal Hands-on Healing Program (AHOHP). The course was informed by the outcomes of the prevalence study and attempted to incorporate both modifiable risk factors (to facilitate the prevention of musculoskeletal conditions) and opportunities for managing the most prevalent musculoskeletal conditions, primarily in the form of tactile, massage therapies.

The emphasis of this Community-based course was to promote collaborative, culturally sensitive and sustainable health care delivery.

The AHOHP was collaboratively developed over a two-year period with a large Aboriginal Community Controlled Medical Service (AMS), an Aboriginal healthcare training college, a local university, and HANDS-ON-HEALTH AUSTRALIA, a not-for profit healthcare organisation.

A critical element of the design process was the incorporation of aspects of traditional healing and hands on healing practices to complement mainstream methodology and create better community engagement and health outcomes. The course was accredited according to the guidelines of the New South Wales Department of Education and Training with a view to expansion to other sites and institutions over time.

Aboriginal Health Workers (AHWs) were identified as key targets for course training. An important characteristic of this system of on-site training was the flexibility of its delivery. The training offered recognition of prior learning attainment (i.e., other relevant subjects such as first aid, occupational health and safety, anatomy and physiology), and an opportunity for students to use existing skills and knowledge as a basis for more advanced studies. The course was delivered in a flexible mode over a two-week period in a local Aboriginal healthcare training college that was easily accessed and provided a culturally safe physical space for course participants.

In implementing the course, it was important to:

• incorporate cultural sensitivities into all aspects of practice so the most prevalent musculoskeletal conditions which included low back pain, neck pain and headaches, shoulder pain and knee pain could be effectively addressed;
• acknowledge the value that the Community attached to sport; and
• respect and incorporate the traditional knowledge and experience of both Elders and AHWs in promoting the health of their own Community.

The AHOHP was piloted, and changes to skills, knowledge and attitudes of AHWs were assessed and implemented as part of a quality improvement process. While the sample size of twenty participating health workers was relatively small, post-intervention enhancement in the skills and knowledge of AHWs was demonstrated. Importantly, the AHOHP was shown to be a culturally acceptable step towards promoting the improved musculoskeletal health of Indigenous people living in this rural Community.

A valuable learning from this project was the importance of listening to and learning from all stakeholders when developing and delivering sustainable, Community-based training programs of this kind. This collaborative approach ensured that services were built on a platform of culture, were culturally appropriate and safe, and that clinical practice worked within a framework of Aboriginal ways of knowing, being and doing, rather than being dominated by forced colonial structures. The project demonstrated the importance of giving consideration to cultural sensitivity, cultural safety and collaboration at every stage of the process when planning health service delivery with and for Indigenous people.

Pivotal to the implementation of project pedagogy and epistemology was an Aboriginal model of leadership/teaching and learning developed by Uncle Paul Gordon titled ‘The 6Ls’:

A leader is not someone with words but someone with action – action that is attached to real knowledge. The only way you can have real knowledge is by acknowledging your responsibilities (Lore), loving, looking, listening and learning. I call these the 5 Ls. By following the 5 Ls, you have an understanding of who you are, where you are from and what your role is in the universe. Once you have done this you are ready for the 6th L. You are ready to lead. (Callaghan & Gordon, 2022, p.270)

Table 1 outlines how The 6Ls model was applied in this project.

Table 1: Application of ‘The 6Ls’ (Callaghan & Gordon, 2014) in the design and implementation of the AHOHP project.

By incorporating an Aboriginal perspective into this program and addressing the underrepresentation of voices and perspectives that have historically been left out of the academy, the AHOHP has achieved a number of significant impacts that mainstream practice has not been able to achieve including:

• the development and application of a Community-based, culturally embedded model of care;
• increased accessibility to, and the benefits of, ambulatory healthcare for a targeted Community;
• the creation of a foundation for the emergence of other initiatives including the Aboriginal Health in Aboriginal Hands (AHAH) program, a chiropractic and allied health service in collaboration with HANDS-ON-HEALTH AUSTRALIA and a Community-based football and netball club;
• a school-based spinal health promotion program;
• the seeding for training programs in other Communities throughout the country as a step towards promoting improved musculoskeletal health of Indigenous people living in rural Australia; and
• the extension of allied and healthcare services overseen by HANDS-ON-HEALTH AUSTRALIA to rural and remote Communities through supervised allied and health students as part of the Koorie Football and Netball carnivals in Victoria and New South Wales.

Reflection

This privileged journey of walking with people of like mind and heart was seeded and nourished by the values and vision embraced by Uncle Paul Gordon and his call for leaders to embrace action that is attached to real knowledge by acknowledging our responsibilities: Lore, loving, looking, listening and learning as a pathway to authentic and fruitful leadership.

If we were to do anything differently, it would be to engage with mainstream health practitioners earlier in the development process so they could see the benefits of community codesign and how the incorporation of Aboriginal views of health and wellbeing can complement clinical practice and generate better outcomes for all stakeholders.

Advice

Socio-economic data suggests mainstream approaches to addressing Aboriginal disadvantage, including creating improved wellbeing in Aboriginal Communities, are failing. Adopting an approach that respects, understands and supports Aboriginal self-determination is critical in addressing this unacceptable situation. To do this, academics need to ensure Aboriginal voices and perspectives are heard and acted upon at a foundational level rather than as an add-on to existing, dominant culture practice. The ‘6Ls Model’ provides a framework to do this. By building knowledge based on Lore, loving, looking, listening, learning and leading, academics will be able to develop teaching and learning approaches and content that can lead transformation that will achieve increased self-determination and improved wellbeing for Aboriginal Communities.

References

Australian Institute of Health and Welfare. (2017). Australia’s welfare 2017: In brief. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/australias-welfare/australias-welfare-2017-in-brief/contents/indigenous-australians

Callaghan, P. & Gordon, P. (2022). The dreaming Path: Indigenous thinking to change your life. Pantera Press.

Callaghan, P. & Gordon, P. (2014). Iridescence: Finding your colours and living your story. MoshPit Publishing.

Davis, M. (2016). Listening but not hearing: When process trumps substance. Griffith Review, (51), 73-87.

Leroy-Dyer, S. (2018). Aboriginal enabling pedagogies and approaches in Australia: Centring and decolonising our approaches. International Studies in Widening Participation, 5(2), 4-9.

Victoria Public Sector Commission. (2022). Aboriginal and Torres Strait Islander self-determination. Victorian Public Sector Commission. Retrieved March 1, 2024 from https://vpsc.vic.gov.au/workforce-programs/aboriginal-cultural-capability-toolkit/aboriginal-self-determination/