PCD Strategy Evaluation 2007.pdf - NT Health Digital Library ...
PCD Strategy Evaluation 2007.pdf - NT Health Digital Library ... PCD Strategy Evaluation 2007.pdf - NT Health Digital Library ...
everything was scrubbed by hand, cleaning up the rubbish. We learnt how tolook after a home the good way.She commented that this was the way to stay healthy, because things were different when youare living in a house and not the bush, but her children strongly opposed these ideas:I tell my own daughter how to do it, but all she says is “we‟re not Munanga - wedon‟t want to live Munanga way. (114)The second type of response is an expectation that services will intervene to an even greaterextent in people‟s lives than is the current situation. For example many people in Ngukurrconsidered that a move to community controlled health should involve a health service thatvisited people in their houses so that they didn‟t have to attend the local health centre (114) .Another factor which underpins the success of the chronic disease strategy is how innovations inpractice and behaviour are accepted by community members and how knowledge of newbehaviours is disseminated through the community. The research of Reid (1983) and Rowse(1996) demonstrates that people in remote Aboriginal communities, will accept andaccommodate new ideas about health and illness and that traditional cultural beliefs about thecausation of illness are not an insurmountable barrier to change. (115, 116) But these changes mustbring about positive and tangible benefits and be able to be accommodated within people‟scultural repertoire. An understanding of the community and the beliefs of the people within it,and also an understanding of the dynamics of knowledge transfer within the community, wouldappear to be fundamental to the success of interventions such as the chronic disease strategy. AsSenior (2003) pointed out, the assumption that a group of people who are exposed to aninnovation will actively disseminate the new information throughout the community can bemisguided. She described a hygiene education program carried out at a Women‟s Centre, wherethe women considered that the information provided to them was privileged as not to be sharedwith others (114) .Traditional understandings of health and illnessCultural beliefs about health and illness are not unchanging. Authors such as Rowse (1996) andReid (1983) point out Aboriginal people are adaptable and pragmatic and will incorporate newthings into their lives (such as clinics and aspects of Western medicine), which they see to bebeneficial. (115, 116) Reid pointed out that this new knowledge gave individuals “an extended rangeof possibilities to draw explanations of causality from, which gave “doubters, thinkers andinnovators room for manoeuvre”. (115)Appendix 4: Ethnographic Field Study – Evaluation of the NT Preventable Chronic Disease Strategy 2007 120
New beliefs do not replace the old, they are incorporated into the belief system, so Aboriginalpeople can be described as having a plurality of health beliefs. Because of this, it is important togain an understanding of “traditional” health beliefs to obtain an understanding of thepossibilities for potential conflict and barriers between these and the largely biomedical modelpracticed by the Health Centres.Reid (1983) has stressed the importance of understand Aboriginal socio-medical theories ofillness where people consider that most illness is the result of either neglect of a person tomaintain correct social and ceremonial obligations or because of malevolent actions of others.She suggests that Aboriginal understandings of illness among the Yolngu of Arnhem Land provideultimate explanations for sickness and death with which Western medicine cannot compete.The primary function of the sociomedical theory is to provide understanding when theloss of a member of society is a reality or a threat. The theory links perhaps the mostuncertain, and therefore anxiety-ridden area of human experience, that of health and illhealth,to the most pervasive and culturally structured area, that of human relations. Itexplains variations in one by variations in the other: if personal or clan conflicts becomemore frequent, the incidence of sickness will rise. The immediate cause of the illness ordeath is usually sorcery. The ultimate causes, however, are disturbances in socialrelationships (115)It is further “internally logical, self validating, strategically useful and, in the case of new ideasand events, flexible” (115) . This is particularly evidence in the post-colonial era where varioussocial, economic and political changes have occurred in Aboriginal society with increasingcommunity intensification and the blurring of social boundaries. Without the traditional means tocarry out order and control, such as makarrata, (115) , due to imposition of the Australian legalsystem and police presence, there has been an increase in accusations and suspicions of sorcery.This is often most evident when comparing the attitudes surrounding living in large communitiesamongst unrelated kin and other associated perils with life in homeland centres which aredepicted as providing security and protection amongst kin. Since deaths are rare in homelandcentres, as the very sick are evacuated to hospital, people are rarely confronted with thepossibility of sorcery.MethodsAppendix 4: Ethnographic Field Study – Evaluation of the NT Preventable Chronic Disease Strategy 2007 121
- Page 87 and 88: Rebates for participating or arrang
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- Page 111 and 112: 5.6 Best practice management5.6.1 P
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- Page 147 and 148: (Draft Version - © August 2006 Jan
- Page 149 and 150: References1. Dunham, H., Ministeria
- Page 151 and 152: 35. Smith, J.D., Progress report fo
- Page 153 and 154: Research Centre for Aboriginal Heal
- Page 155: 114. Senior, K., 'A Gudbala Laif? h
everything was scrubbed by hand, cleaning up the rubbish. We learnt how tolook after a home the good way.She commented that this was the way to stay healthy, because things were different when youare living in a house and not the bush, but her children strongly opposed these ideas:I tell my own daughter how to do it, but all she says is “we‟re not Munanga - wedon‟t want to live Munanga way. (114)The second type of response is an expectation that services will intervene to an even greaterextent in people‟s lives than is the current situation. For example many people in Ngukurrconsidered that a move to community controlled health should involve a health service thatvisited people in their houses so that they didn‟t have to attend the local health centre (114) .Another factor which underpins the success of the chronic disease strategy is how innovations inpractice and behaviour are accepted by community members and how knowledge of newbehaviours is disseminated through the community. The research of Reid (1983) and Rowse(1996) demonstrates that people in remote Aboriginal communities, will accept andaccommodate new ideas about health and illness and that traditional cultural beliefs about thecausation of illness are not an insurmountable barrier to change. (115, 116) But these changes mustbring about positive and tangible benefits and be able to be accommodated within people‟scultural repertoire. An understanding of the community and the beliefs of the people within it,and also an understanding of the dynamics of knowledge transfer within the community, wouldappear to be fundamental to the success of interventions such as the chronic disease strategy. AsSenior (2003) pointed out, the assumption that a group of people who are exposed to aninnovation will actively disseminate the new information throughout the community can bemisguided. She described a hygiene education program carried out at a Women‟s Centre, wherethe women considered that the information provided to them was privileged as not to be sharedwith others (114) .Traditional understandings of health and illnessCultural beliefs about health and illness are not unchanging. Authors such as Rowse (1996) andReid (1983) point out Aboriginal people are adaptable and pragmatic and will incorporate newthings into their lives (such as clinics and aspects of Western medicine), which they see to bebeneficial. (115, 116) Reid pointed out that this new knowledge gave individuals “an extended rangeof possibilities to draw explanations of causality from, which gave “doubters, thinkers andinnovators room for manoeuvre”. (115)Appendix 4: Ethnographic Field Study – <strong>Evaluation</strong> of the <strong>NT</strong> Preventable Chronic Disease <strong>Strategy</strong> 2007 120
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