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Untitled Prezi

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Jan Golembiewski

on 22 November 2013

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Salutogenics: designing for Indigenous Health
Remote Indigenous Australian Health: Bad by any standards.
Indigenous Australians (especially those who live remotely) have some of the worst health statistics in the world.

Differences between remote Indigenous Australians and Urban Australians are extreme for almost all indicators.

The 'gap' is not caused by Governmental neglect or lack of funding. Rural Indiginous Australians recieve more than double the healthcare dollars than other Australians.
A model to understand health holistically
A sense of coherence is the sum of all factors that help against the entropy of illness and inevitability of death.
Another way of understanding
Both Health and disease are foreign concepts to traditional Aboriginal culture. (Sickness and medicine are the closest equivalents.)
- 'Sickness' has no origin unless it is a product of a curse. And curses are deliberate attacks by spirits or people - not the product of poor nutrition, smoking, parasites, pathogens or lifestyle.
Traditional medicine was to treat specific acute symptoms - not 'prevention.' That is the job of tribal law.
Medicine is still a 'Band-Aid' for symptoms, and Western Medicine is used the same way, to augment traditional approaches.
The primary reason for Miscommunication is usually attributed to a lack of cultural exchange. Elders say there must be give and take. They say they want to be listened to also. THey want the 'Whitefellas' to understand them and their laws.

In interpretting this demand, healthworkers undergo cultural orientation sessions, hunting trips, corroborees and story-telling gatherings.

Jan Golembiewski BFA, BArch, MArch, PhD
The threat of conflicting beliefs
In Indigenous traditions, health is the connection to kin, the land, daily life and sacred practices. Not a Western lifestyle. It's also not the absence of pussy sores, vermin, insects etc.

The traditional Indigenous life was nomadic - people ate game, grubs, wild fruit and whatever else they could find when they were hungry. They cultivated no vegetables and kept no livestock. In modern times the equivalent lifestyle is more likely to be a meat pie or chips at the local shop.

Living a meaningful existence
- Meaning is found in relationships with tribes and tribal lands. These have always been pivotal to both understanding and to every aspect of meaning.
- Despite the hardships - remote Indigenous Australians report significantly fewer life stressors in nearly all measures.
- The remote Indigenous Australian sense of Meaning has an intensity that is desirable even to non-indigenous Australians.
- At any time, 1 in 5 remote Indigenous Australians are separeated from kin and place by the legal system.
Health professionals hope to learn so they can get on with educating about the dangers of poor lifestyle, tobacco etc.

Orientation sessions are a step in the right direction... but of a very long journey. They probably help build trust, but how much can they help mutual understanding?
Encrusted scabies, gangrene and other severe nasty looking illnesses are ubiquitous in remote NT (about 5% of children have gangrene, for example.) This is the main reason for kidney failure.

- Images that health-workers
use as scare tactics just aren't
going to be alarming.
Entrenched problems call for radically different approaches.
Pools have been installed so kids can bathe their sores as they swim. Over 18 months:
- skin infections halved.
- Gangrene halved in one community and was eliminated in another.
- Ear infections halved.
- Kids learned to swim,
- Kids got some exercise
- school attendance improved.
'Howards Intervention' 2007-2011

A major intervention to stamp out incest, domestic violence, problem drinking, education problems and unemployment.

The army was brought in to implement 'reforms'.
Alcohol and pornography was banned in Indigenous communities (but not in nearby towns or army camps).

Tribal land was annexed and sometimes leased out to mining companies (to provide 'employment opportunities')

The intervention was (rightly) widely condemned as a human rights violation
and that it was severely misguided. But...

There were positive surprises.
soldiers appear to be a better cultural fit than an army of public health workers:
- Comprehensible homogeneity
- young indigenous men came out of the woodwork and helped
- unexpected cultural synergies and an opportunity to build meaning.

A meaningful poster for a healthworker
A painting with rich meaning for several Aboriginal tribes
Defensive policy
Gangrene Encrusted Scabies
- single level building, in keeping with Australian vernacular
- ground level to emphasize connection with the Earth
- including a pool, barbecues and public laundry
- wide verandas for kin to stay and to keep out of the rain in 'the wet'
- Every bedroom opens outside
- Communal space on verandas
all corridors lead outside
- set in a native medicine garden
Some ideas
to treat the individual, you have to treat the clan
Psychotic spectrum disorders
Somatic illness
Affective disorders
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