ObjectivesTo determine the low back pain beliefs of Aboriginal Australians; a population previously identified as protected against the disabling effects of low back pain due to cultural beliefs.DesignQualitative study employing culturally appropriate methods within a clinical ethnographic framework.SettingOne rural and two remote towns in Western Australia.ParticipantsThirty-two Aboriginal people with chronic low-back pain (CLBP; 21 men, 11 women). Participants included those who were highly, moderately and mildly disabled.ResultsMost participants held biomedical beliefs about the cause of CLBP, attributing pain to structural/anatomical vulnerability of their spine. This belief was attributed to the advice from healthcare practitioners and the results of spinal radiological imaging. Negative causal beliefs and a pessimistic future outlook were more common among those who were more disabled. Conversely, those who were less disabled held more positive beliefs that did not originate from interactions with healthcare practitioners.ConclusionsFindings are consistent with research in other populations and support that disabling CLBP may be at least partly iatrogenic. This raises concerns for all populations exposed to Western biomedical approaches to examination and management of low back pain. The challenge for healthcare practitioners dealing with people with low back pain from any culture is to communicate in a way that builds positive beliefs about low back pain and its future consequences, enhancing resilience to disability.
Participants focused on issues closely related to effective and ineffective management of RF/RHD. The lessons learned are indicators for health staff attempting to improve the quality of management that people receive.
Contrary to previous assumptions, CLBP is profoundly disabling for some Aboriginal people and a priority health concern. Issues of gender, cultural obligations and the emotional consequences of CLBP are important consideration for health care. These findings, and the contextual approach used to gain an in-depth understanding of CLBP, may be relevant to populations elsewhere.
The purpose of this study was to gain insight into what prevocational medical practitioners (PMPs) learnt during a six-month public health medicine and primary health care training program (the Program) in remote Aboriginal Australia in 2001-2002. The Program's curriculum objectives included clinical and public health management of sexually transmitted infections, immunization, clinical audit and quality improvement, primary health care in remote Aboriginal communities, and working as part of an interdisciplinary team with health and non-health professionals, and lay people. The mode and location of delivery of these objectives was determined by the healthcare needs of the Kimberley population, and availability of safe, supported workplaces. Qualitative data from a variety of sources, including PMPs' reflective journals, were examined in the context of the Program's curriculum objectives and by conducting a content analysis of journal notes. Findings are presented using the curriculum objectives and other comments that emerged while examining the data. Preliminary data indicated that PMPs gained knowledge and practical experience in clinical and public health management of sexually transmitted infections, immunization and primary health care in poorly resourced remote Aboriginal settings. Deeper understandings of health and illness in a cross-cultural setting also developed, along with professional and personal growth, as illustrated by the following quotations from PMPs: "I have learnt ... a different way of looking at people's health ... I was encouraged to think more deeply than before about the whys and wherefores of medical practice, and thus consider the most effective ways of influencing patients' behaviours for the better." "I was encouraged to examine the thought processes behind the ways ... healthcare was provided ... [after leaving the Kimberley] I am constantly questioning the reason why we are practising medicine in a certain way in the big city hospitals-much to the consternation of my colleagues ... ." The Program was successful in teaching its first four PMPs the basic tools of public health medicine and remote area primary health care.
Indigenous knowledge systems (IKSs) can, and do, contribute to natural resource management (NRM) in Australia and elsewhere. However, cross-cultural NRM and scientific research usually emphasizes particular components of IKSs, rather than engaging with the value of an integrated complex IKS. Focusing on two case studies of Aboriginal groups in the Kimberley region of northwestern Australia, we present a conceptual framework that represents how IKSs can manifest as a system of wetland management. The framework depicts how beliefs, knowledge, and practices are interrelated , forming a meaningful and organized approach in which indigenous Bardi Jawi and Nyul Nyul people historically managed, and aspire to continue managing nearby Customary Law-inherited wetlands. The framework presents a meso-scale representation of IKSs that highlights four management principles: custodianship, respectful use, active maintenance, and learning. We describe how affinities for these principles, vis-à-vis other indigenous groups, can also be discerned. Providing a visual framework tool has the potential to assist the application of IKSs to wetland management, and take account of the view that "wetlands need people," by emphasizing the active, integrated, and reciprocal nature of these knowledge systems in place (associated with traditional lands). That indigenous people value, as well as shape, wetlands, is also considered. By interpreting the framework to support indigenous wetland management (and services to ecosystems) within active cross-cultural work, IKSs promise benefits for people and ecosystems.
Permanent waterholes in intermittent rivers of northern Australia support a diverse piscifauna and are popular areas for customary and recreational fishing. The present preliminary study explored the perception that fishing reduces the abundance of targeted, large-bodied species that become restricted to disconnected waterholes during the distinct dry season. River sites in the Fitzroy River catchment, Western Australia, could be clearly classified as experiencing either high or low fishing pressure by using metrics of human ‘accessibility’. The abundance of Hephaestus jenkinsi and Lates calcarifer, targeted by both recreational and customary fishers was highly correlated with accessibility and showed a negative relationship with fishing pressure. Non-target species showed no discernible trend. We estimated that 38% of river length remains subject to relatively low fishing pressure. These preliminary relationships suggest that fish harvest can potentially alter the structure of fish assemblages in disconnected habitats. The potential impact of fishing on the sustainability of fish populations is, most likely, greatest for non-diadromous species and will become more apparent with increasing distance from recolonisation sources. Combining management techniques that maintain recolonisation and recruitment potential with traditional fisheries management strategies (e.g. bag and size limits) presents a suitable approach to mitigate the effects of fish harvesting from tropical intermittent rivers.
Water, in all its physical, symbolic and metaphorical guises, has an obvious interconnection with people. Without water, human and other life forms cannot (and do not) exist. Less obvious is water's potential as a site of anthropological investigation to explore attachments to place. Such attachments, as Arturo Escobar observes, facilitate a multiplicity of place‐based cultures, and emerge when ‘connectivity, interactivity and positionality’ are present. His observation makes epistemological room for what Anna Tsing conceptualises as the ‘friction’ that permeates environmental and indigenous projects. Via Australian‐based Kimberley ethnographic insights, this article examines people's attachments to place‐based cultures when they become meaningful through multi‐layered tensions about water.
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