Birth and Death on Cape York
The Aboriginal and Torres Strait Islander peoples of Australia's Far North, in the state of Queensland, feel a strong identification with "country" - an intense attachment to birthplace and yearning for yearly sojourns to home countries. [The term country is used throughout Australia to refer to indigenous peoples' homelands and/or place of birth.-Ed.] When a person dies away from his or her country, the body must be returned. The old way was to be born, reside, and die in one's own spiritually defined country, close to the ancestors. Today almost no births take place in communities because women are evacuated to regional centers and, except for violent deaths, people die in hospitals far away from their country. Aboriginal and Islander people who have moved away from their birthplace feel a need to make return visits to reconnect periodically with their country, and this often coincides with ceremonies surrounding death.
Maintaining a Link to Country
Aborigines and Islanders have origin myths that connect them to their homelands and specific spiritual worlds, even in today's climate of Christianity and satellite delivered communication systems. Aboriginal people's spiritual connection with the land exists as an extension of the creation period, called the Dream-time in many parts of Australia. Ancestors pass on knowledge about the sacredness of rocks, waterholes, hills, rivers, and plants. In Cape York, people maintain this link to the land through Storyplaces, through which a specific group of individuals incorporates timeless custodianship of a country.
Western Torres Strait Islanders center their spiritual connection with country upon the marine habitat. Their accumulated knowledge and custodianship focuses on the littoral, reef flats, seagrass beds, reefs, and deep-water passages, and the species inhabiting these zones. Myths and folktales pass from generation to generation, and the older members teach the younger ones about specific resource zones.
Among the indigenous peoples of Queensland, the link with home territory or country is a spiritual exigency; it is what embodies identity for the individual and for the group. This bond to home country is intimately associated with birth, death, and knowledge about the place. People who do not know their country, or have never visited because they were forced to leave years ago, or lost it when the government granted pastoral or mining leases to outsiders are caught in a spiritual chasm.
In Lockhart, previously a mission and Aboriginal reserve, a 50-year-old woman told of the first time she visited her country. Although she was already a grandmother and very knowledgeable about cultural ways in general, this woman was a newcomer to her own country, along the Nesbitt River. Early in life, her father had taught her about their country and the important Storyplaces; but for this visit, she needed a guide to introduce her to the things and spirits of the place. She was fortunate to find an elderly woman at Coen who, although from a different tribe, knew the Nesbitt country and was able to provide the appropriate guidance and introductions. Finally the woman from Lockhart was reunited with her country at Nesbitt, and a spiritual gap was filled.
Birth in a Western Setting
The birth of a child has always been a spiritual event. During birth among many Cape York groups, the midwife would name an individual who would become the child's guardian and instructor later in life. Older children have always been shown birthing trees and have been taken to sacred sites and Storyplaces to meet the local spirits and learn about custodianship and resource use in their country.
Today the majority of births in the Far North take place in regional hospitals: residents of Cape York must travel to Cairns (up to 1,000 km away), and those living in Torres Strait must go to Thursday Island (up to 250 km away). The Western model of medicalized birth is routine in order to reduce potential risk; indeed, maternal and infant mortality rates among remote area Aboriginal people have dropped over the past 10 years in Queensland. The long-term social implications, however, of separating pregnant women from their support groups and cultural milieu have not been adequately considered by medical policy makers.
The hospital setting does not accommodate non-Western cultural practices. There is no one to help provide the name for a baby, no appropriate individual to cut the umbilical cord, and no spirits to represent the newborn's country. Although we in the West may not be pleased with our model of childbirth, we are generally familiar with having babies in hospitals - our households are but a few miles away, our family and friends visit us, and we rarely stay more than a few days. In remote areas of Queensland, however, pregnant women are evacuated at least four weeks prior to the birth (36 weeks gestation) - or earlier if medically indicated - to be close to the hospital while awaiting the onset of labor.
Cape York women are questioning the necessity of such long periods away from their families in unfamiliar towns and environments. For whose convenience, they wonder, are those evacuations taking place? Rarely do the infants' fathers, grandmothers, or aunts attend the birth. Prior to the delivery, the mother spends her days waiting in a hostel, often with no friends or relatives nearby. After delivery, the mother and baby are alone in strange surroundings, very often with no social support during this crucial stage in their lives. Not surprisingly, younger women approaching childbirth for the first time feel alone and alienated in addition to their natural fears of labor and delivery. Women who have been through pregnancies feel angry at the disruption to their family life and the spiritual estrangement of their newborn children from their country. More and more women are questioning the soundness of the existing policy and resisting it in greater numbers.
Looking for Autonomy in Health Care
In Cape York people are evacuated for almost all medical emergencies and most common medical procedures. The reason? An antiquated health care delivery system and a politically determined dependency model of services. In addition, the dispersed population, poor roads, and severe monsoon season increase the difficulties in providing equitable services in remote areas. A primary health care approach similar to that utilized in some developing countries would encourage self-sufficiency and control over health care by people at the community level [see Hull article in this issue]. A major problem in Cape York has been reliance on centralized hospital services, lack of adequate training for health professionals planning to work in remote areas, and a policy that does not always reflect the people's needs.
The present system creates severe problems for the elderly, who are often evacuated to regional center hospitals - socially hollow institutions - to die. (This is not unique; the Western biomedical model of care in our society has overmedicalized the aging process.) Many elderly die alone in a strange place or, because of the risk of a multitude of chronic ailments, end up waiting for death alone, in an institutional setting, far from their home communities on Cape York or Torres Strait.
In the 1990s the indigenous peoples of Far North Queensland are finally moving toward more political autonomy in their communities, though white Australian economic, legal, and political models continue to dominate subsistence, wage labor, laws, government representation, and organizations. For the Aborigines and Islanders of Queensland, implementing a comprehensive land rights policy is an essential prerequisite for self-determination and long-awaited social justice. The state government is currently evaluating existing policies in all areas; one priority is to restructure and provide health services and education to respond to the needs and expectations of the people being served, as well as to focus on community involvement. Many of those in the communities, on Cape York want to have services that will provide safe environments for birth and legal medical requirements for death (certification, post mortem, etc.); others are working to make independent health services be run exclusively by Aborigines and Islanders. Already in existence in large urban centers, these organizations provide coherent alternatives to state-run health facilities, especially in the areas of prevention (e.g., alcoholism and immunization) and screening (e.g., diabetes and sexually transmitted diseases).
The real challenge is how to encourage the incorporation of culturally relevant customs, such as birthing rituals, into a reliable and safe medical practice. A health care approach that gives people choices and strengthens local skills in management and technology, while incorporating self-sufficiency and community control, is a goal worth fighting for during this progressive era of change in Queensland.
1. Over the past 10 years the number of homicides in Aboriginal communities has increased. High alcohol intake in some Aboriginal communities very often leads to violence and is recognized locally as a major social and health problem.
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