Dr. Dayalan Devanesen, Order of Australia [AM]

Dr Devanesen’s lecture will take us on an extraordinary journey that covers not only Aboriginal Health / Medicine but also Aboriginal Art. He will talk us through the development of values at Bishop Cottons to creative cross cultural health programs for tribal Aboriginal people in remote parts of the Northern Territory of Australia. He will discuss Traditional Aboriginal Medicine and the use of Traditional Healers and Herbal Medicine, share his experience in establishing Aboriginal Health Workers as well innovative culturally appropriate health programs such as the ‘Strong Women, Strong Babies, Strong Culture program, and the use of traditional art for health education.

Lecture Transcript

Cottonians Old and Present, Ladies and Gentlemen, I feel deeply honoured to be speaking here today. I was fortunate to meet General Thimyya when he visited our school in 1960. My elder brother, Sudarshan was the Captain of school that year. The General decided to walk around the school with the students rather than the staff. When we got to the senior dorm, the General looked up at one of the windows and asked whether the centre bar could still be removed allowing us to jump out! We smiled and answered in the affirmative. He then said, “Don’t let the bar fall on the floor. It makes a big racket”. I guess the lesson from the General was, “If you can’t be good, be careful.” In this picture (Slide 1) you see Sudarshan getting the Generals autograph. Like all good Cottonians he was keen to get more time for his extracurricular activities and requested the General to declare a holiday. The General looked at our Warden, Rev. I.L. Thomas (also seen in the photo) and said, “It’s over to you, but I think the boys deserve a holiday”. A holiday was duly declared. Of course, we were disappointed that the Girls School did not get a holiday as well.
Life in Bishop Cottons was some of my happiest days. It was a great education too. It was not just the quality of teaching and the extra curricular activities that built us up but also the very deep hidden curriculum. I will never forget Mr. Singh telling me, “The only way to do it, is to do it’. We had evening sessions on culture. Mr. Lokanath started it off saying, “Now boys, culture is not agriculture”. We clapped and cheered for a long time hoping it was also the end of the lecture. Senior Wynn took us through the steps of Nirvana. And Rev.I.L. Thomas made a huge impact starting with all of us respecting a differently abled person as he managed the school from his wheel chair. I have never forgotten his very first sermon on his first day which was on the first four words from the Bible, ‘In the beginning God’. In a subsequent sermon he asked if any one knew where Lambarene was. My hand shot up and I answered that it was where Albert Schweitzer had his hospital in Africa. Some fifteen years later I found my Lambarene in the deserts of Central Australia in an Aboriginal settlement called Yuendumu. I was the Flying Doctor and District Medical Officer for Yuendumu. It was here that I came to grips with the enormous health problems and tragic social situation of Aboriginal people.
ABORIGINAL HEALTH:
When I first flew into Aboriginal communities in 1974, I was a bit of a novelty. Many of the senior men would approach me and ask, “Are you a white man or a black man?”. When I protested they would say, “We know you look black, but you are the doctor, you command the nurses and the aircraft, you must be white”. Anyway, a few months later the same men came over to me and said, “After observing you and the way you treat us we now know that you are black. Not only are you black, you are ‘Yapa’ (one of us)”. I was soon taken on many journeys across the desert and along the song lines to learn the Dreaming and the language. Later I was made a member of the Warlpiri tribe. I was now determined to make a difference to the appalling health Aborigines suffered. They had very high infant mortality rates and their life expectancy was 20 years less than white Australians. They had malnutrition, diarrhoeal disease, pneumonia, skin infections, tuberculosis, trachoma and leprosy – all the disease of poor living conditions. They also had all the chronic diseases, diabetes, hypertension, kidney disease and cancer. Their death rates for most conditions was very high.
I started my study by looking into the history of these people. There is strong evidence to suggest that Aborigines migrated from Africa some 70,000 years ago. Their long migration by land and island hopping (possible before the ice age) has recently been acknowledged as the first humans to cross Wallace’s line between Borneo and Indonesia. These adventurers were the first to sail to a destination across the sea that could not be seen by the naked eye. This great step (or voyage) has been hailed as a great leap for humankind and a transition from Apehood to Manhood.
Once in Australia, they divided into hunter gatherer tribes that occupied the length and breadth of the country. They developed an extra ordinary, non-materialistic culture whose key philosophy was the Dreamtime. The Dreamtime is the Aboriginal understanding of the world, its creation and how everything is held together in an eternal relationship. It is the beginning of knowledge and a rich philosophy that sustained them for sixty thousand years. (I will elaborate on the Dreamtime later).
In 1770 the Gwegal tribe who lived near what is Sydney today looked at and saw this ship (Slide 2). On board was Captain James Cook. Little did they realize that this was the beginning of the end of their ancient way of life. Cook declared the land New South Wales in the name of King George the 3rd. Cook reported that the land was “Terra Nullius” (not inhabited by people) , ignoring the inconvenient truth that the land was well populated. The doctrine of Terra Nullius promulgated later in 1835 meant that Aborigines did not own the land and is the reason why there are no treaties or constitutional rights for the original inhabitants. Strangely Captain Cook who made detailed observations of the Aborigines wrote, ‘Though they appear to be the miserablest people in the world – they are actually much happier than us Europeans’.
From an Aboriginal perspective, the invasion of Australia began in 1788 when the First Fleet with 11 ships and 754 convicts from England arrived and started a settlement. Aboriginal people had been very healthy with little or no disease. They were in far better health than the average European. A short time after the arrival of the invaders an epidemic of Smallpox broke out. This was followed by epidemics of Chickenpox, influenza, measles, and venereal diseases. There were increasing clashes between the Aborigines and the European settlers. Between 1788 and 1900 there was a 90% decline in the Aboriginal population. Disease, guns and loss of land decimated the Aboriginal people. European settlement destroyed in the blink of an eye an incomparable ancient people. The landing of the First Fleet in 1788 is celebrated as Australian Day but to the Aboriginal people it is a ‘Sorry Day’ and a reminder that ‘White Australia has a Black history’.
In 1974 I met an old man called Spinfex Petiri Jakamarra. He told me how he met his first white man.He was a young boy at the time . He and his family were camped in the Tanami desert when suddenly they heard the sound of a galloping horse. They had never heard a sound like that before. Then they saw a man on a horse. They thought it was just one creature. His father threw a spear at the creature and missed. The next minute his father was shot dead. The creature divided in two and they realized later it was a white man with a gun on a horse. The family were captured and taken to a Government settlement. It took them many years to understand that their plight was the result of new laws that now governed their country.
The Government approach towards Aborigines was influenced by three major policies. I have mentioned “Terra Nullius” already. In 1837 a policy of ‘Protection’ was passed. Aborigines were captured and placed in Government run settlements or Missions. This was thought to ‘smooth the dying pillow’ as Aborigines became extinct. The real intent was to segregate the Aborigines and prevent the spread of disease from them to the white population.
In 1937 the policy of ‘Assimilation’ was established. When it was realized that the Aborigines were not going to die out it was decided to make the black man live and work like the white man but without basic rights such as equal wages. It was not till 1967 that Aborigines were recognized as citizens of Australia.
All these policies led to a depressed and suppressed race who were very sick and struggled to maintain their identity. Alcohol, tobacco and other drugs introduced by the early settlers remain a major problem.
As I examined the history and the social context of Aboriginal health, I realized that the problem now was not a lack of support. Both the Federal and State Governments had numerous programs in health, education, employment and housing to help Aborigines. There were NGO’s, Church groups and numerous charities wanting to help. However, the Aboriginal people felt they were being bombarded by programs that continued to alienate them from their culture and did not recognize their heritage. They moved away from those programs in a sort of non-violent, non-cooperation protest. The white solution for black development had become the real problem.
I knew that to become part of the solution I needed to work with the people and develop programs that provided cultural safety and recognized their rich heritage that had survived for thousands of years.
THE ABORIGINAL HEALTH WORKER TRAINING PROGRAM
I became the first Coordinator of the Aboriginal Health Worker (AHW) Training program in Central Australia in 1976. The program is recognized to this day as one of the main strategies for improving Aboriginal health. AHWs are selected by their communities and trained in various Western medical skills. Today they receive University diplomas, but I want to tell you how the program got started.
The first AHWs were illiterate or semi-literate. It was thought that they could do simple dressings of wounds, give tablets for pain and headache and help to keep the health centres clean and tidy. I wanted them to be able to do three things. First, they should be able to give an injection of Penicillin to a child. Second, prepare and administer oral rehydration salts. This was because pneumonia and diarrhoea were the commonest causes of infant mortality. Third, they should be able to call a doctor using the radio telephone. This was accepted and started to have a dramatic influence on the infant mortality rate. The AHWs soon became an essential cardre of allied health workers gaining many more skills and qualifications. In 1985 the Northern Territory became the first government in the world to register Aboriginal Primary Health Care Workers along with doctors and nurses, thereby recognizing them legally to practice western medicine.
This year is being celebrated as the “Year of the Aboriginal Health Worker” right across Australia to applaud their contribution.
TRADITIONAL ABORIGINAL MEDICINE
There are three main components of Aboriginal medicine. They are; The Ngangkari or Traditional Healers, Yalwalyu painting ceremonies and healing songs, and Herbal Medicine.
Ngangkari:
Prof. Elkin,one of Australia’s leading anthropologists referred to the traditional healers as Aboriginal Men of High Degree. These healers are specially chosen and trained to remove the influence of sorcery and evil spirits. They restore the well being of the soul or spirit. Most serious sickness is thought to be caused by loss of a vital substance from the body or soul loss. Traditional healers posses a spirit called ‘Mapanpa’ which gives them healing power. This is different from the spirit that every Aborigine has ‘like a shadow’.
The traditional healers diagnose the spirit state, for example ‘kurrunpa yulangu’- ‘the spirit is sad’. They then massage, sing or suck various parts of the body during a ritual healing process for the spirit or to remove evil substances. The sick person often gets up dramatically. The traditional healers do not use herbal medicine.
YALWALYU CEREMONIES AND HEALING SONGS
These ceremonies improve the health of the sick person but cannot remove the influence of sorcery. The ceremony consists of singing songs and painting designs on the sick person. The designs are derived from the Dreamtime and are painted by the Owners (Kirda) or the Managers (Kurdunguly) of a particular Dreaming. Healing songs are sung while the sick person is painted. Sometimes a relative dreams a design which is then painted as the sick person. The famous American anthropologist Nancy Munn has described this as “a kind of graphic condensation of the vital qualities of dreams”. I often asked for Yalwlyu ceremonies to be performed recognizing the enormous TLC and family support this gave the patient.
HERBAL MEDICINE OR BUSH MEDICINE
Herbal medicine is taught to all members of the family. Aboriginal people have extensive knowledge of plants and their use in healing. Even Sir Joseph Banks who accompanied Captain Cook in 1770 conceded, “though their manner of life is scarcely removed from the brutes, they had knowledge of plants and clearly had names for them.”
Many Aboriginal bush medicines contain biologically active components. Bitter bark (Alstonia constricta) used to prepare a tonic contains reserpine a tranquillizer and anti hypertensive. Plants used on sores and wounds contain proteolytic enzymes that help healing. Spilanthes the native daisy used to treat toothache contains spilanthol a local anaesthetic. Over half the world’s supply of the drugs hyosine and scopolamine came from the Duboisa tree used by Aborigines as an emu and fish poison. And large quantities of solasodine and cortisone now produced in Europe comes from solanum laciniatum and solanum aviculare which were used to treat sores by the Aborigines.
It must be remembered that traditional Aboriginal medicine was used to treat the diseases of Aborigines before contact with the western world, such as, cuts, bruises, bites, slings and burns. (Slide 3 shows the nest of the processional caterpillar which was used as a dressing for burns providing a cobweb like skin cover.)
In 1988, the first Aboriginal Pharmacopoeia was published.(Slide 4) This major work with beautiful photographs list 70 plants and 6 other natural substances used by Aborigines in the Northern Territory as medicine. All the plants were carefully identified by botanists then screened for essential oils, minerals, saponins, tannins triterpenes and steroids.
THE BUSH FOOD PROGRAM
Aboriginal people often said to me, “Our food is our medicine”. Many foods are known to strengthen the body against sickness and promote healing. An early study in 1983 showed the nutritional composition of 42 bush foods. ‘The Kakadu Plum (Terminalia Ferdinandiana) contains 3150 mg / 100 g of Vitamin C making it the richest source of Vitamin C in the world. The Bush Banana (Leichardtia Australis) contains high protein. A return to eating Bush food was strongly advocated especially for children and adults with diabetes by the Aboriginal Health Workers.
STRONG WOMEN, STRONG BABIES, STRONG CULTURE PROGRAM
Aboriginal children have a bad start to life. Many weigh less than 2.5 Kilograms at birth and are classified as ‘Low Birth Weight’ babies. This not only makes them vulnerable to infections and childhood diseases but also puts them at risk to chronic disease such as hypertension, heart disease, renal failure and lung disease. This association between low birth weight and chronic disease is called the Barker hypothesis.
In this project senior women (strong women) were selected and trained to teach young women about pregnancy and encourage them to go to the health centres for antenatal care. These older women often knew when a girl was pregnant before the young girls did. (Most Aboriginal women get pregnant in their early teens). These strong women also reinstated traditional ceremonies related to pregnancy and young infants such as ‘smoking’ the baby (Slide 5). They were armed with their own form of pictorial presentation for their classes. They also encouraged the women to eat healthy food to increase the pregnancy weight gain.
This project was highly successful in getting Aboriginal women to access antenatal care much earlier than they did previously and most importantly had a significant impact on increasing the birth weight. (Slide 6). I was fortunate in being admitted to many of the discussions with the strong women who regarded me as an ‘honorary woman’. This is one of the greatest honours I have received. (Slide 7).
TWO WAY MEDICINE
The bringing together of traditional medicine with modern medicine in the Aboriginal health service was called ‘Two Way Medicine’ by the Aboriginal people. The Northern Territory Government gave its approval. Its very first policy as Aboriginal Health in 1982 stated that “Aboriginal Traditional Medicine is a complementary and vital part of Aboriginal health care and its value is recognized and supported”. This policy was underpinned by the teaching of cross-cultural skills and competencies to all staff who worked in the health service. Aboriginal health workers in addition to their new clinical role also acted as “cultural brokers’ bridging the chasm between Aboriginal and Western values and health concepts.
THE DREAMTIME In order to come to grips with anything Aboriginal one must try to understand the impact of the Dreamtime.
In the beginning was the Dreamtime – the oldest surviving philosophical concept. The concept of the Dreamtime flows from an understanding of eternity. All life as it is today, human, animal, plants, mountains, rivers are part of one vast unchanging network of relationships that can be traced back to the great Creative Ancestors of the Dreamtime. The Dreamtime concept holds together creation, thought, people, plants, animals, minerals, and their relationships in time and space.
The Dreamtime began when the supernatural Dreamtime Ancestors broke forth through the crust of the earth with great force. The earth at that time was flat and covered in darkness. The sun rose from the ground giving light for the first time. The Creative Ancestors half human half animal or resembling plants or the elements inhabited the earth. They had numerous forms. They traveled, hunted, made camp, fought, married and had families. During their journeys they created the mountains, rivers, trees, waterholes and other creatures. They became the moon and the stars. At the end of the Creation Dreamtime, the Ancestors rested taking up places in rocks, caves, waterholes and the sky from where they keep a watchful eye making these places important sacred sites today.
The Dreamtime Ancestors also created the law, moral and social rules for living. This law is found in the stories and lessons derived from the actions of the Dreamtime Ancestors. The Dreamtime is often referred to as the “Jukurrpa” which means to understand and follow the law. Aborigines fulfill their Dreamtime destiny by following the law.
The events of the era of creation are enacted in ceremonies, dances, songs and paintings. These ceremonies bring the power of the Dreamtime to bear on life today. I like to call it ‘Dreampower’. When an Aborigine sleeps, his or her spirit enters the Dreamtime consciousness becoming one with the primary creative force.
THE ABORIGINAL ART MOVEMENT
To understand the success of today’s Aboriginal art movement one has to only look at the artistry, creativity and ingenuity of the traditional paintings on rocks, in caves, on the ground, on bark and body painting. All these works of art commemorate the adventures of the dreamtime ancestors and maintain the spiritual dimension to their daily existence. The rock and cave art is found in amazing galleries across Australia dating back to 45,000 years. Here are few examples;
Rock etchings or petroglyphs (Slide 8)
Cave art (Slide 9)
Bark painting (Slide 10)
Body painting.(Slide 11)
For many years Aboriginal Australian’s extraordinary art was not attributed to them. In 1837 Sir George Grey documented the cave paintings of the Wanjina spirits shown in (Slide 12). He thought they were too good to be painted by the Aborigines and wrote, ‘ whatever may be the age of these paintings, it is scarcely possible that they could have been executed by self taught savages’.
THE DOT AND CIRCLE ART MOVEMENT
The Dreamtime stimulated one of the most incredible art movements in the world. It began in a remote Aboriginal community called Papunya located in the deserts of central Australia. Robert Hughes an art critic for Time Magazine has called it “The last great art movement of the twentieth centuary”. It has also been referred to as Australia’s greatest cultural treasure.
The art movement started in 1971 when a young Art and Craft Teacher, Geoff Bardon, came to Papunya an official “assimilation” centre for tribal Aborigines established in 1960. Geoff Bardon described Papunya as “a community in distress, oppressed by exile and a place of emotional loss and waste”. He started by encouraging the children to paint their traditional stories and was amazed by the symbols and signs they came up with. He then requested a group of older men headed by Billy Stockman,the school gardener, (who later became a close friend of mine), to paint a mural on the school wall. After days of discussion by senior men on the school lawn the men agreed. Their painting shown in the (Slide13) was a symbolic depiction of the journey of honey ant through Papunya the home of the honey ant Dreaming. (This mural was later painted over by the white authorities in what has been described as an act of ‘cultural vandalism’). Bardon, however, went on to encourage the men to paint on chip board and provided them with paint. Overnight hundreds of paintings were produced. Each painting depicted the stories from the Dreamtime mainly told with symbols and icons. Later large canvas paintings with acrylic paint emerged and began to be marketed. The symbols and signs could be explained by the artists exposing its very ancient origin to the rest of the world. Buyers of this art wanted to be part of this ancient culture and felt they could own a bit of the Dreamtime, the Jukurrpa.
There are many complexities to this art beside the interpretation of the signs and symbols. Sometimes the art revealed sacred, secret information. This was later covered over by dotting the background as described in a book called’ “The politics of the secret’.
The commonest symbol is the circle and could represent a camp, a water hole, a mountain. However, new meaning could be given to same drawing as one rises in ceremonial life learning more of the Dreamtime.
The next few slides depict Yam Dreaming,Possum Dreaming,Snake Dreaming and Water Dreaming.(Slides14,15,16,17 ) While explaining the Water Dreaming to me the artist asked me, why the Water Dreaming Ancestor did not get wet though he was playing in the rain he had created. I could not guess the answer. The artist laughed and said, ‘Because, he is the rain’, leaving me to ponder this Zen like statement on my Aboriginal journey of enlightenment.
These paintings soon made their way into the American and French markets. In 1997 a painting by Johnny Warangkula Tjupurrula from the Pintubi tribe was sold by Sothebys for $206,000. Three years later the same painting was sold for $486,500. In 2007, in Melbourne, Sothebys sold Warlukulong by Clifford Possum Japaljarri for $ 2.4 Million. (Slide 18)
When President Jacque Chiraq of France built the Quay Branley Museum of Art (right next to the Eiffel Tower) he wanted it to represent the art of the planet to pay homage to peoples who have suffered conquest violence and humiliation. Aboriginal artists painted the walls and the ceiling of many part of the Museum. (Slide 19)
Everybody wanted a piece aboriginal art and here you see Qantas planes painted with dot and circle designs. (Slide 20)
This extraordinary art not only transfers the Dreamtime stories across the ages but also communicates ideas, feelings, knowledge, geography and the law.
ART AND HEALTH PROMOTION
I was fortunate to be in Central Australia from 1974 and witnessed the blossoming of this art movement. I was also able to adapt and use this art form for health promotion and communication between Aboriginal and non-Aboriginal people. The Oxford Companion to Aboriginal Art and Culture has this to say: ‘Encouraged by an Indian medical officer with primary health care experience, health workers at Yuendumu in 1979 made a traditional ground painting, Napangardi Jukurrpa, into their symbol for health, incorporating symbolic representations of family life, food, shelter and warmth other paintings followed. These were not only directed at an Aboriginal audience but were also designed to educate Aboriginal understandings to incompetent, non Aboriginal health professionals. They were early examples of social marketing – a social strategy used by health developers to improve outcomes when introducing a new product as a new program’.
The next slides depict the use of art in communicating the strong women, strong babies, strong culture, story and the Bush Food Program. (Slide21,22)
In 1994, I was asked to develop a whole of government policy towards Aboriginal communities. I held many discussions and then decided to hold a workshop with the Yuendumu Community Council – at a remote community 176 miles Northwest of Alice Springs. The Warlpiri people had accepted me into the tribe. I had learnt to speak the language and had been given the name ‘Jampijinpa’. The painting seen in the( Slide 23)was the result of the workshop. The Minister for Health flew down with me to unveil the painting that hangs in the Yuendumu Council Office. Large prints of the painting were made and hung in the Department of Health and the Department of Aboriginal Affairs offices.
The circles to the left and right at the top of the painting represent the Federal and State Government Departments. They should each be having ‘multi lateral discussions’ – ‘Janku Mirnimirni’ with their own sections such as housing, education, health, transport etc. before they come together for ‘bilateral discussions’ with each other – ‘Jankujarra’. These discussions should lead to a common approach by Federal and State Departments to Aboriginal development. The circles in the middle represent the Yuendumu Aboriginal Council who are seen reaching out to the community institutions below to build a plan for the community. They then go up to meet representative from both governments with their agreed plan and will ‘speak as one’, ‘Jitangku Juku’. The role of the two governments would then be the resource the community councils plan rather than getting the community to work into the multiple and varied plans of the State and Federal Governments.
CONCLUSION: The innovative health programs and the use of Aboriginal art have led to the establishment of a two way approach that fosters the both the survival and the cultural survival of Aboriginal people. I was pleased to read Amnesty’s Internationals recent report, May 2011, called ‘Two Ways to Health’ about Aboriginal people in Central Australia. It said, “Using a two way approach to the design, delivery and control of health services has tangible health outcomes”.
I believe that Aboriginal Australians are caught up in a ‘New Dreamtime’ of destruction and creation. New tracks by road and railway are being constructed and the landscape is once again being reshaped with towns, cities and industrial complexes. Aborigines will have to come to terms with these new forces and develop new methods of survival without losing the great heritage of the past. Aboriginal art will be an important strategy for improving their health, culture and actual survival. It keeps the past alive while accommodating to the needs of the present. Aboriginal art has been forced to be dynamic, changing, responsive and successful in the modern world. This is the way Aboriginal people will have to move forwards.
I want to leave you with the words of the famous Aboriginal poet (who I used to know) Kath Walker / Oogeroo Noonucul;
“TO OUR FATHER’S FATHERS
THE PAIN, THE SORROW
TO OUR CHILDREN’S CHILDREN
THE GLAD TOMORROW”.
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