Of the thirty-seven interviews conducted, twenty-two mentioned bush medicine in some form. Many were minor references that did not encapsulate clearly the connection between bush medicine and cancer treatment. The eleven interviews that made significant mention of bush medicine (seven were prompted and four were spontaneous) are the focus for this paper; thus, the comments and themes elaborated reflect only a proportion of Aboriginal people's perspectives on this issue. The themes have been organized to explore two questions: i) what were the key factors for which Aboriginal patients chose to use bush medicine and ii) what factors influenced their decision not to use it. Subthemes are described below:
Reasons for using bush medicine for cancer
Respondents who mentioned using bush medicines saw it as a preventive means to cope with the stress of cancer and believed that the healing powers could help to cure and relieve the anxiety and conditions of cancer.
Relieves stress: "... it gets rid of all your internal stress"
The belief that stress can cause cancer was brought up by many of the respondents. The views of a number of participants were encapsulated in a comment by one participant who saw cancer arising as a flow on effect of the disruption and stress following colonisation:
"One minute, Aboriginal people had land and [then the] 1905 Act... see all those land taken away. ...so, that causes a lot of stress... the stolen generation... stress. We know... people were in stress and depression... that sort of things can cause cancer." [Urban male participant]
Related to this was the idea that bush medicine reduces the risk of cancer. Bush medicine was regarded as a preventive measure as it helped to release stress, making the person stronger from the inside:
"What happens is... it's a bush... or root... that you boil it up... and... it's a browny... it's got like a barky taste like a woody taste... But there is something in it... that is good for insides, just as a cleanser. Makes all your body organs healthy and strong, it gets rid of all your internal stress." [Urban male participant]
Another participant talked about maintaining her longstanding belief in bush medicine and using it even after being diagnosed with cancer. She explained that a great deal of Aboriginal people were naive about cancer and got stressed when they heard the diagnosis. From others' stories it was clear that, to them, bush medicine could help in releasing the burden of their illness.
The 2002 National Aboriginal and Torres Strait Islanders Social Survey showed that Aboriginal people over the age of 18 were 1.5 times more likely to have reported experiencing a life stressor. Lurking in the collective memory of Aboriginal Australians is the legacy of child removal (the "stolen generation") and other historical mistreatments experienced in their recent past with its devastating effect on cultural practices and living conditions, including creating barriers to the development of social capital within Aboriginal communities[37
A connection to spirituality and holistic health worldview: "Healing is mental, emotional and spiritual as well"
For some of the participants the application of bush medicine was not only seen as relieving stress but was also seen as an enabler in maintaining their connections and beliefs on culture, ancestors and spirituality. The practice of bush medicines confirmed and supported participant's cultural beliefs and attitudes that conformed to Aboriginal understandings and epistemologies of health and wellbeing as holistic. Engaging with bush medicines and the associated healing rituals that accompany its use is spiritually significant to Aboriginal people whose identity and connection is embedded in their relationship to the land. The relationship that Aboriginal people have with the land is sacred and related to their concept of health, wellbeing and healing[27
]. Two excerpts clearly illustrate this connection:
"Yeah, their spirituality is always there; they link bush medicine with the land, but it is very hard to get, because there's not many people who go out and get it. You get it from certain trees and what-have-you. But that belief that trying bush medicine will heal them is still there." [Urban female participant]
Consistent with several other interviewees, this participant would not go into particular detail about where you can get bush medicine and what it is. This keeps the spiritual mysticism alive.
"An old lady came up there with a bottle. I said, I can't eat for six months... can't swallow anything. She said, "You drink it, and you would get better." And I believed that. And it's gone. I went back for the check-up, and the doctors asked me, "Hey, what did you do? It's not there. What did you do? Did you see someone special?" I said," Yes, there was this old black lady. She pushed me to drink. And I had it." He said, "Bring that to me." He wanted to know the secret. No, you can't. You have to get it from that old lady. It belongs to her. I hadn't got it. She had got it. So, I asked to the lady, and she said, "It belongs to the land. Leave it where it is." That's the way life is. If you want anything, you go and ask for it. " [Remote male participant]
For this participant, the spirituality associated with healing comes from and belongs to the land. To relinquish the bush medicine to the doctor would be subjecting it to a western medicalised inquiry that conflicts with that spirituality and with the holistic health worldview. The patient wanted to maintain the sacredness of his relationship with the country and its spirits. It could also be about protecting Aboriginal knowledge from appropriation by the western system which in the past has been highly exploitive. The old lady's response was a recognition of cultural protocols and affirmation of ownership in that, she did not have the authority to pass on the information. This highlights the tension between what is allowed to be public knowledge by Aboriginal people and what remains private.
Healing and the holistic health worldview were stressed several times, particularly by two interviewees who worked in health care. One of them emphasised that 'healing isn't just a physical thing' rather it is very much related to patients' 'mental, emotional and spiritual' state. This worker firmly believed that sometimes miracles do happen in life, and people could recover, even from serious illnesses like cancer. As one female participant who worked in an urban Aboriginal medical organization stated: "the spirit world is an integral part of day-to-day life; yes, absolutely". The allusion to 'miracles' by the first respondent also supports the idea that bush medicine is spiritually-based. These participants reinforced the need to cater to the spirituality of Aboriginal patients as part of the healing process.
Many participants generally argued for accepting and communicating about the use of bush medicine with Aboriginal patients in their cancer treatment plan concurrently with western medicine. One participant who was a medicine-man expressed his feeling about someone benefitting from his medicine: "if it worked... if either one (white-men medicine or the black-men medicine) that is good because it gives you a chance". To help in this way confirmed the man's healing ability, establishing his identity and status in the Aboriginal community as a healer and validating Aboriginal knowledge as having a legitimate place alongside western medical approaches. He also stated that he did not take money for bush medicine as he believed his ancestors would not approve, demonstrating his deep spiritual respect for his ancestral relations, a recurring theme in Aboriginal communities. Participants commonly noted that believing in the effectiveness of bush medicine is important: described by one participant as "pure positive thinking". Another participant clarified that bush medicine and western medicine were not incompatible:
"a lot of people say, 'Oh, yeah, that's just a lot of rubbish' and especially you will find doctors that say so...No, I'd never say, 'Discard conventional medicine and just concentrate solely on this', because I think it's got to complement each other, and if you've got those beliefs already... that this is gonna help you, it will (emphasizing). It may not cure you. It may not save your life, but it will help you, even if it's only in a mental or an emotional way of help. So, I really do believe that it would help, and have just having somebody there to go and smoke the house... to get rid of all the bad feelings. I mean that's ... a lot of these are very spiritual stuff that Aboriginal people have known for millennia," [Urban female participant]
Bush medicines and traditional healing approaches are compatible with other complementary, alternative and integrative medicines, of which the use is increasing among patients with cancer, with the average prevalence rate of 31.4 percent in the Australian population[38
]. This underscores the need for complementary therapies such as bush medicines and spiritual healing to be discussed with all patients undergoing cancer treatment. This was put into the context of ancient cultures by one participant:
"Chinese have been practicing all this acupuncture, acupressure and all those sorts of things for thousands of years, and now it's all in vogue, so it's all right. It's the same thing with the bush medicines. Even meditation! and all these things. They are all of a sudden miraculously, 'Yes, they do work.' Well a lot of Aboriginal people, and old cultures have known that for so... long." [Urban female participant]
As the Indigenous concept of wellness and hence healing is linked to their culture and spirituality, there is a need for health care providers to acknowledge and respect this component of Indigenous beliefs when providing health care.
Adverse reaction from biomedicine: "Radiation and chemo nearly killed me"
"I know a couple of people who chose the bush medicine once they read up about chemotherapy and the two per cent of people that chemo cured, they took their chances with the bush medicine, and they are still going. It's either the quality of life or being sick from the chemo, that's what they weighed up." [Rural female participant]
There are some Aboriginal people who use traditional medicine as an alternative to Western medicine. Both cancer patients and the family members felt some people get scared about the intensive procedures of common cancer treatments and their side-effects, influencing them to choose other options instead. As well, some patients did not cope with the side-effects of chemotherapy and radiation treatment and disliked having to spend long periods away from their family and home town. This was made more salient for Aboriginal women if they had the responsibility of taking care of their children and grandchildren, impacting on the choices made between using traditional healing and medicine so that they did not have to go away. One respondent summarized:
"It's hard for a lot of people. So, they prefer to either go for bush medicine or not take the treatment, because they know that they are going to be away for a while from their family."
The perception of some of the participants towards bush medicine was how well people were when they were taking it: "She looked better when she took the bush medicine". These perceptions confirmed and validated the healing qualities of bush medicine as an alternative or as a complementary approach to Western medicine.
Last resort and desperation to try everything: "at the end we were just clutching to hope"
One urban female participant shared the story of her young relative who had died of cancer. The patient kept faith with the Western doctors, hoping that they were going to fix the cancer and seeing them as 'miracle-makers'
. However, when everything failed the family turned back to their traditional treatment which by then was too late as the cancer had advanced too far. After sharing her story, the participant admitted that "really, they
(doctors) are not miracle-makers and, we've got to start doing some stuff, too."
Attempting a range of different healing options to treat cancer, especially when Western medical treatments have not worked are not uncommon in many societies[39
] and is another reason why some people turn to alternative medicine.
Having cancer caused fear and was often associated with fatalism about the likely consequences. Upon diagnosis, many people started thinking immediately about death and consequently panicked. This fear prompts them to desperately try everything to cure the disease. One participant said:
"I would try different treatments. I would try what I have heard works. I would definitely try the hospital, what they had to offer. I would try... if I had heard of a good bush medicine that could fix it, I would try that. Ye.., I wouldn't be hesitant in using alternative medicines at all, whether it be from the Aboriginal bush medicine or from somewhere else." [Urban female participant]
Although this participant reported not knowing much about bush medicine because she grew up in urban areas, she said she would give anything a go if somebody said that it could work.
Reasons why bush medicine was not used
Many respondents did not use bush medicine or did not talk about the use of bush medicine during the interviews. For many, it was not because they did not want to use bush medicine, but rather that they did not have access to the source, got confused about what would be better for them to use, or were unsure about the process of taking it.
Not easy to get
Many participants, especially Aboriginal people who lived in the city and in the rural towns admitted that it was hard to get bush medicine, as most traditional healers lived in rural and remote areas. This meant that they either had to travel away from where they lived or organise for the traditional healer and supplier of bush medicine to travel to where they lived; both a time-consuming and expensive exercise. These issues restricted their choice of using bush medicine. Some people also explained that although they wanted to use bush medicine, they did not know who, how and where to contact a traditional healer.
One participant when asked if they had taken any bush medicine replied:
"No, no. No, I haven't had any. No, I got to go up to Wiluna and get some." [Rural female participant]
It should be noted here that a healer has to be authorized to be able to practice and prescribe bush medicine. As one participant described:
"The 'ok' to use it. You just can't go and use it. He told me that I could go ahead and get the medicine, and prepare them, and use it. Otherwise, in our ways, you can't just use it unless anybody given the 'ok' to you to use it. So, he gave me the 'ok' to use it." [Urban female participant]
Being given the authority to collect the plant used for treating cancer also involved being trusted enough to be told where to harvest it, how to prepare the medicine and how and when to take it. For this to happen requires that the person has a good relationship with the healer, who would not hand over his/her knowledge over lightly.
Urbanized Aboriginal people: "... we are urban Aboriginal, we are not traditional"
A devastating effect of colonisation was the alienation and disconnection of Aboriginal people from their land, their cultural heritage and traditions. Being taken away from their family and raised elsewhere on missions or placed in non-Aboriginal families was traumatic for those who were removed. The separation from their traditional country and families and the relocation to urban and regional centres meant that for some there was a loss of cultural knowledge, language and tradition. Some respondents admitted that they had lost their connection with their traditions and culture, while others said that they continued to visit their homeland occasionally, for funerals or other ceremonies. Participants who grew up in Western society and had been exposed to Western education had access to modern technologies and information systems and a reasonable knowledge of the cancer that troubled their family member. Many of these people did not try to look for bush medicine and traditional healing. As one of the participants said:
"We were born into ... a society that were fully functional at that time... we are urban Aboriginal, we are not traditional. We have access to information, technology, whatever. We didn't have any Aboriginal remedies... or anything like that..." [Urban female participant]
However, not all urban Aboriginal people subscribed to this view. Traditional beliefs and practices persist amongst many urban Aboriginal people and may become visible only when it affects those who are close[41
]. 18 participants reported that they had connections with some traditional practices, but not in a very strong way. For example, use of bush medicines was one thing some of the families were practicing despite limited knowledge and access to other traditional healing practices.
Another reason given by some participants for foregoing traditional practices was religious beliefs. Christianity was imposed as part of the colonizing process and with this came restrictions upon Aboriginal peoples' life-style and values system[41
]. Many Aboriginal people were exposed to Christianity within the missions, places where they were forced to leave their Aboriginal beliefs, culture and traditional rituals behind. Those directly affected by missions and subsequent generations, who have grown up in a "Christian" environment, may regard traditional Aboriginal beliefs as akin to paganism and thus discourage their use. In the words of one participant:
"We didn't use traditional medicine or anything like that. Because we are not traditional Aboriginal, and our family was Christian based, and so...We put our trust on God." [Urban female participant]
Dilemma of usage: "I was a bit worried taking any of that..."
Secrecy and mystery abound in the Aboriginal community about the use and availability of bush medicine. This inevitably means poor availability of accurate information regarding its actual use. As Western medicines usually have detailed prescriptive and side effect information available, this created an expectation among some Aboriginal people for similar processes and information being available for bush medicine. As one participant said:
"I was a bit worried taking any of that because none of them could tell me exactly how much, what quantity to take and I was worried about that...." [Rural female participant]
Another participant from the rural area said that she tried bush medicine but had severe reactions (rash and urine infections) so she stopped it. She wanted to just stay on bush medicine provided more accurate information and guidance was given to her. The conflict between the use of western and traditional healing meant patients had to make choices, presumably based upon their relative confidence in what each treatment would offer: "I tried [bush medicine], but, yeah, I think it reacts with all my tablets I'm taking."