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Original article

Using Indigenous Australian drama to break cultural

barriers in healthcare relationships
K Matharu

Correspondence to: ABSTRACT collectively, with the understanding that the

Mr K Matharu, University of
California, Davis School of
Medicine, 610 N Street,
Sacramento, California 95814,
USA; ksmatharu@ucdavis.edu
Accepted 22 October 2008
Since colonisation, the marginalisation of Indigenous
Australians has adversely affected their language, culture
and health. Mainstream society has failed to address
social differences and establish culturally-appropriate
health programmes for these groups. This paper extracts
important humanistic themes within the context of health
from four Indigenous Australian plays written during a
period of social unrest in response to past oppression: (1)
The dreamers, by Jack David; (2) Murras, by Eva Johnson;
(3) Coordah, by Richard Walley; and (4) The keepers, by
Bob Maza. These plays will be analysed to (a) illuminate
human suffering from an indigenous perspective, based
upon social and cultural planes of analysis; (b) understand
the socio-cultural basis of poor health; and (c) instruct
healthcare professionals that health is a social construct
that can be interpreted as the product of select plays that
are not solely based upon an illness narrative.
In February this year, the Prime Minister of
Australia delivered a long awaited apology to
Aboriginal and Torres Strait Islanders and began
a process of reconciliation and healing. Australia
ranks high in the world in terms of healthcare, yet
Indigenous Australians exhibit a mean life expec-
tancy that is more than 20 years less than non-
Indigenous Australians. This fact is particularly
startling compared to other indigenous groups,
such as the Maori in New Zealand and Native
Americans in the United States, with life expec-
tancies that are not as decreased as in Australia.1
Aboriginal and Torres Strait Islander peoples suffer
from lifestyle-dependent illnesses such as rheu-
matic fever, trachoma and skin infections, which
are more prevalent in underdeveloped nations. The
contrast between medical services to Indigenous
Australians and non-Indigenous Australians is due
to a multitude of complex factors including
geographic location, access to hospitals, along with
social and cultural ideologies. This is evidenced by
the fact that many diseases, such as cancer, affect
both Indigenous and non-Indigenous Australians,
but result in higher mortality rates in the former.2
Difference in quality of treatment results from the
lack of culturally appropriate programmes to
address the incongruence of Indigenous- and
non Indigenous-based health programmes.
‘‘Aboriginalised’’ programmes and ‘‘community-
controlled’’ health centres represent, to many
individuals, another form of control from a
dominant authority that precludes indigenous
authorisation.3 Due to lack of public health and
ethnographic data differentiating between
Aboriginal and Torres Strait Islanders, this paper
will focus on the health of Indigenous Australians
cultures of these groups are vast and intrinsically
unique. This, however, should not detract from the
implicit understanding that various groups experi-
ence different health concerns, values, standards of
living, economies and education attainment levels.
Indigenous Australians comprise 2.5% of the
Australian population, with over-representation in
remote areas of the country. Torres Strait Islanders
make up 0.3% of the total Australian population.
Approximately 31% of Indigenous populations live
in defined major cities, versus 67% of non-
Indigenous Australians.4 Of Indigenous
Australians who live in remote areas, 28% cite
distance from a medical facility as an impediment
to healthcare versus 7% in non-remote areas; this
statistic remains fairly constant when looking at
the availability of a particular service (28% of
Indigenous Australians in remote areas versus 3%
in non-remote areas). The problem of access is
exacerbated in isolated communities, where 50% of
families do not own motor vehicles compared to
20% in non-remote areas.5 Those in remote areas
may be more than 1000 km away from the nearest
hospital. Fortunately, there are several prominent
examples of clinical organisations that were
originally established and run by Indigenous
Australians to meet the needs for those seeking
care that was available and culturally sensitive.
The involvement of Indigenous Australians in
administering health services did not occur until
the 1970s. The Central Australian Aboriginal
Congress, established in 1973, has been critical to
providing healthcare to Indigenous Australians
within Alice Springs and various outstations.
Services provided by the multiple branches include
primary care, women’s and men’s health, adoles-
cent care and extensive psychological counselling.
The Congress at Alice Springs also includes public
health advocacy as another tool for improving the
health of Indigenous Australians. A similar pro-
gramme was created in the Northern Territory
capital city of Darwin, named Binna Billa.6 Further
support for individuals living in extremely remote
locations without adequate access to major hospi-
tal centres is provided by the Royal Flying Doctor
Service. Established in 1928, the service provides for
the immediate healthcare of seriously ill patients in
addition to long-term care through immunisations
and routine health checks. In Sydney, the
Aboriginal Medical Service was established in
1971 to address the health concerns of Indigenous
Australians in a socially- and culturally-appropriate
manner.7
Unfortunately, despite the establishment of
medical centres and increased monetary support

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Original article
to Indigenous Australians, individuals and communities remain
financially under-resourced (Pink 2008, p188).5 Contributing to
the poor health status of Indigenous Australians is the lack of
medical practitioners within communities, especially in iso-
lated parts of the country. The ‘‘medical workforce crisis’’
becomes apparent in remote communities, where physicians
trained overseas are recruited for jobs. The dearth of healthcare
is also felt in urban centres, where medical practitioners are
continually shifting to communities where private billing
yields higher incomes.8 As a result, there are not enough
physicians trained or willing to handle indigenous health
concerns that may be specific to a certain group within an area.
This phenomenon can be especially well hidden in urban
centres, where poor health may solely be attributed to racism
when there are not enough physicians to address the health
needs of one specific ethnic group. Despite the establishment of
academic hospitals in major cities, there remains a stigma due
to past negative experiences.
From a strictly ethno-medical perspective, distance from
medical facilities and the number of available physicians does
not sufficiently explain the shorter life span, higher prevalence
of disease and dissatisfaction with the healthcare system within
the Indigenous population.9 The Indigenous social experience is
plagued by factors contributing to poor health such as lower
employment expectations, reliance on welfare, poor housing
and inadequate access to education and health services. Called
the ‘‘most socio-economically disadvantaged subsection of
Australian society’’, Indigenous Australians often fall into
vicious cycles of despair due to injustices that have been part
of government policies.10 The Henderson Poverty line, describ-
ing the poverty levels of the Australian population, included
strategies for social inclusion and closing socio-economic gaps.
Education and literacy levels are strong indicators of poverty
and health. Half of non-Indigenous Australians complete Year
12 compared to just 22% of Indigenous Australians. In remote
areas only 15% of Indigenous Australians achieve non-school
qualifications compared with 34% of those who live closer to an
urban centre (Pink 2008, p249).5 Such striking differences stir up
images of a devastated minority within a highly educated and
healthy first-world nation.
Many within the public health sector propose a broad
definition of good health, in which ‘‘health itself begins with
recognition of the need for favourable social conditions’’.11 The
health of those within a community is not determined
exclusively by the summation of ethno-medical factors, but is
conditioned by a distinct set of social and cultural issues.12
Indigenous Australians consider health to represent the totality
of their community’s wellbeing, with many factors being
interdependent.13 Those who treat illnesses within the commu-
nity do so in a manner that is based more upon ‘‘social or
sacred’’ mechanisms. European-based medical treatment that
was seen as ‘‘punitive’’ often clashed with traditional methods
of healing. (Hunter 1993, p54)7 Paternalistic behaviour on the
part of the medical profession as well as the Australian
government resulted in sanctioned policies such as forced
sterilisation and removal of children from indigenous commu-
nities.7 14 Indigenous patients remain fully engaged with their
clinician, interacting at an interpersonal level that transcends
the traditional ‘‘patient-physician’’ relationship. Injected into
this complex relationship is the idea that kinship relations are
based upon ‘‘jural’’ aspects as much as moral and religious
ones.15 Due to the underlying relevance of culture in clinical
interactions, theatre emerges as a strong candidate to address
the range of complex issues surrounding poor minority health
48
and express a perspective that is based upon evaluating human
relationships.
DRAMA: AN INFORMAL MEDICAL SCRIPT FOR THE
DISENFRANCHISED
This paper addresses the need for a better understanding of
indigenous-specific health concerns from an analysis of dramatic
works written in a highly political era. They provide an
opportunity for physicians, nurses and other healthcare workers
to supplement their ethno-medical education with social and
cultural tools of analysis. Within an Aboriginal context, acting
represents an integral part of educating others on important
cultural traditions and rituals. Mimicry, or mimesis, is central to
cultural production that may be humorous and extends beyond
the act of replication. Imitation within Aboriginal communities
is by no means a static factor that copies, but rather extends the
learning process. Pitted against theatrical production, ritualistic
performances are contingent upon cultural laws that are
independent of hegemonic forces.16 Dramatic works can thus
translate the health concerns of Indigenous Australians while
interpreting those concerns clearly—with courage, humour,
pathos and anger.
Drama can reach a wide audience and often covers neglected
issues of immediate relevance to minority groups, such as
cultural evidence for poor health and the importance of strong
interpersonal relationships. In a study of Aboriginal Australian
drama, Shoemaker notes that ‘‘more than ever, Aborigines from
all parts of the country [were] mounting a unified response to
major events’’ that were a constant controlling force over the
community.17 This originates to settlement and the historic
control of anthropologists over Indigenous Australian commu-
nities. In the case of Ted Sterhlow, controversy arose because of
his deep-rooted incorporation within the Aboriginal commu-
nity, in which he received sacred objects from traditional land
owners rather than to other members of the community.18
Following the 1960s, an era preceding the establishment of
Indigenous health centres, an international trend emerged in
which many audiences became increasingly receptive to
politically-charged theatre, including positive responses to
‘‘non-Western theatre companies [that] chose active opposition
to their national regimes and helped oppressed countrymen
toward better lives and political liberation’’.19 This timeframe
was especially important for Indigenous Australians because the
burgeoning of theatrical productions coincided with important
political struggles. The Aboriginal Land Rights (Northern
Territory) Act of 1976 was created for the re-appropriation of
land to Indigenous Australians.20 Explanation of culture and
performance can be synergistic as evidenced by land claim
meetings in which community members transmit pertinent
information to the commissioners via song and dance.21
Dramatisation in Aboriginal communities is limited and often
not the discourse of choice due to strict traditional laws and
obligations that restrict the viewing of rituals meant for certain
tribes and tribal members. Additionally, placing a ritualistic
song or dance on paper renders it static, when in reality it is as
fluid as human nature.22 23
Understanding the health problems of Indigenous Australians
requires an understanding of politics and connections to people,
place and one’s body through a medical lens facilitates an
understanding of the health problems of Indigenous
Australians. Many of these problems are sensationalised in the
media.24 Characters that are faithfully presented in a dramatic
piece override such negative associations and elicit a direct
emotional response. A scripted, fictional character may be
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presented sympathetically in context, whereas this same person
might have been unfairly judged in real life without contextua-
lisation. There appears to be a special kind of cultural and
literary interaction in drama that is harder to achieve in other
genres like novels and poems.
The plays discussed here provide a way of producing changes
in attitudes toward marginalised groups. These dramatic works
are the products of a watershed moment in Indigenous
Australian history, when political matters as they related to
land rights claims became increasingly important for cultural
safety. During this period, issues of identity and sovereignty
became more prominent with the right to vote and participate
in government affairs after a long period of suppression. The
goal of this paper is to discuss how physical displacement, poor
nutritional status and housing conditions, cultural humiliation
and racism relate to health and to apply that understanding to
general medical education. The four plays (summaries provided
in box 1) show how poor health in indigenous communities is
conditioned by cultural and political circumstances.
PHYSICAL DISPLACEMENT AND CULTURAL DISPOSSESSION
Forced relocation is an important issue affecting Indigenous
Australians’ mental, physical and spiritual health. This was
largely the result of obtaining land for profit, as well as the
inherent power of controlling social structures that were based
on already established land demarcations.25 Major texts written
even by non-Indigenous authors highlights the interweaving of
the human spirit with the soil.26 Theatrical performances
examining emotional and physical movement should not be
taken as solely text-centreed or text-centric (Zarrilli 2006,
p320).19 Here, drama becomes a fluid, social dialogue that
transcends its actual text in portraying the ramifications of
being removed and moved.
In Davis’s The dreamers, Worru is the eldest living member of
the Wallitch family in Southwestern Australia. Alone, he begins
the play:
I walked down the track
to where the camp place used to be
Box 1 Summary of the four plays discussed in this paper
c The dreamers (1980) by Jack Davis. In the juxtaposition of
Indigenous with white Australian culture, the death of Worru,
a family elder, serves as a harbinger for the disappearance of
Indigenous language, tradition and culture.
c Murras (1988) by Eva Johnson. The physical and
psychological effects of moving from the place of one’s origin
to an urban location are manifest in the loss of one’s ability to
express oneself in a culturally-significant manner, poor
housing conditions and sanitation, and eugenics.
c Coordah (1987) by Richard Walley. A group of Indigenous men
regain a sense of pride in their culture by preparing a cultural
dance for a televised appearance. In doing so, these men
relinquish health concerns like alcohol, which is shown to be
destructive to one’s physical and cultural health in other plays
discussed.
c The keepers (1988) by Bob Maza. This is the tale of an
Indigenous and white Australian couple dating back to
settlement, in which the wives grow emotionally close despite
vast cultural differences that undermine the understanding of
indigenous culture.
J Med Ethics; Medical Humanities 2009;35:47–53. doi:10.1136/jmh.2008.000364
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and voices, laughing, singing
came surging back to me.
It was situated on the Swan
not far from the old homestead.
That’s gone too.27
Worru’s words are a poetic tribute to the land from which he
came. Now, taken from his place of origin, he is left with
memories of happier times that make him realise that the world
he was used to will never be again. Stage directions preceding
Worru’s entrance describe a tribal family, walking along an
escarpment, carrying weapons, bags and fire sticks. The family’s
departure from the stage prior to Worru’s speaking signals the
disappearance of traditional domestic life. Dolly, the strong
matriarch of the family, reminisces with Worru about the times
at their camp. The ‘‘last time she [saw] a corroboree’’ was at
that camp. Worru responds: ‘‘kia, kia, the yongarah dance, the
waitj dance … they all finish now, all gone’’. 27
We are confronted with the real possibility that important
traditional dances have been lost. The audience is left to infer
that this particular family was forcibly evicted from their land
and that they continue to mourn this loss. Dolly’s casual
statement about not seeing a traditional dance demonstrates
that physical dislocation results in one’s inability to immerse in
one’s culture of origin. This can lead to subsequent emotional
distress, because of the missing cultural link in one’s life.
The keepers also touches upon physical removal and cultural
losses. Set in the mid-19th century, it is a period of inevitable
confrontation. Mirnat, an Indigenous woman, and Elizabeth, a
Scot, are brought together when Elizabeth and her missionary
husband settle in the area. Koonowar, Mirnat’s husband, is
killed over suspicions that he robbed and killed a European man.
After this incident, Elizabeth and her husband flee, because of
their close relationship with Koonowar. They take Mirnat with
them to prevent retaliation. Many years later, when Mirnat
speaks better English, she interacts with Elizabeth, who has
now become one of her close friends:
Mirnat: Seems like it was yesterday. Y’know, I felt really bad
when I left my country.
Elizabeth: Mirnat, I never realised you felt that way. I mean you
seemed so happy … and pleased to be … coming with us … I
mean … it was you who kept everyone’s spirits up with your
stories … You were always laughing.
Mirnat: Listen, Elizabeth … I don’t think you’ll ever be able to
understand the blackfella. You’ll never know what it’s like to see
something … precious as what our land is to us … the Boandik
… to me. Oh, yes, my friend, I was laughing … but that’s so my
people couldn’t see I was bleeding inside. I had to be strong to
give them hope … It’s no matter we lost our home … our name
… everything … We had to keep going … We had to.28
This interaction between two women who are so close and
yet so different highlights the immense emotional pain that
Mirnat must feel for leaving her community. Elizabeth, even as
a close confidante, fails to understand the psychological effects
that the move had on Mirnat.
In Murras, the family lives between their original community
and the city. The phrase given to such individuals is fringe
dwellers, because their physical location is uncertain and they
often live in poverty-induced squalor.29 The play begins with a
television announcer reporting on the news:
Commonwealth and state ministers stated that: ‘‘The policy of
assimilation seeks that persons of Aboriginal descent will choose to
attain a similar manner and standard of living to that of other
Australians and live as members of a single Australian community,
49
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Original article
and we believe that if Aboriginal Australians can be helped
and encouraged to help themselves, then they will be readily
attracted to and welcomed to the assimilation we aim for.
Therefore, new housing will be allocated for them in different
towns and cities.’’30
Such paternalistic attitudes and decisions fuel resentment and
uncertainty in the family. Ruby, the matriarch, adamantly
states, ‘‘I can’t leave my country. What I’m gonna do?’’30 The
grandmother echoes Ruby’s fears, stating that she has ‘‘seen too
many things changing. Too many people dyin’ from wrong
ways. Moving about too much, disturbin’ the land.’’ She
ominously states that ‘‘soon we all gone.’’30 The audience
immediately senses the contrast between the bureaucratic tone
of the announcer and the demotic tone of the family members.
From the beginning, this difference between the composed
sentences of the television announcer and the informal units in
which the characters speak is obvious. The assistance the
government provides to Indigenous families literally becomes
‘‘lost in translation’’.
The link between forced relocation, poor health and even
death emerges from the government’s paternalism and mis-
understanding. The grandmother states that the government
wants to ‘‘move [them] around like cattle’’.30 The imagery here
reflects the historically low opinion the government often has
had toward indigenous peoples. Interacting with a liaison officer
named Russel, Ruby finds out that he is Indigenous, but he does
not know where he came from. He was taken away from his
family at a very young age and placed in the care of a white
Australian family. Ironically, Ruby learns this fact about him as
he tells her that her family must move to the city, where life,
according to the government, will be better for them.
DEMISE OF INDIGENOUS HEALTH RESULTING FROM POOR
NUTRITION AND HOUSING
The plays link poor indigenous health to inferior living
conditions and malnutrition. Many Indigenous Australian
families are forced to live in small and overcrowded housing
with up to 26 individuals living in one unit.31 Such factors are
conducive to the spread of infectious diseases such as rheumatic
fever and skin infections, along with the exacerbation of risky
drinking behaviour. Some of the increased incidence of disease
in Indigenous Australians also can be attributed to the poor
sanitation that accompanies destitution and squalor.32 Over
50% of Indigenous Australian households are supported in part
by government assistance such as Commonwealth Rent
Assistance and the State Owned and Managed Indigenous
Housing (Pink 2008, p38).5 Furthermore, 15% of Aboriginal
children lived in households that were deemed overcrowded
(Pink 2008, p40).5
From a health-management perspective, the solution to
infections in such a setting is not antibiotics. However, it is
not always possible to prevent overcrowding, given that many
Indigenous Australian families invite relatives into their
homes.33 Problems arise because indigenous ideas about how
extended families should be housed together clash with white
Australian ideas of single-family housing based on the nuclear,
not extended, family. Culturally-appropriate housing options
that address indigenous notions of selfhood can include several
bathrooms and bedrooms could anticipate those times when
there will be many individuals staying in one housing unit.
Healthcare workers wish to obliterate the diseases fostered by
crowded conditions, but they fail to grasp why indigenous
peoples live in what look to white Australians as ‘‘crowded
50
conditions’’. Drama offers a way of instructing healthcare
workers on this phenomenon within indigenous communities,
so they can better understand family life.
In Murras, the Aboriginal Liaison Officer, Russel, is judg-
mental of the family’s living conditions. He initially exclaims
‘‘My God, look at this place. I mean, how long you been living
like this? I mean here?’’30 The interaction between Ruby and
Russel, in which Ruby persists in finding out where Russel is
from, reveals just how much Russel has distanced himself from
his roots. His shock at the living conditions disturbingly relates
to the physical and emotional ramifications of filth.
Rather than recognise Ruby’s anxieties over leaving, Russel
matter-of-factly states that the move is for her (and her
family’s) own good and thus establishes an ‘‘us/them’’
confrontation. Russel has included himself within the ‘‘us’’
category, which includes proper living and hygiene. In disgust,
he states that their house is ‘‘a breeding ground for rats and
diseases’’,30 but does not acknowledge that the government
housing to which the family would move likely will be no
better. This adds further insult to injury.
Overcrowding arises in Coordah. Note the setting for one
particular scene: ‘‘TREB and ELLY’S place, next morning. TREB is
up; NUMMY sleeps at the table, TANK on the lounge chair, GAZ on
the floor.’’34 Preparing for a cultural show in which the men will
dance for a television station in the nearby capital city of Perth,
several are staying at the house to practice, socialise and
strengthen the already strong bonds between them. However,
there are not enough beds, so the characters sleep on tables and
in chairs.
DESTRUCTION OF CULTURAL ROOTS SECONDARY TO PHYSICAL
RELOCATION
One harmful result of moving to an unknown place is
unemployment. When the men cannot work, they are more
prone to drink and gamble. Drinking destroys traditions simply
because individuals cannot perform important rituals or recite
ancient songs. In The dreamers, the majority of the men are
either drinking or gambling while Dolly is out buying groceries,
bringing Worru back from the hospital, and preparing meals.
This illustrates how indigenous men can be more vulnerable
than women, whose social roles are more likely to be preserved
in a new location. More generally, studies have shown that men
are more susceptible to destructive behaviours resulting from
alcoholism.35 Alcohol consumption was only moderately
increased, 20.4% versus 19.1%, when comparing Indigenous
Australians that were unemployed versus employed.
Additionally, risky alcohol intake displayed an inverse relation-
ship with educational attainment, with 12.2% of those
completing Year 12 compared with 17.2% completing Year 9
or below (Pink 2008, p138).5 However, it is important to note
that these statistics are inextricably linked, as levels of
education may correspond to employment status.
Worru exerts full authority over his cultural domain when he
is sober. When drunk, he is unable to recount and enact
important traditional practices and stories. What is most
disconcerting to the audience is that this elder who possesses
such a vast fund of knowledge is losing it before he can pass it
on to the next generation. In one scene, ‘‘[WORRU rises and
begins a drunken stumbling version of a half-remembered tribal
dance … until his feet tangle and he falls heavily.]’’27 Rather
than teaching others, he simply becomes someone to laugh at.
Later, Worru’s dirge dramatises the cultural groundings of
alcoholism in indigenous communities:
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We are tired of the benches,
Our beds in the park;
We welcome the sundown
That heralds the dark.
White lady methylate
Keep us warm and from crying,
Hold back the hate
And hasten the dying.27
In Murras, the direct effect of alcohol abuse is seen when one
of the characters passes away before the first characters interact.
Wilba sadly questions her mother: ‘‘What he have to die for,
Mum? What did my father have to die, what he drink that
[Whitefella] drink for, make him sick, make him die?’’30 When
trying to put together an annual cultural show to exhibit a
traditional male dance, Treb angrily states: ‘‘None of you
bastards can dance: youse can’t stay sober long enough to
learn.’’33 However, once the men do stay sober, they do learn the
dance, truly amazing the rest of the family because sobriety is so
unusual in the house. Tara states:
They were all sober. Uncle Blue couldn’t get over it. He hid his
bottles when he seen Nummy coming, but he left six cans in the
fridge. Nummy opened the fridge door, pushed the beer aside and
had a drink of milk.33
From a cultural perspective, alcohol is the ‘‘[W]hite man’s
drink,’’ and not part of original Indigenous culture. The same
can be said of certain ‘‘Whitefella’’ foods.36 The integration of
white flour and alcohol into the Indigenous culture can be
viewed as a form of domination by European colonists,
destroying indigenous notions of economy, selfhood and
health.37–39
RACISM AND INDIGENOUS AUSTRALIAN HEALTH
In hegemonic societies, it is not unusual for a minority portion
of the population to feel uncomfortable with particular aspects
of the society, including healthcare.40 Worru, in The dreamers, is
the individual whose health remains poor throughout the story,
until his death. He hates hospitals, but is forced to check into
one by family members. Upon his return, he states: ‘‘Needles,
needles. [Pointing to his arms] In ’ere, in ’ere [pointing to his side]
an’ in there; [pointing to his posterior] an’ in there. I feel like a
bloody nyngarn.’’27 Worru does not understand his illness or the
treatment for it, so he resists going to the hospital and taking
his required medications. He only accepts medication from
certain members of his family. In fact, the audience later learns
that Worru only wishes to ‘‘see [a] Nyoongah doctor’’.27 Worru
wants to see an Indigenous doctor because he does not want to
be treated by someone whose ancestors may have treated his
kin poorly.
In Murras, one of the most horrifying scenes is an exchange
between Ruby and Jayda:
JAYDA: It was a routine check-up. The doctor called me in one
day. He had some special papers there, he said they were from the
government, said that I was part of a programme or something,
long time ago. Had to do with those injections that Sister used to
give me and Jessie.
RUBY: Injections? You didn’t tell me about any injections.
JAYDA: Mum, she said it was alright. I thought you knew, she
said she explained it to you. She told me it was to stop diseases.
RUBY: She lied. Injections to stop disease, injections to stop
babies. They lied to us, who they think they are? Boss over you,
boss over me—your mother?
JAYDA: Mum, it was an experiment. We can’t do anything
about it now. Mum, I’m alright, it’s alright.30
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The realisation that the family is powerless to act comes to
light when Jayda discovers that she cannot have a child. What is
especially disturbing is that such standard procedures were
implemented without the knowledge of Jayda’s mother. The
main purpose of sterilisation was to prevent the propagation of
the Indigenous race. When Jayda asks a social worker for advice,
the social worker advises that nothing can be done because of
secret records and official lies of health workers.
HOW TO IDENTIFY APPROPRIATE INDIGENOUS PLAYS
Drama can quite easily frame important arguments. However,
there are many factors involved in presenting literary works to a
mainly non-Indigenous audience, beginning with the very
definition of ‘‘Aboriginality’’. There remains the ‘‘problem and
practice of classifying Aboriginality has been something ‘given’
to and ‘expected of’ Aboriginal people’’ and that it is a definition
that Aboriginals have had to ‘‘accept and run with’’ in everyday
life.41
What makes the presentation of these scenes so powerful is
not only that they are racial, and are inherently so because of
the playwright, plot and underlying political agenda, but also
that they can be interpreted in a broader social sense.
Indigenous literature is not restricted to an indigenous audience
(Heiss 2003, p25).41 The question of legitimacy for whether a
piece is actually indigenous in nature often arises because of
people’s preconceived notions that may be racialised.
Commercial marketability is a major issue that often plagues
many non-mainstream works because the audience determines
whether a play is published, or whether it is performed in a
certain arena for an audience (Heiss 2003, p58).41 Further issues
arise over whether the material contained within the plays are
verifiable. The complex nature of the playwright and the
cultural facets he/she aims to encapsulate preclude an unam-
biguous statement on the authenticity of observations. Writers
who are not Aboriginal, such as Mary Durack and Judith
Wright, but contribute tremendously to the body of Indigenous
literature, are widely acknowledged for increasing awareness
before the prolific onset of Indigenous authors. Durack’s works
presented facets of ‘‘Outback Culture’’ that vividly portray
lands in the Northern Territory where black and white people
interact with each other and establish their unique connections
to the harsh land.42 Wright, a prolific author and political
activist on behalf of the Indigenous Australians and environ-
mental conservationism, notes the confounding implications of
demarcating a literature subset that is not only a response to
dominant culture, but very much a part of it despite using the
English language as ‘‘an alien imposition’’.43 To that extent,
there remains a difficulty in delineating an exact definition of
‘‘Aboriginality’’ that satisfies both Indigenous and non-
Indigenous Australians. For the purpose of medical education,
physicians can use the plays discussed with the understanding
that they are the social and political products of a well-defined
period of Indigenous Australian literature.
SOCIO-CULTURAL BASIS FOR UNDERSTANDING INDIGENOUS
AUSTRALIAN HEALTH AND APPLYING THAT TO MEDICAL
EDUCATION PROGRAMMES
Although many dilemmas, situations and aspirations are
presented in these plays, some of them are specific to
Indigenous Australians. Other situations can be experienced
by anyone (eg, an ill grandfather). The play is an effective mode
of discourse that lets the audience not only delve into the mind
of the artist who constructed the drama, but also into social
51
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Original article
concerns within the actual dramatic action. Drama is one of the
most commonly talked about forms of literary discourse, more
fluid than a novel, because of the freedom with which one can
interpret the genre through performance.
Plays written by Indigenous Australians deal with some of
the most far-reaching aspects of indigenous culture in con-
temporary society and provide considerable insight. As a
specialised form of artistic representation, many of these plays
have been accepted by a wider audience. The goals of these
plays have been two-fold, namely to act as a catharsis in
presenting their side of colonisation and its ramifications, and to
gain wider acknowledgement of the truth that Indigenous
Australians do, indeed, have a unique culture and set of social
beliefs. The stories and oral histories that these plays present
through their characters provide an intimate communication to
others about the Indigenous community. Plays can change
people’s perspectives regarding minority health and the provi-
sion of mainstream healthcare services.
University-based Aboriginal Health Worker programmes
comprise an important route for Indigenous Australians to
enter the professional fields of medicine, public health, nursing,
dentistry and pharmacy.44 Incorporating these plays into their
training programme is one way of providing a range of
perspectives on indigenous health issues. For the presentation
of dramatic stories, it is essential to have full authority and
leadership given to Indigenous Australians in these exercises.
Rather than a didactic system with a non-Indigenous instructor,
there should be an Indigenous instructor for the presentation of
cultural knowledge. The representation of Indigenous charac-
ters and communities by non-Indigenous authors in particular
novels and works such as in Durack’s Keep him my country are
often controversial because they were not written by an
Indigenous individual.45
There are two ways to implement discussions on important
themes and motifs presented within an analytical, social and
cultural sphere in these plays. One involves the incorporation of
dramatic works in medical education. This has been used
successfully in some instances with one-person shows to make
cogent remarks about particular illnesses, such as HIV/AIDS.46
Another method would be via performance at local art centres.
These performances could be staged for healthcare profes-
sionals, medical students and members of the general commu-
nity and could incorporate opportunities for discussion and
action. The Project Steering Committee within the Committee
of Deans of Australian Medical Schools under Gregory Phillips
has established ways to better prepare Australian physicians to
improve indigenous health outcomes. Guiding principles of the
curriculum aim to instruct students on the vast diversity of
indigenous cultures and gain an appreciation for their value for
minority and mainstream healthcare. Suggested subject areas
include population health, models of healthcare delivery and
communication skills. Multi-disciplinary education constitutes
an innovative avenue through which indigenous literature and
anthropological works can be discussed.47 Several Australian
medical schools, from James Cook University in Queensland to
the Australian National University in the Australian Capitol
Territory, have incorporated indigenous health as an important
part of the clinical curricula.48
Medical education should include the use of radio, television,
film and theatre to broaden the cultural knowledge of future
physicians. Each medium has unique characteristics. Indigenous
Australian films have played an important part in providing an
indigenous perspective on key issues such as cultural safety and
oppression, but have done so in ways that are entertaining to a
52
non-Indigenous Australian audience. One noteworthy example
is the film Rabbit proof fence, released in 2002, which told the
true story of Aboriginal Australian girls who ran away from the
Moore River Native Settlement to return to their families. An
accompanying study guide for the film offers one a chance to
discuss pertinent questions relating to the forced removal of
indigenous children from their communities along with the
psychological, social and cultural ramifications of government-
sanctioned acts.49
One of the major benefits of experiencing a play is the ability
to actively interact with the form as either an actor or a viewer.
When viewing a scene from a play, there is an ability to add
various subtleties and oblique ideas that can be discussed
further by members of the audience. The incorporation of
interpersonal connections through active discussion at a
performance may prove attractive to Indigenous and non-
Indigenous Australian audiences alike.50 Live plays can comple-
ment Aboriginal-supported radio and television programming,
with 8KIN and Imparja Television standing out as prominent
examples (Bell 2008, p314).50 There are other community radio
stations that play songs, host guests and provide information of
interest to the Indigenous and wider community in the states of
New South Wales, Queensland and Western Australia.51
The issue of language arises because many physicians cannot
appropriately treat patients who speak different languages. A
recent study by Cass et al has shown that miscommunication
and communication barriers due to an inability to converse
through their language of origin have prevented Indigenous
Australians from receiving adequate healthcare.52 These barriers
include lack of control by patients, differing modes of discourse,
dominance of the biomedical model, lack of shared knowledge
and understanding, cultural distance and a lack of training in
cross-cultural communication. Illiteracy in the Indigenous
Australian population is an impediment to receiving high
quality care and is the result of poor social and economic
status. If more general practictioners were to learn the language
of the remote community they practiced in, there would be an
improvement in communication with the patient. An ideal
combination for effective treatment would be widely available
interpreters to teach the physicians the language. However, it
should be noted that linguistic acumen alone will not overcome
barriers in treating an Indigenous patient.53
Humour provides another outlet for breaking down cultural
barriers and allows for the improvement of health provisioning.
The Humour Foundation disperses ‘‘clown doctors’’ to various
hospitals in Australia, aiming primarily to address the psycho-
social needs of children, but also to adults in palliative care.
Clown doctors work with health professionals to provide
distractions for those who are extremely ill.54 The high value
placed on laughter and humour as they relate to interpersonal
relationships would prove an invaluable adjunct to indigenous
drama. Dramatic representation of the key issues may bridge
the gap in cultural understanding for both the Indigenous
patient and the physician.
A current project is underway at the University of California,
Davis School of Medicine that aims to compile an audiovisual
library of patient stories from student-run clinics and medical
student re-enactments from theatrical works of cultural
significance. The project, among the first in the USA, involves
participation from the Departments of Internal Medicine and
English Literature to combine methods of instructing the
professional and mainstream community on the efficacy of
understanding the social and cultural manifestations of health
from performance, both real and acted. The underlying goals of
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Original article

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J Med Ethics; Medical Humanities 2009;35:47–53. doi:10.1136/jmh.2008.000364 53

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Using Indigenous Australian drama to break

cultural barriers in healthcare relationships
K Matharu

Med Humanities 2009 35: 47-53

doi: 10.1136/jmh.2008.000364

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