The thematic convening on Indigenous Approaches to Health Equity: a time for remembrance, learning and celebration


By Tlamelo Mmamohlakoana Mothudi, Atlantic Fellow for Health Equity in South Africa

June 22, 2023

A photograph taken during the Convening in Melbourne, Australia, 2023. Photo credit: Global Atlantic Fellow Azeeza Rangunwala.

Acknowledgement of Country

I acknowledge the Traditional Owners of Australia, the unceded land on which the Atlantic Fellows were welcomed: the Wurundjeri Woi Wurrung and Bunurong peoples, and the Dja Wurung people of the Kulin Nation. I pay my respect to their Elders, past, present, and future.

I started grappling with the notion of Indigenousness, Indigenous health, mental health and well-being when I started doing my desk-top research around Indigenous and traditional mental health and well-being in Botswana. Having grown up in Gabane, a village about 30 minutes outside of Gaborone, the capital city, I remember my mother having to go into town to consult with a private psychologist. At that age, while I knew that, like her, I needed support, I did not have the words or resources to ask for help. Help was too far out of reach. With this lived experience and knowing the difficulty around the accessibility of health and mental health and well-being services in my country, I embarked on research hoping to get a better understanding of the need and wanting to explore traditional and Indigenous alternatives for young Tswana, rural children and adults like me. I hope to document, amplify and celebrate our traditional and Indigenous practices.

Indigenous persons have been living on their lands for millennia using holistic ways of healing. Preparing for the convening, I was excited to learn about and engage with Aboriginal and Torres Strait Islander peoples and Indigenous and non-Indigenous Fellows around Indigenous approaches taken in Australia and the world to advance health equity. According to the United Nations (UN), there are an estimated 476million Indigenous persons living in different continents. The drafters of the United Nations Declaration on the Rights of Indigenous Persons (UNDRIP) omitted the definition of Indigenous persons from the declaration on the grounds that the identification of Indigenous persons is the right of the people itself, because the RIGHT to self-identification is the core to the right to self-determination. During the convening, a similar question arose when Fellows asked about Indigenousness and who gets to decide the definition. What emerged was a working group that will be exploring how different Indigenous Fellows around the world define Indigenous persons, and what Indigenous approaches to health equity and Indigenous health looks like in their contexts. These stories will be important for the collection of Indigenous centred data.  As the author Maggie Walters says in her article titled “The voice of Indigenous data,” the stories which will contribute to Indigenous data must be meaningful, useful and portray a nuanced narrative of the people, their cultures, their communities, their resilience, goals, successes, disadvantages, priorities and agendas. Indigenous persons are so much more than their problems which stem from colonial rule and colonialism’s genocidal outcomes.

My journey to Australia to participate in the convening began with no outcome in mind. I was simply excited to extend my limited understanding of Indigenous approaches to health equity. I held an ardent desire to see the integration of Aboriginal and Torres Strait Islander health into the Australian healthcare system while learning about the successes and difficulties experienced along the way, considering Australia’s painful history. I did not know what to expect but knew that when I returned, I would forever be changed.

Introduction to country, lessons, andreflections

Despite Australia’s history and the access to healthcare issues faced by the Aboriginal and Torres Strait Islander people, the strides taken in the attainment of health equity through the integration of their respective approaches to addressing their people’s health into the country's healthcare system were evident. The National Aboriginal Community Controlled Health Organization (NACCHO) and the Oonah Health and CommunityServices Aboriginal Corporation (Oonah) are examples. In learning about the strides taken by Aboriginal and Torres Strait Islander people, I started to evaluate and question the legislative and other steps taken by Botswana, my country, to protect and advance the health and human rights of Indigenous persons.

When asked to reflect on approaches to Indigenous health in the context of Botswana, I acknowledged that while it is a signatory of the UNDRIP, there have been no active steps taken by the country to translate the rights outlined in the declaration into its national legislation, leaving Indigenous rights unprotected. Even though Botswana is home to an estimated 73 100 Indigenous persons, Indigenous rights are not enshrined in its Constitution. This means that Indigenous persons continue to be ethnically, socially, economically, and linguistically marginalized and continue to be affected by a healthcare system unable to cater to their health needs. While I sat with this realization, I began to question my role as an advocate and ally.

The rights of Indigenous people are enshrined in the International Covenant on Economic, Social and Cultural Rights (ICESCR) and UNDRIP. They include the right to improve their economic and social conditions including their health, the right to determine and develop priorities and strategies for exercising their right to development and the right to their traditional medicine and to maintain their health practices and the right to social and health services. As early as 2007, the Australian Human Rights Commission reported the gap in health status between Aboriginal and Torres Strait Islanders and non-Indigenous Australians. While some aspects of how the health system performs for Aboriginal and Torres Strait Islander people have improved, access to healthcare barriers remain. Bridging the gap in healthcare provision for Indigenous persons requires the decolonialization of the public health system because, as outlined by the National Aboriginal Community Controlled Health Organization (NACCHO), Aboriginal and Torres Strait Islander health not only encompasses physical well-being. The health of Aboriginal and Torres Strait Islander people extends to the social, emotional and cultural well-being of the community - when the individual can achieve their full potential as a human being, they bring about the total well-being of their community. The decolonization of the public health system requires partnership with institutions of higher learning tasked with educating future health professionals.

Welcome to country and smoking ceremony – Decolonizing spaces of higher education

A welcome speech, conducted by an Elder, welcomed Fellows to country, acknowledging the traditional owners of the land, past, present, and future. The welcome to country was followed by a smoking ceremony conducted on the University of Melbourne grounds, which to me was a revolutionary act, and involved the burning of Indigenous plants to cleanse Fellows ahead of our time on unceded land.

As I stood there, basking in the sun while the ceremony was explained, comfortably inhaling the smoke while it washed over me, cleansing me, I remembered my grandfather’s funeral during which my older sister became extremely sick with a cold and I was tasked with nursing her back to health. To do so, I was instructed to go and pick leaves from the eucalyptus tree mo jarateng ya rona (in our yard). My mom would later crush and mix the leaves in hot water for my sister to aramela (inhale) under a blanket. The eucalyptus leaves are known as the Red River gum in Australia and are used in the smoking ceremony and for medicinal purposes. As they burnt, they felt familiar and nostalgic, making me wonder about other similarities in culture and traditions between Batswana, including Indigenous Batswana and Aboriginal and Torres Strait Islanders. I later learnt of two further similarities. The first one being the washing of hands as Aboriginal and Torres Strait Islander Fellows left Coranderrk, an Aboriginal station established in 1863 and burial site. This, as explained by Aboriginal and Torres Strait Islander Fellows, was necessary for us to leave the dead where they rested. Another was the similarity in the patterns used by Aboriginal and Torres Strait Islander artists which reminded me of Kuru Art, art of the Khoi San or Bushmen people of Botswana.

The fact that the smoking ceremony took place on University of Melbourne campus grounds brought back memories of past and ongoing conversations about decolonizing health and education and the role that institutions of higher learning play in decolonizing education and knowledge systems. Indigenous people have had a deep connection with their land, a connection that impacts their health and well-being; colonialization and colonial genocide led to a disconnect from traditional ceremonies, medicines and land use. Therefore, the concept of conducting any kind of ceremony on University campus grounds seems very foreign to me. I wondered what the decolonialization of institutions of higher learning could mean for students as I reflected on unsuccessful attempts when, as a house warden/manager, I requested that students be permitted to burn impepho (Indigenous African plant) in their rooms. This would enable students to connect and communicate with their ancestors. This request was denied due to fire safety protocols, disregarding the culture and traditional significance of this ritual for the students.

As if to answer my own question, one of the final exhibitions I attended took place at the Medical History Museum, the University of Melbourne. The exhibition on the Art of Healing: Indigenous Australian Bush Medicines explored the evolution of Indigenous medicine from across Australia, highlighting the importance of combining holistic healing (practised by Aboriginal and Torres Strait Islander persons for millennia) with recent Australian and international research, education and clinical practice. I could only imagine the wealth of knowledge that would benefit health in general. To me, this was a deliberate decision and commitment by the University towards the agenda of decolonizing health and the role of institutions of higher learning in this mission. It was during this exhibition that I was also introduced to the Ngangkari, Aboriginal traditional healers responsible for the health and well-being of communities and a valuable source for my research on Indigenous and traditional mental health and well-being.

They may say we are dreamers, but we will achieve equity and human rights

Towards the end of the convening, we visited Oonah. As an Aboriginal Community Controlled Health Organization, Oonah provides an integrated programme of health, well-being, education, and employment services for the Aboriginal and Torres Strait Islander Community in a cultural framework of respect, caring and sharing. The services are designed according to the needs of the community and consider the community tradition and the ways that the community wants the service delivered. Additionally, Oonah partners with hospitals in Australia to train health professionals to deliver healthcare services to Aboriginal and Torres Strait Islander community members because they believe that people should be able to choose the kind of service provider they use.

During the presentation at Oonah, I kept on asking myself why Botswana could not have this. “Why couldn’t services like this be available to rural communities and Indigenous persons around the world?” Healthcare, mental health and well-being equity stems from places like Oonah. It is an example of best practice around Indigenous approaches to health equity, a success story of a space dedicated to ensuring that community members receive the highest attainable standard of health, mental health, and well-being, provided by Indigenous practitioners or practitioners who are well versed with the tradition, culture, customs and trauma of the community they serve; a space which responds to the health needs of the community in its service delivery.

Filled with thoughts and feelings, I must admit that I was not ready to wrap up the week. I needed more time. As we discussed ways forward, what being in the space meant for us and allyship accountability during Australia’s Reconciliation week, as well as our collective call to action, I again questioned my role within the interconnectedness of rights and in supporting Indigenous rights. One space that we identified as an advocacy tool towards Indigenous rights and which I was excited for us to explore was Parliament. Having monitored the health committee of the Eastern Cape Provincial Legislature (ECPL) and used it as an advocacy tool around health service delivery issues experienced by communities in the Eastern Cape, I appreciate the power of Parliament in protecting the rights of Indigenous persons.

All good things must end, and as the flight carrying me back to Botswana took off, I reflected on my commitment to the collective and to Indigenous peoples. As a volunteer of the Parliamentary working group established during the convening, I silently gave thanks to the land and its people, its Elders and their ancestors for the lessons, the celebrations of strides taken and the privilege to hold Aboriginal and Torres Strait Islander Fellows as they remembered and reflected on their painful history.

Thank you, Atlantic Institute, for the opportunity! They may say we are dreamers, but we will achieve equity and human rights.


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