Many seriously ill Aborigines never experience the benefits of palliative care and remain distrustful of the Australian health system and modern medicine, said a Melbourne-based oncologist to a crowd gathered this week at the University of Chicago’s MacLean Center for Clinical Medical Ethics.

“As happens with many indigenous cultures, there is a historic mistrust,” said Dr. Ranjana Srivastava. “Their life-expectancy is closer to that of sub-Saharan Africa than Australia, which is really shameful.”

The ethnic minority accounts for nearly 3 percent of the nation’s total population. Despite living in a developed nation offering universal health care, Aborigines remain under-represented in the palliative care patient population. Many suffer from painful diseases that could be alleviated with palliative medicine, including heart disease, morbidity and cancer.

Physicians must educate themselves about the beliefs of many Aborigines to provide better palliative care, Srivastava said. For example, injectable drugs for treating pain may be perceived as poisonous. Medical decision-making often occurs in “skin groups” or ceremonial gatherings. Thirty people may attend a single family meeting.

“The average physician or nurse has really no idea,” said Srivastava. “We can’t always assume that someone’s spouse is the speaker for them or that the eldest son takes responsibility. We have to be familiar and ask people about who is the representative, and there may be many representatives.”

The family, extending to the community, is the most significant factor in the identity development of most Aboriginal people, according to a recent study led by Anthony Paul O’Brien, a researcher with the University of Newcastle’s School of Nursing.

“Aboriginal people traditionally regarded the land as spiritual, staying within their own country, identified by a group or tribal name. Despite many Aboriginal people living in cities and regional areas… these beliefs and values have prevailed over many thousands of years,” he wrote in on the of the few studies exploring Aboriginal end of life care. “In terms of health and illness, spiritual beliefs in something other than that which is tangible appears to affect behavior towards others and their understanding of the causes of situational events such as health, illness and the loss of a family member.”

Palliative Care Australia, the national body representing palliative care organizations, has called for increased training of clinicians and social workers to help better understand the concerns of Aborigines.

“Contemporary models of palliative and end of life care in Australia which are dominated by western traditions and the biomedical paradigm should integrate Aboriginal and Torres Strait Islander traditions, values and cultural practice relating to palliation and end of life transitions,” according to a statement. “There is an urgent need for the development and provision of palliative and end of life care education and training for Aboriginal health workers.”

The medical specialty helps treat the side-effects of disease and aggressive medical treatments. The goal is not cure, but symptom management. In 2014, a World Health Organization resolution referred to palliative medicine as being “fundamental to improving the quality of life, well-being, comfort and human dignity for individuals.”