While one would have to live under a rug to remain oblivious of the ‘gap’ in health standards between Indigenous Australians and the remaining population, three weeks in the central desert area with John Flynn Placement Program this summer certainly gave greater depth to my understanding of the physical, economic, political and cultural boundaries Indigenous Australians face.
On my placement in Aputula, I had the pleasure of meeting many Pitjantjara people. Despite having shared the experience of a somewhat isolated upbringing near a similar sized town (although not to this extent), I feel the people of Aputula live a very different life to me. Healthcare was radically different; supplies could easily get cut off for weeks by road closures (as they had been just prior to my arrival), pregnancy meant a compulsory ‘sit down’ period in Alice Springs at 38 weeks, and as I had the opportunity to see, the Royal Flying Doctor Service is the only option in complicated cases.
Not surprisingly, health issues varied considerably. Doctors and nurses were keen to always keep significant (but rare elsewhere) complications such as rheumatic heart disease and post-streptococcal glomerulonephritis at the back of their mind when seeing a patient, and consequently benzylpenicillin was administered considerably more frequently. One nurse told me she’d refuse to have one if needed, they’re that painful!
Skin conditions seemed the norm, and many children had boils. Vaccines were clearly valued in the community, but difficult to keep up with, as many families frequently travelled across the border to spend time with family in South Australia. What also amazed me was the variety in health literacy. For those who had minimal opportunity for health education, their trust in the local health centre and their staff very much impressed me. Doctors and nurses also developed keen communication skills and used a few key Pitjantjatjara words, as English was typically the 3rd or 4th language learnt. My personal favourite was ‘pah-li-ah’*, which the doctor would often ask. This roughly translates as ‘all good’.
Cooling down with the kids in the rarely full Finke River.
I also had the pleasure of learning about Ngangkari; traditional Aboriginal healers. It was interesting to hear opinions about which issues were seen as predominantly ‘for the clinic’, vs. which you might talk to a Ngangkari about. In my experience, I could see Ngangkaris could offer a vital role in addressing mental health. They understood the Pitjantjara worldview vastly better than the nurses could hope to, and have a better grasp of current relational issues in the community. While on my placement, I was lucky to have a very experienced Remote Area Nurse with a special interest in mental health. I saw that most communities would not have access to this, and mental health issues could potentially fall on the backburner.
Increasingly, I gained exposure to the effects of the Northern Territory National Emergency Response Act, or simply ‘the intervention’. As a Western Australian, this was something I only had exposure to via the media, and I thought by 2015, it would be very much ‘over’. I was very much mistaken, and frankly I was disturbed by the long term effects.
In 2007 the ‘Little Children are Sacred’ report was released. The intervention was proposed just six days later1. This included extreme measures such as acquiring townships with five year government leases, scrapping the permit system for prescribed areas on Aboriginal land and creating enforced ‘dry communities’ and defence force assistance within our own country1.
This raises many concerns. Firstly, compulsory health checks place health workers in a compromising place; how does one achieve this while still being able to gain consent and build rapport with the patient and their family?
Unfortunately, the greater problem was that the intervention served to greater build distrust. It served to enforce many negative stereotypes of Indigenous Australians, but most of all sent the message that ‘they cannot be trusted’. This message was strongest towards Aboriginal men, accused of heading ‘pedophile rings’. These claims were later shown to be unsubstantiated (see http://www.smh.com.au/national/pedophile-ring-claims-unfounded-20090704-d8h9.html for more information), and no new charges for child sexual abuse were laid in the first six months of the intervention2. In the Northern Territory, this mistrust was so extreme that it supposedly warranted suspension of the Racial Discrimination Act.
On my placement, I discussed with locals how they felt when government troops moved in at the beginning of the intervention. Some simply saw it as laughable, but others had extreme fear triggered by memories of the stolen generation, and saw it as a ‘second invasion’. As District Medical Officer Dr Steve Foster said, the intervention created a mood of ‘absolute despair’ in Aboriginal people of the Northern Territory. The direct psychological effects of this are concerning; reports of suicide and self-harm attempts increased by five times since the intervention3. Additionally, how can the medical discipline expect to take responsibility for their own health in such isolated areas, if government intervention suggests Indigenous people cannot be trusted and thus require different treatment? Unfortunately, for all the lost trust and cost of the intervention, its outcomes are appalling; hospital admittance for childhood malnutrition increased, school attendance decreased and Indigenous incarceration rates increased by 40-50%3. These all reflect social determinants of health, and I believe these are outcomes we (as future health professionals) have a responsibility to counteract.
As quoted by the authors of the ‘Little Children are Sacred’ Report;
‘Everything we have learned since convinces us that these [issues] are just symptoms of a breakdown of Aboriginal culture and society. There is, in our view, little point in an exercise of band-aiding individual and specific problems as each one achieves an appropriate degree of media and political hype. It has not worked in the past and will not work in the future… What is required is a determined, coordinated effort to break the cycle and provide the necessary strength, power and appropriate support and services to local communities, so they can lead themselves out of the malaise: in a word, empowerment!’
This sign was at all the entries to Aputula.
Despite this strong influence, I still found my time in the Northern Territory a wonderful learning experience. The Northern Territory seemed to be that slightly illogical friend we all have; wonderfully good fun, never on time, a little unpredictable but someone you 100% want to know. It was a place of great beauty – if you’re given the opportunity to work there do not underestimate the amount you can achieve with a mountain bike or a 4WD. And many organizations I came across were filled with passion to work with Indigenous people to improve health outcomes and maintain Indigenous links to culture and land. Two stood out in particular, the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council (aka NPY) and the Purple House, which offered remote dialysis with The Purple Truck. The people I met on placement and while staying in Alice were friendly, kind, and surprisingly patient with me as an inexperienced student on placement.
I hope I will have the opportunity to work again in the Northern Territory, and hope Indigenous health becomes an important part of my career.
Finally I would like to thank John Flynn Placement Program for this experience, and all the staff that helped me to learn so much this summer.
Sunset at Aputula: East of here is the origin of the Simpson Desert.