In Indigenous Communities
In The Northern Territory
By Chris Wilson
I have just completed a six-week stint working as a sexual health specialist in some remote Central Australian Aboriginal communities. This job was not with the Intervention but part of the annual Tri-State screening to survey and assess the incidence of STI’s (sexually transmitted infections) in Central Australia. It was work I had done before and during this time I revisited many communities I had previously worked and lived in as a remote area nurse over a 10-year period.
I was in New Zealand working as a midwife with mainly Maori women and midwives a year ago when I first heard of the Intervention and although greatly disturbed and concerned decided not to comment until I had first hand experience of what was actually happening. I now feel much more qualified to comment. My time over the last six weeks has enabled me to see some of the effects of the Intervention and while I have to agree that there are some positive effects, there are huge problems and structural issues that have been completely ignored and many others that have been created as a result.
The Intervention was a racially motivated, cynical and political campaign, following a formula which had been successful in previous Howard election campaigns (Wik & land rights, ATSIC, opposition to reconciliation, Tampa, etc) but which fortunately this time contributed to the demise of the Howard government. It was almost a stroke of political genius, to mask the real emergency in Aboriginal health and also to blame it on the culture itself. It took a Report, The Little Children are Sacred, by Rex Wilde and Pat Andersen and using powerful emotive argument distorted the issue out of all proportion and unleashed a military style attack on Aboriginal culture and Land Rights.
If the Rudd government, which has thus far acted admirably in apologising to Australia’s Indigenous people, wishes to avoid this racist taint, it should act to end the Intervention immediately, re-instate the Racial Discrimination Act and act in accordance with the Report.
None of the 97 recommendations of the Report were followed by the Intervention. The Little Children are Sacred Report has a theme running through it that the problem of child abuse (and most of the other problems) stems from many years of destructive (of culture), paternalistic solutions and that communities must be involved in solutions. The Intervention was exactly the opposite of what was recommended by the Report.
The emergency in Aboriginal Health has been going on for centuries and there have been unceasing and consistent calls for improvements and increases in appropriate funding for true and proven Primary Health Care solutions, engaging communities to resolve problems. While we have such a discrepancy in life spans, unbelievable differentials in disease rates in virtually every measurable category it is hardly surprising that there would be a worse rate of child abuse in remote communities, yet this single factor was the trigger for the Intervention. I can say with authority that child abuse was not a day-to-day feature of my work as a remote area nurse living and working in communities for eight years.
I would like to spend a moment on this particular point. In my considerable time in Aboriginal communities (I had the privilege of being able to live and work in them for many years) I have always and consistently been struck by the nurturing of children. Fathers are often seen carrying and cuddling children. Fatherhood is not confined to bloodlines and Aboriginal culture has the fantastic capacity to extend paternal and other relationships to children not of one’s own loins. As a result children are generally incredibly open, trusting and affectionate to adults, and also incredibly independent in comparison to other cultures, particularly ours (whitefella culture). This is not to say that there is not a darker side to communities but in my eight years of practicing as a nurse child abuse was not a feature, and I can only remember one case of a young girl whom I was really concerned about. Neglect was another matter but that was born out poverty with all that flows form it; ignorance, cultural and social dislocation, overcrowding, lack of access to services, substance abuse etc rather than a deliberate maltreatment of children. This pattern associated with poverty is transcultural and the same issues can be found anywhere there is poverty. The attempted genius of the Howard and Brough strategy was to taint Aboriginal culture with the opposite of what actually happens, a classic racist approach, and to sheet home the blame to that culture. The Howard government and many others besides would rather blame culture than acknowledge the history that has caused the present problems.
I remember many years ago being considerably impressed by the incredible caring for a newborn baby who never was allowed to touch the ground and was always carried and cuddled by literally dozens of family members of all ages and sexes. While this child grew rapidly, at six weeks it had pus streaming from both ears and was suffering from acute otitis media. This paradoxical and confusing pairing of opposites I found was to become a feature of Aboriginal health. One the one hand a child was unbelievably nurtured but was at the same time effectively inoculated with a toxic brew of virulent organisms from all that cuddled and kissed her. Although some would label such an outcome as neglect, I have come to realise over the years, this, as with so many other problems in Aboriginal lives, is a feature of poverty rather than culture or race and it is this that is the crux of our problem.
I remember in one small clinic during this last stint answering the phone, as the clinic nurse was busy. A dentist in town wanted some information on a child before they commenced a procedure so I looked at the file. I came into contact for the first time with the child health check and was struck by the sheer arrogance of the whole approach and could not believe the utter waste of resources that had taken place. The Intervention child health team had filled out a 15-page child health history and this is the process for each child. I remember in my first remote Community in the Top End some 12 years ago being struck by the enormous amount of work that had gone in to the health of the community by generation of health workers. There were dozens of filing cabinets of health records dating back to mission times and generally increasingly careful documentation of presentations to the clinic and of course of medications, immunisations, physical parameters such as weights, blood pressure etc.
The Intervention tended to ignore this invariably intricate documentation and overwrite it with a new set of data. It is worth examining this process further. Remote area nurses and other health practitioners generally gain some sort of formal orientation and are mentored by other workers in most clinics. Over time they become adept at the generalist work they have to do. Measuring a baby takes some skill and practise, as does most health work. Interviewing an Aboriginal woman about her birth history and the growth and development of her child takes a great deal of experience, time and skill, and is greatly influenced by the practitioner’s relationship with the woman, and the practitioners cultural awareness and safety. The intervention teams were a mix of practitioners from all disciplines and while some would have been expert at various parts of the job some would have been very out of practise with what they were now doing and would certainly be challenged by the environment that they now found themselves in. I heard from one nurse about a specialist medical oncologist who referred 7 children from one community for cardiac echocardiograms in Alice Springs after he thought he heard heart murmurs. This resulted in one positive finding.
The point here is that an incredibly expensive intervention had really achieved very little. It had overlooked the very basic fact that remote area medicine and health practice here in Australia is a sophisticated specialty. It was good to see that the oncologist was at least aware of the terribly high incidence of Rheumatic Heart Disease in communities and was prepared to reduce the margin for error but any remote area nurse or Aboriginal Health Worker would have probably achieved at last the same result and for incredibly less expense and waste of scarce resources. I am not sure of the costs involved but patently sending a medical specialist, (not a paediatrician) two or three nurses, two soldiers, (all being paid very generous and well above award salaries, expensive four wheel drive or air transport, building exclusive accommodation and a wired off compound) was extravagant and excessive to say the least. The administrative cost of getting all this on the ground and then collating the data are hidden and would also be huge. Once again most of this money benefits those who least need it, those comfortable and already employed professionals.
I mentioned above, CRANA, in concert with many other remote and rural
health organisations have been calling unanimously for decades for
more appropriate allocation of resources to address the health issues
in remote Australia.
Once again the spend has not been where it could be most effective, i.e. in the community addressing housing, maintenance more health practitioners on the ground at a constant level, more education programs. Arguably boosting our health workforce would also be an appropriate aim, and that would mean spending on universities and other training and support organisations but the Intervention has proved to be an effective screen for all of these issues
My six-week stint has highlighted the deficit and I am shocked. I have been sent out to participate in an annual sexual health screen in at risk communities. After 10 years or more of this annual screen things are no better and in some age grounds STI incidence is still 30 - 50%. We still do not understand the basis of this epidemic and are certainly no closer to containing it. Of course Aboriginal people are minimally involved on a policy level and this is the basis of the problem. The risk of HIV entering these communities with all that would entail is as great as ever. Little of the resources of the annual screen are spent on education or dialogue with communities in order to find a solution that will be effective.
I came into contact with several other aspects of clinic life that I was all too familiar with. One clinic proved particularly hard for us to get going, as there were no Indigenous workers we could easily identify to work with, a crucial element of our program. It turned out that the clinic manager had a policy of not employing Aboriginal workers. Needless to say this was not an Aboriginal Controlled Health Service. It took a week to gain the confidence of the community to enable us to work hand in hand with a local worker and start the screening, education and treatment process should it be necessary. It goes without saying that this community was one of the worst affected as far as STI rates went and remains so due our ineffective work there.
Recall systems in all the clinics (government or community controlled) I visited were deficient. These systems are essential in being able to supply vital treatments to vulnerable populations; those with rheumatic heart disease, chronic disease, women requiring pap smears, immunisation reminders and so on. The main thing here was support so that the new staff in an environment of huge staff turnover would be equipped to carry on this vital work. In addition adequate staffing was an essential not attained in any clinic and this in the face of an extravagant spend on an unnecessary program that has achieved little.
The benefits: I hear from good people on the ground that the quarantining of money has led to a marked reduction in the level of desperation for food and power cards. Money is not being spent on grog, ganja cars and gambling to the same extent it was. The communities I visited are certainly calmer than when I was there last but that is largely due to the fact that petrol sniffing has largely been abolished, a gain not attributed to the Intervention but the introduction of Opal fuel. Policing has improved but that had already been in place in some of the places I visited, in keeping with the wishes of the communities and had occurred before the Intervention.
Aboriginal people I talked to a year ago when I first heard of the Intervention were cautious with their words and welcomed the increase in funding that was promised. A year later I am saddened that so much waste of resources has taken place, so little support or recognition given to, or use made of, the workers on the ground; so little attention paid to all the reports that had been made over the years, including the very report they were acting on, and above all absolutely no consultation with anyone, especially community members.
My concerns are that money is spent where it is least needed. Children in remote communities are the most examined there are in Australia. There is nothing the Intervention has turned up that was not already known and it is the follow up treatments that need to be concentrated on. More skilled staff are needed on the ground, not visiting in order to address the issues and follow up on complex treatments. Poverty is the root of most of these problems and this needs to be addressed in consultation with the communities, not as directives.
The racist nature of the intervention is still a stark reality. The racial discrimination act is still rescinded to allow this unfortunate process and that will always be a measure of its inherent racism. The insidious effect of highlighting child abuse over all the other known problems in Aboriginal Health is destructive to male health, mental health and community health, is unfounded in fact and is based in the inherent ignorance and this racist approach. Hone Harawira, the brave Maori Party MP from New Zealand was absolutely correct in labelling the former PM as a racist bastard.
It is up
to the new Rudd government to acknowledge this cynical approach and
to streamline the increased resources that have been welcomed by Aboriginal
people to really benefit from the spend. The best way to do this is
to involve the communities and the people living there to identify
problems and adequately resource the long-term plan that will flow
from that consultation. My recommendation would be to build on the
good work already achieved in difficult environments and to improve
on the existing service rather than the half hearted and irresponsible
attempt that we have witnessed.
The Federal Intervention should be repealed immediately if the Rudd Government is not to be tainted by this racist and destructive campaign. And a true consultative framework must be set up in its place dealing directly with communities and their health services, ensuring that the good work that has been done there for decades is respected and utilised.