Elcho 4 - Goodbye

I flew back into Melbourne last Saturday – immediately assaulted by a 6 degree morning. Basking in the 30+ degree days on Elcho Island I had forgotten what it was to feel cold. My memory has now been rather violently refreshed! I have now started a 6-week Psychiatry rotation in Frankston, and look forward to catching up with you guys again.

Family
My sweetest memories of the last week on Elcho Island come from time spent with my Yolnu family. This included more trips out bush, fishing, playing music and listening to stories of the ‘old days’ from my Ngandi (mother). Now an energetic 65yo, she was 3yo and living on a remote Homeland when the first white men (missionaries) came to Elcho Island. Along with most other families, she moved into the Mission – established at what is now the town of Galiwin’ku. Her memories of the ‘mission days’ are very positive, with good schooling and everyone engaged in productive employment. Since the missionaries left (in the 1970s), things have gone downhill dramatically – with loss of Yolnu leaders, no respect for traditional law, and laziness.

As one of the older Yolnu on Elcho Island, she has a unique insight into traditional law and possibilities for Yolnu to truly achieve self-determination. The majority of young Yolnu have little interest or respect for traditional law – but an equally poor understanding of “Balanda” (Western) law and culture. The latter is unfortunately largely based on American rap culture, one of the few models of successful black people available to them.

Interestingly, music and art have been some of the few avenues Yolnu have been able to consistently find expression. My last evening was spent with my brother (Marcus) and cousin (Manuel) – who are musicians blending Yolnu and Balanda sounds and values. Formally a member of Yothu Yindi, my Manuel now fronts a band called “Saltwater” which has broken into the mainstream music scene and will play at the Commonwealth Games next year. I had a great time learning songs, language and traditional dances from them.

Death et cetera
During orientation, my cultural educator spent an inordinate amount of time discussing death and all the cultural intricacies associated with it. While I thought it was overkill at the time, I now realise why it was so important – as there was a funeral on Elcho every week, contributing to an uncomfortable atmosphere of grief and tension and much social disruption. I was able to attend a number of ceremonies, and will recount my very limited experience and understanding of this.

Following the ‘passing on’ of an Aboriginal person, dominant culture rituals take precident initially (certification, autopsy, coronial input etc.) – which invariably means removing the body from the community to Darwin. Grieving is put on hold until the body returns, which means the return is even more saturated with emotion.

A ‘hearing ceremony’ takes place upon reception of the body, which begins with various traditional rituals to welcome the soul back home. With all relatives present (up to 100 people), a heated discussion then follows as logistics of the funeral are worked out.

Returning the body to its Homeland takes place up to a week after its return, with many smaller ceremonies in between. This holds most comparison to a Western funeral or memorial service, with all relatives and much of the extended community attending. Traditional dance and song take place, which are specific to the family, clan and Homeland. Family and community Elders then have their say – which may cover many topics, but never directly relating to the deceased person. Secret women’s and men’s business then occurs, with the physical burial being a more private affair.

As you can now appreciate, funerals mean total shutdown of everyday activities for many Yolnu – even if they are only more distantly related. On a practical note, this means that the Health Centre closes (except for emergencies) at every major ceremony.

Traditional Law
You may have heard recently the results of a Coronial inquiry following a spate of petrol-sniffing related deaths around Alice Springs. Aside from the many issues of substance abuse, this raised issues of the position of Traditional Aboriginal law in Australia. A few weeks earlier, an Elcho Island offender was handed over to Yolnu Elders for traditional punishment - a landmark Supreme Court decision. Currently, Aboriginal people are the most incarcerated ethnic group in developed countries – subject to an irrelevant, ineffective and often downright cruel and unfair justice system. This has been seen as a very positive step forward, both recognising traditional law as legitimate and returning some authority to traditional Elders to implement change in a meaningful way.

Conclusions
Saying goodbye to Elcho Island, and the many friends I made in my short 6 weeks, was difficult. I have learnt so much about Aboriginality and what it means to be Australian. I have few answers, hundreds more questions, and a much better appreciation of the issues facing Aboriginal Australians. I would love to come back up to the Northern Territory as a doctor, perhaps a few years down the track …

Until next time, Djut djut (goodbye)!

Elcho 3 - Flying to the Homelands

Looking out my window, I see the sun sinking below the horizon, splurging a red glow across the sky. The moon and evening star already hang in the clear sky, as a rare cool breeze washes the remaining heat from the air. The last week has flown by, and it is with some sadness I realise that I have only a little over a week left here on Elcho Island.

Thanks to all of you, who have written to me during my placement, much appreciated. Until next time, Enjoy!

Flying out to the Homelands
Last week I had the opportunity to join a community nurse on a trip out to Mapuru, a remote Homeland across on the mainland. Sitting shotgun with the pilot in the 5-seater plane, the views were simply breathtaking. As far as the eye could see stretched red plains, covered sparsely with tall Eucalyptus trees. Occasionally, the black streak of a river, or the treeless streak of a road, would break the monotony. Disembarking the plane into a cloud of red dirt, I stepped into the welcome of one of Arnhem Land’s many beautiful Homeland communities.

Mapuru is home to around 60 permanent residents. However, hundreds more drift in from surrounding camps for community occasions such as funerals (which are unfortunately all too frequent). The dozen tin-sheet buildings provide residences, school and store for the Mapuru community. A recent addition has been a small 2-room building for clinic visits (which occur every fortnight or so).

The local guys jumped at the chance to see a male health worker, and my morning was spent seeing a steady stream of patients. The health of the Mapuru community was very encouraging – alcohol was absent, kava and cigarette use minimal, hygiene relatively good, and health skin highly prized. The latter gave me much amusement as guy after guy requested moisturising cream to keep their skin positively glowing.

With us on our flight back to Galiwin'ku was a young boy with a tender, inflamed knee. Possibility of infection or rheumatic fever meant he would need observation and, if necessary, evacuation to Nhulubuy or Darwin. Fortunately this did not eventuate, but it once again highlighted the challenges of living in a remote community.

Real-life Cowboy
Among the array of characters I met at Mapuru, was Alfred – an original Aboriginal cowboy. His lanky frame decked out in tight jeans, flannelette shirt, cowboy boots, big buckled belt and broad-brimmed hat perched on his bushy white hair, he certainly still looks the part. As he talked of breaking in wild broncos and hustling cattle overland, the loss of horse and saddle was obvious.

Alfred epitomises the many “warriors” who have lost their role and value to society. The host of traditional knowledge he and the Elders hold, its value unrecognised, is sadly being lost forever. The welfare mentality is now an entrenched part of the worldview of almost all my generation and beyond. As Aboriginal leader Djiniyini Gondarra said, “dependency is the biggest disease that is killing Yolnu today”. The reward of hard work, so valued by their Grandparents, makes little sense in the current welfare state.

As I watched Alfred sitting cross-legged in the sandy shade of a tree, I realised that he was one of the lucky ones. For so many others, this loss of roles and self-value have led to the destructive clutches of alcohol and other drugs, gambling, and violence towards themselves and others. And sadly, those who opt for suicide are not the “no-hopers”, but people who could make a difference, but have seen all hope disappear before their eyes.

Yolnu Heart
Children have a way of revealing reality in such a naked, honest way. One afternoon I walked down to the beach, my mind a jumble of thoughts, as I tried to clear my head of the heavy feeling of loss that seems to blanket Galiwin’ku. Settling on the hot sand, I watched a group of a dozen young boys splash about in a large rock-pool. Noticing me, one of the older boys trotted over and struck up conversation.

I spent the next hour swimming, being half-drowned, rolling in the sand and reclaiming the innocence of childhood with these 12 Yolnu boys. Hearing me struggle with Yolnu Matha, they eagerly taught me all the important words – water, boat, shark, crocodile... They left the beach with me, accompanying me back home, where they quickly set to work raiding raiding my fridge, before becoming engrossed in some ABC Kids TV program. As their visit came to an end, and I settled down to clean the fresh layer of red dirt through my entire house, I felt a sweet reinvigoration. And as I remember their sea-swept hair, big brown eyes and gleaming smiles, I am convinced that the Yolnu heart is still beating as strongly as ever.

Plans
Plans are all progressing well.

• More Homeland visits next week.
• Going bush again this weekend.
• Footy and basketball are on hold – my ankle is giving me grief again.
• Still not sick of the beach and, croc-willing, plenty more to come.
• Men’s cultural centre is still on the cards.
• No time to go to school, but plenty more community contact to come
• Hep B management and screening protocol in action

Elcho 2 - Yolnu Family

It’s another beautiful sunny day on Elcho Island – the jewel of Arnhem Land. In the last week I’ve played footy, gone bush, swum with a croc, been adopted, made some fantastic friends and done some great medicine.

Thanks to those of you who have emailed or written, much appreciated!

Adopted Yolnu Family
Hi, my name is Wangirri (meaning grey heron bird). I am from the Dhurrkay family, part of the Wangurri tribe, and my skin name is Bangadee. Last week I had the privilege of being adopted into a Yolnu family by one of the “Strong Women” workers at the Health Centre. I’m still learning what it all means, and who all my relatives are, but it has opened up a lot of doors into the community. One of the first questions people ask is have you been adopted; then proceeds a lively discussion of how you are related to them, who you know, and where you live.

Going Bush
On the weekend, my ‘ngandi’ (mother) took me out bush to her Homeland. With 10 of us piled in (and on) a ute and we bumped over the sandy track up to the north end of Elcho Island. The scenery on the way was amazing – lots of wildlife, beautiful flora, and many little bushfires cleaning up after the cyclone (last wet season). The day was spent at a beautiful beach: fishing; netting; catching crabs; cooking damper; lots of eating; swimming; and snoozing under trees. I came home hot, exhausted and somewhat red – and looking forward to next weekend!

Crocs, crabs, cockatoos and other cool creatures
My curiosity has been having a field day out here with so much to explore. Wildlife is such an example. The other day I spotted a frill-neck lizard, who liked me so much he opened his frills and blew me a kiss (or was it a hiss, hmmm). Black cockatoos, hawks and sea eagles are regularly spotted gliding overhead. Dozens of crazy little hermit crabs scurry over the wet beach sand. Fish fill the waters, and I’ve even spotted dolphins leaping out in the sea.

But most exciting was my discovery down at the beach the other morning. It was the first time I’d visited this particular beach, and as I scrabbled down the rocky cliff overhanging the beach, I spotted a black rock-like object just offshore. When it fully surfaced and began gliding towards deeper water I realized it wasn’t a rock, but a crocodile – and a big one too. Being familiar with Steve Erwin’s efforts as the Crocodile Hunter, and with “see one, do one, teach one” running through my head from medical school, I hurried down to get a closer look. [This is the part where I’m meant to bring the story to climax with a dramatic escape from the jaws of death. However, that may be pushing creative license a little too far. So I’ll leave it at that, and allow you to form your own satisfactory conclusion.]

Health
Work at the clinic has got rather busy lately – as I’ve taken on a few little pet ‘projects’. These involve: Men’s Health; Rheumatic Heart Disease; and Hepatitis B infection. You heard about my role as the “Men’s Health Sexpert” last letter, and the jobs just grown since then.

Rheumatic Heart Disease (RHD) is a serious condition involving heart valve damage following a simple throat or skin infection. The highest rates in the entire world are recorded among TopEnd Aborigines (for reasons unknown). A number of kids got picked up with heart murmurs (possible RHD) at a recent school screening, so my job is to follow them up and make sure they get seen by a Cardiologist. This is proving more difficult than it sounded – when I visited the school last week not a single one was in attendance. I was told that they “could be anywhere in Arnhem Land” (such is the mobility of the population here).

Hepatitis B infection is also very common up here in the TopEnd (estimates as high as 10%). While acute problems are not too bad, Hep B can lead to liver cirrhosis, failure and cancer later in life. Until now, chronic Hep B carriers on Elcho have not been followed up adequately and no testing has been done on their household contacts. [The mistaken logic has been that Yolnu here don't live long enough to get the complications] So over the next 3 weeks I’ll be attempting to follow up all the Hep B carriers and their families as I can find. If all goes well, I’ll have a workable protocol to leave behind. The Darwin CDC (Centre for Disease Control) are the authority on this sort of thing up here, so I’ve had lots of guidance from them thankfully.

Newsbites
There’s been a few significant happenings outside of my TopEnd experience recently:

• My sister, Serena, has just got engaged to Matty King (a top bloke and close family friend in Tassie). So huge congratulations to them! And best wishes for planning next year’s wedding and move to China!
• Job offers for Internships next year have just been released. After a difficult choice between two very different jobs (Alice Springs District Hospital, Monash Medical Centre in Melbourne), I’ve accepted a job at Monash Medical Centre. So I’ll be based in Melbourne for another year, hopefully with a couple of terms at rural Victorian hospitals.

Plans
Last email I listed some plans for my stay here – here’s how I’m going:

• Visiting communities out in the Homelands – fly out with Homelands Health on Tuesday
• Meeting the Traditional Land Owners – yep
• Going bush, maybe even some hunting and fishing – yep and will do more
• Playing basketball and footy – footy yes, b’ball not yet [Footy was a real experience. Picture 50 guys on a dirt/gravel oval, shirts vs skins, all in tussle. It was the first time in footy I’ve been outrun by so many other guys. Had an awesome time – returning with cuts, grazes, bruises and a layer of red dust covering me. Loving it!]
• Lots of beach and swimming – yep, and more planned

And here are some for the coming weeks:

• More of the above…
• Visit the Men’s cultural centre
• Spend time at the school
• Establish the Hep B management and screening protocol