Alice - Greetings from the Red Centre

Wet, wet, wet!
I’ve been in Alice exactly one week and it has rained every single day. In fact, we’ve had so much rain that the usually dry Todd river is full and overflowing. This created such a stir that half the town was down by the river edge to witness such a rare event. The Todd river, completely dry 99% of the time, is home to many Aboriginal families. Usually their makeshift shelters and campfires are easily spotted along the river bed, with children running around their bush lounge room. So the flood means that they have had to pack up their belongings and move to one of the town camps to stay with relatives. While this migration happens most years you will appreciate that it is very disruptive to family life and puts great stress on the already crowded housing situation.

Orientation
I have not actually begun any real clinical work yet – instead I have been subjected to four painful days of orientation. Typical of most orientations, it contained vast amounts of useless information (burying the occasional gems), loads of paperwork, odd characters and a long time just waiting around. However, of much greater interest and value was the day of ‘cultural orientation’. As you probably know, I worked and lived in a Yolnu community in Arnhem Land in 2005, and there are many similarities between the ‘Top-end mob’ up there and the ‘Desert mob’ here in Alice. However, there are also many differences and the clinical aids and approach that worked in the Top-end may be inappropriate, confusing or even downright derogatory down here. Over the next few months I’ll introduce you to some of the locals I meet and share with you the cultural discoveries (and inevitable blunders) that I make.

Alice Springs Hospital
Alice Springs Hospital (ASH) is a very unique place. Despite having only 165 beds, it services an area the size of Victoria and NSW combined! Greetings from the Alice! The next closest major hospital is in Adelaide (~800km south). This means that ASH must be able to deal with pretty well anything that comes through the door.

As the Director of Remote Services commented:

“I have three RFDS (Royal Flying Doctors Service) planes to cover an area the size of Europe!”

A big ask indeed! It also means that, unlike any comparable Australian hospital, ASH has a fully functional Intensive Care Unit (ICU) including three full-time ICU Specialists.

Naturally, ASH has a huge focus on Aboriginal health. Aboriginal peoples comprise around 50% of the local population but constitute more than 80% of the hospital’s workload. Apart from Aboriginal health generally, the hospital is particularly renowned for its Paediatric and Renal (kidney) units. The renal ward is full of young patients with end-stage renal failure. This is usually a diagnosis seen in older diabetics. However, while diabetes is common here in Alice a minority of Aboriginal patients live long enough for its renal complications. Instead, the causes of renal failure in these young patients can be traced to childhood.

One cause is maternal malnutrition (an issue that has been pretty well rectified now). The other cause is the childhood infectious disease burden. In the days before antibiotics, patients with severe infections (e.g. osteomyelitis) would often die not of the infection, but of the renal damage it caused. Here in the Alice, chronic infection is normal among Aboriginal kids. This includes scabies (~50% carrier rate) and bacterial skin infections as well as respiratory tract infections. Such an infectious load puts a large burden on young kidneys and resulting in people in their 20s with end-stage renal failure. [For the medics among you, the typical renal biopsies show scanty large glomeruli consistent with the timing of such an infectious insult].

Plans
I start work on Monday – at the Central Australian Aboriginal Congress (or just Congress for short). It was the first Aboriginal controlled organisation in the NT and was established soon after the Australian government granted full citizenship to Aboriginal peoples (in the late 1960s). It now offers not only GP-style medical assistance to the Aboriginal population, but also legal, public health, advocacy and other health and social services. I’ll be the first resident doctor to ever work there – so it’ll be a time of discovery all round! More on this next letter.

Feel free to write or email me, and pass this on to whomever may be interested.

Till next time, cau!

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)!