I have just completed a six-week stint working as a sexual health specialist in remote Central Australian Aboriginal communities, during which time I revisited many places where I had previously worked and lived as a remote area nurse over a 10-year period. During my latest stint, I was not with the NT Intervention but part of the annual Tri-State screening for STIs (sexually transmitted infections) in Central Australia.
While I saw some positive effects of the intervention, I have also been horrified by the many negatives.
I am particularly concerned by the huge waste of resources with the child health checks program. What was the point of spending so much money effort describing problems that were already well described? Children in remote communities are the most examined in Australia. The intervention has not turned up anything that was not already known -it is the follow up treatments that need to be concentrated on.
The intervention teams were not necessarily well equipped to deal with the demands upon them. 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 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 is a sophisticated specialty.
At least the oncologist was at least aware of the terribly high incidence of rheumatic heart disease and was prepared to reduce the margin for error but any remote area nurse or Aboriginal Health Worker would have probably achieved at least the same result for far less cost.
Sending out teams of a medical specialist (not a paediatrician), two or three nurses, two soldiers (all being paid very generously, expensive four wheel drive or air transport, building exclusive accommodation and a wired off compound) was extravagant and excessive, to say the least.
Once again, most of this money benefits those who least need it, those comfortable and already employed professionals. The intervention would have done far more good if it had invested in the established health services, as well as in measures to reduce poverty, developed in consultation with the communities themselves.
In all my years as a remote area nurse, I can say with authority that child abuse was not a day-to-day feature of my work. Rather, I have been consistently struck by the nurturing of children. 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.
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. On 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 those who 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. The neglect that I saw was born out poverty with all that flows from 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, the same issues can be found anywhere there is poverty
The Council of Remote Area Nurses of Australia, together with many other remote and rural health organisations, has been calling for decades for more funding to address the health issues in remote Australia. Spending has not been where it could be most effective – in the community addressing housing, maintenance, more health practitioners on the ground, and more education programs.
I am shocked by what we found during the recent sexual health screen. After 10 years or more of this annual screen, things are no better and in some age groups, STI incidence is still 30 – 50%. We still do not understand the basis of this epidemic and are certainly no closer to containing it.
The basis of the problem is that Aboriginal people are minimally involved on a policy level. The risk of HIV entering these communities with all that would entail is as great as ever. Few of the annual screen’s resources are spent on education or dialogue with communities in order to find effective solutions. I hear from people on the ground that the quarantining of money under the intervention has helped -that 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 nearly been abolished. A gain not due to the intervention, but the introduction of Opal fuel.
I am saddened that the intervention has wasted so many resources, given so little support or recognition to the workers on the ground, paid so little attention to years of reports and above all involved absolutely no consultation with anyone, especially community members. 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 of this racist approach.
The intervention was a racist election gambit that fortunately backfired. I am concerned that the Rudd Government has not acted more forcefully. Howard and Brough claimed the moral high ground, so that anyone arguing against it would be labeled a supporter of child abuse.
The Rudd Government must repeal the intervention, its racist legislation, involve indigenous people in identifying problems and adequately resource the long-term plan that will flow from that consultation.
Crikey should reduce the space available in comments to stop people like John wittering on about things he knows nothing of. As for Claret….,more ill-informed racist nonsense. “Most adults…” Claret? Wouldn’t have a health department stat to back that up would you? Nah, thought not you wouldn’t be a stat kind a guy, prefer to let your prejudice or fear speak.
Here’s one for you then “Australian Bureau of Statistics, National Health Survey: Aboriginal and Torres Strait Islander Results, Australia, 2001 notes that 58% of Indigenous respondents did not drink alcohol, compared with 38% of non-Indigenous respondents. 12% of Indigenous respondents were likely to consume alcohol at risky/high risk levels, compared with 11% of non-Indigenous respondents.
Housing gets smashed for lots of reasons, in Wadeye because we built a permanent town and unilaterally allocated permanent rights in a place that two distinct groups of people have shared for generations. In other places we try to force people to live in homes that are environmentally and culturally inappropriate. Ask someone who lives in a modern concrete slab concrete block home in Parap Grove or Palmy (like we insist on building in communities) how environmentally appropriate that kind of house is, then ask them what their A/C bill is, now jam 17 people into each one, who wouldn’t want to kick the frigging windows out? But it’s a lot easier just to say that drunken abos don’t appreciate white generosity and are too brutish to live in proper houses.
The roots of abuse are complex but the roots of the intervention are not. It is about assimilation and land theft. If Howard had any intention to address the abuse of children he would have acted on least one of the Wild/Anderson recommendations. Like the engineer says get informed, read the report (http://www.nt.gov.au/dcm/inquirysaac), help where you can and for christ’s sake stop mindlessly blaming aborigines and telling ignorant racist lies about them.
Whilst I agree that much child neglect constitutes abuse, particularly the neglect perpetrated by alcoholic or otherwise addicted parents, this is not confined to the Aboriginal population, despite John’s assertions.
John reckons that “… our correspondent is shocked with the results of the sexual health screening and cannot undersand the meaning of the test results. Even I as a lay peson know that this means that people with STDs are having intercourse with these infants and children.” However John is reading his own bias into Chris’s observations. Chris does not say or imply that these high rates of Indigenous STIs exist amongst children or under age sections of the Indigenous population. There is no basis for John’s subsequent diatribe.
For example, when John states that “… we have many thousands of non aboriginal people living on the same welfare allowance incomes … but the rates of abuse are considerably less, albeit not nonexistant?” this is plain wrong. The rates of child neglect and abuse amongst non-Aboriginal welfare recipients are not “non-existant”: they are also worryingly high.
John, you should think carefully about your assertions and logic, do better research of the topic, and apologise to Chris and any Aboriginal people who may have had the misfortune to read your prejudiced claptrap.
John says; “No other racial or cultural group in this Country has such embarrassingly bad child health results”
He is correct.
The basis of Chris Wilson’s assertion that: “The point 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 is a sophisticated specialty.” seemingly is a ‘grapevine’ story of an oncologist sending 7 aboriginal children for a echocardiograms with only 1 positive finding.
That in fact is a higher positive finding rate than Sydney or Melbourne but even if it did demonstrate a waste of resources (and it does not), it is just one example and proves nothing. Finally Chris Wilson assertion appears to be counter to the first year government interim report. Lastly the assertion that “remote area medicine and health practice is a sophisticated specialty” is tenuous at best (and I acknowledge that fine and disciplined people are developing it) but even if it were true aboriginal health care child and adult in remote Australia is appallingly poor compared to aboriginal health care in urban areas.
Bob Durnan is experienced, sensible and informed but apart from criticising John I would prefer to hear his thoughts on the article (if he is free to and independent of Chris Wilson).
Don’t know which Aboriginal communities you have visited Chris but they are certainly very different from the majority of the ones I have seen in 15 years in Aboriginal areas in WA. Most adults in many of the 300 communities are too drunk to ‘nurture’ their kids and abuse and neglect are rife. The fact is that Aboriginal health will not improve unless communities have the same education and emplyment opportunities that other communities have. We have spent millions on housing in communities only to see it filthy and trashed in no time – and it wasn’t due to ‘poor building standards’ but people running amok, smashing things. I agree with more nurses- especially school and comunity nurses to bring back the old maternal and child health interventions and school education. A lot of the NT intervention works – lets not throw it out for the sake of more PC ‘consultation’ which doesn’t.
The comments from this health professional who has considerable experience in remote nursing appear to me to show why the intervention was necessary. Here we have a professional who thinks that because there is apparently nurturing and love being shown to an infant that things are fine when said infant is predictably afflicted with significant infections as a result of that “nurturing”. Families of monkeys show similar nurturing to their young as do elephants, but if either of those species in a zoo were allowed to inflict such injuries upon their infants there wold be howls of complaint from the public. Incidentally, they don’t do it. Why is it that this sort of behaviour is seen as admirable and desirable in aboriginal communities?
We told that in years of experience that no child abuse was noted. But the description of the illnesses and afflictions these children are suffering from, all of them predicted but avoidable if appropriate care is given, can only be described as one thing ….. ABUSE.
This professional then criticizes a specialist doctor for referring children for further testing with only 1 positive being found and claims nurses could have done better. Firstly surely it is better for the one positive to be confirmed and then treated. Secondly if this nurse is so concerned that a specialist Doctor could be so inaccurate or wrong, was a complaint made to the relevant medical board and specialist college. Surely this is money where the mouth is time!
We are then told that this whole problem is one of poverty. Can someone tell me why we have many thousands of non aboriginal people living on the same welfare allowance incomes as every other Australian, not to mentioin many millions even billions of dollars being spent on other schemes only available to aboriginal people on top of normal allowances, but the rates of abuse are considerably less, albeit not nonexistant?
Then our correspondent is shocked with the results of the sexual health screening and cannot undersand the meaning of the test results. Even I as a lay peson know that this means that people with STDs are having intercourse with these infants and children. Even if it is accepted that we should not impose our moral codes on anyone else, especially members of another race, the fact remans that such behaviour is against the law. There is an offence of misprision of a felony when someone with knowledge of the commission of a serious offence fails to report it to the authorities. It would appear that this professional has committed that offence because apart from sitting on toilet seats, and these poverty inflicted people may well not have such items, there is only one other way for these kids to have caught these diseases. If this health professional doesn’t know how people catch sexually transmitted diseases it is little wonder that the problem still exists in he communities .
The answer of course is that testing needs to be done and treament given to those afflicted, and bearing in mind that we are talking about infants and children then something needs to be done to prevent the abuse. Oh yes, after all these years that is what the Liberal Government (for whom I don’t normally carry a torch) attempted to do, but this health professional disapproves of that approach.
The time is long overdue for strong treatment. If parents will not or cannot protect their infants and children then the community must. If that means removal of the children from the parent’s custody then so be it. Living in remote areas is no excuse. If immigrants from other countries moved here and tended to live in little enclaves, as indeed they do, and treated their childen like this there would be justifiable uproar. Some of these immigrants and refugees come here no better off economically that the meanest aboriginal family and manage to exist, indeed prosper, with the same social welfare support and payments as are available to any member of the community but they manage not to have these common almost predictable health results. Why is it that such behaviour is allowed to happen because it is aboriginal people doing it?
I am sure I will be branded as a racist, but if pointing out the obvious is racist then I plead guilty. No other racial or cultural group in this Country has such embarrassingly bad child health results. No matter what economic background all the immigrant groups over the years have had, and some such as war refugees have had no better economic status than any aboriginal group, they have never allowed their families to suffer such problems. It can only be because there is a cultural belief in the aboriginal community that such a state of affairs if fine or even desireable that this situation exists to such a degree .