Self-determination, Done In Darwin Style
Sydney Morning Herald
Saturday March 4, 1995
CHARLIE Gunabarra is standing on a boat ramp, on the shore of the Arafura Sea. He's talking about his people, the people of Maningrida, Arnhem Land, who come from many different tribal groups and speak several languages.
Gunabarra, one of the Territory's Aboriginal health workers, doesn't say very much. He is watching scores of young, healthy looking Aboriginal kids surfing on old pieces of plywood and cardboard in the waves of the lukewarm sea.
And he says nothing when you ask him about the incidences of tuberculosis among the Aborigines of Maningrida.
"A big croc came right up here once and tried to take one of the little kids," Gunabarra replies.
"They caught him. He wears its teeth on a string around his neck." Dogs are taken from the beach by crocs all the time, he adds.
"It used to be a healthy lifestyle here - people moving around, hunting - but now we have got a takeaway shop here, people sit around getting fat."
Gunabarra, along with the other health workers and four nurses at Maningrida's clinic, are planning their third Heart Week, to remind the community to "settle down a bit" on their intake of fatty foods and alcohol.
The results of the last two Heart Weeks are known only to them. The community doesn't want their problems aired to all.
Heart disease is one of many Western scourges that this community, 350 kilometres by air east of Darwin, is battling. Others include diabetes, smoking-related illness, eye and venereal diseases - particularly syphilis - petrol sniffing and alcoholism.
Leprosy, says Gunabarra, is restricted to "just a few", whose conditions are now under control with the use of the medication Ansalar, enabling them to return to their families on the outstation homelands.
The community was established in 1957 by the Northern Territory Government in a bid to reverse the drift of Aborigines from the area to Darwin.
About 13 different language groups were to live in Maningrida and eventually a local council, with Aboriginal leaders, took over from welfare agencies in managing most of the community's affairs.
Some 2,000 people live at Maningrida and its 30-odd outstations. It is Aboriginal-owned land where visitors require an entry permit.
Sounds like self-determination?
Not according to the head of the Aboriginal health education unit at Darwin's Menzies School of Health Research, Ms Josie Crawshaw.
The health of Aboriginal people in Arnhem Land has repeatedly been cited as the worst among indigenous Australians - despite the appearance of autonomy - and they are not to blame, she says.
"It's just bulls--t, this thing about self-determination, because it's still the department which decides who's going to be out there, what the budget will be, who's going to be at the clinic and what medicines there will be," Crawshaw says.
"It just s--ts me off when I hear non-Aboriginal people talking about the wastage in Aboriginal affairs. We have no say in what's happening. It's a big industry for non-Aboriginal people," she says, pointing to the funds spent financing bureaucrats in government departments.
"They (Aboriginal people) have been kept ignorant for so long on so many issues that they don't know how sick they are."
AT this time of year, during the wet season, it is usually possible to get only as far as Oenpelli by vehicle, more than 130 kilometres away. Barges deliver supplies to the township stores and Department of Social Security payments to many of the residents. When the cheques arrive, they are cashed at the store and a period of "town life" - complete with eating European foods and consuming often large quantities of alcohol - begins for many of the community's family groups.
When there is no more - or simply a will to go - families often head out onto the land and live in the traditional way. As resident Rose Pascoe puts it: "When we don't like Maningrida we go out for bush tucker, get some turtles, some geese ... instead of the bread and butter."
Sometimes they are gone for a week, sometimes a month. And, if it is the end of the dry season, pickings from the land may be lean so groups may gravitate more towards town. Or they may not.
"There is no one way that they live," says Dr Betty Meehan, the director of the Aboriginal and Torres Strait Islander section of the Australian Heritage Commission and an anthropologist who has been visiting Maningrida since 1958.
"People with the best intentions have found this very difficult to deal with. You are not dealing with a uniform system."
All this makes for great difficulty in the delivery of health care, according to the director of public health for the Territory's Department of Health, Dr Dayalan Devanesen. While a doctor may diagnose a patient in need of urgent attention to control diabetes one day, by the next week he or she could be 70 kilometres away, living on an outstation. Even the efforts of the health workers, who "take the clinic out to them", can often be fruitless.
"They're often sick with so many different things that they're just fed-up with medicines," says Crawshaw.
Dr Devanesen says burnout is a problem among health care workers: "Sometimes people may be willing to go out there but when they do ... they find it difficult to stay. It affects their practice - the very practice of medicine can be difficult if there isn't cultural awareness."
In fact the way doctors are trained in this country needs a shake-up, he says.
For its part, the Northern Territory Government is piloting a scheme for mandatory cross-cultural training of Territory health care workers, funded by the Commonwealth Department of Human Services and Health.
But the best innovation, Dr Devanesen says, has been the training of Aboriginal health workers. The Territory now has 300 trained for between one and three years, people who are selected by their communities. The Territory has 20 district medical officers, about seven of whom live in Aboriginal communities. He concedes that this is not when the Territory admits that there is a crisis in the health of its indigenous people (who make up 30 per cent of the population), many of whom are living outside major centres such as Darwin or Alice Springs where they often still choose not to access mainstream health care services.
"We could do with more but there's great difficulties in recruiting doctors," he says.
The Federal Government's Rural Incentive Program has helped a bit. But, as most health care services in the Territory are run by Government, the benefits of this program are not applicable to doctors employed by them.
Dulcie McKenzie lives with her four sisters and an assortment of children and grandchildren in a "shelter" which her sister, Rose Pascoe, dismissed as a "chicken house".
She moved to Darwin, married a white man, had four children and was the apparent picture of the stability that those of a bygone era sought for Aboriginal people from remote tribal areas.
She flashes some colour snapshots of herself at work, and of her husband. "That's him, McKenzie, the European man. He got another woman," says Dulcie. So she came home to the family at Maningrida. Now she doesn't work, suffers a lot from ill health (exactly what, she doesn't say) and says she worries about the drinking among her people, and cancer.
According to Gunabarra, the Western lifestyle is the major killer here.
"Those in the bush are sort of lucky, they do a lot of hunting," he says, describing how those who live near the swamps can catch a file snake by allowing it to wrap around their arms under water and deftly drawing it out to be killed and cooked.
But it isn't as simple as poor diet, or even better sanitation and housing, says Crawshaw. It is about poverty.
"The ill-health of our people is because we are in poverty, which is tied to no employment and, when there is employment, we get second-rate conditions," she says, referring to the Community Development Employment Projects Scheme (CDEP).
"If CDEP is so brilliant why haven't they put it into the non-Aboriginal employment schemes?" CDEP is ATSIC's main employment program. It now employs about 25,000 Aborigines and Torres Strait Islanders at a cost of $290 million this financial year, two thirds of which would otherwise have come from the Social Security system. Participants forgo unemployment benefits and instead receive a payment of no greater value to work part-time on projects which benefit their communities.
The communities receive grants for wages, and for operational and capital costs, to do work projects determined by them.
CDEP is the major employer at Maningrida, along with the Bawinanga Corporation and the Maningrida Progress Association, which runs the general store, the takeaway and a number of other small businesses - often managed by non-Aborigines.
CENSUS information from 1991 says the biggest percentage of the community - 22 per cent - earn as little as $5,000 to $8,000 a year, with only 1 per cent of those living there earning more than $20,000 a year.
Maningrida women rarely work and are often involved in childrearing.
One quarter of the population of Maningrida have never attended school at any level, while nearly 21 per cent finished their education before the age of 15. Some 97.4 per cent of residents fit into the "not qualified" category, lacking even basic vocational training of any kind. On the outstations, 20 per cent live in houses while the majority - 71 per cent - live in improvised homes or they camp out.
Ms Helen Bond-Sharp, the adult education training officer in Maningrida, says most health problems come down to insufficient funds for housing.
"A lot of it is tied to no money for proper housing - there's still places in Maningrida with 30 plus living in one house," she says.
Violence is also a problem. According to the Territory's Office of Aboriginal Development, the number of different language groups living closely often results in violent disputes. In fact, the Aboriginal Legal Service in Darwin has 18 murder cases on the go in the Darwin and Arnhem Land region alone.
Crawshaw says the lack of community control over the infrastructure perpetuates the poverty cycle of the indigenous people living in communities like Maningrida.Even the community store and its "exorbitant" pricing system are part of the trap.
"That storekeeper is allowed to deduct out of their (Social Security) cheque what's owed to him," she explains. "I see them coming out with just $40 from their cheque, so they have to 'book-up' again (charge goods and pay with the next cheque). They will never get out of that cycle ... and there's been no analysis of this system.
"Because they're so poor ... most of them don't have stoves or refrigerators to stock up so they're buying daily and, because of that and because they're ill, a lot of them don't feel like cooking so they're just buying the quick fix - a whole lot of biscuits that will fill them up a bit."
She is also critical of the under-skilling of the Aboriginal health workers sent to the communities and says the Northern Territory Government is copping-out by not funding proper training and placing greater funds generally into indigenous health.
"Many of them (the Aboriginal health care workers) have had only one year of training and that was as long as 10 or 15 years back - and with no upgrading of skills and information. They're the only ones delivering primary health care. Most of the disease goes pretty well undetected ... until the kids have such chronic ear problems that their ear drums are rupturing, or patients have renal failure."
Dr Devanesen is hopeful. He sees the future improving through what he calls the increasing "Aboriginalisation" of services, which has shown its success through programs like the Strong Mothers, Strong Babies, Strong Culture project. "It links in with traditional values and traditional systems," he says.
He defends the current structure which sees the department's five regions headed by district managers, who head a team of Aboriginal health workers, nurses and, in some cases, doctors.
There is a network of health centres, while smaller communities have a clinic instead - perhaps capable of accommodating one or two sick people, he says, and a 24-hour system for contacting a doctor through either the Territory's Aerial Medical Service or the Royal Flying Doctor Service.
The Australian Medical Association's spokeswoman on indigenous health, Ms Barbara Flick, is scathing in her response to this.
"The community really don't have a say about the staff that's employed there and, in a lot of cases, the services that they run," she says.
"(The Northern Territory Government) see Aboriginal organisations as being hostile and have a very colonial view of doing what's best for us on their terms."
But, says Dr Devanesen, there has already been a "definite turnaround, and people are beginning to realise - whether it's housing or education - that it is very important to affirm Aboriginal culture and not just pay lip service."
© 1995 Sydney Morning Herald
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