The Torres Strait contains a group of 70 islands between mainland Australia and Papua New Guinea, 17 of which are inhabited. Politics, geography, and, most importantly, imposed religion have all affected the delivery of health care to the people of these Australian governed islands.¹

The Torres Strait islanders are Melanesians whose ancestors migrated to the region from Papua New Guinea 70 000 years ago.^{2 3} Their first contact with westerners was in 1871 when the London Missionary Society arrived on Darnley Island.² The main pastimes of the islanders were hunting, fishing, and agriculture. The people had a sophisticated system of kinship groups, systems of trade with nearby Papua New Guinea, and social behaviour that was reinforced by rituals and tribal customs. Their religion centred around "cultural heroes" or religious figures, ceremonies, and traditional worship objects--for example, turtle shell masks.⁴ Gardening was important on certain islands and was related to prestige.³

After 1871, the traditional way of life--called the "old ways" by the islanders--gave way to practices more acceptable to the missionaries. Traditional rituals and customs were forbidden leading to a loss of traditional skills and knowledge that would have been passed down through the generations.² The London Missionary Society had a mixed reception. In 1873, two teachers were killed. But by the 1880s, islands that did not have resident missionaries were requesting them.⁵

The society stayed in the region until 1915, when they handed over to the Church of England and regulations were relaxed somewhat. In 1936, following a strike, islanders were allowed to elect their own island councils, but it was not until 1992 that the Torres Strait islanders were given ownership of their own lands through a court ruling.^{4 5}

Particular aspects of traditional life--
for example, feasts and tombstone unveiling ceremonies--have survived to the present day. Tombstone unveiling
ceremonies are performed at the end
of a period of mourning. The tombstone is unveiled in public for the first time and this is followed by traditional dancing and feasting.¹ We went to a feast which was held on Boigu in honour of a modern day event--the visit of the Australian High Commissioner from Papua New Guinea. The menu included giant turtle meat, fruits, and root vegetables, such as yam.

Present day lifestyle

Two traditional languages are spoken in the region, Kalaw Lagaw Ya and Meriam Mer. Since the arrival of westerners, islanders have developed a third language, Creole (Yumiplatok), that is a fusion of the two indigenous languages and English. This language is often used in health promotion leaflets and by healthcare workers. The islanders also understand English.⁴

Today, only a third of Torres Strait islanders actually live in the Torres Strait region. Two thirds live on the Australian mainland, mainly around Cairns, Townsville, and Darwin.⁴ This has meant greater exposure to mainstream white Australian culture and changes to traditional family values and customs.

Picture below shows the sea anenome on the Great Barrier Reef, which stops at the Torres Strait Islands

An experience

We took a boat to the northern tip of mainland Australia. Here the settlements of Seisa and Bamaga are composed of islander communities. The people of Bamaga moved there from Saibai (an island at the north of the strait) after a tidal wave.⁶ We saw a family on a camping holiday and they showed us some of their traditional cooking and hunting skills. These included spear fishing and baking bread in a ground oven. There has been a recent revival in learning the "old ways" from elders and in regaining pride in traditional skills.

The main commercial centre of the Torres Strait is Thursday Island, home to the small hospital and primary health centre. We were working with Dr Sinha, leader of the diabetes team. He is an Indian consultant who has set up a programme for diabetes care, and previously worked in Papua New Guinea. Other members of the team included a dietician from Queensland, local healthcare workers with training in health education, and nurses from mainland Australia.

We travelled with the team to the outer island clinics and helped with practical tasks such as recording electrocardiograms and processing blood samples. We reached the outer islands by boat or carrier plane and minibus or quad bike, depending on the island's size and facilities. Inpatient care was provided in the base hospital on Thursday Island. Any complications were transferred to Cairns by helicopter.

In the past, islanders had very physical lifestyles--canoe building, land clearing, and house building--but now they have mainly sedentary lifestyles.² Motorboats are used, rather than canoes, quad bikes or cars for travelling short distances, and their diet consists mainly of turtle, dugong (sea cow), other seafood, and frozen food from the mainland.

Each island usually has one shop which is part of a chain of island shops. Fresh produce is shipped weekly from Cairns to Thursday Island and from there on to the outer islands. The fresh fruit and vegetables become more expensive the further they are transported from Thursday Island and therefore are not appealing to customers. Ultimately, it works out far cheaper and more convenient for islanders to eat frozen and unhealthy food. Almost all new patients with diabetes, regardless of age, in the Torres Strait region have type 2 diabetes; Torres Strait islanders are genetically predisposed to survive well on a low fat diet.

The Christian faith is still very strong here and the diabetes education programme is spreading through the region in the same way that Christianity did. At a training workshop for health workers, held on Thursday Island, we saw the emotional way in which the message about diabetes was imparted to health workers from the islands. Health workers shared their eagerness to help their fellow islanders reform their diets and lifestyles and frequently expressed the hope that God would help them. The day was concluded with a prayer.

We saw at first hand on Boigu some of the practical complexities that exist in the healthcare system today. The islanders are able to procure high fat turtle meat without much difficulty, using motorboats and modern tools. They enjoy the comforts of 21st century life such as television and modern housing.

The proximity of Boigu and Saibai to Papua New Guinea means that Papua New Guineans also present to the clinic with their various ailments. Under their ancient traditional trading rights they are allowed to come to the islands but they are not allowed to receive long term health care from the Australian government. This means that people with relatively serious diseases such as tuberculosis and diabetes may have to be turned away by the healthcare workers, even though they know that they will not receive an equivalent standard of care in Papua New Guinea.

Afterthoughts

The Torres Strait region threw up constant paradoxes. The beauty of the region is unparalleled and yet swimming is unsafe because of sharks and crocodiles. The region was once a fertile source of healthy food and yet westernisation has led to reliance on convenience food and a loss of traditional skills. Although Torres Strait islanders benefit from being part of a developed country, Australia, the health of the population seems to be more on a par with the developing world. Factors that would help to improve health and nutritional status would come about through returning to a more traditional lifestyle, but modern life lends all the comforts that traditional life could not.