Australias Aboriginal population is overlooked when it comes to health care.
Lilijana Mikuletic felt she needed to find out more and was
dismayed with what she
learnt
Its
like when you are asked to describe an x ray and you see a
significant blob: you know it really is important, but you dont
know what it means. That was what my education in the health of
Australias Aboriginal population was like. Sometimes it would be
obvious and spoken about in cold hard facts, and I would feel guilty.
But most of the time it was shadowy and uncertain. A brief mention in a
lecture, maybe a passing comment by a statistician. It resembled an
undifferentiated tumour that everyone found hard to talk about because
its management was too
complex.
As an Australian medical student I was meant to
understand the facts “life expectancy 19 years lower
than the rest,” and “unacceptable infant mortality.”
But growing up in a major city I had little contact with our Aboriginal
population and am ashamed to say that I never took steps to try to
understand.
Frustrated with my
ignorance, I made moves to gain some perspective. In December last year
I left the comforts of my existence in Sydney and found myself stepping
off a tiny plane onto the sands of the Western Desert. This region, the
Pilbara, forms part of the rugged landscape of far north Western
Australia (see map). Here I was
thrown headfirst into Aboriginal
Australia.
First, let me
describe the environment. It is incredibly hot (40°C average), dry,
dusty (thousands of kilometres of dirt road), few trees, and
precipitation a distant idea. And people live
here.
Punmu, a community of 150, was
my residence. The Martu Aboriginal people here speak Manyjiljarra as
their first language and are acknowledged as the last of
Australias Aboriginal groups to encounter Europeans, in the late
1960s. They were moved from the area to return later in the 1980s. This
is a highly traditional cultural enclave: they live by ancient law,
hunt local game, and participate in traditional
rituals.
My role was to help in the
medical clinic. Here, I had to deal with a multitude of health problems
that would face a health worker in any developing country. Scabies,
otitis media, and boils were commonplace, with syphilis and trachoma
waiting in the wings. Then there was diabetes. The town has one store,
stocked with tinned food and sweets, but no fresh fruit or vegetables.
It would take too much organisation to stock the weekly mail plane with
these non-pharmacological
treatments.
The result?
The people really are in crisis (those lecturers were not lying). The
good intentions of Europeans to create a welfare state—provision
of homes, infrastructure, education—has created a people who have
no role, no real need to think or plan. They have become
institutionalised. As a result a distinct feel of hopelessness and lack
of motivation
prevails.
The examples are numerous. During my stay I saw the
arrival of a new house, a culturally inappropriate prefabricated home
that was driven in to the community over the dusty country miles. Are
these people incapable of building their own
homes?
I do not wish to
debate the reasons for these problems nor list solutions. This has been
done many times. I will, however, share my lasting impression. These
people have so lost control over their lives that they have lost all
motivation or drive to function. In trying to help, the government has
made these people prisoners. Why not let them build their own homes?
Not only would it empower Aboriginal people to take control, it would
be much cheaper for the government. This is one of many critical
questions that we should be debating for future
change.
My concern is that doctors,
policy makers, and others who influence the Aboriginal health arena do
not always have a true appreciation of the situation. This can come
only from first-hand experience, by talking a plunge into the
world of our most needy group. This means talking to Aboriginal people,
eating with them, managing their health problems, seeing how disease
affects their lives. Such a commitment is not always easy, but doctors
need to take some responsibility if things are to
change.
So now I am back home,
studying for finals, and hoping my radiology skills are practised
enough to ensure I do not miss any critical pathology in my exams. But
what I am most certain of is that if questioned on Aboriginal health
issues I will not need to order a scan by magnetic resonance
imaging.
