The Federal intervention into remote Aboriginal communities - Learning from children

A child’s education depends on the motivation of a parent to assist
them in going to school, help with reading and teaching basic discipline
and values in the culture in which they live.
By the same token a child can influence an adult to live a healthy and happy life with joy shared by each party as the years go by.

In the world of remote living Aboriginal people the children are left in many instances to fend for themselves as the parents pursue a lifestyle that their culture has only just discovered. The parents are still experimenting to see if it stacks up better than the traditional life of looking for food and shelter for the present and not worrying too much about the future. The pleasure of being able to have food readily available at a store or takeaway and the ready availability of alcoholic beverages make it a tempting lifestyle to pursue.
It could be said that there is no greater gift for a child than a healthy parent who lives long enough to see their grandchildren able to carry on the culture of the clan. As some say in the NT – “I want to live long enough to
watch my grandson play football”.

In mainstream Australia the life expectancy at birth is one that Third World countries will envy while the Aboriginal person is not sure what this is all about. They never knew when a birth date was to know the meaning of life expectancy. In fact the life expectancy of the remote living Aboriginal is as low as 47 years in many communities. The average that is quoted far and wide is across the entire population that claims to be Aboriginal with the majority of these people living in urban areas. The statistic is correct. It is just that the definition of Aboriginal person casts the net over a far greater cross section of the community than those Aboriginals that are being subjected to the Federal Intervention into Aboriginal Communities in the Northern Territory. In fact only 7% of the Aboriginal population in Australia lives in remote communities in the Northern Territory.

It is necessary, when taking a holistic view of the world of the remote living Aboriginal, to acknowledge that that the children hold a very special place in the demographic. It should be obvious that with such a low age at death the average age of a population will be lowered and children under the age of say 15 years will comprise a much larger proportion of the total than where the age at death is around 77 years.
Aboriginal populations are made up largely of children and therefore attention should be focused on them if the future is to improve.
The influence children can have over their parents in this scenario should not be underestimated. Just like any other culture the child is special as shown through the title of the report - “Little children are sacred”.

It is fair to suggest that if a child learns about healthy lifestyle choices there is every chance this will be passed on to the parent and other family members.

It should also assist the young child understand what choices in education, food, exercise, sleep, happiness and good companionship can have on good health.

Unfortunately the parents of the young children in communities in 2008 have lived their entire life in a community with health status on the decline.

To the parent it is normal for a friend to die at 40 years of age; for a grandparent to have to go on renal dialysis; for a younger brother or sister to have to go to Adelaide for a heart operation; and, for a lot of people to have to go to an alcohol and drug rehabilitation program to withdraw from an addiction.
To the parent born in the last 40 years this is normal and never having experienced good health – bad health becomes normal.
The Federal Intervention is about stabilizing communities (Phase One) and then “normalizing” those (Phase Two) – but what is normal?

The Balanda (white person) view of a normal community is not necessarily the way the Aboriginal person living in 75 locations across the Northern Territory and which are subject to the Federal Intervention wants to live.

The change planning process must come from a close evaluation of the needs as seen by the Aboriginal people themselves – and not just because some Balanda thinks it should happen or try and become a “normal” community like the suburbs of a city. This should go without saying but is being said because it is one principle that the government policy planners have failed to do over the past 40 years.

2008 is the opportunity for the Australian Government to acknowledge that this is the year to start planning with the Aboriginal people a community that meets their values and culture and thus has a distinct “look” of its own. The time has come to stop trying to put these people into little boxes in the same way as Balanda like to live. The often claimed fact that houses are overcrowded implies that the Aboriginal people are at fault because they have too many people in the one house. The real fact is that this is how they want to live as a family unit and the roof was simply not big enough in the first place.

There needs to be model programs established that test a whole host of concepts and beliefs that bring together the wisdom of the Balanda and the vision of the Aboriginal older person who can see the way the decline is affecting their culture.

To take pharmacy as an example and the role pharmacists can play in both public health and primary health care it is possible to build a curriculum that if conveyed to children could have a significant impact on the health of the adult population. It could impact on those suffering from chronic diseases and the ongoing burden of illness due to the environment in which the people are living.

In taking the example of pharmaceutical care it should be possible for children to learn some of the following principles that are inherent in achieving adherence through pharmaceutical management:

1. Understand the condition and what put it there in the first place before starting to look at management through pharmaceutical care. This involves explaining to children through interactive media the common chronic disease states in the community.

2. The use of medicines in managing chronic diseases and the fact that medicines are for sick people and if well people take drugs they might get sick.
This poster (left) was drawn by Linda Joshua from Numbulwar during a pharmacy training session for Aboriginal Health Workers at Bachelor Institute. Input to programs by Aboriginal people is essential to success.

• 3. The importance of adherence – sticking to the doctors recommendations for dosing and when to take them. This would also cover the use of Dose Administration Aids and that Websterpaks (or similar) are the lifeline to a healthy life and should not be tampered with by anyone but the person for whom they have been prescribed.
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  4. The dangers of chemical substances when not used correctly or stored properly.”If its poison you can’t kiss it better” should be the slogan (or similar) to bring the message of safety home to young children.
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  5. Substance abuse and the problems inherent in drug and alcohol abuse by learning about the effect that these substances, along with cigarettes, have on the health of the individual.

6. Misuse of medicines and the way over use of some medicines can cause serious problems. Emphasis can be given to the need to follow the directions on a pack or label. Paracetamol is the most used drug in communities and overuse of it combined with other liver damaging choices can create an insidious illness of hepatic failure that could easily be put down to simply “not feeling well”.
7. Public health programs through education on subjects such as smoking, nutrition, breast feeding, immunization, sexually transmitted diseases and healthy skin are all ones which a pharmacist can contribute to because of their understanding of the treatment processes.

It is to be hoped that in Stage Two of the Federal Intervention there will be the opportunity for pharmacists to be involved. The record of the health authorities at both State/Territory level and nationally is not great in giving pharmacy a status of much more than a supply agent. The value pharmacists can add to primary and public health education can be finally tested on an exercise such as the NT Intervention into Aboriginal communities.

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Change infrastructure for sustainable development

A single authority reporting directly to Federal Parliament should take the place of Commonwealth and Territory Government Departments of Health, Housing and Education to make more money available and be more responsive to community needs

While the police, army, doctors and nurses are rushing around the NT “restoring law and order” it is to be hoped that Dr Peter Shergold and his senior bureaucrats back in Canberra are looking at how they too are part of the problem.
The Australian 2 October 2006If there was ever remote and isolated communities choked with bureaucratic strangulation it is those in the NT that are now the target of help for child abuse.
The problem may not have been nearly as bad if the local government governing councils had more time to consider their community’s future and less about running the red tape gauntlet with Canberra.
Where else in the world would a community of 500 people, governed by an elected body of eight persons and with a support staff of around 12 people but – wait for it – receive its money from 68 different sources of funds from both the Commonwealth and Territory Government level? (Source: Nauiyu Nambiyu CGC – Daly River NT)
The cost of maintaining Aboriginal communities is high and always will be high due to their isolation. But it is how the money is spent that has to be looked at and changes made to the infrastructure that gets the money to the people.
Governments over the years can be blamed for not taking action and whatever is done in 2007 will be wasted unless there is a change to the governance structure.
It is time for a single “authority” to be established to administer monies going into communities and provide it directly to those communities with their core municipal services coordinated regionally. The job of a council at the local level should be to concentrate on improved community facilities and establishing a quality control process so that Council’s future funding is geared to success in improving the quality of life for the population.
There should be no reason why isolated communities should not all have a properly equipped learning and recreational centre for young people. An audit done now would probably show that 90% lack this resource. An email should be able to be sent and internet banking transacted but no – these are Aboriginal communities and they can wait. This institutionalized racism has got to stop and everyone treated equally no matter where they live or the colour of their skin.
The NT Government has showed itself to be inept when administering housing, health and education with the standards in these functional areas being amongst the worst in the developed world. The duplication of effort between the Territory and Commonwealth is ludicrous and an agency in Darwin funded directly by the Federal Parliament to conduct all outgoing expenses would be a far more efficient way of conducting remote Aboriginal business.
The notion that “mainstreaming” programs is best has proved to be a fallacy as the cultures that are the targets are so distinctively different.
In 2007 there is a situation where it is being quoted that half the money through the Commonwealth Department of Family, Community Services and Indigenous Affairs goes back into consolidated revenue as overhead expenses; one third of the education dollars hit the ground at a remote community; and, a health service gets its money from 27 different programs.
This has got to stop so local governing councils can concentrate on the things that matter – the people they represent. If the Prime Minister can shock people with strong arm tactics to restore law and order surely he can take an equally sharp axe to the red tape that surrounds the same communities.
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