October 1, My little family collect me from the airport. I come home to a house that smells like baking and incense and home.
Social determinants of health It takes humility to walk along the path towards better Aboriginal health Marni and her two cousins crowded together on our couch watching the Saturday footy. Like many of the Aboriginal children who regularly visited us, they laughed and chatted and found fun in almost everything.
We were all still damp after a cooling swim at the nearby waterhole, and were about to tuck into a freshly baked cake from our oven. It seemed there could be nothing better. But 8-year-old Marni was unusually breathless.
In fact, she was wheezing and gasping for air. With a stethoscope we could hear the crackles of pulmonary oedema. A few months earlier she had spent several weeks in hospital, and there had been talk that she might need valve replacement surgery. She narrowly avoided it then.
Now her cardiac failure had worsened again. Marni has rheumatic heart disease — a disease of poverty and overcrowding. We had never seen a case before we went to work in Yambarr. As doctors, we had sought the challenges of working in a remote Aboriginal community.
Admittedly, we also found some romantic appeal in the mythical and timeless aspects of Aboriginal culture, which are said to embrace the earth, Journal back to the dreamtime creatures and the spirit world in what is often referred to as The Dreamtime.
Inevitably, however, we found real people living lives of hardship. More than finding The Dreamtime, we were awakened to some stark realities about health in remote communities. Yambarr Aboriginal community Yambarr is hundreds of kilometres from the nearest city.
Closer up, a permanent waterhole can be seen, flanked by scattered houses, a school, a store and a police station, and the ramshackle old clinic.
The doors and windows are barred, and ageing plywood inserts take the place of occasional missing panes. Standing outside, hearing only the rattle of straining air conditioners, it seems a long way from modern specialised medical centres.
Inside, however, activity thrives in the relative coolness. Patients, families, and staff mill among the five consulting rooms, the drug dispensary and the emergency room.
Lining the corridor are posters of Aboriginal athletes and footballers bringing health messages. This clinic has three nurses and six Aboriginal health workers — men and women who work as clinicians, interpreters and cultural aids for transient non-Aboriginals like us.
Nevertheless, white traders, missionaries and developers have left no corner untouched. Indigenous communities today are melting pots of traditional and modern ways. Coca-Cola and ice-cream go well with a meal of fresh kangaroo. Faded jeans, Nike shoes and stereos are just part of the scene at tribal dances and cultural ceremonies.
Children like Marni seem to embrace both their traditional and modern worlds with an ease and simplicity that only children know. But the postcard pictures of painted faces, spears and boomerangs conceal some unspeakable suffering. Rates of chronic disease and substance abuse are increasing. On nearly every social, economic and health indicator Aboriginal people are much worse off.
The human faces of disadvantage Living in Yambarr we saw these statistics in the faces of our friends, neighbours and even the clinic staff themselves. Within months of our arrival, two important Aboriginal men in the community had myocardial infarctions.
One was a health worker and the other a community councillor. Both were still in their 20s. Never had we seen AMIs at such a young age.
The first, Elijah, died only minutes after he had been laughing with us in the tearoom during a busy morning clinic. Then he was on the floor, his lifeless eyes staring at us, surrounded by monitors, tubes and wailing patients.
We had no defibrillator, and he died amidst our helplessness. Only weeks later Bill collapsed during a football match and his team-mates carried him in, his black face pale with fear. Bill had been our chaperone when we arrived in the community, ensuring that we were welcome and safe, involving us in community activities and including us into his family.
Such inexplicable events occurred with tragic frequency. The statistics dissolved into the faces of people we knew — at work, in the street, down at the shop, hanging around the playground.My trip to the Kimberley has rekindled my interest in looking at what might be the case in with respect to our Aboriginal people.
I’m using the ‘A’ word rather than ‘indigenous’, for two reasons. JSTOR is part of ITHAKA, a not-for-profit organization helping the academic community use digital technologies to preserve the scholarly record and to advance research and teaching in sustainable ways.
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Entries; by Date DreamTime, and I met you south of Timothy Lake on our "reverse- direction" hike back to Olallie. Congratulations on a great hike so far. You sure seemed to be in good shape after nearly miles. We enjoyed meeting you .
Since the Dreamtime. and his colleagues from the Australian National University appeared in the journal PNAS in , Australia seesaws back and forth with the seasons.
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