Is anybody listening?
By Don Palmer, Chief Executive Officer, The Malpa Project
Five minutes off the plane at Alice Springs last month and an Aboriginal woman puts her daughter into my arms.
At two years old, Thelma has gunk in her ears and oozing from her nose. Flies crawl on her face. In her eyes is a look a fear and anger that I have never seen before in someone so young.
Suffering from otitis media, or infection of the middle ear, like as many as nine in 10 Aboriginal children, she is right to be afraid. Without intervention, she will be effectively deaf by the time she is a teenager.
Kids like her can’t learn, their immune systems are compromised and their brains may fail to develop properly. Too many then suffer upper respiratory infection, diabetes, heart disease, kidney failure and early death.
Most cruelly of all, this debilitating epidemic is preventable, yet for most Aboriginal children health equity is still an unrealised dream.
The World Health Organisation says that a 4 per cent rate of chronic otitis media is “a massive public health problem” and requires “urgent attention”. Yet in some indigenous communities the prevalence of suppurative otitis media, where the tympanic membrane is perforated and fluid drains from the middle ear, is up to ten times higher than that.
None of this is news to people on the ground. The reports pile up and all say the same thing. Many of the preventative measures are straightforward, from washing hands and wearing clean clothes to keeping the house clean and learning simple lessons from bush and modern medicine.
But the current responses are seriously inadequate. Governments continue to fund measurement but resist spending on delivering services.
The consequences echo into every aspect of the lives of Aboriginal people. School is pointless. Securing work becomes impossible. Simply getting around in a shopping centre is a challenge and crossing a street is fraught with danger.
Then there’s prison. Evidence presented to a Northern Territory Senate enquiry detailed the link between early onset hearing impairment, suffered by up to 90 per cent of Aboriginal prisoners in Darwin, and problems with the police, the courts and time in jail.
Under the Northern Territory Intervention the rate of incarceration has skyrocketed. At the current rate half of Aboriginal males will be in jail in five years, according to a report compiled for the Attorney General’s Department.
The cost to the Australian community is huge, but nothing like the cost to the dignity and future of Aboriginal people.
The problem is not restricted to the Northern Territory. Even in rural towns like Kempsey in NSW, for example, disturbingly many children suffer the same fate.
One local headmistress said: “We just operate on the assumption that all the kids are deaf and get on with it.”
Getting on with it includes teaching sign language. It also includes wiring up teachers with microphones and installing loud speakers in the classrooms. It’s not a solution, simply an admission of the failure of public health service delivery.
Since the NT government tabled the Expanding Health Service Delivery Report in 2011-12, the number of audiology services has actually been reduced. The evidence is clear, the inaction shameful.
In Alice Springs a health worker, drives from one town camp to another doing audiology checks. The children run to her car as though it were an ice-cream van because they know she cares and that she brings some relief. Her clientele rose from 23 at first to more than 600 in a matter of weeks.
But everything is against her succeeding. Appalling overcrowding – houses meant for six people have up to thirty in them. A lack of fresh fruit and vegetables. Houses without running water and power. Broken families existing rather than thriving. And a workload for at least four more people like her.
The response needs to move well beyond clinical service delivery, with a serious commitment to preventative health promotion, proper long term funding and adaptation to the wide variety of geographical and cultural situations. What might work in Cape York will not necessarily work in Utopia or Wilcannia.
Most importantly, the response must embrace the communities and involve them in creating the solutions. People ask “Why don’t they help themselves?”, but Aboriginal people have shown time and again that when they are supported to help themselves that they can and will do so.
We see it every day in our work at the Malpa Project, supporting aboriginal people to teach old and new ways of doing health to young Aboriginal people so they can become health ambassadors and strengthen their communities.
A major trial in the Tiwi Islands north of Darwin found just as much when it gave the community responsibility for running health services. The rates of otitis media, diabetes, kidney failure, heart disease plummeted.
The government hailed the experiment as a great success and even boasted of the savings that followed. A glossy brochure trumpeted the ground breaking results.
Then the government defunded the experiment. Within two years the improved health status of the Tiwi people went back to what it was before.
Australia is one of the wealthiest nations on earth and yet we resist spending money on these issues. How rich do we need to be before we deliver health equity for every Australian? If not now, then when?
Solving the issues that can make a substantial difference to problems like otitis media amongst Aboriginal children is not impossible. The answers already exist.
But is that a message that decision makers are ready to hear?