Ockham’s Razor

At the end of 2008, Don Palmer, one of our directors, did a piece on Ockham’s Razor on ABC Radio National about the impacts of kidney disease in Central Australia. Below is the transcript. A copy of the audio can be found at http://www.abc.net.au/rn/ockhamsrazor/stories/2008/2405650.htm

Robyn Williams: Have you been watching that marvellous series about the First Australians on SBS television? The thing that struck me, looking at the old pictures of Aboriginal people, was how lithe and healthy they looked, when living in the traditional way, close to the land.Even now, when doctors do experiments with town folk suffering Western diseases like diabetes and enable them to return to the old ways in the bush, many people are transformed, becoming near symptom-free with all that good diet and solid exercise. But it’s not just a physical effect, there has to be a recovery of the spirit that goes with the physiology.Don Palmer combines two jobs, at least two. He’s a film maker and also Health Director of the Jimmy Little Foundation, and his connections go back a long, long way.

Don Palmer: Recently a group of scientists began the most audacious experiment in human history. Using the Large Hadron Collider, they began trying to recreate what it was like the split second after the Big Bang.The need to understand our primordial origins has captured the imagination of thinkers since time immemorial. Being able to reach way back to explain the genesis of our very existence is at the heart of every belief system, religious and scientific.This is equally true for those who listen to the Dreamtime to find their bearings in the universe. Travelling across Australia it’s not uncommon to see groups of large football-shaped boulders. To name them, European explorers reached into Christian mythology and said they resembled something Satan had spewed out from the bowels of hell. So they’re usually called ‘The Devil’s Marbles’.But indigenous people usually call them the Eggs of the Sacred Rainbow Serpent. One senior Aboriginal man joked that he knew Adam and Eve were not Aboriginal, because given the choice of an apple or a snake to eat, Aboriginal people would eat the snake every time!

Now these are just stories, aren’t they? So why does it matter? Well, the differences are not simple curiosities. In fact they have a powerful way of working themselves out in a manner that influences matters of life and death.Let me try to explain. Just outside Alice Springs is the grave of the famous Reverend Doctor John Flynn, founder of the Royal Flying Doctor Service. The site takes the simple form of a large egg-shaped boulder sitting on a rectangular plinth. The original boulder was taken from the Karlu Karlu, a cluster of boulders hundreds of kilometres away. This was done against the wishes of the traditional owners, the women whose families have been responsible for them since long before the Pyramids were built.It’s a little ironic that a man who had a policy of banning Aboriginal people from the Australian Inland Mission hospitals should have such a memorial. Nonetheless, when he died, this memorial was built.For twenty years those women fought to have the egg returned. Eventually, in 1972, the authorities relented. The women, as an act of good faith, offered another rock, the one that’s there now, to replace the original. The authorities, in good faith, decided to clean up the old one a little before returning it. When it arrived back in its place the colour had changed from rusty red to a smudgy white.The people were mortified. The ancient story is that when one of the Rainbow Serpent’s eggs turns white, then the Dreaming begins to end.

But surely this is only a story, superstition, a myth?Well it was around this time that the tsunami of chronic diseases, heart disease, diabetes, kidney failure, started to be felt. It was around this time that Aboriginal health started on its downward plummet from which there seems little prospect of recovery.So was this the beginning of the end of the Dreaming? Is there a causal relationship? Now I’m just a whitefella with only partial knowledge, but to me the two things, the Dreamtime story and the facts, sit uncomfortably alongside each other.Kidney diseases in Central Australia now runs at somewhere between 30 to 50 times the national average. Nearly 200 people are stuck on dialysis in Central Australia alone. And there are 200 more identified as pre-dialysis. If that situation pertained in a city like Sydney, there would be more than 13,000 people in dialysis every day!A simple visit to the dialysis unit in Alice Springs is a sobering experience. Nurses work tirelessly to provide leading-edge care. A phalanx of haemodialysis machines grind away all day and into the night dragging out the blood, cleaning it and pushing it back into often uncomprehending patients. The light has gone from their eyes.Some epidemiologists even say this raft of chronic diseases will lead to extinction.One board member of the New South Wales Aboriginal Land Council said, ‘I’m 56 and all my friends are dead. I’m sick of going to funerals. And to make it worse, there are so many people who can’t afford a coffin.’

For many indigenous people there is no real ‘narrative’ to make sense of kidney disease. It’s widely believed that the kidney has no physiological function. It is, rather, where the soul resides. Sick kidney: sick soul!Many believe that a sick kidney indicates that they have been cursed. And certainly the life they have to live with kidney failure becomes a curse. The Ngangkari, the traditional healers, the people of first importance in the tribe, they say that kidney disease is the one thing they cannot fix!The Ngangkari also say that at night they transform into eagles and fly over the country looking for the sick so they can begin the healing.Surely that’s just a primitive belief? But how about this: Every day, right across the planet, 2.1 billion people say they talk to a man who died two thousand years ago! They say he rose into the sky and one day he will return. They say they talk to him and ask for help for everything from world peace to finding their car keys or trying to win Gold Medals at the Olympic Games. These people are called Christians. So perhaps the night flight of the Ngangkaris isn’t all that fanciful?

But all is not lost. Take the Pintupi people, whose traditional country is the western desert. These were the last to encounter Europeans, and that was in 1984. Eight years ago seven of the 500 people had kidney failure. Today there are nearly 40!The only prospect was for people to dislocate 500 kilometres away to Alice Springs and begin the relentless, grinding regime of haemodialysis.This had major challenges. Firstly, it’s considered shameful to be sick on another person’s Country. Most Pintupi can’t speak much English and there are limited translation services in Alice Springs. Once off their ancestral tribal land, people can’t look after their family, or their community or their sacred responsibilities to Country.They saw the trip to Alice Springs as a one-way journey, and they were usually right. The Pintupi people decided they could do better than waiting for the health system to respond to their plight. They decided to purchase their own dialysis machine and put it in their remote community. This had never been done before. Now it would be done by the last Aboriginal people to encounter Europeans.The men and the women collaborated on creating powerful art works. Sotheby’s auctioned the paintings and raised over a million dollars and now they have a dialysis machine in their homeland.They take their people home from Alice Springs for regular trips, life-nourishing visits. These people are resilient, responsible, determined, but it’s a daily struggle.Now the government sees the wisdom behind this and supports the work. But over time, my experiences in the Centre have taught me something more. It’s taught me that at the heart of the problem lies a far deeper thing than education services, health facilities, and other aspects of infrastructure, important as they are. It has to do with what the people in the Centre call the kurrunpa, the spirit, the life force. This has major implications for any project to close the gap in life expectancy.

So how can we respond to this? What’s the answer? The answer begins, I think, by simply asking people, ‘What do you need most?The creative solutions to the health conundrums, the ones that actually work, are those that come from the people themselves. So let’s listen. We could call it Narrative Therapy, call it human decency, call it what you like. But only when the listening really happens can the real healing begin. Not just the flesh and bone, but of the spirit.The kurrunpa must be nourished. It can be done.The people say that to sustain hope they need to be on their Country. Back in early 2006, Kidney Health Australia put their finger on the solutions. One was to have a federally funded national transportation system so indigenous people could connect with the health system enjoyed by every other Australian. Governments are yet to act.So others rolled up their sleeves and launched spirit-nourishing short term trips back to Country, to home, sometimes as much as 700 kilometres each way. One senior man said, ‘It makes me strong, it makes all our spirits strong.’Tom Calma, the indigenous Social Justice Commissioner, reminds us frequently that this is a matter not simply of health, but of social justice. The people only ask for equity, not special favours.When we reflect on indicators of health on our planet – global warming, wealth distribution, social unrest, war – very few would think of Dreamtime stories. But perhaps we are wise to recall that how we understand our place in the cosmos actually does have a material effect on the will to keep breathing, keep doing, and surviving.After living much of his life with the Arrente people in Central Australia, the anthropologist Ted Strehlow said that ‘Aranda reality is a unique combination of a sense of tragedy, strongly coupled with a capacity for joy.’Perhaps if we respond with wisdom and respect, then life for indigenous Australians will have less tragedy and more joy.

Robyn Williams: Something that’s often in short supply these days.