Monday, August 11, 2008


A nurse's perspective: Scrap the wasteful NT intervention

Chris Wilson, a remote area nurse, writes in Crikey 11.8.08:

I have just completed a six-week stint working as a sexual health specialist in remote Central Australian Aboriginal communities, during which time I revisited many places where I had previously worked and lived as a remote area nurse over a 10-year period. During my latest stint, I was not with the NT Intervention but part of the annual Tri-State screening for STIs (sexually transmitted infections) in Central Australia.

While I saw some positive effects of the intervention, I have also been horrified by the many negatives.

I am particularly concerned by the huge waste of resources with the child health checks program. What was the point of spending so much money effort describing problems that were already well described? Children in remote communities are the most examined in Australia. The intervention has not turned up anything that was not already known -it is the follow up treatments that need to be concentrated on.

The intervention teams were not necessarily well equipped to deal with the demands upon them. I heard from one nurse about a specialist medical oncologist who referred 7 children from one community for cardiac echocardiograms in Alice Springs after he thought he heard heart murmurs. This resulted in one positive finding.

The point is that an incredibly expensive intervention had really achieved very little. It had overlooked the very basic fact that remote area medicine and health practice is a sophisticated specialty.

At least the oncologist was at least aware of the terribly high incidence of rheumatic heart disease and was prepared to reduce the margin for error but any remote area nurse or Aboriginal Health Worker would have probably achieved at least the same result for far less cost.
Sending out teams of a medical specialist (not a paediatrician), two or three nurses, two soldiers (all being paid very generously, expensive four wheel drive or air transport, building exclusive accommodation and a wired off compound) was extravagant and excessive, to say the least.

Once again, most of this money benefits those who least need it, those comfortable and already employed professionals. The intervention would have done far more good if it had invested in the established health services, as well as in measures to reduce poverty, developed in consultation with the communities themselves.

In all my years as a remote area nurse, I can say with authority that child abuse was not a day-to-day feature of my work. Rather, I have been consistently struck by the nurturing of children. I remember many years ago being considerably impressed by the incredible caring for a newborn baby who never was allowed to touch the ground and was always carried and cuddled by literally dozens of family members.

While this child grew rapidly, at six weeks it had pus streaming from both ears and was suffering from acute otitis media. This paradoxical and confusing pairing of opposites I found was to become a feature of Aboriginal health. On the one hand, a child was unbelievably nurtured but was at the same time effectively inoculated with a toxic brew of virulent organisms from all those who cuddled and kissed her.

Although some would label such an outcome as neglect, I have come to realise over the years, this, as with so many other problems in Aboriginal lives, is a feature of poverty rather than culture or race. The neglect that I saw was born out poverty with all that flows from it -ignorance, cultural and social dislocation, overcrowding, lack of access to services, substance abuse, etc -rather than a deliberate maltreatment of children. This pattern associated with poverty is transcultural, the same issues can be found anywhere there is poverty
The Council of Remote Area Nurses of Australia, together with many other remote and rural health organisations, has been calling for decades for more funding to address the health issues in remote Australia. Spending has not been where it could be most effective - in the community addressing housing, maintenance, more health practitioners on the ground, and more education programs.

I am shocked by what we found during the recent sexual health screen. After 10 years or more of this annual screen, things are no better and in some age groups, STI incidence is still 30 - 50%. We still do not understand the basis of this epidemic and are certainly no closer to containing it.

The basis of the problem is that Aboriginal people are minimally involved on a policy level. The risk of HIV entering these communities with all that would entail is as great as ever. Few of the annual screen’s resources are spent on education or dialogue with communities in order to find effective solutions. I hear from people on the ground that the quarantining of money under the intervention has helped -that money is not being spent on grog, ganja, cars and gambling to the same extent it was.

The communities I visited are certainly calmer than when I was there last, but that is largely due to the fact that petrol sniffing has nearly been abolished. A gain not due to the intervention, but the introduction of Opal fuel.

I am saddened that the intervention has wasted so many resources, given so little support or recognition to the workers on the ground, paid so little attention to years of reports and above all involved absolutely no consultation with anyone, especially community members. The insidious effect of highlighting child abuse over all the other known problems in Aboriginal health is destructive to male health, mental health and community health, is unfounded in fact and is based in the inherent ignorance of this racist approach.

The intervention was a racist election gambit that fortunately backfired. I am concerned that the Rudd Government has not acted more forcefully. Howard and Brough claimed the moral high ground, so that anyone arguing against it would be labeled a supporter of child abuse.

The Rudd Government must repeal the intervention, its racist legislation, involve indigenous people in identifying problems and adequately resource the long-term plan that will flow from that consultation.