A Doctor's Dream

by Buddhi Lokuge

  In the afternoon I bought a big lunch of fried chicken and we headed over to Rukula’s house where we spent the afternoon out on her verandah eating, chatting and playing with the children. Finally the pressure came off us all. The meetings and posturing and evaluating and negotiating gave way to relief and the kids gravitated to Jennifer, the One Disease CEO, who, despite her perfect hair and outfit, was entirely at ease here.

  She spoke to the kids as equals, effortlessly joining the games and I saw why Sam had taken a risk on her. She had been a volunteer with a background in marketing and it was a big jump to head a new philanthropic organisation that was not just raising funds but also had field operations. She valued the work we were doing and instinctively she put people first.

  Jennifer was new to the sector but she was tough and determined to do the right thing. I felt a sense of gratitude knowing that the work we had started would continue under a strong but compassionate manager.

  The rest of the week was full of presentations and ceremonies and plenty of back-patting but our visit to Rukula’s was the moment it all came together for the One Disease team.

  One afternoon towards the end of his visit Sam came over to visit us in our near-empty house. Tanya listened to some of our discussion, remembering the first day we had met Sam, in our backyard in Canberra just as the cold winter had given way to spring. This time Sam turned to her and asked what she thought about the social marketing.

  She was surprised by the question. We had been trying to dampen the team’s enthusiasm for social marketing and they had been pushing back. Sam was trying to understand why I was giving them the go-slow. Tanya took a moment to answer.

  ‘Remember the Do The Right Thing campaign?’ she began. ‘It was one of the most successful behaviour-change campaigns in Australia’s history. There were singing bins and stickers and catchy jingles; it was huge, and very quickly it became socially unacceptable to throw your rubbish out the car window or on the ground. But the Do The Right Thing campaign that we remember only happened after they put bins out on all the street corners. If they hadn’t made it easy for us to do the right thing, we would have just kept throwing our rubbish on the ground.’

  Sam was watching her quizzically.

  ‘We need to put the bins out first, before we launch any social marketing campaign. The fieldwork—making sure we have a program that works—was our first stage. Next we need to get the policies and protocols in place to support large-scale change, make sure all the clinics are onboard, trained in the new protocols and are stocking all the medications. Then we’ll “have the bins out”, and then we can push for behaviour change.’

  What she hadn’t said was that the team’s focus on denormalising scabies among the Yolngu, another hangover from the NSMR program, could damage the trust we had been building in communities where the only people who had normalised scabies were those in the medical community.

  •

  Doing things by the book, and changing the book where necessary, had slowed us down but it meant we hadn’t frightened the medical establishment. A year into the program Professor Richard Manis was behind our work and had helped revise the Central Australian Rural Practitioners Association guidelines and the approach to treating crusted scabies.

  In an email sent around to senior health policy-makers in the Northern Territory, including Lawrence and Graham, Richard Manis lauded our work as the appropriate standard of treatment for wider adoption.

  But I already had my eye on the next challenge. It wasn’t good enough to create a program that worked, it had to be sustained and that would only happen through changing the approach of governments and frontline clinical staff. We were still waiting to hear back about the grant I had spent the weekend applying for through the Office of Aboriginal and Torres Strait Islander Health (OATSIH), but now One Disease was on the verge of securing a large Brookes Foundation Grant, which would bring the national roll-out one step closer.

  The Brookes Foundation’s focus on fundraising, national expansion and social marketing was outside my area of interest. As far as I was concerned charities shouldn’t run essential service programs, but they had a role as change agents. If the service was essential then it should be provided by the private sector, who could be held accountable by consumers, or by governments.

  And then the day of Miwatj’s twentieth anniversary arrived. The sky was dark grey and it drizzled from morning until evening, so the low-key celebration was forced undercover.

  When it was Sam’s turn to speak he kept it short and understated, giving his thanks for the support we had received from Miwatj and Northern Territory Health and describing the results we had achieved to date. He joined with the CEO of Northern Territory Health and the Chair of Miwatj to sign the program’s official MOU. Finally Yirrkala elder and Rirratjingu clan leader Djwalpi Marika spoke about working together with us and then Miwatj Chairman John Morgan presented Sam and One Disease with a traditional message stick to forge a permanent alliance.

  I was sitting in the back of the audience next to Tanya with our three children. It had been a turbulent time since Sam had first sat with us in our backyard in Canberra. The message stick given to us by Miwatj elders was a moving moment.

  •

  When the speeches were over Sam hurried up to me and quietly apologised. He was upset at himself for forgetting to mention us, his design and implementation partners.

  Sam had betrayed no sign of trouble, but when he had to return to Sydney suddenly that afternoon I sensed something was wrong. As it turned out his commitment to Zambrero’s triple bottom-line philosophy meant channelling a proportion of revenue from the profitable fast food business to the philanthropic activities of One Disease and this was causing trouble among some senior managers at Zambrero. They felt it was holding back expansion.

  Instead of being able to bask in the glow of our successful scabies program, Sam had been in the middle of tense negotiations that resulted in a major restructure of his operations and the inclusion of a new selection criteria for all new staff: a commitment to Zambrero’s triple bottom-line.

  Jennifer had organised to have dinner with Sam and Warren Snowdon, the Minister for Indigenous Health, and asked if I would step in for Sam. That evening we talked about the years the minister had worked in the region as a teacher before becoming an MP, and about his friendship with many of the local families. Some of the names he mentioned were patients of ours. When he stood to leave he promised he would buy a burrito from Zambrero when he was next down south, and wished us luck.

  A few weeks later we received news that OATSIH and the minister had approved $380,000 for our WASH (water, sanitation and hygiene) project.

  With that, the program had received its biggest grant to date. And with $3.5 billion a year spent on Indigenous programs by the Commonwealth Government, we had cracked the deepest pockets in town. Future grants from the Commonwealth would be that much easier to secure now that OATSIH had seen fit to support our work.

  34

  PARTNERSHIPS AND SEPARATION

  Two weeks after Sam’s visit it was time for us to leave. After a few hectic days visiting friends we held a farewell party at our empty house. One of the first to arrive was Raminy and her daughter and grandkids. Raminy was not her jovial self. Tanya sat with her and asked what was wrong. Raminy answered with a story. ‘One time a man came and started work on a big Anglicare program. It was a good program and we enjoyed our work. But then he left and the program fell apart.’ She brushed the fingers of one hand together as though she were spreading sand into the wind.

  ‘We’re worried about that too, Raminy,’ Tanya said and they both fell silent.

  Rukula’s extended family had all piled into a Troopy in their best clothes. They arrived late and stayed long after everyone else had left. Rukula’s teenage son and his cousins painted with our son, who proudly came inside bearing a poster proclaiming him as one of the Gaykamanu Boys. Rukula sat in the last remaining chair. She asked, so qui
etly Tanya barely heard her, if Tanya and the kids would like to be adopted into Rukula’s family? Tanya was sitting beside her on the tile floor cradling our youngest, who was falling asleep in her arms. She readily agreed. Rukula gave names to each of our children and, as she was leaving, asked me to call her Yapa (big sister) from then on.

  The next morning Oliver helped us take the remainder of our worldly goods to the airport. Oliver ran back to the terminal just as we were checking in—we had left all our child car seats behind! A few hours later we touched down in Sydney, found our old car, which Tanya’s brother had parked at the airport for us a few days earlier, and drove north with no plans and nowhere to live.

  After living out of a suitcase on and off for the past fifteen years, we were ready to settle down. Rather than return to Canberra, we had decided to find a place near both our extended families where there was lots of rain for Tanya’s next garden.

  Three days later we stumbled across our new home, a small farm with a run-down cottage.

  I knew it was time to focus on my health, both mental and physical, so I started planning a 1500-kilometre solo bicycle trip. We had designed a program that exposed and managed a neglected disease but I had managed to pile on fifteen kilograms in the process. I wanted to start this new chapter with a clean slate.

  I had never been on a bike tour, but I figured I needed at least a month of dedicated exercise to start shifting the state I was in. I approached the ride like I approached each of my projects, with dedication and plenty of worry. Within days I had learned enough to realise I was attempting the implausible—a 1500-kilometre ride in winter with no training, an old bike and no touring equipment or logistical support. But Tanya wouldn’t hear of it.

  ‘We’re in limbo until our house comes through, so this is the perfect time for you to unwind while we go stay with my parents. Just go slow. Get off and walk if you’re tired. It isn’t a race.’

  But Canberra was freezing. If something broke on my bike on a quiet road far from anywhere it wouldn’t just be miserable. Part of my motivation to lose my deadly belly was to watch my children grow old. And dying of hypothermia would not get me closer to that goal.

  ‘So start from Queensland and cycle south. By the time you reach Sydney you’ll be fit enough to cope with the weather better. And buy what you need—no matter what you spend it will be the cheapest one-month health camp you could do.’

  My projects were always easy through Tanya’s eyes. It frustrated me when she dismissed my concerns with glib answers but this time it was exactly what I needed. In early July I flew to Rockhampton with an eighteen-year-old touring bike and panniers sourced from a recycle shop. From the first day of the ride I was in heaven.

  I listened when aches and pains told me to take a rest or slow down. I learned to read the weather, the terrain and the maps. Day by day I pared down what I needed until I was carrying the bare minimum. Week by week I found myself travelling further and faster and feeling less exhausted at the end of each day.

  I soon fell into a routine and began to discover an Australia I had never encountered before. Here, away from the highways and big cities, mining had not been kind to small communities where fly-in fly-out workers took their money straight out of the local economy and left behind a vacuum, empty of young people willing to call these places home. Yet, everywhere I went, those who had remained to fight for the future of their small towns were engaged and supportive. Tanya had grown up in country New South Wales where there were just sixteen children at her primary school, including her and her brothers, and her parents were the teachers. I began to understand why she had dreamed of raising our children in the country.

  •

  One afternoon, somewhere between Eidsvold and Gayndah on a quiet inland road in rural Queensland, I stopped for the day and turned on my phone to check messages from Tanya and the kids. There was a missed call from Sam Prince.

  When I rang he started with one of his open-ended metaphysical questions that meant we were headed for an interesting discussion that would eventually help to resolve an issue we had been grappling with.

  Sam finally got to the point of the call. Although I had been clear about my intention to hand over the operations once the program was fully functional and had shown that it worked, Sam and I had worked together so closely that this sudden extended silence while I was on the bike ride made him wonder if something was not quite right.

  I had put a lot of thought and time into the field handover and I had delayed my move from Gove several times to make sure the transition would be seamless. Oliver and Penny were confident in their roles and I had set out daily and weekly systems for Jennifer and Chris to continue while I was on my ride. I felt sure they would all manage and, besides, I had given Oliver and Penny my number and they were welcome to call anytime for field issues.

  But Sam continued probing. He wanted to talk ‘tic-tacks,’ as he was fond of saying, and asked me to speak frankly about toothaches I had with him or One Disease.

  Sam had sensed that something was wrong.

  And that’s when I realised what it was. Our work together had been very productive but at the end of the day it did not feel like an equal partnership.

  Sam sounded surprised. ‘In this venture, Buddhi, I see you as my boss!’

  ‘Sam, it’s that I just don’t feel like the field and headquarters have an equal say over key decisions. We shared the early risks of launching this program, but ultimately you control key decisions and the narrative. For any partnership to be durable, you have to be ready to share a sense of ownership and control.’

  When we first went to east Arnhem, Sam and I had a handshake agreement as partners—there were no contracts. The bottom line was that Tanya and I and EveryVoiceCounts, the consultancy we had set up for this work, carried a lot of the risk if something went wrong in the field.

  I felt that to get meaningful outcomes in the long term, we needed field and community partners who thought and acted like owners, sharing the risk and the control. An employee mindset would not work out there.

  ‘There is no effective way to micro-manage staff in this work, because it occurs so remotely. You need people with a genuine feeling of ownership and shared fate. And without empowered partners in the field, managerial actions in headquarters are not intimately linked and accountable to consequences in the field. The bigger the action-consequence gap the more likely programs will drift away from delivering value to our customers—the communities and patients. The risk is that despite best intentions, one day we could find a big disconnect between the reality of what we are doing on the ground, and the promise.’

  My conversation with Sam was close to the bone. I had been reflecting a lot on what it meant to be a good partner, to be equals and to not take each other for granted, because while Tanya and I were in east Arnhem working on the scabies program, our marriage had ended. It wasn’t exactly a surprise but despite our dramatic declarations that we could not live or work together before we moved to the Top End we had both hoped to find something, a disruptive intervention, to fix a broken situation. We poured all our time and effort into finding that intervention for crusted scabies sufferers instead of into our relationship.

  Our relationship had been an essential ingredient in the success of the scabies program. The tension caused by the different ways we operated and saw the world was part of the magic we brought with us. But partnerships are a dead-end road when either, or both, feel unheard and undervalued.

  Both Tanya and I had believed that the goal of a marriage was to do away with any uncomfortable friction when, in fact, it is the friction that gives birth to new directions. But there had been too much time spent trying to control each other and now the hurt was so close to the surface we kept tripping over it.

  Partnerships are not easy but they are all there is. A partnership can lead to far more, or far less, than the sum of the parts. A partnership that takes us further on our journey than we would travel on our own is a
true gift, though never an easy ride. And partnership relies on trust, mutual respect, good communication and commitment.

  The challenge, in business or private relationships, is to take full responsibility for oneself while trying to walk in the other’s shoes—to celebrate and harness the tension between those things. It is too easy to underappreciate the sacrifices and contributions the other makes and to take their input for granted.

  And after almost fifteen years of trying everything she could think of to take an equal place in our partnership, Tanya had decided she needed to re-establish her identity and her sense of agency. She wanted to take off the pressure and expectations and try instead to be good friends and good parents and most of all good people, not co-owners of each other. She wanted to hit the reset button on our relationship, the way I was doing for myself on my long bike ride.

  It made me think about the other partnership I had been preoccupied with over the previous two years. It seems Aboriginal and non-Aboriginal Australia are entwined in a partnership dance that is still struggling to develop trust and mutual respect. We are both fascinated with each other but often the relationship is filled with fear and awkwardness and we don’t really know how to break the ice. There are no magic bullets or quick fixes, but slow and steady partnership work is needed to build trust, to take risks and to reach out beyond our comfort zones, and to learn to walk in each others’ shoes.

  •

  As it happened, soon after the call with Sam, Tanya rang to ask how the ride was going.

  ‘There is no great mystery, Tan,’ I said. ‘If a fat, unfit 40 year old with no prior training can ride from Rockhampton to Sydney then anyone can. You just have to start slow.’

  ‘And keep going,’ Tanya added.

  ‘Yes, and keep going. Step by step. Isn’t that the secret of life?’