West Australian Sergeant Ben Doman, with three children of his own, is a rising star in the police world. The son of a Gold Coast officer, he’s done years in Perth, served in the hard bush townships of Wiluna and Mount Magnet, and been badly injured in a riot. He worked closely with his Aboriginal police colleagues and learned much about the desert people: their family networks, their thoughts, their signs, their ways of conveying hidden information.
Doman secured the Kintore post from a field of forty applicants. “I really wanted to be here, working with the Aborigines. I’m not a person that prejudges; I try to get on with everyone I come across. You’ve got the stereotypical police officer, but I try to become approachable to everyone in the communities.”
Beside him is NT Constable Libby Andrew, who also has extensive bush experience down the track in Yuendumu. “I’ve never felt, as a policewoman, there was anything I couldn’t do, and no one’s ever made me feel like that. It’s obvious to me there should be more women police in the bush – it’s culturally very important to establish close relations with women in the communities.” Andrew is strongly committed to working with domestic violence victims, but painfully aware that she’s always operating through a veil of language and reticence.
Fortunately, like all her colleagues, she has a secret weapon – the fourth member of the bush patrol, Senior Aboriginal Community Police Officer Andrew Spencer Jabaltjarri. Gospel musician, preacher, former council president, artist and recipient of the Centenary of Federation Medal, Jabaltjarri is the key to the Kintore station. A Warlpiri man, married to an influential Pintupi health worker, he has worked in the desert police for many years – indeed, for seven of them he was the lone face of the law in Kintore.
“People didn’t want me here at first,” he says, “because I was a Warlpiri person arresting Pintupi people.” He’s been stabbed seriously while restraining a young man who pulled a knife on him.
The wound nearly cut an artery; his “lucky wife” stitched it up for him in the clinic. It can be tricky, he’s found, putting your relations in the cells; it’s a challenge facing down your cousin when he’s rushing at you in the main street with a machete.
The ambiguous frontier between worlds runs straight through Jabaltjarri: he’s a Western police officer and a traditional man. In this double life, not only does he know exactly what’s going on in the 300-strong community, and provide advance warning of crisis to his colleagues; it’s his job to explain to Kintore’s leaders just what the police are trying to do.
The lavish station, built at a cost of $3 million, may have a vague air of Fort Apache about it, with its encircling Colorbond enclosure, its exiguous lawn and its three neat, identical staff homes. But it’s far from being just another remote outpost. Two years ago, the three governments that have responsibility for the deserts of the Centre met. They knew there was a vast law and order problem, and they knew there wasn’t a single full-time station between Laverton in the WA goldfields and Mulga Bore on the Stuart Highway. Communities with terrible substance abuse and safety problems were being treated as if they had no right to protection. An idea took shape: why not pool resources, co-operate across borders? So was born the tri-state policing initiative, which will eventually see new stations across the desert, with officers from SA, WA and the NT working together. Kintore is the first of these.
*
Morning breaks upon the crest of the Lizard Dreaming. The weekend, with its funeral and its football games, is done. Pastor Reggie turns up at the station with a newly obtained, twenty-year-old four-wheel-drive for registration. Any problems? Well, one or two: the handbrake doesn’t work, nor do the brake lights; in fact there’s no brake fluid, the chassis is deeply cracked, and there’s a window missing. Hall offers him a provisional registration, with all the faults to be fixed up within the week. At which point, a warning call comes in from Kiwirrkurra store.A large group of Toyotas has just left with armed Pintupi men on board. And that can mean only one thing: a payback party is on the way across the WA border.
Jabaltjarri swings into action and quickly finds out the detail of what’s going on. Although the death that led to the weekend funeral took place a year ago, traditional punishment can unfold only now, after the burial. Word spreads through Kintore. The place shuts down. As if they were on the set of a Western when trouble’s brewing, the council offices, the store and the women’s centre all lock and bolt their doors.
Payback is a vexing issue for the multi-jurisdictional patrol. According to desert beliefs, every death is caused by someone, and requires recompense – by strict tradition, this should be exacted in the form of a spear-thrust, or several, into the guilty party’s thigh.
WA authorities deeply disapprove of this practice. In the NT, things are a little more ambiguous. It’s against the law, of course, but magistrates may now routinely take “traditional justice” into account when calculating their sentences. NT police do not condone payback – and yet they have to remain on the scene as it unfolds, to help medical staff and to ensure no one infringes the strict boundaries of the traditional code of punishment. “I was against payback before I came out into the desert,” says Hall. “But if it doesn’t happen in the open, cleanly, it goes on in secret. If it doesn’t happen at the point when it’s required, it can spread out, all across the desert, even into Alice Springs, and you may have members of a particular family getting hit and attacked elsewhere.”
Hall has been speaking already with the chief organiser of this payback, Michael G. “They’ve asked me to be culturally sensitive, and insisted on six spear-thrusts. We’ve asked for ‘no irons’ – no knives or non-traditional weapons to be used. If it has to go ahead, we want it to be done traditionally, on the oval, with medical services standing by, and police at the ready in case we’re required. Of course, I’ve told him that if things get out of hand and we have to make arrests, we will.”
Off the police trucks head, to warn the clinic and disarm any hotheads in the Kiwirrkurra party who are escorting the chief payback victim. Everyone’s gathered at the oval now. The willy-willies are blowing through; the camp dogs are on edge, barking. Things seem at once casual and solemn. The family of the deceased sits to one side. The old Pintupi men, as befits connoisseurs of such events, provide a running commentary.
Suddenly, the victim is at the oval. An ecstasy of movement, loud talking, reproaching: the spears come out, long, shovel-nosed. Michael G. grasps his weapon. Jabaltjarri is in uniform, close by, dictating, calming. The rest of the police hang back, looking for trouble on the fringes. Then Hall spots a knife. A second young man who’s due for spearing has raised a blade to his own throat in terror. Hall moves in and eases the knife from the man’s hands. A few boys on the edge of the crowd tussle and race away, pursued by all the other Kintore children, who think it’s a great joke.
Now chief victim and avenger are close together at the heart of the oval; red dust is being thrown, there’s crying, shouting. The spear rises, and plunges into the thigh, once, twice, three times, swiftly, cleanly. The victim cries out, he slumps down. Jabaltjarri reaches out to help him. The paramedics rush up with their stretcher; the police surround them and escort them to the ambulance. Off to the side, children are bouncing on a back-yard trampoline; dogs are tussling; a cloud drifts briefly across the afternoon sun.
The police drive back to their station, slowly, on the lookout for little side-feuds, comparing thoughts and impressions as they go. The local Pintupi radio is playing country music, sweet and mournful: “The biggest disappointment in the family was me …” On the oval, the crowd’s melting away. The mood has changed completely. Half an hour ago, everyone in town was on edge, at a pitch of emotion. Now all is easy, tranquil intimacy as the various family groups stroll back to their homes.
“That was one of the smoothest paybacks I’ve ever seen,” says Hall, with a weary smile. “There shouldn’t be any trouble tonight. I think we’re in the clear for now. Maybe we can do some more motor vehicle
registrations tomorrow …”
On the road he spots Michael G., walking back, his spears still slung over his shoulder. “Everything righto now, Michael?”
“Yuwai [yes] Sergeant.” Michael’s face is relaxed; he leans against the police truck door. “Everything’s good, happy, Sergeant, thank you. Palya [all right]. Peaceful now here in Kintore.”
* Names of individuals arrested or in contact with police have been changed for legal reasons.
Dying Days
A SICKNES S I S SWEEPING ACROSS remote Aboriginal Australia. From the tip of Arnhem Land to the depths of the Western Desert, men and women are ailing and dying young. The problem barely existed in this population three decades ago; today it is doubling every four years. This epidemic is chiefly caused by poor living conditions. It should be entirely preventable, yet our efforts to control and manage it have been next to fruitless.
The name of this new plague is kidney failure, and its advance explains much about the social collapse wrecking traditional Aboriginal society.
Plague, crisis, epidemic: these are the kinds of words overused in reporting on indigenous Australia. Here, though, they are warranted. The picture emerging across the Centre and remote North, much like a photographic image taking slow shape, casts a fresh light on the profound problems that have long held the voyeuristic headlines of the national press. Alcoholism, domestic violence, petrol sniffing, all the bleak indices of disintegration come into focus. They stand revealed as, in large part, mere symptoms, elements in the medical disaster that is gradually decapitating Aboriginal communities.
End-stage renal disease, as kidney failure is known in medical parlance, can be treated by giving the patient a transplant (but there’s a grave shortage of donor organs) or by dialysis, a moderately hi-tech medical procedure generally performed in special-purpose clinics. Although lifestyle factors are the direct cause of this disease, Aboriginal health experts also acknowledge other, more mysterious connections.
The rate of end-stage renal disease is nine times higher among Aborigines than in the rest of the population, where the number of new cases per year is 80 per million. For Aborigines in remote areas, though, where medical services and living standards are more basic, the rate is twenty to thirty times higher than in mainstream Australia.
These are stark numbers. Unfortunately, they understate the situation and give no more than a hint of what’s coming. “The deserts,” as experts like to say, “are gold-medal renal disease country.”
Much of the key work to build up our picture of what’s happening in remote Australia has been done only in the past few years. It’s becoming plainer that renal failure is a disease of socioeconomic disadvantage, with environmental causes. Indeed, kidney disease is only part of a broader health collapse, a set of four linked conditions, dubbed “syndrome X”: renal failure, hypertension, diabetes and heart disease. These lead to or strengthen each other. Seventy per cent of kidney patients in Alice Springs are also diabetics.
Doctors have now traced out the typical pathway of successive phases in the development of renal disease: their Aboriginal patients move with great rapidity from being young and potbellied to being blind and losing limbs. It is a well-defined progress, which has been seen in indigenous populations worldwide, though Australia’s Aborigines seem, as in so many respects, to be pre-eminent.
How, then, are we coping? The number of nephrologists in the Northern Territory, which has the lion’s share of kidney country, varies around a base level of three or four. More than 150 patients are receiving dialysis in the Top End’s busy clinics and more than 100 in the Centre.
About 500 more indigenous patients have been identified who are already displaying signs of advanced kidney disease, but the medical experts believe the real number is twice as high. New clinics and remote area kidney dialysis treatment centres are being set up across the Centre and the North – but the need for services outstrips the best efforts of government health services.
More important even than the details of the disease’s progress is its effect on the social character of remote Aboriginal Australia. It is a place where community leaders abruptly sicken, disappear to far-off towns for treatment, and die; a place where funerals are weekly affairs, the clinic is the hub of life, and customs and traditions are passed on under a bleak, mocking shadow.
Western research has tackled the renal crisis with such zeal in the past few years that we have come to think we have a good idea of the cause. Intriguingly, though, medical science is beginning to edge towards a new version of events.
When the kidney crisis first swept down, there were attempts to isolate a trigger – some virus, perhaps, or some genetic quirk. There was a belief that a thrifty gene might lead the Aboriginal body to suck up and fail to process sugars. Genes, though, don’t switch on mass susceptibility to disease in less than thirty years.
There is evidence that scabies, which is rife in remote communities, leads to a streptococcal infection that cascades on to a kidney-weakening disease. There also is a strong suggestion that low birth weight and poor fetal health confer on children a legacy of small kidneys, which in turn renders them susceptible to renal failure. The search continues for some unknown infectious agent that might be scything down Aborigines, and them alone. But the emerging consensus these days is a subtler one.
Paul Snelling, one of the much-admired kidney specialists at Royal Darwin Hospital, says firmly that socioeconomic disadvantage is the strongest indicator of disease. It’s what he goes on to say, though, that’s startling: “I believe a large part of this chronic disease situation is directly related to the socioeconomic disparities between indigenous communities and the rest of society. The disadvantages are there; all the health-related causes in renal disease will repeat themselves until those things change. What we do, here in this hospital, makes no difference in the long term. There have to be changes – in educational and economic outcomes – for there to be changes in disease. The things that will set the world alight in kidney disease have nothing to do with medicine.” Treatment, in other words, is an option that only begins long after the invasive barbs of life have bitten in.
Snelling’s super-bleak analysis is worth teasing out. It agrees with new trends in social science inspired by a vast, and now famous, study released seven years ago that found British civil servants were happier, and healthier, the more in control of their lives they felt.
As in Whitehall, so in the deserts and the forests of Arnhem Land. It’s not just because Aborigines in remote Australia live in poverty that they sicken; it’s because they feel no mastery over their lives, lost as they are in little islands surrounded by an invasive world. It’s how they stand in relation to wider society that’s crucial, then; the disparities, the low self-esteem, are the things that do the psychological harm. Health, in this social-determinants view of medicine, is itself a symptom, almost a metaphor for the remote Aboriginal plight: relative poverty, changing lifestyles, disempowerment, a sense of spiritual crisis.
There’s a kicker to this holistic view that sees the body almost as a map on which social stresses and strains are drawn. For if how people feel about their place in the world lies at the bottom of the disease pattern, present trends are dark. Most observers agree that although the economic status of Aboriginal communities has improved in recent years, the relative position of the remote world has declined, and that’s something the younger generations pick up on every time they switch on their televisions. At this point, the kidney disease epidemic turns from a public health crisis into something else.
Even as the medical experts struggle to trace mechanisms, find the precise mix of house overcrowding, obesity, smoking and lack of exercise that advances this illness, they know they are confronting a far deeper malaise. Most students of the field also believe that the preventive message is not out there enough in remote communities: it is not being effectively delivered or heard.
Snelling and his colleagues at Royal Darwin, who dea
l daily with a constant flux of patients, find it increasingly hard to overlook the broader impact of the illness on indigenous society. “Our patients are often the keys to the Aboriginal world – trained community leaders, councillors, experts,” he says. “The most productive cohort in the Aboriginal population is just being decimated – and that adds further to the general cycle.”
*
It was late in 2002 when Charlie Walkabout, the much-admired chairman of Mutitjulu community, close by Uluru, first learned that his kidneys had failed him: if he took no action, he would soon die of end-stage renal disease.
At once, 58-year-old Walkabout realised he was in the fight of his life; not just a fight for his own survival, but a fight to show the other members of his Pitjantjatjara people that their existence could be prolonged even in the grip of kidney disease. He left his home, travelled 460 kilometres to unfamiliar Alice Springs, began attending the dialysis unit there and, much more important, became one of the first indigenous patients to try the latest technique of peritoneal dialysis: a treatment that can be home-delivered.
Walkabout, who also helped set up the Centre’s pioneering Aboriginal-run Nyangatjatjara College, went back to Mutitjulu to live, and began dialysing himself daily, helped by his partner Kathy Tozer. Word spread fast. He became the first patient in the vast Pitjantjatjara lands to live at home this way – “on the machine”, his blood purified by a unit the size of a fax machine as he rested each night.
“A while ago, before my dialysis began, I was feeling very unwell, all I could do was sleep all day,” he told me, when I paid him a visit, several months after he received his diagnosis. “Now I’ve recovered significantly, that treatment through my stomach has done the trick. It feels fine, you just stick in the tube, have a smoke, go back to sleep, don’t worry – you can’t think about it all the time.”
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