Indigenous plan no solution to abuse

The federal government’s plan to fly in health teams to remote Aboriginal communities for physical health checks is no solution to child sexual abuse, says remote area nurse Vivien Hammond.

‘Outrageous’ and ‘ill-conceived’ is how remote area nurse, Vivien Hammond, describes the federal governments’ ‘emergency plan’ to combat child sexual abuse in remote Aboriginal communities.

Vivien is Clinical Services Manager of the Nganampa Health Council – an Aboriginal owned and controlled health service operating on the Anangu Pitjantjatjara Yankunytjatjara Lands in the far north-west of South Australia. The health service is south of the region targeted for take-over by the federal government but many Anangu1 served by Nganampa have family in the Northern Territory and Western Australia and move to and from remote communities in the targeted areas.

‘Anangu are extremely wary and confused about what’s going on,’ she said.

‘Flying in medical teams – who may have no experience working with Indigenous people – will make the work of remote area health teams even more difficult. These ad-hoc “solutions” jeopardise the work done by health workers to build trusting relationships with the people living in these remote Aboriginal communities,’ she said.

‘Basically, physical examination is a useless screening tool to detect child sexual abuse and the proposed “emergency interventions” will not address the problem of child sexual abuse,’ she said. ‘Yes it’s a problem, and not one person living in remote communities thinks sexual abuse is OK. It’s wrong and needs to be dealt with appropriately.

‘We need to keep this in perspective. Child sexual abuse exists in many societies but we don’t impose physical examinations on children,’ said Vivien.

With 10 years’ experience working as an RN with remote Aboriginal communities, Vivien said issues revealed in the Little Children are Sacred report by the NT Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse, which triggered Howard’s emergency plan, have existed for decades.

‘The problems inflicting these communities stem from extreme poverty and disadvantage. Report after report has detailed the lack of infrastructure and services, the extent of substance misuse, child abuse and poverty in these communities. The various government responses have done little or nothing to address the fundamental problems,’ she said.

‘Aborigines in remote communities are basically living in third-world conditions. They are far away from resources and services.

‘The lack of services and infrastructure has left remote Aboriginal communities disadvantaged on every level. Many Aboriginal families living in remote communities are in crisis,’ said Vivien.

‘There is little suitable work available so many residents are unemployed. Many Aboriginal people in remote areas are dependent on social security and live in poverty. Many are struggling to deal with conflicting cultures, have poor literacy and numeracy skills, struggle to deal with bureaucracies, and their living conditions are unimaginable to most non-Anangu Australians.’

As a nurse, Vivien sees first-hand the shocking state of health in remote Aboriginal communities. ‘The health problems start before conception for many Anangu,’ she said.

‘There are major health problems related to poor diet such as type 2 diabetes. Many communities have limited access to healthy, fresh food. Anangu no longer gather food as in the past but are living out of the local shops. They are reliant on what’s available at the local shop.  Getting healthy food choices like affordable fresh fruit and vegetables into remote communities is extremely difficult. Transport to and from remote communities is expensive and limited. Skilled shop managers who can balance shop budgets and healthy food choices are hard to come by. In some communities, it is not uncommon for kids to be eating chips and drinking Coke for breakfast.

‘An important aspect of the role of Nganampa health workers is educating people so they can make healthy food and lifestyle choices. This has involved a process of education and consultation with the people in each community on the Lands and most communities have voted to embrace these policies. We have found that imposing change on people does not work,’ she said.

Vivien has worked at the Nganampa Health Council for the past eight years. Covering a region 1003 kms2, Nganampa Health operates nine clinics, a 16-bed aged care respite facility and assorted health-related programs and services including aged care, sexual health, environmental health, health worker training, dental, women’s health, men’s health, children’s health and substance abuse prevention. Nganampa Health employs over 120 staff – the majority are Anangu residents from the Anangu Pitjantjatjara Lands.

The Anangu Pitjantjatjara Yankunytjatjara Lands serviced by Nganampa Health Council cover over 105,000 kms2 and is home to almost 3,000 Anangu. The traditional Anangu culture is still strong, and Pitjantjatjara/Yankunytjatjara is the first language.

According to Vivien, the key to successfully delivering health care to Aboriginal communities is enabling Aboriginal people in those remote regions to drive health policy and the delivery of health care. These health services need non-Anangu health professionals who are prepared to develop an understanding of the local culture and take direction from the Health Council so that important health interventions and primary health care can be delivered effectively and appropriately.

‘Communities have to trust the health workers delivering care, otherwise many will not come to the clinics unless they are really sick or hurt,’ she said. ‘Health workers need to establish relationships with people that encourage Anangu to bring their children in and present themselves for regular health checks.

‘Aboriginal health workers are integral to the success of delivery of health care to Aboriginal communities.’

Vivien said the federal government’s plan to fly in teams of health workers who have no experience working with Aboriginal people demonstrates its disregard for civil rights and poor understanding of cultural issues. ‘Physical examinations of children are totally inappropriate,’ she said.

‘Health services in remote areas have spent years developing relationships with communities so they are able to do necessary health checks, screening and examinations in a culturally-appropriate way. Howard’s announcement has made many Anangu frightened of what will happen when they take their children to the clinic. Many think that any examination will be about looking for evidence of sexual abuse,’ she said.

More than just inappropriate, Vivien said the federal government’s ‘emergency plan’ for remote Aboriginal communities is ill-conceived. ‘It flies in face of the key principles that need to be in place to combat the problems inflicting these communities.

‘We need investment in infrastructure and services; we need to be working with Aboriginal people to develop and implement solutions; and we need to seek expert advice in developing and implementing solutions,’ she said.