The Christmas Issue of the Medical Journal of Australia has a section on the Northern Territory Intervention. Reading the various contributions in concert with each other is illuminating. Check it out.
A few snippets:
The Northern Territory intervention: voices from the centre of the fringe by Alex Brown and Ngiare J Brown, both working in health research in the Red Centre:
In 2006, revelations offered by the Alice Springs Crown Prosecutor outlining an accumulated dossier of abhorrent cases of child sexual abuse in Central Australia were met with immense public horror. The response was understandable, but failed to acknowledge that the dossier echoed the voices of Aboriginal communities’ repeated calls for action over the span of several decades — voices that had been ignored.
The response, from public commentary and an increasingly vocal anti-Aboriginal-rights sector, was swift and damning, editorialising the suffering of Aboriginal communities. In many respects, a new (or rekindled) language emerged, the language of “Aboriginal deficit”. The media were awash with claims of “paedophile rings”, of a culture that “accepted and protected” the raping of children, of “customary law being used as a shield to protect abusers”. The inference was that all Aboriginal men are “perpetrators”, all Aboriginal children are abused, and that these abuses — fuelled by alcohol, petrol and kava — are compounded by social dysfunction that is largely the consequence of a “primitive” and “barbaric” culture.
Public commentary allowed the seeds of change to be sown, change that “required” a “new paternalism”, “normalisation” or “mainstreaming”; that called for the closure of “unviable remote communities”; that touted the “failure of self-determination”; that required an end to “political correctness gone mad” and the “pouring billions of dollars down the toilet”. Unfortunately, such language has been used to justify blatantly discriminatory policy.
In the weeks and months following the announcement of the NT intervention, it has become clear that decisions were made in a policy and strategy vacuum. Activities have been poorly coordinated, poorly planned, and liable to change and backtracking. This has fuelled confusion and paranoia, and created enormous concern about the squandering of desperately needed resources, which are being used largely to install the bureaucracy rather than provide services.8
Worse still, the current approaches are undermining successful programs already in place in communities. The long fought-for resourcing and community actions required for healing, protecting and nurturing Indigenous children are being de-funded and ridiculed.
The most worrisome elements of the intervention may lie in the likely and unintended consequences. Communities remain deeply concerned that there will be direct casualties of the intervention, casualties that communities can ill afford, but that the government considers necessary and acceptable “collateral damage” — worsening poverty, suicide and unemployment (particularly of Aboriginal men); disempowerment; the creation of an atmosphere of fear, in which complaints of abuse are less likely to be reported; and a “one size fits all” approach that frames all Aboriginal communities as dysfunctional, all Aboriginal people as abusers, and all Aboriginal children as abused.
A nation and its people are judged on how they treat their most vulnerable, disadvantaged and marginalised. The significance of our current federal government’s refusal to ratify the United Nations Declaration on the rights of indigenous peoples9 has not been lost on Aboriginal people and their advocates.
The Northern Territory Emergency Response: a chance to heal Australia’s worst sore by Bill Glasson, ex-AMA president, Brisbane ophthalmologist and member of the NT Emergency Response taskforce:
The government committed $587 million for the stabilisation phase in the 2007–08 financial year. This is for urgent and immediate actions. It includes over $83 million specifically for improving child and family health, with $205.8 million for employment and welfare reform and the balance for promoting law and order, enhancing education, supporting families and for housing and land reform.
On 18 September 2007, the government announced further funding of $740 million to highlight its long-term commitment, bringing the total committed so far to $1.3 billion.
This intervention is not going to be perfect; there will be many problems to overcome, but it gives us a tremendous opportunity. Of course, some people, particularly those with vested interests (like those making money out of selling alcohol), will feel threatened.
Protecting little children’s health — or not? by Peter W Tait, an Alice Springs GP:
The intervention needs to be seen in the broader context of what could be called the “white blindfold” view of history. The white blindfold obscures the benefits that modern Australians have inherited as a consequence of European colonisation of this country. It hides any understanding of how dispossession of the Aboriginal first nations has resulted in the poverty, illness and violence that the government is now, belatedly, seeking to rectify.
In 1989, the National Aboriginal Health Strategy was developed by Aboriginal leaders in partnership with government. It recommended that $2.5 billion be spent nationally over 5 years to achieve improvements in Aboriginal health. In fact, only $232 million was allocated over the 5 years. Since then, Aboriginal health leaders have repeatedly called for adequate funding. In the NT, calls to establish the Primary Health Care Access Program have, until recently, received a muted response from all levels of government. Now, in the lead-up to a federal election, between $0.6 and $1.3 billion has suddenly become available to save Aboriginal children. How do you think Aboriginal people are feeling about that?
The other collateral damage is occurring among the doctors, nurses and Aboriginal health workers who, for years, have been doing their best in a resource-poor environment to treat the sick and improve health. How do they feel about this sudden flood of resources that is bypassing the services they are working in, and the unspoken implication that perhaps they haven’t been doing their job well enough?
The Aboriginal Medical Services Alliance Northern Territory: engaging with the intervention to improve primary health care by John D Boffa et al, NT Public Health and policy officers
The emergency intervention came from left field. The health component, like the intervention as a whole, got off to a bad start. Individual health checks on children were not recommended in the Ampe akelyernemane meke mekarle: “little children are sacred” report,3 but the Australian Government initially talked about compulsory forensic examinations of all children to ascertain a level of sexual abuse. This would have been a form of assault if carried out, and it is likely that no doctor would have agreed to participate in such a process. Thankfully, this never occurred. As with other parts of the intervention, it appears not to have been properly thought through.
Unfortunately, the initial suggestion of compulsory sexual examinations generated widespread fear and misinformation about the health checks. It has taken much work to explain to Aboriginal communities that these were the same checks that were already being done by ACCHSs. The only reason they had not already been provided to all Aboriginal children was a lack of resources.
Some other aspects of the intervention are less likely to be positive and others are likely to be harmful. In particular, its initial implementation was profoundly disempowering to many Aboriginal people in an environment where disempowerment and loss of identity lie at the root of community dysfunction. The medical profession knows that lack of control of life circumstances can contribute significantly to worse health outcomes.