The island is beautiful and full of vegetation that I've never before encountered. It's more marsh-like than I had imagined. There are areas reclaimed by the water where dead gummy tree trunks stand testament to the forest that once ruled there. Intermittently, the trail opens into panoramic vistas of the lake. Ferns predominate on the forest floor. The earth is rich and black.
After breakfast, we prepared to make the journey across the water to the headquarters of the Coop where Lily and Shadow and family from the Northwest Territories were going to demonstrate some of their ceremonies for the local community. We had a marvelous barbecued lunch, met many people we'd seen in the last two years, and then watched Lily and Shadow do their "burning cure". I wrote about this last year in my blogs which are still available on www.futurehealth.org. Briefly they heat palm tree bark in a fire and apply that to painful areas of one's body. This year I asked them to treat my left sacroiliac area. I've been doing more intensive stretching and yoga to open my hips and pelvis (which a healer in Warburton told me were way too stiff) and I've discovered an old injury from 30 years ago which has become painful again as I have removed the armoring that had collected around it. The heat felt wonderful and I enjoyed as much of it as I could. Then they did the ritual where they put people on top of a fire on paper tree bark and throw water onto the fire with the people covered by blankets. It's like a mini-sweat lodge that lasts only a couple minutes. This is their cleansing/smoking ceremony. I also wrote about this last year and Shadow and Lily used their children again. Then they demonstrated spear throwing and it was time to go home.
On the way home, I interviewed Laura, an aboriginal patient advocate (in both senses of the term) from Western Australia who was part of Culture Camp this year.
Laura works the whole of Western Australia. I asked her about her job. She said, "We connect with go-to people in the region. We promote people's rights in the health system. I ask people if they have any problems we can assist them with. I offer to advocate to services about an individual complaint or problem but also more systemic issues because we find that a lot of people don't want to make official complaints either because they have no faith that the service will address their complaint or that they'll get worse treatment if they make a complaint. I think people don't realize that it is an official process that services are obliged to respond to."
I asked Laura about the kinds of problems she often encounters. She said, "People feel discriminated against because they are aboriginal. A lot of what we are addressing is miscommunication and misunderstanding. Often people feel that they get stuck or left in between services. Often it's up to them to get from A to B and people don't know how to do that. Also people have to travel ridiculous distances to access a test or a specialist or an operation. I'd qualify by saying some of that happens in the regions. A lot of times it's about it being available in a timely way. Like the specialist might be coming back in another three weeks or six weeks.
"I hear the same stories so often. One example of racism and discrimination is a young mom being told upon arrival to emergency that her small baby must be suffering from drug and alcohol withdrawal even though she had never drank or smoked or taken drugs. I hear this story regularly. By definition all aboriginals are drunk or doing drugs. Sometimes when people are sent to Perth they might be given a taxi voucher to get themselves to the hospital. They might be sitting in the airport for hours because they don't know how to get a taxi or they don't know what a how to get is a taxi or they're afraid to get into a car with a strange person or they revert to their original language because they're stressed and can't remember how to speak English.
"We do have a service that is just to liaise with aboriginal country patients but it isn't big enough to meet the needs and it's Monday through Friday 9 to 5 and a lot of things happen outside those times.
"In the hospitals even though we do have recently more aboriginal liaisons, often they'll only be liaising on certain wards in the hospital where the majority of aboriginal patients are. You can still be in the hospital and be told you're not entitled to the aboriginal liaison."
I asked Laura for her perceptions of the failure of the health care system for aboriginal people. She said, "Too often it assumes and doesn't communicate or ask the patient anything. They don't ask if they understand. There is a huge divide between services. The assumption is that someone else is taking care of it and it falls back on the patient.
"I think the aboriginal medical services do an outstanding job but we don't have enough health services or health workers to meet the need, particularly outside of Perth. We still have a lot of services in Perth but people can't afford them. Few services advertise that you have no cost for your appointment or that you have a much smaller cost.
"In Perth we have one aboriginal medical service where people get a free medical appointment under the close the gap initiative. Any aboriginal person at risk for getting a chronic disease gets free medication. Private practice gp's can bill the government for aboriginal patients or not. It's up to them. Any patient can take their receipt from the doctor and get a rebate from Medicare. A lot of people don't have the money to pay up front for the appointment. A lot of elders will put them last and not have funds for their appointment or their medication or even their transportation.
"Renal dialysis is one of the saddest examples of that division. A lot of places have no public dialysis services. You can get a machine in your house that the government pays for. You have to have enough space to house the machine and keep it away from children, etc. You have to own your own home or be able to stay for a long time. A lot of people are in Perth just to get their dialysis treatment. 80% are in Perth because there's no dialysis at home or they're waiting for people to die so they can get their spot on the machine. Quite often we have patients who have absconded. We get calls about patients who are not turning up for dialysis. I'll find them staying in the park down from my office because there's not very much in the way of affordable accommodations. That's where they find other countrymen who care about them and look after them. Or they've been kicked out of hostels which care for aboriginal patients because drinking is forbidden and they've had a drink.
"We advocated for a lady getting dialysis for quite a while. They gave her a tablet. She stopped turning up for her dialysis appointments. The service alerted us. We found her. She thought she just needed to take the tablet now and no longer needed dialysis. She didn't understand that without a transplant she'd be on dialysis for the rest of her life. We don't really have accessible interpreting services for a lot of regions. Even in Perth there's a lot of ignorance that aboriginal persons speak languages other than English. Often they let a grandchild do the interpreting. A lady found out she had cancer in Perth. They got her granddaughter to interpret. By the time she found out what her options were, they weren't possible any more. The cancer had progressed too much. We've had quite a few cases in the past 18 months."
"What about mental health care?" I asked.
"One of the biggest things because we ask people what issues they have is the lack of counselors or accessible programs or culturally secure programs for aboriginals. It's a huge void. Namely, the commonest thing is a family member ringing the service for help for someone else. Service says it's unethical to help without the person coming into their office or the gp making a referral. Then the crisis is not managed and the call ends in suicide. Yet they consider acting and preventing a suicide unethical. I think for our population a family referral would be very valuable.