The wind blew the rain horizontally through the slats of the outdoor shower stall. I dropped the soap dish cover and it was gone in a flash, caught in the air jetting past my feet. The flimsy stall walls shook, and the thunder boomed from 360 degrees, echoing back and forth between the high canyon walls of Jarlmadangah community. Lightning broke the pitch blackness with actinic flashes showing branches, leaves and muddy dirt flying across the canyon floor. The rumbles from above shook the earth. I stepped out of the shower and was immediately wetter.

This happened on our 2nd night in Jarlmadangah. My three medical students and our Registrar, Marina, joined with 8 students from Broome and their faculty for a 2 day Aboriginal Health workshop in this small community of about 150 people.

Jarlmadangah is 150 km southwest of Derby. We drove out about 100 km on the Great Northern Highway, and then took a gravel road south. Twenty km down the washboard, an unmarked right turn took us through low scrub inhabited by the occasional group of cows. As we twisted and turned through the scrub, the rusty cliffs of the Grant Range appeared on the horizon, and before we knew it, we were driving between rocky walls into a 30 km long sheltered canyon. We arrived at midday in 100 degree heat in time for a welcome lunch in the small Clinic building.
This consists of two small prefab trailers, with a room built between them serving as a waiting room. The clinic has air-conditioners, but they were laboring. (Also, the community generates its own power. When I worked the Clinic in Jarlmadangah the Monday before, we lost power for 20-30 minute intervals four times during the day. In 20 minutes, a metal trailer becomes an oven in that heat.)

Our hosts were John and Annie Watson, his son Anthony, and the rest of their extended family and community. John and Annie were among the founders of Jarlmadangah. John was born on the Mount Anderson station, where Jarlmadangah is sited. He worked on the station most of his young adult life, only to be fired in the 1970s when the Australian government declared that employers had to pay equal wages to Aboriginal people. This led to mass displacement of people who had been born and lived their entire lives on remote stations, as employers could no longer afford to keep them as employees. Many stations also became economically nonviable as a result of this legislation. The law of unintended consequences prevailed. John and Annie went to live in Looma community, but became unhappy with many aspects of that community, including widespread alcohol use. John had also been active in the Aboriginal land rights movement. After many years, Mount Anderson station was placed in Native Trust and he and Annie founded Jarlmadangah as a drug and alcohol free community. (Despite the Native Trust designation, the people living in Jarlmadangah still do not own or have clear title to their land. This is a concern as there are potential minerals beneath the land, and no guarantee that the government will not displace them again.)

Annie had been trained as a nurse in Perth, and worked for many years in Looma for the state health system. She chafed under rules that kept her in the clinic consulting room 40 hours a week and forbade her from using some of her time to teach and pursue community health and prevention activities. She felt she was just patching up diseases and problems that could have been prevented with community-wide approaches. So when setting up the clinic in Jarlmadangah, she affiliated it with the Derby Aboriginal Health Service (DAHS) which encouraged her to take a community health approach.

We learned these things over the weekend mostly by sitting and talking together. In fact, the main activities of the weekend workshop were simple. We toured the school and parts of the community. The students played extensively with the children. For many hours we sat in a circle in the classroom and listened as John, Annie and Anthony explained their lives and views. I was very proud of all the students for the way to listened generously to the stories and histories of the community. We had meals together outside on the lawns in front of the school. And late Saturday afternoon we all piled into Land Rovers and drove out 15 km across the canyon to climb up the rocks to a sacred waterfall and spring.

I can’t relate all the stories we heard here, but maybe I can give a small example. One of the conversations began with discussing concerns about HIV and sexually transmitted disease. STDs have historically devastated Aboriginal communities, and syphilis is still endemic in the Kimberly. As Anthony discussed community STD prevention activities, the thread suddenly veered off and we went into a discussion of skin groups and long explanation of this traditional Aboriginal concept. Skin groups are a group each person is born into—always different from the skin groups of the parents. Skin groups are intimately bound up into rules in the Aboriginal culture. These rules, among others, famously forbid direct face-to-face conversation between a man and his mother-in-law and her relatives. Intimate, personal information (such as medical concerns) is only to be shared with someone in your own skin group. And the groups also closely govern funeral rules, initiation rites for boys and girls, and even choice of mate. You are not allowed to marry anyone from your same skin group. And each Aboriginal language group and community has variations and different names for the skin groups. The discussion then swerved into a long explanation of funeral rites and customs. They explained the tradition of never speaking a dead person’s name and putting all their photographs away (which explains why many Australian television documentaries begin with a warning that “the following programs include video and photographs of deceased persons”). Finally, after about two hours of wide-ranging storytelling, the conversation came back to STD prevention and the importance of teaching Aboriginal children their culture and heritage as a method of preventing STD spread. This was a fine example of non-Western, circular story-telling structure, and I found it very effective at tying together many concepts. I believe physicians working with Aboriginal people should be aware of this circular structure. The concepts of “chief complaint” and “history of present illness” do not fit neatly into this construction. One huge difference between working in an Aboriginal Health service versus the state health system is that we are given more patient-contact time, and the assistance of Aboriginal Health Workers to encourage patients to tell the stories of their illness, and of how their lives intertwine with their illnesses, in this circular style.

Jarlmadangah is a small community. They declared themselves alcohol and drug-free, and they have a reputation in Derby as “strictly enforcing” that policy, with the implication that physical and public humiliations might be used if necessary. But they have a belief and pride in their culture and a conviction that passing on their heritage is vital to their survival as a people. And, it is clear that the major focus of the community is their school, and its 47 pupils. They are justly proud of what they have built, and their efforts to preserve and pass on their heritage.

Some days I feel very discouraged when I think of how difficult and impossible the problems of Aboriginal healthcare seem, and of the institutional and cultural barriers. But I am glad to have experienced Jarlmadangah. It has helped me not only understand these problems from a different point of view, but also gives me hope and optimism. It serves as an example of that philosophy found in many cultures, but encapsulated in the Jewish proverb: “It is better to light one candle than curse the darkness.” Thanks, Jarlmadangah, for hosting us.

More pictures are here:

Jarlmadangah Feb 07

Labels: Aboriginal Health, Jarlmadangah