Vicki picks me up from the Derby Aerodrome, hot and sticky after an hour and a half in the plane returning from the remote community flight. All I can think of is getting into the shower as quickly as possible. I detest feeling dirty and germy. I can’t help it. I dump my backpack on the back porch, and strip off my clothes in the 38 C. heat so I won’t carry vermin into the house.

I’ve worked with poor people all my professional life, and I hope I have a small inkling of the psychology and environment of poverty. But most of the time, I have seen “the poor” in EDs, my own office, or the hospital or residency setting. I’ve made more than a few house calls over the years, so I’m not shocked anymore. But visiting an entire community is different. There is no place to rest your eyes; nowhere I am not confronted with the stark reality of my patients’ lives.

We fly in to the dusty airstrip in a GA8 Airvan, a very light, high-wing, single engine Australian-built plane. One of the old men in the community drives the 5 k to the strip in a battered ute to fetch us. The truck has a homemade wire bench on the bed, which is loosely attached. We pitch our many bags and boxes in the back. We have to bring everything from meds to band-aids to our own scales. The four of us: pilot, RFDS nurse, health worker, and I then clamber up and sit hip to hip for the bumpy ride to the community center.

The “center” itself is just a big dirty room with a beat up table. There is a kitchen counter which has hot and cold water. There is a dirt encrusted shower room, and around the back, the loo which has no toilet seat and rivals the worst service station johns. Four months ago when I was here the cockroaches were so bad, they were crawling into my doctor bag and all over the files within seconds of my setting the items on the small desk. DAHS threatened to cancel clinics unless the place was cleaned up. The community did a spit and swipe and bug-bombed the place, which helped for awhile, but now the insects are returning. The cockroaches always win in the end.

We set up our gear and I dive in to see patients. I review the older peoples’ chronic disease files. We drew bloods 2 weeks ago, and some are doing well, some need their meds adjusted. The RFDS nurse spends a lot of the morning filling dosette boxes, those clever little plastic devices that set up a weeks worth of meds. Many of the patients speak poor English, so these are essential. I see a child with ringworm of the scalp and head lice. The mom is trying hard, but only had topical antifungal cream, which won’t kill the fungus at the roots. I only have adult strength Griseofulvin, but we work out that she can whack the tablets in half with a knife and a hammer. A gent I saw two weeks before shows me that his extensive pyoderma- boils that reminded me of Job’s sores- has improved, although is still not completely gone. A teenage boy got in a fight 4 days before, knocking out the lower teeth of his opponent, and now he has pus coming out of the human bite he sustained on his middle finger. It’s not bad enough to require the hospital yet, and I hope some high dose Augmentin and wound care might do the job. The last man is young, in his 30s, and has just moved to the community. He seems lost and wants something to help him sleep. I pull him into the back of the center’s not-so-private office, and he admits he is thinking of walking out into the bush and hanging himself. We talk about that, I express concern as best I can across the cultural gulf, start him on some antidepressants and make a referral to community mental health. God knows when they will get a worker out to him. I only know one community mental health worker, and blonde, white Sara is not someone this bloke will be able to easily talk with. He promises to come to the next clinic in a month at least. I hope confessing his black thoughts will help. I’m uneasy, but I’ve done the best I can.

I work right along. “Who’s next” I keep asking the nurses. Part of it is a desire to be efficient, but another part is just revulsion at the working environment and a wish to get the hell out as soon as possible. Prepared this visit, I’ve brought my own towel and dry handwash. I wash my hands as often as I can, but I have to touch the equipment as well as the patients. Everything is a fomite here.

At one point in the morning I step on the back porch and see 3 brilliant blue kookaburras on a branch in the back. But when I turn around, there are piles of trash, scattered cans, garbage bags, rusted machinery, paper, wire, horse manure and dog poo everywhere. It looks like some of the yards I used to see in my grandparents Appalachian community when I was a kid. I remember my parents encouraging me to actually see the poverty, if for no other reason, to appreciate what I had.


But this is poverty in more than one dimension. Financial poverty is the least part of it- as the people get CDEP and pension payments. There is emotional poverty and pain, related to the stealing of family relationships and structure. There is educational poverty: the older generation grew up on stations and never knew school; and now their children and grandchildren are truant and no one cares. With no training, there is vocational poverty, so that the annual cattle muster is the only work event providing any self-esteem, for 1 week a year. There is a spiritual poverty here, where life is out of whack, and the traditional owners of the land are no longer its protectors or custodians. And the end result is a poverty of hope. The people here live in the moment because the past is full of pain, the present is uncontrollable, and the future, unimaginable.

I realize the people in this particular community are mentally not "running on all cylinders". (Thank God not every community here is like this.) Combined effects of deprivation, isolation, racism, cultural loss, diseases, and too much grog leading to loss of neurons have done their damage. It’s not something I can fix on a fly-in. All I can do is really try to be with them in the moments when I visit. And I feel guilty, because a shower sure feels good afterwards.

Labels: Aboriginal Health