You touch me

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I was walking down the corridor in a clinic and a middle-aged Aboriginal man called out to me from a colleague’s room, “Hey Doc, I want to see you!” I explained that the very proficient and careful younger doctor that was attending to him was as good as me. He said, “I know, but you touch me.” It was not something I had been told before, and I contemplated a range of interpretations: did I connect to him emotionally; was I more intimate; or did I examine him, perhaps more thoroughly?

There is a wealth of literature on this subject perhaps best summarised in a TED talk by Dr Abraham Verghese “A doctor’s touch“. Every family has stories that demonstrate this fundamentally important aspect of medical care and there are popular medical aphorisms such as “if you don’t put your finger in it, you’ll put your foot in it”. Health practitioners know it is important, but….

There are a number of forces rising against medical examination that offer relief to the uncomfortable doctor or nurse and their patient, both concerned about social boundaries that may be crossed, or the possible experience of emotional or physical discomfort. First is the rise of ‘tests’ which provide detailed internal images which can be wholly reassuring if normal or biochemical measurements are incompatible with disease, thus avoiding the need to see and feel what might be going on. Second, the increase in a general ‘hypochondriasis’ which involves less than perfect wellness, where examination is redundant as only esoteric genetic, enzyme or protein tests will reveal the minor malady and enable (largely) dietary adjustments. How ‘nice’ to be at a comfortable distance and really get to the core issue while avoiding any embarrassment. It is a dangerous collusion.

One person I saw recently really brought to light this issue. A middle-aged man with right sided chest pain had been seen on a number of occasions in various settings over a period of more than a year. His records and the way he presented with yet further pain, despite two normal CT scans done over a year apart (the second one a few weeks ago), suggested that he was seeking pain medication, perhaps even for illicit use. I checked his story, and his tests. “Well,” I thought, “I owe it to him to examine him carefully if I am going to deny him pain relief”.

Sitting one to two meters away, I asked him to take his shirt off. There in the middle of the right side of his chest was a large lump – perhaps 10cm in diameter. I did not need a CT or any other test to know this was grossly abnormal. I am not an expert at reading CT Scans but I looked up the films. There it was, very obvious to the novice radiologist, and yet the CT Scan was reported as normal! How could that be? I rang the radiologist, who concurred – and then checking the previous CT scan revealed that it was present, although smaller, over a year before. No excuses. Both scans were reported as normal. Here I was, looking from a distance of a little over a meter (with my glasses on admittedly) and detecting something that was not picked up on two expensive scans and perhaps as many as 6 attendances for nursing and medical assessment.

Examining him further, he had widespread sounds in his right lung; evidence that the pain he was experiencing was preventing him breathing fully. He had had a couple of chest infections as a result. With a little advocacy he is now getting the care he needs.

I have many experiences where people want to be examined but have found it difficult to get someone to do so. I do wonder if the increase in post-graduate training for doctors, where older medical students already socialised as adults find it more difficult to cross the major social boundaries necessary to be an effective doctor. Added to this are the concerns of litigation for inappropriate intimate examinations and the rise of gender preference; all both excuse and press for avoiding examination. The sexualisation of children has led to even young prepubertal girls feeling uncomfortable having their chests examined. We can only wonder what it was that led to nobody exposing this man’s chest during examination.

On reflection I am proud that I touch people and want other doctors to feel the same comfort with doing a job well. Our patients want high quality care, even if a little reluctant at times to go through some embarrassment. A young woman with an urgent health concern passing through Alice Springs recently had been to the emergency department and wanted to be sure what was wrong. When I explained that examining her would help sort out what was wrong, and asked if she wanted me to examine her, she replied in a relieved voice, “Please”. An old Aboriginal man with limited English, when I explained to be sure about his prostate I would need to put my finger in his bottom, looked at me and my raised index finger and said while looking at my finger, “I want that one”.

I hope young doctors and nurses will realise how important it is to examine people, and I hope people seeking health care will also expect to be examined thoroughly, even demand it if there is clear value. Clothes need to come off to see the region and even the surface changes. Breast and genital examination are not required in many instances and always need careful explanation and consent if not requested. When the need is high, even major cultural barriers will come down to enable adequate health care. The rise of point of care ultrasound and testing in the hands of primary care practitioners will mean more people will have access to tests, but the eyes, ears, nose and especially touch of the practitioner are all rapid information gatherers of very significant value.

Alright, sure, certainly, indeed, by all means

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I was at a meeting in Alice Springs about 30 years ago in a session led by Ada Parry and Peter Thomsen, two pioneer Aboriginal cultural educators, who set a task for two large groups of doctors in a big meeting room. One group was told they were on an island which was about to be visited by a powerful nation. They had to erect a monument to show their own prowess and demonstrate the importance of their leader. The other group were told of the poverty and lack of education of the island people and were to go to the island to help. They were told to mingle and find out what the population really thought was the best thing for them to offer. My colleagues present will remember the insight we all gained into the difficulties that arise when people negotiate from different positions.

The resonance with Australia’s current experience with ‘the voice to parliament’ is extraordinary. This is not a new experience and one of which every Indigenous leader is acutely aware and it is potentially devastating.

All Australians can understand the “Uluru statement from the heart” – it is a strong request for recognition in the constitution and finishes with “In 1967 we were counted, in 2017 we seek to be heard.” It was the result of a massive national effort to consult with all Australian First Nations’ leaders and communities culminating in a meeting at Uluru and the creation of this historical document. It was delivered to the Prime Minister, Malcolm Turnbull, with pomp and grandeur, but it was not accepted using excuses that still echo today. Mr Turnbull is now advocating for Aboriginal and Torres Strait Islanders to be heard, demonstrating that it takes time for all of us to really appreciate the importance of this small generous step. Changing our minds is always required for progress.

I grew up in a small country town in South Australia with Tony Dodd and Bobby Wanganeen in my class and their brothers and sisters in my school. Two proud families from a South Australian mission given passes to live in our town and work for local industry. I was 12 when these families were accepted as citizens and they moved on, back to their country. My ancestors settled the fertile land in regions of South Australia and my grandmother remembered only one older Aboriginal man working in the region during the second world war. My father, soon to be 100, remembers as a child, a man escaping to Adelaide on horseback to establish an alibi after killing an Aboriginal man. That’s it – no history, no story, no place in the region. But I can still sit on the abundant middens along the limestone coast, find flint knives and imagine the Booandik people feasting on cockles around big fires. Most First Nations’ people of that region died before Federation, without being counted, or heard.

Constitutional change is necessary to guarantee that our Parliament will consider the impact of its new laws on our First Nations people. Why? Because this sovereign group will forever be a minority in their own land.

We can be more generous to the people who have a connection with this country going back millennia. We can see people who live in remote Australia or our islands in the north, not as pioneers but as keeping what is uniquely Australian alive. We can see the imposition of law to stop the cattle being killed as understandable from a British perspective but complex and foreign to open range hunters. We can see the idea that a person can come with some wooden stakes and bits of paper that gives them the right to dig up country and blow up ancient monuments as strange and somehow unfair. Farmers are now experiencing this with fracking and are duly concerned. This ‘voice’ we are voting for (or against), might actually be good for all Australians who have established non-mining interests in rural and remote parts of our country. In the most urbanised country in the world, this voice may also speak for them.

This vote for ‘the voice’ has strong international interest in the press around the world. Our country is under scrutiny. It is seen as a sign of our inclusiveness, our maturity as a nation. I have never had anyone speak out that they voted against the 1967 referendum and opponents have quietly disappeared. This vote will also be seen as a turning point in our nation’s history – towards the future or away from it. It is about inclusion, safety and well-being. It is simply a recognition of First Nations people in our constitution and a requirement that their views be heard by Parliament.

We all have a choice on the 14th October 2023, approaching 250yrs since Federation. If you are uncertain about how you will vote, I hope that you might consider a generous response. One for the history of all our nations.

On air

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Been on a pocast…Dr Luke Crantock, Everyday Medicine

Episode 100 : Working at Central Australian Aboriginal Congress

Cheeky Docs’ “No Cola, Just fun” tour of Central Australia

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Cheeky Docs 2019 tour

A NT band of musical general practitioners toured Alice Springs and communities to the west serviced by Central Australian Aboriginal Congress. They traveled with Prof. Mike Lean who is pioneering reversing diabetes on a large scale in the UK through dietary interventions – the Direct Study.

Why have we got smooth muscle around our bronchi (tubes in our lungs)?

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I am a general practitioner who hits “retirement age” in 3 days. I do feel qualified to ask this question but not really to answer it. It has been bugging me my whole career, but I have realised most people never contemplate this backwater of physiology.

I always expected to ask someone in the know and get a clear answer. I asked professors of paediatrics, as these muscles seem to cause a lot of trouble in young people. Nothing. I moved on to professors of respiratory medicine, as a lot of their work relates to this biological machinery that can narrow our airways. They smiled, looked around quizzically and got on with their work. More recently I trapped a respiratory professor in a pleasant restaurant, but he was not really interested. He proposed that the muscles were embryonic vestiges of bowel muscle.

You may not be interested in my explanation either. But it is an important question. These muscles are in a critical location in our lungs. The inappropriate contraction of these muscles, called asthma, is a significant cause of death in adults. It tragically happened to one of my otherwise healthy young patients and has been a near miss on a number of occasions. During that huge thunderstorm in Melbourne a few years ago, these muscles went on a rampage. We have drugs to relax these muscles that are contained in a blue inhaler and used by many people around the world. We know a lot about these muscles and how they work.

“These smooth muscle cells have muscarinic M3 receptors on their membrane. The activation of these receptors by acetylcholine will activate an intracellular G protein, that in turn will activate the phospholipase C pathway, that will end in an increase of intracellular calcium concentrations and therefore contraction of the smooth muscle cell. The muscle contraction will cause the diameter of the bronchus to decrease, therefore increasing its resistance to airflow.”

https://en.wikipedia.org/wiki/Bronchoconstriction

Searching the internet, has provided no explanation. So, I will have a shot, excused by unrequited inquisitiveness and my age.

My only real experience of these muscles in action is wheeze, the symptom that is caused by their contraction. The noise is generated by the air we breath going through a narrow tube. If you take a deep breath with your mouth open you will hear a soft noise, if you do it again with your mouth shut, you will get a lot more noise in your nose. The same amount of air will make higher pitched noises as the tube narrows. When the tubes get narrow enough they start to hum and whistle and we can hear a “wheeze”.

Living in London for a decade, I noticed that children wheezed a lot. It was usually with a viral infection and was almost always worse at night. It seemed relatively harmless for most, but a few had difficulty. I treated them with the medications we had available, and noticed that most of them settled down as they got older.

I imagined that the viral infection was causing some swelling of the tubes and narrowing them somewhat. I could explain the wheezes disappearing as children got older because the tubes of their lungs were getting bigger. The deterioration at night, something that was particularly evident with croup, was not so easy to explain.

Traveling piqued my interest in this phenomenon. In 1981, I got off a train at Linkoping in Sweden at 1am in the morning and the temperature was minus 30 degrees. The hairs in my nostrils froze in a snap and I began to wheeze gently for the first time in my life. It didn’t last long as we walked knee deep in powder snow to our friend’s apartment. In the early 90s when we returned from London to live in Darwin our wheezy child stopped wheezing altogether. The air was cleaner and it was a lot warmer, especially at night.

Someone told me that the surface area of our lungs, as an adult, is the size of a tennis court. There is a tiny membrane between our blood, pulsing at 37 degrees, and the air we breathe. How do we possibly stay alive and not die of hypothermia? Especially in Sweden! The solution is that our body heats and moisturises the air between entering our nose and delivering the oxygen to our blood in the tiny sacks at the end of the muscular tubes of our lungs. When we breath hard, we bypass our nose, but we are generally exercising when we do this.

Could these muscles have a role to play in temperature regulation? It seemed quite possible. To warm air, it needs to be in contact with a surface, so the thinner a tube the more likely it is to warm during its passage. But the same amount of air passing through a thin tube would travel faster and have less time to warm. What if we didn’t need so much air? That is the case when we are not exercising, especially when we are asleep. Could this be useful when we are at rest, particularly when we are asleep?

The other effect of reducing the diameter of the tubes is to reduce the volume of the tubes. It is dramatic. If you halve the width of the tube, the amount of air being drawn in is a quarter. So for a small reduction, perhaps to 3/4 width, only half as much air would need to be drawn in through our nose to get the same amount of oxygen to our lungs. This sounds handy, less air, more efficient warming and same oxygen.

It seemed to explain why children get wheezier at night. I was told by my Swedish friends that all Swedish footballers wheeze for the first few minutes of the game in winter. Could this explain exercise induced asthma, where the airways constrict until the person is generating enough heat from exercise? Cold air is a well known trigger to wheeze. A person probably also has some swelling in the lining of the tubes when this happens; allergy or a viral infection. Clearly things go horribly wrong with this mechanism at times, causing severe asthma, but a lot of wheeze can be explained physiologically.

So what is my answer to what has become a rhetorical question?

The muscles around your bronchi protect you from excessive heat loss when you are not exercising, and particularly when you are asleep. You can get by at those times with a lot less air coming into your lungs, and so can conserve heat efficiently. You can survive and sleep in cold weather and cold nights without becoming hypothermic.

Now that sounds like evolution.

Whether or not you like the answer, you can start asking experts the question. I think you will be as bewildered as I am by their inability to answer. You should at least consider why that is so and what it says about our profession? No doubt some of you will search the internet. Please comment if you find the answer out there.

Looking after your own

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We are living in a moment when there is evident risk to every soul on earth. We worry for the people we love if not for ourselves. My good friend, young and healthy, has just spent a week in hospital and 4 days in intensive care in a personal battle with this virus. It is a depressingly passive experience lying with plastic lines and tubes, depending on oxygen, coughing discretely when others are around. All the while alone, removed from family and friends. Dying was a real possibility. We talked about it on the phone. The virus spread and wreaked havoc in her family. Her three children had both parents in hospital for a few days, all separated and unable to help each other. This was in Australia in a street near you.

Behind the face shields in intensive care, others hovered, their eyes concerned, concentrating but creasing kindly when looking into another. A gloved tap on the arm, and patience with the endless shuffling of bedpans required by a person whose dignity lives only in facing this dark unmeasured threat to their life. It is a kind of love. These caring people matter immensely. To all of us. Time will inevitably take quite a few of us to the edge of this slippery chasm held back by special people decorated only with gowns and gloves and masks. There will be no one else.

Meanwhile the children danced and played with some delight with a visiting aunt who, recovering from the disease, found herself taking care of energised children who were not allowed out. Their young bodies unaffected and one, despite coughing a little like the rest of the family, could not manage to give a positive swab to the persistent masked visitors in gowns. Like other children around the world, they were somehow protected from its power; the younger, the stronger even if afflicted with other conditions. Cryptonite of youth.

It is a wonder of this condition that the deaths that occur mirror almost perfectly the ‘natural’ rates of death in the community. It is for this reason that despite reaching 4,000 deaths in Italy, this virus had not taken a single life under the age of 30. The problem for all of us is that this ‘natural’ curve of human attrition is delivered over a period of 14 days, and the other health problems facing us do not go away. It is a massive impost on health care and society and a disaster facing us all. But it still has this compassionate element – to take we older folk in stark preference. We, who want nothing more than for our children to outlive us.

Health care workers, paramedics and aged care workers are now the farmers in the drought, the police on Saturday night and the firefighters of the summer. We are needed desperately, our attention, our care and compassion. We will be needed for sometime and it could be dangerous. Some are going to catch the virus. It is going to be tough, but it is going to be much tougher for the older members of our professions. The haunting image of an aged care home in Spain, abandoned by carers who may themselves have been sick, must guide our future.

I hear some of my colleagues saying they did not sign up for this, or they have a young family. This is stark. The younger you are, the safer you are. Society needs young health professionals to step forward and engage. Your older colleagues will be there with you but there will be no equality when the virus hits. This is a real test of civility, of commitment to society.

We sit under a cloud of adversity, wondering what will become of us, of our loved ones. Will we come through this, will we all survive? But we are your own. Please take care of us.

Could my death go viral?

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Image by Meredith Reardon

I am afraid. My eyes fill a little, mostly at night when I consider my future, our future. I have lived a full life, more focussed on the world around me than my family. My lovely wife has channelled her energy to family and friends. Together we have stood easy in our space, even when apart.

We share some sadness; a fatal crash, estranged loved ones and health has become more fragile. We have a wealth of offspring who pluck our sense of being. We have always loved to live in the villages and spaces we moved in, with little concern for the future. We have had good parents, and siblings who have found their feet. My parents still go about their lives, playing bowls and music as they approach their centenary. My body is likely strong.

I have always anticipated my death a little, and felt vaguely cosy with the tears that I would share with my cherished sons and daughters and those grandchildren who had enjoyed exploring the opaque and cheeky thoughts of elders. Even the regrets that we didn’t do more together, that I didn’t show my love enough, or wasn’t there for some when I should have been, could be resolved in that final reckoning. If I was younger my one love in life would carry me, my family would lift my mood and surround me. Perhaps even some of the people I worked with would join the throng and replay forgotten moments. If I was older, the sheer number of offspring would sustain me and I would go easily.

With the news of this virus and my work amongst potential victims a new contagion has begun to haunt my dreams. It is bleak. What if my wife or I were to catch it and get sick? How would it be to need increasing support and finally, to know one of us could not recover? What then?

Would I die in an expensive shiny intensive care bed, my tubes and vital signs attended by masked and selfless strangers, fading into a world where a distant and sunless window occasionally showed a fleeting familiar face? Or less alone in a ward of others suffocating slowly while sharing our stoic denial or whispered acknowledgement of our very possible future? Perhaps I will be amongst a hoard in a warehouse, given what sustenance the conscripted carers can find. They may be the untidy recovered or people out to make some money to pay off recent debts.

Whatever the stage, whatever the course, we seem deemed to tackle this grim reaper alone. Any peace cut by sirens of the tiny oxygen meters on our fingers or the soon futile wailing of ambulances arriving at the barred doors below. Or the creaking of lines of makeshift beds and gasping neighbours. Alone in a sea of drowning strangers.

That is not what I want for me, for my family or anyone. Let me have a little of my own future, and the people I love. Even one to be with me will make me smile and wonder at what might have been and see inside another’s eyes. I think we can and we should.

But how?

Let households be the victim of this wanton infection, strong together within familiar walls. Let resilient children play with their snotty parents, and lovers lie with their fevered friends. They will joke and laugh and cough even as they feel a shared fear of the future. Take out the elders if they wish and test them, returning immediately if they have the little beast within and later if not. The children will wonder what the fuss is about and happiness will replace fear as each recovers, cared for by ones affected not at all or in a little way.

The home while coughing will need help to bring supplies. They will wave together through clean blue windows and call gratefully to the helpful neighbour who turns away. They might go outside in their garden or play music and sing in a balcony choir. Every now and then one will get very sick, and if there is somewhere better to be with a ventilator or new treatment, they can go. They can be visited there and kissed and hugged by their recovered family. And if all fails or they are making a slow recovery, they can go home if they wish to be cherished.

They say things will change with this king of germs. Perhaps it is a chance to discard the notion of health and even being as an individual experience.

Who knows who blows?

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Could we greet each other in a way that meant we kept 1.5m apart?
Photo by Guilherme Stecanella on Unsplash

Few of us blame the Government for this virus pandemic but on a dreadful day when Australia has twice as many new cases as China (and a 60th of the population) we have to ponder whether we have done enough. Peter Wener in the Atlantic points to a major issues in the USA such as, “… the decision to test too few people, the delay in expanding testing to labs outside the Centers for Disease Control and Prevention, and problems in the supply chain. These mistakes have left us blind and badly behind the curve, and, for a few crucial weeks, they created a false sense of security. What we now know is that the coronavirus silently spread for several weeks, without us being aware of it and while we were doing nothing to stop it. Containment and mitigation efforts could have significantly slowed its spread at an early, critical point, but we frittered away that opportunity.” It sounds a lot like us. Five hundred people getting together at the moment is NOT safe. It is very hard to get tested, and we are being told it may be more difficult.

We have seen TV presenters, film stars and politicians come down with the virus. These people certainly mix with more people than we do day to day, but there are not many of them. So if we extrapolate back from their numbers and determine the rate of infection we will arrive at figures many orders of magnitude above that being reported. Let’s face it:

It is infectious, it is deadly and we need to stop it.

Economic predictions of impact are unlikely to be accurate and should not be listened to. Minimising the spread of the virus will have the most positive economic impact. Short, sharp, severe. Norman Swan has been getting air time to promote more health of the nation approaches. If we stop the growth, we can reopen schools and kindergartens. We can probably keep schools open now for children of emergency workers, health workers and other services that are understaffed.

Most of all we need to consider testing. At the moment we are testing a lot of worried people and groups of people who are in contact with an infected case. If we take a community view rather than an individual view and extreme social distancing is in place, we can check one member of a potentially infected household with symptoms and declare it positive or negative. That household should then be supported at home. Children are likely to be infected very quickly and have no difficulty. The disruption of treating individuals in this situation is massive and quite likely to lead to asymptomatic people thinking they are clear. Household members over 70 in infected households can be removed if asymptomatic and offered alternative accommodation if they do not have the virus after brief quarantine and testing.

Small towns with limited movement in and out can test the first locals with fever, and no travel or contact, as sentinel cases. If the sentinel febrile person is negative then we can assume safely that other fevers in that community are almost certainly negative for a period – perhaps the next seven days. This will be especially important when we add the usual winter viruses to the mix. Obviously any new arrivals with symptoms must be tested.

Regions, such as Central Australia, Cape York and Northern Western Australia (and many others) lend themselves to a regional community approach with community-based testing. The experts on our nation’s 60,000 year old cultures are at grave risk and require extreme measures of preservation. This requires checking all arrivals into the region (which is often one or two roads and an airport or two) and testing any of these who are symptomatic or develop symptoms over the next 14 days. We can tell them when we check them at the regional boundaries. In two weeks they become part of the “viral control” community. We will need sentinel testing in communities, perhaps one or two tests per week. The extraordinary thing in Central Australia is that this will require less than 100 tests a week. If we can “bank” the saved tests, we will be able to carry out contact tracing in the way Singapore has done.

If we are short of tests, lets think about how to use them effectively. It is time for extreme social distancing. Whatever we are putting in place, we need to know where the virus has spread.

The Authority of Colour

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I have been moved by the wonderful Toni Morrison, one of my thought mothers, to consider racism from the oppressors point of view. I am a white man, tall, middle class and educated. I work as a doctor of medicine, a powerful role in our country. I have been rewarded with an Order of Australia Medal, probably by people a lot like me (but I do not know). I am ‘in the driving seat’, so to speak, but I have chosen, with the relentless encouragement of Mimi, my ‘specialist in life’, to drive off the track.

I find myself in a position where Aboriginal people employ me. I have two levels of Aboriginal executive above me (who are both women) and the organisation is controlled by an Aboriginal board. I mention this as it is not a common environment for someone like me to work within. It is a very well run organisation, the best I have experienced, very motivating and with great working relationships. It is challenging and I feel good about it.

So Toni has asked for people ‘on the other side’ to describe what racism is. My first piece on this difficult topic was with Waiting for the world to change. I am interested in how the presence of white people changes things in my setting and if this is how institutional racism works. This is not about how redneck we are, or how vile. Rather, how there is an accepted code that gives white people more authority in social settings. There are a couple of subtle ways I have seen this being played out.

Aboriginal people in the Northern Territory use words in everyday discussion that are not so common or acceptable in mainstream culture. I did not notice this when I first came to work in Central Australia but now I do. I have used the ubiquitous terms ‘gammon’ and ‘budju’ for sometime having raised a family in the NT. I now use swear words a lot more at work than I did. I have become reasonably comfortable with the work “cunt”, not when it is used in hate, but in many contexts. Budju is also a word for vagina but is now used by all Territorians to describe very attractive people of both sexes. I am sure this word is acceptable in any setting.

Like my Aboriginal friends and colleagues, I do not say things that might offend when there are too many white fellas about. I wondered about this; about why Aboriginal people change their language when talking to non-Aboriginal people? Why Aboriginal people might stop being Aboriginal when a white person comes close?

Toni Morrison wrote:

“I have always myself felt most alive, most alert, and most sterling among my own people. All of my creative energy comes from there. My stimulation for any artistic effort at all originates there. The compulsion to write, even to be, begins with my consciousness of, experience with, and even my awe of black people and the quality of our lives as lived (not as perceived). And all of my instincts tell me that both as a writer and as a person any total surrender to another culture would destroy me. And the danger is not always from indifference; it is also from acceptance. It is sometimes called the fear of absorption, the horror of cultural embrace. But at the heart of the horror for me is what I know about what the history of the culture that pervades this country have been.”

Toni Morrison “Hard, True and Lasting” in A Mouth Full of Blood.

Lukas Williams, the wonderful young change advocate from Gan’na Healing, told me a story about one meeting he attended in a desert community where he was living. He was talking and projecting slides onto a make-do chipboard screen nailed to a post. The large group of local men who attended these meetings were chatting around the fires for warmth. Lukas put up a drawing of Captain Cook landing on Australia’s shore and waited until people grew silent. He started to talk about sovereignty. As the talking slowed to quiet, a large rock came flying through the air and smashed through the screen leaving a dark hole.

There was an immediate hush: uncomfortable silence. A snigger echoed in the far back of the group. Then more, some now laughing. Then, with the explosive urgency of freedom, a massive outburst of laughter filled the air. It rang and rang and echoed off the nearby mountains.

White gum

Waiting for the World to Change

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I was waiting to board the plane from a community back to Alice Springs and a young client who I had seen the day before  was in the queue. It was great to see she had decided to move on. She had a pillow and a lot of hand luggage as well as her chubby young baby. I offered to carry something and she held out her pillow. I took it. We walked to the plane together sharing a little history and contemplating the new life she was heading towards. She beamed hope and liberation from a very tough time in her life.

On the plane she went to the back, row 23 and I stopped at row 1. I told her I would ask a hostess to bring the pillow down when she was settled in. I put on my headphones and started to listen to John Mayer. Once the door was shut, I asked a lively young, very blonde and Aussie hostess who came from the back of the  plane if she could give the pillow to the tall young woman in row 23 with a baby. She looked at me quizzically, turned her head to one side, pursed her lips, but took the pillow. I was puzzled that she hadn’t noticed the striking appearance of the woman, and I wondered if there were a lot of babies in row 23.

She came back and checked, “You mean the dark one?”

“Yes”, I said.

I worried for that young woman from the bush who will be trying to make her way in mainstream Australia. It is tempting to try and understand what was going on in the young hostess’s mind. She was clearly a caring and well intentioned young person. I think we need to own the state of the young hostess’s mind as a nation and realise how far we have to go to educate ourselves and embrace our Indigenous peoples and cultures. When it comes down to it, the complex cultures of our ancient forebears define our space in an increasingly global cultural ‘mash-up’. The alternative is that our collective ignorance defines us.