The Centre of it all: what is a man to do?

The Diagnosis of Dr. Morse by Rod Moss 2008. Please click on the image to go to his gallery.

I met a woman with two young children and a sore arm this week. Her husband broke it in a violent outburst and she took the plaster off because it was too itchy. It was healing well. Her husband was in jail. Later, at Ingkintja, the men’s clinic, I saw a man in his mid 30s who had taken on work and rented a flat since coming out of prison for violence and alcohol. He was bright and sophisticated. He didn’t want to go back but he had quit his job because his boss was unreasonable (long story with good insight). Centrelink could help him after 8 weeks. He was distressed, anxious and hyperventilating. What to do?

I see myself as a feminist, largely due to living with Merridy and letting her advice and thoughts through my defences from time to time. I am serious about it. Despite this, as a young man I slapped her once. On the face, hard. It was nauseating. I did it to my mother once too, as an adolescent. I never saw anyone else be violent to women; it was in me. I am ashamed to admit it, but when I do, occasionally others speak up. Once a dear and gentle friend told me how he lifted his young bride by the neck up against the wall. Just once. They both laughed as they told me the story. Merridy slapped me too, once. She’s quite strong. She immediately apologised; probably quicker than I did when I hit her.

Family violence has been gradually gaining attention over the past 40 years. My father could beat my mother with impunity; he didn’t, but he could have. Even watching in the emergency department as a young medical student in the 1970s doctors would not get involved with family stuff. Nor would the police. We would feel pity and patch it up. The first laws regarding family violence in Australia were national in 1975. At that time abused children were said by paediatricians to have Silverman’s Syndrome which was “discovered” in 1962 based on multiple healing fractures on Xray! We now call it child abuse. Reporting of child abuse became mandatory in the 1980s. In the NT family violence has been a mandatory report by any suspecting adult since 2009.

Now I am living in Alice Springs and there is apparently more violence about although I have not witnessed any. Rod Moss, the painter, has written a wonderful account of his relationships with local Aboriginal people called “The Hard Light of Day“. It is largely uncensored and observational, without much judgement. It is hard to read at times and tells stories of the shortened life of men who often spend time in jail, and their suffering women. This has a lot to do with family violence and a lot to do with alcohol.

Peter Sutton in his controversial work “The Politics of Suffering” has a more scientific angle and has investigated historical violence in the Wik people at  Aurukun. He makes estimates of murder rates of women before contact, during the mission days and following that. Interestingly quite high rates dropped to virtually zero during the mission influence and have been higher still since. There is general concern about the level of death from violence in the NT. It appears to be warranted from anecdotal evidence and also from national statistics. Some years, such as 2010, all murders were of and by Indigenous people. One surprise, it affected both genders equally; the victims and perpetrators half male and half female. This is surprising to me. I looked on “GooGoo” and discovered there is a national effort to increase knowledge about male victims of family violence. Is this correct?

Australia as a nation has a very low homicide rate at 1.3 per 100,000, inherited from the UK which has been at this level since the 16th Century. The NT murder rate, as high as it is, is still far less than Brazil or many other countries and even when applied to the Indigenous population alone (15/100,000) is far below many cities in the USA such as St Louis, Baltimore or New Orleans which run at over 40/100,000. Alcohol is universally involved here. What are we doing about it? There appears to be one approach from the outside; we are incarcerating Indigenous men. Anecdotally, their assaulted partners visit them in jail and defy Restraining Orders to be with them once out.

There is more to this. My close Aboriginal friend, Ada, surprised me when we were working together in medical education in the 1990s. She had been the victim of domestic violence interstate and had separated from her partner. She attended a seminar on “Domestic Violence” with GP Registrars and came away quite perplexed. “I don’t call that violence”, she said to me. She had obviously been affected by the issues raised. We discussed the fact that it has only recently been seen as violence in the broader Australian society, and that I probably didn’t either until I was educated about it.

What happens when we apply our own legislation, based on an understanding arising from recently changed culture which aims to reduce already low levels of violence, to a population that has limited education in these matters and a relatively high pre-existing rate of violence? The answer would appear to be incarceration. Of men. To an unholy extent. To the shame of our country.

Is there an alternative approach? I was very impressed with Judge Roger Dive running the drug court in the recent “Ice Wars” program on the ABC.  He has been working since 2004 keeping drug users out of prison and has developed an almost parental relationship with those in trouble. Could senior Aboriginal people work with someone like that to get an alternative approach to the use of alcohol and violence? The reason to do this is to try and get some community authority into the mix and communication and education as well. Just like those using drugs in Sydney, locals are using alcohol and drugs with similar consequences; and if it goes on long enough then it escalates. Does incarceration help? It does not appear to.

Apparently, I learned very recently on Friday night at Monty’s, this has been tried before in 2011. The SMART Court (Substance Misuse, Assessment and Referral for Treatment) was established in 2011 but then removed by the CLP in 2013, labelled “do-gooder”. Megan, a nurse working now for Congress but who was one of the SMART Court clinicians, was mortified when it closed; couldn’t believe it. I told her that people must forget very quickly as no one had mentioned it to me!

If a judge and Aboriginal elders were to reconstitute a suitable alcohol, drugs and violence court in the model developed by Judge Dive and the SMART Court , it would have to be a long-term bipartisan or Federal commitment. The decision makers would have to learn how to influence young people setting off on a path of violence. Other agencies would need to understand their role. The range of sanctions might be broader and more culturally sensitive and possibly include:

  • Having intermediate educational and supportive environments which could take people who were doing well
  • Having secure social environments where fathers, mothers and children could mix safely and with zero tolerance of alcohol or drugs – this might include after school centres or other facilities with security precautions
  • Enabling community feedback to people with a history of alcohol or drug induced violence on a path to recovery in a safe way.

I have discussed this with some leading men at Congress. Steve, a visiting GP with a lot of experience in the NT, advised me to steer clear. He might be right, but I can only see opportunity. A lawyer from a women’s legal service came to see me and I raised this. Not sure what she thought. JL, the lead of the Ingkintja Clinic at Congress is talking to me about it, very aware that it can look like I don’t care about the women and children. That is what makes it so hard.

The Centre of it all: beyond the pale

20170118_064216As a rural kid you learn that not everything comes past your door. I went away to school in the city and I could feel the difference. I didn’t like all of it but I liked the opportunities that seemed to present themselves. My parents had to move to a small house to keep it all going so I felt obliged to do my best. I road with Merridy to London and thrived; we spent 12 years there and had 4 children. It takes some bottle to head back to smaller places. The smaller the place, the more bottle.

Mutijulu is the furthest out of our (Congress’s) five remote clinics. I have learned all their names and some alternatives. (The Santa Teresa local names are still beyond me, but I have got Utju and Ntaria now). To get there Teena, Samarra (the team), Ann (from policy) and I take the 30 minute tourist flight west from Alice. I let some Germans have my window seat. The rain nourished African and Asian buffel grass works its tortured agar shapes as we come in to land, crowding out the bluer resident spinifex in many areas. Then there is the rock. Wow….. We get a car and drive through the park gate with a nod from Teena and the ranger. Everyone knows Teena.

Mutijulu is just to the east of Uluru where non-Aboriginal visitors gathered in the old days. Like Yulara for tourists today, Mutijulu is a centre for Aboriginal people from all around. No Sails or restaurants here for visitors though, just mats or cars as bedrooms. The population is running at about 3 times normal due to ceremony. We arrive at the clinic which is a Heath Robinson affair; disconnected, different parts in different styles, lean-tos and dongas tied together with electricity cables, all donning a modern shattered solar panel which has a pram on it! All this wrapped up in high fencing including a car park and a cage for the ambulance bay which leak with neat round human-sized holes at regular intervals. It looks like something from the war in the Iraq.

We meet the staff. A nod and a wry smile from Maria, the new clinic manager. She takes an angle on life which is not familiar. She has worked as a remote nurse for many years, diluting her angled Italian features with flavours from far flung places. A pair of sidelocks hang on each side of her friendly face like Hasidic payots. She is new here and an unknown to Sinead, a tall Irish nurse and midwife who has been working in remote and deprived parts of the world forever. They have two colleagues who are relieving for a while. Dr Julie is here too. She is an experienced remote doctor who survived taking care of the victims of the boat disaster on Christmas Island in 2010. She lives in Yalara with her husband who is the Park Ranger. Robby and his sister are working here; two locals who really know what is going on. Robby is busy with ceremony and his sister chats about how things are going. So many people wandering around town, awake all night, playing cards and having fun. Some break ins and damage by some of the young people. The shop too.

Robby has started training as an Aboriginal Health Practitioner and will be in Alice in a few weeks. I help with some stuff I promise not to talk about. It changes my view of myself as Australian, like my brain grew a little, pressing on my skull.

The toilet is blocked so patients have to use the one entered through the doctor’s room. You can hear and smell the consequences – sometimes there is a rush into the room and an accident. Dr Julie is not sure how long she can take it. The blocked toilet is part of the Heath Robinson construction with drains added to drains. It’s not going away. Bob the (local) builder charges $400 to clear it but it blocks again. It makes everything I take for granted seem so fragile and temporary.

We drive to dinner in Yulara and pass the Mutijulu swimming pool which is exploding with golden spray and gleaming children as we squint against the massive setting desert sun. The rock provides mood lighting above its recent rain nourished green beard.

The staff, like the locals from Mutijulu, are not allowed to drink at Yulara as Mutijulu is a prescribed community under the rules of the Intervention. This is not law but regulation to prevent upsetting tourists with intoxicated locals. Take-away alcohol is illegal. Sitting in the excellent restaurant we have many young Aboriginal people serving fine food and we hear about Sinead’s life. From Ireland to Africa to Canada and all over then to Australia and Mutijulu. She has been a fierce advocate for home birth, particularly in Canada where she did her midwifery training and her remote practice. We share a lot of heroes including Yehudi Gordon and Janet Balaskus who took care of Merridy and I when our children were born. The day I spent with Michel Odent is interesting to her. We share birthing stories – her’s are far more exotic than my London and Darwin homebirth stories. Respect.

I work as the Malpa that night, supporting Sinead on a call out. Two staff have to go to every call-out now due to a recent murder of a nurse in the PTY lands to the south west. Sinead works her web of magic with the family, slowly carefully, showing mother, aunty and grandmother care and attention. The febrile child settles and heads home in arms, cooler for the outing.

I vow to do what I can to get everyone I know to contribute to getting a beautiful clinic at Mutijulu, a place that reflects the values of our Board and managers. It is, after all, our most visible remote community and should reflect in part the offerings we make to our overseas visitors, many of whom have made less effort to get here than their Aboriginal shadows behind the grand ol’ rock. Now that’s a job.