TONY BROWN is an Aborigine. Last year he had fallen into a pattern familiar to his people on reaching adulthood: he was unemployed, broke, and — in his own words — ‘going real bad.’ He was also sick.
So he went to see a doctor at the Victorian Aboriginal Health Service (VAHS) building in Fitzroy. He went in for a prescription. And came out with a job: taking part in Australia’s only Aboriginal health worker education programme run by Aborigines. He and the other workers are being trained as the Aboriginal equivalent of China’s ‘barefoot doctors’.
The programme began last year and already the first graduates are in the field, filling the roles the VAHS has set for them: monitors of the community’s general health, providers of treatment for a wide-range of minor ailments, intermediaries between the Aboriginal community and outside professional medical personnel, and agents of social, political and economic change.
Twenty six students throughout Victoria and aged between 17 and 42 began the course. One of the less usual subjects on their curriculum — designed specifically by the VAKS — is the politics of health: the development of both Western and traditional Aboriginal medical concepts, how the two could be integrated and how powerful lobbies, like doctors and pharmaceutical companies, can and do subvert community control of health care.
Concluding his personal assessment of the course to the Annual General Meeting of the VAHS, Tony Brown wrote the proud words: ‘We have survived’. Tony Brown, the health education programme and the VAHS itself have indeed survived. ‘a But little thanks for this go to the state governments and their bureaucracies.
The death rate from infectious diseases in Queensland’s big Aboriginal reserves, for instance, is 90 times higher than the state average, according to latest research published in Medical Journal of Australia. And death rates from heart disease, violence and accidents is three times higher on the reserves. The report blames the government for these figures, pointing out that statistics are worst for those areas where there was most interference by the government in Aboriginal traditional lifestyles.
‘One thing we are very sure of’, says Dr Paul Wilson, one of the authors of the report, ‘is that, as the level of government intervention rises, social and psychological health appears to diminish’. Although poor hygiene and housing have played a part in the atrocious health records in the reserves, the research showed that high mortality was more closely related to the general morale of the population than it was to the provision of sewerage and water facilities.
The report concluded that ‘the record for conventional medical services in meeting the health needs of Aboriginal communities is woeful’.
Yet the bulk of the money still goes to these discredited organisations. In the 1982-83 financial year $13.7 million was allocated to state departments for health compared to $7.5 million for services run by Aborigines themselves. The VAHS has been refused government funding for its health worker education programme and has frequently been so starved of money that its staff has had to work without pay to keep the service going.
Yet a VAHS survey showed that its own ‘community medicine’ had saved the state government more than $49,000 in hospital bed fees for Aborigines, having treated more than 10,000 Aborigines a year at a cost of $106,000 compared with the health commission’s $440,000 a year for just 1,500 Aborigines.
To be properly funded the VAHS would need at least $1.75 million a year —$175,000 of which would run the health worker education programme. VAHS employs doctors, dentists, social workers and their assistants and has the voluntary services of a team of Melbourne’s leading health specialists. It runs a nutrition programme which includes a daily three-course meal for those in need. It also conducts, in co-operation with a child-care group, an under-five’s clinic which monitors the health of children.
The secret of the service’s success is simple: the community trusts it because the service is part of the community. As one
patient said : This place is better than a big hospital. I reckon they only use you for experiments there. I’d rather come here. The treatment is better and you see all your mates. It’s a blackfella’s place.’
All the evidence points to the inability of even the best - intentioned white-run organisations to cross the culture gap. In a study comparing the VAHS with the state government operated service, sociologist Pam Nathan concluded that ‘the provision of more health services alone will not be sufficient to improve the emergency state of Aboriginal health. The VAHS appears to provide the only successful model in operation. The Aboriginalisation of health services is one avenue towards self-determination which is the only logical cornerstone to health.’
Or, in the words of one Aboriginal patient: ‘I think the people in different communities should organise their own health centres. They can do it if they are given the chance to. If they feel responsible for something you will find that our people will put their heart into it. They are good organisers and once they get grouped together, they’ll get confidence and strength — and better health.’