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  • COVID and remote First Nations communities: Why are vaccination levels so varied?

COVID and remote First Nations communities: Why are vaccination levels so varied?

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In late October I returned to Melbourne after spending some months in the Kimberley and Northern Territory, mainly in two remote areas with significant First Nations people: Balgo and the Kutjungka region in the Kimberley, and Wadeye and the Daly River region in the Northern Territory. I have known people within both regions for nearly 50 years.

As both an ordained priest and health researcher (my doctorate was within the School of Population Health at The University of Melbourne), I left both regions greatly concerned about the effects the Delta variant of COVID would cause when it arrived. I believed it would eventually arrive and, when it did, it would create enormous pain and inevitable deaths if certain actions were not taken.

We are now watching the entry of the Delta variant into the Northern Territory and with increasing concern about its possible spread across First Nations communities who vary greatly with their vaccination rates. This question was posed last Friday (19/11) on the ABC’s Coronacast: ‘Why is Indigenous vaccination so patchy?’

The conversation suggested two main reasons: the lack of State or Territory sponsored supply of vaccines and roll-out of vaccination programs, and the influence of US extreme Christian fundamentalists opposing vaccination. While those reasons hold some validity, I suggest there are other underlying issues and these will remain after the Delta variant of the coronavirus becomes history.

When I first went north in the 1970s people used to joke about the sort of ‘white people’ who came north into remote Aboriginal communities. They were often named as the three ‘Ms’: the Mad, Misfits and Missionaries. Sometimes there were also Mercernaries, those who exploited communities for personal or financial gain.

On this last trip, I heard of a new ‘M’: Mortgagers. People who were willing to work up north for good wages and able to save enough money to pay off their house down south. While the cost of living in remote communities is much higher than the south eg. some grocery items are 100 per cent more costly than in the large cities, there are fewer opportunities to spend money. There are no restaurants, hotels, cinemas, music, or large sporting events held in remote communities. Some staff are flown in and out on regular intervals. This means that staff — working in a community store, school or health clinic — can save a considerable amount of money over a short period of time, particularly if they are provided with a residence, vehicle and their power bills are paid or subsidised.

 

'When the virus first appeared in early 2020, many remote communities were closed off and no one became infected. It can easily be seen as something ‘that came from China’ and ‘a white person’s illness’.'

 

One of the implications of such employment conditions is that some — not all — those employed in remote communities see themselves as only staying for short or intermittent periods of time. This means they can hold a low priority to learn about particular local cultures and community histories, much less how local people understand health and sickness. Learning something of the local language or kinship structures are largely not seen as a priority or even needed. Their energy and focus is on the ‘work’ that is largely conducted within a defined, clinic space.

How is this related to very low vaccination levels found in some communities? The reasons are complex, run deep and within a historical context. Some explanations, such as what has already been mentioned, are valid. Then there is also the significant role that community leaders can play in influencing community behaviour. But others lie more hidden. They point to very different understandings of health between Western models and First Nations people. These differences are reflected in delivery and outcomes and they are exacerbated by poverty, isolation, lack of resources and a history of trauma. As communities learn to live with Delta, they are also vulnerable to fears that can be driven by a lack of control over their lives as well as their health services.

The First Nations people that I know are not aware of anyone who has got sick or died from COVID-19. When the virus first appeared in early 2020, many remote communities were closed off and no one became infected. It can easily be seen as something ‘that came from China’ and ‘a white person’s illness’.

Some of us, who have grown up within a Western model of health hold confidence in Western medical science. On the whole, we largely trust it. And, if we want, we can read, criticise and evaluate the evidence. My northern friends did not grow up with such trust. They can hold very different cultural views on human wellbeing and the many sources of illness. It is why communities have their own traditional ‘healers’ who approach the health of the human body in very particular and cultural ways and have for generations.

It is not surprising that some people will resist imposition from anyone, government or others, dictating how they are to be treated, especially if it is seen as personally affecting that one part of their life over which they have at least some control, their bodies.

My friends also live within an oral tradition. They are strongly influenced by social media, postings on Facebook, rumours and news of tragedies. Fear spreads faster than trust, tragic events over life-giving ones, not helped by fundamental scriptural references and poor theology provided by some Christian pastors. ‘Jesus will save you’ or ‘When you die you get a new body’. None of my friends listen to the ABC or its Coronacast, nor do they have daily access to hard copies of the state and national newspapers.

Most importantly, while health clinics in remote communities are controlled by local and regional Aboriginal organisations, they are largely serviced by outsiders, that is people who are not locals but come trained within a Western model of health. This model, not unlike that of a shop or supermarket, provides a service. It is located within a building, has certain hours where it is open and where people are served. The sick are not encouraged to come to the clinic out of those hours and in such communities there is no separate emergency clinic or intensive care resource. Weekend services are severely limited. It can be very tiring work — the demands are constant — and most of those employed have little energy or express little interest in moving beyond the confines of the clinic. 

 

'There are enormous benefits in having a more collaborative and cross-cultural approach to the provision of health care. It begins with the awareness and acceptance that there can be very different medical models and approaches to health present within a community.'

 

Where there is a bridge between those providing Western medical care and community members, trust develops. This is a two-way trust very dependent on the support of local health workers, some of whom have served in health clinics for decades. Such bridges allow important conversations to occur, interventions to be proposed and action taken. This all takes time, patience and respect.

There are enormous benefits in having a more collaborative and cross-cultural approach to the provision of health care. It begins with the awareness and acceptance that there can be very different medical models and approaches to health present within a community. Such an approach begins to build a bridge across these differing models where the goal is the physical, social, spiritual and emotional wellbeing of all. 

This approach to the delivery of health care draws Western health providers out of the clinic and into the life of the community. In the longer term, community members learn to trust those providing medical care and receive the benefits of such trust. At the same time, those providing such care learn to settle within the community. They begin to understand its history and culture, forming long-term friendships. And, most importantly, local people learn to trust these health providers at those critical times when people are very sick and important life or death decisions need to be made.

At the moment, it is the Delta variant that is taking up attention and concern. The poor health and relatively much lower life-expectancies of people in remote communities is well known and where there is an accompanying increased burden of care. It will be a temptation for governments to turn their attention elsewhere after this virus has moved on and where remote communities, and all Australians, learn to live with it.

What this virus has revealed is what is already well known: the current poor health of many First Nations people. Nowhere is this more clearly evident that the extremely high rates of type-two diabetes in north Australia, where the prevalence is now the highest seen in any population of youth internationally in the past 25 years. Poverty, historical trauma, over-crowded housing, nutrition and epigenetics are all inter-related and with no simple or immediate solution in sight. 

If, in the coming weeks, government, senior community leaders, local health services and clinic providers come out of this Delta experience with greater trust and confidence in each other, this will help shape attention to those other remaining underlying health issues.

In moving forward, I am cautiously hopeful. It is a hope born out of relationships with First Nations people who have taught me to trust that gift of accompaniment when we are willing to stop, listen and walk together. Especially when life is vulnerable.

Yes, there is something in those four Ms: the mad, misfits, missionaries and mortgagers that have come north and influenced the health and wellbeing of communities. And I confess to having been at least one of those Ms. I am hopeful that perhaps in time we will find a new ‘M’ to add to that list: Marlpa

Marlpa in the language of the Kukatja people is ‘friend’ (there is also a similar noun in Pitjantjatjara). But, when the suffix -rarra is added, it becomes a verb suggesting a partnership of activity and action.

When Marlpa becomes Marlpararra companionship is active and friends work closely together. Friends who faithfully walk beside one another in all the ups and downs of life. And it will only be by such walking together: government, community leaders and members, community health services and local providers that the very critical and present health challenges within First Nations communities will be addressed. 

For those of us who are not First Nations people, a wonderful gift is offered us when we are invited to become marlpa, friends and companions. Particularly in that human space where we each seek to live our lives to the full without fear, favour or unnecessary suffering. Together, we can seek to protect and enhance the health and wellbeing of all the members of remote communities. COVID and its Delta variant has alerted us to a health crisis that is real and a challenge ahead, but it has also reminded us of underlying, life-enhancing possibilities that are being offered as well.

 

 

Brian McCoyBrian F. McCoy SJ is the former Provincial Superior for the Australian Province of the Society of Jesus (2014-2020). He was the Director of the Australian Jesuit Tertianship program from 2013-14. He completed a doctorate in Aboriginal men’s health at the University of Melbourne, later published as Holding Men: Kanyirninpa and the health of Aboriginal men.

Topic tags: Fr Brian McCoy SJ, Indigenous vaccination rates, remote communities, COVID-19, Delta variant

 

 

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Existing comments

“Palya” is the Kukatja word that best describes Brian’s article. Many years ago when teaching at Luurnpa School I recall a person complaining of pain in the abdomen. As it was the day of the week when the Flying Doctor flew in, the patient was taken to the clinic. There both a local “medicine man” and a western doctor treated the patient. The respect shown was not faked - it was real and based on the understanding of the importance attached to the healing effect of having a local as well as a western trained doctor treat the patient. I’ve forgotten the details but do remember that the patient made a full recovery.


Ernest Azzopardi | 24 November 2021  

Remote indigenous communities need the friendship and long-term commitment of people who are able to offer themselves. Walking together will involve a few stumbles and some boulders and stones in the way however it is the only path. Your commitment to the indigenous peoples of our nation has been essential to your growth and ours, Brian, thank you.


Pam | 24 November 2021  

"Why are vaccination levels so varied"? Simply because our Australian society is not a monoculture.


john frawley | 24 November 2021  
Show Responses

You're right, John, and Brian has teased out something of the cultural 'complexity' implied by your 'simply ... not a monoculture' comment. Such complexity of life, of course, is to be found anywhere in the world today, not just in remote Aboriginal communities. In such a modern cultural muddle I think there is a place for a 'law of modest returns', whatever M category we may belong to. As non-First Nations people let's cultivate Modesty in the Muddle as we struggle for a unitary base for our values and their episodic expression, on the ground in friendship, as Brian suggests, whether the context be health, education, business, religion, arts, etc.


Noel McMaster | 27 November 2021  

Brian , Thank you for an inspiring ,hopeful example of a way forward.The collaborative approach must be the way in education , health, language preservation and cultural awareness . From Maripa to Maripa- rarra. We have so much to gain from each other, especially in this critical time of pandemic.


Celia | 24 November 2021  

Thanks Brian for such an informative article. It provided many insights to understanding that those of us need who rely only on media reports. I have admired your long commitment to First Nations people – Townsville times included!


Mary McDonald | 24 November 2021  

The need for respectful conversation is showing up all around us: how to end a submarine contract; how to establish consent; Synodality; parish and diocesan pastoral councils; religious discrimination bills. First nations people asking for a voice to parliament and who can be surprised they also want a respectful conversation about illnesses and vaccinations.
Thank you Brian.


Martin Nicol | 26 November 2021  

Thank you for such a thought-provoking article. If only governments would listen to such wisdom. I am also pleased that Jesuits are listening to Coronacast - an informative and well-researched program.


Mary | 26 November 2021  

No-one could reasonably or fairly question the dedicated disposition and good done by contemporary Jesuits like Frs Brian McCoy, Patrick Mullins and Maurice Heading, and the late Jesuit alumnus, Dr Anthony Noonan, who have devoted more than half their lives - directly and largely unacknowledged - in what Brian identifies as "Marlpararra companionship", not without risk to their own health and personal safety. I don't consider any of these missionaries - I use the term unapologetically, for they all share a common motivation in Christ's love and the service of others - should be mentioned in the same breath as "extreme Christian fundamentalists" of the US or any other variety; or as "white paternalists", a more recent misleading and demonizing perception generated by disseminators of Critical Race Theory. These men are held in esteem, appreciation and good affection by the peoples among whom they have lived and served for many years.


John RD | 28 November 2021  

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