- by C Bartholomew
- The Guardian
- Issue #2120
WOMAD, Adelaide, 2016. Photo: Michael Coghlan – flickr.com (CC BY-SA 2.0)
First Nations healthcare today is still fraught with discriminatory practices which have harmful impacts on communities. The gender pain gap – women are more likely to be met with suspicion by medical professionals, have their issues downplayed, and be denied pain relief – is matched by an Indigenous pain gap. Many Indigenous patients are either denied treatment and medications, or made to jump through extra hoops to get them.
For instance, some Indigenous cancer patients have reported being made to take alcohol tests before their doctor will agree to see them. Indigenous women may have to contend with both pain gaps at once: are they a hysterical woman, or a drug-seeking black?
Cultural awareness is also often sorely lacking. A lack of regard for the distinctions between men’s and women’s business, for example, can result in shame and discomfort for Indigenous patients, while language barriers can also lead to unfair treatment. Healthcare professionals are not receiving adequate support from governments to properly address these issues, while Indigenous communities are too often overlooked or ignored.
Among the many ‘Close the Gap’ targets, life expectancy has continued to lag. It isn’t difficult to see why. After three women died of rheumatic heart disease (RHD) in the remote Queensland town of Doomadgee, a coroner’s report was called, while campaigning by the women’s families drew broader media attention to the issue. RHD, as well as its precursor acute rheumatic fever (ARF), are 100 per cent preventable and have been largely eliminated from the non-Indigenous population for over 30 years.
Meanwhile, the prevalence of these diseases in First Nations communities is on the rise. Aboriginal and Torres Strait Islander peoples face some of the highest rates of these diseases in the world, with Queensland having the highest rates in Australia. By 2031, RHD is set to cost Australia’s health system close to $350 million, while bringing continued loss and pain to First Nations communities.
These harms are entirely preventable, so their continued presence marks a political choice. Two of the women were repeatedly turned away at the front door of Doomadgee Hospital, or sent home with a paracetamol tablet. A six-year-old who died in 2017 faced similar experiences from a Torres and Cape Hospital and Health Service. These deaths represent truly disgusting negligence. They represent a choice to deny responsibility, not just for the lives of individual patients, but for the racism that is widespread throughout our health systems. Communities such as Doomadgee have chosen to fight for better healthcare. When will governments and administrators do the same?
DEFICIT DISCOURSE
‘Deficit’ models of community health have consistently fallen short. Deficit discourse identifies issues within communities and attempts to prescribe solutions to those issues. This fixation on symptoms rather than causes far too often places the blame on First Nations peoples and cultures themselves.
These approaches are reactive, only stepping in when a problem has already developed, rather than taking proactive steps to address the factors that cause such problems in the first place. These approaches foster dependency, undermine community agency, and are ultimately unsustainable.
Modern deficit discourse in First Nations health is little more than a continuation of A O Neville’s ‘dying race’ mythology, constituting a form of profound cultural violence against First Nations peoples themselves through learned hopelessness. Far too many Indigenous patients feel it is they who need to “be better,” that they are being oversensitive, or that their experiences are isolated rather than part of a system-wide pattern of neglect.
LESSONS OF HISTORY
Coroner Wilson’s report on RHD deaths advocates for a strength-based approach to community health in Doomadgee and Queensland. Building upon six years’ worth of reports into similar health disparities in Queensland, the Coroner recommended, among other things, that Queensland Health build community trust by working with local communities to address environmental and infrastructural disadvantages that undermine health equality. Paternalistic ‘consultation’ is not enough. Queensland Health must take community recommendations as directives requiring action while also taking responsibility for their own institutional racism.
Given the brutality of Australian healthcare’s treatment of Indigenous communities, Queensland Health and other institutions must learn the lessons of history, and work with communities to rebuild trust and dismantle systems of discrimination. The fact that inquiries, inquests, and the demands of First Nations communities continue to be ignored so often indicates that our healthcare system has, at its core, failed to move beyond the destructive practices of its past.
