Tuesday, May 29, 2012

Aboriginal Health Statistics

I know statistics are largely boring things that fail to take into consideration the human cost of each and every person represented but I thought that it provided quite a bit of insight into where things are at over here.  So I hope you find them slightly enlightening too.

Just over 500,000 people identify themselves as Indigenous in Australia (2.5% of the population), so they are well and truly over-represented in these stats.  The Northern Territory is the least populated of the States with under 220,000 people living here (in over 1,349,129 sq km).  Of that, around 54,000 people are indigenous.

30-50% is the estimated proportion of sexually abused Indigenous children in Australia where the perpetrator was 18 years or younger.
An Indigenous child in 2009 was 7 times more likely to be sexually abused than a non-Aboriginal child.

15% of reported sexual offence incidents in Australia go to court.

The consequences of child sexual abuse are horrifying:
  • Children under the age of 10 and as young as 4 are diagnosed with sexually transmitted diseases like gonorrhoea, chlamydia, syphilis and trichomoniasis.
  • Children as young as three have been exposed to pornographic material in their homes.
  • Teenagers rape children.
Within a six-month period in early 2007 the Northern Territory Health Department reported more than 800 cases of sexually transmitted diseases in Indigenous populations, while just 53 cases were noted in non-Indigenous groups.

http://www.creativespirits.info/aboriginalculture/health/aboriginal-child-sexual-abuse.html#ixzz1wAu7Qamf

http://www.abc.net.au/news/2012-05-26/am-government-27too-secretive27-on-sexual-abuse-report/4034946?section=sa



The life expectancy of an indigenous male living in the Northern Territory is 61 years, while for a non-indigenous man it's 79 years.  For an indigenous woman it is 69 years, and 84 years for a non-indigenous woman. 

Aboriginal people suffer 10 times more from ear disease and hearing loss than non-Indigenous people.

90% of Aboriginal inmates at Darwin Correctional Centre have hearing loss while 95% of male Aboriginal inmates in Alice Springs have hearing loss.

83% of the prison population in the Northern Territory is Indigenous. The NT has the highest incarceration rate per 100,000 people in the world.

58% of juveniles detained in Australia are Indigenous (remember they only make up 2.5% of the population).


70% of youth in the prison have been sexually assaulted as children.

30% of adults in Aboriginal communities suffer from type-2 diabetes (3 times the rate of non-indigenous).

An aboriginal person is 10 times more likely to have kidney disease than non-indigenous.

54% of Indigenous adults smoke cigarettes, can be as high as 70% in some Northern Territory communities.

48% of Aboriginal mothers drink while pregnant

Aboriginal babies are 40 times more likely to have renal problems than other babies born.

28% of Aboriginal children have teenage mums.

More non-indigenous drink alcohol than indigenous people do. But indigenous people have much higher rates of alcohol abuse.

And with all this there are only 125 Indigenous doctors practicing in Australia, compared to 60,000 non-Aboriginal doctors.


http://www.abc.net.au/news/2012-05-27/fisherman-king-retires/4035648/?site=indigenous&topic=latest

http://www.abc.net.au/news/2009-06-23/nt-has-one-of-worlds-highest-jail-rates/1328906

http://www.creativespirits.info/aboriginalculture/

Monday, May 28, 2012

Working in the Watch House

People have been asking me about what it’s like working in the watch house (aka police cells) and what kind of issues have I had to deal with, so I thought I would give you all a little bit of insight into it.  Now out of probably every 300 people who come through the watch house only one of those people are white.  The other 99.9% are aboriginal and they are intoxicated.  Mainly they are there in protective custody but a handful will be arrests, usually for alcohol related offenses such as aggravated assault, domestic violence or breach of a domestic violence order.   In case you’re wondering, these are not all men.  In fact it’s almost a 50/50 split of men and woman.  I have seen people as young at 14 years right up to their 60’s.  Unfortunately, due to poor health status few aboriginals live past their 60’s.

Everyone I have seen (young and old) have a poor health status.  It’s not uncommon for me to see people in their 20’s who have rheumatic heart disease, Arial fibrillation and whom have already suffered their first heart attack. They may be partly deaf from untreated otitis media in childhood. They also smoke gunga  (cannabis), cigarettes and often sniff petrol especially if they don’t have access to grog.  These people tend to be pulled out of school at an early age to look after their younger siblings so are often not very illiterate. Most of the people I see under 40 have been treated in the previous two years for all the following STI’s: Gonorrhoea, Chlamydia, Syphilis and Trichomoniasis (fortunately HIV hasn’t made its way into Aboriginal communities as yet).  Most people over 35 years whom I see have diabetics, kidney disease, latent TB, hypertension & heart disease.  Most men have scars all over their bodies from tribal fighting, sorry business*, or domestic violence incidents.
I tend to be patching up lacerations and doing a lot of neurological observations on prisoners with head wounds from falling over when drunk or from being assaulted.  It’s not uncommon for a man to punch his ‘Mrs’ and for her then to pick up a stick or chair and launch it at his head.  Also punch wounds on hands and wrists and punch injuries around the eye feature often. There are also the odd injury, abrasion that occurs during apprehension which needs patching up.
I see quite a few people who say they have chest pain or try self harming or fake seizures when intoxicated as a way to get to ED where the police will then release them (those in Protective Custody) into the care of the hospital and then they abscond before being seen.  So there are a lot of close observations to do on people in custody, and mental health assessments to do on people before they are released from custody once sober.
But the thing that is the most frustrating are the people who come through with acute infections that don’t care until they are in the watch house where they use it as a means of getting to hospital to escape.  People have infected ulcers that they have clearly had for ages but don’t care.  I give out dressings, saline and gauze to people to take to do their own dressing, as I know they won’t go to the clinics or hospital.
I have seen a few woman who are intoxicated and pregnant who have had no prenatal care because they don’t care.  I see people with fractures who I arrange to get x-rays but they don’t present.  Any follow up is really ‘hit and miss’ as people just don’t go to appointments and they rarely take their kids to appointments either.  The Community Nurses, ED Manager and NGO’s all say they face the same issues with people just not attending appointments, self discharging, not taking their medications, or just not caring about their or their childrens health.  So it’s not just the demographic I see, it’s an epic problem for the aboriginal population here as a whole. They live for the day only.

The other week I saw a young girl at the Watch House who was not much older than my own son.  She was too angry and enraged to talk to; self harming, swearing and just raging like I have never seen a child rage before.  She was arrested for aggravated assault, was also heavily intoxicated and referred to herself in language I don't want to repeat.  Her medical history showed as a baby, ‘failure to thrive’, later, partly deaf from untreated otitis media.  Right through to first being treated for STI’s at 11 years; being raped my all her father’s* and beaten regularly since.  She has also served time at the Juvenile Detention Facility a few times already.  So, what is her future?  It’s not ok in NT law to remove people from their Communities but for her, that community is not protecting her and, her story is sadly not uncommon of the young people I see.  She will again be another youth suicide before much longer.
So yeah, mainly it’s heartbreaking stuff I see.  I do often get to see the same people over and over again coming through Protective Custody, as is the nature of addiction, which is nice in one way as I get to know them, but largely it’s just very sad.
It’s incredibly hard for police when often such incidents go to Court and nothing meaningful can be done to improve things as violence is often referred to as ‘culture’.  It was not unusual in the past for aboriginal men to take (and I mean, take) more than one wife, the youngest one often being 11 or 12 years old.  While this is not legal in our Courts, it still does happen.  So where does culture begin and end in a civilised society?  It seems we have gone from the stolen generation too far the other way..... handing over children to communities of people who are destroying them.


*       Sorry business refers to the ceremony around death and dying often in the form of cutting or scarring (self harm) or payback.  Aboriginal culture is about ‘balance’. Therefore, when someone dies or there is some other ‘issue’ then payback or penance must happen.  This is also true with a suicide. The community looks to blame a person and that person gets the ‘sorry business’ for that death.
*        Father in aboriginal communities is your actual father and all the brothers of your father (aka, your uncles) as well as any stepfathers and their brothers.  All of these fathers children are therefore, called your brothers and sisters too (aka your cousins are called your bro & sis).
http://ipsnews.net/news.asp?idnews=33317

Saturday, May 19, 2012

Suicide among NT girls alarming

15 Feb, 2012 09:08 AM
Katherine Times

The Katherine region has been identified as a ‘cluster region’ where girls as young as 11 are committing suicide, a children’s commissioner says.
Dr Howard Bath said girls would now account for a previously unheard of 40 per cent of all suicides of children under the age of 17 - an unprecedented rate in Northern Territory indigenous communities where family violence is rife.

Mr Bath said the increase in young female suicides coincides with an epidemic of marijuana use and a staggering rise in the number of Territory Aboriginal women being admitted to hospital as a result of violence.

“Aboriginal women are being hospitalised for assault at 80 times the rate of other women. It beggars belief”, Dr Bath said. “Exposure to violence greatly increases the risk of a person taking their life.”

Dr Bath said he believed the proportion of indigenous girls committing suicide in the Territory was now the highest in the Western world.

While in New South Wales, with Australia's largest indigenous population, the youth suicide rate is one young person in every 100,000, in the Northern Territory it is above 30.

A 2011 report by the NT’s child deaths and prevention committee found that over a recent four-year period, 62 children under the age of 17 died from “external causes”.
About one-third were classified as intentional self-harm or “accidental threats to breathing”.

An NT all-party parliamentary committee inquiry into youth suicide has uncovered alarming incidents of unreported suicide and heard evidence from researchers claiming suicide figures in the Territory were seriously understated because of imprecise data collection.

The committee appears likely to accept a recommendation from the Menzies School of Health for a register of suicide deaths to facilitate the policy response of police, government and mental health agencies.

Committee chairwoman Marion Scrymgour said she had been aware of the need to treat suicide with sensitivity because many remote communities affected had tiny populations and the trauma had been overwhelming.

"Young women are hanging themselves, overdosing and attempting suicide and there is nobody to talk to. Suicide has always been regarded as a men's problem, but clearly that is no longer the case.”

The committee has been told suicides of young people have occurred in so-called clusters in East and West Arnhem, Katherine and Central Desert communities.

For help or information visit www.beyondblue.org.au, or call Lifeline on 131 114.

http://www.katherinetimes.com.au/news/local/news/general/suicide-among-nt-girls-alarming/2456282.aspx

Thursday, May 17, 2012

Sunset Dinner Cruise

I've just got in from being away in Darwin since Saturday.  I went up for some site-seeing, shopping and to attend professional development.  So the next few blogs I will post about my Darwin trip beginning now with a few photos of the sunset dinner cruise we went on, on Sunday.  It was wonderful!  These photos don't do the sunset justice.  The sunsets here in the Northern Territory are like none I have ever seen..... just soooo beautiful with sooo much colour!  The cruise also included a four course meal and a 3 hour cruise around the harbour watching the sunset all for $110.  It makes us want to hire a boat and spend the whole day out on the water, coming home after the sunset.  So that's something to work on.
First Course

Second Course

Darwin
Main Course (sorry it's out of focus)
Dessert (yes, that is chocolate sauce)

Our boat on return.



Thursday, May 10, 2012

Fishing outback style

I spent my day off this week fishing with a couple of friends.  Well, actually 'fishing' might be stretching it slightly as basically, I cast the line numerous times and caught nothing.  However, I can say I have had my first adventure fishing in an outback river.  A river that has snakes, and large saltwater crocodiles. So yes, it sounds like I have a death wish but to be honest I didn't even see a crocodile or snake and was sooo disappointed.  Though it didn't stop me from being super cautious around the lake edge, looking for any crocodile trails.  Crocodiles are generally quite territorial so if there is one about there will generally be large mud trails in the area.

Anyway, the day begun at 5am when we drove to the Victoria River in Gregory National Park south of Timber Creek (and 2 hours south east of Katherine).  There are closer rivers, including the Katherine River however, this was as much about having a day away exploring some of the outback as it was about fishing.

The Timber Creek area really is beautiful. We saw plenty of wallabies on the way there and even a few wild donkeys but the highlight was the sunrise with a full moon still high in the sky. I tried to take photos but they don't do it justice.  Also beautiful was the red rock cliffs and the serene river.  These few photos I took will give you a taste of the beauty.

The beginning of the Sunrise with Full Moon (in picture).
Where we tried fishing!

Sign on the Rivers edge
Us fishing!

Barramundi is the fish we were after. I had some fresh 2 weeks ago and it's the yummiest fish! 55cm minumum overall length - that is no small fish!

I'm off to Darwin this weekend to attend a 2 day Professional Development mental health course but I am staying a few extra nights to do some shopping and site-seeing.  So no doubt I will be posting more photos in the next week.

Wednesday, May 2, 2012

Mandatory Reporting

Here in the Northern Territory an amendment to the Domestic and Family Violence Act 2007 became law in the Northern Territory on 12th March 2009 and makes reporting of certain types of domestic and family violence mandatory for all adults.  This law is unique in Australia.  Also is Section 26 of the Care and Protection of Children Act 2007 which makes reporting of all child abuse and, anyone under the age of 18 who is sexually active, mandatory.  These laws also apply to teachers, doctors, health professionals and the police.  If we have knowledge and don't report it we can face stiff penalties.  This reporting overrides professional ethics, codes of conduct and confidentiality agreements therefore, the decision is made for you and you are protected as an informant.

For the Domestic and Family Violence Act 2007: 
These relationships can include:

*     Domestic relationships such as people who live or used to live together (de facto or flatmates)

*     Intimate personal relationships including boyfriends, girlfriends, engaged, married, gay/straight and whether the relationship is sexual or not

*     Family relationships including in-laws, step-children, ex-partners, aunts, uncles, cousins and family as defined by Aboriginal kinship

*      Carers relationship where a person is a dependant on paid or unpaid care of another


It can be any of the following behaviours:

*      Behaviour causing harm including physical assault such as punching, kicking, slapping, biting or use of a weapon and/or sexual assault

*      Damaging of property, including the injury or death of an animal

*      Intimidation e.g. threats causing fear, harassment, causing mental harm

*      Stalking (e.g. intentionally following/watching/approaching someone with intent to cause harm or fear of harm (on at least two occasions)

*      Economic abuse (e.g. coercing someone to give up control of their bankcard/pin/assets, unreasonably withholding money, theft of income etc)

*      Attempting or threatening to commit any of the above


Now in theory these laws sound wonderful.  They have been talked about from time to time in New Zealand as a possible option for combating our child abuse issue.  However, the reality is quite different.  It makes the issue go more underground.  The laws effectively stop people talking to their health provider about such issues because they know it will be reported.  Instead of us as health professionals being able to support someone and try to convince them to report it, they instead, don't tell us at all.

Young people who are sexually active don't use contraceptives, or go for STI checks because they will be effectively saying to the health provider they are sexually active and it would then get reported.  It's not illegal to have sex at 16 or 17 years here but it does need to be reported so the Child and Family Service can talk to the person to find out if it was consensual or not.  Of course, these young people don't like the Child and Family Unit turning up at their house and basically announcing it to the family, so they don't tell people. 
Therefore, we have a young generation of people having babies with no pre-natal care, drinking alcohol through pregnancy, and with untreated STI's, including syphilis. A disease we rarely ever see in New Zealand.  So has mandatory reporting improved things for the young people here or the aboriginal community's?  Has it stopped domestic violence and child abuse?  Not from what I've seen. Instead other health issues have presented themselves.  It's much like the 'grog' issue. One can create laws around grog but an addict still needs his fix.  Such is the issue with domestic violence and child abuse.  Those people who abuse other people don't suddenly stop because there are now laws saying it's not ok. 

Also, tribal fighting has always been a part of aboriginal culture, so are we really able to come in as the superior race and try to educate a better way of being?  Our white man laws really do little to actually help the aboriginal people in any meaningful way.


http://blogs.crikey.com.au/croakey/2009/05/29/indigenous-doctors-join-chorus-of-alarm-over-nt-mandatory-reporting-laws/


http://www.creativespirits.info/aboriginalculture/law/tribal-punishment-customary-law-payback.html


Tuesday, May 1, 2012

Mental Health Service & Restraint Chairs

Restraint chair??  Yes, believe it or not, here in the Northern Territory the police (at least in Alice Springs) still use a restraint chair for people who are self harming.  If they don't wish to take them to ED for assessment and sedation or are unable to due to lack of staff then they use the chair.  Their reason being it takes around 6 police officers off the road for 2 hours to restrain someone at ED until the medication takes effect. Staff they believe they can't afford to take off the road.

Now this doesn't sit well for me at all, and I'm having a hard time trying to make this acceptable in my mind. Maybe I'm just ignorant and they do this in other Aussie and New Zealand Police Stations also, though I hope not!

The MENTAL HEALTH AND RELATED SERVICES ACT was only introduced in 2002 and the Memorandum of Understanding between Police and the Mental Health Service is even newer than that.  So this may explain to a degree why some things I consider to be archaic are still being practised here.  But when I questioned the watch house staff in Katherine about it they said they don't have a restraint chair here, but they really needed and wanted one.

SERIOUSLY??

So do the mental health staff here use restraint chairs in the acute ward?  Who would know!  There is definitely this written in the Mental Health and Related Services Act here: "mechanical restraint means the application of a device (including a belt, harness, manacle, sheet and strap) on a person's body to restrict the person's movement".  It seems to suggest they do use such restraints! When I read that, I get images of Hannibal Lector from Silence of the Lambs.  Eckkk

I will find out and let you all know!