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ChApteR 1 Everyday Illness I n Australia’s outback, disease and suffering have become a part of the everyday lives of Aboriginal people. On a recent visit to Lajamanu, a Warlpiri community in the Northern Territory, I was reminded that illness is ubiquitous and often taken for granted. For residents such as Martin, sicknesses, fevers, aches, and pains are now an accepted feature of their existence.1 When we first met in 1997, Martin was working regularly , but after several years of ill health, he became unemployed and reliant on government assistance payments. During a recent conversation with Martin, I noticed several large scars covering his abdomen, the result of repeated surgeries. Looking gaunt and with his bones clearly visible, I asked how long he had been this thin. Pleased, Martin replied that he had gotten “up to” his normal weight. I was surprised that Martin considered his current appearance to be unremarkable. When we first met, he looked very different. While not a large man, photos of Martin from my early days in Lajamanu show him with a round face and a slightly protruding stomach. Given the dramatic change in his appearance, I asked how he was feeling. Martin told me he had been experiencing almost constant pain for several years. I expressed concern over his chronic poor health and asked what treatments had been prescribed. Annoyed that I could not see the obvious, Martin replied that his health was not poor. Although he had been ill a few years ago, Martin assured me that he was now in “excellent health.” He added, “I don’t have anything anymore. I’m right [healthy].” After a moment, almost as an afterthought, he added, “I have that sugar one [diabetes] but everyone has that. So that really doesn’t matter.” Martin was not exceptional. Despite living in a wealthy nation with a comprehensive health infrastructure, Indigenous Australians— Aboriginal people and Torres Strait Islanders—endure a high burden of disease.2 Epidemiological data clearly reveals the magnitude of ill health. The average national life expectancy is 59 years for Indigenous males and 65 years for Indigenous females (Pink and Allbon 2008, 5). This is 1 five years below the global average and comparable to life expectancy in Bangladesh, Mauritania, and Turkmenistan (United Nations 2007, 79, 80). Furthermore, these statistics are not improving. Over the past thirty years, Indigenous groups across the country have yet to see a noticeable reduction in rates of ill health (Public Accounts Committee 1996, 63; Ring and Brown 2002, 630). In some areas, Indigenous health is worsening . Between 2001 and 2005, rates of heart disease, circulatory problems , diabetes, and kidney diseases all increased (Pink and Allbon 2008, 104). As the years progress, the disparity between Indigenous and nonIndigenous health in Australia is widening. The Northern Territory is the epicenter of this epidemic. Speaking with Aboriginal people, one is struck by the numerous tales of scabies, boils, diarrhea, trachoma, diabetes, rheumatic heart disease, hypertension, heart attacks, amputations, and strokes. Martin’s comment that “everyone ” has diabetes reflects the seeming ubiquity of ill health. Statistics indicate that Aboriginal Territorians have the dubious distinction of possessing the lowest life expectancy in the country (Australian Bureau of Statistics 2009). On average, they will live approximately twenty years less and have a burden of disease 2.5 times higher than that of a nonAboriginal Territorian (Northern Territory Department of Health 2004, 24; Zhao et al. 2004). Although Indigenous mortality and morbidity rates increase appreciably in the remote regions of the continent, this cannot be attributed solely to a lack of medical facilities.3 In Lajamanu, the clinic provides medical care and distributes prescription pharmaceuticals free of charge. Patients requiring more comprehensive treatments are flown to the hospital in Katherine, also at no cost. Not only are medical services supplied, they are utilized. On an average day, staff of the Lajamanu Community Health Centre treat a significant proportion of the population—around 7 percent—much higher than in the urban areas of the country. While some individuals utilize the clinic more regularly than others, many residents consult medical staff several times over the course of a year. Despite receiving care, health remains poor. Indigenous health disparities are not unique to Australia. Around the world, Indigenous populations consistently suffer from higher rates of illness (Ferreira and Lang 2006). Even though countries such as Australia, Canada, New Zealand, and the United States have funded health interventions and introduced dedicated treatment facilities, the health of their Indigenous...

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