For Australian Aborigines, the Health Problems of Westernization

The "'perfect storm" for an unhealthy population in the middle of one of the world's healthiest countries -- and what one group is doing to help

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Colin Nipper tries to get some rest while undergoing dialysis

The Australian aboriginal community Mutitjulu lies in the shadow of Uluru, one of the country's most popular tourist destinations, but it could not be more different from the polished walkways and restaurants that make up the neighboring resort town of Yulara. Its modest buildings are covered in graffiti that demonstrates a remarkably thorough understanding of English profanities. Some of the houses' walls are pocked with holes, and the sandy grounds are filled with trash ranging from empty Coke bottles to a wrapper for something called "Magic Foot Candy." While Yulara seems designed to give vacationing tourists all the services they could ask for, Mutitjulu is equipped with only the most elemental hallmarks of Western civilization: a school, a health clinic, a general store.

Dr. Janelle Trees, general practitioner at the desert community's health clinic, describes the conditions that many of its roughly 300 residents live in as "extreme squalor." But for Kinyin McKenzie, a lanky aborigine who returned to Mutitjulu in late September to see relatives and attend a meeting about possible development projects, the place is just home.

"When I come back home, I'm happy because my family's there," he says, his smile revealing an abundance of missing teeth. "We sit around together and talk together, have meal[s] together."

About three years ago, McKenzie had to move to the central Australian town of Alice Springs -- around 300 miles from Mutitjulu -- for a reason that has become increasingly common among Australia's indigenous population: dialysis. His kidneys were failing, and if he did not get treatment to replace the blood cleaning work that they used to do, he was not going to survive.

In other words, he moved to stay alive. But he was not too happy about it.

"It's tough in Alice Springs," he says. "Nobody comes out and talks to me. I'm by myself. Lonely, you know?"

McKenzie still spends the bulk of his time in Alice Springs, as the medical treatment he needs is much more available there than it is in remote aboriginal communities like Mutitjulu. However, thanks to a mobile dialysis unit that the corporation Western Desert Nganampa Walytja Palyantjaku Tjutaku (the name means "making all our families well" in the aboriginal language Pintupi) launched in 2011, he at least has some opportunities to come back and visit.

The unit, called the Purple Truck, has several goals, says Western Desert Manager Sarah Brown. They include making it easier for aborigines to maintain links with their family and land, giving them something to look forward to, and reducing incidents of kidney disease -- partly by demystifying the treatment process "and helping people to engage with a pretty scary system."

SHARK300200.jpgThe Purple Truck, parked in Alice Springs

"It's about dialysis machines," she says, "and those dialysis machines giving people the option to be home looking after their country."

***

Australia ranked second in the United Nations' 2011 Human Development Index, but its numbers on aboriginal health are grim in almost every category. Their life expectancy is about 10 years less than the country's non-indigenous population. They died from "intentional self-harm" at 2.5 times the rate of non-indigenous Australians between 2005 and 2009, and in some remote communities, over 70 percent of children were found to have skin diseases and infections, according to the academic resource Australian Indigenous HealthInfoNet.

Kidney disease is no exception to these inequalities. Between 2009 and 2010, aborigines were sent to the hospital for treatment involving dialysis 11 times more frequently than non-indigenous Australians, making it the most common reason for them to be hospitalized. And between 2004 and 2008, the death rate of aborigines from kidney disease was 5.1 times higher than the rate for non-indigenous Australians.

"It's taken only three or four generations to turn into the epidemic that it is today," says Fiona Stanley, a professor in the School of Pediatrics and Child Health at the University of Western Australia.

Stanley and other experts in the field are quick to say there is not one grand reason for these harsh statistics. Anne Wilson, CEO of Kidney Health Australia, listed diet and nutrition as two major contributors, as several incidents of kidney disease are brought on by diabetes. In some communities, aborigines may be up to 10 times more likely to suffer from this disease than non-indigenous Australians, according to Australia's Monthly Index of Medical Specialties.

Much of this unhealthy diet arrived in aboriginal communities as part of the country's ongoing legacy of colonization -- a legacy that has not been very kind to Australia's original inhabitants. This rose to the forefront of Australian politics in 2007, when the government introduced a series of controversial legislative actions known as "The Intervention" in response to allegations of child abuse and concerns about general dysfunction in aboriginal communities. Measures included placing restrictions on items the aborigines could purchase with welfare income and banning alcohol and pornography in certain communities.

"They use the excuse that they didn't know how to manage their lives," he says. "... Against that is 60,000 years of living before colonizers came here."

A 2010 United Nations report found no evidence that the Intervention's "rights-impairing discriminatory aspects" were necessary. New York University Anthropology Professor Fred Myers added that these policies angered many of the aborigines, who felt they were being stripped of their autonomy. Bob Randall, one of the listed traditional owners of Mutitjulu, agreed.

"They use the excuse that they didn't know how to manage their lives," he says. "... Against that is 60,000 years of living before colonizers came here."

The aborigines briefly took center stage again in February of 2008, when former Australian Prime Minister Kevin Rudd gave a speech formally apologizing to them for their "past mistreatment." His address included calls to halve the gap in infant mortality and close the gap in life expectancy between indigenous and non-indigenous Australians within a decade and a generation, respectively.

The country is not there yet. And Wilson believes Western civilization may be part of the problem.

"It's like the whole issue of white men trying to impose our lifestyle on communities that have, for hundreds of years, actually functioned quite well without us," says Wilson. "It's a complex issue. It's got to do with the westernizing of indigenous communities, which we know doesn't really work unless that's what they want."

The introduction of the western way of life to aboriginal communities ties into what some see as a potential genetic contributor to their high rates of both kidney disease and diabetes. For generations, they lived as nomadic hunter-gatherers, moving frequently and eating what they could when they could find it. But contact with European settlers and non-indigenous Australians -- in some cases as recently as a few decades ago -- brought with it cars, processed foods and a more sedentary lifestyle.

In short, the aborigines have been faced with what Dr. Graeme Maguire, executive director of the diabetes and cardiovascular research institute Baker IDI Central Australia, calls a "'perfect storm' of social, environmental and health risk factors." They are engaging in less physical activity while eating and smoking more often, which has helped create ideal conditions for kidney disease and diabetes to develop.

"There's some talk about whether, you know, if you're a hunter-gatherer, and you don't know where your next meal is coming from, whether your body adapts to storing the energy quite quickly because you're going to need it soon," says Brown. For those living next to a store and eating multiple meals a day, she continues, "your metabolism needs to be quite different."

Most do not see genetics as the ultimate explanation behind aboriginal diabetes and kidney failure but rather something that can help trigger these problems when combined with other environmental, health and social issues such as poor prenatal care, unsanitary living conditions, and depression.

"They're not necessarily more at risk," says Maguire, "but if you add the existing risk with the environment, then it switches it on."

These are far from the only factors and theories at play. Trees mentions that many aborigines live with high levels of stress; Stanley discusses looking into a link between kidney failure and childhood skin infections; and Maguire is very interested in what happens to the aborigines in utero.

But the most candid assessment concerning the multitude of potential reasons behind why the aborigines have such high rates of kidney disease and diabetes comes from Alan Newbery, clinical services coordinator at the health clinic in the aboriginal community Kintore.

"Now if I could answer that," he says wryly, "I would probably get a Nobel Prize."

***

It would be tough to find anyone who enjoys a treatment as lengthy and frequent as dialysis, but for several aborigines who need to receive it, there is an added difficulty: they have to leave home. For aborigines in remote communities, leaving home is not the same as going to a hospital 20 minutes from their old neighborhood. It typically means traveling hundreds of miles to Alice Springs and -- since treatment is multiple days a week -- not coming back.

"Basically, it was to be a one-way ticket to Alice Springs," says Brown, referring to a diagnosis of kidney failure. "And then people would pass away."

Western Desert was incorporated in 2003 largely as a response to this issue. By 2010, it had established dialysis units in Alice Springs and the aboriginal communities Ntaria (78 miles from Alice Springs), Yuendumu (182 miles), and Kintore (324 miles). And in 2011, it launched the Purple Truck, which promptly traveled 154 miles to dialyze patients in the aboriginal community Papunya.

Patients still need to come to Alice Springs to start dialysis, says Brown, and Western Desert has not yet been able to set up units in all of Australia's aboriginal communities. (The issue is largely one of money, as setting up a remote dialysis unit can cost hundreds of thousands of dollars. Alison Anderson, one of Australia's most influential aboriginal politicians, says there is "nowhere in the world any government would have enough money to put two or three renal machines in every remote aboriginal community.") But because of the Purple Truck, a trip into town for dialysis no longer has to be a permanent, one-way ticket.

"For all those other communities where there's nothing, it means from time to time we can get the truck there and give people an opportunity to get home for a couple of weeks or a month, which we try to coincide with things that they'll really want to be there for," says Brown.

It's a start, says McKenzie, and it's a start that he appreciates. But it isn't perfect.

"We want to go back to our own country and be with our families not for one week, two weeks, but for good," he says.

Presented by

Edward Small is a reporter for The Boston Courant. His work has also appeared in The New York Times, The Wall Street Journal, and The New York Observer.

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