For Australian Aborigines, the Health Problems of Westernization

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The Purple Truck is an impressive, colorful piece of machinery. The cab is a deep purple, as the name suggests, while the outside of the trailer is painted with aboriginal art -- interlocking mixtures of black and red lines, circles and squares, all atop a tan background. The spacious inside resembles a well-maintained doctor's office, as it contains facilities including dialysis machines, an area for food preparation and a bathroom. And nearly everything is spotless.

It sets out for Mutitjulu on the afternoon of Septembter 24 with McKenzie and fellow patient Colin Nipper so they can attend a meeting to discuss how to use funds from the neighboring national park to help benefit their community. Joining them are Colin's wife Teresa Nipper and Ronnie and Noel Edmonds, two married Western Desert workers responsible for making sure everything runs as smoothly as possible in the desert. Ronnie works as the renal nurse, while Noel does everything she doesn't have to. This includes actually driving the truck.

"The most difficult part of the trip is getting out of town," says Noel, as he begins driving the 11-meter vehicle from Alice Springs to Mutitjulu (the rest of the party follows behind in a white Toyota). Once the truck hits the highway, he explains, the drive gets much easier. It's avoiding all the signs, tree branches and various other obstacles Alice Springs has to offer that's hard.

Three hundred miles later, shortly after sundown, he pulls the thoroughly modern hulk of Western medicine into the middle of one of the world's oldest societies. The incongruity is not lost on him.

"Stone age, space age," he later says. "And this is part of it."

Ronnie and Noel spend the first night dropping off McKenzie and the Nippers and sorting out accommodations for themselves. They use the next day to set up the truck and begin dialysis with Colin the day after.

The treatment starts early in the morning to avoid the hottest parts of the day. Noel drives the Toyota along Mutitjulu's mixture of dirt and paved roads to pick up Colin at his house around 7 a.m., when the community is still mostly silent. He helps guide the practically blind 56-year-old to the car and then takes him back to the Purple Truck for dialysis.

The beginning of the session is a flurry of activity: Ronnie weighs and questions Colin about his health, while Noel makes sure the machine is on track to function properly. They also do what they can to make the process enjoyable.

"Colin, if the nurse is too rough, you tell me, ok?" Noel jovially asks as Ronnie starts hooking him up to the dialysis machine. "And I'll put the needles in."

The comment gets a boisterous laugh from Colin, who does not seem particularly nervous about the four-hour session he is about to undergo. He acknowledges that his move to Alice Springs was hard and still claims Yulara as his homeland despite the influx of tourists, but he does not approach his treatment with anything resembling bitterness. Rather, he appears relaxed, genial and occasionally unconscious throughout.

SHARK300200.jpgRonnie Edmonds setting up Colin Nipper for dialysis on the Purple Truck in Mutitjulu

The same is true of Ronnie and Noel. Their easygoing manner with both the patients and each other is a clear indication that, although supervising remote dialysis treatment in the desert is not an activity most people are familiar with, it is something the two of them are quite used to.

"We always wanted to see the Australian outback," says Ronnie, who has been a nurse for about 41 years. "So that's what we decided to do."

After Ronnie gets Colin on the machine, things calm down significantly. He lies back in the chair and closes his eyes, while Ronnie and Noel are left to monitor him and the equipment to make sure nothing goes wrong.

Noel is not quite as lucky the next day, when it is McKenzie's turn for dialysis. In fact, things get more complicated right when he and Ronnie arrive in the community to find that one of the truck's compartments was opened overnight.

"Hopefully everything is ok," Ronnie cautiously says, as the couple begins approaching the truck on the surprisingly cool and cloudy morning.

This hope comes true, as a quick inspection shows that no damage has been done. Noel dismisses the open compartment as "kids just poking their nose in" but is still disappointed that it happened.

"It's a bit upsetting when they start interfering with such a valuable item," he says. "If there was any damage, we'd pack up and go home. We wouldn't come back here."

Noel relays this same message to McKenzie a few minutes later when he picks him up for treatment. Things proceed similarly to the day before at first -- Ronnie and Noel weigh McKenzie, ask him about his health, hook him up to the machine and feed him breakfast (he asks for sugar on his oatmeal, but Noel says he gives him sweetener instead, "so that's not so bad") -- but the process gets more eventful before long.

"Don't end up like him," Noel says, referring to McKenzie.

About halfway through McKenzie's treatment, the power source that the dialysis machine is hooked up to shuts down, forcing Ronnie and Noel to switch to the generator. They go back to the original source soon enough, only to have it shut down again with about an hour left in McKenzie's treatment. And right as his session nears completion, it happens for a third time.

Still, Ronnie and Noel never seem too concerned about any of these outages, while McKenzie does not even seem to notice them. They are inevitable and common incidents, things that simply tend to occur when your office happens to be in the middle of the desert.

"Just too much bloody drain on these plugs," Ronnie says matter-of-factly after the second shutdown. "The power sources are just not reliable enough, are they?"

McKenzie's treatment gets a more welcome interruption between the second and third power failures, when two young aboriginal boys approach the truck. Ronnie and Noel give them a rudimentary explanation about what they are doing and exhort them to not be on these machines themselves in 40 years.

"Don't end up like him," Noel says, referring to McKenzie.

The boys are only on the truck for a few minutes, and it is unclear whether or not they actually absorb anything Ronnie or Noel tell them. They seem a bit confused and overwhelmed the whole time, and between the two of them, the only word they say throughout the conversation is "Yeah."

Ronnie pragmatically says that the only real way to know if this brief, impromptu lesson had any effect on the children will be to wait and see what happens to them when they grow up. However, she is optimistic that it may have had at least a small impact, if only because they know more about kidney disease now than they did yesterday.

Despite the various and numerous disruptions, Ronnie and Noel still get McKenzie finished with his dialysis right around lunchtime. He appears fine but slightly worn out, possibly because he has just spent the bulk of the morning having a machine clean his blood.

It is a long, draining process to treat what Ronnie bluntly describes as "a shit of a disease." But McKenzie says he doesn't mind -- in fact, he likes it.

"No dialysis?" he asks rhetorically. He then spirals his hand down toward the floor, indicating that he knows this treatment is better than the alternative.

***

Administering dialysis is far from the only responsibility Ronnie and Noel take on while out with the truck. This same attitude dominates at the unit in Alice Springs, called the Purple House, where the dialysis room is occasionally the quietest part of the building. Patients hooked up to machines sit calmly sleeping or watching movies, while employees out front deal with a host of different issues: helping patients get groceries, driving them to local banks, making sure they don't get evicted. Workers recognize that, for many of the aborigines, coming to Alice Springs is equivalent to coming to a foreign country, and they are willing to do what they can to help ease the transition.

"Seeing how disadvantaged aboriginal people are every day makes you want to do something about it," says Aaron Crowe, who does social support for the Purple House. "I just think that it's crazy that this is Australia, and we just have these people living in poverty. And it's really pretty shocking."

The errands, meals and phone calls are frequent, but sometimes the Purple House just needs to be a spot for the aborigines to go. Amenities such as the cabinet filled with aboriginal medicine and the outdoor fire pit provide a few reminders of home that can be a comfort regardless of whether or not a patient has a session scheduled.

"There needed to be a middle place," Brown says. "Somewhere where people felt comfortable that it was their place."

SHARK300200.jpgSamuel Nelson at the Purple House in Alice Springs

This comfort is on full display during the morning of September 21, when Samuel Nelson, a 49-year-old aboriginal man who moved from Yuendumu to Alice Springs for dialysis in 2006, decides to stop by the Purple House even though it is not one of his days for treatment. He spends the bulk of his time sitting by the kitchen, snacking, conversing and laughing with three of his fellow patients. When asked what he is doing here, he smiles and holds up his mug.

"Just have a little coffee," he says.

***

The problems of diabetes and kidney disease among the aborigines are not going anywhere. Western Desert nurse Noeline Murray, who works in Kintore, says dialysis patients are increasing at a rate of about nine percent a year, while Brown says the only reason the main renal unit in Alice Springs is not already overflowing is because some patients skip their treatment.

"If everyone turns up to their allotted dialysis," she says, "then there's not enough machines."

People have not settled on one solution to this problem, just as they have not settled on one cause. Randall would like the aborigines to go back to their older and healthier way of living. Murray would like to go through Kintore's community store and remove all the unhealthy foods. Maguire would like to see better education for both the aborigines and health care providers.

All would almost certainly be helpful. And on the night of Sept. 24 in Mutitjulu, an event took place that may have been helpful as well. It was nothing complex -- just a bonfire and a cookout between some aborigines and some young students from Sydney. The two groups appeared to have very little in common, but they spent the dark, warm evening eating, talking and relaxing together by the fire anyway. And at the end of the night, the students gathered together to sing a song to the aborigines, and when they finished, the aborigines responded in kind.

It was a peaceful moment, a happy moment, one that seemed to be blissfully unaware of the complicated and often shameful history between the aborigines and the rest of Australia that has helped create such an unhealthy population in the middle of one of the world's healthiest countries.

The solution lies somewhere in there.

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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