I would like to offer my congratulations to Juli Coffin for her thoughtful, wise and well-written letter on the recent actions by the Commonwealth Government in remote Aboriginal communities in the Northern Territory of Australia. As a researcher who has had the privilege of being able to listen to and document insights from our Aboriginal peoples and the many health professionals who provide care to them, I would like to also affirm the notion that changes must be driven from within the whole community. It is now well documented that in the Northern Territory there is a richness of service provision initiatives driven by dedicated workers with a wide range of skills and insights who are achieving important outcomes with limited resources. Long distances, practical obstacles to travel such as poor roads and the wet season, along with problems with equipment, lack of power and communications, limited personnel and a lack of local community-based services are but a few of the obstacles documented in the health arena. In spite of these challenges, the research indicates that those involved in providing health care to Aboriginal peoples in the rural and remote areas are dedicated people who understand the need for cultural respect and the importance of building trusting relationships over time.
As Juli Coffin points out, anyone who is aware of the complexity of issues associated with addressing the problems endemic in the remote Aboriginal communities knows there are no 'quick fix' solutions. Indeed, the problem is not about how we can solve this problem quickly, but rather how we can provide the appropriate support and resources to those who already have the solutions - those within the communities who understand the myriad of cultural issues from the perspective of their own peoples in collaboration with those who have already demonstrated their cultural respect, experience and expertise in service provision. The ongoing problem has never been that those directly involved in this area were unaware of solutions, but rather that their concerns and ideas have not been listened to. To now impose a quick-fix, culturally inappropriate plan from the outside only compounds the problem and undermines the key strength in the situation - the collective wisdom within the community. The real challenge is to listen not impose. Funding, support and resources are the key ingredients that will create change. Cultural respect and an awareness of basic community development principles must be at the core of any intervention in this area.
Pam McGrath, BSocWk, MA, Ph D
NH&MRC Senior Research Fellow & Director
International Program of Psycho-Social Health Research (IPP-SHR)
Central Queensland University
Brisbane, Queensland, Australia