This wonderful novel by contemporary Indonesian author, Eka Kerniawan, is a breath of fresh air. Part family epic, part magical realism, part political commentary, this book cannot be easily pigeonholed. Continue reading ‘Beauty is a Wound’
First I would like to acknowledge the traditional owners of the Arrernte lands and pay respect to their Elders, past and present.
Imagine, if you can, you are an Aboriginal person living in a remote community in Central Australia. You live with extended family, communing around the campfire sharing stories and songlines. Often you sleep under a blanket of stars, lulled by the rustles of redgum leaves, the creaks of ancient boughs, the whispers of nights heavy with eucalyptus.
You’ve developed a serious infection that requires hospitalisation. In the city, you’d just go to the closest hospital. Up here, a community nurse must phone a doctor on call from miles away to organise the Royal Flying Doctor Service (RFDS) to transport you to Alice Springs Hospital.
It’s terrifying being strapped to a narrow steel gurney, wired up to all sorts of monitors in the plane’s claustrophobic cabin. No family are allowed to accompany you.
Once in ‘Alice’, the hospital is full of spirits of the sick and the dead. The emergency department is all artificial light, air-conditioning, beeping machines and busy staff. They stick needles into you, take blood, administer drips and western poisons. You’d like a cup of tea and a blanket, but you‘re afraid to ask and the interpreter doesn’t speak your language.
How can this possibly be a healing place?
Nine years ago my partner, my greyhound and I lived in ‘Alice’. We (excluding the hound) worked as emergency specialists at Alice Springs Hospital. The hospital covers a million square kilometres of Central Australia, including some of the most remote and hostile environments humans can survive in.
But Central Australia is no desert. The ferrous red earth is criss-crossed by numerous rivers that keep the country alive. The rivers may only flow once a year or once in ten years, but the water is there. It’s just hidden underground. It’s the lifeblood of this place, invigorating the trees and shrubs, pushing the wildflowers up to bloom in spring, and reviving the native wildlife. Aboriginal people have lived here healthily for more than 40,000 years. That is, more than 40,000 years of culture, family and community.
In July this year I attended an emergency medical symposium in ‘Alice’ and was fortunate to participate in a traditional Aboriginal healing workshop. It was hosted by the Akeyulerre Inc. (‘A-keel-yu-ra), a holistic indigenous health service established by the local Indigenous Elders. In a novel approach Akeyulerre has been collaborating with Alice Springs Hospital to treat Indigenous patients in combination with western medicine. This was not available when I worked in ‘Alice’ and the initiative is a long overdue ‘leap of faith’ for the conservative discipline of medicine.
A semi-conscious man is brought to emergency from a riverbed 500 kmaway. Let’s call him Neville. His heart rate is dangerously slow, and I discover he has missed his dialysis (for kidney failure) that week. As a result the potassium in his blood is sky high, which can have fatal cardiac consequences.
I give him medicines to lower his potassium, and liaise with the renal (kidney) team. They tell me that Neville is ‘non-compliant’ with treatment (at least their prescribed treatment). They conclude there is nothing more to offer him because he won’t move to ‘Alice’ for thrice-weekly dialysis.
Neville doesn’t wish to move from his home to a crowded, unhygienic town camp riddled with violence. He would rather live out his days at home among his family, where healers in his community can treat him in the old ways.
How I wished for more cultural awareness within the health system. Neville didn’t choose to have kidney failure, nor did he choose his birthplace to be remote to modern society. If the health system had been more collaborative, he could have received solace in traditional healing within the hospital, fostering his connection to Country. Instead he seemed to be castigated or punished for not wanting to leave his Country for dialysis.
Imagine how traditional healing might have strengthened him spiritually and replenished him bodily before he returned to the earth.
The Arrernte (‘A-run-da’) people are the traditional owners of Country around Alice Springs. I should clarify here that Country with a capital ‘C’ is an all encompassing term, referring not only to the land, but also the sky, water, animals, plants and spirituality of its indigenous people. Aboriginal people and their Country are inextricably linked.
The Arrernte have their own traditional healers called Angangkere (‘A-nung-ke-ra’) who use a variety of healing methods passed down over generations through stories and songs. Unlike western medicine, the secrets are not written down, nor have they been evaluated scientifically. Suffice to say, they must be effective because the people have survived here for so long. The theory behind traditional healing is that medicines and traditions from a person’s Country can heal that person, by putting Country back inside them.
When I attended the opening of the emergency medical symposium in ‘Alice’, Akeyulerre practitioner and Arrernte Elder, Amelia Turner, welcomed us to Country with a smoking ceremony. This wasn’t your average symposium opening; a fire was lit in a billycan and dense grey aromatic smoke from eucalyptus leaves filled the auditorium. I’m sure members of the audience conditioned to think about smoke alarms and asthma exacerbations had conniptions.
But these are not Arrernte concerns. It is traditional protocol to ‘smoke’ newcomers when they arrive on Country. The smoke from indigenous plants is believed to be cleansing and strengthening.
Later that day at the Akeyulerre healing workshop, the women discussed how it is common to smoke problematic places to cleanse them. Hospitals, being full of spirits and dead people, fall into this category. Smoking hasn’t been approved in hospitals (for obvious reasons), although recently the renovated emergency department in ‘Alice’ reopened with a smoking ceremony. The rest of the hospital has yet to be cleansed by smoke.
Amelia described Akeyulerre’s traditional healing practices.
‘Healing power comes from the land. You don’t need to analyse it, it’s handed down. European people need to believe in the culture and healing that’s been handed down for generations.’
She said the knowledge is only passed to people the Arrernte know and trust. Not everyone can become a healer. The healing ‘gift’ must be recognised in children, and methods taught over years.
Making bush medicine requires vast botanical and geographical knowledge, and involves seasonal gathering, preparation and storage, or special trips to remote places for rare plants.
The bush medicines are made from trees and plants specifically from the person’s Country. The plants are pounded, then cooked in animal fat (such as goanna), oil (such as macadamia), or water. These mixtures are made into washes or rubs and are versatile and used for various conditions.
‘There are more women healers, but men do it too. Women tend to work together, sit and talk and grind medicine. Men are more solitary. Opposite genders can treat each other, sometimes skin groups can’t.’
Another important healing role is to help a person’s spirit return to the body. The Arrernte believe the spirit jumps out during illness. According to Amelia:
‘If their spirits jump out, it upsets the apple cart. Particularly with babies, their spirits aren’t fully developed yet, so healers need to be careful, be slow and gentle. The baby must be warned it will be handled.’
This type of healing is usually performed in massage (touch), songs and stories.
The collaboration of western medicine and Arrernte healing is anexceptional model of care for the ‘Alice’ community. It can bridge the fear and distrust of isolated people who are thrust into the western medical system. If western medical staff can be mindful of traditional beliefs such as those outlined above, we can go a long way towards delivering better care.
It is not an easy task to convince western medical practitioners that traditional healings or alternative medicine are effective. We have the tendency to be obsessed by scientific evidence. If something hasn’t been highly scrutinised in a ‘randomised controlled trial’ and published in a peer-reviewed medical journal, it is brushed aside as hocus-pocus, or at best having placebo effect. It is only very recently that western medicine has accepted acupuncture as a useful adjunct despite its widespread practice for thousands of years. Perhaps this can set a precedent for the acceptance of 40,000 year old traditional healing for our Aboriginal patients.
What we fail to respect or prioritise are the patients’ belief systems. Dictated by upbringing and culture, beliefs in different types of healing play major roles in all forms of medicine. If Aboriginal patients believe we are poisoning them, they will not take (what we believe is) the correct treatment. But if they are treated with understanding and have culturally appropriate therapies complementing western medicines, the healing power of both will be maximised.
Imagine, the power of collaboration. The power of the healing land to its people.
This piece was published in slightly shorter form (titled ‘I can probably help’) in the book ‘Emergency: Real Stories from Australia’s ED doctors’, edited by Simon Judkins, Penguin 2015
Into the Swim (Part 3)
A yellow rescue helicopter hovers menacingly just beyond the break. Its downdraft carves a white-fringed crater on the sea’s surface. A rescuer descends on a rope. Soon after a body rises, limp and curved over the sling of the rope. The chopper swings toward the beach, depositing them onto the sand. An ambulance arrives in the carpark. I watch the paramedics run to the body.
I start walking. I’m conscious of being in my swimsuit.
The paramedics are performing CPR. Someone asks me to move aside.
‘I’m an emergency doctor, I can probably help,’ I say.
A paramedic looks up. ‘Are you a doctor? Can you try tubing her?’ He waves the tube and motions for me to join them.
I’m on my knees in the wet sand, leaning over a woman younger than me. She’s clothed in jeans and a t-shirt that’s pulled down exposing her chest. She is cold and grey. Her eyes stare, pupils huge and cloudy. My impression is she’s dead.
I insert the airway tube and frothy pink water gushes out of her windpipe. She has no pulse. We strip off her wet clothes trying to let the sun warm her.
She was dragged out by the rip. The guy next to me saw it happen. He is a surfer and a nurse. He saw her jump off the rock platform after her son. He tried to rescue them, but she was unconscious. Her son was floundering. The nurse chose to rescue the son first because he was still conscious.
We try, but we can’t revive her.
A retrieval helicopter descends to land on the beach. Its downdraft sandblasts us. Two paramedics in navy jumpsuits emerge. I give them a brief run down. I have my doubts she’ll survive; it’s been too long and I think she had drowned before she was pulled from the water.
The paramedics continue CPR as she is carried to the helicopter. The engine powers up and in a moment the helicopter is airborne and away.
When I look up, I realise the beach is empty. No one approaches me. I go to the water’s edge to wash my hands in the sea.
It’s the lead story on the news that night. She didn’t survive. My heart bleeds for her young boy.
I return to the beach a week later. It’s been deserted, labelled treacherous. The people who know what happened feel the need to swim between the flags for a while.
I walk along the expanse of sand and imagine I see her face reflected in the sheen of water left by each wave. Although this is still my favourite place to run my dog and dig mermaid pools with my daughter, it has changed for me forever. I pay my respects both to her and the sea, leaving flowers on the sand.
This microfiction piece was published in the 2015 Spineless Wonders Anthology ‘Out of Place’
Evie lies on her back. The noise-cancelling headphones squeeze her skull. Her surging thoughts press from the inside. Everyone reminds her she has to sleep. The relaxation CD plays but the bewitching voice and tinkling new-age music heighten her frustration.
It isn’t the baby. She’s pretty good, doing what’s expected.
Everything is amplified. At night, through closed doors, she can still hear the dog breathing in the hallway. Drifting doof music competes with her heartbeat. A skateboarder sounds like a freight train on the footpath. Fruit bats arguing in the fig tree sound like pterodactyls.
He brings the baby in for a feed.
Afterwards father and daughter sleep again. Evie doesn’t.
The first train triggers the boom gate’s bells at 04.52 and every twenty minutes thereafter. It heralds the morning cacophony: wattlebirds choking, lorikeets shrieking, magpies gargling.
Every sound shoots an arrow of adrenaline through her body. Her vision is in pixels. Kaleidoscopic windmills twirl under her eyelids. Her chest may explode with her trapped breath.