Good doctor, bad medicine


By Howard Goldenberg
Hybrid Publishers, 2009
225 pages, $29.95 (pb)

When it comes to closing the gap between Aboriginal and non-Aboriginal health, Howard Goldenberg's new book, Raft, could be just what the doctor ordered.

Goldenberg is a Melbourne-based medic who also works as a locum, stepping in for doctors in some of Australia's farthest-flung communities. Raft is his account of those experiences.

The name of the book comes from a painting of a town camp near Alice Springs, painted by Rod Moss. The painting's subjects seem lost at sea, like wreckage in an ocean of desert.

Goldenberg says: "The raft is the industry that keeps afloat the sick and their healers, with such grotesque results … I am one of those whose task is to help steady the raft, to help keep it on course, to keep it straight on course to disaster."

Goldenberg loves Aboriginal art and his own words ooze onto the page in a similar fashion, using a mesmerising, poetic, almost dreamlike palette to paint the slow pace of the desert. His laidback beat isn't broken even when recounting, in stomach-turning detail, some of the medical cases he comes across.

At a former mission town, whose residents nearly all have biblical names, he writes: "A nurse asks me to see Zachariah. He came in with a spot of pus on his left elbow.

"When she started to mop up the bead of pus with some moistened gauze, the skin fell away. The tissues underneath were dead too. The more the nurse cleaned, the deeper and wider became the exposed area, until the bones of the elbow were exposed, horrifyingly."

Goldenberg is horrified by the drama of much that he encounters, but offers some admirably undramatic solutions.

Many of the dogs beloved of Aboriginal communities carry scabies, which causes kids to scratch. The scratches then become infected with strep, which brings on kidney disease.

Such ailments are a factor in the longevity gap between black and white Australia. Goldenberg suggests a simple solution: the same kind of dog control program he has found only in the Torres Strait.

In a west coast community, he found the mere existence of a swimming pool halves ear infections, improving learning and increasing literacy. It even increases school attendance, because the kids can't swim if they don't attend classes.

In a far north community, he found that free fruit at school, supplied at little cost, improved health exponentially, saving a fortune.

Curiously, although Goldenberg recommends the book Why Warriors Lie Down to Die, he fails to note its lesson that free fruit could come with a side-effect of welfare dependency.

In a community near Broome, where Goldenberg's ancestor once worked as a pearl fisher, he describes how a pearl fishing guide complains to his tourist group of a "curious new phenomenon in the west" — Native Title land claims to spiritual sites.

Goldenberg rightly takes him to task. "Everyone who hears you wants to agree with you," he tells the guide.

"Seventy, eighty people will leave here today, all feeling okay about ridiculing Aboriginal belief, all cynically convinced that it is money that is sacred, not land."

But by the same token, Goldenberg could have taken more care when addressing the Northern Territory intervention. This doctor may have the right medicine to cure many of Aboriginal society's ills, but some of his prescriptions could be a little less clumsily written.

"I am not surprised to find myself deeply ambivalent about these brave, bold, brash initiatives," he writes of the intervention. "But no one else I speak to seems confused. Among people who are not customarily supporters of the Prime Minister, minds are quickly made up: it has to be done."

The intervention has been widely opposed by Aboriginal people in the affected communities.

Goldenberg endorses the intervention primarily because health improves whenever alcohol is banned in an Aboriginal community.

Yet, curiously, he fails to see the bigger picture. Alcohol is the single biggest factor in casualty admissions anywhere, so an extension of his logic would put the whole of Australia under prohibition.

Again on the intervention, he writes: "In every community I visit, doctors affirm the prevalence of sexual abuse of children." But he later admits: "In my clinical work in 40 to 50 separate locum terms, I do not discover a single case."

He also lauds the intervention for building 26 new houses in a hard-hit community he does not name. Even Rupert Murdoch's Australian has slammed the intervention for its failure to build new houses.

In his closing words, Goldenberg, an orthodox Jew, incongruously likens the Australian Aboriginals' struggle to that of Israel. He quotes an Aboriginal man as telling his son: "Us mob gotta learn from your mob."

"What do you mean?" asks his son.

"I mean — you mob, you got your land back, you got your culture, you got your pride ... We gotta be like that."

It's a pill too bitter to swallow. If this doctor is advocating Israeli settler colonialism (with all its parallels to white Australian settler colonialism) as a righteous model for Australia's Aboriginal people, some readers may find themselves seeking a second opinion.