DARWIN — The Danila Dilba Aboriginal Medical Service in Darwin is facing a funding crisis. Barely able to pay its workers the fortnight's pay due last week, Danila Dilba may be forced to close its doors in the very near future.
Danila Dilba is an Aboriginal community-controlled organisation that provides a free medical and counselling service for Aboriginal and Torres Strait Islander people in the Darwin area. It is staffed by Aboriginal health workers and doctors.
Although Danila Dilba, in the local Larrakia language means "the dilly bag that carries the bush medicines", the medical service uses many of the same medicines and treatments available in hospitals and clinics run by non-Aboriginal people. The importance of Danila Dilba for its clients is that its staff administer these medicines and treatments in a manner that is both culturally sensitive and attuned to the reality of their clients' circumstances and living conditions.
Yet despite demonstrable strong demand for its services, Danila Dilba has virtually no funds to continue its work. Although a specific case, there are many aspects of Danila Dilba's situation that shed light on the now recognised national crisis in Aboriginal health. Green Left Weekly's TOM KELLY spoke to PAT ANDERSON, director of Danila Dilba, on February 20.
What is the funding situation of Danila Dilba?
Danila Dilba doesn't have a stable funding base. It was set up in 1991 in response to a call from the community. It's been precarious right from the start, and we've just been applying for funds wherever, just to keep the service in operation.
The Northern Territory government has been providing some funds. We were funded under the national Aboriginal health strategy. I sent off another letter last Saturday asking Steve Gordon, chairperson of the joint health planning committee, to hold an emergency teleconference of his committee to give us the funds we need to keep open until June, so that this national debate can be resolved and we can negotiate recurrent operational funding, a stable funding base for Danila Dilba once and for all.
To have to close our doors now would be ridiculous because we've estimated it would cost $230,000 to close us down and pay people out, but it would only cost around $84,000 to keep us open until June. Someone's going to have to pay for that, whether it's the NT government, ATSIC, Commonwealth health, I don't know.
What is the role of Danila Dilba in Darwin?
Danila Dilba delivers primary comprehensive health care to the Darwin region, including many visitors from the Arnhem Land region as well as visitors from the centre. We're seeing roughly 1400 people a month and it's down time at the moment. The longer we keep our doors open the more people we see.
Comprehensive primary health care means not only providing a medical clinic and medicine; it also involves education and prevention work. It's a mistake to compare what we do here to a general practice. In a general practice a consultation consists of something outrageously brief like five to ten minutes. Most of our clients here are very sick. We have people here with two or three major illnesses; a lot of our patients are terminally ill.
A normal consultation with our clients can take anything from 45 minutes to an hour and a half. And if a woman comes in with a baby and one or two children and one of them has a cut or a sore that won't heal, then not only do we deal with that but we take the opportunity, with her permission of course, to check the rest of her children and her as well.
We have a special women's clinic. On Mondays they do promotional work and actively seek appointments from organisations and groups or wherever women congregate. On Tuesdays they're in here at the clinic providing a whole range of women's health services — postnatal, prenatal, family planning, pap smears, nutrition, breast examination, safe sex. We do immunisation of babies and children as well, which is really important for us.
We also have a mobile team which goes out every day. The mobile is a little econovan fitted out with boxes of stuff. It's staffed by a male and a female health worker, and once a week a doctor goes out. We visit all the camps in the area, those that spring up for whatever reason, and also the rare permanent ones. We also do home visits for people who are either permanently or for the moment housebound.
We are also in the process of putting on a male and a female AIDS/STD worker to do education and prevention work around town. We also work closely with the substance abuse places, the hostels around town; they bring all their people in here.
White Australians' eyes glaze over with the appalling statistics on Aboriginal health. And they're getting worse and worse. Aboriginal health is four times worse: whatever illness or disease you take, that's roughly how it pans out. The difference in life span between indigenous people and non-indigenous in Australia is 20 years, so there's a huge disparity. We need, I suppose, an unequal distribution of resources to get an equal outcome.
What do you say to people who say Aboriginal people should be accessing mainstream medical services?
Danila Dilba is like all Aboriginal medical services, another option. Not all Aboriginal people come to Danila Dilba, that's for sure. But there is some criticism of Danila Dilba that we're right smack in the middle of town. But so are the medical services set up years ago in Redfern and Fitzroy, and there are countless other medical facilities around them. So this criticism that's thrown at us takes us back to the '6Os and '70s. It's already been answered, and it's not a reason for not having an Aboriginal medical service here in Darwin.
In fact we're a hub centre for the whole of our region. There's definitely a need here, and people are really sick. We know through our internal research that most people who come here don't access medical services elsewhere. It just doesn't happen. That was the reason for the medical services 20 years ago, A whole flurry of Aboriginal service organisations arose because we weren't accessing mainstream services.
It's still the same today. People feel more comfortable here. They can see an Aboriginal worker, and there's a whole different approach and different attitudes to themselves. And people are given the respect they deserve. People feel part of it; it's their service.
So it's not only providing the service itself. Coming to an Aboriginal-controlled service of any description reinforces people's sense of who they are today. So there's ownership, and being part of something important. There's a lot of politics surrounding Aboriginal-controlled medical services, and that's how it should be.
What would you like to see happen with funding for Aboriginal health?
Danila Dilba was part of a delegation which got an appointment with Brian Howe, Simon Crean, Carmen Lawrence, Robert Tickner and Warren Snowden in Canberra a couple of weeks ago. The delegation also included the Central Australian Aboriginal Congress — that's the medical service down in Alice Springs — and the Cape York Health Council. We stressed to them the importance of the federal government taking on the responsibility that the electorate gave them in 1967.
We said that there had to be some order made out of the chaos that is Aboriginal health at the moment, and we felt that the main reason for that was that there was no single agency, body or whatever taking ultimate responsibility for Aboriginal health.
We were also concerned that the medical services get direct funding from that single agency, to the community-controlled medical services, and that it be in five-year block funding, and we will decide where to spend the money and do whatever accounting for that money that needs to be done.
The single agency we suggested is the Commonwealth Department of Health, not because we think they've done a great job — so far they haven't done a good job at all. But logically thinking, the Commonwealth department is responsible for the delivery of primary health care to the general population, so therefore it should also have the responsibility for primary health care to Aboriginal folk.
At the moment we have no-one to lobby directly. We have to go to Carmen Lawrence, then to [Robert] Tickner, then to ATSIC, then back through the whole process again. They just keep passing the matter or the issue or the letter on around each other and it's just buck passing. In fact it's been extremely difficult to see Carmen Lawrence, so giving responsibility to the Commonwealth is fraught with danger. We understand that, but they would be answerable for it.
We've also strongly recommended that if it goes to the Commonwealth Health Department, that an indigenous health council be set up consisting of community-controlled Aboriginal health services together with at least two commissioners off the ATSIC board of commissioners and one or two people off the National Aboriginal Community Controlled Health Organisation, NACCHO.
That would create a firm relationship that would help coordination. Everyone would be working together, infrastructure and delivery of primary health care. There's no point having a team of doctors but no constant water supply. And vice-versa: you can have all the water and all the houses in the world, but if you haven't got someone there doing education, prevention and delivering primary health care, that's not going to help either.
But there's still a simplistic view around that if you repair the roads and the airstrip and have water and everything, everything's going to be hunky dory. That's not the case. Administrative arrangements aren't really going to help if there's no will and no compassion. At the moment I don't see much compassion and good will out there. Getting the administrative control and all the funding organised isn't enough. There has to be some nurturing of how it's spent, who's delivering, the quality.