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1

Fear, Trust and Aborigines: The historical experience of state institutions and

current encounters in the health system

Leonie Cox

Abstract

As a contribution to understanding the current situation of Aboriginal health this paper

discusses the troubled dynamics between residents of an Aboriginal town in Queensland

and the local health system. I argue that these dynamics were established at

colonisation, consolidated during that period of Australian history where the policies of

‘protection’ (segregation), integration and then assimilation governed their lives and are

perpetuated in the present period. These national policy imperatives were realised in

Queensland historically by an evolving legislative framework referred to by Murrisi as

‘the Act’.

I demonstrate that the status of Aboriginal health is, in part, related to interactions

between the residents’ current and historical experiences of the health and criminal

justice systems as together these agencies used medical and moral policing to legitimate

dispossession, marginalisation, institutionalisation and control of the residents. Thus,

the criminal justice system, mainly in the form of the police, came to be seen as an

extension of the health system.

The punitive regulations and ethnocentric strategies used by these institutions are within

the living memory of many of the residents or in the published accounts of preceding

generations. This paper seeks to impart how the residents recalled their experiences of

state institutions during this period and how current practices perpetuate them.

2

Introduction: Care or control?

Western medical science being part of the oppressive system has always provoked in the native

an ambivalent attitude… the compulsory visit to the doctor… is preceded by the assembling of

the population through the agency of the police authoritiesii.

During 1995 and part of 1996, I undertook an ethnographic study at Cherbourg, an

Aboriginal town in south-east Queensland with a fluctuating population of around 1500

to 2000 people. Attempting to turn the diagnostic arrows back to their source,iii one

research question asked what dynamics occurred in the borderlands of institutional and

community life to perpetuate the persistent, depressing statistical profile of Aboriginal

health in terms of low life expectancy, higher morbidity for various chronic diseases and

a marginal status across a number of social indicators such as education, income,

employment, housing and so on.iv

The methodology was grounded in phenomenology focusing on the world of everyday

experience and on how people explained their situation to themselves.v During sixteen

months of fieldwork, I lived at Cherbourg and used the method of participant

observation among the residents and workers at agencies and services.vi For the first six

weeks, I resided in the nurses’ quarters of the hospital where I interacted with staff. I

also undertook some in-depth, audio-recorded interviews with key participants in the

community. During our conversations residents consistently reflected on their history of

subjugation and related this to their present situation.

I found that some dynamics perpetuating ill health were tied up with residents’

expressed feelings of fear and shame in relation to the health system; they tended to

avoid seeking help at the local hospital until pain or discomfort got the upper hand. As

the fieldwork progressed it became evident that the residents’ reluctance to seek help

3

was related to two major preoccupations. The first was how, historically, Western

medicine (the hospital and the closely related dormitory system) and the police were

central to state attempts to control and ‘normalise’ them and turn them into whites. In

1995, archaic practices at the hospital, such as using the community police to transport

patients for medical programs, rendered problematic the social goals of care, on the one

hand, and social regulation and control, on the other.

The second preoccupation was race relations, particularly the past and present treatment

of residents by the health and criminal justice systems and some of their personnel. The

influence of powerful stereotypes concerning violence and drunkenness on clinical

decisions taken by some staff was frequently raised in this context.

To establish the historical context of the residents’ experiences I use secondary sources,

interspersed with some residents’ accounts from my work, to trace how an evolving

legislative framework established a cumulative regime of power over their daily lives.

To demonstrate the intersection between services, health and law I begin with some

recent instances of potentially preventable deaths at the hospital to show that the

residents fear not only for their dignity at the hands of these agencies but also for their

lives.

Events at the hospital

The ‘hospital’ was grossly overcrowded, with a tiny badly smoking kitchen: it was so tainted

with death that people feared to go near it.vii

This reference by Rosalind Kidd to feelings about Barambah Hospital in 1918 is

remarkably similar to the way that current generations of residents of the town now

known as Cherbourg feel about the hospital. Indeed, as I write in August 2006, it is just

a matter of weeks since a twenty-five-year-old woman passed away in the car park

4

when staff failed to go to her assistance, assuming that the cousin who had brought her

there with chest pain was the husband of a patient admitted for injuries from domestic

violence.

The media reported that:

The hospital claimed a female patient mistook Ms Weazel’s friend for her drunk and violent

boyfriend, and asked for him to be kept out… But yesterday the only two female patients at the

hospital that night denied instructing the nurses to ignore the man, who bashed on the doors…

the three female nurses hid behind a wall in the hospital as the man screamed for help’.viii

Here, in a medical emergency, the police were called by hospital staff since, as the local

mayor commented, ‘the nurse was too scared to open up [the door]’.ix A second woman,

aged sixty-one, ‘died after being turned away from her local hospital and forced to

hitchhike to a neighbouring town to receive medical attention’.x It is almost

inconceivable that an ambulance was not called.xi

Regardless of whether these actions are consistent with policy or not, from my

observations, and from accounts from residents, these recent events typify the problems

that Aboriginal people currently experience. Each instance consolidates the fear,

resistance, shame and avoidance historically associated with the health system. In this

paper I outline early race relations and the legislation that set up these dynamics.

Evolving legislation, race relations and medico-legal regimes

The relationship between settlers and Indigenous groups in Queensland was

characterised by the explicit violence of massacres, poisonings and punitive raids.xii

However, the relationships developing on stations and in the nascent rural towns had

other dimensions. From about 1853, Aborigines became a cheap source of rural labour,

sometimes paid with food, alcohol, tobacco and pipes, or sometimes not at all. In

5

Maryborough the publicans would empty the swill of various drinks into a tub and this

'black fellows’ rum' or 'all sorts' was ‘extremely potent to the Aborigines’.xiii As

Aboriginal people alienated from their land increasingly came into rural towns, a major

concern of settlers was the fear of contagious diseases for which there were few

treatments at the time. Any real basis to such fears was exacerbated by fears of a more

general moral pollution.xiv

As part of the domestication of the environment, the Maryborough Chronicle reported

in 1865 that ‘the process of extermination of the natives of the Colony… is most

satisfactorily going on’.xv Further, a public meeting in Maryborough in the same year,

suggested that the newly formed 1863 Vagrant Act Amendment Act be used to send

monthly ‘as many [Aborigines] as would fill Brisbane gaol’.xvi

It seems that the 'half-castes' reminded Europeans of the unspeakable ‘evil’ of

miscegenation, while ‘semi-naked, drugged and besotted Aborigines were… an

intolerable moral affront’.xvii In the late 1800s, reports from all over Queensland

claimed that Aboriginal people were infected with syphilis and ‘the process of removing

infected blacks principally to rescue whites from contagion remained a favourite

device’.xviii

Attempts to remove Aboriginal people to missions were ostensibly to protect them from

the many ‘corrupting influences’ of white society, although it is clear that Europeans

were preoccupied with protecting their health and their moral sensibilities and, as noted,

were ironically ‘corrupting’ Aborigines with alcohol and tobacco as ‘payment’ for

work. Attempts at missionisation before 1897 were made under Queensland’s 1865

Industrial and Reformatories Schools Act and the 1863 Vagrant Act Amendment. But

6

these Acts could not stop people abandoning missions, nor did they apply specifically to

Aboriginal people.

Government-controlled reserves were made possible using a combination of these Acts

with the extra legislative authority of the 1897 Aboriginals Protection and Restriction of

the Sale of Opium Act. It ‘defined in rigid racial terms’ those who were to come under

its ambit and sought the absolute isolation of Murris from whites. Exemptions from the

1897 Act were possible only by ministerial approval.xix

Cherbourg began under these arrangements as the Barambah Aboriginal Settlement in

1901.xx Initially a philanthropic effort, it was taken over by the government in 1905. To

legitimate removals to reserves, the authorities applied contrived categories to

Aboriginal people, such as ‘half-castes’, ‘intractable criminals’, ‘insane’ and

‘infectious’. Here we see the earliest instances of health/illness being linked with legal

processes such as removal and segregation.

The changes wrought in the everyday life of Aboriginal people on the new settlement

involved programs that, paradoxically, attempted to incorporate them through moral and

medical policing while seeking their absolute segregation from the surrounding

population. These programs were initiated from the outset and signalled a white

administrative domain constituted by institutions of health, law, training and education.

The first school opened in 1903; in 1909 a hospital was built and a much larger

dormitory for single girls replaced the hut and bough shelter for ‘neglected’ children. By

1910, the reserve had a store run by the resident doctor, a male dormitory, a jail and a

bakery.xxi A matron and a teacher were among the first appointees along with the

superintendent and his assistant.xxii

7

These new humanitarian notions of policing entailed a panopticon-likexxiii surveillance

of everyday life and administrators, police and medical personnel worked in concert to

bring this about. Keeping in mind that so-called protectors of Aboriginal people were

also police, and that it was protectors who removed people from their country to these

reserves, the nature of these regimes in terms of their acceptability to the residents was

thoroughly problematic.

Early memories

The town’s residents shared memories of absurd government policies that took them

from their country, then from their parents, and into the dormitory system. Sheridan’s

account demonstrates the control and surveillance exercised by the hospital and the

police and how they were directly involved in removal and oppression. She recalled:

We came here [Barambah]… under a removal order late in 1917... Those days if you answered

your boss... or anything they sent you to a settlement... The fear… it was cruel… They took me

away from my mother and put me in the dormitory when I was 10 years old. Down there we had

an old hospital where we used to live… there would be forty, fifty girls in the dormitory and we

couldn’t go anywhere without we had two policeman escorting us. We couldn’t go to the

hospital without an escort… had to escort us to work, escort us back, we had to go to church and

we had to have an escort to go to church… I got sent to Woorabindaxxiv in 1935 for back-

answering an old nurse… you couldn’t back answer a white person in those daysxxv.

On the reserve, white housing, council chambers, dormitories, school, hospital, police

and jail, stores, churches and industries (pottery, joinery and mechanics workshop) were

all in a separate domain for whites. Outside the business of work, sickness, punishment

or tutelage, these areas were off-limits to Aboriginal residents—firmly placing the

health services in a domain of white control.

8

In living memory: the consolidation of moral policing

In Queensland, the national policy of ‘protection’ (based on the notion that Aborigines

were a doomed race that would die out)xxvi that gave way to ‘assimilation’ was enacted

by the punitive 1934 amendments to the 1897 Aboriginals Protection and Restriction of

the Sale of Opium Act, and then the 1939 Aboriginal Preservation and Protection Acts.

The 1934 amendment to the 1897 Act made sexual intercourse between an Aboriginal

woman and a non-Aboriginal man an offence,xxvii demonstrating the comprehensive

nature of state intrusion and control.

The 1934 Aboriginals Protection and Restriction of the Sale of Opium Act Amendment

Act extended the racial categories in the 1897 Actxxviii to include all people of mixed-

race background; certificates of exemption could be revoked. Kidd wrote of the public

furore created by a group of Thursday Island residents who said they would suddenly be

defined as Aborigines. The Chief Protector countered their public outcry with claims

that exemptions ‘would be reinstated after medical clearance’, although this proved that

citizenship rights had been withdrawn.xxix

Just as in earlier days when the Maryborough residents wanted local Aborigines sent to

gaol, this example shows that citizenship rights and officially approved ‘identity’ were

linked with ideas of health, a dimension that clearly separates the experience of

Aboriginal people from that of Australians generally. These amendments were

motivated and justified by the same two central tenets as operated in the late 1800s—the

fear of disease and the abhorrence of the progeny of liaisons between Aboriginal people

and Europeans.

The dormitory system removed fair skinned and ‘neglected’ children from the camp.

According to Blake, by the 1930s the dormitories at Cherbourg housed 66 per cent of

9

children aged between five and fourteen.xxx The Protector strongly advocated that

socialisation and training were to be the way to assimilation. This goal resulted in the

consolidation of the dormitory system and it formed the third arm of a tripartite system

of removals.xxxi

These different regulations and ethnocentric strategies were remembered by many as

dehumanising and punitive. A woman born at Cherbourg in 1929 and raised in the

dormitory told me of the time she ran away:

The first time I ran away, we only went as far as Goomerixxxii… The yardman cut my hair baldy

and I got a permit to go up to the hospital off the matron—and I had a scout-boys’ scarf on my

baldy head. I went back and picked my curly hair up and stuck them under the scarf on my head

and marched up the hospital as if it wasn't cut. Dad saw me going to the hospital from the Boy's

Quarters and he met me halfway and jerked all my curls out. Ha Ha! I laugh now, but I ran back

crying.

Despite her considerable bravado, the woman’s story reveals the depth of her

helplessness and humiliation and shows that the administrators made the very bodies of

the residents a vehicle for on-going and public degradation. From this story, we can see

how the reserve constituted a network of institutions, including health, within which

punishment, degradation, humiliation, intimidation and control were practiced on

Aboriginal people.

In 1939, the Aboriginal Protection and Preservation Act was passed. It narrowed the

definition of ‘Aboriginal’ by declaring that Aborigines had a majority of Aboriginal

blood. But it also extended the definition of ‘Aboriginal’ to include the over-sixteen

children of ‘half-caste’ parents, children who were deemed to be in need of care and

protection, children who were residents on a reserve, and children whose mother was a

resident on a reserve.

10

This legislative move collapsed the category of ‘Aboriginal’ so that it could now be

legally equated with a Eurocentric definition of neglect, as it was on European terms

that the need for care and protection was defined. The 1939 Act increased the power of

settlement administrators, and extended the range of protective law and legislation.xxxiii

Guthrie observed that under the 1939 Act: ‘Superintendents could deal with almost any

action as an offence. They appointed, promoted, demoted and fired their own police and

acted as arresters, prosecutors, Magistrates, gaolers and rehabilitators.’xxxiv

It delegated ministerial powers to the Director of Native Affairs and all removals,

exemption certificates and ‘moral offences’ came under his jurisdiction.xxxv

This moral panic that required such extreme forms of control as the criminalisation of

petty personal behaviors continued to be constructed around the status of mixed-race

people. When the anthropologist Elkin visited Cherbourg at the time of the next round

of legal amendments—the Aboriginal Regulations of 1945—he wrote in his field-notes

that patients at Cherbourg Hospital, ‘though bathed and washed twice daily the bed will

be filthy by morning… they always save bits of meals to eat later… meals are at

night’.xxxvi

This account tells us that the hospital was more concerned with cleaning patients than

feeding them while their exaggerated horror suggests the attribution of irrational and

disgusting habits. Actions such as saving food for later were deemed as ‘primitive’

rather than as ordinary habits of self-management in a context of extreme deprivation.

The story reveals the hospital’s role as an agent of moral regulation rather than one of

care.

Under conditions such as these, built on a historical background of massacres and

persecution, it is easy to see how agencies such as the hospital, the police and the

11

administrators all constellated into a single enemy that had to be resisted, subverted,

mocked and avoided.

Assimilation

The assimilation policy was formally adopted federally and by the states in 1937. In

Queensland, changes under the 1945 regulations conceptualised assimilation as ‘a

paternally managed order of “progress” from Aboriginal to European status, with steps

administratively determined by “experts” in “human engineering”’.xxxvii Therefore, at

Cherbourg as elsewhere, the authorities saw assimilation ‘as a simple matter of

training’.xxxviii

On reserves, training was undertaken in the series of age-graded and gender-separated

dormitories that I discussed above, and further describe below. It was extended by

practices such as sending residents aged over fifteen to compulsory jobs in the reserves’

institutions or on pastoral stations. One woman told me that, in the 1950s, she had to

pay for a day pass permit to come into Cherbourg to visit her brothers in the

dormitories, a situation she resents and ruminates on to this day. Children were

forbidden to visit their families even if they lived on the same reserve or, as Hegarty

describesxxxix, even when they lived in the dormitory next door.

At the age of four, Ruth Hegarty was taken from her mother in the women and babies’

dormitory, put in the little girls’ dormitory and sent to school. She described ‘a single

piece of timber lattice [that] separated the women’s section of the dormitory from the

small girl’s ward’,xl and said that she and her mother were forbidden to talk to each

other even though they had to eat in the same room. This type of inhumanity

characterised the zealous approach to assimilation. Ruth Hegarty states: ‘the authority of

12

matron was something to be feared. My mother had seen what happened to those who

spoke out against the system.’xli They endured this until finally the mother was sent out

to work.

Like this woman, many residents worked for decades but, since 1897, most of their

meager wages were held in ‘trust’, a practice that is now the subject of the stolen wages

campaign in Queensland. The government used revenue from the personal bank

accounts of 10,450 Murris. Of the total credit of $1.8 million, $1.435 million were

invested in Commonwealth bonds and hospital-building programs, and the state

capitalised on the interest.xlii Here, the health system is the beneficiary of hard-earned

Aboriginal wages, another source of the on-going antipathy of the Aboriginal

population toward the health system.

Coming through the changes

In 1965 the Aborigines’ and Torres Strait Islander Affairs Act replaced the Acts of

1939–46. It, and the Aboriginal and Torres Strait Islander Regulations, came into

operation in 1966. Far from supporting the notion of autonomy for reserves, the 1965

Act designated residents as ‘assisted Aborigines’ who now had to have a ‘certificate of

entitlement’ to live on reserves where previously they needed a certificate of exemption

and work permits to leave.xliii

Under this legislation a whole range of personal behaviours were still punishable

offences. Intense surveillance continued, consolidating the already profoundly blurred

distinction between private and public life. While by the 1960s dormitory children were

allowed to visit the mission area as long as they were back at the agreed time, one

13

resident said that ‘the electricity cut out at 9 pm and the police made sure that no one

was wandering around’.

When young people ran away from the dormitory, the hospital, or from their jobs, the

police were sent to retrieve them. This practice had a significant impact on the

relationship between residents and the health system. One woman now in her fifties

recalls her early experience at the hospital:

The first time I entered hospital I was about 9… I was just a nose bleeder you know… every

time my nose bled I thought I was going to die and hospital was a scary place for me. So it was

early morning the next day everybody was asleep so I crept out—I grabbed my coat and I had

my pyjamas… I ran all the way home hoping that no one would see me. I went under the house

then and I laid down with our dog… I roused when I heard knocking on the door… it was the

police—Black Trackers—”Your daughter disappeared from the hospital and Matron wants her

back down there”. And Dad said, “Oh well we haven’t seen her she hasn’t come here yet”… I

think he figured it out that I’d be around somewhere and he said, “She’ll be right I’ll take care of

it”... Dad came to the back window and sang out after the police left, “You out there? Get up

here” and I said “I don’t want to go back there—I don’t want to go back in the hospital”… the

smell of the hospital, the sputum they used to spit in the thing and then one day you’d go there

and next minute you’d find that they’re dead—it was really scary from a child’s perspective I

suppose to know that people who go in there don’t necessarily come out.

This woman respected the hospital matron, who was worried about her. It was having

the police sent after her as if she were a criminal that frightened her as their involvement

in such personal domestic matters intimidated her and made her angry.

The woman’s experience of intimidation by the hospital and the police was consolidated

in the late 1960s when she was about sixteen years old. In the following she reflects on

her job serving food and washing up at the local hospital. She is talking about how she

was convinced by a slightly older work mate to leave her job with one of her chores

unfinished:

… “Come on let’s go home early.” I went home… next minute police at the door. ‘You’re

wanted at the hospital—Matron wants you down there immediately.” I said “Oh no.” “Yeah”,

they said, “get in the wagon.” I said, “I don’t want to get in the wagon. I can walk.” I didn’t want

14

to be driven down the hospital in a paddy wagon. Everybody looking at you. Shame. “No I can

walk…” Yeah—it’s like you’ve done something wrong, seriously wrong like committed an

offence or something.

The speaker went on to comment about the involvement of the police with travel

arrangements for those working outside the reserve:

… [T]he police with any of our mob when they were out working—if they had to travel to a

place, blackfellas used to have to report to a police station and even sleep there overnight—they

weren’t allowed anywhere else they had to put them up in the cells overnight.

She and others in her age group recalled the delousing and deworming parades that were

held in public like other compulsory medical inspections where, as another resident

reported, staff ‘just stripped you off and you just had to stand there’.xliv Some people

recalled the medical treatments prescribed to them for various ailments and asserted that

they were used as ‘guinea pigs’. One described a lotion that was put on her daughter’s

teeth, which stained them bright yellow. Her mother said that you just couldn't

complain, as this would bring further harassment and in any case there was no forum

where Murris could approach whites as equals.

As on all government-run reserves in Australia, random household inspections were

frequently conducted and medical inspections of residents were compulsory.xlv If

residents failed to turn up for these, again it was the police who were dispatched to take

them to the hospital, further consolidating the perspective that health services were part

of the system of intrusion and social control.

These stories demonstrate the link between the hospital and the police as vehicles for

state power and control. Such practices entrenched fear and mistrust in relations

between Aboriginal people and state institutions. They impressed on people’s

consciousness not only the implacable power of white authority, but also the ever-

present need to counter that power, with habitual techniques of defense, avoidance and

subversion, both practical and psychic. These techniques at the present time take the

15

form of resisting medical programs and avoiding the health system where possible. I

have observed, and others have documented, that this resistance is frequently interpreted

by health workers as ‘laziness’ or ‘non-compliance’ on the part of Aboriginal

patients.xlvi

The health system cannot improve the health status of Aboriginal people without some

attempt being made to heal the historical rifts between the two. Unfortunately these rifts

are frequently reinforced by contemporary practice.

Contemporary health practice

As already indicated, the troubled relations between health services and the residents

was tied up with the hospital’s historical position within the white domain and its

immoral involvement in the regulation of daily life as a co-extension of the dormitory

system and the police.

However, up until the 1970s local women not only cooked and cleaned at the hospital,

they also tended the sick and delivered babies in a separate maternity ward that was, at

the time of my fieldwork, the doctor's residence. According to some residents, new

equipment in the maternity ward, purchased in the late 1980s, was removed when a

policy was adopted that babies would no longer be delivered at Cherbourg.

The removal of birthing facilities from the town because of the high incidence of

teenage pregnancies, became a risk factor to women and babies and infuriated the

residents. For example, young women tried to ‘hang-on’ until the contractions were

advanced, hoping that it would be too late to make the trip to the Kingaroy Hospital, a

practice that increased the likelihood of a medical emergency. Young women avoided

pre- and post-natal clinics too, although this situation seemed to improve after the

16

appointment of a Murri woman to assist the midwife in the late 1990s. Their desire to

give birth at Cherbourg was related to a sense of ownership, identity and belonging that

attaches to one’s birthplace, to issues concerning land rights and native title, and to

wanting to stay close to supportive family and friends.

Young people teased one another about the intimate nature of medical procedures to do

with pregnancy and sexual diseases. The general attitude among men was that it was

weak to go to the hospital. Some expressed considerable hostility toward the power the

service wielded over their lives, and those of women and children. They resented that

the health authorities could restrict their access to women and children both at

Cherbourg and when sending them to Kingaroy, and they could give the women and

children medication without negotiating with the men or giving them information. In

addition, residents often experienced problems getting good or understandable

information as to what had happened to their family members who had died in the

hospital, an issue that played deeply on people’s minds and fed their fears about the

power that staff had over them.

The residents resented visiting in-workers, such as social welfare workers and

nurses,xlvii who were paid well to do jobs that many community people did for free on a

daily basis. Race relations also figured in these ruminations as residents described how

white workers would not give Murris lifts in their cars, lend out money in times of need,

invite them to their homes, attend social events at Cherbourg, have a drink with them, or

otherwise engage socially. Residents felt that workers were oblivious to the living

conditions that contributed to illnesses and so lacked empathy towards them. Further,

residents felt patronised by some staff who did not take the time to listen, and described

17

an attitude by some hospital staff of condescension, as if they were doing them a favour

rather than providing a paid service.

During 1995, the visit of a medical specialist to Cherbourg Hospital saw an influx of

white patients, presumably referred by their general practitioners for the specialist's rare

rural visit. Murri health workers and patients alike felt frustrated that they were crowded

out with white patients on their health budget and time. But they were outraged when

tea and biscuits were served to the waiting white crowd, a courtesy never extended to

Murri patients.

From my observations during the fieldwork many people at Cherbourg refused to go to

the hospital at all and, as a result, often became extremely ill. This was because they did

not want to enter an arena where they felt afraid to challenge non-Aboriginal doctors

and nurses, and feared the things they might do and say to them. When residents did

access services, usually at a point of emergency or crisis, the experience was frequently

a source of embarrassment, confusion, fear and misunderstandings on all sides. This

was as much about race relations as cultural differences: health services are generally

controlled by governments that oppress Aboriginal people, and some hospital personnel

allowed their fear and negative judgments to figure prominently in their clinical

decision making, as demonstrated in the following.

‘Are you a drinker too love?’

The assumptions made by health professionals about Aboriginal people’s use of alcohol

contribute to high levels of morbidity through misdiagnosis and/or alienation of people

from the hospital. That is, there is a demonstrable relationship between race relations

18

and morbidity, and alcohol has become thoroughly implicated in the dialectic of this

relationship.

In a staff development activity with the author, staff complained that they had no

psychiatric, or drug and alcohol training and spoke of the illnesses and injuries that

brought Murris to the hospital as ‘self-inflicted’ (related to alcohol and interpersonal

violence). They freely admitted to being totally fed up with attending to injuries and

illnesses of this nature. Even more insidious and dangerous, however, was the fact that

many nurses operated with the assumption that all people at Cherbourg drink, and do so

to excess. Scores of people told me stories of going to the hospital and being insulted by

this stereotyping. Here are some examples.

A local woman took a friend to Cherbourg Hospital in 1996. The pair had the usual long

wait, only to be told that ‘the doctor was on his break’. After about an hour, they called

the nurse and asked when the woman would be seen. The nurse said to the

accompanying woman, ‘are you a drinker too love?’ The woman asked the relevance of

the question and pointed out that neither she, nor her friend, drank alcohol and that their

presentation at the hospital had nothing to do with alcohol. She complained about the

length of time they had been waiting. The nurse’s response was, ‘well piss off then!’

Another example in 1999 involved a thirty-eight-year-old schoolteacher, who, at around

three in the morning, went to the hospital with severe abdominal pains. Although she is

a non-drinker, her partner, who had been drinking, accompanied her. When the nurses

saw the couple they refused to let them into the hospital and said they should come back

in the morning. It eventuated that she had an ectopic pregnancy, a potentially life-

threatening condition, for which she was refused service solely on the basis of staff

assumptions about alcohol use and users.xlviii

19

There were undoubtedly some very dedicated nurses and doctors at the hospital but, as

demonstrated by the two deaths involving the hospital with which I open this paper,

apathy and fear, as well as assumptions about drunkenness and violence, can be fatal

and persist in producing tragic outcomes through time. In 1984 a thirty-year-old man,

Gregory Michael Dunrobin, hung himself in the Cherbourg watch-house—his death was

examined by the Royal Commission into Aboriginal Deaths in Custody (RCIADIC).

Wyvill reported that Dunrobin was admitted four times to the Cherbourg Hospital in the

seven weeks before he died.xlix He had discharged himself several times, but on the

night he died he went to the hospital complaining of ‘noises in the head’ and was

assessed by a nurse as being ‘a nuisance’.

Dunrobin reluctantly left the hospital, was apprehended by the police on the streets,

arrested, and placed in the watch-house where he hanged himself. The RCIADIC

determined the cause of death as suicide. However, from the perspective of some

community people, Dunrobin died of neglect because the alcohol withdrawal syndrome

from which he was suffering was considered by the nurse to be a nuisance, not a

medical emergency, while the police determined it a crime.

Reports such as this from the RCIADIC, produced between 1988 and 1992,l

are the best published accounts of the inter-relationship between the health and criminal

justice systems in Aboriginal Australia. They show that the issues discussed in this

paper extend far beyond Cherbourg. The RCIADIC also examined what happened in

1984 to Charlie Kulla Kulla (Qld) who ‘was ill, in the advanced stages of septic shock

and pneumonia, lying on a trolley in the Coen Hospital, when he was arrested for being

drunk in a public place’.li He was incarcerated and died later in Coen watch-house. His

death was attributed to ‘natural causes’ by the RCIADIC.

20

Conclusion

This paper explored the cumulative impact of medico-legal regimes and sought to

clarify why it is that, although society generally perceives the health and criminal justice

systems as discrete institutions, many Aboriginal people see them as connected

institutions: as institutions that act—in times past and present—to marginalise

Aboriginal people and promote the agenda of the dominant culture through the powerful

agency of medicine and law. The paper shows that the intimate relationship between

moral regulation by police, and notions of health based on European ideals was

consolidated during the eras of protection, segregation and assimilation policies, and

persists in the present through those of self-management and self-determination.

The history of a legislative framework based on race promoted racial stereotyping and

facilitated the removal of people from their country. This removal had enduring and

profound consequences on their health and wellbeing. Legislation also enabled intrusive

scrutiny of people’s personal lives, and the health system and police were central to

these practices. This legislative history drives dynamics that operate today on two fronts

to perpetuate Aboriginal people’s poor overall health status.

Firstly, it produces, as a form of resistance and an expression of fear, the avoidance of

health services and medico-moral regulation that is evident among some of the

residents. I argue that the health system is experienced not merely as a set of

institutions that aims to prevent and cure disease, but as playing a central role in

colonisation and, from an Aboriginal perspective, in the deaths of many loved ones. The

health system lays down moral programs for how people should live their lives, which

21

alienate individuals and negate their social realities and history by equating health with

moral worth.lii

From my experience, Aboriginal people are acutely sensitive to moralising attitudes and

strongly resist attempts to tell them how they should live. Residents’ avoidance of, and

criticism of, health services can be read as commentary on the practices I have

described. Their narratives about hospitals and health services are an attempt to exert

control and extract meaning in relation to contexts where they have experienced

profound powerlessness.

Secondly, a legislative history based on racial constructs informs the attitudes and

actions of many mainstream health staff, who express dominant value systems in their

daily work at health services. Further, the cultural construction of illness constantly

reproduced by the statistical reports of Aboriginal (ill) health, also influences the way

staff think by activating stereotypical ideas about Aboriginal people. I would argue that

the staff’s fearful reactions are related to these stereotypes, and that their subsequent

actions lead to the outcomes I have described. Health policy processes, along with staff

attitudes, consolidate the ideology of ‘wellness as virtue’liii and illness as an indication

of some moral failing. Finally, the on-going involvement of police in health matters

appears to residents as being very similar to what their families experienced in the past.

Thus, this paper demonstrates that it is not innate tendencies within individuals or

cultures that make health difficult to achieve or maintain. Rather, it is conflicting social

and political values resulting in oppressive and inequitable structures and processes.

Improvements in health cannot be achieved by more or better health services,

particularly if people refuse to access them or do so only in the advanced stages of an

illness. The unfinished business between Aboriginal people and the Australian state, in

22

terms of acknowledgment and reparation for the past, leaves many in an undeclared

state of war that impacts on health not only in terms of service access, but also in terms

of employment, education, housing and high incarceration rates.

In short, health and illness occur in a complex interrelationship of biological,

environmental, cultural and social factors that have historical, political, economic, and

spiritual dimensions. Each new generation carries the burden of history and many feel a

sense of exclusion from society. As a result they carry feelings of fear, mistrust,

disappointment and resentment toward state institutions, including the health system.

These feelings are reinforced by continuing trauma experienced as part of their

interactions with hospitals, and with the police, such as was experienced on Palm Island

around the death of Mulrunji Doomadgeeliv and many others like it. Disappointments

are reinforced by failures of social justice from Land Rights and Native Title,lv and the

lack of practical outcomes from high-profile processes such as the RCIADIC, the

National Inquiry into the Removal of Aboriginal Children from their Families,lvi and the

first (1989) National Aboriginal Health Strategylvii.

Despite the good grace with which Aboriginal people initiate or participate in one after

another of these processes, the result is rarely a concrete generalised improvement for

their families and communities and leave many burnt-out and apathetic about the next

‘whitefella solution’ to come along.

Indeed the next ‘whitefella solution’ came along as this paper was being finalised. In

June 2007, the Howard Government announced, dramatically, that police and the army

would ensure ‘compulsory health checks’lviii to address violence and child sexual abuse

in Aboriginal communities in the Northern Territory.lix The government’s sudden

declaration of a ‘national emergency’ about circumstances that were well known and the

23

subject of various reports and inquiries over decades,lx the linking of health with the

police and the army, the focus on alcohol as the cause of the problems rather than the

result of decades of government neglect, and the opportunistic erosion of Northern

Territory Land Rights, all demonstrate the profound relationship between past and

contemporary processes.

These developments are further evidence, if any was needed, of why establishing trust

between Aboriginal people and government institutions is so challenging, and why

establishing that trust just got that much harder again. This authoritarian approach,

racially based and targeted as always, predictably swerves around the need for political

representation, jobs, economic opportunities, education, resources, capacity building,

and the establishment of sufficient conditions for the development and maintenance of

health and wellbeing.

,

i Aboriginal people in this region refer to themselves generically as Murris. The majority of the residents identified as Aboriginal although a few also identified as Torres Strait Islander. In this paper, however, I will be dealing solely with the situation of Aboriginal people. ii Frantz Fanon, A Dying Colonialism: Freedom for Algeria (London: Writers and Readers Publishing Cooperative, 1980), 99.

iii David Cooper, The Death of the Family, (Ringwood Vic., Pelican Books, 1972), 138. iv There is an indisputable dialectic between these social indicators and poor health. However, here I focus on other contributing factors. v Alfred Schutz, “Some Structures of the Lifeworld,” Phenomenology and Sociology, edited by T. Luckmann (Harmondsworth UK and New York: Penguin Books, 1978), 257–74. vi Also, I was invited by the then Director of Nursing to speak with the nursing team about cultural awareness issues which I did in partnership with a community member. I was also invited by an Aboriginal leader of the time to accompany her to speak to the Director of Nursing about community concerns. vii Rosalind Kidd, The Way We Civilise (Brisbane: University of Queensland Press, 1997), 81. viii Annabelle McDonald, “Hospital fails second dying woman," The Australian, 21 July 2006. ix Health Quality and Complaints Commission, Public Report: An Investigation into the Quality of Health Services in the Cherbourg Aboriginal Community (Brisbane: Health Quality and Complaints Commission, 2007), 13. x Ibid. xi A Health Quality and Complaints Commission investigation instigated by the Cherbourg Aboriginal Council reported that in both cases the actions of the staff were

24

consistent with the South Burnett Health Service District policy, in the first case regarding security, and in the second case regarding transport of outpatients. However, the intercom to the hospital was faulty. No adverse inference was to be drawn about hospital staff (Health Quality and Complaints Commission, 4, 6). The report went on to say that the in the case of the twenty-five-year-old that the staff had little local knowledge and cultural awareness, 16. In the second case, it said the policy contradicted the Cultural Respect Framework 2004–09, 22. xii Raymond Evans, Kaye Saunders and Kathryn Cronin, Exclusion, Exploitation and Extermination: Race Relations in Colonial Queensland (Sydney: Australian and New Zealand Book Company, 1975); Leonie Cox, “Freeloadin’ for tea, freeloadin’ for children, freeloadin’ for tribe: Bureaucratic apartheid and the post-colonial condition” (PhD thesis, The University of Sydney, 2000). xiii R. Evans and J. Walker, “These Strangers Where Are They Going? Aboriginal-European Relations in the Fraser Island and Wide Bay Region 1770–1905,” Occasional Papers in Anthropology (Brisbane: Anthropological Museum, The University Of Queensland, 1977), 63. xiv Barry Morris, Domesticating Resistance: The Dhan-Gadi Aborigines and the Australian State (New York, Berg Publishers Ltd., 1989); Heather Goodall, Invasion to Embassy: Land in Aboriginal Politics in New South Wales 1770–1972 (Sydney: Allen & Unwin in association with Black Books, 1996). xv Evans and Walker, 64. xvi Ibid., 66. xvii Ibid., 73. xviii Raymond Evans, Kaye Saunders and Kathryn Cronin, Exclusion, Exploitation and Extermination: Race Relations in Colonial Queensland (Sydney: Australian and New Zealand Book Company, 1975), 101; Ernest Hunter, Aboriginal Health and History: Power and Prejudice in Remote Australia (Melbourne and New York, Cambridge University Press, 1993), 58–68, describes the Kimberley ‘lock hospitals’ and the legislations that segregated Aboriginal people with ‘stigmatized contagions’ such as leprosy and venereal diseases. xix Charles D. Rowley, The Destruction of Aboriginal Society (Ringwood ,Vic., Pelican Books, 1972a), 183. xx The name of the settlement was changed to Cherbourg Aboriginal Settlement in the 1930s to prevent confusion between it and the nearby Barambah cattle station from which it had been excised. xxi Department of Aboriginal and Islander Advancement, Barambah Cherbourg (Cherbourg, WA, 75th Anniversary Committee, unpublished manuscript, 1979), 4. xxii Thom Blake, “A Dumping Ground—Barambah Aboriginal Settlement 1900–1940” (PhD thesis, The University of Queensland, 1991), 86. xxiii Refers to a model prison design where an observer can observe all inmates without being seen. xxiv Another reserve to the North. xxv Stuart Rintoul, The Wailing: A National Black Oral History (Melbourne: William Heinemann, 1993), 197–200. xxvi See Russell McGregor, Imagined Destinies: Aboriginal Australians and the Doomed Race Theory, 1880–1939 (Melbourne: Melbourne University Press, 1997). xxvii Matt Foley, “The Aborigines Act 1971–Ten Years After,” paper presented to Queensland Council of Civil Liberties Seminar on Civil Rights for Black Queenslanders on 24 October 1981 (University of Queensland Fryer Library 241, E. A. and E. Bacon Collection Box 10), 1. xxviii See, I. Public Acts of the Parliament of Queensland 25 GeorgII v Aboriginal Industries Board, The Aboriginals Protection and Restriction of the Sale of Opium Acts Amendment Act 1934, Part 2, Amendments of the Principal Act, Section B, items i–iii. Accessed on 21 August 2007 at http://www1.aiatsis.gov.au/exhibitions/legislations/pdfs/qld/vn2780180-8x_a.pdf. xxix Kidd, 138–139, emphasis added. xxx Blake, 148.

xxxi By tripartite system, I mean initial removal from country to reserve, between the various reserves, from camp to dormitories and within dormitories. Women with children under school age, big girls, little girls, and boys were all housed in different dormitories. When children reached school age they were taken from their dormitory dwelling mothers and placed in the children's dormitories. At age 13, little girls were

25

,

then moved again to the big girls’ dormitory (Ruth Hegarty, Is That You Ruthie? [Brisbane: University of Queensland Press, 1999]; Cox 2000). xxxii A town about fifteen km to the southeast. xxxiii Charles D. Rowley, The Remote Aborigines (Ringwood, Vic., Pelican Books, 1972b), 227; Foley, 2. xxxiv Gerard Guthrie, “Authority at Cherbourg,” Occasional Papers in Anthropology (Brisbane: Anthropological Museum, The University of Queensland, 1976), 2; see also Charles D. Rowley, Outcasts in White Australia (Canberra, Australian National University Press, 1973), 109–112. xxxv Kidd, 147. xxxvi A. P. Elkin, Field Notes September 1945, Series 0004, Field Notebooks and other Research Material Relating to Aboriginal Tribes in Queensland 1895–1976, Items 1–3, Field Note Books, The University of Sydney Archives. xxxvii Rowley 1972b, 41. xxxviii Ibid., 123; see also Kidd, 141–2, where she notes that in Queensland, Protector Bleakley was strongly opposed to federal ideas of assimilation that rested on eliminating Aboriginal people by interbreeding with whites. Bleakley’s assimilation policy aimed to train Aboriginal people to be whites by socialisation. He said the interbreeding policy couldn’t work since only ‘low-whites’ would go into such relationships. xxxix Hegarty, 24–28. xl Ibid., 27 xli Ibid., 25. xlii Kidd, 266. xliii Rowley 1972b, 115–6. xliv Hope Neill, “Aboriginal Spirituality,” in Women of Spirit: Contemporary Religious Leaders in Australia, edited by Deborah Selway (Melbourne: Longman Australia, 1995), 7. xlv Rowley 1973, 109. xlvi A. K. Eckermann, T. Dowd, E. Chong, L. Nixon, R. Gray, S. Johnson, Binan Goonj: Bridging Cultures in Aboriginal Health (Marrickville, NSW: Elsevier Australia, 2006), 168. xlvii In-workers are usually non-Aboriginal and come in each day to work. xlviii See also Leonie Cox, “Stigma? Racism? Use Your Commonsense Girl: Moral Perception in the Social Field and the Expression of Value Systems in Everyday Life,” (B.A. honours thesis, The University of Sydney, 1993). xlix L. F. Wyvill, Report Of The Inquiry Into The Death Of Gregory Michael Dunrobin (Canberra: Australian Government Publishing Service, 1990), 3, 8–11. l The RCIADIC produced ninety-nine reports of individual deaths along with the national and regional reports; for example, L. F. Wyvill, Regional Report of Inquiry In Queensland (Canberra, Australian Government Publishing Service, 1991). li L. F. Wyvill, Regional Report of Inquiry in Queensland, Royal Commission into Aboriginal Deaths in Custody (Canberra: Australian Government Printing Service, Canberra, 1991), 20. lii cf. Ian Anderson, ‘The ethics of the allocation of health resources’, in G. Cowlishaw and B. Morris, (eds), Race Matters: Indigenous Australians and 'Our Society', Aboriginal Studies Press, Canberra, 1997, 191–208; Peter Conrad, ‘Wellness as Virtue: Morality and the Pursuit of Health’, Culture, Medicine and Psychiatry, vol. 18, no. 31994, 385–399. liii Conrad, 1994. liv Thirty-six-year-old Mulrunji Doomadgee died in the Palm Island police watch house on 19 November 2004 after being arrested by Senior Sergeant Christopher Hurley. Doomadgee was drunk and singing on the street. Initial investigations were highly compromised and carried out by a detective and a police officer who were friends of Hurley and who had dismissed other complaints by Palm Island residents about him. The investigation officers didn’t secure the scene and had off-the-record talks with Hurley. Six days after Doomadgee’s death, the investigation was taken over by the Crime and Misconduct Commission, which released the autopsy report saying that the deceased had four broken ribs and a ruptured liver. It was at this point that the Palm Island community reacted against the suggestion that his death was accidental by burning town the police station and police

26

houses. An independent witness said they saw Hurley punch Doomadgee to the ground and say “Do you want more”? (See Tony Koch and Michael McKenna, 20 December 2006 ‘Friends of police officer led Doomadgee probe’ http://www.news.com.au/story/0,10117,20955075-2,00.html?from=public_rss accessed 31.8.07). In September 2006, Deputy State Coroner Christine Clements found that Senior Sergeant Chris Hurley had hit Mulrunji and caused his fatal injuries at the Palm Island police station. But three months later the Queensland Director of Public Prosecutions said that no charges would be laid. Eventually Queensland’s Attorney General announced that Justice Street would lead an independent enquiry process. On Australia Day 2007 Justice Street determined that Hurley should face a charge of manslaughter. It was the first time that a police officer had ever faced a court over an Aboriginal person’s death in custody. A jury acquitted Hurley of any wrong doing and he remains in the Queensland Police Service. (See National Council of Churches Death in Custody Doomadgee Mulrunji available at http://www.ncca.org.au/natsiec/issues/deaths_in_custody accessed 31.8.07 Mulrunji’s death is one of a long line of Aboriginal deaths in custody that continue since the conclusion of the Royal Commission into Aboriginal Deaths in Custody in the early 1990s. lv Land Rights and Native Title are processes that seek to restore Aboriginal and Torres Strait Islander economic, cultural and political rights in their land however they have not benefited the majority of Aboriginal people. These processes are meant to be more than symbolic and it was hoped that they could deliver social justice in the form of a sustainable economic and cultural base for Aboriginal people and Torres Strait Islanders. However the Native Title Report 2005 shows that economic development has been limited. It expressed concerns that: ‘… individual lease options will not improve economic and social outcomes on Indigenous land. While land that is Indigenous-owned, controlled or set aside for the use of Indigenous peoples comprises approximately 16 percent of the area of Australia, the bulk of it is very remotely located and lacking the most basic infrastructure’. (Human Rights and Equal Opportunity Commission Community Guide to the Social Justice and Native Title Reports 2005 available at http://www.hreoc.gov.au/social_justice/sj_report/sjreport05/communityguide2005.html#land accessed 31.8.2007. lvi Sir Ronald Darling Wilson, Bringing Them Home: Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families, (Sydney: Human Rights and Equal Opportunity Commission, 1997). lvii National Aboriginal Health Strategy Working Party, A National Aboriginal Health Strategy, (Canberra, NAHSWP, 1989). lviii See The Hon Mal Brough MP, Media Releases, National Emergency Response to protect Aboriginal children in the NT, 21/06/2007 available at http://www.facsia.gov.au/internet/Minister3.nsf/content/emergency_21june07.htm accessed 31.8.07. lix There has been no recognition by media or government commentators that child sexual assault is a significant problem in Australian society generally. The perpetuation of the stereotype that all Aboriginal people abuse and/or neglect their children by the assertion that all Aboriginal children in the Northern Territory would be compulsorily checked for sexual assault is a profound insult. Although the government has backed away from this early zealotry in more recent detail of what will actually happen, it does not take away from the fact that the Howard Government failed to see that compulsory health checks would be so physically, psychologically and culturally invasive as to constitute in themselves a form of violent assault. lx Bonnie Robertson 2000, The Aboriginal and Torres Strait Islander Women’s Task force on Violence Report, Queensland Department of Aboriginal and Torres Strait Islander Policy and Development, Brisbane, 2000; S. Gordon, K. Hallahan, D. Henry, Putting the Picture Together: Inquiry into Response by Government Agencies to Complaints of Family Violence and Child Abuse in Aboriginal Communities, Department of Premier and Cabinet, Western Australia, 2002; Breaking the Silence: Creating the Future: Addressing child sexual assault in Aboriginal communities in NSW/Aboriginal Child Sexual Assault Taskforce, Attorney General’s Department NSW, 2006.