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When I first looked at a map of Alice Springs, the ephemeral Todd River was marked as a deceptive blue snake, winding its way through the centre of town. For the local Arrernte people, the river is known as Lhere Mparntwe.
In my head, I pictured a desert oasis, brown-skinned children gleaming with sun and water, screaming with glee as they plunged from rope swings into the cool river water. The rest of the time it is just a dusty creek bed, filled with the soft rusty sand that has now found its way into almost every item that I own.
The analogy of the river is used to describe how pre-existing social, cultural, financial, environmental and historical factors ultimately go on to influence health outcomes in a profound way.
The nurses exasperatedly chase a young boy down the corridor. This pint-sized patient is surprisingly speedy as he makes his naked bid for freedom. A happy little boy and exceptionally cute, this child has quickly become a favourite of mine. His small body has been bombarded with every antibacterial, antifungal and antiparasitic agent we have. In the treatment room Bananas in Pyjamas is playing. The room is crowded. In between the paediatrician, two nurses, the surgical registrar, mum and a writhing, screaming patient, there are bubbles.
So many bubbles. They will require an operation to drain them. She too has been with us for a week already. Her kidneys are struggling, after her body mounted an autoimmune reaction to the streptococcal infection from the boils. We closely monitor her weight and blood pressure until her kidneys are out of the woods.
The diabetes educator and paediatrician discuss a year-old girl, who has just been diagnosed with type 2 diabetes mellitus. Already she weighs over kg. Her case being outside the realm of conventional paediatric practice, the paediatrician is seeking advice on the best management plan Boat Upstream And Downstream Formula Free for this patient.
One of the challenges of managing type 2 diabetes in an adolescent is the general lack of evidence to inform practice. The evidence to inform the management of type 2 diabetes in an Indigenous child is virtually non-existent. At the hospital, we are so far downstream that we are practically out to sea. It is grossly inadequate when almost everything that we see is preventable. How is it then, in a wealthy nation like Australia which boasts a universal health system that is arguably one of the best in the world, that the life expectancy of Indigenous Australians is still at a conservative estimate 10�17 years less than their non-Indigenous counterparts?
Why do the babies of Aboriginal mothers die at more than twice the rate of non-Aboriginal mothers? Why are so many remote communities still plagued by poor hygiene, overcrowding and dysfunctional living conditions, condemning their inhabitants to lifelong chronic disease? The instinct of many is to blame the individual. I know that I am often tempted to do so, especially when you see children who are suffering. However, blaming or inducing guilt is counterproductive. It does not help anyone.
If anything, it alienates and denigrates. It is too simplistic. To do so ignores the fact that every individual is a member of a community and is shaped by that community, his or her environment, education, and a personal and collective history. To date, many health promotion programs have made a grossly inaccurate assumption that health education will automatically translate to behaviour change.
Does knowledge alone empower me to change my behaviour? Sometimes it can, but only when the environment allows. There is no strategic plan or coordination between services to promote hygiene improvement in remote communities. Public servants in air-conditioned offices write hygiene promotion strategies that fail to address the functional state of housing infrastructure and the unique environmental conditions of remote communities.
Obesity and micronutrient deficiency in remote communities is a direct result of food insecurity caused by low incomes and the high price of fresh, nutritious food. This is unlikely to ever be overcome as long as local stores often the sole providers of food in remote communities continue to Upstream And Downstream Questions Linear Equations Group be viewed as a small business, rather than an essential service such as health or education. Government departments are often only as far apart as a different floor in the same building, yet the level of communication and collaboration between departments would suggest there is in fact a chasm between them.
Good health is not made in hospitals. Good health is made by the food we eat, the water we drink, by feeling safe, secure, loved and connected.
It is the roof over our heads, our sense of purpose in the world. Education is not just power, but health too. It is health, not illness that I am passionate about.
I need to be further upstream. Maybe I need to see the Todd River flow. Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted. Basic Search Advanced search search. Use the Advanced search for more specific terms. Title contains. Body contains. Date range from. Date range to.
Article type. Author's surname. First page. Issues by year. Article types. Research letters. Guidelines and statements. Narrative reviews. Ethics and law. Medical education. Volume Issue Victoria C Smith.
Med J Aust ; 10 : Topics Global health. Social determinants of health. Environment and public health. Pediatric medicine. Indigenous health. The river analogy helps describe the health continuum from prevention to treatment Winner � Medical student category.
View this article on Wiley Online Library. Competing interests:. Taylor K, Guerin P. Healthcare and Indigenous Australians: cultural safety in practice. South Yarra: Palgrave MacMillan, McDonald E, Bailie R. Hygiene improvement: essential to improving child health in remote Aboriginal communities.
J Paediatr Child Health ; Improving Aboriginal and Torres Strait Islander nutrition and health. Med J Aust ; Indigenous health part 2: the underlying causes of the health gap. Lancet ; First Name. Middle Name. Last Name. Do you have any competing interests to declare? Yes Competing interests. Email me when people comment on this article. Online responses are no longer available. Please refer to our instructions Boat Upstream And Downstream Formula Vba for authors page for more information.
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