A couple of days ago in Hermannsburg the Prime Minister made it “very clear” to the community that the Government has a simple aim; “and that is whilst respecting the special place of indigenous people in the history and the life of this country, their future can only be as part of the mainstream of the Australian community,” he said. “Unless they can get a share of the bounty of this great and prosperous country, their future will be bleak.”

But the road to the mainstream seems extremely fraught in a township like Maningrida.

Two days ago, the Indigenous Child Health Check (CHC) team rolled into Maningrida, a township of about 2800 Aboriginal people (and 200 non-Aboriginal people) from 13 language communities including Ndjebenna and Kunibeidji spoken by the local traditional owners as well as speakers of Kunbarlang, Kuninjku, Kune, Dalabon, Rembarrnga, Djinang, Wulaki, Burrarra (in three dialects), Nakkara, Gunartpa and Gurrgoni. This is a linguistically diverse and culturally rich community and this diversity extends to art styles, ceremonies and ways of life.

The CHC was clearly briefed about this cultural complexity because they wrote to the local community-based health board seeking the services of Indigenous Community Liaison Officers (ICLOs) to assist the CHC team. The role of ICLOs is to introduce the CHC team to the community, assist communication and assist with interpreting for the CHC team, including explanation of informed consent.

These are all complex and necessary tasks. But none of this is reflected in the proposed pay — the multilingual and highly skilled individuals in this remote Indigenous community are being asked to provide their unique linguistic expertise for a paltry $100 a day.

To understand their role ICLOs are required to be familiar and understand a rather complex eight page document that provides key information on the Aboriginal and Torres Strait Islander Child Health Check (Medicare Item 708) developed last year well before the ‘national emergency’. And the NT Emergency Coordination Centre believes that after an initial period the duties of ICLOs would decrease and they would only be required on an ‘on call’ basis.

This all sounds quite reasonable, except that the Commonwealth Department of Health and Ageing is only proposing to pay ICLOs $100 per day to an overall maximum of $1500 per person. It’s unclear if ICLOs will need to sign an AWA, but while hours are not specified, this represents between $12.50 and $14.30 per hour depending on whether ICLOs are expected to work 7 or 8 hour days.

Try and hire a labourer for that hourly rate! It may not have occurred to the Department of Health and Ageing, but the minimum award rates for interpreters is about four times this rate, even if they happen to be Indigenous. The $100 a day is insulting and could unkindly be compared to the daily rates including generous allowances paid to the visiting CHC team members including ‘volunteers’. Or to the fee for each Medicare Item 708 Aboriginal and Torres Strait Islander Health Check of $167.40.

Two days into a visit scheduled for 30 days, the CHC team has yet to complete a child health inspection. Possibly frustrated at the lack of uptake in Maningrida township, attention has shifted to the children at about 35 small outstation communities in the hinterland.

But these outstations are not prescribed communities. A proposal was floated to use army vehicles to truck in children for health checks, except that this is counter to regulations. So local organizations were asked to provide vehicles (there is no vehicle hire company in Maningrida) and apparently these might be provided at commercial rates. If the CHC team is struggling in the township, it’s unclear why they expect more of an uptake in the bush?

Predictably, the arrival of CHC teams with Norforce support is placing additional strain on community housing and infrastructure. One obvious option might have been to use local expertise: the Maningrida Health centre, Health Board and resident GPs to conduct Indigenous CHCs.

The document ‘Key Information on the Aboriginal and Torres Strait Islander Child Health Check (Item 708)’ recommends just such an approach.

The child health check should be undertaken by a patient’s usual doctor. Special ‘emergency’ measures rule appear to override this sensible approach. Instead external doctors and nurses requiring the assistance of ICLOs are used; strangers are trying to work in a sensitive area. Additionally, local Maningrida health infrastructure will be deprived of significant Medicare income of $200,000 plus.

With such remuneration it will take some time before one has saved up the deposit for a private house.

And existing health infrastructure is being bypassed by visiting CHC teams; one would have thought that undertaking health checks cross-culturally would have been much more effectively conducted by local experts.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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