Leonie Cox

Fear, Trust and Aborigines: The Historical Experience of State Institutions and Current Encounters in the Health System

Troubled dynamics between residents of an Aboriginal town in Queensland and the local health system were established during colonisation and consolidated during those periods of Australian history where the policies of 'protection' (segregation), integration and then assimilation held sway. 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. 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 explores current residents' memories and experiences.

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 authorities.¹

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,² 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.³

The methodology was grounded in phenomenology focusing on the world of everyday experience and on how people explained their situation to themselves.⁴ 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.⁵ 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 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.⁶

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 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.⁷

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].'⁸ 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.'⁹ It is almost inconceivable that an ambulance was not called.¹⁰

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.¹¹ 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 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'.¹² 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.¹³

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.'¹⁴ Further, a public meeting in Maryborough in the same year, suggested that the newly formed 1863 Vagrant Act Amendment be used to send monthly 'as many [Aborigines] as would fill Brisbane gaol.'¹⁵

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.'¹⁶ 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.'¹⁷

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 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.¹⁸

Cherbourg began under these arrangements as the Barambah Aboriginal Settlement in 1901.¹⁹ 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.²⁰ A matron and a teacher were among the first appointees along with the superintendent and his assistant.²¹

These new humanitarian notions of policing entailed a panopticon-like²² 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 Woorabinda²³ in 1935 for back-answering an old nurse ... you couldn't back answer a white person in those days.²⁴

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, thereby firmly placing the health services in a domain of white control.

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)²⁵ 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,²⁶ 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 Act²⁷ 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.²⁸

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 children aged between five and fourteen.²⁹ 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.³⁰

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 Goomeri³¹ ... 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.

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.³² 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.'³³ It delegated ministerial powers to the Director of Native Affairs and all removals, exemption certificates and 'moral offences' came under his jurisdiction.³⁴

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.'³⁵

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 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".'³⁶ Therefore, at Cherbourg as elsewhere, the authorities saw assimilation 'as a simple matter of training.'³⁷ 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 describes³⁸, 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',³⁹ 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 matron was something to be feared. My mother had seen what happened to those who spoke out against the system.'⁴⁰ 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.⁴¹ 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.⁴²

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 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 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.'⁴³ 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.⁴⁴ 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 defence, avoidance and subversion, both practical and psychic. These techniques at the present time take the 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.⁴⁵

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 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 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,⁴⁶ 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 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 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.⁴⁷

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.⁴⁸ 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 1992,⁴⁹ 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.'⁵⁰ He was incarcerated and died later in Coen watch-house. His death was attributed to 'natural causes' by the RCIADIC.

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 alienate individuals and negate their social realities and history by equating health with moral worth.⁵¹

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'⁵² 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 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 Doomadgee⁵³ and many others like it. Disappointments are reinforced by failures of social justice from Land Rights and Native Title,⁵⁴ 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,⁵⁵ and the first (1989) National Aboriginal Health Strategy.⁵⁶

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'⁵⁷ to address violence and child sexual abuse in Aboriginal communities in the Northern Territory.⁵⁸ The government's sudden declaration of a 'national emergency' about circumstances that were well known and the subject of various reports and inquiries over decades,⁵⁹ 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.

Queensland University of Technology

Acknowledgments

I would like to offer my profound thanks to the residents of the Cherbourg community for sharing their lives and stories with me. I would also like to acknowledge the Carlyle-Greenwell Bequest Fund, Department of Anthropology, University of Sydney and the Australian Institute of Aboriginal and Torres Strait Islander Studies for their generous financial support of the fieldwork.

Notes

^1. Frantz Fanon, A Dying Colonialism: Freedom for Algeria (London: Writers and Readers Publishing Cooperative, 1980), 99.

^2. David Cooper, The Death of the Family (Ringwood, Vic.: Pelican Books, 1972), 138.

^3. There is an indisputable dialectic between these social indicators and poor health. However, here I focus on other contributing factors.

^4. Alfred Schutz, "Some Structures of the Lifeworld," in Phenomenology and Sociology, edited by T. Luckmann (Harmondsworth, UK, and New York: Penguin Books, 1978), 257–74.

^5. 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.

^6. Rosalind Kidd, The Way We Civilise (Brisbane, Qld: University of Queensland Press, 1997), 81.

^7. Annabelle McDonald, "Hospital fails second dying woman," The Australian, 21 July 2006.

^8. Health Quality and Complaints Commission, Public Report: An Investigation into the Quality of Health Services in the Cherbourg Aboriginal Community (Brisbane, Qld: Health Quality and Complaints Commission, 2007), 13.

^9.Ibid.

^10. A Health Quality and Complaints Commission investigation instigated by the Cherbourg Aboriginal Council reported that in both cases the actions of the staff were 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.

^11. Raymond Evans, Kaye Saunders and Kathryn Cronin, Exclusion, Exploitation and Extermination: Race Relations in Colonial Queensland (Sydney, NSW: 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, University of Sydney, 2000).

^12. 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, Qld: Anthropological Museum, University of Queensland, 1977), 63.

^13. Barry Morris, Domesticating Resistance: The Dhan-Gadi Aborigines and the Australian State (New York: Berg Publishers, 1989); Heather Goodall, Invasion to Embassy: Land in Aboriginal Politics in New South Wales 1770–1972 (Sydney, NSW: Allen & Unwin in association with Black Books, 1996).

^14. Evans and Walker, 64.

^15.Ibid., 66.

^16.Ibid., 73.

^17. Evans, Saunders and Cronin, 101; Ernest Hunter, Aboriginal Health and History: Power and Prejudice in Remote Australia (Melbourne, Vic. 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.

^18. Charles D. Rowley, The Destruction of Aboriginal Society (Ringwood, Vic.: Pelican Books, 1972), 183.

^19. 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.

^20. Department of Aboriginal and Islander Advancement, Barambah Cherbourg (Cherbourg, WA: 75th Anniversary Committee, unpublished manuscript, 1979), 4.

^21. Thom Blake, "A Dumping Ground—Barambah Aboriginal Settlement 1900–1940" (PhD thesis, University of Queensland, 1991), 86.

^22. Refers to a model prison design where an observer can observe all inmates without being seen.

^23. Another reserve to the north.

^24. Stuart Rintoul, The Wailing: A National Black Oral History (Melbourne, Vic.: William Heinemann, 1993), 197–200.

^25. See Russell McGregor, Imagined Destinies: Aboriginal Australians and the Doomed Race Theory, 1880–1939 (Melbourne, Vic.: Melbourne University Press, 1997).

^26. 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.

^27. See, I. Public Acts of the Parliament of Queensland 25 George 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. Available at http://www1.aiatsis.gov.au/exhibitions/legislations/pdfs/qld/vn2780180-8x_a.pdf (accessed on 21 August 2007).

^28. Kidd, 138–139, emphasis added.

^29. Blake, 148.

^30. 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 then moved again to the big girls' dormitory (Ruth Hegarty, Is That You Ruthie? [Brisbane, Qld: University of Queensland Press, 1999]; Cox 2000).

^31. A town about fifteen km to the southeast.

^32. Charles D. Rowley, The Remote Aborigines (Ringwood, Vic.: Pelican Books, 1972b), 227; Foley, 2.

^33. Gerard Guthrie, "Authority at Cherbourg," Occasional Papers in Anthropology (Brisbane, Qld: Anthropological Museum, University of Queensland, 1976), 2; see also Charles D. Rowley, Outcasts in White Australia (Canberra, ACT: Australian National University Press, 1973), 109–112.

^34. Kidd, 147.

^35. 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, University of Sydney Archives.

^36.Rowley 1972b, 41.

^37.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.

^38. Hegarty, 24–28.

^39.Ibid., 27

^40.Ibid., 25.

^41. Kidd, 266.

^42. Rowley 1972b, 115–6.

^43. Hope Neill, "Aboriginal Spirituality," in Women of Spirit: Contemporary Religious Leaders in Australia, edited by Deborah Selway (Melbourne, Vic.: Longman Australia, 1995), 7.

^44. Rowley 1973, 109.

^45. A. K. Eckermann, T. Dowd, E. Chong, L. Nixon, R. Gray, S. Johnson, Binan Goonj: Bridging Cultures in Aboriginal Health (Sydney, NSW: Elsevier Australia, 2006), 168.

^46. In-workers are usually non-Aboriginal and come in each day to work.

^47. 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, University of Sydney, 1993).

^48. L. F. Wyvill, Report Of The Inquiry Into The Death Of Gregory Michael Dunrobin (Canberra, ACT: Australian Government Publishing Service, 1990), 3, 8–11.

^49. 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, ACT: Australian Government Publishing Service, 1991).

^50. L. F. Wyvill, Regional Report of Inquiry in Queensland, Royal Commission into Aboriginal Deaths in Custody (Canberra, ACT: Australian Government Printing Service, 1991), 20.

^51. cf. Ian Anderson, 'The ethics of the allocation of health resources', in Race Matters: Indigenous Australians and 'Our Society', edited by Gillian Cowlishaw and Barry Morris (Canberra, ACT: Aboriginal Studies Press, 1997), 191–208; Peter Conrad, "Wellness as Virtue: Morality and the Pursuit of Health," Culture, Medicine and Psychiatry, vol. 18, no. 3, (1994), 385–399.

^52. Conrad, 1994.

^53. 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 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" at http://www.news.com.au/story/0,10117,20955075-2,00.html?from=public_rss [accessed 31 August 2007]). 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. 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 wrongdoing 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 August 2007)). 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.

^54. 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. 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 August 2007).

^55. 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, NSW: Human Rights and Equal Opportunity Commission, 1997).

^56. National Aboriginal Health Strategy Working Party, A National Aboriginal Health Strategy (Canberra, ACT: NAHSWP, 1989).

^57. See The Hon Mal Brough MP, Media Releases, National emergency response to protect Aboriginal children in the NT, 21 June 2007 available at http://www.facsia.gov.au/internet/Minister3.nsf/content/emergency_21june07.htm (accessed 31 August 2007).

^58. 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.

^59. Bonnie Robertson, The Aboriginal and Torres Strait Islander Women's Task force on Violence Report (Brisbane, Qld: Queensland Department of Aboriginal and Torres Strait Islander Policy and Development, 2000); Sue Gordon, Kay Hallahan, Darrell Henry, Putting the Picture Together: Inquiry into Response by Government Agencies to Complaints of Family Violence and Child Abuse in Aboriginal Communities (Perth, WA: Department of Premier and Cabinet, Western Australia, 2002); Aboriginal Child Sexual Assault Taskforce, Breaking the Silence: Creating the Future: Addressing Child Sexual Assault in Aboriginal Communities in NSW (Sydney, NSW: Attorney General's Department NSW, 2006).

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