Shadow on Concrete Wall

Birthing Business in the Bush

A Healthy Start to Life Project: Targeting the year before and the year after birth in Aboriginal children in remote areas.

Introduction

This website was prepared by Aboriginal women with Sue Kildea, to be used as a resource for maternity service providers working in remote communities. A participatory action research approach was used to develop the site. The contents are mainly 'Women's Business' and there are some sections that should not be read by men. We knew we could not monitor this once it is available on the Internet and rely on each individuals honesty and integrity to follow these wishes. The Aboriginal women involved in the project were not concerned about this as they said that Aboriginal men would not even try to look if they knew that it was women's business. The women were very happy to think that women all over the world would be able to read their stories, and some women suggested that men could read then too, particularly if they were involved in providing health services to women. Aboriginal communities all vary from each other and the messages here are about one community only. However the local wisdom and experience provides lessons that could be applied universally in many different settings.

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About photo

 

Aims of the website and guide

The overarching aim of this site is to improve the health of women and babies in pregnancy, childbirth and early infancy by assisting maternity service providers to understand issues that are specific to remote area Aboriginal women's business. The project has been led by Aboriginal women with Sue Kildea. Under the section titled 'Your Community' there is a 'Primary Health Care Guide to Birthing Business in Your Community'. This can be printed and used in your community to assist the non-Aboriginal health professionals to work more effectively with their community members.  This guide will assist the health professionals to develop maternity service plans with the local community using a community development approach. Additionally, it is hoped the practitioners will interact more with community members to provide clinical care more effectively. This guide is a part of the participatory action research project and is still being tested for effectiveness and usefulness, it is being updated as it is changed and can be used if you wish.

Service providers who work in remote areas face challenges not present in urban settings. They are isolated from the expertise of others, technical resources and professional support. This in turn effects the recruitment and retention of clinical staff and practitioner satisfaction. Many remote communities have strong cultural systems generating their own health beliefs that conflict with western medical understandings. It is assumed, despite these factors, that these health professionals will be able to move from urban to remote settings and be effective immediately. Many health practitioners are unaware of how their own personal and professional cultures guide their thinking and behaviour, and this inhibits their clinical and social effectiveness in remote Indigenous services. The educational preparation and organisational systems in which health practitioners provide services in remote areas often make it difficult for them to provide care which is socially or culturally appropriate. Training in specific clinical problems, community development and local cultural beliefs is minimal in undergraduate education and rarely have health practitioners been taught how to work in partnership with Indigenous leaders or programs.

These were some of the reasons for developing the website and guide. The inspiration for the project came from a remote area nurse midwife who had worked in remote areas across the top of Australia (Sue Kildea - her story can be read below). She felt as though she had not been well prepared for working in remote areas and wanted to try and make the learning curve for bush nurses and others easier, as well as making their work more effective. Together she worked with the women and health workers from Maningrida and it's outstations; remote area midwives, nurses and doctors; the women's health educators from the Northern Territory; district medical officers; remote support personnel and policy analysts to develop the website and guide. We all hope it helps to make your professional work a little easier and more enjoyable.

How the website and guide were developed

In the beginning we started talking about the project ...

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Sue, Lesley and Jenne talking to Valda about interpreters

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and Helen, a traditional landowner and Health Board Member,

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and talking to Molly about being a researcher with Sue on the project.

Black Water

Team

Phyllis Dungudja

Elizabeth Gandabuma

Deborah Wurrkidj

Molly Wardaguga

The team included Aboriginal women and a non-Aboriginal nurse midwife. The team worked together with women from the Maningrida Community and its outstations in Arnhem Land. The research used a process called participatory action research. The group developed the guidelines and stories that are presented in this guide. 

Molly Wardaguga and Sue Kildea

Dora Daiguma

Margaret Dawumal

Mary Mason

 

Collecting the stories

How we did it

We used participatory action research to gather the information for this project. Click here to view the research plan diagram. We held talks with people to ask them about research and what is the proper way of doing something like this in the community. These are some of their responses:

 

- It is important to talk to all the language groups.

 

- You need to ask around, talk to the people and ask them what is the right thing to do, always ask before you do - you try ask him to see what he say, what is that story. We know that research - we call it - Yimarneyimen Yidjawa wanjh baleh kahyime (Kininjku language)- Tell someone ask them and then see what they say.

 

- You need to talk to the young ones too. The young ones will talk to the older ones about it.

 

- It is important to find out the 'proper story' the 'right story' we call that 'Gun-burral Janguny' (Burarra language), you can only do that by talking around, you have to walk around.

 

- Black people coming together with Balanda - like the blue water 'Jin-gungunyja' that is the black women and the red water 'Jin-gungarlcha' (Burarra language) that is the Balanda women that is what we call Molly and Sue working together - that is the proper way.

 

- Research - we ask them for information, we say 'nyirrbu-wengganacha' (Burarra language).

Working together

Our project

We talked to 52 women overall and many of their stories are documented here. Interpreters (often more than one) were present at many of the interviews. Nineteen of the women did not speak any English and many of the others spoke in a mix of local languages and English. As we showed people the stories and the website more women volunteered to tell their stories and added information to the guide. Unfortunately, due to time constraints of the project, we could not continue to collect all of these stories.

As part of our project, we also created a poster. This poster is available for purchase from the Bawinanga Women's Centre.

Some of the interpreters

Molly Wardaguga

Nancy Gununwanga

Deborah Wurrkidj and Elizabeth Gandabuma

Dora Daiguma

Phyllis Dungudja and granddaughter Kerryantha

Mary Mason and her daughter Kylie

Maningrida

Maningrida is situated at the top of Australia in Arnhem Land on the coast near the Liverpool River roughly half way between Darwin and Nhulunbuy. Today it is one hour's flight from Darwin (300km by air) and approximately five to seven hours drive when the roads are open in the dry season. Maningrida was initially to be established as a Trading Post in 1949, an area not covered by missions. This effort was abandoned until 1957 when it formally became known as a Government Welfare Settlement with the intention of providing trading and medical services to the region.[1] Today Maningrida is one of the largest remote Aboriginal communities in Australia consisting of the town centre and approximately 36 outstation, many of which will be occupied year round.

Map of Maningrida and outstations

In 1957 three non-Aboriginal people arrived by boat to Manayingkarirra on Kunibidji land and they called the town Maningrida. Living in a tent they started to work with the local people. These 'Balanda' (non-Aboriginal) people were Ingrid and David Drysdale and Trevor Millikins.[2] They built a bark hut with a sandy floor, which was to be used by Dr. Hargrave, who arrived in August that year to do a health survey of the area. The major health concerns at that time were leprosy, yaws and tuberculosis.[2] Dr Hargrave championed a new type of treatment for Leprosy which meant that people could be treated in Maningrida rather than be removed from their families and taken to a Leprosarium near Darwin, often for many years. The leprosy camp was set up at one end of the beach and the bark hut was the beginning of the health service that was established for the people in the region.

Languages

There are several very different languages spoken in this region with many dialects (see map produced by Maningrida School below). Many people speak several of these languages and English may be their third or fourth language. Ndjébbana is the language of the Kunibidji people who are the landowners of Maningrida township. The Burarra language is another major language and it is spoken by people to the east of Maningrida and it has several dialects. Also to the east but in smaller numbers are the Na-kara and Gurrgoni languages, further east towards Ramingining (the next town) is the Djinang language and south east is the Rembarrnga language. Southwest of Maningrida is another major language, Kuninjku and due west is Kunbarlang.

Having so many different languages makes it very difficult for non-Aboriginal people to communicate, particularly if you work in an area like health where you must interact with all people. If you concentrate on learning one of these languages then you may be seen to be favouring a particular language group. You would be more effective in your work however, if you were able to speak the language of the person you are seeing at the health centre. This issue is discussed in length in a book by Richard Trudgen, 'Why Warriors Lie Down and Die'.[3]

The old clinic

As described by Molly and Margaret (retired Senior Aboriginal Health Workers [SAHW's] and co-researchers on this project).

The old clinic at Maningrida used to have seven bedrooms on the women's side and seven bedrooms on the men's side, one laundry, one kitchen and one women's room which was used for birthing. We had 12 female nursing assistants (health workers) who took turns to cover the shifts, eight sisters, two male nurses and one orderly (Jimmy). We used to take turns to look after everyone during the night and day. The clinic was running well then. The leprosy patients were in another clinic right down in bottom camp, they used to call it Alamach, East Arm. When they had a bad infection we used to send them to Darwin but otherwise they could stay here in Maningrida.

Then in 1967 there was a fire and we changed the clinic around. We had both the leprosy patients and the main clinic in the one building but separate sides. We had two sisters on the leprosy side, Sister Cecily Carey and Sister Edith Jones. In 1970 we had a doctor that lived in the community. He was a good doctor, Dr Ritchie. We had twins in that clinic. The first one came head first but the second one was coming bottom first and the doctor turned the baby around. The second baby was small for dates and the cord was not as healthy, so we had to send all three into Darwin. One of the health workers went into Darwin with her. The second baby passed away when she was about three days old. We knew she was sick when we saw the cord was so white. In 1971 Dr Jacob came.

Mala'la Health Centre today

In 1995 there was a review of the health services in the Maningrida region: Feasibility Study and Service Plan of Health Services at Maningrida.[4] One of the key recommendations of this study was that the community develop a community management structure, with representation from all the community groups, for the health service. Since then a new Health Centre has been built and a Community Health Board called 'Malabam Health Board Aboriginal Corporation' has been established.

Charlie Gunaburra, Hellen Matthews and Carol Jangalaba are all currently working at the newly built Maningrida Health Centre (80 yrs of practice between them).

Maningrida - Sue's story

I first came to Maningrida in 1995 as a remote area nurse midwife. I had been employed on a two-year contract as a generalist nurse to look after the ‘women’s business’ program. There were around 35-40 women to see antenatally at any one time and lots of women's checks due. The women's business program was only supposed to be done two days a week with generalist work being attended to on the other days. Maningrida Health Centre was always busy and never had enough staff to do the work that was needed in a community with many health concerns (including a tuberculosis incidence rate over 500 times the Australian rate and a prevalence rate for rheumatic heart disease that was one of the highest recorded anywhere in the world: Australia - 0.6/1,000, Soweto 6.9/1,000 and Maningrida 44/1,000).[4]

I commenced in Maningrida with a whole new team of nurses, seven in total, though two had started a little before me. Only two of us had worked in a remote setting before and none of us had any more than a couple of days in Darwin to get organised with not much of an orientation! We had a district medical officer who visited for two days a week. Much of the program work had ceased as short staffing had meant that people with acute presentations were mainly being seen. Health visits to the outstations had ceased apart from emergencies and many of the AHW’s were no longer coming to work, as often occurs when there has been a high turnover of non-Aboriginal staff.

Molly Wardaguga, a retired Senior Aboriginal Health Worker (SAHW) and Margaret Dawumal (SAHW who was initially on extended leave) became my mentors in the time that I worked in Maningrida. Charlie Gunaburra, also a SAHW, was also on leave and he returned after about a year and taught me many more things as well. Joyce Bohme and another (who has since passed away) were health workers who assisted all of the staff through those early days that were pretty confusing in a community that was thought to have approximately 2,200 people in the region. Slowly more health workers returned and several came to start their training. One of these was Mary Mason who was a member of the participatory action research team for this project and is now a fully qualified health worker.

After leaving Maningrida I continued to visit in my role as the Women's Health Educator for the region. I was also involved in a consultation across the Top End for the Women's Health Strategy Unit. Molly worked with me on the project when we talked to women in Maningrida about how maternity services could be improved and produced the report 'And the women said...'.[5] It was only natural that Molly and I would work together again on this project.

How to use the website and guide

This website can be looked at in any sequence. Choose the area that interests you the most and work your way around in your own time and your own way. The primary health care guide to your community is a section that has a document that is in PDF format for you to print off and work through in your own time in your community. This guide is to help you to get to know your own community and as you work through it you will become more knowledgeable about the things that are important to the people who live there and what the health concerns are for maternity care. It is to be worked through in your own time. Using the menu on the top left hand side will show you what else is on this website.

Acknowledgements

This website has been developed with the assistance of many people. Firstly, the women of Maningrida and it's outstations have generously shared their time and allowed their stories and photos to be placed on the web (see names below). The project would not exist without the support, contribution and leadership of the women who were a part of the project team and the interpreters (photos shown above). Although principally a women's project there have also been Aboriginal men who have assisted with the the project and at time have offered their opinion. Many of the organisations in Maningrida have assisted with the logistics of the project, in particular: The Bawinanga Aboriginal Corporation, The Mala'la Health Centre, The Malabam Health Board, The Maningrida School.

The women who have told their stories include: Molly Wardaguga, Deborah Wurrkidj, Margaret Dawumal, Elizabeth Gandabuma, Mary Mason, Dora Daiguma, Phyllis Dungudja, Marie Jingu-wa-rumba, Nancy Du-urrunga Cooper, Sharon Bonson, Janice Mundarwili, Janet Gunamarnay, Theresa Djangala, Margaret Cooper, Dorothy Djilu, Elaine Ngalngali, Esther Djaliba, Ruby Malaridja, Sonia Namarnyilk, Rosie Wulurnurga, Joy Garlbin, Verity Bengarra, Amanda Djawarbuma, Sarah Lee James, Katie Cooper, Wendy Goborrod, Beverly Garadaba, Trixie Nadjerrer, Margaret Fry, Dorothy Galaledba, Daisy Fry, Alice Gunwarbi, Josephine Darcy, Jenny Anne Darcy, Shirley Mininjarla, Elizabeth Mipalangok, Mary Djadbalag, Dixie Wurpamira, Nellie Guiyulin, Clair Lairabidiwanga Brian, Selma Campion, Jill Ganinydja, Kerryantha James and her baby, Tinica Wilson, Charlie Nanguwerr, Nancy Gununwanga, Trudy Nicky, Margot Gurawiliwili, Julieanne Garadaba, Lena Guriniya, Mabel Anaga Bana Buda, Barbara Mondalmi, Mara Mira, Susie Wilson and her new baby Grestina, Carol Jangalba, Rita Mason and baby Cedric, Valda Bocmukagarra. The women's quotes have been recorded directly so that their voices can be heard, there has been very occasional changes to assist readibility only.

The Bawinanga Women's Centre, Maningrida, and the Centre for Family Health and Midwifery, University of Technology, Sydney have been joint partners on this project. Additional support has been received from the Council of Remote Area Nurses of Australia and the Women's Health Strategy Unit in the Department of Health and Community Services, Darwin, in particular Jenne Roberts the Women's Health Advisor .

Many remote area nurses and midwives have given their time and feedback particularly the Women's Health Educators for the NT (esp. Sandy McElligot and Sharon Weymouth) and the Health Centre Staff in Maningrida (esp. Hellen Matthews, Suzanne Peel, Leonie Conn). Lesley Barclay was the project director and Sue Kildea the project officer. Sue Kildea and Molly Wardaguga were co-researchers on the project with the Participatory Action Research Team which included Maningrida women, Aboriginal Health Workers, Remote Area Nurses and Midwives, Local Medical Officers, Women's Centre Co-ordinators, Women's Health Educators, an ex-Remote Area Nurse Midwife.

The project was funded by the Australian Government Department of Health and Ageing through a Rural Health Support, Education and Training (RHSET) grant.

Artwork: The website has been designed by Liquid Rain using photos of Screen Prints designed by Belinda Guringa, Kate Muwulga and Lena Guriniya. All photos taken by Sue Kildea unless otherwise stated.

Spelling: The spelling of names and places was something that was difficult at times. There were many different spellings across languages and we decided to spell the names they way the women wanted them spelt. We had additional assistance from Katie Cooper for the Burrara language, Murray Garde and Hellen Matthews from the Health Centre. We sincerely apologise if any mistakes have been made.

This guide was written and developed by Sue Kildea and Molly Wardaguga through the Centre for Family Health and Midwifery, University of Technology, Sydney. Molly Wardaguga and Margaret Dawumal have been the cultural advisors involved in checking the contents of the Website. Some women who shared their stories have passed away during the course of the project. Discussion have been held with the family members to ensure they are happy for, and give permission for these women's voices, stories and photos to be shared on the website. We have covered their photos with a box so that they will not cause distress and only by placing the mouse over the top of these boxes will people be able to view the photos of these women. The families felt this was important so that they could still see the photo if they chose to. The website has been located on the Maningrida Arts and Culture website so that the community have control over the site and are able to add, update or remove sections as they wish, or if they need to for cultural reasons.

Any feedback you may have on any part of this website or the guide to birthing business in the bush would be appreciated. If you would like to provide any comments, please email us.

Suggested Citation:

Kildea, S., Wardaguga, M., Dawumal, M., Maningrida Women. (2004). Birthing Business in the Bush, Liquid Rain Design, Last updated: ... www.maningrida.com/mac/bwc/birthing/index.html

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