MICHAEL GRACEY. Protecting remote Indigenous people from the COVID-19 pandemic

The current pandemic caused by the virus COVID – 19 is affecting many countries; it is highly infectious and potentially fatal, especially for vulnerable people. Indigenous Australians are especially at risk to this infection and will need special arrangements to minimise the devastation that this virus could bring to them. How can this be best achieved?  

When the Spanish flu swept across the world a century ago the little pearling town of Broome wasn’t spared. There were fourteen influenza deaths; all but three of those deaths were in Aboriginal people. There is no doubt that the current pandemic could reach the most remote parts of Australia unless extraordinary measures are taken to protect people who live in those areas. The results could be catastrophic.

More than 100,000 Indigenous Australians live in remote or very remote areas. Those people have a very high burden of chronic disease which increases their susceptibility to infections like the current pandemic. About one-third to half of the adults in that population have chronic diseases like heart disease, kidney disease, chronic respiratory illnesses, and diabetes and its long-term complications. They also have higher rates of malignancies than non-Indigenous Australians. Those conditions make those individuals much more likely to have a serious or, perhaps, life-threatening episode of COVID–19 infection rather than a self-limiting and less serious outcome.

The increased risk of unfavourable outcomes is made worse in remote Indigenous communities by the prevalence of overcrowding, inadequate “health hardware” such as adequate washing and showering or bathing facilities, unsatisfactory toilet facilities and often by poor understanding of the principles of personal, family and communal hygiene.

The National Aboriginal Community Controlled Health Organisation (NACCHO) helps coordinate the activities of Indigenous-specific health and medical services around Australia. NACCHO has expressed its deep concern at the risks the current pandemic poses to First Nations people. Their CEO, Pat Turner, told the ABC program “Speaking Out” . . . “I can’t be any blunter. If COVID – 19 gets into our communities we are gone”. That organisation has received assurances from the federal government of special support to help avoid such a catastrophe. This includes the provision of special personal equipment to protect against infection, clinical support, and the control of the movement of people into and through Indigenous communities. States and the Northern Territory have helped to strengthen these controls over movement of people throughout remote areas.

Restrictions on the entry of non-Indigenous, non-essential persons into remote Indigenous areas is now in force and some communities have erected roadblocks to prevent access into their lands. However, it can be very difficult to completely block access, day and night, to some communities. In many parts of central and northern Australia, it can be almost impossible to control movement across remote or very remote places where unmarked and ungazetted tracks make such “boundaries” porous, especially to people who know those far-flung places very well.

There is another important consideration; the cultural dimensions that affect the movement of Indigenous people across remote Australia. Those people have very strong links within and between clans and extended families which require them to gather, sometimes in large numbers, from time to time. Some of these gatherings are ceremonial and occur at particular times of the year.  An important example of obligatory gatherings is for funerals or so-called “sorry business”. These events bring together hundreds of people, often from far away, and can last for days. Under such circumstances, accommodation is often in short supply and the eating arrangements involve groups of people in close contact. Needless to say, such gatherings can necessitate travel across arbitrary boundaries such as State or Territory borders.

The risks of the current pandemic are evident and if uncontrolled could bring a heavy burden of sickness and premature deaths to remote Indigenous communities. Experience to date shows how difficult it is to control this viral infection spreading from person to person and causing havoc to people and their basic community functions and viability. The principles involved in suppressing this illness are well known; they require substantial individual and communal discipline. These principles apply to Indigenous communities but are made much more difficult because of socio-economic and environmental disadvantages, increased vulnerability of local people, and limited access to adequate clinical personnel, and diagnostic services, facilities and clinical care.

Exceptionally strong actions will be needed from many sectors, Indigenous and non-Indigenous if a drastic health crisis is to be avoided among remote Indigenous Australians as a result of the COVID–19 pandemic.

Michael Gracey is a paediatrician who has worked with Aboriginal children, their families, communities and organisations for more than forty years. Much of his work was in remote parts of Western Australia. He was Principal Medical Adviser on Aboriginal Health to the Health Department of WA and Foundation Professor of Aboriginal Health at Curtin University.

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Michael Gracey is a paediatrician who has worked with Aboriginal patients , their communities, and organisations for more than forty years. He was Principal Medical Adviser on Aboriginal Health to the West Australian Department of Health, became Australia's first Professor of Aboriginal Health, and is a previous President of the International Paediatric Association.

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