For forty years I have worked as a GP. I have seen and shared in all the dramas of the lives of my patients, both in outer suburban practice and in scores of remote Aboriginal communities. I thought I had passed beyond shock and reached a calmer shore.
1990. My maiden posting in an indigenous community. In the Emergency Department, the first patient is brought in with a burned leg. He lies, apparently insensible of pain. So drunk last night that he fell into the fire, so drunk he couldn’t roll out of it, so intoxicated – the word means poisoned – he slept on in the hot ashes. We remove his trousers and the charred meat that was his leg falls away in chunks.
Next patient: belted over the head with a nulla nulla while drunk – at 10.00am – he won’t wake up. Is he simply pissed, literally out of his mind, or is his brain bleeding?
Next patient is 30 years old. His heart muscle is flaccid, failing. He has alcoholic cardiomyopathy. He’ll die without a transplant.
In the comfortable mainstream such stories feed the mills of lazy generalization and undeclared prejudice. In the mainstream, we ‘know’ blackfellas can’t drink responsibly. Not like us whitefellas.
Let the self-congratulating mainstreamer join me on the Oaks Day train from Flemington back to the City; let us witness together in our crammed carriage, young women falling out of their gorgeous dresses, toppling from their high high heels, shouting to each other, in alcohol disinhibition, intimate details of their love lives, staggering, collapsing into the laps of seated passengers, whinnying with helpless laughter; and note that these people, not underprivileged, not indigenous, belong to our culture where going out equals partying equals drinking equals drunkenness.
Let the disdainful mainstreamer swallow this: the proportion of blackfellers who drink is far lower than that of whitefellers.
There is nothing new in any of the above. We are a nation with a drinking problem. Alcohol is a colourless liquid. Its harms are scarlet and black.
1968. I am a medical student in residence at the psychiatric hospital. Here a patient, intellectually impaired, is eight months pregnant. She has been an inpatient for twelve months. No family visits her. The baby has been fathered in hospital.
1972. I start to work in the outer suburban practice where I will become a partner for nearly thirty years. Every Thursday I visit the local home for intellectually impaired boys. Mental illness is embarrassing, almost shameful, so we have hidden these children away in an institution, where the Brothers care for them.
I cannot gain my footing at the home: the Brothers are neither priests nor nurses; they do not provide satisfactory answers to my clinical questions. I cannot satisfy myself that the residents are well cared for. But I am new to the practice, new to medicine. Perhaps that is it.
2001. I leave the practice after 29 years, no wiser. The Brothers don’t seem holy or caring or competent; nor helpful with information. Again I doubt myself.
It takes a long time for my generation to comprehend the reality of endemic abuse. For too long we lack the questions.
In the year 1990, the question crystallizes for me: I put my question to the esteemed therapist to whom I have referred patients these last ten years: what proportion of our patients have been abused?. My referrals – for depression, anxiety, psychosomatic fixations, insomnia, anger, substance abuse, sexual problems – total some hundreds. The therapist reviews my cases, of ordinary problems of ordinary people. Her answer shocks me: Fifty percent were abused in childhood.
The medical news of the last weeks has shocked me. News of the fifty percenters in the Fitzroy Valley. All the children in the community were tested and half of them suffer Foetal Alcohol Syndrome (FAS). That means every second child has sustained brain damage due to alcohol taken in the first three months of pregnancy. These children will not learn in the normal way – not in the classroom, nor outside it.
Critically, unless you can learn, you may never be able to connect effect with its cause. Responsibility will ever elude you.
Without colossally expensive support the fifty percent is destined for a life on the margins of a marginalized community. Mental illness, substance abuse, incarceration and suicide beckon.
Many of the parents and grandparents of the fifty percent were themselves afflicted by FAS. Hence the failed parenting, the failed marriages, the failed employment. These elders are judged and stigmatized for failing, where they are in fact untreated sufferers.
Two infernos burning in the our backyards of our awareness – alcohol harm and child abuse.
And here, in the paper before me I read of two children presumed dead, unaccounted for. I read on to and discover where my two infernos collide, a home for handicapped children. The newspaper names the institution. The name burns: there were indigenous children there – suffering foetal alcohol syndrome? – in the ‘care’ of the Brothers. This was precisely that home where I used to visit; where I smelled something. Where I failed the children.
The problems are not remote. While our gaze is elsewhere, alcohol harm and child abuse are simply out of our line of sight.
Whose responsibility are they, the damned fifty percenters?