"The doors are opened, the louvred windows tilted to catch any breeze and the fans turned on. The Yolgnu homeland health worker arrives and work begins for the day."
“It’s difficult to describe accurately. The taste and the smell of the red dust that sits in your nose, your hair and clothes. The cloying heat is ever present. The view of the coastline from the 7 seater single- engined plane being lightly buffeted, as it skirts a local rainstorm hanging in the sky, is breath-taking. Vast tracts of scrub with dark green lines of foliage tracing the line of the rivers and billabongs as the bush runs down to the shores. Endless vistas of shimmering light blue waters, inlets, small lagoons and islands. So much land, so much water and then, in the distance a strip of red dirt that transforms into a runway and a collection of 8 or 9 scattered houses. The skilled MAF pilot lands in a heavy crosswind, countering the sudden lift of a wingtip with a deft hand on the controls. As the propellor slows and the engine stops it’s time to unload the medical boxes and equipment.
A group of four young men passes. Each hefting a three-pronged fishing spear, they wander down to the lagoon laughing and joking with each other as they go. They are lithe, fit and strong with characteristic skinny calves and high-set muscle bellies of Yolgnu people. A single hunter with a rifle slung over his shoulder, crosses the dirt runway and an hour later a plume of smoke arises from the direction he has taken.
The health clinic has two rooms with one holding an electric treatment bed. The doors are opened, the louvred windows tilted to catch any breeze and the fans turned on. The Yolgnu homeland health worker arrives and work begins for the day. I see a variety of conditions, not dissimilar to a day in the clinic at home. Some patients have a good knowledge of English and it is easy to gain some history and maintain a conversation. One teenager with a sore knee grunts mostly in a similar way to others of his age but also engages shyly with a smile after a few minutes. He grudgingly acknowledges the weakness in his quads when we both do a wall squat and he is forced to stand after 30 seconds as his muscles burn.
My last patient of the day is a home visit to a 35 year old man born with cerebral palsy that has resulted in flexion contractures in both knees. His brother calls him to come out of his room and he transfers himself out using his hands to move across the floor with both knees bent under him. He is quite mobile in this way and has a manual wheelchair that he can use to get around the village. I wonder what I may do to help, remembering the aged care research reporting no benefit from physiotherapy treatment in the management of contractures. He denies any pain and I provide some massage and passive joint mobilisations to his knees and ankles. As I work on the left leg I hear rustling and glance under the house to see a young, very small puppy pouncing (or trying to) on a lizard in the paper rubbish lying under the house. Having settled in and spent about 15 minutes on each leg, his mother pipes up with reports of his mid and low back often causing pain. I work on his thoracic and lumbar spines and provide some exercises for ongoing maintenance. As the session comes to a close another brother arrives carrying two small black-tipped reef sharks that he speared earlier. His young son gets one of these fish and uses it to play with one of the dogs. The treatment setting is beautiful. The house sits 30m from the ocean, a cooling breeze drifts across the deck and a flame tree drops flowers intermittently to join the growing carpet spread around the trunk.
So now it’s time to pack up and head back to Yirrkala. Everything is loaded onto the plane again, safety briefing given and then we take off and head north towards the smoke spiralling up from the Gove Alumina refinery.”