Doctors Reform Society of Australia
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by Sandy Toussaint

Aboriginal people have often been the subject of inquiry in relation to high rates of morbidity and mortality. The results of such inquiries have clearly and consistently established that Aboriginal Australians are less well and die more often than members of the wider society (Dodson 1991; Johnston 1991; Thomson 1991; Aboriginal and Torres Strait Islander Health Information Bulletin 1995; Anderson 1997). Structural inequality, poor social conditions, inadequate economic resources, the ongoing impact of colonial histories and policies, linguistic confusion, the absence of interpreters and culturally inappropriate services have often been identified as reasons for the shocking state of Aboriginal adult and infant health. Whilst it is clearly important that explanations such as these are highlighted and acted on, there is another subject of inquiry which requires urgent attention: the medical work practices of health professionals (doctors, nurses, social welfare and administrative personnel, nursing aides, occupational therapists, and so on). As I explore below, a wide range of medical work practices should not be ignored in analyses which seek to improve Aboriginal health. Three brief and recent examples drawn from a selection of many might help to clarify and exemplify my concern. The accounts which follow refer mostly to the Kimberley region, Western Australia, where Aboriginal people comprise a dominant population (Crough and Christophersen 1993). The focus is on adults admitted to a northern regional hospital and/or to a Perth hospital or hostel. Toussaint (1989, 1996) Hunter (1993), Marra Worra Worra (1996), and Toussaint, Mak and Straton (1998) provide further Kimberley examples. For discussion on similar issues elsewhere in Aboriginal Australia see Devitt and McMasters (1998) who consider renal disease in Alice Springs, Northern Territory, and Kirk, Hoban, Dunne and Manderson (1998) whose study concentrated on cervical screening procedures in Queensland.

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