Howard Goldenberg
Howard Goldenberg is an Australian writer, whose maiden book, My Father's Compass, a memoir of an unknown orthodox Jewish doctor who raised his observant family in the Australian outback has sold out its first edition.
The story below forms one chapter in a new nonfiction work to be published in 2009 under the title 'RAFT'- the reactions of an Aussie Jewish writer to the devastation of outback Aboriginal life.
The author, in his biographical note states:
Howard Goldenberg was raised in a small country town in rural Australia. On his father's side, he is descended from the Gaon (Genius) of Vilna, and on his mother's from Cyril Coleman, pearl diver, polo player and one-stringed violinist, of Broome. His parents were exemplary citizens, devoted Jews in a gentile world, and admired by all who knew them. As a young man, Howard came naturally to the belief that life was good and that people were good, but now wonders whether this belief, like the dry soils of the Murrumbidgee riverina of his youth, had been artificially watered?
Howard has run thirty-six full marathons and completed sixty-two laps of the sun.
The following work is copyright © 2008. All rights reserved. No distribution or reprinting in any form whatsoever without written permission from the author.
NEXT DOOR TO PARADISE
The very wildest dreams in Kew
Are the facts in Kathmandu.
(Rudyard Kipling)
In August 2006, I spend 16 days next door to Paradise.
The place is Elcho Island, a speck in the Arafura Sea, an Australian football kick from the mainland. I know nothing about Elcho Island, nothing beyond the imaginings that I bring with me. My imaginings, I discover, are not very useful.
From Darwin you take the Air North flight to Maningrida in an aircraft designed for hunchbacks and dwarves, then take an even smaller plane to Elcho itself.
We spend some time in transit at Maningrida, in the shade of an ancient rusted tin structure which is the passenger terminal. Standing alone beneath the tin roof, oblivious of stray dogs and children, is a thin and wrinkled man, the only person not engaged in conversation. He looks quite at home. I ask him whether he has been to Elcho before.
“Yes”, he says, “I have been there before.”
What do you do there? I ask.
“I teach. I’m a relief teacher. This will be the third time I’ve come to relieve. I expect it will be the last.”
His sentences emerge fully made and precise, but with such a lack of emphasis that the speaker and his utterance are almost transparent. The words trail off into inaudibility.
I lean forward to hear: Is the local culture in good shape?
“Not like it was”, he says. “About twenty years back, I used to live on the island. There was ceremony or corroboree every night. Every night I’d fall asleep to the sounds of clapsticks and singing and many feet stamping on the earth. And if on occasion, I couldn’t sleep, I’d lie awake and I’d realise it was the quietness that was keeping me awake; there was no ceremony that night.
But during my last visit, there was no corroboree in the whole six weeks.”
I ask the teacher: Why are things different now? What has made the difference?
The teacher shrugs. He doesn’t know. He screws up his lean face and interrogates the shimmering distance.
We land at Galiwin'ku, which is the town on Elcho Island. There are about 2500 indigenous people on this oblong island four kilometres wide and sixty kilometres long. They call themselves Yolngu. I am one of the 100 so people on the island who are not Yolngu. They call us Balanda.
We call ourselves ‘missionaries, mercenaries or madmen’, a recognisable rubric, but reductive.
We are here on these homelands to provide services that the people here need. What value the Yolngu place on our services is not entirely clear.
I make a preliminary tour of Galiwin'ku. There are houses on short stilts, some dilapidated, some completely ruined, yet others that are tidy and suburban in appearance. The little town has a sleepy Sunday afternoon feeling. Dotted here and there are low mounds of topsoil into which tall bamboo poles have been planted. On the top of each pole flies a rectangular banner of coloured cloth. The effect is like a small garden plot with blooms of bright fabric.
Each mound, I discover, is a grave. The various banners represent the respective clans on the island. On a given grave, the banner of the deceased's clan predominates. Each of the other clans plants a banner as a sign of respect.
Wherever you go on Galiwin'ku, youfindthese memorials where the dead lie in their own soil. Above them fly their clan's colours and between them naked children play and lazy dogs lie down in the sun.
There are a couple of graves not far from the front and back doors of the Clinic, and whenever I emerge I encounter these reminders of death. The effect is not morbid. More than anything, I feel the continuity between the generations and an unbordered relation between people and land.
On my first day, I follow a five-year old boy bouncing ahead of me into the Clinic, dancing and swinging on his mother’s arm along the wide shaded verandahs of the Clinic. To the hungering eye, he shines like the future.
He carries something in his small hand. It’s a DVD from the store, sparkling fresh in its Hollywood packaging. I read the label - The Incredibles.
BOY BLUE
There is no permanent doctor on the Island, which is two hours’ flying time from Darwin. The nearest hospital is 40 minutes away by plane, in the great city of Gove (pop. 4000). Pretty clearly 2600 souls need a doctor, and at this moment, I am all they have. But health is not a high priority for the Yolngu, or perhaps I should say, Medicine – my sort of Medicine - is not their priority.
On my first morning, the health worker asks me to see a one-year old baby. I check his date of birth: he was born a few days after my grandson Noah. He weighs just over 6 kilograms, a little less than half of Noah’s weight. He has fallen off the bottom of his growth chart. The little boy, Jason, has a fever and he cannot breathe. He coughs, cries, then suckles for comfort. His mother’s breasts are dry and Jason is dehydrated.
I look hard at Jason. He is battling mightily for air. He takes 88 breaths in a minute – I count them – where twenty or so should do.
I look at Jason’s darkish lips and I cannot tell whether they are usually blue like this. His nostrils flare like a racehorse’s and as his ribcage expands and contracts, his muscles are sucked inwards with each breath. This baby is fighting hard to breathe.
Back in Melbourne, I might feel less fearful for a child with a chest infection, but this baby has additional problems - malnutrition and anaemia, skin sores and hookworms. His resistance is compromised: this is a pneumonia, possibly complicated by septicaemia.
Initially I am alone with Jason and his Mum. Mum is a tall, slim young lady. I ask her if Jason is her first baby.
“No. Number three.”
Abruptly, she gets up and leaves the room. When she returns, she smells strongly of tobacco smoke.
I spend the morning with Jason, doing things that I do not usually do. Jason needs oxygen. I scrabble around in cupboards and drawers for the plastic tubing that will deliver oxygen to a small baby through little nasal probes. I fit this and insert the probes into Jason’s nostrils. He resents this and pulls them out. I put them back in and secure them, then search for the minute gadget that will gently pinch his fingertip and measure his body’s oxygen levels. I apply the gadget and take the readings. Initially they are awful: 60% saturation. An alarm goes off and I wet my pants. Then the machine completes its booting cycle, and the level rises until it reads 99.4% and it stays there. A sort of reprieve.
Whenever I need to find a piece of equipment or to check on the clinic’s procedure, I dash from Casualty to the office of my boss, Cherryl. Cherryl is the Director of Nalkanbuy Clinic. She is a nursing sister with both clinical and managerial responsibilities. When I have made the ten yard dash about ten times within an hour, Cherryl decides that I need her to manage me. From now onward we care for Jason together.
Cherryl directs me to organize Jason’s air retrieval to Gove, while she conducts a searching interview with Jason’s mother. To do this I must phone the District Medical Officer. The DMO is a potentate of the remote health system. This doctor is both a gatekeeper to the local hospital and in charge of the local air medicine service.
In Melbourne it is very difficult for a GP to arrange an acute hospital admission. The Admitting Officer will agree only to see and assess the patient in the Emergency Department, baulking at an undertaking to admit. I think the assumption is that the GP is just a GP and not an expert in Emergency Medicine.
Outback, the GP has greater credibility. In fact, this applies equally to the Remote Health Nurse. Whenever a nurse or a doctor calls, we are signifying that we need help, and the DMO ensures we get it. And on the Island, we call often: there in an urgent air evacuation every couple of days.
The doctor who answers my call has a soft and musical voice. His accent is African and his name is Samuel. Samuel asks me a few questions, listens attentively to my answers, and quickly says: “That baby will soon be exhausted - and your clinic will be too. We’ll fly in and get him. We can get a plane to you by 13.30 hours.
Do you think he needs a doctor aboard, or will a flight nurse be sufficient?”
We think a nurse alone will do.
It is now 10.30 am and we have been working on Jason for about two hours. Samuel was sounding me out to assess our morale and our reserves of confidence. His response is adroit and tactful.
I measure oxygen saturations and chart them while Cherryl battles to get fluid into Jason. She sets up all the tubing and syringes and the adhesive tape and bags of fluid that she will use for an IV drip. I hold a small arm immobile while Cherryl probes a tiny vein – which is quite invisible under the dark skin – with a fine sterile needle. She says: “I'll make one attempt at this vein - one only. I don’t want to ruin a whole lot of veins for the people in Gove if I fail.”
Cherryl reckons she’s found the linear course of the vein. Gently she manoeuvres the needle, upwards and inwards. Gently, she sucks back with a syringe: if we have a vein, the nozzle of the syringe will fill with blood. Cherryl sucks, I hold the arm that is thinner than my great toe, and nothing happens. Cherryl tries a different angle, then another and another: no luck, a dry hole.
We have a dry baby, and no intravenous access…
The Emergency Room falls silent. Then Jason farts. Now a thin brown fluid issues from his lower body onto the thick cotton sheeting on the trolley. Lying on this adult-sized bed, Jason looks absurdly small, and - if you stand back from him, if you don’t look too closely at his nostrils, at his rushing ribs, at his flying diaphragm – he looks adorably cute. Too small for a one year old, he is a doll, an imitation.
But Jason is in trouble. A couple of hours ago, he fought the oxygen probes and clung to his mother. Now he has strength only to breathe and doze. The lake of smelly fluid around him widens. He is shitting out the water of his life, and with it the sugar that is his body’s fuel and the minerals that operate his muscles.
Unchecked, diarrhoea is an all-out attack of diminishment; it will eventually dry a baby out until his circulation weakens then fails; his blood sugar falls, and he may lose consciousness and start to fit; and in the extreme, potassium is lost and muscles fail; no muscle function, no breathing effort, no cardiac contraction. No Jason.
Jason’s mother offers him her breast. He mouths the nipple for a moment, then dozes again. His mother stands and stares at her son, then flees for another smoke.
I look at the pale brown lake and once again I feel that deep sinking fear that came often to me as a junior resident doctor, working alone at night with a failing patient. Am I going to lose him? Who will save him? Who will save me?
In this case, the answer is Cherryl. That redoubtable lady pulls tubing from a cupboard and a large syringe from a drawer, then grabs some oral rehydration fluid from the dispensary. She insinuates a fine tube through Jason’s nostril, threading it past the oxygen probe. He gags feebly and falls still. There is a look of stern purpose on Cherryl’s face as she feeds the tube past unseen landmarks of internal anatomy towards Jason’s stomach. She lets out her breath: “There, that should do it.” But something is wrong – the tubing peeps out between Jason’s lips. It curled in his throat and sits there mocking us. Another deep breath, another intense session, as Cherryl frowns and works in slow centimetres. She straightens, watches Jason for a moment or two, then - satisfied – she swiftly fills the syringe with the rehydrating solution and squirts tentative dribbles into his stomach. Then stops and watches again. No fluid comes back.
Perhaps a tide is turning.
Meanwhile I continue to log Jason’s respirations at 88 gasps per minute.
We two spend the morning working on Jason, watching and supporting, and - in my case at least – silently asking him: Are you going to die this morning?
By lunchtime Jason hints that he will not die today. The nasal prongs have worked their way loose and hang at a distance from his nostrils, directing the oxygen towards his right ear at a handy four litres per minute. But his oxygen saturations have not fallen!
At lunchtime we take Jason and his mum to the airport in the ambulance – Cherryl and I are the ambulance officers here – and hand him over to the flight nurse, once again feeding oxygen into his nostrils through the forked tongue of the plastic tubing.
Jason and his Mum fly out to Gove. The retrieval by the local flying doctor service in an aircraft equipped for all critical contingencies - complete with flight nurse - costs $8000. And many more fly out on scheduled flights for no-urgent x-rays and scans and specialist appointments in Gove or Darwin.
A conversation has been going on, intermittently, all morning. It is a conversation between Cherryl and Jason’s mother. The two women know each other well: mother is a trained health worker, until very recently employed in this Children’s Clinic.
The conversation (to which I do not contribute) is a painful one.
Cherryl asks her former worker: “Did you feed Jason any breakfast this morning?”
“Yohh” – yes – says Mum. (I will call Mum Matala, because that is not her name, just as “Jason” is not Jason’s name.)
“What did you give him, Matala?”
“Porridge.”
“Real porridge, Matala? Not just flour in milk?”
“Yohh, real porridge.”
“Why is he so small, Matala?”
No answer.
“Matala, did you eat this morning?”
No answer.
Matala looks down.
Cherryl’s looks up and across the bed in the Emergency Room where we are spending our morning. Her eyes meet mine. There is weariness and sorrow in her face, and a deep perplexity. Her face is asking – after all these years – why?
For a while there is silence. Then Cherryl says, in a kindly tone: “Matala, you must be hungry. Go and get yourself some food. We’ll look after Jason. Go quickly and hurry back.”
Matala goes without lingering, without farewell to Jason. All morning, she has seemed only half engaged with him. She goes and does not soon return.
While we are alone, alone that is, with Jason, now a very real, very alert, hypoxic little witness to his own plight and to the struggles in the Emergency Room, Cherryl lets out a series of long and bitter sighs. Then she gives me her reading of Matala – Matala the health worker and Matala the mother.
“ She’s a highly intelligent girl, highly capable. She went to Bachelor College on the mainland and she learned a lot. She became a really skilful worker, you know, accurate and sophisticated. She would have been an asset here. But she wasn’t reliable. Recently, she missed more and more days. A few days ago, I told her it couldn’t go on. I told her she couldn’t work like this. I said not to come any more, not to come until she was ready to decide to come to work every day.”
Matala returns in a cloud of smoke. She carries her lunch - a large bottle of Coke and a bag of hot potato chips. She sits on the floor of the emergency room and starts to eat.
Now Cherryl’s angst goes into overdrive.
“ I know why Jason is so small, why he gets sick. I know and you know! He is small because you have no food for him. There is no food because you spend all your rupiah on gambling and on smokes! You have plenty rupiah, you have enough for food. You have Child Support, and Work For the Dole. Your husband has Unemployment Benefit. But you have no food for Jason and no food for yourself. All your rupiah gone, gone on cards and for smokes.”
Matala has not looked up from her chips. She has eaten little.
“When you don’t eat, you don’t make enough milk. AndJasonstarves!”
Matala has not looked up. Shamed, she says nothing.
I say nothing. I just feel sad.
After a while Cherryl calms down and commands me to accompany her to her office, the old ten yard dash, where I will write a letter of referral for Jason.
“Make sure you ask the hospital to get Children’s Services onto this. That child has to be protected: his older sister had to be taken from Matala and placed in the care of her aunt, Matala’s sister.”
I do as I am bid.
My mind goes back to the country town of my childhood. The year is 1953. Leeton is agog with the coronation in London. Back home, we don’t count Aboriginal people in our census, nor give them the vote. These things will only change after 25 years. But in 1953 we still take mixed blood children from their families with the full force and authority of the law. In my hometown I hear kindly matrons say: “They’ll be placed in a good home. It is for their own good.”
As I write my fateful letter now to Children’s Services, I ask myself: Am I arranging to steal someone’s child - 'for his own good'?
The local gambling schools operate around the clock. On our way to the airport in the ambulance, we pass the card players sitting in a circle on the ground. Early next morning they are still there, still playing as I pass them on my early morning run. They sit gratefully under the street light that we Balanda installed for them and gamble their rupiah away.
Sourly, I reflect on our other gifts to the Yolngu. We taught them to smoke, we introduced them to our diseases and to money and playing cards. They are deeply in our debt.
I am starting to feel the growth of a metaphor on my upper arm. In moments of contemplation it grips me like a ghost. It is a black armband.
