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“Firstly, I would like to thank the traditional owners and the Elders of this land. This is our work crew from Malabugilmah, and this is our story. A lot of communities have many dangerous septic systems and poor infrastructures, and this is just one of those things that happen. We have had flooded ponds, and the previous system was so bad that we had to think about what were we going to do. We had dangerous wells, and you can imagine the worry with kids walking around - even stray animals landed in the ponds. All our current system goes down through the houses, through little tanks and septic systems, eventually going through a big pond. This pond eventually leaks into our current water system. We are out in the middle of nowhere, with no place for our kids to run around or to exercise. We had rubbish around the area and polluted swimming holes. We would go hunting and gathering along the Clarence River which is just 1 km from our community, and we realised we had to stop the run off going into the Clarence River system“.
SLIDES TO GO IN HERE
“Referring to slides, here are some fellows who have had training to operate machinery, and are working in our community. The young fellow on the right is laying turf on the oval. The young fellow on the right doing the wet lands has received a certificate out of all this, and has now got a full-time job. This is one of our Year 2 certificates. This is the sewerage system that we got rid of – at flow times water would just run into the creeks. This is how we set all our wetlands up with gravel pits. We planted trees in them, so the water wouldn’t go anywhere as waste. We designed it for the football oval with a drainage system going through one end of the field, and we also put in an irrigation system which was designed by Jim Byrne. We laid our turf ourselves and put the goal posts up ourselves”.
How did we do it?
- Step 1: Identify all the environmental health problems in our community.
- Step 2: Come up with our own solutions to fix problems and create assets.
- Step 3: Identify who we needed to work with us to fix those problems.
- Steps 4-10: Work hard.
This project was a very long process. It started a large number of years ago, with the Housing for Health Project in Malabugilmah community. The NSW Health Department had a project to go out there, and started to talk to the community about their EH needs. Here’s a day where we were talking about Housing for Health programs, and you can see a box here with all kinds of electrical equipment. We were looking at it and discussing what might, or might not, go right in the community with electricity, so the Housing for Health program was the first step to assess what was there, and what needed to be done. This was a NSW health program which ran
HfH/FHBH Program funded by the NSW Department of Aboriginal Affairs and Department of Family and Community Services. These organisations have great relationships with each other, and we work quite closely to deliver these projects across the state.
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The project was structured around the following nine healthy living practices:
- Washing people, particularly children under five years of age.
- Washing clothes and bedding.
- Removing waste safely from the living area.
- Improving nutrition - the ability to store, prepare and cook food.
- Reducing crowding and the potential for the spread of infectious diseases.
- Reducing negative contact between people and animals, vermin and insects.
- Reducing the negative impacts of dust.
- Controlling the temperature of the living environment.
- Reducing trauma (or minor injury) around the house and living environment.
First of all we had to identify the many problems with plumbing and drainage in Malabugilmah. Many communities we have been to have had sewerage problems caused by leaking appliances, and not so much by failing sewerage systems. There are just huge amounts of water going into the system.
First of all we had to survey the houses and identify the extent of the problems, and this is what we found in August 2004 - (referring to diagram on slide):
- 0 houses had safe electricity.
- 1 house had a passable shower.
- 1 house had a working bathroom.
- 0 laundries, drainage working.
- Many taps, cisterns and valves were leaking, resulting in high water use and an overloading of the sewerage system.
So Malabugilmah mob started fixing them all – tubs, rebuilt stairs, hand rails and kitchens, bathrooms, toilets, taps. In this second survey you can see a drastic improvement in most of those areas. It’s still not 100%, but there’s certainly a huge improvement. What we did find in detail was that pipes were leaking all over the place, septic tanks were blocking up, and the collection wells, pumps and the sewerage ponds were overflowing into the creek. This was polluting the swimming hole, making kids sick, ruining the country and wasting large amounts of water. When I first started working with Terry and Alan in the early days, the automatic pump system
for Malabugilmah didn’t work. Terry and Alan found themselves, day after day, night after night, sometimes sitting down at the river with manual pumps, pumping enough water up to the community. As the Malabugilmah Community worked on the Housing for Health project, we started to discuss concerns that the sewerage treatment system was not working properly. It was overflowing at the village, the ponds, and the creek where the kids were swimming, and ruining their country, as Terry spoke about before. The Malabugilmah community relies very heavily on the Clarence for a lot of their hunting and gathering, so it was a pretty serious situation.
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Existing Sewage Treatment SystemThis was maintained under the Housing for Health program, and you can see it was based on a septic tank with wet patch and leaking pipes all over the place - effluent collection tank which was overflowing, with an overflow box that was full and overflowing. The control box light was flashing constantly, and the pumps weren’t working. The untreated effluent was discharging into the creek, and the swimming hole was just down stream from that. The oxidation ponds were a little way away from the community, but not a long way, because Malabugilmah is quite a steep site and the housing is on slopes, and there isn’t much room to do all this. The overflow ponds were well and truly overflowing. They had also been located when they were originally put in a flood zone, so every time the creek flooded it just scoured out the ponds and sent it all down the river. There were many boggy areas, with lots of mosquito problems. Terry will talk about that in the changes he has noticed. Terry also became an expert screen manufacturer during this process, so he was a bit of a ‘gun’ on all that. Semi-treated effluent was being discharged into the creek. Housing for Health can only do so much in terms of infrastructure, so we cleaned and sealed the septic tanks, serviced the pumps and controls, cleaned the rainwater tanks and resealed them, and put in pressure pumps for the rainwater tanks, but that was as far as Housing for Health could go in terms of infrastructure.
We approached Robert Vidler, CDEP Manager, who arranged meetings with people from the NSW and Federal Governments to sort out these problems. We had meeting after meeting to discuss how to fix the sewerage. As the discussion about fixing the sewerage continued, other issues facing the community were raised:
• There was nowhere safe for kids to play or for people to exercise, as the houses at Malabugilmah are on steep slopes and the roads are all washed out.
• The rural skills program with TAFE was going really well and they had a very good teacher who wanted projects so that people would get practical experience using the skills they were learning.
• Malabugilmah needed some new opportunities for employment.
• Malabugilmah wanted to work with some people who could see what we were trying to do, and who could help us make it happen.
Through this opportunity our people got a lot of skills, and have managed to get jobs in mainstream such as council work. We came up with a solution of how to fix the problem and this was our plan. We set up the new system from the septic tank into the new tank, and it goes through a UV and then back onto the tank and that would aerate the oval. We also put a drainage system in the oval that went back into the wetlands, and the water would then be pumped back out to the irrigation system. This way we would be using water all the time, and have constant use on the oval to keep it green.
We had many meetings and discussions, and we found people who could assist us to put our solution into practice:
• Coffs Harbour ICC – discussed what was possible using a Shared Responsibility Agreement.
• NSW Department of Aboriginal Affairs – discussed what they were prepared to contribute to the project.
• Yabur Yulgun CDEP – assisted us to negotiate the terms of the SRA and agreements with NSW Government.
• Yabur Yulgun CDEP – agreed to take on the role of contractor with Malabugilmah Community to do the work.
The plan required some specialist knowledge, so we called Dr Keith Bolton from Eco Technology Australia, who came and talked to us about wetlands technology. He agreed to help us build our own, and to fix our sewerage problems by treating our wastewater using gravel beds, melaleuca trees and gravity, with a lot of hard yakka.
The community was very much in favour of that. You will see that a lot of people went out on a limb here. Yabur Yulgun, the ICC and CDEP all went out on a limb here. These were not ‘token’ jobs here – these guys welded every piece of pipe and manufactured the whole thing themselves. It was a really big job and was done through really extreme weather conditions. Day after day Alan was the site supervisor, and his job was to get everybody here into their boots, hats and coats. He did an incredible job. This was a huge project. Wetland cells were fabricated on site and were placed in clusters around the village, the idea being that you treat close to the source of the sewerage, and where the sewerage is you treat it there. So if all the pumps and everything else break down, the sewerage is treated. They backfilled the gravel, backfilled and levelled, and finally planted with melaleucas, which are harvested. That is what takes all the stuff out of the sewerage.
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Jeff Green, from All Excavations and Environment, provided the equipment and on-site supervision and training for all the earthworks. Under Jeff’s supervision we put in the wetlands, laid the pipes, did the earthworks and levelling, and installed the civil works such as manholes, sub-surface drains, stormwater drains and erosion control. After getting their machinery operator tickets, we found that a few of the crew were ‘naturals’ on excavators and bobcats. There’s further work in operating equipment on offer with local contractors, based on their demonstrated experience. Here you can see the civil works and earthmoving projects, the installation of underground drainage below the irrigation lines so that the field never becomes waterlogged and no treated water gets to the surface. Jim Byrne, from Irrigation and Water Technology, came and spoke to us about how we could safely reuse the treated wastewater to irrigate underneath our footy field so it would be green all year round. Here you can see ploughing in the subsurface irrigation lines, connecting the irrigation lines to the mains, and setting up the pump shed, with controls, filters, alarms and UV sterilisation. Here you can see the laying of the turf on top - 9000 rolls of turf were laid. This was a huge job, and the bits that were laid had to be kept moist. Here’s Malabugilmah’s oval – their waste water treatment system right there.
Q1. “How often do you need to maintain the Melaleuca”?
A1. Andy Irvine - “It gets harvested as needed, depending on how much water is needed at the time. It gets to a certain height and then it needs to be cut off. The system has to be maintained like any pump system. The system for the community is a fail-safe system, because if anything is washed away for example, the community is safe in the knowledge that the water that escapes into the creek will be treated 100 times better than it was initially without any maintenance”.
For further information
30 Greenwood Avenue, Narraweena, NSW 2099
Ph: 02 9948 3950 Email: email@example.com
No Pulgi – urban Indigenous homelessness and its effect on health
Joan Clark, Dr Katina D’Onise, No Pulgi, Nunkuwarrin Yunti.
Homelessness is a serious population health issue that has been increasing over time in Australia. The extremely poor health experienced by homeless people represents the severe end of the spectrum of poor health from inadequate housing and health hardware.
There is a lot of debate about definitions of homelessness, as a home means different things for different people. What is consistent is that being homeless is not as simple as inadequate or no housing. A home means a person has access to shelter and good, functioning, health hardware. It also includes the security and social connectedness that having a home can provide. Homelessness is a lack of any of these integral aspects of a home.
The concept of homelessness to Indigenous people is broader, and incorporates both spiritual and physical dimensions. Spiritual homelessness can mean a number of different things. It can mean a separation from traditional land, a separation from family and kinship networks, or a crisis of personal identity, wherein one’s understanding or knowledge of how one relates to country and Aboriginal identity systems is confused. People may move around at significant times for important cultural reasons, and due to a lack of accommodation options, may be homeless while in Adelaide.
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In the 2001 census, there were 86 homeless Indigenous people, with 48 people sleeping rough (no adequate shelter). A second study using the capture-recapture technique in 2005 found that Indigenous people made up 35.8% of homeless people sleeping rough in Adelaide, with at least 108 Indigenous people sleeping rough in the city.
The Uwankara Palyanyku Kanyintjaku (UPK) 9 Healthy Living Practices provides a set of basic principles required for good health. When any number of these practices fail or are completely absent for homeless people, issues such as lack of shelter, storage facilities, safety, cleaning facilities, cooking facilities or a lack of sense of wellbeing and self control all combine in different ways to contribute to extremely poor health. This extremely poor physical environment, combined with the unhealthy social and cultural environment in homeless communities, results in significant health problems including psychiatric problems, social marginalisation and even early death. Many Indigenous people who are homeless live in more ‘visible’ public places. This can increase the social marginalisation and discrimination that homeless Indigenous people experience from the general community.
Within the different levels of homelessness, there is more ill health seen in those people who have no shelter at all, compared with those with sub-standard shelter. A review of the literature indicates that homeless people are 3-4 times more likely to die than the general population. The average age of death is between 42 and 52 years old.
Table 1 outlines the major health issues encountered
Healthy living practices
|Washing people||Skin infections, poor wound|
healing, respiratory disease,
|Washing clothes||Skin infections, poor wound|
|Ability to prepare,|
store and cook
|Tendency to therefore eat|
take-away or not at all (poor
diabetic control, obesity/
malnutrition, increased risk
of certain chronic medical
|Temperature control||No protection from extreme|
heat or cold weather, can
lead to dehydration, sun
burns, inability to rest/sleep,
particularly a problem if the
person is unwell
|Safety||Often people are victims of|
|Social||Sense of wellbeing and self-control from having a home is lost – can lead to or worsen alcohol or other drug misuse, psychiatric problems (depression, anxiety, psychosis), family dysfunction, social isolation/ marginalisation|
The No Pulgi program in Adelaide is an example of a primary health care service specifically set up to address these issues. The program in Adelaide works with homeless people to offer holistic primary health care services that acknowledge the complex environment in which homeless people live. It was developed to address the largely unmet health needs for homeless people in Adelaide, particularly their chronic health care needs.
The philosophy of the program is that individuals experiencing homelessness - or at risk of homelessness - have the right to comprehensive primary health care that is accessible, equitable, empowering, encourages inter-sectoral collaboration, and is self- determined.
No Pulgi is a collaborative effort initiated by Nunkuwarrin Yunti, Aboriginal Sobriety Group and RDNS and supported by the South Australian Department of Health and The Central Western Adelaide Aboriginal Primary Health Care Access Program (APHCAP). Other key agencies involved with the service include Drug and Alcohol Services South Australia and the Street to Home service. The partnership was developed to better address the health needs of homeless people, acknowledging that this is a difficult and complex task that would best be tackled by a partnership model.
Services commenced in March 2005. No Pulgi provides outreach primary health care services in a variety of different environmental settings including Day Centres and other places where people live and gather in the city, including the Adelaide city parklands. The service is free, flexible, and has strong links with homeless service providers to ensure integrated, holistic care that also includes social and environmental domains. It considers the whole person and the environment they live in when managing health issues. The team consists of an Aboriginal Health Worker, General Practitioners, an Intra Venous Drug Use Outreach Worker (Nunga HIV Intervention Team), and a Community Health Nurse.
An important learning from the program is that shelter, food and safety are the immediate pressing needs for homeless people, and so all other issues become secondary. In order to be successful, a service for homeless people needs to be easily accessible, including going to people in their own environment, and it needs to consider the whole person and the environment they live in to be effective. Homeless people often need support to attend to their social and physical health needs (transport, accompany people to appointments) and advocacy in dealing with mainstream services.
Structurally, homeless services need to work in partnership with other groups in the sector, including social services, to ensure seamless service delivery and best quality of care.
1. Memmot, P., et al., Categories of Indigenous "Homeless" people and good practice responses to their needs. 2003, Australian Housing and Urban Research Institute.
2. Chamberlain, C. and D. MacKenzie, Counting the Homeless 2001; South Australia. 2004, Swinburne University and RMIT University: Hawthorn.
3. D'Onise, K., Y. Wang, and R. McDermott, The importance of numbers: Using capture-recapture to make the homeless count in Adelaide. Australian Journal of Primary Health, 2007. 13(1).
4. O'Connell, J., Premature mortality in homeless populations: A review of the literature. 2005, National Health Care for the Homeless Council: Nashville.
Ms Joan Clarke
Worked for 20 years as a health worker and nurse.
Working as an Aboriginal Health worker for the No Pulgi program since 2005.
Joan is an Adnyamathanha/Nurrunga woman.
Dr Katina D’Onise
MB BS, MPH andTM, FRACGP Advanced Public Health Registrar
Worked for No Pulgi 2005-2006, and is now working in the South
Australian Department of Health
Q1. “With homelessness, are there are any centres for them where they can sleep at night”?
A1. Joan Clark - “At the sobering up unit. They are breathalysed on the way in, fed in the morning, and then they can go. There aren’t enough beds (there is only one). It is on a first-in first-served basis. A lot of people camp just outside the building as it is a little bit safer there because there are workers and stuff around there all the time. A lot of people are just sleeping outside.
Q2. “What is the breathalysing and sobering up for”?
A2. Joan Clark - “They have to be at a certain limit before they can get in. The only way people can get in sober is if we advocate for that to happen. That is pretty hard for us, because we will save those spots for people who are sick. However, they do have a transitional room. When Doc and I go there on a Monday or Friday we can refer clients into that room if they want to start rehab, and they can stay there as long it takes for them to move onto somewhere else”.
for further information
Dr Katina D’Onise
SA Dept of Health
PO Box 6, Rundle Mail, Adelaide, SA 5000