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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 August 18; 335(7615): 350.
PMCID: PMC1949430
Out of the Box

Trouble down under

Trisha Greenhalgh, professor of primary health care

Greetings from Australia's Northern Territory, where I have been learning the meaning of the word “remote.” Yesterday we drove for three hours before meeting another vehicle. Every 200 km or so we encountered a road sign or a shrivelled lake with a solitary pelican. Otherwise there is just bush—and the red, red earth.

The trip began with a lecture tour. At an interdisciplinary meeting on management of chronic disease in rural and remote communities, one questioner had his hand in the air before I had finished speaking. What, he asked, was my view on the problem of child abuse among the Aborigines?

Apparently a number of incidents have persuaded the authorities that child sexual abuse is “widespread” in some remote Aboriginal communities. The current prime minister, said to be the most right wing premier in living memory, recently decreed that all Aboriginal children below the age of 15 in these areas should be medically examined for the telltale signs of abuse. The issue has also, apparently, been used to justify increased police presence and (in some cases) withdrawal of land rights for the Aborigines.

Depending on whom you ask, all this is either a swift and decisive move to save a generation of innocents from unthinkable trauma or (in a community where teenage marriage has been the norm for centuries) Australia's worst ever example of culturally incompetent health policy, setting back relations with the indigenous community by 20 years.

In Australia's coastal cities, where 85% of the white population live, it is not hard to spot Aborigines who are drunk, destitute, and sometimes psychotic. When they get under your feet it's easy to imagine them behaving shamefully towards their children—and hard to remember that they represent a tiny fraction of the indigenous population. With an election looming much political mileage is to be gained from policies that can demonstrate “containment” of such problems.

I guess it would be too much to invite a serving prime minister to take a briefing on the limited predictive value of so called telltale signs of sexual abuse. But is it unreasonable to ask him to divert from his usual campaign trail and visit the communities that he has accused of moral disintegration? They just might have a story of their own to tell.

Articles from The BMJ are provided here courtesy of BMJ Publishing Group