NACCHO Aboriginal health news: World Diabetes Congress Melbourne registrations closing 16 November


Is the only truly global diabetes event.

Join 12,000 healthcare professionals, policy-makers and advocates from all over the world.


The deadline for the online registration is 16 November 2013. Register now!

New! Online day rate now available for healthcare professionals residing in Australia.

Top Three Reasons to Attend the World Diabetes Congress:

1. Connect

-A unique opportunity to network with over 400 speakers, 12,000 delegates and more than 200 IDF Member Associations from over 160 countries.

2. Learn

-View over 1000 posters and choose from 275 hours of scientific sessions to learn about the latest advances in diabetes research, care and education.

3. Discover

-Follow 7 distinct programme streams including the brand new “Diabetes Research in the 20th Century” and “Diabetes in Indigenous Peoples” streams”.

With less than 25 days to go, the World Diabetes Congress is one of the world’s largest health-related events. It brings together healthcare professionals, diabetes associations, policy-makers and companies to share the latest findings in diabetes research and best practice.


2 to 6 December 2013, Melbourne Convention and Exhibition Centre (MCEC), Melbourne, Australia

The scientific programme, divided into 7 themed streams, offers you 20 CME credits and 275 hours of sessions from some of the world’s top diabetes experts.

The online day rate is now available for healthcare professionals residing in Australia. Join us and help shape the future of diabetes in Melbourne this December 2-6.
For more information please visit

Program highlights

NACCHO CEO keynote speech: Aboriginal Diabetes Policy Forum Parliament House Canberra


 Diabetes 052

Picture above: CEO of Diabetes Australia, Greg Johnson with NACCHO CEO Lisa Briggs

“The importance of community empowerment and engaging Aboriginal and Torres Strait islander communities in the development of culturally appropriate diabetes prevention and management strategies” 

I begin by paying my respects to the elders past and present and the traditional owners of the land we are on today the Ngunnawal people.

 This forum is perfectly timed. This is an important year for the Aboriginal community controlled health movement to “Close the Gap” for better outcomes for our people.

 With a Federal election now locked in by the Prime Minister, Julia Gillard, for September 14, NACCHO, as the national authority in comprehensive Aboriginal primary health care will be ensuring that our voice is heard and that our movement continues to play a major role in shaping the direction of Aboriginal health in this country especially in the area of diabetes prevention and management.

In this 2013 election year there will be many new developments and challenges ahead includingnegotiating the National Aboriginal and Torres Strait Islander Health Plan (NATSIHP),monitoring the growth and influence of Medicare locals, and contributing to the National Primary Health Care Review.

 In my address this morning I will be giving you an overview on how NACCHO, as the national authority in comprehensive Aboriginal primary health care, is empowering and engaging Aboriginal and Torres Strait islander communities in the development of culturally appropriate diabetes prevention and management strategies. 

 Today’s keynote presentation consists of four components

1.The diabetes challenge ahead

 2. NACCHO shaping national health reform ( national policy and advocacy of diabetes)

  1. Closing the Gap and whole of Government
  2. How we support the National Congress and the National Health Leadership Forum?
  3. The current draft National Aboriginal and Torres Strait Islander Health Plan (NATSHIP)

3.    NACCHO and  culturally appropriate diabetes prevention and management strategies 

4.    NACCHO’s key recommendation for Government to help address the diabetes epidemic.


The reason we have so many delegates here today is that all available data shows that the state of Aboriginal health remains appalling despite the introduction of many key initiatives to address chronic diseases such as diabetes.

Diabetes rates in Australia are high but its prevalence in the Aboriginal and Torres Strait Islander population is between three and four times higher than the rest of Australia.

We are fast running out of time to stop this disease from creating a national disaster.

As mentioned many programs have been implemented to address this but still the life expectancy for Aboriginal people remains 15 to 20 years below that of other Australians with death rates for adults 3 to 4 times higher than the non-Aboriginal population.  

We as a group recognise that it is time to make changes to our approach in addressing the negative impact that diabetes and its’ associated morbidity has on the Aboriginal and Torres Strait Islander people.

In a snapshot

  • Aboriginal peoples and Torres Strait Islanders have the fourth highest prevalence of Type 2 diabetes in the world
  • Aboriginal people are more likely to develop diabetes at a younger age than non-Aboriginal people. Our children have an increased incidence of Type 2 diabetes linked to obesity, insulin resistance and a positive family history of diabetes. We now have generations of the same family with diabetes.  
  • Gestational diabetes is more common in Aboriginal mothers with rates 2-3 times that of non-Aboriginal mothers
  • The first case of diabetes among Aboriginal and Torres Strait Islander people was recorded in Adelaide in 1923
  • Records prior to this time showed that Aboriginal and Torres Strait Islander people were fit, lean, and did not suffer from any form of metabolic condition, which were largely believed to be a characteristic of European populations.
  • The earliest detailed studies investigating the development of diabetes in Aboriginal and Torres Strait Islander populations were not undertaken, however, until the early 1960s.
  • These and subsequent studies found a significant correlation between the development of a ‘westernized’ lifestyle and the levels of type 2 diabetes in the Aboriginal and Torres Strait Islander population.
  • Since that time, Type 2 Diabetes has been recognized as one of the most important health problems for Aboriginal and Torres Strait Islander populations across Australia, with the overall prevalence likely to be around four times that of the general population.
    • The higher rate of diabetes in the Aboriginal and Torres Strait Islander population results from genetics, poverty and the lack of education and resources within this population, particularly in remote communities.
    • Evidence from the ‘70s work of Thomas McKeown and built on since by others, reiterates the importance of addressing the social determinants of health as well as providing quality health care services to address chronic health conditions such as diabetes. You need this two pronged strategy to provide improved health.
  • With a history of displacement from land, disconnection from family, social disadvantage and high levels of incarceration, the Aboriginal and Torres Strait Islander people experience these factors which have contributed and will continue to cause the health issue of diabetes and other chronic health conditions.

Addressing these issues are the challenges that face everyone here today

  • A strong primary health care system at a national level is associated with better health outcomes. Our community controlled sector is integral in delivering quality primary health care to the Aboriginal and Torres Strait Islander people.
  • The National Aboriginal Community Controlled Health Organization (NACCHO) that I represent, is the elected national peak body representing over 150 Aboriginal Community Controlled Health Services in Australia.
  • We have here today dedicated members of NACCHO such as Congress Alice  Springs who are delivering frontline comprehensive primary health care to communities across urban, regional and remote regions.
  • Our  Community Controlled Health boards and staff come from different cultural backgrounds, histories, experience and knowledge – but we share a common commitment to our communities at the local, state and national levels and to improving the health and well being of Aboriginal peoples in Australia.
  • Our member services form a network, but each is autonomous and independent, both of one another and of government.
  • The integrated primary health care model is in keeping with the philosophy of Aboriginal community control and the holistic view of health that this entails.
  • Why does community control work so well in addressing health conditions such as diabetes?
  • Diabetes is a complex metabolic syndrome that requires lifestyle and environmental changes, in conjunction with medication and education to achieve improvements in blood sugar levels but more importantly in reducing the macrovascular complications of diabetes. To make these significant life changes and to maintain them long term requires a supportive community approach.
  • Community control is the embodiment of this. The principals of community controlled primary health care were set out in the National Aboriginal Health Strategy in 1989 and remain today the gold standard approach to improving the health status of Aboriginal and Torres Strait Islander people.
  • These principals encompass ;-
  • A holistic view of health care which includes physical, social, spiritual and emotional health of people.
  • Capacity building of community controlled organizations and the community itself to support local and regional solutions or health outcomes
  • Local community control and participation
  • Partnering and collaborating across sectors
  • Recognizing the inter-relationship between good health and the social determinants of health.

Our services were practicing interprofessional and collaborative health care delivery before it became “fashionable” model of service delivery.

I would like to talk about the importance of focusing on our children to address diabetes and other chronic conditions. Pre-disposition to chronic conditions such as diabetes starts in-utero. The sector needs to address maternal health issues such as smoking, alcohol consumption, stress and mental health related conditions and nutrition.

The controversial data on maternal smoking from the recently released AIHW report suggests more needs to be done in this area.

The wider Australian community needs to facilitate the growth of our children in an environment free of racism, which acknowledges the historical mistakes made that caused a disconnection from land and family and work towards rectifying the long term impacts of those mistakes.

Environment can influence how genes express themselves resulting in a predisposition to diabetes. Epigenetics explains why Aboriginal and Torres Strait Islander people have such a high incidence of diabetes and it is only through addressing the environmental, social determinants of health that the situation will be rectified.

Education of our children and development of strong leadership will lead to generational change to our health status.

Robust, culturally appropriate screening for diabetes risk factors to assist in early diagnosis and interventions to reduce the progression of the illness are important.

NACCHO shaping national health reform (national policy and advocacy  of diabetes)

 So what is NACCHO’s strategic direction for its member services?  

It covers three central areas that are consistent with its constitutional objectives.

Strategic Direction 1: Shape the national reform of Aboriginal health .

Strategic Direction 2: Promote and support high performance and best practice models of culturally appropriate and comprehensive primary health care

Strategic Direction 3: Promote research that will build evidence-informed best practice in Aboriginal health policy and service delivery.

 The first, and the one we need to concentrate on today Shape the national reform of Aboriginal health’ makes it clear that we need to embark on a new process of reform at the national level.

The last major national reform was the transfer of responsibility for Aboriginal health to the Department of Health and Ageing back in 1995.

Our sector led the advocacy for this change and it was the springboard we needed to greatly increase the amount of funding now available for Aboriginal health service delivery. This included much better access to the MBS and PBS as well as grant funding.

Unfortunately, these funds have not systematically flowed into the creation of new or enhancing existing Aboriginal community controlled health services even though this is the best practice model agreed in the national strategic plan.

There are systemic barriers within government to transforming of the health system in favour of Aboriginal community controlled comprehensive primary health care. Risks to the community controlled sector include the distribution of funds to Medicare Locals for the provision of services to the sector without the inclusion and consultation of the sector.

NACCHO is committed to working collaboratively with Medicare Locals as partners in service delivery for the sector but there is the network of community controlled services with a consistent track record in improving health status of Aboriginal and Torres Strait Islander people who are now being denied direct to service funding as it is passed directly to a Medicare Local .

We do not want this to occur for programs that are designed to prevent and manage complex, multi-factorial conditions such as diabetes.

Once again, national reform is needed to address these barriers so that our people can access the highest quality, culturally safe community controlled health care in a way that builds our responsibility for our own health.

This requires existing health funds to be better invested to promote the quality and effectiveness of our services and for greater recognition that Aboriginal community controlled health services are the best practice model for Aboriginal people.

As the national peak body in Aboriginal health, NACCHO has taken a lead role in forming and advocating for our position within the National Health and Hospital Reform debate and influencing the government’s health reform agenda in Aboriginal health.

Our sector has grown stronger as we have worked together to forge a unified position on the health reform agenda.

We have been joined by many other stakeholders in Aboriginal health who are keen to work with us and support us such as the National Congress of Australia’s First Peoples

The National Congress of Australia’s First Peoples  has teamed up with NACCHO and ten other Aboriginal and Torres Strait Islander health groups to form the National Health Leadership Forum (NHLF).

The forum is lead by: Congress Co chair Jody Broun and NACCHO Chair Justin Mohamed.

The NHLF is a partnership that builds onto the strength and experience of NACCHO’s members’ views, experience and expertise in primary health care delivery.

Together with our partners we are shaping the national reform of Aboriginal health that primarily is driven by COAG.

In November 2008, COAG agreed to sustained engagement and effort by all governments over the next decade and beyond to achieve the Close the Gap targets for Indigenous Australians.

The National Indigenous Reform Agreement (NIRA) sets out the policy framework for Closing the Gap in Indigenous disadvantage. One of the Better Health Performance Benchmarks is to reduce the age adjusted prevalence rate for Type 2 Diabetes to 2000 levels (equivalent to the national prevalence rate of 7.1%) by 2023

There are other interlinked indicators that cover body weight and smoking rates that impact on diabetes incidence and morbidity.

The COAG commitment also included targeted initiatives for Indigenous Australians of $4.6 billion across early childhood development, health, housing, economic participation and remote service delivery through a number of associated National Partnership Agreements.

Health related Agreements include:

The National Partnership Agreement on Indigenous Early Childhood Development—with joint funding of $564 million over six years to June 2014, to address the needs of Indigenous children in their early years.

The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes—with funding of $1.6 billion over four years to June 2013, centred on five priority areas:

  • tackling  smoking
  • providing a healthy transition to adulthood
  • making Indigenous health everyone’s business
  • delivering effective primary health care services
  • better coordinating the patient journey through the health system.

Addressing issues in peri and neonatal health and early childhood have demonstrated long term health outcomes. The investment in primary health care has been shown to be a major contributor to improving these health outcomes.

The benefits of improvements in children today will only be noticeable in future generation’s reduced burden of chronic diseases such as diabetes .

 NACCHO and culturally appropriate diabetes prevention and management strategies 

The ACCHS model of care has a long history and a proven track record. It has achieved clinical outcomes beyond those of conventional health services through the use of a range of care approaches including proactive[approaches to diabetes and other chronic diseases care, incorporation of health promotion and prevention into primary health care; support of an Aboriginal workforce, multi-disciplinary teams, family involvement and holistic care.

Evidence supporting ACCHS as the best avenue for delivery of Aboriginal and Torres Strait Islander Health can be demonstrated by:

  • The Assessing Cost-Effectiveness in Prevention (ACE-Prevention) Project suggests that up to 50% more health gain or benefit can be achieved if health programs are delivered to the Aboriginal population via ACCHSs, compared to if the same programs are delivered via mainstream primary care services.
  • Aboriginal people prefer health care provided by Aboriginal community health services. A recent survey health in South Australia, conducted by the University of Adelaide for the South Australia Department of Health, found that 52.1% of Aboriginal respondents preferred an Aboriginal specific health service, while only 9.6% preferred a non-specific service.
  • ACCHS are better at treating Aboriginal health problems than mainstream general practices according to the 2003 Bettering the Evaluation and Care of Health (BEACH) report which concluded that 1.4 per cent of consultations in mainstream general practice involved Aboriginal and Torres Strait Islander people. This number is significantly less than the proportion of Aboriginal and Torres Strait Islander people within the Australian community (2.2 per cent).
  • Greater equity, leading to better health outcomes, in relationships between doctor and patient. When Aboriginal people attempt to access mainstream biomedical health care, power imbalances between the doctor and patient may result in the needs of patients being unmet.
  • A recent review in the Medical Journal of Australia which found that the Aboriginal community-controlled sector is in the vanguard of clinical governance in Australia and that input from the sector should be sought from others in Australia to inform the implementation of clinical governance across all primary health care.”
  • A recent BMC paper looked at the differences between ACCHS and private practice and noted the extra “care” taken on by the ACCHS services and their health professionals in moderating access and nurturing patients rather than just a simple service delivery model based on a business model.8

NACCHO key recommendation the Government should take to address the diabetes epidemic.

How is this best achieved?

We need to nurture our children from conception through their early lives. Addressing nutrition, social and emotional well being of the entire family and education to ensure they are afforded every opportunity to make healthy and informed choices.

The government must recognise that Medicare Locals and all other service providers including the tertiary hospital health care team will only be able to deliver on care to the sector if they work in partnership with Community controlled health services.

This is the best system to address the complex issues that cause diabetes and other chronic diseases. It is also the best way to co-ordinate care across the continuum.

We need funding and support for a strong Aboriginal health professional workforce. More doctors, nurses, health workers and allied health and pharmacy services provided in a culturally appropriate manner to Aboriginal people by Aboriginal people.

Provision and support for preventative health programs that address the underlying issues contributing to diabetes such as lifestyle and health literacy.

We need a streamlined uniform medication system for the sector that delivers across the tertiary to primary care environments and does not rely on who writes or where your prescription is written.

At the local community level our community controlled health services need to lead action to address these social determinants.

At the state and territory level our Affiliates need to lead action to address these determinants.

At the national level; this plan commits NACCHO to providing stronger leadership than even before – we must move forward more quickly and not accept the very slow pace of change. Australia can do better than this.

Finally, at the level of each and every Aboriginal person there is also a responsibility to join the struggle.

Together we can make a difference.

For Aboriginals in Centralia Australia,the health problems of westernization.

 The “‘perfect storm” for an unhealthy population in the middle of one of the world’s healthiest countries — and what one group is doing to help

photo 5 -- 615.jpg

Colin Nipper tries to get some rest while undergoing dialysis
Please note:

1. This article is reproduced as published.

2.The article has  spelling and phrases that NACCHO and our movement does not normally use (aborigine,aboriginals ETC)

3.Images are those used in the article

The Australian aboriginal community Mutitjulu lies in the shadow of Uluru, one of the country’s most popular tourist destinations, but it could not be more  different from the polished walkways and restaurants that make up the neighboring resort town of Yulara. Its modest buildings are covered in graffiti that demonstrates a remarkably thorough understanding of English profanities.

Some of the houses’ walls are pocked with holes, and the sandy grounds are filled  with trash ranging from empty Coke bottles to a wrapper for something called “Magic Foot Candy.” While Yulara seems designed to give vacationing tourists   all the services they could ask for, Mutitjulu is equipped with only the most elemental hallmarks of Western civilization: a school, a health clinic, a  general store.

Dr. Janelle Trees, general practitioner at the desert community’s health clinic, describes the conditions that many of its roughly 300 residents live in as    “extreme squalor.” But for Kinyin McKenzie, a lanky aborigine who returned to Mutitjulu in late September to see relatives and attend a  meeting about possible development projects, the place is just home.

“When I come back home, I’m happy because my family’s there,” he says, his smile revealing an abundance of missing teeth. “We sit around together and talk  together, have meal[s] together.”

About three years ago, McKenzie had to move to the central Australian town of Alice Springs — around 300 miles from Mutitjulu — for a reason that has become  increasingly common among Australia’s indigenous population: dialysis. His kidneys were failing, and if he did not get treatment to replace the blood cleaning work that they used to do, he was not going to survive.

In other words, he moved to stay alive. But he was not too happy about it.”It’s tough in Alice Springs,” he says. “Nobody comes out and talks to me. I’m by myself. Lonely, you know?”

McKenzie still spends the bulk of his time in Alice Springs, as the medical treatment he needs is much more available there than it is in remote aboriginal  communities like Mutitjulu. However, thanks to a mobile dialysis unit that the corporation Western Desert Nganampa Walytja Palyantjaku Tjutaku (the name  means “making all our families well” in the aboriginal language Pintupi) launched in 2011, he at least has some opportunities to come back and visit.

The unit, called the Purple Truck, has several goals, says Western Desert Manager Sarah Brown. They include making it easier for aborigines to maintain  links with their family and land, giving them something to look forward to, and reducing incidents of kidney disease — partly by demystifying the treatment    process “and helping people to engage with a pretty scary system.”

The Purple Truck, parked in Alice Springs

“It’s about dialysis machines,” she says, “and those dialysis machines giving people the option to be home looking after their country.

Australia ranked second in the United Nations’ 2011 Human Development Index, but its numbers on aboriginal health are grim in almost every category. Their  life expectancy is about 10 years less than the country’s non-indigenous population. They died from “intentional self-harm” at 2.5 times the rate of    non-indigenous Australians between 2005 and 2009, and in some remote communities, over 70 percent of children were found to have skin diseases and  infections, according to the academic resource Australian Indigenous HealthInfoNet.

Kidney disease is no exception to these inequalities. Between 2009 and 2010, aborigines were sent to the hospital for treatment involving dialysis 11 times  more frequently than non-indigenous Australians, making it the most common reason for them to be hospitalized. And between 2004 and 2008, the death rate of  aborigines from kidney disease was 5.1 times higher than the rate for non-indigenous Australians.

“It’s taken only three or four generations to turn into the epidemic that it is today,” says Fiona Stanley, a professor in the School of Pediatrics and  Child Health at the University of Western Australia.

Stanley and other experts in the field are quick to say there is not one grand reason for these harsh statistics. Anne Wilson, CEO of Kidney Health  Australia, listed diet and nutrition as two major contributors, as several incidents of kidney disease are brought on by diabetes. In some communities, aborigines may be up to 10 times more likely to suffer from this disease than non-indigenous Australians, according to Australia’s Monthly Index of Medical Specialties.

Much of this unhealthy diet arrived in aboriginal communities as part of the country’s ongoing legacy of colonization — a legacy that has not been very kind  to Australia’s original inhabitants.

This rose to the forefront of Australian politics in 2007, when the government introduced a series of controversial  legislative actions known as “The Intervention” in response to allegations of child abuse and concerns about general dysfunction in aboriginal communities.

Measures included placing restrictions on items the aborigines could purchase with welfare income and banning alcohol and pornography in certain    communities.”They use the excuse that they didn’t know how to manage their lives,” he says. “… Against that is 60,000 years of living before colonizers came here.”

A 2010 United Nations report found no evidence that the Intervention’s “rights-impairing discriminatory aspects” were necessary. New York University  Anthropology Professor Fred Myers added that these policies angered many of the aborigines, who felt they were being stripped of their autonomy.

Bob Randall, one of the listed traditional owners of Mutitjulu, agreed.

“They use the excuse that they didn’t know how to manage their lives,” he says. “… Against that is 60,000 years of living before colonizers came here.”

 The aborigines briefly took center stage again in February of 2008, when former Australian Prime Minister Kevin Rudd gave a speech formally apologizing to them for their “past mistreatment.” His address included calls to halve the gap in infant mortality and close the gap in life expectancy between indigenous and non-indigenous Australians within a decade and a generation, respectively.

 The country is not there yet.

And Wilson believes Western civilization may be part of the problem.

  “It’s like the whole issue of white men trying to impose our lifestyle on communities that have, for hundreds of years, actually functioned quite well    without us,” says Wilson. “It’s a complex issue. It’s got to do with the westernizing of indigenous communities, which we know doesn’t really work unless  that’s what they want.”

  The introduction of the western way of life to aboriginal communities ties into what some see as a potential genetic contributor to their high rates of    both kidney disease and diabetes. For generations, they lived as nomadic hunter-gatherers, moving frequently and eating what they could when they could   find it. But contact with European settlers and non-indigenous Australians — in some cases as recently as a few decades ago — brought with it cars, processed    foods and a more sedentary lifestyle.

In short, the aborigines have been faced with what Dr. Graeme Maguire, executive director of the diabetes and cardiovascular research institute Baker IDI   Central Australia, calls a “‘perfect storm’ of social, environmental and health risk factors.” They are engaging in less physical activity while eating and  smoking more often, which has helped create ideal conditions for kidney disease and diabetes to develop.

“There’s some talk about whether, you know, if you’re a hunter-gatherer, and you don’t know where your next meal is coming from, whether your body adapt  to storing the energy quite quickly because you’re going to need it soon,” says Brown. For those living next to a store and eating multiple meals a day, she continues, “your metabolism needs to be quite different.”

Most do not see genetics as the ultimate explanation behind aboriginal diabetes and kidney failure but rather something that can help trigger these  problems when combined with other environmental, health and social issues such as poor prenatal care, unsanitary living conditions, and depression.

“They’re not necessarily more at risk,” says Maguire, “but if you add the existing risk with the environment, then it switches it on.”

These are far from the only factors and theories at play. Trees mentions that many aborigines live with high levels of stress; Stanley discusses looking  into a link between kidney failure and childhood skin infections; and Maguire is very interested in what happens to the aborigines in utero.

But the most candid assessment concerning the multitude of potential reasons behind why the aborigines have such high rates of kidney disease and diabetes  comes from Alan Newbery, clinical services coordinator at the health clinic in the aboriginal community Kintore.

“Now if I could answer that,” he says wryly, “I would probably get a Nobel Prize.”

It would be tough to find anyone who enjoys a treatment as lengthy and frequent as dialysis, but for several aborigines who need to receive it, there is an added difficulty: they have to leave home. For aborigines in remote communities, leaving home is not the same as going to a hospital 20 minutes from their old neighborhood. It typically means    traveling hundreds of miles to Alice Springs and — since treatment is multiple days a week — not coming back.

“Basically, it was to be a one-way ticket to Alice Springs,” says Brown, referring to a diagnosis of kidney failure. “And then people would pass away.”

Western Desert was incorporated in 2003 largely as a response to this issue. By 2010, it had established dialysis units in Alice Springs and the aboriginal  communities Ntaria (78 miles from Alice Springs), Yuendumu (182 miles), and Kintore (324 miles).

And in 2011, it launched the Purple Truck, which promptly  traveled 154 miles to dialyze patients in the aboriginal community Papunya.

Patients still need to come to Alice Springs to start dialysis, says Brown, and Western Desert has not yet been able to set up units in all of Australia’s  aboriginal communities. (The issue is largely one of money, as setting up a remote dialysis unit can cost hundreds of thousands of dollars. Alison  Anderson, one of Australia’s most influential aboriginal politicians, says there is “nowhere in the world any government would have enough money to put two or three renal machines in every remote aboriginal community.”)

But because of the Purple Truck, a trip into town for dialysis no longer has to be a    permanent, one-way ticket.

“For all those other communities where there’s nothing, it means from time to time we can get the truck there and give people an opportunity to get home  for a couple of weeks or a month, which we try to coincide with things that they’ll really want to be there for,” says Brown.

It’s a start, says McKenzie, and it’s a start that he appreciates. But it isn’t perfect.

“We want to go back to our own country and be with our families not for one week, two weeks, but for good,” he says.

The Purple Truck is an impressive, colorful piece of machinery. The cab is a deep purple, as the name suggests, while the outside of the trailer is painted    with aboriginal art — interlocking mixtures of black and red lines, circles and squares, all atop a tan background. The spacious inside resembles a  well-maintained doctor’s office, as it contains facilities including dialysis machines, an area for food preparation and a bathroom. And nearly everything  is spotless.

It sets out for Mutitjulu on the afternoon of Septembter 24 with McKenzie and fellow patient Colin Nipper so they can attend a meeting to discuss how to use  funds from the neighboring national park to help benefit their community.

Joining them are Colin’s wife Teresa Nipper and Ronnie and Noel Edmonds, two  married Western Desert workers responsible for making sure everything runs as smoothly as possible in the desert. Ronnie works as the renal nurse, while  Noel does everything she doesn’t have to. This includes actually driving the truck.

“The most difficult part of the trip is getting out of town,” says Noel, as he begins driving the 11-meter vehicle from Alice Springs to Mutitjulu (the    rest of the party follows behind in a white Toyota). Once the truck hits the highway, he explains, the drive gets much easier. It’s avoiding all the signs, tree branches and various other obstacles Alice Springs has to offer that’s hard.

Three hundred miles later, shortly after sundown, he pulls the thoroughly modern hulk of Western medicine into the middle    of one of the world’s oldest societies. The incongruity is not lost on him.

“Stone age, space age,” he later says. “And this is part of it.”

Ronnie and Noel spend the first night dropping off McKenzie and the Nippers and sorting out accommodations for themselves. They use the next day to set up  the truck and begin dialysis with Colin the day after.

The treatment starts early in the morning to avoid the hottest parts of the day. Noel drives the Toyota along Mutitjulu’s mixture of dirt and paved roads  to pick up Colin at his house around 7 a.m., when the community is still mostly silent. He helps guide the practically blind 56-year-old to the car and  then takes him back to the Purple Truck for dialysis.

The beginning of the session is a flurry of activity: Ronnie weighs and questions Colin about his health, while Noel makes sure the machine is on track to  function properly. They also do what they can to make the process enjoyable.

“Colin, if the nurse is too rough, you tell me, ok?” Noel jovially asks as Ronnie starts hooking him up to the dialysis machine. “And I’ll put the needles in.”

The comment gets a boisterous laugh from Colin, who does not seem particularly nervous about the four-hour session he is about to undergo. He acknowledges  that his move to Alice Springs was hard and still claims Yulara as his homeland despite the influx of tourists, but he does not approach his treatment with anything resembling bitterness. Rather, he appears relaxed, genial and occasionally unconscious throughout.

Ronnie Edmonds setting up Colin Nipper for dialysis on the Purple Truck in Mutitjulu

The same is true of Ronnie and Noel. Their easygoing manner with both the patients and each other is a clear indication that, although supervising remote  dialysis treatment in the desert is not an activity most people are familiar with, it is something the two of them are quite used to.

“We always wanted to see the Australian outback,” says Ronnie, who has been a nurse for about 41 years. “So that’s what we decided to do.”

After Ronnie gets Colin on the machine, things calm down significantly. He lies back in the chair and closes his eyes, while Ronnie and Noel are left to  monitor him and the equipment to make sure nothing goes wrong.

Noel is not quite as lucky the next day, when it is McKenzie’s turn for dialysis. In fact, things get more complicated right when he and Ronnie arrive in  the community to find that one of the truck’s compartments was opened overnight.

“Hopefully everything is ok,” Ronnie cautiously says, as the couple begins approaching the truck on the surprisingly cool and cloudy morning.

This hope comes true, as a quick inspection shows that no damage has been done. Noel dismisses the open compartment as “kids just poking their nose in” but  is still disappointed that it happened.

“It’s a bit upsetting when they start interfering with such a valuable item,” he says. “If there was any damage, we’d pack up and go home. We wouldn’t come  back here.”

Noel relays this same message to McKenzie a few minutes later when he picks him up for treatment. Things proceed similarly to the day before at    first — Ronnie and Noel weigh McKenzie, ask him about his health, hook him up to the machine and feed him breakfast (he asks for sugar on his oatmeal, but  Noel says he gives him sweetener instead, “so that’s not so bad”) — but the process gets more eventful before long “Don’t end up like him,” Noel says, referring to McKenzie.

About halfway through McKenzie’s treatment, the power source that the dialysis machine is hooked up to shuts down, forcing Ronnie and Noel to switch to the  generator. They go back to the original source soon enough, only to have it shut down again with about an hour left in McKenzie’s treatment. And right as  his session nears completion, it happens for a third time.

Still, Ronnie and Noel never seem too concerned about any of these outages, while McKenzie does not even seem to notice them. They are inevitable and common incidents, things that simply tend to occur when your office happens to be in the middle of the desert.

“Just too much bloody drain on these plugs,” Ronnie says matter-of-factly after the second shutdown. “The power sources are just not reliable enough, are they?”

McKenzie’s treatment gets a more welcome interruption between the second and third power failures, when two young aboriginal boys approach the truck. Ronnie and Noel give them a rudimentary explanation about what they are doing and exhort them to not be on these machines themselves in 40 years.

“Don’t end up like him,” Noel says, referring to McKenzie.

The boys are only on the truck for a few minutes, and it is unclear whether or not they actually absorb anything Ronnie or Noel tell them. They seem a bit confused and overwhelmed the whole time, and between the two of them, the only word they say throughout the conversation is “Yeah.”

Ronnie pragmatically says that the only real way to know if this brief, impromptu lesson had any effect on the children will be to wait and see what    happens to them when they grow up. However, she is optimistic that it may have had at least a small impact, if only because they know more about kidney  disease now than they did yesterday.

Despite the various and numerous disruptions, Ronnie and Noel still get McKenzie finished with his dialysis right around lunchtime. He appears fine but  slightly worn out, possibly because he has just spent the bulk of the morning having a machine clean his blood.

It is a long, draining process to treat what Ronnie bluntly describes as “a shit of a disease.” But McKenzie says he doesn’t mind — in fact, he likes it.

“No dialysis?” he asks rhetorically. He then spirals his hand down toward the floor, indicating that he knows this treatment is better than the alternative.

Administering dialysis is far from the only responsibility Ronnie and Noel take on while out with the truck. This same attitude dominates at the unit in Alice Springs, called the Purple House, where the dialysis room is occasionally the quietest part of the building. Patients hooked up to machines sit    calmly sleeping or watching movies, while employees out front deal with a host of different issues: helping patients get groceries, driving them to local banks, making sure they don’t get evicted. Workers recognize that, for many of the aborigines, coming to Alice Springs is equivalent to coming to a foreign   country, and they are willing to do what they can to help ease the transition.

“Seeing how disadvantaged aboriginal people are every day makes you want to do something about it,” says Aaron Crowe, who does social support for the Purple House. “I just think that it’s crazy that this is Australia, and we just have these people living in poverty. And it’s really pretty shocking.”

The errands, meals and phone calls are frequent, but sometimes the Purple House just needs to be a spot for the aborigines to go. Amenities such as the  cabinet filled with aboriginal medicine and the outdoor fire pit provide a few reminders of home that can be a comfort regardless of whether or not a  patient has a session scheduled.

“There needed to be a middle place,” Brown says. “Somewhere where people felt comfortable that it was their place.”

Samuel Nelson at the Purple House in Alice Springs

This comfort is on full display during the morning of September 21, when Samuel Nelson, a 49-year-old aboriginal man who moved from Yuendumu to Alice Springs for dialysis in 2006, decides to stop by the Purple House even though it is not one of his days for treatment. He spends the bulk of his time sitting by    the kitchen, snacking, conversing and laughing with three of his fellow patients. When asked what he is doing here, he smiles and holds up his mug.

“Just have a little coffee,” he says.

The problems of diabetes and kidney disease among the aborigines are not going anywhere. Western Desert nurse Noeline Murray, who works in Kintore, says  dialysis patients are increasing at a rate of about nine percent a year, while Brown says the only reason the main renal unit in Alice Springs is not  already overflowing is because some patients skip their treatment.

“If everyone turns up to their allotted dialysis,” she says, “then there’s not enough machines.”

People have not settled on one solution to this problem, just as they have not settled on one cause. Randall would like the aborigines to go back to their  older and healthier way of living. Murray would like to go through Kintore’s community store and remove all the unhealthy foods. Maguire would like to see  better education for both the aborigines and health care providers.

All would almost certainly be helpful. And on the night of Sept. 24 in Mutitjulu, an event took place that may have been helpful as well. It was nothing complex — just a bonfire and a cookout between some aborigines and some young students from Sydney. The two groups appeared to have very  little in common, but they spent the dark, warm evening eating, talking and relaxing together by the fire anyway. And at the end of the night, the students    gathered together to sing a song to the aborigines, and when they finished, the aborigines responded in kind.

It was a peaceful moment, a happy moment, one that seemed to be blissfully unaware of the complicated and often shameful history between the aborigines and the rest of Australia that has helped create such an unhealthy population in the middle of one of the world’s healthiest countries.

The solution lies somewhere in there.