Croakey is closed for summer holidays and will resume publishing in the week of 13 January 2025. In the meantime, we are re-publishing some of our top articles from 2024.
This article was first published on Thursday, November 28, 2024
Introduction by Croakey: Professor Megan Williams, a Wiradjuri descendent and academic with extensive experience in health and health service evaluation, has been slowly making the move from inner Sydney to the small New South Wales town of Kandos.
Kandos lies on the traditional lands of the Dabee People of the Wiradjuri Nation, with Mudgee, the nearest substantial town, about a 40-minute drive away. The landscape is dramatic – it’s a town nestled picturesquely in a valley with close-up mountain views.
For Williams, Kandos is a place where she can access family, Country, creativity and culture but it is also a place with challenges.
In the article below, published ahead of this weekend’s CroakeyGO in Kandos, she brings her unique and multifaceted lens to the issues of health and healthcare in the region.
This post is part of the #IndigenousEvaluation series of articles, sponsored by Yulang Indigenous Evaluation.
And it’s not too late to join the Croakey team in Kandos this weekend, to walk together and talk about health. All the details are here.
Megan Williams writes:
“Didn’t you know healthcare stops at the Blue Mountains?”
That was the reply I got when I finally admitted I needed advice on a niggling health issue and asked about appointments here in the Kandos-Rylstone area.
But there were none available, only “try again tomorrow” at one and at another the offer to put my name on a waiting list for a waiting list for next year.
“You could go back to the city to get help,” someone else suggested, even though they know I live in this region full-time now.
Patchwork health services
I’ve been coming and going from Kandos for about seven years, after many years of yearning to be back in the area since leaving Mudgee when I was ten.
My Williams Aboriginal family are from Mudgee, as well as Tasmania, and there are stories about Aboriginal “indentured labour” and slavery being brought from Tasmania to here. I’m still exploring the possible links.
My long-term GP, 230km away in Sydney, is okay doing telehealth for a little longer, but she’d like to get her eyes on me and prefers I find a local doctor because, ultimately, a phone call isn’t the same.
I’ve also been looking into healthcare here for a local case study, contributing to an evaluation of NSW Health’s Aboriginal mental health and wellbeing strategy that I’m working on for my company Yulang.
In my research I’ve found that the Rylstone “not a hospital” health service, seven kilometres from Kandos, has an enticing list of visiting allied health professionals. But locals know, “don’t break anything unless it’s Tuesday or Thursday” and, “always have a print out of an e-script”.
The multipurpose health service does have a very helpful Aboriginal knowledge system in place though – biggest paintjob by local Dabee Wiradjuri Traditional Owner and Elder Uncle Peter Swain. He’s matched department names with colours and they’re all over the walls – you know exactly where you are. There’s a flyer for youth health; it lists services everywhere except here.
The Kandos population of 1200 is relatively well spread across older and younger people, though it does have a median age of 54, which is far older than the Australian median age of 38 years.
Unmet healthcare needs
Lack of healthcare isn’t just an issue for older people though. At the other end of the lifespan, almost 20 percent of the Kandos population are young – from zero to 19 – very similar to the NSW and Australian population at around 23 percent in this age range.
The proportion of Aboriginal and Torres Strait Islander people in Kandos is double that of the proportion in the NSW population, at 8.9 percent (with mobs’ median age of 52). Kandos schools, however, count around 15 percent of local students as Aboriginal and Torres Strait Islander.
While there is a wide range of structured and beautiful nature-based activities for young people, there are limited post-secondary education or employment options.
From 1916 until the closure of the works in 2011, Kandos was the home of a strong cement industry – its loss has changed the place.
The population has only shrunk a bit, but it seems more diverse. People have often said that this used to be a very racist town. People of all cultures were in the mines and cement works, just not many Aboriginal people.
Now we hear “Aboriginal people are real leaders here”, and some of the violent truths of the past have been named too.
Strong Indigenous leadership
Dabee people in Kandos have exceptional knowledge of the mountain ranges, waterways, weather, flora and fauna, families, and of the massacres of Dabee and other north-east Wiradjuri people.
Dabee people lead us in cultural heritage protection and there’s deep talk of wellbeing, grieving, connecting, healing, economics, and social determinants of health.
There’s visibility of Dabee and the North East Wiradjuri Company (NEWCO) because of its workshop, gallery and office and big Aboriginal flag in the main street, and because of mobs’ presence on committees and at events, work hung in galleries, portraits at the museum, cultural tourism in the Wollemi, contributions to schools, land care, cultural burns, language, welcomes, ceremonies, workshops and friendships.
These, and the close proximity to Mudgee, Lithgow and Bathurst make living in Kandos viable – if you have a reliable car. The almost-daily buses to these areas help but don’t take us in the Orange, Wellington or Dubbo directions where there are Aboriginal community-controlled health organisations (ACCHOs) and options for natural or specialist healthcare.
Defining the healthcare void
The void in ACCHOs from Bathurst all the way east across to the Blue Mountains, and north-east to Muswellbrook and south-east to Goulburn shows up on the NSW Aboriginal Health and Medical Research Council members’ map.
Rylstone and Mudgee are well known “central west” tourist spots but in the state’s Local Health District context they are part of the Western LHD. Lithgow and Portland, about an hour’s drive to the south-east, are part of the Nepean Blue Mountains LHD even though they too are geographically “west of the divide” – Great Dividing Range.
The Western LHD is huge. Kandos isn’t named on the LHD’s map, and neither is Mudgee but Goodooga 600 kilometres away near the Queensland border is – it has 250 people and 60 percent identify as Aboriginal and Torres Strait Islander – about the same in number as in Kandos but with a younger median age of 37.
Brewarrina is on the Western LHD map and is a similar sized town to Kandos with 1350 people; there, 51 percent identify as Aboriginal and Torres Strait Islander. This is about 440 people with a median age of 31.
Goodooga has the same type of nurse- and LHD-led community health service as Rylstone but nothing like the Brewarrina Aboriginal Medical Service and nearby Bourke Aboriginal Corporation Health Service ACCHOs.
In Orange, just over two hours’ drive from Kandos, 7.9 percent of the population identify as Aboriginal and Torres Strait Islander people – about the same proportion as Kandos but much greater in number – just over 3000. The Orange Aboriginal Medical Service is well known for its number and breadth of services and collaborations.
Clearly, health service availability is about the population number, not only population proportion, of Aboriginal and Torres Strait Islander people. However, proportional planning for healthcare has long been named as essential for achieving health equity and meeting the needs of minority populations who often experience an over-burden of poor health and its determinants.
A case study in self determination
In some ways, I don’t mind being in a formal health service void here in Kandos.
We have access to so many things that promote wellbeing. Health and healing seem more do-it-yourself – an important sign of self-determination that worldwide is considered essential for Indigenous peoples’ health.
Through my work evaluating health programs, and my 1994-2007 work in community health services, I’ve thought a lot about models of healthcare and health workforce planning.
I know that in-reach by visiting health services, telehealth and partnerships (as occurs in other areas of NSW) does improve health care access, quality and outcomes. I wonder what more could happen here, but also wouldn’t want to be told how to do things; this community has all it takes to lead.
Would an ACCHO be sustainable here in Kandos?
Maybe, if it built on actions already occurring, including holistic and healing and family wellbeing programs, addressing social determinants of health through collaboration on education and training programs, providing cultural capability and anti-racism training, leading culturally valid research, and facilitating Caring for Country, arts and language programs.
These obviously don’t solve the inadequacy of clinical care, but ACCHOs with Aboriginal Health Practitioners and Aboriginal Health Workers can and do improve access to timely assessments, early detection, vaccinations, continuity of care, referrals and follow-ups.
Kandos DIY for health
In the void of clinical care and at my age (just below the median age), maintaining health and healthy connections is immensely important. To stay on track, I’ve assembled my top five do-it-yourself Kandos cultural determinants of health on offer here:
- Cultural practices: weaving with Aunty Di Pirotta, NEWCO and family; Wiradjuri community of language speaker camps; Wirimbili Dance Group formed with support of NEWCO and Wagana Dance; rock shelter petroglyph preservation; cultural burns in partnership with other organisations including Wiradjuri-run Yarrabin Fire; woodwork, pyrography, tool making and using; shared meals and time together.
- Connecting to Country: gathering and walking at Ngurang – 500 hectares of crown land now managed by NEWCO; visiting Growee Gulph’s baby feet rock shelter art; intergenerational camping and working in Wollemi Wilderness Park; full moon paddles at Ganguddy with Wirimbili Cultural Tours and Southern Cross Kayaking; ceremony, song, yarning, healing and learning.
- Visual art: making, exhibiting and volunteering at Kandos’ biennial Cementa Art Festival’s locals’ salon at Wayout Artspace, and at NEWCO’s Ngurang exhibition; attending Wayout/Cementa’s Uncooperative youth exhibitions, and Kandos Projects’ and Café 147’s exhibitions; being among multi-disciplinary artists supportive of my work decolonising evaluation so that it is designed around the arts.
- Sharing: Ready access to recycled items through the Kandos Community Charity Shop and Nanna’s Haberdashery – local nonprofit cooperatives, markets, Crop & Swap, the refuse transfer station tip shop, noticeboards, neighbours, Elders and their knowledge and resources.
- Community groups: KRR-FM 98.7 Kandos Rylstone Community Radio, Community Capers newsletter, Watershed Landcare, Koalas of Bara Lue, Mudgee District Environment Group, Kandos Returned Services Community Club, Cementa, Kandos School of Cultural Adaptation, Wayout, NEWCO and Wirimbili, and shoutout to Kandos Street Machine and Hot Rod Show – although burning rubber is toxic to the environment, the number of people brought together safely, happily, alcohol-free and full of creativity is astounding!
These and more are available in Kandos even if clinical healthcare isn’t!
Having it all
Older people have said that the lack of physical healthcare will eventually force them to leave. They’ve managed until now with their legs giving way, lung problems, heart failure, dental difficulties, wounds and cancer, but it’s been exhausting and depressing and at huge personal and family costs.
There are also very real threats to cultural determinants of health and social capital including drought, bushfires, poisoned and diminished waterways from mining, habitat destruction, road accidents, high food costs and underemployment.
In the void, lack of choice in healthcare is a reality.
But on the other hand, the do-it-yourself cultural determinants and social capital – they are overwhelmingly life affirming. Our spirits soar.
I want it all – to be among some Williamses and mob, Wiradjuri nation building, space and nature, as well as accessible, reliable and culturally safe clinical healthcare. Surely that’s not too much to ask in terms of what other similar locations and communities experience.
It’s also about being holistic, which the NSW Government has committed itself to achieving with Aboriginal and Torres Strait Islander people through its new Aboriginal Health Plan and its Closing the Gap implementation plan.
How much healthier this community and its future would be if healthcare didn’t stop at the Blue Mountains.
Megan Williams PhD is Wiradjuri through her father’s family and has 25 years’ experience working on programs and research to improve the health and wellbeing of Aboriginal and Torres Strait Islander people, particularly in the criminal justice system. She is a co-owner of Yulang Indigenous Evaluation.
She will be part of a #CroakeyGO – walking journalism – in her hometown of Kandos on the weekend of 30 November and 1 December. Find out more here.
Acknowledgements
The #IndigenousEvaluation series of articles was conceived and organised by Professor Megan Williams and Dr Mark Ragg and is edited by Dr Ruth Armstrong.
Bookmark this link to follow the series.
The series is supported by Yulang Indigenous Evaluation. The supporter respects the independence of the authors and the editors.
On Twitter, follow #IndigenousEvaluation.
