Relational Medicine

COVID, colonialism and fighting the memes of conspiracy in the Northern Territory

This spring, while New South Wales was planning family reunions and haircuts, and counting down till it crossed the ’70 per cent double dose’ line, and Victorian case numbers were still spiking, another, highly anxious, Delta-time story was unfolding across the Northern Territory. The landing of the virus, vaccines and pandemic misinformation in highly disadvantaged, deeply intercultural and enduringly marginalised, colonised country has been presenting unique immunological, informational, logistical and political challenges. Trust has been a casualty of these factors, vaccine suspicion and ‘complacency’ the fallout. But the practice of what I venture here to call ‘relational medicine’ is showing signs of successfully turning things around in remote Central Australian community settings. 

Alarming numbers

In late October, vaccination rates in many remote settlements and Alice Springs town camps were still sitting dangerously below targets. In advance of Australia ‘opening up’, frontline community-sector workers were urgently trying to loosen the grip of vaccine suspicion and turn hesitancy and resistance around. Faith-based and other misinformation and fear seeded far from the desert floor had flourished in the context of zero community transmission in the first year of the pandemic, and any impact of anti-vax social media was obscured by steady urban NT vaccine uptake. With NSW, Victorian and international travel restrictions about to be relaxed, there were however grave concerns that a regional outbreak would be unavoidable, with dire consequences for unvaccinated communities. 

The major Alice Springs–based Aboriginal community-controlled health service, Central Australian Aboriginal Congress (CAAC), and its professorial medical colleagues in Sydney and Melbourne were clear about the stakes of the ‘big state’ premiers’ and PM’s epidemiological-economic gambits: ‘Aboriginal and Torres Strait Islander adults and teenagers need vaccination rates of 90-95%…to protect their communities’; winding back restrictions elsewhere in the country before this was achieved could have ‘devastating’ results.  The remote northern arts sector went further, calling for 95-per-cent-plus vaccination rates. Anything less would risk the sudden loss of key cultural leaders and irreplaceable knowledge, with incalculable effects for younger generations.  

In early October, when 10 per cent of the predominantly Aboriginal population of Wilcannia was infected in a matter of days, only 20 per cent of eligible Central Australian Aboriginal people had had one dose of any vaccine. CAAC estimated that if the roll-out continued at current rates it would take until March 2022 to fully vaccinate its target population. CAAC’s modelling suggested that 800 to 900 people would die if an outbreak were to occur. 

Through the first half of spring, the Central Australian region of the NT Department of Health had the lowest vaccination rates of its six reporting zones. By early November, rates across remote communities varied dramatically. While a CAAC-run clinic boasted over 90-per-cent coverage, others run by the government were struggling to achieve 20 per cent, and over half remained below 50-per-cent first dose. Rates for Aboriginal people in Alice Springs were also still worryingly low. Alice Springs hospital, which caters for patients from town, over twenty-five remote communities and many outstations, has a ten-bed ICU that treats more than 600 patients a year and is almost always operating at capacity. It has two ventilators.

From preparedness to hesitancy

When COVID first hit Australia, NT community-controlled health services activated ‘pandemic preparedness’ and peak bodies lobbied government in support of biosecurity zoning. Social service organisations worked hard together to move people back from towns to remote settlements, to restructure programs and to distribute COVID safety information in local languages. It seemed everything was in place for a successful vaccination program. Not only were community health and social service organisations proactive but also the Aboriginal media sector was on board and an adequate, early vaccine supply had been secured. The experience of lethal influenza and other fatal epidemics within living family memory, and well-established, very high rates of childhood seasonal flu and pneumococcal vaccination, also pointed to successful vaccine uptake. But that early promise was not to be realised.

In some parts of Central Australia, online and off, at the intersection of Christian faith, self-determination ethos and practice and sovereignty politics, and anxieties about new forms of emergency state power, fear shifted from the virus and potential health calamity to confusion and fear about the medicine that could arrest it. 

Health inequality is a primary marker of (post)colonial injustice. In Central Australia, Aboriginal lives end forty years earlier, on average, than they do in Canberra. For many people, everyday life is shaped by chronic and acute sicknesses and their management. Accessing specialist healthcare drives travel between bush and town, and this brings complex and preoccupying challenges, especially extended-family resource sharing. Widespread and beneficial traditional healing practices, strong Christian faith in an omnipotent interventionist God (and His devil) and belief in the power of prayer complement medical treatment. Within these conditions of necessity, precarity and trusted care—and with no COVID in sight—it was easy to not fear infection and to ‘not worry about’ vaccination, as some Anangu friends put it. 

As well, ongoing traumatic histories of subjection to non-Aboriginal laws and orders has produced deep distrust of government-managed ‘crisis’ interventions. Communities know the exhausting realities of health and social disadvantage, but they also know what it is to be considered ‘endangered’, targeted and ‘protected’ by ‘special measures’, and they know whitefella violations of bodily and family integrity. Some local vaccine resistance is voicing fear of ‘medical experimentation’. 

Discourses of vaccine ‘complacency’ and ‘lag’ decontextualise and individualise the challenges of cultivating trust in vaccination as a shared social good. Such discourses also ignore the ways in which personhood, well-being, unwellness, healing, risk, protection and death are understood and experienced in local worldviews, and how these have been impacted not only by dispossession and settler governance but by colonial science,  as well as by secular and religious moral economies of reparative care, divine destiny and salvational prayer. National and state/territory roadmaps don’t accommodate the challenges of non-medical understandings of life and death for public health communications. Of course, neither do they wait, in an emergency, for any situated analysis of the ways in which fear might manifest, be cultivated, or become infectious. 

Fear and conspiracy in context

Frontline medical and faith workers have reported that some people haven’t wanted ‘the needle’ because they’ve heard doctors are being paid a commission for each jab into an Aboriginal arm. A slickly designed red, black and yellow anti-vax e-flyer that has circulated in Alice Springs, ‘Questions All Communities Need to Ask Their Medical Service or GP’, features this proposition and is tagged in populist libertarian social-media feeds #justsayno and #nofear (as well as the still small and potentially valuable #keepingmobsafe). Ideas of ‘natural’ Aboriginal immunity contra non-Aboriginal vulnerability to the virus are also circulating, their sources unclear.

5G-receptive-microchip-in-the-needle-tip anti-vax stories told by online ‘experts’ and through graphic memes have been very influential. Some anti-vax content proclaims that the vaccines are designed to wipe out First Nations people as an act of racial cleansing. Interstate authorities are investigating possible white-supremacist peddling of these stories to Indigenous and other non-dominant communities across the country. 

The virus, the vaccines, stories about them and measures around them are everywhere unsettling lived senses of the present, the future, urgency, evidence and agency. Whereas Central Australian health providers and public communications can explain the how of a sickness that is yet to arrive, they can’t provide answers to the why of its existence. This renders vaccination only one protective proposition among others. 

‘Vaccine hesitancy’, then, may express the concern that the benevolence and efficacy of human-made medicine should never be taken for granted. Some patients have told their doctors, and community leaders have told government, that it’s the speedy birth of the vaccines and the rush to vaccinate that are most unsettling—that ‘nothing ever happens so fast here’. Hesitancy might be seen as a form of action to slow the pandemic experience, while also carrying a vital sense that healthcare decisions shouldn’t ever happen without sufficient information, time for consideration, and consolidation of understanding. 

Illness, suffering, medical treatment and healing can be painfully slow experiences for anyone. Across the desert, many people with chronic co-morbidities die taking all kinds of medicines and awaiting answers to their prayers for cure and recovery. From a Christian faith-based perspective, salvation in life, suffering or death can also be very slow business—so slow, it can be boring waiting for Jesus’, as a desert Inkgata (Lutheran pastor) once told my partner. 

Over the past year, Christian-coded conspiratorial questions about the reality of the pandemic and the purpose of the vaccine were insinuated into local social media and moved very quickly across communities. Meanwhile, a handful of small desert community church leaders began to proclaim faith as a secure mode of inoculation.

The global Pentecostal drift linking the most and least socio-economically empowered believers in moral economies of personal salvation has traction in long-time Lutheran, Anglican, Baptist and Catholic desert country. A smartphone scroller who is being fed evangelical salvational content by the algorithms enters a personalised digital communion with what feels like an immediate and cosmically encompassing transcendent community. 

Across the desert denominations, the promise of divine sanctuary and the proclamation of mercy has appeal as something ‘old’ amid the hard-edged, everyday realities of contemporary colonised life. Its images can have a busy digital social life. In the online meme-sphere it’s not far visually from Jesus’ love-pulsating heart to conspiracist images of magnetic orbs bleating in biceps or shrivelling poisoned ovaries. 

Well-laid vaccination plans have been hanging in suspended animation in many locations for many months, with GPs, nurses and other vaccination workers witnessing first-hand the reach and impact of anti-vax social media. Contrary to an ecumenical statement issued by the major churches of the region, some local small church preachers are continuing to promote faith over vaccination. Darwin and Canberra, dramatically underestimating the nuances of localised vaccine fear, hesitancy and resistance, have not allocated budgets in ways that could have equitably addressed them. 

Igniting new community action

In early October, NT Police Commissioner Jamie Chalker and Chief Health Officer Hugh Heggie (previously a doctor in remote communities who speaks some Aboriginal language), were dispatched to low-vaccination communities to meet with local leaders. They returned to Darwin very worried, having seen for themselves that Chief Minister Michael Gunner’s bullish commitment to ‘protecting all Territorians’ with borders and jabs alone had largely missed its mark in many small, remote places. Soon after, the chief minister declared that some communities had been ‘mugged by misinformation’. Noting the proximity of ‘all Territorians’ to ‘vulnerable people’, he announced a vaccine mandate for most employed adults, starting 13 November. The mandate positions the majority of non-Aboriginal people across the NT as co-responsible for Aboriginal health and futures.  

The NT Aboriginal health and community service sector has been working in tandem with top-down modelling and vaccine advice, in its own ways, for months. Towards the end of winter, the Central Land Council offered its 200 staff, many of whom work between remote communities and Alice Springs or Tennant Creek, a $500 salary bonus for taking the jab. A partnership between Tangentyere Council and CAAC saw mobile clinics in Alice Springs’ town camps offering vaccination, barbecue lunches and $25 food vouchers. Music festivals, sporting events and town camps have all housed pop-up vaccination clinics. 

The dynamic desert mediascape of CAAMA, PAW Media, First Nations Media, ICTV, IndigiTube, ABC Alice Springs and Aboriginal organisations’ websites, YouTube channels and Facebook pages continues to play a key role in relaying pandemic information. Last year, pre-vaccine videos mobilised the power of direct address to convey COVID safety and biosecurity measures in local languages and in English. These were siren alerts, informational and instructional, and drew from authorised public health statements to communicate principles of personal safety and mutual responsibility. Communications now carry the added burden of having to neutralise the effects of Facebook and YouTube anti-vax propaganda, without ‘giving it oxygen’, as one colleague describes his task. 

Conventional health infographic and poster art online is a genre at risk in a sea of misinformation; the generic authority of epidemiological charts and infographics is also their weakness. Central Australian Indigenous media have made ‘community service announcements’ to ‘fight fire with fire’ since the early 1980s. Health superhero ‘Cuz Congress’ burst forth into the HIV/AIDS epidemic as an iconic regional health ‘influencer’. This year he’s back, wrapped around town buses, proclaiming vaccination, while Aboriginal media organisations are producing and disseminating an array of short videos featuring local elders, health, arts and youth workers encouraging vaccination as protection for self, family and community. An extensive network of social service organisations and individuals has coalesced around the AMSANT ‘Vaccination Information Program’ to promote vaccination in culturally appropriate ways across the Territory’s diverse regions.

Relational medicine 

The deeply intercultural and often close-knit sociality of remote Australia is a key vector of COVID infection risk. It is also playing a key role in pro-health faith and media interventions under pandemic conditions.

Staff shortages, an enduring challenge for remote health, have been in the spotlight of criticisms of the vaccine roll-out, but frontline workers know that having more feet on the ground will not in itself guarantee protection from community transmission. Knowledge of local language and of local understandings of health, history and culture is essential in developing and sustaining trust. So too is intimate friendship, a form of kinship that carries responsibility for care and expectations of honesty and truth. This mode of relationality expects things to be done with Aboriginal people’s interests in focus, ‘proper way’, observant of all gender, age and other protocols.

An ethos of intimate relationality between vaccinated and unvaccinated people is now guiding a range of interventions and informing important elements of an emerging vaccine-era tactical desert media wave. Low-budget phone-made productions are being released online while newly funded door-to-door Aboriginal health worker conversations take place in the least vaccinated remote communities.

Tactical media in whichever format is neither complicated nor resource-intensive healthcare, but it does require embedded social knowledge, dedicated labour, and creative agility. Graphic and animated TikToks designed by networked youth workers depicting vaccination as the work of angels or ‘the needle’ as the gunship of a ‘space-invaders’ game are quickly reaching many thousands of viewers. For older audiences, videos featuring respected vaccinated men and women, old and young, deploy the relational affectivity of care-based direct address. Some feature a confessional conversion story, echoing born-again faith tropes, where a speaker testifies that they have moved from vaccine fear to vaccine confidence.  

In early spring, a major renal dialysis service called urgently on local whitefella Lutheran clergy to pray with high-risk patients who were worried by social-media images of arms pulsating with magnetic light—the devil’s work via ‘the needle’—and resisting vaccination. Prayers positioned science and faith as not mutually exclusive, affirming that people could faithfully trust the vaccine as God’s work on earth. After the prayer session, everyone chose to be vaccinated. Both the prayer and people’s relationships with the trusted pray-er were key to this outcome. 

In a similar vein, after witnessing a Pintupi-speaking non-Aboriginal former community doctor motivate 140 people in Walungurru (Kintore) to get vaccinated, CAYLUS (Central Australian Youth Link-Up Service) solicited video messages from trusted vaccinated people with long-standing community relationships—linguists, health workers, arts workers, youth workers, teachers, pastors, anthropologists—self-identifying with kin names, speaking in many languages, and code-switching as needed. Some of these have been recorded in ‘TikTok-ready’ portrait form.  

This approach has mobilised intercultural interpersonal affect to expand the sense of shared pandemic experience, re-spatialising the present and future across domestic and international borders. In these messages, the social-media ‘influencer’ is recast as a relation who cares. Re-mediating the oldest intimate communication practices—a message from a caring friend or relation—is helping to counter diabolically antisocial social media influence. 

Interventions based in trust-based relationships and creative new media experiments are operating beneath the radar of the nation’s roadmap strategy. In this proactive cultural labour of care, responsibility and collaboration, the pirate DIY spirit of grassroots desert Indigenous broadcasting is challenging top-down pandemic policy from the ground up. Through its reversal of the state’s terms of address, frontline health, social and faith workers, as well as long-distance tactical media, are performing relational medicine—an antidote to the universalising clutches of both anonymous anti-vax social media and the paternalism of epidemiology.

Lest We Forget: The Harmful Policy Legacies of the Northern Territory Intervention

Jon Altman, 24 Jun 2021

Fourteen years on, one looks back sadly at the devastation and havoc wreaked by the Intervention, with contemporary morbidity—long-term ill effects—experienced by many whom the imposed measures were supposed to heal and restore.

About the author

Lisa Stefanoff

Lisa Stefanoff is an anthropologist and media-arts producer based in Mparntwe (Alice Springs), Central Arrernte country, and holds senior adjunct positions at Charles Darwin University and the UNSW School of Art and Design. She respectfully acknowledges the creators, owners and keepers of all Country and the priority of their action and voices.

More articles by Lisa Stefanoff

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