Return to NE Arnhem Land: Charitable Works

Sport & Spinal Physiotherapy has had a long history of playing an integral part in assisting SOS Health Foundation in providing physiotherapy volunteers as well as supporting the charity financially. Our practice had been involved in 3 other health outreach missions in the past, so when the opportunity came to volunteer in North East Arnhem Land this May 2014, I grabbed the chance. As it is as always with volunteering in such situations, I gained more than I gave.

SOS Health Foundation provides allied health services to the disadvantaged in remote communities. The Foundation began in 2009 and has provided allied health services (namely physiotherapy) to the indigenous people mainly in North East Arnhem Land, Northern Territory, and on Palm Island, Queensland. As of 2014, SOS Foundation is aiming to provide missions to North East Arnhem Land every 2 months.

The team for this particular mission involved physiotherapists and non-clinician members from varied places across Australia. When describing our team, it sounds as if you were telling a joke about the patrons in a bar, but essentially we all fitted in well together and worked cohesively.

Although there were some constraints in managing such a large team and making sure we were all kept busy, SOS Manager Lynda Cunningham, did a great job in doing just that. Not only that, Lynda coordinated several sessions where we were asked to reflect on our experiences in the homelands in dealing with the indigenous Yolngu people. Although unintentional in some regards, these sessions were like personal development sessions and added to the experience as a whole.

The 8 team members were as follows:
Vanessa Alvaro – physiotherapist from Adelaide
Kane Burrow – physiotherapist from Melbourne
Lynda Cunningham – manager of SOS from Melbourne
Savio Furtado – student physiotherapist from Melbourne
Don Griffin – used car salesman from Melbourne
Craig Honeybrook – physiotherapist from Canberra
Chris Ludescher – lawyer from Melbourne
Cath Thomson – physiotherapist from Brisbane

We gathered on Sunday evening 18 May 2014 at Nhulunbuy, everyone excited about the chance to make a difference to the health of the indigenous Yolngu people on the homelands. The homelands are remote communities ranging in population from 20 to 2000 people. Most communities are very small without any shops and the housing is very basic. Some communities have a health clinic whilst others do not. Most homelands have a school but education is limited by only having a teacher 2-3 days per week.

The Yulgna people are very proud and have a strong family network. Coming to this area was an eye opener for myself in learning about the health services provided to the Yolngu people. Laynha Health, based in the nearby town of Yirrkala (about 20kms from Nhulunbuy), do a fantastic in managing the health of these people in terms of nursing and medical needs, but they are pretty much limited to just providing these services alone on a regular basis. I quickly realised that the homelands had received little to no physiotherapy services until SOS Health Foundation had come onto the scene.

On my first day and second day, I travelled with 2 medical practitioners to the communities of Dhruputjpi and Gan Gan. These homelands are about a 4 hour drive from Yirrkala and due to the distance we camped out overnight. What surprised me the most when I first arrived, was how long some injuries had been going on for. A typical conversation would go like this:

“How long have you had this injury for?” I would ask.
To which the Yolngu person in respect would reply “Long time, long time.”
I pressed for more information “When you say long time, do you mean a few weeks or a few months?”
To this I received the reply “1980!”. This literally blew me away.

Sport & Spinal Physio in Bremmer IslandIndeed, it was not unusual for some people to have musculoskeletal injuries for 20 to 30 years. If this had of been in Canberra, they would have seen 5 GPs, half a dozen physios, a couple of orthopaedic surgeons and probably a psychologist to boot, just to sort the problem out.

From my part, it was a learning experience in terms of physiotherapy in the way I managed patient care and also in the types of injuries that I treated. Some injuries I had never seen previously but had only learned from text books. This happened when I visited Birany Birany homeland on our 3rd day up in NE Arnhem Land.

Birany Birany homeland is about a 2 hour drive from Yirrkala. It is a small homeland on the Gulf coastline consisting of about 30-40 Yolngu people. They have a small school, but no health clinic. I travelled with Gerard, a nurse from Laynha Health, and Savio, the physio student from our group.

I would estimate that about 75-85% of the cases we looked at were low back pain. Nearly all these were lumbar facet joint impingements, which were quite easy to treat with some mobilisations, manipulations and massage techniques. However, there was one particular 39 year old Yolngu man called Mark that was different.

Mark complained of generalised low back pain on the left side. When I assessed Mark in standing I could tell that his alignment was all wrong. It looked to me like one leg was longer. When we continued the assessment in lying, we could see that the leg length difference was a whopping 3cm, the right leg being the short leg. Mark’s right hip also had restricted range resembling an osteoarthritic hip joint. I questioned Mark further and we established that Mark had fallen off his bicycle when he was 12 years old and had been limping around for a long time with a sore leg soon afterwards. No health worker had looked at the injury at the time.

My impression is that Mark probably sustained a slipped capital femoral epiphysis, a condition in which there is a fracture through the growth plate of the upper thigh (femur). This results in slippage of the overlying ends of the femur. This injury generally requires orthopaedic surgery to correct the problem. Unfortunately, this injury was missed at the time and has left Mark with an osteoarthritic hip and a large leg length difference. Yet he copes very well with only mild back pain. To counter the leg length difference, he bends his knee more on the longer right side. He does not experience any hip pain as yet, but I would imagine he will require a total hip replacement in time as the hip joint continues to degenerate. Mark does not wear any shoes, so it is of no use building up one shoe to correct the leg length difference. So in the end we merely just treated his lower back with some manual therapy techniques and gave him an exercise to keep his back more flexible. We organised with Gerard (nurse) for Mark to have a right hip x-ray when next he was in Nhulunbuy to at least document his osteoarthritic hip and allow one to check the progression of the degeneration into the future.

When working in the homelands, I quickly learned that I could not treat the Yolngu people the same way as I treat clients in Canberra. I guess this came down to my enthusiasm to make a difference and some assumptions I had formed about the Yolngu people.

In regards to the assumptions I had made, Lynda told a tale called “How the Monkeys saved the Fish?” that seemed pertinent:
The rainy season that year had been the strongest ever and the river had broken its banks. There were floods everywhere and the animals were all running up into the hills. The floods came so fast that many drowned except the lucky monkeys who used their proverbial agility to climb up into the treetops. They looked down on the surface of the water where the fish were swimming and gracefully jumping out of the water as if they were the only ones enjoying the devastating flood.

One of the monkeys saw the fish and shouted to his companion: “Look down, my friend, look at those poor creatures. They are going to drown. Do you see how they struggle in the water?” “Yes,” said the other monkey. “What a pity! Probably they were late in escaping to the hills because they seem to have no legs. How can we save them?” “I think we must do something. Let’s go close to the edge of the flood where the water is not deep enough to cover us, and we can help them to get out.”

So the monkeys did just that. They started catching the fish, but not without difficulty. One by one, they brought them out of the water and put them carefully on the dry land. After a short time there was a pile of fish lying on the grass motionless. One of the monkeys said, “Do you see? They were tired, but now they are just sleeping and resting. Had it not been for us, my friend, all these poor people without legs would have drowned.”

The other monkey said: “They were trying to escape from us because they could not understand our good intentions. But when they wake up they will be very grateful because we have brought them salvation.” (Traditional Tanzanian Folktale)

Since many injuries had been there so long and there had never been any physio out in the homelands, my assumptions were that they would want exercises to fix the injury particularly as we may not have physio again for some time. So I proceeded to give a few exercises with each treatment, as I do in Canberra. But I quickly realised that the number of exercises and in some cases the complexity of the exercises was frustrating some of the Yolngu people. I had to tone it down. I also started to ask if they were actually interested in an exercise that would help their pain after we had gone, some said yes and some said no. This was where my assumptions were corrected.

In essence, as more and more blue shirted SOS volunteers descend on the North East Arnhem land homelands, the Yolngu people will develop a more trusting relationship with our physios and be more accepting of our approach with exercises in helping to rehabilitate injuries.

On my fourth day, I helped with some handy-man jobs on some Mission Aviation Fellowship (MAF) houses. I felt a bit guilty here, since my wife has been pestering me for ages to do all these jobs on my own house and here I was working on someone else’s. Apparently I was not alone here as Don and Chris mentioned the same. Nonetheless, it was good to help out with MAF as they do good work up in these remote areas.

MAF are a church-based volunteer organisation spread across the globe that helps connect remote areas through aviation support. Indeed, during the wet season, aviation is sometimes the only way to reach these remote communities up in North East Arnhem Land.

DeonIn the afternoon of the fourth day, I visited Bremer Island with nurse Gerard and a medical team. This homeland was very small but set on a lovely location with ocean views. We set up a make-shift health clinic in the homeland school. Here I showed Gerard some physio techniques to continue our good work whilst SOS was away. I also met Deon, who showed me his new spear and we discussed how he made it.

On my last day, Catherine (neurological physio) and I provided an in-service to MAF pilots about safe lifting techniques and posture. Some of the physios of the group had provided physio to the MAF staff and their families during the week and in appreciation MAF put on a BBQ for our whole group. At the BBQ, I found it interesting talking to some of the MAF lads about their organisation.

On our last day, a few of us from the group also managed to duck down to the Yirrkala Arts Centre and purchase some amazing indigenous art work from the area. These are traditionally bark or log paintings.

In my downtime, I also managed to write a media release for the local Nhulunbuy newspaper “The Arafura Times”.

I would like to thank SOS Health Foundation for the opportunity to travel to North East Arnhem Land. This experience benefited myself both personally and professionally. It was lots of fun working with the team and I enjoyed getting to know the small town of Nhulunbuy and tasting its many ways of cooking Barramundi.

SOS Health Foundation are doing some great things in the homelands and I am proud to say, we are making a difference. Sport & Spinal Physiotherapy will continue to support SOS both physically and financially as our primary charity that we support as part of our charitable works program because I now know first hand how we are helping.

I believe any small business can benefit from being involved with an organisation that helps the disadvantaged in ways the business could relate to. Sport & Spinal Physio chose SOS as a health related organisation because that’s what we do, but these remote communities could use any help that any business could offer. Not only do mission volunteers gain a worthwhile experience both personally and professionally but the general public are generally interested in what one can offer up in these remote areas.

Since I have returned back to Canberra, I have recollected many times my experiences to various people of all walks of life. Australians do have empathy for the plight of the indigenous in these remote homelands and any business that contributes to helping, I believe puts that business in good standing within the community. In my opinion, people tend to trust businesses that do assist in such causes. Not only this, we have found at Sport & Spinal Physio that helping out in such programs has helped gel our team together in striving to make a significant difference to the disadvantaged.

From my own personal experiences, one always gets a personal gain from volunteering for worthwhile causes. In conclusion, I shall end this report as I began – As it is as always with volunteering, one gets more back than you give, and I can certainly vouch for that after my experience in NE Arnhem Land.

About Craig Honeybrook

Craig is the practice principal of Sport & Spinal Physiotherapy. He attained a Masters in Sports Physiotherapy degree in 2000 at Sydney University studying foot injuries in runners and anterior knee pain in cyclists. He has been working as a physiotherapist for over 20 years and moved to Canberra over 12 years ago. He has been consultant physiotherapist for Balmain Rugby League, Eastern Suburbs Rugby, Australian Track & Field and Brumbies Rugby. His special interests include lower limb biomechanics, spinal instabilities and malalignments, bike fitting, running assessments, shoulder injuries and knee injuries. Craig was a former international level middle distance runner but now enjoys endurance mountain biking achieving a 2nd placing in the 2010 World Solo 24 hour Mountain Bike Championships. He also enjoys skiing, swimming, kayaking, gym work and spending time with his family.