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Lungmarama Yolngu nha: (1) a week in the life of an outreach program.

Abstract: The Yolngu of north-eastern Arnhem Land have lived with alcohol for just over 30 years. For some, particularly those who permanently or transiently camp on the fringes of the predominantly non-Indigenous township of Nhulunbuy, it has resulted in devastating health, social, family and cultural impacts. The Miwatj Health Aboriginal Corporation Outreach Program is a response to alcohol use by this Aboriginal community. We examine the outreach program in terms of its conception and development and 'success'. The impact that funding (or lack of funding), the funding source, and different expectations by the Indigenous and non-Indigenous communities can have on the success or otherwise of such a program are manifest in this case study. Extracts from a journal written by one of the researchers while involved in the program provides a grounded insight into the practicalities and realities of undertaking this type of activity in a remote community. The outreach program has achieved some success by helping a small number of Yolngu to turn their lives around and move off a path of self-destructive alcohol use. However, the program has been narrowly fashioned and continues to be driven by the concerns of the non-Indigenous community for whom its "success" has been the attention given to litter and antisocial behaviour.

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The Yolngu of north-east Arnhem Land have lived with alcohol for just over 30 years. In that short time it has had devastating health, social, family and cultural impacts. This is particularly the case for a population of Yolngu who permanently or transiently camp on beaches and skirting woodland around the predominantly non-Indigenous township of Nhulunbuy. The Miwatj Health Aboriginal Corporation Outreach Program is a response to alcohol use by this Aboriginal community. Miwatj Health also delivers primary health care and encourages lifestyle and drinking behaviour change. For Yolngu, alcohol forms part of the conjunction of Western and traditional influences they deal with as they forge a contemporary and distinctive Yolngu society. Miwatj Health sought a comprehensive review of the outreach program as part of their wider commitment to bringing Aboriginal-controlled health care to the region. An insight into the day-to-day operation of an alcohol misuse intervention program and an evaluation of that program is provided using excerpts from a journal written by one of the researchers involved in the evaluation.

Research design and methodology

The aim of the outreach program was to assist and support Yolngu who chose to camp in and around Nhulunbuy and who were heavy consumers of alcohol. The specific objectives of the program were:

* to decrease the rubbish around the town beach and drinkers' camping and drinking places;

* to educate the target group on their legal rights and responsibilities under the Liquor Act and other relevant legislation; and

* to develop longer term strategies to sustain reductions in rubbish and levels of public drunkenness in Nhulunbuy, including diversionary and other activities.

Our evaluation of the outreach program was more than an assessment based on its stated objectives. It explored the conception and development of the program, drawing heavily upon the thoughts, concerns and priorities of Yolngu. Determining the effectiveness or otherwise of an intervention is difficult, for example changes in alcohol consumption may be influenced by a range of factors such as employment, housing and education, as well as or in spite of participation in an intervention program (Gray et al. 2004). Any evaluation must therefore be cognisant of what realistically it can assess.

There have been few evaluations of alcohol intervention programs undertaken in a culturally appropriate way (Gray et al. 2000, 2004). In this evaluation no party was unclear about the intentions of the research: to be of primary benefit to the outreach program. Consent for this research was obtained from relevant Yolngu elders and Miwatj Health and Yolngu leaders were involved in its planning and conduct. This was important because external evaluations of Aboriginal health initiatives often engender mistrust on the part of the organisation involved, especially if funding is threatened (Alati et al. 1995; Duquemin et al. 1991; Gray & Sputore 1998:49).

Perhaps the most serious ethical matter that confronted this research, in a contemporary climate that supports Aboriginal community infrastructure and control, was that the researchers are non-Indigenous (Anderson 1999; Saggers & Gray 1991; VicHealth 2000). This ethical dilemma was addressed by BW's affiliation with Miwatj Health and the Yolngu, and the collaborative involvement of Miwatj Health and Yolngu leaders in the planning and conduct of the research.

The research was conducted over a 12-month period (June 2000--June 2001). Ethics approval was gained from the Monash University Standing Committee on Ethics in Research Involving Humans. Key research techniques used were: unconcealed participant observation, formal and informal semi-structured interviews, group interviews and opportunistic impromptu discussion, and documentary/ archival review (Burns 2000; Daly et al. 1997). Semi-structured interviews were the most common type of interview conducted with key informants such as outreach program staff, Yolngu community members and the Town Administrator. Group interviews were conducted with two groups of campers, outreach program workers and Aboriginal health care workers. Opportunistic impromptu discussions frequently happened when quietly sitting around or while walking together on a hunting trip; such discussions provided useful information and different perspectives not readily available through more structured research techniques. Gender reflective pseudonyms have been used for those participants who wanted to remain anonymous.

Camping

Campers around the community of Nhulunbuy are primarily Yolngu and come from all over northeastern Arnhem Land. Some of the Yolngu that lived in these camps were permanent residents while others were transient. The population of each camp varied, ranging from 2 to 20. The overall camper group ebbs and flows, ranging from 20, usually in the wetter months, to as many as 120 in the dry season. Ceremonial activity influenced the number of campers. Some Yolngu attending local ceremonies, such as funerals, choose to stay in town camps. Some then stayed on permanently.

The importance of the setting, that is people, place and structural issues, has often been neglected in studies of drug use (Brady 1995a:184) Within the context of this research, we considered, it was essential to examine the setting for alcohol purchase and its use to understand why Yolngu chose to drink alcohol and live in camps. The reasons given were diverse and complex. What is clear is that while Yolngu campers drink alcohol and Yolngu drinkers camp, a direct causal relationship between camping and drinking rarely existed.

The only place that alcohol could be purchased legally in north-eastern Arnhem Land was in Nhulunbuy. Living in camps around Nhulunbuy appealed to Yolngu who wanted to drink regularly because they are closer to the point of sale. Cameron (pers. comm., 2 October),2 one of the outreach program workers, explained that 'they [the campers] drink all the time, when the pubs open they go straight in ... because they don't want to hitchhike, they live closer'. So rather than seek lifts each day into town to drink either at the pub or around town, it is more convenient to 'live' close to the point of alcohol sale.

Family and relationship problems were also reported to be an important reason for choosing to live in the camps. Mandawuy Yunupingu (pers. comm., 5 October) said that 'there's probably a family conflict there somewhere, that sort of thing that they'd rather take away and lose it by drinking'. Conflicts can arise for all sorts of reasons, particularly if relationships develop that diverge from Yolngu law. Shane (pers. comm., 5 October), an outreach program worker, explained that 'if Yolngu find miyalk with wrong malk and get together, they camp around here in town'. The camps around Nhulunbuy provided an avenue for escape and conflict evasion. It is important to note that alcohol use is often implicated in the development of these problems and is not always simply the end result of conflict.

Peer pressure and the sociability of the drinkers' networks often contributed to the decision to drink or to continue drinking (Alati et al. 2003). Many Yolngu campers found that camping and alcohol use created an attractive social environment. Dancing and singing is an enjoyable social feature that campers talked about and, while more difficult to research, the camping lifestyle created opportunity for sexual activity (Brady 1992; Samson 1980). This often contrasted with the campers' perception of their home environments where 'there's bagnu djama ... and they get bored sitting around doing nothing and probably they think well I'll go and drink nanitji. That's more enjoyable and I can make more friends' (Nanikiya Munungurritj, pers. comm., 19 September). Mary (pers. comm., 9 October), a long-term camper, simply said that 'home is boring ... so we get out here and drink'.

As Yolngu spoke of the camping lifestyle a strong sense of camaraderie and interdependence was evident. The camper group, in particular the Yolngu who lived together in a single camp, shared a close bond. As Raymattja (Marika-Munungurritj, pers. comm., 20 September) explained, 'they're like their own family, they look after themselves'. The sense of belonging does not come without sacrifices though. Nanikiya Munungurritj (pers. comm., 19 September), a senior ranger with the Dhimuru Land Management Aboriginal Corporation explained that 'some Yolngu might say "but I want to give up nanitji" but they can't because their friends are always drinking and always around'. Many campers commented on the 'peer pressures' that have a dynamic influence on drinking patterns and their decision to stay in the camps.

Indigenous versus non-Indigenous perspectives

Among the local non-Indigenous community there was an overwhelming concern about the anti-social behaviour of the camper group resulting from intoxication and also about the large amount of litter left in the town precinct and on nearby beaches. To the non-Indigenous population the behaviour of intoxicated campers was of constant concern. The townspersons saw their quality of life, and to some extent their safety, affected by drunken behaviour. The Nhulunbuy police reported that they were frequently called to attend such misdemeanours (Mick Reid, pers. comm., 18 October).

These negative perceptions held by non-Indigenous residents had a racist edge. A minority were openly racist in their attitude to Yolngu and rejected the legitimacy of Yolngu history and land ownership. These harsh attitudes were evident every day in the schoolyard, in the shopping precinct, at sporting functions, in the hotels and clubs, and despite Nabalco's attention to race relations through their induction and staff development programs (Nhulunbuy community members and ex-employees of Nabalco, pers. comm.). It was often Indigenous drinkers, particularly the campers, who bore the brunt of the hostility and racism evident in Nhulunbuy. However, most residents showed goodwill, understanding and tolerance in their interactions.

The Yolngu perception of the alcohol problem was a starkly different one. There was no emphasis on the rubbish left in public places or on the drunk and disorderly behaviour of Yolngu drinkers. This lack of concern is quite ironic considering it is Yolngu families, through general social contact and kinship and family obligations, who suffered most and had to deal with the consequences of drinking (Arbon et al. 2000; Trevana & Butler 1996). Yolngu perceptions of the alcohol problem showed a deep concern for the individual, family life and family breakdown, spiritual wellbeing, culture and community life. Nanikiya Munungurritj (pers. comm., 19 September) talked about how 'Yolngu are getting really infected by nanitji' and how it is 'affecting Yolngu more deeply than anything else, because it is destroying Yolngu culture, destroying its right, its heritage, and values that Yolngu have had for long long time'. Andrew (pers. comm., 26 September) explained that 'alcohol is bad for our future manikay, our song cycles, ga baparru ceremonies and other important ceremonies like initiation ceremonies'. For Yolngu there is a great deal of personal injury for both the individual and for their family because of 'emotional ga mental, ga spiritual breakdown--lot of spiritual breakdown waku' (Raymattja Marika-Munungurritj, pets. comm., 20 September).

A week in the life of the outreach program

On the surface, the outreach program was an initiative that appeared to be running smoothly. There was a daily routine. The program had a vehicle and the administrative support of a larger Indigenous organisation, Miwatj Health. At the time of the evaluation the outreach program was coordinated by Susan Tipungwuti, an Indigenous woman from the Tiwi Islands, and overseen by Deborah Perry, the Miwatj Health Improvement Program (HIP) coordinator, an Indigenous woman from Burketown. It provided employment for eight Yolngu workers (five men and three women). Many of these workers were campers who lived on the town beach or other camps located around Nhulunbuy. Other program participants lived in Gunyunara and Galupa, small Yolngu communities on Gove harbour 10 minutes by car from Nhulunbuy. They, too, often spent time living in the camps.

The outreach program appeared to have been successful in helping some individuals curtail their dependent drinking and camping lifestyle. However, closer inquiry showed a fragmented program struggling to find its identity and function. Below are excerpts from the journal maintained by BW; these impressions alternate with a discussion of key issues for the program:
 Monday: Litter and tip trips
 Susan's arm is still in plaster so to help out I offered to
 drive the vehicle again this week. All the other workers
 have lost their drivers licence. On the way back to
 town Cameron and Janelle were waiting by the side
 of the road near Wallaby beach where they have been
 staying for the last few weeks to get away from life at
 the town beach (Nhulrangi). For Cameron this must be
 hard as this country is his father's land and is significant
 to him.

 After morning tea we got the vitamin-B tablets and
 low-joule cordial organised and drove down to the
 town centre. We left Campbell and Troy to hand out
 the vitamin-B tablets with the fluids while the rest of us
 weeded and raked the sand of the adventure play area
 for children at the town pool. This is a weekly job and
 part of the contract with the Town Corporation. Today,
 like most Mondays, was a bad day for rubbish. From
 one area we burned close to ten 5-litre Riesling casks
 and piled three full garbage cans of empty beer cans
 and stubbies into the vehicle.

 The men pumped up a bit to the radio on the way
 out to the tip. Not bad singers as well as dancers. (At
 the Garma festival just passed, Campbell and Troy had
 been the dancers during the closing concert performed
 by none other than Yothu Yindi.) The tip run wouldn't
 have been complete without the usual fossicking for
 useful stuff. Cameron found some copper wire for the
 spears he is making and the women some empty flour
 tins I think they'll use for boiling foods.


Primary health care, education and service provision

Yolngu were concerned about the health effects that alcohol has on their people and most, including many of the heavy drinkers, were aware of the consequences. The delivery of appropriate health care and treatment for drinkers was regarded as essential. The health status of outreach program participants and the camper group was difficult to assess from Miwatj Health's patchy medical records. Some clients had frequent contact with the clinic and had consented to a wide range of screening and diagnostic investigations, while others had had minimal medical information recorded. Effective medical screening and follow-up were very difficult for the clinic staff and for Susan who was often made responsible for finding campers and encouraging them to come to the clinic.

Anecdotally, Aboriginal health care workers and doctors said that the main problems that campers presented with were injuries (fractures and lacerations), usually from interpersonal violence. Skin and parasite infections, malnutrition, dehydration, and health problems associated with long-term heavy drinking such as liver disease were other major health issues.

Most Yolngu informants supported the provision of water and vitamin-B tablets as a useful intervention. The health benefits of vitamin-B supplementation to dependent drinkers is well documented, and Aboriginal health care workers and doctors reported improving health status among the camper group who received supplements (Ambrose et al. 1994; Harper 1983; Reilly 1979; Roe 1989). The improvement in health status might also be attributed to improvements in hygiene. During 2000 the outreach program installed showers and laundry facilities at Miwatj Health. The facilities were available to campers during business hours. The outreach program also provided water supplies to campers; however, this appeared to be on an ad hoc basis. Three of the larger camps around town had their own twenty-litre water container which the outreach program refilled every one or two days.

The research literature recognises the value of education with particular emphasis on resistance training skills and individual counselling (Brady 1995a). This was particularly relevant to the camper group, for whom bereavements, family and relationship problems were some of the core reasons for dependant drinking and/or living in the camps. However, health education and health promotion activities within the outreach program were minimal. The outreach program workers sometimes had the opportunity to watch educational videos; however, other campers were not involved in these sessions and only two such sessions were conducted during the evaluation period. In the past, the outreach program workers had delivered an informal mix of individual and group counselling and resistance training. Workers would regularly spend time with drinkers, just sitting and talking. However, the increasing demands of litter collection had diminished this activity to infrequent and unstructured efforts which were delivered to limited audiences.
 Tuesday: Drinking, health and vitamin-B
 We attended first to the rubbish problem evident yesterday
 down at the town beach. We managed to squeeze
 eight bags of garbage into the back of the vehicle. There
 were many weary looking people sleeping around in
 the shade following drinking binges last night, some
 certainly worse than others. Cameron this morning
 talked about some fighting which involved some visiting
 Aboriginal people from Groote Island who have
 been living in the camps. Apparently someone was
 threatening people with a shotgun and harassing
 and scaring residents in the Nabalco flats nearby. We
 encouraged a number of campers with minor injuries
 to return with us to Miwatj Health to see an Aboriginal
 health worker, however, none were willing. After our
 tip run we returned to Miwatj Health where the clinic
 staff gave us a list of six or so people that they needed
 to see. A number we had already seen and asked earlier
 today and had no success so it was going to be a difficult
 task.


Litter and employment

The collection of litter was a core activity of the outreach program and much time each day was dedicated to it. The coordinator decided which 'drinking areas' were to be targeted, and accompanied and assisted the program workers. The focus on litter, a largely non-Indigenous priority, was a core and defining activity of the program during the research period. This was because funding for the outreach program came from a Wine Cask Levy (WCL) grant. In July 1995 the Northern Territory introduced a $0.35 per litre levy on wine casks (withdrawn in 1997), with the money being used to fund the Living with Alcohol Program. This program worked with other areas of government and the community to support activities that reinforced responsible and sensible alcohol use and aimed to make a substantial and direct contribution to reducing alcohol-related harm in the Northern Territory (Gray et al. 1999). Litter on the town beach had been a longstanding concern of non-Indigenous Nhulunbuy residents. The WCL grant agreement specifically stated that the purpose of the grant was for projects that could demonstrate a reduction in: 'alcohol related public littering; and alcohol related public offence'. Despite the outreach program coming under the organisational umbrella of Miwatj Health, control effectively remained in non-Indigenous hands, as the fundholder for the grant was the Nhulunbuy Town Corporation; WCL funds were allocated through local government organisations.

The narrow focus on litter was further strengthened with the outreach program entering an agreement in February 2000 with the Town Corporation to take the town clean-up contract. Although beneficial in providing top-up funding to Community Development Employment Projects (CDEP) payment for the program workers, it acted to cement the litter management role of the outreach program. As David Simmons (pers. comm., 14 September), Miwatj Health program manager, pointed out, 'they have now got legal obligations and responsibilities to the contract'.

The Yolngu involved in the outreach program's early development had a different perspective. The non-Indigenous focus on litter and antisocial behaviour was not shared; instead, their concerns were for their people. There was a focus on talking with the drinkers, cultural activities such as hunting and art and crafts, and liaising with the Northern Territory Living with Alcohol Program and the police. The focus on litter collection did nothing to skill participants for future employment or to provide much motivation for participation. Sometimes outreach program workers approached the routine of collecting rubbish and cleaning up with lassitude and boredom. Many of the workers openly expressed their preference to engage in a wider range of activities. Miritjnga Yunupingu (pers. comm., 4 October), a former outreach worker, agreed that 'it's important to show them different djama ... like me when I started working same djama, so I started asking "eh, I want different djama" like I'm working with the corporation'. Indeed, many of the Yolngu who worked for the outreach program were qualified and skilled in a range of areas. Cameron had been a grader driver for many years, Janelle had worked at the Child Care Centre in Nhulunbuy, and others had had employment with Yirrkala Business Enterprise.

Although this study questions the focus on litter, the work it provided had some positive diversionary outcomes. The employment of dependent drinkers is well documented as a successful and meaningful diversionary activity, not only for alcohol but also other drug dependencies (Burns et al. 1995a, 1995b; O'Connor 1984). In a study that investigated relapse prevention options for Indigenous clients of alcohol and drug intervention services, a counsellor (Alati et al. 2003:139) from one of the services commented:
 The main problem is that there are no jobs. There is
 nothing to go back to. That's what Aboriginal people
 need primarily: jobs. The need to learn basic skills and
 be able to do something, once they leave this place.


Those close to the outreach program agreed with this statement. Sue Smith, medical practitioner with the Miwatj Health Clinic (pers. comm., 2 October), offered her perspective on the role of work:
 ... when they're actually working ... as opposed to just
 living down there ... they do a lot better, drinking less,
 feeling better about themselves and looking after their
 health a bit better. My Balanda interpretation is that
 having a job, a place to be, and a purpose and a sense
 of belonging, makes the difference.


However, employment could be more than just a diversionary activity. There was a sense that the outreach program needed to take a more deliberate approach to encourage the next step to more meaningful employment. Lack of employment opportunities is a common reality for many Indigenous communities and this in turn impacts on rates of alcohol use (Alati et al. 2003; Gray et al. 2004).
 Wednesday: Here, there and everywhere
 Today was a pretty hectic and tense day for everyone
 involved. It began with Campbell and Troy venting
 their frustration with Susan for not waiting for them
 yesterday. Campbell was adamant if more time had
 been given he would have been able to get up and
 prepare himself to come in for work: Yaka 2 minutes!
 Yaka 5 minutes! Wait 10 to 15 minutes!

 The journey back into town only got more and more
 tense with accusations beginning to fly and Campbell
 and Troy making unfavourable comparisons between
 Susan and past coordinators.

 For most of the morning Debbie, the outreach
 workers and I worked down at an uncleared block
 of land next to the local sporting oval. After a while
 Debbie and I were the only ones left working. The
 others had gone to have breakfast and an evangelical
 singing session with the local pastor from the Assembly
 of God. After morning tea at the oval with the pastor, I
 dropped Debbie back to Miwatj Health. She was planning
 to organise a flight for Campbell and his wife to
 Darwin to take their unwell child to Darwin hospital.


Responding to other needs

The outreach program often responded to the needs of the campers and to those of its workers as they arose. These needs ranged from simple requests, such as a lift into town that might require half an hour, to needs that could impact on an entire working day. Although this might mean going beyond the stated aims and objectives of the program, the staff, through their close relationships with participants, felt a certain personal obligation. Debbie Perry (pers. comm., 29 September) put it in the following terms:
 I always care for people who I feel are at a disadvantage
 and for the simple reason they are the people who
 no one's ever bothered to help ... it's just care, it's just
 caring for them because I know there is a better life
 there for them and they don't have to live this life ... I
 like to protect my people and care for my people.


And Susan Tipungwuti (pers. comm., 3 October) explained:
 I was sick yesterday morning but I worked in the
 morning and went home in the afternoon because I
 wanted to come in and I haven't got anyone to help me.
 These people turn up for work nearly every morning
 and they will wonder why I'm not here.


Evaluations of other programs have found that there are considerable pressures on alcohol and drug workers to provide a wide range of services beyond the remit of their program (Gray et al. 2000:13).
 Thursday: Drinking, shelter and pay day
 During the usual litter collection rounds we took some
 time out down at the beach with some of campers who
 were sitting around relaxing. They were listening to the
 radio and boiling up 30 or so turtle eggs they'd found
 earlier this morning. It would have been quite nice to
 sit around under the Casuarina trees all morning feasting
 on turtle eggs. We were fortunate today the rubbish
 duties were light on as a heavy rain shower swept in
 for half an hour. Susan told me, as we waited in the car
 for things to settle, that during the wet last year they
 had deaths down at the beach due to pneumonia. The
 campers are very much exposed to the elements of the
 tropical climate, so Debbie and Susan help the campers
 by purchasing second-hand clothes and blankets that
 they would otherwise struggle to organise or afford.
 Just before lunch I made a water run with Cameron to
 his new camp on the beach. Down at the beach, further
 pay day drinking binges were into full swing with an
 abundance of wine casks and beer cartons being passed
 around. When the time came to leave, no sooner had
 I started the vehicle than the back was full, everyone
 wanting to go somewhere: some to town, some to
 Yirrkala and others to Gunyunara.

 I made it clear that the vehicle was only going to
 Miwatj Health but I was happy to drop people into
 town on the way if they wanted. Half the occupants
 jumped out. We dropped 4 people off in town before
 finishing up for the day. We decided that tomorrow we
 would go hunting.


Relationship with Miwatj Health

Staff working in substance-misuse intervention programs need to be well supported and integrated within a larger organisation, with opportunities for staff development and with sufficient staff to allow for rotations and time off (Gray et al. 2004). As a result of its origins, funding and development, the outreach program was isolated and marginalised within the Miwatj Health organisation, and marginalised from other regional strategies that addressed alcohol dependency and alcohol-related harms. The program was transplanted into Miwatj Health at a time when it was concentrating on establishing its medical and administrative centres and determining the role of doctors, Aboriginal health workers and other medical staff. The outreach staff had little professional or collaborative support and a narrow operational context. As a consequence, they faced a range of problems, including insecure job tenure, inadequate skills and skill development, a limited career pathway, isolation within the structure of Miwatj Health, and minimal professional support from other drug and alcohol agencies.
 Friday: Hunting and getting there
 As usual it was work first before the hunting trip. It
 was close to 11 before we got the rubbish cleaned up
 and the tablets handed out. When we got back, Debbie
 was trying to arrange some money Miwatj Health owed
 to the workers (for cleaning Miwatj Health vehicles) to
 purchase some hunting supplies. I recall Debbie telling
 me that she finds this process very frustrating and, on
 some occasions, the hunting trip fails to happen unless
 she digs into her own pocket.

 Today the money drama worked out. The campers
 who'd been waiting around most of the morning all
 jumped in the Troopie. After a quick lap around town
 to pick up a few others interested in coming, we finally
 got away.

 Like most hunting trips we went behind one of
 Nabalco's red mud ponds where the mining company
 stores caustic waste, a by-product of the bauxite refining
 process. While the Yolngu have unrestricted access
 to this area, we need to inform Nabalco of our presence.
 The beaches and mangroves here that line Gove
 harbour provide a traditionally good hunting ground
 for mud crab, fish and mussels. Some of the women
 made for the mangroves while the others searched
 on the exposed mud bars of low tide for mussels and
 pipis. I followed the men as they waded waist-deep
 around the mangrove line for crabs, fish and stingray.
 Their hunting skills and intuitive knowledge of where
 to look were inspiring. I was more concerned about
 the whereabouts of crocodiles but the men didn't seem
 to be. The communal collection in the end was quite
 impressive with 10 mud crabs, 2 stingray and no less
 than 150 mussels. We feasted on the seafood collected
 and also the damper that had been quickly prepared.
 There was plenty left over for the Yolngu to take home
 with them.


The importance of culture and connectedness

A major consequence of heavy drinking was the progressive disconnection from kin networks. Yolngu informants talked about how they no longer attended ceremonies, engaged in traditional cultural activities or showed interest in following in the footsteps of their elders (Clare, pers. comm., 26 September; Emily, pers. comm., 25 September).

Drinkers drifted away from their families and 'when they come back in [to the community] they feel left out, they don't belong to the family, that's why they prefer to stay with their own group, a lot of our people feel unwanted in a way' (Raymattja Marika-Munungurritj, pers. comm., 20 September). They became more dependent on other drinkers, forming close bonds like a new family, as Miritjnga (pers. comm., 4 October) explained:
 I just go there and drink with them 'cause they're my
 family, I belong to them ... I don't see my family, you
 know, as an alcoholic, I just sit in the long grass.


What is implied here is the importance of recovering networks that could facilitate rehabilitation. Reconnection to family and kin was not only meaningful to the individual but to the families themselves because of their links through the kinship system and 'those strings shouldn't be cut' (Nanikya Munungurritj, pers. comm., 19 September). Yolngu welcomed individuals who wanted to become close to the family again: 'It's good for them to come back because family do miss family. It makes the family feel happy ... we know it's hard for them' (Raymattja Marika-Munungurritj, pers. comm., 20 September).

Yolngu related the importance of culture and land to a potential source of personal strength and rehabilitation for drinkers. It is important to 'get them in touch with the land, take them out to the bush, enjoy the bush and land, take them hunting, fishing ... anything like that will help them to restore their memories again' (Nanikya Munungurritj, pers. comm., 19 September).

Saggers and Gray (1998:160) recognised that in Australia, as in New Zealand and Canada, there is widespread acknowledgment of the importance of strengthening traditional culture and cultural values as a means of resisting excessive alcohol consumption and as a means of making treatment and other interventions more effective. However, as Brady (1995b:1495) warned, cultural and spiritual enactments in themselves will be ineffective unless they succeed in helping people to form peer groups that devalue drug and alcohol abuse, and which assist individuals to cope with the persuasive pressures of some of their kin and friends to use alcohol excessively.

Hunting trips were a potentially important activity of the outreach program, helping to reconnect campers to their culture and social networks. The trips were usually reserved as an activity for Fridays following the usual outreach program activities. Despite their value they took place quite infrequently and irregularly, perhaps because they required enormous energy and effort to organise. When they did happen, the hunting trips acted as a successful diversionary activity from heavy drinking since no alcohol is allowed and intoxicated individuals are not allowed to participate.

The place of Yolngu campers in cultural life was assured if they chose to or were able to participate in Indigenous community activities, as they did have the cultural skills to engage in them. However, drinkers found it difficult to organise art and craft activities, ceremonial attendance and hunting trips. It was essential that the outreach program continue to facilitate cultural engagement but on a more regular and focused basis with a wider range of activities and paying particular attention to ensuring attendance at important ceremonial events. The likelihood of successfully reducing dependent drinking and discouraging Yolngu from living in town camps would improve by reconnecting drinkers to a wider range of important networks. That includes actively restoring links with families, cultural and ceremonial obligations, sport and recreation.

One way of achieving this reintegration would be to increase the participation of local Aborigines as leaders in the program. Interventions are also more likely to succeed when solutions come from the local community. Indigenous communities share common problems; however, they are heterogeneous and require local strategies (ATSIC 2003; Gray et al. 2004; Strempel et al. 2003). The value of employing local persons also was acknowledged, as they bring to 'their work knowledge and expertise of their own community, which is invaluable in the operation of particular programs' (Anderson 1994:35). This was in part the experience of the outreach program staff. Susan Tipungwuti (pers. comm., 3 October) told us of the difficulty she faced each day; for example, the conflict that had occurred on Wednesday (above) was due to the fact that, although Indigenous, she is not Yolngu: 'it's been hard, I reckon, I feel that I shouldn't be doing this work'. This compounded existing pressures that Susan felt as the often sole member of staff handling the outreach program. While Yolngu members of the community unanimously commended and valued the efforts of both program coordinators, they said that there needed to be involvement by local Aborigines. Gundimulk Marawili (pers. comm., 11 November), a member of the Sober Women's Group, said that 'this is the only way, sitting with them, feel like them. They can feel that ... it is a counselling job but this is the only way, Yolngu to Yolngu understanding'. At the time that the research was being conducted, the outreach program lacked the direct involvement and guidance of local Aborigines; their participation would infuse cultural and community objectives and further culturally appropriate service delivery.

Conclusion

From its beginnings there have been markedly different perceptions about the purpose of the outreach program. These differences were reflected in the life of the program and revealed an underlying tension between what it purported to achieve, what it actually managed to achieve and what the Yolngu participants, their families and communities hoped to achieve. The strongly held opinion of Yolngu both inside and outside of the outreach program was that its task was to attend to the wellbeing of those individuals and families whose lives were disrupted and in some cases devastated by alcohol. For perhaps the majority of the non-Indigenous population the purpose was to curb anti-social behaviour and control the litter problem. These differences were not just misunderstandings about the project objectives, but were representative of polarised views and values about alcohol and its use. These underlying differing perceptions played a part in limiting the effectiveness of the outreach program, while at the same time providing the potential for a renewed and refocused response.

The outreach program had made a difference to the lives of a few Yolngu who were seriously affected by alcohol abuse. Anecdotal evidence suggested there had been an improvement in the health of the campers as a cohort, particularly those involved in the program as field workers. It had assisted some heavy drinkers to find regular employment, to reduce their alcohol consumption and to improve their health.

If this evaluation had concentrated on the stated objectives of the WCL funding criteria, it could be claimed that the outreach program had achieved success. It was consistently active in reducing litter in public places and camping venues, and had had some effect on the level of anti-social behaviour among Yolngu campers. However, Yolngu seek more from the program than these narrowly defined objectives.

This evaluation found challenges for the outreach program which limited its effectiveness when assessed against the wider objectives of the Yolngu community. The program was isolated and marginalised within the Miwatj Health organisation; few collaborative and communicative channels existed between outreach and other Miwatj staff. Outreach staff faced a range of problems, including insecure job tenure and minimal professional support from other drug and alcohol agencies. The program lacked the direct involvement and guidance of local Aborigines.

There was a need to implement ongoing evaluation processes that reflected the wider concerns of the Yolngu community. At the time of this study, there was no formal internal evaluation process. Reports to the funding body only reflected the limited objectives of the funding program.

This evaluation recommended that Miwatj Health seek a broader recurrent funding base that Yolngu, through Miwatj Health, can control. A funding base that is sufficient to support a tenured career structure within Miwatj for outreach staff and appropriate development for all relevant Miwatj Health staff. It recommended establishment and reinvigoration of networks among agencies that support alcohol rehabilitation. Part of this reinvigoration should include the active involvement of Yolngu leaders in the future development and conduct of the program.

Epilogue

In November 2001 funding to the outreach program, under the Northern Territory Department of Health Alcohol and Other Drugs Program (Wine Cask Levy), was withdrawn. In June 2003, the Northern Territory Government announced a $5.25 million budget allocation to extend a Northern Territory-wide Community Harmony Strategy which had a strong focus on outreach and withdrawal rehabilitation services for those affected by substance abuse and mental illness (DCSSCA 2004).

In Nhulunbuy, the relevant committee was the Harmony Djamamirri Mala Working Group. A key initiative of the working group was the proposed construction of a Substance Abuse Special Care Centre, located within Nhulunbuy. The intention of the proposed centre was to assist in the care, treatment and rehabilitation of those suffering substance abuse in the region in a culturally appropriate way. It would cater for up to 36 individuals at a time and would be attended 24 hours a day, all year round. A key target group of this centre was itinerant campers. Repatriation to homelands was also to be an important objective. It was anticipated that after the centre was constructed, a night patrol program would play an important ancillary role (Harmony Djamamirri Mala 2003).

Acknowledgments

The authors thank the Yolngu who participated in this research and Miwatj Health Aboriginal Corporation. The authors also thank the referees for their comments and suggestions which contributed much to the final article. For BW, the Yolngu of north-east Arnhem Land have been an important part of his life. He moved with his family to the Gove peninsula in 1979 where his parents worked as teachers. Having grown up in Gove, he knows many of the Yolngu involved and their families through friendship and adoption by kin. This project was his opportunity to, hopefully, provide a positive contribution to the Yolngu community.

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Glossary
Bagnu none, nothing, not at all
Balanda white person, European
Baparru clan, tribe, a death (in the family)
Djama work
Ga and
Malk skin name, skin group
Manikay music
Miyalk woman, girl, lady, wife, female
Nanitji alcoholic beverage, grog
Waku mother's son or daughter
Yaka no
Yolngu the name that Aborigines of north-eastern
 Arnhem Land call themselves


NOTES

(1.) 'Getting people together' (a title suggested by Clare, one of the participants in the research).

(2.) All personal communications relate to the year 2000 unless indicated otherwise--editor.

Ben Wearne

Victoria Department of Sustainability and Environment

Janice Chesters

School of Rural Health, Monash University, Moe

Sue Whyte

School of Rural Health, Monash University, Moe

Ben Wearne is a project manager with the Victoria Department of Sustainability and Environment. His research and general interest in Indigenous issues has developed from 12 years living in remote northeastern Arnhem Land and continued contact with the Indigenous people of the area.

<ben. wearne@dse.vic.gov.au>

Dr Janice Chesters is the deputy director of the Centre for Multidisciplinary Studies, School of Rural Health, Monash University.

<Janice.Chesters@med.monash.edu.au>

Sue Whyte is a researcher with the Centre for Multidisciplinary Studies, School of Rural Health, Monash University. She is also a freelance editor and writer.

<susan.whyte@med.monash.edu.au>
COPYRIGHT 2005 Australian Institute of Aboriginal and Torres Strait Islander Studies
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Copyright 2005 Gale, Cengage Learning. All rights reserved.

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Publication:Australian Aboriginal Studies
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Date:Sep 22, 2005
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