Geoff Helisma

For the past two years, Dr Simon Quilty has been working as head physician at the Katherine District Hospital. He lives there with his wife, Phoebe, who grew up on the Lower Clarence.

Katherine has a population of just over 6,000 people, and is a tourism gateway to the nearby Katherine Gorge and Arnhem Land. It is sold as a place to immerse oneself in the area’s “rich tradition of Aboriginal art, culture and heritage”.
But it’s also a place that illustrates the dichotomy that exists in Australia when comparing the health, social and economic conditions experienced by many Aboriginal people and those enjoyed by the wider population.
For Quilty, this dichotomy is tragic. The death of one of his patients motivated him to write a story, straight from this heart, which was also published on The Guardian Australia website’s ‘Comment is free’ blog page in December, 2013. It is a story he describes as his “silent, tearful farewell to a patient destroyed by alcohol, a young father who loved his daughter as much as I do mine”.

It rained last night in Katherine. Riding my bike to work shortly after sunrise along a dirt trail behind a pocket of suburban houses, I see fresh pram tracks. They must have been made before dawn, and a few hundred metres along they veer right onto a narrow path defined in the scrub by regular traffic. In the distance, under the thirsty trees and tall dry grass, a small tent sits silently in the morning stillness. The beating sun is already hot, and a few pots hang from a stump.
I’ve seen these tents pop up and disappear, and a few tarpaulins hanging between trees staying in place for months at a time with collections of cans, old chairs, shopping trolleys and blankets gradually accumulating. Occasionally, I see a figure stooped over a fire. The homeless population of Katherine – the “long-grassers” – form spontaneous bush-camps at the fringes, I imagine not too dissimilar to how Bennelong spent his last days by Sydney Harbour.
I have never seen children in these camps, but sometimes wonder at the size of the footprints in the sand. With 15 per cent of the town’s Aboriginal population homeless – the highest rate in the country – this scene is an inherent part of contemporary life in Katherine, rarely appreciated by the steady flow of tourists who come north over winter to escape the cold and take stories south.
My cycle to work continues, down the pock-marked old runway that once landed warplanes 60 years ago, and past the Katherine cemetery where more than a few of my patients have finally lain to rest – a lifetime under the beating sun finally rewarded beneath the cool mahogany-covered shady lawns beside the river. Finally, I turn into the frangipani-lined driveway of the hospital; the smell is so pungent that the air feels sticky.
The pram tracks and the cemetery come together in my mind. An Aboriginal man who was a patient of mine passed away a few weeks back. He wasn’t old – in fact he was the same age as me, and I’m not quite middle-aged. But his body was old and worn, a consequence of a very hard childhood, crushing tragedy at every turn, an absence of opportunity regardless of education and a decision years ago to numb the pain with grog. He came to the hospital with few expectations, extremely unwell and with a handsomely sad face. I knew he had only a little life left to live and told him; he accepted his reality and asked me to do anything I could.

This man’s sadness is a normal daily heaviness that I live with. The Katherine region has a brutal history of colonisation and every Aboriginal person I meet wears its scars. My friends who are survivors of authoritarian regimes overseas have survived and prosper. Their scars exist, but for the most part life is good. But for most Aboriginal people in this town, their grandparents were born into an ancient land, living lives that I guess were probably not dissimilar to the way my own ancestors lived many thousands of years ago. These survivors of colonisation did not end their journey in a land where they could find safety and prosperity at least. Instead, they were engulfed by a world so profoundly different that nothing at all was familiar – not a brick, not a spoon, not a thread of cloth. These are complex generational scars, and for some the wounds will never heal.
When I first met this man on the wards of Katherine Hospital, my initial reaction was frustration with a tinge of anger. How could a young person allow such profound pathologic processes to overwhelm his body? Why did he drink so much alcohol? It’s hard to watch a young man die from a completely preventable death. Yet his story is not unusual; in fact it is normal. The life expectancy of an Aboriginal man in this region is 49, he was about 10 years shy, and there are a reasonable number of young men like him who drag down the average.
He was a really likeable bloke; timid, but happy for a chat. My registrar spent more time with him than me, possibly with more hope and compassion than I could afford because she was leaving Katherine a few weeks later, and noticed that he would sit on the veranda of the hospital, always in the same spot looking out towards the cemetery, his eyes fixed on something distant and untouchable.
One afternoon I sat with him, ceiling fans whirring and warm moist air always prefaced with the faint smell of stale cigarette smoke. I asked him where he would like to “finish up”. Many of the patients I meet have strong attachments to their country and want to die on their land. At first he was silent, his gaze on the cemetery. “My daughter in that cemetery,” he said, eyes moist but without tears. “I wanna be buried next to her.”
She had died when she was just nine – a car had run her over. I don’t know if alcohol was a participant in the tragedy. It was 15 years ago and had broken his heart and his spirit, and I suspect also his will to live. His life disintegrated and he became itinerant, living in Darwin, Katherine, over to the west and down to the southeast, where his country was.
Plagued by alcohol and progressive poor health, he’d finally come back to Katherine because he felt close to the end and needed to be near his daughter. He told me that over previous years he’d found it hard to come back here, as the memories were too much. When he did visit, he would spend a few weeks drinking heavily down by the river and would retreat to the cemetery at night to sleep by her grave. Now he knew he was at the end, and he was torn between a desire to die on traditional country and his profound and unresolved grief.
Katherine cemetery is a peaceful place, sitting at the northern end of the old runway and from the practical realities of the time the town was planned, next to the hospital. The river runs silently past on the western boundary, and once every decade or so its ferocity overwhelms the banks and deposits another layer of fertility that keeps the grass green and the trees enormous. There are always flowers on the graves, and solar-powered multi-coloured lights are also popular adornments that leave an eerie night-time presence under the great African mahoganies.
A few weeks ago, I picked bagfuls of mangoes dripping from the trees that lie along the fence between the hospital and the graves. My two little daughters sat in the tray of the Hilux, sweating in the afternoon heat and carefully placing the mangoes in bags as I handed them down, excited to get home to eat the juicy fruits. They didn’t see my tears as I was up in the tree giving my silent farewell to a father who loved his daughter as much as I do mine. It was a death that represents so much about the history of this land, a death shared down the line of fringe-dwellers all the way from Sydney Cove to Katherine River, the last ripples of colonisation.

Practising the essence of ‘sorry’
Doctor Simon Quilty, 39, is a humanist. What he can do to improve conditions for those born into a society of disadvantage is a fundamental motivator of his career as a physician. The Northern Territory town of Katherine is his home, and a place where his efforts can make a difference.
“It’s spectacularly beautiful in the region,” he says. “We have Katherine Gorge, Arnhem Land … and the Katherine River is amazing. Aboriginal people are wonderful to work for and it’s extremely gratifying.”
Quilty worked in hospitals at Newcastle, Darwin and Alice Springs before taking up his post at the Katherine District Hospital. He says he’s practising “real medicine”; when he compares what he does now to his work in the big city hospitals. “Young people are dying,” he says. “The life expectancy here is 50. You actually get involved in saving people’s lives, everyday, rather than trying to keep old people alive for another day longer, which I found quite ethically challenging down on the east coast.”
As an outsider, relatively new to Katherine, Quilty says he felt “a bit nervous” about putting his thoughts about an Aboriginal death into the public domain. “But a few weeks ago I had an Aboriginal lady come in and she said, ‘You’re the doctor who wrote that story. My son committed suicide 10 years ago. When I read your piece I cried and read it to all of my children.’
“I didn’t want to exacerbate any suffering. I didn’t want to write something that painted anybody poorly. I just wanted to tell my side of the story. What I saw was a profound tragedy. I’m touching those kinds of tragedies every day.
“I wrote the piece spontaneously because of what I’d seen. He’s a father like me. He’s my age. He’d had an incredibly hard life that I cannot even hope to fathom – the absolutely abject poverty that these people have grown up with. When he was a child, he would have had a one in 10 chance of dying as an infant. He was born into a Northern Territory that was profoundly impoverished. It has improved a lot, but he had a tremendously hard life.
“I meet these kinds of people all of the time; and they are fascinating, lovely and non-judgemental, they have very low expectations and they are very grateful for my input.”
Quilty hopes his story strikes a chord with those who read it, particularly people who have no practical understanding of the problems faced by many Aboriginal communities. “What strikes me, and what people don’t understand about Aboriginal people, is they are so profoundly different to us. When you think about this riverbank and the people who live along the river; they’ve had 40,000 years of generations of people living in the same region.
“They are profoundly attached to their land and their country. I think that the bones that lie in the region are so much more ancient than any other people in the world, in terms of continuity of living on the land. It’s all a part of the bigger picture.”
It’s the bigger picture that has moved Australian society towards reconciling with the country’s indigenous peoples, but it’s the smaller picture, one of dysfunction and hopelessness, that often obscures society’s focus on the goal.
“You can look at it and say all this ‘Sorry’ business is a waste of time,” says Quilty. “But it’s not time wasting. These are people who are losing young children. This man was 40 and the life expectancy is 50. Young people die all of the time, and it just absolutely, fundamentally undermines progress in the most profound way; for people to be experiencing grief all of the time.”
Quilty has copped some criticism for his story, the type that labels him a bleeding heart or a condoner of “a welfare system that allows people to drink their lives away”.
“I tend to ignore the [negative] comments because it was a very personal piece for me. Speaking as a doctor, who sees inside people’s lives every day; sure the Aboriginal dysfunction is more visible and stigmatised, but I don’t think it’s any more or less than everybody else. The deaths of young people in this region are more to do with the impoverishment and extremely poor health.
“It’s much more complex than [alcohol abuse and dysfunction]; the main driver is inequality in wealth distribution and poverty.
“I guess, when you write something publically, you have to expect all kinds of feedback.”