- Email: [email protected]
The growth of children for two generations at an australian aboriginal community
INTERNATIONAL PEDIATRIC N U R S I N G Column Editor: Bonnie Holaday, DNS, RN, FAAN
The Growth of Children for Two Generations at an Australian Aboriginal Community Linda Alsop-Shields, MMedSc, RN, MRCNA PHYSICAL growth of children is an T HEindicator of the health of a population. Growth was thought to be racially determined until Greulich, in his studies of children in Guam (Greulich 1951) and in Japanese children raised in Hawaii and California after World War II (Greulich 1957, 1976) showed that growth was more closely related to diet and environment than to heredity. In Australia, differences in growth between Aboriginal and nonAboriginal children were thought to be caused by race (Brown, Barrett 1971; Brown 1972; Bowden, Johnson, Ray, Towns 1976). Eileen Kettle, a nurse who worked in the Northern Territory in the 1950s and 1960s, devised percentile charts for use with Aboriginal children. The percentile lines were smaller than those used for nonAboriginal Australian children. It was thought that because Aboriginal children must be racially smaller than their white counterparts, it was inaccurate to expect Aboriginal children to grow to the same size (Kettle 1966). This article shows that this is not so, Aboriginal children can and do grow to the same standard as nonAboriginal children. The key to optimum growth for the children in this study has proved to be the education of mothers. Such education, though, has been long-term, over generations. Through such education, mothers From Mater Children's Hospital, Brisbane and the Department of Child Health, University of Queensland, Queensland, Australia. Supported by a grant from the National Health and Medical Research Council of Australia, under the supervision of Dr. A.E. Dugdale. Address reprint requests to Linda Alsop-Shields, Department of Child Health, Mater Children's Hospital, South Brisbane, 4101, Queensland, Australia. Copyright 9 1996 by W.B. Saunders Company 0882-5963 / 96/1106-001353. 00/0 402
have been empowered to care for their children well.
BACKGROUND It is well known that the health of Australian Aboriginal people has been poor. This has largely been blamed on the colonization of Australia by the British, and subsequent emigration. Aboriginal people have higher incidences of heart disease and diabetes than white Australians (Thomson 1991) and their children suffer from more middle ear disease (Kellt, Weeks 1991), kidney infections, and rheumatic heart disease (Jose, Self, Stallman 1967). However, a contemporary folk myth has formed that Aboriginal people were almost devoid of illness before colonization, but there is some evidence that their health was not very good before 1788, when Captain Arthur Phillip arrived with the first convicts and settlers (Dampier, 1699). It is also thought that poor growth of Aboriginal children is a symptom of white oppression. This may not be so. Figures 1 and 2 are photographs taken early this century of a small boy from Central Australia who lived in a huntergatherer society, looking at himself in a mirror for the first time. His swollen belly and very thin legs caused by chronic malnutrition and possibly worm infestation, are easily seen. This boy has had no prior contact with white civilization, but the photographs are graphic evidence that he has not grown well (Idriess 1941).
DESCRIPTION OF CHERBOURG ABORIGINAL COMMUNITY The data for this project were collected at Cherbourg Aboriginal Community, in Queensland, Australia. Cherbourg is approximately 260 Journal of Pediatric Nursing, Vol 1 t, No 6 (December), 1996
INTERNATIONAL PEDIATRIC NURSING
403
negative views on such forced repatriation today, governments of the time implemented such strategies with intentions that were not malign. As reserves and missions were set up, so were health and education programs. At Cherbourg, the health and education programs have been in place since the 1920s. A general hospital, (also a tuberculosis hospital in early times), infant welfare clinic, primary and preschools, and more recently, a retirement home, have been built. The hospital has always been staffed with registered and enrolled nurses with a visiting doctor until 1983. Since then, there has been a fulltime, resident doctor in the community. There were regular visits by dentists, optometrists, and a team especially trained to examine and treat chronic ear disease and related hearing problems. A primary health care team was set up in 1974, and health education programs have been in place since the 1920s (Shields 1994).
Figure 1. Aboriginal child from Central Australia looking at himself in a mirror for the first time. Reprinted with permission (Idriess, 1941 ).
kilometers northwest of Brisbane, and was the first government Aboriginal settlement in Queensland. People came to Cherbourg from all over Queensland, but mainly from the areas around Cooktown, Stradbroke Island, and Goondiwindi (Figure 3). They joined the original inhabitants of the land, the Wakka Wakka, and Kabi Kabi people. This forced repatriation of people to reserves and missions means that many Aboriginal people have been dispossessed of their original lands, and the current land rights movement seeks to redress this injustice. It is possible that if Aboriginal people had not been sent to such reserves and missions early this century, complete genocide may have ensued because the Aboriginal populations of the time were being decimated by tuberculosis, syphilis, and in some cases, murder by unscrupulous white settlers. In other words, despite the
Figure 2. The same child, showing swollen abdomen and thin legs. Reprinted with permission (Idriess, 1941 ).
404
LINDA ALSOP-SHIELDS
Figure 3. Queensland, Australia.
In 1967, a referendum was held in Australia, which allowed Aboriginal people to be included in census statistics, to vote, and to have the same freedom that white Australians have always enjoyed. Until that referendum, Cherbourg people had to gain permission from the community manager to travel to and from the community. Afterwards, they were able to move about freely. This means that the population during the 40 years investigated in this study has remained relatively stable. At present, many of the Aboriginal people work in nearby towns or in the community, however, the main source of income is social security. Some of the people own their homes, but most homes are leased from the Cherbourg Council. Alcohol and juvenile crime are the most obvious social problems, although these are not as common as on some other Aboriginal communities in Queensland. The health of children at Cherbourg has been influenced by various health care programs that have been implemented by state and federal governments. These have tended to be shortterm, "quick fix" programs, often running only for the length of an electoral term. Some programs, such as the hearing and ear disease programs that started in the 1970s, and intestinal parasite eradication campaigns conducted in the 1960s, have been longer-term, but these are in the minority. The longest-running service has been the infant welfare clinic, which was conducted by a full-time registered nurse with
early childhood nursing qualifications until 1993. Since 1993, because of regional financial considerations, the service has been shared with a neighboring town, so the clinic is now held only once or twice a week. A major influence on the health of children has been the care given by the health staff. Some of the staff at both the hospital and infant welfare clinic stayed for many years, including Matron Cornelia Rynne, who was matron of Cherbourg Hospital from 1937 until her retirement in the 1970s.
PURPOSE OF STUDY The purpose of this retrospective study was to determine the changes in the growth of Aboriginal children in two generations of families at Cherbourg.
METHODS At Cherbourg Hospital, the infant welfare clinic and hospital records have been preserved intact since 1952. This data set is probably unique in the western world because of its completeness. Data were collected from the infant welfare clinic records. Initially, data for four generations of children in 13 families were collected after obtaining the permission and cooperation of the senior members of the families. However, it transpired that adequate data for analysis was available for only two of the four generations. Two generations of children
405
INTERNATIONAL PEDIATRIC NURSING
from the 13 families, the first group born between 1944 and 1982 (Generation 1), the second group born between 1965 and 1991 (Generation 2), were studied. The subjects in Generation 1 were the parents of Generation 2. The weights for each participant, which had been recorded by infant welfare clinic nurses, were collected. Weights at birth, 1 year of age, and 5 years of age for each child from each generation were recorded (a total of approximately 300 children for both generations) and converted into percentage-weight-for-age-for-sex (%W/A/S), as used by the World Health Organisation/National Center for Health Statistics (WHO/ NCHS) (World Health Organization 1983). One hundred percent is the 50th percentile of the WHO/NCHS data set, and is conventionally used as a standard. Each %W/A/S recording was assigned to sets of %W/A/S, less than 60%, 61% to 75%, 76% to 90%, 91% to 100%, 101% to 110%, and greater than 110%, and the totals of the recordings in each set were graphed for weights at birth, 1 year, and 5 years of age. The mean %W/A/S for each generation was compared using a two-tailed t-test for birthweights, 1 year, and 5 year weights.
RESULTS The birthweights of both generations are shown in Figure 4. The graph shows the percentage of children in each generation whose birthweights were included within the categories described. Three and a half percent of the
children in Generation 1 and 1% of children in Generation 2 were within the less than 60% set, 3.5% of children in Generation 1 and 5% of children in Generation 2 were in the 61% to 75% set, 23% of Generation 1 children and 21% of Generation 2 were in the 76% to 90% set, and so on, for birthweights. Those birthweights within normal range are those between 91% and 110%. The number of children in each generation with birthweights that were within normal range were similar, and the mean birthweights of children in each generation were not statistically different (Table 1). At 1 year and 5 years of age, growth had improved from one generation to the next. In Figure 5, which shows growth at 1 year, there were less children in Generation 1 whose weights were approximately 100% of the international standard than in Generation 2 and more children whose weights were less than the standard. In other words, children in Generation 2, at 1 year of age, grew better than children of Generation 1. The increase in the mean weights of children at 1 year from Generation 1 to Generation 2 were statistically significant (p < .001) (Table 1). Similar results were found for weights at 5 years of age (Figure 6). There were more children who grew well in Generation 2, and less children who did poorly. The mean weights of children at 5 years of age from generation to generation was significant (p < .025) (Table 1).
Distribution- %W/A/S Birthweight Generation I Gener~on 2
~ 2o~............... i .............................
o~-
~iill
........
61%-75% 76%..90% 76%-90% 81%-100%~101%-110%' >110%
zw/A/s Figure 4. % W / A / S ~ B i r l h .
.................
406
LINDA ALSOP-SHIELDS
Table 1. Mean Percentage Weight for Age for Sex
1994). However, the single most important factor in the improvement of health was the will of mothers to have healthy children. In the first 2 decades studied in this project, health care was delivered by a paternalistic system that made mothers bring their children to a clinic for assessment; this was often imposed by police action. Along with health care came education, largely of mothers, about infant care, nutrition, hygiene, family planning, and related topics. Some of the education was formal, such as talks to mothers' groups and lectures, but much of the education was informal. When a mother and baby came to the clinic, the nurse taught the mother many aspects of good child care. Of course, some mothers needed little instruction, whereas others needed much. With such education, a "snowbailing" of knowledge and will to improve occurred. Mothers whose children were not doing well saw other children who were well cared for. They saw the well cared for children as desirable, and sought the instruction and help they needed. A few more mothers saw this occur, and realized that their children would also benefit if they sought help, and the effect grew exponentially, until most of the mothers in the community had children who were growing well. Through education, the mothers had been empowered to seek quality health education and care for their children. Cherbourg mothers
Age at Measurement Generation
Birth
5 Years
1 Year
n Mean SD
86 100.1 16.9
97 91.8 10.7
n Mean SD
179 100.6 17
156 97.8 10.3
91 92 11 96 96.2 13.8
DISCUSSION This article shows that despite the poor health statistics of Aboriginal populations in Australia, Aboriginal children can and do grow well. As found by other authors who have worked in third world societies, birthweights were approximately normal (Mata, Urrutia, Beteta 1978). Babies at Cherbourg in both generations were born with acceptable weights, but similarly to other third world societies, growth became poorer as the children became older (Jelliffe 1970). The growth of children at Cherbourg, however, improved during the two generations, indicating a significant improvement in child health over 40 years. This improvement in growth is attributable to many factors. Public health measures such as a clean water supply and sewerage were in place by the early 1960s; immunization, worm eradication, and tuberculosis screening campaigns were performed in the 1950s and 1960s (Shields
Distribution- %W//A/S 1 yr weight
I
Gen~eratlon 1
l GeneraUon2
............................................... / 1
ii
.........................~
!i:
...............~
!
i
61%-75%
,
76%90%
t
91%-100%
101%-110%
~/A/s Figure 5.
%W/A/S--1
Year.
>110%
INTERNATIONAL PEDIATRIC NURSING
407
Distribution- %W/A/S 5 years 1 0 0 "j'
ration 1 8C~ ..........................................................................................................................................................
2
Genecati~ 2
ii!i
.............................
<60~
61%-75%
............
76R~0~
~/A/s
ill
-................
>gO%
Figure 6. % W / A / S - ~ 5 Years.
were forced to bring their infants to a clinic approximately until the 1970s. By then, they had had almost 30 years of child care education. The style of health care changed, and mothers were encouraged, rather than forced, to bring their babies. Some mothers and babies dropped out of the program, and did not attend clinic again. However, many of them still came, because these mothers now wanted to see their babies grow and develop well, and they used the clinic facilities including growth monitoring, immunization, nutrition education, infant care education, and support from the clinic nurse. Slowly, over time, the mothers who were not such good care-givers saw that other children grew better and were healthier than their children, and wanted to improve their care, and their children's health. In other words, the Cherbourg mothers, through education over a long period of time, were empowered to choose optimal health care for their children. Planners of health care programs for Aborigi-
nal people need to take account of this time factor. Government plans are usually shortterm, often no more than 3 years, depending on the timing of the next election. Short-term programs often fail. Health education programs will work, but health educators must be prepared to wait and be persistent in their support. Empowerment comes from education, and further education will follow empowerment. As these results from Cherbourg show, Aboriginal children can grow to the same standard as other Australian children, but only through a slow process of education, empowerment, and more education will the health of Aboriginal people improve. These findings have relevance for disadvantaged populations world wide.
ACKNOWLEDGMENT The author thanks the Chairman of the Cherbourg Community Council, the health staff, past and present, for their help, and the families who so graciously cooperated in the project.
REFERENCES Bowden, B.D., Johnson, J., Ray, L.J., Towns, J. (1976). The height and weight changes of Melbourne children compared with other population groups. Australian Paediato ric Journal, 12, 281-295. Brown, T., Barrett, M.J. (1971). Growth in central Australian Aborigines: Stature. Medical Journal of Australia, 2, 29-33. Brown, T. (1972). Growth in Central Australian Aboriginal children: weight. Medical Journal of Australia, 2, 9991002.
Dampier, W. (1699-1729). A New Voyage Around the World. London: James Knapton. Greulich, W.W. (1951). The growth and developmental status of Guamanian school children in 1947. American Journal ofPhysicalAnthropology, 9, 55-70. Greulich, W.W. (1957). A comparison of the physical growth and development of American-born and native Japanese children. American Journal of Physical Anthropology, 15, 489-516. Greulich, W.W. (1976). Some secular changes in the
408
growth of American-born and native Japanese children. American Journal at Physical Anthropology, 45, 553-568. Idriess, I. ( 1941). Lasseter's Last Ride. Sydney: HarperCollins. Jelliffe, D.B. (1970). Diseases of Children in the Subtropics and Tropics (2nd ed.). London: Edward Arnold Ltd. Jose, D.G., Self, M.H.R., Stallman, N.D. (1969). A survey of children and adolescents on Queensland Aboriginal settlements, 1967.Australian Paediatric Journal, 5, 71-88. Kellt, H.A., Weeks, S.A. (1991). Ear disease in three Aboriginal communities in Western Australia. Medical Journal of Australia, 154, 240-245. Kettle, E.S. (1966). Weight and height curves for Austra-
LINDA ALSOP-SHIELDS
lian Aboriginal infants and children. Medical Journal of Australia, 1, 972-977. Mata, L.J., Urrutia, J.J., Beteta, C.E. (1978). The Children of Santa Maria Cauque: A Prospective Field Study of Health and Growth. Cambridge: The MIT Press. Shields, L. (1994). The influence of the family on young children "sgrowth and disease at CherbourgAboriginal Community, Queensland. Unpublished master's thesis, University of Queensland, Queensland, Brisbane, Australia. Thomson, N. (1991). A review of Aboriginal health status. In J. Reid, P. Trompf (Eds.), The Health of Aboriginal Australia. Sydney: Harcourt, Brace, Jovanovich. World Health Organization. (1983). Measuring Change in Nutritional Status. Geneva: World Health Organization.
The Growth of Children for Two Generations at an Australian Aboriginal Community Linda Alsop-Shields, MMedSc, RN, MRCNA PHYSICAL growth of children is an T HEindicator of the health of a population. Growth was thought to be racially determined until Greulich, in his studies of children in Guam (Greulich 1951) and in Japanese children raised in Hawaii and California after World War II (Greulich 1957, 1976) showed that growth was more closely related to diet and environment than to heredity. In Australia, differences in growth between Aboriginal and nonAboriginal children were thought to be caused by race (Brown, Barrett 1971; Brown 1972; Bowden, Johnson, Ray, Towns 1976). Eileen Kettle, a nurse who worked in the Northern Territory in the 1950s and 1960s, devised percentile charts for use with Aboriginal children. The percentile lines were smaller than those used for nonAboriginal Australian children. It was thought that because Aboriginal children must be racially smaller than their white counterparts, it was inaccurate to expect Aboriginal children to grow to the same size (Kettle 1966). This article shows that this is not so, Aboriginal children can and do grow to the same standard as nonAboriginal children. The key to optimum growth for the children in this study has proved to be the education of mothers. Such education, though, has been long-term, over generations. Through such education, mothers From Mater Children's Hospital, Brisbane and the Department of Child Health, University of Queensland, Queensland, Australia. Supported by a grant from the National Health and Medical Research Council of Australia, under the supervision of Dr. A.E. Dugdale. Address reprint requests to Linda Alsop-Shields, Department of Child Health, Mater Children's Hospital, South Brisbane, 4101, Queensland, Australia. Copyright 9 1996 by W.B. Saunders Company 0882-5963 / 96/1106-001353. 00/0 402
have been empowered to care for their children well.
BACKGROUND It is well known that the health of Australian Aboriginal people has been poor. This has largely been blamed on the colonization of Australia by the British, and subsequent emigration. Aboriginal people have higher incidences of heart disease and diabetes than white Australians (Thomson 1991) and their children suffer from more middle ear disease (Kellt, Weeks 1991), kidney infections, and rheumatic heart disease (Jose, Self, Stallman 1967). However, a contemporary folk myth has formed that Aboriginal people were almost devoid of illness before colonization, but there is some evidence that their health was not very good before 1788, when Captain Arthur Phillip arrived with the first convicts and settlers (Dampier, 1699). It is also thought that poor growth of Aboriginal children is a symptom of white oppression. This may not be so. Figures 1 and 2 are photographs taken early this century of a small boy from Central Australia who lived in a huntergatherer society, looking at himself in a mirror for the first time. His swollen belly and very thin legs caused by chronic malnutrition and possibly worm infestation, are easily seen. This boy has had no prior contact with white civilization, but the photographs are graphic evidence that he has not grown well (Idriess 1941).
DESCRIPTION OF CHERBOURG ABORIGINAL COMMUNITY The data for this project were collected at Cherbourg Aboriginal Community, in Queensland, Australia. Cherbourg is approximately 260 Journal of Pediatric Nursing, Vol 1 t, No 6 (December), 1996
INTERNATIONAL PEDIATRIC NURSING
403
negative views on such forced repatriation today, governments of the time implemented such strategies with intentions that were not malign. As reserves and missions were set up, so were health and education programs. At Cherbourg, the health and education programs have been in place since the 1920s. A general hospital, (also a tuberculosis hospital in early times), infant welfare clinic, primary and preschools, and more recently, a retirement home, have been built. The hospital has always been staffed with registered and enrolled nurses with a visiting doctor until 1983. Since then, there has been a fulltime, resident doctor in the community. There were regular visits by dentists, optometrists, and a team especially trained to examine and treat chronic ear disease and related hearing problems. A primary health care team was set up in 1974, and health education programs have been in place since the 1920s (Shields 1994).
Figure 1. Aboriginal child from Central Australia looking at himself in a mirror for the first time. Reprinted with permission (Idriess, 1941 ).
kilometers northwest of Brisbane, and was the first government Aboriginal settlement in Queensland. People came to Cherbourg from all over Queensland, but mainly from the areas around Cooktown, Stradbroke Island, and Goondiwindi (Figure 3). They joined the original inhabitants of the land, the Wakka Wakka, and Kabi Kabi people. This forced repatriation of people to reserves and missions means that many Aboriginal people have been dispossessed of their original lands, and the current land rights movement seeks to redress this injustice. It is possible that if Aboriginal people had not been sent to such reserves and missions early this century, complete genocide may have ensued because the Aboriginal populations of the time were being decimated by tuberculosis, syphilis, and in some cases, murder by unscrupulous white settlers. In other words, despite the
Figure 2. The same child, showing swollen abdomen and thin legs. Reprinted with permission (Idriess, 1941 ).
404
LINDA ALSOP-SHIELDS
Figure 3. Queensland, Australia.
In 1967, a referendum was held in Australia, which allowed Aboriginal people to be included in census statistics, to vote, and to have the same freedom that white Australians have always enjoyed. Until that referendum, Cherbourg people had to gain permission from the community manager to travel to and from the community. Afterwards, they were able to move about freely. This means that the population during the 40 years investigated in this study has remained relatively stable. At present, many of the Aboriginal people work in nearby towns or in the community, however, the main source of income is social security. Some of the people own their homes, but most homes are leased from the Cherbourg Council. Alcohol and juvenile crime are the most obvious social problems, although these are not as common as on some other Aboriginal communities in Queensland. The health of children at Cherbourg has been influenced by various health care programs that have been implemented by state and federal governments. These have tended to be shortterm, "quick fix" programs, often running only for the length of an electoral term. Some programs, such as the hearing and ear disease programs that started in the 1970s, and intestinal parasite eradication campaigns conducted in the 1960s, have been longer-term, but these are in the minority. The longest-running service has been the infant welfare clinic, which was conducted by a full-time registered nurse with
early childhood nursing qualifications until 1993. Since 1993, because of regional financial considerations, the service has been shared with a neighboring town, so the clinic is now held only once or twice a week. A major influence on the health of children has been the care given by the health staff. Some of the staff at both the hospital and infant welfare clinic stayed for many years, including Matron Cornelia Rynne, who was matron of Cherbourg Hospital from 1937 until her retirement in the 1970s.
PURPOSE OF STUDY The purpose of this retrospective study was to determine the changes in the growth of Aboriginal children in two generations of families at Cherbourg.
METHODS At Cherbourg Hospital, the infant welfare clinic and hospital records have been preserved intact since 1952. This data set is probably unique in the western world because of its completeness. Data were collected from the infant welfare clinic records. Initially, data for four generations of children in 13 families were collected after obtaining the permission and cooperation of the senior members of the families. However, it transpired that adequate data for analysis was available for only two of the four generations. Two generations of children
405
INTERNATIONAL PEDIATRIC NURSING
from the 13 families, the first group born between 1944 and 1982 (Generation 1), the second group born between 1965 and 1991 (Generation 2), were studied. The subjects in Generation 1 were the parents of Generation 2. The weights for each participant, which had been recorded by infant welfare clinic nurses, were collected. Weights at birth, 1 year of age, and 5 years of age for each child from each generation were recorded (a total of approximately 300 children for both generations) and converted into percentage-weight-for-age-for-sex (%W/A/S), as used by the World Health Organisation/National Center for Health Statistics (WHO/ NCHS) (World Health Organization 1983). One hundred percent is the 50th percentile of the WHO/NCHS data set, and is conventionally used as a standard. Each %W/A/S recording was assigned to sets of %W/A/S, less than 60%, 61% to 75%, 76% to 90%, 91% to 100%, 101% to 110%, and greater than 110%, and the totals of the recordings in each set were graphed for weights at birth, 1 year, and 5 years of age. The mean %W/A/S for each generation was compared using a two-tailed t-test for birthweights, 1 year, and 5 year weights.
RESULTS The birthweights of both generations are shown in Figure 4. The graph shows the percentage of children in each generation whose birthweights were included within the categories described. Three and a half percent of the
children in Generation 1 and 1% of children in Generation 2 were within the less than 60% set, 3.5% of children in Generation 1 and 5% of children in Generation 2 were in the 61% to 75% set, 23% of Generation 1 children and 21% of Generation 2 were in the 76% to 90% set, and so on, for birthweights. Those birthweights within normal range are those between 91% and 110%. The number of children in each generation with birthweights that were within normal range were similar, and the mean birthweights of children in each generation were not statistically different (Table 1). At 1 year and 5 years of age, growth had improved from one generation to the next. In Figure 5, which shows growth at 1 year, there were less children in Generation 1 whose weights were approximately 100% of the international standard than in Generation 2 and more children whose weights were less than the standard. In other words, children in Generation 2, at 1 year of age, grew better than children of Generation 1. The increase in the mean weights of children at 1 year from Generation 1 to Generation 2 were statistically significant (p < .001) (Table 1). Similar results were found for weights at 5 years of age (Figure 6). There were more children who grew well in Generation 2, and less children who did poorly. The mean weights of children at 5 years of age from generation to generation was significant (p < .025) (Table 1).
Distribution- %W/A/S Birthweight Generation I Gener~on 2
~ 2o~............... i .............................
o~-
~iill
........
61%-75% 76%..90% 76%-90% 81%-100%~101%-110%' >110%
zw/A/s Figure 4. % W / A / S ~ B i r l h .
.................
406
LINDA ALSOP-SHIELDS
Table 1. Mean Percentage Weight for Age for Sex
1994). However, the single most important factor in the improvement of health was the will of mothers to have healthy children. In the first 2 decades studied in this project, health care was delivered by a paternalistic system that made mothers bring their children to a clinic for assessment; this was often imposed by police action. Along with health care came education, largely of mothers, about infant care, nutrition, hygiene, family planning, and related topics. Some of the education was formal, such as talks to mothers' groups and lectures, but much of the education was informal. When a mother and baby came to the clinic, the nurse taught the mother many aspects of good child care. Of course, some mothers needed little instruction, whereas others needed much. With such education, a "snowbailing" of knowledge and will to improve occurred. Mothers whose children were not doing well saw other children who were well cared for. They saw the well cared for children as desirable, and sought the instruction and help they needed. A few more mothers saw this occur, and realized that their children would also benefit if they sought help, and the effect grew exponentially, until most of the mothers in the community had children who were growing well. Through education, the mothers had been empowered to seek quality health education and care for their children. Cherbourg mothers
Age at Measurement Generation
Birth
5 Years
1 Year
n Mean SD
86 100.1 16.9
97 91.8 10.7
n Mean SD
179 100.6 17
156 97.8 10.3
91 92 11 96 96.2 13.8
DISCUSSION This article shows that despite the poor health statistics of Aboriginal populations in Australia, Aboriginal children can and do grow well. As found by other authors who have worked in third world societies, birthweights were approximately normal (Mata, Urrutia, Beteta 1978). Babies at Cherbourg in both generations were born with acceptable weights, but similarly to other third world societies, growth became poorer as the children became older (Jelliffe 1970). The growth of children at Cherbourg, however, improved during the two generations, indicating a significant improvement in child health over 40 years. This improvement in growth is attributable to many factors. Public health measures such as a clean water supply and sewerage were in place by the early 1960s; immunization, worm eradication, and tuberculosis screening campaigns were performed in the 1950s and 1960s (Shields
Distribution- %W//A/S 1 yr weight
I
Gen~eratlon 1
l GeneraUon2
............................................... / 1
ii
.........................~
!i:
...............~
!
i
61%-75%
,
76%90%
t
91%-100%
101%-110%
~/A/s Figure 5.
%W/A/S--1
Year.
>110%
INTERNATIONAL PEDIATRIC NURSING
407
Distribution- %W/A/S 5 years 1 0 0 "j'
ration 1 8C~ ..........................................................................................................................................................
2
Genecati~ 2
ii!i
.............................
<60~
61%-75%
............
76R~0~
~/A/s
ill
-................
>gO%
Figure 6. % W / A / S - ~ 5 Years.
were forced to bring their infants to a clinic approximately until the 1970s. By then, they had had almost 30 years of child care education. The style of health care changed, and mothers were encouraged, rather than forced, to bring their babies. Some mothers and babies dropped out of the program, and did not attend clinic again. However, many of them still came, because these mothers now wanted to see their babies grow and develop well, and they used the clinic facilities including growth monitoring, immunization, nutrition education, infant care education, and support from the clinic nurse. Slowly, over time, the mothers who were not such good care-givers saw that other children grew better and were healthier than their children, and wanted to improve their care, and their children's health. In other words, the Cherbourg mothers, through education over a long period of time, were empowered to choose optimal health care for their children. Planners of health care programs for Aborigi-
nal people need to take account of this time factor. Government plans are usually shortterm, often no more than 3 years, depending on the timing of the next election. Short-term programs often fail. Health education programs will work, but health educators must be prepared to wait and be persistent in their support. Empowerment comes from education, and further education will follow empowerment. As these results from Cherbourg show, Aboriginal children can grow to the same standard as other Australian children, but only through a slow process of education, empowerment, and more education will the health of Aboriginal people improve. These findings have relevance for disadvantaged populations world wide.
ACKNOWLEDGMENT The author thanks the Chairman of the Cherbourg Community Council, the health staff, past and present, for their help, and the families who so graciously cooperated in the project.
REFERENCES Bowden, B.D., Johnson, J., Ray, L.J., Towns, J. (1976). The height and weight changes of Melbourne children compared with other population groups. Australian Paediato ric Journal, 12, 281-295. Brown, T., Barrett, M.J. (1971). Growth in central Australian Aborigines: Stature. Medical Journal of Australia, 2, 29-33. Brown, T. (1972). Growth in Central Australian Aboriginal children: weight. Medical Journal of Australia, 2, 9991002.
Dampier, W. (1699-1729). A New Voyage Around the World. London: James Knapton. Greulich, W.W. (1951). The growth and developmental status of Guamanian school children in 1947. American Journal ofPhysicalAnthropology, 9, 55-70. Greulich, W.W. (1957). A comparison of the physical growth and development of American-born and native Japanese children. American Journal of Physical Anthropology, 15, 489-516. Greulich, W.W. (1976). Some secular changes in the
408
growth of American-born and native Japanese children. American Journal at Physical Anthropology, 45, 553-568. Idriess, I. ( 1941). Lasseter's Last Ride. Sydney: HarperCollins. Jelliffe, D.B. (1970). Diseases of Children in the Subtropics and Tropics (2nd ed.). London: Edward Arnold Ltd. Jose, D.G., Self, M.H.R., Stallman, N.D. (1969). A survey of children and adolescents on Queensland Aboriginal settlements, 1967.Australian Paediatric Journal, 5, 71-88. Kellt, H.A., Weeks, S.A. (1991). Ear disease in three Aboriginal communities in Western Australia. Medical Journal of Australia, 154, 240-245. Kettle, E.S. (1966). Weight and height curves for Austra-
LINDA ALSOP-SHIELDS
lian Aboriginal infants and children. Medical Journal of Australia, 1, 972-977. Mata, L.J., Urrutia, J.J., Beteta, C.E. (1978). The Children of Santa Maria Cauque: A Prospective Field Study of Health and Growth. Cambridge: The MIT Press. Shields, L. (1994). The influence of the family on young children "sgrowth and disease at CherbourgAboriginal Community, Queensland. Unpublished master's thesis, University of Queensland, Queensland, Brisbane, Australia. Thomson, N. (1991). A review of Aboriginal health status. In J. Reid, P. Trompf (Eds.), The Health of Aboriginal Australia. Sydney: Harcourt, Brace, Jovanovich. World Health Organization. (1983). Measuring Change in Nutritional Status. Geneva: World Health Organization.