Planning a Pandemic in Paradise

Just 2 weeks ago we took another day trip out to Rocky Point. Friends showed us a beautiful spot where, when the tide was low, there were large, very shallow pools with clear space all around so that the children could romp and get wet without fear of crocs. The day was a wonderful escape from the looming difficult questions that we had reluctantly been answering. No, we could not justify a trip to Sydney for Kate and Mike's wedding. We could not expect to escape Maningrida in the Easter break to be with the Cookski clan and our grandparents. At any point we could be asked to quarantine. At any point The Virus might strike Maningrida and I could not risk leaving my colleagues high and dry. So we cancelled those long anticipated trips (not quite able to bring ourselves to talk about the trip to visit David and Sophie in July) and set out for this little slice of Paradise to console ourselves.

Back in Maningrida life seemed to be ticking along. Luca has grown increasingly fond of Aussie Rules and spent several happy Wednesday afternoons running water boy for the mens' games. Work at the clinic ticked along. Home visits provide a change of scene and the many mangy mutts accompany us everywhere, sometimes providing some very cute moments (Shelly with puss). Ed and the kids make it to running club every Thursday afternoon. Cheering from on top of the troopie seems to be part of the appeal for the children.

In the clinic we started disaster planning. We met with community leaders to draft a town plan. In fact we had to start with basic education to get us all on the same page. I presented Covid 19 basics to Maningrida's heads of agency which included leaders from the school, the shops, Centrelink, Police, Rangers and the National Land Council, and more. Initially it seemed we had to sell the severity of the situation. Where Ed and I had got our heads around what we might have to give up, other community members weren't there yet. They found it difficult to agree not to leave the town for holidays. They couldn't see how we could realistically function in the town with closed borders. The clinic staff were at the other end of the spectrum, wanting to shut everything down immediately. After two and a half hours we left at a stale mate.

The next step was to get the traditional leaders on board. The town Mayor asked me to present again so I had the privilege of walking these people through the information about covid 19. Maningrida has a reputation as a pretty dysfunctional town. Positioned awkwardly in a region near multiple tribes and language groups it was created here almost arbitrarily. There is plenty of tribal infighting. Groups of people that really do not feel comfortable together are forced to share this space. Yet what transpired in another marathon meeting was one of the most inspiring things I have experienced since we have been in this place. Every single elder and traditional owner in the room was very genuinely invested in understanding what I was explaining. A couple of brilliant young women who walk very well between my world and theirs helped me refine my presentation and interjected to help explain. Matty (the Mayor) was a remarkable leader, giving different people the voice they needed, clarifying the issues and pushing the group along towards some constructive end points. There were a number of general hurdles like the language barrier and the broad lack of basic education so that I had to clarify what exactly a virus is and how it might spread. There were specific myths I needed to dispel such as that the virus did not arrive on the wind, was not a result of black magic and could definitely be carried into the town by people of any race, not just by white people.

The single biggest issue that the traditional leaders needed to come to grips with was the issue of their burial rites. Sorry time is the most important of the traditional rituals and we needed to get some agreement on what that might look like if covid 19 comes here. They had to get their heads around the potential for the virus to live on the body. It would be dangerous for people to keep bodies in their homes for a couple of days after death as they are used to. It would be dangerous to handle the bodies. We have a small morgue here but it has only 6 bays and it often takes many weeks (sometimes months) for people to gather the money and necessary family members from far flung places, to host the week long (sometimes longer) ceremony for a funeral. If we accumulate multiple bodies, where will we put them? And how can they commemorate if they can't come together for ceremony? People usually bury their dead in the back yard but that might be impractical if there are lots of bodies. The town has long discussed a cemetry and it would be great at this time to push ahead with that decision. Almost all of these questions were answered by the end of that day and I can only hope that the disparate parts of our national government can come together half so well to resolve the larger issues arising from the outbreak of covid 19.

By the end of that week the heads of agency had their heads around the significance of this virus and what might be required of all of us to combat it. We had to thrash out many details and we'll have ongoing weekly meetings to discuss the rapidly unfolding changes that are arising but we had a plan. We had to compromise in lots of ways. Our dream of complete isolation was just too idealistic. In particular the Clinic manager was very concerned about how we would manage our nursing staff as about half are FIFO (fly in fly out). The police and school also had difficulty at that stage giving up planned leave (though they seem largely to have reached that place now). We agreed to stop unnecessary travel in and out of town. We came up with a plan to manage the repatriation of long grassing countrymen from Darwin as so generously offered by the Larrakia nation (this is essentially Darwin getting their drunk and homeless off the streets which makes sense in terms of virus transmission in town but creates a difficult kettle of fish for us as these people in poor health trickle back into town). We resolved the broad brushstrokes of how we will approach the shutting down of the town if we identify a case in Maningrida and what things might look like as they unfold.

Amongst all that we had an uncommonly difficult time in the clinic. We had 2 dramatic and terrible deaths. One young man with complex underlying illness. Another horrendous workplace accident. We had a stressful but satisfying save of a lovely young woman in preterm labour. This is the reality of Covid 19. The rest of the healthcare doesn't just stop while we deal with it. We have to manage the virus on top of everything else.

At this stage here in Maningrida it feels like we are overreacting to a virus that is actually a long way from us, at the expense of other basic services. We have been forced to close the pool and the youth centre and stop all footy games. These might seem like little things but in this community they are huge. Without these there is very little to do. The kids here already struggle with complex and difficult behaviours including avgas sniffing and recurrent self strangulation. Last year a child tragically died from sniffing deodorant. Pools in towns like this serve a dual purpose in promoting basic hygiene, reducing skin and ear infections especially in children. How long might these be closed for? If we manage to keep covid 19 out of Maningrida will we instead be dealing with a surge in youth deaths, a spike in deafness due to glue ear and another peak in cases of Rheumatic Heart Disease which is so closely related to skin infections? Time will tell.

For now we celebrate another birthday and seek moments of peace as the world shifts under our feet. We are feeling the distance from family and friends so much right now because somehow the means with which we might bridge that space has been removed. We are stuck here for now and, like the rest of you, we will make the best of it. With cake, if you please.