Eric Moora holds a rifle with his elbow sticking out of the passenger seat window.
The traditional owner and former ranger is aiming at the far-off shrubs along a vast escarpment of red land outside the remote Aboriginal community of Balgo in north-east Western Australia.
This is kipara country (bush turkey country) — there are plenty of Australian bustards to catch out here.
“Long time ago, [my people] were fit, healthy, eating bush tucker,” Eric says.
“Today people are getting sick, some people are going to dialysis.”
Balgo is one of the country’s most isolated communities, in a cross-section of the Tanami and Great Sandy deserts.
Remote Indigenous communities have some of the highest rates of kidney disease in the world, but Balgo locals must leave their country for life-saving dialysis treatment.
Now, Indigenous-owned non-profit Purple House has plans to open a local service by 2024 so people can continue to live at home.
Eric returns to a nearby dam where his nephews are playing to cook his haul of bush turkeys over a fire.
He grew up in Balgo, where the older generation, some of whom lived in the bush, taught him to hunt for goanna, kangaroo and bush turkey.
These days Eric lives in Perth, where his partner receives treatment for type 2 diabetes.
Eric has flown three hours from Perth to Kununurra and then drove eight hours to get to Balgo and take part in cultural practices.
“We have to go right back to the bush, back to my country, you know, to eat.”
Eric also has diabetes but doesn’t need dialysis; he sees bush tucker as a way to stay healthy and avoid highly processed food contributing to his condition.
Patients who develop chronic kidney disease have to receive dialysis when their kidneys stop working.
Dialysis machines remove waste products and excess fluid from the blood and need to be used two to three times a week.
Balgo has never had a dialysis service before, despite locals having to leave country to towns more than 10 hours away for ongoing treatment.
At the dam, Eric plucks the kipara‘s feathers, removes the intestines and hands them to his nephew who quickly fashions a “bush sausage”.
He will eat some turkey tonight and give others away to extended family.
He’s concerned about the younger generation developing the same chronic health conditions that would require them to leave home.
“My people eat wrong thing, you know, sugar. We need to stop the Coke, making people sick from the Coke, diabetes, all that.”
Many elderly residents worked on cattle stations before they were brought to Balgo, which was a Catholic mission until 1975.
They were rationed on white flour and white sugar after living traditionally on the land.
The introduction of highly processed foods to Indigenous people’s diets and their health consequences have been well documented.
Dr Aron Chakera runs a chronic kidney disease research group at the Harry Perkins Institute and says poor nutrition has intergenerational repercussions.
“Exposures in development can have lifelong implications to people’s health,” he says.
“Maternal diets in particular and the subsequent development of kidney disease in children may manifest decades down the track.”
At the only shop in the community, Coca-Cola is the highest-selling product.
Eric has seen family members die in their 40s from kidney-related diseases or leave community for care.
The rate of deaths from diabetes in remote Indigenous Australia is approximately nine times the rate of the non-Indigenous population.
While Eric had the benefit of cultural knowledge passed onto him from elders as he was growing up, he laments that children these days don’t have the same access to that knowledge.
“Today it’s changed now because we got no old people.
“I want my people to come back to home.”
At the community’s aged care centre, the empty chairs at the breakfast table indicate the prevalence of locals living away for dialysis.
Reece Cotchilli is out the front in hysterical laughter.
He’s very pleased with a joke he’s just made about an elderly woman burning coffee at the breakfast station.
While Reece is decades younger than the older people at the centre, he plays a vital role in lifting their spirits.
“I come here in the morning, have a yarn, have a laugh, I’m the joker,” he says.
“He’s playing with us every morning, he makes us happy,” an elderly woman at the breakfast table says.
Reece says he’ll keep dialysis patients company when people return to receive care back home.
Frances Nanguri, who works at the aged care centre, has three relatives living away receiving dialysis.
“It’s too hard, you know, we worry about them.”
Frances uses the Kukatja word “marnmarl” when she talks about the people who have to leave their homes for health care.
Marnmarl translates to soreness, and Frances uses it to describe a “pain in the heart”.
Dr Chakera says while end-stage kidney disease often comes with worse outcomes for patients, it doesn’t have the same profile as cancer or heart disease.
“Because it doesn’t get into the public’s attention as much, it doesn’t get the same focus of philanthropic support and research dollars,” he says.
Purple House began in 2000 when Papunya Tula artists from Western Desert communities — including some of the Pintubi Nine, who had lived traditional nomadic lifestyles until 1984 — sold paintings to the Art Gallery of NSW and used the money to begin health services in remote communities.
The federal government recently announced a $13 million investment for Purple House to build and operate dialysis units in six remote communities, Balgo included.
The organisation says the Balgo project is moving ahead “with as much speed as you can building in a remote community”.
Sarah Brown, the chief executive of Purple House, says keeping people on country is essential.
“It’s about ensuring that senior community members are home on country for important cultural business and to teach the younger generations and keep culture strong,” she says.
“It’s not a nice-to-have, it’s vital to the health of remote communities.”
Balgo’s unit will be a four-chair nurse-assisted haemodialysis unit operating six days a week.
Treatment is three days a week for approximately five hours for eight patients who do alternating days.
Bobby West, a Purple House director and dialysis patient himself, has family ties to Balgo.
“We need to get those old people home so they can take care of their families and keep their culture strong.”
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