Utopia: the poorest place in Australia

John Pilger’s new movie on Indigenous Australia has raised hackles, but health practitioners working in the remote communities he filmed admit they are still struggling with Dickensian-era diseases.

David Smith stares into a filthy, blocked toilet, rusted through to the U-bend. Faeces still cling to the rim from when it last overflowed days ago, sewage spilling onto the red dirt floor.

There is no wash basin, no mirror, and four corrugated iron walls worn away at the base provide easy passage for vermin and snakes attracted to the festering smell.

Welcome to Utopia: the most disadvantaged and poorest place in Australia according to a Federal Government report, and home to 1400 of Australia's first people.

Stationed 325km north-east of Alice Springs, Mr Smith runs the local Ampilatwatja Health Clinic that cares for the Aboriginal community who have called the Utopia region home for thousands of years. But you have to wonder whether a plumber or pest exterminator would do more for the health and welfare of the land's custodians than a trained medical officer.

"We're meant to be providing quality healthcare but we can't even provide the basic needs of human beings," Mr Smith says.

"Health workers don't believe me when I tell them I'm pulling cockroaches out of people's ears. Adults and children — you look down the ear canal and you can see their legs kicking."

Many of the children of Utopia, like those in many remote Aboriginal communities, are partially deaf as a result of untreated otitis media, which delays their learning, exacerbating illiteracy and the rate of school drop-out.

Hydration is also a serious problem for these kids. Diarrhoea and gastroenteritis run rampant. Dickensian-era diseases, wholly preventable and unthinkable in white Australia, have crippled the community.

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Some 3000km away from Utopia, on a towering open-air movie screen in Sydney's inner-west suburb of Redfern, I'm watching Mr Smith wandering through one of Utopia's shantytowns.

As I sat wrapped in my picnic blanket at the Sydney premiere of John Pilger's latest documentary, I had the distinct feeling that Utopia's healthcare emergency had languished in silence long enough.

The irony of the name ‘Utopia' was not lost on Pilger, who chose to name his documentary in honour of the region. Nor did it escape the 4000-strong crowd that joined me that evening in January.

The night was punctuated by shouts of outrage and "shame", made all the more eerie by our surroundings, on a grassy square of the city's notorious Aboriginal housing project known universally as "The Block".

The dilapidated terrace houses along Eveleigh St that flank the iconic brick wall emblazoned with a red, yellow and black Aboriginal Australian flag form a spiritual heartland in the city for many Indigenous Australians.

The Block was also the site of bitter riots in 2004 and a protracted stand-off between Aboriginal residents, police and the project developers fighting over some of Sydney's most sought-after real estate. The Indigenous residents of this inner-city suburb still share much with the people of Utopia: a long history of dispossession and demonisation.

This is the focus of Pilger's cinematic exploration of the "forgotten Australia".

There is plenty about Pilger's Utopia that sits uncomfortably. This is not your objective, fly-on-the-wall documentary. The combative journalist is the star and overbearing guide as he flays government officials, unapologetically demands answers to leading questions, and speaks with a rhetoric that risks alienating middle-class Australia.

At one point, a Northern Territory MP and former minister for Aboriginal Health is hectored by Pilger till you think the two will leap out of their chairs and at each other's throats.

I am not Pilger's intended audience. He talks of "miles" instead of kilometres, alludes to the US slave trade, Robben Island prison, depicts white Australians as yobbos and bogans, and describes Canberra as if it were some off-world colonised paradise. It's clear the polemic ex-pat gave up trying to convince mainstream Australia to address its failings long ago.

He looks to overseas audiences, but for what I'm not sure. Help? Vilification? Foreign intervention? He certainly does more than hint at the latter.

No matter what you think of the man's methods, his thesis is damning: our collective failure to improve the lot of Indigenous Australians in one of the richest countries on Earth is reprehensible.

As Indigenous AFL star and 2014 Australian of the Year Adam Goodes said, "This extraordinary film tells the unpleasant truth. It should be required viewing for every Australian."

Pilger has made documentaries depicting the endemic suffering in Indigenous communities since the 1960s. Sadly his early footage bears remarkable similarities to his latest work. Squalor, poverty and destitution.

"We're treated like refugees in our own country," one Indigenous elder told him.

The film is expansive, stretching far beyond the borders of the Utopia region as it traces Australia's fraught history of the battle for land rights, the Stolen Generations, deaths in custody and the NT Intervention.

But the deplorable state of Indigenous healthcare is where the least progress has been made since a much younger and blonder Pilger first rolled tape decades ago.

Today almost one-third of Aboriginal people are dead by the age of 65. Indigenous people are astronomically over-represented across all rates of chronic illness and are least likely of any group to receive appropriate medical care, according to consecutive AIHW and ABS reports.

Close to one in eight Indigenous people have a long-term cardiovascular condition. Up to 30% of Aboriginal people have undiagnosed diabetes. In some areas, 70% of Aboriginal children are partially deaf.

All this in a modern, thriving country.

Dr Janelle Trees with a patient in Mututjulu.

John Pilger, director of Utopia.

Dr Janelle Trees had not seen Pilger's Utopia when I tracked her down last month, although she features prominently. For years she worked as the GP in Mutitjulu, one of the many impoverished and remote Indigenous communities that lie in the shadows of Uluru and a booming tourist industry.

Families live in asbestos-riddled shacks that have been condemned by government agencies, but neither torn down nor replaced with the sizeable government funds set aside by consecutive Coalition and Labor governments for housing in rural and remote Indigenous communities.

Over 30 people, most primary school-aged children, live in one small house crammed with mouldy mattresses and sectioned into dim claustrophobic rooms by stained and crumbling walls.

"I'm dealing with conditions that affected the English working class back in the 1870s," Dr Trees told Pilger. "Sometimes I wonder if I should be testing people for cholera."

Now working at a practice in Tonga, Dr Trees is wary of speaking to journalists, having seen first-hand how the media misrepresents Indigenous Australians.

Mutitjulu gained infamy at the height of the Howard Government's Intervention in 2007. The town was a lightning rod for national outcries of disgust and accusations of depravity when it became the target of overblown media claims of mass paedophile rings and rampant sexual abuse.

But Dr Trees, the daughter of an Aboriginal mother and a red-haired, white Australian father, smiled broadly as we chatted over Skype. She explained that John Pilger just happened to catch her at a moment when she was anxious to get just one message across.

"There is still an emergency going on in Aboriginal health," she told me.

"We need help. We don't even have the resources the people need to establish a good basis of health.

"There are problems with housing, issues with water supply, access to food and electricity. There's a high rate of preventable infectious diseases.

"It's a big strain on families just trying to keep your skin healthy and clean," she said.

"The kids have very damaged feet. They don't wear shoes and the ground is very, very hot. They get terrible cracks and cuts in their feet.

"We've got obese and overweight people who are malnourished because they're living on flour and meat that has been subsidised by the tourist trade. But fruit and vegetables are too expensive," Dr Trees said.

"It's part of the legacy of dispossession — the very poor diet that the British imposed on the Aboriginal people when their land was taken."

Dr Trees and the nurses at the Mutitjulu clinic made do with the scant resources and the nearest hospital six-and-a-half hours away in Alice Springs.

"It would have been nice to have an X-ray machine. Or a morgue," she said.

When the Mutitjulu community need to store a dead loved one, they take the body to the medical centre at a tourist resort 30km away, where staff turn up the air conditioner in one of the storage rooms.

It was a daunting assignment, but it's clear from Dr Trees' passion for her patients that it is by no means despairing.

"You can save a person's life everyday being a rural GP. I know I've made a difference at Mutitjulu. I saw people get stronger and happier, and come to trust me and the clinic."

Will Pilger's documentary make a difference? It's winning awards overseas, but in the arena of public opinion at home, its adversaries rival supporters. Pilger's detractors criticise the fact that his documentary doesn't spend enough time on the national Closing The Gap campaign.

As the 2030 deadline for the initiative inches closer, it is all too clear that we have so far fallen woefully short of closing the gap between the health and life expectancy of Indigenous Australians and the general population.

A Close the Gap progress report published in February noted some successes: reductions in smoking rates, and improvements in maternal and childhood health to name two.

"They provide encouragement that the gap will close by 2030, even though more time must be allowed for significant change to be seen," the report reads.

So far, $1.57 billion has been poured into the Closing the Gap initiative by the Council of Australian Governments. The steering committee is lobbying for more.

Back in Utopia, Mr Smith probably just wants someone to fix the bloody toilet.

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