Ngyiampaa Non-Compliance with Boring Medicare Cards

by Daniela Heil, University of Newcastle, Australia

 

In Australia, public health insurance cards are known as Medicare cards. The name of the public health insurer is Medicare, and both Aboriginal and non-Aboriginal Australians, including permanent Australian residents use and are familiar with the card. Ngyiampaa Aboriginal Australians consider these Medicare cards ‘boring objects’ because they are one of the things that reflect the inclusion of non-Aboriginal influences into Australian Aboriginal lives and practices. In the following, I examine the boring object of the Medicare card in the all-Aboriginal Ngyiampaa community of Murrin Bridge in regional, central-Western New South Wales, Australia.

New South Wales is the Australian state where different Aboriginal language groups first experienced Anglo-European occupation and where they have become participants in colonial encounters since 1788 in the eastern and the 1850s in the western parts of the state. In 1949, the Aborigines Welfare Board (AWB) established Murrin Bridge as an Aboriginal station. The AWB is a former representative of what is now the state government of New South Wales. The AWB resettled Aboriginal residents from different settlements throughout New South Wales to other places on their behalf. These inherent practices of Australian colonial history have added to contemporary inconsistencies between traditional Aboriginal language groupings, their former homes and places, where they have been positioned by others since, and what they understand to be ‘home’ now. What these historicized dynamics and contemporary Ngyiampaa Aboriginal experiences point to are continuing inconsistencies that have existed between government decisions and the non-inclusion of the formerly colonized, now often socio-economically marginalized, Aboriginal Australian voices throughout the process. The ongoing disconnect between local Aboriginal experiences and the often detrimental decisions that non-community-intrinsic policymakers have generated on their behalf, come to the fore in reference to Australian Medicare cards as well.

As maintained by Svendsen (2005), boredom, and this entails boring things and experiences, frequently stands out as a typical phenomenon of modernity. From the perspective of the Ngyiampaa, “boredom normally arises when we cannot do what we want to do” and “things are boring when we have to do something that we are not keen on doing,” and “boring is when nothing exciting happens and all is predictable.” These comments made by some Ngyiampaa people point to the internalized relational understanding in people’s daily lives and practices that such things — and, yes, the Medicare card is understood to be “a boring thing” from Ngyiampaa perspectives, too — are determined in other settings and contexts that are “non-Ngyiampaa, culturally.”

Two short ethnographic examples help to illustrate this as well. Lucy is a Murrin Bridge elder who has left her Medicare card at the local surgery for more than 8 years. ‘They don’t help us without it, and they keep telling us we need it, otherwise there won’t be any support. We, blackfellas share, and take care of other relatives, we do not need cards to help people. Medicare is a whitefella law. Because we need health care, we require the card. Without it, we end up with nothing.” Gary has had type 2 diabetes for the last 18 years. His Medicare card is also at the local surgery, because the grand-children will end up playing with it if he keeps it at home. Leaving it at the surgery “is the best solution. When it goes missing, I won’t get my script and the doctor won’t see me either.” Gary knows that the Medicare card is necessary for “looking after my sugar. We have to comply with it. If we don’t, we are considered non-compliant patients. So, we conform, because we need our medication. On its own, the card is boring, and does not mean much at all.” As another Murrin Bridge resident indicates, “we socialize in practices with each other, no matter what forms these take.”

These Ngyiampaa ethnographic examples above, and many other additional ones, show that the ‘boring’ component of the Australian Medicare insurance cards points to the disjuncture between individual patient commitment to produce the card whenever access to health care is necessary, and the simultaneously enforced compliance with ‘whitefella law.’ For Murrin Bridge people leaving their Medicare cards for safekeeping at the local surgery allows them at the same time to protect their Ngyiampaa cultural practices more easily, too. That is, Ngyiampaa Australians engage regularly in interactions with kin-related others for the purpose of staying present socially and, thus, maintaining and reiterating their proper cultural ways and engagements with extended kin-related others. The significant shaping of Murrin Bridge residents’ everyday practices derives primarily from the demands of kin-relatedness and what local Aboriginal people refer to as ‘enjoyment.’ All of these practices serve people’s interactive engagements with others, as well as their personal obligations to others. What this suggests is that they have a socio-centric, also known as a relational, understanding of themselves as persons rather than a sense of their selves as individuals. The latter is ideologically defined as an autonomous, self-animated and self-enclosed agent, in correspondence to Western-like images of individuals.

Ngyiampaa enjoyment-related activities demonstrate and continuously reinforce the importance for them to be engaged in socialities, which requires one’s social presence, one’s involvement in and responsiveness to social obligations, and their personal responsive demands on kin-related others. To participate in this social world means to be part of the social modus operandi (Bourdieu 1990) within which the self is constituted, transformed, reconstituted, maintained, responsive to, and responded to by others and oneself; hence, others are a prerequisite to constitute meanings for oneself. What this means is that there is a socio-centric emphasis and focus on relational obligations for the Ngyiampaa, and prioritizing extended kin-related others regularly on a social and communal presence centered basis. ‘Proper [Ngyiampaa] relatives’ will never end up prioritizing themselves, nor their individual health; and they do know the purpose of Medicare cards, too. However, because they are familiar to Ngyiampaa Australians, as they are to everybody else, Medicare cards are not understood as pivotal, certainly not as long as one is not in need of immediate medical attention. Accordingly, leaving the supposedly ‘boring, whitefella’ health insurance card with the local surgery effectively accommodates reciprocal self-other Ngyiampaa challenges of being a self-centered patient without jeopardizing one’s communal, relational, social and cultural exchanges with others. Alternately, if a Ngyiampaa person ended up prioritizing their personal health, others would consider their personal, ‘sick patient’ issues more important than their communal social obligations and corresponding practices. In other words, other community members would refer to them as “neglecting their social kin-related obligations” and, hence, “not being a proper relative” any more.

Overall, the mainstream Australian health care system has worked with the neoliberal ideology of patient responsibility, in reference to applying for the Medicare card, safekeeping the card, maintaining a connection to it, and being able to produce it when going to a surgery or when in need of personal health care. Surgery staff often accommodate Ngyiampaa patient requests, because they know that the cards may otherwise end up missing or lost. Leaving the health insurance cards in the care of local surgery staff both generates and maintains realms for Ngyiampaa patients that place health-centred obligations with non-Aboriginal onto others and prevent jeopardizing Aboriginal personhood and the intensity of one’s obligations to kin-related others at the same time. A counterbalance and, hence, counter-productivity in reference to boredom is brought to the fore. That is, Ngyiampaa Australians are continuously being required to conform with non-Aboriginal policies and practices that are reflective of non-Aboriginal cultural understandings, order, insurance compliance, and the inherent related cultural practices, too. As long as all of the latter maintain to work with influences of non-Aboriginal government policies, the Ngyiampaa will neither prioritize compliance with nor correspondence to these non-Indigenous practices; and, hence, the Ngyiampaa continue to insist on pursuing their personal and cultural practices instead.

 

References

Bourdieu, Pierre. 1990. The Logic of Practice. Stanford: Stanford University Press.

Svendsen, Lars. 2005. A Philosophy of Boredom. London: Reaktion Books.