Bingo! How transforming kids' first years sets them up for success

Updated

When it comes to ending Indigenous disadvantage, these women know the earliest years matter most.

How important are your first 1,000 days on Earth?

"It's a period of time that determines the health and wealth of the world," says Professor Kerry Arabena, a Torres Strait woman, a mother, and an expert on Indigenous child health.

Tamworth two-year-old Nayte Slater is in the middle of these crucial days. Today he's playing with his twin baby sisters and cuddling up to his mum, Megan Naden.

Megan's one-year-old twins, Jameliah and Taylanah, crawl around on the mat at her feet.

They're her first set of twins — and "her last", she jokes.

The days of Nayte and his sisters' little lives are being diligently tracked by a team of researchers. They are a big part of one of one of the largest studies of Indigenous mothers and babies in the world.

Megan says she signed up because she saw it as a rare opportunity: she wants her children to get the best care.

"If you wanted to know anything, they could tell you there and then or they could check it up," she says.

While a reduction in infant mortality is touted as one of the success stories of Closing the Gap, the data hides a troubling trend that makes this research all the more important — since 2008 indigenous infant mortality rates have plateaued.

'A safe space'

Ground zero for the team trying to find answers to this problem is an unassuming warehouse on a back street of Tamworth in north-western New South Wales.

Inside, colourful dot paintings cover every wall in a brightly coloured waiting room. There are ultrasound machines and a pathology room, and out the back you'll find a vast paint-splattered arts studio.

Art teacher Aunty Pearl Slater is here, making fried rice for lunch for a group of mothers. They're decorating life-sized plaster casts moulded from their expanding bellies.

Aunty Pearl teaches her craft to women who've never picked up a paintbrush before. She's also free to have a yarn to mothers who might need some reassuring on a hard day. Now a grandmother, she says when she had her three sons, Aboriginal mothers didn't have the support or the knowledge they have now.

"It was completely different, there was none of this, there's more health information now," she says.

"You've got the health coming to you, mums know where to come now."

The Gomeroi gaaynggal centre — which means "Babies from Gomeroi lands" in local Kamilaroi language — is an eclectic place; part arts studio, health centre and research lab.

The centre has steadily grown to become the longest-running study of Indigenous mothers and their babies ever undertaken, not just in Australia but globally.

Gomeroi gaaynggal now tracks the health of about 250 mothers and their children. But, in its own first 1,000 days it had trouble getting off the ground. "In the early days when we first started we had absolutely no-one turn up," Dr Kym Rae laughs. "We just sat there waiting for weeks and weeks and weeks."

When the University of Newcastle academic started the centre in 2009, she'd envisioned a friendly space, employing Aboriginal health workers and art teachers, where mothers could come if they had any concerns about their pregnancies.

She also hoped the health centre would be the catalyst for a new type of research project. She wanted to follow the health of local Aboriginal mothers and babies over five years.

The challenge, though, was convincing dozens of shy pregnant women to sign up to a long-term study, to agree to be tracked and monitored for years to come.

Local Aboriginal women had often felt uncomfortable in mainstream health services in Tamworth. Trust didn't come quickly.

"Certainly, talking to the Indigenous community, they didn't feel that they were safe in health services. There's still so much current history, I guess, in the elders and the older members of the community about how they've been treated in the past."

Baby bingo

So, Kym and her team brainstormed. How could they convince Aboriginal women to come to the centre to get free check-ups and perhaps agree to take part in the study?

The answer was Baby Bingo.

One of the Aboriginal aunties suggested the idea. They advertised a bingo event, telling pregnant women they could win donated baby products if they answered a series of health questions correctly. Kym and her team weren't sure whether it would work.

"We got a big crowd! The girls were all really comfortable," Kym says.

While bingo was the beginning, the service has succeeded due to the hard work of people like Kamilaroi woman Loretta Weatherall.

Ms Weatherall has done most of the recruiting to get local mothers to agree to come to regular ultrasounds at Gomeroi gaaynggal, and to have their blood, saliva and measurements taken for research.

On a hot and busy Friday morning in Tamworth, she's got 10 women booked back-to-back in the clinic. She takes a blood sample from each and escorts them into the ultrasound room, chatting easily with each woman about their families and their birth plans. "Trust plays a big role in everything," she says.

As a mother of two teenage daughters, Loretta had only recently moved her family from outback Walgett to Tamworth when she took up her job at Gomeroi gaaynggal. She felt like an outsider too, so she could sympathise with young mothers who felt intimidated. She staked out waiting rooms in hospitals and health services, asking pregnant Aboriginal women if they would consider visiting Gomeroi gaaynggal.

"When we first started I was kind of shy too. I'm not from this area so I had to build trust and it came really quick. I think [that's] because I'm Aboriginal, the mums are Aboriginal and I'm sort of connected.

"Now I get on really well with some of the mums, I even got invited to some of the baby showers, that was rewarding. I just felt like I'm doing a really good job because they like me!"

Many of the women here talk often about judgement — feeling uncomfortable and uneasy among health professionals can be a big barrier for young mothers who are too shy to ask for help.

At Gomeroi gaaynggal, mothers tend to be younger: the average age is 24. Some are still teenagers, navigating their first pregnancy and their first steps into adulthood.

"We don't judge them, we just try and help them," Loretta says. Recently a 16-year-old girl pregnant with her first baby asked her for advice.

"A lot of people were telling her, 'You won't have fun, you'll be raising a child', and I just said 'Look, it's up to you, if you think you can raise your own baby [then] later in life you still can have fun, and you can have fun with your baby'."

If a mother can't make it to her appointment because she doesn't have a car, Loretta will drive to their house in her own car to pick them up and make sure they get there on time.

"They're nice people, they look after you," says father of six, Elvis Ward.

"There's no arrogant people here, they're all down to earth."

He and his partner Courtney Price haven't felt this welcome in other places. "You just sense the way they talk and look at you. Here you don't feel that, you feel more at home."

The pair say they want to bring their six boys up to be proud Aboriginal children. "That's how I was brought up," Courtney says.

"You got to keep the culture going, you don't want it to die out," Elvis says.

A trend of tough births

Slowly, more women started trickling into the health service, and slowly more and more agreed to take part in the five-year project to monitor the health of their babies.

This study is a snapshot telling a common story of what Indigenous mothers around the country are experiencing. And it may paint a more accurate picture on why so many Aboriginal mothers are having premature births and smaller babies, and why they're more likely to experience the death of a baby.

Gomeroi gaaynggal's research shows that many Aboriginal mothers in Tamworth are having tough births — more than half will have a complicated pregnancy. Too many are already showing concerning signs of chronic disease at an early age.

Dr Kym Rae is distressed whenever she finds that a young mother has early signs of kidney failure. It happens often.

"Renal disease in women who are so young, we shouldn't be seeing that, there should not be any sign of it. We see about 16 per cent of our mums have got evidence of renal disease, and our average age [of mothers] is only 24," she says.

"We're seeing high blood pressure, all the things we shouldn't be seeing in these young women, it's really awful."

Aboriginal mothers in Tamworth, and across the country, are giving birth much earlier than other Australian mothers.

"We see about 14 per cent of our mums [give birth prematurely]. Non-Indigenous it's about 6 per cent, so it's almost double.

"Our premmie babies were most likely to have mums who were very heavy smokers and I think the mums also had other health conditions going on as well."

Smoking rates in pregnancy are more than triple in Aboriginal communities, so that's certainly a factor in premature births.

But Luke Wakely says there's more to the story. He's completing a PhD looking at how premature births affect families in rural areas.

"I think there's a range of complex reasons, just poorer health in general." He suspects that infant mortality rates in many Indigenous communities are "massively" under-reported.

"Often in really remote communities these babies are being born prematurely and aren't surviving. There's no facilities and these [births] possibly aren't being captured.

"The further you go, the less rigorous [stats] are recorded, so I don't think we have an accurate picture of it."

Beyond birth

The Federal Government often points to the declining Indigenous child mortality rate as one of its success stories when it comes to Closing the Gap. It marks its target to halve the gap in mortality rates for Indigenous children under five by 2018 as "on track".

Indigenous child health expert Professor Kerry Arabena argues that's an overreach, because there's been no significant decline since 2008 and she's worried that progress has stalled.

"I think it's a bit more nuanced than what's being presented in the national picture," she says.

"The trajectory [since 2008 ] is not a downward trend, it actually looks like it's plateauing.

"In the first 30 days of a baby's life, we've actually got significant gains being made. But it's when women leave hospital and go home — before a child is one — we are still seeing a rise in the gap."

At Gomeroi gaaynggal, Dr Kym Rae's team has had one baby die since they began their research. That doesn't include a high rate of miscarriage.

"Of our cohort we've only had one bub that's been lost, and I touch wood that it doesn't happen again because it was fairly awful for the families of course."

She's happy that attitudes appear to be changing, and a growing number of Aboriginal mothers are now sharing their stories for research.

"I think particularly in engagement with research, mums are going, 'Actually, research is an OK thing and there's things that I'm going to get out of this'."

Loretta Weatherall often thinks of what life will be life for her daughters in a generation's time.

"I'm always thinking about that because I hope it gets better; crime wise, health, employment, everything. I wish it would all change," she says.

"You have to get out there and do things yourself and be heard and don't let anyone put you down."

Megan Naden is grateful for the research tracking her twin girls, which will last all the way into their first days in primary school.

"The main thing was checking on the babies' kidneys and make sure everything was functioning right."

But Megan, who grew up at Gilgandra south-west of Tamworth, worries for young mums in other towns who have few services and nothing like what Gomeroi offers.

"Especially where I come from — a remote area — we don't have support like this out there."

Topics: indigenous-culture, indigenous-aboriginal-and-torres-strait-islander, indigenous-policy, infant-health, health, tamworth-2340

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