Bureaucrats and Bleeding Hearts: Indigenous health in Northern Australia

By Tess Lea . Published by UNSW Press , 2008 . Paperback, 320 pages with index . ISBN 9781921410185 . RRP $49.95

Reviewed by Mridula Bandyopadhyay

Mother and Child Health Research, La Trobe University, Victoria

Bureaucrats & Bleeding Hearts presents an up-close and personal ethnography of the lives of public health policy makers and ‘bureau-professionals’ in the Northern Territory government, particularly the Northern Territory Department of Health and Community Services (previously known as the Territory Health Services).

This book takes us into the social lives of ‘bureau-professionals’ working with Indigenous Australians in remote communities and their experiences in these communities. It details their frustrations, complaints about lack of consultative processes, yet striving for new approaches, and complaints that ‘nothing changes’, that things are getting worse, but believing that with redirection of effort and consistent funding, more can be achieved in Aboriginal health.

The book depicts the Territory Health Services (THS) as a ‘cultural organisation,’ where people inhabiting these spaces hover between pen and paperwork, conveying an appearance of serious action in improving Aboriginal health. The ethnographic material presented in this book further reveals how bureaucrats' give an impression of indispensability by conducting numerous, repetitive, banal and redundant workshops, meetings, whiteboard – dot point discussion sessions, and mini meetings to create an illusion of serious ‘policy at work’.

The book is organised into three main parts. It makes instant connection with the readers orientating them into ‘Outback’ Australia. Part I describes the bureaucratic setting of the THS and presents an overview of and insight into the white bureau-professionals ‘bleeding hearts’ and their commitment to Aboriginal health. Chapter 1 introduces the ‘helping white’ in the context of Aboriginal health, and provides a tool of anthropological analysis to study and interpret a bureaucratic organisation through ethnography based on fieldwork. Chapter 2 examines the interaction between social dynamics and ‘passion in policy’ that results in policy production, and is illustrated with a case-study on the formulation of a new corporate plan and a scheme to privatise all public hospitals in the Northern Territory. Chapter 3 deals with the irony of co-ordination within the THS – between Head Office policy staff and their regional counterparts – that, in turn, creates more disintegration which is resolved by more co-ordination.

Part II examines the institutional socialisation, which is presented in Chapter 4, on how bureau-professionals learn the ‘art of helping’ when they consider the problems of Aboriginal health and how they readily adopt the required attitudes to be regarded as competent or worthy in the eyes of their important superiors. Chapter 5 describes the social life of health facts in an organisation, and how health factoids – something that may not be true but is widely accepted as true because it is repeatedly quoted – circulate as evidence based accounts of success, of a ‘good approach that worked elsewhere and could be made to work here’ philosophy. Chapter 6 is about how an organisation manufactures optimism and maintains faith, and is aptly described with the example of the Strong Women, Strong Babies, Strong Culture (SWSBSC) program, that has been hailed as a success in terms of ‘real health gains’ by the THS.

Part III wraps up the ethnography by describing Lea's own journey as a bureau-anthropologist. Chapter 7 illustrates how bureau-professionals attempt to make programs with embodied interactions between their Aboriginal clients and project partners that present normality at one level and at another a surreal lack of engagement. The remaining chapters depict the authors' personal involvement as a bureau-anthropologist within the THS. She concludes that bureau-professionals are only trying to do their best to help Indigenous Australians, but in this quest, the dependency of bureau-professionals on Aboriginals they prefer to see as dependent on them is generally inclined to be obscured, thus generating the power of intervention programs.