The impact of renal disease is devastating, with a large representation of those afflicted with it being Indigenous. The consequences upon the communities and families have a cultural as well as an emotional impact.

Big Girls Don't Cry synopsis

A moving documentary about Indigenous women living with kidney disease.

Big Girls Don't Cry curator's notes

The prevalence of kidney disease is overwhelming in Indigenous communities, with Darwin having an incidence ten times higher than anywhere else in the country, with 80 per cent of that number being Aboriginal. It is difficult to watch the impact of renal disease on Mariah, who has lived with it since she was a baby, as well as elder and activist Essie Coffey OAM, who in her final years lived with renal disease. The title Big Girls Don’t Cry comes from an affirmation Essie Coffey’s family uses in the film. Essie Coffey eventually succumbed to a common cold, her immune system so weak she could not fight it off.

This is a very moving film, and the strength of women – Essie Coffey of the Muruwari clan, Mariah Swan of the Kamilaroi clan, Glenda Kerinaiau of the Tiwi clan – who lived with, and continue to live with, renal disease touches your heart.

Notes by Romaine Moreton

Education notes

This clip shows patients and staff in the Northern Territory Renal Unit in Darwin and then at the Tiwi Dialysis Centre on Bathurst Island, 80 km north of Darwin, conveying information about the effect of kidney disease on Indigenous Australian communities. Dr Paul Snelling, Director of NT Renal Health, speaks about kidney disease in Indigenous communities. Glenda Kerinaiau from Bathurst Island explains how important it is for her to be able to access dialysis treatment in her home community.

Educational value points

• The effect of the centralisation of renal services on Indigenous Australian communities is explored in this clip. A 2006 report by Kidney Health Australia estimated that up to 30 per cent of Indigenous renal service clients choose not to start treatment, stop treatment or regularly miss treatment because of anxiety and depression caused by the demands of the treatment and separation from family and community.
• The clip exposes the disproportionately high rate of renal disease within Indigenous Australian communities. NT has the highest rate of end-stage kidney disease requiring dialysis or kidney transplant in Australia. Kidney Health Australia’s 2006 report states that more than 85 per cent of renal patients in the NT are of Aboriginal or Torres Strait Islander descent and are on average 20 years younger than non-Indigenous Australians when they present for treatment.
• The causes of the high rates of renal disease in Indigenous Australian communities are complex. They probably relate to the low health status of Indigenous people, arising from economic disadvantage that exposes them to poor living conditions, unhealthy lifestyles and reduced access to health services.
• The clip indicates difficulties in providing renal services to remote communities. NT’s small population of 200,000 is dispersed across an area of more than 1 million square km. Indigenous Australians represent almost 30 per cent of the NT’s population, but 71 per cent live in remote or rural areas. Diverse cultures and languages, as well as movement between communities, further challenge health service provision.
• The clip shows a new renal unit built on Bathurst Island to provide treatment to patients closer to where they live and where they have family support. The NT Renal Services Strategy 2005–2009 has this as one of its key initiatives and there are now new renal units at Palmerston and Tennant Creek and home dialysis services on Groote Eylandt, Maningrida and Elcho Island.
• In the clip Glenda Kerinaiau reveals the relative freedom she can enjoy through accessing mobile peritoneal dialysis treatment at the Tiwi Dialysis Centre. After six years of dialysis treatment in Darwin she was offered treatment close to home and her family. Four times a day she connects herself to a special bag of fluid via a catheter in her abdominal cavity. At the time this film was made she was the longest surviving NT peritoneal dialysis patient.
• The increased incidence of renal disease and its effect on the Tiwi people of Bathurst and Melville Islands is referred to in the clip. In the ten years to 1996, kidney disease claimed 42 per cent of the Tiwi people. However, a recent study of a systematic treatment program introduced to the Tiwi Island communities showed that there has been a marked improvement in blood pressure and stabilisation of renal function in people who receive treatment.
• The clip is from the documentary Big Girls Don’t Cry, produced by the Central Australian Aboriginal Media Association (CAAMA) about Indigenous women living with kidney disease. Established in 1980 and owned by the Indigenous people of central Australia, the Association’s primary purpose is to represent Indigenous Australians in film and television. The clip is in the form of an informational report and its purpose is also to persuade Indigenous people to seek medical advice.

Education notes provided by The Learning Federation and Education Services Australia