Book Reviews

Balanda: My Year in Arnhem Land

Book Review

Balanda: My Year in Arnhem Land

In a nation often eager to present a whitewashed version of Australian history, Mary Ellen Jordan gives us an uncomfortable, yet refreshingly honest account of her experiences living in a remote Indigenous community for 14 months. Balanda: My Year in Arnhem Land [1] follows her experience, highlighting the stark social and cultural divisions between Indigenous and non-Indigenous Australians. This book recounts Jordan’s time at the Community Art Centre in Maningrida, a 2,300 strong coastal Aboriginal community in the heart of Arnhem Land in the Northern Territory [2]. Having previously lived and worked as an editor in Melbourne, Jordan’s role in Maningrida is to organise the community art centre and work on a bilingual dictionary including English and the local Indigenous language.

One can only learn so much about Aboriginal culture in a medical school lecture theatre. Guest lecturers, workshops in Australia’s history, and explanations of Aboriginal culture as ‘deeply spiritual’ reward us with only a broad, generalised view of what is, in reality, a diverse collection of tribes, languages, and individuals. The impact of these diverse cultures on diagnosis and treatment is often only touched upon, or otherwise described only in general terms.

Despite accounting for 3.7% of total health expenditure, the Close The Gap initiative of 2008 is failing [3,4]. There is an average life expectancy gap of ten years between Indigenous and non-Indigenous Australians, a 2.5 times greater disease burden, and disproportionate incidences of preventable diseases such as rheumatic heart disease and trachoma in Aboriginal and Torres Strait Islander populations [5]. Furthermore, the ultimate goal of Closing the Gap between Aboriginal and non-Aboriginal Australia in terms of culture is not always clear. Is it a covert attempt to achieve Western assimilation? Or an endeavour to preserve a culture already re-shaped by the influences of a dominant white culture?

In remote Maningrida, a sense of cultural alienation results in a type of split community, where “there is very little crossover between the two cultures, although [they] live side-by-side [1].” Balanda aims to investigate the involvement of white Australians in Aboriginal communities as ‘modern day missionaries’, a resonant phrase for medical students considering placements or working in an Aboriginal community. While Jordan’s inability to offer a solution to the social determinants of health may frustrate readers, it reinforces her sense of helplessness regarding the complexity of the current situation for Indigenous people and cross-cultural communication.

Confronting and critical, Jordan’s recount lingers in the reader’s mind long after the covers are closed. Questions regarding what it means to be non-Indigenous in a country built on dispossession are raised and not always answered clearly. For medical students inexperienced with Indigenous cultures, these questions are unsettling. Jordan describes the healthcare system as an imposition of one culture onto another, in which health practices are taught based on the Western model of medicine rather than Aboriginal tradition. To her, the “unspoken…unintentional assimilation [1]” of healthcare delivery is often administered in a paternalistic fashion, in which Aboriginal people are prevented from taking responsibility for themselves and their community.

Integration and success have been noted, however, in the example of Aboriginal Community Controlled Health Services (ACCHS) [6]. These services, offering general practice, allied health, antenatal care, and support programs deliver holistic and culturally appropriate primary healthcare. ACCHS exist as autonomous organisations initiated by Indigenous communities and governed by a locally elected board. These services overcome trends of non-participation and tokenism by engaging the community through partnership, self-determination, and community ownership. For these services to succeed, building community capacity, addressing risk factors, and implementing evidence-based strategies to address social determinants is necessary.


Health practitioners and medical students may well feel intimidated by the candid accounts of the communication challenges faced by Jordan, such as differences in verbal and non-verbal language, and social organisation. Jordan’s recognition of her difficulties in cross-cultural communication highlights how bridging two disparate cultures can pose a major impediment to clinical practice.

Practitioners and students, however, should not to be dismayed or dissuaded by Jordan’s cynicism. Rather, this book encourages us to reflect on how our own beliefs and social milieu shape how we act towards others, and in turn, form partnerships that celebrate diversity. The author’s insights and experiences can be used to formulate inventive and novel approaches to addressing health disparities, and help prepare for both the inevitable frustrations and rewards experienced when working with such a unique and ancient culture.

Dr Tarun Sen Gupta, the Lynn Kratcha Memorial Bursary selection committee, and the staff of the University of Saskatchewan for making my placement in Canadian rural Indigenous communities a success.


Conflict of interest
None declared.




[1]       Jordan ME. Balanda: my year in Arnhem Land. Australia: Allen & Unwin; 2005.

[2]       Maningrida Demographics (NT) [Internet]. Australian Bureau of Statistics; 2011 [cited 2016 Jul 1]. Available from:

[3]       Australian Government Department of the Prime Minister and Cabinet. Closing the gap: Prime Minister’s report 2017. In: Department of the Prime Minister and Cabinet, ed: Commonwealth of Australia 2017; 2017.

[4]       Aboriginal and Torres Strait Islander Social Justice Commissioner. Close the gap: statement of intent [Internet]. 2008 [cited 2016 Jul 1]. Available from:

[5]       Australian Institute of Health and Welfare. Indigenous health profile 2014 [Internet]. 2014 [cited 2017 Apr 11]. Available from:

[6]       Panaretto KS, Wenitong M, Button S, Ring IT. Aboriginal community controlled health services: leading the way in primary care. Med J Aust. 2014;200(11):649-652. doi:10.5694/mja.00005