One of the features of the Vietnam War was the daily body count. According to US army colonel, David Hackworth:

… the body counting completely eroded the honor code of the military, specifically among the officer corps. It taught people to lie. The young lieutenants fresh out of the military academies were taught to lie. The generals, who were pretty proficient liars anyway, pushed the body count. A high body count meant great success. So, in every battle, enemy bodies were counted several times. If there were 200 bodies, suddenly the figure became 650 …

But that doesn’t seem to worry health minister Tony Abbott, whose office claimed in the Sydney Morning Herald yesterday that 6,500 Aboriginal kids had so far been examined as part of the federal “intervention” in the Northern Territory.

Simply not true. The “body count” of Aboriginal kids examined by the end of August was a shade over 1500; Abbott’s inflation of the body count would have done General Westmoreland proud.

The military leader of the federal intervention, Major General David Chalmers, agrees. Abbott’s figures are a wilful exaggeration. In fact he acknowledges only 67% of the kids are getting medical checks in any case—let alone Abbott’s claimed 6,500.

But other interests are at play here in re-interpreting history. Chris Perry, chairman of the Queensland branch of the Royal Australasian College of Surgeons, claimed in the same SMH story the incidence of ear infections among Aboriginal children was the worst in the world. Fair enough, but to claim this is creating “catastrophic” learning and development problems that have been largely ignored for 50 years is, again, simply not true.

Aboriginal medical services and educationalists have been arguing this case for at least two decades. To suggest knowledge of this plight has only “been brought to light by the Federal Government’s intervention in the Northern Territory to deal with health and s-xual abuse problems in Aboriginal communities” is – frankly – self serving bullsh-t on the part of Abbott.

Chronic Suppurative Otitis Media (CSOM) is almost unknown in developed countries such as Australia. It is caused by persistent bacterial infection of the middle ear. It is a disease of poverty – largely a consequence of overcrowded and related poor living conditions, including lack of appropriate washing facilities, poor nutrition, and lack of access to comprehensive primary health care. Children as young as four days old are found to have bacterial loads in their ear canals that are simply not seen elsewhere.

In the Northern Territory, ear disease, consequent hearing loss and associated disabilities constitute an invisible public health problem. The World Health Organisation suggests that a prevalence rate of CSOM of 4% indicates “a massive public health problem requiring urgent attention”.

The prevalence of CSOM is often greater than ten times this rate in Aboriginal communities of the Northern Territory. This is more than a “massive public health problem” – it is a crisis of calamitous and long term proportions.

In a 2002 survey of 29 communities throughout the Northern Territory conducted by the Menzies School of Health research, an overall average of 25% of young Aboriginal children had perforated ear drums, 31% had middle ear fluid in both ears and only 7% of children had normal ears. Five communities had perforation rates greater than 40%.

Chalmers, and the intervention, are telling us nothing we don’t already know, but are fearful of supplying a long term solution.

The proximate cause of CSOM is persistent nasopharyngeal colonisation by multiple bacterial species and subtypes. In Aboriginal communities, infants are frequently exposed to other children whose bacterial carriage rates are almost 100% for each of the major otitis media pathogens.

In non-Aboriginal children, low-dose infection usually eradicates pathogens which in turn reduces inflammation and tissue damage. In Aboriginal children it is understood that early exposure to large scale, multiple bacterial infection constantly inflames and damages tissue without eliminating the pathogens.

There is a vicious cycle which persists throughout early childhood: early and chronic exposure, leading to persistent infection, thus leading to chronic mucosal disease. Kids become chronic carriers of disease, thus infecting other children.

For reasons that are unclear, but which may in fact indicate the sheer prevalence and hence apparent normalcy of the condition, the Aboriginal infants that are infected rarely exhibit symptoms such as fever, pain, irritability or inflammation of the ear. This means the illness goes unnoticed by parents, and is thus untreated. The invisibility is further exacerbated by two related features. Aboriginal childhood hearing loss is intermittent – that is, hearing phases in and out.

This means that for at least some of the time, children can hear, and so can acquire the capacity to speak and interact as the full hearing children can. These compensation skills quickly mask the impact that the periods of hearing loss are having on their full linguistic and motor neuron development. Unlike the child who is deaf from birth, whose deafness is able to be detected with simple tests, the impact on the Aboriginal child remains dangerously undetected.

In any case, entirely unlikely to be picked up by the one-off medical inspections dictated by the intervention. As Crikey has already reported, the intervention’s checks are designed to understate the disease load of Aboriginal kids.

This results in suppurative infection of the middle ear, the build up of fluids in the ears and perforation of the eardrums. Untreated, mild to major hearing loss is an inevitable result. Remedial measures at school age, such as hearing aids and bone conductors, or special acoustic design in schoolrooms – while critical for those who have suffered hearing loss – miss the point. Prevention of the disease must be regarded as the primary strategy. Everything else is ameliorating after the damage (to hearing, to language acquisition and hence to pre-literacy capacity) has been done.

In any case, access to hearing services by Aboriginal children in remote areas is negligible.

Dr Perry has pointed out there has been no commitment of sufficient long-term funding to combat the problem — which he told the SMH was “widespread, catastrophic socially and an indication of poverty”. Exactly. Poverty is a root cause, and overcrowded housing situations iads a direct cause of the almost instant re-infection Aboriginal kids face — even after successful antibiotic treatment.

Aboriginal-controlled health services and indeed the Northern Territory health department have been arguing for years that housing is at the root of massive health problems such as CSOM – a claim conveniently side stepped by successive federal health ministers – let alone housing ministers. The failure to deal with the problem, which could be easily fixed, was “a national shame”, according to Dr Perry.

He has urged Federal Labor to go into the next election with the kinds of commitments which would alleviate conditions such as CSOM. He estimates a $10 million a year price tag – not counting the bill for adeqaute housing. Indigenous Affairs spokeperson Jenny Macklin has said nothing about a condition suffered by close to 100% of Aboriginal kids at the age of three months, and almost unknown amongst suburban white children.