Moral economies of kidney disease and care: Interdependencies between Yolŋu and the Australian state

My thesis analyses the social, economic and political relations of care that arise through end stage
kidney disease in an Australian Indigenous society. An epidemic of end stage kidney disease amongst
Indigenous Australians, and poor access to life-sustaining dialysis treatment in remote communities,
sees healthcare for patients from remote areas administered through urban displacement. I consider
how the care for Yolŋu renal patients is practiced and valued in Yolŋu families and in health and
social policy. I explore how the multiple values and practices of care for Yolŋu renal patients in Yolŋu
families and in health and social policy interact; and the implications for relations between Yolŋu and
the state. In this thesis I bring together the scholarship of care, the anthropology of Indigenous
economy and classic gift theory in a novel way. I adopt an ethnographic approach grounded in renal
patients’ and carers’ narratives, while also incorporating service provider and policymaker
perspectives.
I begin by exploring the social suffering produced by kidney disease and the relations and practices of
domestic care in the families of Yolŋu renal patients, describing a Yolŋu ethics of care. I show that
care-giving is understood by Yolŋu as investing value in people, relationships, family solidarity and
material equality. Giving and receiving care is understood by Yolŋu primarily as a relationship
between generations, and may provide a means of exercising power and responsibility within
gendered and age-based social roles. Care is enacted through interlocking material and non-material
reciprocities in Yolŋu domestic moral economies.
I go on to explore how Yolŋu attempt to realise a Yolŋu ethics of care through healthcare, social
housing and social security payments. I show that while some of the care needs of renal patients are
recognised in health and social policy, the everyday subsistence struggles of their carers and other
kin are often neglected in public policy embodying neoliberal values of self care, self sufficiency and
responsibilisation. My research reveals how the neoliberal state relies on social relations and care
practices in Yolŋu families, constituted through fundamentally different values, to realise health and
social policy agendas. Yolŋu care practices such as performing domestic labour rather than working
in the formal economy, sharing, extending shelter to kin, and hunting and gathering are mobilised yet
marginalised by the neoliberal state. Neoliberal values of care are parasitic on social roles within
families and in some cases may strain relations among kin, reproducing bodily, social and economic
precarity.
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By considering the intertwining of material and non-material dimensions of care, my thesis
challenges received ideas about Indigenous dependency on state welfare. I show that an
interdependent but unequal relationship exists between Yolŋu families and the state, through health
and social policy agendas, in satisfying the basic needs of life of Yolŋu renal patients and their kin.
Such interdependencies become particularly salient in times of post-universal, conditional healthcare
and welfare. In some circumstances, they also provide a means by which Yolŋu may exercise power
and gain recognition from the state.