Problem drinking has its tentacles in traditional communities around the world, so strategies to deal with the issue can leap national borders.
Find out how an action manual designed for Australia’s Indigenous communities made the long trip to South Africa.

Claude Manbulloo, Australia: “Oh, real weak on the two knee, and arm you know and I couldn’t pick em up anything. Couldn’t even hold the tea. No – real weak. Couldn’t see from here to that motor car. Just see the country, [like] smoke. That’s what happened from the grog. Yeah. I bin tell them all, you know, I can’t take it my grog. I can’t see too far. I can’t feel my stomach, and I can’t get myself clean, and I got no good bed …”

Roeschanda, South Africa: “Then I was born, and that was the wrong step she took. Then she drank. She went through her life … she kept on drinking. She stopped sometimes. Then the second child came along. The family didn’t want my mother because she was drinking so much. She slept in bushes, put up a cottage, she had no one to support her. By the third child, social services decided to give us to our grandma.” *

He is an Indigenous Australian from the Northern Territory; she is a woman of mixed descent from the Western Cape in South Africa. Although they are separated by the world’s third largest ocean, the lives of these two people have both been deeply affected by the demon drink. It goes by many names – grog, dop, monkey blood, booze, wama – but the consequences of problem drinking are a common predicament. Anthropologist Dr Maggie Brady likens alcohol misuse to a monstrous octopus.

“It’s associated with so many other problems: road accidents, violence, injuries, child neglect low birth weight babies – it just has its tentacles reaching out into all parts of life, let alone the kind of stress and disorder it can cause, such as lack of sleep for those who are kept awake by rowdy drunks,” Brady says. “Lack of sleep is like a form of torture, but it’s one of those things that people don’t think about.”

Factoring in the deaths, illnesses, accidents, health care costs, crime and lost productivity that result from alcohol misuse, it was recently estimated that the issue costs Australia $7.5 billion each year. Estimates place the cost in South Africa at upwards of R9 billion a year. In both countries, problem drinking is identified as a serious matter in Indigenous and historically disadvantaged communities, whose members experience a disproportionately high level of the adverse affects of alcohol use. Brady, from the Centre for Aboriginal Economic Policy Research (CAEPR) at ANU, says the flow-on effects of problem drinking are magnified in Indigenous communities, where family ties and communal interaction tend to be much stronger than in the general population.

“The fact is that problem drinking affects a wide range of people – not just those consuming the alcohol. In the Aboriginal community, the ripples from the problem drinking of some people affect everybody. In the broader community, such behaviour is muffled by population size and the fact that we’re much more urbanised than the Indigenous population.”

It was these concerns that cropped up in a conversation Brady had with Professor Marcia Langton in the mid 1990s. Langton, then the Chair of the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS), suggested that what was needed was a simple, accessible guide book that would explore each aspect of the Indigenous alcohol problem and propose remedial strategies. The model she had in mind was the classic manual Where there is no doctor, which was written in the 1970s to offer practical medical advice to communities that had limited or no access to health practitioners.

Inspired to act, Brady set to work. The fruit of her efforts was called The Grog Book, published in 1998 with support from AIATSIS, the Council for Aboriginal Reconciliation, and the Department of Health and Family Services. This 250-page, spiral-bound action manual employs a combination of cross-referenced text, cartoons, graphics and tables. Brady worked with materials developer Mouli MacKenzie (an anthropology graduate from ANU in the 1980s) who was responsible for the clever concept and design work. Each of its eight chapters tackles a different aspect of alcohol misuse, beginning with a brief history of alcohol use in Australia, then moving on to the affects of alcohol on the body, before suggesting strategies for community action, prevention and care. The emphasis throughout is on community action, building on the idea that the impetus to change a society must come from within that society itself, rather than being imposed from outside.

“The book is for Indigenous peoples, those who work with them, and community members who ask, ‘How do we start? We know our community has a problem with alcohol but what can we do about it?’” Brady explains.

“People can feel overwhelmed by how difficult it all seems. They are often a minority who are non-drinkers, or who only drink a little and who are nervous about taking on a leading role. The Grog Book is designed to show them what’s possible and how even small actions can make a difference.”

The initial print run of 5,000 proved extremely popular. Provided free of charge, the guide was hailed as a plain-English approach to a complex problem, winning an Australian Award for Excellence in Educational Publishing in 1999. A year later, it also caught the eye of a visiting academic. This chance encounter was to inspire an adaptation of the book for use on the other side of the Indian Ocean.

In 2000, Kirstie Rendall-Mkosi was teaching at the School of Public Health at the University of Western Cape (UWC) in South Africa. During a trip to Australia on an academic exchange program, a colleague handed her a copy of The Grog Book.

“The drinking problem in South Africa is significant,” Rendall-Mkosi says. “Although the patterns of drinking may be different across different areas and cultures, it is an underlying cause of most road accidents, interpersonal violence and child abuse. It is recognised as a risk factor in the transmission of HIV and in reducing the effectiveness of the anti-retroviral treatment program. We also have the highest prevalence of fetal alcohol syndrome measured internationally.

“I started to gain insight into the alcohol problems in South Africa through my work as a community-based occupational therapist and then as a public health lecturer. I am always attracted to creative books that can be used by people working at a community level and The Grog Book fit the bill.”

Impressed by what she saw, Rendall-Mkosi made a mental note of the name Maggie Brady. There was a person whose views on alcohol misuse seem to accord with her own, she reasoned. Soon after, the South African was successful in applying for funding from AusAID to bring an Australian health care expert to the Western Cape to help deliver a series of short courses at UWC. By a fateful coincidence, Brady was alerted to the opportunity by one of her colleagues at ANU, and submitted a tender. When AusAID recommended Brady as a suitable consultant, Rendall-Mkosi jumped at the chance to work with the author of The Grog Book.

Together, the two women developed and delivered a series of summer courses for public health workers. When The Grog Book was used as a resource in the classes it impressed participants so much that Brady and Rendall-Mkosi developed a plan to create a similar action manual targeting problem drinking in South Africa. Rendall-Mkosi applied for and won AusAID funding for the project.

Building on the framework set out in The Grog Book, the authors began a series of trips around the Western Cape and further afield to meet with people who had been affected by problem drinking, and also those who had developed ways of addressing the problem. These stories from individuals, NGOs, community groups and health professionals were eventually seeded throughout the South African manual, in line with the community action philosophy of its predecessor.

After two years of consultation, writing, design, development and testing, Tackling Alcohol Problems was published by UWC in 2005. Like The Grog Book, it takes a simple, structured approach to the issues, working from the history of alcohol use through to strategies for action. Yet the chapters on farm action and urban action are just two indications of how the manual was adapted for South African consumption, dealing with the different histories and consequences of alcohol misuse in the nation’s rural areas as opposed to its cities. An example of this divide is the legacy of the ‘dop system’, where agricultural workers were paid in crude wine instead of money. Now illegal, this once widespread practice created rafts of health and social problems. Brady says that recognising these historic practices is an essential part of tackling problem drinking.

“The history is important in both countries because of race and prejudice and because alcohol was a focus of discriminatory legislation. In South Africa there was prohibition for people of colour, and then gradations of access depending on how you were classified. Alcohol was also used as a kind of trap: the authorities provided beer halls for workers at the mines to keep them happy.

“In Australia, prohibition for Indigenous people was introduced quite early on and was only repealed in the 1960s. Grog was used in both countries to entice workers, to divide and rule. The history is really important and that’s why it’s such a sensitive issue in both countries. When you talk about having restrictions on supply, which is one of the chosen Aboriginal strategies for controlling harm, it reminds people of those early days. So there is sometimes a lot of resistance to it.”

Just as important as understanding the history behind problem drinking, the authors of Tackling Alcohol Problems believe that it’s crucial to spread the word about current remedial strategies. Case studies in the book cover organisations like the Dopstop Association, an NGO that’s dealing with the legacies of the dop system in rural areas, and the Manenberg Peace Organisation, a group of volunteers in Manenberg who are reclaiming the streets from drug-trafficking gangsters. Rendall-Mkosi says examples like these are proving heartening for readers.

“The feedback from anyone who sees or uses the book is very positive,” she says. “The most gratifying feedback has been from Soul City, which is a large edutainment organisation that produces a TV series, as well as printed media, on health and development issues. They’ve based much of their upcoming series on the book. Also, the Dopstop Association is using it as a training manual, and I will use it as the main text when I present the short course at UWC this year.”

The Dopstop Association is also taking on marketing the book, which will help get it out to communities around South Africa. Meanwhile, its older sibling continues to prove popular in Australia. In 2005 the Department of Health and Ageing printed another 30,000 of The Grog Book to meet the volume of requests for copies.

“I’ve been surprised that the second edition has been in such demand,” Brady says. “The original 5,000 in the first edition just skimmed the surface of the people who found the book useful. And it’s not just Aboriginal and Torres Strait Islander people. I think the book is used a lot by non-Indigenous helpers and workers.”

Brady says adapting The Grog Book with Rendall-Mkosi for use in South African proves that similar manuals could be developed for communities around the world. She says the Pan American Health Organisation expressed interest in the project, probing the possibility of its adaptation for the Americas. When asked about whether she is fazed by the idea of her original manual continuing to grow and develop, Brady is positive. She credits the support of her colleagues at CAEPR and AIATSIS for helping her to get through each publication. Besides, creating something that is making inroads against the reach of problem drinking is extremely satisfying, she says.

“It’s been the most rewarding thing I’ve ever done.”

• For copies of The Grog Book, contact the Department of Health and Ageing
http://www.health.gov.au/
• For copies of Tackling Alcohol Problems, contact the Dopstop Association
E: director@dopstop.org.za

*Quotes taken from The Grog Book and Tackling Alcohol Problems respectively.


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ANU Reporter 
Autumn 2007