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Teacher’s notes

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This clip uses a series of interviews intercut with family photographs that tell the story of Mariah and the effect of kidney disease on her and her family. Her parents, Angie and David, recollect their experience of Mariah’s illness, dialysis and the news of a possible transplant. Photographs of Mariah and her parents at the time of the illness complete the picture they describe. A doctor provides information about the illness and the clip concludes with shots of Angie and David describing their joy at receiving the news that a suitable kidney is available.

Educational value points

• The effect of chronic kidney disease on Mariah and her family, who are from the Kamilaroi clan, is graphically illustrated through her puffed-up face, a symptom of the disease. When kidney function falls below a certain level due to chronic kidney disease, the kidneys fail. At this point drastic medical intervention is necessary to sustain life. Her parents’ recollection of this time causes them considerable anguish.

• The doctor in the clip explains that the kidneys’ essential function in the body is removing waste products and extra water from the blood. They also regulate blood pressure, balance essential chemicals such as sodium and potassium, produce hormones to help bones grow and keep the blood healthy by making new red blood cells. Damage to the kidneys impairs their capacity to perform these functions and wastes build up in the blood.

• The sensitive issue of a child’s illness and the suffering of Mariah and her parents is well handled in this clip. The camera pans slowly across a photograph to show toys, then a child’s hand and arm, before we see Mariah with tubes taped to her face. Her parents recount the development of the disease over photographs of Mariah at the time. The camera only briefly focuses on the parents’ faces so as not to intrude on their personal distress.

• The disruption to the lives of parents whose child has a chronic illness is alluded to in the clip. Photographs show Angie and David living in Sydney, an unfamiliar city that was to become their home for 12 months. Describing themselves as 'shy and from the bush’, they were only teenagers when the Royal Flying Doctor Service transported them and their sick baby daughter from their home in Moree, New South Wales, to Sydney’s Children’s Hospital.

• It is recommended practice for parents to be with their children during the period of treatment and hospitalisation to provide the comfort and love that will assist with the child’s recovery. As was the case for Angie and David, this period can last for many months. For parents from rural or remote Australia the period away from home can be very difficult because of enforced absences from work and from other family members and the pressure on family finances.

• Kidney disease is rare among children, with adults 20 times more likely to experience the disease. Kidney failure resulting from injury or poisoning is usually temporary. The two leading causes of irreversible kidney failure among children aged 4 and under, such as Mariah, are birth defects, for example being born without kidneys or with abnormally formed kidneys, and hereditary diseases.

• The subject of kidney donors is raised in the clip. Most kidneys for transplant come from people who have recently died, as was the case for Mariah who received a kidney transplant from another child who had died in a car accident. As most people have two kidneys, but need only one functioning kidney, it is possible for living people to also donate a kidney provided there is a good blood, tissue and size match.

• 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. This film is in the form of an informational report, but its purpose is also to persuade Aboriginal people to seek medical advice.

This clip starts approximately 3 minutes into the documentary.

Still images of Mariah as a toddler show her in a hospital gown with a tube from her stomach into her nose, playing with dolls. The clip goes back and forth from an interview with Mariah’s parents set in front of a dining table to images of Mariah in the hospital. Mariah’s doctor is interviewed in an office.

David, Mariah’s father After about a few weeks, they placed her on what was called dialysis. They took her up to the operating theatre and when she came out, she had a tube coming out of her stomach. I looked at her and didn’t know what to think first time I saw it. Just to think what she was just going through at the time, to see needles and tubes…

David and Angie are shown being interviewed at their dining table.

Angie, Mariah’s mother Tubes up her nose…

David Down her nose and coming out of her stomach. Oh, it was just…

Angie Because she wouldn’t eat, they put tubes in her…

David And then, at the time, I started to realise how serious it really was.

Still images of the family in Sydney are shown.

Angie They got us a place around from the hospital in a lodge, a little house.

David I think we stayed there for about…

Angie Yeah, we stayed there for a while.

David Well after 12 months.

Angie We stayed there for a while.

David Things were alright for a while and she got a – then she got her first infection. Then the infections became more constant and then they got us in – Ange and I – into the room and told us that, like, she needed a kidney, like, straight away. It was pretty serious.

An interview with Mariah’s doctor begins.

Mariah’s doctor When your kidneys fail completely, you die. It’s impossible to live without kidneys. Fortunately, science has invented a replacement for kidney function called dialysis. So we can – either with a haemodialysis machine, which cleans the blood, or with a peritoneal dialysis, where you wash salt water in and out of the belly, we can replace some of the function of the kidney, particularly that function that gets rid of waste products out of the body. But even the very best dialysis only achieves about 5% of normal renal function. So people on dialysis are still really sick. A much better treatment is kidney transplantation.

David I offered to give her my kidney but they – oh, they – I was young, fit, had nothing really wrong with me and they – they just told me that oh, being so young, that maybe somewhere down the track, maybe I might get some sort of illness or anything. Maybe I might need it, you know, but I still – I was willing to give her whatever she needed. Take it from me to give it to her, you know, but…

Doctor Fortunately, a kidney became available from the transplant waiting list. I think it was a kidney from a child who’d been in a car accident and it was a bit too small to go into any other person so it was just perfect for Mariah.

David I walked into the ward and, oh – a few nurses just ran up to me and said, ‘Oh, we’ve found a kidney, we’ve found a kidney for Mariah.’

Angie Oh, I just started crying and Dad and all that was there, Aunty (inaudible). I had them crying, I was jumping around, you know. Everyone in the house was crying.