The community laundry working to reduce heart disease in the Northern Territory

When former Olympian Liz Morgan-Brett toured remote Aboriginal communities in 2018, she saw first-hand the impact of unsafe living conditions.

“[There were] scabies infections, crusted scabies, and those secondary complications that stem from repeated scabies infections, which is acute rheumatic fever and rheumatic heart disease,” she says.

Rheumatic heart disease was largely eliminated in developed nations by the mid-20th century, with the advent of running water to ensure people and homes could remain clean. But in the overcrowded and broken housing in many remote communities, the diseases persist.

A significant contributing factor is the spread of scabies. Up to 70% of Indigenous children in remote communities contract scabies before their first birthday. If untreated, scabies sores can become infected with group A streptococcus bacteria, which can lead to acute rheumatic fever and ultimately rheumatic heart disease.

And one of the easiest ways to reduce rates of scabies is to ensure access to a working laundry.

“We knew the drivers [of scabies] from our communities were overcrowded housing and a lack of access to commercial-grade washers and dryers,” Morgan-Brett tells Guardian Australia.

So that’s what her organisation, the Indigenous-owned not-for-profit Aboriginal Investment Group (AIG), built.

“We built our first prototype in 2019 and shipped it out to Barunga [a remote community about 300km south-east of Darwin], and within two years of operation, scabies have dropped 60% … and there have been no new cases of rheumatic heart disease in Barunga,” she says.

“We have since built and delivered six more. So, across our seven laundries, we’ve tipped over 88,000 cycles of washing.”

Currently, the project has seven laundry sites across the Northern Territory, providing commercial-grade laundry facilities free of charge.

Gemma Brogan is a teacher in Gunbalanya, one of the communities with a laundry – which was featured in a short film about the project. She says every community in the territory should have the same facilities.

“The cost of laundry powder, softener and disinfectant is really high,” she says. “You’re pretty much paying double the price to what you normally would in urban areas.

“In the community, no one really has a washing machine because the cheapest you could probably buy a washing machine for around here would be about $800. No one around here has that kind of money spare.

“I think every remote community should have one of these laundries, because scabies and rheumatic heart disease are curable and preventable.”

‘It’s a basic human right’

Perpethua Ali was diagnosed with acute rheumatic fever five years ago, at the age of 38. At first, she says, she didn’t take it seriously and didn’t really understand it.

“It took me a while until the doctor said to me: ‘do you want to live longer to see your grandchildren or your great-grandchildren grow up? Do you want to be around and alive to see your children grow?’,”, the Warumungu and Warlpiri woman says.

Now 43 and with three grandchildren, Ali says both rheumatic heart disease and type 2 diabetes – which she also has – are common in her home town of Tennant Creek.

As of late December 2024, more that 11,700 people living in Australia had rheumatic heart disease and either current or past acute rheumatic fever infections. At least 80% of those with the disease are Aboriginal or Torres Strait Islander, who are at least 20 times more likely to die from it than non-Indigenous people.

“A lot of our mob get diagnosed with diabetes but they are mostly dying of heart attacks,” Ali says. “They were all strong and healthy and then health issues like diabetes, heart disease and all the other health conditions started coming into our community and it was making our mob sick.

“We didn’t receive education or know about heart disease, acute rheumatic fever, rheumatic heart disease. We had no awareness of that and we had no education around it.

“It really affected my health. It really affected my lifestyle and affected me to see other family members and friends in my community also affected.”

First Nations principal research fellow at the Menzies school of health research, Assoc Prof Aunty Vicki Wade, has been working to reduce rates of rheumatic heart disease for more than 15 years. The Noongar elder told Guardian Australia that remote laundries played an “important role” in preventing the spread, but said it was just one small part of what was needed.

“It’s part of the environmental health plan … they have a place, but we can’t rely on remote laundries,” she says. “We can’t rely on any one solution, it’s got to be part of the endgame strategy.

“It’s a basic human right that we’ve got access to water, and we’ve got access to washing. It’s part of healthy living practices.”

Wade says community education and awareness is also a significant piece, as is ensuring funding for culturally safe care and other preventive measures.

“We’ve got a blueprint for rheumatic heart disease and it’s certainly environmental health, which is really, really important,” she says.