A group of women hit play on a Celine Dion remix and start fighting for their lives in the backyard of an Alice Springs dialysis clinic.
The Power of Love booms from a speaker as the Aboriginal women lift weights, hit punching bags, and stretch on yoga mats.
Standing nearby is physiotherapist Nicki Scholes-Robertson, who calls encouragement and exchanges banter with the group as they work out.
A kidney transplant recipient herself, she knows how important these sessions are to take steps toward healing.
“I hope I give them a sense of hope for transplant,” she said.
“The transplant rates up here are not as high as in some of the other parts, but people are working really hard to improve that.
“I’m just encouraging people to stay on the right track.”
Journey to transplant
It has been more than a decade since Ms Scholes-Robertson received the news that changed her life.
What started as a sore throat ended up being the diagnosis of an underlying chronic kidney condition known as IgA nephropathy.
“Unfortunately a lot of my kidney function had gone,” she said.
After nine months of dialysis — a treatment that cleaned her blood in lieu of functioning kidneys — her little brother offered to give her his kidney.
She said she was one of the “very, very lucky ones” with a kidney transplant.
“For me, it’s really generated a passion for making things better for other people who have to go through the same thing,” Ms Scholes-Robertson said.
But she said many people were not so fortunate in the deserts of Central Australia.
And the road to a kidney transplant could often seem long and even hopeless.
No ‘walk in the park’
Ms Scholes-Robertson started working in December last year with Purple House, an Indigenous-owned and run health service in Alice Springs striving to increase dialysis access for remote communities.
Central Australia has among the highest rates of chronic kidney disease in Australia, with 1 per cent of the population on dialysis.
NT Health says almost half of the Territory’s Aboriginal population aged over 50 has chronic kidney disease or the “clinical biomarkers” of the condition.
There are concerns demand for renal services is rising in line with the “rapid growth” of diabetes.
Through her fitness classes, Ms Scholes-Robertson hoped to support more people towards a life-saving transplant.
“It’s not an easy walk in the park to get on the transplant list, particularly if you have things like diabetes, or cardiac issues or other things underneath. There’s quite an extensive screening process,” she said.
“It takes a lot of effort and a lot of support to get to that point.”
Pitjantjatjara woman Selina Bob, from the remote Aboriginal community of Utju (Areyonga), has been participating in Ms Scholes-Robertson’s fitness classes with her sister and cousin.
She said she was on track to make the transplant list.
“I feel happy,” she said.
“It’s going to be a good life out bush, going back, not stuck in a renal ward, if we get a kidney.”
Long road to healing
Many of Purple House’s clients are young enough to receive a transplant but have to tick numerous boxes before they are accepted.
They include attending dialysis appointments several times a week, taking medication, avoiding smoking, and staying fit and healthy.
“Each kidney is precious, so doctors want to make sure it has the best chance of survival,” Purple House chief executive Sarah Brown said.
Once patients receive the transplant, they have to take medication for the rest of their lives to ensure their body does not reject the kidney.
They also need to do all they can to avoid infection, which authorities say can be difficult in remote communities where there can be inadequate housing and health infrastructure.
Ms Scholes-Robertson said there was also a desperate need for more education about chronic kidney disease in remote communities to reduce the need for transplants in the first place.
“There certainly needs to be more funding around prevention,” she said.
But as calls for greater investment continue, clients such as Ms Bob are working to spread the word in their own communities.
“I always talk in language … when I go out visiting families,” she said.
“Always telling family, ‘You got to be careful. Do the right thing. Take good food, healthy food. If you want to be healthy, strong.’”
Minister for Health Selena Uibo said her government was developing a new kidney care plan for the NT.
“Key components of the new plan is a focus on prevention and more care closer to home with comprehensive, coordinated, and culturally appropriate supports for people living with kidney disease throughout their journey,” she said.
“This will be done by developing hybrid models of dialysis with new workforce models for virtual or onsite clinical and allied health support matched to their individual needs.”