Remote Australia Online

This chapter is concerned with the relationality of law and politics in historical and contemporary expressions of colonial sovereignty in the Northern Territory of Australia and how this weaves webs of control over Indigenous peoples’ lives. It illustrates the inter-disciplinary exercise of colonial carceral control, encompassing ‘welfare carceralism’, ‘protectionist carceralism’ and ‘penal carceralism’. In doing so, it delves deeper than the current focus on mass imprisonment to demonstrate that incarceration has a long colonial lineage. It concludes that a relational analysis—of place, time and disciplines—opens up a broader understanding of structural colonial oppression and Indigenous resurgence that challenges colonial carceralism through self-determination. It does this through the lens of the Royal Commission into the Protection and Detention of Children in the Northern Territory.

This article emerges from a study of the incidence of Indigenous driving offending conducted by the authors in the Northern Territory (NT) from 2006 to 2010 on two central Australian communities. It demonstrates how new patterns of law enforcement, set in train by an 'Emergency Intervention' in 2007, ostensibly to tackle child sexual abuse and family violence, led to a dramatic increase in the criminalisation of Indigenous people for driving-related offending. We suggest that the criminalisation of driving-related offending was part of a neocolonial turn in the NT through which the state sought to discipline, normalise and incorporate as yet uncolonised, or unevenly colonised, dimensions of Indigenous domain into the Australian mainstream. In terms of methodology, we adopted a mix of quantitative and qualitative approaches, blending criminal justice and policing data with insights from criminological, anthropological and postcolonial theory. We argue that running together the insights from different disciplinary traditions is necessary to tease out the nuances, ambiguities and complexities of crime control strategies, and their impact, in postcolonial contexts.

There is a strong contemporary research and policy focus on climate change risk to communities, places and systems. While the need to understand how climate change will impact on society is valid, the challenge for many vulnerable communities, especially some of the most marginalised, such as remote indigenous communities of north-west South Australia, need to be couched in the context of both immediate risks to livelihoods and long-term challenges of sustainable development. An integrated review of climate change vulnerability for the Alinytjara Wilurara Natural Resources Management region, with a focus on the Anangu Pitjantjatjara Yankunytjatjara lands, suggests that targeted analysis of climate change impacts and adaptation options can overlook broader needs both for people and the environment. Climate change will add to a range of complex challenges for indigenous communities, especially in relation to hazards, such as fire and floods, and local environmental management issues, especially in association with invasive species. To respond to future socio-ecological risk, some targeted responses will need to focus on climate change impacts, but there also needs to be a better understanding of what risk is already apparent within socio-ecosystems and how climate interacts with such systems. Other environmental, social and economic risks may need to be prioritised, or at least strongly integrated into climate change vulnerability assessments. As the capacity to learn how to adapt to risk is developed, the value attributed to traditional ecological knowledge and local indigenous natural resource management must increase, both to provide opportunities for strong local engagement with the adaptation response and to provide broader social development opportunities.

Objective: to examine the transition of care in the postnatal period from a regional hospital to a remote health service and describe the quality and safety implications for remote dwelling Aboriginal mothers and infants. Design: a retrospective cohort study of maternal health service utilisation and birth outcomes, key informant interviews with health service providers and participant observation in a hospital and two remote health centres. Data were analysed using descriptive statistics and content analysis. Setting: a maternity unit in a regional public hospital and two remote health centres within large Aboriginal communities in the Top End of the Northern Territory, Australia. Findings: poor discharge documentation, communication and co-ordination between hospital and remote health centre staff occurred. In addition, the lack of clinical governance and a specific position holding responsibility for the postnatal discharge planning process in the hospital system were identified as serious risks to the safety of the mother and infant. Conclusions and implications for practice: the quality and safety of discharge practices for remote dwelling mothers and their infants in the transition from hospital to their remote health service following birth need to be improved. The discharge process and service delivery model must be restructured to reduce the adverse effects of poor standards of care on mothers and infants.

Targeted chronic disease programs are vital to improving health outcomes for Indigenous people globally. In Australia it is not known where evaluated chronic disease programs for Aboriginal and Torres Strait Islander people have been implemented. This scoping review geographically examines where evaluated chronic disease programs for Aboriginal people have been implemented in the Australian primary health care setting. Secondary objectives include scoping programs for evidence of partnerships with Aboriginal organisations, and use of ethical protocols. By doing so, geographical gaps in the literature and variations in ethical approaches to conducting program evaluations are highlighted.

Ongoing chronic pain is an epidemic in Australia. One in five people are living with chronic pain and this number rises to one in three over the age of 65. People with chronic pain have the greatest levels of disability in our community. It is the leading cause of early retirement from the workforce, with back problems and arthritis accounting for around forty per cent of forced retirements. The level of workforce participation in people with chronic pain could be as low as nineteen per cent. The estimated cost of chronic pain, calculated over a decade ago, was thirty four billion per year. Untreated chronic pain also has profound consequences in every area of life, commonly resulting in decreased enjoyment of normal activities, loss of function, role change and relationship difficulties, and these experiences can exacerbate feelings of isolation and stigmatisation. It can also severely impact mental health, with over a quarter of adults with severe or very severe pain experiencing high or very high levels of psychological distress. While a quarter of Australians live with chronic pain, data also tells us that this burden is disproportionately harder to bear in rural and remote areas of our country. Recent data released by the Australian Institute of Health and Welfare shows that people living in our rural regions are also more likely to misuse pharmaceuticals, with use of opioid analgesics nearly twice as high as in major cities. This is consistent with data from the National Wastewater Drug Monitoring Program reported higher levels of drugs in regional areas than capital city areas. Much of this use is likely to be related to initial management of chronic pain conditions. While it is well known that pain management services along with pain specialists and allied health professionals trained in pain management are limited in rural and remote Australia, there needs to be broader recognition of the fact that these access issues often delay treatment and therefore increase levels of disability and reduce capacity to return-to-work while impacting quality of life. Our presentation will discuss the development of the National Action Plan on Pain management, in particular highlighting our priorities to improve timely access to appropriate pain management strategies for all Australians. We will discuss new research on the economic burden of pain findings in regional and rural Australia and provide an overview of how this epidemic can be more effectively managed in regional centres.

The “Top End” of Australia is presently experiencing a gonorrhea epidemic. Gonococcal infection is usually limited to mucosal tissues but can lead to disseminated gonococcal infection (DGI), joint destruction, and severe sepsis. This study aimed to explore the epidemiology, presentation, management, and health-care impact of DGI in the Top End of the Northern Territory. Health records of patients diagnosed with proven, probable, or possible DGI between January 2010 and September 2018 were analyzed retrospectively. One hundred six cases of DGI were identified. Ninety-four patients (88.7%) were Indigenous Australian. The incidence of proven and probable DGI in the Indigenous population was 27.1 per 100,000 person-years, compared with 7.1 in the Top End population overall. Of 7,540 laboratory-proven gonococcal notifications, 1.3% (<span class="jp-italic">n</span> = 97) were complicated by DGI. The highest incidence was in the 15–19-year age-group. Thirteen cases (12.3%) occurred in patients younger than 15 years. . High rates of comorbid alcohol misuse, diabetes, systemic lupus erythematosus, rheumatic fever, and complement deficiency were observed. The “classic triad” of tenosynovitis, dermatitis, and polyarthralgia was rare. Ninety-four patients (88.7%) presented with purulent arthritis. Disseminated gonococcal infection was estimated to cause at least 10.0% of nonpenetrating septic arthritis in the Top End and 1,234 days of hospitalization during the study period. DGI is an important cause of morbidity in the Top End, particularly in the young, remote Indigenous Australian population. Clinical presentation varies from classical teaching. Urgent action in the health and community sector is required, particularly for at-risk populations, to prevent further debilitating and costly complications of gonococcal infection.

Night Patrols (‘patrols’) are a uniquely Indigenous Australian form of community self-policing. Patrols do not fit neatly into established paradigms of ‘policing’ emanating from the Global North. They are not part of the apparatus of the state police, nor do they offer commodified private security services and, unlike mainstream police, they cannot legitimately call on a reservoir of coercive powers to ensure compliance. In this article we sketch out what we describe as the ‘contested space’ of Indigenous self-policing, as represented by patrols, through a post-colonial lens, paying particular attention to the role of Indigenous women’s agency in creating, nurturing and sustaining night patrol work within an Indigenous ethics of care and notions of well-being. Drawing on international critical post-colonial scholarship we tease out the links between patrol work and broader expressions of sovereign power embedded in Indigenous law. Our key contention is that there are learnings from the Australian experience for other post-colonies, where there are kindred debates regarding the balance between Indigenous and colonial systems of justice and policing. We highlight the experience of patrols in the Northern Territory (NT) where the policing of Indigenous space and place have become a key priority for the Australian Government after a major focus on issues of child abuse and family violence.

In the absence of an effective international legal regime to regulate biopiracy, a second-best solution is for source countries to regulate access to their genetic resources. Among the pioneering legislation in this regard is the Indian Biodiversity Act of 2002. This legislation seems to accord with world’s best practice of nesting bioprospecting within the broader environmental legal framework which will allow a greater degree of certainty. Similarly South Africa has enacted its National Environmental Management: Biodiversity Act, 2004, which regulates bioprospecting, within the framework of the National Environmental Management Act, 1998. The slow evolution of an international legal regime to deal with the biopiracy of genetic resources is now threatened with obsolescence as it now becomes possible to assemble DNA sequences in a laboratory. Those genes can be accessed in public databases without the necessity to access biological material from source countries. In 2016 the Conference of Parties of the Convention on Biological Diversity (CBD CoP) has begun meeting to consider how the Nagoya Protocol might be modified to deal with biopiracy and synthetic biology.

Objective To identify national and international research and literature focussed on policy responses to elder abuse in rural and remote communities to generate recommendations for Australian responses. Design Scoping literature review. Setting Australia (some international policy also included). Participants National and international elder abuse policy documents relating to rural and remote responses were reviewed. Seventy-two stakeholders were invited to contribute literature that may have been missed in the scoping review. Main outcome measure(s) Identification of the extent to which issues for rural and remote communities were discussed in elder abuse policy. Result Of the 13 Australian policy documents reviewed, only four made mention of rural and remote communities, though this was generally only in regard to increase in vulnerability. No mention of these communities were identified in reviewed global policy. One document focussing on abuse in rural and remote Indigenous communities highlighted the importance of developing culturally appropriate responses hinged on community collaboration and consultation. Conclusion Consideration of rural and remote communities in elder abuse policy is generally not meaningful. It is recommended that future policy development includes recognition of the distinct features of elder abuse in rural and remote communities, as well as how these features may impact on prevention and responses in these locations. These features include geographical isolation, lack of access to services and transportation, confidentiality and privacy issues, and the need for culturally sensitive approaches to address elder abuse for Indigenous people which take into account the impact of historical disenfranchisement.

A recent Lancet publication reported the substantial and largely unmet health needs of Australian Aboriginal and Torres Strait Islander (Indigenous) adolescents; needs that we have been working tirelessly to address in the Northern Territory. In order to improve health outcomes for Indigenous adolescents, we must create health systems responsive to their needs. This paper focuses on changes made at Royal Darwin Hospital, which continue to improve the quality of care for this group. We describe these changes here, to celebrate the gains made and ultimately, we hope, to help address the health of Indigenous adolescents more broadly.

Compared to other Australian women, Indigenous women are frequently at greater risk for hypertensive disorders of pregnancy. We examined pre-pregnancy factors that may predict hypertension in pregnancy in a cohort of Aboriginal and Torres Strait Islander women in north Queensland.

Background: Point-of-care (POC) tests could be important public health tools in settings with treatment delays and high rates of sexually transmissible infections (STIs). Use is limited due to suboptimal performance. The performance and ease-of-use of a new molecular-based POC test for simultaneous detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) was assessed, alongside two single-organism immunochromatographic tests (ICT). Methods: The evaluation occurred between May 2012 and March 2013 during community STI screens in two remote Aboriginal health services. Urine was tested with the GeneXpert®CT/NG and if sufficient volume, also with Diaquick CT and Gonorrhoea Card. The gold standard comparison was laboratory nucleic acid amplification testing (NAAT). Operational characteristics were also assessed. Results: Among 198 samples, GeneXpert CT sensitivity and specificity was 100% [95% confidence intervals (CI): 75.9–100] and 99.5% (95% CI: 96.5–100), and NG was 100% (95% CI: 96.5–100) and 100% (95% CI: 97.5–100), respectively. Among a sample subset, Diaquick CT (n = 104) sensitivity and specificity was 27.3% (95% CI: 7.3–60.7) and 66.7% (95% CI: 12.5–98.2), and Gonorrhoea Card (n = 29), was 66.7% (95% CI: 12.5–98.2) and 76.9% (95% CI: 56.0–90.2), respectively. GeneXpert required 1 mL of urine, four steps, 1 min specimen preparation and 90 min to result. ICTs required 15 mL of urine, eight steps, 18 min preparation and 10–15 min to result. Conclusion: The accuracy and operational benefits of GeneXpert CT/NG make it very suitable in these settings where delays to treatment are encountered.

For the indigenous population living in remote Australia Streptococcus pyogenes and community-associated MRSA (CA-MRSA) are common causes of skin and soft tissue infections (SSTIs). For S. pyogenes oral sulfamethoxazole/trimethoprim has been shown to be non-inferior to intramuscular benzathine benzylpenicillin for the treatment of impetigo. Since β-lactam-resistant CA-MRSA is a frequent co-pathogen, sulfamethoxazole/trimethoprim is the recommended oral alternative for community-based treatment of impetigo in remote Australia. In Western Australia (WA), a trimethoprim-resistant Panton–Valentine leucocidin-positive ST5-IVc MRSA clone (WA121) has emerged as a frequent cause of SSTIs in the state’s northern regions, causing 941 cases in 2016/2017. The bioMérieux VITEK® 2 ID/AST System, used by the majority of diagnostic microbiology laboratories in WA, classifies WA121 as sulfamethoxazole/trimethoprim resistant. Consequently, it has been recommended that sulfamethoxazole/trimethoprim should not be a first-line oral antibiotic treatment alternative for impetigo in remote Australia.

In 2007, a report into the sexual abuse of children in Aboriginal communities in the Northern Territory, Australia, led to allegations that ?rivers of grog [alcohol]? were destroying these communities. It also precipitated a dramatic shift in Aboriginal policy by the Australian government, in which principles of self-determination were discarded in favor of top-down measures designed to restrict Aboriginal access to alcohol. While not disputing the gravity of current levels of alcohol-related harm in some Indigenous settings, this article challenges the assumption that ?rivers of grog? have swept away all capacities for local control, and argues that a more theoretically and empirically informed analysis of the nature, determinants, and outcomes of social control provides a basis for a more viable policy than the current so-called emergency response. The article traces the evolution of policies affecting Indigenous alcohol use, and of concerns expressed by both Indigenous and non-Indigenous commentators about problems in controlling drinking at a local level. It then examines sociological perspectives on social control. The article concludes by reviewing initiatives by Aboriginal organizations aimed at developing more effective local controls over alcohol.

Rural, regional, and remote settlements in Australia require resilient infrastructure to remain sustainable in a context characterized by frequent large-scale natural disasters, long distances between urban centers, and the pressures of economic change. A critical aspect of this infrastructure is the air services network, a system of airports, aircraft operators, and related industries that enables the high-speed movement of people, goods, and services to remote locations. A process of deregulation during the 1970s and 1980s resulted in many of these airports passing into local government and private ownership, and the rationalization of the industry saw the closure of a number of airlines and airports. This paper examines the impacts of deregulation on the resilience of air services and the contribution that they make to regional and rural communities. In particular, the robustness, redundancy, resourcefulness, and rapidity of the system are examined. The conclusion is that while the air services network has remained resilient in a situation of considerable change, the pressures of commercialization and the tendency to manage aspects of the system in isolation have contributed to a potential decrease in overall resilience.

The demands placed upon employees in their roles have long been thought to be important in predicting employee well-being and in reducing the risk of anxiety and depression, increasing cardiovascular functioning and reducing employee burnout. The present study sought to examine the job demands of rural, regional and remote educational leaders. Demand ratings were generally lower for regional areas than rural areas and lower for rural areas than remote areas. Higher qualifications and experience were associated with lower demand ratings. Participants in desired areas rated themselves under lower demand than participants in undesired areas and participants who were undecided about the desirability of their locations. These findings have important implications for the selection, preparation and support of leaders in non-metropolitan contexts.

This chapter explores the possibilities of relationality through collaboration between an Indigenous and non-Indigenous scholar. It describes an attempt to move beyond the problematic ways in which Indigenous history has largely been written by non-Indigenous historians who utilise archival sources without engaging with the Indigenous communities or people about whom they write. We describe the methodology of a project that focuses on the work of the Finke River Mission and its head missionary Friedrich Wilhelm Albrecht who, during the 1950 and 1960s, initiated an education scheme that targeted ‘half-caste’ Indigenous girls living on pastoral stations across Central Australia.

The School of Education underwent a reaccreditation of the Bachelor of Teaching and Learning (Pre-service) in 2012, and the Head of School sought facilitation grant funds from the Charles Darwin University Office of Teaching and Learning to ensure the course was effectively incorporating Indigenous knowledge. This paper explores the embedding or increasing of Indigenous knowledge content in teacher education with particular focus on building an Incorporating Indigenous Knowledge LibGuide with library staff, academics and indigenous students. The LibGuide design offers multimedia access to Indigenous knowledge, culture and languages for the needs of academic teaching staff, and pre-service education students in one convenient location.

Objectives To characterise the people retrieved by the Royal Flying Doctor Service (RFDS) for treatment of mental and behavioural disorders, and to assess mental health care provision in rural and remote areas. Design Prospective review of routinely collected RFDS and Health Direct data. Setting, participants RFDS aeromedical retrievals of patients from anywhere in Australia except Tasmania during 1 July 2014 – 30 June 2017 for the treatment of mental or behavioural disorders. Main outcome measures Retrievals by ICD-10 mental and behavioural disorder diagnoses. Results 2257 patients were retrieved by the RFDS for treatment of mental or behavioural disorders, including 1394 males (62%) and 863 females (38%); 60% of patients were under 40 years of age, 35% identified as Indigenous Australians. The most frequent mental and behavioural disorders were schizophrenia (227 retrievals, 16.5% of retrievals with ICD diagnoses), bipolar affective disorder (185, 13.5%), and depressive episodes (153, 11.2%). Psychoactive substance misuse triggered 194 retrievals (14.2%), including misuse of multiple drugs (85, 6.2%), alcohol (61, 4.5%), and cannabinoids (25, 1.8%). The mean age of patients retrieved for treatment of substance misuse (29.6 years; SD, 11.6 years) was lower than for retrieved patients overall (37.0 years; SD, 19.3 years); 38 of 194 patients retrieved after psychoactive substance misuse (19.6%) were under 19 years of age. Most retrieval sites were rural and remote communities with low levels of mental health care support. Conclusion Mental and behavioural disorders are an important problem in rural and remote communities, and acute presentations trigger a considerable number of RFDS retrievals.

Objectives The objective was to determine the frequency of trachoma genotypes of Chlamydia trachomatis-positive urogenital tract (UGT) specimens from remote areas of the Australian Northern Territory (NT).Setting The setting was analysis of remnants of C. trachomatis positive primarily UGT specimens obtained in the course of clinical practice. The specimens were obtained from two pathology service providers.Participants From 3356 C. trachomatis specimens collected during May 2012–April 2013, 439 were selected for genotyping, with a focus on specimens from postpubescent patients, in remote Aboriginal communities where ocular trachoma is potentially present.Primary and secondary outcome measures The primary outcome measure was the proportion of successfully genotyped UGT specimens that were trachoma genotypes. The secondary outcome measures were the distribution of genotypes, and the frequencies of different classes of specimens able to be genotyped.Results Zero of 217 successfully genotyped UGT specimens yielded trachoma genotypes (95% CI for frequency=0–0.017). For UGT specimens, the genotypes were E (41%), F (22%), D (21%) and K (7%), with J, H and G and mixed genotypes each at 1–4%. Four of the five genotyped eye swabs yielded trachoma genotype Ba, and the other genotype J. Two hundred twenty-two specimens (50.6%) were successfully genotyped. Urine specimens were less likely to be typable than vaginal swabs (p<0.0001).Conclusions Unlike in some other studies, in the remote NT, trachoma genotypes of C. trachomatis were not found circulating in UGT specimens from 2012 to 2013. Therefore, C. trachomatis genotypes in UGT specimens from young children can be informative as to whether the organism has been acquired through sexual contact. We suggest inclusion of C. trachomatis genotyping in guidelines examining the source of sexually transmitted infections in young children in areas where trachoma genotypes may continue to circulate, and continued surveillance of UGT C. trachomatis genotypes.

This paper examines the use of predator fences for conservation in Australia. It argues that these major infrastructures for enclosure act as a form of 'provocative containment' in which particular forms of nature are not simply protected but made to happen. The primary focus is Newhaven, a property in remote central Australia managed by the Australian Wildlife Conservancy, a non-profit organization with the biggest estate of privately managed land for conservation in the nation. At Newhaven, the first stage of an ambitious and expensive predator fencing programme has recently been completed, with a second phase under construction that will see the property become the site of the largest feral cat-free enclosure on the planet. In analysing this significant material infrastructure, and the practices and discourses that the Australian Wildlife Conservancy deploys to both justify and attract funding for it, it is possible to see a new conceptualization of conservation emerging in which nature is not simply offered sanctuary but actively stimulated and simulated. The Newhaven fence is much more than a passive material boundary between desired and undesired life. It is a reality-generating device with complex and contradictory biopolitical effects. The concept of provocation highlights how the fence emerges as a deliberate intervention into the dynamics of life. We examine how this is done in four distinct ways: through the sociotechnical design and construction of the fence as 'cat-proof', by enrolling Indigenous labour and tracking skills to kill cats, through the use of ecological surveys and baselines to make some life calculable, and via the translocation of species in order to allow them to be both protected and flourish. Each of these practices is essential to making new natures at Newhaven through the complex dynamics of provocation and containment. The issue is: what sort of nature?

The development of effective cryopreservation techniques for both red blood cells and platelets, which maintain ex vivo biological activity, in combination with frozen plasma, provides for a unique blood banking strategy. This technology greatly enhances the storage life of these products. The rationale and potential advantages of using cryopreservation techniques for the provision of blood products to remote and military environments have been effectively demonstrated in several conflicts over the last decade. Current haemostatic resuscitation doctrine for the exsanguinating patient supports the use of red blood cells, platelets and frozen plasma early in the resuscitation. We believe an integrated fresh?frozen blood bank inventory could facilitate provision of blood products, not only in the military setting but also in regional Australia, by overcoming many logistic and geographical challenges. The processes involved in production and point of care thawing are sufficiently well developed and achievable to make this technology a viable option. The potential limitations of cryopreservation and subsequent product thawing need to be considered if such a strategy is to be developed. A substantial body of international experience using cryopreserved products in remote settings has already been accrued. This experience provides a template for the possible creation of an Australian integrated fresh?frozen blood bank inventory that could conceivably enhance the care of patients in both regional Australia and in the military setting.

The presence of other tourists is an integral part of the tourist experience. Hence, gazing upon other tourists is an inevitable part of being a tourist. This paper introduces the concept of the intratourist gaze, a tourist gaze where tourists are both the subjects and objects of the gaze. An analysis from ethnographic fieldwork carried out with senior tourists in rural and remote Australia indicates that the intratourist gaze has the potential to be a disciplinary gaze which, in this case, privileges and safeguards the natural environment. This paper explores the important influence other tourists have on tourists? behaviours and sense of identity. It also contributes to discussion regarding tourist/tourist interactions in the under-explored area of qualitative research into senior tourism.

The creation of a digital archive database system for the Pitjantjatjara and Yankunytjatjara people in Central Australia has been a challenging information technology (IT) project requiring unique thinking about database design, implementation and deployment. What might seem like sound, standards-based IT practice in a typical urban or academic location becomes unworkable in the physical realities of remote Australia and in the context of indigenous Australian cultural sensitivities. Based on the experience of the Ara Irititja Project, this chapter outlines the central issues facing the development of archive databases for indigenous peoples in remote Australia and points towards the need for a new approach to IT best practices in this context.