Remote Australia Online

Objective: This paper considers the short, intermediate and longer term effects of climate change in relation to the mental health of Indigenous residents of northern Australia, and what these effects mean in terms of supporting adaptation and resilience.Conclusions: Indigenous Australians have contended with change for millennia, with the drivers shifting from ecological to social pressures since European colonization. Climate change resulting from human activities introduces a new set of change forces which will in the short term be mediated by economic and social effects internationally.

This paper outlines issues arising from engagement with the remote Aboriginal community of Papunya. Researching the relationship between the community's football club and the organization of competitive fixtures in the Central Australian Football League (CAFL), we found that contrary to popular discourse the well-being of men in Papunya may be damaged by their participation in ?town football?. We outline the nature of the current relationship between Papunya and the CAFL and the efforts of Elders to reshape the organizational interface via the establishment of an ?on-country? football league. We highlight that organizational rhetoric about reconciliation and cross-cultural awareness is not enough to warrant effective working relationships with Papunya people. We argue that there is a need to move beyond recognition of difference that is embodied in such agendas to develop strategies of interface inclusive of Aboriginal understandings of football

The increasing transient population within rural and remote communities challenges the sustainability of regional Australia. Challenges to sustainability are particularly present for mining communities that have an increasing reliance on transient workforces. Identifying ways to increase length of residency within mining communities could assist in increasing the economic and social stability of these communities. The aim of this qualitative research was to explore residents' intentions to stay and factors that increased their intentions to leave a remote mining community. Twenty residents (three males, 17 females) recruited from a remote mining community in Queensland, Australia, participated in interviews. Interview data was analysed using thematic analysis within an interpretative phenomenological analysis framework. The participants reported their connection to people and place was their predominant motivation for wanting to stay in the community. The main reasons that participants reported wanting to leave the community was a perceived lack of access to family, services and employment, and lifestyle factors. Additionally, some participants reported intentions to leave as they perceived that the community was not their permanent home. These findings provide practical insight into strategies that could be developed to increase length of residency. For example, improving community attachment and satisfaction through promoting awareness of the available services and activities in which residents can participate. Through these strategies for increasing the length of residency within regional communities, the sustainability of these communities may then in turn be enhanced.

This article aims to extend the concept of collective reflexivity into marketing theory. We also identify the potential of ethnographic film-making as an approach for fostering collective reflexivity in social marketing. We focus on the making of an ethnographic film called Ngarali: The Tobacco Story of Arnhem Land, arguing that collective reflexivity is an important theoretical concept and practical objective in social marketing that can help address issues around creating social ties and social identity and of sharing metaphoric meaning. Conceptually, we argue that collective reflexivity encourages us to rethink reflexivity in social marketing and consumer research through a relational perspective. Furthermore, we extend current conceptualisations of collective reflexivity by identifying how sharing metaphoric meaning can act as a vehicle for its occurrence. We argue that facilitating collective reflexivity through ethnographic film-making can offer a more culturally respectful approach to social marketing.

Background and objective Chronic lung disease is prevalent among Australian Aboriginal children. Chronic wet cough is an early marker of disease but often goes undetected. Currently, no studies have examined health practitioner knowledge of chronic wet cough. We set out to examine health practitioner knowledge of chronic wet cough and chronic lung disease in Aboriginal children and to identify barriers and enablers to effective management. Method A qualitative study, gathering data through individual semi-structured, in-depth interviews and focus groups to ascertain health practitioner knowledge about management of Aboriginal children with chronic wet cough in a regional Kimberley town and remote community. Results Thirty-seven health practitioners participated. Key barriers identified were: (i) limited training in assessment and management of chronic wet cough; (ii) prioritization of acute presentations and competing complex chronic conditions; and (iii) normalization of cough in children by health practitioners. Key enablers were: (i) improving practitioners’ knowledge and expertise in managing chronic wet cough; and (ii) health system changes to facilitate longitudinal patient care, improved cultural competence, improved chronic disease management and post-hospitalization follow-up. Conclusion Key barriers to effective management of chronic wet cough are limited training in chronic wet cough management combined with competing complexities of both acute and chronic healthcare needs for Aboriginal families. Early detection and management of chronic wet cough in Aboriginal children can be facilitated through health practitioner training, access to standardized management guidelines and a service model that allows longitudinal patient follow-up and resources to effectively prevent and manage chronic lung disease in children.

Background: To examine the association between delay in planned diabetes care and quality of outcomes. Methods: A retrospective analysis of primary care and inpatient records for 2567 Aboriginal patients, with diabetes, living in 49 remote communities in the Northern Territory of Australia. Poisson regression was used to estimate the association between delay from diagnosis to documented diabetes care plan and three outcome measures: mean HbA1c level, most recent blood pressure and number of diabetes-related hospital admissions. Results: Compared with no delay (< 60 days), patients with delay had increased risk of elevated mean HbA1c: 60 days to < 2 years, incidence rate ratio (IRR), 1.2 (95% CI:1.07–1.39); 2 years to < 4 years, incidence rate ratio (IRR), 1.2 (95% CI:1.04–1.45); 4 years and over, incidence rate ratio (IRR), 1.3 (95% CI:1.12–1.52). There was no evidence of association between delay and optimal blood pressure control. Risk of diabetes-related admission increased with increased delay. Compared with no delay the IRRs for delay were: 60 days to < 2 years, 1.2 (95% CI:1.07–1.42); 2 to < 4 years, 1.3 (95% CI: 1.15–1.58): and 4 years and over, 2.6 (95% CI,2.28–3.08). Conclusion: The study found that a timely diabetes care plan was associated with better short-term blood glucose control and fewer diabetes-related admissions but not with improved blood pressure control. Delays may be a result of both patient and service-related factors.

Rheumatic heart disease, as a result of a single or recurrent episode of acute rheumatic fever (ARF), remains a significant cause of morbidity and mortality in northern and remote Australia; ARF has a peak incidence among 5–14-year-old Aboriginal and Torres Strait Islander children. Long-term regular benzathine penicillin G injections are the only currently successful secondary prevention strategy; however, rates of adherence remain critically low. In contrast, rates of adherence to immunisations on the National Immunisation Program (NIP) Schedule are high, even among this target population. This article compares strategies used to implement and improve ARF secondary prophylaxis with those used in the NIP. Some successful NIP strategies, such as Service Incentive Payment for health providers, home-visiting delivery models and integration into the National Immunisation Register, if applied to ARF secondary prophylaxis have the potential to improve benzathine penicillin G adherence.

OBJECTIVE—This study examines associations between self-reported diabetes and self-reported smoking, alcohol consumption, fruit consumption, and participation in adequate exercise in remote indigenous communities, using data from the Well Persons’ Health Check (WPHC). RESEARCH DESIGN AND METHODS—The WPHC was a cross-sectional survey of 2,862 indigenous individuals (1,602 Aborigines, 1,074 Torres Strait Islanders, and 186 persons of joint descent) aged ≥15 years. The study was conducted in 26 remote communities in northern Queensland, Australia, between March 1998 and October 2000. RESULTS—A total of 32% of individuals with self-reported diabetes and 25% of other individuals reported eating enough fruit, according to National Health and Medical Research Council criteria: odds ratio (OR) 1.407 (95% CI 1.108–1.786), P = 0.006. After adjustment for age, sex, and ethnicity, no significant difference could be observed: adjusted OR 1.22 (0.944–1.574), P = 0.128. A total of 58% of participants who reported diabetes and 51% of others reported adequate exercise: OR 0.761 (0.609–0.952), P = 0.018. This difference was not significant after adjustment for age, sex, and ethnicity: adjusted OR 0.896 (0.705–1.14), P = 0.370. A total of 43% of individuals who reported diabetes and 72% of others reported consuming alcohol: OR 0.295 (0.235–0.369), P < 0.001. After adjustment for age, sex, and ethnicity, this difference was still significant: adjusted OR 0.550 (0.428–0.709), P < 0.001. Diabetic drinkers consumed alcohol at harmful levels similar to those of nondiabetic drinkers (P = 0.691). A total of 40% of individuals who reported diabetes and 63% of other persons were tobacco smokers: OR 0.403 (0.322–0.505), P < 0.001. Although this crude difference was attenuated by adjustment for age, sex, and ethnicity, persons with self-reported diabetes were still significantly less likely to smoke tobacco than other participants: adjusted OR 0.666 (0.521–0.852), P = 0.001. Smoking prevalence among the diabetic indigenous participants was more than double that in nondiabetic nonindigenous Australians. CONCLUSIONS—This study suggests that indigenous individuals with diabetes living in rural and remote communities are not adopting lifestyle changes required for optimal self-management of the disease. This contributes to the large excess of mortality and morbidity experienced by this population.

Remote-living Aboriginal and Torres Strait Islander women experience a higher burden of influenza infection during pregnancy than any other Australian women. Despite recommendations of inacti-vated influenza vaccination (IIV) in pregnancy, uptake and safety data are scarce for this population. We examined uptake of IIV in pregnancy and report adverse birth outcomes amongst a predominantly unvaccinated group of remote-living Aboriginal and Torres Strait Islander women from the Northern Territory (NT), using data from the 1+1 Healthy Start to Life study. Data were deterministically linked with the NT Immunisation Register to ascertain IIV exposure in pregnant women during 2003–2006 and 2009–2011 inclusive. Overall, IIV uptake in pregnancy was 3% (n=20/697 pregnancies); 0% (0/414) pre-influenza A(H1N1)pdm09 and 7% (20/293) post-influenza A(H1N1)pdm09 (2009–2011). Vaccine uptake was poor in this cohort and it is unclear at what stage this policy failure occurred. Women with known comorbidities and/or high risk factors were not targeted for vaccination. Much larger study participant numbers are required to validate between group comparisons but there was no clinically nor statistically significant difference in median gestational ages (38 weeks for both groups), mean infant birthweights (3,001 g unvaccinated vs 3,175 g IIV vaccinated), nor birth outcomes between the few women who received IIV in pregnancy and those who did not. There were no stillbirths in women who received an IIV in pregnancy.

Attempts to recruit Aboriginal and Torres Strait Islander students into nursing degrees have made minimal impact on the number of registered nurses working in Australia's healthcare sector. Yet increasing the number of Indigenous nurses remains one of the most important objectives in strategies to close the health gap between Indigenous and non-Indigenous people. Poor retention of Aboriginal and Torres Strait Islander students in a Bachelor of Nursing Science degree offered in far north Queensland, Australia, indicates the need for a different approach to support and retain Indigenous students. This action research study used a decolonizing methodology and was conducted at a satellite university campus in a remote Torres Strait Island community. Researchers trialled the use of a mentoring circle to support and retain nursing students and interviewed mentors and mentees about their experiences. Grounded theory methods were used to analyse the data. Findings indicated a growth in participant students? emotional intelligence as a result of participating in a mentoring circle. Students developed confidence, formed a group identity, better-negotiated the university environment, became more effective communicators and supported one another through difficulties. The mentoring circle model improved students' university experience and its use should be considered by tertiary educators working with Indigenous students.

Prosthetic valve thrombosis (PVT) is an uncommon but serious cause of morbidity and mortality after cardiac valve implantation. The most common cause leading to PVT is inadequate anticoagulation. Royal Darwin Hospital is a major referral centre for the Top End of Australia and is unique in having a high burden of rheumatic heart disease (RHD) requiring valve surgery, issues with adherence with oral anticoagulants, and the absence of onsite cardiothoracic facility.

One hundred years ago, colonial criminal law applied to Indigenous people in the bush was rough justice, if it was any sort of justice at all. Historical surveys describe police officers and judges visiting remote communities in a whirlwind of terrifyingly swift and often arbitrary crimi nal punishment. Over half a century later, in the 1970s, 'bush courts', as they came to be known, were more formally incorporated into the criminal justice system. Even then, the courts still focused on efficiency rather than justice. Accounts from that time include descriptions of court hearings in the Alice Springs region where Aboriginal defendants were herded together like cattle for group sentencing exercises unlike anything permitted in the southern capitals. Now, another fifty years later, we have come some way, but not so far as we might like to believe. People living in remote Indigenous communities continue to be afforded a second-class justice system, the reality of which is largely unknown beyond those communities and the lawyers that service them.

This chapter provides a history of agricultural development in Northern Australia, which includes many past grand plans for northern development, before progressing through a consideration of the historic and contemporary challenges and drivers (regional, national and global) for growth. This information is then considered against existing policy paradigms, along with the perennial challenges of infrastructure provision.

Appropriate housing, education, access to healthy food and economic, physical and emotional security are all vital determinants of good health. However, access to appropriate health services, ideally close to home, is important in terms of delivering the required preventive and curative health care to maximise the potential of community members for health and wellbeing. Rural and remote communities remain underserved in terms of access to health care. Yet innovation, born of necessity in the provision of health care to rural and remote residents, has been a stimulus to the evolution of remote health service delivery. Health services across Australia tend to adopt the lessons learnt from the bush to increase access to services and efficiency of service delivery for a wide variety of populations.

This book is set in and specifically relates to Northern Australia, but it is not a story of Northern Australia. It is a story of the people who both live and farm there, and their resilience strategies to cope with the region’s inherent social and physical uncertainties. A dominant agricultural paradigm operates in Australia (and many other parts of the developed world) that is in keeping with Descartes insistence that facts and values must be kept in separate worlds, and so agricultural discussions are often in the context of facts, figures, yields, production schedules, contribution to GDP, seasonal forecasts and return on investment. Talk of humanity in agriculture is often missing or discounted to a subheading, particularly when new development is the focus. This is social research and as such stands at the intersection of a number of disciplines in an attempt to ground individuals, and the events that affect them, into the broader social context of humanity.

We are paying attention to the resilience agenda now because it has become policy, but policy must be measured. Resilience has been used in many fields of science over the past seven decades, and it is now also found in political science, business administration, sociology, history, disaster planning, urban planning and international development. The shared use of the term does not, however, imply unified concepts of resilience, nor the theories in which it is embedded. The use of resilience across such varied fields does however indicate its appeal; and perhaps it has become a ‘metaphor’ for something that cannot be directly observed or measured.

This chapter frames Northern Australia’s possible agricultural future and considers the specific relevance of planet and people matters to the past, present and future of individuals involved in Northern Australian Agriculture. As human populations have grown and civilisations developed, land use planning has emerged as a profession to facilitate a negotiated outcome between conflicting parties. While regional land use planning has not developed to the level of complexity of urban planning, its focus in most countries remains on the institutional processes to meet “public” interest and “utopian” ideals, of which sustainable development is the latest manifestation. Despite widespread adoption of neo-liberal principles by governments in the later decades of the twentieth century, and the commensurate improvement in living standards attributed to them, the free market has not delivered an optimal simultaneous solution for allocating resources, maximising consumer welfare, stabilising foreign trade, and reducing agricultural price instability. Governments are still called upon to intervene in the market and stimulate, regulate, or control economic forces, particularly when policy focus moves from direct production issues into less agreed arenas such as environmental management. Some of these policies emphasise the willingness of the middle-class consumer to pay a little extra for quality, a force that encourages product differentiation and thereby feeds investment in both production and marketing of new goods. This latter role has become more pronounced with the expansion of global trade, and new trade theories have evolved to explain why most trade expansion has been occurring at the extensive margin – that is, through the expansion of new goods rather than greater trade of existing products.

Any property that conveys resilience to a specific farm at a specific point in time might well be irrelevant at a later point in time when both the farm and the context will have changed. In this chapter, the principal author’s ontological and epistemological positions within the interpretative paradigm are described, and there is reflection on how these have influenced and underpinned the methodological approach. The emergence and evolution of this approach within the social sciences is also described, as it is an important element of both how the study was approached and why it is important. The methods used for data collection and analysis are described and the emergent research themes introduced.

In any human endeavour, there are individuals who stand out. Whether through financial success, personality, remarkable actions or even notoriety, these are names which come up regularly in conversation. Agriculture is no exception, and considering the relatively small number of people in the game in Northern Australia, the same names are repeatedly provided as examples of successful or stand-out farmers. This success often related to a demonstrated ability to understand the operating context, and implicitly and explicitly factor variables into successful decision-making to take advantage of a situation. This situational awareness was one of four themes that, along with the Capacity to Plan, the Capacity to Adapt, and Social Connectedness were found to form the core of individual resilience strategies irrespective of industry, scale, or geographic location.

When it’s hot, we find a shady tree to sit under; when it’s cold, we find a windbreak and build a fire; and if there’s danger, we find a safe protected place. This is what people have always done; we’re just a little more sophisticated in the twenty-first century. It’s still about function and amenity of the shelter: function – the requirements of utility and economy, efficiency in construction of a serviceable building for the needs of production and profit. Architecture is the consequence of human interactions and lies on the realm of memory and the experienced. Architecture has the power to comfort and to inspire, and through the intimacy of places and moments lived, there is a blurred line between the built and natural environment – dream and reality – time and space. Every creative endeavour is woven from and relative to the processes that influence the way we experience the world, and mostly it’s the little unnoticeable things that create sweeping change.

Disasters happen, and it is not only natural events that cause them; they can also be the product of social, political and economic environments. However, when talking about human-induced (and possibly preventable) disasters, participants thought that their impact was not fair, and as a consequence they felt more removed from the broader community than just geographically. How this impacts on an individual’s perception of agency in the broader system is discussed.

That Northern Australia will not develop in the same historical manner as the more populated south is a reasonable assumption – it is different geographically, climatically and demographically, and further development will occur in today’s globally connected and informed community, very different from the colonial development of Southern Australia. Nevertheless, it remains important to understand and always consider a region’s history as a component of development planning, as past and present aspirations combine with contemporary trends and influences to determine the future. This is necessary not to understand agriculture, but to understand the operational context and perspective of farmers involved in Northern Australian agriculture.

Aim To report the surgical and audiological outcomes of myringoplasty (Type I tympanoplasty) in Indigenous Australian children living in remote and regional communities in northern Australia. Method An observational cohort study, with prospective recording of the details of surgery. Audiological outcomes were collected independently, and these data were integrated in the present study. Children aged 5-18 year underwent myringoplasty in the Northern Territory during a program initiated by the Australian Government. Surgery was performed by surgeons drawn from across Australia. Results 412 primary myringoplasties were performed. The mean age at surgery was 11 years. The tympanic membrane was closed in 64.2% of cases. Fascial grafting was associated with greater surgical success than cartilage. Dryness of the ear at surgery did not affect drum closure. Post-operative aural discharge was half that reported in historical literature. Surgical success was independent of the patient’s age at surgery. Post-operative audiograms were available on 216 cases. At last review, hearing had improved even when the operation was not a surgical success, with hearing aid candidacy falling from 84-34%. Hearing was similar irrespective of the size of the perforation at surgery or the graft used and did not change with the time between surgery and review. The best hearing was associated with drum closure and Types A or C tympanograms. A conductive hearing loss persisted after surgery that was greater when there was an immobile drum. Conclusions Indigenous children benefited from myringoplasty, even when the operation was not a “surgical success” as deemed by drum closure. There lower incidence of post-operative discharge from persistent perforations suggests an improvement in the ear health of the population. A persistent conductive loss persists, likely a consequence of the underlying disease but possibly from the surgery.

New approaches to support the early learning for young Indigenous children are important to government policies across Australia. This study explores whether the Abecedarian Approach Australia (3a) intervention, with strong cultural adaptations, can boost young Aboriginal children’s early language and learning skills, prior to preschool. Participants in this study were Aboriginal children attending playgroups, Families as First Teachers, in school settings in two remote communities in the Northern Territory. Implementation data on two components (Conversational Reading and LearningGames) of the Abecedarian Approach Australia (3a) intervention are reported, and the level of exposure the children had to the programme during the study period is analysed. Child outcomes were assessed on the Brigance Early Childhood Screen II for 149 children aged from 24 to 56 months. Children’s language and early learning were associated with intervention dosage. Higher exposure to Conversational Reading and LearningGames predicted stronger language and overall development for young children. This study demonstrates that this intervention can be delivered effectively in playgroups in remote settings and is a meaningful and robust strategy to support early childhood learning, with potential to improve educational outcomes for young Aboriginal children in remote communities.

Health literacy is strongly associated with health outcomes and is important for health policy and service delivery. Low health literacy was reported in 59% of Australian adults, however, there is no national data on the health literacy of Aboriginal and Torres Strait Islander (ATSI) peoples. The ATSI population in Australia experience a notable gap in health outcomes compared with non-Indigenous Australians which is due, in part to a higher prevalence of chronic diseases. The health outcome gap is more pronounced in rural and remote locations. This study aims to establish the health literacy profile of ATSI adults with chronic disease living in remote North-West Queensland Australia, and to investigate associations between the Health Literacy Questionnaire (HLQ) domains and self-reported chronic disease and demographic characteristics.