Remote Australia Online

School completion has been hailed by many as the ‘holy grail’ of Indigenous education, and 42% remote-living Indigenous students now attain year 12 completion each year. But for a range of complex reasons, only 60% of these graduates translate this achievement into further engagement in study, training or employment. This systematic literature review examined the evidence for strategies that support the post-schooling transitions of these students. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, it examined the scope and quality of the existing evidence and applied qualitative meta-synthesis to elucidate the conditions that enable or hinder, and strategies that support post-schooling transitions. Findings suggested that lower rates of post-schooling study or employment uptake are influenced by: historical misalignment of education approaches with community values and aspirations; limited opportunities in remote communities; and other socio-economic factors. Strategies were found to be most effective when cross-sectoral education/employment and community partnerships were formed, and remote communities were integral in the planning and implementation process. Strategies to improve transitions included: embedding Indigenous and Western knowledge systems in education, task-based learning, explicitly addressing students’ language needs, providing immersion experiences such as in universities, and mentoring programs to widen students’ aspirations. However, the evidence-base remains weak and further research is needed to understand the impact of strategies on students’ aspirations and their immediate and long-term post-schooling transitions.

Wellbeing is a useful indicator of social progress because its subjectivity accounts for diverse aspirations. The Interplay research project developed a wellbeing framework for Aboriginal people in remote Australia comprising government and community wellbeing priorities. This article describes statistical modelling of community priorities based on surveys administered by community researchers to 841 participants from four remote settlements. Constructs for Aboriginal language literacy, cultural practice, and empowerment were identified through exploratory factor analysis (EFA); structural equation modeling (SEM) was used to confirm relationships. Cultural practice was associated with Aboriginal language literacy and empowerment, which were both associated with wellbeing. Aboriginal literacy and empowerment mediated negative direct relationships between cultural practice and wellbeing. Direct relationships were significant only for females for whom empowerment and Aboriginal literacy appear key to enhancing wellbeing.

Exponential growth of water demand and a decrease in usable freshwater due to various climate, environmental and anthropogenic events make rainwater harvesting a useful practice. According to Australian health regulations, drinking rainwater is low risk, if the roof catchment, collection system and storage are well maintained. The CSU Engineering building, which has received an architectural award for its sustainable design, produces its drinking water (3.7L/person/day) within the premises. Rainwater is collected from the roof catchment, stored outside the building and treated on demand at a fully transparent water treatment plant installed at the entrance of the building. The water treatment facility is fully powered by solar panels installed on the roof. The treatment process consists of several operations, including aeration, sand filtration, GAC adsorption and UV disinfection. The performance of the CSU Engineering water treatment plant for the past 30 months is discussed in this paper. Primary and secondary water quality parameters of treated water were well within Australian drinking water quality standards and showed better results than municipal water available in the host town. The aeration unit improved secondary water quality standards (odor and taste) and the adsorption process was effective for elimination of metals. The result of this experiment indicated that this process could be a promising solution for providing safe drinking water in remote Australia, including sessional demands in rest areas and caravan parks.

Objectives To identify the effects of the introduction of a ketamine sedation protocol on the rates of intubation and adverse events associated with retrieval of patients with acute behavioural disturbance. Transport of patients with acute behavioural disturbance poses clinical and logistical management difficulties, as well as risks. Remote Australian communities are separated by vast distances. Risks to aircraft and crew, and patient and community must be balanced. Ketamine has received increasing attention in recent years for pre-hospital sedation of behaviourally disturbed patients, predominantly with psychiatric illness. This paper explores the benefits and suitability of ketamine in undifferentiated presentations, using data from the retrieval service in Alice Springs, Australia. Methods A pre- and post-intervention study was carried out. The intervention was the introduction of a ketamine sedation protocol. Pre-intervention data was collected retrospectively, pre-2015 and post-intervention data prospectively from 2015 onwards. Prospective data, rather than only including confirmed psychiatric cases as in previously published series, will provide a powerful message for pre-hospital and retrieval practice. Group variables were created to compare the incidence of adverse events. Results The introduction of a ketamine protocol significantly reduced rates of intubation. The incidence of adverse events was strongly associated with the method of sedation (P = 0.000, confidence interval −0.56, −0.22), with significantly lower rates with ketamine (P < 0.0001). Conclusion The introduction of a ketamine protocol is associated with a decrease in intubation, and accordingly, a decrease in adverse events, though it is not without its risks. Further analysis is required to establish the likely cost saving to health systems.

In 1788 there were between 300 and 700 Indigenous languages spoken across Australia by millions of people, as shown in anthropologist Norman Tindale's 1974 map. However in the Australian 2016 Census, only around 160 of these languages were reported as being spoken at home.

Background: Australia implemented mandatory folic acid fortification of bread-making flour in 2009.Objective: To assess the impact of folic acid fortification in remote vs. regional urban areas and Indigenous vs. non-Indigenous populations in northern Queensland.Methods: Routinely collected data on folic acid measurements in remote areas and two regional urban centres in northern Queensland between 2004 and 2015 were analysed (n?=?13,929) dichotomously (folic deficient vs. non-deficient).Results: Overall prevalence of folic acid deficiency was 3.2% (235/7282) in urban centres compared with 7.2% (480/6647) in remote areas (p?<?0.001), and 9.3% (393/4240) in the Indigenous population compared with 3.2% (273/8451) in the non-Indigenous population (p?<?0.001). Prevalence of folic acid deficiency dropped from 12.2% (n?=?481) in 2004?2008 to 1.5% (n?=?126) in 2010?2015 (p?<?0.001). This translates into a relative risk reduction (RRR) of 88%. RRR was 79% (7.2% vs. 1.5%) in urban centres, 91% (17.3% vs. 1.5%) in remote areas, 92% (20.5% vs. 1.6%) in the Indigenous population and 80% (7.4% vs. 1.5%) in the non-Indigenous population (p?<?0.001 for all).Conclusions: Substantial declines of folic acid deficiency to low and comparable proportions in former high-risk populations indicate that mandatory folic acid fortification of flour has had a population-wide benefit in northern Queensland.

Mining operations in remote Australia represent a unique opportunity to examine the impact of supplementary food and water provision on local wildlife. Here, we present a dietary analysis of dingoes living at a mine site in the Great Sandy Desert, Western Australia. A total of 270 faeces (scats) were collected from across the mine footprint on two occasions three months apart. The most frequently consumed food resource was anthropogenic (rubbish), which was found in 218 of 270 faeces (80.7% of scats and 65.3% of scat volume). Also of note was a high proportion of dingo remains, which was found in 51 of 270 faeces (18.9% of scats and 10.4% of scat volume), suggesting the occurrence of cannibalism. These findings highlight the potential influence of human-modified areas and associated resource availability on the diet of dingoes, and have implications for the environmental management of areas surrounding mining operations.

Telehealth using high quality satellite internet has been shown to improve health service delivery in three very remote Aboriginal communities, however, further expansion of telehealth in this and other areas of the Northern Territory (NT) is limited by the lack of adequate internet. Despite the growing evidence of the benefits of telehealth there remains limited uptake in the NT in the primary health care sector. A national survey through Broadband for the Bush Alliance (B4BA) and its member organisations into consumers' experiences of telecommunications and telehealth services was done. The survey was supported by detailed case studies based on semi-structured interviews. It was found there were a number of barriers to telehealth uptake at the national level: Lack of adequate internet; consumers not being aware of, or knowing how, to access telehealth; lack of access to clinicians providing telehealth services; lack of Medicare item numbers for telehealth and the lack of resourcing at the patient end. The research indicated there needs to be investment into telecommunications infrastructure, public education about telehealth, an increase in Medicare telehealth item numbers and resourcing for primary health care services to support telehealth expansion particularly in rural, regional and remote areas.

Suicide is having a devastating impact on remote Aboriginal and Torres Strait Islander (ATSI) communities in Australia. In 2002, the Hunter Institute of Mental Health first distributed a set of resources on the reporting of mental illness and suicide to Australian journalists. Funded under the Mindframe National Media Initiative, this study investigates why Australian journalists decide to report or avoid the coverage of issues related to the social and emotional well-being of ATSI Australians and what barriers journalists face, particularly those of ATSI descent, in generating coverage of these sensitive issues. Participants raised serious concerns about the social and cultural responsibilities of covering issues related to mental health, mental illness and suicide in an informed way. They further highlighted the need for specific training of journalists and the need to create new resources to help journalists generate informed coverage of ATSI mental health issues. This study examines the possibility for ATSI and mainstream media to contribute to improved mental health among its target audience. In order to do so, the study examines: how mental health is promoted currently; whether barriers to positive coverage might exist; and if so, to suggest ways that such barriers might be overcome.

We aimed to explore the lived experiences of Kimberley Aboriginal people with type 2 diabetes managed by remote Aboriginal Community Controlled Health Services using phenomenological analysis. Semi-structured interviews formulated by Aboriginal Health Workers, researchers and other clinicians were used to obtain qualitative data from 13 adult Aboriginal patients with type 2 diabetes managed in two remote communities in the Kimberley. Together with expert opinion from local Aboriginal Health Workers and clinicians, we used this information to develop strategies to improve diabetes management. Of 915 regular adult patients in the two communities 27% had type 2 diabetes; 83% with glycated haemoglobin A >10%. Key qualitative themes included: the need for culturally relevant education and pictorial resources; importance of continuous therapeutic relationships with health care staff; lifestyle management advice that takes into account local and cultural factors; and the involvement of Aboriginal community members and families in support roles. Recommendations to improve diabetes management in the remote communities have been made collaboratively with community input. This study provides a framework for culturally-relevant recommendations to assist patients with diabetes, for collaborative research and for communication among patients, Aboriginal Health Workers, community members, researchers and other clinicians. Interventions based on recommendations from this study will be the focus of further collaborative research.

For First Nations people living in the central desert of Australia, the performance of oral storytelling drawing in the sand drives new agency in the cultural metamorphosis of communication practices accelerated by the proliferation of portable digital devices. Drawing on the ground sustains the proxemic and kinesthetic aspects of performative storytelling as a sign gesture system. When rendering this drawing supra-language, the people negotiate and ride the ontological divide symbolized by traditional elders in First Nations communities and digital engineers who program and code. In particular, storytelling’s chronemic encounter offsets the estrangement of the recorded event and maintains every participants’ ability to shape identity and navigate space-time relationships. Drawing storytelling demonstrates a concomitant capacity to mediate changes in tradition and spiritual systems. While the digital portals of the global arena remain open and luring, the force enabled by the chiasmic entwinement of speech, gesture and sand continues to map the frontier of First Nations identity formation and reformation. View Full-Text

In remote Aboriginal communities in East Arnhem Land, Northern Territory of Australia, the Yol?u people, traditional owners of this remote and isolated region, have a long tradition of ?arali? [tobacco] use, which is commemorated within funeral ceremony, as manikay [songlines] and bu?gul [dancing]. Today, smoking is very prevalent and a highly normalised social activity among Yol?u. There are concerns that tobacco control activities aiming to denormalise smoking may lead to stigma in already disadvantaged communities with high smoking prevalence. Interviews were conducted from August 2014 until December 2015 to ascertain whether smokers may have experienced smoking-related stigma through their interactions and engagement with health services and regional tobacco control activities including denormalisation strategy. Informants described their experiences, observations and perceptions of smokefree environments, television and media advertising, and smoking cessation support. We found that while tobacco control denormalisation is not leading to stigma in these communities, some clinical consultations and interactions may have led to feelings of smoking-related shame among Yol?u health workers who smoked. However, we found that caring, trusting relationships and having the right people communicating the right messages respectfully enabled raising the issue of smoking in clinical consultations without causing shame.

Background: Traditional medicinal plants are still used today in many Aboriginal communities across Australia. Our research focused on the contemporary use of such plants in the two communities within the Tiwi Islands, Wurrumiyanga and Pirlangimpi. Methods: This qualitative research project performed a video ethnography, community interviews, and a trial intervention to better understand the extent to which these plants are still used throughout the community and how they may be used more in the future. Results: We found that several plants are still used predominantly as medicinal washes to treat skin disorders and/or as a tea to treat congestion associated with cold and flu. Those plants that are commonly used are found near to the community in large amounts and are recognized as being both safe and effective. Conclusions: Within the community, it is the elder women who remain most knowledgeable about these plants and continue to make them for their families. However, there are many families who no longer know how to make these traditional medicines though they express a desire to use them. Therefore, it would be beneficial to have a central location or method to produce traditional medicine for the community—a bush pharmacy.

Research does not occur in a vacuum. It is important to develop an intellectual understanding of the social context of your research. Social researchers must listen to opinion leaders and synthesise academic literature, but they must also listen to the people they meet: children, the elderly, teenagers, men and women. Understanding the social context of your research requires curiosity; you must use everyday interactions and conversations with people as opportunities to learn. Your reading about history, politics, economics and the culture of a place should be as wide as possible. It is important to get a sense of the power dynamics at play in the dominant narratives. Ask whose voices are being shared and heard and whose are not. Who benefits from the status quo and who does not? How can things be made fairer? The tools and media available to analyse and understand social context of research will differ from place to place and over time. Source material may include journals, newspapers, textbooks, government or industry reports, social media, bulletin boards, conversations, literature reviews and even graffiti. This chapter illustrates my attempts to understand the social context of Central Australian Aboriginal health.

Objective: This research was undertaken to explore factors operating at the level of the clinic and the community which influence the development of the oral health role of Indigenous Health Workers. The research is a significant aspect of a wider study of the disconnect between the strong national policy support for the development of the oral health role of Indigenous Health Workers and the limited development of the role.Design: Semi-structured interviews were conducted with Indigenous Health Workers to explore their perceptions of the priority of the development of an oral health role and to identify facilitators and barriers to sustainable role development.Setting: The study was conducted in three remote Indigenous communities and two regional centres of the Cape York region in far north Australia.Method: Interviews were conducted with 21 Indigenous Health Workers through five group interviews and eight individual interviews.Results: The findings highlight the high priority given by Indigenous Health Workers to the development of their oral health role while also identifying significant barriers to the sustainable development of this role.Conclusion: The identification of barriers to role development operating at the level of the clinic and the community helps to explain the disconnect between policy and practice in the development of the oral health role of these community health personnel.

Northern Australia faces an increasing risk of a canine rabies incursion due to the eastwards spread of rabies across the Indonesian archipelago. Remote Indigenous communities in northern Australia are situated within complex ecosystems containing large populations of free-roaming domestic dogs,surrounded by widely dispersed wild dog populations. Managing the response to a rabies incursion within this ecosystem presents enormous challenges.

The relationship between Aboriginal communities and police continues to be a pressing issue in contemporary debates about criminal justice reform in Australia. The Australian Law Reform Commission’s recent Pathways to Justice report offers a set of recommendations on how to interrupt the continuing cycle of Aboriginal people’s disproportionate susceptibility to arrest, police custody, and incarceration. Many of its recommendations are grounded in the principle of building more systematic forms of cultural accommodation and community collaboration into the culture of policing. Some of these principles are already adopted by Australian police authorities in programmes such as the employment of Aboriginal police liaison officers, the inclusion of cultural awareness education in the training of law enforcement personnel, and the guarantee of interpreter services. Focusing upon the Anangu Pitjantjatjara Yankunytjatjara Lands and drawing upon the reported experiences of Anangu with police, this article examines the extent to which such reforms have transformed Aboriginal/police relations and worked to incorporate cultural difference into the culture of contemporary policing. While none of the policing issues discussed here are unique to the Anangu Pitjantjatjara Yankunytjatjara Lands, the geographical remoteness of the Lands and the diversity of their communities combine to establish a unique set of policing challenges. Having considered existing strategies to meet these challenges, the article concludes that Aboriginal people’s fuller access to justice requires deeper structural reform to the culture of policing than is yet available.

Chronic suppurative otitis media (CSOM) is a significant health issue affecting Aboriginal Australians. Long-term hearing loss can cause communication problems, educational disadvantage, and social isolation. Current standard treatment for CSOM in our region is twice daily dry mopping of the pus from the ear canal followed by instillation of ciprofloxacin antibiotic ear drops for up to 16 weeks, or until the discharge resolves for a period of 3 days. The treatment is long, laborious and fails to resolve ear discharge in 70% of cases in remote communities. Bacterial pathogens also persist. Povidone-iodine ear wash is the preferred method of clearing ear discharge in Western Australia. However, evidence of its effectiveness is lacking. In systematic reviews, topical antibiotics (ciprofloxacin) have been shown to be more effective than oral antibiotics or topical antiseptics. Currently, it is unclear whether there are any benefits of combining these treatments.

Aim There is a wealth of data concerning the health behaviours of Indigenous Australians, but the health behaviours of Indigenous Australians with diabetes are not systematically documented. At the clinical level, understanding a person's health behaviours can help identify and address barriers to diabetes care and promote good clinical outcomes. Methods We used a novel survey tool to systematically collect health behaviour data on Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional well-being (SNAPE) from Indigenous Australians with Type 2 diabetes in a remote primary care setting in Alice Springs. Results At least one of the five surveys in the SNAPE tool was completed by 210 participants: 30% male, mean age 52.6 years (range 22.9 – 87.4). Fifty per cent of men and 23% of women were current smokers (P < 0.001). None of the participants reported an adequate intake of vegetables. Only 9.6% reported an adequate fruit intake. Some 49% of men and 32% of women consumed alcohol in the past year (P = 0.022), and 46% of drinkers were considered high-risk or likely-dependent drinkers. On average, participants walked 10 min or more at a time 6.0 days a week and spent 4.8 h sitting on a weekday. Mean adapted Patient Health Questionnaire 9 score was 4.61, with 34% of participants having mild depressive symptoms and 11% having moderate-severe depressive symptoms. Conclusions Our SNAPE survey tool results present a high-risk, disadvantaged Indigenous population with Type 2 diabetes. More resources will be needed to sustainably implement interventions with the goal of improving health behaviours and subsequent long-term health. This article is protected by copyright. All rights reserved.

The PREEpared – Partnering for Remote Education Experience project (formerly known as Improving Teacher Education for Better Indigenous Outcomes) was an initiative seed-funded by the Department of Education (formerly the Office of Learning and Teaching, OLT) in 2016–2017 and conducted by a project team from Monash University. Data were collected and resources developed in collaboration with a number of teacher educators across Australia who formed a main interview pool, and several members of a diverse expert reference group, whose experience provided a vital, critical reflection on the project’s deliverables. The guiding principle for this project was to respond to the staffing needs of remote Indigenous schools and ensure graduate teachers are well-equipped and expertly prepared to work and teach inclusively within and for diverse geographic communities. The project has responded to this aim by providing a central ‘go to’ website that houses both curriculum and professional experience resources for all initial teacher education providers to access and use. The PREEpared (Partnering for Remote Education Experience) website can be accessed at www.PREEpared.com

The academic literature on Australian Indigenous health and well-being suggests an overwhelming need for education to alleviate ‘lifestyle’ diseases and social dysfunction. Yet, the socio-cultural diversity of Australian Aboriginal communities provides a challenging landscape for efficacious and long-lasting support processes. The ‘Uncle Jimmy Thumbs Up!’ (UJTU) programme is facing these issues from an innovative perspective. ‘Thumbs up’, addresses health and well-being in remote Aboriginal communities from the ground up by engaging in music education programmes with the youth of the community, which subsequently filters through to the broader community. Based on an analysis of the effectiveness of a ‘Thumbs Up’ case study, this article will present preliminary recommendations for working with Australian Indigenous youth and their broader communities through facilitated musical activities. Informal learning frameworks, which incorporate music-making shared between educators and community members, are shown to be a constructive means of engaging the youth and empowering them in the management of their health and well-being.

Background:The overarching cultural context of the brain injury survivor, particularly that related to minority peoples with a history of colonisation and discrimination, has rarely been referred to in the research literature, despite profoundly influencing a person’s recovery journey in significant ways, including access to services. This study highlights issues faced by Australian Aboriginal traumatic brain injury (TBI) survivors in terms of real-life consequences of the high incidence of TBI in this population, current treatment and long-term challenges.Method:A case study approach utilised qualitative interview and file review data related to five male Aboriginal TBI survivors diagnosed with acquired communication disorders. The five TBI survivors were from diverse areas of rural and remote Western Australia, aged between 19 and 48 years at the time of injury, with a range of severity.Case Reports:Common themes included: significant long-term life changes; short-term and long-term dislocation from family and country as medical intervention and rehabilitation were undertaken away from the person’s rural/remote home; family adjustments to the TBI including permanent re-location to a metropolitan area to be with their family member in residential care; challenges related to lack of formal rehabilitation services in rural areas; poor communication channels; poor cultural security of services; and lack of consistent follow-up.Discussion and Conclusion:These case reports represent some of the first documented stories of Aboriginal Australian TBI survivors. They supplement available epidemiological data and highlight different contexts for Aboriginal people after TBI, contributing to an overall profile that is relevant for rehabilitation service planning.

The published evidence for allied health interventions and services is limited, particularly in relation to service models and models of care in rural and remote Australia. Furthermore, there is limited published research or evidence of the effectiveness of various workforce strategies, including cost effectiveness for rural and remote Allied Health. It is likely that much of the evidence, particularly around workforce and service models sits in the grey literature and/or in ‘local intelligence’ of what works (or not). A recent report by The International Centre for Allied Health Evidence, June 2018, prepared in response to the review of MBS items highlights a similar paucity of evidence of the impact of allied health services across the sector, not just in relation to rural and remote service delivery. Traditional notions of evidence hinge on scientifically controlled research studies with a focus on measurement of intervention effect, reliability and replicability. Such studies have been and continue to be undertaken in relation to allied health interventions, predominantly in acute settings. However most allied health services in Australia are provided outside acute clinical settings and increasingly the evidence being sought is not about specific interventions per se, but rather about the impact of allied health services in ‘real world’ environments. A forum of researchers, education providers, rural workforce agencies, allied health, other health care service providers and policy makers, convened by SARRAH identified opportunities to build the evidence base for allied health in the real world. Examples include: linking with PHNs to co-design and evaluate models of care and service delivery strategies where allied health is a component of the multidisciplinary team; identifying and evaluating emergent models of allied health intervention; establishing partnerships with rural and remote NDIS service providers to analyse model and workforce requirements; identifying private practice models in rural and regional areas and determine key ingredients for viability; documenting case studies of service providers around Communities of Practice for priority areas e.g. NDIS, aged care, solo practitioner models; establishing and evaluating service learning models in rural and remote locations to determine impact on service capacity, learning outcomes for allied health students and early career health professionals, perceptions of remote practice. While allied health peak bodies have a role in building the evidence base in rural and remote Australia, the need for improving evidence collection, analysis and dissemination is common across the allied health sector and requires a coordinated and collaborative approach.

Aim: The aim of the project was to demonstrate that telehealth could be successfully done with good quality reliable satellite internet for three very remote communities. Setting and participants: This project was a collaboration between the Northern Institute (Charles Darwin University), Laynhapuy Homelands Health Service (LHS), Aboriginal Medical Service Alliance NT, eMerge, Broadband for the Bush and Telstra Health and was supported by a Regional Economic and Infrastructure grant. The three communities chosen by the Laynhapuy Health Service for telehealth implementation were Gan Gan, Yilpara and Wandawuy (that is, their most remote sites). Design and methods: A collaborative approach was taken with project consultation, development and implementation to demonstrate the value of telehealth and video conferencing and maximize benefits to the community. Three Gilat satellite dishes and twelve months uncontended internet connectivity were deployed in three very remote East Arnhem communities. (Contention in network terms refers to the number of people on a network link competing for the network’s limited resources. An uncontended network is one where only users from one organisation have access to the bandwidth on that private network.) Results: LHS staff now regularly use video conferencing cameras and software for telehealth. Diagnoses are being aided by less formal modes of video conferencing rather than scheduled appointment driven video conferencing tools (St Clair et al, 2018; St Clair et al., 2019). For example, clinicians are using Facetime, smart phone camera optics and digital capabilities for triage and diagnostic assessment. Anecdotally, video conferencing has proved to be a “game changer” in remote Indigenous health service delivery for many reasons, including the facilitation of joint and more informed decision making by patients, families and clinicians, and the patients being able to see familiar faces. Using videoconferencing has also resulted in more accurate assessments for evacuations and acute care retrievals, provision of access to a wider range of services, provision of training and direct supervision of staff including registrar GPs (St Clair et al., 2019). Additionally, savings to the patient travel for the last 6 months of 2018 are estimated to be in excess of $13,000 per month (St Clair & Murtagh, 2018a). Conclusion: Face-to-face consultation via video conferencing and direct supervision and observation of patient examinations are delivering better health outcomes for patients (St Clair et al, 2019). By showing patients and families pictures and videos from the internet, the supervising GP can demonstrate clearly what the problem is, the treatment required and opportunistically provide education for both patient and remote end clinicians (St Clair et al., 2018). Additionally, telehealth implementation has facilitated timely joint decision making for remote Aboriginal people resulting in a more positive patient outcome and crucial clinical procedures being done more expediently therefore improving the probability of survival (St Clair et al., 2019).

Hearing loss affects some 3.6 million Australians and is predicted to more than double by 2060, in line with Australia’s ageing population(2). In 2017, hearing loss was estimated to affect one in seven people in Australia, including as many as three out of four people aged over 70 years(3). For every 10,000 live births, between nine and 12 children have a moderate or greater hearing loss in both ears. Another 23 children per 10,000 will acquire a hearing impairment by the age of 17 years— through accident, illness (e.g. otitis media), or other causes(4). People living outside major cities (15%) fare the worst, and are more likely to experience hearing disorders than people living in major cities (12%)(5). Aboriginal and Torres Strait Islander (Indigenous) Australians are also disproportionately impacted by poor ear health and hearing problems, compared to non-Indigenous Australians.The Royal Flying Doctor Service (RFDS) does not routinely conduct hearing screening in rural and remote Australia. However, the organisation is committed to identifying appropriate service models to inform the national deployment of a hearing screening program. To achieve this, the Queensland Section of the RFDS collaborated with Australian Hearing to develop an appropriate service model focused on conducting hearing assessments, raising hearing awareness and facilitating appropriate referrals, and to conduct a hearing screening trial. The trial was evaluated by the RFDS of Australia (Federation Company) and results are presented in the current report. A Community Hearing Worker (CHW) was recruited to provide hearing screening during the trial. The CHW employed a mixture of otoscopy, tympanometry, otoacoustic emissions testing, hearScreen and Sound Scouts to screen clients. The hearing screening service was paired with the RFDS Mobile Dental Unit (MDU) to take advantage of the current RFDS ‘footprint’ in rural and remote Queensland. By including the CHW on rotations (2-week trips to rural/remote Queensland towns) with the MDU, no additional infrastructure costs were incurred in delivering the hearing screening trial. The trial took advantage of the existing RFDS travel, management, brand, clinical governance and community engagement platforms. Based on results from all tests, 92 children (15.6% of all children) were identified as having hearing outside the normal range and 79 received a referral to at least one other service. Similarly, 81 adults (36.2% of all adults) were identified as having hearing outside the normal range and received a referral to at least one other service. Clients were mainly referred to Australian Hearing, primary health care or other services, such as ear nose and throat specialists.