Remote Australia Online

This paper considers the Australian federal government's approach to climate adaptation policy for remote northern Indigenous communities through the close examination of a seminal Scoping Study. This approach is taken to illustrate the lag between adaptation theory and practice, and to highlight important considerations to enable the development of a just and effective policy. The analysis suggests that policy in this area would benefit from the further consideration of three factors, namely the role of uncertainty in climate policy, the need for meaningful consultation with communities, and the benefit of integrating contextual and bottom-up assessment of vulnerability with decision-making in an iterative manner. The paper concludes by suggesting that the current approach to vulnerability assessment is insufficiently nuanced to allow an adequate appreciation of factors that influence social vulnerability in remote communities, and consequently, policy developed from it is likely to be ineffective.

A self-help approach to remote area housing, St Paul's Village, Moa Island, Torres Strait, 1986-92

High turnover of teachers in remote Indigenous community schools in the Northern Territory has long been considered a significant contributing factor to low academic outcomes for students in those communities. The average length of stay for a non-Indigenous teacher in a remote school can more easily be measured in months than years. This instability in staffing is largely responsible for the instability experienced by many students in these schools. This ‘Come and Go’ syndrome holds true for non-Indigenous staff; however, the opposite can often be said of Indigenous staff. Indigenous staff in these schools tend to be the ‘Stay and Stay and Stay’ teachers. They have often worked in their local community school for decades and have seen literally hundreds of non-Indigenous teachers ‘Come and Go’. They have been the ones to provide a semblance of stability and some level of program sustainability in education for the children of their own communities. While there is some qualitative data on the things that improve retention of non-Indigenous teachers in rural and remote schools, it mostly looks at the training and skills development that can be applied to the situation. No one has really ever asked Indigenous teachers for their observations or opinions about what makes teachers stay and what makes them go. This article will draw on conversations from two focus groups of Indigenous teachers from remote schools in Central Australia who were invited to discuss just this question.

Indigenous peoples’ participation in vocational education and training (VET) is explored, along with employability outcomes. Cultural aspects are discussed conveying the challenges in merging societal and Indigenous norms in order to more effectively engage learners. This is determined by acknowledging complexities, formulating a critical evaluation of learning strategies, reflecting, reviewing and amending curriculum to include Indigenous Standpoint Theory, and Indigenous Standpoint Pedagogy in the delivery of VET. A case study is presented to highlight challenges, pedagogical practices, within the context of William Angliss Institute’s implementation of training programs to Aboriginal and Torres Strait Islander peoples. Traineeships resulting in qualifications and employment are achieved at Australia’s most iconic remote tourist destination Uluru, in partnership with Voyages Indigenous Tourism Australia, the management group for Ayers Rock Resort.

A Black Reality: Aboriginal camps and housing in remote Australia

Introduction: Past and present approaches and future trends in Aboriginal housing

Epilogue: The Aboriginal & Torres Strait Islander Housing Panel

What does it mean to be a "rights-holder" and how does it come about? Remote Freedoms explores the contradictions and tensions of localized human rights work in very remote Indigenous communities. Based on field research with Anangu of Central Australia, this book investigates how universal human rights are understood, practiced, negotiated, and challenged in concert and in conflict with Indigenous rights. Moving between communities, government, regional NGOs, and international UN forums, Sarah E. Holcombe addresses how the notion of rights plays out within the distinctive and ambivalent sociopolitical context of Australia, and focusing specifically on Indigenous women and their experiences of violence. Can the secular modern rights-bearer accommodate the ideals of the relational, spiritual Anangu person? Engaging in a translation of the Universal Declaration of Human Rights into the local Pintupi-Luritja vernacular and observing various Indigenous interactions with law enforcement and domestic violence outreach programs, Holcombe offers new insights into our understanding of how the global rights discourse is circulated and understood within Indigenous cultures. She reveals how, in the postcolonial Australian context, human rights are double-edged: they enforce assimilation to a neoliberal social order at the same time that they empower and enfranchise the Indigenous citizen as a political actor. Remote Freedoms writes Australia's Indigenous peoples into the international debate on localizing rights in multicultural terms

Aboriginal health and history: Power and prejudice in remote Australia

Conservation activities, including translocations of threatened species, are increasingly important priorities for conserving biodiversity and culture on Indigenous-managed lands, which occupy over 20% of the Australian landmass. In the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands of north-western South Australia, the Warru Recovery Team reintroduced the threatened black-footed rock-wallaby (warru) to Wamitjara in May 2018. We outline the unique planning and logistical issues inherent in securing support and involvement of Traditional Owners and Indigenous rangers for predator, weed and fire management, cross-fostering, captive breeding, monitoring and translocation of the rock-wallabies. Altogether, the project cost AU$3.86 million (actual – AU$1.86 million, in kind – AU$2.00 million) over 10 years of preparation and one year of post-translocation monitoring. This consisted of AU$1.18 million for cross-fostering and captive breeding at Monarto Zoo and a further AU$0.55 million for the construction and maintenance of a fenced exclosure in the APY Lands. It is estimated that AU$0.51 million of the total costs were directly attributed to working remote and Indigenous-owned land, with most of the remaining costs typical of other reintroduction programs. Large-scale reintroduction opportunities on Indigenous-managed land can provide considerable conservation outcomes as well as delivering cultural objectives and supporting employment.

This report summarises research conducted by ReachOut Australia and Mission Australia on young people living in regional and remote Australia. The aim of the report is to gain a better understanding of young people’s lives, including the benefits and challenges of living in regional and remote areas, the mental health of young people living in these areas, and their service needs. These insights have the potential to improve mental health service design, resulting in better mental health outcomes and a reduction in youth suicide. These findings point to the need for a whole-of-community approach to address the mental health needs of young people living in regional and remote Australia. To achieve this, we need to: • promote the co-design of services with young people, and re-orient services to meet young people’s needs; • empower parents, guardians and peers to provide appropriate support to young people experiencing mental health difficulties; • invest in programs that promote mental health and wellbeing in the early years; • fund and support schools to improve the mental health and wellbeing of young people through evidence-based programs; • equip communities and gatekeepers to support the mental health of young people utilise the potential of Primary Health Networks to deliver better mental health outcomes for young people; • harness the potential of digital technologies to improve service availability and accessibility, and to train and resource those who play a key role in helping and supporting young people; and • improve financial supports and offer programs that help young people to transition from education to work, or through different types and levels of education, so that those living in regional and remote areas can achieve their educational, employment and career goals.

In 2008 the Federal government introduced a range of key national targets addressing Indigenous health, education and employment. The targets, part of the Closing the Gap strategy, were a response to growing calls to address the severe disparity between the outcomes of Indigenous and non-Indigenous Australians. They marked a watershed moment in Indigenous affairs, and gave genuine hope that this seemingly perpetual issue might finally have an endpoint by setting expiry dates for the targets to be reached. Ten years on, however, it appears that the Closing the Gap strategy is itself facing an important turning point. Four of the seven targets have a 2018 expiry date yet, as Table 1 opposite shows, only one of these—halving the gap in child mortality rates—is set to be met. Overall, only three targets are reported to be on track.

Objective: To assess the extent to which socioeconomic status (SES) contributes to geographic disparity in cardiovascular disease (CVD) mortality. Methods: An ecological study assessed the association between remoteness and CVD mortality rates, and the mediating effect of SES on this relationship, using Australia-wide data from 2009 to 2012. Results: Socioeconomic status explained approximately one-quarter of the increased CVD mortality rates for females in inner and outer regional areas, and more than half of the increased CVD mortality rates in inner regional and remote/very remote areas for males, compared to major cities. After allowing for the mediating effect of SES, females living in inner regional areas and males living in remote/very remote areas had the greatest CVD mortality rates (Mortality Rate Ratio: 1.12, 95%CI 1.07–1.17; MRR: 1.15, 95%CI 1.05–1.25, respectively) compared to those in major cities. Conclusion: Socioeconomic status explained a substantial proportion of the association between where a person resides and CVD mortality rates; however, remoteness has an effect above and beyond SES for a number of subpopulations. Implications for public health: This study highlights the need to focus on both socioeconomic disadvantage and accessibility to reduce CVD mortality in regional and remote Australia.

Throughout the world, there is growing recognition of the important role Indigenous people play in natural resource management and conservation. Indigenous Land and Sea Management Programs (ILSMPs; which provide funds to Indigenous people to support Indigenous land management activities) are also known to generate social and economic benefits, although relative few of these co-benefits have been quantified. Using northern Australia as a case study, we analysed data on ILSMP expenditure within three regional input–output tables, learning more about the size and distribution of their associated regional economic benefits. We found ILSMPs make a significant contribution to regional economies—with multipliers commonly exceeding that of other key regional industries such as agriculture and mining. We also found ILSMP expenditures make a larger contribution to Indigenous household incomes than they do to non-Indigenous incomes—thus helping to close the (income) gap. They will continue to do so, provided the proportion of ILSMP money spent on Indigenous (compared to non-Indigenous) incomes does not fall below a threshold amount. Rather than finding evidence of a trade-off between socio-ecological and financial/economic goals, our results suggest ILSMPs, known for their ecological importance, can also make a vitally important contribution to economic development in rural areas.

Teachers’ lives and teachers’ work remain important areas of educational research today, particularly given the influence of school-based management and the significance of shared leadership in schools. Almost nowhere do the two research fields intersect more closely than in the remote school setting, where teacher turnover is high and the recruitment of experienced teachers is difficult. This article investigates the realities of teachers living and working together in a small school located in a remote, northern Australian, Aboriginal community. It highlights environmental conditions that can be challenging for teachers, both new and recent graduates and those with experience. The research draws attention to collegial community building in a geographically remote location, particularly the development of material and emotional support systems, as a means of managing some of these challenges.

Indigenous Australians experience disability at almost twice the rate of non-Indigenous Australians. Indigenous children with a disability have been described as ‘doubly disadvantaged’ and many children and their families experience significant barriers to accessing services. Despite high rates of disability in childhood, remote Indigenous communities across the Top End experience a chronic lack of disability services, including access to specialist allied health. The Remote Paediatric Therapy Program (RPTP) was developed in response to growing inequities in disability service provision between urban and remote areas of the Top End. RPTP was established as a pilot program in 2010, with the program’s unique design reflecting a scarcity of literature around Indigenous children with disabilities and provision of services for this population. RPTP’s initial aim was to provide intensive, multi-disciplinary intervention for children with disabilities. In the early years, the team travelled frequently and widely across the Top End to consult with children, families and schools in a number of remote communities. Initial evaluations of the program were completed in 2010 and 2012, via survey of key community contacts (KCs). Survey results highlighted that RPTP’s capacity to provide therapy intervention was limited, given the large geographical area, high rate of childhood disability across the Top End and infrequency of RPTP visits to each community. This feedback highlighted the need for RPTP to shift focus from providing therapy to building capacity of key community partners. Using learnings from the initial years, the program has evolved to become a support structure for KCs, who are a regular presence in community and form close working relationships with children and families. The most recent evaluation (2014) identified the success of RPTP in building capacity of KCs to work with children with a disability. This is done through joint community visits, case conferences, mentoring, videoconferencing and resource development. Given the complexity of paediatric disability in the remote context, the learnings and principles from RPTP should be considered in the rollout of the NDIS in the NT. Many allied health professionals have little or no experience in paediatric disability or working in remote communities. Adequate support structures, such as RPTP, are essential in ensuring safe and evidence-based practice for this vulnerable population.

Indigenous infants and children in Australia, especially in remote communities, experience early and chronic otitis media (OM) which is difficult to treat and has lifelong impacts in health and education. The LiTTLe Program (Learning to Talk, Talking to Learn) aimed to increase infants’ access to spoken language input, teach parents to manage health and hearing problems, and support children’s school readiness. This paper aimed to explore caregivers’ views about this inclusive, parent-implemented early childhood program for 0–3 years in an Aboriginal community health context.

Australia's Northern Territory Emergency Response and subsequent School Enrolment and Attendance Measure (SEAM) credibly threatened to remove welfare benefits from Indigenous families if their children failed to attend school regularly. A difference-in-difference analysis of participation rates in the National Assessment Program – Literacy and Numeracy shows a substantial increase in participation rates the year after SEAM was implemented. However, administrators rarely carried out the threatened sanctions, and these initial gains largely dissipated in subsequent years. This unique episode illustrates the limited scope for promoting Indigenous school participation through conditional cash penalties.

This paper reports on an evaluation of an educational initiative that seeks to improve the diabetes health outcomes of a vulnerable group, Indigenous Australians residing in remote and rural New South Wales. In this context seven Aboriginal Health Workers (AHWs) and ten registered nurses (RNs) undertook an accredited Australian Diabetes Educators Association (ADEA) course. The aims of this study were to identify the beliefs, attitudes and experiences of this group concerning specialist diabetes training, strategies already used by managers and those that could be used to help consolidate the diabetes expertise of AHWs and RNs. The findings indicate specialist diabetes training and constructive support is required if AHWs and RNs are to develop from a novice to an expert. We concluded that the ADEA diabetes course is highly relevant to the needs of Indigenous Australians and that constructive support from managers and the university is most important in the development of diabetes expertise.

This review aimed to assess the evidence to answer the question whether palliative end-of-life care needs of patients and caregivers in rural and remote communities differs from those of urban dwellers. Peer-reviewed studies from 1996 to the present dealing with the experience of rural and remote patients and caregivers at the end-of-life compared with that of urban people were extracted for narrative synthesis. The eight studies included showed that palliative needs of rural and remote residents are related to context. Diagnosis and treatment are less well managed in rural areas. Rural differences include: people are more accepting of death and less likely to intervene to delay death; caregivers tend to be younger and include friends as well as family and local support networks are important. Rural and remote end-of-life needs are shaped by reduced access and availability of services which has a negative influence on outcomes. This is counterbalanced by an acceptance of death and local support networks. Well-designed longitudinal studies with samples comprised of rural and urban residents for comparison are required to monitor how end-of-life need might change with the approach of death. Clinicians, health services and policy makers need a better understanding of rural attitudes and of how rural community networks mobilise to support end-of-life care in their rural and remote communities.

Objectives: Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) has excellent cure rates and minimal side effects. Despite the high burden of disease, strategies to ultimately eradicate HCV are being developed. However, the delivery of care in regional settings is challenging and the efficacy of decentralised models of care is incompletely defined. Methods: A prospective cohort study of patients whose treatment was initiated or supervised by Cairns Hospital, a tertiary hospital which provides services to a culturally diverse population across a 380,748 km2 area in regional Australia. Patients‘ demographics, clinical features, DAA regimens and outcomes were recorded and correlated with their ensuing clinical course. Results: Over 22 months, 734 patients were prescribed DAA therapy for HCV. No patients were prescribed interferon. Sofosbuvir/ledipasvir (n=371, 50.5%) and sofosbuvir/daclatasvir (n=287, 39.1%) were the most commonly prescribed regimens. No patients ceased treatment due to adverse effects. There were 612/734 (83.4%) patients with complete results, with 575 (94%) cured. At the end of the study period, there were 50 (6.8%) patients lost to follow-up and 72 (9.8%) awaiting SVR12 testing. The presence of cirrhosis (n=147/612, 24.1%) did not impact significantly on SVR12 rates, this being achieved in 136/147 (92.5%) cirrhotic patients versus 440/465 (94.6%) in non-cirrhotic patients (p=0.34). Treatment-experienced patients (95/612, 18.3%) were more likely to be non-responders than treatment-naïve patients (10/95 (10.5%) versus 26/517 (5%), p=0.04). Strategies to facilitate treatment included a dedicated clinical nurse consultant, education to primary health care providers, specialist outreach clinics to regional communities and shared care with general practitioners. SVR12 rates were similar amongst gastroenterologists (283/306, 92.5%), general practitioners (152/161, 94.4%), sexual health physicians (104/106, 98.1%) and other prescribers (37/39, 94.9%). Conclusions: This study confirms that decentralised, multidisciplinary models of care can provide HCV treatment in regional and remote settings with excellent outcomes.

Aim To describe the first foods of Aboriginal and Torres Strait Islander infants and young children who were recruited to a nutrition promotion and anaemia prevention program conducted from 2010 to 2012, in six remote communities across northern Australia. Methods Food records (24-hour diet history, food variety checklist) were completed on recruitment by interview with a parent or carer. Cross-sectional analysis assessed the proportion of participants consuming recommended and not-recommended foods and drinks and meeting recommendations for meal frequency and dietary diversity. Results Of 245 Aboriginal and Torres Strait Islander participants aged 6–24 months, 227 (92.7%) had a recruitment food record. On the previous day, most (67.4%) had breastmilk, nearly all (98.2%) ate solid food, but only 13% ate fruit, 33% had neither fruit nor vegetables, and 25% had sweet drinks. Children living in smaller households (3–5 people) were more likely to meet the criteria for frequency of meals than those living in larger households of 12–31 people (93% vs 78%, P = 0.012 for trend over household size). Only 30% met the criteria for dietary diversity. Where information was available (n = 91), dietary diversity was adequate more often in ‘pay week’ compared to ‘not pay week’ (31.3% vs 9.3%, P = 0.007). Conclusion Support for current beneficial breast-feeding practices and promotion of nutrient-dense complementary foods, need to be embedded in initiatives for improved family food security. Good nutrition in early life can reduce the disparity in health, education and economic status between Aboriginal and Torres Strait Islander peoples and other Australians.

The CatholicCare NT model involves teams comprised of financial counsellors and financial wellbeing and capability case managers, who operate from each of the three regional hubs (Darwin, Katherine and Tennant Creek). The approach is innovative in that the targeted clients are often subject to Income Management; a cohort who do not traditionally access financial counselling services. Moreover, the FWC teams travel to or are place-based in remote communities. The teams are domiciled in regional offices that are local to the communities which they serve. This allows them to develop enduring relationships with those communities over time, which would be hard to achieve using fly-in fly-out models of practice which extricate practitioners from communities and the lived context of their broader environs. Coupled with an emergency relief referral strategy, this immersive approach provides staff with an enhanced opportunity to identify and engage with clients on an ongoing basis. While ‘mainstream’ financial counselling and case management defines much of the work that takes place with metropolitan-based Darwin and Palmerston clients, the outreach teams’ work with remote and regional clients have to undertake the complex task of working across cultural and geographic space. This translates as a need to negotiate different economic worlds. Further, the increased financialisation of everyday life in remote communities heightens the requirement to develop and sustain an appropriate and culturally sensitive FWC model that is responsive to local challenges. This report evaluates and provides further research on such a model.

Over the past 10 years, great improvements have been observed in the Year 12 attainment rate of Indigenous Australians. This has been due, in part, to government funding of programmes aimed at improving education opportunity for Indigenous Australian students, including funding of scholarships for students from remote areas to attend boarding schools. The current qualitative study investigated the perspectives of school leaders and Indigenous secondary students across the Australian state of Western Australia, on the utility and impact of this boarding provision. Students identified that boarding education allowed them to achieve a dual goal of meaningful career pathways and improved health outcomes, although they faced challenges unique to the Indigenous boarding school experience in terms of student self-concept, racism, homesickness and post-school transitions.

Objective: To evaluate a system for improving diabetes care in remote Indigenous communities. Design: Randomised, unblinded cluster trial over one year (1 March to 29 February 2000). Participants and setting: Primary healthcare staff in 21 primary healthcare centres in the Torres Strait and Northern Peninsula Area (NPA) Health Service District, north Oueensland, and 678 people with diabetes, mostly Torres Strait Islanders. Intervention: Diabetes recall system established at eight of the 21 sites, as well as staff training in basic diabetes care, regular phone calls from the project officer, a two-monthly newsletter and a mid-project workshop. Main outcome measure: Regular checks of weight, blood pressure, eye and foot care, serum lipid levels and glucose monitoring and control, urinary albumin to creatinine ratio and serum creatinine levels, and administration of recommended vaccines; hospitalisation in the preivous 12 months. Results: There was improvement in most measures at most sites, except for blood pressure monitoring and control, and vaccination status. Intervention sites showed greater improvement in most indicators than control sites (combeind relative risk [RR], 1.21; 95% CI, 1.03-1.43). The intervention group showed a 32% reduction in hosptial admissions for diabetes-related conditions over the study period (P=0.012). At follow-up, patients in intervention sites were 40% less likely to be hospitalised for a dibatetes-related condition than those in control sites (RR, 0.60; 95% CI, 0.41-0.86; P=0.007). Conclusion: A simple recall system, managed by local healthcare workers and supported by a diabetes outreach service, achieved significant inprovements in diabetes care and reduced hospitalisation in a high-risk population.