Remote Australia Online

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a major public health problem in Australia, as in many other parts of the world. High rates of CA-MRSA skin and soft tissue infection have been reported from Aboriginal communities. We used a single-nucleotide polymorphism (SNP) genotyping typing system based on the multilocus sequence type (MLST) database to investigate the epidemiology of CA-MRSA and methicillin-sensitive S. aureus (MSSA) over a 12-month period in three remote Aboriginal communities of Northern Australia. This was supplemented by real-time PCR for Panton-Valentine leukocidin (PVL) genes, staphylococcal cassette chromosome mec (SCCmec) typing, and antimicrobial susceptibility testing. S. aureus was recovered from pyoderma lesions on 221 occasions and throat swabs on 44 occasions. The median monthly recovery rate of S. aureus from skin sores was 58% (interquartile range, 62 to 78%), and there was no seasonal variation. Twenty-three percent of isolates were CA-MRSA; the proportion was similar across the communities and did not vary over the study period. Erythromycin resistance was found in 47% of CA-MRSA and 21% of MSSA. SNP-based typing identified 14 different clonal complexes (cc); however, cc75 was predominant, accounting for 71% of CA-MRSA isolates. These were confirmed as ST75-like by using an additional SNP and MLST of selected isolates. All but one of the cc75 isolates had SSCmec type IV (one had type V), and all were PVL negative. Monthly tracking of SNP-based cc types showed a highly dynamic process. ST75-MRSA-IV appears to be unique to the region and probably evolved de novo in remote Aboriginal communities.

Throat swabs are regarded as the “gold standard” for diagnosing streptococcal pharyngitis and for surveillance research. Culturing throats in remote tropical settings is logistically difficult, and these settings are commonly burdened by high rates of streptococcal disease. The survival of streptococci on swabs may depend on whether they are of “throat” or “skin” type, as determined by emm pattern typing. The aims of this study were to compare the recovery rates of beta-hemolytic streptococci (BHS) using three different transport methods and to determine whether the recovery rates correlated with the emm pattern type. Monthly duplicate throat swabs were taken from occupants of selected households in three remote Aboriginal communities. Paired swabs were separated and handled in one of three ways: (i) direct inoculation onto culture media with cold-box transport (plated), (ii) sealed in a bag with a silica gel desiccant and cold-box transport (desiccant), and (iii) transport at ambient temperature and humidity (ambient). emm pattern typing was done by standard methods. Over 23 months, 4,842 throat swabs were taken, and 4,122 were paired. BHS were recovered on 11.5% of the 4,842 occasions (group A, 4.5%; group C, 1.7%; group G, 5.4%). Results from paired swabs showed the plated method was superior to desiccant and desiccant was better than ambient. Pooled data indicated that plated and desiccant were equivalent, and both were significantly better than ambient. There was no correlation between the emm pattern type and recovery of group A streptococci by different methods. In tropical and remote settings, cold-box transport with desiccant and subsequent inoculation of culture plates in the laboratory is a practical alternative to direct plating.

Aboriginal Australians in remote communities have high rates of rheumatic heart disease (RHD); yet pharyngitis is reportedly rare whilst pyoderma is common. Some strains of group A streptococci (GAS) have preference for the throat and others for the skin depending on M protein type. A study in three remote communities provided 350 GAS isolates for emm sequence typing, 244 were also emm pattern typed. There was 100% correlation between emm sequence and pattern type. Patterns D and E (non-throat tropic) made up 71% of throat and 87% of skin isolates although patterns A–C (throat tropic) were more common in the throat than the skin (RR 2·3, 95% CI 1·4–3·8) whilst the opposite was found for pattern D (RR 2·2, 95% CI 1·7–3·0). Pattern E favoured the throat (RR 1·4, 95% CI 1·1–1·8). Where environmental factors predispose to skin infection, emm pattern types D and E prevail, whatever the recovery site.

Australia’s financial system is undergoing a period of substantial structural change. A number of interrelated factors are implicated: changes in the competitive forces within the sector, the introduction of new technology, and changing consumer demands. While these changes may have had positive impacts on most consumers, they have had a number of negative impacts, particularly for low-income consumers of financial services and for people located in rural and remote communities. This Discussion Paper (218) and the one following (219) will analyse the proposition that an alternative model for the delivery of financial services or re-regulation of the financial sector is required to protect the interests of low-income groups and, in particular, Indigenous people. The argument is based on an understanding of the impact of the deregulation of the financial sector on the delivery of banking services to low-income groups and to people located in rural and remote communities. Indigenous people make up a significant proportion of both of these groups. It is argued that deregulation has had a profound impact on Indigenous people, both because of their historical lack of equitable access to financial services, and their comparatively low socioeconomic status. Supply of financial services to rural and remote communities within Australia is currently in decline. This paper explores current banking and financial services in the context of Australia’s financial system, the current supply of banking and financial services to rural and remote communities, and the impact that the lack of access to these services has on the relatively increasing Indigenous populations of these communities. Work by Westbury has detailed the specific problems faced by Indigenous people in the Barwon–Darling region. These include: • the failure of financial providers to take account of the different conceptions that Indigenous people have of financial facilities; • the problems caused by the inadequate provision of banking and financial services within the region; • the fact that many Indigenous people do not understand either the way bank fees and charges operate, or how to minimise these fees and charges; and • the low technical proficiency of many Indigenous people. In addition Indigenous people want banking services to be provided on a personal, private, face-to-face basis, by Indigenous staff. If these requirements are to be met, alternatives to the current delivery of banking and financial services to rural and remote Indigenous communities will have to be considered.

This article is set within the context of concerns about Indigenous workforce participation disadvantage. It discusses conflicting life-worlds relating to work of both Aboriginal and non- Indigenous residents in Ngukurr, a remote community in South East Arnhem Land in Australia’s Northern Territory. It contrasts an Indigenous social culture of kinship and relatedness to a Western one where employment is central to identity and its formal rules shape behaviour. We investigate how these different social ideologies affect cross-cultural relationships and shape the formal employment domain in Ngukurr. Given that governments have moved to more assimilationist policies in recent years, there are important policy implications following from this mutual cultural incomprehension.

OBJECTIVE: Respiratory diseases are a leading cause of morbidity and mortality in Indigenous Australians. However, there are limited approaches to specialist respiratory care in rural and remote communities that are culturally appropriate. A specialist Indigenous Respiratory Outreach Care (IROC) program, developed to address this gap, is described. METHODS: The aim of the present study was to implement, pilot and evaluate multidisciplinary specialist respiratory outreach medical teams in rural and remote Indigenous communities in Queensland, Australia. Sites were identified based on a perception of unmet need, burden of respiratory disease and/or capacity to use the clinical service and capacity building for support offered. RESULTS: IROC commenced in March 2011 and, to date, has been implemented in 13 communities servicing a population of approximately 43000 Indigenous people. Clinical service delivery has been possible through community engagement and capacity building initiatives directed by community protocols. CONCLUSION: IROC is a culturally sensitive and sustainable model for adult and paediatric specialist outreach respiratory services that may be transferrable to Indigenous communities across Queensland and Australia.

Introduction: The Australian Aboriginal population experiences significantly poorer health than the non-Aboriginal population. The contribution of environmental risk factors in remote communities to this health disparity is poorly understood.Objective: To describe and quantify major environmental risk factors and associated health outcomes in remote Aboriginal communities in Western Australia.Methods: The association between environmental health indicators, community infrastructure and reported health outcomes was analysed using linear and logistic regression of survey data.Results: Housing/overcrowding was significantly associated with increased reports of hearing/eyesight (OR 3.01 95?% CI 1.58?5.73), skin (OR 2.71 95?% CI 1.31?5.60), gastrointestinal (OR 3.51 95 % CI 1.49?8.26) and flu/colds (OR 2.47 95 % CI 1.27?4.78) as health concerns. Dust was significantly associated with hearing/eyesight (OR 3.16 95 % CI 1.82?5.48), asthma/respiratory (OR 2.48 95 % CI 1.43?4.29) and flu/colds (OR 3.31 95 % CI 1.88?5.86) as health concerns.Conclusion: Poor environmental health is prevalent in remote Aboriginal communities and requires further delineation to inform environmental health policy.

This paper describes two phases of a community-directed intervention to address strongyloidiasis in the remote Aboriginal community of Woorabinda in central Queensland, Australia. The first phase provides the narrative of a community-driven 'treat-and-test' mass drug administration (MDA) intervention that was co-designed by the Community Health Service and the community. The second phase is a description of the re-engagement of the community in order to disseminate the key factors for success in the previous MDA for Strongyloides stercoralis, as this information was not shared or captured in the first phase. During the first phase in 2004, there was a high prevalence of strongyloidiasis (12% faecal examination, 30% serology; n = 944 community members tested) that resulted in increased morbidity and at least one death in the community. Between 2004-2005, the community worked in partnership with the Community Health Service to implement a S. stercoralis control program, where all of the residents were treated with oral ivermectin, and repeat doses were given for those with positive S. stercoralis serology. The community also developed their own health promotion campaign using locally-made resources targeting relevant environmental health problems and concerns. Ninety-two percent of the community residents participated in the program, and the prevalence of strongyloidiasis at the time of the 'treat-and-test' intervention was 16.6% [95% confidence interval 14.2-19.3]. The cure rate after two doses of ivermectin was 79.8%, based on pre-serology and post-serology tests. The purpose of this paper is to highlight the importance of local Aboriginal leadership and governance and a high level of community involvement in this successful mass drug administration program to address S. stercoralis. The commitment required of these leaders was demanding, and involved intense work over a period of several months. Apart from controlling strongyloidiasis, the community also takes pride in having developed and implemented this program. This appears to be the first community-directed S. stercoralis control program in Australia, and is an important part of the national story of controlling infectious diseases in Indigenous communities.

Australian Aboriginal children experience early, persistent and severe middle ear infections. We conducted a review of the medical literature that addressed acute otitis media (AOM) in Australian Aboriginal children. Comparisons were made with the recent guidelines on the diagnosis and management of AOM prepared by the American Academies of Pediatrics and Family Physicians (AAP & AAFP 2004). Otitis media in Aboriginal children living in remote communities begins in the first 3 months of life following early bacterial colonisation. Young children with persistent signs of suppurative disease (bulging of the tympanic membrane or middle ear discharge) are probably most at risk of developing chronic suppurative otitis media.

Middle ear disease (otitis media) is common and frequently severe in Australian Aboriginal children. There have not been any recent large-scale surveys using clear definitions and a standardised middle ear assessment. The aim of the study was to determine the prevalence of middle ear disease (otitis media) in a high-risk population of young Aboriginal children from remote communities in Northern and Central Australia.

Background: Heart failure (HF) is associated with significant morbidity and mortality and recurrent hospitalisations, particularly in the Indigenous Australians of the Northern Territory. In remote Northern Australia, the epidemiology is less clear but anecdotal evidence suggests it may be worse. In addition, some anecdotal evidence suggests that prognostic pharmacological therapy could also be underutilised. Minimal HF data exists in the remote and Indigenous settings, making this study unique.

The need for effective, culturally safe residential rehabilitation services for Aboriginal people is widely acknowledged, however the combination of treatment components that is optimally effective, is not well defined. Most existing Aboriginal residential rehabilitation research has focused on describing client characteristics, and largely ignored the impact of treatment and service factors, such as the nature and quality of therapeutic components and relationships with staff.

Significant research attention has been given to understanding the entanglements of culture and climate change in Indigenous communities for global and Australian contexts. Although there is a growing body of knowledge on the threats and vulnerabilities posed by climate change to Indigenous peoples and cultures, there is only modest substantive research on the ways that Australian Aboriginal people in remote, arid-zone communities observe, understand, experience, and act upon the changing climate. This paper emphasises the importance of place-based research methods for understanding local social and cultural processes in a research project which investigated Aboriginal understandings and responses to climate change in the interior, arid Upper Georgina River Basin (UGRB) in North West Queensland, Australia. The study used a multidisciplinary and mixed-method approach, including a modified national climate change survey. Based on this survey methodology, a distinctive geographic and Indigenous focus shaped the study on public risk perceptions, understandings, and responses to climate change. This study recognises the crucial importance of identifying, measuring and documenting important changes and impacts taking place in the human landscape as only this kind of attention will insure that remote regional communities are coping with the environmental stressors and challenges of the Anthropocene.

Objective Surveillance programs and research for acute respiratory infections in remote Aboriginal communities are complicated by difficulties in the storage and transport of frozen samples to urban laboratories for testing. This study assessed the sensitivity of a simple method for transporting respiratory samples from a remote setting for viral PCR compared with frozen specimens. Methods We sampled every individual who presented to a remote Aboriginal community clinic in a non-epidemic respiratory season. Two anterior nasal swabs were collected from each participant. The left nare specimen was mailed to the laboratory via routine postal services. The right nare specimen was transported frozen. Testing for 16 viruses was undertaken using real-time multiplex PCR. ResultsA total of 140 participants were enrolled who contributed 150 study visits. Respiratory illnesses accounted for 10% of the reasons for presentation. Sixty-one viruses were identified in 50 (33.3%) presentations for 40 (28.6%) individuals; bocavirus and rhinovirus were the most common viruses identified (14.0% and 12.6% of episodes respectively). The sensitivity for any virus detected in mailed specimens was 67.2% (95%CI 55.4, 78.9) compared to 65.6% (95%CI 53.7, 77.5) for frozen specimens. ConclusionThe mailing of unfrozen nasal specimens from remote communities does not compromise the viability of the specimen for viral studies.

BACKGROUND: Surveillance programs and research for acute respiratory infections in remote Australian communities are complicated by difficulties in the storage and transport of frozen samples to urban laboratories for testing. This study assessed the sensitivity of a simple method for transporting nasal swabs from a remote setting for bacterial polymerase chain reaction (PCR) testing. METHODS: We sampled every individual who presented to a remote community clinic over a three week period in August at a time of low influenza and no respiratory syncytial virus activity. Two anterior nasal swabs were collected from each participant. The left nare specimen was mailed to the laboratory via routine postal services. The right nare specimen was transported frozen. Testing for six bacterial species was undertaken using real-time PCR. RESULTS: One hundred and forty participants were enrolled who contributed 150 study visits and paired specimens for testing. Respiratory illnesses accounted for 10% of the reasons for presentation. Bacteria were identified in 117 (78%) presentations for 110 (79.4%) individuals; Streptococcus pneumoniae and Haemophilus influenzae were the most common (each identified in 58% of episodes). The overall sensitivity for any bacterium detected in mailed specimens was 82.2% (95% CI 73.6, 88.1) compared to 94.8% (95% CI 89.4, 98.1) for frozen specimens. The sensitivity of the two methods varied by species identified. CONCLUSION: The mailing of unfrozen nasal specimens from remote communities appears to influence the utility of the specimen for bacterial studies, with a loss in sensitivity for the detection of any species overall. Further studies are needed to confirm our finding and to investigate the possible mechanisms of effect. CLINICAL TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry Number: ACTRN12609001006235.

This chapter traces the varied uses of Aboriginal and Torres Strait Islander building traditions across different periods of colonisation to the early twenty-first century. In Australia, two-way exchanges of European and Indigenous building technology began on the colonial frontier and continued in remote parts of the country into the twentieth century. Despite the eventual dominance of colonial and modern architecture, Indigenous building traditions have persisted in certain places across an uneven history of European contact. Largely dismissed by the colonists, the continued use and adaptation of building traditions, as well as projects that reconstruct lapsed building practice, demonstrate a richer and more diverse history of Indigenous building skills and knowledge. Since the 1970s, increasing references to the Indigenous culture, art and history in Australian architecture contrast with the relatively few buildings that have referenced Aboriginal or Torres Strait Islander building traditions. The wider recognition of the varied Indigenous dwelling types and materials suggests a potential for greater reuse and inventive adaptation of these traditions in contemporary architecture.

This chapter examines Aboriginal and Torres Strait Islander domestic architecture across the period from the onset of European colonisation to the early twenty-first century. In these two centuries, housing and living conditions reflected and shaped the often abrupt and disruptive change to the culture, health and livelihoods of Aboriginal and Torres Strait Islander peoples. The post-contact history of Indigenous housingIndigenous housingAustralia has been determined by government policies, informed by politics and settler attitudes to Indigenous Australians. Until the 1970s, state and territory governments, with specific legislation, exercised control over Aboriginal and Torres Strait Islander lives including place of residence and access to housing. For an extended period of this history, housing choice was oppressively limited. Despite entrenched disadvantage, it is a story of cultural persistence and adaptation to an imposed architecture that expected sedentary living patterns rather than the more mobile Indigenous lifestyles. Towards the end of the twentieth century, a combination of research and architectural practice had identified approaches to Indigenous housing that could improve living conditions of Aboriginal and Torres Strait Islander people.

Room to move: Contemporary Alyawara settlement patterns and their implications for Aboriginal housing policy

This paper examines some challenges we confront working with preservice teachers prior to serving in remote Indigenous communities. Some challenges include what preservice teachers bring to their studies - subjectivities, experiential understandings of teaching and notions of childhood/adolescence, culture and social justice, all of which involve minds, emotions and our notions of our places in society. Some challenges involve linking new notions of teaching to what they already know which may entail unlearning before relearning. Some challenges involve making sense of the theory/action dialectic - teasing out links between strongly held but unarticulated values, beliefs and actions that derive from them. Some challenges involve anticipating what it might be like to live and teach in a remote setting and preparing to work effectively across cultures. I then discuss how we might tackle them in the light of productive pedagogy and culturally relevant pedagogy (Osborne, 2001a, 2001b).

Background: Lung cancer incidence, mortality and hospitalisation rates are higher for Indigenous Australians compared with non-Indigenous Australians and increase again when living in more remote areas. If Indigenous Australians are made more aware of lung cancer through better access to health services and programmes, lung cancer outcomes might improve. Aim: We aimed to survey the level of lung cancer awareness in rural and remote Aboriginal and Torres Strait Islander communities and discover perceived barriers to timely diagnosis and treatment of lung cancer. Methods: Interviews were conducted in three discrete outer regional and remote Aboriginal communities and one urban setting in Queensland. Participants included Aboriginal and Torres Strait Islander peoples from three target population groups: patients referred for medical treatment with symptoms suspicious of lung cancer or confirmed lung cancer; Indigenous health workers; community members aged 18 years and over. Participants gave written, informed consent. Results: Of 51 community members and 14 Indigenous health workers, 32 reflected they knew very little about lung cancer, 60 cited smoking as the cause of lung cancer and 54 recognised warning symptoms as a prompt to seek healthcare. Indigenous health workers were not able to describe a healthcare pathway that would apply to a patient with suspected lung cancer. Conclusion: The two main barriers identified as impacting on quality healthcare were communication and follow-up processes. These could be addressed by service improvement activities.

The Australian Federal Native Title Act 1993 marked a revolution in the recognition of the rights of Australia’s Indigenous peoples. The legislation established a means whereby Indigenous Australians could make application to the Federal Court for the recognition of their rights to traditional country. The fiction that Australia was terra nullius (or ‘void country’), which had prevailed since European settlement, was overturned. The ensuing legal cases, mediated resolutions and agreements made within the terms of the Native Title Act quickly proved the importance of having sound, scholarly and well-researched anthropology conducted with claimants so that the fundamentals of the claims made could be properly established. In turn, this meant that those opposing the claims would also benefit from anthropological expertise. This is a book about the practical aspects of anthropology that are relevant to the exercise of the discipline within the native title context. The engagement of anthropology with legal process, determined by federal legislation, raises significant practical as well as ethical issues that are explored in this book. It will be of interest to all involved in the native title process, including anthropologists and other researchers, lawyers and judges, as well as those who manage the claim process. It will also be relevant to all who seek to explore the role of anthropology in relation to Indigenous rights, legislation and the state.

Despite government policy and initiatives for remote areas, indigenous people are amongst the most disadvantaged and do exhibit higher levels of unemployment in the Australian community. A number of commentators have suggested that better educational opportunities for this minority group will considerably improve their socio-economic status and employment opportunities. This myth is exposed in this article, which reports evidence from an educational–vocational programme for Yolngu who are the indigenous people of East Arnhem Land in the Northern Territory of Australia. The Arnhem Learning Education and Regional Training (ALERT) programme is conducted, mainly at Nhunlunbuy, in partnership with Rio Tinto Alcan and the Charles Darwin University, with the primary objective of preparing indigenous people for mainstream sustainable jobs. The presented content suggests that while higher educational status is important, this sole strategy is unlikely to comprehensively address outstanding issues that are confronting indigenous people and their labour market concerns.

Sport-based mentoring programs have been used across many contexts to engage young people in education. In this research, we explored the influence that an Aboriginal controlled organisation?s youth mentoring program has on three remote Aboriginal communities in Northern Territory, Australia. We used a composite set of culturally sensitive methods by including artefacts from the community members and mentees, informal interviews with community, and semi-structured conversations with mentors and schoolteachers. The findings demonstrate the positive feelings, many benefits, and relationships that had been established between mentors and mentees, the organisation and community over time. However, participants also suggested that it would be beneficial to engage mentors in activities with students not in the school system, and adults in the broader community. Despite some identified challenges, the mentoring program was perceived to be successful in engaging remote Aboriginal children in school and developing future career aspirations.

Aboriginal Australians living in remote desert communities, usually far from centres of mainstream economic activity and employment, show little inclination to leave them for economic opportunities elsewhere. Some have argued that the tie is based on the ontological significance of place, while others have emphasized marginalization brought about by past government policies. In this article I question both of these views and suggest that emplacement is grounded in the centrality of the relational ontology and the need to live within a dense network of sociality. This raises the issue of whether there are desirable forms of long-term dependency.

In the Indigenous Australian community of South Goulburn Island (NT), this study found that people’s preferences for adaptation usually concerned building general community capacity, drawing from customary knowledge, being more involved in government decision-making and learning more about scientific knowledge. The Indigenous dependence on marine resources led this study to explore aquaculture as an option for adapting to future climate change and marine related impacts. Participants showed a strong interest in aquaculture as an option to help diversify food sources and minimise reliance on store purchased foods and provide income for the community – especially under future climate uncertainty. However, the understanding of aquaculture practices, technology, logistics, and capacity involved in establishing and maintaining enterprises was limited for the Indigenous community participating in this project. Although people desired greater employment and skills, conventional employment was not a high aspiration except where work was closely related to the natural environment. Implementing programs of ‘aquaculture for adaptation’ will require improved communication and learning among all stakeholders, developing long-term relationships built on trust, and awareness of different worldviews on adaptation, planning, resource management and development.