Remote Australia Online

Research on South Goulburn Island aimed to improve understanding of Indigenous perspectives on climate change and options for adaptation within the scope of the local coastal, marine environment and resources utilized by the community. We also aimed to promote awareness among community members of western scientific concepts of climate change. Workshops and interviews with participants emphasized the use of participatory, visual techniques to encourage discussion and visioning of the future. Participants indicated very limited understanding of western concepts and English language terms associated with climate change and why change was occurring. However, in deeper conversations, many reported observing unusual patterns of environmental change they could not explain by other means. These observations, combined with changes in customary practices and loss of local knowledge in recent years, worried participants, particularly the elderly. The idea that climate change was resulting from human impacts on the environment was an easy concept for most participants to grasp. The demonstrated worldviews of participants was dominated by social and cultural links to the past and present, but had weaker links to western concepts of ?the future?. Thus, discussions around planning adaptation did not generally fit easily into peoples' framings of their worlds. People's preferences for adaptation included building general community capacity, drawing from customary knowledge, being more involved in decision-making and learning more about scientific knowledge on climate change. Enabling collection of plant and animal foods and associated interaction with the landscape was also considered important for improving community independence, resilience and well-being for adaptation.

Objective: This study highlights the benefits of a tailor-made course for an Indigenous high school in a remote North Queensland community. Design: Qualitative research study using a Grounded Theory approach to allow thematic analysis of participant's responses to a researcher-administered, pre-defined, semistructured questionnaire. Setting: Remote community college in Abergowrie, North Queensland. Participants: Four male high school students and eight key stakeholders were interviewed over the telephone (n=12). Results: Thematic analyses of the feedback from students and stakeholders showed a variety of benefits from the course for Indigenous students: increased knowledge of health issues, greater awareness and interest in health career pathways, increased pride, self-esteem and self-confidence, positive role-modelling and leadership behaviour in the students, and hope for future career development. Weaknesses identified were mainly associated with a lack of resources and support for the course. Conclusions: This study demonstrates that a tailor-made primary health-care education course can create opportunities for Indigenous people to pursue health careers, promote health knowledge and leadership skills, inspire pride and self-esteem, and strengthen links within the community.

This article details the construction of a Grounded Theory to explain the concept of enhancing professional learning through mobile devices. The research data was delimited to the behaviours and beliefs of Aboriginal and Torres Strait Islander pre-service teachers enrolled in two community-based initial teacher education programs in very remote communities in Australia. Four educational uses of mobile devices were identified: accessing content, handling administration, collaborating for academic support and sharing personal encouragement. The use of mobile devices enabled adults to choose times of study, choose places of study, complete assessment relevant to their course and achieve a career goal. Three elements that impact the educational use of mobile devices were identified (i.e. context, precursors and catalyst). Seven categories underlie the concept of enhancing professional learning through mobile devices: fostering access, facilitating customisation, promoting collaboration, supporting relevance, completing the course, empowering agency and enabling networking.

Over the last two decades medical schools have increased rural practice learning opportunities for students in an effort to improve recruitment to the rural workforce. James Cook University’s (JCU) medical school was established in northern Australia in 2000 with a specific focus on meeting the health needs of people in rural and remote areas.

The aim of this study was to describe the reorientation of a remote primary health-care service, in the Kimberley region of Australia, its impact on access to services and the factors instrumental in bringing about change. A unique community-initiated health service partnership was developed between a community-controlled Aboriginal health organisation, a government hospital and a population health unit, in order to overcome the challenges of delivering primary health care to a dispersed, highly disadvantaged Aboriginal population in a very remote area. The shared goals and clear delineation of responsibilities achieved through the partnership reoriented an essentially acute hospital-based service to a prevention-focussed comprehensive primary health-care service, with a focus on systematic screening for chronic disease, interdisciplinary follow up, health promotion, community advocacy and primary prevention. This formal partnership enabled the primary health-care service to meet the major challenges of providing a sustainable, prevention-focussed service in a very remote and socially disadvantaged area.

A lack of specialist knowledge and skills in teachers, as well as high levels of teacher turnover has contributed to the reported poor educational outcomes of Indigenous students in remote communities in Australia. In response to these reports, Australian universities have been required to include curriculum and pedagogical content that addresses two specifically focused Indigenous standards in their initial teacher education provisions. To enrich these standards, universities have offered placement opportunities in Indigenous communities for pre-service teachers. In this chapter, I report on a newly designed remote Indigenous placement through the presenting and analysing reflective narratives written by four pre-service teachers who participated in the placement. Many aspects of the stories are distinctive with respect to the individuals and their experiences, but commonalities emerge in the form of four over-arching strands of story: stories of equity and social justice; stories of building relationships and collaboration; stories of the ‘right’ pedagogy; and stories of Learning on Country.

A matter of control: Aboriginal housing circumstances in remote communities and settlements

This paper reports on an action research study that investigated the integration of Aboriginal and Western science knowledges and languages into science learning for Aboriginal adolescent students in one regional independent secondary school in Queensland. To strengthen the students’ learning, the study drew on community members’ local knowledge and language of fauna and integrated this understanding with the teaching of science to 12 students in Years 8–9. As part of the study, 75 lessons were conducted and included an initial short-beaked echidna (Tachyglossus aculeatus) study and a collection of local animal narratives. It applied thematic analysis to data to explore the effect of this integrated approach on students’ language use, pride in heritage, cultural knowledge, learning and the Linnaean zoology taxonomy. Results showed that to enable the flow of the science lessons, the average number of words spoken (103) at introduction times needed to remain low to facilitate engagement and to avoid embarrassment and an overwhelming factor when the teaching site is cluttered with words. The sensitive planning in terms of two-way Linnaean and local languages gave rise to meaningful contextualisation of culture.

Participatory evaluation can be embedded in programs to support good governance and facilitate informed decision making in Aboriginal communities in remote and urban contexts. An Aboriginal Elder from the Tiwi Islands in the Northern Territory of Australia described participatory evaluation as a sea eagle looking “long way wide eyed.” The metaphor refers to the long-term and broad approach undertaken when a complex community development program used participatory processes to build evaluation capacity and solve problems. The evaluation approach ensured the program was inclusive, responsive, empowering, and resulted in direct benefits for the communities. This article addresses the lack of literature on applying developmental and empowerment evaluation approaches in practice by describing the methods, tools, and use of evaluation findings. The value of participating for the community members and partner organizations is shared and the benefits and implications for participants and the evaluator are discussed. The authors hope this article inspires practitioners and evaluators to consider participatory ways of working with communities to support community directed action and social change.

Aim: To describe the pattern of disease and other health problems in children living in remote Far North Queensland (FNQ). Design, setting and participants: Retrospective review of the FNQ Paediatric Outreach Service’s Medical Director database for the period June 2001 to February 2006. Three subpopulations were compared: children from predominantly Aboriginal communities, predominantly Torres Strait Islander communities, and other communities. All children referred to the service during the study period were reviewed. Main outcome measures: Number of children seen and common diagnoses. Results: 3562 children were referred during the study period, and a total of 3932 diagnoses were made; 56% of the paediatric population of the Aboriginal communities and 23% of the paediatric population of Torres Strait Islander communities were seen. Of 40 separate diseases/health problems reviewed, the three most common reasons for presentation were chronic suppurative otitis media, suspected child abuse and neglect, and failure to thrive. In the paediatric population of Aboriginal communities, the prevalence of fetal alcohol spectrum disorder was at least 15/1000 (1.5%), and in Torres Strait Islander children, rheumatic heart disease prevalence was at least 6/1000 (0.6%). Rheumatic fever rates were among the highest in Australia. Conclusion: Rates of preventable complex and chronic health problems in Aboriginal and Torres Strait Islander children in remote FNQ are alarmingly high. Areas requiring urgent public health intervention include alcohol-related conditions and rheumatic fever

This last book of Professor Rowley's trilogy on Aboriginal Policy and Practice deals with the situation of the 'full-blood' Aborigines in the centre and north of Australia. The author refers to this area as 'colonial Australia', offering reasons including the restrictions on movement by the Aborigines, with the resultant emphasis on mission and government 'settlements'; the much lower wages paid to Aborigines in the area; the withholding of social service benefits which other Australians may obtain easily; and the power vested in officials and missionaries to control Aborigines. Professor Rowley argues that, in the remote areas, policy and practice of government must be altered fundamentally, otherwise the last remnants of the tribes will be reduced to the situation described in Outcasts in White Australia. Like Rowley's other two books, this one is an indictment of white Australian indifference to the maltreatment of an inarticulate minority. His basic argument is that no policy can now succeed without reconciliation; that governments, after two centuries, must come at last to negotiate with the Aborigines. It is also argued that even now it may not be too late to learn from the Aboriginal how to see and appreciate the continent in which we live. But this is an issue which demands some humility from non-Aboriginal Australians.

Purpose Continuous quality improvement (CQI) programmes have been taken up widely by indigenous primary health care services in Australia, but as yet there has not been a systematic assessment of their focus and achievements. A scoping review of the literature from studies of CQI in indigenous primary health care services was undertaken to explore impacts on service systems, care and client outcomes with the aim of providing guidance on future evaluation efforts. The paper aims to discuss these issues, Design/methodology/approach Searches were conducted in MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews to December 2016 and handsearching of key websites and publications. Studies of CQI programs or activities in Indigenous primary health care services which demonstrated some combination of CQI characteristics, as described by Rubenstein (2013) were included. A two-stage approach to analysis was undertaken. Stage 1 identified the range and scope of literature, and Stage 2 investigated impacts to service systems, care and client outcomes. The Framework for Performance Assessment in Primary Health Care was used to frame the Stage 2 analysis. Findings The majority of Aboriginal community controlled health services have been involved in CQI but there are gaps in knowledge about uptake in general practice and government clinics. There are as many baseline studies as studies on impacts over time. Of the 14 studies included for further analysis, 6 reported on impacts on service systems; all 14 reported on impacts on care and 6 on client outcomes. Changes to services systems are variable and studies of impacts on care and client outcomes show promising though uneven improvements. There are no economic studies or studies addressing community engagement in CQI activities. Research limitations/implications To supplement existing limited knowledge about which service system change strategies are effective and sustainable for which problems in which settings, there needs to be investment in research and development. Research needs to be grounded in the realities of service delivery and contribute to the development of CQI capacity at the service level. Knowledge translation needs to be built into implementation to ensure maximum benefit to those endeavouring on a daily basis to constantly reflect on and improve the quality of the care they deliver to clients, and to the stewardship structures supporting services at regional, state/territory and national levels. Practical implications Improved approaches, methods, data capture and reporting arrangements are needed to enhance existing activity and to ensure maximum benefit to services endeavouring to reflect on and improve quality of care and to the stewardship structure supporting services at regional, state/territory and national levels. Originality/value Although there is a growing body of research evidence about CQI both nationally and internationally, and considerable investment by the federal government in Australia to support CQI as part of routine practice, there has not been a systematic assessment of the achievements of CQI in Indigenous primary health care services. Many unanswered questions remain about the extent of uptake, implementation and impacts. This is a barrier to future investment and regional and local programme design, monitoring and evaluation. The authors conducted a scoping review to address these questions. From this, the authors draw conclusions about the state of knowledge in Australia with a view to informing how future CQI research and evaluation might be intensified.

Paediatric melioidosis is uncommon in Northern Australia. In the Northern Territory, children with melioidosis often report an inoculation event and localised skin and soft tissue infections predominate. However, in Far North Queensland, children with melioidosis are frequently bacteraemic and have a high case fatality rate. To confirm this observation, all culture-confirmed cases of Burkholderia pseudomallei processed at Cairns Hospital between 1998 and March 2017 were reviewed. During the study period, B. pseudomallei was isolated from 223 people; ten (4%) were children (aged from three days to 14 years). Bacteraemia occurred in 6/10 (60%) children compared with 161/213 (76%) adults (p=0.24). The primary diagnosis was localised, cutaneous disease in three children, meningoencephalitis in two and pneumonia in two. Three had bacteraemia with no primary source evident. No child had a parotid abscess or liver abscess. Five children (50%) died, and all of whom were bacteraemic.

Acute lower respiratory infection (ALRI) is a major cause of hospitalization for Indigenous children in remote regions of Australia. The associated microbiology remains unclear. Our aim was to determine whether the microbes present in the nasopharynx before an ALRI were associated with its onset. A retrospective case-control/crossover study among Indigenous children aged up to 2 years. ALRI cases identified by medical note review were eligible where nasopharyngeal swabs were available: (1) 0–21 days before ALRI onset (case); (2) 90–180 days before ALRI onset (same child controls); and (3) from time and age-matched children without ALRI (different child controls). PCR assays determined the presence and/or load of selected respiratory pathogens. Among 104 children (182 recorded ALRI episodes), 120 case-same child control and 170 case-different child control swab pairs were identified. Human adenoviruses (HAdV) were more prevalent in cases compared to same child controls (18 vs 7%; OR = 3.08, 95% CI 1.22–7.76, p = 0.017), but this association was not significant in cases versus different child controls (15 vs 10%; OR = 1.93, 95% CI 0.97–3.87 (p = 0.063). No other microbes were more prevalent in cases compared to controls. Streptococcus pneumoniae (74%), Haemophilus influenzae (75%) and Moraxella catarrhalis (88%) were commonly identified across all swabs. In a pediatric population with a high detection rate of nasopharyngeal microbes, HAdV was the only pathogen detected in the period before illness presentation that was significantly associated with ALRI onset. Detection of other potential ALRI pathogens was similar between cases and controls.

Objective:To determine whether the use of tissue spears to remove otorrhoea from Aboriginal children's ear canals improves hearing in the affected ear.Design:Case series study with controls.Methods:The study comprised 61 Aboriginal children from communities in the remote arid zone of South Australia who had otorrhoea obscuring the tympanic membrane in 1 or both ears. Eighty ears were treated with tissue spears, and hearing was assessed before and after treatment.Results:Forty-two children had unilateral and 19 had bilateral active disease. An additional 13 ears without otorrhoea served as controls. Improvement by 5 dB HL or greater in a four-frequency pure tone average occurred in 41.3 per cent of treated ears. Subsequently, blinded audiologists made qualitative judgements that a functional improvement in hearing had occurred after tissue spear use in 28.4 per cent of ears.Conclusion:Tissue spears can improve hearing thresholds in a significant proportion of children with otorrhoea. However, the duration of the effect is unknown.

The brumby dance episode occurred as a Warlpiri-inspired response to an emotionally charged conversation regarding the Northern Territory Emergency Response. It took place during the Cross-Cultural Collaboration Project, undertaken in the Northern Territory Department of Education, Employment and Training in 2008. This paper contextualises, describes and analyses the brumby dance episode, examining the perspectives and intentions underlying its enactment. This analysis proposes the brumby dance episode as an exemplar of the great value of cultural continuity processes in bringing traditional Aboriginal ways of knowing, doing and being to the localised complexity of contemporary Indigenous education in Australia, particularly in remote settings. Such strongly relational, strength-based approaches are juxtaposed with those of the currently dominant standardisation policy agenda in Indigenous education, critiqued as over-simplistic (one size fits all), deficit-focused and relationally impoverished.

Early career teachers eager to find employment are often encouraged by employers to accept positions in remote locations which are traditionally difficult to staff. This paper reports research that examined a case study of a graduate teacher employed in a remote school. Drawing on resilience theory, we challenge the profession to consider whether in fact employers are relying on the personal resilience of early career teachers to cope with the rigors of teaching in remote schools and are remiss for not providing adequate support at school and system levels.

One important component of the Nyirranggulung Health Authority’s strategy is a partnership between the Fred Hollows Foundation and the Jawoyn Association. As an extension of its ongoing work in the area of Indigenous eye health, the Fred Hollows Foundation is working with the Jawoyn Association on the development and implementation of a project which seeks to improve nutrition in the region’s Aboriginal communities. The first initiative of this partnership was to identify the various elements which currently impede better nutrition in the Katherine East communities, and to examine the current capacity to evaluate the health impacts of any interventionist activities. The Centre for Aboriginal Economic Policy Research (CAEPR) at the Australian National University was commissioned to respond to this need. Its specific tasks were to examine and discuss: • the capacity to establish key health indicators for the Jawoyn and the means by which these indicators may be measured over time; • the key structural impediments to the provision of better nutrition, particularly in relation to community stores; • the structure and delivery of services to the Jawoyn people and other Aboriginal people residing on Jawoyn land; and • practical opportunities to address the structural impediments, including policy initiatives. This report, Aboriginal Nutrition and the Nyirranggulung Health Strategy in Jawoyn Country, outlines the work of the CAEPR research team. It seeks to make sense of research on nutrition interventions, to verify the situation in Katherine East, and to examine ways to develop a wide-ranging and sustainable health strategy in that region. The findings of this report contributed greatly to the development of the objectives, protocols, and initiatives of The Nyirranggulung Health Authority’s nutrition strategy.

Objectives Rates of youth suicide in Australian Indigenous communities are 4 times the national youth average and demand innovative interventions. Historical and persistent disadvantage is coupled with multiple barriers to help seeking. Mobile phone applications offer the opportunity to deliver therapeutic interventions directly to individuals in remote communities. The pilot study aimed to evaluate the effectiveness of a self-help mobile app (ibobbly) targeting suicidal ideation, depression, psychological distress and impulsivity among Indigenous youth in remote Australia.Setting Remote and very remote communities in the Kimberley region of North Western Australia.Participants Indigenous Australians aged 18–35 years.Interventions 61 participants were recruited and randomised to receive either an app (ibobbly) which delivered acceptance-based therapy over 6 weeks or were waitlisted for 6 weeks and then received the app for the following 6 weeks.Primary and secondary outcome measures The primary outcome was the Depressive Symptom Inventory—Suicidality Subscale (DSI-SS) to identify the frequency and intensity of suicidal ideation in the previous weeks. Secondary outcomes were the Patient Health Questionnaire 9 (PHQ-9), The Kessler Psychological Distress Scale (K10) and the Barratt Impulsivity Scale (BIS-11).Results Although preintervention and postintervention changes on the (DSI-SS) were significant in the ibobbly arm (t=2.40; df=58.1; p=0.0195), these differences were not significant compared with the waitlist arm (t=1.05; df=57.8; p=0.2962). However, participants in the ibobbly group showed substantial and statistically significant reductions in PHQ-9 and K10 scores compared with waitlist. No differences were observed in impulsivity. Waitlist participants improved after 6 weeks of app use.Conclusions Apps for suicide prevention reduce distress and depression but do not show significant reductions on suicide ideation or impulsivity. A feasible and acceptable means of lowering symptoms for mental health disorders in remote communities is via appropriately designed self-help apps.Trial registration number ACTRN12613000104752.

Historically, Australian policy makers have associated rural Indigenous communitys high un-employment levels and low labour force participation rates with poor livelihood outcomes. The researchers therefore conducted fieldwork in Wakathuni, a remote Aboriginal community settlement located in the Pilbara region of Western Australia, to determine factors affecting unemployment. However, the following conclusions were made: firstly, patterns of indigenous unemployment must be considered within a complex system relative to cultural context; and, secondly, by enforcing an understanding relative to western capitalist contexts, policy makers may never be able to fully understand Aboriginal ways of life. Alternative sustainable livelihood solutions must be sought to address economic development in remote Indigenous communities, and this would require challenging the value perspectives that inform government policy. Transformation must come from within communities, and governments need to change how they conceptualise Indigenous peoples issues; otherwise, colonising and disempowering processes will continue to be enforced.

Using examples drawn from the Mardu, a Western Desert people, we seek to illustrate the incommensurability of remote Aboriginal and mainstream Australian cultures, including their opposed constructions of politics. Although there is ample evidence of Aboriginal people like the Mardu having adapted to their changed circumstances, deep differences persist. Kin-based authority and regulation of behaviour have been weakened and are often ineffective, but no viable civil society has emerged; this gap between Mardu and Western values and customs results in cultural clashes and the elusiveness of mutual accommodation. We emphasize elements of difference and difficulty that stem largely from the contrast in how these two kinds of societies deal with the tension between autonomy and relatedness.

In 2010 a group of teacher educators from four universities, experienced in rural and remote education, formed the Tertiary Educators Rural, Regional and Remote Network (TERRR Network). The collaborative goal was to improve the quality of graduates taking appointments beyond the metropolitan areas of Western Australia. The TERRR Network developed a research project to improve the capacity of universities to prepare teachers for employment in rural and remote locations. A range of outcomes emerged from the project, including: 1) the development of seven rural and remote-oriented curricula modules linked to the Australian Professional Standards for Teachers; 2) a cross-institutional field experience, and; 3) the development of a community of practice involving the Department of Education, universities and schools to address the logistical implications of placing pre-service students in rural and remote locations. This paper reports on the five phases of the project design, with a focus on learning in the field and concludes with reflections on the collaborative process used by the four universities in order to ensure that research evidence informs future policy and program development.

People in residential aged care facilities (RACF) are at very high risk of developing complex oral diseases and dental problems. A multidisciplinary approach incorporating oral health professionals and RACF staff is important for improving and sustaining oral health in RACFs. However, difficulties exist with access to oral health services for RACFs, particularly those in regional and rural areas. This study investigated the impact and experience of an integrated oral health program utilising tele-dentistry and Oral Health Therapists (OHT) in RACFs in a rural setting within Australia.

Western environmentalism and conservation are deeply entangled with histories of colonialism. This entanglement has marginalised Indigenous and migrant perspectives on the environment to protect settler norms and interests. This paper approaches those two types of othering together in the context of environmental debate, using the lens of a mainstream conservation magazine. We analyse representations of indigeneity and migration in a shifting settler-colonial discourse on the environment, throughout the 45 volumes of the Australian Conservation Foundation’s magazine Habitat (1973–2016). The Australian Conservation Foundation was Australia’s first nation-wide conservation organization. Its magazine exemplifies a settler-colonial discourse that initially aimed to conserve pristine nature but that over time has responded to increasing awareness that environmental crises have transnational causes and consequences, and require intercultural and international cooperation. We found that, while contributors to the magazine increasingly represent Australian conservation issues as connected to international processes and closely collaborate with remote Indigenous communities, they continue to assume the settler as norm and prioritise the protection of wealth and lifestyles. These goals are achieved through the conditional inclusion of others and through the treatment of environments as having zero-sum limits. The colonial imaginaries of ‘wilderness’ and carrying capacity are repurposed to frame migration as being at odds with Australian people’s wealth and wellbeing. The reiteration of settler-colonial environmentalism as a dominant way of protecting the environment stands in the way of the greater pluralism of environmental relationships that will be needed for coping with environmental change.

Few published studies are available describing the prevalence of paediatric strongyloidiasis in endemic areas within Australia. This literature review and exploratory clinical audit presents the first seroprevalence data for paediatric patients in Central Australia. A total of 16.1% (30/186) of paediatric inpatients tested for Strongyloides stercoralis in 2016 were seropositive (95% CI: 11.5% to 22.1%). Eosinophilia of unknown aetiology was the most common indication for testing (91.9%). Seropositive patients were significantly more likely to reside in communities outside of Alice Springs (p = 0.02). Seropositive patients were noted to have higher mean eosinophil counts with a mean difference of 0.86 x 109/L (95% CI: 0.56 to 1.16, p < 0.0001), although the limited utility of eosinophilia as a surrogate marker of strongyloidiasis has been described previously. All seropositive patients were Indigenous. There was no significant difference in ages between groups. There was a male predominance in the seropositive group, although this was not significant (p = 0.12). Twelve patients had known human T-lymphotropic virus 1 (HTLV-1) status and all were seronegative. Further research describing the epidemiology of strongyloidiasis in Central Australia is required.