Remote Australia Online

Background Evidence is mounting that price discounts can be effective in improving diet. This study examined the effectiveness of a 20% price discount on food and drink purchases with and without consumer education in remote Indigenous Australia. Methods A 20% discount on fruit, vegetables, water, and artificially sweetened soft drinks was applied for 24 weeks in 20 communities in remote Indigenous Australia where the community store was managed by the Arnhem Land Progress Aboriginal Corporation (ALPA) or Outback Stores (OBS) in a stepped-wedge randomised trial. Communities were randomly allocated to a fixed framework of five sets of four stratified by store association; ten stores (two in each set) were randomly assigned to receive consumer education. A store from each of the ALPA and OBS store groups (contained in separate opaque envelopes) was selected, and stores in turn continued to be consecutively allocated to the fixed store set framework, starting with the first store slot in the first store set, until all stores had been allocated. The effect of the discount on the weight of fruit and vegetables purchased (the primary endpoint) was assessed using weekly store sales data and mixed models per protocol. We did sensitivity analyses by repeating the analyses with the outliers included and repeating the analyses for the primary outcome measure removing each store one at a time. This trial was registered with Australian New Zealand Clinical Trials Registry, number ACTRN12613000694718. Findings Weekly store sales data on all food and drink products sold in 20 stores were collected from July 1, 2012, to Dec 28, 2014. Price discount alone was associated with a 12·7% (95% CI 4·1–22·1) increase in purchases in grams of fruit and vegetables combined (primary outcome), and a 19·8% (6·2–35·1) increase post discount (after vs before); an effect of 12 g and 18 g per capita per day. Sensitivity analyses did not modify the results for the primary outcome measure. Interpretation A 20% discount can only increase fruit and vegetable purchases to help protect against obesity and diet related disease to a certain extent. Large discounts might have a greater impact than small discounts. Creative merchandising approaches to consumer education could also be considered alongside fiscal interventions to achieve marked improvements in diet. Funding Australian National Health and Medical Research Council.

Background Antibiotic optimization is an urgent international issue. Regulatory frameworks, including the requirement to have a functioning antimicrobial stewardship (AMS) programme, are now ubiquitous across the hospital sector nationally and internationally. However, healthcare is ultimately delivered in a diverse range of institutional settings and social contexts. There is emerging evidence that implementation of antibiotic optimization strategies may be inappropriate or even counterproductive to attempts to optimize in atypical healthcare settings. Aim To document the experiences and perspectives of clinical staff in a remote healthcare setting in Australia with respect to antimicrobial use, and strategies for optimization in that environment. Methods Semi-structured qualitative interviews were conducted with 30 healthcare professionals, including doctors, nurses and pharmacists, from a remote hospital in Queensland, Australia. Findings Four themes were identified from the analysis as key challenges to antibiotic optimization: (i) AMS as externally driven, and local knowledge sidelined; (ii) perceptions of heightened local population risks, treatment failure and the subsequent pressure to over-use of antimicrobials; (iii) interprofessional relationship dynamics including medical hierarchical structures perceived as a barrier to AMS; (iv) a clinical workforce dominated by transient locum staff and other process issues were perceived as significant barriers. Conclusion The perceptions of healthcare professionals in this site lead to the conclusion that antimicrobial regulations and practice improvement strategies more generally are unlikely to succeed if they fail to accommodate and respect the context of care, the resource and structural constraints of the setting, and the specificities of particular populations (and subsequent clinical ‘know-how’).

A $12 million Commonwealth funded consortium project trialled energy efficiency initiatives in six remote Indigenous communities over three years. This project, which won several awards, employed and educated over 80 local Yolŋu to educate their fellow community members to use power wisely. The research and evaluation component was designed together by Indigenous and non-Indigenous researchers and entailed ethnography and a local Indigenous co-researcher approach. Sixteen local Yolŋu co-researchers conducted 125 in-depth qualitative interviews with community members across six communities in the local languages. At the beginning of the project, the Yolŋu co-researchers conducted 40 narrative interviews with fellow Indigenous community members to find out how they use power, and to identify barriers to and enablers of using power efficiently. Towards the end of the project, Yolŋu co-researchers conducted 85 in-depth interviews with fellow Indigenous community members and with Yolŋu who had educated community members to evaluate the project. The interpreted and transcribed interviews were analysed using a combination of thematic and narrative strategies (interviews at the start of the project) and of content, thematic and narrative strategies (evaluation interviews). The stories provide rare insights into how Yolŋu used, experienced and interpreted fire or power in the old days, missionary times and government days. The stories identify barriers to, and enablers of, Indigenous and non-indigenous people working together designing and conducting projects. The stories capture how Yolŋu educators and Indigenous community members experienced and interpreted the project—including effective practices, challenges, impediments and recommendations for the future. In this paper, we share the essence of these stories to provide an overview of the key barriers and enablers of Indigenous and non-Indigenous people working together in remote Indigenous communities to use power efficiently. We propose that, for projects with Indigenous people to be effective, non-indigenous partners need to closely and genuinely work together with remote Indigenous communities prior to applying for funding and implementing projects as well as throughout the projects. The projects need to employ a long-term and adaptive process.

Governments and network utilities are grappling with how to manage increasing costs of electricity supply, the prospect of distributed generation while still meeting social objectives of access and affordability in remote areas. Due to geographical isolation and dispersed populations, remote Australian communities are generally electrified by distributed networks using diesel generation. This is expensive, environmentally damaging and fails to exploit vast renewable resources available. These communities are often regarded as “low hanging fruit” from a renewable energy deployment perspective. This paper examines why that fruit has not been readily picked in Australia in the context of a case study of three remote West Australian communities. In Western Australia, the local electricity distribution network service provider (DNSP) responsible for regional networks, developed a scheme (the Scheme) to incentivise renewable energy deployment in remote communities. This scheme aims to encourage communities to install renewable energy from the “bottom up” by providing a feed-in tariff capped at $0.50/kWh, to reduce the supply cost and environmental damage from diesel generation. However, to date there has been limited deployment of renewable energy in remote communities. The scheme and viability of renewable energy is assessed for three indigenous communities located in the Kimberley region of Western Australia. These communities are connected to isolated, diesel powered networks. Viability is assessed from the DNSP and community perspectives and incorporates quantitative and qualitative financial, social / human and institutional factors. Renewable energy deployment is found to benefit the DNSP and can also benefit communities subject to their cost of capital and to the imposition of connection charges. However a range of barriers are currently frustrating deployment and a dynamic and adaptive approach that recognises local challenges and provides the communities with a pathway to installation is needed.

Rationale To identify the possible savings in the cost of primary health care of chronic disease associated with the participation by Aboriginal people in land management. In so-doing we investigate the connection of health of Aboriginal people and the extent of their involvement in land management in remote-very remote Australia. Methods Possible savings in primary care costs for hypertension, renal disease and diabetes were estimated using multivariate regression to examine associations between Aboriginal involvement in land management and Northern Territory Government-defined chronic disease outcomes, controlling for socio-demographics and health behaviours. Participants were 298 Aboriginal adults aged 15–54 from a remote Aboriginal community, classified by their chronic disease status and a previously validated measure of self-reported participation in land management activities. Results Land management participants were significantly less likely to have diabetes, renal disease or hypertension. Using the sampled mean value of engagement in land management, we found the expected net annual savings for the community from involvement in land management of $268,000. This equates to a net present value of primary health care savings in chronic disease care for the sampled community over 25 years of $4.08 million. This estimate does not include further savings in other primary health conditions nor costs anticipated in referred and hospital-based health care for chronic disease. Conclusion While the association between involvement in land management and better health requires further clarification, our findings indicate that significant and substantial primary health care cost savings may be associated with greater participation in land management activities. These estimated savings are in addition to the market and non-market economic benefits of a healthier population and environmental benefits.

Objective. To examine the role of the registered nurse in remote and isolated areas of Queensland, the Northern Territory, South Australia and Western Australia; and to illustrate the impact of the burden of disease on nursing practice.Data sources. A literature search was undertaken using electronic databases and the grey literature (including policy documents, project reports and position descriptions).Data synthesis. The role of the nurse in remote areas is diverse, and varies according to the context of practice. Although some states and territories offer formal programs to prepare nurses for the role, it is unclear whether this is routinely provided. The burden of disease is higher in remote Australia, and although nurses work to reduce the burden, the need to provide primary care can be at the expense of primary health care.Conclusions. Whilst the nature of nursing practice is influenced by many factors, considerable agreement exists between states and territories around the role of the registered nurses in remote and isolated communities. The higher burden of disease in remote and isolated areas of Australia impacts on nursing practice, and nurses are uniquely placed to assist in reducing the burden of disease. Greater agreement around what constitutes ‘remote’ is needed.What is known about the topic? Many papers have reported on the difficulties encountered by registered nurses in remote and isolated practice; however, there is a dearth of information describing the role of registered nurses in remote or isolated Australian communities.What does this paper add? This review describes the diverse role of nurses and their role in addressing the burden of disease in remote and isolated Australia. Comparison between states and territories highlights differences in preparation for the role.What are the implications for practitioners? National agreement is needed around preparation for practice, conditions of work, and what constitutes ‘remote’. Greater utilisation of the nursing workforce in remote and isolated areas would assist in addressing the burden of disease.

The construction sector represents one of the most significant contributors to global waste production and is responsible for over 30% of the waste that ends up in landfill. Sending construction waste to landfill results in a broad range of environmental consequences including: degradation of land, habitat destruction, contamination of soil and groundwater, and release of methane. There is a growing awareness of the need to divert construction and demolition (C&D) waste from landfill for reuse or recycling. This helps maximise the value of the resources embodied in these materials and reduce the demand for virgin raw materials and the associated environment effects resulting from their extraction, processing and manufacture. However, diversion of C&D waste to reuse or recycling in remote communities can be difficult and costly. This poses a significant challenge for improving the environmental performance of construction waste management in these communities. A housing refurbishment project in Alice Springs, a remote town in central Australia, was used to identify the barriers associated with improving the environmental performance of construction waste management in remote communities. This study considers the materials removed as part of the demolition phase of the project. Material types and quantities were documented and on-site and off-site waste management practices observed. Reasons for waste management decisions were recorded. The study identified a range of barriers to improving the environmental performance of construction waste management in remote communities. These include cost and time associated with on-site waste management, industry culture, lack of education, competing project priorities, and lack of financial incentive. Greater incentives to encourage the diversion of C&D waste from landfill are needed, in particular. This and other strategies for improving construction waste management practices in remote communities must be targeted at the context of individual communities though, due to their unique characteristics.

In 1950 Robert Menzies, then Prime Minister of Australia, was party to a little known, high-level agreement which acknowledged that in some circumstances a bilingual approach in education might be the best way to reach more traditionally oriented Aboriginal students in remote areas of the Northern Territory (NT) of Australia.

This study investigated movements of seven species of small mammals at study areas in arid Western Australia and Queensland. Populations of all species fluctuated dramatically in abundance over time, with the recapture rate for individuals averaging at a low 11.3%. Mean long-distance movements ranged from 1.04 km in the marsupial Sminthopsis hirtipes to 6.34 km in the native rodent Pseudomys hermannsburgensis; the maximum distance recorded was 14 km. Long-range movements occurred independently of sex, age and reproductive status in all species, but tended to increase during or after rain in the study regions. Individuals moved toward areas of rainfall, probably because rains produce local increases in food resources. We suggest that long-range movements are crucial in allowing small mammals to exploit both permanent and ephemeral refugia of increased productivity, hence facilitating long-term persistence in regional areas. Although protection of fixed refugia can be achieved by land reservation, conservation goals for small mammals and other biota will be met more realistically by improving land management throughout the arid zone with the involvement and cooperation of all land users.

This paper provides an overview of the challenges faced by remote, rural and regional airports in Australia. The deregulation of airports over the past decades has resulted in local councils owning most of the rural and regional airports across Australia. The paper provides an overview of the international literature on regional airports and research directed at defining the issues faced by regional and rural airports in Australia. A survey of airport managers, regulators and local councils was undertaken across Australia to outline the challenges and stresses that regional airports are facing. Core findings indicate that the operation of rural and regional airports is under stress due to the interrelating factors of infrastructure costs, high cost of maintenance, and security infrastructure upgrades. Small airports often compete with one another to attract airlines and maintain their infrastructure advantage.

Background Visual-motor integration (VMI) skills are essential for successful academic performance, but to date no studies have assessed these skills in a population-based cohort of Australian Aboriginal children who, like many children in other remote, disadvantaged communities, consistently underperform academically. Furthermore, many children in remote areas of Australia have prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD), which are often associated with VMI deficits. Methods VMI, visual perception, and fine motor coordination were assessed using The Beery-Buktenica Developmental Test of Visual-Motor Integration, including its associated subtests of Visual Perception and Fine Motor Coordination, in a cohort of predominantly Australian Aboriginal children (7.5–9.6 years, n = 108) in remote Western Australia to explore whether PAE adversely affected test performance. Cohort results were reported, and comparisons made between children i) without PAE; ii) with PAE (no FASD); and iii) FASD. The prevalence of moderate (≤16th percentile) and severe (≤2nd percentile) impairment was established. Results Mean VMI scores were ‘below average’ (M = 87.8 ± 9.6), and visual perception scores were ‘average’ (M = 97.6 ± 12.5), with no differences between groups. Few children had severe VMI impairment (1.9%), but moderate impairment rates were high (47.2%). Children with FASD had significantly lower fine motor coordination scores and higher moderate impairment rates (M = 87.9 ± 12.5; 66.7%) than children without PAE (M = 95.1 ± 10.7; 23.3%) and PAE (no FASD) (M = 96.1 ± 10.9; 15.4%). Conclusions Aboriginal children living in remote Western Australia have poor VMI skills regardless of PAE or FASD. Children with FASD additionally had fine motor coordination problems. VMI and fine motor coordination should be assessed in children with PAE, and included in FASD diagnostic assessments.

We investigated the ways in which cormorants (Phalacrocorax spp.) acquire behavioural cues from unpredictable habitats in arid Australia, using 10 years of temporal data on abundance at one wetland, fine-grained habitat and microhabitat use at two wetlands, and broad-scale spatial data from aerial surveys across north-west New South Wales. Abundances were highly variable and cormorants were aggregated at every temporal and spatial scale of observation. Cormorants were associated with short-term patches of food, and apparently travel frequently in a quest for newly formed patches. Movements and abundance of cormorants are linked to boom periods of their prey, and, like many Australian waterbirds, cormorants would benefit from improved water management practices.

The staffing of rural, remote and isolated schools remains a significant issue of concern in Australian education. In this paper we provide a comprehensive account of the Australian research related to the staffing of rural schools post 2004. The review identifies the overarching themes of the opportunities and challenges of staffing rural schools, pre-service teacher preparation, and leadership. Within these there are numerous sub-categories such as the policy setting, incentives, understanding place, mentoring, professional development, and teacher education. Overall the review identifies that the issues explored in the research literature between 2004 and 2016 are similar in character to those examined prior to 2004. As such we raise the question of, if we have such a well-developed knowledge of matters related to rural school staffing, why does it remain an ongoing issue? While this review does not seek to answer this question, it provides an opening for discussion by identifying and describing the research on issues, and approaches, in the staffing of rural, remote, and isolated schools to date.

Hanging is one of the commonest methods of suicide. It is an expression of despair and powerlessness. Young Australian Indigenous men from remote communities are over represented in the suicide statistics and the care provided to them when they are expressing suicide ideation or have a near hanging injury in most cases is inadequate. Discussion The national recommendations for the management of alcohol-related problems in Indigenous primary care do not reflect the national reality. This article proposes that Australia is developing an underclass in remote Australia where the life chances of remote Indigenous people are being compromised by the lack of access to appropriate primary health care services, education and employment opportunities and that young men are communicating their despair both in life and death. Conclusion Improving the rates of suicide amongst young remote Indigenous men requires more than adequate resuscitation.

Invasive species can have negative and positive impacts for local communities. Conflict between these different values can complicate and sometimes prevent broad-scale management and decision-making. Multi-functional landscapes and community-based conservation paradigms have emerged as constructive approaches to integrating competing interests and the development of sustainable and locally meaningful management planning. Here, we report on a five year feral ungulate exclusion fence project that was used to focus local people's attention on the eco-cultural and socio-economic impacts of feral ungulate invasion in a remote Aboriginal-owned region of northern Australia. Exclusion of feral buffalo, horses and pigs from three culturally significant freshwater billabongs from 2009 to 2013 resulted in variable increases in smooth ground (from 64–93%), ground cover vegetation (from 18–95%) and water lily cover (bush food) (from 20–60%), dependent on the site. The reduction in feral animal ground surface damage in the fenced areas was fastest at the floodplain billabong, Nalawan, which took only a year to become negligible. At the two channel billabongs, Costello and Namaliwiri, feral animal damage was negligible after 3 years. Senior Aboriginal Traditional Owners of these areas were pleased that these environmental assets were protected, but only agreed on the wholesale culling of pigs. Despite recognition of the negative eco-cultural impacts of feral ungulates as observed through the exclusion fence project, they wanted to maintain buffalo and horse on their Country to financially benefit from potential pet-meat and live export industries. Fencing was requested for culturally meaningful sites including those that were used for fishing and were sacred. Fenced areas were viewed by Traditional Owners as “protected” areas of ecological and cultural resources. These multiple management preferences can be combined to build socio-ecological resilience into regional strategic planning for feral ungulate management that will deliver multiple benefits for local communities.

Problem Australian Aboriginal women’s aspirations for birthing on country (having our babies born on our traditional land) are increasingly being reported in Australian scholarly and policy literature. However given the paucity of publications authored by Aboriginal Australians from remote areas of Australia, how well can the current knowledge base in Australia inform the development of culturally appropriate maternity services for our communities? Objective The aim of this literature review is to critically analyse the policy documents informing maternity services policy and scholarly literature on the birthing experiences (including the provision of maternity services) of Aboriginal Australian women from remote communities from an Indigenous standpoint. Method Policy documents and scholarly literature were critically analysed to identify who the authors were, their background, approaches and perspectives; and emergent themes. A further analysis of the literature drew on Fairclough’s ideas on discourse, power and hegemony. Findings A critical discourse analysis of this literature exposed how these texts are ideologically shaped to give voice (and power) to the medical fraternity, maternity care services practitioners and policy makers (whose knowledge is valued) while simultaneously silencing the voices of Aboriginal Australians that pose a challenge to that power. Conclusion This critical review of current literature highlights the importance of ongoing critique of maternity services policy and practice discourse necessary to combat western medical hegemony that maintains the disenfranchisement of Aboriginal Australians.

A range of factors has affected the design and construction of Indigenous housing in remote areas of Australia in recent times, including: socio-demographic issues; culture and design; consultation processes; the costs of remoteness; and procurement and delivery processes. Their implications for appropriate design and construction of remote Indigenous housing are analysed in this paper. Most significantly, these factors cannot be separated from cost because the need to spread available funds broadly to build the largest number of houses at the best price affects design and construction quality, and these are often neglected in the short-term budgeting within this process.

This analysis of housing experiences and aspirations in three remote Indigenous settlements in Australia (Mimili, Maningrida and Palm Island) reveals extreme liveability problems directly related to the scale and form of housing provision. Based upon field visits to each of the settlements and extensive interviews with residents and local housing and community officers, the paper analyses two aspects of living in such housing conditions at two spatial scales, the layout of the settlement and the design of individual houses. The failings at both scales are shown to be the fault of a dysfunctional housing system that is only recently being addressed.

Information about the regional population distribution of sports injury rates is important for the identification of priority groups for injury prevention and sports medicine service delivery. This study describes the relationship between regional measures of social disadvantage (socio-economic index for areas, SEIFA) and remoteness (accessibility/remoteness index of Australia, ARIA) and the incidence of sport/leisure hospitalisation episodes for 2003–2004. All hospital separations, of New South Wales (NSW, Australia) residents, with an ICD-10-AM principal diagnosis indicating an injury and an activity code indicating sport/leisure activity were included. Age-standardised hospitalisation rates were calculated across SEIFA and ARIA categories. There was no clear trend in hospitalisation rates across SEIFA quintiles, with rates ranging from a low of 150.3/100,000 population (95% CI: 145.5–155.2) in the quintile of most disadvantage to a high of 201.8/100,000 population (196.1–207.4) in the middle quintile. In contrast, there was a strong positive and significant trend across ARIA groups (p<0.001) with rates ranging from a low of 156.2/100,000 population (153.2–159.2) in the most urban areas to a high of 335.5/100,000 population (306.5–364.6) in remote areas. Reasons for these trends are unclear but may include differences in medical and allied health service provision, sport/leisure infrastructure and opportunities across regions or differential participation in sport across NSW. Further investigations into why remote and very remote areas, in particular, have such high rates, including exploration of participation rates, sport/leisure opportunity delivery factors and the provision of sports medicine services need to be undertaken before injury rates can be reduced in these areas.

The diets of six species of arid zone dasyurid marsupials were investigated at study areas in Queensland and Western Australia. At least 11 orders of insects were taken, as well as spiders, scorpions and centipedes. Beetles and spiders were taken more frequently than expected along foraging trails, whereas ants were avoided; there was no selectivity for other taxa. All species ate small prey (< 2·5 mm long) less frequently than expected. Four of the five species of smaller dasyurids (less than or equal to 13 g) showed some preference for prey 5·0-7·4 mm long, whereas the largest species, Dasycercus cristicauda (65 g), preferred prey >7·5 mm in length. Dasycercus cristicauda was also the only dasyurid regularly to include large, hard beetles in its diet. Beetles with hard cuticles were not eaten by the small dasyurids, although the three smallest species foraged in areas where hard prey were seldom encountered. Dasyurid marsupials are conspicuously successful inhabitants of the arid zone of Australia; most species are wholly insectivorous. Dietary generalism should be advantageous in arid zone dasyurids by permitting continuous exploitation of a temporally and spatially unpredictable food resource.

We investigated the relationships between the vegetation and soil surfaces on two active floodplains and associated stable landforms in a grazed arid landscape, over a period of seven years. Our intention was to distentangle the effects of processes which lead to variability at the landscape scale, using a large data set, as a prerequisite to better interpretation of vegetation changes. Long-lived trees were established on stable soil surfaces laid down in 700-year-old superfloods and on older landscapes. Less stable surfaces supported shorter-lived trees and shrubs, while the most frequently disturbed surfaces were entirely treeless. Many herbage species showed preference for particular soil surface types. For example, the presence of Sclerolaena bicornis distinguished active floodplains from stable sand sheets, while S. cuneata separated severely eroded from less damaged floodplains. The dynamics of herbage composition over the seven-year period were also different for contrasting surfaces, enabling the identification of a number of erosional, depositional and stable surface types. However, erosion of previously stable surfaces did not change herbage dynamics until the subsoil became exposed. Regardless of surface type, changes in species composition brought about by major rainfall events persisted for several years. The impact of cattle grazing on herbage composition over time was not detected despite independent evidence of grazing effects over the area. We attributed this to the confounding effect of a topographic and soil gradient, the lack of sufficient sites to stratify for all relevant factors despite a large initial data set and, possibly, an inadequate rating method for species abundance.

Summary Background Nurses are expected to embrace research and evidence-based practice but in rural/remote facilities it is particularly difficult to develop and utilise research skills. Objectives This collaborative study aimed to explore nurses’ orientation to research and address known inhibitors to engagement with research in rural/remote north Queensland locations. Participants The sample comprised nurses from two rural/remote areas within a regional health service. Methods A pre-test post-test intervention study with two levels of data collection: responses to Edmonton Research Orientation Scale administered 3 times to all nurses, and number of research proposals developed. This intervention comprised provision of face-to-face workshops, paper-based resources, and informal videoconference, email and telephone contact. Results Survey response rates varied from 56% to 34%. Two-thirds of respondents were over 40 years old; 75% were Registered Nurses. One quarter rated understanding of journal articles as poor or very poor and 50% rated their knowledge of research similarly. However, 50% said research had changed the way they practiced. Older nurses, nurses with tertiary qualifications and those with senior appointments had more positive orientation to research scores. Several locally relevant research proposals were developed from one site; two received internal funding for further development and implementation. The intervention also led to increased utilisation of library resources which has continued past this study's end. Conclusions The variation in uptake between sites reinforces the need for locally targeted support. This study has gone beyond measuring research utilisation by including evaluation of support mechanisms to engage nurses in developing research proposals.

Australian-trained doctors are often reluctant to work in rural and remote areas and overseastrained doctors (OTDs) are recruited to practise in many rural Aboriginal medical services. This paper focuses on recent research carried out in Australia to analyse factors affecting OTDs? professional, cultural and social integration and examine their training and support needs. Ten case studies were conducted throughout Australia with OTDs, which also included interviews with spouses/partners, professional colleagues, co-workers, and Aboriginal and Torres Strait Islander community members associated with the health service. Key themes emerging from the data across all informants included the need to better address recruitment, orientation and cross-cultural issues; the importance of effective communication and building community and institutional relationships, both with the local health service and the broader medical establishment.

Aboriginal people in remote Australian communities have limited opportunity to participate in the market economy. The Aboriginal arts and craft industry offers an important option to generate cash income and the sustained supply of native plants used in production is vital. We assessed the current harvest of a rainforest tree species commonly used for sculpture, Bombax ceiba. Information from field surveys, a regional rainforest inventory and sales figures from the Maningrida region were used to estimate the population size and structure of B. ceiba, the harvest intensity of patches and the economic value of the harvest. We estimate the density of B. ceiba to be 105.10±12.32 stems ha−1 and a regional population of 76615±14063 stems. A cumulative harvest over 20 years of 6% suggests approximately 4596 stems harvested, and the harvest was worth about $200,000 over the last three years. The majority (80%) of harvested stems coppiced and were suitable for harvesting. Logistic regression suggests both distance to outstation and township influence harvesting intensity, with some localised over-harvest. Rainforests provide a valuable resource to Aboriginal artists in Maningrida and their maintenance provides important conservation benefits to the Australian community.

Background The current American College of Cardiology (ACC) guidelines recommend that elective percutaneous coronary interventions (PCI) should not be performed in institutions without on-site cardiac surgery. We sought to determine the safety of PCI without cardiac surgical support on-site and specifically the safety of complex elective procedures. The results of the first 1000 procedures performed at our institution, which is a rural centre 80km from the nearest cardiac surgical facility, are reported. Methods Between September 2002 and April 2006 a total of 1000 procedures were performed in 893 patients at our institution. Patients included both high and low risk cohorts. Clinical and procedural outcomes were recorded and analysed. Results Of the 921 elective and 79 emergency primary PCI procedures performed, 1138 vessels were treated and 1429 stents deployed. A 95% procedural success rate was recorded. Complex PCI was performed with multi-vessel PCI in 13%, bifurcation PCI in 8%, chronic total occlusions (CTO) in 5%, saphenous vein graft interventions in 5%, unprotected left main interventions in 0.8% and rotational atherectomy in 0.8% of all procedures performed. Of the cohort, 75.3% of the lesions treated were either American College of Cardiology (ACC)/American Heart Association (AHA) type B or C lesions. In the primary PCI group, three deaths and three sub-acute stent occlusions occurred. In the elective group, the following major complications occurred: one death, three sub-acute stent occlusions, one case of contrast nephropathy requiring short-term dialysis, two cases of cardiac tamponade, two significant femoral pseudo-aneurysms and one misplaced stent. Acute myocardial infarction occurred in 21 patients. There were no urgent transfers for CABG surgery to salvage a complication of PCI. Conclusion PCI including high risk elective procedures can safely be performed without on-site cardiac surgery by experienced high volume operators.