Remote Australia Online

Two hypotheses have been advanced to explain the spatial patterning of service accessibility. The bureaucratic hypothesis holds that spatial inequalities are unpatterned and result from the application of decisions rules, while the competing political hypothesis suggests that politically-motivated decision making results in discriminatory outcomes. We use the example of the centralization of service provision in remote Indigenous communities in Australia's Northern Territory to show that these hypotheses may in fact be complementary. In recent years, government rhetoric about Australia's remote Indigenous communities has moved to focus on economic viability instead of social justice. One policy realization of this rhetoric has been the designation of ‘growth towns’ and ‘priority communities’ to act as service hubs for surrounding communities. The introduction of such hubs was examined and substantial inequality in access to service hubs was found. Inequality and overall system efficiency could be reduced with by optimizing the selection of hubs but the imposition of any hub-and-spoke mode in the study area was associated with racially-patterned patterned inequality of access. We conclude that when policy contexts are politically motivated, the application of racially-blind decision rules may result in racially-discriminatory spatial inequalities.

Objectives To develop culturally appropriate and effective strategies to reduce the risk from pandemic influenza (H1N109) in rural and remote Australian Aboriginal and Torres Strait Islander communities. Methods Participatory Action Research (PAR) approach that enabled communities and researchers to work together to develop understanding and take action to reduce risk. Results The H1N109 pandemic raised deep concerns and serious issues in all of the Aboriginal and Torres Strait Islander communities involved in this project. The participants expressed distrust and scepticism in relation to current Australian health policies on containment and told the researchers that specific plans for Aboriginal and Torres Strait Islander peoples were needed. Respondents indicated that policies and plans had been developed without respectful engagement with communities. The strong and recurring themes that emerged from the PAR cycles were: the importance of family; ways of life and realities of living in response to influenza; and key messages to government and health services to focus on communication, understanding and respect. Conclusion The essential work of reducing risk of pandemic influenza with Aboriginal and Torres Strait Islander communities is not straightforward, but this project has highlighted a number of useful pathways to continue to journey along with communities. A number of strategies to reduce the spread of pandemic influenza in Aboriginal and Torres Strait Islander communities were identified. These strategies would make a good starting point for conversations with communities and health services. In Aboriginal and Torres Strait Islander communities the environment, community structures and traditions vary. Respectful engagement with communities is needed to develop effective policy.

Background: Rates of cardiovascular disease and renal disease in Australian Aboriginal communities are high, as is the prevalence of some ‘traditional’ cardiovascular (CV) risk factors, such as diabetes and cigarette smoking. Recent work has highlighted the importance of markers of inflammation, such as C-reactive protein (CRP), homocysteine and albuminuria as predictors of cardiovascular risk in urban westernised settings. It is not clear how these factors relate to outcome in the setting of these remote communities, but very high CRP concentrations have been shown in this and other Aboriginal communities. Methods and results: In a cross-sectional survey including 237 adults in a remote Aboriginal community in the Northern Territory of Australia, we measured carotid intima-media thickness (IMT), together with blood pressure, diabetes, lipid levels, smoking and albuminuria, CRP and fibrinogen, serum homocysteine concentration, and IgG titres for Chlamydia pneumoniae, Helicobacter pylori and cytomegalovirus. Median carotid IMT was 0.63 [interquartile range 0.54–0.71] mm. As a categorical outcome, the prevalence of the highest IMT quartile (‘increased IMT’, ≥0.72 mm) was compared with the lower three quartiles. Increased IMT was associated in univariate analyses with greater waist circumference, systolic BP, fibrinogen and serum albumin concentrations, urine albumin/creatinine ratio and older age as continuous variables. Associations of increased IMT with some continuous variables were not linear; univariate associations were seen with the highest quartile (versus all other quartiles) of CRP and homocysteine concentration and CMV IgG titre. In a multivariate model age, smoking, waist circumference and the highest quartile of CRP concentrations (≥14 mg/l) remained significant predictors of IMT ≥0.72 mm. Conclusions: Measurement of carotid IMT was possible in this remote setting. Increased IMT (≥0.72 mm) was associated with increased CRP concentrations over a range that suggests infection/inflammation may be important determinants of cardiovascular risk in this setting. The associations of IMT with markers of renal disease seen in univariate analyses were explained in this analysis by confounding due to the associations of urine ACR with other risk factors.

Poor spatial access to health care remains a key issue for rural populations worldwide. Whilst geographic information systems (GIS) have enabled the development of more sophisticated access measures, they are yet to be adopted into health policy and workforce planning. This paper provides and tests a new national-level approach to measuring primary health care (PHC) access for rural Australia, suitable for use in macro-level health policy. The new index was constructed using a modified two-step floating catchment area method framework and the smallest available geographic unit. Primary health care spatial access was operationalised using three broad components: availability of PHC (general practitioner) services; proximity of populations to PHC services; and PHC needs of the population. Data used in its measurement were specifically chosen for accuracy, reliability and ongoing availability for small areas. The resultant index reveals spatial disparities of access to PHC across rural Australia. While generally more remote areas experienced poorer access than more populated rural areas, there were numerous exceptions to this generalisation, with some rural areas close to metropolitan areas having very poor access and some increasingly remote areas having relatively good access. This new index provides a geographically-sensitive measure of access, which is readily updateable and enables a fine granulation of access disparities. Such an index can underpin national rural health programmes and policies designed to improve rural workforce recruitment and retention, and, importantly, health service planning and resource allocation decisions designed to improve equity of PHC access.

Social support is a significant factor in the cancer patient's psychosocial wellbeing. This paper presents the findings ofrecent Queensland-based research that explored the experience of families returning home to the regional, rural and remote sector after a family member completed specialist treatment for a haematological malignancy and related blood disorder in a major metropolitan centre.Family and friends are the key resource persons providing support. To a large degree, this is because of the absence of alternative sources. Even support from health professionals can be problematic and for many the only source of support is the specialist centre many hundreds of kilometres away. The primary response to developing supportive services needs to be through person to person contact either via telephone or newsletter. If targeted appropriately, there is also evidence that educational programs, support groups and volunteers would be an effective medium for providing support. Educating the local health professionals (GPs and nurses) about haematological conditions is a logical extension of providing support to families.

As people living in remote areas rely on SPS systems for their electricity and water needs, they hold a practical and non-idealistic perspective towards using renewable energy technologies. This research explores pastoral owner-operators’ personal experience and opinion of stand-alone power supply (SPS) systems over 30years in remote pastoral regions Western Australia (WA). This research was undertaken qualitatively in terms of the experience of remote Australians of energy service delivery and SPS system performance to obtain personal opinions of remote pastoral people who rely on SPS systems to provide basic needs. This research concluded that the impressive growth in total renewable energy capacity in remote off-grid SPS systems in WA is primarily due to subsidies that aim to fuel-switch to renewable energy sources. Despite this, other major reasons for the increases in renewable energy capacity are escalating conventional fuel costs, difficulties in attracting qualified service contractors, increasing desire for quiet, 24-h energy services, and a range of unique situations. Despite the increased use of renewable energy technologies, this research reinforced previous research conclusions that consistently found both the conventional and renewable energy service sector wanting in remote areas. Three areas needing attention to sustain the growth in renewable capacity are: technical SPS system integration, service infrastructure, and technical reliability.

In 1996 Hegney published a seminal review of the literature concerning the status of Australian rural nurses. This article updates and expands that original paper by reporting on an integrative review exploring the same topic area between the years 1996 and 2008. Findings show that definitions of rural nursing are now integrated with those of remote nursing on a continuum of distance and contextual difference. The role and function of rural nurses is examined, along with a discussion of the importance of a primary health care approach in meeting community needs. The influence of social determinants of health is explored in this context. The culture of rural health workplaces in relation to the role and function of rural nurses is also a feature of this review. Research into the rural nursing workforce and, in particular, the recruitment and retention of staff are examined, with the high attrition rate of new or novice rural nurses pinpointed as a common theme in these studies. Important legislative changes that have affected rural nursing practice are also identified. This article concludes with a discussion of the latest research into Australian rural nursing, focusing on education in rural universities and the potential to develop new or novice nurses through the development of supportive relationships.

In this chapter Meg Mooney reflects on her work firstly as literature production coordinator for the bilingual education program at Pintupi-Luritja schools, and then some years later supporting two-way science education programs in a number of Central Australian communities including Papunya, Haasts Bluff and Mt Liebig in the Pintupi-Luritja region. The events, which took place in the late 1980s and then between 2009 and 2014, are retold as anecdotal, almost poetic episodes. They focus on successful Indigenous Language and Culture (ILC) activities which were supported by committed local Aboriginal staff and school principals. Meg also touches on the future for materials created during the bilingual education program.

Aim To investigate the acceptability and satisfaction with the Aboriginal Community Antenatal Program by staff in the program and partner agencies. Design A Strengths, Weaknesses, Opportunities and Threats framework guided the research and data collection methods. Mixed methodology was used, accessing qualitative and quantitative information from data bases, program and supporting agency staff. Quantitative data were analysed through a social sciences statistical package. Qualitative data were identified through questionnaires and analysed using thematic analysis. Setting Remote Aboriginal communities in the Goldfields region of Western Australia. Participant sources Twenty two participants including program and supporting agency staff. Main outcome measures This study measures acceptability and satisfaction of program antenatal and pre-conception activities by program staff and partner agencies. Results Qualitative results indicate acceptability and satisfaction with the program, identifying a range of organisational, staffing, cultural and interagency issues relating to a model of service provision. Quantitative data suggested positive program outputs from service delivery. Conclusion Findings suggest the Aboriginal Community Antenatal Program and partner agencies are increasing provision of community based pre-conception and antenatal health services and enhancing collaboration between a range of health provider agencies, with partnerships between Aboriginal and non-Aboriginal program staff contributing to an emerging model of community antenatal care.

There is compelling evidence for the success of the “rural pipeline” (rural student recruitment and rurally based education and professional training) in increasing the rural workforce. The nexus between clinical education and training, sustaining the health care workforce, clinical research, and quality and safety needs greater emphasis in regional areas. A “teaching health system” for non-metropolitan Australia requires greater commitment to teaching as core business, as well as provision of infrastructure, including accommodation, and access to the private sector. Workforce flexibility is mostly well accepted in rural and remote areas. There is room for expanding the scope of clinical practice by non-medical clinicians in both an independent codified manner (eg, nurse practitioners) and through flexible local medical delegation (eg, practice nurses, Aboriginal health workers, and therapists). The imbalance between subspecialist and generalist medical training needs to be addressed. Improved training and recognition of Aboriginal health workers, as well as continued investment in Indigenous entry to other health professional programs, remain policy priorities.

Introduction Relatively few psychiatrists live and work in rural South Australia. The rural GP is an essential component of support for people with mental health problems. However, considerable GP maldistribution between rural and metropolitan Australia still exists. Thus, accessing health services, including medication, becomes challenging for rural communities. Extending mental health nurse prescribing could be a strategy to build additional capacity to complement the GPs and psychiatrists who practice in rural South Australia. Until now, no studies have examined mental health workers’ attitudes towards nurse prescribing in rural Australia. Objective To examine the attitudes of rural and remote South Australian mental health workers about mental health nurse prescribing. Design/method A cross-sectional survey assessing mental health workers’ attitudes to mental health nurse prescribing. Setting The study was conducted across South Australia, excluding metropolitan Adelaide. Participants Mental health workers employed by the Country Health South Australia Local Health Network for Mental Health. Results Of the 289 potential participants, 93 (32%) responded and were included in this study. All the respondents reported positive attitudes towards mental health nurse prescribing. However, they expressed concerns about safety, educational preparation and supervision structures. Conclusion The attitudes of rural South Australian mental health workers are not a barrier to mental health nurse prescribing. The implementation and sustainability of mental health nurse prescribing will require additional staff training in psychopharmacology and a governance framework to assure quality and safety. Policy-makers need to focus their attention on the uptake of mental health nurse prescribing in parts of Australia that struggle to attract and retain psychiatrists.

We use a 31 year dataset to assess the effects of resources (rainfall, soil, relief) and disturbance (cattle browsing and fire) on regeneration and growth in a long-lived tree Acacia peuce from arid inland Australia. Temporal and spatial resource availability had an overwhelming effect on recruitment and stand density; but cattle browsing and fire limited sapling growth and stand persistence, respectively. Seedling establishment over the 31 years was effectively confined to a single prolonged high rainfall phase. Cattle browsing in productive (run-on) patches kept saplings short; while long-fenced and low cattle-use (run-off) patches provided spatial escape opportunities for sapling growth. Fire caused the death of standing plants, but it did not stimulate recruitment, and was therefore an additional limiting factor for stand persistence. Our study provided further support for the central role of prolonged large rainfall events for regeneration in long-lived arid trees, but it also emphasised how disturbance can strongly limit stand regeneration. Overall, we expect that desert trees such as Acacia peuce that are characterised by slow population dynamics will be adversely affected by climate change due to increasingly rare recruitment. Minimisation of disturbance factors will be an increasingly important requirement for the long-term persistence of this species.

Adaptation to climate change and mitigation of the rising costs of electricity are key incentives for improving building energy efficiency. The need is particularly acute in remote communities in Far North Queensland and Central Australia. Electricity is expensive, incomes are relatively low and maintenance services are difficult to access. At the same time buildings have to provide an environment that is safe and productive while coping with extremely challenging climates. We report eight case studies that investigated community buildings and their associated electricity consumption, temperatures and relative humidities over a nine month period. The study focused on two building construction types: i) concrete block and ii) steel frame, in the hot arid and hot humid climate zones of northern Australia. Key findings are described relating to i) improving building thermal efficiency, ii) reducing the electricity consumption by appliances, particularly standby consumption, iii) the potential for adapting the energy efficiency rating tool AccuRate for use in remote communities in arid and tropical northern Australia.

This paper presents an analysis of the perceptions and actions of five Information Communication Technology (ICT) Education lecturers, at the University of New England (UNE), concerning issues associated with the online teaching to students in rural and remote areas. The authors reflect upon the strategies that support these models and discuss how these may in turn provide students with firsthand experiences to develop transferable skills and knowledge to create their own motivating and engaging online learning activities and environments.

Arid birds are known to be highly responsive to spatio-temporal changes in food and water availability, and it is thought that this ‘resource tracking’ will obscure predictable patterns of community structure. Here we examine this resource hypothesis by assessing assemblage structure of birds in relation to landscape-scale environmental variation in the Finke bioregion of arid inland Australia, during an exceptionally high and extended rainfall period. We surveyed 197 sites stratified according to land system, run-off/run-on elements and distance to water, and recorded 106 resident and nomadic species. Cluster analysis produced five assemblages, four of which could be readily linked to a specific habitat type. Constrained ordination (CCA) was carried out using 38 variables that measured environmental gradients, vegetation attributes, food and water availability, and disturbance level. Species patterns correlated most strongly with vegetation variables (woodland, chenopod, grassland, and % mulga cover), and % weed cover. By contrast resource variables (flowering, fruiting, and water proximity), introduced herbivores, and most structural variables were poor predictors of species presence. Thus, we showed that resource availability and grazing disturbance are not major drivers of Australian arid bird assemblage patterns. Instead, patterning relates more to the interaction between bird foraging behaviour and breeding requirements and vegetation assemblages.

This paper draws upon Hubbard's (1999, p. 57) term ‘scary heterosexualities,’ that is non-normative heterosexuality, in the context of the rural drawing on data from fieldwork in the remote Western Australian mining town of Kalgoorlie. Our focus is ‘the skimpie’ – a female barmaid who serves in her underwear and who, in both historical and contemporary times, is strongly associated with rural mining communities. Interviews with skimpies and local residents as well as participant observation reveal how potential fears and anxieties about skimpies are managed. We identify the discursive and spatial processes by which skimpie work is contained in Kalgoorlie so that the potential scariness ‘the skimpie’ represents to the rural is muted and buttressed in terms of a more conventional and less threatening rural heterosexuality.

Cape York Peninsula's iconic status relies on its world-class landscapes and continuity of Indigenous occupation. Contests between economic, environmental, cultural and social interests have not considered valuations of ecosystem services. This first valuation of Cape York's ecosystem services asks the question: who is winning and where? The total ecosystem services value of Cape York is estimated conservatively to be AUD $130 billion per year. The value for each biome ranges from $0ha−1y−1 in ‘non-remnant’ areas, to $602,000ha−1y−1 for coral reefs. Ecosystem services value is comparable to the region's largest industry, bauxite mining. Mining has produced great benefits to the economy, but local communities remain disadvantaged, receiving a fraction of the ecosystem services value, estimated to be worth $120 M. The productivity of grazing lands is $18ha−1y−1, compared to the ecosystem services value of at least $3,300ha−1y−1. We argue that the high ecosystem services value of Cape York is because of Indigenous land management over millennia. Since the disenfranchisement of Indigenous people, ecosystems of northern Australia have suffered significant land degradation. A policy framework is required that acknowledges the value of ecosystem services and also incentivizes the cultural ecosystem services of Cape York.

Background Since the National Maternity Services Review, non-medical models of care involving midwives as the primary care giver are gaining prominence in urban settings in Australia. However, there remains a paucity of evidence about which non-medical primary maternity care models are best suited for rural and remote communities. Aim We investigated the perceptions, acceptability and barriers and enablers to the delivery of non-medical primary maternity care models in Far West NSW, as an example of remote Australia. Methods We purposively sampled and invited 24 clinicians and/or policy makers to an in-depth interview via the phone or face-to-face. Quantitative items were coded and analysed descriptively, whereas qualitative responses were analysed for thematic content via two independent authors. Results Of 16 eligible participants, 14 consented to participate and were very experienced practitioners from a range of roles and settings. There was strong agreement that evidence supporting non-medical models of care was relevant to the remote context in Far West NSW. Participants reported that pregnant women and health service partners would find midwifery-led care very acceptable and that team models would be the easiest to deliver in their setting. Reported barriers and enablers for the delivery of midwifery-led care conversely reflected each other and emphasised the need for retention of local maternity staff to provide continuity of care. Conclusions Local health service partners are demonstrably ready for further local improvement in providing midwifery-led models of maternity care to women who live in very remote communities in NSW, Australia.

Cover and survivorship of perennial chenopods, Atriplex vesicaria and Maireana astrotricha, declined markedly during a prolonged dry period at Roxby Downs in arid South Australia. Despite their resilience to browsing in favourable seasons, only 2% of the A. vesicaria shrubs browsed heavily by cattle survived the drought. M. astrotricha exhibited greater drought survivorship, although the post-drought cover retention in browsed shrubs was only half that of unbrowsed controls. Survivorship was highest for unbrowsed chenopods growing in moisture-enhanced run-on or dune-base environments. Maintenance of these patchy areas with reduced water-stress is hence important for the persistence of browsed chenopod shrublands. Light browsing by either European Rabbits (Oryctolagus cuniculus) or Greater Stick-nest Rats (Leporillus conditor) had no measurable impact upon chenopod survivorship.

Indigenous Australians living in remote areas have little access to the Internet and make little use of it. This article investigates the various dimensions of Internet take-up in remote Indigenous communities in Australia and considers the implications for broadband policy. It focuses specifically on the circumstances and experiences of three remote Indigenous communities in central Australia. Residents in these communities provided significant insight into the social, economic and cultural aspects of communications access and use. This evidence is used to examine the drivers and barriers to home Internet for remote Indigenous communities and to discuss a complex set of issues, including: the dynamics of remote living, economic priorities, cultural engagement with technology, and the characteristics of domestic life in remote Indigenous communities.

This paper reports on the design and successful field testing of a photovoltaic (PV)-powered desalination system. The system described here is intended for use in remote areas of the Australian outback, where fresh water is extremely limited and it is often necessary to drink high salinity bore water. A hybrid membrane configuration is implemented, whereby an ultrafiltration (UF) module is used for removing particulates, bacteria and viruses, while a reverse osmosis (RO) or nanofiltration (NF) membrane retains the salts. The concepts of water and energy recovery are implemented in the design. Field trials, performed in White Cliffs (New South Wales), demonstrated that clean drinking water was able to be produced from a variety of feed waters, including high salinity (3500 mg/l) bore water and high turbidity (200 NTU) dam water. The specific energy consumption ranged from 2 to 8 kW h/m3 of disinfected and desalinated drinking water, depending on the salinity of the feed water and the system operating conditions. The optimum operating pressure when filtering bore water was determined to be in the range 6–7 bar.

In order to provide safe drinking water in isolated communities where water supply and electrical infrastructure is limited, a system combining solar energy and advanced water treatment technology (a two-staged membrane process with ultrafiltration followed by nanofiltration/reverse osmosis (NF/RO)) has been developed. The objective of this study is to model the speciation of commonly-occurring and sometimes health-threatening trace contaminants, and then to evaluate the impact of speciation on fluoride, arsenic, and magnesium retention by NF/RO. A series of experiments were performed in central Australia in late 2005 to assess elemental retention with four different membranemodules (BW30, ESPA4, NF90, and TFC-S) at various pH values between 3 and 11 at two different source waters (Pine Hill Station and Ti Tree Farm). The removal of fluoride and arsenic was observed to be independent of pH, while magnesium removal is pH dependent. Compound speciation is considered to explain dependence observations. Membrane type was found to impact retention. The results obtained in this study will provide valuable information on the reliability and the optimization windows of the renewable energy powered desalination system that has been developed.

Over the last decade there has been at best limited implementation of preventive interventions for vulnerable Aboriginal and Torres Strait Islander children and their families in remote communities of northern Australia despite growing involvement in the child protection system. This paper describes challenges for services seeking to engage parents who are subject to child protection measures. Brief case studies from an early intervention program in a remote community illustrate that responsiveness and continuity of engagement of parents over time is a necessary basis for an integrated approach to meeting the needs of vulnerable children and families in very remote settings.

We describe a robust methodology to detect and estimate the size of temporary wetlands using AVHRR satellite data within large areas (106km2) of the arid zone. The methodology uses spectral matching and exclusion of salt surfaces to discriminate between water and non-water surfaces. The status of 115 lakes was used to evaluate the methodology. A classification accuracy of 98% was achieved for wetlands >120ha, with accuracy of area estimates varying with the size and shape of individual lakes. Spectral matching of AVHRR data has methodological and cost advantages over the use of higher spatial resolution data for understanding changes in the distribution of water at broad scales.

Camp dogs in indigenous communities in the Western Australian Kimberley Region, share the domestic environment with humans and have the potential to act as carriers of, and sentinels for, a wide range of zoonotic agents, including intestinal parasites and antimicrobial resistant bacteria. In this study, we investigated the carriage of extended-spectrum-cephalosporin-resistant (ESC-resistant) Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA) and species of hookworm and Giardia among camp dogs in remote Western Australian Aboriginal communities. A total of 141 canine faecal samples and 156 nasal swabs were collected from dogs in four communities of the Western Australian Kimberley region. Overall, ESC-resistant E. coli was detected in 16.7% of faecal samples and MRSA was isolated from 2.6% of nasal swabs. Of most significance was the presence of the community-associated Panton-Valentine leucocidin (PVL)-positive MRSA ST93 and ST5 clones and ESC-resistant E. coli ST38 and ST131. The most prevalent zoonotic intestinal parasite infection was Ancylostoma caninum (66%). The prevalence of Giardia was 12.1%, with the main genotypes of Giardia detected being dog specific assemblages C and D, which are unlikely to cause disease in humans.