Remote Australia Online

Background Despite multiple risk factors for neurodevelopmental vulnerability, few studies have assessed neurodevelopmental performance of Australian Aboriginal children. An important risk factor for neurodevelopmental vulnerability is prenatal alcohol exposure (PAE), which places children at risk for Fetal Alcohol Spectrum Disorder (FASD). Aims This study assesses neurodevelopment outcomes in a population of Australian Aboriginal children with and without PAE. Methods and procedures Children born in 2002/2003, and living in the Fitzroy Valley, Western Australia between April 2010 and November 2011, were eligible (N=134). Sociodemographic and antenatal data, including PAE, were collected by interview with 127/134 (95%) consenting parents/caregivers. Maternal/child medical records were reviewed. Neurodevelopment was assessed by clinicians blinded to PAE in 108/134 (81%) children and diagnoses on the FASD spectrum were assigned. Outcomes and results Neurodevelopmental disorder was documented in 34/108 children (314.8 per 1000). Any diagnosis on the FASD spectrum was made in 21/108 (194.4 per 1000) children (95% CI=131.0–279.0). Conclusions and implications Neurodevelopmental impairment with or without PAE is highly prevalent among children in the Fitzroy Valley. Rates of diagnoses on the FASD spectrum are among the highest worldwide. Early intervention services are needed to support developmentally vulnerable children in remote communities.

This report explores ‘deficit discourse’ in Aboriginal and Torres Strait Islander health policy. ‘Discourse’, in this context, encompasses thought represented in written and spoken communication and/or expressed through practices. The term draws attention to the circulation of ideas, the processes by which these ideas shape conceptual and material realities, and the power inequalities that contribute to and result from these processes. ‘Deficit discourse’ refers to discourse that represents people or groups in terms of deficiency – absence, lack or failure. Our aim with this report is to provide the groundwork both for further analysis in this area, and for challenging and ‘changing the conversation’ about the health and wellbeing of Australia’s First Peoples. The main analytical method used was critical discourse analysis – a form of linguistic deconstruction that aims to reveal the interconnections between language, power and ideology. This method highlights the role of language and associated thought in producing and challenging social inequality. The discussion in this report draws attention to the role of discourse in shaping how we imagine ourselves and others, and the relations between us, and in defining what can be thought, said and acted upon. It appears likely that deficit discourse impacts on the health and wellbeing of Aboriginal and Torres Strait Islander people in multiple ways. It contributes to forms of external and internalised racism, and shades out solutions that recognise strengths, capabilities and rightsI. n this report we have paid particular attention to deficit statistics, such as in the Closing the Gap agenda. We argue that deficit data has been used for politically diverse purposes, including by Aboriginal and Torres Strait Islander advocates to highlight injustice and hold governments to account. However, divorced from context and frequently reiterated, such statistics can also form a narrative that homogenises and dehumanises Aboriginal and Torres Strait Islander people into an intractable ‘problem’ to be ‘dealt’ with. Worse, they can form part of a narrative that situates responsibility for inequalities wholly with Aboriginal and Torres Strait Islander people themselves, obscuring the ways entrenched structural inequalities are affecting health. At the same time, policy itself is far from monolithic: it incorporates a range of views, is often ‘discursively aware’, and exists in a state of flux and contestation. It demonstrates a tension between a desire to ‘fix’ the ‘Indigenous other’ according to a normative non-Indigenous ideal, and more sophisticated understandings of the roles that factors such as language, country and community control play in health outcomes.

This report explores strengths-based approaches to shifting the deficit narrative in the Australian Aboriginal and Torres Strait Islander health sector. There is evidence that deficit discourse has an impact on health itself — that it is a barrier to improving health outcomes. This report is the result of desk-based research, carried out over six months at the Australian National University’s National Centre for Indigenous Studies. There are some serious barriers to implementing strengths-based models of development for Aboriginal and Torres Strait Islander health. These include: (a) an often broad, weak or ill-defined conceptual base for research, policy and program design; (b) a tendency in the grey literature in particular to use platitudes or to ‘pay lip service’ to strengths-based ideation; and (c) a real paucity of strong qualitative evaluation. This includes a lack of formative evaluation design. In addition, there is almost a complete lack of evaluation of actual impact on discourse itself and, in turn, on Aboriginal and Torres Strait Islander health outcomes. Similarly, we found no evaluation techniques specifically designed to measure or demonstrate shifts in the discourse around Aboriginal and Torres Strait Islander health. We have identified two ‘successful’ justifications for using strengths-based approaches to influence a change in the narrative of Aboriginal and Torres Strait Islander health: the utilitarian approach and the binary approach. In certain circles there is an increasing awareness of strengths-based approaches and we are hopeful that such approaches will continue to be critically explored, developed and implemented, and that recognising the rights, culture, diversity and strengths of Australia’s First Peoples will become the norm.

Objective: To assess the use, effectiveness and acceptance of prescribed contraception in three remote Western Australian Aboriginal communities. Participants and design: Mixed method study, including retrospective file review of contraception methods for 566 regular female Aboriginal patients, 1 November 2010 – 1 September 2014, and semi-structured interviews with 20 Aboriginal women. Setting: Primary care clinics in three remote Aboriginal communities. Main outcome measures: Number of episodes of contraceptive use, effectiveness and continuation rates of prescribed contraceptive use; personal experiences, attitudes towards and beliefs about contraception options. Results: 34% of women had used contraception, ranging from 15% of women aged younger than 15 years to 55% of women aged 15–19 years. The most common forms of contraception at the census date were long-acting reversible contraceptives (LARCs): 77% of women using contraception had an etonogestrel implant and 7% had depot medroxyprogesterone. Etonogestrel continuation rates at 1, 2 and 3 years were 87% (95% CI, 81–92%), 72% (95% CI, 64–78%) and 51% (95% CI, 41–60%) respectively. Medroxyprogesterone depot continuation at one year was only 14% (95% CI, 8–22%). Social acceptance of the etonogestrel implant was high; no concerns were raised about stigma or unwanted attention related to implant use. Conclusion: The high uptake of LARCs in these communities is consistent with international recommendations about contraception use. High acceptability was reflected in excellent continuation rates. Service delivery models that use community engagement and capacity building are recommended for broadening the focus of sexual health beyond sexually transmitted disease detection and management, giving priority to the reproductive rights and unmet needs of Aboriginal women.

Over the last decade, very remote Northern Territory has seen significant improvement in participation, retention and completion rates of Aboriginal and Torres Strait Islanders in vocational qualifications. The number holding a certificate qualification increased fourfold in the period from 2001 to 2011 while employment only increased by 10 per cent. This is despite increased attention to equipping people with necessary foundation skills through language literacy and numeracy and employability skills programs. Recent strategic policy interventions emphasise the importance of collaboration between training and employment service providers to improve outcomes for clients. The theory is that collaboration should reduce duplication of services, make service provision more efficient, and provide a seamless pathway for clients into employment. This paper presents two case studies of programs which, through service provider collaboration, aimed to improve the capacity of remote Aboriginal jobseekers to engage with and secure employment. Drawing from data obtained through the programs by researchers from Batchelor Institute, they demonstrate how collaboratively engineered pathways work or fail. Having tested assumptions about engineered pathways and collaboration to improve remote labour force participation, the paper concludes with implications for provision of job services and training in remote Australia.

Indigenous Australians suffer significant disadvantage in health outcomes and have a life expectancy well below that of non-Indigenous Australians. Mortality rates of Indigenous Australians are higher than that of Indigenous populations in developed countries elsewhere in the world. A number of parasitic diseases which are uncommon in the rest of the Australian population contribute to the high burden of disease in many remote Indigenous communities. High rates of infection with enteric parasites such as Strongyloides stercoralis, hookworm and Trichuris have been recorded and infection of the skin with the ecto-parasitic mite Sarcoptes scabiei is also a substantial problem. Secondary infection of scabies lesions, including with Staphylococcus aureus and group A Streptococcus, can produce serious sequelae such as rheumatic fever and post-streptococcal glomerulonephritis. Transmission of many parasites in many remote communities is facilitated by overcrowded living conditions and infrastructure problems which result in poor sanitation and hygiene. Improvements in environmental health conditions must accompany medical initiatives to achieve sustainable improvement in the health of Indigenous Australians.

The present study sought to understand the rural and remote influences on people’s identification of, and response to, mental health problems. Twenty-two key informants living in northern and western South Australia were interviewed. They included mental health and generalist health professionals, other human service workers and mental health consumers. Three themes are reported here: reluctance to acknowledge mental health problems and the avoidance of appropriate help; stigma and the avoidance of mental health services; and the influence of rural and remote circumstances. Most informants considered that many mental health problems were amenable to help from generalist workers, with backup support from mental health specialists. Informants thought this intervention to be appropriate because a common view of mental health problems as ‘insanity’ and a culture of self-reliance created a reluctance to seek help from a mental health specialist. These themes need to be taken into account when designing mental health interventions for rural and remote communities.

Background The vast majority (>75%) of Aboriginal people in the Northern Territory (NT) live in remote or very remote locations. Children in these communities have high attendance rates at local Primary Health Care (PHC) centres but there is a paucity of studies documenting the reason and frequency of attendance. Such data can be used to help guide public health policy and practice. Methods and Findings Clinic presentations during the first year of life were reviewed for 320 children born from 1 January 2001–31 December 2006. Data collected included reason for infectious presentation, antibiotic prescription and referral to hospital. The median number of presentations per child in the first year of life was 21 (IQR 15–29) with multiple reasons for presentation. The most prominent infectious presentations per child during the first year of life were upper respiratory tract infections (median 6, IQR 3–10 ); diarrhoea (median 3, IQR 1–5); ear disease (median 3, IQR 1–5); lower respiratory tract infection (median 3, IQR 2–5); scabies (median 3, IQR 1–5); and skin sores (median 3, IQR 2–5). Conclusions Infectious diseases of childhood are strongly linked with poverty, poor living conditions and overcrowding. The data reported in our study were collected through manual review, however many remote communities now have established electronic health record systems, use the Key Performance Indicator System and are engaged in CQI (continuous quality improvement) processes. Building on these recent initiatives, there is an opportunity to incorporate routine monitoring of a range of infectious conditions (we suggest diarrhoea, LRTI, scabies and skin sores) using both the age at first presentation and the median number of presentations per child during the first year of life as potential indicators of progress in addressing health inequities in remote communities.

Scabies is endemic in many Australian Aboriginal and Torres Strait Islander communities, with 69% of infants infected in the first year of life. Previous mass drug administration (MDA) programs using topical acaricides to decrease scabies prevalence have had varying degrees of success in Australia. We were invited by one community in eastern Arnhem Land to develop and deliver an oral-ivermectin MDA. Utilizing a before and after study design, we measured scabies prevalence through population census with sequential MDAs at baseline and month 12. Scabies prevalence fell from 4% at baseline to 1% at month 6, rising to 9% at month 12 in association with an identified exposure to a presumptive crusted scabies case. For new entries to the cohort at month 12 scabies prevalence was higher at 14%. We were able to demonstrate a reduction in scabies prevalence in the six months after each MDA with a low risk of acquisition (1–2%); however, a sustained reduction was not achieved.

This study examined dog and cat demographics, roaming behaviours, and interspecific interactions in a remote Aboriginal island community using multiple methods. Our results revealed temporal differences between the roaming behaviours of dogs, cats, and wildlife. Dogs showed crepuscular behaviour, being active around dawn (5:30 a.m. to 9:30 a.m.) and dusk (6:00 p.m. and 11:35 p.m.). The majority of cats were active between dawn (6:30 a.m.) and dusk (7:30 p.m.) and travelled shorter distances than dogs. However, some cats were also observed roaming between dusk and dawn, and were likely to be hunting since flightless wildlife were also recorded on our remote-sensing cameras during this time. These baseline data provide evidence to suggest that new management programs are needed to reduce the number of roaming cats and therefore their potential impacts on native wildlife. Collaborations between Aboriginal owners and other stakeholders is necessary to design innovative and effective animal management and policy on the island

The untimely death of an Aboriginal young person in 2016 highlighted community concern for stronger engagement with youth, demonstrated by the high rate of youth antisocial behaviour occurring in the community. These concerns resulted in the Kalgoorlie Youth Project (now named Guthoo, meaning we are one) which aims to describe the perceptions, experiences and aspirations of Aboriginal youth. It is the intent of Guthoo to contribute to a better understanding of the key drivers of youth disengagement in Kalgoorlie Boulder. Guthoo will benefit the community by providing knowledge that will contribute to a reduction in antisocial behaviour and align with the Government objectives of Safer Communities. This will flow onto longer term sustainable outcomes by building community-organisational capacity. A mixed methods research design using community participatory action research methods was used for the Guthoo Project and consisted of 3 stages: Stage 1– Instrument Development Stage 2– a) Pilot study of instrument b) Full scale study Stage 3– Dissemination with Youth Summit In April 2017, the Kalgoorlie Youth Project commenced using an art therapy workshop to understand and describe the lived experiences, perceptions and attitudes of Aboriginal young people’s current situation, future, barriers to services, aspirations and opportunities. The outcome was the development of a world first tool called Guthoo-meaning we are one. This tool was co-designed with Aboriginal youth and consists of a 170-item written survey measuring both the current experiences and the current needs of the young person across each of 12 key themes of individual and community well-being. Items were scored using a five-point Likert scale. An open-ended section was added to enable youth to describe: a) current life in Kalgoorlie-Boulder and, b) aspirations for the future. Guthoo was administered to the target population aged 11-17 years by trained Aboriginal Kinship Champions. In stage 2a, it was piloted, resulting in 66 completed surveys. Analysis and refinements were made for the full-scale study in stage 2b which resulted in 126 completed surveys. In sum, 192young people (11-17yrs) were surveyed, accounting for 71% of the estimated total population of Aboriginal young people 11-17 years2old in Kalgoorlie- Boulder. Refinements and consultation in the pilot resulted in the addition of the adapted Kessler 5 for use in the full-scale study (stage 2b). The Kessler 5 is a written survey using 5 items to determine current distress experiences. The Kessler scale is a widely used measure of mental health and wellbeing that allows comparison with other populations. Open-ended Guthoo survey responses were examined using thematic analysis as outlined by Colaizzi’s (1976) analysis principles. Quantitative data from demographics, Guthoo survey and Kessler 5 were analysed using simple descriptive statistics. KEY FINDINGS: 1. The Aboriginal young people of Kalgoorlie-Boulder recognise and value their identity as Aboriginal people; 2. The majority of Aboriginal young people have positive attitudes and aspirational goals for their future; 3. Aboriginal young people in Kalgoorlie-Boulder experience high levels of psychological distress; 4. Young people are concerned about anti-social behaviour in Kalgoorlie-Boulder; 5. Some Aboriginal young people are reluctant to use services in the region when they need them; 6. Aboriginal young people perceive a lack of interesting activities in Kalgoorlie-Boulder; 7. Aboriginal young people want to be treated with respect.

Objective: To investigate markers of reproductive health in a remote Indigenous community in Northern Australia. Methods: A retrospective, cross–sectional analysis of case notes of 342 women between the ages of 20 and 45 years, living in one community in a remote region of the Northern Territory. Results: The total rate of current infertility in the community was 26.3%; 8.2% for primary infertility and 18.1 % fa secondary infertility. An additional 3.3% of women had resolved infertility. Only 43% of the women had sought medical help for the problem. A history of ectopic pregnancy was recorded in 2.6%, stillbirth in 1.8%, miscarriage in 14.3% and neonatal death in 12.3%. Depot steroidal contraception or tubal ligation were used by 50% of the women but 45.9% used no contraception. A history of pelvic inflammatory disease (PID), T, vaginalis N. gonorrhoeae, genital C. trachomatis infection, syphilis or bacterial vaginosis was noted in 32%, 46%, 27%, 30%, 41% and 9% respectively. Current alcohol consumption was reported in 23% and cigarette smoking in 76%. In multivariate analysis, infertility was strongly associated with PID (adjusted OR 8.5), alcohol consumption (AOR 3.1), T. vaginalis (AOR 2.5), N. gonorrhoeae (AOR 2.2) and bacterial vaginosis (AOR 2.9). Conclusion: Reproductive health is poor in this community of Indigenous women, with endemic levels of STDs, PID and tobacco consumption. The absence of barrier contraception (e.g. condoms, diaphragms) has implications for HIV and STD control. Clinical and public health interventions are urgently required but the implementation of these is hindered by a number of structural, social and economic barriers.

Non-metropolitan Australia is diverse in terms of population density, educational experiences of the population, occupation and industries for employment. In addition to the issues associated with the vast distances between where some Australians live and large population centres where most educational infrastructure exists, there are other differences between metropolitan and non-metropolitan Australia. Rural adults are less likely to have completed secondary school, have post-school qualifications, participate in post-school education and training (especially personal enrichment programs), be an employee, be a professional and work in manufacturing, property and business services or finance and insurance. They are more likely to be older, have left school early, be unemployed or out of the labour force, work in small business, be self-employed or an employer, be a labourer or other low-skilled occupation and work in agriculture, forestry and fishing, mining, construction or tourism. Issues for vocational education and training in rural and remote Australia relate to training outcomes; access, equity and participation; and curriculum, delivery and assessment. Within each of the three categories there are issues for individuals and businesses, locations, and the policies and providers which make up the vocational education and training system. Seven key issues and associated questions for further research can be distilled from consideration of the existing body of research within the context of non-metropolitan Australia.

Contemporary diabetes management is a specialised area of health care and qualified health professionals in this country seeking employment as diabetes educators are first advised to undertake a postgraduate accredited Australian Diabetes Educators Association (ADEA) course. In 1998, aware that type 2 diabetes was a major health problem in the Aboriginal population, Flinders University opened its ADEA accredited course to Aboriginal health workers.This initiative was supported by the South Australian Aboriginal Health Partnership, and the Aboriginal Health Council of South Australia and, as a result, three cohorts of Aboriginal health workers (n=31) were funded to undertake the diabetes course between 1998 and 2001.This was the first time in Australia that health workers in large numbers had undertaken an accredited ADEA course that had been developed for registered nurses and allied health professionals. In view of the different educational background of the two groups, it was thought that the course may not meet the learning needs of Aboriginal health workers.Thus, a qualitative study using critical ethnography was undertaken in fourteen sites in South Australia. The aim was to identify the perceptions of the course held by the health workers who had undertaken the course and the supervisors whose responsibility it was to oversee their clinical activities. It also included establishing whether the course was relevant to the health care needs of Aboriginal people with diabetes in South Australia.The participant group was comprised from the health workers (n=18) who had undertaken the diabetes course and their supervisors (n=21). Data collection and analysis took place between 2001 and 2002.The instrument used was a semi-structured questionnaire. The methods included interviewing and tape recording, observation and fieldwork.The transcripts were thematically analysed and managed by using NVivo software.Three main themes emerged:the positive and negative perceptions of the course held by the participants, the development of the health workers as health professionals and the relevance of the course to the health care needs of Aboriginal people with diabetes.We concluded that other Schools of Nursing & Midwifery in Australia who offer ADEA courses might also enable Aboriginal health workers to access their courses. This contribution would greatly help improve the diabetes health status of Aboriginal people.

Palliative care is a service available to many Australians subject to location and varying criteria. This paper seeks to identify some of the issues that hamper the provision of this sophisticated service to Aborigines living in remote parts of the Northern Territory. The paucity of literary sources of information demonstrates the need for research to be carried out in this field.

Like many impoverished areas around the world, Aboriginal communities in Australia experience an unacceptably high burden of scabies, skin infections, and secondary complications. Young children are most at risk. Our study investigated scabies in a remote setting with very high rates of skin disease, a high level of household overcrowding, and limited infrastructure for sanitation and preventive health measures. We assessed uptake of scabies treatment and scabies acquisition following provision of treatment by a community-based skin program. In a household where scabies was present, we found that treatment with topical permethrin cream of all close contacts can significantly reduce a susceptible individual's risk of infection. Our findings also demonstrate the challenges of achieving a high level of treatment participation, with limited permethrin use observed among household contacts. This suggests an urgent need for a more practical treatment option. International efforts to reduce childhood morbidity and mortality have demonstrated the efficacy of numerous child health interventions but have also highlighted the deficits in their delivery and implementation. Experiences like this, where the effectiveness of a coordinated local program delivering an efficacious intervention is hampered by poor treatment uptake and ongoing transmission, are an important and timely message for researchers, program managers, and policy-makers.

Prevalence of skin sores and scabies in remote Australian Aboriginal communities remains unacceptably high, with Group A Streptococcus (GAS) the dominant pathogen. We aim to better understand the drivers of GAS transmission using mathematical models. To estimate the force of infection, we quantified the age of first skin sores and scabies infection by pooling historical data from three studies conducted across five remote Aboriginal communities for children born between 2001 and 2005. We estimated the age of the first infection using the Kaplan–Meier estimator; parametric exponential mixture model; and Cox proportional hazards. For skin sores, the mean age of the first infection was approximately 10 months and the median was 7 months, with some heterogeneity in median observed by the community. For scabies, the mean age of the first infection was approximately 9 months and the median was 8 months, with significant heterogeneity by the community and an enhanced risk for children born between October and December. The young age of the first infection with skin sores and scabies reflects the high disease burden in these communities.

This study examines the impact of travelling for treatment on cancer patients and their families. Twenty-eight consecutive cancer patients, who were receiving radiation therapy treatment and 19 family carers, completed a structured needs assessment questionnaire and an in-depth interview. Both patients and carers reported moderate to high levels of unmet psychological need. Carers were found to have higher levels of anxiety than patients, although both groups had higher anxiety levels than the general population. Taking more responsibility for household tasks and organising new living arrangements for the family were the most frequently identified demands of a dual burden of caring. Nearly 40% of carers reported some disruption to their schedule and half reported experiencing financial difficulties. The qualitative interviews highlight the disruption that parents and children experience under the present system, particularly in relation to the demands of family life and the need to maintain some level of continuity and security for children.

The Australian Government (AG) employs Indigenous Engagement Officers (IEO) in many of the remote Aboriginal communities of the Northern Territory (NT). IEOs are respected community members who apply their deep understanding of local tradition, language and politics in providing expert cultural advice to government. Competing priorities of workplace and cultural obligation make the IEO role stressful and dichotomous in nature. The workplace experiences and perceptions of IEOs remain largely unexplored and there is scant understanding of the significant crosscultural issues associated with the role. IEOs typically confront ongoing workplace stress and are unable to perform at full capacity. This qualitative study explores participant meaning regarding workplace and community roles to inform the AG in development of culturally appropriate training and support for IEOs. The study captures detailed information from six IEOs through an interpretive process sensitive to phenomenological experience. Personal meanings associated with the workplace are assembled through individual interviews and focus group sessions. Interpretative Phenomenological Analysis methodology is applied to the resulting idiographic dataset in exposing a range of superordinate themes including desire for recognition and feelings of abandonment. Findings reveal the need to incorporate correct cultural protocols in the workplace and give preference for Aboriginal learning styles in professional development activities. There is urgent need for a range of workplace supports for IEOs in future capacity-building strategies.

Torres Strait Islanders living in the Torres Strait region have the highest prevalence of Type 2 diabetes in Australia; more than three times the rate of other Australians. Abdominal obesity and insulin resistance are the main causes for these high rates of the disorder. Further, Aboriginal and Torres Strait Islanders diagnosed with diabetes have poorer glycaemic control and much lower rates of insulin use than non-Indigenous Australians diagnosed with Type 2 diabetes alongside extremely high rates of renal failure and other comorbidities. Interventions have been instigated in order to overcome these issues. Previously a simple recall system managed by local health workers achieved significant improvements in diabetes care, reduced diabetes-related hospitalisations by 40% and led to the implementation of a chronic disease register and recall system throughout the Torres Strait region. Nurses, Indigenous health workers and other health professionals play important roles in ensuring these interventions continue.

Poor environmental conditions and poor child health in remote Australian Aboriginal communities are a symptom of a disjuncture in the cultures of a disadvantaged (and only relatively recently enfranchised) minority population and a proportionally large, wealthy dominant immigrant population, problematic social policies and the legacy of colonialism. Developing effective health promotion interventions in this environment is a challenge. Taking an ecological approach, the objective of this study was to identify the key social, economic, cultural and environmental factors that contribute to poor hygiene in remote Aboriginal communities, and to determine approaches that will improve hygiene and reduce the burden of infection among children. The methods included a mix of quantitative and qualitative community-based studies and literature reviews. Study findings showed that a combination of crowding, non-functioning health hardware and poor standards of personal and domestic hygiene underlie the high burden of infection experienced by children. Also, models of health promotion drawn from developed and developing countries can be adapted for use in remote Australian Aboriginal community contexts. High levels of disadvantage in relation to social determinants of health underlie the problem of poor environmental conditions and poor child health in remote Australian Aboriginal communities. Measures need to be taken to address the immediate problems that impact on children's health—for example, by ensuring the availability of functional and adequate water and sanitation facilities—but these interventions are unlikely to have a major effect unless the underlying issues are also addressed.

This thesis is an ethnographic study of the ‘work’ ideologies inherent in a remote Australian Aboriginal community; Ngukurr in South East Arnhem Land of the Northern Territory. Formerly known as the Roper River Mission and established in 1908, it is today home to approximately 1000 Aboriginal inhabitants. Fieldwork for this project was conducted in three phases between 2006 and 2007 totalling seven months. The aim of this research was to gain an insight into the meaning and value of ‘work’ for Aboriginal people in Ngukurr. First, this involved acknowledging the centrality of paid employment to mainstream western ‘work’ ideology and its influence on my own, and other non-Aboriginal peoples, understandings and ways of being in the world. Through this recognition the historical and contemporary relationship between Aboriginal and non-Aboriginal people in the northern part of Australia, specifically the Roper River region, was found to be fundamentally shaped by labour relations and dominant western ‘work’ ideology. The influence of this ‘work’ ideology on Aboriginal people, expressed through the policies and practices of both Governments and Missions, is explored through an analysis of Aboriginal memories of ‘work’. Ambiguity in the meaning and value of ‘work’ is emphasised and elements of Aboriginal ‘work’ ideology, as distinct from dominant western work ideology, are explored. The influence of contemporary employment arrangements on Aboriginal understandings of ‘work’ is investigated and the sometimes problematic relationship between Aboriginal cultural beliefs and practices and those espoused by dominant western work ideology illustrated. In conclusion this research found that Aboriginal people in Ngukurr have a ‘work’ ideology that is distinct from its western counterpart. Shaped by unique historical, social and cultural phenomena it is not confined to the sphere of paid or formal employment. The multidimensional nature of contemporary Aboriginal ‘work’ ideology in Ngukurr suggests that overcoming high levels of unemployment in remote communities may not simply be about providing more ‘jobs’, training or education.

The objective of this paper is to document the knowledge and experiences of healthcare professionals and researchers in Australia about the barriers to controlling Strongyloides stercoralis in Australian Indigenous communities. Qualitative research methods were used to conduct in-depth semi-structured interviews, which were digitally recorded, transcribed, and participant-checked. Data were thematically analysed to identify significant themes. Five major themes were identified: 1) Barriers to health/treatment; 2) Access to healthcare; 3) Policy; 4) Learning opportunity; and 5) Ideas for intervention. The findings suggest that Australian Indigenous communities will continue to suffer increased morbidity and mortality due to a lack of control or prevention of Strongyloides stercoralis. Issues such as institutional racism, improvements to health promotion, education, socioeconomic determinants, and health care system policy and procedures need to be addressed. This study identifies several direct implications for Indigenous health: The need for increased knowledge and understanding of the risks to health for Indigenous community members; The need for prevention policy development for neglected tropical diseases in Indigenous communities; The need for increased knowledge and understanding of the treatment, diagnosis, and healthcare access concerning Strongyloides stercoralis for health professionals and policymakers who work within Indigenous health; The need to raise awareness of systematic institutional racism in the control and prevention of neglected tropical diseases in Indigenous communities; and The need for a health promotion framework that can provide the basis for multiple-level interventions to control and prevent Strongyloides in Indigenous communities.

In 1998 a telemedicine network was established in South Australia and the Northern Territory to deliver educational material to professionals working in child and adolescent mental health in remote areas. The network involved a wide range of health professions, from psychiatrists to psychologists and social workers. The first 12 months of network activity were evaluated by quantitative and qualitative techniques. Four sources of data were used: an activity log, questionnaires, interviews and action research. A total of 36 telemedicine sessions were held, ranging in duration from 45 to 90 min (average 56 min) and involving a total of 45 different professionals, who participated an average of four times each (range 1-15). The most common types of session were case discussions (47%), followed by specialist seminars (36%) and administrative and introductory sessions (17%). The benefits of the network included: networking and peer support; improved efficiency and reduced travel costs; and improved efficiency of health services. The problems included: costs; lack of access to technical support; and the need for staff induction and training.

Pregnant Aboriginal and Torres Strait Islander women are at particular risk of severe illness and high attack rates of influenza infection. In Australia, routine seasonal influenza vaccination is currently strongly recommended for all pregnant women and women planning pregnancy, and is provided free of charge for all pregnant women. We sought to determine vaccination coverage, describe the trends and characteristics associated with influenza vaccine uptake and determine the validity of self-reported influenza vaccination in a population of Indigenous pregnant women who were participants of a vaccine trial, prior to and during the 2009 H1N1 influenza pandemic. Vaccine coverage over the study period was 16% (35/214), increasing from 2.2% (3/136) in the period preceding the pandemic (2006–2009) to 41% (32/78) in the intra-pandemic period (2009–2010). Self-report was not a reliable estimate of verified vaccination status in the pre-pandemic period (κ=0.38) but was reliable in the intra-pandemic period (κ=0.91). None of the socio-demographic characteristics that we examined were associated with vaccine uptake. Whilst the increase in maternal influenza coverage rates are encouraging and indicate a willingness of pregnant Indigenous women to be vaccinated, the majority of women remained unvaccinated. Activities to improve influenza vaccination coverage for Indigenous pregnant women and monitor vaccine uptake remain a priority. Commun Dis Intell 2016;40(3):E340–E346