Remote Australia Online

Complicating dynamics: Adapting the Sustainable Livelihoods Framework to a remote Indigenous context in Australia

Access to mental health services within rural and remote Australia is limited, with increasing remoteness the availability of mental health professionals decreases (AIHW 2015).

Singing on country and singing for country

This paper presents the recent findings from a study on the postdiagnosis support needs of women with breast cancer living in rural and remote Queensland. The findings presented in this discussion focus on support needs from the perspective of the women experiencing breast cancer as well as health service providers. The tyranny of distance imposes unique hardships, such as separation from family and friends, during a time of great vulnerability for treatment, the need to travel long distances for support and follow-up services, and extra financial burdens, which can combine to cause strains on the marital relationship and family cohesion. Positive indications are, however, that the rural communities operate on strong, informal networks of support. This network of family, friends and community can, and does, play an active role in the provision of emotional and practical support.

Despite considerable efforts at the academic level to prepare student teachers for teaching Aboriginal students, most students persist with hegemonic approaches in their teaching upon graduation. One process which appears to have a major influence on attitudes towards teaching Aboriginal students is participation in a teaching practice in an Aboriginal community. In this paper student teacher perceptions of their experiences on such a practice are presented to illustrate the influence of the practice on their view of teaching Aboriginal students

Conducting research in centres remote from home has many risks associated with it. In this paper, these risks are described in relation to the events that occurred while a research project was being undertaken. The project involved researching community perceptions and attitudes towards involvement in a school in a small town in a remote part of Western Australia. Distance, cultural differences, communication difficulties, lack of knowledge of the community and personnel problems were some of the risks that were evident. The paper provides advice on strategies to avoid the risks that remote management of research entails, and examines literature related to the topic.

This article is a critical and creative discussion of Milpirri, the experimental Warlpiri ceremony produced in conjunction with Tracks Dance Company since 2005. It utilizes Warlpiri key words as a formal device to disrupt the ubiquity of English literacy and highlight the demands of translation. A radical Warlpiri initiative, Milpirri belies categorical definition. A complex, hybrid, multiplatform event, Milpirri is discussed as a highly strategic form of community attention, assemblage, and performance: a deeply embedded and embodied practice-base of activation and activism for at-risk Warlpiri knowledge, language, and heritage.

People living in rural and remote locations are disadvantaged in accessing palliative care. This can be attributed to several factors including the role diversity and the low numbers of patients with specific conditions, as well as the difficulties rural health practitioners have in accessing opportunities for professional education. A program of multidisciplinary palliative care video conferences was presented to health practitioners across part of northern Australia in an effort to address this problem.

Making Tracks and Visioning Journeys: Understanding further education pathways among remote and very remote Indigenous communities of the Northern Territory

Introduction: This paper describes the evaluation of an intermediate obstetric ultrasound and emergency medicine ultrasound education workshop for rural and remote Australian doctors, which was developed in response to an educational needs assessment that showed an unmet need in this area. The workshop was held in four Australian states. The participants were 61 rural and remote doctors. Methods: Data from pre- and post-workshop knowledge tests and general workshop evaluation were analysed. Results: Sixty-one doctors attended an ultrasound workshop and self-reported increases in knowledge, confidence and expertise in ultrasound. The mean pretest score for 56 doctors who completed both the pre- and post-workshop knowledge tests was 31.6 and the post-test score mean was 33.3 out of a possible score of 44, which demonstrated a statistically significant increase in knowledge (P=0.003). Discussion and implications for practice: The evaluation of the workshop demonstrated that it was an effective way of increasing knowledge and confidence in intermediate obstetric ultrasound and emergency medicine ultrasound. The workshop was popular and received very positive feedback from the attendees.

Objective:To review available national and State/Territory survey data on water supply and sanitation in remote Indigenous Australian communities and to discuss the findings in terms of priorities for health and infrastructure development. Methods:Descriptive analysis of data on relevant variables from available data sources. Results:All relevant published reports arose from only two data sources: the Community Housing and Infrastructure Needs Surveys, and from a Northern Territory-wide survey of community-owned dwellings. The data show that many communities do not have a reliable water supply and experience frequent and prolonged breakdown in sewerage systems. For example, 12% of communities of 50 people or more experienced five or more periods of water restrictions in a one-year period, and 10% of communities experienced sewage overflow or leakage 20 or more times in a one-year period. Items of basic household infrastructure regarded as essential for household hygiene are missing or not functional in many community-owned dwellings. For example, in about one-third of houses bathroom taps and toilet drainage required major repairs. Conclusion and Implications:Given the widely accepted importance of water and sanitation to health, the data support the contention that poor environmental conditions are a major cause of poor health in remote communities and provide some measure at a national level of the magnitude of the problem. Action to ensure easy access to adequate quantities of water and secure sanitation should receive greater priority. There is need for better quality information systems to monitor progress, equity and accountability in the delivery of water and sanitation services.

There has been a proliferation in the use of technology in people's lives, both for professional and leisure purposes. However, educational institutions have made limited use of technology for delivering courses. The use of print material and face-to-face modes remain predominant. Where technology is used it is mainly in non-interactive forms such as in the use of overhead projections, audio and video tapes and computer projections. As Sachs, Smith and Chant (1990, p.6) argue information in the form of a productive resource is as yet rarely exploited in mainstream tertiary education. In most cases video disc, texts on diskettes, authoring languages and interactive computer based programs remain things of life beyond the schools and higher education institutions. Teacher education programs in particular have been slow to take up the possibilities for alternative modes of program delivery that Information Technology (IT) now provides. Policy makers and administrators have failed to recognise schools and universities as workplaces that are in need of modernisation and re-equipping with the new learning technologies (backed up with necessary levels of training), if they are to provide the higher standards of learning and of pupil and teacher commitment to learning that are now expected (POST, 1991).In this paper we present information about the use of IT in tertiary education derived from a study of the first phase of the Remote Teacher Education Program (RATEP) project. The program was implemented in four Aboriginal and Torres Strait communities on Cape York Peninsular and Torres Strait during 1990 and 1991. We argue that in this project the potential for IT to be used as an instrument for teaching and learning was demonstrated. In its early stages the success of IT surpassed the expectations of most of those involved in the project for the delivery of course materials in what can only be described as very remote and difficult conditions with inexperienced tertiary students. In developing our argument we will focus on three issues as they emerged during the first year of the project: conceptualisation and design of technology based courses, interactive learning systems, pedagogy and the features of IT and RATEP pedagogy. However, before developing these issues we contextualise the study within teacher education and then briefly describe the aims and program characteristics of RATEP.

Footprints in Time: The Longitudinal Study of Indigenous Children (LSIC) is a national study of 1759 Australian Aboriginal and Torres Strait Islander children living across urban, regional and remote areas of Australia. The study is in its 11th wave of annual data collection, having collected extensive data on topics including birth and early life influences, parental health and well-being, identity, cultural engagement, language use, housing, racism, school engagement and academic achievement, and social and emotional well-being. The current paper reviews a selection of major findings from Footprints in Time relating to the developmental origins of health and disease for Australian Aboriginal and Torres Strait Islander peoples. Opportunities for new researchers to conduct further research utilizing the LSIC data set are also presented.

The small, decentralised communities, known as outstations which satellite larger Indigenous Australian remote communities have often been conceptualised as places that are beneficial to health and well-being. This paper provides an exploration of the meaning of their outstation for one family and the benefits that this connection brings to them, which are expressed in a deep connection to the land, continuing relationships with ancestors and a safe refuge from the stresses of the larger community. We argue that the outstation provides a place for people to be in control of their lives and form hopes and plans for the future. These benefits are position in a context where the future liveability and sustainability of the outstation is both fragile and vulnerable.

Objective: To assess the extent of diagnosed and undiagnosed pelvic inflammatory disease (PID) in Aboriginal women in remote central Australia. Design, setting and subjects: Retrospective cross-sectional study in five remote central Australian primary health care centres. Medical records of all resident Aboriginal women aged 14–34 years were examined. Data were from presentations with documented lower abdominal pain, excluding other causes, for 2007–2008. Main outcome measures: PID investigations undertaken, PID diagnoses made, recommended treatment, and presentations meeting the guideline criteria for diagnosing PID based on pelvic examination, symptom profile or history. Results: Of 655 medical records reviewed, 119 women (18%) presented 224 times with lower abdominal pain. Recommended investigations to diagnose PID were infrequently undertaken: bimanual examination (15 cases [7%]); testing for gonorrhoea and chlamydia (78 [35%]); and history taking for vaginal discharge (59 [26%]), intermenstrual bleeding (27 [12%]) and dyspareunia (17 [8%]). There were 95 presentations (42%) consistent with guidelines to diagnose PID, most (87 [39%]) based on symptom profile and history. Of these, practitioners made 15 diagnoses of PID, and none had the recommended treatment documented. Conclusion: Pelvic inflammatory disease occurred frequently among Aboriginal women in central Australia during the study period but was vastly underdiagnosed and poorly treated. Undiagnosed or inadequately treated PID leads to poorer reproductive health outcomes in the long term. Increased awareness of PID symptoms, diagnosis and treatment and a revision of the guidelines is needed to improve detection and management of PID in this high-risk setting.

In Australia, as in many parts of the world, Indigenous teenage girls are more likely than their non-Indigenous counterparts to fall pregnant as teenagers. Teenage parenthood can trigger a life-long cycle of disadvantage, starting with disengagement from school. These outcomes are often intergenerational. Teenage pregnancy can also be viewed as a turning point for young women and an opportunity to funnel greater investment into girls to change the typical outcomes. The Girl Academy School is a unique solution. Unlike other schools, it takes a holistic approach, providing girls with an opportunity to re-engage by living on campus with their child/children, learn how to parent as primary caregivers for their children in a supportive and nurturing environment, learn to live independently (e.g. learning nutrition and self-care), develop work skills through hands-on experience and vocational training, and support each other on their parenting journeys. Holistic, intensive solutions like this are necessary to gain traction and break the cycle of disadvantage.

Background: Sexually transmissible infection (STI) rates are persistently high in central Australia, creating conditions for a potential HIV pandemic in the area. There is a shortage of qualitative research examining the underlying factors affecting STI transmission in this region. The present study investigates Aboriginal women’s current levels of knowledge regarding STI and their transmission, perception of risk for STI, patterns of condom use, access to condoms and experiences of condom negotiation with their partners. It also explores the sociocultural context of their sexual health. Methods: The present study used qualitative methods with a semistructured questionnaire. Twenty-four women aged 18–35 years from one remote central-Australian Aboriginal community were recruited. Results: The results revealed poor understandings of STI transmission, limited access to condoms and low levels of condom use despite a high perception of risk to STI. They also identified specific issues facing these women regarding the sociocultural context of their condom use, their access to condoms and the transmission of STI. The perceived effects of alcohol abuse, infidelity, sexual assault and shame on the acquisition of STI were significant issues for the women. Conclusion: This research has identified an urgent need for further qualitative research into the sociocultural factors that facilitate the spread of STI among Aboriginal people of remote central Australia. Implications include the need to increase their knowledge regarding STI and STI transmission, to increase women’s access to condoms and to incorporate the teaching of skills to deal with sexual assault and violence into sexual-health education.

Gender disparities in testing rates for sexually transmitted infections (STIs) have been identified as one potential factor sustaining high rates of STIs and repeat infections in the Northern Territory of Australia, especially in remote Indigenous communities. The study aimed to investigate the reasons for these disparities utilising a mixed-method study design. We conducted an audit on client information at a remote community health clinic, focus-group discussions with young men in the same community and interviews with experienced remote area clinicians. The clinic audit found a significantly higher proportion of female residents of the community than males visited the clinic (72.8 versus 55.3%, p < 0.005). Women were also more likely to be tested for STIs than men when visiting the clinic (49.7 versus 40.3%, p = 0.015). Major barriers to men?s seeking STI testing included a sense of shame from being seen visiting the clinic by women, men?s lack of understanding of STIs and the need for testing, and inadequate access to male clinicians. Increasing men?s access to healthcare and STI testing requires offering testing at a gender-sensitive and separate locations, and community-based sexual health promotion to increase knowledge of STIs.

Rural and remote communities in Australia fare worse than their urban counterparts across major health indicators, with geographic isolation, restricted accessibility to health services, socioeconomic disadvantage, lifestyle and behavioural factors all implicated in poorer health outcomes. Health disparities, which are especially stark in Australian Aboriginal and Torres Strait Islander populations, underscore the urgent need to build a culturally responsive and respectful rural health workforce.

Study background Increasing cultural safety in health settings is essential to address stark health disparities between Indigenous and non-Indigenous Australians. Respect for cultural knowledge, better communication, and recognition of racism as a determinant of health are required for improved service delivery. How this knowledge is acquired in health professional training and translated to clinical settings is poorly understood.PurposeImpacts of an innovative Indigenous health unit and remote clinical placements on knowledge acquisition and attitude change were explored among midwifery students to inform cultural competency initiatives in health professional training.MethodsA multiphased, mixed methods research design used surveys, observations, and interviews. Qualitative analysis was strengthened through triangulation with quantitative data.ResultsA unit conceived with substantial Indigenous Australian input and which privileged these voices enhanced knowledge and shifted attitudes in a positive direction; however, immediate gains diminished over time. Remote placements had a profound effect on student learning. Exposure to Indigenous Australians in classrooms and communities, and the self-reflection generated, helped dispel stereotypes and challenge assumptions based on limited cultural knowledge and contact.ConclusionOptimization of receptivity to Indigenous Australian content and opportunities for remote placements contributed to students’ developing cultural capabilities with implications for all health professional training. Whether this heightened awareness is enough to address institutional racism identified in health service delivery remains unanswered. The focus must include those established health practitioners and administrators who influence organizational culture if real systemic change is to occur. Given appropriate on-going support, graduates can play a vital role in expediting this process.

Cultural immersion programs are increasingly offered to medical and health science students in an effort to provide experiential learning opportunities that focus on ‘the self’ as well as ‘the other’. Immersion programs encourage self-reflection on attitudes towards cultural differences, provide opportunities to build relationships and work with community members, and allow students to apply knowledge and skills learned in training programs in a supervised practice setting. The aim of this paper is to describe midwifery students’ reflections on a remote Aboriginal clinical placement that has been offered at a Western Australian university since 2010.

Objective To describe midwifery students' insights on promoting health to Aboriginal women in remote Australia following a supervised clinical placement. Design Semistructured, in-depth interviews were conducted with all midwifery students who undertook the placement between 2010 and 2013. Setting Aboriginal communities on the Ngaanyatjarra Lands, Western Australia. Participants Undergraduate and postgraduate midwifery students from a Western Australian university. Interventions Remote cultural immersion clinical placement. Main outcome measures Student learning related to culturally respectful health care delivery and promotion of health. Results Students observed that, despite vast distances, high rates of participation in a breast screening program were achieved due to the informal provision of culturally relevant information and support. Opportunistic encounters in communities also enabled sexual health messages to be delivered more widely and in less formal settings. The role played by Aboriginal Health Workers and female family members was vital. The importance of culturally respectful approaches to sensitive women's business, including discretion, the use of local language and pictorial representations of information, was recognised as was the socio-cultural context and its impact on the health and well-being of the community. Conclusions Although short in duration, the Ngaanyatjarra Lands clinical placement provided midwifery students with a rare opportunity to observe the importance of local contexts and cultural protocols in Aboriginal communities, and to adapt health promotion strategies to meet local needs and ways of doing things. These strategies embraced the strengths, assets and capacities of communities, yet students also witnessed challenges associated with access, delivery and acceptance of health care in remote settings.

Introduction In remote Aboriginal communities in Australia, scabies affects 7 out of 10 children before their first birthday. This is more than six times the rate seen in the rest of the developed world. Scabies infestation is frequently complicated by bacterial infection, leading to the development of skin sores and other more serious consequences, such as septicaemia and chronic heart and kidney diseases. Tea tree oil (TTO) has been used as an antimicrobial agent for several decades with proven clinical efficacy. Preclinical investigations have demonstrated superior scabicidal properties of TTO compared with widely used scabicidal agents, such as permethrin 5% cream and ivermectin. However, current data are insufficient to warrant a broad recommendation for its use for the management of scabies because previous studies were small or limited to in vitro observations.Methods and analysis A pragmatic first trial will examine the clinical efficacy of a simple and low-cost TTO treatment against paediatric scabies and the prevention of associated secondary bacterial infections, with 1:1 randomisation of 200 participants (Aboriginal children, aged 5–16 years and living in remote Australia) into active control (permethrin 5% cream) and treatment (5% TTO gel) groups. The primary outcome for the study is clinical cure (complete resolution). Secondary outcome measures will include relief of symptoms, recurrence rate, adverse effects, adherence to treatment regimen and patient acceptability.Ethics and dissemination The project has received approvals from the University of Canberra Human Research Ethics Committee (HREC 16-133), Wurli-Wurlinjang Health Service Indigenous subcommittee and the Aboriginal Medical Services Alliance Northern Territory reference group. The results of this study will be published in core scientific publications, with extensive knowledge exchange activities with non-academic audiences throughout the duration of the project.

The Menzies Remote Short-item Dietary Assessment Tool (MRSDAT) can be used to derive a dietary index score, which measures the degree of compliance with the Australian Dietary Guidelines. This study aimed to determine the relative validity of a dietary index score for children aged 6–24 months, living in a Remote Aboriginal Community (RAC), derived using MRSDAT. This validation study compared dietary index scores derived using MRSDAT with those derived from the average of three 24-h recalls. Participants were aged 6–36 months at the first dietary assessment and were living in a RAC. The level of agreement between the two methods was explored using Lin’s concordance correlation coefficient (CCC), Bland-Altman plots, weighted Cohen’s kappa, and Fischer’s exact and paired t-tests. Forty participants were recruited. The CCC was poor between methods (R = 0.35, 95% CI 0.06, 0.58), with MRSDAT estimating higher dietary intake scores for all food groups except fruit, and higher dietary quality scores by an average of 4.78 points/100. Community-based Aboriginal researchers were central to this validation study. MRSDAT was within the performance range of other short-item dietary assessment tools developed for young children, and shows promise for use with very young children in RACs.

Health policy in Australia positions Aboriginal and Torres Strait Islander Health Workers (AHWs) as central to improving Aboriginal and Torres Strait Islander peoples’ health, with high expectations of their contribution to closing the gap between Indigenous and non-Indigenous health outcomes. Understanding how AHWs’ governance and accountability relationships influence their ability to address such health inequities has policy, programme and ethical significance. We sought to map the evidence of AHWs’ experiences of accountability in the Australian health system.