Remote Australia Online

While changes in work and employment practices in the mining sector have been profound, the literature addressing mining work is somewhat partial as it focuses primarily on the workplace as the key (or only) site of analysis, leaving the relationship between mining work and families and communities under-theorized. This article adopts a spatially oriented, case-study approach to the sudden closure of the Ravensthorpe nickel mine in the south-west of Western Australia to explore the interplay between the new scales and mobilities of labour and capital and work–family–community connections in mining. In the context of the dramatically reconfigured industrial arena of mining work, the study contributes to a theoretical engagement between employment relations and the spatial dimensions of family and community in resource-affected communities.

During the population-based (Lililwan) study of Fetal Alcohol Spectrum Disorder (FASD) prevalence in the remote communities of the Fitzroy Valley in Western Australia, families and teachers reported challenging child behaviours as a major problem for all children. In response, Marninwarntikura Women’s Resource Centre initiated a partnership with clinician-researchers to bring the Positive Parenting Program (Triple P) to the Valley. In other Australian Aboriginal communities Triple P has been found to be effective for increasing carer confidence and parenting skills resulting in improved child behaviour. In April 2016, a workshop was held in Fitzroy Crossing with the local Advisory Group to ensure community understanding and consent for the program. The group selected Triple P level 4, which includes all 17 core parenting skills and an additional 7 skills relevant to children with complex needs. This was based on recognition of the complexities of family life in the Valley, similar to those in other remote communities. With the imperative to building community capacity, 20 women (18 residents, 12 Aboriginal, from 10 local organizations) were trained in July 2016 by an Aboriginal implementation consultant and a trainer with experience in diverse Aboriginal communities. Following weekly support, consultation and team-building with 18 local trainees, all were accredited as “Parent Coaches” in August 2016. Training and accreditation provided a safe space for women to share past historical trauma and parenting experiences and reflect on how they have impacted their own parenting skills. Parent Coaches are very motivated to share their skills: 3 parent groups have commenced and 2 parents have completed the program. Feedback from trainees is excellent. One Parent Coach wrote: ‘…I’m glad we’ve been taught the Positive Parenting Way I can’t wait to tell my countrymen and hear what they got to say. I hope they feel like I do and practice it everyday ‘Cause it makes you feel real deadly when bringing up kids this way….’ One employer of a Parent Coach acknowledged the program empowered women and built self-esteem, stating: ‘This training and support has been the making of her.’ The strategy of engagement through extensive consultation; gaining support of key Aboriginal community organisations; collaboration; and the provision of ongoing trainee support by an experienced Triple P Practitioner has been essential for the successful implementation of the program. An approach that ensures that Aboriginal communities are equal partners in program delivery and evaluation is imperative for efficacy, engagement and sustainability of programs.

A range of significant occupational health and safety challenges affect clinicians resident in remote communities, as well as visiting Allied Health, Medical Specialist, Retrieval and Management staff. While violence towards the remote health workforce has not been accurately quantified, it has been identified extensively in research and the national media. In 2016, violence took the life of one clinician and forever damaged the lives of at least two others. However, remote area workforce safety and security involves much more than assault and provision of on-call services. Vehicle accidents are the largest single cause of severe injury and death of remote health staff. Sub-standard infrastructure has been a primary cause to others. Bullying and harassment has also been identified by clinicians as a major health challenge, and a cause of changing staff retention behaviours. Consultation to date with remote area staff has detailed a number of safety and security concerns. Seventy percent of those surveyed have had no formal training in the use of four-wheel drive vehicles or emergency communications equipment. Fifty percent of staff had no structured orientation. While eighty-five percent considered clinic buildings were secure, twenty-five percent identified that their accommodation was unsafe or not secure. Forty percent of clinics were consistently implementing safety protocols – a good start. However, thirty percent of clinics had no indigenous health staff – a real challenge to promoting effective, culturally safe services in remote communities. Thirty percent identified violence, bullying and harassment as the primary reason for their decision to leave work. While there’s no quick fix, the Remote Area Workforce Safety and Security Project has identified practical interventions that will improve remote area workforce safety and security. Some responses are built on OHS guidelines and industry accepted standards such as ‘Never Alone’. Some interventions will require considerable resource input to facilities, equipment and training. However, to improve safety and security, all primary stakeholders including clinicians, recruitment agencies, managers, employers, communities, educators, researchers, professional organisations, and government must be committed to introduce and sustain a culture of safety into remote area health services.

Background/aim Private providers of Medicare funded services are an integral part of the Australian primary health-care system. Evidence on private occupational therapy practice in rural and remote Australian settings is sparse. Methods Providers of private occupational therapy services in outer regional and remote areas were surveyed regarding location and type of services provided, practice models and demographics. Descriptive statistics were used to summarise the findings. Results Thirty-seven respondents completed the survey. In remote areas a number of occupational therapy services are not provided and no practices are based in very remote towns. One quarter of respondents visit at least five towns each week and one third had other paid employment. Nearly half indicated they will leave private practice within the next five years and nearly one third believed they could not sustain their practice. Medicare Chronic Disease Management was the main income source of only around half the respondents. Conclusions There is a potential market failure of private occupational therapy in rural and remote areas, impacting on people who need these services and on workforce replacement. Contributing factors include population imbalance between cities and regional/remote areas, financial implications where only face-to-face contact is paid for and low incomes and levels of health insurance in regional/remote areas. Potential strategies include addressing the lack of reimbursement for travel, enabling private providers to overcome barriers to providing student placements and recognising rural practice as a specialist field.

The use of art to improve health and healing environments in our hospitals is widely demonstrated. This case study explored the use of art in hospital redevelopment to achieve culturally appropriate, culturally safe and ultimately culturally effective design that positively impacts on the healing environment, and on patients and the broader hospital community. It highlighted the value of community consultation and engagement guiding art creation and purpose consistent with the needs of the local community. In the rural setting Aboriginal and Torres Strait Islander people are a significant part of the community and account for a disproportionately high number of patients through the hospital doors. The important part that art plays in aboriginal culture and social fabric means that it can contribute even more to the welcome of these patients into the unfamiliar hospital environment. In this project, consultation with community groups identified that use of natural light, access to outdoor sitting areas, use of plants that are indigenous to the region, use of art and imagery, especially aboriginal art that was by local artists, would all assist greatly in helping aboriginal clients feel more comfortable accessing health services. It was also discussed that for many aboriginal clients in the region English was a second language and that traditionally characteristics of the land were used for way-finding rather than signs and writing (even if written in language). This critical feedback guided the health service to work with a group of local artists forming a community of arts and health practice for the life of the project. Themes representative of the region reflect safety, wellness and welcome drawing on local aboriginal imagery, motifs and stories. These were incorporated in sculptures, exterior decorative design, paintings and most importantly into way-finding vinyl designs for the floors throughout the building. The sense of welcome was further enhanced by continuing imagery across other media such as t-shirts of staff members, pamphlets and banners. The response to the project funded by the Percent for Art Scheme and the health service redevelopment was so successful that the health service invested in arts and health beyond the initial outlay implementing a consistent community and artist engagement strategy across all redevelopment work and beyond the initial campus to other areas of the service. Art and health practice is now integral to campus redevelopment and part of hospital life.

This article illustrates how a conservation planning approach combined Indigenous knowledge and Western science to support Indigenous Traditional Owners to make decisions about managing their ancestral lands and seas, and communicate more strategically with external stakeholders.

The economies of remote Indigenous settlements are dominated by public finances. The current system of governing public finance is highly saturated, fragmented and centralised, and this has a corrosive effect on local governance capability. The political accountability of leaders to their constituents is weakened in favour of an administrative accountability ‘upwards’ to higher authorities. New Public Management reforms have promoted administrative deconcentration, over political devolution, and this has been accompanied by an influx of public servants, Non-Government Organisations (NGOs) and private contractors, and a decline in Indigenous organisations and local government. The end result in many settlements is a marked disengagement of Indigenous people in their own governance. There is evidence of considerable political capabilities existing within local government electorates. Decentralised financing arrangements can be used to catalyse these capabilities and then address deficits in administrative and technical performance.

While the occurrence of extreme events generally cannot be prevented, their negative effects can be lessened by reducing risks and improving the capacity of people and communities to deal with them. Improving community resilience helps reduce the effects of natural hazards and is increasingly becoming a goal of communities, organisations and governments. To meaningfully determine, coordinate, plan and prioritise the most effective measures to improve resilience, a baseline assessment of a community's strengths and weaknesses is required. This paper quantitatively assesses the status of community resilience in two remote indigenous communities, Ngukurr and Gunbalanya in the Northern Territory. A quantitative assessment is used to explore community perceptions of disaster resilience within the study areas as well as the methods of assessment and appropriateness of the assessment methodology.

Although the occurrence of extreme events generally cannot be prevented, their negative effects can be lessened by various risk reductions actions and by improving the capacity of communities and individuals to cope. Improving the resilience of both individuals and communities reduces the effects of hazards allowing a faster recovery and return to normal and is increasingly becoming a goal of communities, organisations and governments throughout the world. Improving resilience is complicated and often requires numerous interrelated actions that vary depending specific circumstances of the people, community and location. To meaningfully determine, co-ordinate, plan and prioritise the most effective measures of improving resilience, a baseline assessment of the community’s strengths and weaknesses is required. This paper contributes by examining the status of community resilience in two remote towns within the Northern Territory of Australia. A qualitative narrative assesses community resilience for small remote locations and discusses relevant issues alongside the scoring achieved using a common scoring methodology. It further provides insights and an examination of the methods of assessment and appropriateness of assessment methodology.

Objective: To determine the coverage provided by the Kimberley Diabetic Retinopathy Screening Program and evaluate the impact of the Kimberley diabetic eye health coordinator (KDEHC) position using an evidence-based approach. Design: Retrospective audit. Setting: Primary care services in the Kimberley region of Western Australia. Participants: Individuals with diabetes mellitus who underwent screening for diabetic retinopathy (DR) from 1 March 2010 to 28 February 2014. Interventions: A KDEHC was engaged from February 2012 to provide coordination and support for the DR screening program. Main outcome measure(s): Coverage provided by the program for Indigenous Australians with diabetes, as measured against annual projected needs for diabetic eye examinations. Results: Data were collected for 1247 screening episodes for 947 Indigenous Australian patients. Coverage provided by the program increased from 9.44% in 2010–2011 to 29.8% in 2013–2014 (P < 0.05). The number of sites engaged in screening increased from four in 2010–2011 to 17 in 2013–2014. After the engagement of the KDEHC, significant increases in visual acuity recording and coverage were observed, as well as a non-significant increase in photo quality. Conclusions: Engagement of the KDEHC was associated with significant increases in program coverage. Despite the observed increase, there were significant shortfalls in the number of Indigenous Australians with diabetes undergoing screening in the Kimberley region. This may be explained by examinations provided by other services in the Kimberley region, namely visiting optometry services, but also highlights a large proportion of the population not undergoing screening.

Summary The Black-footed Rock-wallaby (Petrogale lateralis MacDonnell Ranges Race), or warru, as it is known by Anangu, the traditional owners of the region, formerly inhabited the rocky hills of the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in north–west South Australia. However, introduced carnivores and inappropriate fire regimes have decimated the population, and there are now only 150–200 animals remaining in the wild. This prompted the formation of the Warru Recovery Team (WRT), a collaboration between Traditional Owners, Anangu communities and scientists, who are working together to recover warru populations across the APY Lands. The team are working on the Warru Reintroduction Project, which is combining modern science and the traditional ecological knowledge of Anangu to reintroduce warru back into the APY Lands. Between 2007 and 2009, 22 iti-warru (warru-joeys) were taken to Monarto Zoo (Monarto, South Australia) to initiate the captive population. These zoo-warru have successfully bred in captivity, and in 2011, six founder animals and five captive bred warru were returned to the APY Lands. They are being held in a 97-ha predator-proof warru enclosure that will allow zoo-warru to adjust to the local environment and to learn the survival skills of their ancestors, prior to being released into the wild. Lessons learnt from the release of warru into warru pintji will inform future release situations, as well as management of the in situ warru population, which remains the priority of the WRT.

Background: Risky levels of drug and alcohol-related harm among Aboriginal Australians are both a consequence of, and contribute to, the disproportionate health and social gap between Aboriginal and non-Aboriginal Australians, especially in rural and remote Australia. High quality Aboriginal drug and alcohol residential rehabilitation services are an important form of treatment for Aboriginal substance users and are therefore making a vital contribution towards the Government’s target to close the life expectancy gap within a generation. However, limited available evidence exists about the models of care being delivered, client characteristics and the range of data being collected. Orana Haven Residential Rehabilitation Service (OH) is a 3-month voluntary rehabilitation program for Aboriginal males. OH is a dynamic Aboriginal Community Controlled Health Organisation that has been in operation since the 1980s and is the only service of its kind in Western NSW. The National Drug and Alcohol Research Centre (NDARC) have been invited to partner with Orana Haven Residential Rehabilitation Service (OH), located in remote western NSW, to work with them to evaluate, tailor and monitor their program from 2015-2017. Aims: Outline the OH Model of Care; Describe the demographic and client characteristics of OH between 2011 and 2016; and Analyse perceptions of staff and clients about their experience of the OH program, especially in relation to OH’s primary purpose of providing culturally safe drug and alcohol treatment. Methods: This research adopted a mixed methods approach to evaluate the program, including the analysis of five years of demographic, referral and service utilisation characteristics of clients, and semi-structured interviews with staff and clients to understand the perceptions of the program. Results: The Model of Care was developed in consultation with OH staff and clients. The program is defined by three guiding principles (strong governance, skilled staff and effective and culturally safe service delivery) and five core components (consistent routine and rules, counselling and case management, groups, culture and identify and learning and development of skills.) From 2011-2016, the service had a total of 329 clients (average age 36 years) access treatment, with the median length of stay of 55 days. A total of 84% of clients identified as Aboriginal or Torres Strait Islander and 77% were referred from Corrective Services. Themes from the qualitative analysis included: hopes for the future, impact of substance abuse for both clients and staff, the positive perception of the rehabilitation being located in a remote location and the importance of culture and spirituality that is embedded within the program. Conclusions and implications: This is the first evaluation of this kind focusing on defining and strengthening a remote Aboriginal drug and alcohol rehabilitation service in Australia. The implications of this research is to highlight the value of Aboriginal residential treatment to clinicians, academics, policymakers and senior bureaucrats more broadly, as well as make recommendations to strengthen the OH model of care to ensure it continues to be leading service in the field of Aboriginal substance abuse treatment, both in Australia and internationally.

NSW Health rural e-health strategy provided funding to rural Health Districts to trial remote tele-home monitoring in the Hospital in the Home (HITH) setting. Two trials commenced in Western NSW Local Health District (WNSWLHD) in 2016. Trial one is targeting HITH inpatients with acute, post-acute or sub-acute illness and community outpatients with chronic disease. Multiple sites are participating including large base health services, medium-sized procedural hospitals and small rural and remote health facilities. Remote tele-health home monitoring is an emerging technology and service, provided to small degree in WNSWLHD by non-government organisations like Integrated Living and CareWest. The WNSWLHD trial represents an opportunity to pilot tele-home monitoring technology with public health service clinicians and key community partners to test how it can be integrated into current HITH, community health and Primary Health Networks in rural and remote NSW. Staff initially targeted to manage tele-home monitoring are community or HITH nurses. The second trial is a partnership between WNSWLHD and Bila Muuji Aboriginal Medical Service Group. Eight Aboriginal Medical Services in Bourke, Brewarrina, Wellington, Orange, Dubbo, Coonamble, Forbes and Walgett will trial tele-home monitoring with their community clients with chronic disease. The partnership will facilitate sharing of resources and early learnings from the first trial and supporting local Aboriginal Medical Services to test tele-home monitoring within their unique business models, staffing and clientele. The purpose of the trials are to expose clinicians to this technology; test tele-home monitoring equipment with existing clients and evaluate if the additional biometric data contributes to better informed health care decisions and earlier detection of clinical deterioration in health status. The trial objectives include: - acceptance of tele-home monitoring by health service medical and nursing clinicians and patients; - useability of tele-home monitoring within existing rural and remote HITH, community health, primary care and AMS service delivery; - relevance of tele-home monitoring with the target groups to detect early deterioration in health potentially leading to reduced frequency of hospitalisation, presentation to the emergency department, decreased length of stay or increased referrals to HITH; - improve patient knowledge and capacity to self-manage. Guidelines, clinical tools, professional and patient resources were developed, with trial one training and patient enrolment commenced in May 2016. Trial two partnership with Aboriginal Medical Services commenced in October 2016. Progress reports will be presented on both trials, outlining early learning’s, key challenges, issues and successes.

The NT leads the country in the use of standards-based secure messaging for clinical information (eg specialist referrals, hospital discharge and pathology reports), shared health patient records and other internet connected diagnostic devices such as the iStat machine (blood analysis) and internet connected Electrocardiography (ECG). Benefits of telehealth have been demonstrated both internationally and through local assessments through reduced costs associated with patient travel, minimised time spent away from community and providing improved patient satisfaction eg use of remote diagnostic systems for identification of cardiac issues can improve patient care and save lives. For example, the Chinese government is looking to telehealth as a solution to service delivery issues. Uptake of telehealth in the NT has been limited, for a variety of reasons including inadequate broadband access. Through collaboration between stakeholders, staged implementation has been developed at a number of test sites. Program partners (AMSAANT, NT DoE, Northern Institute, TelstraHealth) are keen to negotiate an incentivised remuneration system to assist increased uptake of telehealth in NA requiring engagement with hospitals and Aboriginal Community Controlled Health Organisations (ACCHOs). Additionally, initial discussions with colleagues from CDU working in remote China and Indonesia indicate there may be opportunities for collaborative work on extending telehealth services to remote areas in China and Indonesia. NA context: Currently NT DoH is working to expand the number of acute, allied health and specialist services that provide telehealth solutions to remote patients. NT ACCHOs are developing change management strategies for telehealth usage that recognise existing work practices. They are also expanding the use of video conferencing within their organisations to support management, training, internal and external clinical support. Multiple organisations who currently interact to provide remote communities with primary health services and individuals who require access to specialist and acute/emergency clinical interventions will also be included in the digital solutions expansion. The program will assist remote ACCHOs to establish telehealth and aid them in evaluating the cost/benefits of reliable internet and telehealth services as well as expanding digital inclusion. It will also promote telehealth enabled health outcomes into the future and has a significant research component: assess the costs and benefits of telehealth implementation including financial and non-financial identify barriers and enablers for implementing telehealth identify other potential and perceived outcomes and successes assess if additional roles (eg telehealth coordinators) can be developed and sustainably funded through patient travel savings and additional Medicare income develop strategies to deal with technical issues such as delay in communications with satellite solutions. This research will inform policy development to improve service delivery to remote communities and provide support to ACCHOs to expand telehealth and digital inclusion.

In 2007 the Northern Territory report on child abuse Little Children Are Sacred, Akelyernernane Meke Mekarle (Aranda) (In our law children are sacred because they carry the two spring wells of water from our country within them) was released. In July–August 2007 the Federal Government enacted the Northern Territory National Emergency Response Bill, in the name of protecting children from abuse, giving the Federal Government wide control over Aboriginal lands, families, and community services; and the Indigenous Affairs Minister total control over Indigenous community governance. More widely known as the Northern Territory Intervention, this dramatic move began with the Howard Government in 2007 and has been largely continued under the Rudd Government. Taking control of a large number of Aboriginal settlements, the Government instituted the following measures: supply of additional police to affected communities; mass health checks for Aboriginal children, initially mandatory but changed to voluntary; new restrictions on alcohol, kava and pornography; the compulsory acquisition of townships with five-year leases; Commonwealth funding for community services; removal of customary law from bail applications and sentencing in criminal cases; suspension of the system by which visitors to Aboriginal settlements were required to have a permit; quarantining of a portion of welfare benefits to all recipients in designated communities; and the abolition of Community Development Education Projects (CDEP), which had paid unemployed people to work locally. Mal Brough was the Federal Minister for Aboriginal Affairs when the Intervention commenced and he led it with a passion. The army, albeit unarmed, were directed to accompany the new army of people employed to service the Intervention. Intervention measures were exempted from the Racial Discrimination Act, breaching two treaties to which Australia is a signatory – the Convention on the Elimination of All Forms of Racial Discrimination and the International Covenant on Civil and Political Rights. The Labour Government has essentially upheld the measures of the Intervention. Prime Minister Rudd at Yirrkala on 24 July 2008 spoke about the policy of closing the gap, in terms of life expectancy of adults and children under five, infant mortality, the Year 12 completion rate, and literacy and numeracy achievements, and of closing the gap in a practicable and measurable way. Some changes and modifications have been introduced. The CDEP has been partially re-introduced, permits re-introduced and 99-year leases established.

Problem: The continuity of care for people with neurological conditions in a remote northwest Queensland town as services are currently only available intermittently. Design: Mixed methods design using questionnaires and staff review of the program and processes. Setting: Intermittent community rehabilitation service for clients with neurological conditions has been offered in Mount Isa and is supported by a similar fulltime service in Townsville. Both services use a unique client-centred, student-assisted, interprofessional model of care. Key measures for improvement: Understanding participant experiences by obtaining feedback from clients, students and allied health professionals (AHPs) regarding their experiences of using telehealth in this setting. Strategy for change: Previous clients of the North West Community Rehabilitation service were offered a review assessment using telehealth by an interprofessional team. Effects of change: Using telehealth enabled the client, remote AHP and students in Mount Isa to be connected to expert assistance in Townsville. Lessons learnt: The findings suggest that telehealth was useful in a community rehabilitation setting to provide review services for clients. This improved continuity of care for these clients because without this telehealth assessment, the clients would have had to wait up to 12 months for the next service period in Mount Isa or travel to a major urban centre to access a similar service. Feedback from clients, students and AHPs was positive; however, some challenges were identified. Recommendations for future service delivery using telehealth are outlined in the paper.

Aims: Upskilling is crucial to the delivery of patient-centred emergency medicine in rural/remote facilities. The Emergency Medicine Education and Training (EMET) Cairns Hub aims to provide high-quality emergency medicine education in service-driven rural facilities of Far North Queensland (FNQ). A secondary outcome is to cultivate the relationship between each referring facility and the receiving regional centre. Methods: The federally funded EMET Cairns Hub program, commenced in mid-2012 and is overseen by the Australasian College of Emergency Medicine (ACEM). Emergency Physicians (FACEMs) from the Cairns’ Hospital are rostered 3 days each week to deliver training specifically targeted to the needs of rural practitioners working in the eleven rural/remote hospitals that drain to Cairns Hospital. A Program Support Officer and FACEM Clinical Lead administer the program. The educational sessions are delivered by the rest of the Cairns’ ED FACEM team and include outreach workshops, videoconference case-based discussions or expert tutorials, and hi-fidelity simulation workshops. Continuous evaluation coupled with yearly service reviews keeps the program focused on the individual learning needs of each facility. Relevance: Finding ongoing opportunities to update critical emergency medicine skills can be difficult for staff in rural/remote facilities. Challenges include geographical isolation, staff recruitment and retention, lack of protected education time, high clinical load, and inadequate opportunity to network with FACEMs and other rural/remote staff. Results: The EMET Cairns’ Hub has delivered four full years of education to rural/remote facilities. Overall, participants hold the program in high regard with many reporting that ongoing contact with FACEMs builds rapport and reduces the geographical isolation they feel, leading to improved patient outcomes. Onsite workshops remain the most highly valued modality as a source of two-way education as FACEMs can assess local challenges. Short, monthly videoconference based education remains the best fit for busy workloads of facilities. One-day, hi-fidelity simulation is highly valued as an intensive critical skills building and networking opportunity. The majority of sites advocate for inclusion of nursing and other allied health staff into all initiatives for the purpose of supporting a multi-disciplinary collegiate culture. Conclusions: A multi-disciplinary, flexible, multi-modal framework is crucial for the successful implementation and sustainability of education initiatives for busy rural/remote facilities. A grassroots approach tailored to facility needs through regular evaluation and adjustments is critical for creating solutions to overcome ever-changing institutional and service challenges. Underpinning all is a growing network of contacts in a strong collegiate culture to overcome professional isolation.

The challenges of recruitment and retention of health professionals in rural and remote Australia are well documented. Increases in need arising from an ageing population and the burden of chronic disease, together with a decrease in workforce supply globally, creates further challenges in rural and remote areas where high turnover is frequently reported. This research focuses on rural and remote managers, and seeks to understand where improvements in management practices can have the greatest impact in improving health workforce retention. Social Exchange Theory proposes that where there are effective employee-manager workplace relationships and where there is perceived organisation support from the employee’s perspective, organisations will observe improvements in retention, as well as improvements across a range of performance indicators. Hence, there are many benefits that arise from an effective employee-manager employment relationship. This research examined the words that health professionals and managers use to describe what it is like to work in rural/remote northern Australia. The aim of the study was to identify if similarities and differences in manager and health professional’s perceptions provide opportunities to improve retention through effective employee-manager relationships. This qualitative research study used a purposive sampling method to recruit participants who were either managers or health professionals working in rural/remote regions of northern Australia. Twenty-four semi-structured interviews were conducted in-person or via telephone depending on the participant’s location. Participants were asked to provide five words that best described working in a rural/remote community from their perspective and then from the alternative perspective. That is, health professionals in rural/remote areas described their work experience and then how they perceived that their manager would describe it. Managers described it from their perspective and then how they perceived that a remote health professional would describe it. The research found opportunities to improve retention through the similarities and differences in each group’s perceptions about working in rural and remote northern Australia. Few managers hesitated in describing the health professionals’ perspective, yet many health professions paused and contemplated whether their manager really understood what it is like to work in rural and remote regions. This research provides evidence not that there are differences and similarities; it provides language around where these similarities and differences emerge enabling opportunities to further explore where these misaligned perceptions may be translating into unrealised potential and poor retention of otherwise competent and passionate health professionals.

The challenges for health professionals working in remote regions are diverse, particularly where voluntary turnover is high. This study examined the influence of management practices on workforce sustainability in remote regions of northern Australia using human resource management (HRM) policy choices. In this study, 24 semi-structured interviews with HR managers, health professionals and health managers revealed that the impact of HRM policy choices on remote workforce sustainability is significantly influenced by management practices. The emergent themes depict work environments where ineffective management practices for recruitment, remuneration, resourcing and relationships have profound consequences. Despite these contextual challenges, examples emerged where effective management practices created stability and improved retention. Hence, the findings suggest that sustainable remote health workforces are achievable where localised management practices improve equity, where employee–manager relationships are fostered, and where there is equitable access to resources and professional development.

Health professionals working in remote Australia have demanding and stressful yet diverse and rewarding roles. The health domain literature examines the challenges of health service delivery non-cognisant of the benefits of a human resource management (HRM) approach. This systematic literature review uses an HRM approach to examine what is already known on this topic, and to identify key extant themes in order to determine: 1) which factors are common across the entire remote health workforce; and 2) whether there are factors that are unique to working in remote Indigenous communities that need further consideration. The findings suggest that the challenges and rewards are similar for health professionals working in remote Indigenous communities and those working in rural and remote regions. Therefore, the emergent themes (personal, professional, organisational and contextual) presented within a conceptual framework in this article are pertinent for all health professionals working in remote Australia.

Objective: To identify key workplace demands and resources for nurses working in very remote Australia and measure levels of occupational stress in this population. Methods: The study used a cross-sectional design, utilising a structured questionnaire. Setting: Health centres in very remote Australia. Results: Nurses working in very remote Australia experience significantly higher levels of psychological distress and emotional exhaustion, compared with other professional populations. Paradoxically, results also highlight higher than average levels of work engagement. Nurses working in very remote regions in Australia further report moderate levels of job satisfaction. Most significant job demands identified were emotional demands, staffing issues, workload, responsibilities and expectations, and social issues. Key job resources included supervision, opportunities for professional development, and skill development and application. Conclusion: In a context of high stress, high levels of work engagement and moderate levels of job satisfaction do not obviate high workforce turnover for this population. There is a need to reduce job demands and increase job resources in order to foster long-term work engagement and reduced emotional exhaustion. This might subsequently decrease remote area nursing workforce turnover.

Background: Historically it has been challenging to recruit and retain an appropriately trained medical workforce to care for rural and remote Australians. This paper describes the Queensland North West Hospital and Health Service (NWHHS) workforce redesign, developing education strategies and pathways to practice, thereby improving service provision, recruitment and retention of staff. Concept: The Mount Isa-based Medical Education Unit sought accreditation for a Rural Generalist (RG) training pathway from Internship to Fellowship with the Australian College of Rural and Remote Medicine (ACRRM) and the Regional Training Provider (RTP). This approach enhanced the James Cook University (JCU) undergraduate pathway for rurally committed students while improving recruitment and retention of RMOs/Registrars. Achievements: Accreditation was achieved through collaboration with training providers, accreditation agencies, ACRRM and a local general practice. The whole pathway from ignore Internship to Fellowship is offered with the RG Intern intake as a primary allocation site beginning in 2016. Comprehensive supervision and excellent clinical exposure provide an interesting and rewarding experience – for staff at all levels. Results: Since 2013 RMO locum rates have been <1%. Registrars on the ACRRM pathway and Interns increased from 0 to 7 positions each in 2015, with similar achievements in SMO staffing. Three RMOs expressed interest in a Registrar position, Conclusions: Appropriate governance is needed to develop and advertise the program. This includes the NWHHS, the RG Pathway and JCU.

The 2014 Wilson review of Indigenous Education in the Northern Territory recommended boarding school models as the preferred secondary education option for very remote Aboriginal students. This study considers boarding uptake by Aboriginal students from the Central Land Council region of the Northern Territory. An examination of boarding programs available to Aboriginal students in this region found that scholarship access is largely determined by socioeducational advantage and the perceived social stability of the family and student. To increase access and participation in boarding, more flexible funding assistance programs are needed. An expanded role for brokering could also increase retention and completion rates. Ultimately, more investment is also required in remote community schools, and in the development of ‘both ways’ capital if the social and educational aspirations of young Aboriginal students and their families in this region are to be realised through a boarding school model.

This article explores country music as an important means for Aboriginal men in Central Australia to articulate contemporary forms of manhood and indigeneity. These desert men perceive their own music scene as a last stronghold for real country music. The article demonstrates how such notions of real involve the ongoing intercultural mediation of global and local male aesthetic styles and manhood ideals. In making and performing their country music, desert men continue to draw on enduring ancestral regimes for male demeanour that resonate with global country music imagery and practice, as well as with prominent non-Indigenous models of manhood in the regional settler history.

Aboriginal Australians experience significant disparities in oral health with even poorer outcomes reported in rural and remote areas. The high rates of preventable dental disease in Aboriginal communities are a serious concern from a social standpoint and in terms of service provision and health care expenditure. In this review, primary research literature was comprehensively reviewed. Papers were selected if they reported designing or implementing an intervention or oral health programme specific to the needs of Aboriginal communities. Twenty-one publications fulfilled the inclusion criteria with 19 different interventions being described. Interventions were categorized using a classification adapted from the work of Whitehead (2002). The review identified interventions that aimed to reduce early childhood caries, increase services to remote communities, develop the role of Aboriginal health workers, improve oral health literacy, establish water fluoridation and provide periodontal therapy. Implementing successful oral health interventions in Aboriginal communities is a challenge that is compounded by the complex interplay between psychosocial and cultural determinants. Even interventions that follow a rigorous and consultative design have a high failure rate in Aboriginal communities if upstream determinants of health are not adequately understood and addressed.