Remote Australia Online

This discussion paper reports on findings from a collaborative study between the Centre for Aboriginal Economic Policy Research (CAEPR) and Central Australian Remote Health Development Services that involved two remote Indigenous communities in the Northern Territory. Data was collected using interviews which incorporated a National Reporting System (NRS) assessment of language, literacy and numeracy competence. The study explored the social context of literacy acquisition and use in these communities, analysed the findings and explored their implications for training, employment and capacity development in remote Indigenous communities. The findings from the NRS assessments indicate that a large discrepancy exists between people’s perception of their literacy competence and their actual competence. The study also revealed that adult literacy levels were generally low, and in several cases, much lower than was assumed by some non-Indigenous people living and working with members of these communities. The contents are: Introduction; The problem of literacy and capacity development; Theoretical framework for the project; An overview of the research sites; Methodology: the interviews and literacy assessments; Findings; Some preliminary conclusions and recommendations for policy directions.

Crusted scabies is a highly infectious, debilitating and disfiguring disease, and remote Aboriginal communities of northern Australia have the highest reported rates of the condition in the world. We draw on monitoring data of the East Arnhem Scabies Control Program to discuss outcomes and lessons learnt through managing the condition in remote communities. Using active case finding, we identified seven patients with crusted scabies in three communities and found most had not presented to health services despite active disease. We compared presentations and hospitalisations for a cumulative total of 99 months during a novel preventive program with 99 months immediately before the program for the seven cases and seven sentinel household contacts. Our preventive long-term case management approach was associated with a significant 44% reduction in episodes of recurrent crusted scabies (from 36 to 20; P = 0.025) in the seven cases, and a non-significant 80% reduction in days spent in hospital (from 173 to 35; P = 0.09). It was also associated with a significant 75% reduction in scabies-related presentations (from 28 to 7; P = 0.017) for the seven sentinel household contacts. We recommend active surveillance and wider adoption of this preventive case management approach, with ongoing evaluation to refine protocols and improve efficiency. Contacts of children presenting with recurrent scabies should be examined to exclude crusted scabies. In households where crusted scabies is present, a diagnosis of parental neglect due to recurrent scabies and weight loss in children should be made with extreme caution. Improved coordination of care by health services, and research and development of new therapies including immunotherapies for crusted scabies, must be a priority.

Objectives: To determine the utility of point-of-care (POC) capillary blood glucose measurements in the diagnosis and exclusion of diabetes in usual practice in primary health care in remote areas. Design: Cross-sectional study comparing POC capillary glucose results with corresponding venous glucose levels measured in a reference laboratory. Participants: 200 participants aged 16–65 years enrolled: 198 had POC capillary glucose measurements; 164 also had acceptable venous glucose laboratory results. Setting: Seven health care sites in the Kimberley region of Western Australia from May to November 2006. Main outcome measures: Concordance and mean differences between POC capillary blood glucose measurement and laboratory measurement of venous blood glucose level; POC capillary blood glucose equivalence values for excluding and diagnosing diabetes, and their sensitivity, specificity and positive-predictive value. Results: The concordance between POC and laboratory results was high (ρ = 0.93, P < 0.001). The mean difference in results was 0.48 mmol/L (95% CI, 0.23–0.73; limits of agreement, − 2.6 to 3.6 mmol/L). The POC capillary glucose equivalence values for excluding and diagnosing diabetes were < 5.5 mmol/L (sensitivity, 53.3%; specificity, 94.4%; positive-predictive value, 88.9%; for a venous value of < 5.5 mmol/L) and ≥ 12.2 mmol/L (sensitivity, 83.3%; specificity, 99.3%; positive-predictive value, 95.2%; for a venous value of ≥ 11.1 mmol/L), respectively. While the choice of glucometer and whether or not patients were fasting altered these results, they did not have a significant influence on the diagnostic utility of POC glucose measurement in this setting. Conclusion: POC capillary blood glucose analysers can be used as part of the process of diagnosing and excluding diabetes in remote rural communities using these locally established capillary equivalence values.

Objectives: To describe service characteristics of Derby Aboriginal Health Service (DAHS) and document diabetes management activities and intermediate clinical outcomes for Aboriginal patients with type 2 diabetes. Design, setting and patients: Retrospective audit of records for patients 15 years old who had a confirmed diagnosis of type 2 diabetes, received primary health care from DAHS for at least 6 continuous months between 1 July 1999 and 30 June 2009, resided in the Derby area and were not on renal replacement therapy. Main outcome measures: Electronic records of blood pressure (BP), glycated haemoglobin (HbA1c) level, weight, albumin–creatinine ratio, creatinine level or estimated glomerular filtration rate, lipid levels and smoking status during each audit year; and proportions of patients who met clinical targets for HbA1c, BP and cholesterol. Results: Over the 10 years, the proportion of clinical care activities undertaken according to regional protocols increased significantly, with very high levels recorded in the last 3 years (at least 70% of patients had each activity recorded). There were significant improvements in systolic BP, diastolic BP and cholesterol levels over the 10 years (P< 0.001 for all). In the final year, 69% of patients had at least half their BP measurements 130/80 mmHg and 83% had median annual cholesterol levels of < 5.5 mmol/L. There were small improvements in HbA1c levels that approached statistical significance (P= 0.05). In the final year, 34% of patients had median annual HbA1c levels of 7.0 %. Conclusions: This study shows that diabetes monitoring and outcomes can be improved and maintained over a 10-year period in a well supported remote Aboriginal community-controlled health service setting.

Recruitment challenges for mining corporations operating in Australia have intensified with the increasing global demand for mineral resources and the 1993 Native Title legislation compelling negotiated land use agreements. A finite labour pool, further compressed by an ageing and retiring workforce, competition for labour, a poor industry image as well as a requirement for applicants to possess particular educational and vocational competencies has not been offset by greater Indigenous participation, despite training provisions being a feature of land use agreements. This paper presents an analysis of a novel recruitment technique that is devoid of the need for English literacy and numeracy skills, for Indigenous people with expectations to be employed in the extensive mining operations at Nhulunbuy on the Gove Peninsula of the Northern Territory (NT) of Australia. Predicating the scheme design was a comprehensive literature reporting that the English literacy and numeracy skills likely to be held by Australian Indigenous people would preclude them from usefully participating in standard Western recruitment procedures. Analyses reveal that the scheme is a robust predictor of sustainable employment. This leads to a line of reasoning that discriminatory recruitment practices can be substituted with alternative methods to identify human work related potential and, subsequently, address economic challenges and social dislocation of marginalised Indigenous groups. Published abstract.

The Australian mining industry is undergoing resurgence in economic development, and the high demand for additional skilled workers is reflected in employment strategies targeting Indigenous people in remote regions of the nation. Driven by legislative reforms during the 1990s mining companies are installing educational vocational programs for Indigenous communities and this paper provides primary data of five Indigenous people who successfully transitioned an inaugural unique [vocational education and training] VET scheme to become full time operators at the Pacific Aluminium refinery at Nhulunbuy on the Gove Peninsula of the Northern Territory (NT) of Australia. The presented evidence challenges simplistic assumptions the delivery of VET programs to Indigenous people will facilitate their employment at remote Australian mining operations. Published abstract.

Remote-area nursing practice

Indigenous birthing in remote locations: Grandmothers’ Law and government medicine

This book provides a new take on the digital divide. Why do whole communities choose to go without the internet when the infrastructure for access is in place? Through an in-depth exploration of the digital practices occurring in Aboriginal households in remote central Australia, the authors address both the dynamics of internet adoption and the benefits that flow from its use. The book challenges [the reader] to the think beyond the standard explanations for the digital divide, arguing that digital exclusion is not just another symptom of social exclusion. At its heart, [the book] is a compelling examination of equality and difference in the digital age, asking: Can internet access help resolve the disadvantages associated with remote living? Published abstract.

This Road Map has been developed by the SA Aboriginal Chronic Disease Consortium Coordinating Centre on behalf of the Executive Group, Community Reference Group, Cancer Leadership Group, Diabetes Leadership Group, and Heart and Stroke Leadership Group, in consultation with attendees of the May 18, 2017 Priority Setting Workshops.

This paper reports on a study commissioned by the Aboriginal and Torres Strait Islander Commission (ATSIC) in 2000. The study investigated the best way to establish a Community Development Employment Project (CDEP) scheme in four remote Aboriginal communities. CDEP is a publicly funded employment program that is mainly located in rural and remote areas of Australia. One of its aims is to address labour market disadvantage and a lack of local employment opportunities. It serves Indigenous people with poor employment prospects, especially youth, those with low skills, and people who have difficulty speaking English. It provides work managed by, and on behalf of, the local community. Within ATSIC, there has been an emerging preference over recent years for larger multi-locational CDEPs as a better way of using CDEP on-cost resources. As a result, questionnaires in the four communities sought responses about the knowledge of and interest in CDEP as well as views towards sharing a CDEP with the other communities in the regional group. The final section of the report provides an overview analysis of CDEP size for ATSIC policymakers. It argues that many CDEPs in remote Aboriginal communities may in fact be too big. It is recommended that ATSIC should be giving more support to small CDEPs through changes in rules and funding arrangements.

In this chapter, the author examines the impacts of changes to Community Development Employment Projects (CDEPs) in the Anmatjere region of the Northern Territory, just north of Alice Springs. Taking a political science perspective, he critiques what he sees as the dominant mode of policymaking in Indigenous affairs, which is premised on a 'failure and change' style of analysis. That is, if policies and programs do not meet the high expectations placed upon them, they can quickly become labelled as failures and subject to major institutional change. While this approach is understandable, the author suggests that there is also 'a downside to this well intentioned dynamic' in that existing good practice and corporate capacity can be lost. This is clearly apparent in his analysis of the Anmatjere region CDEPs. Edited excerpt from publication.

Discussion of welfare and work for Indigenous Australians leads quickly to the Community Development Employment Projects (CDEP) scheme. Introduced by the Fraser Coalition Government in 1977, CDEP was both a response and an alternative to increasing eligibility for social security unemployment payments among Indigenous people in remote areas. The idea was to make grants to Indigenous community organisations to employ community members part-time who would otherwise be eligible for unemployment benefits. How is it that an employment program designed to avoid Indigenous reliance on social security payments in 1977 became reframed as part of the welfare system 32 years later? How does a popular and successful solution to a significant public policy problem come, over time, to be seen as part of that problem? These questions are explored under the following headings: Legislative recognition and complaints of discrimination; Administrative inclusion alongside Work for the Dole; Employment in and out of CDEP: ATSIC's balancing act after Spicer; DEWR's contractualism and employment service model; Pearson's 2007 reversal and the Northern Territory Intervention; Equalising CDEP and income support: FaHCSIA's contribution; From CDEP to RJCP: Service integration and reframing confirmed. Edited excerpts from publication.

The current literature on peripheral tourism appears conceptually weak for its inability to distinguish between different types of “peripheral” destinations. This review article argues that “remote” destinations have intrinsically different characteristics compared to peripheral ones and require different theoretical approaches to better explain the dynamics of tourism in remote areas. The review builds on theoretical models from the fields of economic geography and political economy, which have been largely absent from peripheral research in Tourism Studies in the past. In particular, the Canadian “staples thesis” is seen by these authors to offer some valuable insights into the unique patterns of economic development and core–periphery relationships in remote areas. They argue that while peripheral areas usually have entrenched relationships with a clearly defined core, remote areas are characterized by “disconnectedness” and face substantial challenges in establishing viable connections with other places. This review article thereby suggests that understanding the processes and implications of connection seeking is critical if tourism is to provide an effective tool for economic development in remote areas.

The social and educational disengagement of Indigenous youth, who see education and training as irrelevant to their lives and experiences, is a looming crisis for many Indigenous communities in remote Australia. This paper is an exploration of a youth program in Canada, the Junior Canadian Rangers (JCRs), that addresses a similar crisis in that country. The Canadian program is of national importance to Canada in the context of not only community stability and capacity development but also border security, marine management in coastal areas and in search and rescue services. While Australia has a Defence Force Cadet program that operates in a limited number of Indigenous communities, it is a more traditional and much smaller cadet program. This paper suggests there is value in adapting some of the components of the Canadian program in Australia. The paper begins with an analysis of the educational disengagement of young Indigenous people in remote Australia. Then, as background for a description of the JCR program, the paper provides a brief comparison of Australia and Canada, outlining a few of the cultural, historical and geographic similarities. The paper goes on to provide a detailed overview of the JCR program, its aims, history, structure and pedagogical underpinnings. The paper closes with some discussion of the value of the program for Canada, the potential value of some version of the program or its elements for Australia and some insights for Australia from the Canadian experience. Published abstract.

Much has been written about Aboriginal night patrols in recent decades; this has typically been ethnographic or evaluative. However, little work has been done to situate night patrols against wider historic trends in criminal justice and theorize their contribution in relation to neoliberal regimes of justice. Drawing on data collected as part of an evaluation of Aboriginal night patrols in New South Wales, this paper develops a critical approach to understanding night patrols. We interrogate the notion of ‘community’—central to the philosophy and practice of night patrols—examining the limitations of community forms of justice in challenging dominant understandings of crime and addressing the structural causes of crime.

Questions of race and crime in Australia largely revolve around indigenous peoples. Australian criminologists cannot escape racial terminology which divides the population into groupings and largely ignores the complex ways in which Indigenous justice is experienced and practiced in diverse contexts. While there has been much research into Aboriginal and Torres Strait Islander (ATSI) crime and justice, previous research draws exclusively on mainland peoples who are culturally distinct from Torres Strait Islander peoples. Further, as a distinct setting, the Torres Strait Islands offer a unique opportunity to observe how justice is practiced in remote contexts. Drawing on statistical data from the Torres Strait Region, we argue that relatively low crime rates in the region may be linked to numerous indicators of social capital in the region.

This paper examines young people's perceived vulnerability to sexually transmitted infections (STIs) and their efforts to create a sense of personal safety within an environment in which risks may be high and where STIs are highly stigmatised. The paper reports on findings from research involving both Indigenous and non-Indigenous 16- to 25-year-olds from remote, rural and regional Australia, including communities in the Northern Territory, Western Australia and South Australia. The study used qualitative methods, including body mapping and scenario based interviewing, to explore how young people made decisions about potential sexual partners and how STIs were understood within the context of young people's everyday social worlds. The paper has important implications for the design and implementation of sexual-health education programmes by documenting the stigmatisation of young people with STIs and the protective mechanisms peer groups employ to create perceptions of personal safety.

This presentation explores the complexity of the interface between the workplace and Anangu from the remote Indigenous communities of the Anangu Pitjantjatjara Yankunytjara Lands (APY Lands), north-west of South Australia. Transitioning through education and training into the workforce is a pathway few have followed. Understanding the complexity has the potential to inform the role for vocational education and training (VET). The story of work is one of change and the implications of differing world views in an employment context dominated by government policies and remoteness is challenging for the job seeker, employee, employer and trainer. The labour market is dominated by the tyranny of distance with a low population in small communities spread across a vast area. Increasing legislation and specialisation is a reality that currently results in a workforce reliant on outsiders. VET outcomes are mixed. The Prime Minister, Tony Abbott, recently acknowledged how the employment gap for Indigenous job seekers remains and the intent of government is to provide pathways to real employment with further reforms. Indigenous communities are critical of VET, as the political adage of 'training for employment' is not seen in practice. Often there is reference made to training for training's sake, and at the same time the need for more training is expressed. This presentation will highlight the differing world views that effect being a part of the market economy and relook at the role of VET in the APY Lands. The intelligence on how to improve the transition into and within the workforce is essential for reviewing VET and for changing current workforce demographics. Consideration of the cultural interface between Anangu, the workplace, and the characteristics of the local labour market in the APY Lands, will inform the role of VET. Published abstract.

Aim: To evaluate the effect of a community-oriented primary health care (CPHC) intervention on oral health behaviours of Indigenous preschool children living in remote communities of Australia's Northern Territory. Methods: The study was a community-clustered randomised controlled trial over two years, set in 30 remote Indigenous communities in the Northern Territory of Australia. Children aged 18–47 months at baseline were enrolled in the study. The intervention included fluoride varnish applications, training of primary care workers, and health promotion for oral health at an individual, family and community level. Intervention communities received six-monthly visits over two years and control communities were visited at baseline and two years later with no contact in the intervening period. The outcome measures reported in this paper are the impact of the intervention on two secondary endpoints: oral health promotion activities in the community and personal oral health practices of children. Results: The intervention did not produce any significant change in oral health behaviours, clinical measures of oral hygiene, or community programmes promoting oral health. Dental caries can be reduced but will continue to be a problem among young remote Indigenous children while they experience major social disadvantage.

The caries experience of Australian Indigenous children has deteriorated at the same time as that of non-Indigenous children has greatly improved. Fluoridating the water supplies of Indigenous communities emerged as a policy direction at the beginning of the 2000s. However, remote Indigenous communities are small, highly dispersed and isolated. This paper describes the Strong Teeth Study, a series of projects for the fluoridation of remote Indigenous communities in the Northern Territory. The background and rationale for two demonstration fluoridation projects are presented and the feasibility of operating small-scale fluoridation plant and measuring the impact on caries experience described. The demonstration fluoridation projects were commenced, but not sustained. The lessons learnt about environmental enablers and essential service requirements are highlighted. Fluoridation has the potential to improve oral health so as to contribute positively to child development as part of the broader mission of closing the gap in health between Indigenous and non-Indigenous Australians.

Background: Remote Australia is a complex environment characterized by workforce shortages, isolated practice, a large resident Indigenous population, high levels of health need, and limited access to services. In recent years, there has been an increasing trend of utilizing a short-term visiting (fly-in/fly-out) health workforce in many remote areas. However, there is a dearth of evidence relating to the impact of this transitory workforce on the existing resident workforce, consumer satisfaction, and the effectiveness of current services. Objective: This study aims to provide rigorous empirical data by addressing the following objectives: (1) to identify the impact of short-term health staff on the workload, professional satisfaction, and retention of resident health teams in remote areas; (2) to identify the impact of short-term health staff on the quality, safety, and continuity of patient care; and (3) to identify the impact of short-term health staff on service cost and effectiveness. Methods: Mixed methods will be used. Administrative data will be extracted that relates to all 54 remote clinics managed by the Northern Territory Department of Health, covering a population of 35,800. The study period will be 2010 to 2014. All 18 Aboriginal Community-Controlled Health Services in the Northern Territory will also be invited to participate. We will use these quantitative data to describe staffing stability and turnover in these communities, and then utilize multiple regression analyses to determine associations between the key independent variables of interest (resident staff turnover, stability or median survival, and socioeconomic status, community size, and per capita funding) and dependent variables related to patient care, service cost, quality, and effectiveness. The qualitative component of the study will involve in-depth interviews and focus groups with staff and patients, respectively, in six remote communities. Three communities will be high staff turnover communities and three characterized by low turnover. This will provide information on service quality, impact on resident and visiting staff, and patient satisfaction with the services. The research team will work with staff, patients, and a key stakeholder group of senior policymakers to develop workforce strategies to maintain or attain remote health workforce stability. Results: The study commenced in 2015. As of October 2016, fieldwork has been almost completed and quantitative analysis has commenced. Results are expected to be published in 2017. Conclusions: The study has commenced, but it is too early to provide results or conclusions.

The purpose of this Fellowship was to enhance and develop the maritime training delivered to indigenous Australian students, not only in the Torres Strait but elsewhere in remote and regional Australia. It involved a comparison between remote maritime regions in Canada and the Torres Strait region within Australia, given the similarities between the two communities. The specific aims were: (1) to investigate different methodologies in training and assessment for Indigenous communities situated in remote maritime regions in the Coastal Inuit population of Canada; and (2) to gain valuable information on best practice delivery models undertaken by providers of Indigenous training, to be trialled and implemented in the University of Tasmania Australian Maritime College's maritime training delivery in the Torres Strait. Edited excerpts from publication.

Background: The Aboriginal and Torres Strait Islander community has an increased risk of developing chronic illnesses including diabetes. Among people with diabetes, foot complications are common and make a significant contribution to the morbidity and mortality associated with this disease. The aim of this review was to systematically evaluate the literature comparing the rates of diabetes related foot complications in Aboriginal and Torres Strait Islander Australians to non-Indigenous Australians. Methods: MEDLINE, EMBASE, The Cochrane Library; PUBMED and CINAHL were searched from inception until August 2016. Inclusion criteria were: published cross-sectional or longitudinal studies reporting the prevalence of diabetes related foot complications in both a cohort of Aboriginal and Torres Strait Islander Australians and a cohort of one other Australian population of any age with diabetes. Risk of bias was assessed using the STROBE tool. Results: Eleven studies including a total of 157,892 participants were included. Studies were set in Queensland, the Northern Territory and Western Australia, primarily in rural and remote areas. Aboriginal and Torres Strait Islander Australians experienced substantially more diabetes related foot complications with the mean age up to 14 years younger than non-Indigenous Australians. Aboriginality was associated with increased risk of peripheral neuropathy, foot ulceration and amputation. In several studies, Aboriginal and Torres Strait Islander Australians accounted for the vast majority of diabetes related foot complications (up to 91%) while comprising only a small proportion of the regional population. Reporting quality as assessed with the STROBE tool showed underreporting of: methods, sample description and potential sources of bias. There are no data available for some Australian states and for specific types of diabetes related foot complications. Conclusions: Aboriginal and Torres Strait Islander Australians have a 3–6 fold increased likelihood of experiencing a diabetes related foot complication compared to non-Indigenous Australians. Evidence-based, culturally appropriate screening and intervention programs and improved access to effective health care services are required to prevent a widening of the gap in diabetes related foot complications between Aboriginal and Torres Strait Islander and non-Indigenous Australians.

The Australian government is aiming to improve remote participation and employment services and announced a review of existing arangements on 29 June 2011. New arrangements will be put in place by 1 July 2013 and the goal is that they be simpler, more integrated and more flexible than exising arrangements. Many people in remote areas lack the skills and work experience required to get and hold a job. Additionally, in most remote communities there are more job seekers than there are jobs. The new arrangements will focus on building individual capabilities, including foundational skills, improving employment services to get more people in remote locations into jobs and creating meaningful participation activities. The consultation strategy will be assisted by the Remote Participation and Employment Services Engagement Panel, and will involve community and stakeholder consultations. The consultations will guide and inform the design of the new arrangements. The purpose of this discussion paper is to gather public views on future arrangements for remote participation and employment services. The submission period ended on 12 October 2011. Excerpts from publication.