Remote Australia Online

Print newspapers tend to form part of the conversation on sustainable development goals in terms of the ability to communicate goals to the public, but to what degree are print newspapers part of the solution to sustainable rural and regional communities in particular? The COVID-19 pandemic coincided with a global crisis in print journalism. This article takes Australia as an extreme case study of the collapse of print news, tracing both the immediate causes as well as the scale of the decline, and the impacts in terms of community conversation, building social capital, and improving governance, particularly in sub-populations such as the aged, and in digitally disadvantaged regional and remote communities. This paper uses a range of secondary and primary data sources to build a paradoxical picture of a revival of rural and regional journalism, a revival that is focused on survival rather than revisiting the activist origins of early independent rural and regional media in the country. The new papers include part of the traditional mission of print news—building social capital—but are less engaged in creating political and financial transparency. It is concluded that the new wave of rural and regional titles may be simply at an early stage of evolution, but with the digital divide in Australia reducing, they may have little time to evolve.

Ethical perspectives on regional, rural, and remote healthcare often, understandably and importantly, focus on inequities in access to services. In this commentary, we take the opportunity to examine the implications of normalizing metrocentric views, values, knowledge, and orientations, evidenced by the recent (2022) New South Wales inquiry into health outcomes and access to hospital and health services in regional, rural and remote New South Wales, for contemporary rural governance and justice debates. To do this, we draw on the feminist inspired approach to rural health ethics involving analysis of power relationships developed by Simpson and McDonald and related ideas from critical health sociology. In presenting this analysis, we extend contemporary thought about spatial health inequities and structural violence.

The delivery of health services in New South Wales is a joint responsibility between the Australian and New South Wales governments. In simple terms, the Australian Government is responsible for the provision of GP services, and the State Government is responsible for the public hospital system. Eleven years ago, as a result of the Garling Inquiry, the State Government established 15 Local Health Districts to deliver health care that was to be tailor made for the communities that they served. While recognising that the provision of health services to an area as large as rural, regional and remote New South Wales is challenging and complex, throughout this inquiry the committee heard repeatedly about individuals and families let down by the health system. We heard stories of emergency departments with no doctors; of patients being looked after by cooks and cleaners; of excessive wait times for treatment; and of misdiagnoses and medical errors. This evidence is by no means a reflection on the NSW Health staff working tirelessly in challenging circumstances; rather it is an indictment of the system that has allowed this situation to develop. Overall, the committee has found that residents of rural, regional and remote New South Wales have poorer health outcomes and inferior access to health and hospital services, and face significant financial challenges in accessing these services, compared to their metropolitan counterparts. This is a situation that can and should not be seen as acceptable.

Governments and public servants need to enact the requirement to change the way public servants work with Aboriginal and Torres Strait Islander people and communities under the Closing the Gap (National Agreement 2020), Clause 18. However, as with any significant change agenda, there are a number of real and perceived risks and barriers to ‘working differently’. In exploring solutions for all Australian governments and public services to overcome these challenges there are distinct roles for First Nations/ Indigenous public servants and roles for significant intermediaries involved in service delivery, and in particular First Nations corporations. Underpinning all actions is a clear imperative to incorporate First Nations voices into government policies and servicing. The literature review (Part 1 - p.8) establishes for all stakeholders, an acknowledgment that limited guidance exists for bureaucrats on how to handle broad reforms such as self-determination and devolution. This is in large part because so many topics, government perspectives, community views and public opinions intersect and confound solutions. There are a number of barriers that confront public servants when they seek to partner and share decision making with Aboriginal and Torres Strait Islander Peoples and their organisations. Some challenges highlight structural issues which require profound changes in the ways bureaucracies engage with community. Other barriers reflect the day-to-day experiences of public servants attempting to address the devolution agenda, and the efforts, initiatives and experiments they have engaged with – something that they are themselves in a better position to inform. Interviews conducted with current and former senior public servants and managers of First Nations service organisations identified six specific challenges (Part 2 - p.49) including: the accountability of systems, organisations and leaders; partnerships and the capacity of entities to partner; power and decision making; Identifying and engaging with the right partners; cultural change of organisations; and data availability and quality. Potential solutions are explored with examples of different approaches that have been put in place by various levels of government to increase participatory approaches to policy and service delivery promoting engagements based in localisation, co-design and co-production. Essentially while many of these challenges may not be easy to address, valuable changes can happen when good people commit to making a difference in an informed way.

Introduction: The COVID-19 global pandemic has been a significant challenge worldwide. This has been particularly so in rural and remote communities where largely metropolitan-based policies do not translate into the rural context. Western NSW Local Health District (Australia), a region spanning almost 250,000 km2 (slightly larger than the UK), has implemented a networked approach that spanned public health measures, acute care services and psycho-social supports for rural communities. Method: A synthesis of field observations and experiences in planning and implementing a networked rural approach to COVID-19. Results: This presentation reports on the key enablers, challenges and observations in operationalising a networked, rural-specific, 'whole-of-health' approach to COVID-19. As of 22 December 2021, the region (total population 278,000) had confirmed over 112,000 cases of COVID-19 across some of the state's most disadvantage rural communities. This presentation will provide an overview of the framework used to address COVID-19, including descriptions of the public health response, specific care needs of those with COVID-19, cultural and social support for vulnerable peoples and an approach to keeping the community well. Discussion: Responses to COVID-19 need to be 'rural proofed' to ensure that the need of rural communities can be met. Acute health services must leverage a networked approach that supports existing clinical workforce through effective communication and developing rural-specific processes to ensure best practice care can be delivered. This includes utilising advances in telehealth to ensure people can access clinical support when diagnosed with COVID-19. Managing the COVID-19 pandemic across rural communities requires 'whole-of-system' thinking and strengthening partnerships to manage both public health measures as well as an acute care response.

Emerging from the digital archive of Circus Oz are a multiplicity of visual images, pathways and memories that circulate around planes of past performances and their touring contexts; this paper explores the re-negotiation of topographical space and bodies that sits at the heart of the early Circus Oz tours to the Northern Territory. This paper focuses on the power of the ever-widening and rippling rings as a symbolic frame for circus performance and the impacts that both establishing and rethinking alternative centres has had for one arts company. Specifically, through the exploration of detail extracted from maps, cultural data and the historical record, this paper argues that Circus Oz’s engagement with remote Indigenous communities in Arnhem Land and Central Australia in this early period ultimately informed an intermittent but nonetheless persistent experimental corporeal practice – still present in the digital bodies of recordings available in the Living Archive and on the University of Melbourne Theatre and Dance Platform, and the visualization and interpretation of these tours presented on the People, Places and Radical Exchanges project website.

Importance In remote communities of the Northern Territory, Australia, children experience high rates of otitis media (OM), commonly caused by non-typeable Haemophilus influenzae (NTHi). Few data exist on antibiotic susceptibility of NTHi from OM. Objective To determine whether population-level nasopharyngeal NTHi antibiotic susceptibility data could inform antibiotic treatment for OM. Methods NTHi isolates (n = 92) collected from ear discharge between 2003 and 2013 were selected to time- and age-match NTHi isolates from the nasopharyngeal carriage (n = 95). Antimicrobial susceptibility were tested. Phylogenomic trees and a genome-wide association study (GWAS) were performed to determine the similarity of nasopharyngeal and ear isolates at a population level. Results Among 174 NTHi isolates available for antimicrobial susceptibility testing, 10.3% (18/174) were resistant to ampicillin and 9.2% (16/174) were resistant to trimethoprim-sulfamethoxazole. Small numbers of isolates (≤3) were resistant to tetracycline, chloramphenicol, or amoxicillin-clavulanic acid. There was no statistical difference in the proportion of ampicillin-resistant (P = 0.11) or trimethoprim-sulfamethoxazole-resistant isolates (P = 0.70) between ear discharge and nasopharynx-derived NTHi isolates. Three multi-drug resistant NTHi isolates were identified. Phylogenomic trees showed no clustering of 187 Haemophilus influenzae isolates based on anatomical niche (nasopharynx or ear discharge), and no genetic variations that distinguished NTHi derived from ear discharge and nasopharyngeal carriage were evident in the GWAS. Interpretation In this population-level study, nasopharyngeal and ear discharge isolates did not represent distinct microbial populations. These results support tracking of population-level nasopharyngeal NTHi antibiotic resistance patterns to inform clinical management of OM in this population.

Additive manufacturing and in particular, concrete 3D printing has been suggested as one of the interesting solutions to unlock remote development, enhance the strength and capability of the local and national manufacturing and construction industries, and offer fast recovery in post-disaster scenarios. In this study, the remote housing construction challenges with a particular focus on Australian Northern Territory (NT) are reviewed and the feasibility and efficiency of using concrete 3D printing to tackle those challenges have been discussed. Besides the advantages of 3DP for remote housing, it's limitations and concerns have also been presented. Finally, some completed 3D-printed construction projects in remote locations were introduced. According to the findings of this review, to establish whether 3D printing is practicable and desirable in remote locations, trade-offs between several aspects, including materials, structural design, process efficiency, logistics, labour, and environmental impact, must be taken into consideration. In the case of using local materials that meet the printability, buildability and robustness requirements, 3DP could be considered a cost-effective solution for remote housing. However, researchers, designers, and decision-makers should consider the options, such as remote on-site fabrication, available local materials and their quality, and the large-scale manufacturing process and concrete 3DP limitations when evaluating the feasibility of using 3DP in comparison to conventional construction methods.

Objectives To investigate the effects of extended short-term medical training placements in small rural and remote communities on postgraduate work location.Design and setting Cohort study of medical graduates of The University of Queensland, Australia.Participants Graduating medical students from 2012 to 2021 who undertook a minimum of 6 weeks training in a small rural or remote location. Some participants additionally undertook either or both an extended short-term (12-week) placement in a small rural or remote location and a long-term (1 or 2 years) placement in a large regional centre.Primary outcome measure Work location was collected from the Australian Health Practitioner Regulation Agency in 2022, classified as either rural, regional or metropolitan and measured in association with rural placement type(s).Results From 2806 eligible graduates, those participating in extended small rural placements (n=106, 3.8%) were associated with practising rurally or regionally postgraduation (42.5% vs 19.9%; OR: 2.2, 95% CI: 1.1 to 4.6), for both those of rural origin (50% vs 30%; OR: 4.9, 95% CI: 2.6 to 9.2) or metropolitan origin (36% vs 17%; OR: 2.8, 95% CI: 1.7 to 4.8). Those undertaking both an extended small rural placement and 2 years regional training were most likely to be practising in a rural or regional location (61% vs 16%; OR: 8.6, 95% CI: 4.5 to 16.3). Extended small rural placements were associated with practising in smaller rural or remote locations in later years (15% vs 6%, OR: 2.7, 95% CI: 1.3 to 5.3).Conclusion This work location outcome evidence supports investment in rural medical training that is both located in smaller rural and remote settings and enables extended exposure with rural generalists. The evaluated 12-week programme positively related to rural workforce outcomes when applied alone. Outcomes greatly strengthened when the 12-week programme was combined with a 2-year regional centre training programme, compared with either alone. These effects were independent of rural origin.Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. The University of Queensland (UQ) Human Ethics Committee imposes restrictions on the data. Anonymised data are available to researchers who meet the conditions of the ethics approval and research governance policy that applies to this study via UQ eSpace. Requests for the data may be sent to the Director of Research, Rural Clinical School, UQ (rcsrc@uq.edu. au)

Background: Hyperglycaemia in pregnancy (HIP) is a significant intergenerational issue. The ORCHID Study aims to improve screening for and management of HIP in regional, rural and remote communities. Methods: 27 clinics recruited 694 pregnant women (39% Aboriginal women) and conducted oral glucose tolerance tests (OGTT), glycated haemoglobin (HbA1c) and albumin tests early in pregnancy and at 24–28 weeks gestation during 2015–2018. Antenatal records from Aboriginal women attending a Kimberley Aboriginal Community Controlled Health Services were audited (2018–2022). Results: Aboriginal women were more likely to do a HbA1c test early in pregnancy compared to an early OGTT. Early pregnancy glycated haemoglobin (HbA1c) ≥5.6% identified women at high-risk for large-gestational-age (LGA) babies. Sixty percent of Aboriginal women did not complete the OGTT at 24–28 weeks gestation. In women who were tested, 62% of HIP is missed due to glycolysis. Undiagnosed HIP leads to missing women at high-risk for LGA babies. Combining HbA1c with glycated albumin at 24–28 weeks gestation can identify women at high-risk for LGA babies earlier than an OGTT. Conclusion: Opportunities for improving HIP screening protocols include lowering the first trimester HbA1c threshold, preventing glycolysis due to pre-analytical handing, and combining HbA1c with glycated albumin at 24-28 gestation screening.

This report examines telecommunications debt in regional and remote Indigenous Central Australian communities; specifically, how mis-selling by telecommunications service providers and regulatory weaknesses led to widespread systemic debt for Indigenous telco consumers. Our work over the last two and a half years has found hundreds of Indigenous telco consumers in Central Australia (and some consumers in other parts of the country) with large mobile phone debts. Almost all were unaware that the manner in which they had been sold plans did not meet appropriate consumer protection standards, and in fact suggests a culture of cavalier behaviour existed where telcos were pushing sales at the expense of meeting a consumer’s needs. For the remote Indigenous consumers we talked to for the purpose of this work, a pattern of sales practices bordering on predatory was revealed, with significant numbers of people sold mobile devices, accessories and plans that they neither needed nor could afford, on contracts that they did not understand. Amongst the hundreds of cases we have documented are some confronting examples of indifference to a generally vulnerable cohort; consumers with severe mental illnesses, in situations of homelessness and where there was clear evidence that the purchaser was not going to be the end user of the phone. In some cases, salespeople manipulated the sales interaction to sell more products - for example, by using the family members listed on a Medicare card to persuade a consumer they needed more devices. The substantial majority of cases we reviewed were people who were in receipt of government benefits only. Many reported that contract obligations and additional costs were not explained to them at the point of entering into the contract. Nor did most have any idea of the existence of financial hardship schemes. New mobile phone technology which should have paved the way for bridging the communications gaps in remote communities instead became yet another area of financial burden and stress for too many Indigenous people. This project took place in challenging times. The work was restricted by deaths in the remote communities we visited (including a death in custody) and constrained by the onset of the COVID-19 pandemic which required us to suspend outreach visits for a number of months. Despite these challenges, another $108,273 worth of telco debt was documented during our outreach trips in Northern Territory remote Indigenous communities; enough to suggest that if the resources to intensively canvass this issue existed, a lot more historic debt might be out there. In total, over the last two and half years, we have now (including some cases of interstate sales to vulnerable consumers) recorded a total of $1,123,297.09 where the circumstances of the sales raise concerns. Most of our findings relate to Telstra, which is the sole service provider in many remote Indigenous communities. However examples of poor practice from other telcos were also found. Perhaps unsurprisingly, there is evidence that the arrangements between Telstra and its licensees exacerbated this problem. Telstra itself has acknowledged this and taken a range of actions since 2019 to mitigate the issues that were uncovered. These have included the separation of handset contracts from data contracts; simplification of plans from many hundreds down to 20; the introduction of "Peace of Mind” month to month plans which prevent consumers from accruing excess data charges and prominently displaying the total cost of handsets in some stores so vulnerable consumers immediately understand this information. These actions will likely address the issues seen up to mid-2019, where many debts were accrued with a large component of excess data charges. However, our analysis suggests the structure of business arrangements between Telstra and its licensees retains some elements which could still in future result in sales staff minimising vulnerability or affordability concerns in favour of making a sale. A regulatory environment that also fails to connect with Indigenous consumers or their experience contributes substantially to the problem. Some of the case studies that we have documented – from here and around Australia - suggest that even though the Telecommunications Industry Ombudsman knew after its October 2018 systemic issues investigation that questionable sales practices were an issue, this knowledge did not flow through to their complaints resolution area. Certainly, financial counsellors were submitting cases to the TIO during 2019 which should have been recognised as unfair sales. However frontline TIO complaints staff seem rarely to have acknowledged the possibility of unconscionable conduct in the sales practices before them. Instead, some of the case studies we have collected suggest they preferred to push financial counsellors and community lawyers down the path of a financial hardship claim in resolving complaints (and at times to take a personal or moral position rather than reaching resolutions commensurate with breaches of rules and obligations by the industry, including potential breaches of Australian Consumer Law). The result is a continuing perception that the TIO takes a fairly meek line with the telco industry. We conclude with recommendations for better engagement between telcos and Indigenous consumers especially in remote communities, improved clear and easy to understand consumer information, and legislative and regulatory reform.

Wangkatjungka remote community in the Fitzroy Valley, Western Australia, is home to approximately 180 Wangkatjungka, Walmajarri, or Gooniyandi Aboriginal people.(1) Many of the women living in Wangkatjungka Community enjoy painting and use creative art as a therapeutic practice. Three health promotion educators from Nindilingarri Cultural Health Services, Fitzroy Crossing, created a chronic disease education program, designed to utilise the Wangkatjungka artists’ strengths to capture their thoughts and ideas on health subjects. This study aims to improve the health literacy, and therefore health outcomes, of women living in Wangkatjungka Community through two-way learning and empowerment; coupling the women's art skills and traditional stories with chronic disease health education. The observational cohort study design program was advertised in the Wangkatjungka Community and at local Influenza vaccination clinics prior to the study commencement. Names, phone numbers, and house numbers were collected from Wangkatjungka Community women who were interested in participating in the program. The program is implemented weekly over a 12-week period, from July 2022–October 2022. Participants are collected from their homes each week, and sessions take place in a communal building in community. Each session involves interactive activities covering one of various topics including heart disease, type 2 diabetes, smoking, kidney disease, healthy eating, alcohol, bush medicine, and camp cooking; followed by healthy cooking and painting contributions to a large canvas. Each session runs for approximately two hours; however, cultural consideration allows for flexibility around the exact schedule timing.(Reference Wilson, Kelly and Jones2) Pre- and post-evaluation surveys are used at the end of each session and at the beginning of sessions 2–12 to evaluate the women's learnings. Survey questions are verbalised to promote clarity and understanding, and survey answers are recorded by the health promotion educators as literacy is limited among group members.(Reference Choudhry, Ming and Munawar3) Over the 12-week program, there will be 12 individual sessions. To date, participants have engaged well throughout the sessions, asked health-seeking questions, and have retained information from the sessions. Approximately five women per session have attended, with week-to-week variations. Participant absence in program attendance has been mainly due to grocery shopping, and/or health service appointments/commitments in Fitzroy Crossing. Participants have also voiced their desire for program sessions to be taken on-country near the local water hole. Overall, a strengths-based approach for this study has been successful in gaining participant engagement in the program. The finished painted canvas will be displayed in the community office and, together with knowledge gained from the program, may empower the participants and wider community to make healthy lifestyle choices. To improve program attendance for future health education programs in Wangkatjungka Community, educators should consider on-country sessions and ensure the sessions are facilitated on a day of the week suitable for the whole group.

If love can blind, are there are also scenarios in which relationality invokes clarity of knowledge and closeness of hearing? In this collaborative piece, Bardi artist and weaver Juanita Mulholland and researcher Sarah Bacaller explore the intersection between friendship and Australian Indigenous art forms. They reflect on the development and ethos of Juanita?s artistic practice, as it pertains to her sense of Indigenous identity and selfhood, including in the context of dislocation and loss. The dialogue is prefaced by reflections on recent criticism by Fisher [2012. The Art/Ethnography Binary: Post-Colonial Tensions Within the Field of Australian Aboriginal Art. Cultural Sociology, 6 (2), 251?270] on the ethnography-art binary in approaches to interpreting Australian Indigenous art in its diverse and varied forms. By exploring the dangers inherent in both objectivist ('ethographic') and subjectivist (art 'on its own terms') approaches, and building on the work of Biddle and Steffanoff [2015. What is Same but Different and why Does it Matter? Cultural Studies Review, 21 (1), 97?120], the authors explore how ethical relationality and connection can lead to a fuller understanding and appreciation of artworks and their artists, especially in relation to non-Indigenous engagement with Australian Indigenous artistry.

This report builds upon the Kimberley Clean Energy Roadmap (KCER) by providing updated, cost-effective, low-emissions electricity generation options for the town of Broome, located in the Kimberley region of WA. New modelling software enabled a wide range of generation options to be considered, using 2024 cost estimates for fossil-fuel and renewable electricity generators. Levelised Cost of Energy (LCOE) was used to compare various combinations of technologies across their expected lifetimes. Section 3 outlines the assumptions used in the modelling, including why a carbon price of AU$60/tCO2-e has been applied as the base case. Capital costs in the Kimberley are higher than elsewhere in Australia due to remoteness and severe weather factors. The results are described in Section 4. The current LNG-only generation has an estimated LCOE of $293/MWh. Gas generation costs are strongly sensitive to variations in carbon and fuel prices. Given the increasing likelihood of a carbon price imposition in the short to medium term, and the high volatility of gas prices internationally and domestically, continuing the LNG-only option represents a high to extreme risk for electricity generation costs in Broome. This report shows that the lowest estimated LCOE ($215/MWh) occurs at a solar PV capacity of 60MW, combined with 40MW/160MWh battery storage, backed up by the existing 30MW of gas (LNG) generation. This scenario leads to an 82% reduction of LNG consumption. Table 6 summarises four optimised scenarios, with PV capacities of 40, 50, 60 and 80MW, respectively, where the LCOE differs by only $8/MWh (4%) across the range. The percentage of RE with these scenarios varies from 58% to 88%. Increasing the amount of PV to 80MW will generate 52GWh per annum of intermittent, surplus energy with only a marginal increase in LCOE, although most of this is available only in the Dry season. This surplus is available for use in innovative applications, which would further reduce the LCOE. Further modelling showed that wind generation has an LCOE in the same range as the optimal PV options. There is no benefit from adding wind to the generation mix in Broome when climatic, visual, land and wildlife impacts are considered. Seasonal factors preclude achieving a higher RE percentage at acceptable costs (with or without Wind) with current technologies and costs. From December to March, lower solar radiation results in insufficient energy to meet demand and backup gas generation is needed. Into the future, this generation could be decarbonised. The optimum 60MW PV outcome with 82% of RE will substantially reduce the amount of fuel needed for generation in Broome. To provide Broome’s annual 131GWh of electrical energy, an average of 7.35 LNG road trains are required per week. With only 18% of the original fuel requirement, this equates to an average of only 1.32 shipments a week, or 10.4 tonnes of LNG per day. The final part of the report considered implementation options – how a transition to large-scale renewables could occur in Broome. One factor was that the modelling did not distinguish between rooftop and utility solar PV. The total costs of utility and rooftop PV can be made comparable by appropriately setting the levels for feed in tariffs. Section 5.2 discussed why a mixture of rooftop and utility solar PV may be appropriate in Broome, and the pros and cons of each. A certain amount of utility PV and associated battery will need to be installed by 2027 to replace the gas generators at the end of their contract.

Objective: To quantify Indigenous mortality in the Northern Territory by remoteness of residence. Design, setting and participants: Australian Bureau of Statistics mortality data were used to compare rates of death from chronic disease in the NT Indigenous population with rates in the general Australian population over the period 1998?2003. Rates were evaluated by categories of remoteness based on the Accessibility/Remoteness Index of Australia: outer regional areas (ORAs), remote areas (RAs) and very remote areas (VRAs). Main outcome measures: Mortality from cardiovascular disease, diabetes and renal disease; standardised mortality ratios (SMRs); percentage change in annual death rates; changes in mortality between 1998-2000 and 2001-2003. Results: In 1998-2000, SMRs for all-cause mortality were 285% in ORAs, 875% in RAs and 214% in VRAs. In 2001-2003, corresponding SMRs were 325%, 731% and 208%. For the period 1998-2003, percentage changes in annual all-cause mortality were 4.4% (95% CI, -2.2%, 11.5%) in ORAs, -5.3% (95% CI, -9.6%, -0.8%) in RAs, and 1.1% (95% CI, -7.2%, 11.3%) in VRAs. In 2001-2003, compared with 1998-2000, changes in the number of Indigenous deaths were +35 in ORAs, 37 in RAs and +32 in VRAs. Similar patterns were observed for cardiovascular mortality. Conclusions: Compared with mortality in the general Australian population, Indigenous mortality was up to nine times higher in RAs, three times higher in ORAs and two times higher in VRAs. The fact that rates were lowest in VRAs runs contrary to claims that increasing remoteness is associated with poorer health status. Despite the high death rate in RAs, there was a downward trend in mortality in RAs over the study period. This was partly attributable to a fall in the absolute number of deaths.

Objectives To evaluate the relationship between markers of staff employment stability and use of short-term healthcare workers with markers of quality of care. A secondary objective was to identify clinic-specific factors which may counter hypothesised reduced quality of care associated with lower stability, higher turnover or higher use of short-term staff.Design Retrospective cohort study (Northern Territory (NT) Department of Health Primary Care Information Systems).Setting All 48 government primary healthcare clinics in remote communities in NT, Australia (2011–2015).Participants 25 413 patients drawn from participating clinics during the study period.Outcome measures Associations between independent variables (resident remote area nurse and Aboriginal Health Practitioner turnover rates, stability rates and the proportional use of agency nurses) and indicators of health service quality in child and maternal health, chronic disease management and preventive health activity were tested using linear regression, adjusting for community and clinic size. Latent class modelling was used to investigate between-clinic heterogeneity.Results The proportion of resident Aboriginal clients receiving high-quality care as measured by various quality indicators varied considerably across indicators and clinics. Higher quality care was more likely to be received for management of chronic diseases such as diabetes and least likely to be received for general/preventive adult health checks. Many indicators had target goals of 0.80 which were mostly not achieved. The evidence for associations between decreased stability measures or increased use of agency nurses and reduced achievement of quality indicators was not supported as hypothesised. For the majority of associations, the overall effect sizes were small (close to zero) and failed to reach statistical significance. Where statistically significant associations were found, they were generally in the hypothesised direction.Conclusions Overall, minimal evidence of the hypothesised negative effects of increased turnover, decreased stability and increased reliance on temporary staff on quality of care was found. Substantial variations in clinic-specific estimates of association were evident, suggesting that clinic-specific factors may counter any potential negative effects of decreased staff employment stability. Investigation of clinic-specific factors using latent class analysis failed to yield clinic characteristics that adequately explain between-clinic variation in associations. Understanding the reasons for this variation would significantly aid the provision of clinical care in remote Australia.No data are available. The datasets generated and analysed during the current study are not publicly available due to identifiability of remote primary health care providers and the need to protect their privacy.

Objective To assess the observed pain behaviours of Aboriginal residents with cognitive impairment in aged care facilities and compare these results with a matched national sample of non-Aboriginal residents. Methods Observed pain behaviours of Aboriginal residents (N = 87) with cognitive impairment in aged care facilities across the Northern Territory of Australia were assessed using PainChek Adult and compared with data from a matched national sample of non-Aboriginal residents (N =420). Pain scores were derived from inbuilt automated facial recognition and analysis software plus a series of digital checklists requiring manual input by care staff. Results The median total pain score for the Aboriginal residents was 2 (IQR 1-4) and for the matched external residents was 3 (IQR 2-5). In a multivariable negative binomial regression model, this difference in total pain score was statistically significant (p < 0.001). The pain score derived from the automated facial recognition and analysis component of the PainChek Adult app was not statistically different between the two groups when adjusted for multiple observations and context of observation (odds ratio = 1.06, 95% confidence interval 0.97-1.16, p = 0.169). Conclusions We found under-reporting of observed pain signs and behaviours for Aboriginal aged care residents by assessors. Further training in the assessment of pain in Aboriginal and Torres Strait Islander aged care residents may be necessary and a continuing shift in clinical practice to using technology and point-of-care assessment.

This paper is a work in progress of an aspect of a PhD research. The study investigates Indigenous female principals and issues involving school and community partnerships in remote Indigenous community schools in Northern Territory in Australia. As a data collection strategy the author has drawn upon the work of Rosenthal and Fisher-Rosenthal’s biographical narrative interpretive method (BNIM) developed in the early 1990s. The study adopts modifications of the approach by Wengraf. In recent years, there have been calls for Indigenous communities to have greater involvement in education as a way of improving Indigenous education. In the Northern Territory, Indigenous women in remote communities have been aspiring to leadership positions in education in their respective communities. These Indigenous female leaders are “breaking new ground” into a terrain that for a long time was the domain of non-Indigenous educators. The women narrate stories about their experiences in building school community partnerships, the journeys to their positions as school principals, as well as the day-to-day battles they face as women in leadership positions. The researcher interviewed each of the Indigenous female study participants in November and December of 2007. The methodology intends to privilege the voice of study participants. In achieving this aim, extensive interviews were conducted with study participants to capture their perspectives. The outcome of these discussions has provided rich and informative data on which this paper draws. Through biographical narratives, which employs a single question inducing narrative (SQUIN) the researcher elicits these stories and uses the principles and procedures of the Biographic-Interpretive Method to interpret their meaning. [Author abstract, ed]

Ensuring safe drinking water in Walgett has been a long-term priority for the Dharriwaa Elders Group (DEG) and the Walgett Aboriginal Medical Service (WAMS). Their work has raised awareness of systematic water mismanagement which, exacerbated by both drought and flood, has rendered surface water supplies unreliable and produced high levels of water insecurity for Walgett residents. As a result, Walgett’s long term drinking water security relies on regular and prolonged extraction of groundwater from the Great Artesian Basin (GAB). By engaging external experts, DEG and WAMS have been able to provide evidence that consumption of local groundwater containing high concentrations of sodium on an ongoing basis is unhealthy, especially in communities managing chronic conditions such as hypertension and kidney disease. The advocacy of the DEG and WAMS since 2018, including around the installation of a Reverse Osmosis (RO) facility to reduce the concentration of sodium, has been directed at finding a long-term supply of safe drinking water for all residents of Walgett and the nearby Namoi and Gingie villages. However, Walgett continues to experience water insecurity and quality issues and associated health risks. This Briefing Paper documents a timeline of events in Walgett’s recent history of drinking water management. It sets out the context in which drinking water is accessed, the associated risks, and the story of community advocacy pivotal to change. Its purpose is to inform efforts to improve water security and quality for residents in Walgett and the nearby Namoi and Gingie Villages, including the following urgent actions called for by DEG and WAMS1: • Desalination solutions for towns relying on groundwater and evaporating rivers • Potable water supplied to Aboriginal communities • Fluoridation of potable water supplies • Accessible safe public drinking water sources • Australian Drinking Water Guidelines that include a health guideline for sodium rather than just referring to ‘palatability’ • Drinking water community education campaigns conducted by Aboriginal community controlled organisations (ACCOs) supported by quality community education resources. • Wastewater recycling and other water efficiency measures and infrastructure for remote Aboriginal communities • Greater engineering capacity in Walgett and regional and remote communities to enable the functioning of critical community water infrastructure Declaration of a climate emergency and requirements made of local governments for Climate Resilience Plans which incorporate measures for managing vital community water infrastructure during increasing natural disasters and water scarcity • Sustainable management of surface and groundwaters to ensure the health and wellbeing of all species While the timeline set out in this Briefing Paper begins in earnest with the rivers running dry in 2018, the story of mismanagement starts long before. Much of the articulation around the water crisis and associated issues can be found in DEG’s published statements and submissions.

Access to perinatal mental health services in rural and remote areas is scarce, particularly perinatal psychiatry services. Telehealth, together with psychiatry consultation-liaison services are one way to improve access to areas of need. The New South Wales State-wide Outreach Perinatal Services – Mental Health (SwOPS) program is a Sydney-based program, offering specialist perinatal consultation-liaison services to rural and remote community mental health clinicians caring for perinatal women with significant mental health problems. This study aimed to evaluate healthcare practitioners’ perceptions of the SwOPS program.

Solid waste and its associated environmental, health and wellbeing impacts and resource and land availability are becoming increasingly challenging to manage in remote and isolated communities. This is primarily due to the lack of infrastructure, land availability, high collection cost, poor economies of scale and low environmental awareness. This paper seeks to understand the factors that contribute to this solid waste management challenge and that hinder more sustainable management in a remote community context, through a systematic and critical literature review. 265 scientific articles and industry and government reports were collected and reviewed from Web of Science, Scopus, and Google search from 2011 to 2021. Barriers and enablers were synthesised and critically reviewed using a systematic literature review approach following the Drivers-Pressures-State-Impact-Response (DPSIR) framework. The review identified a lack of waste collection and recycling infrastructure, increasing trade and local economic development, low environmental awareness with respect to impacts of consumer waste products and disposal, and limited access to funding as the major drivers for the current unsustainable waste problem in remote communities. Notable impacts literature identified include water pollution (including marine environments), land pollution, and air pollution. Six categories of responses reported in the literature are: 1) technological improvements, 2) waste avoidance and reduction, 3) reuse and recycle, 4) increase government support, 5) inter-organisation partnership, and 6) innovative solutions to create value from waste. This paper informs policy makers on existing problems and potential circular economy approaches to achieve greater sustainability in this area. The paper also provides recommendations on a future research agenda to achieve such changes on the ground.

The paper is concerned with music programs designed for diverse people or populations facing barriers to participation. While studies in the fields of community cultural development, community music and participatory artmaking have embraced the complex work of aligning various stakeholder interests and outcomes as part of the creative process of collaboration in such contexts, there is notably less discussion of this process through the lens of classical music community outreach and engagement. As such, this paper provides small insights into how conservatoire trained professional musicians perceive this process when employed in regional and remote touring with major performing arts companies in Australia. Particular attention is focused on activities involving collaboration with rather than performance for the communities they visit.

It is presently unclear whether a distinct “rural ethics” of navigating professional boundaries exists, and if so, what theoretical approaches may assist practitioners to manage overlapping relationships. To be effective clinicians while concurrently partaking in community life, practitioners must develop and maintain safe, ethical, and sustainable therapeutic relationships in rural and remote healthcare. A narrative review was conducted identifying a significant body of qualitative and theoretical literature which explores the pervasiveness of dual relationships for practitioners working in rural and remote healthcare. Rather than viewing dual relationships as ethically unacceptable, much contemporary work focusses on the lived experiences of healthcare workers and explores what approaches may be available that both protect the therapeutic relationship while recognizing the unique nature of rural and remote healthcare practice. We conclude that practitioners must have a means of operating within a contextually informed ethics of professional boundaries. Drawing on pre-existing work, one schema is proposed that could form the basis for further engagement through interactive teaching sessions, professional development, mentoring, or guidelines.

Novel approaches to geohealth data analysis offer major benefits to neglected tropical disease control by identifying how social, economic and environmental elements of place interact to influence disease outcomes. However, a lack of timely and accurate geohealth data poses substantial risks to the accuracy of risk identification and challenges to the development of suitably targeted disease control programs. Scabies is one of many skin-related NTDs that is nominated as a priority for global disease control by the World Health Organization, but for which there remains a lack of baseline geospatial data on disease distribution. In this opinion paper, we consider lessons on impediments to geohealth data availability for other skin-related NTDs before outlining challenges specific to the collection of scabies-related geohealth data. We illustrate the importance of a community-centred approach in this context using a recent initiative to develop a community-led model of scabies surveillance in remote Aboriginal communities in Australia.

It is well established in Australian research and policy literature that children attending schools in regional, rural, and remote locations will benefit from access not only to experiences and interactions offered in their own communities but also to the sorts of experiences available to those in more populated areas of Australia as well. Virtual interactions afforded by technology are an obvious solution to achieving this access by enabling Australian classrooms to be increasingly connected. However, with the plethora on offer and little oversight of their quality, literacy educators are left to sift and sort through volumes of virtual interactions and to make decisions regarding their capacity to promote the development of oral language through play. Using a design-based research approach, this study aimed to identify in research literature key principles for the design of virtual interactions for children that can support the development of oral language through play and test them against those currently on offer. The study confirmed the value of virtual interactions as rich sources for learning that offered shared experiences built on language interactions between creators and users and giving access to new information where learning is scaffolded and understandings can be transferred from virtual to real contexts. The study also identified personal advantages that access to new physical geographies within virtual interactions can offer to those in regional, rural, and remote communities.