Remote Australia Online

This article discusses ideas for a new literacy compact in Australia that would encompass multilingual, language revitalizing, and Indigenous grounded perspectives. A key question posed is whether a uniquely Australian literacy order can be imagined, one that would extend the historically inherited tradition of Western grammar–centred practices as conventionally typified in print-based English book and letter reading and its digital equivalents, to include the many languages of the nation and their distinctive literacies, whether Indigenous and immigrant in origin. Any such imagining must understand the inherited and dominant tradition it seeks to change, the colonial legacy of damaged language vitality, and the various revitalization practices underway, and therefore must be situated in the concrete circumstances of contemporary communication issues. This means more than merely teaching non-dominant languages and literacies, but re-conceiving what the national project of “becoming literate” is taken to be, incorporating multiple perspectives, interests, and circumstances. This re-imagining would tie literacy outcomes not just to academic curriculums and assessment purposes, but also to health and wellbeing of populations, to regenerative cultural vitality, and to linguistic human rights. Such aims represent a challenge to current Closing the Gap policy, which is based principally on ameliorating group comparisons of reading performance. The article argues that public discussion about literacy should be able to comprehend such different activities in a coherent and overarching literacy endeavour to grasp the opportunity represented by contemporary social movements calling for a reconstruction of Australian national identity and direction. None of this should lose sight of the need to improve reading acquisition nor deflect from how what counts as literacy is itself being transformed in response to new economic and technological developments as discussed by Farrell, Newman, and Corbel (Discourse: Studies in the Cultural Politics of Education 42 (6):898–912, 2020).

Objective To explore health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic. Setting Australia. Participants Allied health, nursing and medical students with a planned rural or remote placement between February and October 2020. Design Semi-structured interviews (n = 29) with data thematically analysed. Results Five main themes emerged from student experiences: (1) 'Do we go? Don't we go? Like how much risk is involved?' related to student concerns regarding acquiring and transmitting COVID-19 on placement; (2) 'We are sort of just standing at the door trying to watch' encompassed student perceptions of missed clinical learning opportunities in response to health and safety measures related to COVID-19; (3) 'I, as a student, sort of fell under the radar' related to student perceptions of suboptimal supervision; (4) 'It was a bit more difficult to engage with that wider community' recognised student feelings of social disconnection and their lack of opportunity for community immersion; and (5) 'We felt like we got something that is more than we expected' emerged from student reflections on training during the pandemic and alternative placements (virtual, simulated and non-clinical) that exceeded expectations for learning. Conclusions Although most students were willing and able to undertake their rural or remote placement in some form during the early stages of the pandemic and identified unanticipated learning benefits, students recognised lost opportunities to build clinical skills, become culturally aware and connect with rural communities. It remains unknown how these rural and remote placement experiences will impact rural intention and in turn, rural workforce development.

A survey is reported of psychiatric disorders in an Australian Aboriginal tribal group of 650 persons residing at Yuendumu, Central Australia. Methods of case detection and criteria of inclusion of cases are described. Clinical summaries of all affected individuals are supplied and the frequency distribution of psychiatric illness by age, sex, diagnosis and severity is presented. The survey results are discussed and related to sociocultural circumstances of the Walbiri people and to epidemiological findings from other parts of the world.

Professional development programmes for teachers have become an increasing focus in the quest to improve teacher quality. In regional and remote areas of Australia the delivery of professional development programmes can become problematic. This study compares and contrasts the two separate professional development programmes evaluated (Programme A and Programme B), which were focused on aspiring leadership and delivered in the Northern Territory. Findings are presented which identify enablers for success in professional development programmes delivered in remote areas. Programme A and Programme B varied in their levels of success in achieving stated goals. The findings suggest that when professional development is delivered to remotely located teachers, local context and shared experience become critical for success. Local agents and local leaders are shown to be an essential element of successful professional development in context. The results have implications for those developing and delivering professional development programmes to remote locations.

Chronic hepatitis B is a public health concern in Aboriginal communities in the Northern Territory of Australia with prevalence almost four times the non-Aboriginal population. Infection is suspected to mainly occur in early life, however, the mode of transmission and vaccine effectiveness is not known in this population. WHO has set a target for hepatitis B elimination by 2030; elimination in this disproportionately affected population in Australia will require understanding of the modes of transmission and vaccine effectiveness.

Objective: To determine the prevalence of Giardia duodenalis and other intestinal parasites in children, dogs and cats from Aboriginal communities in the west Kimberley region of Western Australia. Design: A four-year parasitological survey of faecal specimens from humans and faecal and intestinal specimens from dogs and cats. Setting: Local hospital servicing Aboriginal communities surveyed in this study and the Veterinary School, Murdoch University. Population: Children (under 14 years) and adults, as well as dogs and cats, from five Aboriginal communities. Results: G. duodenalis was the most prevalent parasite in children and adults (32.1% in children, n = 361; 12.5% in adults, n = 24). Human infections with Hymenolepis nana (20.5%) and Entamoeba coli (13.0%) were also common. Ancylostoma duodenale (1.3%), Pentatrichomonas hominis (1.0%), Chilomastix mesnili (0.52%), Entamoeba hartmanni (0.52%), Sarcocystis sp. (0.52%), Trichuris trichiura (0.26%), Enterobius vermicularis (0.26%), Strongyloides stercoralis (0.26%) and Isospora belli (0.26%) were present at low rates. Dogs were most commonly infected with Ancylostoma caninum (51.1%) and G. duodenalis (17.0%). Cats were found to have a high prevalence of Ancylostoma tubaeforme (18.2%), Toxoplasma gondii (18.2%), Isospora felis (15.1%) and Spirometra erinacei (15.1%). Conclusions: This study has shown that children from Aboriginal communities in the west Kimberley region of Western Australia, particularly in the age group one to five years, are commonly infected with intestinal parasites. The dogs and cats in these communities are also infected. The high prevalence rates of Giardia and other enteric parasites in this survey are indicative of poor living conditions and low levels of hygiene. In addition, the high prevalence of hookworm and Giardia infection in dogs and hookworm and Toxoplasma infection in cats is of potential zoonotic significance for humans in these communities.

A forum of health professionals was held in Brisbane, Queensland, Australia, 30-31 August 2003, to discuss the relevance and potential of the Community Based Rehabilitation (CBR) model to rural, remote and Indigenous communities in Australia. The forum identified principles and guidelines for the development of CBR, which are presented here as a focus point for future discussion and action by people with disabilities, rural community members, Indigenous people, policy makers and health professionals. Forum members noted that while considerable strengths were evident in the CBR model, it has yet to make a significant impact on the service system in Australia. While recognising that the Australian context is quite different from many countries in which CBR has traditionally been implemented, they suggested that it may have particular application to remote, rural and Indigenous communities. To facilitate the principles of CBR in these communities, the forum called for recognition of the need for greater community involvement in disability services, the need to develop appropriate training frameworks, and the need to redirect resources to such community models. In keeping with the CBR philosophy, forum members noted that if the model is to be implemented effectively, substantial consumer and community involvement will be instrumental in future steps.

On a 15 month Consultant Psychiatric placement in Central Australia the senior author learned that Indigenous suicide rates in this region over 2001 to 2006 were almost ten times as high as European ones. What accounts for this, and what can be done to reduce it? Within the limits imposed by organisational and service delivery priorities, the authors conducted an opportunistic qualitative study, investigating hospital records, opinions of colleagues, interviews with survivors, and Coroners' and Psychiatric reports, in an attempt to address these questions. Basic data patterns were similar to those in other Indigenous suicide studies; reflecting dire overall levels of chronic stress, and indicating an undermining of resilience. Canvassed opinions of medical colleagues, informed by contemporary epigenetic perspectives, developed this hypothesis further. Chronic deprivation and stress may have resulted in a transgenerational cascade of epigenetically impaired resilience to stress, mediated by the impact of stressed infant nurturing, resulting in Hypophyseal Pituitary Adrenal (HPA) Axis dysfunction and its behavioural sequelae (depression, anxiety, substance abuse, violence, suicide; but also impaired capacities for nurturance). The authors wondered about the impact of this on the development of that prefrontallymediated interiority (capacity for reflective inner life) that authors like Fonagy (2004) associate with the ability to deal with extreme emotional states. Survivor vignettes reflected something of the interior process of suicidees. The suicide gestures could be read as expressions of social powerlessness and implicit pleas for the kind of nurturance that might facilitate development of a capacity for reflectiveness that might lessen impulsive emotional acting out. The developing individual's impaired capacity for an inner life may be repaired to some extent, in psychotherapy, by the application of an empathic reflective nurturance (Fonagy, 2004; Meares, 2000). What is required in a social tragedy of this magnitude goes way beyond the psychotherapist's rooms. Informed by a post-Jungian sensibility, the authors extend this model of therapeutic nurturance, as heuristic metaphor, to the notion of the larger Euro-Australian milieu as failed nurturer, with a particular focus on psychiatric and forensic services. In an attempt to see how organisations might become more effective nurturers, we used a Leximancer 'concept analysis' of Coroners' Reports to explore organisational 'collective countertransference'. The Leximancer data suggested slippage between collective intentions and outcomes, prompting a discussion of ways of enhancing the nurturing capacities in organisations/services (in this case, Psychiatry and the Law). A 'Kanyini/nurturance' project of repair is outlined.

Against the background of popularisations of Freud's theory of laughter as anxiety release and Lustgewinn (pleasure gain), this paper presents some ethnographic examples of laughter from Yuendumu, central Australia, in which weakness and fear are considered to originate from laughter. Analysing some of the specific conceptual links that Warlpiri people make between laughter and weakness on the one hand, and between laughter and fear on the other, the paper makes a case for recognising both socio-culturally hyper- and hypocognised aspects of laughter.

Objectives We hypothesise that rising prevalence rates of non-communicable diseases (NCDs) increase infection risk and worsen outcomes among socially disadvantaged Indigenous Australians undergoing a rapid epidemiological transition. Design Available pathology, imaging and discharge morbidity codes were retrospectively reviewed for a period of 5 years prior to admission with a bloodstream infection (BSI), 1 January 2003 to 30 June 2007. Participants 558 Indigenous and 55 non-Indigenous community residents of central Australia. Outcome measures The effects of NCDs on risk of infection and death were determined after stratifying by ethnicity. Results The mean annual BSI incidence rates were far higher among Indigenous residents (Indigenous, 937/100 000; non-Indigenous, 64/100 000 person-years; IRR=14.6; 95% CI 14.61 to 14.65, p<0.001). Indigenous patients were also more likely to have previous bacterial infections (68.7% vs 34.6%; respectively, p<;0.001), diabetes (44.3% vs 20%; p<0.001), harmful alcohol consumption (37% vs 12.7%; p<0.001) and other communicable diseases (human T-lymphotropic virus type 1, 45.2%; strongyloidiasis, 36.1%; hepatitis B virus, 12.9%). Among Indigenous patients, diabetes increased the odds of current Staphylococcus aureus BSI (OR=1.6, 95% CI 1.0 to 2.5) and prior skin infections (adjusted OR=2.1, 95% CI 1.4 to 3.3). Harmful alcohol consumption increased the odds of current Streptococcus pneumoniae BSI (OR=1.57, 95% CI 1.02 to 2.40) and of previous BSI (OR=1.7, 95% CI 1.1 to 2.5), skin infection (OR=1.7, 95% CI 1.1 to 2.6) or pneumonia (OR=4.3, 95% CI 2.8 to 6.7). Twenty-six per cent of Indigenous patients died at a mean (SD) age of 47±15 years. Complications of diabetes and harmful alcohol consumption predicted 28-day mortality (non-rheumatic heart disease, HR=2.9; 95% CI 1.4 to 6.2; chronic renal failure, HR=2.6, 95%CI 1.0 to 6.5; chronic liver disease, HR=3.3, 95% CI 1.6 to 6.7). Conclusions In a socially disadvantaged population undergoing a rapid epidemiological transition, NCDs are associated with an increased risk of infection and BSI-related mortality. Complex interactions between communicable diseases and NCDs demand an integrated approach to management, which must include the empowerment of affected populations to promote behavioural change.

Strongyloidiasis, caused by the intestinal helminth Strongyloides stercoralis, is commonly found in developing nations in tropical and subtropical regions. Strongyloidiasis was omitted by the World Health Organization (WHO) as one of the Soil Transmitted Helminths in their Neglected Tropical Diseases Roadmap and can therefore be considered one of the most neglected tropical diseases. Despite its reputation as a disease of developing countries, strongyloidiasis remains an important disease in Australia, particularly for Aboriginal and Torres Strait Islanders, and those living in remote communities. The majority of people infected with S. stercoralis present with a chronic form of strongyloidiasis. Infected people may be asymptomatic, or they may suffer primarily with gastrointestinal, respiratory and/or dermatological symptoms, ranging in severity from mild and intermittent to severe and unrelenting. Due to the autoinfective life-cycle, almost unique among human intestinal helminth infections, infection may be life-long. Secondary infection may cause pneumonia, meningitis or septicaemia, and is more likely to occur in immunosuppressed individuals, particularly those treated with corticosteroids. Returned service personnel and those who have migrated from, lived in, or travelled through endemic areas, may develop severe disease many decades after initial infection. Control and prevention measures must incorporate education, environmental health, effective diagnostics, and appropriate treatment of infected persons. Commonly used anthelminthics such as albendazole, mebendazole, and pyrantel are not effective against S. stercoralis, leaving patients with residual worms that subsequently multiply and re-establish infection. Ivermectin is currently recommended as the most effective treatment option. The pioneering work on strongyloidiasis in Australia was performed by Professor David Grove and his colleagues for World War II ex-prisoners of war who were still infected 40 years after returning home. Grove developed an enzyme-linked immunosorbent assay (ELISA) based on the detection of antibodies to Strongyloides in serum, which became a routine pathology test for diagnosing strongyloidiasis from 1987. National Strongyloides workshops: The first National Workshop on Strongyloidiasis was held in Nhulunbuy in 2001. A community elder asked “We’ve had Strongyloides for so long, why hasn’t something been done?” In response to this, the National Strongyloides Working Group (NSWG) was formed as a special interest group of the Australasian College of Tropical Medicine. The chairperson, Emeritus Professor Rick Speare from James Cook University, is an internationally recognised expert on strongyloidiasis. The group has expanded to consist of several multidisciplinary experts including parasitologists, veterinary and molecular scientists, pathologists, environmental health officers, medical practitioners, health promotion and prevention professionals, and other interested parties. The stated aims of the group are to: raise awareness of strongyloidiasis; inform health professionals and community members about the disease and its prevention, diagnosis, treatment, and control; advocate on behalf of affected people for appropriate changes to government policy in relation to prevention, diagnosis, and treatment, based upon current research. The ultimate goal is eliminating the disease from Australia. Much has been achieved in Australia since the first meeting of this interest group of concerned experts. These achievements deserve recognition. Here we describe the achievements and make a series of recommendations for consideration for research and clinical practice in the future.

Over the last several decades, electronic gaming machines (EGMs) have been steadily introduced into non-casino gambling venues, that is pubs and clubs, in all Australian jurisdictions apart from Western Australia. This spatial dispersal is of immediate policy concern given the documented relationship between EGM participation and gambling-related harm. However, while research has been conducted on the geography of EGM gambling in metropolitan Australia, less is known about the spatial patterns of EGM distribution in remote urban centres. In this paper we present a spatial and temporal examination of EGM expenditure trends in the main urban centres of the Northern Territory on a venue-by-venue basis over a 5-year period (2002?07). Three general spatial patterns of EGM expenditure were identified, namely suburban gambling complexes, city-centre gambling agglomerations, and opportunistic gambling nodes. We explain these patterns in the context of the interplay between existing spatial infrastructure, the accessibility of venues to particular markets, and the overall market distortions produced by regulation. We suggest that the sensitivity of existing harm-minimisation tools, based on a generic capping of EGM numbers by venue type, could be improved by consideration of these spatial processes at the local level.

The objective of this review was to identify and critique over forty years of peer-reviewed literature concerned with the transmission of canine zoonoses to Aboriginal people and determine the zoonotic organisms documented in dogs in Australian Aboriginal communities. A systematic literature search of public health, medical and veterinary databases identified 19 articles suitable for critical appraisal. Thirteen articles documented the occurrence of recognized zoonotic organisms in dogs in Aboriginal communities, including Toxocara canis, Dirofilaria immitis, Streptococcus dysgalactiae, Rickettsia felis, Sarcoptes scabiei and Giardia. Currently, there is definitive evidence indicating that dogs act as a reservoir for human scabies in Aboriginal communities. However, there is a need for large-scale, high-quality, comparative studies of dogs and humans from the same household to assess the occurrence and importance of transmission of S. scabiei and other diseases between dogs and humans. These studies should use current genetic and molecular techniques along with traditional techniques to identify and type organisms in order to better understand their epidemiology. This review has revealed that there is a lack of high-quality comparative studies to determine whether dogs are contributing to human disease by transmitting zoonoses. Our recommendations differ significantly from current public health policy and may have substantial implications for human and dog health.

In the past, population growth in Australia's Northern Territory, as in other peripheral parts of high-income countries, has been driven by internal labour migration and migration from outside of Australia. These have been contributing to the high population turnover experienced in peripheral areas. Since 2010, the Northern Territory has experienced low (and even negative) population growth, and public policy is currently focused on migration as a lever to reverse this trend. However, the extent to which the characteristics of migrants influence the potential for longer-term population growth is poorly understood. This paper uses a new method to analyse the contributions of various types of migrants to both population turnover and retention. Two major sets of findings emerge: First, the significance of separating newer in-migrants from longer-term residents when analysing migration patterns; and secondly, the contribution of age, gender, Indigenous status, international origin, wages and industry of employment to the Northern Territory's population turnover. The research suggests that current forms of migration favour people who are likely to stay for only short periods, and have high wage demands. The main policy inference is that long-term population growth will likely not eventuate unless new forms of migration can be stimulated.

If implemented, the recommendations of a recent review of the Aboriginal Land Rights (Northern Territory) Act 1976 would see relatively strong provisions for Aboriginal people to obtain and manage their traditional lands abolished. A centrally regulated and assimilationist system of local governance would be substituted. The neo?colonial implications of the proposals are masked by liberal rhetoric of community and local democracy.

Perspective

Objective The objective of this study was to assess the clinical utility of a model of seven principles for effective visiting primary care services and to determine how it could be conceptualised as a tool for evaluation. Setting The research was undertaken in the context of visiting primary care services with an agency, Outback Futures, selected as a case study. Participants Three executive staff with Outback Futures participated in the research. Design The case study design involved data collection by four group interviews conducted between July and November 2021. The interview data were analysed using thematic analysis. Results This case study is additional evidence for the clinical utility of the model of seven principles. The results reinforce the importance of a community-focussed approach to assess the impact of visiting service organisations on rural and remote communities. A comprehensive approach to evaluation is required to justify the investments made and safeguard the health and well-being of rural and remote residents. A self-assessment protocol has been established from the model for use by visiting services. Furthermore, three themes were drawn from the data: relationship is fundamental, the importance of co-design, and being effective as a visiting service is challenging. Conclusion The model is appropriate for the case study organisation, and has clinical utility and implications for other visiting services. A self-assessment protocol has been developed. Future research should apply the model and protocol self-assessment tool in an effort to construct a consistent and credible approach to evaluation of visiting primary care services.

This paper focuses on the growing immigrant-born population of early childhood education and care (ECEC) workers in the Northern Territory of Australia, who represent a committed but poorly understood group within this workforce. The recent reforms to the ECEC workforce in Australia aim to achieve high-quality ECEC services by (a) growing this workforce size to meet the demand for services; (b) meeting the higher educator-to-children ratios; and (c) raising the overall level of qualifications of ECEC workers. By combining the statistical data in an innovative way, this paper shows that even when the growing numbers in this group are combined with newly qualified, immigrant-born and Australian-born entrants, the total number of workers may still be too small to fully implement recent reforms. It concludes by identifying data quality issues and future research directions that would help inform and develop a new strategy for the Northern Territory ECEC workforce.

In this paper we explore a series of interviews across three related research projects from 2018-2022 with women in rural and remote Australia, who agitate for better support and services in their communities, against environmental impacts, and about changes to land clearing legislation. An aspect reconstituting rural women’s activism is the use of online and digital spaces; however there is a significant gap in research considering rural women’s digital activism in Australia. We explore, then, participants’ uses of online advocacy in conjunction with their offline actions and digital access issues. We also examine their rejection or identification with the ‘activist’ label. We address the importance of approaching rural activism and advocacy from a perspective that addresses gendered and power relationships, and time-space complexities including how activism and/or advocacy develop in place.

Background An association between blood stream infections (BSI) and HTLV-1 seropositivity in Indigenous Australians might result from HTLV-1 mediated inflammation and parasite coinfections that provide portals of entry for bacteria. Objectives To determine whether BSI risk increases with HTLV-1c proviral load (PVL) and to identify the pathogens responsible in the context of HTLV-1 related conditions. Study design Indigenous adults admitted to Alice Springs Hospital, central Australia, were recruited as cases or controls according to whether they had a BSI. Clinical data were extracted from case notes and the hospital pathology database. HTLV-1 serology and PVL assays were then performed and risk factors for BSI were determined for HTLV-1 infected subjects. Results Risk factors were compared between 44 cases and 30 controls who were HTLV-1 Western blot positive. In a multivariable model, high HTLV-1c PVL was predictive of BSI during the study period (OR, 9.10; 95% CI, 2.40–34.4). Median (IQR) HTLV-1c PVL (copies per 100 PBL) was 39-fold higher for patients recording any BSI (0.116 (0.009, 0.277)) relative to those who had no BSI (0.003 (0.000, 0.067))(p=0.0007). Mean (SD) PVL for subjects with no BSI (n=27), 1 BSI (n=37) and ≥2 BSI (n=10) during the study period were 0.120 (0.301), 0.271 (0.622) and 0.500 (0.654) copies per 100 PBL, respectively (p=0.0007). Five BSI were associated with possible complications of HTLV-1; strongyloidiasis (3), infective dermatitis (1), HTLV-1 associated bronchiectasis (1). Conclusions Higher HTLV-1c PVL predicts BSI risk; however; most BSI were not associated with recognised complications of HTLV-1 infection.

BACKGROUND: In central Australia, Aboriginal women use wild tobacco plants, Nicotiana spp. (locally known as pituri) as a chewed smokeless tobacco, with this use continuing throughout pregnancy and lactation. Our aim was to describe the biological concentrations of nicotine and metabolites in samples from mothers and neonates and examine the relationships between maternal self-reported tobacco use and maternal and neonatal outcomes. METHODS: Central Australian Aboriginal mothers (and their neonates) who planned to birth at the Alice Springs Hospital (Northern Territory, Australia) provided biological samples: maternal blood, arterial and venous cord blood, amniotic fluid, maternal and neonatal urine, and breast milk. These were analysed for concentrations of nicotine and five metabolites. RESULTS: A sample of 73 women were enrolled who self-reported: no-tobacco use (n = 31), tobacco chewing (n = 19), or smoking (n = 23). Not all biological samples were obtained from all mothers and neonates. In those where samples were available, higher total concentrations of nicotine and metabolites were found in the maternal plasma, urine, breast milk, cord bloods and Day 1 neonatal urine of chewers compared with smokers and no-tobacco users. Tobacco-exposed mothers (chewers and smokers) with elevated blood glucose had higher nicotine and metabolite concentrations than tobacco-exposed mothers without elevated glucose, and this was associated with increased neonatal birthweight. Neonates exposed to higher maternal nicotine levels were more likely to be admitted to Special Care Nursery. By Day 3, urinary concentrations in tobacco-exposed neonates had reduced from Day 1, although these remained higher than concentrations from neonates in the no-tobacco group. CONCLUSIONS: This research provides the first evidence that maternal pituri chewing results in high nicotine concentrations in a wide range of maternal and neonatal biological samples and that exposure may be associated with adverse maternal and neonatal outcomes. Screening for the use of all tobacco and nicotine products during pregnancy rather than focusing solely on smoking would provide a more comprehensive assessment and contribute to a more accurate determination of tobacco and nicotine exposure. This knowledge will better inform maternal and foetal care, direct attention to targeted cessation strategies and ultimately improve long-term clinical outcomes, not only in this vulnerable population, but also for the wider population. NOTE TO READERS: In this research, the central Australian Aboriginal women chose the term 'Aboriginal' to refer to themselves, and 'Indigenous' to refer to the broader group of Australian First Peoples. That choice has been maintained in the reporting of the research findings.

This chapter examines experiences of Australians living in regional, rural, and remote communities where distance, drought, climate change, workforce challenges and the nexus of social, health, economic, and environmental policy influences health social work practice. Geographical disadvantage is explored with particular attention on the intersection of structural oppressions, including the experiences of Aboriginal and Torres Strait Islander peoples, people with disability, people from refugee and migrant backgrounds, people where English is another language, and older people. The chapter argues that health social work practice must be culturally safe, adopt a climate aware lens, be contextualised, creative, and community-embedded in order to respond to the unique challenges and strengths of Australians living outside major cities.

Remote communities, which do not have a connection to the national grid in Far North Queensland (FNQ), depend on dirty and costly diesel generators to meet their energy demands. The cost of power generation is considerable in those areas, because the diesel fuel must be carried by truck or ship and a fuel reserve must be held on-site in case of expected demand or weather closure. Moreover, Australia has an energy security issue in relation to liquid fuels. Australia is reliant on imported fuel such as diesel to fill the shortage, as domestic production and supply are unable to fulfil domestic demand. As a result, by deploying hybrid integrated renewable energy systems in remote areas, isolated communities may lower their power prices, enjoy a more secure and dependable source of electricity and minimise their carbon footprint by eliminating or reducing the usage of diesel. In this study, an extensive literature review has been conducted focussing on renewable resources for Australia and Far North Queensland, different hybrid energy systems including energy storage, and finally highlights the alternative clean and renewable energy options for Far North Queensland (FNQ) remote communities. In addition, this study has performed an assessment of renewable energy available from solar and wind resources considering climatic, geographical and economic aspects for FNQ. The literature review and the assessment show that solar and wind resources including hydrogen storage have significant potential for energy solution of FNQ. The assessment results indicate that selected regions of FNQ have suitable land area of 142,294.86 km2 (55.94% of total selected areas) for solar and 144,563.80 km2 (56.83% of total selected areas) for wind. The total calculated potential power can be 14,448 GW from solar PV and 1040.97 GW from wind energy. This study provides a significant pathway for parties interested in investing in renewable energy in FNQ. Moreover, knowing a land’s suitability will increase confidence and hence speed up the renewable energy investment.

Personal experience of working as a remote nurse in Australia has brought an awareness that the uniqueness and complexity of this nursing brings challenges that are significantly different from those experienced by nurses in other clinical contexts. While there has been literature published around remote nursing mainly regarding violence, stress, education, and scope, little has been documented about the nature of nursing in the remote context and how nurses experience working in these environments. The purpose of this qualitative study was to take a holistic look and investigate a nurse’s experience of working in remote Australia. Case study research, which is an empirical inquiry that investigates a contemporary phenomenon in depth within its real-world context was selected. The single case study design was undertaken using Yin’s guidelines for a descriptive study. An in-depth interview with a remote area nurse was held and thematic analysis undertaken utilising the framework by Braun & Clark (2006). The thematic analysis discovered themes within the data that together gave an overall picture of the phenomenon studied. Three themes were generated: adapting, constantly preparing, and wellbeing and safety. There are several groups or individuals that may benefit from the findings of this study such as new to remote area nurses, nurses aspiring to work in the remote context and those that employ remote nurses. Recommendations for practice and further research provided based on the findings of the study.

Context: The Northern Territory (NT) of Australia is a unique setting for training medical students. This learning environment is characterised by Aboriginal health and an emphasis on rural and remote primary care practice. For over a decade the NT Clinical School (NTCS) of Flinders University has been teaching undergraduate medical students in the NT. Community based medical education (CBME) has been demonstrated to be an effective method of learning medicine, particularly in rural settings. As a result, it is rapidly gaining popularity in Australia and other countries. The NTCS adopted this model some years ago with the implementation of its Rural Clinical School; however, urban models of CBME are much less well developed than those in rural areas. There is considerable pressure to better incorporate CBME into medical student teaching environment, particularly because of the projected massive increase in student numbers over the next few years. To date, the community setting of urban Darwin, the NT capital city, has not been well utilised for medical student training. Issue: In 2008, the NTCS enrolled its first cohort of students in a new hybrid CBME program based in urban Darwin. This report describes the process and challenges involved in development of the program, including justification for a hybrid model and the adaptation of a rural model to an urban setting. Relationships were established and formalised with key partners and stakeholders, including GPs and general practices, Aboriginal medical services, community based healthcare providers and other general practice and community organisations. Other significant issues included curriculum development and review, development of learning materials and the establishment of robust evaluation methods. Lessons learnt: Development of the CBME model in Darwin posed a number of key challenges. Although the experience of past rural programs was useful, a number of distinct differences were evident in the urban setting. Change leadership and inter-professional collaboration were key strengths in the implementation and ongoing evaluation of the program. The program will provide important information about medical student training in urban community settings, and help inform other clinical schools considering the adoption of similar models.