Remote Australia Online

Objective: To examine the feasibility of using point-of-sale data to assess dietary quality of food sales in remote stores. Design: A multi-site cross-sectional assessment of food and nutrient composition of food sales. Point-of-sale data were linked to Australian Food and Nutrient Data and compared across study sites and with nutrient requirements. Setting: Remote Aboriginal Australia. Subject: Six stores. ResultsPoint-of-sale data were readily available and provided a low-cost, efficient and objective assessment of food and nutrient sales. Similar patterns in macronutrient distribution, food expenditure and key food sources of nutrients were observed across stores. In all stores, beverages, cereal and cereal products, and meat and meat products comprised approximately half of food sales (range 49–57 %). Fruit and vegetable sales comprised 10·4 (sd 1·9) % on average. Carbohydrate contributed 54·4 (sd 3·0) % to energy; protein 13·5 (sd 1·1) %; total sugars 28·9 (sd 4·3) %; and the contribution of total saturated fat to energy ranged from 11·0 to 14·4 % across stores. Mg, Ca, K and fibre were limiting nutrients, and Na was four to five times higher than the midpoint of the average intake range. Relatively few foods were major sources of nutrients. Conclusions: Point-of-sale data enabled an assessment of dietary quality within stores and across stores with no burden on communities and at no cost, other than time required for analysis and reporting. Similar food spending patterns and nutrient profiles were observed across the six stores. This suggests potential in using point-of-sale data to monitor and evaluate dietary quality in remote Australian communities.

Rheumatic heart disease (RHD) caused by acute rheumatic fever (ARF) is a disease of poverty, poor hygiene and poor living standards. RHD remains one of the major causes of childhood cardiac disease in developing nations. Within developed nations, there has been a dramatic drop in the prevalence of RHD because of the improvement of living standards, access to health care and the widespread availability of penicillin-based drugs. Despite a dramatic reduction of RHD in Australia overall, it continues to be a major contributor to childhood and adult cardiac disease in Indigenous communities throughout northern and central Australia. Currently, Australia has among the highest recorded rates of ARF and RHD in the world. The most accurate epidemiological data in Australia come from the Northern Territory's RHD control programme. In the Northern Territory, 92% of people with RHD are Indigenous, of whom 85% live in remote communities and towns. The incidence of ARF is highest in 5-14-year-olds, ranging from 150 to 380 per 100,000. Prevalence rates of RHD since 2000 have steadily increased to almost 2% of the Indigenous population in the Northern Territory, 3.2% in those aged 35-44-years. Living in remote communities is a contributing factor to ARF/RHD as well as a major barrier for adequate follow-up and care. Impediments to ARF/RHD control include the paucity of specialist services, rapid turnover of health staff, lack of knowledge of ARF/RHD by health staff, patients and communities, and the high mobility of the Indigenous population. Fortunately, the recently announced National Rheumatic Fever Strategy, comprising recurrent funding to the Northern Territory, Queensland and Western Australia for control programmes, as well as the creation of a National Coordination Unit suggest that RHD control in Australia is now a tangible prospect. For the disease to be eradicated, Australia will have to address the underpinning determinants of poverty, social and living conditions.

Background: The delivery of effective oral health promotion strategies is essential to improving oral health outcomes among remote Aboriginal communities. This study aimed to explore the perceptions and attitudes of Aboriginal Australians living in remote Kimberley communities towards oral health education and disease prevention. Methods: Semi-structured interviews and yarning circles were carried out following purposive sampling of Aboriginal adults living in the East Kimberley region of Western Australia. Results: A total of 80 community members participated in the yarning process. School-based oral health promotion and community-driven restrictions on the sale of sugary food and drink were seen as positive strategies in improving oral health. Lifestyle changes brought about by modernity, internet availability and fixed community stores were perceived to create new challenges and shift the priorities for those living in remote communities. Conclusions: Community-based yarning may better inform future oral health strategies in the Kimberley. A neoliberal approach of shifting responsibility onto the individual ignores the complex social inequities faced by Aboriginal people living in remote communities where macro-level determinants such as remoteness, food security and education significantly influence decisions around diet and oral health.

In this presentation, we draw on our experience of teaching ‘policy and ethnography’ to students who were also employed as government bureaucrats working in remote Aboriginal communities in northern Australia. Initially, we draw on our own experiences as STS researchers working in policy landscapes shaped by multiple discourses that included subjectivities, objects and contexts that were at times uncomfortable or excluding. We share stories of ethnographic research practice where we position our own collaborative engagements, and those of the student’s engagement in the institutions of government bureaucracy and the institutions and knowledge practices of Indigenous people-places. In foregrounding ethnographic stories as actors in these complex policy landscapes, and mobilising a working typology (‘figures’, ‘tensions’, ‘located subjects’ and ‘materialities’), we’ve reached towards ways that student-researchers can work with their own embodied participation in the configuring networks of policy practice to generate research accounts which do not abstract or step away from the situations of their involvement, but nonetheless produce robust policy data, and generative research outcomes.

Boarding schools, by definition, house students in residence either on campus or close by in residential facilities - where the sleep environment is likely to differ from their home environment. For boarders, being in the boarding environment occurs alongside a convergence of psychosocial and physiological factors likely to impact adolescent sleep. This paper comprises a review of the literature on sleep and boarding students in the Australian context. We also propose recommendations aligned with the scientific evidence base that can be used to promote healthy sleep in Australian boarding school students, focusing on staff training and sleep knowledge, daily routines, sleeping arrangements, and student mental health and wellbeing. It must be noted that these recommendations should be considered interim recommendations until further research is performed in the area. Further, we suggest the development of standardised practice guidelines, to ensure that student sleep is supported appropriately within the Australian boarding context.

This report is the second of two volumes detailing the methodology and results of a major survey of Aboriginal and Torres Strait Islander temporary mobility in Central Australia, undertaken under the auspices of the Cooperative Research Centre for Remote Economic Participation (CRC-REP). It should be read in conjunction with Volume I, which provides a more detailed background to the Population Mobility and Labour Markets Project and the motivation for the survey, the survey methodology and sampling frame. The overall ‘Mobility Survey’ consisted of two main components: (1) a baseline survey collecting respondents’ demographic and other baseline data, data on where they go to access services, and their most common destination involving overnight stays outside of their community; and (2) a series of follow-up surveys collecting information on respondents’ two most recent trips, barriers to mobility and visitors they had staying with them from outside of the community. This Volume 2 report provides a detailed overview of the methodology and survey results of the follow-up surveys conducted after the baseline survey. The field work was undertaken over almost two years from early October of 2014 to late September of 2016 and resulted in 924 individuals completing at least one follow-up survey, making it, to the best of our knowledge, the largest survey ever undertaken focusing specifically on Aboriginal and Torres Strait Islander mobility. Volume 1 provides a background to the project and an overview of the methodology, implementation and results from the baseline survey. The objective of this second volume is as a reference guide to the follow-up surveys. It sets out the sampling frame and methodology, provides a descriptive analysis of the main data items collected in the follow-up surveys, and canvasses problems encountered in collecting the data and associated limitations for their analysis.

This Final Report provides a narrative account of activities and outcomes against Key Performance Indicators (KPIs) associated with the implementation of the Whole of Community Engagement (WCE) initiative led through the Office of Pro Vice Chancellor – Indigenous Leadership at Charles Darwin University (CDU). The WCE has been funded through the Higher Education Participation and Partnership Program of the Australian Government Department of Education. The report provides a summary account of the planning and implementation of activities in each of the six remote and very remote communities of focus together with overall commentary. This Report builds on information contained in the previous five WCE Progress Reports previously submitted to the Australian Government during: July 2014, November 2014, June 2015, November 2015 and June 2016. This document generally reports against two separate streams of implementation. Work progressed by CDU staff to meet the WCE Aim and Objectives; and work progressed by the North Australian Institute of Indigenous Land and Sea Management (NAILSMA) relating to building educational aspiration and pathways specifically associated with Indigenous land and sea management. Reporting against a smaller project led by the Research Institute for the Environment and Livelihoods (RIEL) associated with the development of an Indigenous fire curriculum specific to Northern Australian contexts is also included. This report is not an evaluation report, and is best read in tandem with Appendix 2: Final Evaluation Report of the Whole of Community Engagement initiative, alongside the six Community Evaluation Reports (Appendices: 3 to 8).

Summary Agile Wallaby (Notamacropus agilis) has been in the diet of Aboriginal inhabitants of northern Australia for millennia. The species inhabits riparian zones and savannah woodlands, has a high rate of natural increase and can become pests in modified agricultural or plantation systems. Although the profitability of market-based game harvesting appears marginal, local consumption could be incorporated into existing employment programmes on Aboriginal lands as a social enterprise. The legal environment is discussed, and further investigation and a trial as a pilot enterprise are recommended.

OBJECTIVE: The objective of this study was to describe the psychiatric assessment of Aboriginal patients from remote Aboriginal communities in Central Australia. METHOD: The method consisted of a summary of the experiences gained during a dissertation year placement as senior registrar with the Northern Territory Remote Area Mental Health Team. RESULTS: Remote area Aboriginal psychiatry entails learning a whole new set of skills in terms of history taking and the mental state examination, a knowledge of the importance of extended kinship ties and cultural issues, the use of Aboriginal mental health workers as partners in assessing and managing patients via their families and accepting referrals from a wide range of sources. CONCLUSIONS: Working on a service providing psychiatric care to remote area Aboriginal communities can be a deeply rewarding personal and professional experience.

Most Aboriginal communities in the Northern Territory have used provisions under the NT Liquor Act to impose total or partial bans on alcohol and only eight (as of 30 June 1995) had established licensed clubs. This article examines (a) patterns of alcohol consumption in communities with clubs, and (b) economic, social and political aspects of the place of clubs in these communities. Alcohol consumption was estimated on the basis of ?purchase into store? figures for 1994?95 provided by the NT Liquor Commission. Among male drinkers, consumption of absolute alcohol in 1994?95 was estimated at 42.5 litres a head, 76% higher than the figure for the NT as a whole, which in turn was 42% above the national level. Similar differences were found for female drinkers. Combined retail turnover of the seven clubs that traded throughout the year was estimated at $8.1 million. It is argued that many clubs are able to use their monopolistic control of a valued resource to become powerful political institutions in communities, sometimes leaving non-drinkers effectively disenfranchised. It is also argued that the health consequences of these high consumption levels have received far less attention than the effects of Aboriginal public drunkenness in urban areas. It is concluded that, while the rights of Aboriginal communities to establish community-controlled clubs should be respected, the notion that they are under some sort of obligation to do so should be exposed as a measure likely to add to the health burdens of people already inadequately served by health, education and other services.

In Australia’s north, Aboriginal peoples live with world-high rates of rheumatic heart disease (RHD) and its precursor, acute rheumatic fever (ARF); driven by social and environmental determinants of health. We undertook a program of work to strengthen RHD primordial and primary prevention using a model addressing six domains: housing and environmental support, community awareness and empowerment, health literacy, health and education service integration, health navigation and health provider education. Our aim is to determine how the model was experienced by study participants.

This research investigated how well tenancy management arrangements are working under the National Partnership Agreement on Remote Indigenous Housing (NPARIH); the appropriateness and effectiveness of the tenancy management policy and service delivery approaches; and the efficiency and value for money of the service delivery models. It also identified policy and practice lessons gained from the NPARIH experience. It is not a review of NPARIH itself, and includes some consideration of non-NPARIH communities.

Ensuring sufficient and adequately maintained housing in Indigenous Australian communities remains an ongoing policy challenge for government, with major implications for the health of Indigenous Australians. This study sought to characterise the current status of housing conditions experienced by Indigenous Australians, with special reference to the Northern Territory. The assessment examined a range of indicators relating to crowding, dwelling condition, 'health hardware', and provision of maintenance and repairs. While acknowledging data deficiencies and inconsistencies, the analysis produced mixed results. There was evidence of a reduction in crowding but little observable improvement in the provision of maintenance and repairs. Some housing-related health outcomes have shown improvement, though these have tended to coincide with mass treatment campaigns. Achieving the goal of healthy homes - and ultimately closing the gap on Indigenous disadvantage - requires further investment in new houses that are appropriately designed and constructed, alongside an increased emphasis on cyclical maintenance.

Many Aboriginal Community Controlled Health Services (ACCHS) embrace Facebook as an organisational tool to share positive stories, which counter the negative narrative surrounding Aboriginal issues. However, the Facebook algorithm prioritises posts on personal pages over organisations. To take advantage of the algorithm, this project paid three Yolŋu employees of a north-east Arnhem Land ACCHS to share quit smoking messages on their personal Facebook pages. Smoking prevalence among Aboriginal and Torres Strait Islander Australians is nearly three-fold higher than non-Indigenous Australians, and previous research has identified the need for culturally appropriate communication approaches to accelerate the decline in Indigenous smoking. This research found Yolŋu participants nurtured healthy behaviours through compassionate non-coercive communications, in contrast to fear-inducing health warnings prevalent in tobacco control. Cultural tailoring of tobacco control messages was achieved by having trusted local health staff sharing, and endorsing, messages regardless of whether the content was Indigenous specific. This research also revealed online Facebook activity does not reflect the reach of posts, which may extend beyond social media users to individuals who do not have a Facebook profile.

In Australia’s Northern Territory, most Aboriginal people primarily speak an Aboriginal language. Poor communication between healthcare providers and Aboriginal people results in adverse outcomes including death. This study aimed to identify remediable barriers to utilisation of Aboriginal Interpreter services at the Northern Territory’s tertiary hospital, which currently manages over 25,000 Aboriginal inpatients annually.

Over 5 days, 120 schoolchildren from two schools in the remote Kimberley region of Australia were screened for Strep A pharyngitis. Molecular point-of-care testing identified Strep A pharyngitis in 13/18 (72.2%) symptomatic children. The portability and feasibility of molecular point-of-care testing was highly practical for remote settings.

Objectives To explore the process of learning for allied health students providing a student-implemented service for older Yolngu in remote East Arnhem, Northern Territory, Australia. Design An exploratory qualitative study following an 8-week student-implemented service. Setting Nhulunbuy and Yirrkala and surrounding remote Aboriginal communities of the East Arnhem Region of the Northern Territory. Participants Data were collected from: 4 students who implemented the service; 4 professional supervisors, 3 placement coordinators, a Yolngu cultural consultant and a care manager from a local community organisation, all of whom supported implementation of the service; and 7 older Yolngu and their families who were recipients of the service. Interventions A student-implemented service for older Yol?u delivered by allied health students from James Cook University. Clinical, cultural and pastoral supervision and support was provided by Flinders University, James Cook University, Indigenous Allied Health Australia and 2 Yolngu cultural consultants and 2 local community organisations. Main outcome measures Semi-structured interviews with those who implemented, supported and received the service. Data were analysed thematically using an inductive approach. Results 'Learning to connect and connecting to learn' described how allied health students were learning to provide a service for older Yolngu. Four interrelated processes connected their learning: 'preparing and supporting', 'bonding and responding', 'growing and enriching' and 'working and weaving'. Conclusion The co-created student-implemented service provided a unique learning opportunity for allied health students on how to provide a culturally safe service in a remote Aboriginal community in northern Australia.

Allied health services play a critical role in preventing and managing the disabling consequences of disease and injury,1 which occur at disproportionately higher rates in northern Australia than for Australia as a whole.2 Northern Australia supports a population of only 1.3 million people widely dispersed across 3 million square kilometres over a varied and often harsh geographical environment (cyclones, flood, high temperatures). The region includes the whole of the Northern Territory, and those parts of Western Australia and Queensland that are north of the Tropic of Capricorn. The northern Australian population includes over 190 000 Aboriginal and Torres Strait Islander people (~30% of Australia's Indigenous population,3 most of whom live in remote communities). Aboriginal or Torres Strait Islander people have significantly poorer health status than the non-Indigenous population,4 which makes them more vulnerable to the health and well-being impacts of disasters, including pandemics, both as individuals and as a community. Its vast size, small population and limited infrastructure mean that health service delivery in northern Australia is characterised by travel over vast distances.

https://doi.org/10.1111/1753-6405.13035

Objective This research was undertaken to explore the priority given by remote area health personnel to the development of the oral health role of Indigenous Health Workers and the rationale for this prioritisation. Design Semistructured individual interviews and focus group interviews were undertaken with remote area health personnel working alongside Indigenous Health Workers. Setting Three Indigenous community clinics and two regional centres of remote northern Australia. Participants Interviews were conducted with 32 remote health personnel (11 dental, 14 nursing, 5 medical and 2 allied health personnel). Results The findings highlight the strong support found among remote health personnel for the development of the Indigenous Health Worker oral health role emphasising not only the perceived high impact of oral disease on the health of community members and community health resources, but also on the clinical practice of remote health personnel. Conclusion In identifying the high priority given to the development of this role, the study has also highlighted the impact of oral disease on the practice of remote health personnel and the need to develop training for remote health personnel to respond to oral disease.

Background: A survey of dental caries experience in children was undertaken in five Aboriginal and Torres Strait Islander communities in the Northern Peninsula Area of Queensland prior to the introduction of water fluoridation. Methods: Data were obtained from screening dental examinations conducted by the Australian Army as part of a community assistance programme between May and September 2004 from 486 children aged 4?15 years. The clinical examinations were performed in a dental van using a dental chair, light, mirror and probe by a single calibrated examiner. Results: Caries experience was high with a mean 6-year-old dmft of 6.37 and a mean 12-year-old DMFT of 3.50. The 6-year-old dmft Significant Caries Index (SiC) for the third of the population with the highest caries experience was 11.65 and the 12-year-old DMFT SiC was 7.08. Only 15.3 per cent of 6-year-old children had dmft=0 and 28.9 per cent of 12-year-old children had DMFT=0. Conclusions: Dental caries was a significant problem for these remote communities. Aboriginal and Torres Strait Islander children from the Northern Peninsula Area of Queensland had more than four times the caries experience of Australian children for both 6-year-old dmft and 12-year-old DMFT.

Indigenous Australian landowners are increasingly seeking to develop agricultural production on their lands to improve the welfare and economic opportunities of their communities. This can require substantial capital input and, in the absence of enough government funding, Indigenous groups are turning to private investors. Development literature has explored private sector-led and ?financialized? approaches to development at a macro level as something that is done to communities; however, less research has examined how remote communities themselves seek to develop their natural assets through partnerships with businesses and with global finance. This article examines the work being done to prepare land for external investment. It provides an example of emergent assetization processes being undertaken outside the financial sector, driven by social outcomes seemingly beyond the domain of shareholder value. Paradoxically, individuals engaged in these asset-making processes may oppose the withdrawal of direct funding for community development associated with a financialization of development, yet they are left with few options but to further these efforts by seeking private finance themselves ? facilitating financialization for development. This interaction of structural effects and local agency complicates narratives of financialization as they are commonly presented and has important implications for Indigenous economic development in Northern Australia.

During the American-Australian Scientific Expedition to Arnhem Land in 1948, a nutritionist (Margaret McArthur), a medical officer (Brian Billington), a biochemist (Kelvin Hodges) and also the 'flying dentist' (John Moody) observed the nutrition and health of Aborigines in the settlements on Groote Eylandt, at Yirrkala and at Oenpelli, Northern Territory. The results of their research were published in the Records of the American-Australian Scientific Expedition to Arnhem Land Volume 2 Anthropology and Nutrition. (Melbourne University Press, 1960). Although seasonal and regional variations in food supply were a constant problem for nomadic Aborigines living on 'bush tucker' gathered from marine, freshwater and terrestrial ecosystems, the variety of food provided a well-balanced diet according to the international recommendations of 1948. In contrast, improvements in the 1948 diet of Aborigines in the settlements were strongly recommended. 1 An increase in the quantity of food given to older children and adolescents. 2 Regular distribution of fresh fruit and vegetables throughout the year from settlement gardens. 3 Regular supplies of fish, meat and other animal products, particularly for children, adolescents, pregnant and lactating mothers. 4 Increased production of milk and greater care in its handling. 5 Greater use of whole grain cereals in preference to refined products.

Background There are no contemporary published data on the frequency of the ABO and Rhesus D (RhD) blood groups in the Northern Territory (NT) of Australia, particularly for the large Aboriginal population. Aims To establish the frequencies of ABO and RhD blood groups in the NT Aboriginal and non-Aboriginal populations in order to aid transfusion inventory management and clinical practice. Methods Retrospective data were collected from 1 January 2012 to 31 December 2012. All patients with a blood group sample processed by the NT public hospital laboratories and a recorded ABO and RhD report were included. Results were analysed using Stata 14. Results The Aboriginal and non-Aboriginal populations had significantly different ABO and RhD distributions (P <?0.001). For Aboriginal individuals, 955/1686 (56.6%) were group O and 669/1686 (39.7%) were group A. In non-Aboriginal individuals, 1201/2657 (45.2%) were group O and 986/2657 (37.1%) were group A. We found that 1646/1686 (97.6%) of Aboriginal individuals were RhD positive, compared with 2225/2657 (83.7%) of non-Aboriginal individuals. Only 62/1686 (3.7%) of Aboriginal individuals were group B or AB, compared with 470/2657 (17.7%) of non-Aboriginal individuals. In Aboriginal individuals we found that group O was more common than A in the ?Northern? NT, whereas there was similar distribution of the groups in ?Central Australia?. Conclusions We found a significant difference in ABO and RhD blood groups between Aboriginal and non-Aboriginal individuals in the NT (P <?0.001). These findings will aid transfusion inventory management, allowing us to plan supply of blood products and reduce waste.

In 1996, a group of Aboriginal dancers from Elcho Island in north-east Arnhem Land will travel to Macassar (Ujung Pandang), in Indonesia, to perform a ritual associated with the 'Dreaming' creation figure, Walitha' walitha, also known as Allah. Aborigines are said to share this ceremony, known as the Wurramu, with the people of Macassar, but the Aboriginal version, a mortuary ritual, has never before been performed outside of Australia. The performance has been designed to reunite these old acquaintances, but the ceremony itself, in this context, embodies a paradox. According to senior Aboriginal leaders, the songs and dances are sacred. On an 'outside' level they are about the new world introduced to Aborigines in pre-colonial times as a result of this first contact experience, but on an 'inside' level, they focus on the Aboriginal deaths that occurred as a consequence of contact with these fishing peoples from the north of Australia. The 'inside' meaning of the ritual relates to the passage of the soul of the deceased to a heavenly paradise above, the abode of Allah.