Remote Australia Online

People living in rural and remote areas face unique mental health risk factors and have more limited access to mental health services. Service provision and workforce issues have been the subject of many reviews, inquiries and policy development. The extent of mental ill-health experienced by young people living in rural and remote Australia is unknown. What is known, is that young people experience high rates of suicide and the rate of suicide increases with remoteness. A critical reference group was convened to understand the issues that need to be addressed to improve delivery of mental health services for young people in rural and remote Australia. There are three key areas in rural and remote mental health requiring new policy solutions. This policy paper presents solutions to address workforce gaps, enhance service models and identify how technology can play a role. DEVELOPING SOLUTIONS: Attracting and retaining mental health professionals to rural and remote Australia continues to be a challenge. The Productivity Commission has identified that working in rural and remote areas is ‘less attractive from both a professional and personal perspective’. For many young people living in rural and remote Australia primary health professionals are the only health providers they have access to. Professional support and development are required to equip them for these expanded roles. Where a doctor is not available the lead primary health care providers needs to be accredited to provide referrals to specialist mental health care. A number of barriers exist in providing supervision and professional development in rural and remote health services. The practice of inter- professional supervision needs to be supported by professional bodies and coordinated at a service level. Existing inter-professional practices provide an example for the development of such initiatives in rural and remote contexts. An ageing workforce in rural and remote areas highlights the need to educate and train the future workforce. There is evidence that undertaking education and training in rural and remote areas leads to continuing practice. Trialling bonded scholarships for allied health students would provide an incentive to practice in rural and remote areas. Technology present a means to help solve some – but not all – of the barriers to delivering mental health services for young people in rural and remote communities. While digital service delivery is a focus of health policy (with telehealth and mobile applications expanded in response to the coronavirus/COVID-19 pandemic) it is important new service models and platforms are designed with young people. Orygen supports the Productivity Commission’s draft recommendation [5.1] for an MBS item for psychiatrists to provide advice to GPs over the phone and suggests that it be expanded to include expert advice on alcohol and other drug disorders in young people. Innovative responses to support primary health services provide mental health care are required to enable improved access for young people. A trial of new initiatives in local contexts provides an opportunity to test ideas and identify solutions that can then be implemented more widely. KEY POLICY SOLUTIONS: A number of policy solutions are proposed in this policy paper that address workforce challenges, service innovation and the role of technology. Three key solutions have been identified that build on existing policies and have the potential to improve mental health care for young people.

Aboriginal tourism entrepreneurs operating in remote regions of Australia draw on their 60,000 years of heritage to offer unique and distinct cultural experiences to domestic and international tourists. Living and operating in remote climates presents challenges to achieving successful and sustainable enterprises, including extreme weather, substandard infrastructure, distance from policy makers, distance from markets and the commercialisation of culture, which is customarily owned by and for use by traditional custodians, to produce and deliver a market-ready tourism product. However, many remote Aboriginal tourism entrepreneurs nevertheless achieve success and sustainability. This paper builds on the work of Foley to identify the characteristics of successful remote Aboriginal tourism enterprises and Aboriginal entrepreneurs in remote areas and the resourceful and creative business practices used by remote Aboriginal entrepreneurs to overcome barriers to success and finds that ongoing connections to community and culture are a key factor in that success. It also draws on the United Nation’s Sustainable Development Goals to identify how the characteristics of remote tourism entrepreneurs and enterprises promote or inhibit the achievement of sustainability and suggests that they offer a framework for effective support of remote Aboriginal entrepreneurs. It concludes by noting that the industry would benefit from further investigation of the contributions made to sustainability by remote Aboriginal tourism enterprises and their stakeholders.

This chapter describes characteristics of populations in regional, rural and remote Australia. It helps the reader to understand the context of health care service relevant to non-metropolitan occupational therapy. The chapter explains the diversity of occupational therapy roles in regional, rural and remote Australia. It identifies strategies for successful occupational therapy practice in regional, rural and remote locations. Rural occupational therapy service provision has distinctive characteristics that present a multitude of rewarding opportunities, as well as some professional and personal challenges. Some rural and remote occupational therapists operate outreach services from major cities to rural and remote communities. There are vast distances involved in travel to some of the remote and very remote locations. The populations served in regional, rural and remote areas may include people from a variety of cultural backgrounds, including Indigenous Australians.

In 2012, a team of academics from six universities worked on an OLT-funded project, ‘Rethinking Law Curriculum: developing strategies to prepare law graduates for practice in rural and regional Australia’. The project was motivated by the declining proportion of lawyers being attracted to and remaining in practice in rural and regional Australia. The main outcome of the project was an open education resource designed to sensitise students to the realities of the rural and regional legal practice context in the form of a customisable curriculum package that can be embedded as components within existing units of study, or developed as a stand-alone unit. Three of the team members have now implemented the curriculum package within their law school programs, two in the form of a stand-alone elective unit delivered to undergraduate law students, and the third to support placement programs for law and paralegal students. Applying the process of peer observation and collaborative reflection, this paper reports on their experiences to offer insights on how to adapt and integrate the ‘Rethinking law’ package within the law school curriculum. In particular, this paper will discuss the significance of place-consciousness as a pedagogical tool, and the capacity of the ‘Rethinking Law’ package to encourage law students to ‘re-imagine’ careers in rural and regional Australia and their role as the country’s future lawyers.

The epidemiology of acute post-streptococcal glomerulonephritis (APSGN) has changed substantially over the past 50 years. Before the 1980s APGSN was relatively common worldwide with multiple large and recurrent epidemics reported, especially in the Native Americans in the United States and in Central and South America.1 Many of these epidemics were thought to be related to streptococcal skin rather than throat infection, often associated with preceding scabies.2,3 Over the past 20 years there has been a substantial decline in the reported incidence of APSGN in many industrialized countries. Despite this declining incidence of APSGN in many developed countries, there is still a significant global burden of disease. It has been estimated that there are more than 470,000 cases of APSGN worldwide annually with ~5,000 deaths, with 97% occurring in less developed countries. It is likely that APSGN is underreported in many developing countries and these figures are likely to be an underestimate of the true burden of this condition. As in most developed countries, the southern temperate regions of Australia have sporadic cases of APSGN, mostly related to pharyngitis. In contrast, in tropical northern Australia APSGN is far more common and outbreaks have previously been reported in Aboriginal communities. In the Northern Territory (NT), which comprises a semi-arid central Australian region and a tropical northern region, sporadic cases occur each year but also larger outbreaks in the northern region are documented by public health authorities around every 5–7 years. The majority of these cases are related to pyoderma caused by infection with Streptococcus pyogenes (Group A Streptococcus [GAS]), often with underlying scabies. The overall incidence and patterns of disease in this population have not been characterized. It has long been recognized that certain GAS M protein types, as now determined by the emm genotype (emm sequence type), are associated with nephritis and these are mostly different from the emm types that cause acute rheumatic fever. Previous studies of the molecular epidemiology of GAS in Aboriginal communities of the NT have shown that there is a wide diversity of emm types present. The GAS carriage is dynamic with high acquisition rates within households. We reviewed the epidemiology of APSGN within the NT over a 16-year period with the aim of determining the current incidence, patterns of disease, and diversity of emm sequence types of GAS responsible for APSGN in the region. We document that despite declining rates of APSGN in other industrialized countries, rates remain very high for children living in remote Indigenous Australian communities.

Issue addressed: The complexities encountered in a Indigenous community when a white project support team assisted a school (Bwgcolman on on Palm Island, Queensland) to implement MindMatters, a centralised, national project aiming to promote the psychosocial health of young Australians through the development of a comprehensive, school-based mental health promotion program. Approach: The MindMatters consortium offered pilot schools curriculum materials, professional development for staff, funding and ongoing support at a local level in return for their participation in the project. The support team flew to the island on two occasions to provide support. Conclusion: Whether or not MindMatters constituted a community project at Bwgcolman is debatable. Nevetheless, the project at Bwgcolman was considered a ‘success’ by key players since initial aims identified by the school were tangible (e.g. professional development, curriculum development) and met in a way that the school could take ownership of. Additionally, behavioural management policy was implemented in a manner that was cognisant of a history of coercive relations with Indigenous communities. So what? It is important in the telling of the success story at Bwgcolman that even though MindMatters endeavoured to be culturally sensitive, it was nevertheless a centralist mental health promotion program. Future mental health promotion initiatives need to be aware that the approach of the support team in attempting to hand back some community control at the local level may have played a role in the school succeeding.

This is the first review of literature and synthesis of data on community onset methicillin resistant Staphylococcus aureus (CO-MRSA) infections in Australia. Incidence of CO-MRSA varies considerably in Australia, depending on geographic and demographic factors.

OBJECTIVE: To test an evaluation framework designed to evaluate implementation of the North Queensland Indigenous communities between August and December 2005. SETTING: Both communities are located in Cape York, North Queensland. Community A has an estimated population of around 600 people; Community B has an enumerated population of 750, although health centre records indicate a higher number. PARTICIPANTS: Process evaluation involved health centre staff in both communities; clinical audits used random samples from the adult population (each sample n = 30); ethnographic fieldwork was conducted with resident population. MAIN OUTCOME MEASURES: Health centre scores and qualitative findings using a System Assessment Tool; clinical audits--extent to which scheduled services recorded; selected primary health performance indicators; qualitative ethnographic findings. RESULTS: On almost all indicators, implementation of NQICDS had progressed further in Community A than in Community B; however, some common issues emerged, especially lack of linkages between health centres and other groups, and lack of support for client self-management. CONCLUSIONS: The evaluation framework is an effective and acceptable framework for monitoring implementation of the NQICDS at the primary health centre level.

Scabies has recently gained international attention, with the World Health Organization (WHO) recognizing it as a neglected tropical disease. The International Alliance for the Control of Scabies recently formed as a partnership of more than 15 different countries, with an aim to lead a consistent and collaborative approach to preventing and controlling scabies globally. Scabies is most prevalent in low-resource and low socioeconomic areas that experience overcrowding and has a particularly high prevalence in children, with an estimated 5% to 10% in endemic countries. Scabies is widespread in remote Aboriginal and Torres Strait Islander communities in Australia with the prevalence of scabies in Aboriginal and Torres Strait Islander children in remote communities estimated to be as high as 33%, making it the region with the third highest prevalence in the world. This population group also have very high rates of secondary complications of scabies such as impetigo, poststreptococcal glomerulonephritis (PSGN), and rheumatic heart disease (RHD). This article is a narrative review of scabies in remote Aboriginal and Torres Strait Islander populations in Australia, including clinical manifestations of disease and current treatment options and guidelines. We discuss traditional approaches to prevention and control as well as suggestions for future interventions including revising Australian treatment guidelines to widen the use of oral ivermectin in high-risk groups or as a first-line treatment.

There is a need for emergency management systems in Australia to shift to a more collaborative model that involves working with communities rather than simply delivering to communities. This research paper argues that in order to address this, emergency services organisations in Australia need to continue to shift from a service delivery approach to a more localised, participatory and consultative model that acknowledges and harnesses local leadership, knowledge, skills and experience creating opportunities for community driven and fit-for-purpose emergency management. The paper makes the case for why localised approaches are important in places with diverse populations such as the Northern Territory (NT). The NT Aboriginal community of Nauiyu’s experience of evacuations due to flooding in 2015 and 2018 will be used as a case study to offer an example of locally led approaches to disaster resilience.

Objective To undertake a systematic review to determine similarities and differences in metrics and results between recently and/or currently used tools, protocols and methods for monitoring Australian healthy food prices and affordability. Design Electronic databases of peer-reviewed literature and online grey literature were systematically searched using the PRISMA approach for articles and reports relating to healthy food and diet price assessment tools, protocols, methods and results that utilised retail pricing. Setting National, state, regional and local areas of Australia from 1995 to 2015. Subjects Assessment tools, protocols and methods to measure the price of ‘healthy’ foods and diets. Results The search identified fifty-nine discrete surveys of ‘healthy’ food pricing incorporating six major food pricing tools (those used in multiple areas and time periods) and five minor food pricing tools (those used in a single survey area or time period). Analysis demonstrated methodological differences regarding: included foods; reference households; use of availability and/or quality measures; household income sources; store sampling methods; data collection protocols; analysis methods; and results. Conclusions ‘Healthy’ food price assessment methods used in Australia lack comparability across all metrics and most do not fully align with a ‘healthy’ diet as recommended by the current Australian Dietary Guidelines. None have been applied nationally. Assessment of the price, price differential and affordability of healthy (recommended) and current (unhealthy) diets would provide more robust and meaningful data to inform health and fiscal policy in Australia. The INFORMAS ‘optimal’ approach provides a potential framework for development of these methods.

The Australian Dental Association NSW Branch thanks the NSW Government for the opportunity to provide a submission to this Parliamentary Inquiry into Health Outcomes and Access to Health and Hospital Services in Rural, Regional and Remote NSW. We wish to highlight specific dental and oral health outcomes, patient experiences, wait-times and quality of dental and oral health care for people who live in rural, regional and remote NSW. Our submission has been prepared with the input of our members who have experience working in rural, regional, and remote clinics. These include published research and anecdotal evidence or observations as a result of experiences from student dental practitioners through to experienced dental clinicians. We believe this is the most reliable and current evidence of the status of dental and oral health services in regional, rural, and remote communities.

In March 2014, a large group of Pitjantjatjara Yankunytjatjara traditional owners gathered outside the South Australian Museum in Adelaide to protest the proposed closure of the Ngintaka Exhibition. Bad press generated by one powerful dissenting Aboriginal elder threatened to close the exhibition before it opened. However, busloads of traditional owners had travelled thousands of kilometres to open their exhibition; they would not be moved! The ancient parable of the Ngintaka Songline conflict over a special grindstone was dramatically re-enacted in the fight over the exhibition. The powerful Murdoch press chose to exclusively support the dissenting elder whose fame and influence in white circles of power was much greater than the elders from the bush. Issues of power, privilege and class were lost behind a desert storm of false charges. The voices of the senior traditional owners of the exhibition were drowned in the press beat-up of the Storm in the Desert. Stoically, the senior law men and women stood outside the Museum until their voice was heard. Remote Aboriginal people are the working poor in Australia today; they are more often spoken for by others than listened to directly. Museums need to be more aware of disempowered disenfranchised voices in our multi-culturally diverse society and not just listen to the loud voices supported by power and privilege.

Conditional welfare, a social policy mechanism in which disadvantaged groups are required to conform to behavioural changes to receive income support, has become an influential policy mechanism in recent decades. Conditional welfare in Australia involves compulsory income management (CIM), comprising the quarantining of between 50 and 90 per cent of a participant’s welfare payment for use on food, rent and other essential items. A major objective of all Australian income management (IM) programs since 2007 has been to enhance children’s wellbeing by protecting them from harm caused by anti-social behaviour such as alcohol and drug abuse, and ensuring they have access to basic needs such as food, education and health care. To explore the outcomes of these objectives, this qualitative study explores the views of both compulsory and voluntary IM participants as well as community stakeholders in relation to child wellbeing in four IM locations across Australia. It finds minimal evidence to support the view that IM contributes to positive outcomes in children’s welfare.

Indigenous people in wealthy countries have outcomes of chronic disease that are comparable to those of patients in low socio-economic developing countries. This is not different for renal disease and outcomes of renal replacement therapy. This chapter addresses the dilemmas of using Peritoneal Dialysis in aboriginal patients in Australia. The focus is on aboriginal people in very remote areas and some personal views are presented as to the causes of the gap between outcomes for aboriginal and non-aboriginal patients and how the many failed attempts to close the gap could be addressed.

Initially reported in Western Australia in the 1980s, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become a major cause of S. aureus infections globally. We report the complete genome sequences of three of the earliest CA-MRSA strains isolated from remote Australian Indigenous communities in the Kimberley region of Western Australia.

This report presents information from the 2016 Survey of Health Care (the Survey) for people living in rural and remote areas. It extends previous work done by the AIHW and Australian Bureau of Statistics [1]. The Survey is the cornerstone of the AIHW’s Coordination of Health Care Study. It examines patients’ experiences with continuity and coordination of health care in detail and provides nationally consistent and local-level information on experiences with health care providers. Results from the Survey show that people living in Remote/Very remote areas experience poorer access to a range of health services than people in Major cities, and that people living outside Major cities experience less sharing of information between health care providers than their city counterparts. These findings support previous research about the experiences of people in rural and remote Australia [2,3]. The data tables associated with this report provide detailed results on general practitioner (GP), specialist and hospital service use and patient experiences. What do we mean by ‘rural and remote’? Rural and remote areas comprise 4 of the 5 remoteness groups defined by the Australian Statistical Geography Standard [4]—Inner regional, Outer regional, Remote and Very remote areas. (The fifth remoteness group is Major cities.) Remote and Very remote areas are combined for some of the analysis in this report. Access to health professionals: As part of the Survey, patients were asked about any potential barriers to seeing a health professional. Compared with people living in Major cities, people in Remote/Very remote areas were: more likely to report not having a GP nearby was a barrier to seeing one (20% compared with 3% for people in Major cities); more likely to indicate that not having a specialist nearby was a barrier to seeing one (58% compared with 6%); more likely to have been to an emergency department (ED) in the past 12 months because no GP was available when they needed one; (17% compared with 10%). Usual GP and usual place of care: Having a usual GP or place of care can improve health care for people who have chronic conditions, a complex medical history, or who take several medications [5]. The Survey results show that: people living in Major cities were more likely than those living in Outer regional and Remote/Very remote Australia to have a usual GP; (89% compared with 81% and 69%, respectively); people living in Inner regional areas were the most likely to have a usual place of care (92%); people living in Remote/Very remote; areas were the least likely (86%). Information sharing between health professionals: The Survey included some questions about information sharing between health care providers. For example, participants were asked whether their usual GP or place of care seemed informed of their follow-up needs or medication changes after a visit to an ED, a hospital admission, or care provided at a specialist appointment. Overall, participants living in Remote/Very remote areas were less likely than people living in other areas to indicate that their usual GP or place of care seemed informed of their follow-up needs after they had seen a health professional for their physical, emotional or psychological health, visited a specialist or had been admitted to hospital (see tables 3, 4 and 5). The Survey of Health Care: All results are from the Survey of Health Care, which was sent to a selection of people aged 45 and over who saw a GP at least once between November 2014 and November 2015. Survey participants gave information about their health; health service use; experiences with access, continuity and coordination of care; and their demographic characteristics.

Around 7 million people—about 28% of the Australian population—live in rural and remote areas, which encompass many diverse locations and communities (ABS 2019d). These Australians face unique challenges due to their geographic location and often have poorer health outcomes than people living in metropolitan areas. Data show that people living in rural and remote areas have higher rates of hospitalisations, deaths, injury and also have poorer access to, and use of, primary health care services, than people living in Major cities. Despite poorer health outcomes for some, the Household, Income and Labour Dynamics in Australia (HILDA) survey found that Australians living in towns with fewer than 1,000 people generally experienced higher levels of life satisfaction than those in urban areas and major cities (Wilkins 2015).

Sequence type 1 (ST1) methicillin-resistant Staphylococcus aureus (MRSA) SCCmec IV[2B] has become one of the most common community-associated MRSA clones in Australia. We report the complete genome sequence of one of the earliest isolated Australian S. aureus ST1-MRSA-IV strains, WBG8287, isolated from an Indigenous Australian patient living in the remote Kimberley region of Western Australia.

University students living in regional, rural and remote (RRR) communities of Australia face unique challenges including geographical isolation, lack of access to face-to-face support, and technological barriers. This paper outlines a project funded by the Australian Government's Higher Education Participation and Partnerships Program that was undertaken by five universities with significant enrolments of students from low socio-economic backgrounds living in RRR communities. The project established a Framework for Australian Universities and Public Libraries Supporting Regional, Rural and Remote Students that provides a set of strategic recommendations that will guide the development of accessible, relevant and sustainable study and learning support to meet the needs of low socio-economic students living in RRR communities. This national project provided a unique opportunity for Australia?s universities and public libraries to work together in order to 'future proof' the education of students from low socio-economic backgrounds living in regional and remote communities.

Children from Australian remote areas are vulnerable to complex childhood trauma (CCT) as their communities face higher rates of disadvantage and exposure to potentially traumatic circumstances such as natural disasters, and family and community violence. This is compounded by difficulties associated with the tyranny of distance in accessing effective support. In such contexts, the role of schools and teachers in addressing trauma’s debilitating effects is both vital and amplified. This Doctor of Philosophy study utilised constructivist grounded theory methodology to generate a new theory, Building Trauma Informed Teachers from data collected in individual interviews with 23 teachers and a focus group with 7 teachers. Building Trauma Informed Teachers explains the social processes teachers undergo in their work with children living with the effects of CCT. This study contributes important insights into the scope and nature of teachers work with children experiencing CCT and recommends ways in which cognate systems can prepare and support teachers in remote areas for their important role as key professionals in the lives of children who have experienced CCT.

Addressing nursing shortages in rural areas remains essential, and attracting nursing graduates is one solution. However, understanding what factors are most important or prioritized among nursing students contemplating rural employment remains essential. The study sought to understand nursing student decision-making and what aspects of a rural career need to be satisfied before other factors are then considered. A cross-sectional study over three years at an Australian university was conducted. All nursing students were invited to complete a Nursing Community Apgar Questionnaire to examine their rural practice intentions. Data were analyzed using principal component analysis, and mean scores for each component were calculated and ranked. Overall, six components encompassed a total of 35 items that students felt were important to undertake rural practice after graduating. Clinical related factors were ranked the highest, followed by managerial, practical, fiscal, familial, and geographical factors. Maslow’s Hierarchy of Needs provided a lens to examine nursing student decision-making and guided the development of the Rural Nursing Workforce Hierarchy of Needs model. Each element of the model grouped key factors that students considered to be important in order to undertake rural employment. In culmination, these factors provide a conceptual model of the hierarchy of needs that must be met in order to contemplate a rural career.

Aboriginal and Torres Strait Islander peoples are the First Nations people of Australia and comprise 3.3% of the total Australian population. With over 150 language groups, the Aboriginal and Torres Strait Islander population is diverse in culture, beliefs and knowledges and has both unique and shared experiences.

Objective: To analyse the implicit discourses within the COVID-19 policy response for Aboriginal and Torres Strait Islander remote communities. Method: This paper uses Bacchi's 'What is the Problem Represented to Be' framework to analyse the Emergency Requirements for Remote Communities Determination under Subsection 477(1) of the Biosecurity Act 2015 (Cth). Results: Despite the leadership of community-controlled health services and regional councils, and the actions of Aboriginal and Torres Strait Islander communities, the policy response constructs Aboriginal and Torres Strait Islander people as vulnerable and mobility as a problem that needs a law and order response. Conclusions: The policy response perpetuates an ongoing paternalistic discourse where Aboriginal and Torres Strait Islander people must be controlled for the sake of their health, informed by notions of Indigeneity as deficient. This stands in contrast with the work of community-controlled health organisations, advocacy by Aboriginal and Torres Strait Islander people for and against restrictions, and examples of communities protecting themselves. Implications for public health: Unilateral government intervention creates limiting discourses of Aboriginal and Torres Strait Islander people. In contrast, ongoing COVID-19 responses can build on the strengths of and work done by Aboriginal and Torres Strait Islander families, leaders, and communities.

This exploratory study investigates aspects of sleep quality and some of the potential impacts of sleep complaints for 168 male boarding students from regional and remote communities in Years 7 to 12. An online self-report questionnaire was used to examine the relationship between sleep quality and participants’ sense of academic self-perception, motivation and regulation, resilience, as well as indicators of non-specific psychological distress, life satisfaction, behavioural and emotional wellbeing. Results found general parity between participants’ overall scores for sleep quality and norms on the sleep/wake problems scale. However, it emerged that over the previous seven days only a small proportion of participants were satisfied with their sleep every night, with the majority reporting feeling tired or sleepy during the day. This and other findings are discussed in relation to current national sleep recommendations for adolescents, as well as with consideration to the promotion of healthy adolescent development and optimal academic performance, behavioural and cognitive functioning, and emotional regulation. Implications for boarding school routines are discussed with an emphasis on time allocated to sleep, and actual time spent asleep, by adolescent boarders. Strengths and limitations of this study are presented.