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Remote Australia Online

Search here for evidence-based reports and resources about remote Australia
Remote Australia is a vast and complex area. To create opportunity, foster social inclusion and drive economic development in this region, you need a comprehensive knowledge base to drive change.
Remote Australia Online is exactly that. It’s an online platform that delivers authoritative research on topics that impact this region and its people, including education and its pathways, policy, business, social and cultural welfare, infrastructure, communication and natural resource management.

Remote Australia Online is for those who want to delve deeper into the complexities of remote Australia: its intricate and interconnected networks, the geographical, social, cultural and environmental influences, its opportunities, challenges, and to understand just what makes this unique region tick.
Journal Article
Ageing in remote and cyclone-prone communities: geography, policy, and disaster relief: Ageing in remote and cyclone-prone communities
Author(s):
Astill, Sandra
Published:
2017
Focussing on the experience of independent-living older adults, this study explored how those in regional Australian coastal communities have coped with repeated natural disasters. Using an exploratory, mixed-method, and phenomenological approach, an array of non-probability snowballing techniques was used to seek participation from residents aged 65 years or more, and from emergency services officers, disaster managers, and community health care providers located in regional communities affected by Cyclone Larry (2006) and Cyclone Yasi (2011). The research found that post-disaster political decisions have had a negative long-term impact on local economies, causing outmigration by those seeking employment, and resulting in many elderly residents facing a future without family support. As government policies encourage ageing-in-place by providing subsidised in situ care, increasingly older adults are remaining in exposed vulnerable locations, reliant on authorities for their survival both day-to-day and during an emergency. Findings also uncovered inconsistent disaster management policies between neighbouring local government councils and an unrealistic reliance on in situ care organisations by disaster managers during preparation and recovery stages of a natural hazard. These results highlight the need for those charged with emergency management to reassess both the future natural hazard adaptive capacities of ageing regional communities and policy responses to such challenges.
Journal Article
Barriers and enablers to Aboriginal and Torres Strait Islander careers in health: A qualitative, multisector study in western New South Wales
Author(s):
Bailey, J.; Blignault, I.; Renata, P.; Naden, P.; Nathan, S.; Newman, J.
Published:
2021
OBJECTIVE: Growing a strong Aboriginal and Torres Strait Islander health workforce is key to closing the gap in health outcomes between Indigenous and non-Indigenous Australians. This study sought to explore barriers and enablers to career development for Aboriginal health staff and potential strategies to enhance career pathways. DESIGN: Qualitative study, with data collected primarily through focus group discussions (yarning circles) at different health workplaces. SETTING: Western New South Wales. PARTICIPANTS: Aboriginal health staff (n = 54) from Aboriginal Community Controlled Health Services, a Local Health District and a Primary Health Network, and their managers (Aboriginal and non-Aboriginal; n = 28). MAIN OUTCOME MEASURES: Identified barriers and enablers and regional strategies for improving career pathways. RESULTS: Aboriginal people interested in pursuing a career in health face barriers in: pre-employment, recruitment, the workplace and further education and training. Being given practical and emotional support, as well as opportunities, makes a difference at every stage. Family and community are very influential in career decisions. Within the workplace, culturally appropriate human resource systems and management structures are vital. The ability to obtain employment and access education and training locally is important to rural and remote communities. CONCLUSION: To enhance health career pathways for Aboriginal people, strategies are needed at all levels: community, organisation, system and society. Aboriginal leadership and self-determination are crucial, as are partnerships within the health sector and between the health and the education and training sectors. Cultural safety is essential to expansion of the Aboriginal workforce, and to health care experiences and outcomes for Aboriginal community members.
Journal Article
A systematic review of disability, rehabilitation and lifestyle services in rural and remote Australia through the lens of the people-centred health care
Author(s):
Bohanna, India; Harriss, Linton; McDonald, Malcolm; Cullen, Jennifer; Strivens, Edward; Bird, Katrina; Blanco, Leisyle; Thompson, Fintan; Wapau, Hylda; Wason, Alan; Barker, Ruth
Published:
2021
Publisher:
Taylor & Francis
Purpose: The aim of this systematic review was to identify models of community disability, rehabilitation and lifestyle service delivery in non-metropolitan areas of Australia, and to describe these models through an Integrated People-Centred Health Services (IPCHS) lens. Materials and methods: We identified peer-reviewed studies published between 2000 and June 2021 that met the following criteria: described or evaluated a community service delivery model, intervention or program in regional, rural or remote Australia; provided for people with a disability or a potentially disabling health condition. A scoring rubric was developed covering the five IPCHS strategies. Results: Nineteen studies were included in the review. We identified a range of service delivery models providing support to people with a range of disabilities or conditions. We report evidence of the use of the IPCHS strategies in ways relevant to the local context. Discussion: Several strengths emerged, with many services tailored to individual need, and significant community engagement. Innovative rural service delivery approaches were also identified. Key areas requiring action included improved coordination or integration within and across professions and sectors. There was limited evidence of co-production of solutions or participatory governance. While people-centred approaches show promise to improve community-based services, large-scale fundamental change is required. IMPLICATIONS FOR REHABILITATION: Community-based disability and rehabilitation services in rural and remote Australia performed well at delivering tailored care and engaging in community consultation. These services must urgently implement strategies to enhance community ownership of solutions and participatory governance. Services must place a greater focus on explicit strategies to integrate and coordinate across services and professions, and to create an enabling environment, to deliver people-centred care. The World Health Organisation Integrated People-Centred Health Services framework provides an important roadmap to improving service delivery in rural and remote Australian communities.
Journal Article
Associations with sight-threatening diabetic macular oedema among Indigenous adults with type 2 diabetes attending an Indigenous primary care clinic in remote Australia: a Centre of Research Excellence in Diabetic Retinopathy and Telehealth Eye and…
Author(s):
Brazionis, Laima; Keech, Anthony; Ryan, Christopher; Brown, Alex; Neal, David; Boffa, John; Bursell, Sven-Erik; Jenkins, Alicia
Published:
2021
Objective To identify factors associated with sight-threatening diabetic macular oedema (STDM) in Indigenous Australians attending an Indigenous primary care clinic in remote Australia.Methods and analysis A cross-sectional study design of retinopathy screening data and routinely-collected clinical data among 236 adult Indigenous participants with type 2 diabetes (35.6% men) set in one Indigenous primary care clinic in remote Australia. The primary outcome variable was STDM assessed from retinal images.Results Age (median (range)) was 48 (21–86) years, and known diabetes duration (median (range)) was 8.0 (0–24) years. Prevalence of STDM was high (14.8%) and similar in men and women. STDM was associated with longer diabetes duration (11.7 vs 7.9 years, respectively; p<0.001) and markers of renal impairment: abnormal estimated Glomerular Filtration Rate (eGFR) (62.9 vs 38.3%, respectively; p=0.007), severe macroalbuminuria (>300 mg/mmol) (20.6 vs 5.7%, respectively; p=0.014) and chronic kidney disease (25.7 vs 12.2%, respectively; p=0.035). Some clinical factors differed by sex: anaemia was more prevalent in women. A higher proportion of men were smokers, prescribed statins and had increased albuminuria. Men had higher blood pressure, but lower glycated Haemoglobin A1c (HbA1c) levels and body mass index, than women.Conclusion STDM prevalence was high and similar in men and women. Markers of renal impairment and longer diabetes duration were associated with STDM in this Indigenous primary care population. Embedded teleretinal screening, known diabetes duration-based risk stratification and targeted interventions may lower the prevalence of STDM in remote Indigenous primary care services.Trial registration number Australia and New Zealand Clinical Trials Register: ACTRN 12616000370404.Data may be obtained from a third party and are not publicly available.
Journal Article
P171 From trial to program: TTANGO2 scale-up and implementation sustains STI point-of-care testing in regional and remote Australian Aboriginal health services
Author(s):
Causer, L; Watchirs-Smith, L; Saha, A; Wand, H; Smith, K; Badman, S; Hengel, B; Andrewartha, K; Richards, J; Tangey, A; Hawkett, K; Carroll, C; O’Connor, S; Marshal-Lang, R; Moore, E; Shephard, M; Guy, R; on behalf of the TTANGO2 Collaboration
Published:
2021
Background Young people living in remote Aboriginal communities experience some of the highest rates of chlamydia (CT) and gonorrhoea (NG) infection globally. A cluster-randomised controlled trial (TTANGO) in 11 remote primary health services demonstrated point-of-care (POC) testing for CT/NG was acceptable, accurate, improved the uptake and timeliness of treatment, and was cost-saving. Subsequently, POC testing was scaled-up and implemented in a further 20 remote health services (TTANGO2 program) across four jurisdictions (31 in total). We determine whether the uptake of POC testing observed in the trial was also achieved and sustained during the long-term program.Methods We conducted descriptive, interrupted time series and trajectory analyses to compare POC testing patterns over two time periods (trial: 2013–15 and program: 2016–19). For the trajectory analysis, we applied a Poisson model to identify and fit health services to testing groups.Results Among the 11 services who participated in both the trial and program, 7871 tests were conducted in total. The median number of tests per month in the trial was 241(IQR:178–305) and 408(IQR:294–538) in the program, with no significant trend in the trial (5.6 tests per month, p=0.190) but a significant increasing trend in the program (10.52 tests per month, p<0.001). Among the 31 program services (n=20,622 tests), three trajectory group were identified (low, medium, high). There was a significant upward trend in mean monthly testing in the ‘high’ trajectory group (model-predicted linear regression coefficient:0.03, p=0.002).Conclusions Our findings suggest POC testing can be scaled-up and sustained as part of a routinely implemented program, achieving greater than expected testing numbers to support the clinical and public health benefits of more timely treatment. Further research is underway to investigate barriers among the ‘low’ testing sites. These findings support the proposed transition from syndromic management towards aetiological diagnosis and treatment in low- and middle-income countries.
Book Section
Defiance in the detail: Young women’s embodied future selves
Author(s):
Chenhall, Richard; Senior, Kate; Hall, Trudy; Turner, Bronwyn; Daniels, Daphne
Published:
2021
Publisher:
ANU Press
Introduction: All of us are doomed to the life of choices, but not all of us have the means to be the chooser. (Bauman 1998, 86). Future thinking, which may encompass ideas of hopes, aspirations, concerns and fears, has become an important focus of anthropological interest, with authors suggesting that such a focus stems from global feelings of crisis and uncertainty (Kleist and Jansen 2016). Within this larger global perspective, people also develop their own personal sets of hopes and aspirations. The ambitions of these are largely constrained by the opportunity and experience that individuals and groups have to imagine potential life paths (Appadurai 2013). People living in impoverished environments are expected to have a limited set of choices regarding their lives, because their experiences and their opportunities to enact change are constrained. But, as Hoffman (2017) argues in her study of youth in Haiti, limited options may reduce outcomes, but not necessarily the desire to make change. Disadvantaged people do not necessarily suffer from a ‘poverty of aspiration’ (Hoffman 2017, 18). Young people are often the focus of studies about futures, hopes and aspirations, as they are in the process of actively constructing their own futures; indeed, the words ‘youth’ and ‘aspiration’ are often combined to inform a discourse of future planning that revolves around education, tertiary opportunities and a successful career. Implied is a step wise plan, in which each action leads to the next desirable outcome. Young women in Australia expect to have lives that are different from those of their mothers and grandmothers—they expect to be involved in the labour force and to delay marriage and motherhood until their late 20s (Wyn and Woodman 2006)—which implies a step-by-step rendering of their futures. As Kenway and Hickey-Moody (2011, 152) point out, this consideration of aspirations, which appears deeply embedded in educational policy, fails to recognise ‘how complex and diverse aspiration is and how it is rooted in social, cultural and spatial inequalities’. Harwood et al. (2017) have recently described research in which they engaged disadvantaged young people in discussions about their educational futures, including how they imagined their post-school educational options. Importantly, these young people conceptualised the future as being ‘both distant and fragile’ and only to ‘be dealt with seriously after the pains of the present, inflicted by schooling have been managed’ (Harwood et al. 2017, 132, original emphasis). Implicit in this is the suggestion that disadvantaged young people, whose present lives are problematical and unpredictable, are too busy responding and reacting to the present to make concrete plans for the future. For Indigenous youth living in Australia’s remotest regions, a range of structural inequalities resulting from colonisation, poverty and a history of exclusion from participation in economic, education and governance processes has resulted in the poverty of available choices (Senior and Chenhall 2008, 2012) or, in Appadurai’s terms, a reduced ‘capacity to aspire’: If the map of aspirations (continuing the navigational metaphor) is seen to consist of a dense combination of nodes and pathways, relative poverty means a smaller number of aspirational nodes and a thinner, weaker sense of the pathways from concrete wants to general norms and back again. (Appadurai 2013, 189) In 2008 and 2012, two of us published some of the results of our study of young women’s present lives and future aspirations in the remote Aboriginal community of Ngukurr in the Northern Territory (Senior and Chenhall 2008, 2012). We drew on material that we had collected through our extended periods of ethnographic engagement in the community from 1999 to 2008. In our earlier papers, we discussed the limited range of options available to young women, their limited conceptions of future selves, and their limited agency to either make or imagine a different type of future. We concluded that: Young women’s agency examined within the context of a culture which is bound in age and gender hierarchies would appear very limited … community living requires a series of compromises from the young women. (Senior and Chenhall 2012, 384). The young women in our study described feeling trapped by what they considered to be traditional gender roles; they also considered escaping from these roles to be impossible. For example, one young woman commented that the only way she saw to avoid this was to ‘go to Melbourne and get a sex change operation’ (Senior and Chenhall 2012, 383). This possibility aside, it was clear from what the young women had to say that they thought that leaving the community would not enable them to take up opportunities unavailable to them in their own communities. Young people talked about the strong pull that the community and their families had on them, and made it clear that they could never consider living anywhere else (Senior 2003; Senior and Chenhall 2008). The limited range of choices available to young women in remote communities is also a strong theme of McMullen’s research, described in Chapter 7 of this volume. This chapter presents findings from further work conducted with a group of young women in a remote Aboriginal community for whom the opportunities to engage, or even imagine engaging, in the sorts of trajectories set out in educational policies are very limited.
Journal Article
The pragmatics of managing children's distress in Murrinhpatha, a traditional Australian language
Author(s):
Davidson, Lucinda; Kelly, Barbara F.
Published:
2021
This paper examines the strategies that speakers employ in response to children's crying in the remote Aboriginal community of Wadeye, in northern Australia. Drawing on spontaneous interactions amongst Murrinhpatha speaking families, we analyse instances of crying by children aged 0;6 to 8;11 years, and the ways in which they are responded to. Results indicate that adult Murrinhpatha speakers manage children's distress through a variety of verbal and non-verbal strategies, and multimodal combinations thereof. The selection of strategies directly relates to the developmental stage of the crier. Adult caregivers respond differently to the crying of infants, of children who can walk unaided but are producing little if any language, of children who can talk intelligibly, and children more advanced again who have a degree of social independence. In the particular strategies that caregivers apply, they guide children towards a developmentally appropriate self-sufficiency. Caregivers encourage autonomy in ways that reflect a child's current abilities, be it physical, linguistic, emotional, or social. By exploring responses to crying in an under-researched cultural and linguistic context, this paper offers a unique perspective on the pragmatics of managing distress and what this reveals about local constructions of personhood within the context of carer-child interaction.
Conference Paper
Helping grey nomads with diabetes self-management: ADEA Diabetes Research Foundation Showcase and Masterclass
Author(s):
De Bellis, Anita
Published:
2021
Grey nomads who travel in remote and rural Australia are a growing population. Many are over 55 years of age and have chronic conditions including diabetes. The preparation, management and problems experienced by grey nomads on the road in self-managing their diabetes were the foci of a number of research studies and publications in this area. Following ethical approval, a faculty seeding grant initiated the research to ascertain the health problems experienced on the road by grey nomads and rural and remote diabetes educators in South Australia. Interviews with grey nomads had to be abandoned, however, the interviews with diabetes educators went ahead and the findings were published. Rural and remote general practictioners did not respond to participate in the research. A scoping review of the literature was published on the health of grey nomads with diabetes whilst travelling. Following this, successful funding from the Australian Diabetes Research Foundation was obtained to conduct further research and develop a preparation checklist specific for grey nomads travelling in rural and remote areas of Australia, and a draft education module for rural and remote allied health professionals. Following the gathering of a research advisory group, a survey of grey nomads was undertaken to ascertain their preparation prior to travel and self-management whilst travelling. Further interviews with rural and remote pharmacists on their experiences of grey nomads who had diabetes accessing their services was also conducted, as the previous research with diabetes educators indicated that pharmacies were often the first point of call when there were problems. A draft preparation checklist has been developed and further funding applied for its implementation and evaluation. Further funding will be sought for a specific education module on diabetes self-management for access by pharmacists and allied health professionals.
Conference Paper
Grey nomads with diabetes on the road
Author(s):
De Bellis, Anita; Hill, Pauline; McCloud, Christine; Abigail, Wendy; Giles, Jane; Apolloni, Marc
Published:
2021
Aims: The aim of this study was to explore the experiences and perspectives of grey nomads with diabetes and their self management whilst travelling in rural and remote Australia. As the baby boomers retire this cohort of grey nomads is increasing. Previous research with rural and remote diabetes educators in South Australia identified issues with diabetes management for these travellers including a lack of preparation such as understanding the services available in rural and remote regions. Methods: An exploratory online survey of grey nomads was undertaken in 2020 to 2021. The research was advertised on several grey nomad social media sites inviting those with diabetes to complete the survey. Questions sourced demographic and diabetes information, as well as closed and open ended questions regarding travel preparation, self management strategies, and problems experienced whilst on the road. Results: A total of 103 grey nomads with diabetes aged over 50 years undertook the survey. Most respondents had type 2 diabetes and co-morbidities were common. Results focussed on their planning prior to travel, self management whilst travelling, access to healthcare services, use of healthcare summaries and action plans, medical emergencies, and the impact of COVID-19 and natural disasters. Many of the respondents managed their diabetes well with pre planning and knowledge of their self management strategies. Conclusions: An outcome of the research is to develop a checklist for travellers with diabetes, general practitioners, and diabetes educators to use in preparation for clients planning rural and remote travel. Further policy development is required in the areas of a universal health record for access by healthcare professionals and telehealth services.
Journal Article
Grey nomads with diabetes self-management on the road - a scoping review
Author(s):
De Bellis, Anita; McCloud, Christine; Giles, Jane; Apolloni, Marc; Abigail, Wendy; Hill, Pauline; McClory, Liam
Published:
2021
Introduction: This scoping literature review explored the characteristics and behaviours of a subset of Australia’s older population: ‘grey nomads’, many who live and travel with type 1 or 2 diabetes mellitus. Grey nomads are people aged more than 55 years, who travel in caravans or motorhomes for extended periods of time around rural and remote areas of Australia. Grey nomads are challenging the established view of ageing in Australia by their lifestyle choices, which include social and economic contribution, independence and furthering of personal fulfilment. However, some evidence suggests that grey nomads experience health issues while in rural locations, which exerts a significant burden on already under-resourced Australian rural health services. This review seeks knowledge on grey nomads’ self-management of diabetes while travelling, with the aim of understanding their experiences and identifying support services and strategies that would facilitate improved self-management. Furthermore, this review seeks knowledge of how Australia’s rural and remote health services support the nomads with diabetes and the influence of this burgeoning population on such services. Methods: A scoping review methodology provided the methods to map the current evidence concerned with this broad and complex topic. A systematic six-step framework was adopted: identifying the research question; identifying relevant literature; selecting studies; charting the findings; collating, summarising and reporting results; and a final consultation. Results: The grey nomads in this review travelled long distances through the often-harsh Australian countryside where they sought, privacy, isolation, self-sufficiency and a closeness with nature. Although their motivations included life- and health-enhancing experiences, most grey nomads travelled with at least one chronic health condition, which they did not consider as a barrier to adopting a grey nomad lifestyle. However, many were underprepared for their health needs when in rural or remote Australia. Specific literature concerning grey nomads and self-management of diabetes was not found but salient aspects of diabetes self-management were identified and included a well-developed relationship with their diabetes healthcare provider; a relationship that relied on ongoing communication and support. When travelling, the ability to form or sustain supportive relationships with local health care providers was limited due to sparseness of rural services and the perceived transient nature of the relationship. Increasingly, grey nomads utilised digital technology via telemedicine or social media sites for information and advice on health issues. The local pharmacies in rural and remote locations were also identified as sources of support and services. Conclusion: The literature showed that the grey nomad population had a similar distribution of chronic illness, including diabetes, to that of the general Australian population, but very little was published about how they self-manage conditions when in remote locations where healthcare services were limited. The emerging roles of digital technology and development opportunities for pharmacists offer new and innovative avenues to support grey nomads with diabetes while travelling in rural and remote Australia.
Book Section
Bush medicine knowledge and use among young Kriol speakers in Ngukurr
Author(s):
Dickson, Greg
Published:
2021
Publisher:
ANU Press
In 2013, in a Ngukurr backyard, I was preparing to interview a young mother about her knowledge and use of bush medicine. It was a familiar remote community scene—outdoor social space populated by ebbing and flowing tides of various relatives. Present at the time was me, the young Kriol-speaking mum who had agreed to be interviewed, some kids, the parents of the interviewee and a visiting elder of some stature in the community. Each generation had distinctive upbringings: the visiting elder had been born in the bush and the parents of the interviewee were mission raised. Their daughter—the target of my interview—was old enough to have spent considerable time on local outstations when they were funded, while the children were a southern Arnhem Land version of ‘urbanised’ in Ngukurr. We all spoke in Kriol, as is the norm in Ngukurr, despite the older people present having knowledge of traditional languages. I was explaining the premise of my little study—in Kriol. Hearing that I was investigating what young people know about bush medicine, the visiting elder declared, with some disdain, ‘they don’t know nothing’. This chapter focuses on the issue of language retention among youth in this community. The research was conducted at the same time as the Ngukurr research that generated the other chapters in this book and so is situated within an exchange of ideas about health and wellbeing, particularly in regard to traditional knowledge and bush medicine. Stated beliefs that younger generations are not retaining cultural knowledge and practices of their forebears are common. They can be heard coming from elders, from non-local/non-Indigenous commentators and even among young people themselves. These perceptions are unsurprising given the sharp shifts in lifestyles that remote Aboriginal societies have experienced in so few generations. Language shift—in which younger generations speak a different language from preceding generations—is a salient phenomenon, inescapably noticeable given the obvious primacy of verbal communication in daily life. Loss of language (or, more accurately, language shift) becomes an easy hook on which to hang feelings of loss when a group or society is stressed and ways of life are threatened. In its crudest form, this manifests as the sentiment: ‘got no language, got no culture’. There is certainly good anecdotal evidence to affirm ideas of disappearing cultural knowledge and practices. In Ngukurr, no one has made or paddled a dugout canoe for decades and there are now two generations who have never seen or hunted goanna. But, as a blanket statement, beliefs that young people are not retaining cultural knowledge are rarely investigated.
Journal Article
I want to teach in the regional areas: A qualitative study about teachers’ career experiences and decisions in regional Australia
Author(s):
Dos Santos, Luis Miguel
Published:
2021
Publisher:
Richmann Publishing
The Australian government seeks to develop regional and rural communities and school systems. One of the challenges would be the human resources and workforce for registered and qualified teachers, particularly in the field of Languages Other Than English (LOTE). Based on social cognitive career theory (Dos Santos, 2021a; Lent et al., 1994), this study focused on the career perspectives and career decision-making processes of registered and qualified teachers in the field of Languages Other Than English (LOTE). The following research question guided the direction of this study, why would registered and qualified teachers in the Languages Other Than English (LOTE) field (i.e. foreign languages) decide to move to Australian regional and rural communities to develop their teaching career? With the general inductive approach, 18 participants were invited for the interview sessions and focus group activities. The results of this study indicated that missions and goals for development in the regional and rural communities and governmental encouragement for regional and rural developments are the two personal consideration elements. The sharing and comments become a blueprint for government agencies, school leaders, and policymakers to reform the current human resources plans and schemes to attach additional workforce to the regional and rural communities, particularly for teachers.
Book Section
‘They do think about health’: Young Indigenous women’s ideas about health and their interaction with the health system
Author(s):
Friderichs, Mascha
Published:
2021
Publisher:
ANU Press
Introduction: One day I was talking with a non-Indigenous service provider who asked me what my research was about. I told her I wanted to know how often young Indigenous women in Katherine thought about health and how they engaged with health and social services. Her response was that it would be 0 per cent because Indigenous people do not think about ‘health’ because health it is a Western concept. This service provider’s idea was in line with much of the literature, which states that there is no Aboriginal word for health (Atkinson 2002, 44; National Aboriginal Health Strategy Working Party 1989). However, to say that Indigenous young women in Katherine have no conception of the term health or ideas about health is to overlook the reality they live in. The young women in my research were living in a town where non-Indigenous people were in the majority; they attended school, engaged with Western media and used the Western health care system. As such, they cannot be regarded as isolated and independent from their surroundings (Merlan 1998). Moreover, the fact that there is no word in Aboriginal languages that means health in the Western sense does not mean that people do not think about issues that are generally regarded as being in the domain of health and sickness. Research on Aboriginal health often falls into one of two categories. Research from a biomedical perspective only looks at health from that perspective and is generally based on statistical indicators of mortality and morbidity, without acknowledging the existence of traditional beliefs. Conversely, much research on Aboriginal health beliefs focuses on traditional beliefs (Maher 1999), with anthropologists emphasising sorcery and traditional healing (see also Senior 2003). Both perspectives run the risk of overlooking the reality and complexity of people’s views and behaviour. Indigenous health is an issue of concern for governments, service providers and researchers, which makes it imperative to consider whose perspectives are prioritised. Research findings need to reflect Indigenous people’s own lived experiences. The majority of anthropological research on Indigenous health has focused on the general population or on small children (see e.g. Carson et al. 2007; Reid 1983; Saggers and Gray 1991a). Research focused on Indigenous youth, on the other hand, is not always focused on health specifically (Burbank 1988; Eickelkamp 2011).1 However, research with young people is important, as many health-compromising behaviours, as well as patterns of health service utilisation, are developed during adolescence (Vingilis, Wade and Seeley 2007). It is at this age that people become aware of their bodies and start making active decisions regarding their health (World Health Organization 2003, 7–9). If public health policies and the work of service providers are to contribute to improved health outcomes for Indigenous young women, it is necessary first to understand their views on health and what is important to them. Many ethnographic studies on Indigenous health focus on remote locations rather than town contexts. Yet, young Indigenous women in towns are exposed to different influences on their health beliefs and behaviours than those in remote areas. Although there is increasing recognition that the living circumstances of Indigenous people in remote communities should be seen as intercultural (Burbank 2011), there is a stronger boundary between Aboriginal and non-Aboriginal contexts in remote communities than in towns. Whereas in the former, non-Indigenous people are always outsiders (i.e. never permanent), towns form home for both Indigenous and non-Indigenous people. In towns, Indigenous and non-Indigenous people mutually influence each other, and strict distinctions between Aboriginal and non-Aboriginal domains—between tradition and modernity—cannot be made (Merlan 1998, 4).2 This is especially relevant when considering young people may have multicultural friendships and who attend school and activities such as sports together. Another difference related to location is that, although the populations of remote communities generally consist of people from various language groups, this variety is even more pronounced in towns. In this chapter, I show the multitude of health beliefs held by Indigenous young women in Katherine. The chapter starts with a description of Katherine and the 12 main informants in this study. This includes an explanation of how their Indigenous identity can be understood, as well as a consideration of Katherine as an intercultural place. This is followed by a short overview of the methods used, then an exploration of definitions of health, including how services influence young women’s views, as well as ideas around taking responsibility for health. Subsequently, I discuss the use of health services, focusing on the role of Aboriginal Community Controlled Health Organisations (ACCHOs). The final section before the discussion considers the changing role of bush medicine and traditional healing.
Journal Article
Active case detection methods for crusted scabies and leprosy: A systematic review
Author(s):
Glennie, Miriam; Gardner, Karen; Dowden, Michelle; Currie, Bart J.
Published:
2021
Publisher:
Public Library of Science
Background: Crusted scabies is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia and carries a high mortality risk. Improvement in active case detection (ACD) for crusted scabies is hampered by a lack of evidence about best practice. We therefore conducted a systematic review of ACD methods for leprosy, a condition with similar ACD requirements, to consider how findings could be informative to crusted scabies detection. Methods and principle findings: We conducted systematic searches in MEDLINE, CINAHL, Scopus and the Cochrane Database for Systematic Reviews for studies published since 1999 that reported at least one comparison rate (detection or prevalence rate) against which the yield of the ACD method could be assessed. The search yielded 15 eligible studies from 511. Study heterogeneity precluded meta-analysis. Contact tracing and community screening of marginalised ethnic groups yielded the highest new case detection rates. Rapid community screening campaigns, and those using less experienced screening personnel, were associated with lower suspect confirmation rates. There is insufficient data to assess whether ACD campaigns improve treatment outcomes or disease control. Conclusion: This review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. The potential benefit of ACD for crusted scabies is not quantified, however, lessons from leprosy suggest value in follow-up with previously identified cases and their close contacts to support for scabies control and to reduce the likelihood of reinfection in the crusted scabies case. Skilled screening personnel and appropriate community engagement strategies are needed to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models.
Journal Article
A revised model for evaluating visiting health care services in rural and remote settings
Author(s):
Healy, L. J.; Beccaria, G.; McIlveen, P.
Published:
2021
OBJECTIVE: Visiting health care services were developed to improve access to essential health care in rural and remote areas. Evaluating these services requires a robust framework. The objective of this study was to assess the confirmability and credibility of a model of 7 principles for effective visiting health care services. SETTING: Three iterative online survey rounds administered between July and December 2020. PARTICIPANTS: A heterogeneous panel of 13 experts in rural and remote health care participated, including managers of health care services, senior clinical staff in rural and remote regions and research academics specialising in rural infrastructure. DESIGN: The model was appraised using the Delphi method involving iterative online survey rounds to facilitate anonymous and structured discussion between panel members. RESULTS: Findings indicate consensus between panel members and support for a revised model. The revised model includes 4 modifications: (a) proposal of a new principle titled Feasibility, (b) restructure of 2 existing principles, (c) refined shape of the model to more accurately reflect the nature of service delivery and (d) detailed definitions of each principle. CONCLUSION: This study presents a credible, revised version of the model of 7 principles for effective visiting services. This will enhance the quality of the health workforce across geographically large countries, like Australia, enabling organisations to more effectively and consistently evaluate the impact of their service on rural and remote communities.
Report
Improving primary health care workforce retention in small rural and remote communities: how important is ongoing education and training?
Author(s):
Humphreys, John; Wakerman, John; Wells, Robert; Kuipers, Pim; Jones, Judith; Entwistle, Philip; Harvey, Pam
Published:
2007
Publisher:
Australian Primary Health Care Research Institute, School of Rural Health Monash University, Centre for Remote Health Flinders and Charles Darwin universities, Menzies Centre for Health Policy
Many small communities throughout rural and remote Australia experience a shortage of health workers, high levels of staff turnover, and significant problems in recruiting new health workers. In order to ensure the provision of appropriate, high quality, accessible primary health care services to residents of small geographically dispersed communities, the need to retain competent and confident health workers once recruited is particularly important. Rapid changes characterising the health industry, combined with the challenges and complexities of rural and remote practice, require a well-qualified workforce to meet their roles and responsibilities. Previous research investigating sustainable rural and remote health services auspiced by the Australian Primary Health Care Research Institute (APHCRI) suggested an association between workforce retention and the availability of ongoing education and training, such that the provision of effective continuing professional development may lower turnover rates of health workers in small rural and remote communities. At the same time, anecdotal evidence suggests that increasing demands on service delivery have resulted in reduced time available for Continuing Professional Development or Continuing Professional Education (CPD/CPE) activity in many rural and remote services and less support from service providers in relation to staff needs. This study examines the role and contribution of continuing professional development in enhancing workplace attractiveness and improving retention of primary health workers in small rural and remote communities. In particular, it examines how important education and training is to increasing workforce retention relative to other factors, the best way of providing effective education and training to rural and remote primary health care workers, and evaluates the costs and benefits associated with providing such education and training.
Book Section
The Aboriginal spring? Youth, mobile phones and social media in a remote Aboriginal community
Author(s):
Kariippanon, Kishan
Published:
2021
Publisher:
ANU Press
Introduction: The Field Site and the Project: Awakened to the events of the Arab Spring, in which mobile phones and social media became the conduit for a revolution spearheaded by young people (Eltantawy and Wiest 2011), the potential for an ‘Aboriginal Spring’ sparked my interest in what I assumed were the temporal tools of an ever-changing technoscape (Appadurai 1988). The location of the research and its objectives emerged as a result of a social marketing project that attempted to address scabies with the help of emergent technology in a remote Aboriginal community. Rather than just regarding this technology as a convenient vehicle for public health messages, in the early stages of this project, I became interested in its meaning in this location. Similar to Hinkson’s (2002, 2017) study of Walpiri new media, I was interested in how technology provides opportunities to extend and/or redefine sociality. This chapter explores the meanings embedded in mobile phones and social media for Yolngu youth in Yirkala in north-east Arnhem Land. The aims of the study were crafted in consultation with multiple stakeholders. This involved a series of meetings with government agencies and the Aboriginal Medical Services Board and their public health team, and leaders of the families whose land I sought to enter to conduct my work. As a collective, we agreed that this research could be beneficial to the community by providing a clear understanding of the role of mobile phones and social media in Yolgnu society, and insight into the prevailing attitudes towards mobile phones and social media in the community, particularly among young people. To enable accessible and translatable findings for a broad audience, I would conduct ethnographic research exploring how emergent technologies belong in the community, and how they affect young people’s kinship structure, social life and perceptions of community, including an account of how these technologies operate in their lives. Through my attempts at learning the kinship system of the Yolngu people—that is, Dhuwa and Yirritja moieties and their respective clans—I arrived at an understanding that a randomised method of sampling would be culturally inappropriate. Through my interactions with cultural mentors, I became aware that my responsibility was to seek guidance from my maternal uncles (ngapipi), brothers (wawa and gathu) and fathers (bapa) regarding the networks and individuals I could access for the study. Knowledge in this community, and in Aboriginal Australia more broadly, is often held by specific individuals. My adopted status determined my relationship to these individuals and enabled them to share some of their knowledge. Female members of this Arnhem Land community to whom I was connected via kin relationships were also interviewed to achieve a balanced view. These included senior, young and non-Indigenous women; the last worked closely with Yolngu families and were accorded the cultural authority needed to share their knowledge with me on specific aspects of the community. The study participants held multiple roles in the community, were of various ages and held various kinship relationships to me. My engagement with young people was guided by their personal interests and I was sensitive to their autonomy. I did not expect them to feel obliged to me, even though I was regarded as their ‘kin’. As the study focused on emergent technologies, and not Yolngu traditional knowledge systems, there was little need to intrude in culturally sensitive or inappropriate areas. The young people negotiated an intercultural or two-way approach (Marika and Isaacs 1995) to our engagement, balancing Yolngu law and non-Yolgnu culture. I quickly adapted to the new role of ethnographer, driving ‘family’ to and from funeral ceremonies or town, having the neighbours’ children over for a play, being a water boy for one of the footy teams, setting up new mobile phone connections and producing music videos for teenagers. After three months in the community, I approached my next-door neighbour, a Traditional Owner, to ask if I could apply for the installation of wi-fi ADSL 2 broadband, which could be made available to the community. With his approval, the Telstra man arrived (there was only one contractor in the mining town) and my house was connected with 100 gigabyte ADSL 2+ broadband. Soon thereafter, chairs showed up near my house, often on the veranda of my immediate neighbour, to access my wi-fi. Young people with mobile phones asked me for the wi-fi password and then added me as their friend on Facebook. They ‘suggested’ and ‘introduced’ other friends or family from different communities to extend their ‘friend list’ on Facebook. The wi-fi connection had anywhere between three and 10 users at a time. Depending on the ability of their phones’ connection, and their proximity to my house, some young people were able to surf the internet from the comfort of their own homes. Within two months, several mobile devices such as iPhones, Samsung flip phones and smartphones were joined by Android tablets as the arsenal of new technology in the community began to accumulate. Three months later, a brand new Hewlett Packard laptop was purchased by a neighbouring family who streamed movies and YouTube videos and downloaded music. As I began hearing different songs, I observed the transformative power of technology; however, it remained a technology that was wrapped in Yolngu culture, as I shall discuss throughout this chapter. The variety of expression and choices made via laptop, phone and the internet truly amazed me.
Journal Article
New thinking about old ways: Cultural continuity for improved mental health of young Central Australian Aboriginal men
Author(s):
Liddle, Joel; Langton, Marcia; Rose, James W. W.; Rice, Simon
Published:
2021
Publisher:
John Wiley & Sons, Ltd
Decades of reports and policy have drawn attention to the significant social and occupational impairment of many young Aboriginal men in Central Australia. However, the role of mental ill-health as a contributing factor to this impairment, and culturally appropriate intervention targets have received insufficient attention in the psychiatry literature. Despite having the worst health outcomes of any population in Australia, Aboriginal men chronically underuse primary health care services. It's proposed that interventions ensuring cultural continuity through Identity-strengthening with a particular focus on positive Aboriginal masculinities will address a critical mental health gap for young men. In Central Australian and broader Indigenous populations, tangible and measurable kinship, language, religious and economic (KLRE) activities are catalytic vehicles for restoring traditional knowledge that suffer ongoing pressures as a result of colonization and assimilationist Government policy. By transforming KLRE knowledge content from ethnographic archives, these culturally rich repositories may be utilized to create education and engagement materials that will support young Aboriginal men's efforts to obtain and maintain positive mental health. This proposal focuses on building resilience through the acquisition of KLRE knowledge which young Aboriginal men can utilize as resources for enhancing positive identity and mental health outcomes.
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