Remote Australia Online

Having begun as a short-term rental platform in major cities, Airbnb has now extended to many remote and regional areas of Australia. One effect of this spread has been disruption to the conventional rental industry, which stimulates micro-entrepreneurship in local communities directly through short-term accommodation and indirectly through related industries. Given Australia?s core?periphery settlement structure, resulting from the country?s historical development, disruption through entrepreneurship has relatively more potential in remote and regional areas. This article uses the Porter diamond model to explain how Airbnb-led micro-entrepreneurship interacts with territorially embedded socioeconomic characteristics across regional and remote Australia. Drawing on Airbnb data for Australia between 2014 and 2018 at the scale of regional labour markets, we use a quantile regression model to explain the association between Airbnb-led micro-entrepreneurship and four distinct structural dimensions between metropolitan and non-metropolitan regions. The analysis provides evidence that non-metropolitan regions have certain stronger competitive advantages for attracting Airbnb-led micro-entrepreneurship compared with metropolitan regions, particularly across regional cities and in areas associated with mining, agriculture, and tourism. We conclude that policymakers should weigh concerns relating to peer-to-peer accommodation in major metropolitan regions against the purported benefits to peripheral regions.

To date, there is scant research literature that explores the provision of end-of-life care to Aboriginal peoples in Australia. In particular, there is a lack of published research available on issues at the interface of Aboriginal languages and English during palliative care. The complexity and importance of the issue for palliative care provision, however, is demonstrated by the fact that in Australia, Aboriginality is itself a very broad category, containing many distinct language groups and subcultures. Thus, although to date there is some mention of the problems associated with language in the literature, there is scant research on the topic of the provision of palliative care to Aboriginal peoples in remote areas. The following findings from a recent two-year National Health and Medical Research Council (NHMRC) study are provided to address this hiatus. The findings provide insights on the impact of language difference on palliative care practice for Aboriginal peoples in the Northern Territory of Australia.

Indigenous scholars continue to argue for decolonial approaches to research in Indigenous communities. This work involves challenging accepted institutionally generated ‘truths’ about Indigenous experiences and realities – often framed in deficit terms – and calling for methodological reform (Smith, 1999) that shifts research-generated truth-making from power-laden (monologic) approaches towards what Haraway (1988) calls ‘power-sensitive’ dialogue. Attention is drawn to the inadequacy of monologic research instruments dependent upon English for relevant education provision for Aboriginal communities. The purpose here is to demonstrate the relationality among Indigenous Australian epistemologies, ontologies, and languages, and allow for centring decolonial and southern methodologies in educational planning, provision, and research. A process of ‘decolonizing’ survey and research methodology is traced over a seven-year period through three sets of survey instruments and a collaborative research project with Anangu researchers and three Anangu communities in remote southern Northern Territory. The use of first language narrative and a ‘consensual conversation’ (Maturana & Cabezon, 2001) approach encourages young people to make powerful assertions on their aspirations for education and the future. It renews focus on urgently needed Aboriginal languages and policy reform and investment, particularly in local Aboriginal educator workforce development, teacher preparation pedagogy and programmes, and the production of high-quality first language resources. Indigenous scholars continue to argue for decolonial approaches to research in Indigenous communities. This work involves challenging accepted institutionally generated ‘truths’ about Indigenous experiences and realities – often framed in deficit terms – and calling for methodological reform (Smith, 1999) that shifts research-generated, truth-making from power-laden (monologic) approaches towards what Haraway (1988) calls ‘power-sensitive’ dialogue.

Between 1953 and 1963 the British, in collaboration with the Australian Government, conducted atmospheric atomic tests and malfunction trials of uranium and plutonium based devices at two locations, Emu and Maralinga, in the Great Victoria Desert of South Australia. As a result of the tests quantities of radioactive debris, including americium and plutonium isotopes which are still present, were scattered over an area of several thousand square kilometres in the vicinity of the test sites. Some of the worst contamination occurred at a site named Taranaki situated at Maralinga, but other test sites in the region are also badly contaminated with radioactive debris, as well as being the location for cemeteries of low level waste and contaminated machinery and materials used in the tests and trials. Plutonium was buried at Maralinga, and some of this was repatriated to England in 1979, amid great secrecy. However, the bulk of the plutonium imported into Maralinga remains there, either dispersed by the tests or buried in pits close to the test sites. As a result many of the test sites are not safe for casual visitation and some pose a serious health threat to anyone not properly equipped to enter the area. The effects on the vegetation, food chain, ground water and the degree of contamination in airborne dust was unknown and little studied. The Maralinga test sites remained within a Commonwealth Prohibited Area, and permission to enter the area had to be sought from the relevant authorities. These lands were Aboriginal lands and had once been home to a group who are now generally identified as Pitjantjatjara. Years before the testing most of these people, or their immediate forebears, had moved into missions at Cundeelee in Western Australia or Ooldea in South Australia, a siding on the Trans-Australian Railway line (Gara et al. 1988). Others had travelled further afield: north to places like Ernabella; west to towns like Kalgoorlie; and south-east to Ceduna. Those Aboriginal people who stayed on settlements close to the railway line retained intimate knowledge and attachment to their lands. We know from the work of both Ronald and Catherine Berndt as well as that of Daisy Bates (all of whom worked at Ooldea) that Aboriginal people made visits back into their desert homelands up until the 1940s (RM Berndt 1941; Berndt and Berndt 1942–45; Bates 1938). The oral accounts we have collected from the people confirm this view.

The Swan Book (pub. 2013) by the Indigenous-Australian author Alexis Wright is an eco-dystopian epic about the Indigenous people’s tough struggle to regain the environmental balance of the Australian continent and recover their former habitat. The book envisions a dire future in which all Australian flora and fauna—humans included—are under threat, suffering, displaced, and dying out as the result of Western colonization and its exploitative treatment of natural resources. The Swan Book goes beyond the geographical and epistemological scope of Wright’s previous two novels, Plains of Promise (pub. 1997) and Carpentaria (pub. 2006) to imagine what the Australian continent at large will look like under the ongoing pressure of the Western, exploitative production mode in a foreseeable future. The occupation of Aboriginal land in Australia’s Northern Territory since 2007 has allowed the federal government to intervene dramatically in what they term the dysfunctional remote Aboriginal communities; these are afflicted by transgenerational trauma, endemic domestic violence, alcoholism, and child sexual and substance abuse—in themselves the results of the marginal status of Indigeneity in Australian society—and continued control over valuable resources. This essay will discuss how Wright’s dystopian novel exemplifies an Indigenous turn to speculative fiction as a more successful way to address the trials and tribulations of Indigenous Australia and project a better future—an enabling songline rather than a disabling swansong.

Introduction: This study of young people’s leadership aspirations begins with a corroboree, which was part of the initiation ceremony for three young boys. This was the final corroboree before the boys were to be circumcised the following day. Circumcision marks the end of a period of exclusion from the mainstream world, after which the boy is reintegrated into society as a man. During his period of removal, he has been taught traditional law, and sacred objects and knowledge are revealed to him. Ivory (2009, 128), in his study of Indigenous leadership, explains that this rite of passage is ‘vital to being considered an adult male and progression towards becoming a leader’. At dusk, the boys and their families gathered at the small settlement of Urapunga, about 20 km from Ngukurr, and waited for the dancers from Numbulwar to arrive. This period was marked by uncertainty; the women said they were unsure about where to sit or what their role would be (and were in fact moved several times until everyone was satisfied). There appeared to be considerable unease about the timing of the ceremony’s start; the men had said it would begin in the late afternoon, but nothing had been heard about the whereabouts of the dancers from Numbulwar by nightfall. Ceremonies such as this were infrequent in Ngukurr and this may have heightened people’s anxieties about their ability to ensure that it was conducted properly. Such anxieties are not a new feature of Ngukurr society. In 1970, Bern described the hesitance of the Djungaii (managers) in the conduct of the Jabadurwa ceremony because they were ‘unsure of their ability’ (Bern 1970, 18). As it got darker and darker, people became more and more anxious, and periodically the men would call out. Finally, their calls were answered with short bursts of digeridoo and song and a large, old, flatbed truck pulled up disgorging a surprising number of people, the men carrying spears and digeridoos. The little boys, who were about eight years old, sat at the front of a bower shade. The Red Flag Dancers from Numbulwar led the dancing, the men acting as though they were pushing the boys forward, the women as though they were trying to bring them back to their world with the actions of hauling in a net. These dances were followed by short explosive ones by small groups of men, appropriate to their own skin and clan. There was considerable reluctance from the local residents to take part in the dancing, some of the women said that they did not feel confident dancing in public, others practised tentative steps at the side of the gathering. Only a few older people attempted any public display, which was met by nervous laughter from the spectators. By 11 pm, there was no sign that the ceremony would end soon, and it was explained that the boys would be cut (circumcised) tomorrow after being kept awake all night by the singing and dancing. This ceremony was an important and highly anticipated community event, but, as the opening quote indicates, there was a feeling among older men that such ceremonies were no longer respected by many people in the community, particularly younger people.

A ‘rural proofing’ framework, which offers assessment of the potential impacts of policies on rural and remote communities, has been advocated for by state governments and interest groups throughout Australia. It is argued that rural proofing can be used to redress health inequities between urban and rural and remote communities. While implementation of rural proofing in some countries shows promising results, there are many social and spatial contexts that should be considered prior to its adoption in Australia. Rural proofing is not the best option for rural health policy in Australia. It has been imported from communities where the urban/rural divide is minimal. It is based on a rigid urban/rural binary model that targets disparity rather than accommodating the diversity of rural communities. Rural proofing concentrates on tick-the-box activities, where rural communities are not sufficiently consulted. There is no unified federal ministry in Australia with responsibility for rural and remote affairs. Considering potential shortcomings of rural proofing for health policies, it is imperative for Australia to have a specific rural health policy at both federal and state levels.

At the Western Institute of Technical and Further Education (WITAFE) in New South Wales (NSW), vocational education and training (VET) courses are being delivered to students in isolated homesteads and remote Aboriginal communities by Interactive Distance eLearning (IDL). IDL provides satellite-supported two-way broadband voice, one-way video and Internet access for school-age and adult distance education. Adults commonly access VET courses offered by WITAFE using the equipment provided to their children who are students of a 'School of the Air' or through community facilities in remote Aboriginal communities. By providing lessons via satellite to isolated students TAFENSW is helping to counter long-standing inequities in distance and rural education by decreasing the digital divide and assisting with rural renewal. Through a case study, this paper examines the influence of the provision of IDL and Internet access for adult students in isolated homesteads in NSW and also the benefits and challenges of teaching and learning with IDL.

Aim and Objective: To delineate contemporary practice of registered nurses working in rural and remote areas of Australia. Background: Despite the implementation of strategies to address challenges reported by rural and remote nurses, concern remains over safety and quality of care, the well-being of nurses and retention of the nursing workforce. Twenty years on, geographically dispersed nurses still experience scarce human and material resources. Design: A multiple case study design was implemented. Methods Nurses were recruited from 240 sites. The study comprised three phases of data collection. First, a content analysis of 42 documents relating to the context of nursing, specifically rural and remote nursing; second, a content analysis of an online questionnaire (n = 75); and third, a thematic analysis of semi-structured interviews (n = 20). COREQ reporting guidelines were used. Results: Each phase of data collection informed subsequent data collection and analysis within the study. Following triangulation of data from each phase of the study, the major themes reported are 'a medley of preparation for rural and remote work'; 'being held accountable'; 'alone, with or without someone'; and 'spiralling well-being.' Conclusions: Regardless of strategies, challenges of nursing in rural and remote areas persist. Issues of isolation, stress, burnout and a lack of organisational commitment to employees affect the retention of rural and remote nurses. While useful, professional development courses and graduate certificates are yet to make an impact on reducing these issues. Relevance to clinical practice Registered nurses argue for more experience rather than more education to facilitate transition into this nursing area. The finding that experience is perceived as more valuable than education suggests the need for innovative ways to gain experience to practice in rural and remote nursing. Lack of organisational commitment requires attention to promote the well-being of nurses and patient safety.

Education policies and practices developed for urban populations are not always effective when implemented in regional and remote locations. Despite government policy initiatives that may provide for collaboration across communities, a singular issue is that a diversity of solutions may be required rather than a ‘one size fits all’ approach. This article presents a potential solution to this problem through engaging collaboration and co-creation to optimise educational opportunities in initial teacher education in Australia. Qualitative analysis of a collaborative and co-created process of enhancement, lesson development and reflection brings together the every-day problem-solving processes used by pre-service teachers and classroom students with those used by research scientists and community experts. A consequence of such a process that benefits regional and remote communities is the development of collaborative networks founded in co-creation of educational opportunities and based on daily life in local communities.

Objectives To scope the evidence surrounding workplace health and safety risks for the remote health workforce in Australia and to collate the recommendations to address those risks.Design A five-stage scoping review framework refined by Cooper et al was used for this review. Informit Health Collection, Ovid Emcare, Medline, Web of Science Core Collection, ProQuest and the grey literature were searched in October 2020 using a combination of key words derived from the eligibility criteria. No date restriction was placed on the search. Title and abstract screening, full-text review and data extraction were performed by three reviewers. Data were analysed by the lead author using qualitative thematic analysis.Eligibility criteria Articles were eligible for inclusion if they were published research or industry reports, focused on safety for the remote health workforce in Australia, identified hazards/safety risks or recommendations to reduce risk, and were written in English.Results The search yielded 312 articles, of which 18 met the inclusion criteria. A wide range of hazards/safety risks and recommendations were identified within the literature, which related to safety culture, isolation, safe environment, and education and training. Some recommendations, such as the use of a risk management approach, good post-incident support, safer clinics and accommodation, and improved access to education and training, had been discussed in the literature for over a decade, with a high level of agreement regarding their importance. Two articles briefly evaluated the impact of some recommendations.Conclusion While many recommendations have been developed to improve the safety of the remote health workforce in Australia, there is little evidence of their implementation and evaluation. As many remote health professionals report ongoing or worsening workplace safety issues, there is an urgent need for the implementation and evaluation of the workforce safety strategies recommended in the literature and required by legislation.Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplemental information.

The prevalence of diabetes among Aboriginal and Torres Strait Islander (hereafter ‘Aboriginal’) Australians is three times greater than non-Aboriginal Australians, contributing to a greater risk of blindness from treatable and preventable ocular conditions, most prominently cataract and diabetic retinopathy. In rural and remote Aboriginal communities, blindness prevalence is higher, and ocular treatment coverage and uptake are lower. In collaboration with Aboriginal Community Based Researchers (CBRs), this study explored complex contingent factors that shape access to eye health services among rural and remote Aboriginal Australians living with diabetes. Interviews (n = 126) and focus groups (n = 12) were conducted with patients, primary care clinicians, and CBRs, in four rural communities in the Northern Territory and New South Wales. Factors internal and external to health systems were examined, drawing on Bourdieu's concepts of habitus, and doxa to understand agency and decision-making among patients and clinicians. The study used the ontology of critical realism, categorising contingent factors as underlying structures (generative mechanisms), and applying a decolonising approach that centred causal relationships and tensions between dominant (Western biomedical neoliberalism) and non-dominant (Aboriginal) value systems. Three forms of marginalisation; linguistic, economic, and cultural, were identified as the generative mechanisms that inhibit equitable eye health outcomes. Marginality is linked to structural factors that position Aboriginal culture as a barrier, and is reinforced through biomedical health systems, and the agents who operate in and influence them. In order to address eye health inequity, a shift in how Aboriginal cultural sovereignty is understood within health systems is needed, to position it as a strength that can facilitate eye care accessibility, and to support enhanced cultural responsivity among clinicians and service providers.

Objective This paper describes the service distribution and models of rural outreach by specialist doctors living in metropolitan or rural locations. Methods The present study was a national cross-sectional study of 902 specialist doctors providing 1401 rural outreach services in the Medicine in Australia: Balancing Employment and Life study, 2008. Five mutually exclusive models of rural outreach were studied. Results Nearly half of the outreach services (585/1401; 42%) were provided to outer regional or remote locations, most (58%) by metropolitan specialists. The most common model of outreach was drive-in, drive-out (379/902; 42%). In comparison, metropolitan-based specialists were less likely to provide hub-and-spoke models of service (odd ratio (OR) 0.31; 95% confidence interval (CI) 0.21-0.46) and more likely to provide fly-in, fly-out models of service (OR 4.15; 95% CI 2.32-7.42). The distance travelled by metropolitan specialists was not affected by working in the public or private sector. However, rural-based specialists were more likely to provide services to nearby towns if they worked privately. Conclusions Service distribution and models of outreach vary according to where specialists live as well as the practice sector of rural specialists. Multilevel policy and planning is needed to manage the risks and benefits of different service patterns by metropolitan and rural specialists so as to promote integrated and accessible services. What is known about this topic? There are numerous case studies describing outreach by specialist doctors. However, there is no systematic evidence describing the distribution of rural outreach services and models of outreach by specialists living in different locations and the broad-level factors that affect this. What does this paper add? The present study provides the first description of outreach service distribution and models of rural outreach by specialist doctors living in rural versus metropolitan areas. It shows that metropolitan and rural-based specialists have different levels of service reach and provide outreach through different models. Further, the paper highlights that practice sector has no effect on metropolitan specialists, but private rural specialists limit their travel distance. What are the implications for practitioners? The complexity of these patterns highlights the need for multilevel policy and planning approaches to promote integrated and accessible outreach in rural and remote Australia.

Introduction: A large workforce is employed in remote environments in the Australian mining and fuel sectors. Whereas paramedics are increasingly assuming roles as healthcare providers in these locations, little is known about industrial paramedic practice. The aim of this exploratory study was to better understand the demographics, education, clinical practice and work environment of the Australian paramedic workforce in remote and industrial settings to inform future research and education for the emerging specialty. Methods: Web-based respondent driven network sampling was used to recruit remote and industrial paramedics in this cross-sectional descriptive study. A self-administered questionnaire elicited responses (n=111) about participant demographics, work environment, initial and continuing education, and clinical scope of practice. Results: Paramedic participants working in remote and industrial settings are predominately male (86.5%) with the majority aged 35 to 44 years (38.7%). Their job titles range widely and include paramedic, intensive care paramedic, industrial, mine and offshore paramedics. Participants report an average of 15.4 years of total healthcare experience and working in the remote or industrial health sector for a mean of 7.1 years, primarily in Western Australia (34.2%). These paramedics often engage in continuing education, with 45% studying at a vocational or tertiary institution at the time of the survey. Most respondents (63.9%) describe their employment as directly or indirectly related to the natural resource sector and 75.7% have experience in remote settings such as camps, mining sites, offshore platforms, vessels or small communities. Most practitioners (59.5%) work in a full-time capacity and can perform core paramedic skills including intravenous cannulation, 12-lead electrocardiogram interpretation, chest needle decompression and restricted drug administration. Additionally, more than 40% of those actively working in the sector report having endotracheal intubation and intraosseous access in their scope of practice. They also administer immunisations, antibiotics and other prescription medications, manage chronic diseases, and perform low acuity skills typically included in a community paramedic role. Conclusion: This workforce survey is the first of its kind designed to gain a broader understanding of the paramedic practitioners who work in remote and industrial settings and the characteristics of their work environment. Key areas highlighted by this study serve to inform professional regulators, educators and employers with respect to the skills that remote and industrial paramedics perform and the education that is required to support the evolving specialised practice.

Despite rapid digital development in the past two decades, the remote parts of Australia still experience disadvantages with the adoption and diffusion of digital technology. As the adoption of information and communication technology continues to increase at a significant rate, investigating the underlying factors of the digital divide in general and also in the context of social exclusion in Australia is pertinent. The current study fills the gap in the existing body of knowledge by exploring the effect of socio-demographic factors and remoteness on the digital divide landscape with a country-specific focus on Australia. Using state-wide longitudinal data covering the 1998-2015 period within the panel data estimation framework, this study finds that digital divide is significantly associated with socio-demographic factors and remoteness in Australia. Moreover, the findings affirm that in addition to telecommunication infrastructure development, policymakers should also underscore socio-demographic factors in shaping digital inclusion strategies.

In this book, the authors present current research in the study of capacity development opportunities and challenges and capacity building in education, health and capital. Topics discussed include capacity building for school improvement; unique challenges in developing capacity in rural and remote Australia; women with disabilities in urban Cambodia and vocational training; capacity building and sex workers in Southeast Asia; capacity building in old industrialized regions of Europe and in non-profit organizations using blended learning as a gateway to practitioner education; and capacity development research in public health and the environment in the Caribbean.

Executive Summary Participation in the digital economy provides a major opportunity to diversify regional economies, develop improved global economic participation, improve workforce attraction and retention, and enable competitiveness. The deployment of digital infrastructure also has significant non-economic impacts such as facilitating enhanced wellbeing, improved service delivery, opportunities for education and training, and improved liveability and social connectivity. Key to this is high-speed reliable digital connectivity, effective planning for access, and localised digital capabilities (Marshall, Babacan & Dale, 2021). Torres and Cape Indigenous Councils Alliance Inc (TCICA) commissioned studies suggest that broadband and mobile infrastructure and services will provide real opportunities for economic and social development in the Cape and Torres region (ARUP, 2019; Matson, 2020). ARUP (2019:86) concludes that poor digital connectivity “limits the ability to maximise economic opportunities, partake in e-learning or benefit from tele-health services, and generally impacts on social connectivity and quality of life”. These TCICA studies, along with this report, identify connectivity as one of the transformative strategies needed for the region. As the As a consequence of that need, and as an alliance of 13 councils in the Cape York and Torres Strait, TCICA has commissioned The Cairns Institute at James Cook University (JCU) and the Digital Media Research Centre at Queensland University of Technology (QUT) to develop a Telecommunications and Digital Connectivity Strategy for the Torres and Cape region. This regional scope includes the Local Government Areas (LGA) of Aurukun Shire Council Cook Shire Council, Hopevale Aboriginal Shire Council, Kowanyama Aboriginal Shire Council, Lockhart River Aboriginal Shire Council, Mapoon Aboriginal Shire Council, Mornington Shire Council, Napranum Aboriginal Shire Council, Northern Peninsula Area Regional Council, Pormpuraaw Aboriginal Shire Council, Torres Strait Regional Authority, Weipa Town Authority and Wujal Wujal Aboriginal Shire Council. A range of methodologies were used to undertake the project, including focus groups in each of the LGAs, the development of technical audit and digital community profiles for the TCICA region, a focus group meeting with an expert technical panel and interviews with targeted telecommunication providers. The digital profiles for each LGA were developed, mapping out mobile, satellite and fixed internet and ADSL provision across the region and the extent and nature of coverage. Focus groups were undertaken with over 103 stakeholders from different sectors and agencies to gain an understanding of the nature of issues experienced. These contributions to the study uncovered key challenges relating to: • Infrastructure gaps: The levels of service available and those enjoyed in the major metropolitan areas differ significantly. The economics of communications provision in remote areas militates against extensive provision of terrestrial backbone links, whether by microwave radio or optical fibre, and mobile phone coverage. While satellite internet can deliver acceptable service, it is recognised that the quality and reliability of services deteriorates particularly during cyclones and storms. Participants reported unreliability of internet and mobile services with slow speeds, inadequate network capacity, drop outs, black spots and lack of geographical coverage. • Service quality and social infrastructure gaps: Limited or mismatched telecommunications services/plans to meet rural and remote consumer needs and the affordability of plans (particularly where there are redundancies and lack of access to local technical support). TCICA Region Telecommunications and Digital Connectivity 2 • Digital awareness and skills: There is limited consumer knowledge about digital options, a lack of skills for problem solving, limited localised support for digital knowledge sharing and skills development, intergenerational digital skills gaps, and a lack of cyber security knowledge. • Safety Considerations: Due to lack of digital connectivity, problems emerge during disasters and emergencies, times of isolation along major roads and routes, periods of high compliance with COVID- 19 measures, and times when people need to respond to social issues (e.g. domestic violence, policing), border security and bio-security. • Equity and Rights: Digital connectivity was seen as an issue of equity and rights across TCICA communities. Participants felt that the Universal Service Guarantee (USG) was either not adequately being met or was inadequate to meet the needs and expectations for social and economic development within the Torres and Cape region. • Emerging Impacts: There were a range of impacts of digital connectivity challenges in areas such as work, employment, social connectivity, economic development, safety, education and training information needs, links with government agencies; options for remote digital service delivery, health and mental health, region’s liveability and attracting professional staff. While there are significant constraints on digital telecommunications, some progressive investments are being made into the region. These include investments under the federal Mobile Black Spot Program and the Regional Connectivity Program (RCP), where some LGAs have received funding to address specific issues. Additionally, NBN Co and Telstra have announced significant investment with a focus on regional and rural connectivity. From this broader context, a Telecommunications and Digital Connectivity Strategy for the TCICIA region was developed with six strategic focus areas, along with suggested initiatives and time frames (see Table below). The strategy was aligned to the three dimensions of digital inclusion (access, affordability and ability) and focused on different categories of enablement from (i.e. Category 1: Individual, family or business; Category 2: Community organisation or community; Category 3: Regional; Category 4: Cross-regional). The implementation of the Strategy will require the development of an implementation plan and should involve the formation of working groups to drive investment development, delivery, monitoring and evaluation. TCICA should lead the development of such a plan, supported by its University and other partners and it should also be guided by a critical reference group as outlined in the Strategy. The engagement of telecommunication providers and other stakeholders is going to be critical to the successful implementation of the Strategy. Thought should be given to which stakeholders will be engaged, mechanisms and levels of engagement and which stage of delivery. The communities in the Torres and Cape region have aspirations for economic and social and cultural development and wellbeing. This report concludes that a lack of regional-scale planning leaves individuals, families and communities to resolve complex digital planning and service development issues. At the local scale, digital connectivity enables people to earn a living, run a business, have social contact, access services, and participate in civic life. Evidence highlights the critical roles that digital connectivity plays, particularly in information exchange, decision making, building social capital, civic participation, and connection for long term recovery. A whole of region approach to resolving these issues can empower local communities, businesses, families and individuals to secure better access and to improve the benefit they derive from these emerging new opportunities. Digital participation can be strongly empowering, helping people to overcome their sense of helplessness, giving them a sense of control and agency for individuals, communities and businesses, and helping them fulfil economic and social aspirations and develop resilience in the long term.

Diffracting Diffraction: Cutting Together-Apart

Provision of cardiac rehabilitation (CR) was disrupted in 31% of the 155 countries according to the World Health Organisation during the early months of the COVID pandemic. This might have been associated with worsening clinical outcomes and is of particular concern to patients living in rural and remote areas. In Australia, these patients have a higher prevalence of cardiovascular diseases, higher rates of adverse outcomes due to acute myocardial infarction and limited availability to regional services.We aimed to investigate how the COVID affected the delivery of CR services in rural and remote South Australia (SA) during the first wave of the COVID pandemic. CR attendance, completion and waiting times in the pre-COVID period (February-July 2019) was compared to data during the first wave of COVID (February-July 2020) using data from CR services across six regional local health networks recorded in the Country Access to Cardiac Health (CATCH) database.There were 922 patients (32.2% females; mean age 69.2 years; 36.6% living in areas with high socio-economic disadvantage) referred to CR in the pre-COVID period, and 1032 patients (30.7% females; mean age 68.1 years; 35.7% living in areas with high socio-economic disadvantage) in the COVID period across the six regional areas in South Australia. Acute coronary syndrome was the main reason for referral both pre (251; 27.2%) and during COVID (273; 26.5%). The proportion of CR attendance was higher in the pre (522; 56.6%) compared to the COVID period (431, 41.8%; p < 0.001).  Completion was higher pre (413, 79.1%) compared to during COVID period (205,47.6%) completed CR during the COVID period (p < 0.001). The waiting time was 35 (SD 27) days pre-COVID and 34 (SD 25) days in the COVID period (p = 0.37).Our data show that attendance and completion of CR programs were significantly reduced during the COVID period in rural and remote Australia. Limited service access during the pandemic and fear to physically attend health services during the period of social and physical restrictions might have contributed to this. Telehealth-delivered CR can provide opportunities to continuity of cardiovascular care and secondary prevention during pandemic restrictions.

Infectious disease burden, antimicrobial use and resistance highlight the need for antimicrobial stewardship in Indigenous communities. Antimicrobial stewardship is a set of coordinated strategies to improve antimicrobial use, enhance patient outcomes, reduce antimicrobial resistance (AMR) and decrease unnecessary costs. In Australian publicly funded health care, it is required for hospital accreditation under the National Standards, with highly developed strategies for hospitals (inpatient and outpatient) and nursing homes. Strategies in primary health care are much less developed, in settings where almost one in two Australians are prescribed an antibiotic every year. The Coordinated Remote AntiMicrobial Stewardship (CRAMS) Group is funded by HOT North (Improving Health Outcomes in the Tropical North), a National Health and Medical Research Council Collaborative Research Program, which has AMR as one of its pillars. This network of doctors and pharmacists working in northern Australian primary health care (Kimberley Aboriginal Medical Services [Western Australia], Top End Health Service [Northern Territory] and Queensland Health) collaborate with researchers with experience in infectious diseases in remote Australia and antimicrobial stewardship. We write this perspective to raise awareness of AMR as an issue in Indigenous primary health care and to foster ongoing consultation with Indigenous people and communities to identify potential solutions. We summarise what is known about infection burden, AMR and prescribing; review and identify critical gaps in current antimicrobial stewardship programs; and provide suggestions for improving and implementing stewardship programs in partnership with Indigenous communities and remote primary health care. Our proposed framework for antimicrobial stewardship leans heavily on urban tertiary hospital practices. This will need local adaptation (and perhaps complete rethinking) to be effective in remote primary health care.

Background Rural and remote Australian women are less able to access locally situated maternity care and birthing facilities, largely due to the gradual closures of rural and remote birthing services. Closures have occurred due to workforce issues, safety and quality issues and economic rationalisation of services to offset rising health system costs. An examination of the published literature to gain a deeper understanding of this phenomenon is warranted. Question What are the impacts of rural and remote maternity unit closures in Australia? Methods A systematic integrative review of published literature on Australian maternity unit closures was undertaken using Whittemore and Knafl's (2005) framework. A database search was conducted with date limiters of 2010 to 2020 on papers within the search parameters “maternity unit*” AND closure* AND women AND (midwife OR midwives) AND Australia, also with “birth unit”, “labour ward“ and “rural” in varying combinations. This search resulted in 348 papers. After applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process and the Crowe Critical Appraisal Tool (CCAT) and discarding those non-relevant, seven papers remained. Findings A methodological analysis of seven papers occurred, three qualitative studies, three quantitative studies and one mixed methods study. Two main stakeholders were identified, the woman, and the health service. Women identified risks associated with travel, lack of access to services, costs or financial issues, safety, and emotional burdens. Women explicitly stated that access to local maternity services would negate many of their concerns. Health services indicated closures were due to safety and quality considerations and workforce issues. Conclusion Conflict exists in trying to meet the perceived needs of both stakeholder groups. Published evidence supports midwifery models for low-risk women. National policy also supports woman-centred care; however, local service uptake is minimal due to organisational barriers.

Aboriginal and Torres Strait Islander women are disproportionately affected by violence in all its forms, and are overrepresented as domestic, family, and sexual violence victims (The Northern Territory Government, 2018). They are 35 times more likely to be hospitalised as a result of violence than non-Indigenous women and they report three times as many incidents of sexual violence compared to non-Indigenous women (Olsen & Lovett, 2016, p. 13). Indigenous women are also far more likely to be killed due to assault than non-Indigenous women (Our Watch, 2016). They are also hospitalised due to family violence at three times the rate of Indigenous males (Our Watch, 2018). With the increasing use of electronic and communication technology and internet connectivity in regional and remote areas, technology-facilitated abuse (TFA) is believed to be becoming more widespread yet the extent of it in regional and remote areas remains relatively unexplored. TFA refers to abusive behaviour using phones and other devices, as well as social media and online accounts. There are four main types of technology-facilitated abusive behaviours: harassment, stalking, impersonation, and threats (Office of the eSafety Commissioner, 2019). TFA covers the sharing of sexual images without consent; the use of GPS technology to monitor a person’s location and movement; the creation of fake social media accounts (such as on Facebook or Instagram) to impersonate and humiliate a person; and threatening or abusive messages. This research report looks into the experiences of TFA among Aboriginal and Torres Strait Islander women in remote and regional locations, with a particular focus on different types of experiences, cultural sensitivities which surround this abuse, and how women can best be supported. The findings of this research aim to inform programmatic and policy responses to address and prevent TFA in ways that are culturally safe and appropriate.

Many historical, environmental, socioeconomic, political, commercial, and geographic factors underscore the food insecurity and poor diet-related health experienced by Aboriginal people in Australia. Yet, there has been little exploration of Aboriginal food practices or perspectives on food choice recently. This study, with 13 households in remote communities on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, fills this gap using ethnographic and Indigenist methods. Results highlight Anangu resourcefulness, securing food despite poverty and adversity, and provide unique insights into factors influencing the three major types and range of dietary patterns identified. These factors include household economic cycles and budgeting challenges; overcrowding and family structures, mobility and ‘organization’; available food storage, preparation and cooking infrastructure; and familiarity and convenience. Structural and systemic reform, respecting Aboriginal leadership, is required to improve food security.

Remote Aboriginal communities in Australia have not been exempt from the rapid and radical changes that have characterised recent human history (e.g. Rowse 2017). While much of this change has resulted in improved health and wellbeing for many world populations, for others the consequences have been mixed. Drawing primarily on autobiographical material from a senior Numburindi man, this chapter looks at the effect that one of these changes has brought for Aboriginal youth over a span of 30 years in the south-east Arnhem Land community of Numbulwar. Somewhat ironically, it is the continuity of these changes—the control over Aboriginal people by an outside polity—that disables what may be a necessary and helpful control over young people. How and why some individuals respond more constructively to their current circumstances than others are questions that point to the complexity inherent in the control and guidance of youth in the intercultural spaces of remote Aboriginal Australia. The south-east Arnhem Land community of Numbulwar was originally established by the Anglican Church Missionary Society (CMS) as the Rose River Mission. Its first Aboriginal residents were Wubuy-speaking people, known as the Nunggubuyu, or Numburindi, many of whom had previously lived at CMS missions on the Roper River and at Groote Eylandt. I have visited this community, located at the confluence of the Rose River and the Gulf of Carpentaria, on a number of occasions, first in 1977 and most recently in 2007.1 Between these years, Numbulwar grew from a community of roughly 400 to 800 relatively permanent residents. In the early mission years, Aboriginal people were ‘Wards of the State’ and their activities were largely under mission control. At this time, a great many changes to their lives and livelihoods were made, changes that continued throughout the years. While the people of Numbulwar were still hunting, fishing and gathering in 2007, provisions of Western-type foodstuff, once as mission rations, later to be purchased in the ‘shop’, provided a major part of the diet. Marriage-related practices such as mother-in-law bestowal,2 polygyny and a pre-menarcheal marriage age for females had all but disappeared. Senior men could no longer punish, as they once did, those who violated the ‘Law’—that is, the imperatives of life established in the Dreaming, which had been challenged, if not supplanted, by Christianity and other Western beliefs. Wubuy and other languages of Numbulwar’s population, such as Wandarang and Anindilaguwa, had largely been replaced with Roper/Ngukurr Kriol and, for a number of residents, Aboriginal English. Most people were supported by some form of welfare and, increasingly, Western material objects had made their way into the community. Although surrounded by Western things, social arrangements and institutions, such as vehicles, houses, a school, governing councils, town clerks and Western schedules, the people of Numbulwar identified themselves in terms of Aboriginal categories and continued to attend to some of their older laws and customs. For at least some, this would include mother-in-law/son-in-law avoidance, the custom of mirriri that prescribes distance and respectful behaviours between mature brothers and sisters, the use of an Aranda-type system of kin classification, circumcision of boys and attendance at various Indigenous ceremonies (see also Biernoff 1979; Cole 1982; Heath 1980). While many discussions of the difficulties faced by Aboriginal people focus, appropriately, I think, on changes that have taken place in their lives, I want to frame this discussion, inspired and illustrated by segments of one man’s autobiography, in terms of what I have mentioned as a significant continuity—the control over Aboriginal people by an external power. This control changed in some details, from the assimilation polices of the mission period through the integration, self-determination and intervention policies of the Commonwealth and Territory entities that have been in power over the years (Rowley 1977; Austin-Broos 2011). In effect, however, or so I argue, Aboriginal lives have been governed to a large extent by the policies and institutions of an encompassing polity that is largely ignorant of, and, usually, indifferent to, Aboriginal values and goals. As the circumstances created by this continuity have affected every part of Aboriginal being, it is no surprise that they have affected the experience of Aboriginal youth, and have long done so. I focus on just one aspect of this experience, the intergenerational guidance and control of adolescents.

Background: Little is known about whether living in remote areas is associated with worse health outcomes in Australians with MS. Objectives: To evaluate whether living in remote areas was associated with worse health outcomes, employment outcomes and different disease modifying therapy (DMTs) utilisation among Australians with MS. Methods: We included 1,611 participants from the Australian MS Longitudinal Study. Level of remoteness (major cities, inner regional, outer regional, remote, and very remote Australia) was determined using postcode. Data were analysed using linear, log-binomial, log-multinomial and negative binomial regression. Results: Living in more remote areas was not associated with substantial worse health/employment outcomes. There was a consistent pattern of those living in inner regional areas having worse outcomes, but the effect sizes were relatively small with no clear dose-response relationships with increasing remoteness. Those living in more remote areas were less likely to use high efficacy DMTs. Adjusting for age, disease duration, and education level only marginally reduced the associations. Conclusions: There is no large inequity in health outcomes in the Australian MS population due to remoteness. However, modest and consistent differences in health outcomes and DMTs treatment are likely to have a substantial cumulative impact at an individual level.