Dr Lynore Geia is an Aboriginal and Torres Strait Islander woman born and raised on Palm Island, home to the Bwgcolman people. Lynore has over 30 years’ experience as a nurse and midwife with her most extensive practice being in rural and remote health, particularly in Aboriginal women’s health and birthing in Central Australia. Lynore supports Aboriginal community controlled health and is committed to developing effective research and education in nursing and midwifery that impacts on health praxis; in particular ‘Closing the Gap’ in Aboriginal and Torres Strait Island health. This has led to a passion for working with community to develop support strategies to strengthen Aboriginal and Torres Strait Islander youth health and families through best practice. The passion to work with community has extended into the use of social media for public health activism and advocacy such as #IHMayDay an annual 15 hour Twitter event convened and moderated by Lynore in collaboration with public health journalist Melissa Sweet and other health professionals. Lynore is currently the Academic Lead for Aboriginal and Torres Strait Islander Health and Indigenous Futures Research Lead in the Centre for Nursing and Midwifery Research, at the College of Health Care Sciences, James Cook University.
There is widespread concern about the health of youth and young adults in Indigenous communities in Australia. One such community Palm Island, identified the need to address the issues of young people’s health, their risk taking behaviors, relationships and health decision making. Anecdotal evidence suggests a culture of youth and young adults using drugs, alcohol and other substances which has given rise to community concerns on the social cost of this behavior to young people and their families.
This current study framework was developed through iterative community service meetings from 2013 to 2015 when services were tackling acute petrol sniffing in the community. A significant intervention secured through these meetings was the implementation of Low Aromatic Fuel (LAF) in May 2014 to the community as a strategic interruption to the sniffing activity, this was subsequently legislated in November 2015 under the Australian Government, Low Aromatic Fuel (Designated Area) (Great Palm Island) Instrument.
This study’s aim is to undertake a collaborative community survey towards a twofold outcome, (1) to develop a Palm Island baseline database of youth and young people’s health issues, (2) findings of the study would inform better service delivery by Palm Island organisations. Essential to this study are Palm Island young people and their close-knit peer groups, where verbal communication “Murri Talk’ is a highly functioning method of sharing information between peer groups in the community.
James Cook University recruited and provided research training to youth, employing them on a short term basis as research assistants who were involved in the survey tool design (based on the groundbreaking Indigenous Goanna Study model), data collection and analysis. This youth capacity building process is strategic towards future youth research projects on Palm Island.
The study is congruent with ongoing community strategic health plans, the practical outworking realised through committed cross-party support from the Palm Island Aboriginal Shire Council, the Townsville Aboriginal and Torres Strait Islander Corporation for Health Services who funded the study, Ferdy’s Haven Rehabilitation Aboriginal Corporation Palm Island and local Queensland Health Joyce Palmer Health Service.
A first of its kind this project is significant. Undertaken on Palm Island by Palm Island people it is centered on the community’s very young population with 53.6 percent of total population under 24 years. The study is a component of a broader tri-stage comprehensive youth strategy for Palm Island, this is the second stage; the study findings bearing potential for change.
Amanda Gill currently works with the National Critical Care and Trauma Response Centre. Amanda has completed a Gradate Diploma in Remote Health Management and a Masters in Remote and Indigenous Health. After graduating as a registered nurse from the University of Western Sydney – Hawkesbury she worked as a peri-operative nurse at Camperdown Kids Hospital and RPA in Sydney. Her love of travel and rugby took her to Ireland to work with the Galweigns Rugby Club for three years as the club nurse. On returning to Australia her journey led her to rural nursing in Julia Creek, Mt Isa. She gained further experience at PA hospital in the emergency department. Amanda developed itchy feet again and decided to drive around Australia, working in rural and remote health services. Her passion for travel and working with Indigenous communities eventually lead her to the Northern Territory where she has been able to combine all her passions for travel, nursing and Indigenous health care into one. Amanda joined the NCCTRC after completing AusMAT training in 2011. She has deployed twice as part of Team Alpha to Typhoon Haiyan and Team Bravo to Fiji post Cyclone Winston. She now works as an Education Consultant with the NCCTRC.
Background: Sudden onset disasters may exceed the capabilities of local health services. Emergency medical teams (EMTs), including the Australian Medical Assistance Team (AusMAT), are a vital element of the Australian Government’s capacity to respond to regional disasters. We explore the suitability of the remote area doctors and nurses for an AusMAT deployment.
Discussions: The National Critical Care and Trauma Response Centre (NCCTRC) is federally funded and supported to provide a medical response to sudden onset disasters. The Centre has trained more than 600 doctors, nurses, allied health and health logisticians to a national standard as members and leaders of an AusMAT. The NCCTRC response can include capabilities ranging from a triage and outpatient facility up to a full field hospital comprising inpatient wards, high dependency unit, two operating tables, full resuscitation and an outpatient service.
The NCCTRC recognises that disaster health professionals must have key clinical and humanitarian competencies i.e. registered to practise in their stated profession, do no harm approach and be able to apply their clinical speciality skills in an austere/disaster context.
On arrival to a disaster zone locally, nationally or internationally the AusMAT must be fully self-sustaining and able to adapt to working in an austere environment including managing food /water supply, medical consumables and working with limited equipment.
Remote area doctors and nurses work in geographically and professional isolation, they are mindful of resource limitations as well as providing health care within their scope of practise in difficult circumstances. The resourcefulness and broad range of skill sets performed by the remote area practitioner makes them an ideal candidate for an AusMAT deployment.
Conclusion: The clinical experience of many doctors and nurses in rural and remote settings means they are ideally suited to the demands of practice in an austere/disaster environment. The inclusion of these skills in a sudden onset disaster can bring an important component to balance the emergency and surgical response of an AusMAT deployment
Stuart Gordon is currently the CEO of the Western Queensland Primary Health Network and was also a member of the consortia which was awarded the Western NSW PHN. Previously he was CEO of the Far West Medicare Local, having successfully lead the formation of this new organisation. In previous roles he has been CEO of the NSW Outback Division of General Practice (2005 – 2012), COO and CEO Aga Khan Health Services Tanzania (2003 – 2004), General Manager Far West Area Health Service (1996 – 2003) and Regional Manager of the Murdi Paaki Region Aboriginal Council (ATSIC 1993 – 1996). He has also held other senior appointments in the Qld Agricultural sector (1990- 1993).
Stuart is the nominated QPHN representative on the Queensland Aboriginal health Partnership and a strong advocate for improving engagement and innovation within the PHN – ACCHO sector. He has served on a number of Commonwealth and NSW Ministerial Advisory Committee’s including the Health services for small country towns which presided over the establishment of 38 MPS facilities throughout rural NSW and more recently on the DoHA Establishing effective collaboration across local health economies supported by the McKinsey Group. Stuart was a member of the Western NSW Integrated Care Demonstration site and served for a number of years on the LHD sponsored governance where he contributed to the design and implementation of the WNSWLHD Integrated Care Strategy. He has been responsible for a range number of capital works projects, delivery of innovative programs in Aboriginal health, allied health clinical workforce development, and the delivery of community development initiatives targeting social reforms and improved social determinants of health in remote communities.
Stuart is also an active Director on the NSW Outback Division of General Practice where he has been working to create more robust workforce solutions and better position rural and remote practices to diversify current business models, capability and multi-disciplinary team based approaches through collaboration and innovation with Government and nongovernment sectors. Over the last three years Stuart has also served as Board Chairman of the Far West Academy of Sport.
Portrayed as having a long love affair with rural and remote communities, Stuart is currently living in Queensland and working across the WQ catchment, and is part of a third generation farming family with his home on a small vineyard on the banks of the Darling River in Bourke.
Aboriginal and Torres Strait Islander people living in the North West and Lower Gulf regions of Queensland experience a disproportionate level of illness, disease and exposure to health risk factors. These regions comprise some of the most disadvantaged communities in Australia.
Regional planning initiatives undertaken across the regions have repeatedly acknowledged the need to improve the cultural-appropriateness of mainstream health services to enhance accessibility and uptake of services. If there are to be any improvements in the health outcomes of our people, then it is imperative that all Aboriginal and Torres Strait Islander people across the region are provided with equitable access to culturally-appropriate, comprehensive Primary Health Care services, with a stronger focus on prevention, early-intervention services and the management of chronic disease.
A number of systemic issues have been identified within the existing model of care, which, if rectified, would support significantly improved health outcomes across the regions. These include:
In March 2016, Gidgee Healing submitted an application to the Australian Government for funding through the Indigenous Australians Health Program (IAHP), proposing a new way of delivering PHC services across the North West and Lower Gulf region. This was submitted in a tripartite partnership with the Western Queensland Primary Health Network (WQPHN) and the North West Hospital and Health Service (NWHHS). Gidgee Healing has recently been advised of the success of this application, representing a critical acknowledgement of the evidence-base that supports the approach of Aboriginal Community-Controlled Health Services (ACCHS), and the Commonwealth's resolve to ensure these resources form part of the funding envelope available for ACCHS.
The opportunity to work collaboratively with the WQPHN and NWHHS represents a greater opportunity to develop a shared-vision and cohesion of strategy; improved coordination of care; and the capacity to leverage a greater value proposition for Aboriginal and Torres Strait Islander people in the North West and Lower Gulf regions. This partnership will also enable a shared accountability framework to be crafted through new models of care, along with an opportunity for a new unique conversation with Lower Gulf communities in the planning, co-design and delivery of services in their local communities. This level of collaboration across the peak organisations will enable a significantly greater capacity for innovation, and the ability to jointly evaluate and develop an evidence base to support a more comprehensive and integrated model of care across one of the most geographically remote and disadvantaged regions in Australia.
Michelle Gourley is the current Head of the Burden of Disease and Mortality Unit at the Australian Institute of Health and Welfare (AIHW). She was the lead analyst for the Indigenous component of the Australian Burden of Disease Study 2011 and continues to provide national leadership on work on burden of disease in Australia. She is also the current custodian of the AIHW’s National Mortality Database. A key component of this role is to fill priority information gaps by producing analytical products using this key data source. Michelle has extensive experience in leading the development and release of a wide range of reports by the AIHW with a particular focus on burden of disease, Indigenous health and welfare statistics, and geospatial analysis of health data.
Introduction/background: The recently published Australian Burden of Disease Study (ABDS) 2011 quantified the fatal and non-fatal impact of over 200 diseases and injuries in Australia. This included disaggregation of estimates by state/territory, remoteness areas, and socioeconomic groups. The contribution of various modifiable risk factors to disease burden was also estimated. The results from the study fill an important information gap as the last national study was published in 2007 using 2003 data.
Methods: Disease burden is measured by the Disability Adjusted Life Years (DALY). A DALY is a measure of healthy life lost, either through premature death, defined as dying before the ideal life span (YLL), or through living with ill health due to illness or injury (YLD).
Key data inputs are death registration data, disease prevalence and severity, and risk factor exposure distributions, most of which are readily available in Australia. The study builds on methodological developments in recent global and country burden of disease studies, and tailors these to the Australian context.
The ABDS produced burden of disease estimates by remoteness area using the Australian Statistical Geography Standard 2011. It is possible to assess the variation in disease burden across remoteness areas as well as examine the leading diseases causing burden for a particular remoteness category.
Results/discussion: Overall, rates of disease burden were higher in more remote areas, with Very remote areas experiencing 1.7 times the rate of burden of Major cities. This was largely due to fatal rather than non-fatal burden.
The gradient of the inequality in disease burden across remoteness areas varied by disease. For example, coronary heart disease, COPD, lung cancer, suicide and diabetes had higher rates of burden in more remote areas. In comparison, dementia, anxiety disorders and depressive disorders had lower rates of burden in more remote areas.
Work is planned to extend the methods and estimates from the ABDS to produce burden of disease estimates at sub-regional levels, as well as produce sub-national estimates of the attributable burden due to selected risk factors.
Conclusions/implications: The results from the ABDS provide an important resource for research, and to inform health policy and health service planning. They highlight which diseases are causing the greatest health inequalities and the areas where there are the most potential for health gains. The study has built significant infrastructure that will enable efficient updates in the future, as well as more detailed analysis and modelling for particular aspects.
Jane Greacen (MBBS, MPH, FAFOEM, FACRRM) is a rural general practitioner and occupational physician in East Gippsland, working in mainstream and Aboriginal health services. She is secretary of the Centre of Excellence for Aboriginal Health in East Gippsland Ltd (CEAHEG), which is an organisation of Aboriginal Elders and Community members working together to build the Aboriginal health workforce in East Gippsland. CEAHEG works mostly with school students and their families to encourage the students to complete their schooling and enter health professional careers. Jane has received awards from Monash University and RWAV for her support for CEAHEG. Jane is Senior Lecturer, Monash University School of Rural Health Bairnsdale, and also the Director of Community Clinical Training for the East Gippsland Community Based Intern Program. She has extensive senior management experience: CEO Rural Workforce Agency Victoria (RWAV); Director of Program Development and Training Unit, Victorian Accident Rehabilitation Council; Chief Medical Officer WorkHealth, Victorian Public Transport Corporation; Assistant Director Primary Care, Victorian Department of Human Services; Director Medical Services at Bairnsdale, Echuca, Alexandra and Omeo Health Services.
Research to “Identify the Barriers to East Gippsland High School Students Becoming Health Professionals” was conducted in East Gippsland secondary schools in 2013 by the East Gippsland School for Aboriginal Health Professionals (EGSAHP), with support and funding from the Monash University School of Rural Health East Gippsland. EGSAHP is the trading arm of the Centre of Excellence for Aboriginal Health in East Gippsland Ltd.
There is a lack of qualified Aboriginal workers in all health professions in East Gippsland, apart from Aboriginal Health Workers. Only one doctor has come from the local Aboriginal Community, and a few nurses.
There is a significant gap between the health of Aboriginal and non-Aboriginal people in East Gippsland. In efforts across Australia to "Close the Gap" and improve health outcomes for Aboriginal people, it is widely acknowledged that Aboriginal people are more likely to engage with the health system if they have access to culturally appropriate services and Aboriginal health professionals. When they do they are more likely to be open to advice and support about healthy lifestyle choices and to seek health interventions and access follow-up support services and treatment as needed.
The EGSAHP research sought to identify barriers to school student awareness and interest in the health professions and ascertain views on what strategies might be helpful in encouraging local students, particularly Aboriginal students, to consider health professions as a potential career.
The EGSAHP research project involved an extensive literature review to ascertain barriers to Indigenous participation in tertiary education, particularly health professions, as well as interviews and consultations with students and parents from East Gippsland.
98 parents/ carers and students in East Gippsland (from Lakes Entrance and Bairnsdale Secondary Schools) were interviewed and surveyed. Of these, 44 were Aboriginal parents or carers reporting on 42 students, and 11 were Aboriginal students. The Aboriginal parents and carers as well as a small number of Aboriginal Elders were interviewed face to face. Other research participants responded by written survey. Feedback and discussion sessions were also held.
The research results formed the basis to a two day conference held in the region to consider future action, and from this a series of activities and programs have evolved that CEAHEG are delivering or coordinating to support local Aboriginal school students to complete their schooling and go into health profession training.
Therese Greenlees is a registered nurse with a diverse background in management and rural primary health care. She is currently employed by the Hunter New England Central Coast Primary Health Network (HNECC PHN) as an Integration Officer, working collaboratively with health professionals and organisations to improve health outcomes and the quality of life of people living in rural areas. While Therese’s role is based in the New England North West region of NSW, there is a focus on the health of those ageing in the community or residential aged care facilities across the footprint of the PHN. The New England Dementia Partnership involves HealthWISE New England North West, Hunter New England Local Health District and the PHN, and has evolved from a collaboration that dates back to 2003. The aim of the Partnership is to improve the assessment, diagnosis, management and support of those living with dementia, their carers and families, across the New England North West.
The Dementia Partnership builds on a collaboration to improve the timely assessment of mild to moderate cognitive impairment and dementia care, which began in 2003. Through the Agency of Clinical Innovation’s Building Partnerships program, the three partner organisations were able to develop team skills in planning, diagnostics and solution design that ensured a sustainable project model, linking team members in three rural centres. Despite geographical challenges and initial reports of gaps in services, the team were able to document clinicians across the region who implement initial, brief screening, where there is concern for an individual’s cognitive or functional decline, and a standardised referral pathway for those individuals requiring further comprehensive dementia assessment. This then led to a region-wide:
The Dementia Partnership successfully demonstrated that although it was a collaboration between three organisations, the team were able to work together and make decisions as if they were employed by one organisation – the single, standardised referral and referral pathway being good examples of collaborative work practices. The project team chose not to employ a project officer, rather the work that was undertaken was built into the current roles and work hours of everyone on the team, with the idea that any project work would be viewed as business as usual. This decision has ensured a sustainable model, and as the partners have all committed to continual improvement of dementia assessment and care, the work of the team will continue beyond the life of the current project.
A key learning from the project has been that although initially dementia clinicians believed there were few services to support dementia assessment in our rural and remote communities, working with clinicians across the region to determine clinical roles that are able to undertake screening and assessment, and documenting a referral pathway has shown that assessment services are available to individuals and general practitioners across the whole of our region. However, the work of the partnership would not have been successful if it were not for the early assurances of executive sponsorship from the three partner organisations, and a commitment to develop a strong working relationship to ensure a solid foundation for future project work.
Glenis Grogan is the NEP Coordinator at Ngoonbi Community Services Indigenous Corporation, Kuranda, north Queensland. Glenis is from Sunset Kuku Yalanji Bama with connection to the Djabugay, Djiru and Takalaka Traditional Aboriginal peoples and is a descendant of Mona Mona Mission (which is approximately 40 km from Cairns). Glenis is also Public Officer/Director of Western Yalanji Aboriginal Corporation Registered Native Title Prescribed Body Corporate and Chairperson of Mona Mona Bulmba Aboriginal Corporation.
Glenis Grogan coordinates the Queensland National Empowerment Program (NEP) that is managed, coordinated and delivered by Ngoonbi Community Services Indigenous Corporation (Ngoonbi) in the Queensland communities of Kuranda and Cherbourg.
The NEP originated from a Pilot Project established by the Indigenous community and the School of Indigenous Studies of the University of Western Australia (UWA) in response to alarmingly high rates of Indigenous suicide in the Kimberley Region of WA.
Upon the success of the Kimberley project a NEP participatory action research was completed in 2013 in partnership between UWA and 11 Indigenous communities across Australia. Cherbourg and Kuranda are both one of these sites.
Funded by the Queensland Mental Health Commission (QMHC) and with UWA academic and other support; Ngoonbi established the Qld NEP Pilot Sites and commenced delivery of the Cultural Social and Emotional Wellbeing (CSEWB) program, healing projects and community access to various training opportunities.
Since January 2014, over 170 community individuals have completed the CSEWB program and significant numbers have participated in other training programs and healing projects in both Cherbourg and Kuranda.
The NEP project CSEWB program is an innovative Aboriginal and Torres Strait Islander led initiative working directly with communities to address their cultural, social and emotional wellbeing.
The program is an empowering program that gives people the knowledge and skill to be able to address situations as they arise and have the ability, encouragement and support to make any change that the individual, family and community may want to make.
Further the success of the program is evident at a community level. An evaluation report found that the NEP CSEWB program is contributing to healing among families, improving role modelling to future generations and is reaffirming cultural identity in Kuranda and Cherbourg.
Stefan Grzybowski practised as a family physician for twelve years on the Queen Charlotte Islands/Haida Gwaii. After moving to Vancouver in 1994 he worked at the Three Bridges Health Centre, an inner-city clinic, until 2006. He currently provides part-time rural locum services and is active in the SRPC, RCCbc, and the Division of Rural and Remote Family Practice. He is interested in health services research and is a Professor at the University of British Columbia’s Department of Family Practice. His current research is focused on studying the sustainability of rural health services with the goal of improving health services for rural people and their communities. He has also had a long-term commitment to building research capacity through strategies to support clinical investigators in family medicine.
Background: In both Canada and Australia, there have significant service reductions in rural surgical and maternity services. The causes of these closures are multifactorial and include difficulty recruiting health professionals, regionalised planning priorities focused on centralising services in referral centres, and a loss of local community voice needed to keep services open. The impact of this on the safety and sustainability of rural communities is generally not well understood, particularly by service planners and policy makers with urban-centric values and perspectives. This has led to a lack of support for rural health services and consequent poorer population health outcomes.
Objective: To create a continuously evolving learning system designed to support rural health services structure by the following pillars:
This integrated approach is designed to be driven through a partnership between rural community representatives, rural health providers, researchers, policy makers and educators. It is built upon principles of flexibility and adaptability recognising that the needs of a rural population and the health service models that attempt to meet those needs are constantly evolving. It allows the privileging of generalist approaches to rural health care and the rapid uptake of innovations like telehealth and coordinated electronic medical records. Ultimately, this approach supports the agency of rural communities and rural health leaders to build systems of health care that are effective and safe.
Helen Guyupul is a the coordinator of the Stronger Women, Stronger Babies program by Miwatj Clinic and is one of 12 Yolŋu Elders from Elcho Island who are on Hope For Health’s Strategic Management Committee. She is passionate about ending the epidemic of chronic diseases facing Elcho Island and other Indigenous Arnhem Land communities. Having experienced first hand the effects of the Westernisation of Yolngu diet over the last 40 years, she is committed to reawakening Rom Walgnaw—the Yolŋu way to vitality. Guyupul is Hope For Health’s lead health coach and brings a wealth of traditional knowledge and engagement experience to program delivery.
Hope For Health (HFH) is an Indigenous led nutrition project located on Elcho Island, East Arnhem Land, Northern Territory and is focused on preventing non-communicable diseases (NCDs).
Sixty five years ago the Yolngu (aboriginal people of Elcho Island) were vital, healthy people. They now face an epidemic of NCDs such as diabetes, chronic kidney disease, cardiovascular heart disease and a life expectancy ten to fifteen years less than other non-indigenous Australians. A major contributing factor to this situation is poor nutrition.
Due to complex cultural and political influences, the Yolngu diet has dramatically changed. No longer comprising purely of nutrient-rich, local food sources, today the Yolgnu diet is predominantly based upon refined and processed western food choices. These changes are contributing to nutritional deficiencies, multiple NCDs and high morbidity rates. The burden of these health consequences are not only felt by the health sector but also resulting in the loss of important cultural knowledge and disruptions to social order. The situation is further exacerbated by a lack of tangible, consultative, cross-cultural nutritional education.
To overcome these challenges HFH has utilised their 40 years of cross cultural work in Arnhem Land to create a pioneering blend of methodologies towards community wide nutritional and lifestyle education. This includes experiential learning with short-term health retreats focused on acutely improving individuals with nutrient dense food, daily exercise and nutritional education. Participants are then supported back in community with regular, ongoing practical and theoretical nutritional workshops. HFH also focuses on removing challenges of continuity and on facilitating the sharing of their health education to families and community.
The Yolngu culture has thrived for thousands of years. HFH’s unique methodology also empowers the local people to draw from their cultural wisdom. Essentials for the program’s successful integration into the community include a Yolngu steering committee; nutritional education workshops, exercise classes and resources all delivered in the local language, and program frameworks derived from traditional culture, diet and bush medicine.
Using an integrated medical approach the programs efficacy is evaluated using both qualitative and quantitative data including pathology testing, measurable clinical examinations and naturopathic consultations. HFH is compiling data pre and post retreat. Results thus far that are demonstrating positive outcomes include participants, under medical supervision, reducing or eliminating pharmaceutical prescriptions.