There have been many innovative programs that have worked in Indigenous Health. The hard part it ensuring you can keep obtaining funding to run them. Much of the funding is one off grants and won’t necessarily continue even if the health program has shown it can make a difference.
The online booklet “10 out of 10 Deadly Health Stories – Nutrition and physical activity” has been produced by the Aboriginal Health and Medical research Council of NSW to hi-light 10 successful programs produced by Aboriginal Community Controlled Health services in NSW in the areas of nutrition and physical activity.
These usually form part of the Chronic Disease programs endeavouring to promote healthy lifestyles, reducing the incidence of and improving the health outcomes of those with chronic disease.
Download (PDF, Unknown)
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The incidence of chronic kidney disease is increasing in Australia, most significantly amongst Indigenous Australians, with rates in remote areas being 35 times higher than amongst non-Indigenous Australians. When the kidneys fail, a person must receive a transplant or their blood must be cleansed of waste artificially (dialysis).
There is strong evidence that effectively managing high blood pressure can delay the need for dialysis, a treatment which in remote areas, can require long distance travel to access services and result in separation from family, social and cultural support. There is also strong evidence that an arteriovenous (AV) fistula is the most effective means of providing permanent access to veins in people starting dialysis.
When best practice is not applied, there is a significant psychological and financial cost to the individuals and their community
The above comes from the profile of Bhavini Patel, Director of Pharmacy, Department of Health and Community Services, NT and a NICS-HCF Foundation Fellow in 2007.
As part of her project “Improving management of chronic kidney disease in remote indigenous communities” she charted the steps taken and the patient contact with various parts of the health service from when the renal clinic in “town” (in this case Darwin) contacted a remote clinic wishing to see a patient. And remember the patient may be in town for up to several weeks depending on the transport options to get home.
It views best in full screen.
The term “PAT form” you see in one of the slides is the transport assistance provided to remote Australians going for health appointments.
Look at the slide show (only 4 slides) again and picture yourself not knowing the language, being away form country and family with all these people you don’t know wanting to interact with you and pass on all sorts of information in a way that is foreign to you.
I wouldn’t go.
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many thanks to Bhavini for the copy of the slides (previously seen in the NT Chronicle).
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The joint seminar recently presented by the Menzies School of Health Research and the Public Health Association of Australia mentioned in a previous post is now available on the web.
You can watch a recording of the seminar, view a PDF of the Powerpoint presentation and a summary of the Question and Brainstorm Points
The presentation had a number of points on drinking water. I find it disturbing that in Australia we are still discussing the need for sanitation and clean drinking water for its citizens.
The second slide focused on the achievements of John Snow in these areas.
Another slide discussed the prevention of illness as the key to improving public health.
Public Health – The key is prevention
•Clean water and sanitation
•Immunisation
•Health protection
•Peace and shelter
•Social determinants
•Health promotion
And then the question was posed:
Clean water and sanitation
•How many indigenous communities do not have this basic infrastructure 150 years after John Snow?
Unfortunately I believe many remote communities do not have this infrastructure. I know of some communities with drinking water nitrate levels regularly over 50ppm for at last two years and still have no filtration devices. (A discussion of inorganic chemicals in drinking water.)
In Western Australia we are only working towards implementing the drinking water standards of 1995. From the website of Parsons Brinkerhoff who manage the Remote Area Essential Services Program (RAESP) on behalf of Western Australia’s Department of Housing and Works (DHW)
RAESP delivers safe, reliable drinking water to some of the most isolated people in the driest part of the driest inhabited continent on earth.
The program is working toward implementing the Australian Drinking Water Guidelines 2004 (link now goes to current draft standards) and the Framework for Management of Drinking Water Quality. It provides monthly sampling of water supplies in 91 communities, and is achieving targets for microbiological and chemical water quality (95% compliance with the Australian Drinking Water Guidelines).
Water source protection plans are under way in 36 communities.
The Federal Government is promoting Preventative (sic) Health for all Australians and Closing the Gap in health for our Indigenous Australians.
Yet we cannot provide the basic public health measures for all Australians.
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Croakey (The Crikey Health blog) has recently had a post on Home Medication Reviews and the “thorny issue of interprofessional practice”. The problem of pharmacists providing a “complete” role in rural and remote areas was mentioned.
I couldn’t help myself and made comment. It can almost stand alone so I have reproduced it below. I guess there will have to be more to follow on this subject in a future post.
Regarding the impact on rural and remote areas:
Home Medicine Reviews (HMRs) in remote areas have long been problematical. As discussed, solo pharmacists in remote rural areas cannot leave their pharmacy to perform them. In truly remote areas there is usually no pharmacist as part of the primary healthcare team.
The Australian Pharmacy Council (of which all Pharmacy Boards are members) released a report in June 2009 on the Remote Rural Pharmacists Project (PDF) looking at ways for pharmacists to be able to work outside the confines of a pharmacy in remote rural areas.
The Department of Health and Ageing in December 2008 released a report by Campbell Research & Consulting on the Home Medicines Review Program Qualitative Research Project (PDF) that contain strategies for providing alternative models of HMRs to reach Indigenous consumers.
OATSIH has also recently funded a pharmacist position with an Aboriginal Health Service. If this continues and some points in these reports are acted on there is hope for better service delivery of HMRs by pharmacists in remote areas.
Robbo
(Disclosure: I had some input into both reports)
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