The challenges of bush pharmacy

A couple of weeks ago I had the Pharmacy Guild of Australia President George Tambassis and the Guild’s Communication Manager Greg Turnbull travel with me in remote Western Australia. Here is George’s view of the trip originally published in the Guild newsletter “Forefront”.

ForefrontIf I had to choose three words to summarise my recent tour of pharmacy services in remote Aboriginal communities in Western Australia, they would be: educational, confronting, and inspiring.

The idea for the four-day tour arose when I bumped into my old university friend Andrew ‘Robbo’ Roberts, at the FIP international pharmacy conference in Thailand in September last year.

Robbo has been a remote pharmacist attached to the Ngaanyatjarra Health Service for the past ten years. The health service, with headquarters in Alice Springs, covers an area the size of Victoria, including 10 clinics equipped with drug rooms. All of the communities are actually in Western Australia, in the remote lands to the west of Alice Springs.

The catchment area includes about 2500 people – 90 per cent Aboriginal. Robbo’s job as a salaried pharmacist is to maintain the medicine stocks across the ten clinics, provide professional pharmacy services directly to patients at the clinics and in homes, and to provide medication continuity across the vast area.

For one thing, this means more driving than I imagined could be inserted into anybody’s workflow! On day one of my tour, Robbo picked me up at Alice Springs Airport, we stopped for a meeting with the CEO of the Health Service, James Lamerton, then drove 924 kilometres to Robbo’s home in the community at Jameson.

One of the key achievements I observed was Robbo’s organisation of the remote clinic medicine facilities – through an ‘imprest’ system he has devised. The purpose of this is to ensure that the medicine stocks at all of the clinics are the same, and fully replenished as needed. The stock comes through bulk supply under Section 100 of the National Health Act – medicines packed and supplied by community pharmacies in Alice Springs and Kalgoorlie.

Near Windborne Rocks

One area of concern for Robbo is the inability of pharmacists to claim Medical Benefits Schedule funds for services within his scope of practice and where no community pharmacy is available, while a nurse delivering the same service can make a claim. This is a vexed and longstanding issue, but I feel it is one that should be addressed in recognition of the primary health care role that can and should be played by pharmacists in remote parts of Australia.

What I saw on this brief visit was quite confronting in terms of living standards and cultural differences. It was a first-hand glimpse of why our society has found it so hard to bridge the gap in morbidity, mortality and education. The Third World conditions in which some people are living in these areas is quite disturbing. Health literacy is very poor and is reflected in adherence rates. I wish to sincerely thank the Ngaanyatjarra health Service for the work it is doing, and for allowing me to visit some of its clinics. I also pay my respects to Robbo for his commitment.

I was pleased to learn that some of the medicine shelving in the clinics was provided with the assistance of the Guild under the Fourth Community Pharmacy Agreement. I believe there is more we can do to assist, and as we work on the shape of the next Pharmacy Agreement we will look for opportunities to assist Aboriginal health, through rural and remote community pharmacies, and through services such as the one that employs Robbo.

Coalition Indigenous Affairs Policy

Earlier today the LNP released their internet filter plan. An 11 page document describing an opt-out system. That policy lasted less than five hours. Apparently despite the coalition having all their policies ready to go Messrs Abbott and Turnbull (his portfolio area) only read the policy the night before, and in Turnbull’s case a short time before he went on radio today (Thursday).

The Coalition also released their Policy for Indigenous Affairs. Again 11 pages long. A plan Mr Abbott has promoted is to create the “Prime Minister’s Indigenous Advisory Council” chaired by Warren Mundine. Bob Gosford has written on Mr Mundine’s ideas over at The Northern Myth.

There is not much detail in their policy. The Health “policy” is a little more than half a page long and very few of their plans are costed. Several pages of their “policy” document are used to bag Labor policies and programs (and some do need to be bagged). But their are a few costings mentioned over the forward estimates (4 years):

  • Up to $45 million to assist Andrew Forrest’s Generation One Indigenous training and employment program
  • $22mil to be spent in remote schools to introduce phonic based education models over 10 years
  • $22mil to expand boarding school opportunities through scholarships (means tested -compare that to maternity leave!)
  • $5mil to design a trial of Jawun’s “Empowered Communities Initiative”
  • From the LNP policy document:

    The Coalition’s Policy for Indigenous Affairs will invest $94 million over the forward estimates in a better future for indigenous Australians.

    If they are spending to introduce phonic based education over 10 years then it is not an investment of $94 million over the forward estimates. But still, some funds flowing in has to be a good thing. Right?

    It has been a busy day for the Coalition. They had promised more funding cuts and held a press conference to publicise them today. Eight pages of what was described as “political fluff“. The funding cuts document is here.

    The document shows the funding for the Indigenous training and employment is only over 2 years (Point 7.12). They think they will have full Indigenous employment by then?

    But the kicker is Point 9.3 Reprioritise Indigenous Policy Reform program saving $42mil over the forward estimates. What is this program? It is Indigenous Legal Aid. Despite rapidly increasing Indigenous prisoner populations they are ripping away their right to legal representation.

    Makes a mockery of their policy document investing $94mil into Indigenous Affairs “innit”?

    Cancer and Indigenous Australians

    The Australian Institute of Health and Welfare Report “The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2008” indicated that 15.1% of all Indigenous deaths was due to cancer. This is the second highest single cause of death.

    Chemotherapy outside major hospitals is almost impossible to achieve, indeed most health service policies allow for oral dose forms only. For remote Indigenous Australians the choice is “finishing up on country” or moving away from friends or family for treatment. Whilst the Patient Assisted Transfer Scheme is federally funded it is state managed and varies from state to state. In some states it is impossible to have family travel in under the scheme to give support.

    There is a distinct lack of policy in the areas of cancer and palliative care for Indigenous Australians. This is particularly noticeable in remote areas.

    There is a great article by Daniel Vujcich over at Croakey on the dearth of policy in the area of cancer and Indigenous Australians.

    He writes:

    Last year I conducted interviews with current and former senior bureaucrats and Ministers directly responsible for the formulation of Indigenous health policy. Their responses led me to conclude that misplaced assumptions continue to play a role in the way in which Indigenous health issues are prioritised for government action.

    One Minister described the dearth of cancer policies in the following way: “Well … if you don’t live very long, obviously trachoma is more of a problem than cancer”. Another Minister offered a virtually identical explanation: “Cancer was not seen to be such a particular issue for the very simple reason of life expectancy. It becomes a more acute issue the longer you live.”

    Meanwhile a former Director-General of a State Health Department expressed surprise when told that cancer was one of the leading causes of Indigenous death, saying “I wouldn’t have put it as a high cause”, and a third Minister omitted it from his list of “biggest killers” of Indigenous people, instead citing cardiac disease, renal disease, diabetes, smoking and accidental or violent death.

    I urge you to read the complete article “Cancer and Indigenous health: the pitfalls of assumption-based policy

    Pharmaceutical Benefits Scheme – Fiscal Challenges

    The 109 page briefing document provided to the new Finance Minister Penny Wong by the Secretary of the Department of Finance and Deregulation is now online.

    Well the “expurgated” version is available anyway.

    There are a couple of pages related to health costs. “Health Reform – National Health & Hospitals Network” and “Pharmaceutical Benefits Scheme – fiscal challenges”. These are highlighted within the report as their growth rate is above 2% and in the case of the Pharmaceutical Benefits Scheme has a special appropriation for funds to run the program.

    The document can be found on the government website here or in my Google Documents below.

    And enjoy John Cleese as he looks for the Expurgated book of British Birds.

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