It’s been hot all over Australia with Tasmania alight and NSW having a shocking day today with over 132 fires.
Out bush we’ve had fires burning out almost continuously for months now. Some of it as planned patch burning, others by lightening strikes and others well, just because…. But we have a bit of room out here so they barely impede us.
It’s also been a bit warm. Here’s the daily maximum temperatures at Warburton (125km away) since Christmas Day
Recent Maximum Temperatures
Maximum Temperature (Centigrade)
25 Dec 2012
26 Dec 2012
27 Dec 2012
28 Dec 2012
29 Dec 2012
30 Dec 2012
31 Dec 2012
1 Jan 2013
2 Jan 2013
3 Jan 2013
4 Jan 2013
5 Jan 2013
6 Jan 2013
7 Jan 2013
8 Jan 2013
We’ve had eleven days in a row over 40C and if it wasn’t for the cool change on the 27th and 28th of December with maximums of only 39.5 and 39.7 respectively we would have had 19 days straight above 40C.
December’s minimum temeratures were 2.2C above average at 23.7C and the maximum average was 38.3C, 1.9 above average.
Last night was warm, perhaps the warmest January night out here ever at 32.2C and if these temperatures keep going we’ll have our warmest January average at 43.^C which id over five degrees above average.
I don’t know about you lot but I’m going to enjoy the cool change on Sunday. It’s predicted the maximum temperature will drop to 41C.
A couple of posts ago I wrote about the Minister for Families stating she could live on the Newstart allowance. Personally I think she was talking rubbish that she may yet come to regret down the track. I also mentioned the cost of a few things in remote Australia.
This remote allowance works out – for a single person – at an extra $474.50 a year.
What would the public servants receive when they visit remote areas? The Public Servants Association has a list of the current allowances.
It’s hard to tell what is paid when they come past gazetted towns and onto Aboriginal lands. But their allowance for visiting Alice Springs is a lazy $224.30 a day. Now that covers accommodation and meals (apparently you can’t buy food for yourself when travelling).
But here’s what a public servant would get extra for living remote.
A person on Newstart with no dependants living in remote Australia receives an extra $474. If he/she was a public servant they would receive $1260. It is nice it is recognised it costs more to live remote. But are the costs greater for those with a job?
But the discrepancy is even worse if you have children and live remote. If you are on Newstart you receive an extra $7.30 per extra child a fortnight. But if you are a public servant with kids out bush you get an extra $10.50 a week. Apparently kids of public servants cost more to look after than Newstart kids.
And that’s for the lowest employee class in the table.
I’ve written in the early days of my blog about the effect of fly in – fly out miners on rural and remote communities.
This article by Stephen Duckett, La Trobe University looks at the effect of fly in fly out health services.
This is a story about two small Aboriginal communities in the Gulf region of North Queensland: Mornington Island and Doomadgee. They share two key characteristics with many other remote communities: very poor health status on every dimension and fragile permanent staffing of their health services. But they also share an increasingly common third characteristic: an abundance of fly-in, fly-out siloed health services.
I recently visited Mornington Island to learn more about primary health-care delivery in the region. Getting off the plane with me was a renal nurse practitioner, a sexual health nurse, an alcohol and drug worker and a mental health worker, all arriving for their regular visits and clinics. The Royal Flying Doctor Service wasn’t in town for its clinics that day, and, of course, specialist doctors normally come by charter. The same sort of pattern applies in Doomadgee.
I spent about an hour in Mornington talking to an elder, whose main message to me was not about the key health problems in her community but that the community had established mechanisms for consultation that were being ignored.
Aunty Pearl (not her real name) made a heartfelt plea for the community to be consulted before new services were helicoptered in, and for community leaders to be apprised of new clinics being established, so that if they were local priorities, the leaders could work with the whole community to build awareness of the new clinics and hence increase their effectiveness.
In Doomadgee, a whole new service is being established by a new-to-the-town non-government agency. Local health services know it will provide health services for kids but have no idea about the specifics, whether it will duplicate what they are doing already, or how it will integrate with existing services and existing staff.
I asked staff to estimate what sort of contribution the existing fly-in fly-out services were making: were they mostly bringing skills or just time to do things the overworked locals didn’t have time to do? The answer in this non-scientific survey was about 90% skill, 10% time.
The follow-up, then, was whether, with purposive effort (which isn’t seriously occurring now), that ratio could change, by how much and by when? The response was it could shift to 50/50 over an 18-month period.
So here’s the rub. We are all full of good intentions, we want to do something about the Aboriginal health tragedy, and do it now.
But what we are doing is not creating a sustainable service. Staffing by locums, agency and fly-in fly-out staff is expensive. They generally don’t provide continuity of care. And we get the dismal trifecta because they disempower the locals and don’t build a sustainable, local workforce.
The international development literature is full of papers on the distorting effects of siloed funding: specialist disease-specific funding agencies establishing narrowly-defined, specific programs available to developing countries with no one willing to fund the broad primary health-care infrastructure which is necessary for a sustainable and effective health system.
We are doing the same in Australia with special funding programs by state, Commonwealth and non-government agencies. Which brings me back to Aunty Pearl. What we need is good local priority setting: working with the community to determine the local health-care needs.
But let’s not be naive: local planning is hard. Humans and local communities suffer from bounded rationality: we don’t know what we don’t know. So local planning needs to be supported and informed by planning in the larger region or district.
We also need ongoing effective mechanisms to ensure local collaboration among service providers, which do something about long-term workforce sustainability. The 50/50 skill-to-time ratio or even the 90/10 one begs the question of whether the benefits of higher order skills being provided to these communities are greater than the coordination costs created.
For communities where chronic disease is so prevalent, the place to start is clearly to ensure a good primary care foundation. Wagner’s chronic care model now forms the base of chronic disease management and promotes the idea of “productive interaction” between an “informed, activated patient” and a “prepared, proactive practice team”. Both sides of this interaction require support to be effective.
In Wagner’s model, support comes both from the community (in terms of resources, policies, and self-management support) and from the health system, involving improvements to the organisation of health care, delivery system design, decision support, and clinical information systems.
This does not appear to be happening in either Doomadgee or on Mornington Island, or at least, is happening only in fits and starts.
The fly-in, fly-out model of siloed care I saw is certainly responding to the immediate needs of those communities. But it may be doing so in a way that inhibits a long-term improvement in the health of these communities.
Stephen Duckett was Thinker in Residence at Mt Isa Centre for Rural and Remote Health
A few months ago I decided I needed a watch. What watch would handle remote conditions the best? I put the call out to a bunch of watchnerds on Twitter. The G-Shock seemed to be the best option. AP on her new watch blog thought it worthy of an article and she wanted a pic of my watch with Girl, my dingoX. She wasn’t expecting these pics. Read her post about my watch on Horologium