Remote Pharmacist Job in the Kimberley

Occasionally I put up pharmacist wanted job adverts for positions working mainly with Indigenous Australians. Here’s one in the Kimberley.

This job described below is at a new site within a remote hospital in the area providing a range of services to the hospital and outside of the hospital. I like the “team management approach to chronic disease”.

If you want to test yourself out bush send your resume to Kimberley Pharmacy Services, PO Box 5737, Broome WA 6725 or email to hannah.mann at

Kimberley Pharmacy Services is looking for two motivated health outcomes focused pharmacists interested in rural and remote pharmacy with a focus on Aboriginal health.
These positions provides an opportunity to deploy your clinical skills, community pharmacy management, DAA supply and services in an environment designed specifically to meet the needs of the regional community. They involve a large client contact and require engagement in a team management approach to chronic disease.

KPS is an expanding organisation with opportunities to travel and work across a number of sites within the region.

The roles involve a rotation between our Broome store and also our new site within a regional hospital servicing 3500 clients.

Key points
• Previous experience in Indigenous health preferred but not essential
• Ability to work independently whilst being part of a larger management team
• Experience with variety of DAAs (webster paks and medisachets) preferred
• HMR accreditation an advantage
• An interest in S100 supply and support
• Excellent package including salary, accommodation and relocation expenses

Why Aren’t We Listening To The Kids?

CHILDREN of the troubled Kimberley town of Halls Creek have unanimously nominated an alcohol ban as their No1 wish, ahead of a local cinema and an international airport.

More than 100 children aged 10 to 14 at the school in Halls Creek told youth facilitator Michael O’Meara that, more than anything else, they wanted alcohol eliminated from their town and wanted help for their parents and other adults in Halls Creek to get sober.

“The young people were very clear about what they wanted … they weren’t prompted or given suggestions,” said Mr O’Meara, facilitator of last year’s 2020 Youth Summit.

“They spoke of their fears that some in the community would not like them asking for the elimination of alcohol, and they spoke of the impact of alcohol on their lives – I can say they have very real reasons for wanting it to stop.” continued at The Australian newspaper Jan 12th 2009

A few days ago I quoted from the Western Australian Aboriginal Child Health Survey:

Just over one in five children (22%) were living in families where 7 or more major life stress events had occurred over the preceding 12 months. These children were five and a half times more likely to be at high risk of clinically significant emotional or behavioural difficulties than children in families where 2 or less life stress events had occurred

Perhaps we should be acting on what the children want us to.

Instead, as well as the above reports, other states also continue to produce reports rather than acting and introducing sustainable and ongoing programs (one off projects seem to constitute long term planning and solutions).

Queensland has recently released the report Children and young people in Queensland: a Snapshot 2008.
Here a few of the “highlights”:

the infant mortality rate (11.8 per 1000) is twice the state average – reducing the number of pre-term Indigenous births would significantly reduce the high Indigenous infant mortality rate.

31.6% of youth suicides under 18 years were Indigenous children in 2006–07.

6.0% of all 0 to 17 year olds in Queensland were Indigenous, although Indigenous people make up only
3.3% of the population

the Indigenous youth detention rate almost 15 times the non-Indigenous rate

In the Northern Territory we had the report Ampe Akelyernemane Meke Mekarle “Little Children are Sacred” (large PDF) that was misused by the then government to initiate ““The Intervention”“(Northern Territory Emergency Response). This seems to have led to a doubling of infrastructure, finding out what we already new but no sustainable programs in healthcare, or to increase resources to further deal with the health issues we already knew about and where the “very foundational principles on which Aboriginal existence are built — community, culture and collective rights — have been shaken, demonised and exposed to a level of scrutiny unparalleled in recent times.”

A review of the Northern Territory Emergency Response can be found here. Various articles in the Medical Journal of Australia about the response have stated:

paints a demeaning and misleading picture of NT communities as exhibiting “a complete breakdown of normal mores”. This fits snugly with the “white blindfold” view, described by Tait, that will only further disempower marginalised Aboriginal people and communities”

another states:

Existing systems are not providing for adequate follow-up of identified medical and social problems for children living in remote Aboriginal communities”

and another

Indigenous communities must have a role in data collection and anagement“.

It just goes on and on.

There is no one better than Fiona Stanley to conclude with. In a recent speech (video here)

The frustrating and anguishing thing is that we have known what we need to do for 20 years; the evidence has been around in Royal Commissions, HREOC reports, a myriad of government reports as well as our research papers. How to implement is the major issue. Other countries with Indigenous colonised populations have similar problems but are doing much better than Australia – what can we learn from them?

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Indigenous Child Mental Health

The first few lines in any article on indigenous health in Australia are the statistics. Indigenous Australians have an average life expectancy 17 years less than the average Australian. The incidence of chronic disease is higher, the death rate from cardiovascular disease is at least 2.7 times higher than the rest of the population etc etc. An aboriginal man in Australia will live on average for only 59 years.

Statistics, statistics. Put this in some context. Five men aged between 35 and 45 years from a population of just over 2000 people spread over several small communities died in a 10 day period ending on Boxing Day. Sorry camps have sprung up and funerals have started. Whilst funerals can be a social occasion, seeing family you may not have seen for a while, you have to wonder about the effect on people from what seems to be a continual cycle of grief.

How do you assess Mental Health in an indigenous population with a different view if health and of the world? The Kimberley have developed some tools, but how can you be sure they are validated correctly and will they be suitable for use in other indigenous populations?

Some years ago the Western Australian Aboriginal Child Health Survey commenced looking at over five thousand indigenous children in Western Australia. The report consisted of several volumes focusing on different areas. Volume 2 looked at the social and emotional wellbeing of young aboriginal West Australians. There were many statistics in the report and the downloadable summary is worth a read. One group of statistics I hink is quite depressing.

The factor most strongly associated with high risk of clinically significant emotional or behavioural difficulties in children was the number of major life stress events (e.g. illness, family break-up, arrests or financial difficulties) experienced by the family in the 12 months prior to the survey.

So how many major life stresses do indigenous kids have each year?

Just over one in five children (22%) were living in families where 7 or more major life stress events had occurred over the preceding 12 months. These children were five and a half times more likely to be at high risk of clinically significant emotional or behavioural difficulties than children in families where 2 or less life stress events had occurred.

If you were aged from 4 to 11 years and had 7 or more major life stressors you had a 42% chance of developing clinically significant emotional of behavioural difficulties. If you were between 12 and 17 years old you had only a 34% chance of developing clinically significant emotional or behavioural difficulties if you were in a family that had experienced 7 or more life stress events in one year.

These culminate in risk taking behaviour in adolescence and adulthood.

In the report there is a small positive. It seems that in the more remote areas where a more traditional way of life and greater family supports occur that the traumatic events do not take such a toll.

Children living in areas of extreme isolation were one-fifth as likely to be at high risk of clinically significant emotional or behavioural difficulties compared with children in the Perth metropolitan area.

In remote desert regions many of these communities are quite small, from a few hundred down to about 30 or so people. In the Northern Territory communities this small are called outstations or homelands and the Northern Territory Government (and the previous federal government before them) is looking at closing them down.

I have commented previously about the health benefits shown from living in the small outstations of Utopia where the population had a better quality of life, better health and greater life expectancy than normal for an aboriginal population.

I concluded the article titled “Community Size and Indigenous Life Expectancy” with:

Are we are so intent on “economies of scale” that we are going to close these smaller communities down? These same communities that may provide the biggest bang for the buck in keeping people healthy.

Being remote and small may be the way to keep both your physical and mental health.

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Home Medicine Reviews in the Bush

A little over a week ago I posted the first on what I hope is a series on Home Medicines Reviews out bush. This post is written by pharmacist Lisa Crisp who has been doing the Bush HMRs for the Kimberley Division of General Practice.

The Kimberley presents some unique challenges for pharmacy practice, but as I have found, the greater the challenge, the greater the reward. The distances are vast and the patients often unsure and mistrusting of this new service. But providing a valuable service to people in remote locations has been one of the best jobs I have ever done.

For the past two years I have been fortunate enough to work across the Kimberley region of Western Australia. It is one of the most beautiful offices in the world and this is the story of how I established a career in this wonderful workplace.

Before moving to the Northern Territory in 2007 I contacted as many different pharmacists and others with an interest in pharmacy practice as I could find in the area. Initially the response to my call for employment was slow, but once word spread that there was a pharmacist willing to travel to rural and remote NT and WA, the work flowed. One of the first (and best) positions I took up was working with the Kimberley Division of General Practice (KDGP) to provide a HMR service to the Kimberley region of WA.

With the support of KDGP I am able to travel to the Kimberley and the towns within it at no cost to me. Without this support it would not be economically feasible to make the trip. With KDGP funding my travel, I am also able to venture out to aboriginal communities to provide some patients with the first pharmacy service of their lives. Because many indigenous Australians collect (or have delivered) their medications directly from the aboriginal health service (AHS), they may never enter a pharmacy or come into contact with a pharmacist. While AHS staff are competently trained, it is rare that an AHS staff member would have the time to provide the type and quantity of medicines education that can be passed on during a home medicine review. Over and over again I find myself spending much time providing medication counselling and education to remote patients, but it is this basic medicine information that allows people to better self-manage their medications and avoid adverse outcomes and medication misadventure. For these patients, the education provided at the HMR interview is easily the most valuable part of the process and is always wonderfully rewarding for me.

Each time I visit an aboriginal community I am accompanied by an aboriginal health worker who introduces me to the patient to rapidly establish a level of trust that would otherwise be unachievable in a single visit. I vividly remember my first visit to a remote aboriginal community in the Kimberley. We were so far out of town that we were almost back in the NT and we were completely isolated. Although there were several houses in the community, it felt completely deserted. In the middle of nowhere, with no mobile phone coverage, in a community where I was not known or trusted, I was especially grateful to have a health worker with me that day. It’s a very different place to do a HMR as compared to my home town of Launceston that’s for sure!

I have also found that I have been able to establish much closer working relationships with the GPs that I report to. At some AHSs I spend time discussing the patients face-to-face with the GP both before and after the interview; a luxury very rarely found elsewhere. Remotely located GPs (AHS or other) also seem even more grateful for the service than urban doctors – I figure that they are so used to facing barriers to service provision that to have a willing pharmacist provided through KDGP at no extra work or cost for the GP, is an absolute dream!

The community pharmacies should also receive a mention here. Without their cooperation and support the process would cease. Across the Kimberley community pharmacists have been nothing but helpful and supportive, which makes the process that much easier for me.

It takes a lot more planning to conduct HMRs in the Kimberley. It’s many phone calls and time for KDGP to arrange the logistics of getting me to the Kimberley, and accommodating me there (they provide a hire car, flights, hotel room etc). There’s more preparation to be done at my end for a week on the road, and of course it’s a day’s travel each way to get there, but at the end of a busy week I am always happy to reflect on how much has been achieved and how great it has been to provide home medicine reviews for remotely located patients that otherwise would have missed out on such a service.

For any accredited pharmacist willing and able to travel, there is unmatched reward waiting in rural and remote Australia. With the support of local divisions of general practice, a two week working “holiday” to remote Australia may just be the best thing you ever did! And once you’ve been once, I’m sure you’ll be back because it’s very hard to give up once you get the taste for it!

Lisa Crisp is an accredited pharmacist based in Katherine, NT. She graduated from the University of Tasmania in 2004 and achieved DMMR accreditation with AACP in 2006. Despite living in the Top End, Lisa continues to work in Tasmania, across the Kimberley and the Top End in many roles; accredited pharmacist, locum pharmacist in both community and hospital pharmacies as well as consulting for divisions of general practice and other pharmacy-linked groups.

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