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.

Kungkaku Yungupalaku Healthy Relationships Project – a Improving Sexual Health in Aboriginal and Torres Strait Islander Youth Demonstration Project

These stories were developed and mostly filmed, animated by young people in Warburton and Warakurna. They have identified ways of health seeking, appropriate services, supporting each other, problem solving and identity through these stories. Young people really engaged and enjoyed the workshops and processes involved in the development and provided fantastic learning opportunities around problem solving.

Lost Zac from Ngaanyatjarra Health on Vimeo.

Kungkaku Yangapalaku from Ngaanyatjarra Health on Vimeo.

Carlston’s Love Song from Ngaanyatjarra Health on Vimeo.

Kulila Kangyima from Ngaanyatjarra Health on Vimeo.

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