Community In Arnhem Land Research Articles

Aboriginal educators at the intersection: Intimations of greater nuance in both-ways education

The Whole of Community Engagement (WCE) initiative sought to identify barriers and enablers in Aboriginal students’ pathways to post-compulsory education, in six remote communities in Arnhem Land and central Australia. It identified known factors like colonial history, low English literacy, job prospects and cultural difference. Responses often focus on “both-ways” curriculum and pedagogy, and teachers’ cultural competence. Another factor found was interculturality, the fact of living and working at the intersections of Aboriginal and other socio-cultural worlds. The initiative found that students’ engagement with school and with pathways into further education were troubled by both cultural difference and intersection. The Aboriginal researchers involved in the initiative, living at the intersections in their own lives, exemplified the challenges of, and the capabilities needed to negotiate, cultural intersection. The authors propose an intercultural perspective as a refinement to the both-ways approach to remote education.

Editorial

Editorial

"Only your blood can tell the story"--a qualitative research study using semi-structured interviews to explore the hepatitis B related knowledge, perceptions and experiences of remote dwelling Indigenous Australians and their health care providers in northern Australia.

BackgroundHepatitis B is endemic in the Indigenous communities of the Northern Territory of Australia and significantly contributes to liver-related morbidity and mortality. It is recognised that low health literacy levels, different worldviews and English as a second language all contribute to the difficulties health workers often have in explaining biomedical health concepts, relevant to hepatitis B infection, to patients. The aim of this research project was to explore the knowledge, perceptions and experiences of remote dwelling Indigenous adults and their health care providers relating to hepatitis B infection with a view to using this as the evidence base to develop a culturally appropriate educational tool.MethodsThe impetus for this project came from health clinic staff at a remote community in Arnhem Land in the Northern Territory, in partnership with a visiting specialist liver clinic from the Royal Darwin Hospital. Participants were clinic patients with hepatitis B (n = 12), community members (n = 9) and key informants (n = 13); 25 were Indigenous individuals.A participatory action research project design was used with purposive sampling to identify participants. Semi-structured interviews were undertaken to explore: current understanding of hepatitis B, desire for knowledge, and perspectives on how people could acquire the information needed. All individuals were offered the use of an interpreter. The data were examined using deductive and inductive thematic analysis.ResultsLow levels of biomedical knowledge about Hepatitis B, negative perceptions of Hepatitis B, communication (particularly language) and culture were the major themes that emerged from the data. Accurate concepts grounded in Indigenous culture such as “only your blood can tell the story” were present but accompanied by a feeling of disempowerment due to perceived lack of “medical” understanding, and informed partnerships between caregiver and patient. Culturally appropriate discussions in a patient’s first language using visual aids were identified as vital to improving communication.ConclusionsHaving an educational tool in Indigenous patient’s first language is crucial in developing treatment partnerships for Indigenous patients with hepatitis B. Using a culturally appropriate worldview as the foundation for development should help to reduce disempowerment and improve health literacy.

Caring for Country, a Form of Bureaucratic Participation. Conservation, Development, and Neoliberalism in Indigenous Australia

‘Conservation-as-development’ policies are increasingly implemented for and by Indigenous peoples across the world. In particular, such policies have been introduced and adopted in many Indigenous communities of northern Australia since the 1990s. In this context, the transnational model of community-based natural (and cultural) resource management has produced the ‘ranger system’: a multi-actor, multi-rationale, and multi-level system articulated around job opportunities in the domain of ‘caring for country’. In this paper, I explore how the ranger system reflects and extends a process of neoliberal bureaucratisation into Indigenous communities, and to what extent this process can be described as a form of ‘bureaucratic participation’. I argue that the notion of ‘bureaucratic participation’ contributes to the investigation of existing entanglements between rationales of empowerment and neoliberal principles in Australia and beyond. My analysis is based on the ethnography of the daily work of the Indigenous rangers operating from a remote community in Arnhem Land in 2009 and 2010. I examine the complex relationships between local practices and bureaucratic requirements imposed by the Australian state at the core of the Indigenous ranger jobs.

Runs of homozygosity and a cluster of vulvar cancer in young Australian Aboriginal women

ObjectiveA cluster of vulvar cancer exists in young Aboriginal women living in remote communities in Arnhem Land, Australia. A genetic case–control study was undertaken involving 30 cases of invasive vulvar cancer and its precursor lesion, high-grade vulvar intraepithelial neoplasia (VIN), and 61 controls, matched for age and community of residence. It was hypothesized that this small, isolated population may exhibit increased autozygosity, implicating recessive effects as a possible mechanism for increased susceptibility to vulvar cancer. MethodsGenotyping data from saliva samples were used to identify runs of homozygosity (ROH) in order to calculate estimates of genome-wide homozygosity. ResultsNo evidence of an effect of genome-wide homozygosity on vulvar cancer and VIN in East Arnhem women was found, nor was any individual ROH found to be significantly associated with case status. This study found further evidence supporting an association between previous diagnosis of CIN and diagnosis of vulvar cancer or VIN, but found no association with any other medical history variable. ConclusionsThese findings do not eliminate the possibility of genetic risk factors being involved in this cancer cluster, but rather suggest that alternative analytical strategies and genetic models should be explored.

Health Beliefs and Behavior

Recently, social determinants of health frameworks are receiving some criticism in that they do not engage with questions related to individual subjectivity and agency as they relate to health decision-making behavior. This article examines the different ways in which people living in a remote Arnhem Land community in the Northern Territory of Australia, take responsibility for their own health and the extent to which they are able to prevent illness. A number of related sub-questions are explored relating to how people perceive their health and their role in health care in their community, including their engagement with the health clinic, traditional medicines, and the influence of sorcery on ill health and sickness.

A prospective study of neurocognitive changes 15 years after chronic inhalant abuse

In a previous study, neurological and cognitive deficits reflecting central nervous system (CNS) disruption from chronic inhalant abuse showed substantial recovery after 2 years' abstinence. Functional recovery was progressive, with recovery rates dependent on the degree of impairment prior to abstinence, and severity and duration of initial abuse. Persistent deficits occurred in those with previous 'lead encephalopathy' from leaded petrol abuse. The current study examined recovery in the same cohort 15 years after baseline. Prospective cohort design. Two remote Aboriginal communities in Arnhem Land, Australia. Using baseline group classifications, 27 healthy controls, 60 ex-chronic inhalant abusers and an additional 17 with previous lead encephalopathy were assessed. Standard neurological, ocular-motor and cognitive functions and blood lead levels. Chronic (non-encephalopathic) inhalant abusers showed elevated blood lead levels and abnormal scores on most tasks at baseline. At 2 years' abstinence, blood lead was reduced but remained elevated and most scores had normalized. By 15 years, blood lead and all performance scores were equivalent to healthy controls for this group (P > 0.05). The encephalopathic group was more severely impaired on all scores at baseline and showed little improvement, if any, across all tests after both 2 and 15 years' abstinence. Blood lead for this group declined, and was not significantly different to controls after 15 years. Some inhalant abusers experience severe and persistent neurological deficits, suggesting irrecoverable damage attributable to lead encephalopathy. In the absence of this encephalopathy long-term abstinence from inhalants may allow recovery of normal brain function.

Rewards for providing environmental services — Where indigenous Australians' and western perspectives collide

Rewards for environmental service provision, couched under market-based instruments, are widely touted in Australia as a means of improving natural resource management while empowering indigenous people. We document here the views of indigenous Australians in a community in Arnhem Land about their motivations for, and ways to provide, such services. Most respondents (93%) said that they ‘look after country’ to fulfil cultural responsibilities. Natural resource management, they said, should be carried out communally, primarily under the direction of elders and family. Sixty percent of respondents preferred direct payments such as cash or salaried remuneration like that commonly offered in return for ranger-like activities such as feral animal/weed control, coastal surveillance and prescribed burning. Some (14%) either did not want or did not need rewards for environmental service provision. Others (19%) preferred rewards in a form that benefited their community or family rather than themselves as individuals. There was agreement that outcomes should be monitored, consistent with the principle that reward payments should be conditional on performance. We suggest that a reward system that is too narrowly defined could thwart the potential for win-win outcomes from indigenous incentive-based natural resource management but that their articulation could allow solutions to be negotiated.

LIFE HISTORY AND REAL LIFE: AN EXAMPLE OF NEUROANTHROPOLOGY IN ABORIGINAL AUSTRALIA

A recent conceptual reworking of the developmental origins of health and disease model that places it within a life history framework is used to interpret some of the history of people living today in the remote Arnhem Land community of Numbulwar. This approach suggests some of the means by which their past circumstances may have had an impact on their current health. A combination of history, ethnography, and the neurobiology of stress and pregnancy provides a neuroanthropological approach for considering the manner in which environmental stressors, particularly those of social origin, may have intergenerational consequences for health.

Macassan/Indigenous Australian ‘sites of memory’ in the National Museum of Australia and Australian National Maritime Museum

For over two centuries people from Makassar on the Indonesian island of Sulawesi came to northern Australia with the onset of the northeast monsoon winds. They came in search of trepang that, with the help of Indigenous Australians, they collected and traded on to China. Their impact on the Indigenous communities in Arnhem Land was considerable. Along with sharing language, technology and culture, they built relationships, many ongoing, that are celebrated in Yolngu art, song and stories. These stories of contact are well known to many archaeologists and anthropologists but for many Australians the only place where they come into contact with these stories is in a museum display. In this paper I examine the ways in which these stories are disseminated by two national museums, the Australian National Maritime Museum in Sydney and the National Museum of Australia in Canberra. As important ‘lieux de mémoire’ or ‘sites of memory’, they tell of Macassan visits to northern Australia as part of Australian history. In both cases not only are the stories situated in the past but both Macassan and Indigenous Australian voices are largely absent.

Five‐year longitudinal study of cannabis users in three remote Aboriginal communities in Arnhem Land, Northern Territory, Australia

To examine predictors of cannabis use at 5 year follow up in an Australian Aboriginal cohort. A longitudinal study consisting of two waves of data collection 5 years apart was conducted. Of the 100 Aboriginal residents (aged 13-36 years) interviewed about cannabis use in 2001, 83 were re-interviewed in 2005-2006 from three remote communities in Arnhem Land, Northern Territory, Australia. Self-reported cannabis use was categorised at each time point (none; former use, quit > or = 3 months; lighter use, < 6 cones, 2-3 times weekly; daily use, > or = 6 cones, daily) and summarised as any current use, heavy use, dependence or cessation. Other substance use, employment and involvement in school or training were also compiled. Most respondents who reported cannabis use at baseline again reported use at follow up. A history of petrol sniffing predicted later heavy cannabis use (P < 0.05). Trends were evident for men to have persisting cannabis use, and for employment and/or engagement in school or training to be associated with cannabis cessation. Ongoing heavy cannabis use is commonplace in this Aboriginal cohort and raises concerns for the physical, social and psychiatric burden on these already vulnerable communities. Prevention, treatment and intervention programs developed with communities are badly needed.

Should the Pharmaceutical Benefits Advisory Committee extend the range of free nicotine replacement therapies available for Aboriginal and Torres Strait Islander people?

To the Editor: In March 2008, nicotine patches (15 mg per 16 hours) were authority-listed for Aboriginal and Torres Strait Islander people by the Pharmaceutical Benefits Advisory Committee (PBAC) as part of efforts to improve access to medications.1,2 Although timely and welcome, the decision to list only 15 mg patches should be revisited, as it is not consistent with current smoking cessation clinical guidelines.3-5 Neither is it consistent with evidence from a 2008 tobacco survey that we conducted in remote Aboriginal communities in Arnhem Land, Northern Territory.

Healthy country, healthy people: the relationship between Indigenous health status and “caring for country”

To investigate associations between "caring for country" -- an activity that Indigenous peoples assert promotes good health -- and health outcomes relevant to excess Indigenous morbidity and mortality. Cross-sectional study involving 298 Indigenous adults aged 15-54 years in an Arnhem Land community, recruited from March to September 2005. Self-reported involvement in caring for country, health behaviours and clinically measured body mass index (BMI), waist circumference, blood pressure, type 2 diabetes status, albumin to creatinine ratio (ACR), levels of glycated haemoglobin (HbA(1c)) and high-density lipoprotein (HDL) cholesterol, lipid ratio, score on the five-item version of the Kessler Psychological Distress Scale (K5), and 5-year cardiovascular disease (CVD) risk. Controlling for sociodemographic characteristics and health behaviours, multivariate regression revealed significant and substantial associations between caring for country and health outcomes. An interquartile range rise in the weighted composite caring-for-country score was significantly associated with more frequent physical activity, better diet, lower BMI (regression coefficient [b] = - 2.83; 95% CI, - 4.56 to - 1.10), less abdominal obesity (odds ratio [OR], 0.43; 95% CI, 0.26-0.72), lower systolic blood pressure (b = - 7.59; 95% CI, - 12.01 to - 3.17), less diabetes (OR, 0.12; 95% CI, 0.03-0.52), lower HbA(1c) level (b = - 0.45; 95% CI, - 0.79 to - 0.11), non-elevated ACR (OR, 0.28; 95% CI, 0.13-0.60), higher HDL cholesterol level (b = 0.06; 95% CI, 0.01-0.12), lower K5 score (b = - 0.97; 95% CI, - 1.64 to - 0.31) and lower CVD risk (b = - 0.77; 95% CI, - 1.43 to - 0.11). Greater Indigenous participation in caring for country activities is associated with significantly better health. Although the causal direction of these associations requires clarification, our findings suggest that investment in caring for country may be a means to foster sustainable economic development and gains for both ecological and Indigenous peoples' health.

Heavy cannabis use and depressive symptoms in three Aboriginal communities in Arnhem Land, Northern Territory

To determine the extent to which depressive symptoms are associated with heavy cannabis use in an Aboriginal population in Arnhem Land, Northern Territory. Cross-sectional study involving interviews with 106 Indigenous participants (57 males, 49 females) aged 13-42 years in three remote Aboriginal communities in Arnhem Land, NT, Australia. Measures of depressive symptoms (a raw score of > or = 6 out of a possible 18 on a modified version of the Patient Health Questionnaire-9) and self-reported heavy cannabis use (six or more cones daily). After adjusting for other substance use (tobacco, alcohol and lifetime petrol sniffing), age and sex, heavy cannabis users were four times more likely than the remainder of the sample to report moderate to severe depressive symptoms (odds ratio, 4.1; 95% CI, 1.3-13.4). Given its high prevalence in Indigenous populations, the development of clinical and prevention strategies for cannabis misuse are warranted.

Evaluation of a community‐driven preventive youth initiative in Arnhem Land, Northern Territory, Australia

We evaluated a community-driven initiative established to prevent substance misuse and increase respect for culture and their elders among young people in a group of remote Aboriginal communities in Arnhem Land, Northern Territory (NT), Australia. The Youth Development Unit provided a range of training, recreational and cultural activities within a community development framework to all young people in the community. Methods of operation, community acceptability, perceived impact and likely ability to meet goals were assessed. Data included community, staff and stakeholder interviews and observation. School attendance, youth apprehension rates and information on levels of substance use were compared 2 years before and after the initiative was implemented. Interviewees reported increased youth training and recreational opportunities, increased communication between local agencies, overall satisfaction with programme delivery and optimism that it could achieve its goals. Suggested improvements included even more training, cultural programmes and other activities and employment of more community-based Indigenous staff. The importance of key staff, involvement of a respected Indigenous staff member and community engagement were noted as probable contributors to its success. Indigenous young people in Australia remain one of the most disadvantaged and vulnerable groups. Community-driven preventive initiatives offer enhanced youth resilience and connectedness in remote Aboriginal communities and alternatives to substance use.

High levels of cannabis use persist in Aboriginal communities in Arnhem Land, Northern Territory

[Extract] Cannabis use is implicated in serious social disruption in many Northern Territory Aboriginal communities.1 Rising levels of cannabis use were first reported in Aboriginal communities in Arnhem Land in 2002, along with associated concerns about escalating social impacts and mental health effects compounded by other substance use.2 A random sample of 164 people in Arnhem Land initially interviewed and assessed in 2004 were followed up between October 2005 and June 2006. Their cannabis use was measured using health worker assessments and self-reports from interviews. Ethical approval was granted by the NT Health Department, Menzies School of Health Research, and James Cook University. Despite a modest decline in cannabis use in this population between 2002 and 2004,3 the 2005–2006 data indicate persisting high rates, with 61% of males and 58% of females (aged 13–34 years) using cannabis at least weekly.

Donald Thomson and the Freedom of ExclusionDonald Thomson: The Man and Scholar. Edited by Bruce Rigsby and Nicolas Peterson. Canberra: Academy of the Social Sciences in Australia, 2005.

Donald Thomson and the Freedom of Exclusion<i>Donald Thomson: The Man and Scholar</i>. Edited by Bruce Rigsby and Nicolas Peterson. Canberra: Academy of the Social Sciences in Australia, 2005.

Aeromedical evacuations from an east Arnhem Land community 2003–2005: The impact on a primary health care centre

To understand the profile and impact of aeromedical evacuations in remote Indigenous communities. Descriptive study. A primary health care centre in east Arnhem Land, Northern Territory, Australia. Four hundred and ten evacuations from a total population of more than 2200 were analysed from February 2003 to August 2005. Patient demographics, seasonal variations, diagnostic categories, utilisation of staff resources. On average 6.5% of the community were evacuated to hospital every year with an evacuation occurring every 2.2 days. Children aged under five years were 3.3-fold overrepresented in evacuations (comprising 37.7% of those evacuated versus 11.3% of the community, P < 0.001). Four diagnostic categories accounted for 61% of evacuations: respiratory disease (21%), obstetric conditions (15%), gastroenteritis (14%) and injury/poisoning (11%). Over the study period four patients required intubation at the clinic. Evacuation rates were higher in the monsoon season. Forty-seven per cent of evacuations occurred after hours. The waiting time for plane arrival ranged from one hour to 21 hours with a median wait-time of three hours. Aeromedical evacuations place a heavy burden on primary health centres. Clinic staff are regularly required to provide hospital-level acute care, often for several hours at a time. Meeting this burden competes with primary prevention programs and regular clinic duties. The age and diagnostic profiles encountered in this study have significant implications for the range of skills required to provide an adequate acute care service. This study highlights the need for remote area health centres to be well resourced to meet these needs.

Feral pig predation threatens the indigenous harvest and local persistence of snake-necked turtles in northern Australia

Northern snake-necked turtles ( Chelodina rugosa) traditionally provided an important seasonal source of protein for indigenous communities in Arnhem Land, northern Australia. Harvest techniques today differ little from those used historically, harvesting being applied in the late dry season when ephemeral waters have drawn down and turtles are aestivating. Radio-telemetry was used to quantify survival rates of C. rugosa at a traditional turtle harvest site and relate them to harvest, predation by feral pigs ( Sus scrofa) and environmental factors. Although turtle survival was positively correlated with body size, the survival of turtles of all sizes and stages of maturity was compromised by pig predation. Seasonal variation in the onset, duration and severity of rainfall and associated influences on periodic drying, are important for C. rugosa survival because such variation influences the timing and intensity of both Aboriginal harvest and pig predation. Contemporary harvest rates of C. rugosa in Arnhem Land by Aboriginal people are very low because pig predation depletes available stocks immediately before Aboriginal harvesting. Aboriginal harvest rates are regulated also by the frequency and timing of ceremonies and other cultural activities that interfere with harvests. Before the arrival of pigs, such relaxation of harvest pressure in years when harvest would otherwise be possible would have contributed to the local abundance and persistence of C. rugosa. In contrast, pig predation is unrelenting, and years of high turtle survival are now restricted only to years of high wet season rainfall.

Changes in cannabis use and its consequences over 3 years in a remote indigenous population in northern Australia

Few studies describe cannabis use in indigenous populations, and no longitudinal studies are available in Australia. We conducted 3-year follow-up interviews and assessments in Aboriginal communities in Arnhem Land (Northern Territory, NT). A randomly selected sample (n = 161; 80 males, 81 females aged 13-36 years) was assessed in October 2001 and then reassessed in September 2004. An opportunistically recruited sample (n = 104; 53 males, 51 females aged 13-36 years) was also interviewed in 2001 and followed-up in 2004. Cannabis and other substance use were determined by combining proxy assessments by local Aboriginal health workers, medical records and data from interviews. Changes in cannabis use and symptoms of misuse were assessed using McNemar's test for paired proportions and the Wilcoxon signed rank test. Logistic regression assessed associations between clinical presentations and cannabis use at both time-points. Those who used cannabis at both baseline and follow-up were at greater risk than those who never used it to have suffered: auditory hallucinations; suicidal ideation; and imprisonment. In the randomly selected cohort there were fewer cannabis users at follow-up than at baseline (P = 0.003). The reduction was evident in females generally (P = 0.008) and older males (aged = 16 at baseline) (P = 0.007). In those interviewed at both baseline and follow-up we measured no statistically significant reduction in frequency and levels of use, although fewer cannabis users reported symptoms of misuse such as: fragmented thought processes; memory disruption; difficulties controlling use; and auditory and visual hallucinations. Modest reductions in cannabis use and its consequences in this population were demonstrated. These may be the result of enhanced supply control and broader socio-political changes.