Communities In Central Australia Research Articles

At home on the outstation: Barriers to home Internet in remote Indigenous communities

Indigenous Australians living in remote areas have little access to the Internet and make little use of it. This article investigates the various dimensions of Internet take-up in remote Indigenous communities in Australia and considers the implications for broadband policy. It focuses specifically on the circumstances and experiences of three remote Indigenous communities in central Australia. Residents in these communities provided significant insight into the social, economic and cultural aspects of communications access and use. This evidence is used to examine the drivers and barriers to home Internet for remote Indigenous communities and to discuss a complex set of issues, including: the dynamics of remote living, economic priorities, cultural engagement with technology, and the characteristics of domestic life in remote Indigenous communities.

Heart failure, ventricular dysfunction and risk factor prevalence in Australian Aboriginal peoples: the Heart of the Heart Study

BackgroundLimited strategies have been developed to evaluate and address the alarming discrepancy in early mortality between Indigenous and non-Indigenous populations.ObjectiveTo assess heart failure (HF), HF risk factors and document cardiac...

Prevalences of overweight and obesity among children in remote Aboriginal communities in central Australia

The chronic diseases associated with overweight and obesity are major contributors to the excess disease burden of Aboriginal Australians. Surveillance of overweight and obesity is required to monitor these conditions, and to develop and evaluate interventions to improve health and wellbeing. Remote Aboriginal communities in Australia's Northern Territory (NT) are where approximately two-thirds of the NT Aboriginal people live, a proportion which has been stable over many years. However the remote communities suffer significant socioeconomic disadvantage including limited education and employment opportunities, and poor quality and overcrowded housing. Approximately one-third of Aboriginal people in NT live in central Australia, which consists of the Alice Springs and Barkly districts. The Healthy School-Aged Kids Program includes health promotion and child health screening, and is run in remote Aboriginal communities of NT. This report provides estimates of prevalences of overweight and obesity among children in central Australia who participated in health checks as part of Healthy School-Aged Kids Program in 2010. All children in remote central Australian Aboriginal communities were invited to participate in health checks. Children who attended were weighed and measured. Date of birth, sex, height and weight for each child were used to determine prevalence of overweight (≥+1 standard deviation [SD] BMI-for-age) and obesity (≥+2 SD BMI-for-age) according to WHO Growth standards. Differences in proportions of overweight and obesity by age group and sex, and their statistical significance were calculated. Weight, height, sex and age data were available for 996 children from a population of 1764. It was found that 22.1% of girls and 20.7% of boys were overweight; and 5.1% of girls and 5.8% of boys were obese as defined by BMI-for-age. Prevalence of overweight but not obesity increased with age (for overweight z=3.28, p=0.0011; for obesity z=0.68; p=0.50). The prevalences of overweight and obesity as estimated by BMI-for-age among children in remote central Australian Aboriginal communities were compared with those in other Australian surveys. They appear unlikely to reflect future relative risk of the chronic diseases with which overweight and obesity are associated. Routine collection of data on BMI-for-age may not provide adequate estimation of future risk of chronic disease burden attributable to overweight and obesity among these children. Alternative measures for surveillance for overweight such as waist circumference may prove more useful. Appropriate interventions to reduce risk of chronic disease are required, including interventions to reduce prevalences of overweight and obesity.

Safeguard or mollycoddle? An exploratory study describing potentially harmful incidents during medical student placements in Aboriginal communities in Central Australia.

To assess the number and characteristics of potentially harmful incidents occurring during placement of medical students in remote Aboriginal communities in the Northern Territory. A retrospective audit of medical students' files from Northern Territory General Practice Education placements in Central Australia for the period from January 2006 to December 2007. Number and type of potentially harmful incidents. A total of 163 placements were undertaken. Of these, 98 (60%) had adequate documentation to determine whether an incident had occurred. There were 28 cases (17%) where potentially harmful incidents were judged to have occurred. Most incidents fell under several descriptive categories, but clinical supervision, professional practice and administrative issues were most common. One in six students experienced a potentially harmful incident during remote area placement in 2006-2007. While acknowledging the exploratory nature of this investigation and the major educational benefits that clearly arise from these placements, our findings indicate problems with clinical supervision and administration.

Imagining an Indigital Interface: Ara Irititja Indigenizes the Technologies of Knowledge Management

Ara Irititja exemplifies how Indigenous ontologies are reshaping the technologies of information and cultural heritage management. A project that began in 1994 with the digital repatriation of photographs, oral histories, film recordings, and documents to remote communities in Central Australia, Ara Irititja is transitioning from an object-based FileMaker Pro database into a multimedia knowledge management system. In this article, I build on two years of anthropological fieldwork to interrogate three tools of knowledge preservation and transmission often taken for granted and/or presumed neutral — databases, archives, and the Internet—to argue that they can and must be actively re-worked as contemporary Aboriginal people imagine, produce, and safeguard their own cultural futures.1

Aboriginal Practical Experience and its Impact on Pre-service Teachers' Decisions About Living and Working in Remote Indigenous Communities in Australia

In June 2008, 10 pre-service teachers and 2 teacher educators from Edith Cowan University (ECU) participated in an existing community education program in rural and remote Indigenous communities in central Australia. From an intrepid start with a mountain of overloaded baggage and camping cutlery; setting off the scanning machine at the airport, these educational risk takers trekked off into the desert. Our explorers joined 60 pre-service teachers and several teacher educators from the Victoria University (VU) Story Writing in Rural Locations (SWIRL) project. This project has been operating annually for 14 years in communities around Alice Springs, some up to 400 km of dirt track away. This paper reports the powerful effect of a short lived experience on pre-service teachers' attitudes and experience of living and teaching in a remote community. The experience described here represents the beginning of an authentic approach to giving experiences to pre-service teachers which may support them to consider teaching in remote Indigenous communities as part of their teaching career.

Epidemiology of sexually transmitted infections on the Anangu Pitjantjatjara Yankunytjatjara Lands: results of a comprehensive control program.

To assess the impact of a long-term comprehensive control program for sexually transmitted infections (STIs) in remote Aboriginal communities in Central Australia, and to investigate a recent rise in gonorrhoea prevalence. STI prevalence was determined from annual, cross-sectional, population-wide, age-based screening, 1996-2006. During 2006, gonococcal isolates were obtained by on-site culture and tested for antimicrobial susceptibility. Six remote clinics on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, South Australia, which are served by Nganampa Health Council, an Aboriginal community-controlled health service. All resident Aboriginal people aged 14-40 years at the commencement date of each annual population-wide screen. Multivariable logistic regression models were used to compare prevalence of chlamydial infection, gonorrhoea and syphilis measured during each annual population-wide screen; antimicrobial susceptibility of gonococcal isolates obtained in 2006. Between 1996 and 2003, there was a significant reduction in prevalence of gonorrhoea and chlamydial infection, by 67% and 58%, respectively. Subsequently, chlamydia prevalence rate plateaued, but there was a rapid rise in prevalence of gonorrhoea. Syphilis prevalence decreased linearly over the study period (odds ratio, 0.81; P < 0.001). During the first 6 months of 2006, 89 gonococcal isolates were obtained, 39 through on-site culture during the 6-week screening period, and all were sensitive to penicillin (in the less-sensitive category). The decrease in STI prevalence associated with the program was maintained until 2006 for chlamydial infection and syphilis, but not for gonorrhoea, which rose in prevalence after 2003. There was no change in antimicrobial resistance to explain this rise, and gonorrhoea transmission dynamics and travel of core transmitters to regions without STI control programs might be responsible.

(Re)presenting experience: a comparison of Australian Aboriginal children's sand play in two settings

AbstractThis paper examines how Australian Aboriginal children present and re‐present experience in their symbolic play. Based on anthropological field research in one location and therapeutic work in another, it reports from a psychodynamic perspective how the Indigenous children create meaning on the personal and social level in two distinctive play forms. These are a traditional sand story game played by Anangu Pitjantjatjara girls in a remote Western Desert community in Central Australia, and the European sand play therapy that was introduced as part of an intervention program in a Tiwi Islands community off the northern coast. In phenomenological terms, both techniques draw on the symbolizing activity of the lived body (Schilder, 1950, 1951; Merleau‐Ponty, 1961; Scheler, 1973) or, in the language of organismic‐developmental theory, physiognomizing processes (Werner and Kaplan, 1984). These processes are seen to rest on the primary human capacity for imagination (Castoriadis, 1987). However, the schematizing activity that creates a meaningful relationship between symbol and referent (Werner and Kaplan, 1984) is specific to each play form. Set up retrospectively as a comparison, the discussion leads to the observation that the self‐directed play in the natural social setting is of a higher symbolic order (re‐presentational) than the externally induced play in the artificial social setting that indicates spontaneous linkages between symbol and referent (presentational). It is suggested that this raises certain questions about the potentially therapeutic effect of children's symbolic play. Copyright © 2007 John Wiley &amp; Sons, Ltd.

UFOs, Otherness, and Belonging: Identity in Remote Aboriginal Australia

UFO beliefs exist around the world yet they have been almost exclusively analysed within the context of urban American society. This article seeks to understand the ways in which people from differing social and cultural backgrounds also engage in UFO narratives. In a remote Aboriginal desert community in Central Australia, descriptions of UFOs merge popular and media portrayals of extraterrestrials with elements and themes found in local Aboriginal cosmology. Consequently, Aboriginal narratives regarding extraterrestrial beings are able to both reflect the local social environment of race relations and affirm Aboriginal identity.

Relationship Building in Remote Indigenous Australian Communities: Case Studies from a Literacy Program

SWIRL (Story Writing in Remote Locations) is a literacy program that has been offered by Victoria University in remote Indigenous communities in central Australia. It has been in operation for the past 11 years. The SWIRL program attempts to achieve a number of goals. One is enhancing literacy engagement with young people, which is inclusive and respectful of the needs of culturally diverse communities. The program consists of a range of stakeholders who work in remote and rural settings for up to 4 weeks at a time. During this time, programs are offered to indigenous communities, which embody a range of innovative activities that centre on the literacy needs of the community. This paper will present the personal experiences of two university lecturers who participated in SWIRL during 2006 and will focus on the importance of relationship building in enhancing the success of the program. The contention of this paper is that the success or failure of SWIRL is completely dependent on the ability of program participants to develop and build trustworthy and meaningful relationships. This paper not only explores this contention, but also provides insight into community relationships and their impact upon the sustainability of the program.

Aboriginal women working in vocational training and education: a story from Central Australia

This article outlines research undertaken by an Aboriginal women’s non‐government organization (NGO) into vocational training and education (VTE) needs and issues for remote Aboriginal communities in Central Australia. It describes the Central Australian context, and in particular the impact of remoteness, inequity and disadvantage upon Aboriginal people’s access to and participation in VTE. Waltja Tjutangku Palyapayi (Waltja) is an Aboriginal NGO based in Alice Springs, at the centre of the desert region of inland Australia. Waltja supports the development of family services and the self‐determination of remote Central Australian Aboriginal communities. Senior Aboriginal women from widespread communities govern Waltja. In their communities, and working with and through Waltja, women play a significant role in identification of training needs, advocacy for their communities, and facilitation of education and training, including VTE. This article outlines Waltja’s research over the past decade into training needs and issues and documents the organizational ‘journey’ of this Aboriginal NGO into and within the VTE system. In particular, the article discusses Waltja’s ‘Training Nintiringtjaku’ initiative to develop a professional role for Aboriginal community leaders mediating between the VTE system and their communities.

Genital ulcer disease in central Australia: predictors of testing and outcomes

To identify factors associated with the uptake and outcome of testing for infectious causes of genital ulcer disease (GUD) in central Australia. Prospective investigation of GUD cases in central Australia from February 2002 to August 2003. Data were collected from primary health care clinics in remote indigenous communities of Central Australia. During the study period, 134 cases of GUD were reported and investigated. Of these cases, 71 (53%) were in women (age range 14-75, median 28) and 63 (47%) in men (14-63, median 28). Testing for syphilis was undertaken for 111 (82.8%) cases, 75 (56%) were tested for herpes simplex virus infection, and 82 (61.2%) for donovanosis. Testing for at least one of the three sexually transmissible pathogens of interest was undertaken in 128 (95.5%) cases, while 99 (73.9%) were tested for two pathogens and 41 (30.6%) for all three agents. Of subjects tested, 19.8% had new syphilis infection, 51% had herpes simplex virus infection and 7% had donovanosis. In 19 of 41 (46.3%) subjects fully investigated no cause for genital ulceration was found. This study provides the first quantitative description of GUD diagnosis in central Australia. Logistic constraints limited the systematic application of diagnostic tests. Current treatment protocols may need to be reassessed in light of the higher than expected detection of genital herpes as a cause of GUD.

Prevalence of cicatricial trachoma in an indigenous population of Central Australia: the Central Australian Trachomatous Trichiasis Study (CATTS).

Trachoma is one of the leading causes of blindness worldwide, resulting from conjunctival scarring, upper lid entropion and trichiasis, leading to corneal scarring and opacification. This study was designed to investigate the current prevalence of cicatricial trachoma in an indigenous population within Central Australia and help determine whether trachoma remains a public health issue. Participants aged 40 and over were recruited from patients attending one of 16 remote ophthalmology clinics held at indigenous communities in Central Australia within the Northern Territory. Once informed consent had been obtained, each patient underwent examination for evidence of trachomatous scarring, trachomatous trichiasis and corneal opacities. Results were collated and compared with previous prevalence surveys. Among the sample (n = 181), there were 97 patients (54%; 95% CI 46.7-61.3) with trachomatous scarring, 15 patients (8%; 95% CI 2.8-13.2) with trichiasis and 5 patients (3%; 95% CI 0.5-5.5) with corneal opacities. This study suggests that, although the prevalence of the cicatricial and blinding consequences of trachoma may be decreasing in patients aged 40 years or greater, when compared with the current prevalence in other areas of Australia, trachoma still remains a public health issue in Central Australia.

Psychiatric assessment in remote Aboriginal communities.

The objective of this study was to describe the psychiatric assessment of Aboriginal patients from remote Aboriginal communities in Central Australia. The method consisted of a summary of the experiences gained during a dissertation year placement as senior registrar with the Northern Territory Remote Area Mental Health Team. Remote area Aboriginal psychiatry entails learning a whole new set of skills in terms of history taking and the mental state examination, a knowledge of the importance of extended kinship ties and cultural issues, the use of Aboriginal mental health workers as partners in assessing and managing patients via their families and accepting referrals from a wide range of sources. Working on a service providing psychiatric care to remote area Aboriginal communities can be a deeply rewarding personal and professional experience.

Incident sexually transmitted infections and their risk factors in an Aboriginal community in Australia: a population based cohort study

Objective: To identify risk factors for incident sexually transmitted infections (STI) in a remote Aboriginal community in Australia. Design: A population based cohort study. Setting: An Aboriginal community in central...

Historical perspectives on indigenous health in Australia

In spite of much effort over the past 25 years, the life expectancy of the indigenous people remains nearly 20 years behind the non-Aboriginal white population of Australia. These figures compare unfavourably with the improved life expectancy over the past 25 years of other indigenous peoples, such as the New Zealand Maori and the American Indian populations. By 1990-94, the average Australian indigenous all-cause mortality rate was 1.9 times the Maori rate, 2.4 times the US indigenous rate and 3.15 times the all-Australian rate. The persistence of this discrepancy in Australia is obviously a matter of great concern. There is clearly a gap between available knowledge and its application. Some indication of the possibility of reversal of the current situation is given by a recent report of the beneficial impact of the Homelands Movement on Health Outcomes in Central Australian Aborigines. The study compared the prevalence of obesity, hypertension and diabetes in two groups of Aboriginal adults: those living in homelands versus those living in centralized communities in Central Australia. Baseline studies revealed a lower prevalence of diabetes, hypertension and obesity in the homelands group, compared with those living in centralized communities. They were also less likely to die and less likely to be hospitalized for any cause, particularly infections, injury involving alcohol and other injury. Mean age at death was 58 and 48 years for the residents of homelands and centralized communities, respectively. The benefits were most marked in young adults. It is suggested that the homelands communities have a greater degree of control of their own lives than those living in the centralized communities and this may be an important factor in their improved health status. Improvement in indigenous health should be one of the key issues of reconciliation. Priorities include community control of Aboriginal Health Services under the National Aboriginal Community Controlled Health Organisation (NACCHO), throughout Australia, a greater priority for prevention and public health services (housing, water supply and environmental services) education and economic issues, improved training of indigenous health professionals and increased funding. A national professional organization including NACCHO needs to be established to bridge the big gap between available knowledge and its application for the benefit of the indigenous people of Australia.

The turmoil of Aboriginal enumeration: mobility and service population analysis in a Central Australian community

This paper documents Aboriginal population change and mobility over time in a remote community in central Australia. The movement of population has implications for service delivery and resource allocation. Aboriginal population in the region is characterised by high mobility. We conducted four population surveys in a selected remote community over a 12 month period and categorised individuals into four mutually exclusive groups: residents, dual residents, visitors and absent residents. Based on these categories we developed two population classifications: actual and potential service populations. The potential service population was consistently higher than the Australian Bureau of Statistics (ABS) census figure. We question the use of ABS census estimates as appropriate population figures for determining resource allocation to remote communities. We quantify inter- and intra-community mobility. When the potential population is used as denominator, 35% of the population of this community was classified as inter-community mobile. Given this level of mobility we argue that: (1) Resources should be allocated to compensate health services for the additional time and resource requirements to deal with the high level of population mobility. (2) Health programs such as STD control, trachoma, scabies and other communicable diseases common in Central Australia should be coordinated and delivered as regional programs often crossing State/Territory borders.

Reduced prevalence of impaired glucose tolerance and no change in prevalence of diabetes despite increasing BMI among Aboriginal people from a group of remote homeland communities.

To examine trends in glucose tolerance and coronary risk among Aboriginal people from a group of homeland communities in central Australia during a 7-year follow-up period. Community-based screenings of adult volunteers were performed in 1988 (n = 437; 93% response rate) and in 1995 (n = 424; 85% response rate). A health promotion intervention program commenced after the 1988 survey that focused on the benefits of exercise and appropriate diet. Mean (95% CI) BMI increased significantly from 22.8 kg/m2 (22.3-23.2) to 24.2 kg/m2 (23.8-24.7) during the follow-up period (P < 0.001). This increase was similar for men and women and across all age-groups. The increase in BMI was greater among subjects residing adjacent to a store compared with those residing in communities located far from a store (P < 0.001). Decreases were evident in the prevalence of impaired glucose tolerance (IGT) (from 22.5 to 10.1% among women, P < 0.001; from 12.2 to 6.5% among men, P = 0.074) and hypercholesterolemia (from 36.7 to 25.8% among women, P < 0.01; from 52.4 to 44.0% among men, P = 0.147), but no change was evident in the prevalence of diabetes. Smoking remained rare among women (<4%) and decreased among men (from 52.9 to 40.8%, P < 0.05). The trends in glucose intolerance were clearly better than have been observed in other Aboriginal communities. The institution of an intervention program corresponded with reductions in the prevalence of IGT, hypercholesterolemia, and smoking. The prevalence of diabetes remained unaltered despite a significant increase in mean BMI, possibly because of the promotion of increased physical activity levels.

Increase in prevalence of obesity and diabetes and decrease in plasma cholesterol in a central Australian aboriginal community.

To document change in prevalence of obesity, diabetes and other cardiovascular disease (CVD) risk factors, and trends in dietary macronutrient intake, over an eight-year period in a rural Aboriginal community in central Australia. Sequential cross-sectional community surveys in 1987, 1991 and 1995. All adults (15 years and over) in the community were invited to participate. In 1987, 1991 and 1995, 335 (87% of eligible adults), 331 (76%) and 304 (68%), respectively, were surveyed. Body mass index and waist: hip ratio; blood glucose level and glucose tolerance; fasting total and high density lipoprotein (HDL) cholesterol and triglyceride levels; and apparent dietary intake (estimated by the store turnover method). A community-based nutrition awareness and healthy lifestyle program, 1988-1990. At the eight-year follow-up, the odds ratios (95% CIs) for CVD risk factors relative to baseline were obesity, 1.84 (1.28-2.66); diabetes, 1.83 (1.11-3.03); hypercholesterolaemia, 0.29 (0.20-0.42); and dyslipidemia (high triglyceride plus low HDL cholesterol level), 4.54 (2.84-7.29). In younger women (15-24 years), there was a trembling in obesity prevalence and a four- to fivefold increase in diabetes prevalence. Store turnover data suggested a relative reduction in the consumption of refined carbohydrates and saturated fats. Interventions targeting nutritional factors alone are unlikely to greatly alter trends towards increasing prevalences of obesity and diabetes. In communities where healthy food choices are limited, the role of regular physical activity in improving metabolic fitness may also need to be emphasised.

Private business: the uptake of confidential HIV testing in remote Aboriginal communities on the Ananau Pitiantiatiara Lands

Background and methodsDespite a concentration of risk factors for HIV transmission, many remote Aboriginal communities in central Australia have a low uptake of HIV testing. We studied, the uptake of HIV testing in six clinics in remote Aboriginal communities following the introduction of voluntary confidential testing to assess the impact of the intervention and to determine if the program was reaching people most at risk of HIV infection and transmission. SettingThe study was conducted by Nganampa Health Council, an Aboriginal-controlled health service on the Anangu Pitjantjatjara Lands in the far north-west of South Australia. ResultsSince the introduction of confidential coded testing in August 1994 the number of HIV tests provided through the remote clinics has increased from 83 tests/year to 592 tests/year. In the 12-month audit period (August 1, 1995, to July 31, 1996) 62.7% of women aged 20-24 years, 44.6% of people aged 12-40 years and 24% of the total population had an HIV test. Fifty per cent of tests were accounted for by the 15-25 year age groups and 60% of tests related to an STD consult. DiscussionThis study shows that a high uptake of HIV testing in high-risk groups can be achieved in remote Aboriginal communities where a high level of confidentiality is maintained.