Aboriginal Communities In Northern Territory Research Articles

“Talking about something no one wants to talk about”—navigating hepatitis B-related work in remote Australian Aboriginal communities: a decade of learning and growth

Abstract Background Chronic hepatitis B (CHB) is one of the leading causes of liver cirrhosis and liver cancer globally. In Australia, Aboriginal and Torres Strait Islander people of the Northern Territory (NT) have the highest prevalence of CHB (6%) and are six times more likely than non-Aboriginal people to be diagnosed with liver cancer. In 2010, a “liver one-stop shop” model of specialised care and research was initiated to address this disparity. Despite many challenges, the program was accepted in NT Aboriginal communities. This study aimed to identify the key elements linked to this success. Methods We conducted a retrospective case study using Stake’s methodology to understand the hepatitis B phenomenon. A constructivist approach allowed a holistic understanding from the real-life perspectives of those involved in the hepatitis B work. Information was sourced from the Aboriginal workforce, patients of remote clinics, interested community members and service providers. Results We identified six elements critical to the successful conduct of our hepatitis B program, which included the essential role of the local Aboriginal workforce, providing health education in a patient’s preferred language, addressing shame and stigma, respecting culture, taking time, and building trust in the community. Conclusions Commitment over the long term was crucial for the success of our hepatitis B program. Adhering to the identified elements was essential to create a culturally safe environment and engage more Aboriginal people in clinical care and research. This study provides powerful lessons and insights that can be applied to other programs and comparable settings worldwide.

Indigenous Housing Rights and Colonial Sovereignty: Self-Determination and Housing Rights beyond a White Possessive Frame

Through the lens of Aileen Moreton-Robinson's ‘white possessive logics’, this article addresses a series of legal cases concerning inhumane Aboriginal housing in the Northern Territory of Australia. It critiques successive government policies in relation to First Nations people since the colonisation of the Northern Territory in the nineteenth century, setting the cases in their historical context of ongoing subordination of First Nations people to the interests of white possession of land and governance. We argue that domestic law pertaining to First Nations housing rights manifests white possessive logics. Such control can only be overcome through affording First Nations communities self-determination over housing in accordance with international law and First Nations claims. Self-determination and sovereignty are antidotes to the colonial histories that underlie inadequate housing for Indigenous peoples not only in Australia but across settler colonies. In developing this argument, we draw on international law and honour the advocacy of Northern Territory Aboriginal communities who have struggled for community-control over housing and homelands over successive generations.

Evaluating the role of asymptomatic throat carriage of Streptococcus pyogenes in impetigo transmission in remote Aboriginal communities in Northern Territory, Australia: a retrospective genomic analysis

Streptococcus pyogenes, or group A Streptococcus (GAS), infections contribute to a high burden of disease in Aboriginal Australians, causing skin infections and immune sequelae such as rheumatic heart disease. Controlling skin infections in these populations has proven difficult, with transmission dynamics being poorly understood. We aimed to identify the relative contributions of impetigo and asymptomatic throat carriage to GAS transmission. In this genomic analysis, we retrospectively applied whole genome sequencing to GAS isolates that were collected as part of an impetigo surveillance longitudinal household survey conducted in three remote Aboriginal communities in the Northern Territory of Australia between Aug 6, 2003, and June 22, 2005. We included GAS isolates from all throats and impetigo lesions of people living in two of the previously studied communities. We classified isolates into genomic lineages based on pairwise shared core genomes of more than 99% with five or fewer single nucleotide polymorphisms. We used a household network analysis of epidemiologically and genomically linked lineages to quantify the transmission of GAS within and between households. We included 320 GAS isolates in our analysis: 203 (63%) from asymptomatic throat swabs and 117 (37%) from impetigo lesions. Among 64 genomic lineages (encompassing 39 emm types) we identified 264 transmission links (involving 93% of isolates), for which the probable source was asymptomatic throat carriage in 166 (63%) and impetigo lesions in 98 (37%). Links originating from impetigo cases were more frequent between households than within households. Households were infected with GAS for a mean of 57 days (SD 39 days), and once cleared, reinfected 62 days (SD 40 days) later. Increased household size and community presence of GAS and scabies were associated with slower clearance of GAS. In communities with high prevalence of endemic GAS-associated skin infection, asymptomatic throat carriage is a GAS reservoir. Public health interventions such as vaccination or community infection control programmes aimed at interrupting transmission of GAS might need to include consideration of asymptomatic throat carriage. Australian National Health and Medical Research Council.

The Whole of Community Engagement initiative: Interculturality in remote Aboriginal education

It is generally accepted by researchers, policy-makers and practitioners that progress in Indigenous education depends on working in partnership with Indigenous people, and that programs and services are best provided in partnership. The 2014–2016 Whole of Community Engagement initiative built a partnership of non-Indigenous researchers with researchers, teachers, education leaders and elders from six remote Northern Territory Aboriginal communities. In this paper we describe the features that led us to characterise the initiative and the remote community and school context as intercultural and complex. The former included methodology, staffing, meeting procedure and interpersonal communication, negotiation of meaning and decision-making. On the basis of this approach, we found that intercultural complexity was strongly evident in schooling in Galiwin’ku, Elcho Island, North East Arnhem Land, which was the community most closely studied by the authors. The paper contributes to the recognition of intercultural complexity in remote Aboriginal schooling, and the potential benefit that its recognition can have for educational outcomes in those contexts.

‘We're Hands-On People’: Healing Diabetes in the Absence of Traditional Healers in an Aboriginal Community in Northern Territory, Australia.

This study of a remote Aboriginal community in Australia’s Northern Territory in 2014 sought to understand diabetes from a local Aboriginal perspective. Participants drew on a variety of holistic healing methods in the absence of an individual or individuals identified as holding a healing role in the community. The study offers an alternative to the common assumption that all communities can identify specific individuals as Aboriginal healers who are central to maintaining Aboriginal beliefs and wellbeing who contribute to holistic health (Clarke 2008; Maher 1999; McDonald 2006; Seathre 2013; Williams 2011). This research found the seven adult Aboriginal diabetes patients participating in the longitudinal ethnographic study actively engaged in self-healing strategies. Moreover, diabetes clinicians could combine local remedies and biomedical treatment to heal diabetes within the clinic, as well as actively engaging the patient in their own treatment, effective to reduce the symptoms and prevalence of diabetes in Aboriginal populations.

Maternal Anaemia in Pregnancy: A Significantly Greater Risk Factor for Anaemia in Australian Aboriginal Children than Low Birth Weight or Prematurity.

To identify maternal and perinatal risk factors associated with childhood anaemia. A retrospective cohort studywas conducted in three remote Katherine East Aboriginal communities in Northern Territory, Australia. Children born 2004-2014 in Community A and 2010-2014 in Community B and C, and their respective motherswere recruited into the study.Maternal and child datawere linked to providea longitudinal view of each child for the first 1000 days from conception to 2-years of age. Descriptive analyses were used to calculate mean maternal age, and proportions were used to describe other antenatal and perinatal characteristics of the mother/child dyads. The main outcome was theprevalence of maternal anaemia in pregnancy and risk factors associated with childhood anaemia at age 6months. Prevalence of maternal anaemia in pregnancy was higher in the third trimester (62%) compared to the first (46%) and second trimesters (48%). There was a strong positive linear association (R2 = 0.46, p < 0.001) between maternal haemoglobin (Hb) in third trimester pregnancy and child Hb at age 6months. Maternal anaemia in pregnancy (OR 4.42 95% CI 2.08-9.36) and low birth weight (LBW, OR 2.62, 95% CI 1.21-5.70) were associated with an increased risk of childhood anaemia at 6months of age. This is the first study to identify the association of maternal anaemia with childhood anaemia in the Australian Aboriginal population. A review of current policies and practices for anaemia screening, prevention and treatment during pregnancy and early childhood would be beneficial to both mother and child. Our findings indicate that administering prophylactic iron supplementation only to children who are born LBW or premature would be of greater benefit if expanded to include children born to anaemic mothers.

Township Leases and Economic Development in Northern Territory Aboriginal Communities

The Australian Government has put considerable effort into the uptake of township leases in Aboriginal communities in the Northern Territory, a reform introduced in 2006. It argues that the leases have the potential to transform the economic environment of Aboriginal communities. This article explores the true relationship between township leases and economic development. It draws on empirical research and a set of newly-developed concepts – the leasehold spectrum, an occupier-driven approach, a landowner-driven approach – to explain the particular way in which township leases alter the economic circumstances of communities. Contrary to what is often suggested, for the most part township leases implement a landowner-driven rather than occupier-driven approach. This has consequences not just for how development occurs, but also for who benefits from developments. Until now, those consequences have not been debated in public forums. Similar issues arise in other Indigenous communities around Australia. The article reframes discussion about land reform in Indigenous communities so that these important issues can be given more careful thought.

Mentoring as a tool to engage Aboriginal youth in remote Australian communities: a qualitative investigation of community members, mentees, teachers, and mentors’ perspectives

Sport-based mentoring programs have been used across many contexts to engage young people in education. In this research, we explored the influence that an Aboriginal controlled organisation’s youth mentoring program has on three remote Aboriginal communities in Northern Territory, Australia. We used a composite set of culturally sensitive methods by including artefacts from the community members and mentees, informal interviews with community, and semi-structured conversations with mentors and schoolteachers. The findings demonstrate the positive feelings, many benefits, and relationships that had been established between mentors and mentees, the organisation and community over time. However, participants also suggested that it would be beneficial to engage mentors in activities with students not in the school system, and adults in the broader community. Despite some identified challenges, the mentoring program was perceived to be successful in engaging remote Aboriginal children in school and developing future career aspirations.

Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia.

To identify the risk factors for preterm birth, low birthweight and small for gestational age babies among remote-dwelling Aboriginal women. The study included 713 singleton births from two large remote Aboriginal communities in Northern Territory, Australia in 2004-2006 (retrospective cohort) and 2009-2011 (prospective cohort). Demographic, pregnancy characteristics, labour and birth outcomes were described. Multivariate logistic regression analysis was conducted and adjusted odds ratios were reported. The preterm birth rate was 19.4%, low birthweight rate was 17.4% and small for gestational age rate was 16.3%. Risk factors for preterm birth were teenage motherhood, previous preterm birth, smoker status not recorded, inadequate antenatal visits, having pregnancy-induced hypertension, antepartum haemorrhage or placental complications. After adjusting for gender and birth gestation, the only significant risk factor for low birthweight was first time mother. The only significant risk factor for small for gestational age baby was women having their first baby. Rates of these events are high and have changed little over time. Some risk factors are modifiable and treatable but need early, high quality, culturally responsive women centred care delivered in the remote communities themselves. A different approach is recommended.

Township Leases and Economic Development in Northern Territory Aboriginal Communities

The Australian Government has put considerable effort into the uptake of township leases in Aboriginal communities in the Northern Territory, a reform introduced in 2006. It argues that the leases have the potential to transform the economic environment of Aboriginal communities. This article explores the true relationship between township leases and economic development. It draws on empirical research and a set of newly-developed concepts – the leasehold spectrum, an occupier-driven approach, a landowner-driven approach – to explain the particular way in which township leases alter the economic circumstances of communities. Contrary to what is often suggested, for the most part township leases implement a landowner-driven rather than occupier-driven approach. This has consequences not just for how development occurs, but also for who benefits from developments. Until now, those consequences have not been debated in public forums. Similar issues arise in other Indigenous communities around Australia. The article reframes discussion about land reform in Indigenous communities so that these important issues can be given more careful thought.

Rhetoric, Aboriginal Australians and the Northern Territory Intervention: A Socio-legal Investigation into Pre-legislative Argumentation

Presented within this article is a systematic discourse analysis of the arguments used by the then Australian Prime Minister and also the Minister for Indigenous Affairs in explaining and justifying the extensive and contentious intervention by the federal government into remote Northern Territory Aboriginal communities. The methods used within this article extend the socio-legal toolbox, providing a contextually appropriate, interdisciplinary methodology that analyses the speech act’s rhetorical properties. Although many academics use sound-bites of pre-legislative speech in order to support their claims, this analysis is concerned with investigating the contents of the speech acts in order to understand how the Prime Minister’s and Minister for Indigenous Affairs’ argumentations sought to achieve consensus to facilitate the enactment of legislation. Those seeking to understand legislative endeavours, policy makers and speech actors will find that paying structured attention to the rhetorical properties of speech acts yields opportunities to strengthen their insight. The analysis here indicates three features in the argumentation: the duality in the Prime Minister’s and Minister’s use of the Northern Territory Government’s Little Children are Sacred report; the failure to sufficiently detail the linkages between the Intervention and the measures combatting child sexual abuse; and the omission of recognition of Aboriginal agency and consultation.

‘Our own Hurricane Katrina’: Aboriginal disadvantage and Australian national identity

Since Prime Minister Howard's declaration in 2007 that child sex abuse in Northern Territory Aboriginal communities was Australia's ‘own Hurricane Katrina’, the trope of natural disaster has been a regular feature of print and television media coverage of Indigenous affairs in Australia. The effect of this rhetorical strategy is to separate what happens to Aboriginal people from the fabric of ‘mainstream’ Australian cultural and political life; to render it alien and unconnected to the relative privilege enjoyed by other Australians. This strategy also produces peculiar temporal effects by erecting a cordon sanitaire around Australian history and the national identity that it supports. Howard's comparison of Aboriginal disadvantage with Katrina, if read alongside his politicization of the teaching of Australian history, demonstrates an unwillingness to incorporate systemic injustice toward Indigenous people within the composition of that history. This article interrogates the relationships between the manifold understandings of Aboriginal disadvantage and attempts to commemorate its violent history, as these aspects of Australian life are both integrated and refused by national identity narratives. Specifically, the paper reinterprets the trope of natural disaster as a means of comprehending Indigenous disadvantage and Australian identity by drawing on Walter Benjamin's philosophy of history. Benjamin's understanding of activism as a constructive retrieval of the past will be developed to reconnect catastrophe to history, and to enable an exploration of responsibility for that history as an integral condition of contemporary Australian identity.

Aboriginal contributions to the evaluation of housing (and to postcolonial theory)

Housing Reference Groups (HRGs) began to be established in remote Northern Territory (NT) Aboriginal communities in 2009 when the Northern Territory Government compulsorily acquired remote Aboriginal housing and closed down 75 Aboriginal Housing associations. In this highly contested context, we were invited to undertake an evaluation of the HRGs. Through both open discussion and semi-structured interviews, we learnt from the Aboriginal people we worked with to see a much wider, more structural understanding of housing and its governance. This in turn led us to reflect upon Aboriginal contributions to the theory and practice of evaluation, and their various relations to received theories such as social justice, pragmatist philosophy and ethics, and Frierian conscientization. This collaborative ground-up evaluation process contributed to our own ongoing practices of evaluation, and possibly to some slight but reverberating changes in government policy and practice.

Prevalence of scabies and strongyloidiasis before and after MDA in a remote Aboriginal Community in Northern Territory, Australia

Prevalence of scabies and strongyloidiasis before and after MDA in a remote Aboriginal Community in Northern Territory, Australia

Governing Sex: Removing the Right to Take Responsibility

The exposure in 2006 of horrific cases of sexual violence that allegedly characterised Northern Territory Aboriginal communities, evoked responses dominated by a predictable moral panic. Thus the Commonwealth Intervention of 2007 largely missed its ostensible aim of protecting sexually abused children. This essay moves beyond a moralising analysis to consider relevant social, cultural and historical factors based on specific ethnographic work. First I present a sense of some profound historically established differences and common themes in traditional Aboriginal and mainstream law in relation to the regulation of sexuality. Then I draw on evidence that Aboriginal people embraced the notion of ‘two laws’, even as the new era created profound difficulties in relation to sexual norms. Their ‘right to take responsibility’ (Pearson 2000) was further undermined by ‘Interventions’ that unashamedly diminished the ability of NT Aborigines to govern their own communities. Finally, mainstream institutions that are deeply engaged with Aboriginal communities need to consider the ways they may be perpetuating entrenched difficulties.

Prevalence of scabies and strongyloidiasis before and after MDA in a remote Aboriginal community in Northern Territory, Australia

Prevalence of scabies and strongyloidiasis before and after MDA in a remote Aboriginal community in Northern Territory, Australia

Current evidence of ‘female flight’ from remote Northern Territory Aboriginal communities – demographic and policy implications

A small body of research has demonstrated the dramatic social, settlement and demographic effects of Indigenous ‘female flight’ from remote communities in Alaska, Canada, and the Northern Sparsely Populated Areas of Europe. In the Northern Territory of Australia, remote Indigenous settlement patterns are highly similar to these areas but neither research nor policy have had anything to say about whether female flight has or might also impact there. This paper applies quantitative tests to thirty years of Census data to look for evidence of precursors in the Northern Territory and discusses the demographic and policy implications in light of the findings.

Microbially synthesized modular virus‐like particles and capsomeres displaying group A streptococcus hypervariable antigenic determinants

Effective and low-cost vaccines are essential to control severe group A streptococcus (GAS) infections prevalent in low-income nations and the Australian aboriginal communities. Highly diverse and endemic circulating GAS strains mandate broad-coverage and customized vaccines. This study describes an approach to deliver cross-reactive antigens from endemic GAS strains using modular virus-like particle (VLP) and capsomere systems. The antigens studied were three heterologous N-terminal peptides (GAS1, GAS2, and GAS3) from the GAS surface M-protein that are specific to endemic strains in Australia Northern Territory Aboriginal communities. In vivo data presented here demonstrated salient characteristics of the modular delivery systems in the context of GAS vaccine design. First, the antigenic peptides, when delivered by unadjuvanted modular VLPs or adjuvanted capsomeres, induced high titers of peptide-specific IgG antibodies (over 1 × 10(4) ). Second, delivery by capsomere was superior to VLP for one of the peptides investigated (GAS3), demonstrating that the delivery system relative effectiveness was antigen-dependant. Third, significant cross-reactivity of GAS2-induced IgG with GAS1 was observed using either VLP or capsomere, showing the possibility of broad-coverage vaccine design using these delivery systems and cross-reactive antigens. Fourth, a formulation containing three pre-mixed modular VLPs, each at a low dose of 5 μg (corresponding to <600 ng of each GAS peptide), induced significant titers of IgGs specific to each peptide, demonstrating that a multivalent, broad-coverage VLP vaccine formulation was possible. In summary, the modular VLPs and capsomeres reported here demonstrate, with promising preliminary data, innovative ways to design GAS vaccines using VLP and capsomere delivery systems amenable to microbial synthesis, potentially adoptable by developing countries.

Impact of swimming on chronic suppurative otitis media in Aboriginal children: a randomised controlled trial

To measure the impact of 4 weeks of daily swimming on rates of ear discharge among Aboriginal children with a tympanic membrane perforation (TMP) and on the microbiology of the nasopharynx and middle ear. A randomised controlled trial involving 89 Aboriginal children (aged 5-12 2013s) with a TMP, conducted in two remote Northern Territory Aboriginal communities from August to December 2009. 4 school weeks of daily swimming lessons (45 minutes) in a chlorinated pool. Proportions of children with ear discharge and respiratory and opportunistic bacteria in the nasopharynx and middle ear. Of 89 children randomly assigned to the swimming or non-swimming groups, 58 (26/41 swimmers and 32/48 non-swimmers) had ear discharge at baseline. After 4 weeks, 24 of 41 swimmers had ear discharge compared with 32 of 48 non-swimmers (risk difference, - 8% (95% CI, - 28% to 12%). There were no statistically significant changes in the microbiology of the nasopharynx or middle ear in swimmers or non-swimmers. Streptococcus pneumoniae and non-typeable Haemophilus influenzae were the dominant organisms cultured from the nasopharynx, and H. influenzae, Staphylococcus aureus and Pseudomonas aeruginosa were the dominant organisms in the middle ear. Swimming lessons for Aboriginal children in remote communities should be supported, but it is unlikely that they will substantially reduce rates of chronic suppurative otitis media and associated bacteria in the nasopharynx and middle ear. However, swimming was not associated with increased risk of ear discharge and we found no reason to discourage it. Australian New Zealand Clinical Trials Registry ACTRN12613000634774.

The Northern Territory Emergency Response: The More Things Change, The More They Stay the Same

The Northern Territory Emergency Response (NTER) was a raft of measures introduced by the Commonwealth of Australia in response to allegations of child sexual abuse in Northern Territory Aboriginal communities.  The measures included the compulsory acquisition of Aboriginal lands, the quarantining of welfare payments, prohibitions on alcohol, and the vesting of expansive powers in the Commonwealth Minister to intervene in the affairs of Aboriginal organizations.  This article aims to provide a brief historical background of Aboriginal people's experiences with the law in Australia, discuss certain provisoins of the NTER, and, finally, examine the consequences three years after the implementation of the NTER.  Through this analysis, the author suggests that history remains a powerful influence, resulting in the NTER being based on assumptions of Aboriginal people that are grounded in a racist past.  Further, independent studies have shown that the NTER has been largely ineffective at accomplishing its stated objectives.