Remote Aboriginal Communities Research Articles

Uptake and acceptability of human papillomavirus self-sampling in rural and remote aboriginal communities: evaluation of a nurse-led community engagement model

BackgroundAboriginal women experience disproportionately higher rates of cervical cancer mortality yet are less likely to participate in screening for early detection. This study sought to determine whether a community-based HPV self-sampling service model can effectively recruit never-screened and under-screened Aboriginal women to participate in cervical cancer screening; assess the clinical outcomes; and explore the acceptability of the model from the perspective of the participants.MethodsAboriginal women aged 25–69 years of age were recruited from eight rural and remote communities in New South Wales, Australia to participate in HPV self-sampling via a community-based service model. Outcome measures were: number of women screened by HPV self-sampling, their prior cervical screening status (under-screened or never-screened), clinical outcomes and participation in follow-up pathways of care, and satisfaction with the service model.ResultsIn total, 215 women conducted a HPV self-sampling test and 200 evaluation surveys were completed. One-fifth of participants (n = 46) were never-screened and one-third (n = 69) were under-screened. Many were unsure of their screening status. Nine women were HPV 16/18 positive and eight had completed all follow up by the conclusion of the study. A further 30 women tested positive for a high risk type other than HPV 16/18 (HPV other), of which 14 had completed follow up at the conclusion of the study. Satisfaction with the HPV self-sampling kit, the process of self-sampling and the service model was high (> 92% satisfied on all items). Many women had difficulty understanding their official HPV results and placed high importance on the nurse explaining it to them.ConclusionsA community-based service model that respects Aboriginal Women’s Business can effectively recruit under-screened and never-screened Aboriginal women to complete cervical cancer screening. Furthermore, this service model supports them to complete recommended follow-up care and engage with their local existing health services.

Preconception Care in a Remote Aboriginal Community Context: What, When and by Whom?

Preconception care (PCC) is acknowledged as a vital preventive health measure aiming to promote health today and for subsequent generations. We aimed to describe the content and context of PCC delivery in a very remote Australian Aboriginal Community Controlled Health Service setting. A retrospective audit was undertaken to identify what PCC was delivered between 2011 and 2018 to 127 Aboriginal women who had at least one pregnancy during this period. Of 177 confirmed pregnancies, 121 had received PCC prior to the pregnancy. Sexually transmissible infection screening (71%) was the most common care delivered, followed by folic acid prescription (57%) and smoking cessation support (43%). Younger women received PCC less often, particularly screening for modifiable pregnancy risk factors. Rates of prediabetes/diabetes, albuminuria, overweight/obesity and smoking were high amongst those screened (48–60%). PCC was usually patient-initiated and increased significantly over the audit period. Presentation for antenatal care in the first trimester of pregnancy was high at 73%. Opportunities to increase PCC delivery include integration with routine health checks, pregnancy tests and chronic disease programs. PCC programs codesigned with young people are also recommended. All primary care providers should be supported and assisted to provide opportunistic PCC and health promotion.

Data linkage and computerised algorithmic coding to enhance individual clinical care for Aboriginal people living with chronic hepatitis B in the Northern Territory of Australia - Is it feasible?

BackgroundChronic hepatitis B (CHB) is endemic in the Aboriginal population of Australia’s Northern Territory (NT). However, many people’s hepatitis B virus (HBV) status remains unknown.Objective1. To maximise the utility of existing HBV test and vaccination data in the NT by creating a linked dataset and computerised algorithmic coding. 2. To undertake rigorous quality assurance processes to establish feasibility of using the linked dataset and computerised algorithmic coding for individual care for people living with CHB.MethodsStep 1: We used deterministic data linkage to merge information from three separate patient databases. HBV testing and vaccination data from 2008–2016 was linked and extracted for 19,314 people from 21 remote Aboriginal communities in the Top End of the NT. Step 2: A computerised algorithm was developed to allocate one of ten HBV codes to each individual. Step 3: A quality assurance process was undertaken by a clinician, using standardised processes, manually reviewing all three databases, for a subset of 5,293 Aboriginal people from five communities to check the accuracy of each allocated code.ResultsThe process of data linking individuals was highly accurate at 99.9%. The quality assurance process detected an overall error rate of 17.7% on the HBV code generated by the computerised algorithm. Errors occurred in source documentation, primarily from the historical upload of paper-based records to electronic health records. An overall HBV prevalence of 2.6% in five communities was found, which included ten cases of CHB who were previously unaware of infection and not engaged in care.ConclusionsData linkage of individuals was highly accurate. Data quality issues and poor sensitivity in the codes produced by the computerised algorithm were uncovered in the quality assurance process. By systematically, manually reviewing all available data we were able to allocate a HBV status to 91% of the study population.

Dietary intake of Aboriginal Australian children aged 6\u201336\u2009months in a remote community: a cross-sectional study

BackgroundScarce literature comprehensively captures the transition to solid foods for children in remote Aboriginal Australian communities, a population expected to be especially vulnerable to nutritional inadequacy for largely socio-economic reasons. This study describes the dietary intake of children aged 6–36 months in a remote Aboriginal community during the years of solids introduction and establishment. Specifically, we aimed to explore milk feeding practices, major sources of nutrition and traditional food consumption, dietary patterns and nutrient and food group intakes, and compare these to national and international recommendations.MethodsThis dietary assessment was conducted as part of an observational, cross-sectional Child Health and Nutrition study. Three 24-h dietary recalls were completed with the parent/care-giver of each participant over 2–4 weeks, capturing a pay-week, non-pay-week and weekend day from October 2017–February 2018. Additional information collected included sociodemographic data, food security status, usual cooking practices, and attendance at playgroup.ResultsDiet histories for 40 children were included in the analysis (~ 40% of the population). Breast feeding rates were high (85%), with mothers exclusively feeding on demand. Very few participants met recommended intakes for wholegrains (n = 4, 10%), vegetables (n = 7, 18%), dairy (n = 5, 18%) and fruit (n = 13, 33%), while more children met the guidelines for meat (n = 19, 48%) and discretionary food intake (n = 28, 70%). Traditional foods were always nutritionally dense and consumed frequently (n = 22, 55% of children). Statistically significant pay-cycle differences in intakes of all macro-, and numerous micro-nutrients were observed.ConclusionsMany positive early feeding practices are currently enacted in remote Aboriginal communities including responsive and long duration breastfeeding, and nutrient-dense traditional food consumption from earliest solids introduction. However, the non-pay-week/pay-week cycle is impacting the quality and quantity of children’s diets at a time of rapid growth and development.

A Qualitative Analysis of the Accessibility and Connection to Traditional Food for Aboriginal Chronic Maintenance Hemodialysis Patients.

ABSTRACTBackgroundDue to the lack of resources in remote Aboriginal communities within the Northern Territory of Australia, Aboriginal people requiring chronic maintenance hemodialysis often must relocate from their home communities to Darwin city permanently to receive ongoing care. This phenomenon can cause distressing isolation from important traditional food, land, and family.ObjectiveThe aim was to identify the relation to traditional food from an Aboriginal perspective and the enablers and barriers to accessing traditional food post-relocation from remote regions of the Northern Territory, Australia, to the urban city of Darwin.MethodsThis was a qualitative study design with a total of 12 Aboriginal participants (4 males, 8 females) receiving ongoing hemodialysis at the Nightcliff Renal Unit. Participants had all relocated from a remote region to Darwin. Interviews were conducted between July and September 2018 in Darwin, Australia. Data interpretation was conducted by an Aboriginal researcher and co-authors with a combined 30 y of experience conducting research with Aboriginal people in a health context. Data analysis comprised an inductive thematic analysis approach with an indigenist knowledge interpretation lens to construct, reaffirm, and protect Indigenous views.ResultsTraditional food was an important part of participants’ identity and strongly connected to social, emotional, spiritual and physical health, and well-being. Access to traditional food post-relocation is associated with enablers and barriers including mobility, local knowledge, social support networks, commercial access, and economics.ConclusionsDialysis patients who are dislocated from remote Aboriginal communities to Darwin experience clear disruption to traditional food access, consumption, availability, and knowledge dissemination to the younger generations.

Supporting holistic care for patients with tuberculosis in a remote Indigenous community: a case report

Tuberculosis (TB) is a serious infectious disease with high rates of morbidity and mortality if left untreated. In Australia, TB has been virtually eradicated in non-Indigenous Australian-born populations but in remote Aboriginal and/or Torres Strait Islander communities TB presents a rare but significant public health issue. Remote health services are most likely to encounter patients with suspected and confirmed TB diagnosis but may be unprepared for supporting someone with this disease and the complexities of balancing public health risk with patient autonomy. This case study will outline the process for diagnosis and treatment of a TB patient in a remote Cape York community. This case involved significant delay in diagnosis and required several strategies to achieve successful disease eradication. The process of treatment, however, had a significant effect on the patient's physical health, and social and emotional wellbeing. This case highlights the importance of early collaboration between medical, nursing, Indigenous health worker and allied health services and the importance of technology such as electronic information records to support opportunistic access to diagnostic services and treatment. The enactment of the TB protocol should include discussions about the consequences of any restrictions of movement, employment or social/community roles. Identifying alternative opportunities to engage in meaningful roles may reduce the impact the disease has on a patient's quality of life.

Barriers and Enablers of Health Service Utilisation for Childhood Skin Infections in Remote Aboriginal Communities of Western Australia.

In Australia, children living in remote Aboriginal communities experience high rates of skin infections and associated complications. Prompt presentation to primary care health services is crucial for early diagnosis and treatment. We performed a qualitative study in four remote Aboriginal communities in the Pilbara region of Western Australia to explore factors that affected health service utilisation for childhood skin infections in this setting. The study consisted of semistructured interviews and focus group discussions with parents and carers (n = 16), healthcare practitioners (n = 15) and other community service providers (n = 25). We used Andersen’s health service utilisation model as an analytical framework. Our analysis captured a wide range of barriers that may undermine timely use of health services for childhood skin infections. These included general factors that illustrate the importance of cultural competency amongst healthcare providers, patient-centred care and community engagement. Relating specifically to health service utilisation for childhood skin infections, we identified their apparent normalisation and the common use of painful benzathine penicillin G injections for their treatment as important barriers. Health service utilisation in this setting may be enhanced by improving general awareness of the significance of childhood skin infections, actively engaging parents and carers in consultation and treatment processes and strengthening community involvement in health service activities.

Enhancing Social and Emotional Wellbeing of Aboriginal Boarding Students: Evaluation of a Social and Emotional Learning Pilot Program.

Boarding schools can provide quality secondary education for Aboriginal students from remote Aboriginal Australian communities. However, transition into boarding school is commonly challenging for Aboriginal students as they need to negotiate unfamiliar cultural, social and learning environments whilst being separated from family and community support. Accordingly, it is critical for boarding schools to provide programs that enhance the social and emotional skills needed to meet the challenges. This study evaluated a 10-session social and emotional learning (SEL) program for Aboriginal boarders and identified contextual factors influencing its effectiveness. The study combined a pre-post quantitative evaluation using diverse social and emotional wellbeing measures with 28 students between 13–15 years (10 female, 11 male, 7 unidentified) and qualitative post focus groups with 10 students and episodic interviews with four staff delivering the program. Students’ social and emotional skills significantly improved. The qualitative findings revealed improvements in students seeking and giving help, working in groups, managing conflict, being assertive and discussing cultural issues. The focus groups and interviews also identified program elements that worked best and that need improvement. Secure relationships with staff delivering the program and participation in single sex groups stood out as critical enablers. The findings lend evidence to the critical importance of collaborative design, provision and evaluation of SEL programs with Aboriginal peoples.

The Well-Being of Carers of Older Aboriginal People Living in the Kimberley Region of Remote Western Australia: Empowerment, Depression, and Carer Burden.

Objective: To describe demographic features and well-being of carers of Aboriginal Australians aged ≥45 years in remote Western Australia. Method: Carer burden, empowerment, and depression were assessed in 124 Aboriginal carers in four remote Aboriginal communities. Results: Carers were aged 38.8 ± 15.0 years, 73.4% were female, and 75.8% were children or grandchildren of the person cared for. The mean Zarit-6 score was 3.7 ± 3.6. Attending high school (odds ratio [OR] = 0.3; 95% confidence interval [CI] = [0.1, 0.7]) and feeling empowered (OR = 0.2; 95% CI = [0.1, 0.8]) were inversely associated with carer burden; female carers were less likely to feel empowered (OR = 0.4; 95% CI = [0.2, 0.9]); and empowerment was inversely associated with depression (OR = 0.3; 95% CI = [0.1, 0.7]). Discussion: Aboriginal carers in remote communities are relatively young and most are children or grandchildren. Carer burden was lower than anticipated. However, existing tools may not adequately measure Aboriginal perspectives. Education and empowerment are key factors which support programs must consider.

Early childhood anaemia more than doubles the risk of developmental vulnerability at school-age among Aboriginal and Torres Strait Islander children of remote Far North Queensland: Findings of a retrospective cohort study.

AimsEarly childhood anaemia, usually attributed to iron deficiency, is associated with persistent detrimental effects on child development. This study investigates the association of anaemia between age six and 23 months with indicators of childhood development at school‐age among children of remote Aboriginal and Torres Strait Islander communities of Far North Queensland.MethodsThe triennial Australian Early Development Census (AEDC) encompasses five domains of early childhood development—physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school‐based), communication skills and general knowledge. AEDC 2012 and 2015 assessments were linked with health information for children and their mothers from remote Aboriginal and Torres Strait Islander communities of Far North Queensland.ResultsAEDC assessments were available for 250 children who had measurements of haemoglobin recorded at age 6 to 23 months. More children who had had early childhood anaemia (n = 66/143, 46.2%, [37.9%, 54.4%]) were developmentally vulnerable on two or more domains compared to those who had not been anaemic (n = 25/107, 23.4% [15.2%, 31.5%], P < .001). Multivariable analysis confirmed that early childhood anaemia more than doubled the risk of developmental vulnerability (OR 2.2 [1.1, 4.3] P = .020) at school age.ConclusionsEarly childhood anaemia is a risk factor for developmental vulnerability at school‐age in this setting. Interventions combining nutrition promotion and multi‐micronutrient food fortification, are effective in prevention of early childhood anaemia. Such interventions could also improve early childhood development and subsequent educational achievement.

All-cause mortality following low-dose aspirin treatment for patients with high cardiovascular risk in remote Australian Aboriginal communities: an observational study

ObjectivesTo evaluate the benefit and risk of low-dose acetylsalicylic acid (aspirin) in patients from remote Aboriginal communities in the Northern Territory, Australia.DesignRetrospective cohort study using primary care and hospital data...

Keeping it real: Virtual connection with SToP trial community navigators

Building trust and forging relationships with remote Aboriginal communities is an essential element of culturally informed, reciprocal research. Historically these relationships have been formed over-time where community members and researchers come together face to face to share their knowledge and yarn in both an informal and formal manner. Researchers from Telethon Kids Institute are partnering with local stakeholders and remote Aboriginal communities in the Kimberley, Western Australia (WA) to support healthy skin through the SToP (See, Treat, Prevent skin sores and scabies) Trial. The SToP trial, a collaboration between Telethon Kids Institute, Kimberley Aboriginal Medical Services (KAMS), Nirrumbuk Environmental Health Services and Western Australia Country Health Services (WACHS) – Kimberley is a clustered randomised trial with a stepped-wedge design. SToP trial consultation with stakeholders and communities commenced in 2016 to proceed consenting in 2018 and trial commencement in 2019. Since that time, the SToP trial team have been conducting intermittent fieldwork in nine remote Aboriginal communities in the Kimberley. However, due to the COVID-19 pandemic when Aboriginal health leaders recommended a cessation to research related travel in northern WA from March 11, 2020 to prevent the incursion of COVID-19 into Aboriginal communities with health vulnerabilities, crucial face-to-face yarning was no longer possible. At the time it appeared the existing relationships with communities involved in our research (the SToP trial) would be challenging to maintain without this ability to visit the communities. Fortunately, when tested, this assumption was erroneous. Here we report the successful use of technology to bridge the inability to visit communities in 2020 due to COVID-19. The Telethon Kulunga Aboriginal Unit (Kulunga) and SToP trial team members were able to connect virtually with Community Navigators from the Dampier Peninsula communities. The initial virtual meeting using Microsoft Teams technology involved four Community Navigators and their mentor, three Telethon Kids Institute and five Kulunga staff members. Community Navigators joined Microsoft Teams from their respective communities and Kulunga and Telethon Kids Institute staff joined from their homes. Not only was this an exciting new way of communicating, it enabled existing relationships to continue to be strengthened. Since the initial meeting, the teams have continued to meet virtually, and plan SToP trial health promotion activities including a community-driven, collaborative music video. While the significance of face-to-face yarning can never be overstated, having to adjust to a new way of yarning has reiterated the importance of connection, albeit virtually. Unfortunately, due to technical limitations, intermittent internet connectivity and various other challenges, there has been no opportunity to engage virtually with SToP trial communities in the East Kimberley. However, we continue to seek ways where virtual communication in these communities is possible.

Young Aboriginal people's sexual health risk reduction strategies: a qualitative study in remote Australia.

In-depth interviews with 35 young Aboriginal women and men aged 16-21 years in two remote Australian settings were conducted; inductive thematic analysis examining sexual health risk reduction practices was also conducted. Participants reported individual and collective STI and pregnancy risk reduction strategies. Individual practices included accessing and carrying condoms; having a regular casual sexual partner; being in a long-term trusting relationship; using long-acting reversible contraception; having fewer sexual partners; abstaining from sex; accessing STI testing. More collective strategies included: refusing sex without a condom; accompanied health clinic visits with a trusted individual; encouraging friends to use condoms and go for STI testing; providing friends with condoms. Findings broaden understanding of young Aboriginal people's sexual health risk reduction strategies in remote Aboriginal communities. Findings signal the need for multisectoral STI prevention and sexual health programs driven by young people's existing harm minimisation strategies and cultural models of collective support. Specific strategies to enhance young people's sexual health include: peer condom distribution; accompanied health service visits; peer-led health promotion; continued community-based condom distribution; enhanced access to a fuller range of available contraception in primary care settings; engaging health service-experienced young people as 'youth health workers'.

Editors' Foreword

Editors' Foreword Mark G. Brett and Susan E. Hylen This issue of JBL was produced under extraordinary circumstances. The world was in lockdown in response to the COVID-19 pandemic, and each day we woke to news of rising infection rates and death tolls around the globe. There have been significant variations among the international reports, although a relentless unveiling of inequalities has been typical in many different contexts. In the United States and the United Kingdom, the infection statistics are disproportionately high; in Vietnam and Kerala, remarkably low. Remote Aboriginal communities in Australia have so far been spared, in part because their leaders saw the potential dangers very early and exhorted people to retreat to their traditional lands away from the centers of industry. Because Aboriginal people have suffered from imported diseases many times in the past, the communal memory was sensitized to the signs of danger.1 Amid these very pressing global concerns, academic journals have reported a dramatic fall in the number of submissions written by women. But as Gale Yee made clear in her Presidential Address to the Society of Biblical Literature last year, there are many other intersectional factors that need to be considered: race, color, and class would need to be added to our statistics before the dynamics of inequality could be understood in all their layered complexity. And even if some institutions in the United States can celebrate the participation of nonwhite faculty, there are researchers from universities in many other parts of the world who have never contributed to JBL. Most of us will be all too aware that patterns of inequality have steadily increased since the 1980s, and even the dismal science of economics has managed to produce bestsellers on the theme. Most recently, in Capital and Ideology, Thomas Piketty has delivered a one-thousand-page challenge to all of us who worry about [End Page 231] the problems generated by inequality in education.2 That book was written before the coronavirus pandemic, so there is already a new genre of revelation upon us. In the September issue of JBL this year, we are aiming to provide a forum on the topic "Biblical Studies in a Pandemic," and an international group of scholars has been asked to offer their brief reflections. We hope that this will just be one example of a lively debate in years to come. [End Page 232] Footnotes 1. Amy McQuire, "Aboriginal Community Health's Success with Covid-19," The Saturday Paper 298 (2020), https://www.thesaturdaypaper.com.au/news/health/2020/04/25/aboriginal-community-healths-success-with-covid-19/15877368009740. 2. Thomas Piketty, Capital and Ideology, trans. Arthur Goldhammer (Cambridge: Harvard University Press 2020). Copyright © 2020 Society of Biblical Literature

Contextual and behavioural risk factors for sexually transmissible infections in young Aboriginal people in central Australia: a qualitative study

Rates of sexually transmissible infections (STIs) in remote central Australian Aboriginal communities have been persistently high for over two decades, yet risk factors for STIs in these communities are not well understood. This qualitative study explored behavioural and contextual risk factors for STIs in young Aboriginal people in central Australia. The study identified that casual relationships between young people are common and that there is a strong association between travel, alcohol and casual sex, highlighting the ongoing need for comprehensive sexual health programs that are tailored to the specific social, cultural and interpersonal circumstances of young people in this setting.

Gesturing Across Settler Divides in Marumpu Wangka! Kukatja Hand Talk

In 2014, the government of Western Australia proposed a plan to defund, and in effect close, about half of the nearly three hundred remote Aboriginal communities in the state. During this time, the author collaborated on a hand sign video project with five women Elders at the Kapululangu Women’s Law and Culture Centre in Balgo, an Aboriginal community in the Great Sandy Desert. The author articulates why Marumpu Wangka! Kukatja Hand Talk—an unassuming and largely improvised video—struck a chord at this precarious moment for Aboriginal communities. The author argues that hand sign videos provide a rare mode of intercultural engagement that is simultaneously culturally specific and broadly relatable. In a mediascape in which most Australian viewers are inundated with visual tropes of Aboriginal communities as either suffering or mystical, representations of jovial gesture encourage understanding beyond these stereotypes by intimately engaging everyday community interaction. Referencing the supplemental eight-minute video throughout, the author (1) overviews the significance of hand sign systems in Aboriginal Australian communities, (2) describes the collaborative and improvised hand sign video production process, and (3) argues for the importance of visual representations that can transcend—even if modestly—settler/Indigenous divides during the current dangerous times for Aboriginal communities.

Supporting healthy drink choices in remote Aboriginal and Torres Strait Islander communities: a community‐led supportive environment approach

ObjectiveTo create supportive environments to reduce sugary drink consumption and increase water consumption by partnering with remote Aboriginal and Torres Strait Islander communities in Cape York. MethodsThis paper applied qualitative and quantitative methods to evaluate a co‐designed multi‐strategy health promotion initiative, implemented over 12 months from 2017 to 2018. Outcome measures included changes in community readiness, awareness of the social marketing campaign and changes in drink availability. Changes in store drink sales were measured in one community and compared to sales in a control store. ResultsCommunity readiness to address sugary drink consumption increased in two of the three communities. Awareness of social marketing campaign messaging was high (56–94%). Availability of drinking water increased in all communities. Water sales as a proportion of total drink volume sales increased by 3.1% (p<0.001) while sugary drink volume sales decreased by 3.4% (p<0.001). ConclusionsA multi‐component strategy with strong engagement from local government, community leaders and the wider community was associated with positive changes in community readiness, drink availability and sales. Implications for public healthPartnering with community leaders in the co‐design of strategies to create environments that support healthy drink consumption can stimulate local action and may positively affect drink consumption.

Empowerment is the Basis for Improving Education and Employment Outcomes for Aboriginal People in Remote Australia

In Australia, Aboriginal and Torres Strait Islander people score poorly on national mainstream indicators of wellbeing, with the lowest outcomes recorded in remote communities. As part of a ‘shared space’ collaboration between remote Aboriginal communities, government and scientists, the holistic Interplay Wellbeing Framework and accompanying survey were designed bringing together Aboriginal priorities of culture, empowerment and community with government priorities of education, employment and health. Quantitative survey data were collected from a cohort of 841 Aboriginal people aged 15–34 years, from four different Aboriginal communities. Aboriginal community researchers designed and administered the survey. Structural equation modelling was used to identify the strongest interrelating pathways within the framework. Optimal pathways from education to employment were explored with the concept of empowerment playing a key role. Here, education was defined by self-reported English literacy and numeracy and empowerment was defined as identity, self-efficacy and resilience. Empowerment had a strong positive impact on education (β = 0.38, p &lt; .001) and strong correlation with employment (β = 0.19, p &lt; .001). Education has a strong direct effect on employment (β = 0.40, p &lt; .001). This suggests that education and employment strategies that foster and build on a sense of empowerment are mostly likely to succeed, providing guidance for policy and programs.

A Bit of Ripping and Tearing: An Interpretative Study of Indigenous Engagement Officers’ Perceptions Regarding Their Community and Workplace Roles

The Australian Government (AG) employs Indigenous Engagement Officers (IEO) in many of the remote Aboriginal communities of the Northern Territory (NT). IEOs are respected community members who apply their deep understanding of local tradition, language and politics in providing expert cultural advice to government. Competing priorities of workplace and cultural obligation make the IEO role stressful and dichotomous in nature. The workplace experiences and perceptions of IEOs remain largely unexplored and there is scant understanding of the significant crosscultural issues associated with the role. IEOs typically confront ongoing workplace stress and are unable to perform at full capacity. This qualitative study explores participant meaning regarding workplace and community roles to inform the AG in development of culturally appropriate training and support for IEOs. The study captures detailed information from six IEOs through an interpretive process sensitive to phenomenological experience. Personal meanings associated with the workplace are assembled through individual interviews and focus group sessions. Interpretative Phenomenological Analysis methodology is applied to the resulting idiographic dataset in exposing a range of superordinate themes including desire for recognition and feelings of abandonment. Findings reveal the need to incorporate correct cultural protocols in the workplace and give preference for Aboriginal learning styles in professional development activities. There is urgent need for a range of workplace supports for IEOs in future capacity-building strategies.

Skin infections in Australian Aboriginal children: a narrative review.

Summary Impetigo, scabies, cellulitis and abscesses are common in Australian Aboriginal children. These conditions adversely affect wellbeing and are associated with serious long term sequelae, including invasive infection and post‐infectious complications, such as acute post‐streptococcal glomerulonephritis and acute rheumatic fever, which occurs at the highest documented rates in the world in remote Aboriginal communities.Observational research in remote communities in northern Australia has demonstrated a high concurrent burden of scabies and impetigo and their post‐infectious complications.Few data are available for other Australian states, especially for urban Aboriginal children; however, nationwide hospital data indicate that the disparity between Aboriginal and non‐Aboriginal children in skin infection prevalence also exists in urban settings.The Australian National Healthy Skin Guideline summarises evidence‐based treatment of impetigo, scabies and fungal infections in high burden settings such as remote Aboriginal communities. It recommends systemic antibiotics for children with impetigo, and either topical permethrin or oral ivermectin (second line) for the individual and their contacts as equally efficacious treatments for scabies. β‐Lactams are the treatment of choice and trimethoprim–sulfamethoxazole and clindamycin are effective alternatives for treatment of paediatric cellulitis. Abscesses require incision and drainage and a 5‐day course of trimethoprim–sulfamethoxazole or clindamycin.Addressing normalisation of skin infections and the social determinants of skin health are key challenges for the clinician. Research is underway on community‐wide skin health programs and the role for mass drug administration which will guide future management of these common, treatable diseases.