1. Aboriginal sexual health: The Australian : Was the syphilis epidemic preventable ? NACCHO responds
2.Royal Flying Doctors Service extra 4-year funding $84 million Mental Health and Dental Services
3.Nurses PAQ continues political membership campaign spreading false and misleading information about our cultural safety
4.AMSANT has called for re-doubled efforts to implement the recommendations of the Royal Commission into the care and protection of children in partnership with NT Aboriginal leaders
5.Dialysis facilities worth $17 million are sitting padlocked, empty and unused in WA’s north
6.ALRC Report into Incarceration of Aboriginal and Torres Strait Islander People.
7. Minister Ken Wyatt : Listening to Indigenous Needs: Healthy Ears Program Extended with $29.4 commitment
8.Tangentyere Alice Springs Women’s Family Safety Group visits Canberra
9.Minister Ken Wyatt launches our NACCHO RACGP National Guide to a preventative health assessment for Aboriginal and Torres Strait Islander people
10. Your guide to a healthy Easter : #Eggs-actly
1.Aboriginal sexual health: The Australian : Was the syphilis epidemic preventable ? NACCHO responds
“These (STIs) are preventable diseases and we need increased testing, treatment plans and a culturally appropriate health education campaign that focuses resources on promoting safe-sex messages delivered to at-risk communities by our trained Aboriginal workforce,”
Pat Turner, chief executive of peak body the National Aboriginal Community Controlled Health Organisation, is adamant about this.
Read full article in Easter Monday The Australian or Part B below
2.Royal Flying Doctors Service extra 4-year funding $84 million Mental Health and Dental Services
3.Nurses PAQ continues political membership campaign spreading false and misleading information about cultural safety
SEE an Indigenous Patients Response
See Nurses PAQ Misleading and false campaign
4. AMSANT has called for re-doubled efforts to implement the recommendations of the Royal Commission into the care and protection of children in partnership with NT Aboriginal leaders
Read full AMSANT press Release
Listen to interview with Donna Ah Chee
Press Release @NACCHOChair calls on the Federal Government to work with us to keep our children safe
#WeHaveTheSolutions Plus comments from CEO’s @Anyinginyi @DanilaDilba
4.Dialysis facilities worth $17 million are sitting padlocked, empty and unused in WA’s north
6.ALRC Report into Incarceration of Aboriginal and Torres Strait Islander People;
Read Download Full Transcript
Download the report from HERE
Community Groups Call For Action on Indigenous Incarceration Rates
7. Minister Ken Wyatt : Listening to Indigenous Needs: Healthy Ears Program Extended with $29.4 commitment
The Australian Government has committed $29.4 million to extend the Healthy Ears – Better Hearing, Better Listening Program, to help ensure tens of thousands more Indigenous children and young adults grow up with good hearing and the opportunities it brings.
8.Tangentyere Alice Springs Women’s Family Safety Group visits Canberra
Read Download the Press Release
TANGENTYERE WOMEN’S FAMILY SAFETY GROUP (FED
9. Minister Ken Wyatt launches our NACCHO RACGP National Guide to a preventative health assessment for Aboriginal and Torres Strait Islander people
Read press releases and link to Download the National Guide
10. Your guide to a healthy Easter : #Eggs-actly
And finally hope you had a Happy Easter all you mob ! After you have enjoyed your chocolate #Easter eggs and hot cross buns , this is how much exercise you will require to work of those Easter treats .
For medical and nutrition advice please check with your ACCHO Doctor , Health Promotion / Lifestyle teams or one of our ACCHO nutritionists
Part B Full Text The Australian Article Easter Monday
There is no reason it should have happened, especially not in a first-world country like Australia, but it has: indigenous communities in the country’s north are in the grip of wholly treatable sexually transmitted diseases.
In the case of syphilis, it is an epidemic — West Australian Labor senator Patrick Dodson described it as such, in a fury, when health department bureaucrats mumbled during Senate estimates about having held a few “meetings” on the matter.
There have been about 2000 syphilis notifications — with at least 13 congenital cases, six of them fatal — since the outbreak began in northern Queensland in 2011, before spreading to the Northern Territory, Western Australia and, finally, South Australia.
What’s worse, it could have been stopped. James Ward, of the South Australian Health and Medical Research Institute, wrote in mid-2011 that there had been a “downward trend” over several years and it was likely at that point that the “elimination of syphilis is achievable within indigenous remote communities”.
But governments were slow to react, and Ward is now assisting in the design of an $8.8 million emergency “surge” treatment approach on the cusp of being rolled out in Cairns and Darwin, with sites in the two remaining affected states yet to be identified.
It will be an aggressive strategy — under previous guidelines, you had to have been identified during a health check as an active carrier of syphilis to be treated. Now, anyone who registers antibodies for the pathogen during a blood prick test, whether actively carrying syphilis or not, will receive an immediate penicillin injection in an attempt to halt the infection’s geographical spread.
This is key: the high mobility of indigenous people in northern and central Australia means pathogens cross jurisdictions with impunity. Australian Medical Association president Michael Gannon calls syphilis a “clever bacterium that will never go away”, warning that “bugs don’t respect state borders”.
Olga Havnen, one of the Northern Territory’s most respected public health experts, points out that many people “will have connections and relations from the Torres Strait through to the Kimberley and on to Broome — and it’s only a matter of seven or eight kilometres between PNG and the northernmost islands there in the Torres Strait”.
“This is probably something that’s not really understood by the broader Australian community,” Havnen says. “I suspect once you get a major outbreak of something like encephalitis or Dengue fever, any of those mosquito-borne diseases, and that starts to encroach onto the mainland, then people will start to get a bit worried.”
But it is not just syphilis — indeed, not even just STIs — that have infectious disease authorities concerned and the network of Aboriginal Community Controlled Health Organisations stretched.
Chlamydia, the nation’s most frequently diagnosed STI in 2016 based on figures from the Kirby Institute at the University of NSW, is three times more likely to be contracted by an indigenous Australian than a non-indigenous one.
The rate was highest in the NT, at 1689.1 notifications per 100,000 indigenous people, compared with 607.9 per 100,000 non-indigenous Territorians. If you’re indigenous, you’re seven times more likely to contract gonorrhoea, spiking to 15 times more likely if only women are considered. Syphilis, five times more likely.
As the syphilis response gets under way, health services such as the one Havnen leads, the Darwin-based Danila Dilba, will be given extra resources to tackle it. “With proper resourcing, if you want to be doing outreach with those people who might be visitors to town living in the long grass, then we’re probably best placed to be able to do that,” she says.
But the extra focus comes with a warning. A spate of alleged sexual assaults on Aboriginal children, beginning with a two-year-old in Tennant Creek last month and followed by three more alleged attacks, has raised speculation of a link between high STI rates and evidence of child sexual assault.
After the first case, former NT children’s commissioner Howard Bath told this newspaper that STI rates were “a better indicator of background levels of abuse than reporting because so many of those cases don’t get reported to anyone, whereas kids with serious infections do tend to go to a doctor”. Others, including Alice Springs town councillor Jacinta Price and Aboriginal businessman Warren Mundine, raised the spectre of the need for removing more at-risk indigenous children from dangerous environments.
However, Sarah Giles, Danila Dilba’s clinical director and a medical practitioner of 20 years’ standing in northern Australia, warns this kind of response only exacerbates the problem. She is one of a range of public health authorities who, like Havnen, say connecting high STI figures to the very real scourge of child sex abuse simply makes no sense. They do not carry correlated data sets, the experts say.
“One of the things that’s really unhelpful about trying to manage STIs at a population level is to link it with child abuse and mandatory reporting, and for people to be fearful of STIs,” Giles says. “The problem is that when they’re conflated and when communities feel that they can’t get help because things might be misinterpreted or things might be reported, they’re less likely to present with symptoms. The majority of STIs are in adults and they’re sexually transmitted.”
Havnen says there is evidence of STIs being transmitted non-sexually, including to children, such as through poor hand hygiene, although Giles says that is “reasonably rare”. And while NT data shows five children under 12 contracted either chlamydia or gonorrhoea in 2016 (none had syphilis), and there were another five under 12 last year, Havnen points to the fact that over the past decade there has been no increasing trend in under 12s being affected. Where there has been a rise in the NT is in people aged between 13 and 19, with annual gonorrhoea notifications increasing from 64 cases in the 14-15-year-old female cohort in 2006 to 94 notifications in 2016.
In the 16-17-year-old female cohort the same figures were 96 and 141 and in the 12-13-year-old group it rose from 20 in 2006 to 33 in 2016. Overall, for both boys and girls under 16, annual gonorrhoea notifications rose from 109 in 2006 to 186 in 2016, according to figures provided to the royal commission into child detention by NT Health. Havnen describes the rise as “concerning but not, on its own, evidence of increasing levels of sexual abuse”.
Ward is more direct. Not all STIs are the result of sexual abuse, he warns, and not all sexual abuse results in an STI. If you’re a health professional trying to deal with an epidemiological wildfire, the distinction matters — the data and its correct interpretations can literally be a matter of life and death.
Indeed, in its own written caveats to the material it provided to the royal commission, the department warns that sexual health data is “very much subject to variations in testing” and warns against making “misleading assumptions about trends”. Ward says: “Most STIs notified in remote indigenous communities are assumed to be the result of sex between consenting adults — that is, 16 to 30-year-olds. Of the under 16s, the majority are 14 and 15-year-olds.” He says a historically high background prevalence of STIs in remote indigenous communities — along with a range of other infectious diseases long eradicated elsewhere — is to blame for their ongoing presence. Poor education, health services and hygiene contribute, and where drug and alcohol problems exist, sexually risky behaviour is more likely too. The lingering impact of colonisation and arrival of diseases then still common in broader society cannot be underestimated.
But Ward claims that an apparently high territory police figure of about 700 cases of “suspected child sexual offences” in the NT over the past five years may be misleading. He says a large number of these are likely to be the result of mandatory reporting, where someone under 16 is known to have a partner with an age gap of more than two years, or someone under 14 is known to be engaging in sexual activity. Ward points out that 15 is the nationwide median sexual debut age, an age he suggests is dropping. At any rate, he argues, child sex abuse is unlikely to be the main reason for that high rate of mandatory reporting in the NT.
Data matters, and so does how it is used. Chipping away at the perception of child sexual abuse in indigenous communities are the latest figures from the Australian Institute of Health and Welfare showing the rate of removals for that crime is actually higher in non-indigenous Australia.
According to a report this month from the AIHW, removals based on substantiated sex abuse cases in 2016-17 were starkly different for each cohort: 8.3 per cent for indigenous children, from a total of 13,749 removals, and 13.4 per cent for non-indigenous children, from 34,915 removals.
Havnen concedes there is a need for better reporting of child abuse and has called for a confidential helpline that would be free of charge and staffed around the clock by health professionals.
It’s based on a model already in use in Europe that she says deals with millions of calls a year — but it would require a comprehensive education and publicity campaign if it were to gain traction in remote Australia. And that means starting with the adults.
“If you’re going to do sex education in schools and you start to move into the area about sexual abuse and violence and so on, it’s really important that adults are educated first about what to do with that information,” she says. “Because too often if you just educate kids, and they come home and make a disclosure, they end up being told they’re liars.”
These challenges exist against the backdrop of a community already beset by a range of infectious diseases barely present elsewhere in the country, including the STIs that should be so easily treatable. It is, as Havnen is the first to admit, a complex matter.
Cheryl Jones, president of the Australasian Society for Infectious Diseases, says the answer is better primary treatment solutions and education, rather than trying to solve the problem after it has occurred. “For any of these public health infectious disease problems in remote and rural areas, we need to support basic infrastructure at the point of care and work alongside communities to come up with solutions,” she says.
Pat Turner, chief executive of peak body the National Aboriginal Community Controlled Health Organisation, is adamant about this. “These (STIs) are preventable diseases and we need increased testing, treatment plans and a culturally appropriate health education campaign that focuses resources on promoting safe-sex messages delivered to at-risk communities by our trained Aboriginal workforce,” Turner says.
The Australian Medical Association has called for the formation of a national Centre for Disease Control, focusing on global surveillance and most likely based in the north, as being “urgently needed to provide national leadership and to co-ordinate rapid and effective public health responses to manage communicable diseases and outbreaks”.
“The current approach to disease threats, and control of infectious diseases, relies on disjointed state and commonwealth formal structures, informal networks, collaborations, and the goodwill of public health and infectious disease physicians,” the association warned in a submission to the Turnbull government last year.
However, the federal health department has rebuffed the CDC argument, telling the association that “our current arrangements are effective” and warning the suggestion could introduce “considerable overlap and duplication with existing functions”.
“I think it (the CDC) might have some merit, if it helps to advocate with government about what needs to happen,” Havnen says, “but if these things are going to be targeted at Aboriginal bodies, it needs to be a genuine partnership. It’s got to be informed by the realities on the ground and what we know. That information has to be fed up into the planning process.”