NACCHO Aboriginal ehealth technology news: Telehealth,ehealth and the Aboriginal digital divide

Eh ealth

In this issue Telehealth

Roy Monaghan, national telehealth delivery officer at the National Aboriginal Community Controlled Health Organisation (NACCHO), says the lack of reliable broadband in remote and rural Australia has contributed to a digital divide.

Please note that NACCHO plans to launch an ABORIGINAL HEALTH APP this week as part of its Sports Healthy Futures Program ;

Followed by Ehealth below

The PCEHR will become the primary record for all new information, but the MeHR will also be accessible for historical documents.

The NT is also holding off until next year as the national PCEHR cannot yet receive pathology and diagnostic imaging reports, which the MeHR can. The NT is planning to go live just after the major upgrade of the PCEHR planned for April, when pathology reports are expected to be available.

TELEHEALTH: Slow NBN rollout contributing to digital literacy deficit

Roy
The slow roll out of the National Broadband Network is contributing an ongoing digital literacy deficit across Australia, especially in telehealth, according to speakers at the Connected Australia event in Sydney.

“There’s a lot of up-skilling to do, in particular at the home end or recipient end of healthcare. There’s a notion of build it and they will come: If you don’t have the NBN, you won’t generate the digital literacy to maximise the use of it. So it’s a little like chicken and egg,” said Professor Colin Carati, associate head of ICT at Flinders University.

Roy Monaghan, national telehealth delivery officer at the National Aboriginal Community Controlled Health Organisation (NACCHO), agreed, saying the lack of reliable broadband in remote and rural Australia has contributed to a digital divide.

“It’s like having a bike: you don’t really learn what the bike can do until you get on it. You may make a few mistakes, but essentially you have a vehicle that can take you faster than you can with your legs. If people don’t have the ability to jump onto a system and make those mistakes, adjust and learn on how to do things a bit better, we are not going to go places.”

Carati pointed to issues around the NBN rollout schedule not going according to plan, saying it has made the process of providing adequate teleheatlh services difficult.

A NACCHO survey showed that only 30 of about 100 members were actually engaging in telehealth services, with the lack of an effective Internet connection being the main reason why many weren’t engaging in telehealth, said Monaghan.

He added that the new government’s fibre-to-the-node broadband policy is “an incomplete solution”, but it could offer some flexibility in being able to make changes to the network as technology continues evolves over time.

“It could be that wireless technology does evolve and you may be able to [leverage] it at these nodes, and maybe there will be a Wi-Fi tower that can shoot out the information at a very high speed.”

A telehealth project that Carati is working on in South Australia is providing people at home with particular health conditions to have their health status monitored remotely on a regular basis through an iPad app and through video conferencing.

He said he was able to provide this without the need for a large amount of bandwidth; less than 1Mbps per video conference. However, he said he is still limited in the quality of service he can provide due to poor reliability of Internet.

“There are occasions, especially when you are using non NBN related technologies, where you are getting poor quality and reliability of service, primarily though the contention of those technologies where you are getting too many people trying to jump on the bandwidth.

“The NBN will improve access, especially pushing out to the home and the bandwidth demands are likely to increase.”

ehealth

States commit to rapid eHealth integration project

Written by Kate McDonald on 10 October 2013., Pulse IT magazine

The majority of states and territories will have the ability to begin allowing acute care clinicians to view clinical documents and send discharge summaries to the PCEHR system by the end of the year.

In a panel discussion at a recent ICT forum organised by the Department of Health and NEHTA, jurisdictional representatives provided an update on their respective eHealth strategies and how they planned to connect acute care to the PCEHR.

No representatives from South Australia and Western Australia were on the panel, although SA has already begun sending discharge summaries from nine public hospitals and has developed software called Healthcare Information and PCEHR Services (HIPS) that is being used by other states as part of NEHTA’s unfortunately named rapid integration project (RIP).

Paul McRae, the principal enterprise architect with Queensland Health, told the forum that the jurisdictions were all members of a RIP steering committee that he chairs. Mr McRae said the committee had agreed that the first steps to integrating with the PCEHR was to enable discharge summaries to be uploaded and to allow clinicians to view clinical documents.

Mr McRae said Queensland Health had linked with the HI Service in January this year, and those using it were achieving an 85 per cent match rate when pulling in batches of Individual Healthcare Identifiers (IHIs).

He said NASH certificates and HPI-Os were recently acquired for healthcare organisations to support the rapid integration program.

“We are looking to roll out statewide the ability to send discharge summaries to the PCEHR from all facilities that use our enterprise discharge summary application, which is all bar about three,” he said.

“And we are going to provide the ability to view PCEHR information from our clinical portal, which is called The Viewer . That will be available in around 200-plus facilities and that will all happen early in November.

“At the same time, discharge summaries in CDA format level 2 will be able to be sent point to point as well.”

Yin Man, manager of NSW Health’s RIP program – better known as HealtheNet – said CDA discharge summaries and event summaries had been able to be sent to GPs and the NSW clinical repository from within the Greater Western Sydney lead site since August last year.

Clinicians in Greater Western Sydney are now able to access the national system through a clinical portal , which Ms Man said would be rolled out to all public hospitals in the state over the next two years.

“Our clinicians in hospitals within Greater Western Sydney have been viewing CDA discharges since last August and this year we have been integrating with the national,” she said.

“All hospitals will be connected to this one portal. Things have been going quite well and we already have half a million CDA documents within our clinical repository, and we pretty much generate about 6000 a month. As soon as we connect, we will be sending a lot of documents to the national.”

Victoria’s representative on the panel, the Victorian Department of Health’s advisor on eHealth policy and engagement, Peter Williams, did not go into much detail on his state’s plans for integrating with the PCEHR as a review of the state’s health IT sector is currently with the health minister.

It is understood that some local health districts – particularly those that took part in the Wave 1 and 2 lead site projects – are soon to begin sending discharge summaries to the national system, but Victoria does not have the centralised approach that the other states are taking.

Mr Williams said Victoria had put a proposal to NEHTA to look at how to expand the viewing capacity of hospitals outside of the lead sites. “Once you have done it for some, you can extend it to others … using common software, and we have licences across Victoria,” he said.

“With the secure messaging project that is being done in SA, while they are using different technology, the design approach is adaptable in Victoria very quickly. That is absolutely the core of what the RIP project is about – fast-tracking some of those things.”

The Northern Territory is currently working through a major project that it is calling the M2N , in which it is transitioning its successful My eHealth Record (MeHR) system over to the national PCEHR. For that reason, it will not go live with full discharge summary and viewing capability until March or April next year.

Robert Whitehead, director of eHealth policy and strategy with the NT Department of Health, said the territory was probably going to follow Queensland and provide a combined view of both the MeHR and the PCEHR for its departmental staff.

The PCEHR will become the primary record for all new information, but the MeHR will also be accessible for historical documents.

The NT is also holding off until next year as the national PCEHR cannot yet receive pathology and diagnostic imaging reports, which the MeHR can. The NT is planning to go live just after the major upgrade of the PCEHR planned for April, when pathology reports are expected to be available.

“We have a unique set of circumstances in that we’ve been operating [the MeHR] now for eight years,” Mr Whitehead said. “We’ve got an established community of consumers and providers who have expectations about usability.

“We needed … for our clinicians in particular to be confident that what they see in [the PCEHR] matched what they currently are able to see. That has been the driver for asking DoHA and NEHTA to advance some aspects of PCEHR work in terms of a view that would support an aggregation of some key pieces of primary care information and event summaries.

“Our clinicians at the moment have access to a document that aggregates information … and that gives them a bit of a context about what has been going on with that patient in the last little while.

“The other thing is around pathology and diagnostic imaging reports in that our clinicians are used to being able to seeing pathology results that were ordered in a primary care context. Hospital stuff at the moment appears in the discharge summary and we are not arguing that should be changed.

“So our go live is a little later in that we are targeting around March-April next year as the go live date because of this need to do a hard transition from one to the other. We will still do a dual view of MeHR for people who are registered so that historical information is still accessible to our current participating healthcare providers.”

Like Victoria, Tasmania is also currently undertaking a review of its eHealth strategy. Tim Blake, deputy chief information officer with the Tasmanian Department of Health and Human Services, said Tasmania was “on the cusp” of releasing its updated eHealth strategy, which is expected to include more details about connecting to the national system.

Pulse+IT understands that Tasmania will adopt the South Australian technology to begin allowing discharge summaries to be sent and clinical documents to be viewed within its public hospitals.

The ACT has been very active in eHealth, with Calvary Hospital playing a large role in one of the Wave 2 projects and already having the ability to send CDA discharge summaries to the PCEHR and to GPs.

The ACT Health Directorate’s manager for the national eHealth project, Ian Bull, said the territory had been investigating how to quickly verify IHIs for newborn babies, so their parents can register them for a PCEHR from birth.

“Within our jurisdiction we are building a consumer portal , so consumers can log in and look at their appointments for outpatients services,” Mr Bull said.“We are also building a provider portal for clinicians in the region to be able to submit referrals and get bookings.”

He said the ACT was also in discussions with the federal Department of Human Services to investigate using Medicare’s Health Professional Online Services (HPOS) system more widely in the hospital environment.

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Update 1.00 pm October 16

UGPA calls on Government to address clinical utility of the PCEHR as an urgent priority

Australia’s general practice (GP) leaders are calling on the Government to heed concerns raised by GPs regarding the significant clinical utility issues associated with the Personally Controlled eHealth Record (PCEHR) system and address them as an urgent priority.

At a recent United General Practice Australia (UGPA) meeting in Canberra, representatives of the GP sector unanimously agreed that the focus of the PCEHR needs to be redirected to clinical utility and standardisation to ensure seamless clinical adoption.

Significant issues have been identified and currently there is no alignment between consumer registration and meaningful use through engagement of the clinical community and assurance of improvement of patient health outcomes.

In August 2013 a number of key clinical leads resigned from National E-Health Transition Authority (NEHTA). This was amidst ongoing concerns and requests for NEHTA and the Department of Health and Ageing (DoHA) to review the PCEHR development cycle and re-establish meaningful clinical l input.

Since August, DoHA has become the PCEHR system operator and opportunities for clinical engagement have been less clear.

UGPA is calling on Government to implement strategies to ensure the PCEHR is best structured to improve the health outcomes of all Australians. The process should be profession led and include:

• GP input at every level of the PCEHR development life cycle; including planning through to implementation

• Ensuring the system is clinically safe, usable and fit for purpose

• Supported by an acceptable, and robust legal and privacy framework

• Secure messaging interoperability is a critical dependency priority.

E-health and the PCEHR have the potential to transform Australia’s health system and provide superior, safer and more efficient healthcare to all Australian patients. UGPA members believe that this potential will only be fully realised if there is meaningful clinical engagement at a grassroots level.

The Government has announced it will review implementation of the PCEHR. UGPA supports the review and look forward to contributing to the review and expect that the clinical voice and the concerns raised will be heard.

ENDS

UGPA comprises the Royal Australian College of General Practitioners (RACGP), the Australian Medical Association (AMA), the Australian Medicare Local Alliance (AMLA), the Australian General 2

Practice Network (AGPN), General Practice Registrars Australia (GPRA), the Australian College of Rural and Remote Medicine (ACRRM), and the Rural Doctors Association of Australia (RDAA).

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NACCHO health news: The role of Aboriginal Community Controlled Health Services in Indigenous health

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“Our right to take back responsibility.” Noel Pearson, 2000 [1]

This emotive aphorism by Pearson embodies the struggle of Australia’s Indigenous people to gain control of their destiny, which for generations has been wrested from them into the power of governments.

Although his statement was primarily directed toward welfare, the same right of responsibility can be applied to health, perhaps the gravest challenge facing the Aboriginal population.

Article by: Michael Weightman
Sixth Year Medicine (Undergraduate)
University of Adelaide

As Pearson alluded to, the only way to solve the health crisis is by enabling local communities to take charge of their own affairs.

This principle of self-determination has led to the creation of Aboriginal Community Controlled Health Services (ACCHS), which has allowed over 150 Aboriginal communities throughout Australia control over their healthcare. [2] This article describes the founding principles behind community controlled health centres in Aboriginal communities through considering several different ACCHS and the unique challenges they face.

The fundamental concept behind each ACCHS – whether metropolitan, rural or remote – is the establishment of a primary healthcare facility that is both built and run by the local Aboriginal people “to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it.” [2] This is based upon the principle of self-determination and grants local people the power to achieve their own goals. From the beginning ACCHS were always intended to be more than exclusively a healthcare centre and each ACCHS has four key roles: the provision of primary clinical care, community support, special needs programmes, and advocacy.

ACCHS endeavour to provide primary healthcare as enshrined by the World Health Organization in the 1978 Declaration of Alma-Ata. This landmark international conference defined primary healthcare as:

“essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain… in the spirit of self-determination.” [3]

Although conceived subsequent to the advent of the community controlled healthcare movement in Australia, this definition echoes many of the underlying principles upon which ACCHS were founded, including the most important aspect – local control. Indeed, it is widely accepted throughout the literature that the community itself must identify its needs and problems so an effective and appropriate course of action can be undertaken. [4-7]

This principle is espoused in the National Aboriginal Health Strategy’s frequently quoted statement that “Aboriginal health is not just the physical well-being of an individual but the social, emotional and cultural well-being of the whole community in which each individual is able to achieve their full potential thereby bringing about the total well-being of their community.” [8] The notion of ‘community’ is an essential component of the Indigenous view of the self and therefore strongly related to health and well-being. Accordingly, ACCHS have a holistic view of healthcare, recognising that Indigenous healthcare needs to be multi-faceted and focus on cultural complexities that may not be appreciated by mainstream health services. As each Aboriginal community across the country has a distinct culture and language, [9] local control is paramount.

The concept of community control is not new. It can be traced back to early nineteenth-century America, where such services were used with success for improving the health of the poor and recent migrants. [4] The first ACCHS was established in the inner city Sydney suburb of Redfern in 1971. [10] Known as the Aboriginal Medical Service (AMS), it pioneered the concept of community controlled healthcare in Australia and, from modest beginnings, has now expanded into a major, versatile healthcare facility that provides free medical, dental, psychological, antenatal and drug and alcohol services to the large Aboriginal community in Sydney. Redfern’s AMS overcame struggles against an initially distrustful and paternalistic government through the dedication of visionary Indigenous leaders and support of benevolent non-Indigenous Australians. [10,11]

Specialised Indigenous policies are essential, as it is impossible to apply the same approach that is used in health services for non-Indigenous patients. Many Indigenous people are uncomfortable with seeking medical help at hospitals or general practices and therefore are reluctant to obtain essential care. [12] In addition, access to healthcare is often extremely difficult due to either geographical isolation or lack of transportation. Many Indigenous people live below the poverty line, so the services provided by practices that do not bulk bill are unattainable. Mainstream services struggle to provide appropriate healthcare to Aboriginal patients due to significant cultural and language disparities; [5,13] the establishment of ACCHS attempts to overcome such challenges.

For example, the Inala Indigenous Health Service in south-west Brisbane performed extensive market research to determine the factors keeping Aboriginal patients from utilising the mainstream health service. The results showed that several simple measures were highly effective in engaging the local community, such as employing an Indigenous receptionist and making the waiting room more culturally appropriate through local art or broadcasting an Aboriginal radio station. [12] In the five years following implementation of these strategies, the number of Indigenous patients at Inala ballooned from 12 to 899, and an average of four consultations per patient per year was attained, compared to the national Indigenous average of fewer than two. [14] A follow-up survey attributed patient satisfaction to the presence of Indigenous staff and a focus on Indigenous health. [12]

Nevertheless, the consequence of  longstanding obstacles to Indigenous access to mainstream healthcare is manifest in the stark inequity between the health outcomes of Indigenous and non-Indigenous Australians. The most recent data from the Australian Institute of Health and Welfare (AIHW) shows that the discrepancy in life expectancy between Aboriginal Australians and their non-Indigenous counterparts remains unacceptably high, at 11.5 years for males and 9.7 for females. [15] Moreover, studies demonstrate that Aboriginal people have significantly worse outcomes in key health indicators, including infant mortality, diabetes, heart disease, infectious disease and mental illness. [5,12,13,16] Such disparities indicate that a novel, tailored approach to Indigenous health is required.

Cultural understanding is essential, as demonstrated by the example of the Anyinginyi Health Aboriginal Corporation in the Northern Territory. Anyinginyi serves the twelve remote Aboriginal communities within a 100km radius of Tennant Creek and its name comes from the local Warumungu language, meaning ‘belonging to us’ [17] emphasising the community’s control of, and pride in, this service. Anyinginyi has always strived to be more than just a health service and has evolved to deliver many other community programmes. This is embodied by Anyinginyi’s insistence on ‘culturally appropriate’ healthcare for Aboriginal people. In addition to medical advice, the local Aboriginal community is offered support through various programmes that range from employment services to cultural and spiritual activities promoting Indigenous language and culture. One such social service is the ‘Piliyintinji-Ki Stronger Families’ initiative, which assists community members through access to support services relating to issues such as family violence and the Stolen Generations. [17] Indeed, ACCHS such as Anyinginyi have the additional benefit of providing employment opportunities for community members, as the vast majority of the employees are Indigenous. All new staff members participate in a Cross Cultural Workshop, as one of Anyinginyi’s goals is to ensure that the local Aboriginal cultures are respected and continue to thrive.

The other important arm of healthcare in ACCHS relates to population health, with initiatives ranging from education campaigns to immunisations and screening for diseases. [2] One of the first large-scale community health promotion campaigns run specifically for Aboriginal people was conducted by the Redfern AMS between 1983-1984 to encourage breast-feeding among the local Koori mothers. [11] It achieved such stunning success that it set a precedent for all future ACCHS to continue in the important area of preventative medicine, with similar campaigns for sexual health and safe alcohol consumption having been undertaken subsequently.

Moreover, each ACCHS runs special services that are dictated by local needs and priorities. In some instances, there is a specific health problem that needs to be addressed, such as poor nutrition or substance abuse. Other programmes are directed at specific groups, such as young mothers or the elderly. The flexibility of these special services allows each ACCHS to identify and address the most significant problems within its area – problems that can only be identified by the community itself. For example, the Danila Dilba Health Service in Darwin runs a programme called ‘Dare to Dream’ that provides support and counselling for young Indigenous people suffering from mental illness. [18] It is an early intervention programme that intends to identify and support adolescents exhibiting early signs of both behavioural and mental health problems. To this end, school visits are undertaken to promote awareness of mental health issues to students and staff, as well as the services that Danila Dilba has to offer. A ‘chillout’ centre has been set up in Darwin as a safe place for young people to come and allows the community workers to refer those who present to appropriate counselling services. As such, Danila Dilba is empowered to proactively address an important local issue in the most culturally-appropriate way.

ACCHS are also active in the area of advocacy. This involves providing a voice for the community so that their needs can be expressed. Although each ACCHS operates autonomously, they form a national network with their collective interests represented both on a state/territory level and also nationally. Each of the eight states and territories has a peak representative body that acts on behalf of all ACCHS within that jurisdiction. [2] Examples of these organisations include the Aboriginal Health & Medical Research Council of New South Wales and the Aboriginal Medical Services Alliance Northern Territory. At the national level the umbrella body overseeing all the different stakeholders across the country is the National Aboriginal Community Controlled Health Organisation (NACCHO). [2] Individual ACCHS, as well as NACCHO and the affiliated state or territory peak bodies, lobby all levels of government for increased funding and greater recognition of the issues facing Aboriginal communities. The collective weight of NACCHO as a national advocate allows each community’s needs to be heard.

Inevitably, the scope of the services each ACCHS can provide is restricted by funding, most of which comes from the Commonwealth or State and Territory Governments. [2] More money continues to be spent per capita on mainstream health services than on Aboriginal health, despite the great dichotomy in health outcomes. Indeed, the 2012 Indigenous Expenditure Report published figures showing that for every dollar spent on healthcare subsidies for non-Indigenous health, only $0.66 is spent on Aboriginal health. [19] This statistic covers all the key areas of healthcare expenditure, such as Medicare rebates, the pharmaceutical benefits scheme (PBS) and private health insurance rebates. Therefore, Indigenous patients are not receiving the same level of health service delivery, including clinical consultations and treatment, compared to their non-Indigenous counterparts. However, it is propitious to note that the funding bodies have recognised the value of the public health efforts of ACCHS, as the spending in this area is a $4.89 to $1.00 ratio in favour of Indigenous health. [19] Nevertheless, the priority needs to be placed on ensuring that sufficient funding exists to allow Indigenous patients to access health care subsidies as required.

In addition to inadequate funding, another major obstacle that ACCHS face is the difficulty in attracting and retaining doctors and allied health professionals. According to the AIHW’s most recent report, only 63% of Indigenous health services currently employ a doctor. [20] Consequently, a significant increase in the number of general practitioners working with Indigenous patients is required simply to provide adequate services. There is additionally a severe lack of Aboriginal medical students and general practitioners, which limits the opportunities for Indigenous professionals to provide culturally-appropriate care to their own communities. Census data from 2006 found that there were 106 Indigenous doctors nationally, accounting for only 0.19% of all medical practitioners. [21] These shortages are compounded further for ACCHS in rural and remote areas. By 2011, further data from Medical Deans demonstrated that the numbers had increased to 153 Indigenous medical practitioners nationally, along with 218 enrolled Indigenous medical students. Although promising, these numbers remain grossly inadequate to fulfil workforce demand. [22]

Services become stretched due to perpetual resource inadequacies. Understandably, the remoteness of some communities makes service delivery challenging, yet even major metropolitan areas with large Indigenous populations can struggle to adequately provide for those in their catchment area. Under-resourcing places major constraints on service delivery and different ACCHS throughout the country exhibit significant variation in the level of services offered. Some are large, employ several doctors and provide a wide range of services; others are much smaller and operate without doctors. [20] These rely on Aboriginal health workers and nurses to provide the bulk of primary healthcare.

As such, the success of the ACCHS concept would not have been possible without the contribution of Aboriginal health workers. The role of Aboriginal health workers, who are often sourced from the local community, is to provide the primary healthcare that ACCHS offer. [23] This involves assessing patients and then coordinating or providing the medical attention required. Health workers are able to treat certain conditions with the help of standard treatment guidelines and provide a selection of important medications to patients. Importantly, Aboriginal health workers have a liaison role between medical professionals and Aboriginal patients. They are often required to act as an interpreter between the patient and health professional, thus providing an intermediary for cross-cultural interactions, and therefore improving the quality of healthcare provided to the local community.

Due to the often quite remote locations of ACCHS and the scarcity of doctors and nurses, Aboriginal health workers perform many clinical tasks that would be provided by a medical professional in mainstream health services. Aboriginal health workers bear much greater responsibility than their colleagues in the public sector and often learn a wide range of procedural skills including how to perform standard health checks, vaccinations and venepuncture. [23] Indeed, some choose to specialise in a specific area (such as diabetes, pregnancy or infant care) thus gaining additional skills and responsibilities. Still others take on managerial responsibilities. This is in contrast to the public sector, where health workers are often fixed to one routine area or even to non-clinical work such as transportation or social assistance. [23] Without Aboriginal health workers performing these additional tasks, ACCHS would not be able to provide a sufficient level of service for the community. For this reason, Aboriginal health workers are rightly considered the backbone of community controlled health services.

As one example, the Pika Wiya Health Service in the South Australian town of Port Augusta runs two outreach clinics for communities in Copely and Nepabunna. Due to the shortage of doctors, these clinics are staffed entirely by Aboriginal health workers. Their invaluable contribution is evident, with 695 clinical encounters performed by health workers during 2008, [24] ensuring that the absence of doctors did not deny the local people the chance to receive healthcare. Whilst the major health issues faced by Indigenous people are broadly similar between urban and remote communities, these problems are often compounded by the remoteness of the location. Although these are challenges that Copely and Nepabunna will continue to have to face, the empowerment of Aboriginal health workers has helped redefine the direction of Pika Wiya’s outreach health services.

Aboriginal health workers face many difficulties. Perhaps the most significant is that, until recently, there had been no national qualifications or recognition of the skills they developed. [23] The introduction of national registration for Aboriginal health workers (from July 1 2012) and the new qualification of Certificate IV in Aboriginal and Torres Strait Islander Primary Health Care (Practice) have revolutionised the industry. [25] This has had the benefit of standardising the quality and safety of the Aboriginal health worker labour force. However, as the changes will increase the required length and standard of training, there is the potential for current or prospective health workers to be deterred by the prospect of undertaking study at a tertiary level, particularly if they have had limited previous education. Nevertheless, national registration is a positive step for recognising the important work done by Aboriginal health workers, and in providing them with the training to continue serving their communities.

In addition to doctors, nurses and health workers, medical students are also important stakeholders in Indigenous health. First, much has been done in recent years to increase the numbers of Indigenous medical students. For example, the University of Newcastle has been the first medical school to make a dedicated attempt at training Indigenous doctors and has produced approximately 60% of Australia’s Indigenous medical practitioners. [26] This achievement has been based on a “strong focus on community, equity and engagement by the medical profession.” [26] Encouraging community members to enter the profession can be an important way of addressing both the lack of doctors in Indigenous communities and paucity of doctors of Indigenous background. The benefits are broader than this, as Indigenous doctors provide strong role models for young Indigenous people and also have the opportunity to contribute with advocacy and leadership within Indigenous health.

Secondly, the medical student population as a whole is exposed to increasingly more Indigenous health as part of the core curriculum at university following adoption of the updated Australian Medical Council accreditation standards from 2007. [27] Additionally, some students even have the opportunity to spend time in an ACCHS and experience first-hand how the system works. There has been some criticism of these ‘fly in, fly out’ medical electives, where students are sent to ACCHS for short periods and then leave. [28] Whilst this model may be beneficial for the student, it fails to engage the local community as they are unable to build meaningful or lasting relationships with the student.

Better models allow for a longer-term placement and immersion in the community. These include the John Flynn Placement Programme where some students are able to spend a fortnight annually in an ACCHS in the Northern Territory over a period of four years. [29] Another example is the Northern Territory Clinical School, which allows third-year medical students from Flinders University to spend a whole year of study in Darwin, providing the opportunity for increased contact with local Indigenous communities. [30] Initiatives such as these help to build a relationship with the community, and allows for increased acceptance of the medical student. Additionally, the student is able to make a more meaningful contribution to various client’s healthcare. Prolonged or longitudinal attachments have also been shown to increase the likelihood of students returning as a doctor. [31] Certainly, there is much scope for the contribution of medical students to be harnessed more effectively.

It is abundantly apparent that any solution to address the health inequalities of Aboriginal people will only be effective if it recognises that the local Aboriginal communities must control the process of healthcare delivery. This is the principle upon which ACCHS were founded and can be attributed to their many successes, as demonstrated through the examples of Redfern’s AMS, Inala, Anyinginyi, Danila Dilba and Pika Wiya. In spite of the challenges posed by inadequate funding, under-staffing and often remote locations, these organisations strive to uphold the ideals of self-determination and community control. It is hoped that wider adoption of these principles by national governing bodies together with improved financial support will enable Indigenous Australians control over their lives and destinies, leading to better health outcomes.

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NACCHO Aboriginal Health News : New search tool makes finding Aboriginal Health Literature easy

LowitjaInstitute

The Lowitja Institute will today launch a landmark search tool that will make online searching for information about Aboriginal and Torres Strait Islander health easy.

LIt.search is now available on the Lowitja Institute website.

LIt.search enables the user to search the worldwide PubMed database and confine their search to articles about Aboriginal and Torres Strait Islander health. With one click the tool provides access to all available literature in this field and to 27 predefined search topics.

Funded by the Lowitja Institute and developed in partnership with Flinders Filters at Flinders University, LIt.search will be launched at 3.30pm today at the Primary Health Care Research Conference at the Hilton in Sydney.

Lowitja Institute Director and launch host, Professor Lisa Jackson Pulver AM, is keenly aware of how useful this tool will be, not just for students, but for anyone interested in Aboriginal and Torres Strait Islander health. ‘Some of our students are absolutely baffled by the amount of information available on the Internet. A tool like this is critical in providing the best quality information to help them through their studies, as well as helping policy makers make the best informed decisions,’ said Professor Jackson Pulver.

Flinders Filters Project Manager, Dr Jennifer Tieman, has been pleased to be involved with a project that will provide greater access to the wealth of literature available on PubMed about the health of Australia’s First peoples. ‘Given the importance of the Closing the Gap strategy, access to the research knowledge about Australian Aboriginal and Torres Strait health is crucial. The LIt.search tool will help health care providers, community organisations, academics, researchers and policy makers find this literature quickly and easily’ said Dr Tieman.

The Lowitja Institute would like to thank Flinders University, the Flinders Filters project team, the PHC Search Filter team and Media Insights for their great work and support in developing LIt.search.

LIt.search is now available on the Lowitja Institute website.

The Lowitja Institute is Australia’s only national health research institute with a sole focus on Aboriginal and Torres Strait Islander peoples.

Media contact – Tracey Johnston 0428 347 573

NACCHO Eye Health News:Curable eye disease still rife among Aboriginal Australians

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Australia remains the only developed country in the world not to have eliminated trachoma, the leading cause of infectious blindness, despite recent progress in tackling the disease.

Picture above (from left) Fourth-year Master of Optometry students Antara Saha and Kate Weller with Professor Hugh Taylor

Source article picture

While it disappeared from mainstream Australian society 100 years  ago, trachoma continues to be a significant problem among remote  Indigenous communities.

Professor Hugh Taylor, Harold Mitchell Chair of Indigenous Eye Health at the University of Melbourne, told Flinders Indaily that while trachoma rates in some areas of central Australia had  plunged in the four years since the Rudd Government’s commitment to  eliminating the disease, much more work needed to be done.

“We’re halfway through the work but, at the moment, the money runs  out at the end of June and we need the commitment for ongoing funding,”  Professor Taylor said.

“As of today there’s a lot of uncertainty: will this highly  successful, highly important, highly visible program actually continue  to be funded?”

Professor Taylor, who was visiting Flinders University’s Department of Optometry and Vision Science to talk to students about Indigenous eye health and discuss research  with department head Professor Konrad Pesudovs, said trachoma had “come  on and gone off the agenda”.

“Fred Hollows raised the issue in the ‘70s but then it got swamped by  other things and the attention has been on other things such as  diabetes or alcoholism or kidney failure,” he said.

“We’ve actually developed a whole lot of much more effective ways of  eliminating trachoma. The World Health Organization has developed a  strategy that combines medical, surgical, health education and  environmental components that actually works.”

Simple measures such as promoting clean faces and personal hygiene  can go a long way to eradicating trachoma. But improving the health of  Indigenous Australians, Professor Taylor said, also had a social  dimension.

The passage of an Act of Recognition in the Federal Parliament, on the day of this interview, was cause for optimism.

“I don’t know it will affect the non-Indigenous community’s  perceptions and attitudes greatly but I think it has a very important  role to play for the Indigenous people of Australia, their sense of  identity and place in the community,” he said.

“I’ve been extraordinarily impressed by the positive impact that the  Rudd Apology has had on so many Indigenous people. I’ve also been very  impressed by the negative impact the Northern Territory Intervention had  on the feelings and self-worth of very many people in the NT…The  unilaterality and lack of consultation was just devastating to people.  It was really hurtful.”

The “profound depression” produced by the rejection of land rights claims and which lasts for years was another case in point.

“These things, while one sees them as symbolic or important here or  there, actually have a huge impact on the whole way people see  themselves and their community within the greater Australian society,”  Professor Taylor said.

Flinders University