Archive for September, 2007

Child Health Checks

September 26, 2007

The NTER child health checks continue in the Top End.  I’ve been to various remote community health centres over the past few weeks where the teams have been and gone. The verdict is unanimous- a waste of time and money.

Why?  Because the visiting teams see fewer kids than the clinics do, they find already known problems and provide no services to meet the identified needs. 

The most that can be said is that they leave behind a pile of referrals.

We Want You!

September 21, 2007

Fancy joining the Remote Area Health Corps? Details are lacking, but it’s bound to be an interesting ride given the making-it-up-as-we-go-along nature of the NTER. 

When I first heard that $100m was to go towards remote health services, my head was spinning with the possibilities; bolstering  community clinics and Aboriginal Community Controlled Health Organisations (ACCHOs), expanding the range of services, preventative primary health care initiatives,  increasing Aboriginal Health Worker numbers, the possibilities seemed endless. Then I had a look at what scant details were available and my enthusiasm shrivelled. I had assumed that this funding would be directed to existing health services, either the NT Government or Aboriginal health services, ie, bolstering the already existing health infrastructure.  Unfortunately, it looks like the Govt envisages a separate Commonwealth controlled structure of visiting health providers.  That in itself is no problem as fly-in fly-out services are part of the picture, but this should be part of an integrated  health system.     

From what little information is available it seems that this is the only plan for the $100m. And that is a problem.  Visiting health practitioners rely on a functioning and adequately resourced community clinic to work from, and with.  When the visitors leave there is usually follow-up required and if the capacity of existing community clinics is unchanged, this initiative will fail to deliver on its promise. Directing part of this funding to ACCHOs would be a very sensible option, but the Minister appears to have an inexplicable aversion to this. Worryingly, there is a scent of the temporary around this measure.  The funding commitment is for 2 years and if it is to be a stand-apart Commonwealth controlled service, it would be very easy to simply end the measure after an announcement of ‘mission accomplished’.  Some of the language used in the Minsters’ press release reinforces this impression.  For instance it is suggested that the ‘Corps’ will be involved in “blitzes” on selected health issues, such as middle ear disease in children. This is a worry.  The current ‘blitz’, known as the child health checks, is the perfect demonstration of its’ limitations. What is required is an increased and sustained commitment to comprehensive health care over the long-term to address chronic health issues. A ‘blitz’ on middle ear disease will not solve the problem of high rates of ear infections in Aboriginal kids.  Middle ear disease is a condition associated with overcrowding and poverty, and without simultaneously addressing the causative factors, the ‘blitz’ will fail. 

The extra funding announced for health is welcome and much needed, but is likely to be highly flawed in application owing to two clear characteristics of the intervention to date; the desire for highly centralised control, and a lack of interest in involving those being affected, especially Aboriginal organisations.  

Saving the Kids from SBS

September 20, 2007

This is bizarre.

Mal Brough’s title should be changed to The Minister for Families, Communities, Indigenous Affairs and Public Morality.

If you missed this, The Federal Governments latest knee-jerk response is to legislate for the banning of R rated TV in Aboriginal lands in the NT. The original obsession with banning pornography was strange enough, given that there is no link between adults watching pornography and the sexual abuse of children, so the rationale for this is a mystery to me.

However, some Aboriginal people have expressed concern about ‘pornography’ on SBS and pay-TV. To give you an idea of what we’re talking about, this will include movies like ‘Pan’s Labyrinth‘ and ‘Wolf Creek‘. The fact that it’s probably impossible to actually enforce, hasn’t stopped the Minister from careering down this latest blind-alley. Though you have to wonder, why, if Brough believes this nonsense, is he prepared to leave the rest of Australia’s children exposed to the menace of the depraved SBS-watchers.

But no-one should be too surprised by such incredibly simplistic ideas. Last year Mal Brough made it clear that this is exactly the kind of thing we could expect when he said in regards to the problems in remote communities, I don’t think they have complex answers”. He’s quite famous in my work area for his amazing statements about the troubles in Wadeye last year. There were 2 rival ‘gangs’ in Wadeye causing lots of property damage, one of them was called ‘Judas Priest’ and they were into heavy metal paraphernalia. Brough showed his deep insight by declaring that it was all the fault of TV,

it’s because its been jammed down their throats through television, particularly watching Rage on the ABC, quite frankly

I kid you not.

Getting a Clue 2?

September 19, 2007

As expected, the Federal Government announced significant new spending in the NT.  The details (such as they are) are here and here. 

At first glace it seems surprisingly good.  Here are the main items, 

$18.5 million over two years from 2008-09 for 66 additional Australian Federal Police;

$514m to repair and build housing in remote communities over the next four years, on top of the $279m already allocated;

$100m over two years from 2008-09 for more doctors, nurses, allied health professionals and specialist services;

$78.2m over three years to create real jobs in Australian Government service delivery; and

up to $30 million over three years to match on a dollar for dollar basis contributions by the NT Government to assist them to convert CDEP positions supporting NT and local government services into real jobs.

I particularly like the last two, but I’ve no idea if they are of sufficient scope to achieve the desired outcomes.  But I think that they are recognition of the disastrous policy of abolishing CDEP. 

This is how Mal Brough introduced the announcement,

The Howard Government will provide over $740m in further funding for initiatives in 2007-08 and future years….

 If you have a good look at it, you soon realise that nothing like $740m will be provided in 2007-08, it’s more like $120m, some of it conditional and much of it coming from previously announced programs. Housing is a good example.  I was pleasantly surprised to see the scale of the proposed funding.  It looks big, but it’s worth keeping in mind that this is only a fraction of the known need.  And what I’d  figured out belatedly from the sparse information available, is that this is not new funding allocated specifically in response to the NTERT, but is coming from the already announced ARIA program, due to commence in June 2008.  The NT Govt had publicly stated that it was hoping around 50% of this funding would come to the NT. Some people have suggested that ARIA is a $1.6 billion dollar program, but that looks like the 2 year expenditure from what I understand. Based on this, the announced funding is about 25% of the total program. And that’s over 4 years.  So the Federal Govt is proposing to provide 1/3 of the housing funding that is known to be required.   The program itself is a concern.  Detail of how it will work is patchy at best, but an interesting aspect of it is that the Government attaches significance to one particular goal,

ARIA will also provide assistance for Indigenous people to directly purchase new homes or to lease-purchase a home.

I don’t personally know any people in remote communities that are desperate to jump on the mortgage merry-go-round, but Brough and Howard seem convinced they are.

The major health-related announcement was the Remote Area Health Corps .  The overt military terminology continues.  I’ll have more to say about this later. 

Getting A Clue?

September 13, 2007

I’ve been advised by someone very high up in the NT health bureaucracy that the Federal Government will be announcing a very substantial increase in funding for remote health services in the NT. This will apparently occur in the next few days.

It’s the bleeding obvious response to the situation. There shouldn’t be any doubt about this, but given the level of incompetence displayed to date and the ideologically driven agenda pursued by Howard and Brough, I won’t hold my breath.

But let’s hope that it’s true.

A Paediatricians’ View.

September 10, 2007




Alcohol Restrictions: Update

September 10, 2007

Typical. I say that updates are hard to come by and 3 days later we have one.  There is an announcement regarding the alcohol restrictions which are due to come into force on Sept 15. The Minister announced some minor changes to the legislation which will be introduced this week (I presume before the 15th).  The detail is here.

The basic change is that instead of enforcing the complex 1350 ml rule, alcohol purchases of over $100 or more than 5L of cask wine will require proof of identity.  Another change is that some tourists in the NT will be able to consume alcohol within the prescribed areas. 

As Andrew Bartlett  points out, this latest announcement raises 2 issues – that the Federal Government is far more interested in the views of alcohol retailers than Aboriginal people themselves, and that the Legislation was so rushed that barely a month after being passed it needs changing. An example of the former is that the NTs peak body representing Aboriginal controlled health organizations, AMSANT, has found it impossible to get a meeting with Minister Brough.

Prohibition, policing and punishment remain the favoured methods of engagement with the issue of alcohol abuse, leaving virtually untouched an obvious target in the fight – addiction treatment services.  If ‘Social Clubs’ are to remain operating in some communities, as they appear to be, then perhaps it would be a sound strategy to ensure that alcohol treatment services are just as readily available as the ‘green can’ is.

TaskForce Update

September 7, 2007

It’s an unofficial update as official information is hard to come by. Just have a look at the taskforce media centre here.

A few bits and pieces surface via the ABC. This one from yesterday is very interesting. NTERT’s operational head, David Chalmers, made this claim,

He says two-thirds of the children in remote communities have had health checks, and that about 20 per cent of those will need follow up treatment for dental problems.

Well, I can guarantee you that 60% of Indigenous kids in the NT have not had a health check courtesy of the NTERT. The health checks have not even started in most communities in the northern half of the NT, where well over half of the Indigenous population of the NT live. Many won’t see one of the medical teams till November. Checks have started at 2 of the largest communities, Wadeye and Maningrida, but only 150 and 60 children respectively have been seen so far. To give you some idea of what sort of progress this represents, Wadeye’s 0-15 population is 600 according to the Census (which almost everyone thinks is a serious underestimate, it’s probably closer to 800-900). The health checks have been going for just over 2 weeks, with 3 weeks to go. They’ll do well to see 50% of the kids in Wadeye.

But the second part of Chalmers’ statement is where the most significant problem lies. So, 20% of kids need a dentist (I’m stunned it’s so low)? Where is the dentist coming from? The knee-jerk nature of the response is exposed yet again – do medical checks so you can make referrals to services that don’t exist in sufficient quantity to meet the need. It’s particularly ironic that dental services were mentioned. Back at the start of the Howard Government it was public dental services that were slashed in its’ cost cutting exercises.

There has been no effort to expand on-going health services to meet the needs in remote communities, which makes the visiting health teams an expensive exercise in futility. The Federal Government is also starting to have trouble attracting volunteers, which is hardly surprising given the current shortages of medical staff across Australia.