Collaboration – Key to Awards - DoH Digital Library:...

The Chronicle April 2002 1

Volume 5 , Issue 6 Apri l 2002

N umbulwar Numburindi Com-

munity Government Council

recently won the National

Best Overall Project in the Heart

Foundation Kelloggs Local Govern-

ment Awards 2001 for their Commu-

nity Food and Nutrition Project. They

were also the winners in the Healthy

Nutrition Project category.

Numbulwar is one of the remote In-digenous communities in East Arn-hem, Northern Territory with a popu-lation of approximately 1000 people (see NT Map page 3). By air it is ap-proximately 250 kms south of Nhu-lunbuy and 575 kms east of Kathe-rine, in the Gulf of Capentaria. Access to the com-munity in the wet season is by aircraft only and a barge brings supplies every 2 weeks, taking 5 days from Darwin.

Numbulwar Numburindi Community Council realised an opportunity to work on nutrition issues with the opening of the new store and concern about diabe-tes in their community. The original plan involved training a nutrition worker. Over time and with con-sultation the project developed into a store policy and the promotion of healthy food choices. The store thus became the focus of the nutrition intervention and education project and incorporated other areas within the community the school, women’s and res-pite centre.

As the Community Nutritionist in East Arnhem, I have been working with the council and community people in developing the Community Food and Nutri-

tion Project. This project has taken many turns but with regular trips, consultation and guidance from the President, Samuel Numamurdirdi, the successes have been recognised.

The project involved:

§ the development of a store policy representing pictorially the products that should be available in the store. Features of the store policy include a policy for foods for 0-12 months old and a state-ment that the store will close at 4.30 pm to en-courage people to look for bush foods for their evening meal, thus encouraging exercise and bush foods.

§ use of shelf talkers to indicate healthy food choices.

§ weekly cooking demonstrations at the store, Women’s and Respite centre using store prod-

(Continued on page 2)

Collaboration – Key to Awards Community Food and Nutrition Project

Wulja Nunggarrgalu, Samuel Numamurdirdi (President of Numbulwar Community Council) and Jenny Freeman (Community Nutritionist)


A p r i l

20-21. Tai Chi for Arthritis, a two-day Instruc-tor' Workshop by Dr. Paul Lam. Learn this spe-cially designed program for people with chronic disease from the creator. Venue to be advised. Cost $ 250.00 incl. course material, morning and after-noon tea. For more Info contact Arthrtis and Osteo-porosis NT phone 89 48 52 32 (10-2pm)

30 April-3 May 2002 5th WONCA World Con-ference on RURAL HEALTH Working Together Carlton Crest Hotel, Melbourne, Australia. Confer-ence secretariat The Meeting Planners Tel: 03 9417 0888 Web: www.ruralhealth2002.net

4-6 May 2002 WONCA satellite Conference Working Together Sharing Experiences. A con-ference focusing on Remote & Indigenous Health. Alice Springs. Tel: 08 8951 4700 Email [email protected] 6-7 May The National 2002 Indigenous Diabetes Network Conference Cairns Qld Outrigger Resort Country Comfort. Tel 07 49457122 15th May 6th Annual Chronic Diseases Network Workshop. “Chronic Disease – Beyond the Health Sector.” Mirrambeena Resort Darwin 8922 8280. [email protected] (note change of date)

17-18 June 2002 Australasian Women’s Health Issues Congress. Sydney NSW Carlton Crest Ho-tel. Call for papers and early bird registration. For a brochure call 07 4945 7122.

12-14 September 2002 Section of Social & Cul-tural Psychiatry of the Royal Australian & New Zealand College of Psychiatrists Triennial Con-ference Cairns, FNQ. Theme: Setting Strategic Di-rections in Mental Health Policy & Practice. The Conference Organisers PO Box 214 Brunswick East, Australia 3057. Tel: 03 9380 1429 Email: [email protected]

29 Sept – 2 Oct 2002 Call for Papers. 34th Public Health Association of Australia Annual Conference Mobilising Public Health. Adelaide Festival Cen-tre. [email protected], PHAA, PO Box 319 Curtin ACT 2605

Chronic Diseases Events Calendar

2002

THE CHRONICLE EDITOR: Justine Glover -Chronic Diseases & Injury Prevention Project Officer

DEPARTMENT OF HEALTH & COMMUNITY SERVICES PO BOX 40596 CASUARINA NT 0811 PHONE: (08) 89228280 FAX: (08) 89228310 E-MAIL: [email protected] Contributions appearing in The Chronicle do not necessarily reflect the views of the editor or DHCS. Contributions are consistent with the aims of the Chronic Diseases Network and are intended to : • Inform and stimulate thought and action; • encourage discussion and comment; • promote communication, co-ordination and collaboration.

(Continued from page 1)

ucts. This was supported by the production of recipes, which included pictures of local people in the preparation of the meals.

§ posters on food themes displayed at the council, the store, Health Clinic Women’s Centre, School and respite Centre.

§ monthly cooking sessions at Women’s and Respite cen-tre including education about hygiene, equipment use and budgeting.

§ development of food and nutrition policy for the take-away, which included a unique initiative of, only selling fried foods on Fridays.

§ displays in the store of the recipes and ingredient to be bought.

Antedoctal evidence indicates that there is better control of diabetes, better understanding of healthy food choices, in-creased sales of food items demonstrated, requests for reci-pes from community people and a general interest outside the store on demonstrations days.

One of the strengths of this project has been the collabora-tive approach of groups within Numbulwar of council mem-bers, health educator, store manager and nutritionist and consultation with others such as health workers, store work-ers and school teachers. In this way the whole community was involved in knowing about the project or being involved in taste testings or education. The leadership of the Presi-dent encouraged success, as he was patient to see results and yet be available for consultation and direction.

As a nutritionist, the lessons I have leant from being in-volved in this project include the need for consultation and flexibility, a commitment to the project, taking nutrition to the community and finally, focusing on food, both store and bush foods, as the centre of the project.

Jenny Freeman Community Nuritionist East Arnhem District Nhulunbuy Ph 89870446


Who’s Where in the NT

Community Food & Nutrition Project Jenny Freeman

Terrence Guyula Feb Chronicle “One Suc-cessful Health Worker”

Chronic Disease Coordinators

Katherine West Health Board

Tiwi Health Board

Public Health Nurses


A Word from Arthritis & Osteoporosis N.T.

W e are a self-help group dealing not only with arthritis and osteoporosis, but with a variety of muscular and joint ailments. We do not

profess to have any magic cures, but we seek to make our members move more freely through a selection of exercises and strategies that will help them to have bet-ter control over their lives. AONT promotes physical movement and an atmosphere of support with encour-agement to sufferers of these types of illness.

We operate a number of courses consisting of:- • Osteoporosis Self Management course • Hydra therapy • Tai Chi for Arthritis • Tai Chi by the Sea

AONT offers a library & resources for a better under-standing muscular-skeletal problems. We have a great deal of up-to-date information on new treatments, to-gether with aids for self management. We also circulate a quarterly national, & local newsletter on relevant is-sues.

AONT is currently located at the Nightcliff Community

Centre. We will be leasing a new building in Caryota Crt, Coconut Grove sometime around May this year. The new building will contain a pool for hydra therapy and generally more space to conduct courses. It offers better access to our members and is centrally located be-hind the clock tower on Dick Ward Drive. Our organisation runs on volunteers and they do a won-derful job in overseeing courses, client support, & fund-raising. As with all self-help groups, we know the value of volunteers to stretch our achieved & allocated funds to their full potential. We do however, need a lot more volunteers to sustain present courses & initiate new in-centives.

It is rewarding work and its great to see our members consistently improving both physically and mentally through our courses. Our members have a daily battle with muscular & joint pain, but it is a battle over which they are achieving constant success with the motivation offered by our association. With the help of volunteers, we hope to continue to build on our achievements when we move into our new premises.

AONT Ph 8948 5232 between 10 am and 2 pm for more infor-mation


Summary

T he use of tobacco is a major

cause of premature mortal-

ity and morbidity among

Indigenous people in Australia. The

life expectancy of Indigenous Aus-

tralians in 1992-1994 was 15-20

years less than that of the general

population. Much of this difference

was due to high rates of cardiovascu-

lar disease, respiratory disease and

other diseases related to tobacco.

Few health programs have addressed

tobacco use among Indigenous peo-

ple. There has been little or no

evaluation of such programs and lit-

tle formal research about Indigenous

people and their use of tobacco.

History of tobacco use Indigenous people traditionally used pituri and native tobaccos, especially in south-western Queensland and Central Australia. They came into contact with tobacco hundreds of years ago through trade with Macas-sans, and then through contact with Europeans, where tobacco some-times was used as an instrument for social control. Indigenous people were paid with tobacco rations until the 1960s. It is possible that Indige-nous people's history of colonisation and dispossession may affect the im-plementation of tobacco programs.

Prevalence of tobacco use by Indigenous Australians The prevalence of tobacco use among Indigenous Australians is much higher than among other Aus-tralians. Nationally approximately 54% of Indigenous Australians smoke, compared to 22% of all Aus-tralians. In some regions, up to 83% of Indigenous men and up to 73% of Indigenous women use tobacco. The

prevalence of tobacco use by Indige-nous people is also higher than for other ethnic groups within Australia, as well as being higher than for other indigenous people. Indigenous smokers use about the same amount of tobacco as smokers in the general population. Some In-digenous people chew tobacco.

As with the general population, In-digenous people are more likely to smoke if they have a low level of education or are unemployed. In-digenous people are also more likely to take up smoking at a younger age. Many Indigenous people are exposed to environmental smoke (passive smoke). Tobacco consumption among In-digenous people is probably best measured by self-report, but the use of visual aids such as showcards may be useful in assisting people to quan-tify the amount smoked. Tobacco consumption in remote communities may also be measured by assessing tobacco turnover in community stores, but store turnover is unlikely to be a useful measure for urban In-digenous people. The high prevalence of tobacco use among Indigenous people indicates that there is a need for interventions to reduce the prevalence of tobacco use in this population and to reduce exposure to environmental tobacco smoke.

Why Indigenous people smoke There are a number of similarities between Indigenous and other Aus-tralians' reasons for using tobacco. However there are also some impor-tant differences which can be ex-plained by historical, social, cultural and economic factors which have re-sulted in different Indigenous life-styles, needs, vulnerability's and pri-orities. These include: • Colonisation and dispossession.

The colonisation of Australia led to disruption of culture and the crea-tion of unhealthy living and social conditions. Dispossession and in-stitutionalisation, and the resultant separation and loss have led to a higher level of risk-taking behav-iour among Indigenous people, in-cluding tobacco use.

• Socioeconomic inequity. Low rates of education, high rates of unem-ployment and poor housing are linked with higher rates of tobacco use.

• Lack of knowledge about harmful effects. Some (but not all) Indige-nous people know less about the harmful effects of tobacco than others. Some studies of Indigenous people have shown very low levels of awareness of the medical prob-lems caused by smoking. Similarly smoking is not widely perceived to be a cause of most drug-related

deaths. • Cultural beliefs. Among some In-

digenous people, tobacco may have been, and contin- ues to be, linked with traditional cultural practices and beliefs.

• Social contexts and pressures. Sharing tobacco plays a large part in the social life of many Indige-nous people, and using tobacco re-inforces family relationships and friendships. People who don't use


Indigenous Australians and Tobacco: A literature review Extract from report by Rowena Ivers October 2001. MSHR & CRC-ATH

In some regions, up

to 83% of Indigenous

men and up to 73%

of Indigenous

women use tobacco



tobacco may end up feeling iso-lated and alienated from the com-munity.

• Early uptake of smoking. Indige-nous children and adolescents take up smoking earlier than non-Indigenous young people. Addic-tion to nicotine is therefore more likely to be established by adoles-cence.

• Health priorities. Indigenous peo-ple have often prioritised other health issues above tobacco use - for example, alcohol use (which, unlike tobacco, has acute disruptive effects), housing and infrastructure improvements, dog programs and nutrition programs.

• Targeted Advertising. There is evi-dence that some tobacco advertis-ing campaigns have been targeted at Indigenous people.

• Less access to medical services and resources. Indigenous people may have poorer access to health ser-vices than other Australians. Even where health services are available, there may he barriers to access, in-cluding language barriers, racism and lack of Indigenous involve-ment in the delivery of health ser-vices. Few health promotion re-sources about tobacco are targeted at Indigenous people.

However there are also some factors which influence smoking behaviour, such as enjoyment, which are similar across the whole Australian popula-tion. As with other smokers, some Indigenous people are aware that they are addicted to tobacco. The cost of smoking does not appear to influence their decision to continue smoking. Nonetheless, the context for delivery of tobacco programs differs signifi-cantly from that in the general popu-lation because of differences in the history, socioeconomic status and culture of Indigenous people. Many of these factors may make it more difficult for Indigenous people to quit and may require specific tar-geted strategies which take on board specific histories, needs and socio-

cultural contexts.

The health effects of tobacco use for Indigenous people The high prevalence of tobacco use among Indigenous people is likely to contribute to reduced life expec-tancy. Indigenous people experience 2-8 times the death rate of non-Indigenous people across all age groups, but tobacco smoking is likely to contribute to a similar pro-portion of deaths among Indigenous people as that in the general popula-tion (about 15%).

Indigenous people die younger from tobacco-related illness than do non-Indigenous people. Forty-nine per cent of Indigenous males and 48% of Indigenous females whose deaths were related to using tobacco were aged 55 years or under, compared to 11% of non-Indigenous males and 10% of non. Indigenous females. Indigenous people are hospitalised at 2-3 times the rate of people in the general Australian population, with many people being hospitalised for respiratory disease. Indigenous peo-

ple are more likely to be hospitalised for conditions attributed to tobacco use than other Australians. Indigenous people suffer from a higher prevalence of many medical disorders compared to non- Indige-nous people, much of which is likely to be related to tobacco use. Specifi-cally: • Indigenous women are up to 3.1

times and Indigenous men up to 2.2 times more likely to die of lung cancer.

• Indigenous women are up to 6.8 times and Indigenous men up to 3.2 times more likely to die from is-chaemic heart disease.

• Indigenous women are up to 19.2 times and Indigenous men up to 15.1 times more likely to die from pneumonia.

• Indigenous women are 2.8 times more likely to deliver an infant with a low birthweight, and the perinatal mortality rate is 2-3 times higher for Indigenous infants. In-digenous infants are 3.9 times more likely to die from Sudden Infant Death Syndrome (SIDS).

• Indigenous people are more likely to suffer from blindness, cataracts and deafness.

• Indigenous people are more likely to be exposed to environmental (passive) smoke. Indigenous chil-dren are more likely to suffer from ear infections, and are more than 10 times as likely to be hospitalised for respiratory infections.

However, while there is an abun-dance of data on the prevalence of a range of tobacco-related conditions among Indigenous people, only a few studies have reported on tobacco use among those suffering from the health problem. The high rate of mortality and mor-bidity attributable to tobacco use among Indigenous people indicates a definite need for interventions to re-duce the prevalence of tobacco use and to reduce exposure to environ-mental tobacco smoke in this popu-lation.


The high prevalence

of tobacco use among

Indigenous people is

likely to contribute to

reduced life

expectancy

Forty-nine per cent of

Indigenous males and 48%

of Indigenous females

whose deaths were related

to using tobacco were

aged 55 years or under,

compared to 11% of non-

Indigenous males and 10%

of non. Indigenous females



Attitudes to quitting Few studies have assessed how or why Indigenous ex-smokers quit. Some Indigenous smokers may have quit due to health reasons or preg-nancy, through gaining the support of their family or the support of health professionals, or because of smoking bans in the workplace or public places. Most Indigenous people support policies which are aimed at prevent-ing children and adolescents smok-ing. Over 70% of Indigenous people support bans on smoking in the workplace and shopping centres. From the available evidence, most Indigenous ex-smokers, like other ex-smokers, quit by themselves, without help, for health reasons. Like other smokers, Indigenous smokers believe that they would quit if given external support, through provision of NRT, or through legis-lative or other restrictions on tobacco use. A smaller proportion of Indigenous smokers are ready to quit than smok-ers in the general population, and fewer Indigenous people intend to quit in the future. There is conflict-ing evidence about the proportion of Indigenous smokers who attempt to quit compared to the general popula-tion. The numbers may well be quite similar. There are indications that many In-digenous people make a number of unsuccessful quit attempts and that, like other smokers, they face prob-lems with addiction and social con-texts conducive to smoking.

Conclusion There is compelling data on the prevalence of tobacco use among In-digenous people, and on the preva-lence of health conditions that are potentially related to tobacco. There is less clear data specifically on the link between tobacco use and these health conditions among Indigenous

people. There is an abundance of literature on the effectiveness of a range of to-bacco interventions in other popula-tions, including evidence on inter-ventions in primary care, community and legislative interventions. Much of the evidence for tobacco interven-tions in primary care and in the com-

munity is of high quality according to the NHMRC rating system for evidence. Other public health-oriented tobacco interventions, such as legislative interventions and me-dia campaigns, have also been rec-ommended by systematic reviews of the evidence. However, only three tobacco inter-ventions have been formally evalu-ated in Indigenous communities, with only one being able to conclu-sively show a positive effect. This audit of tobacco programs for Indigenous people reveals that nu-merous small programs have been conducted, especially in the area of health promotion (in particular, de-velopment of health promotion mate-rials). Many of these programs ap-pear to have been innovative, but few have been evaluated. An emphatic conclusion is that there is a major lack of research and evaluation of tobacco interventions in Indigenous Australian contexts. Nonetheless, it is possible to ex-trapolate from interventions that have been effective for other popula-tions. However, more research or evaluation is required to ensure that such interventions are effective for Indigenous people.

Despite this lack of conclusive data about effective interventions, there is no doubt that the prevalence of to-bacco use and the high rate of mor-tality and morbidity attributable to tobacco among Indigenous Austra-lians, constitute a serious health problem. The evidence indicates a definite need for effective interven-tions to reduce the prevalence of to-bacco use and to reduce exposure to environmental smoke in this popula-tion. The challenge for health profession-als will be to work with Indigenous communities to devise ethical, cul-turally appropriate and effective in-terventions. In the words of lan Anderson (quoted more fully in Chapter 7) it is important that: ... programmes are structured in such a way as to allow Indigenous people to engage with the possibili-ties, have the necessary resources to make changes, and to be convinced that the changes will enhance their lives (1994).

The challenge for health

professionals will be to work

with Indigenous communities

to devise ethical, culturally

appropriate and effective

interventions

For a copy of the report please contact Rowena Ivers Menzies School of Health Research and the Cooperative Research Centre for Aboriginal & Tropical Health PO Box 41096 Casuarina NT 0811 Ph 8922 8196 Fax 08 8927 5187


N orthern Territory has an area of 1351 961.8 square kilometres, and a popula-

tion as of June 2001 of 197 590. Prior to November 2001, the South Australian Organ Donation Agency coordinated all organ donations from Royal Darwin and Alice Springs hospitals. The agency (LifeNet NT) and in particular my role of Organ Donor Coordinator, was developed to allow more contact with families during the organ donation process as well as after the organ donation has oc-curred. This opens the way for donor families in the Territory to receive similar support services as families around Australia. As organ donors can be aged between the ages of 0 – 75 years, the age of family members are just as diverse. Therefore this involves developing a network of profes-sional bodies that families can see if they need extra sup-port, and the instigation of support groups for donor families as well as recipients who are secluded purely by their distance from transplant units within Australia. Although kidney transplants are the most common in the Territory, we have healthy heart/lung, heart and liver re-cipients as well. The isolation these patients and their family’s feel when they leave the security of the trans-plant unit’s is a real fear that is further compounded by returning to their homes, a considerable distance from the support of fellow transplant recipients and their fami-lies. Each year it will be the aim to reflect upon donors and recipients at the annual Memorial Service in an area especially designated for donor families and recipients. Education is very high on the agenda to demystify stories that have prevented people from making informed choices about organ donation. The aim of the agency is to demystify the organ donation process and in doing so, increase organ donation rates as well as intended donations as seen with increased num-bers of ‘Australian Organ Donor Registry’ forms filled in

within the Northern Territory. With the agency being a more visual identity in the community now, educa-tion goals have been directed to reach every aspect of the population. The Aboriginal population has the highest percentage of renal disease in the Terri-tory that is treated with kidney trans-plants, yet due to cultural choices they have chosen not to donate in the past. However, by liaising with appropriate community members and forming an educational plan that is culturally sensi-tive, we may one day see an Aboriginal donor. At present all transplantations are done interstate with the retrieval of organs only being done at Royal Darwin or Al-ice Springs hospitals. Although the do-

nation of tissues (corneas, heart valves, bone and skin) is actively promoted as part of the education process, we are unable to logistically participate in tissue retrievals. However, as both hospitals continue to expand and in-corporate new services for patients within the Territory, we may one day see tissue retrievals and perhaps even a kidney transplant performed within the Northern Terri-tory. Helen Stewart (NT Organ Donor Coordinator) 8922 8786 Pager 768

Ordinary People Doing Extraordinary Things

Helen Stewart


C hronic diseases pre-

dominate among the

leading causes of

death. The five major chronic

diseases, ischaemic heart disease,

chronic obstructive airways dis-

ease, diabetes, renal disease and

hypertension accounted for more

than one-fifth of all NT deaths

between 1979 and 1995. The

health service costs are signifi-

cant, particularly for renal disease

and the demand for dialysis treat-

ment. Total expenditure in NT

public hospitals on admissions for

chronic diseases from 1995 –

1998 was approximately $72M.

Improvements in the prevention and management of chronic dis-eases at the primary care level will reduce chronic disease re-lated hospital admissions and consequently overall hospital ex-penditure. The impact of organ-isational systems on the improve-ment in the quality of care in this context has not been studied in the remote Australian context other than that learnt through the evaluation of the coordinated care trials.

The Project The Menzies School of Health Research, will receive $458,500 over 5 years for a study entitled “Community Health Centre Or-ganisation & Quality of Care for the Prevention and management of Chronic Disease”, which will focus on improving care for In-

digenous Australians in rural & remote areas. This is a collabora-tive project between MSHR, DHCS and a number of commu-nity controlled services in the Top End. The chief investigators are Ross Bailie & Joan Cunningham from Menzies, and Tarun Weera-manthri and Christine Connors from the DHCS. The project will investigate the impact of organisational systems

on the quality of clinical care di-rected at the prevention and man-agement of chronic diseases in primary level health centres in the NT. A number of health centre organisational changes, such as best practice guidelines and infor-mation systems for reminders and recall have been introduced in im-plementing the Preventable Chronic Disease Strategy. Critical success factors in achieving high quality care will be identified through examining existing sys-tems and innovations in the or-ganisation of community health centre activity, the impact of these systems on change in clini-cian behaviour and intermediate health outcomes, and staff experi-ence of these systems. The qual-ity improvement process, through audit and feedback, in this study is itself designed to contribute to improvements in quality of care.

The project will make a signifi-cant contribution to improving the effectiveness of service deliv-ery systems in rural and remote communities.

Research Plan The project will consist of three components. The first will pro-vide a detailed description of the systems in participating health centres for the effective preven-tion and on-going management of chronic disease. This description will be developed from informa-tion gathered during visits to par-ticipating health centres that will include semi-structured inter-views with key staff members, in-cluding Indigenous staff mem-bers, and observation of systems in place in each health centre. The second component will involve semi-structured interviews with health centre staff on their experi-ence of using these systems, and the strengths and weaknesses of the systems, including costs, benefits and barriers to imple-mentation. The third component will consist of an audit and feed-back process of reviewing a sam-ple of client records for delivery of clinical services against the best practice protocols/clinical guidelines in use in the health centre. For more information contact Ross Bailie on 8922 8196

Community Health Centre Organisation & Quality of Care for the Prevention and man-agement of Chronic Disease

The project will make a significant

contribution to improving the

effectiveness of service delivery

systems in rural and remote

communities


T he Top End Division has

a Diabetes Project Officer

who started in January.

Her name is Brenda Randall, she is

a registered nurse who has been

working remote for the last 4 years,

in Oenpelli and Goulburn Island.

She is working with Sandra Miles

who is a GP working for Danila

Dilba, and who is on the Chronic

Disease working group.

Her role will be to give Practice In-centive Payment (PIP) and Service Incentive Payment (SIP) informa-tion and help practices set up diabe-tes registers and recall/reminder sys-tems. These systems can be either electronic or paper based systems. A hand held summary/ referral form/care plan and annual assess-ment form is in a draft form and available for trial. A diabetic flow chart will be available shortly. The International Diabetes Institute¹ states that, out of all the developed countries Australia has one of the highest rates of Diabetes. Diabetes education is very important as dia-betes is a major risk factor for mor-bidity and death from coronary heart disease, stoke and peripheral vascu-lar disease. According to the AUS-

DIAB report there as many undiag-nosed as there are with the condition diagnosed. Early detection, active treatment and lifestyle changes are needed to reduce risk factors. The chronic disease working group held their first CME event for Dia-betes in February. Dr. Dianne How-ard spoke on Type2 diabetes in pregnancy, Dr. Mahmoud gave a talk on Diabetic Retinopathy. Chris Spargo from NPS talked about medications and Linda Rennie from DANT showed us the latest pens, the new ketone monitor and how to do waist measurements properly. The working group plan to hold 2-3

more CME events this year. The government has prioritised dia-betes, and the new medicare benefits schedule includes new diabetic items, to finish an annual assess-ment of care. These items will gen-erate payments through the PIP pro-gram for those practices that are ac-credited or will be accredited in the next 12 months. This program re-wards GP’s that provide comprehen-sive quality care, and it aims to compensate for the limitations of fee for service payments. To get SIP there are minimal guidelines at the moment that most GP Practices should be able to meet. To enroll in this program and to re-ceive more information, please con-tact Brenda Randall at the division on 89 821025. 1. A Year of Care International Dia-betes Institute, Victoria 2000-2001.

Brenda Randal

Diabetes Project Officer for the TEDGP

Adding the Funding Opportunities for Research database to my Lotus Notes Workspace? 1 From the menu bar, choose “File”, then “Database” and then “Open”. 2 At the Server prompt at the top of the Open Database window enter the server name emdhh-s1 and press “Enter”. 3 From the Database options area scroll down and choose the yellow folder named THS. 4 Select Funding Opportunities for Research from the list of databases and choose the “Add Icon” button

(NOT open). 5 Click on “Done” and you should now be able to see the Funding Opportunities for Research database on your

Workspace. 6 It is advisable to add this database to your Favourites.

Funding Opportunities Data Base for DHCS


ABS@NTG Australian Bureau of Statistics - ABS@NTG The Chief Minister Clare Martin officially launched the ABS@NTG service on 13 March 2002. ABS@NTG is a service providing easy access to an ex-tensive range of ABS information and capability. It can be accessed through the intranet as follows: 1. Open the http://uluru.nt.gov.au intranet home page 2. Select the Online Systems menu option on the left hand side 3. Select the ABS@ option. OR Type the following web address http://finke.nt.gov.au/abs/[email protected]/abshome into your web browser. The site is easy to navigate, provides search facilities and a catalogue of the full ABS product range. ABS@NTG sees ABS data integrated into the NT Gov-ernment information holding and computing environ-ment. It contains

� All ABS publications since 1998 in electronic form (ie Acrobat) from the day of release. � Basic Community Profiles for all of Australia at the Statistical Local Area level (derived from the 1996 Census of Population and Housing). � The 2002 Australian Year Book and "Australia Now" a national snapshot � Time series data and tables � Multi-dimensional data sets, which allow flexible cross-tabulation analysis, across a wide range of fields � ABS Catalogue of Publications and Products � Release Advices � Media Releases � ABS Information Consultancies commissioned by NT Government.

Each NT Government employee is authorised to use this database for work related purpose. Any request from other organisations should still be directed to ABS.

Training for frequent users will be provided by ABS in the coming months. For further information on the ser-vice please contact Yuejen Zhao on telephone 92521.

All costs include morning and afternoon tea, lunch, and all course materials and handouts.

A limited number of places are available – early booking is absolutely essential!!

Are you involved in the delivery of services to Indigenous people?

Would improved cross-cultural understanding and communication skills make your work more effective?

One of NT’s most popular community educators is coming! “WHY WARRIORS LIE DOWN AND DIE”

Author RICHARD TRUDGEN is COMING TO DARWIN

Richard will be in Darwin to conduct cross-cultural education in the form of a Community Development Workshop.

This two day workshop is an opportunity to discover a wide range of cultural and communication skills and issues relating to community development, health and education. Topics covered include The Importance of Language, Learning Approaches, Traditional Law and Politics, Family Structures and Communication

Across Cultures. We promote an open and question-driven environment.

DATE: Monday 15 and Tuesday 16 April 2002 TIME: 8.30am – 4.30pm COST: $470 (incl GST) VENUE: Uniting House - 191 Stuart Hwy, Parap. (entrance via Railway St)

Contact Justine on 8987 3910 [email protected]

www.ards.com.au


K aren O’Keefe is a consultant from Sydney who recently visited Darwin to investigate options for an in-patient palliative care unit in the NT

for the Department of Health & Community Services. Karen has extensive experience, over 12 years, in pallia-tive care service provision, development and planning in the UK and Australia. She is the Deputy Director of the Sacred Heart Palliative Care & Rehabilitation Services on the campus of St Vincent’s Hospital Sydney. During her visit I was able to catch up with her to discuss her consultancy and palliative care services in the NT.

What is Palliative Care? Palliative care is about caring for people with a terminal illness as well as their families and friends. It aims to ease the pain, distress and many other physical, emo-tional and spiritual problems that are present with a ter-minal illness. It is given when treatment to cure an ill-ness won’t work any longer. The goal of palliative care is achievement of the best possible quality of life for patients and their families and friends. Palliative care involves a multi-disciplinary team and can include doctors, nurses, allied health workers, comple-mentary therapists (music/art therapy), chaplain’s, volun-teers and even pets. Services can be provided in the com-munity, client’s home, nursing home, and hospital or in a hospice/specialist in-patient unit. Many people mistakenly think of a hospice/in-patient palliative care unit as a long term care facility. Palliative care is not a substitute Nursing Home. A palliative care in-patient unit generally provides short term (around 14 days) admissions for symptom control and respite care and works with the community based services to pro-mote the clients quality of life and avoid acute admis-sions.

What services are available through Palliative Care? Palliative care teams provide a range of services to pa-tients and their families. As I mentioned before palliative care services can be delivered in a range of settings, where possible, where the person wants to be. Services aim at supporting the client’s choices, promot-ing their quality of life and providing symptom manage-ment. The types of services are very broad and include nursing, medical care, day care, respite, counselling, diet advice, loan of equipment, physiotherapy, occupational therapy, music therapy, pet therapy, support writing wills, bereavement support, and pastoral care.

Who is eligible for Palliative Care? Any person of any age, in advanced stages of life threat-ening disease where cure is no longer possible, is eligible to access palliative care along with their family, partner and carers. Palliative care is for anyone who has a terminal illness. Most people receiving palliative care have cancer, but some have diseases like motor neurone disease, HIV/AIDS or end stage heart, lung or kidney failure.

What services are currently available in the NT? There are excellent Community Palliative Care Teams based in Darwin and Alice Springs that provide • client assessment • facilitation of care coordination (case management) • advice, counselling and support for clients • direct specialist care and consultancies • access to services of: medical officer, nurse, allied

health professionals, pastoral care and volunteers • telephone support and advice to clients and health

care providers 24 hours per day, seven days per week • bereavement services • community education • education for service providers • access to equipment and • access to designated palliative care hospital beds Palliative Care Service can be contacted at: Darwin 8922 7004 Alice Springs 8951 6762

How will services change in the future? It really is too early for me to say yet. It is up to the De-partment Steering Committee to consider my options and recommendations. There is very strong community sup-port for an in-patient palliative care unit to complement the community-based services. I understand Labor’s Plan 2001 for Senior Territorians gave an undertaking to ex-pand current works occurring in the Royal Darwin Hos-pital precinct to include the construction of a hospice, to enable Territorians to enjoy the same level of care in an appropriate facility as people take for granted interstate. My final report will be submitted to the Palliative Care In -Patient Steering Committee late April 2002. Justine Glover

Palliative Care Options in the NT


T he Federal Minister for Health and Ageing, Senator Kay Pat-terson, announced funding of

$1.09 million for 10 strategic research projects in palliative care in Australia. The research program will be funded under the Commonwealth's $10.7 mil-lion National Palliative Care Program and administered by the National Health and Medical Research Council. Senator Patterson said that the research program aimed to achieve the best pos-sible quality of life, both for people who are dying, and for their families. "Australians who are dying deserve to be treated in an appropriate and digni-fied manner," Senator Patterson said. "Many of these projects will help en-sure that there is equitable access to care for terminally ill people, including those living in rural or remote regions of Australia, older Australians and In-digenous Australians. Other projects will examine what happens as people approach the end of life." Senator Patterson said Australians in rural and remote areas could face spe-cific challenges when it came to get-ting the care they needed. "Three of the projects funded will address such is-sues by trialling innovative ways of de-livering services to rural areas, such as developing a kit for use in remote com-munities or videoconferencing," she explained. Other projects will look at what good work is already happening and suggest how this could be improved. Palliative care service delivery to Indigenous people living in the Northern Territory, people dying of neurological diseases such as Parkinson's disease, motor neu-rone disease or multiple sclerosis, and residents in aged care facilities will be assessed. In addition, a random control trial will be carried out to determine how soon after diagnosis terminal can-cer patients should be referred to pal-liative care services.

"Because little is known about the course of end of life illness, some of the projects will look at the things that make a difference at the end of life. For instance, one will look at ways to improve the care of people dying with chronic heart failure," Senator Patter-son said. Sharing good ideas, trying out different solutions, building on strengths and learning from each other - that is what this program is all about. "Because the research priorities were developed in response to a broad con-sultative process with stakeholders, consumer groups and researchers, I'm confident that they will provide a strong evidence base to improve ser-vice delivery and symptom manage-ment," the Minister said.

Details of the ten projects Innovative models of palliative care health service delivery to rural ar-eas: a multi-disciplinary study Contact: Pam McGrath (07) 3365 2162 University of Queensland $100,000 Development of a 'pop-up palliative care service': a new model for pro-viding palliative care to rural and remote communities Contact: Kate White (08) 9273 8437 Edith Cowan University, WA $150,000 The investigation of innovative tele-medicine models to support pallia-tive care delivery in rural and re-mote Australia Contact: Ian Olver (08) 8222 5577 University of Adelaide $30,000 Assessment of the effectiveness of Australian models of palliative care delivery in four neuro-degenerative disorders. Contact: Linda Kristjanson (08) 9273 8617 Edith Cowan University, WA $150,000 Palliative care constituency, utilisa-tion and impact on health care: a

Western Australian based epidemi-ological and sociological study Contact: Beverley McNamara (08) 9380 2742 University of Western Australia $150,000 Early referral to palliative care: a randomised trial of patients with metastatic cancers and a survival ex-pectation of less than 12 months. Contact: Martin Tattersall (02) 9660 7362 University of Sydney $70,000 Body composition changes in cardiac cachexia: patho-physiology and quantification Contact: David Kaye (03) 9276 3263 Baker Institute of Medical Research, Vic $120,000 Improve care of the dying with chronic heart failure Contact: Patricia Davidson (02) 9350 3171 South Eastern Sydney Area Health Service $130,000 Objective assessment (based on whole body bio-impedance) of the trajectory of the course of illness for end of life non-cancer related dis-eases: biological, social and environ-mental determinants Contact: Neil Piller (08) 8204 4711 Flinders University, SA $120,000 Palliative care in aged care facilities for residents with a non-cancer diag-nosis Contact: Carol Grbich (08) 8201 3271 Flinders University, SA $70,000

$1.09 MILLION TO INVESTIGATE

BETTER WAYS TO CARE FOR THE DYING


Executive Summary

I ncreasing awareness of the im-portance of adequate housing and health hardware for improving

health status has assisted in improving investment in indigenous housing in-frastructure. At the same time, there is a growing recognition at a policy level that corresponding support of programs addressing management of houses is a critical component of ob-taining optimal social and health benefits. This project is the product of an interagency collaboration seeking better understanding of the focus and range of such programs occurring in the Northern Territory. Home Management Programs were first introduced into the Northern Ter-ritory as Homemaker Programs funded by the Department of Commu-nity Development in 1978. Activities historically included education of in-digenous people in home hygiene, budgeting, food and nutrition and par-enting support. As other organisations developed programs, activities diver-sified into environmental health ac-tivities, white goods operation and maintenance, and education on rights and responsibilities of house tenancy. Although the range of activities is broad, the fundamental objective of all programs is to enhance the ability of households to maximise the social and health benefits of a house. This common objective is taken in this re-port to be the definition of Home Management Programs. Home Man-agement Programs includes Home-maker, Living Skills, Home Living Skills and Healthy Home Living Pro-grams, amongst others. The first ob-jective of this project was to 'map' (identify, describe and docu-ment) current Home Management ac-

tivities and service providers, to better inform the interagency collaboration of the Home Management landscape in the Northern Territory. The broad range of activities is partly the result of the multiple program ar-eas that have an interest in Home Management services, including envi-ronmental health, public health, Women's Programs, Housing Pro-grams and capacity strengthening ac-tivities. This project also found that Home Management activities are of-ten located on the periphery of core business, resulting in less prominence at a policy level and disadvantage in terms of obtaining resources and sup-port. One of the recommendations of this report is that development of a flexible policy framework would be useful in supporting service provision and consolidating collective inter-agency contributions. The second objective of the project was to explore expected outcomes of programs. The mapping process re-vealed that NT Home Management Programs adopt one of two ap-proaches to enhance the skills of households to improve health and so-cial benefits from houses. The first approach is based on the un-derstanding that some Indigenous people require education or training in home hygiene, nutrition, environ-mental health and house maintenance to manage their households. Home Management Programs utilising this approach include certified education programs, as well as less formal train-ing. Many of these programs are based in towns and are aimed at peo-ple moving to urban settings from re-mote communities. The second approach assumes that

most people have adequate knowl-edge of how to maximise the health and social benefits from their houses, but are prohibited from doing so due to other factors. These have been termed 'functionality factors' and can include level of income, cost of liv-ing, geographical isolation, kinship relationships, appropriateness of health hardware, availability of clean-ing agents and nutritious food, etc. Recognition and understanding of functionality factors is essential for future development of Home Man-agement Programs. The third objective of this project was to identify areas of potential future re-search in Home Management. The re-port concludes that there are three critical areas for further exploration which would support service delivery: 1 in-depth identification and un-

derstanding of functionality factors;

2 identification of a hierarchy of' importance of functionality fac-tors; and

3 development of a home man-agement activities practical framework to guide policy de-velopment and service provi-sion. Given the interagency in-terest in Home Management Programs, the framework will need to identify contributions from appropriate agencies and define service guidelines.

It is suggested that practical and theo-retical framework development is of primary importance for further im-provement of Home Management Programs in terms of effectiveness, monitoring and policy development. A research proposal has been devel-


Exploring Indigenous Home Management Programs in the Northern Territory Sallie Cairnduff & Steve Guthridge CRC-ATH


Collaborative Aboriginal and Torres Strait Islander

POLICY DEVELOPMENT

Working Together Through Partnerships, Community Engagement and Capacity Build-ing to Achieve Improved Policy Objectives and Service Delivery for Indigenous Com-

munities

Two-Day Conference * 29 & 30 May 2002 * Hilton, Cairns Attend this conference and learn from top-level decision makers and grass root community case stud-ies how leading agencies are effectively developing collaborative partnerships and engaging Aborigi-nal and Torres Strait Islander stakeholders in policy development for improved service delivery.

REGISTER YOURSELF AND A TEAM OF KEY PEOPLE TODAY on (02) 9223 2600


oped in conjunction with this report, which is currently being submitted to appropriate funding bodies. The pro-posal outlines the development of a practical policy framework that will enable an integrated and flexible ap-proach for the improvement, deliv-ery and evaluation of Home Man-agement services. Flexibility is im-portant to continue to allow Home Management services to cater for lo-cal needs, while obtaining inter-agency support. At a national level, the current policy environment is increasingly suppor-tive of programs and initiatives that focus on strengthening family and community relationships (or 'social capital’). Enhancement of social capital is currently an emerging component of policy development in Australia. There is scope for Terri-tory agencies to investigate appropri-ate ways in which existing programs,

such as housing and health infra-structure development, can be sup-ported utilising the impetus of the national-level policy direction. Home Management policy and pro-gram development is particularly ex-citing given the relatively tittle pol-icy-level understanding of this area, and multi-agency support for Home Management growth. This project is an initiative of agen-cies including Department of Com-munity Development, Sport and Cul-tural Affairs (formerly Territory Housing), the Department of Health and Community Services, the Abo-riginal and Torres Strait Islander Commission (ATSIC), the Common-wealth Department of Family and Community Services and the North-ern Territory University. The project reflects the collaborative interest of a range of service providers in exam-ining and improving Home Manage-ment policy and service provision in

the Northern Territory. There is clearly goodwill amongst agencies to adopt an integrated approach to ad-dressing Home Management issues. For a copy of the report contact the Cooperative Research Centre for Aboriginal & Tropical Health PO Box 41096 Casuarina, NT 0820 Tel: 08 8922 8451 Fax 08 8927 5187


Review of the Tobacco Act - Discussion Paper A Discussion Paper is now available seeking your input into the review of the Tobacco Act. Tobacco is a key public health issue in the NT and our current legislation needs to be strengthened to minimise the im-pact of tobacco on our community. The paper presents a series of proposals to address environmental tobacco smoke (passive smoking), dis-couraging children from starting to smoke (by restricting advertising), and regulating tobacco (by licens-ing tobacco retailers). Given the vast amount of professional expertise in this Department may I encourage each of you to con-sider both a personal and a professional submission in response to these proposals. Submissions from professional bodies, unions and community organisations with whom you may be associated are also en-couraged. It is available in hard copy from Di Rayson, Tobacco Policy Officer (92690), through Alcohol and Other Drugs offices, in public libraries and MLA offices. It is also available at www.health.nt.gov.au under 'noticeboard', and also from the Alcohol and Other Drugs internal site. You can submit a response directly online. A tick-the-box approach means a simple response will only take a few minutes, although of course longer responses are most welcome, especially those which may identify gaps in the proposals. Please contact Di for further information. Closing date is April 26.

Please note that the article “One Successful Health Worker” By Terrence Guyula published in the February Edition of The Chronicle was reprinted from the Aboriginal & Torres Strait Islander Health Worker Journal.

The Evidence Based Guidelines for Primary Prevention of Type 2 Diabetes and Case Detection & Diagnosis of Type 2 Diabetes represent systematically generated state-ments that are designed to assist health care clinicians and consumers to make informed decisions about appropriate treatment in specific circumstances.

The Evidence Based Guideline for Primary Prevention of Type 2 Diabetes aim to inform and guide health promo-tion and preventative activities for Type 2 diabetes with evidence based information on what non-pharmacological interventions work and what does not.

While this Guideline contains information that would be relevant for a range of audiences, the focus of the system-

atic review is primarily on the efficacy and effectiveness of one to one interventions.

The Guideline targets clinicians, health promotion practi-tioners, planners and policy makers. Since certain risk factors are common to both the Prevention Guideline and the Case Detection and Diagnosis Guideline, where possi-ble overlap has been minimised.

To view the full publication visit: http://nhmrc/publications/synopses/cp86syn.htm

Source: Australian Department of Health & Aging Website

Evidence Based Guidelines for Type 2 Diabetes: Pri-mary Prevention, Case Detection and Diagnosis


A new swim program launched in Darwin on Saturday 9th March will assist young

children with asthma to cope with their symptoms.

A healthy lifestyle is important and swimming is ac-cepted as the best form of exercise for people with asthma and in particular for young children.

Asthma is prevalent throughout the NT. Some of the associated statistics are: • 1 in 4 primary school children have asthma • Asthma ranks amongst the 10 most common

reasons for seeing a General Practitioner • Asthma is the highest cause of absenteeism for

school children • An average of 15 Australians are recorded as

having died of asthma each week. The annual death toll has risen with 454 asthma deaths in-cluding children of all ages.

• 60% of asthma deaths are preventable • highest cause of hospitalization of all children

under 15

In 2000 Asthma NT was forced to abandon the swim program due to lack of funds.

In late 2001 an opportunity arose to revive the pro-gram when Woodside and Asthma NT identified a

mutual and appropriate partnership to revamp the program to assist young people in our community who have asthma. Needless to say that without Woodside, this program would not have been possi-ble.

At this stage it is anticipated that the program will be for 2 years. Classes correlate with school semesters. The program caters for 20 children whose opportuni-ties are restricted due to limited financial circum-stances.

The program is centered on obtaining better health outcomes for young children by: • Adopting an active, healthy lifestyle • Learning to swim in a professional environ-

ment • Building on their social skills • Education of best practice management of

asthma through parent/guardians • Achieving certain levels of swimming skills

For more information please contact Asthma NT on 89228827

WOODSIDE ASTHMA SWIM PROGRAM


Registration Details Name .................................................................................................................................................................. Organisation ...................................................................................................................................................... Postal address (internal mail address for NTG) .............................................................................................. ............................................................................................................................................................................ State/Territory ................................................................................................................................................... Postcode ............................................................................................................................................................ Phone ................................................................................................................................................................. Fax ...................................................................................................................................................................... Email .................................................................................................................................................................. Member .................................................. Non member .......................................... I would like to join the network ...........

Phone: (08) 8922 8280 Fax: (08) 8922 8310 Email: [email protected]

Centre for Disease Control PO Box 40596 CASUARINA NT 0811

Nor thern Ter r i to ry Chron i c D i sease s Network

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6th Annual Workshop REGISTRATION FORM

FAX to 8922 8310 or Post to address below

When: When: Wednesday 15th May 2002

Time: Time: 0815-1630

Where: Where: Mirrambeena Resort Darwin

NT

Registration: Registration: Free Morning, afternoon

tea, lunch and refreshment

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