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27 Apr 2018

Three days in the Top End left AMA President Dr Michael Gannon in no doubt as to the scale of the health burden facing Aboriginal Australians, and the difficulty in attracting and retaining medical staff in remote communities.

Dr Gannon and Shadow Indigenous Health Minister Warren Snowdon flew to the remote communities of Kintore and Utopia, and visited health facilities in Alice Springs to get firsthand insights into the successes and challenges of Aboriginal health services.

Whether it was the tiny town of Kintore, or the regional city of Alice Springs, the same themes recurred – dialysis is expensive, Aboriginal patients need culturally sensitive care, and keeping a medical workforce requires innovative strategies and incentives.

And without adequate housing, even the best health care will struggle to keep people healthy.

“When we talk about disease processes like trachoma, a bacterial infection that’s basically unseen in metropolitan Australia, or rheumatic heart disease – rates of RHD in the Northern Territory are 55 times that of the Australian average – these are diseases of poverty, of poor housing and poor hygiene,” Dr Gannon said.

“And we shouldn’t be surprised that these most simple, basic bacterial infections exist when you can’t provide the most basic housing amenities like water – to have a shower, to wash your hands, to clean your hands before you prepare food. We shouldn’t be surprised that these disease processes exist. They shouldn’t exist in the 21st century.

“But concepts of social determinants of health, that a clean water supply and a reliable power supply and a regular supply of fresh foodstuffs is how you prevent disease processes that end up costing the taxpayer many tens of thousands of dollars, they are messages that we need to get to people in power who often live very remote from the conditions we are talking about.”

Aboriginal and Torres Strait Islanders are almost four times as likely to die with chronic kidney disease as a cause of death than non-Indigenous Australians, and about nine in 10 Indigenous Australians with signs of chronic kidney disease are not aware that they have it.

The Alice Springs Hospital has the largest haemodialysis facility in the southern hemisphere, yet it depends on patients failing to show up for appointments to keep running.

By contrast, the Purple House outpatient dialysis centres in Alice Springs and Kintore have 100 per cent attendance rates, but do not attract any Medicare funding as there is no Medicare Benefits Schedule item number for outpatient dialysis.

A medical retrieval to airlift a pregnant woman from a remote community can cost as much as $70,000, yet there is no funding for a woman’s family to accompany her to the city unless it is her first pregnancy, meaning that women often return to country before giving birth.

Remote communities often have people travelling across State borders, from Queensland, Western Australia and South Australia, yet rigid guidelines mean that a nurse with Queensland or WA accreditation cannot deliver a vaccination in the Northern Territory.

And it can be hard in particular to keep nurses in very remote communities for longer than a year.

“It’s very difficult to deliver services to small, remote communities, but quite simply as a nation, we need to,” Dr Gannon said.

“Keeping people on country for treatment, rather than forcing patients and their extended families to come into Alice where accommodation might be difficult or expensive, is another example of something that requires a bit of thought and substantial investment to start things up, but they are cost-effective programs.

“It’s another example of what the AMA can do. We are the organisation that has the ear, perhaps not as often as we’d like, but we have the ear of the people who make decisions in this country.

“I meet regularly with Minister for Indigenous Health, Ken Wyatt. I meet regularly with Minister for Health, Greg Hunt. We speak to the Opposition. We speak to the Health Department in Canberra.

“That’s one of the things that we can do. We can talk to the people on the ground, we can talk to doctors, nurses, other health staff on the ground, and we can take those messages to Darwin, to Canberra, where those decisions are made, and ultimately where the money comes from.”




Published: 27 Apr 2018