Gambling in a remote Aboriginal setting - the good, the bad and the ugly

The effort undertaken by the Ceduna Koonibba Aboriginal Health Service (CKAHS) and Statewide Gambling Therapy Service (SGRS) to investigate the impact of gambling on Aboriginal people living in the region is discussed. The different initiatives undertaken after obtaining additional funding to help stop gambling in the region are highlighted.

Considering Aboriginal palliative care models: the challenges for mainstream services

This review discusses palliative care and end-of-life models of care for Aboriginal people in the Australian state New South Wales, and considers Aboriginal palliative care needs by reflecting on recent literature and lessons derived from Aboriginal consultation. Aboriginal people in Australia account for a very small proportion of the population, have poorer health outcomes and their culture demonstrates a clear resistance to accessing mainstream health services which are viewed as powerful, isolating and not relevant to their culture, way of life, family and belief systems. Aboriginal people regard their land as spiritual and their culture dictates that an Aboriginal person needs to know their origins, emphasising the value placed on kin and also demonstrating a strong desire to remain within their own country. Currently Aboriginal people tend to not access palliative care services in mainstream facilities; and there is very little data on Aboriginal admissions to palliative care centres. Over the last two decades only two models of palliative care focusing on and developed in Aboriginal communities have been implemented. The seminal contribution to Aboriginal Palliative Care was in the form of a resource kit developed to support palliative care providers to examine their practice for cultural appropriateness for Aboriginal and Torres Strait Islanders. The "living model" coming from this project is adaptive and flexible, enabling implementation in different Aboriginal country as a participative process with community input. The Australian government"s National Indigenous Palliative Care Needs Study similarly indicated that Australian empirical research on Aboriginal palliative care service provision is in its infancy, and comprehensive data on the rates of Aboriginal access to palliative care services did not exist. What literature does exist is drawn together in an argument for the development and need for culturally specific Aboriginal palliative care models, which are culturally appropriate, locally accessible and delivered in collaboration and partnership with Aboriginal controlled health services. This is essential because Aboriginal people are a minority cultural group who are disconnected from mainstream health service delivery, and have a sense of cultural isolation when accessing mainstream services. It is preferable that palliative care is delivered in a collaboration between Aboriginal Controlled Health Service and mainstream palliative care services to ensure a dignified end of life for the Aboriginal person. These collaborations and partnerships are fundamental to ensure that a critical mass of Aboriginal clinicians are trained and experienced in end of life care and palliation. Developing palliative care programs within Aboriginal communities and training Aboriginal Health Workers, promoted and developed in partnership with the Aboriginal community, are important strategies to enhance palliative care service provision. Further partnerships should be championed in this collaborative process, acknowledging a need for palliative care models that fit with Aboriginal peoples" community values, beliefs, cultural/ spiritual rituals, heritage and place.

An Aboriginal obligation to Country: challenging the status quo

Australian Aboriginal Traditional Owner ancestral responsibilities to Country involves listening and exercising vested responsibilities and duties of care, passed down from generation to generation through clan and familial connections. Traditional Owners is a term used to describe today’s descendants of the original Aboriginal inhabitants and have ongoing cultural and spiritual connections to land and water where their ancestors lived. The incorporation of Traditional Owner relationships to Country and the need to engage with Traditional Owners in Western planning regimes are often expressed positively; that Aboriginal needs and aspirations need to be recognized in the urban landscape. However in practice, decisions involving the address of Aboriginal aspirations are usually made in a generic context rather than a Country and knowledge specific context. This can have adverse effects on obligations to Country stewardship, and Custodial perceptions are being ignored and negated. Improving our understanding of how Traditional ancestral obligations to Country are expressed and embodied within the context of generic Western planning instruments, is critical as cities expand and increase the pressures and threats on Traditional Owners Country, their resources, their cultural heritage, their knowledge and their histories. This paper contributes to this understanding by focusing upon Traditional Owner communities in the Brisbane metropolitan region who are attempting to address their responsibility to Country through Western State and local planning instruments. This paper draws on empirical data collected through interviews and observations between 2013-2015 with the Quandamooka communities and a content analysis of current planning instruments. The paper reports on their obligations of and to Country and the consequences that engagement within Western planning instruments has had upon their Traditional Ownership well-being and landscape health. Lessons learned from this case study are discussed to offer future planning policy initiatives that could better meet the needs of Traditional Owners in Australian cities.

Exploring Aboriginal patients’ experiences of cardiac care at a major metropolitan hospital in Melbourne

Objectives: The aim of the present study was to explore Aboriginal patients' lived experiences of cardiac care at a major metropolitan hospital in Melbourne.Methods: The study was a qualitative study involving in-depth interviews with a purposive sample of 10 Aboriginal patients who had been treated in the cardiology unit at the study hospital during 2012-13. A phenomenological approach was used to analyse the data.Results: Eight themes emerged from the data, each concerning various aspects of participants' experiences: 'dislike of hospitals', 'system failures', 'engagement with hospital staff', 'experiences of racism', 'health literacy and information needs', 'self-identifying as Aboriginal', 'family involvement in care' and 'going home and difficulties adapting'. Most participants had positive experiences of the cardiac care, but hospitalisation was often challenging because of a sense of dislocation and disorientation. The stress of hospitalisation was greatly mediated by positive engagements with staff, but at times exacerbated by system failures or negative experiences.Conclusion Cardiac crises are stressful and hospital stays were particularly disorienting for Aboriginal people dislocated from their home land and community.What is known about the topic? Aboriginal people have higher mortality rates due to cardiovascular diseases compared with other Australians. Along with different factors contributing to the life expectancy gap, Aboriginal people also face significant barriers in the use of the healthcare system.What does this paper add? Aboriginal patients' lived experience of cardiac care at a major metropolitan hospital in Melbourne is explored in this paper. Different issues were revealed during their interaction with the hospital staff and the hospital system in conjunction with their cultural aspect of patient care.What are the implications for practitioners? Positive interactions with staff, ongoing support from family and community, culturally appropriate cardiac rehabilitation programs can improve the cardiac care experiences of Aboriginal patients.

Chronic disease self-management in Aboriginal communities : towards a sustainable program of care in rural communities

The Chronic Disease Self-Management (CDSM) strategy for Aboriginal patients on Eyre Peninsula, South Australia, was designed to develop and trial new program tools and processes for goal setting, behaviour change and self-management for Aboriginal people with diabetes. The project was established as a one-year demonstration project to test and trial a range of CDSM processes and procedures within Aboriginal communities and not as a formal research project. Over a one-year period, 60 Aboriginal people with type-2 diabetes in two remote regional centres participated in the pilot program. This represents around 25% of the known Aboriginal diabetic population in these sites. The project included training for four Aboriginal Health Workers in goal setting and self-management strategies in preparation for them to run the program. Patients completed a Diabetes Assessment Tool, a Quality of Life Questionnaire (SF12), the Work and Social Adjustment Scale (WASAS) at 0, 6 and 12 months. The evaluation tools were assessed and revised by consumers and health professionals during the trial to determine the most functional and acceptable processes for Aboriginal patients. Some limited biomedical data were also recorded although this was not the principal purpose of the project. Initial results from the COAG coordinated care trial in Eyre suggest that goal setting and monitoring processes, when modified to be culturally inclusive of Aboriginal people, can be effective strategies for improving self-management skills and health-related behaviours of patients with chronic illness. The CDSM pilot study in Aboriginal communities has led to further refinement of the tools and processes used in chronic illness self-management programs for Aboriginal people and to greater acceptance of these processes in the communities involved. Participation in a diabetes self-management program run by Aboriginal Health Workers assists patients to identify and understand their health problems and develop condition management goals and patient-centred solutions that can lead to improved health and wellbeing for participants. While the development of self-management tools and strategies led to some early indications of improvements in patient participation and resultant health outcomes, the pilot program and the refinement of new assessment tools used to assist this process has been the significant outcome of the project. The CDSM process described here is a valuable strategy for educating and supporting people with chronic conditions and in gaining their participation in programs designed to improve the way they manage their illness. Such work, and the subsequent health outcome research planned for rural regions, will contribute to the development of more comprehensive CDSM programs for Aboriginal communities generally.

The Centre of Clinical Research Excellence in Aboriginal Health : an operational rationale and some reflections on progress so far

The Centre of Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander Health was established in late 2003 through a major National Health and Medical Research Council (NHMRC) grant involving collaboration between the Aboriginal Health Council of South Australia (AHCSA), Flinders University, and Aboriginal Health Services. Our foundation research communities are the Aboriginal communities served by these Aboriginal Health Services in the Spencer Gulf / Eyre Peninsula region. In recent years a number of collaborative research programs involving chronic illness management, self-management and coordinated care have been implemented in these communities and this work is the basis of the initial CCRE activities. Key objectives of the CCRE are to improve the health status of Indigenous people through conducting relevant and meaningful Aboriginal controlled health research, providing formal training for Indigenous health researchers and developing innovative approaches to health care that can be readily translated and applied to support communities. The inclusion, empowerment and engagement of Indigenous people in the process of managing community health represent tangible strategies for achieving more equitable health outcomes for Aboriginal people. This paper outlines the CCRE operational rationale and presents early activities and outcomes across the three strategic areas of CCRE operations: research, education and training, and translation. Some critical reflections are offered on the progress and experience of the CCRE thus far. A common obstacle this CCRE has encountered is that the limited (especially staff) resources available to the Aboriginal Health Services with which we are collaborating make it difficult for them to engage with and progress the projects we are pursuing.

Building audiences: Aboriginal and Torres Strait Islander arts

FOREWORDAs a culturally ambitious nation we are shaped by our cultural engagement and it is an important catalyst for critical discourse. It is vital that audiences and artists discuss their experiences, enabling us as a community to come together through engagement with diverse practice that challenges and entertains. This research has been undertaken in response to the Australia Council’s strategic vision for a nation where there are no borders to accessing Australian arts, and all Australians are able to experience and cherish Aboriginal and Torres Strait Islander arts and culture.Building Audiences provides an insight into the nature of existing Australian audiences and the broader public. It reveals how Australians engage with Aboriginal and Torres Strait Islander arts in the public sphere as audiences, highlighting that this engagement is part of a broader national dialogue about their relationship with and towards Indigenous Australia.

Implementing the Flinders Model of self-management support with Aboriginal people who have diabetes : findings from a pilot study

A pilot program for Aboriginal people with diabetes on Eyre Peninsula, South Australia, aimed to test the acceptability and impact of using the Flinders model of self-management care planing to improve patient self-management. A community development approach was used to conduct a twelve-month demonstration project. Aboriginal health workers (AHWs) conducted patient-centred, self-management assessment and care planning. Impacts were measured by patient-completed diabetes self-management assessment tool, goal achievement, quality of life and clinical measures at baseline and 12 months. Impact and acceptability were also assessed by semi-structured interviews and focus groups of AHWs. Sixty Aboriginal people with type 2 diabetes stated their main problems as family and social dysfunction, access to services, nutrition and exercise. Problems improved by 12% and goals by 26%, while quality of life scores showed no significant change. Self-management scores improved in five of six domains. Mean HbA1c reduced from 8.74-8.09 and mean blood pressure was unchanged. AHWs found the process acceptable and appropriate for them and their patients. It was concluded that a diabetes self-management program provided by AHWs is acceptable, improves self-management and is seen to be useful by Aboriginal communities. Barriers include lack of preventative health services, social problems and time pressure on staff. Enablers include community concern regarding the prevalence and mortality associated with diabetes.

Investigative Interviewing of Aboriginal children in cases of suspected sexual abuse

This study examined the investigative interviewing of Australian Aboriginal children in cases of alleged sexual abuse, with a focus on three commonly included components of interview protocols: ground rules, practice narrative, and substantive phase. Analysis of 70 field transcripts revealed that the overall delivery and practice of ground rules at the beginning of the interview was positively associated with the spontaneous usage of rules in children's narratives of abuse. When specifically examining the "don't know" rule, however, only practice had an effect of children's usage of the rule (as opposed to simple delivery or no delivery at all). Children spoke more words overall, and interviewers used more open-ended prompts during the substantive phase when the interviews contained a practice narrative. Children most often disclosed sexual abuse in response to an open-ended prompt; however, they produced the most words in response to suggestive prompts. This article concludes with a discussion of the effectiveness of ground rules, practice narratives, and questioning with Aboriginal children.

Improving investigative Interviews with Aboriginal children

This thesis focused on improving investigative interview protocols with Australian Aboriginal children (predominantly in cases of abuse). Current investigative interviewing procedures were evaluated, and a revised interview protocol tailored to Aboriginal children was created.

Aboriginal palliative care and mainstream services

The Aboriginal person's strong wish to die at home with family, surrounded by their 'country' and in their own community means effective palliative care services must be Aboriginal centred and focused.

Prey selection, size, and breakage differences in Turbo undulatus opercula found within Pacific Gull (Larus pacificus) middens compared to Aboriginal middens and natural beach deposits, southeast Australia

Qualitative discrimination criteria are employed commonly to distinguish cultural shell middens from natural shell deposits. Quantitative discrimination criteria remain less developed beyond an assumption that natural shell beds tend to contain a wider range of shell sizes compared to cultural shell middens. This study further tests this assumption and provides the first comparative quantitative analysis of shell sizes from cultural middens, bird middens, and beach shell beds. Size distributions of opercula of the marine gastropod Turbo undulatus within two modern Pacific Gull (Larus pacificus) middens are compared with two Aboriginal middens (early and late Holocene) and two modern beach deposits from southeast Australia. Results reveal statistically significant differences between bird middens and other types of shell deposits, and that opercula size distributions are useful to distinguish Aboriginal middens from bird middens but not from beach deposits. Supplementary qualitative analysis of taphonomic alteration of opercula reveal similar opercula breakage patterns in human and bird middens, and further support previously recognised criteria to distinguished beach deposits (water rolling and bioerosion) and human middens (burning). Although Pacific Gulls are geographically restricted to southern Australia, the known capacity of gulls (Larus spp.) in other coastal contexts around the world to accumulate shell deposits indicates the broader methodological relevance of our study.

Book review: An Appreciation of Difference: WEH Stanner and Aboriginal Australia, edited by Melinda Hinkson and Jeremy Beckett, xvii + 293 pp, Aboriginal Studies Press, Canberra, 2008, ISBN 9780855756604 (pbk), $39.95

An Appreciation of Difference: WEHStanner and Aboriginal Australia is a tribute nearly 30 years after his death to one of the lost esteemed anthropologists who worked in Indigenous Australian contexts. It is also a reflection on what Stanner achieved in his lifetime and what his work contributes to current Indigenous issues and Indigenous studies in Australia today.