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Objective: The need for more Remote Area Nurses in the Northern Territory is clear. This paper investigates the perspectives of Remote Area Nurse workforce issues among multiple stakeholders. The aim is to identify how Remote Area Nurse staffing issues are perceived by clinic managers, Remote Area Nurses themselves, Aboriginal colleagues and community members in seven remote communities in the Northern Territory. Design: This is a qualitative study that uses interviews and focus groups to identify key messages of local stakeholders about Remote Area Nurse workforce issues. A content analysis was used for data analysis. Setting: Seven diverse remote Aboriginal communities in the Northern Territory with government‐run health clinics were visited. Participants: Non‐random sampling techniques were used to target staff at the clinics at the time of field work. Staff and community members, who agreed to participate, were interviewed either individually or in groups. Interviews were conducted with 5 Managers, 29 Remote Area Nurses, 12 Aboriginal staff (some clinics did not have Aboriginal staff) and 56 community residents. Twelve focus groups were conducted with community members. Results: Content analysis revealed that participants thought having the "right" nurse was more important than having more nurses. Participants highlighted the need for Remote Area Nurses to have advanced clinical and cultural skills. While managers and, to a lesser extent, Remote Area Nurses prioritised clinical skills, Aboriginal staff and community residents prioritised cultural skills. Conclusions: Participants identified the importance of clinical and cultural skills and reiterated that getting the "right" Remote Area Nurse was more important than simply recruiting more nurses. Thus, retention strategies need to be more targeted and cultural skills prioritised in recruitment. [ABSTRACT FROM AUTHOR]

Objective: This paper reports on findings related to intersectoral collaboration stemming from an evaluation of a dementia awareness resource for use in remote Aboriginal communities*. The resource includes a DVD in English and three (3) Aboriginal languages of the Northern Territory. Design: A qualitative evaluation was conducted in four Northern Territory Aboriginal communities/organisations where the resource had been implemented by external dementia educators. The method included five focus groups with Indigenous aged care workers, community members and aged care service users ( n = 26), individual interviews with health care professionals and service coordinators ( n = 5), and observation. Data were analysed thematically. Results: Specific findings relating to intersectoral collaboration as a key enabling factor of effective dementia awareness and care are discussed in this paper. In addition to context variables such as understaffing and under-resourcing, there might be a lack of knowledge or interest on the part of some health practitioners concerning clients with dementia within remote communities. Conclusion: Dementia awareness in remote communities needs to be tackled from a 'whole system' perspective and not be the exclusive domain of the aged care services. Strategies that increase the critical mass of informed caregivers as well as health professionals will contribute to better services. [ABSTRACT FROM AUTHOR]

Background This paper aims to assess the barriers and solutions to the delivery of eye care in primary care settings and solutions to improve the use of comprehensive eye care among Indigenous Australians. Design, setting, participants Qualitative, mixed method study participants include Aboriginal community members, and health and eye care providers in urban, rural and remote settings. Main outcome measures Present evidence for health care providers to better understand and address some of the barriers that limit access to eye care in primary care settings. Results Patient perspectives on barriers to accessing eye care and reasons they choose to seek care or not are presented. Health system barriers identified by health and eye care providers are also presented. Additionally, key enablers for improving access to eye care through primary care services are identified. Conclusion Primary health care services have an important role in Indigenous eye health. There is a critical role for primary care in the coordination of the patient journey and cooperating with other services to improve access to comprehensive eye care. Through improved provision of primary eye care, monitoring of Indigenous eye health indicators and supporting patients to access eye care, it is possible to close the gap for vision. [ABSTRACT FROM AUTHOR]

Objective: This paper evaluates adherence with secondary preventative treatment and follow up of acute rheumatic fever (ARF) within the Katherine region of the Northern Territory after the introduction of an ARF register. We aimed to assess the rate of adherence with penicillin prophylaxis and follow-up guidelines in patients with previous ARF and the effect of factors such as age, sex, disease severity and clinic attendance. Design: Retrospective study. Setting: Five Indigenous Community Health Centres located in the Katherine region of the Northern Territory, Australia. Participants: Fifty-nine people resident in five communities who were prescribed monthly prophylactic penicillin for ARF during the 24 months between September 2002 and September 2004. All subjects were Indigenous. Main outcome measure: Main outcome measures were the number of penicillin injections received over the 24-month period and frequency of echocardiogram and specialist follow up in comparison to Rheumatic Fever Registry Guidelines. Results: Mean adherence with prophylaxis was 56% of prescribed doses. A non-significant trend towards improved adherence was seen in children, patients with less severe disease and those who attended the clinic more frequently. Rheumatic Fever Registry Guidelines for echocardiogram and specialist review were met by 63% and 59% of subjects, respectively. Conclusion: Within this population adherence with penicillin prophylaxis is inadequate to protect against recurrence of ARF and consequent worsening of rheumatic heart disease. In addition, the Rheumatic Fever Registry Guidelines for specialist follow up and echocardiogram are not being adhered to for many patients. [ABSTRACT FROM AUTHOR]

Highlights the upcoming Australian College of Rural and Remote Medicine's 2004 Scientific Forum in Alice Springs, Northern Territory. Theme of the forum; Attendees; Topic to be covered at the event.

This is the report of stage three of a three stage project. The aims of the overall project were to seek advice from expert Indigenous women on how to gather information from birthing Indigenous women while in hospital. Information was gathered from Indigenous women who gave birth in hospital or were admitted after the birth of their baby. The opinions of healthcare professionals on the care of these women were investigated. This paper describes the opinions and concerns of healthcare professionals regarding identified cultural, social and economical issues for Indigenous women at a large acute care hospital in the Northern Territory, Australia. The opinions of healthcare professionals are vital if the needs and concerns of Indigenous women are to be considered within the hospital setting. Stages one and two of this project have been presented previously. Stage three, reported here, describes a survey of 18 non-Indigenous and one Indigenous healthcare professionals regarding their opinions of the maternity experiences of Indigenous women admitted to an acute care setting. The consultative process for designing the questionnaire and reflections on issues raised by Indigenous women during their interviews in the previous two stages is presented. The methodology of the survey, demographics and perceptions of healthcare professionals who participated in the project are examined and the similarities and differences between the issues raised by the healthcare professionals and the Indigenous women in stage two of the project are discussed. Suggestions made by the healthcare professionals regarding improving quality of care for Indigenous women when admitted to an acute healthcare setting are presented. [ABSTRACT FROM AUTHOR]

Objective: To undertake an economic evaluation of community water fluoridation (CWF) in remote communities of the Northern Territory (NT). Design: Dental caries experiences were compared between CWF and non‐CWF communities before and after intervention. Costs and benefits of CWF are ascertained from the health sector perspective using water quality, accounting, oral health, dental care and hospitalisation datasets. Setting and Participants: Remote Aboriginal population in the NT between 1 January 2008 and 31 December 2020. Intervention: CWF. Main Outcome Measures: Potential economic benefits were estimated by changes in caries scores valued at the NT average dental service costs. Results: Given the total 20‐year life span of a fluoridation plant ($1.77 million), the net present benefit of introducing CWF in a typical community of 300–499 population was $3.79 million. For each $1 invested in CWF by government, the estimated long‐term economic value of savings to health services ranged from $1.1 (population ≤300) to $16 (population ≥2000) due to reductions in treating dental caries and associated hospitalisations. The payback period ranged from 15 years (population ≤300) to 2.2 years (population ≥2000). Conclusions: The economic benefits of expanding CWF in remote Aboriginal communities of NT outweigh the costs of installation, operation and maintenance of fluoridation plants over the lifespan of CWF infrastructure for population of 300 or more. [ABSTRACT FROM AUTHOR]

Objective: GP vocational training enrolments are declining Australia‐wide and, in the Northern Territory (NT), considered by some as '...the litmus test for the national scene' the decline is precipitous. This research investigates the drivers of declining GP training uptake in the NT and identifies and ranks potential solutions. Setting: NT, Australia. Participants: Ten senior medical students, 6 junior doctors, 11 GP registrars, 11 GP supervisors and 31 stakeholders. Design: Mixed methods: scoping review of Australian literature mapping key concepts to GP training pathway stages and marketing/communications; secondary data analyses; key informant interviews; and a stakeholder validation/prioritisation workshop. Interview data were thematically analysed. Workshop participants received summarised study findings and participated in structured discussions of potential solutions prior to nominating top five strategies in each of five categories. Results: Highly prioritised strategies included increasing prevocational training opportunities in primary care and selecting junior doctors interested in rural generalism and long‐term NT practice. Also ranked highly were: [Medical School] ensuring adequate infrastructure; [Vocational Training] offering high quality, culturally sensitive, flexible professional and personal support; [General Practice] better remunerating GPs; and [Marketing] ensuring positive aspects such as diversity of experiences and expedited GP career opportunities were promoted. Conclusion: Multifaceted strategies to increase GP training uptake are needed, which target different stages of GP training. Effective action is likely to require multiple strategies with coordinated action by different jurisdictional and national key stakeholder agencies. Foremost amongst the interventions required is the urgent need to expand primary care training opportunities in NT for prevocational doctors. [ABSTRACT FROM AUTHOR]

Introduction: Low retention is a significant contributor to medical workforce shortages in rural and remote regions of Australia, including in the Northern Territory (NT). Many of these areas are susceptible to climate change, which could exacerbate workforce retention problems. Objective: To examine factors influencing medical workforce retention in the NT, including the potential impact of climate change. Design: Cross sectional online survey of NT medical professionals, distributed via email through professional networks. Predominantly quantitative mixed methods (descriptive statistics, multivariate logistic regression, thematic analysis). Main 2 outcome measures reported were proportion of respondents intending to leave the NT, timeframe of intention to leave and motivating factors. Findings: Of 1407 registered practising medical professionals in the NT, 362 responded who met inclusion criteria (26% estimated response rate) and 351 completed all questions. Of the latter, 143 (41%) intended to leave the NT, 102 (29%) were unsure, and 106 (30%) did not intend to leave. Among doctors in training (DITs) 67 (55%) intended to leave and 29 (24%) were unsure. The best multivariable predictive model included only practice type (with general practitioners/rural generalists and non‐GP specialists significantly less likely to intend to leave compared to DITs), and location of primary medical degree (with non‐NT training non‐significantly associated with greater intention to leave). Of those intending to leave 94 (66%) reported planning to do so within two years. Training and career development opportunities, job dissatisfaction, moving to a preferred location and family‐related factors were all important motivators. Of those considering leaving, 58 (24%) identified climate change as a motivating factor. Conclusion: Retention remains a key challenge in addressing rural workforce shortages. In addition to established factors, climate change is an important driver that has the potential to worsen workforce shortages in susceptible regions. [ABSTRACT FROM AUTHOR]

Objective: To examine the influence of newspaper and Internet advertising, word-of-mouth endorsement and student experience in attracting applicants for junior medical officer positions in the Northern Territory. Design: A retrospective study. Participants: Fifty-four applicants for junior medical officer positions. Main outcome measure: Proportion of applicants who reported newspaper advertising, Internet advertising, word of mouth or personal experience in attracting their application for an intern or resident medical officer position. Results: Nineteen per cent of applicants saw the newspaper advertisement and 52% of the Internet advertisement. Eighty-seven per cent of applicants were influenced by word-of-mouth endorsement and 52% by student experience in the Northern Territory or Indigenous health. Conclusion: These results suggest that word-of-mouth endorsement has the greatest influence in attracting applicants for junior medical officer positions in Northern Territory hospitals. [ABSTRACT FROM AUTHOR]

Objective Indigenous Australians have poorer health outcomes compared to the non-Indigenous population. Malnutrition, and subsequently iron-deficiency anaemia, impairs childhood development. The aim of this study was to identify the prevalence of anaemia in school-aged children of an Australian Indigenous community and evaluate the effectiveness of treatment. Design A retrospective cohort study. Setting A Northern Territory Indigenous community. Participants Two hundred and one school-age students (5-15 years old) undergoing annual school screening. Main outcome measures Presence of anaemia. Anaemic and non-anaemic students were compared to determine any differences in age, gender, BMI and past history of anaemia. The response to treatment was analysed using initial and repeat haemoglobin results. Results Altogether, 201 students were screened with 105 (52%) classified as anaemic. No significant association was found between anaemic students and age, gender, BMI or prior history of anaemia. After treatment, the mean rise in haemoglobin was 13% (95% CI 11-15) at the 4-week interval. Age ( P = 0.17), gender ( P = 0.53) and weight ( P = 0.14) were not significantly associated with treatment efficacy. Only 11 students (17%) were still anaemic after treatment. Discussion Anaemia in Indigenous Australian school-aged children is a major public health issue. The prevalence of anaemia in this population is 52% and many times higher than that of the general Australian population. As per current guidelines, the recommended treatment is effective in over 80% at the 4-week interval. Community wide interventions are required to combat this alarming issue. [ABSTRACT FROM AUTHOR]

Objective: Assess nursing and allied health student satisfaction with their remote Northern Territory integrated learning placement and consideration of future rural/remote work Describe the characteristics of these students Examine changes in student characteristics over time., Design: A cross-sectional survey of students and a review of student placement data., Setting: Northern Territory, Australia., Participants: Former students having a work integrated learning placement of more than 1 week in the Northern Territory from 2017 to 2019., Main Outcome Measure(s): Agreement with the statements 'This placement has encouraged me to consider living and working in a rural or remote location after I graduate' and 'Overall, I was satisfied with my placement.' The administrative record review examined student numbers, and placement length over time., Results: A total of 341 students responded to the online survey. Overall satisfaction with the placement was very high (93%), and 84% agreed/strongly agreed that the placement had encouraged them to consider working in a rural or remote setting. High-quality clinical supervision and educational resources were associated with overall placement satisfaction. Overall placement satisfaction, prior interest in working remotely and satisfaction with educational resources were associated with consideration of working remotely. The number of students having a placement increased by 29% in 2017 to 2019. The number of placement weeks also increased (35%)., Conclusions: The number/placement time of nursing and allied health students has increased in the NT. Satisfaction with remote work integrated learning placements is an the important pathway to growing a local health professional workforce in remote and rural settings., (© 2021 National Rural Health Alliance Ltd.)

Objective To evaluate health practitioners' confidence and knowledge of alcohol screening, brief intervention and referral after training in a culturally adapted intervention on alcohol misuse and well-being issues for trauma patients. Design Mixed methods, involving semi-structured interviews at baseline and a post-workshop questionnaire. Setting Targeted acute care within a remote area major tertiary referral hospital. Participants Ten key informants and 69 questionnaire respondents from relevant community services and hospital-based health care professionals. Intervention Screening and brief intervention training workshops and resources for 59 hospital staff. Main outcome measures Self-reported staff knowledge of alcohol screening, brief intervention and referral, and satisfaction with workshop content and format. Results After training, 44% of participants reported being motivated to implement alcohol screening and intervention. Satisfaction with training was high, and most participants reported that their knowledge of screening and brief intervention was improved. Conclusion Targeted educational interventions can improve the knowledge and confidence of inpatient staff who manage patients at high risk of alcohol use disorder. Further research is needed to determine the duration of the effect and influence on practice behaviour. Ongoing integrated training, linked with systemic support and established quality improvement processes, is required to facilitate sustained change and widespread dissemination. [ABSTRACT FROM AUTHOR]

Objective: To evaluate Deadly Thinking, a social and emotional well-being promotion program targeted to remote and rural Aboriginal and Torres Strait Islander communities. Deadly Thinking aims to improve emotional health literacy, psychological well-being and attitudes towards associated help-seeking., Design: Participants completed pre/post-test evaluations via a brief self-report survey immediately before and after the Deadly Thinking workshop., Setting: Aboriginal and Torres Strait Islander communities in rural and regional Australia., Participants: Data were obtained from 413 participants (69.8% female, mean age 41.6 years), of whom 70.4% identified as Aboriginal or Torres Strait Islanders., Intervention: Deadly Thinking workshops involve participant's engaging with a series of videos and facilitated group discussions with other participants related to social and emotional well-being topics relevant to individuals and communities., Main Outcome Measures: Participants completed measures of psychological distress, suicidal ideation, substance use, changes in attitudes towards help-seeking and help-seeking intentions and satisfaction with the workshop. Additionally, participants in a train-the-trainer workshop rated their perceived confidence to deliver the program post-workshop., Result: Participants reported positive perceptions of community safety and well-being and low rates of marked distress, with no significant difference between train-the-trainer and community workshop participants. Results indicated significant improvement in help-seeking intentions post-workshop and high rates of satisfaction with workshop components., Conclusion: Initial evaluation indicates good acceptability and feasibility of delivering the Deadly Thinking program in rural and remote Indigenous communities; however, more robust evaluation of the program is warranted using controlled conditions to measure effectiveness, particularly for changing in help-seeking behaviour., (© 2020 National Rural Health Alliance Ltd.)

Objective We investigated patient perceptions of a virtual preoperative anaesthesia evaluation clinic linking Royal Darwin Hospital to Katherine Hospital. Design Descriptive study, cross-sectional survey. Setting Regional and rural areas of Northern Territory, Australia. Participants Sample includes 27 respondents, five Indigenous, 18 non- Indigenous and four unknown. Interventions Introduction of a preoperative anaesthesia evaluation clinic. Main outcome measures We designed a 10-item, 5-point Likert scale questionnaire assessing patient perceptions in four domains: (i) technical quality; (ii) perceived efficacy; (iii) affective patient experience; and (iv) patient preference. Qualitative responses are also reported. Results Twenty-seven out of 35 patients (77%) completed the questionnaire. Ninety-eight per cent were in positive agreement on technical quality with a mean score of 1.35 ( SD: 0.53); Ninety-five per cent on perceived efficacy, 1.35 ( SD: 0.65); Eighty-four per cent in negative agreement on affective patient experience (negative perception item), 4.19 ( SD: 1.07); Eighty-one per cent in negative agreement on patient preference (negative perception item), 4.23 ( SD: 1.14). There were no significant differences in the answers between Indigenous (five patients) and non- Indigenous patients (18 patients). Conclusion Our study confirms the acceptability of telemedicine in the remote assessment of preoperative patients in the Northern Territory, with positive perceptions in all four domains. [ABSTRACT FROM AUTHOR]

Objective Little is known about Australian Aboriginal world views related to child rearing and child development. The aim of this qualitative study was to provide an opportunity for remote Aboriginal families in Central Australia to share what they felt was important for non- Aboriginal people, working in the same setting, to know about their parenting methods. Design, setting and participants A descriptive study was carried out in a remote Central Australian community by an Aboriginal and non- Aboriginal researcher, working in partnership, combining ethnographic and participatory approaches. Eight families with children under five were primary participants. Data were collected through participant observation and informal conversational interviews. Findings Three main interlinked themes were identified through this research: 'fitting in' (integration of children into community life), 'growing up' (children's development) and 'staying strong' (children's autonomy within a communal social structure). In this community, the development of independence and self-reliance within a closely nurturing environment are paramount. Children are taught responsibilities and obligations through interaction in community life from birth. Children's growth and development is not linked to chronological time scales. Rather, children are encouraged and praised for their social and emotional maturity as well as physical development, regardless of the age at which milestones are achieved. Conclusions This descriptive study provided an opportunity for Aboriginal people in one remote community to share their perspectives about child rearing and child development. It provides some insights into positive child-rearing practices and perspectives which can assist non- Aboriginal service providers to work more effectively with Aboriginal families. [ABSTRACT FROM AUTHOR]

Problem: In the Northern Territory, 64% of Indigenous births are to remote-dwelling mothers. Delivering high-quality health care in remote areas is challenging, but service improvements, informed by participative action research, are under way. Evaluation of these initiatives requires appropriate indicators. Few of the many existing maternal and infant health indicators are specifically framed for the remote context or exemplify an Indigenous consumer perspective. We aimed to identify an indicator framework with appropriate indicators to demonstrate improvements in health outcomes, determinants of health and health system performance for remote-dwelling mothers and infants from pregnancy to first birthday. Design: We reviewed existing indicators; invited input from experts; investigated existing administrative data collections and examined findings from a record audit, ethnographic work and the evaluation of the Darwin Midwifery Group Practice. Setting: Northern Territory. Process: About 660 potentially relevant indicators were identified. We adapted the Aboriginal and Torres Strait Islander Health Performance Framework and populated the resulting framework with chosen indicators. We chose the indicators best able to monitor the impact of changes to remote service delivery by eliminating duplicated or irrelevant indicators using expert opinion, triangulating data and identifying key issues for remote maternal and infant health service improvements. Lessons learnt: We propose 31 indicators to monitor service delivery to remote-dwelling Indigenous mothers and infants. Our inclusive indicator framework covers the period from pregnancy to the first year of life and includes existing indicators, but also introduces novel ones. We also attempt to highlight an Indigenous consumer. [ABSTRACT FROM AUTHOR]

The recent Federal Government Report and Media release, Stronger Futures in the Northern Territory: Report on Consultations and its claim of 'widespread Indigenous Support' has brought the topic of the Northern Territory Emergency Response (the Intervention) back into the public mind. This article provides a synthesis of four years of debate around the Northern Territory Emergency Response, at a time when the program is nearing the end of its time frame. It outlines the main arguments supporting the Intervention, the central criticisms and the government's response to these evaluations, with the aim of providing a primer or summary for health professionals to the discussion around this important public issue. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to improve pathology services in selected remote health centres from the Northern Territory (NT) through the implementation of a quality managed point-of-care pathology testing (POCT) service. Design: Study of the efficacy of the POCT service after 1 year and qualitative survey of POCT device operators. Setting: The study was set in thirty-three remote health centres in the NT administered by the NT Department of Health. Participants: Remote health centre staff at participating remote health centres participated in the study. Interventions: The introduction of the i-STAT device to perform on-site POCT. Main outcome measures: The main outcome measures used in the study were the number of remote staff trained, volume of testing performed and satisfaction of POCT device operators. Results: One hundred and sixty-four health professional staff were trained to perform i-STAT POCT during the first year of the program. A total of 2290 POCT tests were performed on the i-STAT. The volume of testing consistently increased across the year. Tests for international normalised ratio were the most frequently performed (averaging 70 tests per month). Stakeholder satisfaction with the i-STAT device was high, with a statistically significant improvement in satisfaction levels with pathology service provision being reported after the introduction of POCT. Greater than 80% of respondents stated POCT was more convenient than the laboratory service and assisted in the stabilisation of acutely ill patients. Conclusions: The NT POCT Program has been operationally effective and well received by staff working as i-STAT POCT operators in remote health centres. Retention of remote health centre staff is the most significant challenge to ensuring the program's long-term viability. [ABSTRACT FROM AUTHOR]

Objective: To establish a baseline of levels of Indigenous professional engagement in the health and community services sector in remote Northern Territory. Design: Analysis of data from 2001 and 2006 Census. Setting: Northern Territory - Balance Statistical Division. Participants: Persons employed in health and community services sector in 2006. Main outcome measures: Indigenous status, level of education, current education status, occupation type and residential mobility. Results: Indigenous employment grew by 137% between 2001 and 2006. In 2006, 42% of Indigenous employees were labourers and 9% professionals, in contrast to non-Indigenous workers of whom 41% were professionals and 5% labourers. Over 50% of workers who moved into the region between 2001 and 2006 were professionals, compared with 20% of those who had remained in the region. Indigenous in-migrants were twice as likely as Indigenous people who had stayed in the region to be professionals. Indigenous workers were much less likely to have post-school educational qualifications than non-Indigenous workers. Indigenous workers were also less likely to be studying for a post-school qualification. Indigenous in-migrants were three times as likely to have post-school qualifications than Indigenous people who had remained in the region and were also more likely to be enrolled in post-school education. Conclusions: The baseline is low Indigenous engagement as professional labour, and low Indigenous engagement in formal education. Mobile Indigenous people have higher levels of engagement. The situation might be addressed by increased formal education in remote areas and increased mobility of Indigenous health labour. [ABSTRACT FROM AUTHOR]

Objective: To understand the profile and impact of aeromedical evacuations in remote Indigenous communities. Design: Descriptive study. Setting: A primary health care centre in east Arnhem Land, Northern Territory, Australia. Participants: Four hundred and ten evacuations from a total population of more than 2200 were analysed from February 2003 to August 2005. Main outcome measures: Patient demographics, seasonal variations, diagnostic categories, utilisation of staff resources. Results: On average 6.5% of the community were evacuated to hospital every year with an evacuation occurring every 2.2 days. Children aged under five years were 3.3-fold overrepresented in evacuations (comprising 37.7% of those evacuated versus 11.3% of the community, P < 0.001). Four diagnostic categories accounted for 61% of evacuations: respiratory disease (21%), obstetric conditions (15%), gastroenteritis (14%) and injury/poisoning (11%). Over the study period four patients required intubation at the clinic. Evacuation rates were higher in the monsoon season. Forty-seven per cent of evacuations occurred after hours. The waiting time for plane arrival ranged from one hour to 21 hours with a median wait-time of three hours. Conclusion: Aeromedical evacuations place a heavy burden on primary health centres. Clinic staff are regularly required to provide hospital-level acute care, often for several hours at a time. Meeting this burden competes with primary prevention programs and regular clinic duties. The age and diagnostic profiles encountered in this study have significant implications for the range of skills required to provide an adequate acute care service. This study highlights the need for remote area health centres to be well resourced to meet these needs. [ABSTRACT FROM AUTHOR]

Background: Remote general practice can be a highly rewarding career, but poses many personal and professional challenges. It is characterised by significant geographical, professional and social isolation and a requirement for practitioners with public health, emergency and extended clinical skills. The remote practitioner faces further challenges in the remote Aboriginal community setting, including language and cultural barriers., Objectives: This paper discusses the specific components of a remote Aboriginal community general practice registrar orientation program in the Northern Territory, and their particular importance and relevance to remote training and practice in this context., Discussion: Northern Territory General Practice Education, the regional general practice training provider in the Northern Territory, has developed a model for a comprehensive orientation program for general practice registrars planning to work in remote Aboriginal community locations. This comprises a number of core components, including communication and cultural safety training; clinical and procedural skill development; population health; self-care and personal/professional role delineation; and organisational issues. We believe it is a program that is applicable to other disciplines undertaking work in remote Aboriginal communities.

Palliative care is a service available to many Australians subject to location and varying criteria. This paper seeks to identify some of the issues that hamper the provision of this sophisticated service to Aborigines living in remote parts of the Northern Territory. The paucity of literary sources of information demonstrates the need for research to be carried out in this field.

The usual and common-sense definition of disability is based on a medical model that sees disability as a limitation or lack of competence on the part of the individual. This definition fails to acknowledge that in some cultures disability as a concept does not exist. This paper, based on research undertaken in 1994/1995, examines how the social construction of disability among the Anangu of the cross border region of Western Australia, South Australia and the Northern Territory, takes into consideration the important factors of history, culture and language. The theoretical underpinning of the research was symbolic interactionism, which led to collaborative ethnography becoming the methodology employed to collect and analyse the data. The findings of the research indicate that the social construction of disability among the Anangu occurs in three historical phases: the impairment, oppression and empowerment phases. The paper's purpose is to offer service providers to Aboriginal people with disabilities, information that will help them understand some of the attitudes, customs, mores and beliefs of their clientele.

This study investigated the use of condoms, attitudes to condoms and correlates of these in women in Darwin, Northern Territory, Australia. A survey using a Condom Attitudes Scale was administered to a convenience sample of 160 women. With regular partners, these women had a low level of use of condoms, with a somewhat higher level of use with casual partners. Their perceived risk of Human Immunodeficiency Virus and other sexually transmitted diseases was not strong. These women's attitude towards the condom was reasonably positive. The major factor that correlated with attitudes to condoms was the type of relationship with a partner. This paper demonstrates the need for health professionals to continue to promote condom use among women.

This paper provides a description of initiatives and changes made in remote primary healthcare service delivery in Central Australia. These changes included the introduction of an orientation and Aboriginal cultural awareness program, revising the recruitment process to include communities in staff selection, developing policies and protocols to support practice, and increasing support for remote area staff through managers being out and about in remote areas. The change from centralised management to an increasingly decentralised participatory management model, and involving local communities and local staff in decision making, was initiated early in the change process and continues to be of prime importance. After 5 years of intensive effort, it is clear that despite these initiatives sustainable change has been elusive and some problems remain. Further change and development is necessary. A number of new initiatives are described, including a Menzies School of Health Research project that examines structural issues, which will provide direction for the future by providing better support for remote area staff and facilitating greater community participation.