Volume 199 Issue 1

Creating effective collaboration takes time and requires building trust and demonstrating commitment. The Australian Indigenous Doctors’ Association hopes that values will be evident in the new National Aboriginal and Torres Strait Islander Health Plan that will guide governments and individual medical professionals in providing quality, culturally appropriate health care.

Tammy M Kimpton BMed

Closing the gap among First Nations children requires community involvement in service implementation, consistent monitoring of child health indicators, and a good understanding of how public policies affect children.

Sandra J Eades BMed, PhD · Fiona J Stanley MB BS, MSc, MD

Using the concept of trauma-informed care to help Aboriginal and Torres Strait Islander children and their families recover from stressful life events.

Helen M Milroy MB BS, FRANZCP, CATCAP

The full content of this article is available by downloading the PDF.

The full content of this article is available by downloading the PDF.

Social media success stories in the Indigenous health sector include connecting young people with a public health initiative in sexual health and delivering mental health care online by empowering individuals.

Melissa A Sweet MA(SciTechStud), BA

A poorly addressed factor in the health and behavioural problems of Australian Indigenous children deserves more attention.

Sarah L Blunden BA(Hons), MSocSc, PhD · Danny Camfferman BA, GradDipPsych, PhD

The recent visit of the Dalai Lama to Australia shows that positivity and vision is most important, focused on what is required, rather than rehashing past mistakes and a blinkering imposed by over-obsession with economic and political constraints. But in order to translate this into concrete policy, it is important to be aware of the complex way in which policy develops and the multiple perspectives that are brought to bear.

Stephen R Leeder MD, PhD, FRACP

There are now signs of substantial improvement in the health of Indigenous people, although there are persisting problems of access and worsening issues in some areas. But there is also a conspicuous lack of health data to show impacts and help plan future activities. The new national plan to guide investment is a step forward, but issues of racism and discrimination need to also be addressed.

Kerry Arabena

A case-note audit at a community-based sexual health clinic has shown that hepatitis C treatment outcomes among Indigenous Australians are similar to those among non-Indigenous Australians, which might be partly due to genetics.

Joshua S Davis · Anuja C Kulatunga · Krispin Hajkowicz

To the Editor: Telehealth is the umbrella term for the electronic and telecommunication-based expansion of health care services, both clinical and non-clinical, which include telemedicine (telehealth clinical services) and electronic health record (EHR) systems. A re-evaluation of health care in Australia is needed, including characterisation of new systems of care focused on improving health outcomes using mobile device-based telehealth (mHealth). This will be accelerated through ...

Sven-Erik Bursell · Alicia J Jenkins · Laima Brazionis · Kevin G Rowley · Alex D Brown

To the Editor: Interpreting coronial legislation can prove challenging for junior doctors at the bedside, with significant local variation in interpretation.1 The Victorian Coroners Act (Coroners Act 2008 [Vic]) has recently undergone changes that have coincided with a decline in numbers of reported cases,2 with the Coroners Court raising the question of whether there was “unintentional under-reporting of reportable deaths”.2 What constitutes a reportable death ...

Alison J Dwyer · Philip Visser · Lynette Russell

To the Editor: We report a case of severe Vibrio cholerae infection acquired in Sydney, likely due to ingestion of imported seafood. An 83-year-old man with Parkinson disease presented with a 3-day history of vomiting, large-volume watery diarrhoea and acute renal impairment necessitating admission to the intensive care unit. Blood cultures grew curved gram-negative bacilli, and intravenous piperacillin–clavulanic acid was commenced. Subsequent microbiological testing of blood ...

Chiao-Yun Hsu · Simon Pollett · Patricia Ferguson · Brenden J McMullan · Vicki Sheppeard · Suzanne E Mahady

A local case highlights the current worldwide resurgence of this disease among men who have sex with men and the need to consider it as a cause of genital ulceration.

Phillip J Read · Anna McNulty

To the Editor: Conflicting information about treatments is known to undermine compliance with the use of medications.1 The education of patients and caregivers that accompanies prescribing should therefore be as consistent as possible. Clients may conduct research on the internet into particular medicines and try to corroborate “what the doctor said”. In the case of the use of clonidine in children, publicly available information is ...

Klaus Martin Beckmann

A retrospective review among patients admitted to a Queensland palliative care unit showed that a large proportion was prescribed nine or more medications. Vigilance in review and appropriate cessation of drugs that are no longer needed is recommended.

Ross P Cruikshank · Bruce Stafford · Lee Jones

Part 2 of the MJA’s Cardiology series focuses on assessing patients with possible cardiac chest pain, including risk stratification, cardiac biomarkers and the role of non-invasive testing for myocardial ischaemia and coronary artery disease.

William A Parsonage DM, MRCP, FRACP · Louise Cullen MB BS, FACEM · John F Younger MB ChB, MRCP, FRACP

Cultural competence strategies aim to make health services more accessible for patients from diverse cultural backgrounds. Recently, such strategies have focused on specific groups, and particularly Indigenous Australians, where services have failed to address large disparities in health outcomes. Limitations of cultural competence largely fall into three categories: lack of clarity around how the concept of culture is used in medicine, inadequate recognition of ...

Rosalie D Thackrah BA, GradDipEd, MA · Sandra C Thompson MPH, PhD, FAFPHM

Aboriginal and Torres Strait Islander women are more than three times more likely to smoke during pregnancy than non-Indigenous women, greatly increasing the risk of poor birth outcomes. Our systematic review found that there is currently no evidence for interventions that are effective in supporting pregnant Aboriginal and Torres Strait Islander women to quit smoking, which impedes development and implementation of evidence-informed policy and ...

Megan E Passey BMed(Hons), MPH, MSc · Jamie Bryant PhD, BPsych(Hons) · Alix E Hall BPsych(Hons) · Robert W Sanson-Fisher PhD, ClinMPsych, BPsych(Hons)

This study attempts to determine the frequency and types of stressful events experienced by urban Aboriginal and Torres Strait Islander children, and to explore the relationship between these experiences and the children’s physical health and parental concerns about their behaviour and learning ability.

Deborah A Askew PhD, MHlthSci, GradDipNutr · Philip J Schluter BSc(Hons), MSc, PhD · Geoffrey K P Spurling MB BS, FRACGP, MPH · Chelsea J R Bond BAppSci(Hons), PhD · Alex D H Brown PhD, FRACP

This before-and-after study aimed to measure the short-term health value of promoting healthy eating by regularly supplying fresh produce to disadvantaged families. Episodes of illness and common clinical conditions, prescription of antibiotics and the prevalence of anaemia and iron deficiency were measured as indicators of the short-term health effects of having healthy food provided.

Andrew P Black MB BS(Hons), PhD, FAFPHM · Hassan Vally BSc(Hons), PhD, MAppEpi · Peter S Morris MB BS, PhD, FRACP · Mark Daniel BSc, MSc, PhD · Adrian J Esterman BSc(Hons), MSc, PhD · Fiona E Smith BSc, MNutrDiet, APD · Kerin O’Dea BSc, PhD

Children in two remote Northern Territory Aboriginal communities were studied to measure the impact of four weeks of daily swimming on rates of ear discharge with a tympanic membrane penetration and on the microbiology of the nasopharynx and middle ear.

Anna T N Stephen MPH · Amanda J Leach BAgSc(Hons), MAgSc, PhD · Peter S Morris MB BS, PhD, FRACP

While the quality of data in the peer-reviewed literature has improved over time, there are still some important gaps in the evidence. The findings of this study provide a framework to allow Indigenous communities, researchers, funding bodies and the NHMRC to consider priorities for future research.

Peter S Azzopardi MB BS, MEpi, FRACP · Elissa C Kennedy MPH, MB BS · George C Patton MB BS, MD, FRANZCP · Robert Power BSc(Econ), PhD, PGCE · Robert D Roseby MB BS(Hons), FRACP · Susan M Sawyer MB BS, MD, FRACP · Alex D Brown BMed, MPH, PhD

The Leaders in Indigenous Medical Education (LIME) Network has developed over time as an avenue for sharing, developing and improving upon the emerging discipline of Indigenous health in medical educationThe Leaders in Indigenous Medical Education (LIME) Network (a program of Medical Deans Australia and New Zealand, funded by the Australian Government Department of Health and Ageing [DoHA]) has an 800-strong membership of Indigenous and non-Indigenous ...

Timothy M Haynes BHIth · Margo E Collins BA, GradDipCounselling · Odette Mazel BA, LLB(Hons), GDLP · Louise M A Lawler BHSc, GradCertArts, MEd · Caitlin Ryan BA, MSocSc(International Development) · Shaun C Ewen BAppSc(Physio), MMIL, DEd

Diversifying educational opportunities for remote Indigenous students is a key step to improving health outcomesYoung people and old people, Bininj, Yol and Balanda; we need to stand together for the future. The health and wellbeing of our people and our country depends upon us all.1 Djelk Rangers Victor Rostron, Wesley Campion and Ivan Namarnyilk. (Djelk Indigenous Protected Area, Arnhem Land.) The terms Bininj and Yol are ...

Jessie C Webb BA(Hons) · Sally C Godinho BEd, MEd, PhD · Marilyn F Woolley BA(Hons), MEd · Kenneth D Winkel MB BS, PhD, FACTM

IN 2009, THE ROYAL Australian and New Zealand College of Psychiatrists awarded the Mark Sheldon Prize for Indigenous mental health to ngangkari (traditional healers) Andy Tjilari and Rupert Langkatjukur Peter. The two were further honoured in 2011 by the World Council for Psychotherapy with the Sigmund Freud Award (bestowed by the City of Vienna, Austria). The awards recognised their distinguished contributions in mental health to the ...

Robert M Parker

CorrectionsIncorrect name of organisation, and further clarification: In “Public reporting of surgeons’ performance” in the 6 May 2013 issue of the Journal (Med J Aust 2013; 198: 399-400), the organisation named as the Australian Vascular Society should have been given as the Australian and New Zealand Society for Vascular Surgery (ANZSVS). The administrator of the Australasian Vascular Audit, a project of the ANZSVS, has requested that it be ...

Guy J Maddern MB BS, PhD, FRACS

CorrectionsError in footnote: In “Financial incentives for childhood immunisation — a unique but changing Australian initiative” published in the 17 June 2013 issue of the Journal (Med J Aust 2013; 198: 590-592), the second footnote in Box 2 should read: “† In Queensland, immunisation providers receive $3 per notification of completion of all vaccines at each age-based NIP schedule point, in recognition of the fact that a separate register, ...

Kirsten Ward · Brynley P Hull · Julie Leask

Specialist outreach and care coordination in primary care are saving lives in Indigenous communities

Annabel McGilvray

Dr David Hughes, the new chief medical officer for the Australian Institute of Sport, has had a lot to deal with since his appointment late last year, but his main aim is to keep people moving.

Cate Swannell

NOT-for-profit surgery and training provider Interplast Australia and New Zealand (Interplast) is celebrating 30 years of service across the Asia–Pacific region. Twenty-one thousand surgeries, 500 surgical programs and 32 000 patients across 25 countries later, Interplast’s “best kept secret” status is in danger of being exposed. Chief executive officer Prue Ingram, speaking in a recent interview in CEO Magazine, said she was justifiably proud of the group’s achievements in improving the quality of life for people who are disabled as a result of congenital or acquired medical conditions such as cleft lip and palate, burn scar contractures, growths, tumours and other reconstructive surgery conditions.1 “We only work in countries we are invited to, and we work very closely with our local partners to determine what the needs are for that particular time and location”, Ms Ingram said. “When sending a surgical team, we also provide all the supplies and equipment required to undertake the program [because] it’s important … our activities do not place a burden on overstrained hospital facilities.” Two billion people have no access to basic surgical care worldwide, according to the World Health Organization. But 11% of the global burden of disease can be treated with surgery alone.2 Out of 234 million surgeries performed worldwide each year, the world’s poor get just 3.5% and the world’s richest get 73.6%. Interplast has sent over 600 volunteers, including Australian and New Zealand plastic and reconstructive surgeons, anaesthetists, nurses and allied health professionals to the Asia–Pacific region to provide free surgical treatment for patients who would otherwise not have access. It has also supported over 70 surgeons, anaesthetists and nurses from these developing countries to continue their training in Australia in an effort to empower local medical personnel by building their independence. “We are very proud to have been able to assist in providing what is often basic surgery in Australia across the Asia–Pacific region and are committed to ensuring this continues for generations to come by also equipping the local medical staff, as a result of our training programs”, Ms Ingram said. 1 CEO Magazine 2013; Unsung heroes http://www.interplast.org.au/wp/wp-content/uploads/2013/06/CEO-June-Interplast-v1.pdf 2 WHO. Emergency and essential surgical care. http://www.who.int/surgery/en/

Cate Swannell