TRAINING FOR WORK

The contribution pharmacists can make to the National Close the Gap day to be held on 2 April is to commit to training an Aboriginal person to work in the pharmacy of an AHS and help to develop a system whereby Aboriginal people can understand medicines and their role in the management of chronic diseases.

Recent research in the Medical Journal of Australia (1) has shown that Aboriginal children are not predisposed to chronic diseases such as renal failure, diabetes or circulatory diseases and that these conditions are brought on by lifestyle choices in later life.

As the Nation focuses on Close the Gap pharmacists too should be examining what they can do to contribute in a way that is more than just supplying medicines and feeling the day’s work has been done.

There is one trap that can easily be fallen into and that is imagining that everything should be done in the same way as it has been for western society – making the assumption that “they” can be like us. “We” have developed our culture - its norms and its customs after thousands of years of living in a world that has been constantly changing and with advances in transport, mode of living (houses), food sources and industrial activity. Aboriginal people too have developed there culture through the same time period but with the dramatic difference of being isolated from the rest of the population of the world. It is so different when there are no means of transport (the wheel was not even there); no metallic objects; no materials for housing; and food that had to be found day by day. To many of these people, especially in remote Australia, access to the developed world has only been available for the past 100 years and in some cases in the last 50 years. This is a minuscule period of time and the change to a different way of thinking has to be done gradually, with sensitivity to their beliefs, and in a manner that takes account of their view of the world. This was well described in the book by Richard Trudgen , “Why Warriors lie down and die” (2), and that has become a standard reading text for anyone entering the Aboriginal health industry across the North of Australia.

We have to understand where Aboriginal are coming from in their understanding of disease states, why they occur, what can be done to overcome the onset and the management practices (that suit their ways) and which will maintain a life that is symptom free.
It is not just a matter of devising a training course that embraces subject areas that have worked in western culture because they are there. There is little evidence to show that VET Certificate courses in business administration, community health, community services, health administration and others have produced workers who are able to understand the tasks needed to improve the workplace and its clients. Often Aboriginal people attend training because it is a condition of receiving a Centrelink benefit and afterwards do not even remember what the training course was or upon receipt of a certificate cannot recall having done the course.

The Department of Education Employment and Workplace Relations (DEEWR) is stacked with principles, guidelines, protocols and acronyms that point towards funding for training. The only trouble is there are not the jobs to be undertaken when the training is finished and whatever was learnt is quickly forgotten.

Pharmacy is at the sharp end of a revolution that will try and close the gap. It (pharmacy) is in an ideal position to develop WITH Aboriginal people training programs that help to bridge the gap and provide knowledge in a manner that can be used. It is no use trying to teach anyone the mode of action of an ACE inhibitor to control blood pressure and increase the flow of blood through the kidney without knowing:

a. What the kidney does?
b. How it does it?
c. Why it is important?
d. What causes it to malfunction?
e. What needs to be done to prevent this?
f. How people should live to avoid kidney damage?
g. And finally what the drug will do in contribution to a good functioning kidney given that all, preventative measures have been exhausted.
Without this understanding the elements in training for a pharmacy technician in an Aboriginal Health Service could be useless because it is not relevant to the needs of the client.

In developing any training program the main focus has to be on the client (patient) and not what conforms to the downloadable training package available from the National Industry Training Council. Sure there is funding available for mainstream training packages but what use is that if the patient will still not understand why their kidneys have packed it in. There is a lot to be done in devising training programs that meet the needs.

The time to start is now. Play your part. Help to close the gap by demanding that training meets the needs of the client – not the criteria that works in mainstream.

Whether it is pharmacy technicians at urban Aboriginal health services, remote health clinics or as an adjunct to other health professionals make sure it meets the need – and that is not necessarily an already established training package.

Footnotes
1) Patterns of mortality in Indigenous adults in the Northern Territory, 1998–2003: are people living in more remote areas worse off? Karen Andreasyan and Wendy E Hoy. MJA 2009; 190 (6): 307-311

2) “Why Warriors Lie Down and Die” by Richard Trudgen. Aboriginal Studies Press. ISBN: 0-646-39587-4

Ends

The Trachoma issue – what does it take?

There are times when people involved in trying to close the gap in Aboriginal health hold up their hands in despair and scream “what does it take?”
Following the statement of achievements during February 2009 by Prime Minister Kevin Rudd to “Closing the Gap” the Aboriginal Medical Services Alliance of the Northern Territory has called for a way to get the dollars promised to the ground as directly as possible.
Congratulations to AMSANT for the suggestion that a single authority accountable to the Parliament be established to deal with all matters pertaining to Aboriginal health and the funds that are promised for this use.
It is so often the public forgets the announcements, makes a judgment at the time and then waits for the next one assuming the previous has been actioned. It does not work that way. By the time a policy proposal moves along the three levels of government a time space of years has gone by and governments have changed meaning the proposal as it stood is probably lost.
This is where the AMSANT proposal makes so much sense - a direct line from politician announcement to program implementation on the ground by community controlled (not government controlled) health services.
In reality there has to be an agency that is holding governments and politicians accountable for the promises that are made.
As an example of just how hard it is to make things happen take a look at the problem of trachoma – a debilitating eye disease that can send people blind if not treated properly (and simply) with improved personal hygiene and Azithromycin.
Mr. Rudd also announced during the week that $58.3 million would be made available for eye and ear health with a focus on eradicating trachoma, a disease that leads to blindness. It has been eliminated in all other developed countries.
The PMs Media Release said (interalia)
“Our objective must be clear: to eliminate trachoma among Indigenous Australians within a finite timeframe”.
Now wind the clock back to 1997 when in The Age 27th June it is stated:
“Dr Wooldridge said the Government would spend whatever was necessary to fix what was preventable blindness striking 100,000 Australians. The minister said he was angry that after so long little had improved in relation to the eye health of Aborigines in remote communities”
And then in the SMH on 18th November:
“Aboriginal eye health …has worsened, with the rates of the blinding disease trachoma found to be 80 per cent among some children, and indigenous people 10 times more likely to be blind than other Australians.”
This followed a study, by the head of Melbourne University's Department of Opthalmology, Professor Hugh Taylor - the first such review in two decades – which found the eye health of Aborigines in remote communities had barely improved in that time.
To which Minister Woolridge’s office responded that:
"These things take time," he said.
The amount of money the government committed in March 1998 was $4.8 million but who remembers what happened, whether it worked and ask why this is still going on. (See on left extract from "The Age" March 1998)
The price has now increased to $58 million although that does include ear health.
Professor Hugh Taylor, the long time advocate for action on eye health must be really wondering how much time it needs for what should be a simple undertaking. Read the transcript of ABC Ockhams Razor program on 1st July 2001 on the link to the title of this article.
Pharmacists involved in Aboriginal health will know that it was the desire to have Azithromycin made free to remote living Aboriginal people that lead to the Section 100 supply arrangements for the entire PBS Schedule Yellow Pages. It was during the PMs visit to Maningrida (NT) in 1998 that prompted the action that lead to the implementation of this change in April 1999 and now follows to all remote Aboriginal Health Services.
Picture on right shows the writer assisting the RFDS Nurse at Tablelands Station in the Kimberley administer Azithromycin suspension to children diagnosed by the visiting doctor with Trachoma.
This column supports the AMSANT call for a National Aboriginal Health Authority and calls on pharmacy organisations to give their support to the proposal by agreeing to work with it in ensuring the quality use of medicine is exemplary in whatever programs it administers.
Close the Gap is not just about life expectancy – it is about reducing the distance between the politicians announcements of money being available and that money then being used on the purpose for which it is intended with the minimum of administration in between.
With two levels of health bureaucracies (Australian and State/Territory governments) dealing with programs and even then it not being delivered the total sum quickly diminishes.
The Aboriginal community controlled sector needs support in responding to such calls.
In the Northern Territory there are 47 government controlled health clinics as against 26 community controlled. This gap needs to be narrowed also until they are all community controlled and using the money directly that is voted through the Parliament for spending on improving Aboriginal health.

The Trachoma issue – what does it take?

There are times when people involved in trying to close the gap in Aboriginal health hold up their hands in despair and scream “what does it take?”
Following the statement of achievements during February 2009 by Prime Minister Kevin Rudd to “Closing the Gap” the Aboriginal Medical Services Alliance of the Northern Territory has called for a way to get the dollars promised to the ground as directly as possible.
Congratulations to AMSANT for the suggestion that a single authority accountable to the Parliament be established to deal with all matters pertaining to Aboriginal health and the funds that are promised for this use.
It is so often the public forgets the announcements, makes a judgment at the time and then wait for the next one assuming the previous have been actioned. It does not work that way.
So in reality there has to be an agency that is holding governments and politicians accountable for the promises that are made. This is where the AMSANT proposal makes so much sense and without it the wheels of the bureaucracy through three levels of government still have to turn - and oh so slowly.
As an example of just how hard it is to make things happen take a look at the problem of trachoma – a debilitating eye disease that can send people blind if not treated properly (and simply) with improved personal hygiene and Azithromycin.
Mr. Rudd also announced during the week that $58.3 million would be made available for eye and ear health with a focus on eradicating trachoma, a disease that leads to blindness. It has been eliminated in all other developed countries.
The PMs Media Release said (interalia)
“Our objective must be clear: to eliminate trachoma among Indigenous Australians within a finite timeframe”.

Now wind the clock back to 1997 when in The Age 27th June it is stated:
“Dr Wooldridge said the Government would spend whatever was necessary to fix what was preventable blindness striking 100,000 Australians. The minister said he was angry that after so long little had improved in relation to the eye health of Aborigines in remote communities”
And then in the SMH on 18th November:
“Aboriginal eye health …has worsened, with the rates of the blinding disease trachoma found to be 80 per cent among some children, and indigenous people 10 times more likely to be blind than other Australians.”
This followed a study, by the head of Melbourne University's Department of Opthalmology, Professor Hugh Taylor - the first such review in two decades – which found the eye health of Aborigines in remote communities had barely improved in that time.
To which Minister Woolridge’s office responded that:
"These things take time," he said.

The amount of money the government committed in March 1998 was $4.8 million but who remembers what happened, whether it worked and ask why this is still going on. The price has now increased to $58 million although that does include ear health.

Professor Hugh Taylor, the long time advocate for action on eye health must be really wondering how much time it needs for what should be a simple undertaking.

Pharmacists involved in Aboriginal health will know that it was the desire to have Azithromycin made free to remote living Aboriginal people that lead to the Section 100 supply arrangements for the entire PBS Schedule Yellow Pages. It was during the PMs visit to Maningrida (NT) in 1998 that prompted the action that lead to the implementation of this change in April 1999 and now follows to all remote Aboriginal Health Services.

This column supports the AMSANT call for a National Aboriginal Health Authority and calls on pharmacy organisations to give their support to the proposal by agreeing to work with it in ensuring the quality use of medicine is exemplary in whatever programs it administers.
Close the Gap is not just about life expectancy – it is about reducing the distance between the politicians announcements of money being available and that money then being used on the purpose for which it is intended with the minimum of administration in between.
With two levels of health bureaucracies (Australian and State/Territory governments) dealing with programs and even then it not being delivered the total sum quickly diminishes.
The Aboriginal community controlled sector needs support in responding to such calls.
In the Northern Territory there are 47 government controlled health clinics as against 26 community controlled. This gap needs to be narrowed also until they are all community controlled and using the money directly that is voted through the Parliament for spending on improving Aboriginal health.