Remote living Aboriginals in Australia

May 2012 be the year that SOCIAL INCLUSION is the commitment to inspiring a reinvigorated relief for Aboriginal disadvantage

2012-01-03T06:31:00.000+09:30

Minister for Social Inclusion, Mark Butler MP needs to be reminded that remote living Aboriginals are in need of recognition before being excluded even more—write and tell him c/o Parliament House, Canberra, ACT, 2600

Extract from The Australian, Monday 26th December 2011

I never stop wondering what I could do to help bring about social inclusion. There are so many examples of where it has gone wrong over the few years I have been involved, such as the following...

Deleece was let down by a system that thrives on mediocrity.
Centrelink, Job Services Australia and the entire “job ready” effort is organised by an army of bureaucrats gobbling up endless amounts of money and losing sight of what they are really there for – the people, and yes... there are people at the end of the line that need help.
SOCIAL INCLUSION should mean the provision of the tools for everyone, regardless of location, to education and training to join in their share of the Nation’s wealth.

Zoe and Lucinda are from a remote community with a population of 1200 people 500 Kms north east of Darwin. There are few employment opportunities apart from services and little attention is given to starting entrepreneurial businesses. Without this to observe, the growing child has little opportunity to view scope, dreams or vision for the future. Their future is in our hands.

SOCIAL INCLUSION should give all children the chance to dream and aspire to future successes - at present they complete their schooling and have no idea what they want to do with the rest of their life. Hundreds of young Aboriginal children who finish their schooling are lost every year to another generation of welfare recipients simply because they know of nothing better to do.

Bob Beadman asked...
"WHAT HAPPENED TO THE DREAMS?"
(Do Indigenous youth have a dream– Menzies Research Centre 2004)

“I am looking at human detritus right here in Darwin, and wonder what dreams they might have once had for themselves?

What dreams they might have had for their children? What dreams their children might have had for themselves?

I wonder if people have abandoned those dreams, what caused them to give up, what is it about the world that surrounds us all that makes them think that their dreams are unachievable.”

We must strive to assist the young ones to develop those dreams they once had but now seem forgotten.

SOCIAL INCLUSION should not be hard to grasp - it does what it says - includes people in a social context as well as economic and environmental settings in communities. Where social capital is the glue that holds a community together - social inclusion is the philosophy under which all else happens.

SOCIAL INCLUSION must be the focus of a renewed reconciliation for all young Aboriginal children and youth no matter where they are from BUT particularly those from remote commuinities where an understanding of the dominant culture's world view is somewhat lacking. The youth of Australia must be made to know they are wanted and loved and be inspired to enjoy the Nation's opportunities just like their urban counterparts attending the plush private schools in the capital cities.

Ends

INTEREST HIGH WITH STUDENTS IN ABORIGINAL HEALTH

2011-11-30T06:31:00.000+09:30

The future supply of pharmacists to work in Aboriginal health is healthy if the outcome of a National Australian Pharmacy Students’ Association survey is anything to go by.

While 83% of respondents felt it is important to be taught about Aboriginal and Torres Strait Islander health issues as part of their pharmacy course curriculum, only 60% have access to such education. Furthermore, only half of those respondents feel they are taught enough about this topic.

Students believed that the present level of awareness was good with 60% saying they had exposure to Aboriginal health learning during their course.

Only 9% of respondents had Aboriginal health as an integral part of the core curriculum while 50% had the information delivered in just one or two lectures.

A minority of respondents (25%) felt they were trained to competently practice in a culturally acceptable manner while 35% felt they could not.

The favoured method of learning about cultural awareness in Aboriginal health was a half day or one day training course (45%) while practical experience was mentioned as the best way of learning the subject.

The recommendations of the survey outcomes should see an increase in the component of Aboriginal health training in pharmacy curriculum with an emphasis on cultural awareness.

With a workforce planning study being commenced on the supply and demand for pharmacists in rural and remote areas it is to be hoped that staff establishments for primary health care in communities will include the position of a pharmacist.

It is only by participating that pharmacists will be able to show how they can contribute beyond the “pick and lick” image that is currently held on their role.

Ends

Comment to Rollo Manning at rollom@iinet.net.au or call on 0411 049 872

Senate inquiry agreed to in Parliament— PBS to remote living Aboriginals to be examined

2011-03-29T16:17:00.001+09:30

On 24th March 2011 the Senate agreed to a motion from Senator Rachel Siewert (Greens, WA) that the supply of Pharmaceutical Benefits Scheme medicines to remote area Aboriginal Health Services be referred to the Senate Community Affairs Reference Committee. The special arrangements under Section 100 of the National Health Act have provided a bulk supply scheme with no value added component from a pharmacist.

Three reviews of the scheme in 2004 (Kelaher) 2006 (Urbis) and 2010 (Nova Policy) have failed to produce any significant improvement in the quality use of medicines by Aboriginal clients of health services.

A matter of equity

The matter to be reviewed by the Senate Committee is a matter of justice, fairness and equity particularly relevant at a time when Closing the Gap is so much in the headlines and remote living Aboriginal people are dying at such a young age.

After three reviews of the Section 100 supply arrangements little change has occurred. The Senate Inquiry should be able to identify what needs to be improved and which agency should be responsible for making it happen. The involvement of pharmacists in this process should be a leading principle.

Inequities for remote Aboriginal Health Services (AHS) and the Pharmaceutical Benefits Scheme (PBS) include:

Over the ten years the scheme has been in place there has been no money made available to the Aboriginal Health Services to develop their own pharmaceutical care program.
Recording of outgoing supplies (dispensing) by any electronic process incorporating scanning is absent and hand written labels are the norm.
While the PBS pays a dispensing fee ($6.42) to pharmacies in all situations under Section 85 (mainstream) there is no fee paid for the dispensing carried out at Aboriginal Health Services.
The PBS saves $3.68 every time a PBS medicine is dispensed to a remote living Aboriginal person. A handling fee of $2.74 is paid to the supplying Approved Pharmacy for the bulk supply but no dispensing fee is paid to the AHS.
Mainstream Australians have access to a pharmacist (by law) in every pharmacy in Australia when a PBS prescription is dispensed. No such facility is available to an Aboriginal patient of an AHS or to a
person trained by a pharmacist to inform them of the nature of the medicine prescribed.
No data is analysed to assist in decision making towards improved medicine utilisation across States and regional boundaries.

Go to the following link for details on the Inquiry and the making of a submission:
http://www.aph.gov.au/Senate/committee/clac_ctte/pbs_medicines/index.htm

Closing date for Submissions is 30th June 2011.

The Terms of Reference seek comment on a range of issues. The full text of the Motion agreed to by the Senate follows:

The effectiveness of the special arrangements established in 1999 under section 100 of the National Health Act 1953, for the supply of Pharmaceutical Benefits Scheme (PBS) medicines to remote area Aboriginal Health Services, with particular reference to:

(a) whether these arrangements adequately address barriers experienced by Aboriginal and Torres Strait Islander people living in remote areas of Australia in accessing essential medicines through the PBS;

(b) the clinical outcomes achieved from the measure, in particular to improvements in patient understanding of, and adherence to, prescribed treatment as a result of the improved access to PBS medicines;

(c) the degree to which the ‘quality use of medicines’ has been achieved including the amount of contact with a pharmacist available to these patients compared to urban Australians;

(d) the degree to which state/territory legislation has been complied with in respect to the recording, labelling and monitoring of PBS medicines;

(e) the distribution of funding made available to the program across the Approved Pharmacy network compared to the Aboriginal Health Services obtaining the PBS medicines and dispensing them on to its patients;

(f) the extent to which Aboriginal Health Workers in remote communities have sufficient educational opportunities to take on the prescribing and dispensing responsibilities given to them by the PBS bulk supply arrangements;

(g) the degree to which recommendations from previous reviews have been implemented and any consultation which has occurred with the community controlled Aboriginal health sector about any changes to the program;

(h) access to PBS generally in remote communities; and

(i) any other related matters.

Question agreed to.

Any person or organisation requiring further background to the Inquiry or assistance with the writing of a submission can contact Rollo Manning at rollom@iinet.net.au or 0411 049 872.

Take medicines - seriously, and help Close the Gap

2011-03-16T06:41:00.002+09:30

The life expectancy gap for Indigenous Australians could be significantly closed if the same level of pharmaceutical care was applied to those living in remote communities as it is for the rest of the Australian population. The management of chronic diseases requires urgent attention in the provision of prescription medicines - in both monitoring adherence and follow up adjustment of dosing.

Patients attending Aboriginal health services in remote communities are being dispensed medicines with little recording, probably no label and scant advice on what to expect of it. This is the outcome of ten years of bulk supply of Pharmaceutical Benefits Scheme (PBS) medicines from an Approved Pharmacy with no involvement of a pharmacist in the dispensing process. The scheme is costing the Australian taxpayer $40 million a year yet even the Department of Health and Ageing admit there is wastage and an analysis of the Medicare records of payment would not be an accurate evaluation of what is being supplied to patients.

Whilst it will take years for medicine taking to impact on the life expectancy gap between Indigenous and non-Indigenous Australians this discreet group of patients with only one supply route should be an ideal target for some primary practice research.

But no!

Researchers admit that the missing element in data with respect to chronic disease management is knowing whether the patient is taking their medicine. Whilst this might apply to the bulk of Australians with chronic diseases, the clinical signs should be there to illustrate the benefits of medicine taking. Otherwise why is the taxpayer paying $8.4 billion a year on the PBS?

With no record of supply and the labelling an unknown quantity – the quality of pharmaceutical care is suspect.

Approved Pharmacies (agents for the supply of PBS medicines) are under no obligation to provide support in the supply on to the patient. That is the job of the Aboriginal health service and done by doctors, nurses and Aboriginal Health Workers with no payment from the PBS to meet the cost of dispensing.

In mainstream PBS supply the Approved Pharmacy is paid $6.42 every time a prescription is dispensed. It is recorded on an IT system that has been paid for and upgraded by the PBS. In remote “drug rooms” there is no such luxury – not even a typewriter for labelling.

Of the $40 million dollar cost to the PBS in this financial year, $10 million will go to the Approved Pharmacy through a combination of a $2.74 handling fee per item and a 15% mark up on the cost of goods. The PBS actually saves $3.68 every time a packet of pills is given to a remote living Aboriginal person. Extended across a year this amounts to $5.52 million and that would employ a lot of pharmacists at Aboriginal health services to add some quality to the supply and give the patients an understanding of what western medicine is all about.

All Australians, when given a prescription by a doctor, take it to a pharmacy for dispensing. They can then ask the pharmacist (always present by law) whatever question they want about that medicine. The salary of that pharmacist is largely contributed to by the PBS through the dispensing fee. For the remote living Aboriginal there is no such practice. There are no pharmacists employed by Aboriginal health services in the NT and only three in the whole of Australia.

This is a shameful situation and one that shows a high degree of discrimination and unacceptable level of unequal opportunity. The National Indigenous Health Equality Council is not interested in this matter claiming that it does not fall within its terms of reference. The Pharmacy Guild is interested in its members being viable entities while NACCHO (the Aboriginal health peak body) is overwhelmed by the Pharmacy Guild into thinking that “this is as good as it gets”.

The diseases killing Aboriginal people at a young age were not there 40 years ago and have been brought on by lifestyle choices. This makes it even more important that information is provided to help the patient understand what the medicine is going to do and how it will work to help them live longer.

Such is the need for a greater emphasis on the quality use of medicine for Aboriginal people in remote communities if Close the Gap is to be taken seriously.

Ends

The plethora of pharmacy programs

2011-01-24T11:52:00.001+09:30

The purpose of this paper is to describe the current situation for Aboriginal and Torres Strait Islander people obtaining a prescription for medicine under the Pharmaceutical Benefits Scheme and dispensed by a pharmacy – be that in a hospital, the community setting or from an Aboriginal Health Service either government owned and operated or under community control.

Introduction
The past ten years has seen some effort put into improving the compliance rate and health gains by Aboriginal and Torres Strait Islander people from the use of western medicines. Emphasis has been placed on chronic disease conditions which are having a serious impact on longevity of life and forcing a wide gap in life expectancy between Indigenous Australians and non-Indigenous Australians. The average “gap” is shown to be 17 years although by region those living in remote areas of Australia have a lower life expectancy and are thus crucial to “closing the gap” on an Australia wide count.

Background
The respective stakeholders in primary health care each has a concern for the health of Indigenous Australians. The needs of the patient must be paramount over the processes that suit a mainstream population. Too often remote living Indigenous Australians have been forced to accept a mainstream model of service delivery when their needs reflect more that of a Third World country requiring a program designed to specifically meet their needs. This applies to the Section 100 PBS to remote AHS arrangements. In urban areas where possible the needs of the patient can be made to fit the mainstream model and this should be done rather than establishing new processes. The QuMAX and Close the Gap programs have failed to do this effectively.

The Federal Government, as the funder, has tried to meet the requests emanating from the prime peak bodies, the Pharmacy Guild and NACCHO. In addition the following have had some part in the lobbying process:

· The Pharmaceutical Society of Australia
· The Australian Medical Association
· Australian Divisions of General Practice
· Royal Australasian College of Physicians
· Royal Australian College of GPs
· Rural Doctors Association
· National Rural Health Alliance
· Australian Pharmacy Council
· The Society of Hospital Pharmacists of Australia

The following programs have been put in place over the past ten years:

· Special PBS listing of medicines specifically for Indigenous Australians
· Section 100 arrangements for supply to remote living Indigenous Australians
· Special allowance for pharmacists supplying remote health services under s100 to implement quality use of medicine measures
· National Prescribing Service program for “outreach pharmacists” to remote Aboriginal health services (OPRAH)
· QuMAX program for cost of DAAs to Indigenous patients attending eligible community controlled health services.
· Close the Gap co-payment relief for Indigenous people attending eligible general practice centres and registered for chronic disease management.

The above programs have solved some problems but in doing so have created problems of their own. There needs to be a “global” look at the whole scene to evaluate where this has occurred and what can be learnt from the past ten years involving operators at the coalface.

In evaluating the cost benefits of these programs it is important to keep in mind the four basic principles of the National Medicines Policy which should be the underlying guide to development of quality pharmaceutical care. These are:

1. Timely access to the medicines that Australians need at a cost individuals and the community can afford – this has been assured across the Nation

2. Medicines meeting appropriate standards of quality, safety and efficacy – including the correct recording and labelling of prescribed medicines in accordance wit the law – this has been assured across the Nation.

3. Quality use of medicines with information to allow the patient to understand the medicines they are getting including effects, side effects, interactions and expectations of outcome. This is available to ALL Australians through a local retail pharmacy – but not remote living Aboriginal people.

4. Maintaining a responsible and viable medicines industry including sustainable research, manufacturing and supply chain to the patient. The s100 to remote arrangements offer a sizeable income to retail pharmacies thus ensuring their viability. The urban programs ensure the “bill” is paid at the local pharmacy by health services and their patients.

Situation analysis
The following comments are now made on each of the above:

1. Special PBS listing of medicines specifically for Indigenous Australians
The list is essentially medicines which can be bought over the counter at a pharmacy. The cost of such an item when added to the PBS list and supplied in accordance with a legal PBS order immediately increases the cost to taxpayer by the dispensing fee, safety net recording fee and in the instance of urban dwellers the “additional extra charge”. This result means either the PBS or the consumer is paying more because of PBS listing unless the consumer has a Health Care Card.

2. Section 100 arrangements for supply to remote living Indigenous Australians
This has increased the availability of the full range of PBS general list of medicines to remote Aboriginal health service. However in devising the reimbursement formula to supplying pharmacies no consideration has been given to meeting the cost of dispensing at the AHS as the PBS does for every other Australian attending an Approved Pharmacy. The result has been poor quality in the standard of pharmaceutical care and no apparent indication of which party is responsible for improvements. The State/Territory governments are responsible for ensuring the legal requirements for supply are being met whilst the Commonwealth should be responsible for ensuring the remuneration is adequate to meet the principles of the National Medicines Policy.

3. Special allowance for pharmacists supplying remote health services under s100 to implement quality use of medicine measures
This allowance has provision for two visits a year by a pharmacist to an Aboriginal Health Service to which the pharmacy is supplying medicines. This is inadequate to meet the needs of the patients attending that centre to understand and comply with the expectations of the medicine. Trust and confidence as a member of the central team is simply not possible with such infrequent visits. Reports of the major mission being to check for out dated stock do not indicate a high level of QUM activity.

4. National Prescribing Service program for “outreach pharmacists” to remote Aboriginal health services (OPRAH)
This program has the distinct advantage of bringing together pharmacists who are involved in the supply function to remote AHSs. This could provide a forum for a wide ranging discussion on improving quality and the avenues that work but unfortunately due to the policy of the NPS it is an educational session on a topic identified though “focus groups” in mainstream Australia and does not always bear relevance to a vital subject in remote Aboriginal health. If it was more directed to the target audience it could be more relevant.
Participants should be assisted to understand the social determinants for health and where the management of medication use fits in to the overall patient care and prevention of illness process.

5. QuMAX program for co-payment relief and cost of DAAs to Indigenous patients attending eligible community controlled health services.
This program has failed to meet a wide audience of need due to its restriction to the community controlled sector. Funding for this program will cease on 30 June 2011. Even then the bureaucratic processes that have been established have not assisted a rapid uptake of co-payment relief or provision of more DAAs. An examination of the 13 page “Business Rules and Guidelines”[1] is testament to this. The money spent on preparing, implementing and evaluating these could have been well spent in providing a pharmacist to many ACCHOs to do what they wanted in the spirit of community control.
The positive side for NMP purposes is that it assists in paying the bill at the pharmacy providing the services and thus add to its likely sustainability.
The provision of DAAs through this program will cease on 30 June 2011 while this has been seen by pharmacists as a positive aid to adherence. A scheme such as exists for Department of Veterans Affairs beneficiaries is advocated to replace the QuMAX initiative.

6. Close the Gap co-payment relief for Indigenous people attending eligible general practice centres and registered for chronic disease management support
While the QuMAX program assisted patients of community controlled health services, the Close the Gap program assists patients attending a GP centre or an ACCHO thus replacing the QuMAX scheme. Patients eligible to register must be considered at risk of developing a chronic disease. The notion that cheaper PBS medicine will improve adherence is suspect as at some ACCHOs patients have had “free” medicine for years. This program is simply helping to “pay the bill” at the local pharmacy and not assisting the patient to obtain the quality needed to meet principle three of the National Medicines Policy shown above.

To summarise – for the remote living Indigenous Australians there is a second class PBS that provides no help in understanding medicines and their effect on the body but provides a good income to the supplying pharmacies. The cost of dispensing is not being met by the PBS as it does for every other Australian with the Commonwealth saying that this is a State/Territory government responsibility.

For urban living Indigenous Australians there are two systems both of which provide financial advantages to the dispensing pharmacy by ensuring the cost is met by the PBS as opposed to the health service or patient. Where this is advantaging the Aboriginal health service by saving it money on patient co-payments there is no requirement for these savings to be spent on “Quality use of Medicine” improvements.
The complicated bureaucratic process to obtain the benefits is believed by some to be “not worth the effort” while the Indigenous patient has no idea of what the programs are or how best they can access them. Even pharmacists are confused as to what applies to whom.

Recommendations

1. PBS listing – disband the current Indigenous Expert Advisory Panel due to its listings being inconsequential to improving Indigenous health in a cost effective way. Replace it with a panel including people involved in delivering pharmaceutical care services and have a scope beyond just PBS listings and include quality use of medicine measures. The most relevant factor is making product available to Indigenous Australians at the best price through a functioning pharmacy in every Aboriginal Health Service under the supervision of a registered pharmacist.

2. Section 100 Remote – make funds available to AHSs to meet the cost of dispensing on to patients after having received product from a supplying pharmacy. This can be done by initially meeting the cost of dispensing as it applies in mainstream ($6.42 at 1 January 2011). At present 25% of government outlays (estimate $40 million in 2010-11) goes to the supplying pharmacy and nil to the dispensing AHS.
No data is available to analyse drug utilisation as happens with the mainstream PBS. Although this has been called in a review of the program[2] – Medicare Australia is still unable to make publicly available detailed statistics.

3. Special allowance under s100 – disband this allowance and put funds into 2) above. The current arrangement provides no value add to the individual patient which is where the focus should be. Pharmacists checking stock for out of date and smoothing administrative arrangements are a waste of professional time.

4. NPS OPRAH program – this should be directed to pharmacists working “at the coalface” and be relevant to the needs of the patients. Past programs such as pain management, stroke prevention, COPD and diabetes are well covered by primary health care specialists in patient education. An evaluation from the AHS level would be of interest.

5. and 6. QuMAX and Close the Gap - should be disbanded and incorporated into the PBS General Scheme with Aboriginal people entitled to whatever concessions Governments of the day believe provides equity and justice. This should NOT be based on where a person attends a doctor as it is now. If all persons identifying as Indigenous and at risk of chronic disease they should be issued with a Health Care Card. If there is a need for an income/asset test then leave that to Centrelink in issuing the card as for every other Australian. There must be a universal Indigenous Pharmaceutical Care program and not one based on the governance structure of a health service. Hospital pharmacies must be included in having access to these measures. At present patients are discharged from hospital with a varying array of quantities and charges. The training provided for Medicare officers and retail pharmacy operators has also failed to meet the need with respect to the detail and cross cultural sensitivities.

Conclusion
As a general principle all benefits should be made to fit a program developed with the Indigenous patient as the beneficiary. The PBS contains various elements that can be utilised to suit the need. There is no reason why NGOs such as the Pharmacy Guild, NACCHO or Divisions of General Practice, should be involved in delivering a program that falls within the scope of PBS capability with the elements to obtain special benefits for special groups of patient needs.
The reality is that for some patients money would have to be paid to them for them to take their medicine. Making it available at little or no cost does in no way help them to understand why they should take it.
Rollo Manning

GET A JOB AND A LOT OF SOCIAL PROBLEMS WILL DISAPPEAR

2010-12-02T12:11:00.000+09:30

This may be a simplistic few words but let’s think it through – how relevant is this in today’s remote communities?

One indication to the drastic social problems confronting young Indigenous Australians living in remote communities is the fact that there are two references before Parliamentary Committees in Canberra that have a direct bearing on two major social problems. They are:
1. Indigenous youth and the criminal justice system

2. Early intervention programs to prevent youth suicide

The population in jails in the Northern Territory for Aboriginal people is 82% of all inmates and over 50% of them are under the age of 30 years. There are around 900 Aboriginal people in gaol with 95% being males.

In the NT there has been a concerning increase in suicides in recent months. The NT news typifies the situation in the following Editorial on 29^th September 2010:

AT least seven Territory children have killed themselves in the past month.

That bald statistic masks unfathomable pain - the hopelessness that leads young people to give up on life, the never-ending anguish of the loved ones left behind.
As revealed in the NT News yesterday, the problem is not confined to remote Aboriginal communities, although the suicide rate among indigenous youth is far higher than among non-indigenous children.
Most young Territorians are drunk or stoned - or both - when they kill themselves, proving that alcohol and ganja (Marijuana) can turn someone who is depressed suicidal.

The unemployment rate where these young men come from is around 30%, although an exact figure is hard to know due to the various reporting processes and Centrelink definitions that include people on disability pensions as not being employable. A person may be classed as disabled for Centrelink because they are illiterate.

The social scene and degree of cohesion and strength of social capital is weak on all counts and the greatest thing missing for young people is hopes, dreams and ambitions for the future.

When life in a community is a struggle to exist from day to day due to the indicators of poverty there is no time to think about or plan for the future. The future around them is bleak, the facilities are non existent and there is no encouragement for developing personal micro economic enterprises that might create a job.

The manner in which these social problems have been dealt with in other Third World situations revolves around enterprise facilitation and that means self help and initiative.

Why can’t Aboriginal people be encouraged to do this?

There is one simple barrier–money – money from heaven for doing nothing. A tempting gift to resist.

In the meantime employment opportunities must be considered as a solution to social malaise.

A reason to get up in the morning.

A reason to be pleased to come home at the end of the day and eat a good meal satisfied that life is good.

And then a good nights sleep.

Should that be too hard? – well it is – so lets work through the barriers together with the Aboriginal people and stop blaming them, the Government or other external factors.

Get a job – give a job – make a job – it is good for your health and then you live longer.

IE CLOSE THE GAP!

Remote Aboriginals left out of inclusion agenda

2010-08-30T09:12:00.000+09:30

“Hey – don’t forget us – we were here first!”
Remote living Aboriginals and the cycles of disadvantage which place them at the bottom of the socio economic ladder in Australia must get special treatment from a new Government in Canberra. The fact that Australia’s first people are still living in “Third World” conditions in one of the wealthiest countries of the World is a shameful situation and only special treatment will raise their standards to a point where they can be considered “included” in Australian society.

The “social inclusion agenda” of the Rudd Labor Government said that it was a means of “building a nation in which all Australians have the opportunity and support they need to participate fully in the nation’s economic and community life, develop their own potential and be treated with dignity and respect.”
These words are admirable except that there is a need for an Action Plan to ensure it is followed through in reality. The population cohort of 150,000 Aboriginal people living in remote communities across the north of the country and in the central and western desert regions – are at present living in a constant state of “exclusion”.

The National Social Inclusion Board has been asked to take immediate steps to arrest the slide that has been happening since the introduction of “self government” and welfare dependency in 1970s. These are:

A “Third World” classification is given by Government to remote communities that are home to Aboriginal people across the north of Australia and in the central and western desert. This is said to be essential for the rebuilding of social capital and economic prosperity to a standard required by the inhabitants to contribute to the Australian Society.
The Aboriginal people themselves must be involved in identifying their own social priorities of need and establishing measures to alleviate these with funding available to initiate micro economic enterprises that will provide the incentive to work and shake off welfare dependence.
The payment of money to individuals should cease on a universal basis when a clan or tribe group present a solid business plan for social and economic reform. Universal welfare payments have failed and worked against social inclusion. “Cashed out” Centrelink payments should be possible to put the same amount of money into targeted assistance packages and economic development.
The life expectancy of remote living Aboriginal Australians should be expressed separately in order to show the difference between urban and remote.
An acceptance of the fact that to educate young women between the age of 16 to 24 years will assist them and enable them to pass down to their children the need for an education and work ethic. Without this another generation will be lost to welfare dependency.

Remote living Aboriginals are a unique cohort whose life style and life outcomes are clearly delineated through statistical measurements. Nowhere near is enough use made of this information in planning change. This is “Third World” country and has to be recognised as such. Some input from AusAid might be more useful for framing policy than bureaucrats used to dealing with mainstream populations living in communities with a wide range of services available in settings with already strong social capital. The remote living Aboriginal has none of these “luxuries”.

The cycles of disadvantage
The numerous cycles of disadvantage in remote Aboriginal communities are interrelated and synergistic in their effect on the individual. More research needs to be done to identify the priorities of need (as seen by the community) in attacking each one. Too often the cry goes out that it is “too hard” and nothing is done. The people themselves must be drawn into a conversation on the social priorities and needs for their communities. In this way moves towards building social capital can be commenced through social and economic development.
The main cycles are:

o A denial of the human rights of the child such that abuse of those rights becomes the norm and is accepted by new generations. Housing, nutrition, education and leisure opportunities are lacking and this leads to a child frustrated from inactivity, opportunities to show creativity and exercise initiative. The overcrowded house is under estimated in the minds of government policy makers as a prime influence on this fact and each of those following. The overcrowded house brings with it immense unsafety, insecurity, a lack of food security, own space to reflect, household facilities that do not work because they were never built for so many persons living in the house. This absolutely hopeless situation is still evident with no real action to make an immediate response to this devastating influence on the ability to feel included in a social setting filled with joy and harmony. It is disgraceful that the policy makers allow a town of 2,200 people (Galiwin’ku) to have 152 houses while another in the white man’s world (Boorowa NSW) to have 857 for the same population. Galiwin’ku has five retail outlets against 15 in Boorowa – how much more serious can a lack of social inclusion get when people are denied choices, job opportunities but receive money for doing nothing and have little choices of what to spend it on.

o Poor literacy and numeracy stems from an inability of children to understand why this is needed when all they see is adults sitting around doing nothing and no role models from their parents or carers who do not work. Creating work opportunities should be an essential part of the mix and is not receiving nearly enough attention at the local level. Unemployment is the norm and this becomes the key in removing welfare dependence. Much bolder mechanisms must be tried at the local level to encourage economic activities and employment opportunities such as “cashing out” Centrelink payments within a community or Clan group in a community. The writer is in the process of obtaining from Centrelink the stats on the quantum of money going into communities to ascertain how much would be available if people decided to “cash out”. The principle involved here relates to the social justice in paying money to individuals rather than to communities for economic and social development.

o Substance abuse leads to violence and both are symptoms of a community without direction. The fact that substance abuse (alcohol and Marijuana or Gunja) is so widespread means that children are exposed to it at an early age and peer pressure may result in consuming drugs (marijuana) by age 10 years. This rules against any possible development of social dreams, hopes and ambitions. Future planning is absent and few children have any idea of what they want to do in a future life apart from nothing which carries with it distinct boredom and further substance abuse. The flow on is arguments, fighting, stealing for money to sustain the habit and prosecution. It is well recognised that recidivism for Aboriginal prison inmates is high following its acceptance as being “part of life”. The cyclical nature of family violence is strong, despite the resource of domestic violence orders which seem useless in alcohol and drug charged family disputes. Men and women seem to ignore the rights of the individual to lead a peaceful life free of torment, danger, uncertainty and stress. Mental health problems surge to the front of “health” problems and the resulting stress is a dampener on many a discussion regarding future hope. It is the survival of “today” that is the prime motivator not consideration of a peaceful future and how that can be attained. The definition of poverty given by Muhammad Yunus in an Interview with Andrew Denton describes the situation admirably:

“Poverty, is almost, you can describe is a living in a box, all with the thick wall, no window, no door, no light, so you don't know what's coming next, you have no idea of new day starting in different way, you repeat the same thing over and over again. No hope, basically. So you try to survive the day in very uncertain conditions. So that's poverty, you have no control over your life, that's total, that's it.” (ABC-TV 07/12/09)

o Health, nutrition and physical activity – the cycle of poor nutrition and reduced physical activity leading to poor health has been gaining momentum since 1975. This has lead to a situation where all people born after 1975 have lived their entire life in a community with the health status on the decline. The child fed a breakfast of black tea with noodles thinks that is normal. The two takeaway shops in town (two of the five retail outlets at Galiwin’ku) selling death through cigarettes, high fat content foods and sugar loaded soft drinks are making huge profits by selling sickness. The businesses of the two takeaways are owned by Darwin based syndicates and staffed by Asian workers on “457” Visas. And we allow this to happen to the most under privileged Australians who were here for 40,000 years before colonial British settlement. Social justice? Hardly. Social inclusion? No attempt. Only recently has there been evidence of organised sport for young people with the major emphasis having been on adult age football and basketball. The scope for athletics, swimming sports, junior football and basketball is immense and such activities could include the entire family.
The end result is the early death – and at a much earlier age than the National average depicts – let’s get real and respect the huge differences where the median age at death for men is 43 years and for women 53 years. That is a lot of adults taken out of a community at a young age and this then becomes the norm in people’s minds as if this is the way it has to be.

It does not have to be this way and a concerted effort under the banner of social inclusion which has with it a “bottoms up” approach to a social revolution might help to reduce the intensity of these cycles.
Better health is not about building better health clinics and employing more clinical staff – it is about the relationship the dominant culture has with the people to enhance their understanding of the risks associated with lifestyle choices and the opportunities they create to reduce stress and lead a useful life. This was well expressed by Professor Fiona Stanley who said:

“..the real gains in reducing disease and improving health will come from the social and economic circumstances operating in families, communities and the wider society. That is that the most effective preventive strategies lie OUTSIDE the traditional areas of the health professions.” (National Press Club. August 2003.)

The entrapment of cycles of disadvantage
People are born into these communities and have no option when their families have lived there for generations and their ancestors respected and owned the land for thousands of years. There is an affinity to the land which is unique. It is the heritage a child takes on from its predecessors.
It is very important that when there are people who want to break out of the cycle of disadvantage that they are helped 100% in a quest to do so. If someone puts up there hand and says “I want to lead a better life” there must be the facility to make that happen. To follow the lead of overseas efforts in Third World countries it will be the young women who are targeted for improvement. Educate a girl and you educate a future family. We must put sexist attitudes aside and decide to concentrate on young women between the ages of (say) 16-24 years old. If nothing is done to help these young women there will be no role models coming forward to show the younger ones that good is a better choice in life than bad. Is it any wonder there are no persons from remote communities attending university? – there is simply not enough done to make it happen. The fault is not with the person but with the system that seems intent on having these people continue a life of poverty.

Mutual obligation has to work both ways
An example can be given of a 21 year old woman from a remote community who came to Darwin to “make good” and was shuffled between Centrelink and Job Services Australia (JSA) agencies for three months. All she got was appointments or on three occasions cancelled appointments that did not suit the JSA agent. So much for mutual obligation! The Prime Minister during the recent election campaign claimed a get tough policy on the unemployed who did not turn up for appointments. The same should apply to JSA agents who fail to meet appointments and more importantly fail to provide a training program. Sure excuses will be made as to how hard this is but regrettably no excuses should be accepted. It is imperative we return the obligation for to leave a person in a city like Darwin with all the distractions for three months with no work, no training and no future is just asking them to continue the exclusion.

What do the authorities planning this transition from welfare to work expect people to do with their idle time? Or are they so used to people that do not want anything to happen (like find a job) that when a person wanting to do better comes along they cannot handle the positive nature of the inquiry. It appears that the entire system is geared to mediocrity and the Centrelink and job finding agencies are so used to people that don’t want to work that they have no strategy to help those few that want to make good. There could be no bigger turn off for anyone than to be left in front of a TV all day waiting for the next appointment when what they really want is to learn and find work that suits their ambitions.

The problem of “disengaged youth” is attracting a lot of attention from Government programs and in the work of Non Government Organisations (NGOs). And yet little is being done to prevent young people from becoming “disengaged” when they really want to be more engaged. There are youths (aged 16-24yo) who want to be included in the world—not excluded like so many of their peers that end up in prison or on diversion programs.

In Darwin there is an 800 bed prison, Berrimah Gaol, costing $80 million a year for people who have chosen to be bad. The young Aboriginal inmate – and that is 90% of the prison population – is probably in there for some anti social behavior fuelled by alcohol and Gunja – will receive tuition in literacy and numeracy and computer skills.

Upon release they will be remanded to a formal rehabilitation program in a beautiful garden setting hostel style accommodation with all meals and training provided for a further 12 weeks.

Oh for such a facility for those those who want to do “good” – and not just for those who choose to do “bad”.

Government programs exist—the Job Services Australia network; Language, Literacy and Numeric Program; Step-Up; WELL; Youth Connect; the Indigenous Youth Mobility Program; Youth in Communities and the exalted Youth Attainment and Transitions program - BUT there is no co-ordination and each program is delivered by a contracted provider that once having gained the contract has little competition leaving mediocrity to reign.
Glossy websites and publications mean nothing if the product is not being delivered. The so-called “mutual obligation” means equal commitment from all parties and yet Governments seem to think their obligation is finished with the appointment of an agency to deliver programs. If the government funded agency fails to perform there seems to be no obligation but if the client does not arrive at an appointment the welfare payment can be stopped. This begs the question of why it is so hard to co-ordinate the efforts of these similar government funded programs with the same goals so that the clients get what they want. An element of “discretionary funding” must be made available for use at the local level to stimulate initiatives and help to fund the work needed to build plans to a point of applying for funding.

Breaking out of cycles of disadvantage
Control of ones own life is an important element in building social capital. The principles that were espoused in the Australian Assistance Plan of the Labor Government in 1972-75 were said to be ahead of their times but maybe the time is NOW for Aboriginal communities to receive an Aboriginal Assistance Plan along the same lines that could involve the people in determining their social needs and priorities. This would also make micro loans available to seed new ventures that would create training, employment, independence from welfare and a purpose for rising every morning and getting the children to school.
The time is now when it comes to building stronger social capital in remote Aboriginal communities and this is well reflected in the words of Nobel Laureate Chilean born Gabriel Mistral who said of the needs of children:

Many things we need can wait, the child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being developed. To him we cannot say tomorrow, his name is today.

There must come a time when the policy makers shed the shroud of fear about matters such as “paternalism”, “stolen generations” and “separatism”. In decrying paternalism self determination was brought in and it has now been recognised that has been a failure. The basic ability and understanding is simply not there for these Aboriginal people to negotiate the machinations for moving ahead in the western world. There does need to be considerable mentoring, guidance and fostering of confidence which can still be done in a facilitative way without being labelled as paternalistic. To wait until the people are ready for change could be to wait another one or two generations – a prospect that no Australian would feel comfortable in accepting. If there is tutoring and mentoring to be done we must do it in a vigorous manner and not just pay lip service to it against a backdrop of centralist policies and program development.
With respect to the stolen generation - there is no doubt the forced removal of children from their parents in previous generations was despicable. However this was forced removal. To suggest that an Aboriginal child may be assisted by attending a boarding school in another state is not forced removal. The paranoia that surrounds suggestions of moving must be diminished by examples of well being fostered from such experiences. Research should be done to demonstrate the long term benefit in voluntary removal to allay these fears. Even the “dormitory” style living and mentoring and caring for children who are disengaged would be better than the nomadic existence so many young children have to undertake when abandoned by their natural mother or father.
Separatism was a sensitive issue in the world in the early 1970s with vivid memories of the tour of the Springbok Rugby Team in 1971 still vivid in the minds of those of us around at the time. The apartheid movement in

South Africa

has finished and should never be seen again. It was the forced separation of one race of people from another with harsh penalties for anyone who crossed the line. However in decrying apartheid it should be acknowledged that there will be situations where one race of people may decide that it does not want to live in the same way as another. At no time in the history of the Aboriginal survival efforts have they been given the opportunity to decide the way they want to live. The Aboriginal men from remote communities seem unable to embrace a mainstream culture and legal constraints while for the women there are those that simply see themselves as “community girls” with no intention of even trying to live the mainstream lifestyle. If we do accept that assimilation failed and that self determination has failed then we need another word that will describe a phase whereby Aboriginal people are given the resources to develop a world of their own that takes what they want from the western world and allows them to remain in their own country.

Personal choice should play a part
Choices are made on a basis of knowledge so that the costs and benefits of a situation can be weighed up critically to choose a path. In the situation under review the people involved do not have an education or awareness of a logical framework in thinking that allows to them to participate in an analysis of choices. The educated mainstream person does not appreciate the manner in which their upbringing in a culture that has thousands of years of development through many “revolutions” that have embraced invention to move that culture ahead in a manner that is “mind boggling” to a person from a culture that subsisted in the desert for thousands of years without even knowing what a wheel could do. It was not until the arrival of ships from foreign countries such as Holland and

Indonesia

(Macassans) in the 16^th and 17^th century that these people learned what metal was. The power of logical thinking that comes with an ability to manage a situation, prioritise things, file away messages and thoughts in the brain to a later date are all practices that come naturally to the educated dominant culture person in

Australia

. This value was highlighted during a recent visit to

Australia

of the

Somalia

born women’s activist Ayaan Hirsi Ali who said:

“We can learn from you and your centuries of critical thinking. You Westerners come to Africa with your money but you can keep your money - we want to share with you your values. The most important value – the value of critical thinking – questioning authority – no matter who it is – question why things are the way they are and why they cannot be done better.” (Interview with Monica Attard – Slow TV – August 2010)

To expect Aboriginal people to think through their options for survival in a world that none of them has grown up in is a tall order and the resolution needs a lot more talk and research to find the best path ahead. In 2005 the present Co-ordinator General for Remote Service Delivery in the NT, Mr. Bob Beadman wrote a paper in which he lamented the fact that something had taken away the ability for Indigenous people to have dreams for their future. He wrote:

“I am looking at human detritus right here in Darwin, and wonder what dreams they might have once had for themselves. What dreams they might have had for their children? What dreams their children might have had for themselves? I wonder if people have abandoned those dreams, what caused them to give up, what is it about the world that surrounds us all that makes them think that their dreams are unachievable.” (Do Indigenous youth have a dream Menzies Research Centre, Canberra, 2004).

Work is needed to ascertain how many young people would like to see a better life and this needs to be carefully structured. The target population is not English speaking, does not understand concepts of space and time and is not confident in working with the dominant culture. The young people must be encouraged to question why the situation is the way it is and not to simply accept as normal or necessary for it to stay the same.

Somehow the minds of the young have to be engaged in wanting to see an improved life ahead for their children – the next generation and social inclusion could be the agenda through which to make this happen.

Ends

30^th August 2010

Is the PBS playing its part in “Closing the Gap” in Indigenous Health?

2010-05-22T12:21:00.004+09:30

ADDRESS BY ROLLO MANNING to the
7th Annual Future of the Pharmaceutical Benefits Scheme Forum, Sydney, organised by Informa Australia, 22-23 April 2010

The Pharmaceutical Benefits Scheme and Aboriginal Australians

The future sustainability of the PBS centres on whether it is achieving the objectives that were set out for it when it was introduced in 1949 – to provide a range of medicines to Australians that are essential to achieve better health. We must not lose sight in all the discussions that in the end there is a patient and so long as that consumer of the PBS is getting healthier as a result of it is achieving its objective. At times there is too much emphasis on the process rather than the patient.

The PBS is a small part of a big effort to try and maintain good health so we should not get carried away with the importance of the PBS in an overall sense.

This presentation will look at
• The background to Aboriginal health and the overall picture of the problems that exist and how these have arisen.
• The infrastructure that supplies the PBS to Australians with the retail pharmacy sector still being dominant in that supply chain.
• Evaluate the PBS against the four pillars of the National Medicines Policy to comment on its effectiveness in Closing the Gap – that difference in life expectancy between an Aboriginal person and mainstream Australians.

Working in this field of endeavour is a constant learning process. In my first venture into Aboriginal health I was amazed at how badly pharmacy was practiced in the remote communities in the Katherine region through the 23 remote community health centres being supplied medications from the Katherine Hospital. There was little quality in the way medicines were being used - few records were kept of outgoing supplies, no labelling was being done and the consumer had very little idea of what their medicines were all about. There was little emphasis on dispensing and indeed no payment was received for the cost of dispensing and even now – 13 years further on – there is a discrepancy of $3.73 between what the PBS pays for dispensing PBS medicines to people from retail pharmacies and what is paid to pharmacies to supply PBS to remote Aboriginal health centres. $6.42 is the price paid to dispense a PBS item from a retail pharmacy and only $2.69 when that same item is supplied to a remote living Aboriginal person. The result of this that the Aboriginal health service – be it either government owned and operated or an Aboriginal community controlled health organisation (ACCHO) has to pay for the cost of dispensing.

In a question to the Senate Estimates Committee in June last year Senator Rachel Siewert asked why the difference and was told by the DoHA officers that the “function is not as intensive”. One has to ask why is it not so “intensive”. Are you saying the Aboriginal people do not need the same rigour in the supply of medicines as other Australians?” Of course they do and it is a cop out to say otherwise.
The Wurli pharmacy upgrade project in Katherine is asking for the $3.73 per item supplied to go towards the cost of employing a pharmacist for 12 months – that based on 12 month usage of PBS will amount to $70,000.

Let’s look at the situation in a remote Aboriginal community - Galiwin’ku in north east Arnhem Land. It has a population of 2000 people – they live in 152 houses - 90% of children under one year old have been diagnosed with scabies; dosette boxes are still used as they say they cannot afford Websterpaks; 10,000 cigarettes are smoked a day; there are five retail outlets. One store, three takeaway outlets, and the place where they buy petrol. What is it about us that we think these 2,000 people only need one store as a retail outlet?
A comparison between Galiwin’ku and Boorowa (NSW) shows a stark contrast. Boorowa has 15 retail outlets and the people live in 850 houses. Straight away it shows up the over crowded housing and lack of employment opportunities. This is the sort of community that I feel for with their level of health far below the average Australian.
The median age of death for these people is 43 years for males and 53 years for females. This is showing that the Australian average of a life expectancy gap of 17 years is not a true picture when remote living Aboriginals are included. It means young children left without a parent (or both) and their upbringing left to the grandparents who are still around with their education from the mission days. These young children are destined for a life of alcohol and drug taking simply because they have nothing better to do and through a lack of quality education. We cannot blame children who at age 10 wonder why they need an education when they see so many adults sitting around doing nothing. Jobs are a must to stimulate the need for an education. Sadly we have young adults leaving school with a Year 12 Certificate but they cannot read and write. This is sad for them and a bad reflection on our ability to help them raise their living standards.

The above shows examples of the social determinants of health that are so prevalent in Aboriginal communities - poor education and lack of employment opportunities. Along with these come overcrowded housing, high crime rate, substance abuse and poor personal and domestic hygiene. These factors have to be recognised by anyone working in primary health care as they have such a huge impact on the quality of life and therefore health. To live in a constant state of poverty is a classic precursor to poor health.

As shown by Professor Fran Baum at a Chronic Disease Network conference in Darwin last September it is no use helping people to get better and then make them go back to live in the unhealthy environment that caused them to be sick in the first place – and yet that is what we are doing. There is an urgent need for a total approach to the living environment to improve health across all sectors that have a responsibility to improve housing, environmental health, employment opportunities and education.

So this is the profile of the people I concern myself with – the remote living Aboriginals across the north of Australia – and there are some 150,000 of them living in remote communities. For many of these people the developed world has only been with them for the past 50 years and that is a very short time for them to get used to our way of living.

I used to think that we should find the latest advances and rocket these people into the next generation of pharmacogenetics and the like but really we are not even doing the simple things well. I will show later what I mean in outlining the Tiwi Islands Pharmacy that was owned and operated by the Tiwi Health Board itself with an Approval Number to supply and claim the cost of PBS supplied to the Health Centre.

What is the PBS?
The PBS is a huge sum amount of money (ca $10 billion) that funds a large amount of things one of which, and the most important one, is the supply of medicine to the public. In the process of doing this it helps to fund research, manufacturing, marketing, distribution, dispensing and the provision of information to the client. It is thus money that we have to be sure is being used in an efficient manner to enable the patient at the end of the line to receive the right drug with enough information for them to understand why they need the medicine to get better.

The landscape for supplying the PBS to the Australian public is dominated by the retail sector which in turn means the Pharmacy Guild of Australia. One aspect that is often overlooked by parties criticising the Guild for its actions is that the Pharmacy Guild is the only organisation named in the National Health Act to negotiate with Government over the fees to be paid to pharmacists for their role in supplying PBS medicines to the Australian public. The criticism emanates from those, such as the PSA, saying that the Guild has overstepped the powers given to it by negotiating professional services that go beyond the scope of fees.
The five yearly Community Pharmacy Agreements sets the scene for the next five years on how pharmacy practice is going to be conducted.
The carve up of the PBS money “pie” shows that the manufacturer gets the largest share, the wholesalers a small amount and the pharmacy 26% of the total to cover the mark up on cost of goods and fees. Now there is no problem with the mark up as that is a legitimate amount to cover the cost of the inventory in a business. It is the fees component where the worry starts in terms of getting value for money. The Consumers Health Forum weighed in two weeks ago with a Discussion Paper calling for input to inform the 5th Community Pharmacy Agreement. Justifiably so in their criticisms is the lack of audit processes to see if pharmacists are delivering the services they are getting paid to provide through the dispensing fee of $6.42. If we compare the rigid audit process the wholesalers have to undertake to justify the spend of $150 million through the Community Service Obligation with its reams of paper work with the degree of audit the retail pharmacists do for their $1.2 billion the difference is stark.

When we have a look at the programs that should have been delivered by retail pharmacists following the $570 million in the 4th Agreement we see from the budget papers for 2009/10 that only half the pharmacies were participating. The rest are simply taking the dispensing fee of $6.42 and doing nothing more than a supply function. The statement by the PSA in the pharmacy press some two weeks ago that the Pharmacy Guild had overstepped its responsibility to negotiate fees is wholly justified. The Guild, to give it credit, is doing the job it has to do to maintain the viability of the 5,000 pharmacies and this it does very well. It is just that we do not need 5,000 pharmacies to do the job at hand resulting in an inefficient use of public money with it being spread across too many outlets.

At the PBS Future Forum last year I made the statement that if half the pharmacies in PhARIA One closed tomorrow nobody would really miss them – the consumers would simply go to one nearby. We do not need four pharmacies in the CBD of Darwin to dispense all the PBS prescriptions and the same happens in most urban areas. It means there is a lot of money being distributed to too many pharmacies resulting in the PBS dollar being unevenly distributed and the consumer is missing out by not being provided with the service expected. The PBS dollar is being inefficiently distributed.

I do not have a problem with the $1.2 billion paid out in fees, it is just that when spread across to entire population of retail pharmacies there is too much to too many that provide nothing but a supply function.

Where does this having an impact on Aboriginal Health Services?
As a result of the above inefficient supply system for PBS and the insistence on the 5,000 retail pharmacies remaining the custodians of the PBS Aboriginal Health Services are forced to fit into an inefficient mainstream model that simply does not work for their client base. The time must come when Aboriginal Health Services have their own in house pharmacy operation so they have complete control over the pharmaceutical care process in the same way as they do over every other aspect of primary health care. It is only when this happens that the wealth in the PBS can be shared and put to work in the best interests of the client (consumer). Dispensing is happening now in Aboriginal Health Service but in a way that does not meet the standards that are expected in mainstream pharmacy. Examples exist where dispensing is done from a tiny room stacked full of samples from drug reps and any other source that can be found to be able to dispense to patients who are unlikely to take their prescription to an Approved Pharmacy.

Let’s look at the PBS for Aboriginal people against the principles of the National Medicines Policy. We can see that access is okay in that the facility is there to provide medicines. It is just that the client base is not comfortable in a glitzy mainstream store in a prime retailing location. The quality is there for storage however efficacy is compromised by a lack of information on the medicines supplied. As for quality use of medicine it is simply not there and largely because of the lack of access to a pharmacist to steer the process. In terms of a collaborative effort on the part of stakeholders there is a lot that could be done by manufacturers to ensure the client who receives a prescription for their product has the information needed to want to take the medicine.
The Aboriginal population is spread across the continent with only a small number in the remote regions – around 150,000. This is not a lot for a politician to take an interest in and the ability of this consumer to lobby is negligible. It behoves us all, if we have a social conscience, to make an extra effort for these people who really have had a very hard time over the past 220 years. The manner in which additional product has been made available on the PBS through the special listings for ATSI people is also an inefficient use of public money and the perfect example of how many of the problems would be overcome with an in house pharmacy business. As an example Clotrimazole Cream – Item No 1017M – can be bought by the pharmacy from the manufacturer for $1.43. The same item when listed on the PBS costs the Government $11.26 or can be bought from an Internet pharmacy for $4 - $1.50 less that the Concessional co-payment. Given its own pharmacy the AHS could be making a much more efficient use of Government money with a pharmacist on site to provide information as happens in every other Approved Pharmacy across Australia.

A solution has to be found to pay for the cost of dispensing at remote Aboriginal Health Services – the iniquitous situation that exists where there is a $3.73 shortfall between what the PBS is paying to supply a PBS item to mainstream Australia ($6.42) compared to the $2.69 for the same item to a remote Aboriginal person.

Balance cost with information for maximum adherence

The concentration on cost also has to be balanced against the need for information. There is currently a program to commence on 1 July, 2010 whereby Aboriginal people on Health Care Cards will get their benefits for no cost – and general beneficiaries will get their PBS medicines at Concessional rates. This will not solve the problem. For some people you might have to pay them to take something which they know nothing about. So reducing the co-payment will not necessarily result in patient compliance. Research conducted at the University of Newcastle has shown that there needs to be a lot more work on the impact of co-payments before any further changes are made. To me information is more important than cost – and that needs to be rectified first.

Statistics needed
Statistics are another area in Aboriginal health that needs attention. Under the Section 100 arrangements there are only 166 AHSs being supplied through 34 pharmacies but we are still not able to find out what is going where to make any regional comparisons or correlate this with health outcome information. In the NT we do not even know the value of the PBS spend even though Medicare Australia makes payments to every pharmacy supplying and dissects this by individual items.

It does not have to be this way

Pharmacy practice to Aboriginal people does not have to be this way as it is possible to do the simple things well as was shown with the pharmacy at Nguiu on Bathurst Island, which was owned by the community controlled health board. Information systems allowed us to know what was going out, who prescribed it and with a label on every supply. However their has to be the infrastructure in place and this needs a certain will on behalf of the leaders to want to see it happen. On the Tiwi Islands compliance was improved significantly in less that two years and it is hoped that this will be able to replicate a model being developed at the Wurli Wurlinjang Health Service in Katherine that will bring into play technological advancements. You don’t know what you don’t know and the people involved in Aboriginal health have not experienced a pharmacy of the quality that exists in other parts of the country. We must all contribute to improve this situation as it is all possible.

Thank you
Rollo Manning
rollom@iinet.net.au
30th April 2010

The inequity of the PBS to remote Aboriginal people

2010-02-18T11:06:00.002+09:30

When every Australian can get a Pharmaceutical Benefit prescription dispensed and have access to the advice of a pharmacist it is taken for granted. Yes every one of the 22 million people in this country has access to a pharmacist in one of the 5,000 Approved Pharmacies around the Nation every time they have a script filled. In fact the PBS pays for that pharmacist to be there through the dispensing fee of $6.42 paid on each and every prescription dispensed..
But what of the 150,000 Aboriginal and Torres Strait Islander people who live in remote places in Western Australia, Rural Queensland, the top and west of South Australia and the Northern Territory scattered across the 70 odd communities there?

Ask any of them what a pharmacist is does or hangs out and they wouldn’t have a clue. They will never have seen one. They may remember the glossy looking shop in town when they had to go there for a medical purpose but chances are they wouldn’t have noticed because they were so intent on knowing whether they were going to get back home alive.

Pharmacists do not exist in the remote Aboriginal health workforce, with a very few exceptions. The Government provides through the Section 100 Support Allowance a possible six monthly visit by a pharmacist with the grand sum of $4 million spent on this annually across 166 health services serviced by 34 community pharmacies.

We have to get real and understand that these people not only deserve an equal deal to mainstream but probably require the help 10 times more because of their poor state of health.

The PBS has to find some money to support the appointment of pharmacists located strategically around remote Australia where they can at least direct and train others towards a quality improvement process. Go to any of the 166 health services and you will find a pharmacy supply system that simply does not match current day practice standards. This is an indictment on the profession and requires urgent attention before someone goes to the UN claiming institutionalised racism.

And okay – there cannot be pharmacists everywhere of course we know that – but then it is a matter of training persons to take the pharmaceutical care message out to people in their own language and using the basis of knowledge the person is coming from in their own cultural way. This is done in Africa (Zambia) through what is called Adherence Support Workers and a similar trial in Australia is hoped to be struck in Katherine (NT) this year to test the concept. If we cannot have pharmacists everywhere we can at least try to have their agents as ASWs trained in the need for compliance and the actions and interactions of popular medicines for the chronic diseases that are killing these people at a rate unknown in the developed world.

It is all a matter of equity – and at the moment that does not exist.

Unfortunately as in many areas of endeavour towards alleviating Indigenous disadvantage we tend to rest on our laurels with the 10% of good effort and put aside the 90% that are not benefiting.
As Noël Pearson put it recently:
“I’m sorry I can’t take my focus off the glass 90 per cent empty, rather than being thankful for the glass 10 per cent full. Because I know what that 90 per cent translates into when those beautiful children who miss out on the social justice ticket become adults. Jail. Ill health. Early death.” (The Weekend Australian 28th November 2009).

The start of a new decade - lets do it!

2009-12-30T10:49:00.004+09:30

Click on image to view full slide

Allow me to share with you my views on two key issues that I believe will help to favourably shape the future destiny for Aboriginal people living in remote communities.

In this field we(white fellas) are learning all the time.

I started in 1997 looking after the pharmaceutical supplies for the 6,000 people who lived across 23 communities to the East and West of the town of Katherine in the Northern Territory.

When I left there eight months later I thought if people took their medicines they would live longer.

How wrong I was.

And what a contrast to the views I now hold having obtained an understanding of the social determinants that impact so severely on the lives of these people.

The state of poverty being experienced is such that it is a continual struggle day by day to simply survive so any ideas of time spent thinking about the future is simply not there.For those who come to Darwin it is usually for medical treatment. If it is renal dialysis, as is the case for some 200 persons at any one time, the family comes too and begins a continual round of Centrelink, bank, housing, ID through Births Deaths and Marriages, Medicare and the dozen other agencies that go towards the social capital of a developed society
.

I look forward to comments or support for what I call my two key elements to a future better life for all.

Promoting an early death

2009-07-26T08:14:00.010+09:30

The Australian public is exposed to some outrageous headlines attempting to excite them about spending rorts by people in high places. Rarely though is it exposed to the enormous spending on death defying recklessness by people on tobacco products.

The headline (on right) is supposed to create anger that the Nation’s Prime Minister travels too much.

What about the other? (on left) – Would it raise an eyebrow or simply be put aside with a sigh and an exclamation of – “oh well – you have to die of something”. And after the death – “oh yes but he was a smoker” as if that makes it all right to smoke to death.
No - it should not be like this.
The hackneyed old excuse that people have to take responsibility for their own health must be banned from use in a situation where people are legally allowed to buy products that are promoting a low life expectancy. By the time people “learn” to take personal responsibility for their actions thousands will have died from the effects of tobacco products and only the government of the day will be to blame for allowing this carnage to continue. Who will then say “sorry” in 50 years time?
A remote community of 2,500 population spends $80,000 a fortnight of a $500,000 welfare cheque on tobacco products. It is estimated that a further $80,000 is spent on Ganja. (References available). 12 years ago the community store, takeaway and licensed club at Nguiu (Bathurst Island) was taking over 50% of its total revenue from beer and tobacco products. What of the others and where are the stats now? If anyone has them please speak up or is this vital market intelligence silenced by the same people that are profiting from the marketing of ill health?
And how good would it be if that same amount was being spent on community development activities or to facilitate the development of enterprises that would create employment opportunities. Yes that is right – something to do. Anyone who has (or does) smoke will know how much less is smoked when in a working environment that does either not allow smoking or is such that it is not possible to smoke. Imagine if of that 2,500 population there were suddenly 200 with a job – no time to smoke. If the money was put into a community fund a lot could happen.
As for the price of cigarettes – who cares?
A smoker will spend up to $15 a packet if they feel they need it. For all the debate about what difference the price makes, and how “price sensitive” is the marketplace – forget it. Not many smokers would know how much they paid for their last packet of cigarettes.
Just put the price up to $25 a packet and put the $10 a packet into a community fund.
If $80,000 a fortnight is being spent on cigarettes and people halved the amount they smoked – there would be (potentially) $40,000 a fortnight to go into a community fund for extra community development activities or an educational fund for school excursions. That is $ One million a year for a community fund from a self imposed tobacco tax. The cost benefit to the community is huge – what a headline that would make!
Only drastic measures will bring about behavioral change and it is about time the authorities “bit the bullet” and did something drastic. Tinkering around the edges has produced no change and the situation still exists where people in these communities do not know what good health is.
Spend the money from the tobacco tax on promoting good health – but in the same vigorous way that McDonalds, Coke and Kentucky promote ill health and oh yes VB, Four Ex, Tooheys and Fosters too.
As for the remote community takeaway stores – some of them are just selling sickness. Bulldoze them all and create a “good health” store where at least the choices will be healthy ones.

Ends

TRAINING FOR WORK

2009-03-30T11:41:00.012+09:30

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?

2009-03-08T09:40:00.012+09:30

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.

Aboriginal towns stark contrast to mainstream

2009-02-09T14:49:00.044+09:30

Governments must open their eyes and do something to create the infrastructure needed to have a thriving economy in remote Aboriginal towns across the north of Australia. There is no need to keep thinking that one store, a couple of takeaways and a fuel outlet is all that is needed and then say the people must move to the jobs if they want to work for a living!

Indications are something is going to happen - it is a matter of when and how!
There is no reason to believe that Aboriginal people do not need the retail outlets and service facilities that the rest of Australia takes for granted. Regrettably that is all many people know because that is all they have seen living in isolation to the rest of the population.

A comparison of an Australian country town, Boorowa in NSW, with Galiwin’ku on Elcho Island shows up some sharp contrasts.

Population of both places 2,000 people

If it looks as though Boorowa is the bigger

of the two – it is - in terms of number of houses. 950 for 2,000 people compared to Galiwin’ku with 152 houses.

Then you really know what over crowding” means! 8.5 persons per house at Galiwin’ku compared with 2.4 in Boorowa.

The biggest contrast in terms of retail opportunities is the number of
businesses - be they retail or service.

Galiwin’ku has just five retail outlets. One store, three takeaways and a fuel bowser.
Boorowa on the other hand has 15 retail outlets as well as three

hotels - (none at Elcho), three motels (none at Elcho), eight café/restaurants (none at Elcho) other retail stores including a pharmacy - pictured right - and the gathering of service clubs, special interest groups and supporting organisations mainstream Australians take for granted.
Overall the strength of social capital in Boorowa is huge compared with Galiwin’ku where it has been decimated over the past 100 years as a result of colonisation. There were people living in North East Arnhem Land in the 1930s who did not know the “south” had been settled by the British. They thought Japanese (from pearling) and Asians (from trepang) were the only other people on the planet.(1)
The people of Galiwin’ku are from 15 different clan groups that were at loggerheads years ago and have been thrust together in a “community” with no help in developing their alternative social networks, activities or sporting opportunities. There is football club run by a group under the auspice of the Council but with little opportunity for the player to have a say in how it is run.
The clan groups are the focus of social gatherings.
The 24 page booklet (pictured left) lists all the shops, services, clubs, festivals, history and attractions of Boorowa.
Galiwin’ku does not have ONE motel. Only a “guest house” that many walk away from on first sight. (Pictured right)
The following table gives a comparison of other indicators (2) :

It does not have to be this way and yet for some reason governments over the past 30 years have believed remote living Aboriginal people only need the most fundamental of services to make their communities thrive.
It is shameful that in 2009 these towns have chronic unemployment, illiteracy among children, poor health through overcrowded houses and phenomenal amounts of boredom that leads to domestic violence, drug abuse and general anti social behaviour.
This is the profile of a town where only 10% of the population has reached Year 10 level at school.
The retail store - with no competition - is under no commercial pressure to do better - although the one at Galiwin'ku is community controlled and does its best (pictured right).
It is hard to expect a child to want to go to school when all they see is chronic unemployment and no industries that attract their desire

as a future career path.

As Noel Pearson put it in an article in The Australian in August 2008:
"You can educate people as much as you like, but if they've got no jobs to go into, as a young Aboriginal 10 year-olsd told me"Why do we need to be educated if there's nothing for us, there's no future"."

The answer lies in developing enterprises which the people themselves want to see happen and where they are responsible for that development.

In the world of “Enterprise Facilitation”, and as promoted by Ernesto Sirolli through his Sirolli Institute (3) based in Canada, the facilitator has no original ideas of their own – they all come from the people – and – only work with people who want to be helped. It remains to be seen whether this approach will work in remote Aboriginal towns but it is worth a try.

Let’s face it – nothing else has worked over the past 100 years so why not ENTERPRISE FACILITATION a la Sirolli.

Remote living Aboriginals need some dreams. The dreams they had have been destroyed by Governments with a passion to have them be like us.

What needs to be done is foster and facilitate their dreams so success can come and by example the children will at last see a reason to want to go to school.
The Enterprise Facilitator helps people to live their dreams and provide them with the answers they need to achieve their goals.
Aboriginal people in the main have been to Darwin, they spend a lot of money at stores of all types and sizes. K-Mart and Target are popular as is The Good Guys and Harvey Norman. The amount of money being spent is mind boggling for people who are allegedly living in a state of poverty. For the ones that do not waste their money on grog, gunja and drugs there is plenty of disposable income left for clothing, electrical goods and gadgets, sporting accessories and music.
The big retailers are benefitting but there is no reason why a wider variety of shops in the town would not succeed given the obvious demand.
A concerted effort on the part of the Australian society (including government) is needed to bring these Aboriginal towns up to the same level of services as the towns mainstream Australians call home.

This has to happen so the playing field is level when a comparison is made between the two cultures.

References:
1. Mcintosh, I., & Burrumarra, D. (1994). The whale and the cross: conversation with David Burrumarra MBE. Darwin, Historical Society of the Northern Territory.

2. Australian Bureau of Statistics: 2006 Census QuickStats. Boorowa and Galiwin’ku

3. Ernesto Sirolli: Ripples from the Zambezi: Passion, Entrepreneurship, and the Rebirth of Local Economies. New Society Publishing, British Columbia, Canada

Equity needed in PBS supply to Aboriginal patients

2008-11-04T05:36:00.009+09:30

Let me tell you a story –
…the story of the Pharmaceutical Benefits Scheme and Aboriginal people in urban and remote areas.

Pharmacy services in Australia have evolved over the past 50 years following a model of retail dominance. Emerging from the 1960s when the compounding of medicines in all forms gave way to manufactured product the pharmacy profession ceased to be the wise old man of the mortar and pestle and exchanged this for the emerging technology of retail business management.
For a time in the early 1970s through to the 1990s the shop based dollar turnover dominated through the “front of shop” sales of anything from coffee and asparagus to health and beauty aids. The franchised style of branded chains came out of the individually owned businesses of the earlier “master pharmacists”.
More recently the pendulum has swung the other way and dispensary turnover is exceeding the front of shop due to the enormous change in retail shopping behaviour influenced by the supermarkets. In an attempt to counter this pharmacists’ have turned their stores into supermarkets. With some deft political maneuvering they too have been able to have legislation passed that means it is illegal to have a pharmacy in a supermarket but okay for a supermarket to be in a pharmacy!
The driver of the force that created a unique retail profile combining the retailing with the professional services was driven (and continues to be driven) by the union for pharmacy owners – the Pharmacy Guild of Australia. The organisation is now in its 80th year after having been initiated in New South Wales in 1928 in response to news that the powerful Boots the Chemist chain in the United Kingdom was considering entering Australia to overpower the dominance of a “pharmacist owned” policy. So it happened that bullions of gold were exchanged for political favors and the same principle still applies today as the powerbrokers of the ancient establishment continue to disperse their wealth in successful endeavors to maintain the highly anti competitive practice of retaining the pharmacist only owned policy in all jurisdictions except the Northern Territory.
In that “State” the law allows an Aboriginal health service to own a pharmacy business so long as it has Ministerial approval.
In 2004 the Pharmacy Guild convinced the NT Labor Government that it was out of step with the rest of Australia by not having a pharmacist only ownership rule. In point of fact and following National Competition Policy (NCP) principles it was the rest of Australia that was out of step with the NT (by default) being the only place that conformed to NCP guidelines.
A lobby to retain the opportunity to allow Aboriginal health services to own a pharmacy was successful and with the help of the Independent Member for Nelson, Gerry Wood MLA, the clause to allow this to happen was passed and the NT became the only place in Australia where someone other than a pharmacist could own a pharmacy. The remainder of the restrictions were carried into legislation by stealth following the Pharmacy Guild claims that it HAD to be changed to meet NCP principles.
The fact that the clause allowing AHSs to own a pharmacy has not been utilized to improve the way Aboriginal people access pharmacy services is more because of a lack of understanding of how to make it happen rather than an acknowledged acceptance that it is not needed.
In point of fact the manner in which pharmaceuticals are delivered to Aboriginal clients of AHSs does not match up to National Medicine Policy principles. Aboriginal health services (AHS) could well do with an injection of pharmaceutical know-how through the employment of pharmacists in their primary health services to close the gap between what is available to mainstream Australians compared to Aboriginal clients of community controlled health services.
The Pharmaceutical Benefits Scheme (PBS), the primary funder of essential pharmaceuticals to the Australian community, has discriminated against Aboriginal Australians living in remote places since the introduction of special arrangements in 1999 to allow AHSs in certain remote locations to access a full range of PBS items without having to pay a cost to the client but also without the full dispensing fee allowed to the rest of Australia.
Across Australia there is the legislative requirement to have a pharmacist employed at every pharmacy. This means the PBS supply is supervised by a pharmacist and a “professional fee” is built into the remuneration from the Australian Government to allow this to happen. It is the PBS that is employing the pharmacist through the remuneration structure.
From the 1st August 2008 the fee paid to pharmacists was $5.99 and in addition to that they receive $1.02 to record the safety net for a client on each prescription dispensed - a fee which is meant to be voluntary for the client but rarely offered. If the cost of the PBS medicine is below the threshold for Government subsidy the client pays the lot and the pharmacy builds into the cost an amount of $3.63 simply because it is not being subsidised by the Government. This is also meant to be voluntary and explained to the client but rarely is.
When a medicine listed on the PBS prices out at $20 it means that more than half the cost is going to the pharmacy in fees without even the cost of the medicine being covered. If that cost is less than $5.00 (which can easily be the case) the gross profit margin to the dispensing pharmacy is 300%.
Such charges are being incurred by Aboriginal clients across Australia who live in urban areas and access medicines through a retail pharmacy or from their AHS which in turn is paying these fees to their supplying pharmacy.
In remote areas the situation is different again and in most respects worse. Unlike the rest of Australians who access PBS through an approved pharmacy to dispense PBS the AHS will have a “pharmacy” of its own which accesses, stores and dispenses medicines under State/Territory legislation. The acquisition of the PBS medicines to the AHS is at no cost and the retail pharmacy (that is approved) will supply in bulk the medicines and not contribute to the dispensing process. In fact the supplying pharmacy will only receive $1.14 an item compared with the rest of Australia’s fee of $6.50 as outlined above.
The question can well be asked “what happens to the difference?”
The difference between $5.99 and $1.14 (= $4.85) is the amount the Australian Government saves when a PBS medicine is supplied to an Aboriginal client attending a remote health clinic.
National Medicines PolicyAddressing the National Medicines Policy (NMP) it is possible to determine how well the pharmaceutical service supply function to Aboriginal client’s matches up to that provided to the rest of Australia visiting a general practice clinic, multi purpose health service, GP Super Clinic or similar health service delivery facility. The pharmaceutical service will be supplied by a retail pharmacy or in a few instances a private pharmacy business on the site of the health facility.The Department of Health and Ageing website states the following re the NMP: The overall aim of the National Medicines Policy is to meet medication and related service needs, so that both optimal health outcomes and economic objectives are achieved. The Policy has four central objectives:
timely access to the medicines that Australians need, at a cost individuals and the community can afford;
medicines meeting appropriate standards of quality, safety and efficacy;
quality use of medicines; and
Maintaining a responsible and viable medicines industry.
ACCESS

– on the question of access there can be no dispute. Aboriginal clients in both urban and remote locations have ready access to PBS medicines through a nearby retail approved pharmacy.
STANDARDS

– there should be no question of doubt on quality as State/Territory Poisons legislation requires proper adequate and safe storage situations for all human medicines.
QUALITY USE OF MEDICINE

– this relates to the manner in which the client is supplied the medicine and whether they are assisted in understanding matters such as why it has been prescribed; what it will do; whether there are side effects; how it will assist them get better; the importance of dose related times and circumstances; and why it is essential for improving the diagnosed disease together with any co-related measures such as diet, exercise or avoiding foods, alcohol and other substances.

In the management of acute illness this is crucial especially with infections and antibiotics or topical treatments.In the case of chronic disease the QUM process will well make the difference between extending the life span of the individual or an early and premature death.A prescription for medicines in the treatment of chronic disease is usually a prescription for life and must be understood as such if the measure to “close the gap” to be successful. It should be of interest in this discussion that the responsibility of Government in the National Medicines Policy is stated as being:
Governments, their agencies and committees are responsible for:• developing and implementing the National Strategy for QUM; • coordinating relevant government programs; and• investigating and developing appropriate structures, funding mechanisms, legislation and environments that support QUM.
RESPONSIBLE AND VIABLE INDUSTRY

A “responsible” industry, both retail and manufacturing, should have some social responsibility apart from the required financial motive in its dealings. The fact that both sectors allow the current state of pharmacy services to Aboriginal people to continue with no proactive support in bringing about change indicates a lack of concern for this marginalised sector of the population.
It could well be said that Governments have failed to hold up their end of the NMP and QUM agreement when it comes to Aboriginal Australians in both urban and remote environments. In addition the retail and manufacturing sector have allowed a situation to continue which would simply not be tolerated if inflicted upon mainstream Australians in urban areas. The total thrust behind change for Aboriginal clients for the PBS must come from those sectors that know how it should be being provided. The AHSs themselves have never experienced a “good” pharmacy service and thus do not know what they don’t know.
The essential planks of a good pharmacy service at an Aboriginal Health Service could thus be summarized as follows:
ACCESS – ready access to all PBS medicines to provide optimum treatment for its clients.
STANDARDS – storage and transport of products in a safe and secure manner
QUALITY USE OF MEDICINES - information added to ensure client is able to take advantage of medicine to extend life expectancy
INDUSTRY co-operation to enhance the value of the pharmacy service from both the manufacturing and retail sectors of the pharmaceutical industry. Academia can also play a part in practice research to evaluate best practice models and evidence based outcomes.
Continual dialogue is needed between the Aboriginal health sector and Government policy makers. If the gap is to be closed pharmacists can play a big role in making it happen.
So far there is little evidence that this is taking place.

Jobs the best form of welfare

2008-08-04T10:16:00.007+09:30

Provide empowerment through work
The best and most cost effective way of alleviating poverty and delivering social security to disadvantaged people is to help them get a job[1].
Sounds simple but true.
A job creates a feeling of empowerment as the person is at last in charge of their own future destiny and is not dependent on the State for a livelihood. Children brought up by parents without a job do not have role models to drive their intent to a better future and the state of poverty the family is forced to live under is detrimental to all concerned. ( 2)
So it was that since the mid 1970s when welfare payments Aboriginal people in Australia started there has been a decline of social capital in remote Aboriginal communities that has continued ever since with the jobs that used to be done by Aboriginal people now being done by non-Aboriginals.
Reverend Steve Etherington, pastor with the Uniting Church and school teacher for many years in a remote community in the Northern Territory summed it up this way in a paper prepared for the Bennelong Society[3]:
“IF YOU READ NO FURTHER THAN THIS…
It’s about jobs: not overcrowding.
It’s about jobs; not about culture or ethnicity or missions, or history.
It’s about jobs: not about grog and drug abuse.
It’s about jobs: it’s not even about child abuse.
All these are merely symptoms of long-term unemployment.
It’s about jobs.”
There is little evidence of anything being done towards encouraging communities to take charge of their own future. All that is evident is the old and long term frowned upon dominant culture wanting Aboriginal people in their communities to “be like us” – it will never happen.
There is a need for programs such as that announced on 4th August 2008 which are positive, focused on the individual and actionable at community level. While the planning still has to happen the prospect of real co-operation between the government, private corporate sector and Aboriginal communities is a plus.
It is probably time to go back in history and read the writings of people like A P Elkin in the mid 1930s. It is all there. We need to pay attention to the past to plan a better future and one of the failings of the past 30 years is to ignore what has gone before.

It is all there.
We should use the experience of wise people who have been there and done that. The words of John Singleton back in 1979 still apply in 2008 as they did in 1979. He wrote in The Bulletin:
“…every time I look at one of those bearded university-trained southern do-gooders, I wonder if they will ever realise that they can never solve the Aboriginal problem because they are the problem”.
There is a need to engage with communities in a meaningful way. Stop “fly in – fly out” visits and genuinely be prepared to live amongst them to understand the way they think.
Government at the three levels needs to review what its role should be in enterprise/economic development. It is likely that the interference at the local level by trying to micromanage the spending of public money is having an adverse effect on motivating local people to act.
Mark Latham[4], writing in 2002 said “…inequality and social exclusion have become …entrenched in our society, despite high levels of welfare spending. The welfare state has been built around bureaucratic structures instead of around the capacities of people. It has placed its dead hand on innovation and self-help in disadvantaged neighborhoods.”
There is a need to provide “seed” funding to catalyse establishment of core business functions for emerging enterprises. The early availability of “seed” funding is necessary to build capacity at the local level and take the opportunity of initiatives that come from the grassroots.
A “bottoms up” approach is needed with government seeing its role as providing the infrastructure to allow enterprise to grow with the assistance of local facilitators paid by government in the same way that “business enterprise centres” came about 30 years ago in mainstream communities.
A pharmacy enterprise in a remote community has the opportunity of providing jobs, training and a cash flow from the provision of medicines under the government paid for Pharmaceutical Benefits Scheme. The opportunity to put to work all the knowledge a pharmacist has obtained through their undergraduate experience should make this a richly rewarding experience for young pharmacists. There are other opportunities especially if the industries that used to be there are listed and returned to produce the products they did in yesteryear. Things like a bakery, poultry farm, market garden, saw mill or cleaning service.
An analysis of the comparable shopping opportunities between an established country town in New South Wales with a remote community in the Northern Territory shows that for a comparable population base the NT community has only five retail outlets compared to 18 in the NSW country town. Another way at looking at this is to wonder how much of the retail spend stays in the town (in NSW) compared with the amount that goes out of the remote community because of the fewer businesses being owned by people external to the community.
If there is a budding entrepreneur in a remote disadvantaged community they only need to look around and see who is making the money out the products consumed and ask themselves why they could not be doing the same.
The jobs could be there if there was a planned co-operation between government, private sector and local people. It is possible that money put into job creation could have a more lasting impact on improving better health outcomes than money being put into new health clinics or the provision of primary health care staff, including doctors.
To look at the world through the eyes of the people is essential if useful opportunities are to be made available for those same people to develop their own potential. Young people especially need role models to look up to who work and set an example. Against all indicators this is not happening. By example they must be shown that there can be businesses in remote communities that will help the hours in a day pass more pleasurably than by doing nothing. This is also the ONLY way to solve the attendance at school problem. Show children why they must go to school. A child cannot be blamed for not seeing a need for school when the adults do nothing all day long.
The example is the key.

[1] “…the fact remains that the best way to get out of poverty is a job.” ACOSS president Andrew McCallum in Annabel Crabb, “Labor plan to help poor buy shares”, The Age, 7 May 2002.

(2) Cartoon acknowledgement Nicholson Cartoons at www.nicholsoncartoons.com.au "The Australian" newspaper.
[3] http://www.bennelong.com.au/occasional/etherington2007.pdf Accessed 2nd August 2008

[4] Mark Latham. “From the suburbs. Building a nation from our neighbourhoods”. Pluto Press 2003

12 months of frustration

2008-06-30T06:50:00.009+09:30

June 2008 should not pass without a comment on the feature which dogged Aboriginal communities in the Northern Territory for the past 12 months – the NT Emergency Response or the “intervention”

This badly planned and poorly thought through political catastrophe was launched with the force of a tsunami on communities severely weakened by decades of government ineptitude and bad policy. The suspects, the first people of Australia, were stunned by the rigor of the force that Dr Sue Gordon, Major General Dave Chalmers and their Northforce compatriots stormed into communities erecting army tents, shipping containers as houses and massive communications dishes to tell the world that here was a disaster that had been waiting to happen for years.

(Government Business Managers residence - Maningrida pictured at right)
(“We are nothing to do with the Army…” Dr Gordon said in a subsequent TV interview!)
In point of fact the disaster had been there for decades and getting worse and it took an upcoming election for the “rabbit” to come out of the John Howard “hat” and be thrown onto the political landscape in the same way as the Tampa incident had some six years earlier.
The trick backfired, the Government lost the election and the two masterminds of the NTER lost their political seats in Sydney and Brisbane.
But what of the real sufferers who had to be humiliated by seeing the laws of the land precluding racism suspended so measures could be put in place which were clearly discriminating against them for being Aboriginal and living in a remote community in the NT. As if that in itself was a crime and now we find the suggestion (again) that some communities may be economically unviable. In other words people should not be able to live where their ancestors walked because the government cannot afford it. What a joke - those same ancestors did not need a government in the first place and it was not their doing that the British launched its raid on the country they called home 220 years ago.
Recently in the same country (Australia) it has been exposed of children dying in houses that were only fit for rodents and children killed (allegedly) by a parent that was taking action to prevent the other parent from seeing the children. How bad is that and where is the intervention?
Some will say that there have been good points to the NTER and so there should be. Let’s face it - years of neglect create a situation where there is a lot to do and to do it well means a lot of money – a helluva lot of money. 20 people to a house, children not attending school, no jobs for people to want to work and so it goes on. Of course there is a place for help and even an intervention – but not one that is racially motivated, rude and confronting to the subjects and lacking in the most suited piece of politeness – consultation.
Yes 12 months has passed, little has been achieved that should not have happened years ago and the anguish goes on for people who quite simply fail to be understood by politicians, bureaucrats and the rest of the dominant culture residing on the southern seaboard of Australia.
Remote living Aboriginals are entitled to housing, education, good nutrition and primary health care as a basic human right – not as an emergency intervention into their lives.

Live, learn and understand

2008-05-29T05:35:00.006+09:30

You never stop learning

A personal journey with Rollo Manning

In the world of work with Aboriginal people one never stops learning.
Today we have a dispute between a Prime Minister and a former Minister for Aboriginal Affairs who thinks he should have been appointed to a National Policy Commission to develop innovative proposals to improve the provision of housing in remote Indigenous communities. The former Howard Government Minister, Mr. Mal Brough, believes his experience can contribute to the work of the Commission. To many people this is true because they applaud the intervention into Aboriginal communities in the Northern Territory. But to many others, and no doubt the majority, the intervention was a cynical political exercise intended to win votes for Howard et al in the November 2007 Federal Election. The result – out with Howard and Brough and the entire Liberal-NCP Government.

Mal Brough’s knowledge comes from nothing but “seagull” visits to a large number of communities and conclusions reached after sitting on the ground for the cameras apparently in deep discussion with community elders. His understanding and statements would have been formed after talking to advisers who form their opinions from similar exercises with Canberra bureaucrats renowned for flying in and out of communities for two hour visits and leaving to solve the problems of that world.

This is not the way to understand the Aboriginal “problem.” There are too many people in powerful positions influencing decisions on Aboriginal disadvantage with paper thin knowledge of the needs compared to white people who have spent years living among Aboriginal people and far have better deserve a seat on the PMs Commission for Aboriginal housing.

Something must be done to bridge the gap between the aspirations of the politicians and the effective delivery of resources to the people who need them most. This was the subject of recent comment in the National daily, The Australian newspaper.

When I think back to 1998 when I moved back to Darwin after 10 months in the Katherine region following my first exposure to remote Aboriginal life I thought I knew a lot – but now looking back I knew very little.

A colleague said to me before I started with the Tiwi Health Board – “you only start to understand Aboriginal people when you live with them” – a true anthropological approach and so much the truth.
Certainly today after over ten years of close contact and work with these ancient Australians I am still learning and marvel at the broad scope of subjects we take for granted and yet for my Aboriginal friends they have not embraced and even started to appreciate as a possibility.
Kids going to school – something we dream about before the child is born when we wonder whether we should book them into a school for five to six years hence or maybe just for secondary school. From the day the child is born we start teaching it and read to it and help it learn to count. For the Aboriginal child the parent may not be able to read, write or count let alone pass this knowledge on to the child. We have activities like little athletics on a Saturday morning where someone has to write down the names of the participants, count how many are in a race and then time the speed of the run. All educational in value and bringing parents together to be proud of their children and share the joy of parenthood with others. And yet on Saturday mornings in an Aboriginal community there is rarely anyone on the football field with it just waiting for the grown-ups later in the day for their single grade competition. There is not even a competition for the younger kids although they just love practicing their kicking and marking and pretend to be playing a game.
The value and place of money in our society is understood and we probably had our first money box before we started school and knew that it was to be saved, spared and spun out for as long a time as possible. Unlike the Aboriginal person who may not have seen money until they were 10 years old if born around 1960 and lived in a remote location. The view is to spend it as quick as you can before someone else gets it and if that means buying grog and ganja to not have any for food “tomorrow” then so be it. Someone will give us food.
It is necessary to develop an understanding of the people before you can make any significant contribution to improving the lot of remote living Aboriginal people.
For too long we have tried to make them like us but that will never happen. They are not like us, do not want to be us, and must passionately retain their strong and rich cultural values if they are to succeed in a modern developed world. Aboriginal people must be allowed to develop their own program of assimilation if that is what they want and to get there at their speed – not hurried because of some political aspiration of a person struck with a passion for their own ego.

A correspondent to the Sydney Morning Herald said in a letter this week:-
As a resident of the Tiwi Islands for the past 3½ years, I have been deeply saddened by the path that Brough and his supporters on the Tiwi Land Council are pushing Tiwi people onto. Brough often speaks about "what indigenous people want" and claims that they ask for the things that he puts forward. But how is he to know what Tiwi people want? In my time on the islands I have never heard a Tiwi person express a desire to own a house. Yes, they want better housing - they don't want to share a house with 15 other people. But does this mean they want to do away with communal ownership of land (which is central to their culture) as Brough suggests? Of course not.” (Rollo’s emphasis).
And Chris Graham, Editor of the National Indigenous Times had this to say:“…the problem is Aboriginal Australia doesn't need another showman, it needs solutions. Brough doesn't have any now, and he didn't have any in office. …. Brough may be fun to watch and he may make for great sound bites…. But he's all sizzle, no sausage. Hold your ground Kevin Rudd.”
The National Director of ANTaR, Gary Highland said:“…during his time as Minister, Mal Brough failed to act in a bipartisan way and alienated many Aboriginal people by his heavy handed tactics. He's therefore unsuitable for a bipartisan commission of this kind."
Next time you see or hear Mal Brough just remember- you have to live with them before you can understand them and commit yourself to pay a visit, stay awhile and then put your dreams for them into action.
In the words of Robert F Kennedy:There are those that look at things the way they are, and ask why? I dream of things that never were, and ask why not.
Remote living Aboriginals need some dreams. The dreams they had have been destroyed by Governments with a passion to have them be like us. It will not happen – they are people too – and they do have a conscience, a love for their children and a desire to move ahead. What we have to do is facilitate their dreams so success can come and by example the children will at last see a reason to want to go to school.
Darwin

Australia

29th May 2008

Please – look beyond doctors and nurses

2008-04-30T07:59:00.004+09:30

Please – look beyond doctors and nurses

The headline of the story in The Age on 20th March 2008 said “Sharing a load to close the health gap”. The opening par read “… Prime Minister Kevin Rudd and Opposition Leader Brendan Nelson signed the Close the Gap Statement of Intent along with a coalition of health leaders. The statement committed Australian governments to close the indigenous health gap by 2030.”

But please, will someone tell the policy makers, speech writers and “health leaders” that improving the health of Aboriginal people goes a lot further than doctors and nurses, signed statements and extra funding to Aboriginal health services.

The real risk factors that are keeping the life expectancy down to a 20 year plus difference to mainstream Australia lie in the fundamental provision of adequate housing, good personal hygiene, better domestic hygiene, improved diet, exercise and above all improved education.

It is all very well to improve infant mortality and have more children living to age five but of little sustainable help if by that age they have had a scabies infection that settles in the kidney or heart muscle to go on to cause end stage renal failure or rheumatic heart disease. This is the reality of Aboriginal disadvantage. Bigger and better housing will result in a clean living environment devoid of mangy dogs, mattresses on the floor, malfunctioning toilets and with food security.

It matters not how good the primary health care service is in a community if these external environmental factors are left unattended. It is the opinion of this writer that unless the environmental factors are fixed the downward spiral in Aboriginal health will continue.

Education of children (and adults) has got to improve to a point where this marginalised population in Australia can understand the consequences of their actions and are able to take an informed view of their living environment.

When bad health is normal it is hard for anyone to understand what good health means. It will take a generation to make a difference and that is assuming the education of children takes on a new meaning. When the majority of primary school age children fail to attend school it is hard to see this happening.

The health policy planners must come out of their silo and place pressure on the nearby cells of government administration to encourage them to adopt a “housing for health” policy. Social marketing strategies need to be boosted and programs such as the WHO “hand washing” campaign given a lot more exposure. It is futile to expect a change in behavior when the advertising industry is so heavily sponsored by unhealthy choices. Any Saturday afternoon during the football season the household is bombarded with ads for fast foods at a time when most are watching their favorite team.

Unless there is a concerted effort towards the environmental factors causing long term ill health no agreement towards the year 2030 will work.

It’s more than doctors and nurses and new health clinic buildings. More and better housing to suit the lifestyle of the people is the biggest factor that needs fixing along with better education.

Ends

The Federal intervention into remote Aboriginal communities - Learning from children

2008-03-06T05:37:00.014+09:30

A child’s education depends on the motivation of a parent to assist
them in going to school, help with reading and teaching basic discipline
and values in the culture in which they live.
By the same token a child can influence an adult to live a healthy and happy life with joy shared by each party as the years go by.

In the world of remote living Aboriginal people the children are left in many instances to fend for themselves as the parents pursue a lifestyle that their culture has only just discovered. The parents are still experimenting to see if it stacks up better than the traditional life of looking for food and shelter for the present and not worrying too much about the future. The pleasure of being able to have food readily available at a store or takeaway and the ready availability of alcoholic beverages make it a tempting lifestyle to pursue.
It could be said that there is no greater gift for a child than a healthy parent who lives long enough to see their grandchildren able to carry on the culture of the clan. As some say in the NT – “I want to live long enough to
watch my grandson play football”.

In mainstream Australia the life expectancy at birth is one that Third World countries will envy while the Aboriginal person is not sure what this is all about. They never knew when a birth date was to know the meaning of life expectancy. In fact the life expectancy of the remote living Aboriginal is as low as 47 years in many communities. The average that is quoted far and wide is across the entire population that claims to be Aboriginal with the majority of these people living in urban areas. The statistic is correct. It is just that the definition of Aboriginal person casts the net over a far greater cross section of the community than those Aboriginals that are being subjected to the Federal Intervention into Aboriginal Communities in the Northern Territory. In fact only 7% of the Aboriginal population in Australia lives in remote communities in the Northern Territory.

It is necessary, when taking a holistic view of the world of the remote living Aboriginal, to acknowledge that that the children hold a very special place in the demographic. It should be obvious that with such a low age at death the average age of a population will be lowered and children under the age of say 15 years will comprise a much larger proportion of the total than where the age at death is around 77 years.
Aboriginal populations are made up largely of children and therefore attention should be focused on them if the future is to improve.
The influence children can have over their parents in this scenario should not be underestimated. Just like any other culture the child is special as shown through the title of the report - “Little children are sacred”.

It is fair to suggest that if a child learns about healthy lifestyle choices there is every chance this will be passed on to the parent and other family members.

It should also assist the young child understand what choices in education, food, exercise, sleep, happiness and good companionship can have on good health.

Unfortunately the parents of the young children in communities in 2008 have lived their entire life in a community with health status on the decline.

To the parent it is normal for a friend to die at 40 years of age; for a grandparent to have to go on renal dialysis; for a younger brother or sister to have to go to Adelaide for a heart operation; and, for a lot of people to have to go to an alcohol and drug rehabilitation program to withdraw from an addiction.
To the parent born in the last 40 years this is normal and never having experienced good health – bad health becomes normal.
The Federal Intervention is about stabilizing communities (Phase One) and then “normalizing” those (Phase Two) – but what is normal?

The Balanda (white person) view of a normal community is not necessarily the way the Aboriginal person living in 75 locations across the Northern Territory and which are subject to the Federal Intervention wants to live.

The change planning process must come from a close evaluation of the needs as seen by the Aboriginal people themselves – and not just because some Balanda thinks it should happen or try and become a “normal” community like the suburbs of a city. This should go without saying but is being said because it is one principle that the government policy planners have failed to do over the past 40 years.

2008 is the opportunity for the Australian Government to acknowledge that this is the year to start planning with the Aboriginal people a community that meets their values and culture and thus has a distinct “look” of its own. The time has come to stop trying to put these people into little boxes in the same way as Balanda like to live. The often claimed fact that houses are overcrowded implies that the Aboriginal people are at fault because they have too many people in the one house. The real fact is that this is how they want to live as a family unit and the roof was simply not big enough in the first place.

There needs to be model programs established that test a whole host of concepts and beliefs that bring together the wisdom of the Balanda and the vision of the Aboriginal older person who can see the way the decline is affecting their culture.

To take pharmacy as an example and the role pharmacists can play in both public health and primary health care it is possible to build a curriculum that if conveyed to children could have a significant impact on the health of the adult population. It could impact on those suffering from chronic diseases and the ongoing burden of illness due to the environment in which the people are living.

In taking the example of pharmaceutical care it should be possible for children to learn some of the following principles that are inherent in achieving adherence through pharmaceutical management:

1. Understand the condition and what put it there in the first place before starting to look at management through pharmaceutical care. This involves explaining to children through interactive media the common chronic disease states in the community.

2. The use of medicines in managing chronic diseases and the fact that medicines are for sick people and if well people take drugs they might get sick.
This poster (left) was drawn by Linda Joshua from Numbulwar during a pharmacy training session for Aboriginal Health Workers at Bachelor Institute. Input to programs by Aboriginal people is essential to success.

3. The importance of adherence – sticking to the doctors recommendations for dosing and when to take them. This would also cover the use of Dose Administration Aids and that Websterpaks (or similar) are the lifeline to a healthy life and should not be tampered with by anyone but the person for whom they have been prescribed.
4. The dangers of chemical substances when not used correctly or stored properly.”If its poison you can’t kiss it better” should be the slogan (or similar) to bring the message of safety home to young children.
5. Substance abuse and the problems inherent in drug and alcohol abuse by learning about the effect that these substances, along with cigarettes, have on the health of the individual.

6. Misuse of medicines and the way over use of some medicines can cause serious problems. Emphasis can be given to the need to follow the directions on a pack or label. Paracetamol is the most used drug in communities and overuse of it combined with other liver damaging choices can create an insidious illness of hepatic failure that could easily be put down to simply “not feeling well”.
7. Public health programs through education on subjects such as smoking, nutrition, breast feeding, immunization, sexually transmitted diseases and healthy skin are all ones which a pharmacist can contribute to because of their understanding of the treatment processes.

It is to be hoped that in Stage Two of the Federal Intervention there will be the opportunity for pharmacists to be involved. The record of the health authorities at both State/Territory level and nationally is not great in giving pharmacy a status of much more than a supply agent. The value pharmacists can add to primary and public health education can be finally tested on an exercise such as the NT Intervention into Aboriginal communities.

Ends

It’s a new world with new diseases – don’t expect me to understand

2008-01-27T08:36:00.000+09:30

A novel way is needed of remembering to take medicines - seriously
It is less than 50 years since many remote living Aboriginal people were living in a traditional way; obtaining their food largely from hunting and supplementing this with the basics of western diet such as flour for making dampers. In 2008 the Australian health authorities are faced with an epidemic of chronic diseases brought on by too rapid a change to fast food, TV advertising of junk food and alcoholic beverages. During this period tobacco was first portrayed as an appropriate and smart thing to do. Then advertising was banned and the message has turned around.
Australian Aboriginal people have been abruptly confronted with a totally different world to the one in which they were raised. Their children, born in the last 30 years, are growing up in an environment where most of their elders suffer ill-health, with an epidemic of diseases such as diabetes, cardio-vascular diseases, renal failure, asthma and heart failure.
These are not diseases understood by the traditional belief systems of the Aboriginal people or their traditional healers. There are no traditional remedies for clearing hardened arteries, or reducing blood cholesterol. By the same token, the concept of lengthening the life span of a person already feeling bad may conflict with beliefs that welcome the chance to pass away and have their spirit return as a better being.
The task of introducing western concepts of ongoing medication a group of people who do not understand why they are feeling sick is made more difficult by virtue of the fact that the people have English as a second language. The younger generations have better English skills but do not have the disease and medication knowledge, the doctors do not have the skills in local languages. The present generations of Aboriginal Health Workers have not been trained to address medication adherence.
The successful use of medicines to manage chronic disease will only occur when the person understands their illness, their body and how it is affected by life style choices that oppose healthy living. So little has been achieved over the past 30 years that people who are growing up in 2008 will only experience a community that is in a constant state of ill health which then becomes perceived as normal. Children will expect to get overweight and diabetic.
Australian Aboriginals with chronic disease will be confronted with the medical jargon of the doctor or the need for exercise by the diabetic educator; and, if there is the opportunity in the mix of allied health professionals, the pharmacist or pharmacy assistant on the notion of taking medicines as directed, regularly, at the time specified and with or without food.
The mix is already confused with language meaning that understanding is poor and adherence minimised to a dangerous level that leads to avoidable complications and hospitalisation.
The consequent temptation to spend the available money on quick fixes is too great for the uneducated person. That means the purchase of fast food for an unbalanced diet and the hazards of alcoholic beverages and other drugs (especially marijuana) to take the stress out of an otherwise boredom riddled day.
Strategies to address medication use in Aboriginal people, especially those from remote areas, must be founded upon their view of the world.
Ends

Pharmacy has a long way to go -more money given for supply and still no cognitive services

2007-12-25T12:41:00.000+09:30

Pharmacy has a long way to go before it can be seen as playing a role in arresting the continuing downward spiral in Aboriginal health. In the area of kidney disease in the Northern Territory there is an increasing rate of admission of Aboriginal people to end stage renal failure through dialysis. This is the direct result of the health systems failure to manage these people in the early stages of kidney disease associated with diabetes and cardiovascular disease. Part of the reason is cost and not enough money in the Australian Health Care Agreement for the Territory Government health department to allocate sufficient resources to preventative measure that will arrest the slide to end stage failure. The cry is that there is not the money to employ pharmacists.

It is worth looking for a moment at exactly what is being said here. It is as if the sole responsibility for Aboriginal health rests with a Territory Government health department. This should not be the case for with respect to pharmacy the subject is fairly and squarely on the Pharmaceutical Benefits Scheme. The pharmacy lobby has been careful to ensure that the business of the PBS goes through its retail pharmacy outlets. There have been no supplies through the NT Hospital System since this was moved to the private sector after the introduction of the s100 arrangements.

So why should the same health department that was left out of this loop be put to blame for not providing pharmacists to go out and promote adherence for diabetic and cardiovascular sufferers in the remote areas now being supplied their PBS through a retail pharmacy. Every other Australian citizen has access to a pharmacist paid for by the PBS to give advice and put in place programs that will assist with information and dose administration aids for their chronic disease.

Not the remote living Aboriginal. He/she has to suffer a PBS where the remuneration is $4.30 short of the mainstream fee paid to Approved Pharmacies and then see that same pharmacy get an extra payment based on sales volume rather than quality achieved.

The announcement by the Pharmacy Guild that there will be a reward to retail pharmacies based on the volume of stock it sends out to remote health clinics under the s100 arrangements is hard to believe.
See at http://www.guild.org.au/content.asp?id=1562

Fourth Agreement money being used to supplement the income of already satisfied pharmacy contractors with no apparent accountability back for improved quality use of medicine!

“Payments for pharmacists with existing supply arrangements to AHS have been increased based on volume of PBS medicines supplied to the AHS per year,”

Really and truly what sort of a message is this sending to the policy makers at Government level? The more you send out the more you will get paid. This is calling on all to let the medicines go out of date so the pharmacy can replace them and make more money. The media release accompanying the announcement does say… “…These increases will be accompanied by improved accountability arrangements.” One would hope so but the Information Kit relating to this still carries the dateline of 2001!

Surely the remuneration structure should in some way be geared towards improved quality in the way medicine is used rather than using Fourth Agreement money to reward for higher sales achievement. The question must be asked where the Pharmaceutical Society Australia is in all of this or does the body representing the professional aspects of pharmacy practice not get a look in when it comes to PBS remuneration.

The fact that there is $27 million in the Fourth Agreement budget for Aboriginal health projects should not be a reason for approaching the priorities of need from the wrong end of the spectrum. The Aboriginal client should come first or is it just another case of pharmacist’s wealth before Aboriginal health?

This area of medical need (Aboriginal health) that is requiring so much is being treated as a second class audience when it comes to pharmacy services dominated by the vested interests of the retail industry leaders. The Aboriginal community controlled health sector through its peak body (NACCHO) sees the Pharmacy Guild as the experts in a complicated and hard to understand sector of primary health care (pharmacy). No doubt the longer interest groups like NACCHO can be kept in a state of confusion the better for retail pharmacy. There is little apparent balance in thinking provided by the pharmacists in the field working on quality programs who expect to be represented by their professional organisation - PSA.

A recent visit to a remote community in the NT by this author revealed a situation where the visiting pharmacist spent the time checking for out of date product and assisting with the ordering while medication reviews, education and information programs for clients and clinicians had to take a back seat. And at the same health service dosette boxes were still being used because the clinic budget could not afford the cost of Websterpaks. It is a pity some Fourth Agreement money could not be used specifically for this. It would certainly be more towards the quality use of medicine goals.

But it is not just in remote Aboriginal health that the health system is being let down by “pharmacy” - it is also in urban areas. In urban Aboriginal health services the cry has been to “…give us Section 100”. Why? Because they have been told it gets the PBS product for nothing. As for what happens then? - it has never been near enough to ask but obviously it would need a pharmacist on the premises to dispense the prescriptions that are written in accordance with State/Territory law. No support from the retail pharmacy lobby is probably the reason why this has never got off the ground and yet all that is needed is a Ministerial regulation saying that the same claiming procedure can be used by an AHS as is used for the remote PBS business – and by an approved pharmacy operating from within the precinct of the AHS. As pharmacies have to be owned by pharmacists (everywhere except the NT) the pharmacy could also be a Guild Member.

The improvement this would create is huge with a pharmacist on site, product sourced from wholesalers and the PBS used to claim the cost. The AHS would need to meet the cost of the pharmacist and this could be included in the business model where a retail pharmacy worked in collaboration with the AHS to provide the business expertise, management and professional oversight.

Sounds easy and should be - apart from the barriers that will be put forward to protect the status quo in retail pharmacy land.

Maybe the new Federal Government Department for Finance and Deregulation will have something to say about competition policy now that Labor is back in power and it will be able to pick up the pieces that were left on the “cutting room floor” after the National Competition Policy reviews around the turn of the millennium. It was after all Labor under Hawke and Keating that started off that whole process of deregulation. Watch out pharmacy – you are still on that cutting room floor after the deals done behind the scenes with the NCP review of pharmacy regulation.

Ends

Equal opportunity needed in medicine supply

2007-10-12T05:14:00.000+09:30

A discriminatory approach is being taken by government policy on the supply of Pharmaceutical Benefit Scheme (PBS) items for remote living Aboriginal people. For the past eight years the supply of PBS items to this marginalised population group has been made by "community" (retail) pharmacies for $1.14 an item. The fee paid to dispense PBS to other Australians is $5.44. The question has to be answered as to where is the $4.30 difference and when will that be made available to remedy the serious situation that exists with the spend on PBS for Aboriginal people being one third that of non-Indigenous Australians.

The advisers to the Federal Government on pharmacy policy, the Pharmacy Guild and NACCHO, must take their minds away from making more money for pharmacists and focus on the individual client to determine the best approach. Information is needed for the client regarding their prescribed medicines for without it a pack of medicine tablets may as well be just any old chemical. Without information medicine is useless.

While the explanation is simple – there is no recording process or counseling opportunity – the question remains as to why remote living Aboriginal people should be subjected to a second rate PBS system. Surely they are as entitled to at least a pharmacy service that suits the needs of the health centres where they have primary health care delivered.
It is the view of this column that the $4.30 shortfall should be made available as a block grant to the Aboriginal Community Controlled Health Organisations at a State/Territory level to distribute in a way the allows the larger health services to employ their own pharmacists to apply quality use of medicine programs across the client population.

The amount of money would be determined by the number of PBS items supplied in the 2006-07 year multiplied by $4.30. It is estimated this would provide a fund of around $1.5 million for the NT alone. Pharmacists could be responsible for programs delivered on a regional basis – the way health services are being developed in the NT for remote areas.
If official pharmacy through the Pharmacy Guild, PSA and SHPA want to do something to assist with the intervention in the NT then this amount would be a small contribution from the 4th Community Pharmacy Agreement coffers.
There is nothing more important for a child that to have both parents live longer – and at the moment there are too many children deprived of parental support by the early age of death.

Change infrastructure for sustainable development

2007-06-27T12:19:00.001+09:30

A single authority reporting directly to Federal Parliament should take the place of Commonwealth and Territory Government Departments of Health, Housing and Education to make more money available and be more responsive to community needs

While the police, army, doctors and nurses are rushing around the NT “restoring law and order” it is to be hoped that Dr Peter Shergold and his senior bureaucrats back in Canberra are looking at how they too are part of the problem.
The Australian 2 October 2006If there was ever remote and isolated communities choked with bureaucratic strangulation it is those in the NT that are now the target of help for child abuse.
The problem may not have been nearly as bad if the local government governing councils had more time to consider their community’s future and less about running the red tape gauntlet with Canberra.
Where else in the world would a community of 500 people, governed by an elected body of eight persons and with a support staff of around 12 people but – wait for it – receive its money from 68 different sources of funds from both the Commonwealth and Territory Government level? (Source: Nauiyu Nambiyu CGC – Daly River NT)
The cost of maintaining Aboriginal communities is high and always will be high due to their isolation. But it is how the money is spent that has to be looked at and changes made to the infrastructure that gets the money to the people.
Governments over the years can be blamed for not taking action and whatever is done in 2007 will be wasted unless there is a change to the governance structure.
It is time for a single “authority” to be established to administer monies going into communities and provide it directly to those communities with their core municipal services coordinated regionally. The job of a council at the local level should be to concentrate on improved community facilities and establishing a quality control process so that Council’s future funding is geared to success in improving the quality of life for the population.
There should be no reason why isolated communities should not all have a properly equipped learning and recreational centre for young people. An audit done now would probably show that 90% lack this resource. An email should be able to be sent and internet banking transacted but no – these are Aboriginal communities and they can wait. This institutionalized racism has got to stop and everyone treated equally no matter where they live or the colour of their skin.
The NT Government has showed itself to be inept when administering housing, health and education with the standards in these functional areas being amongst the worst in the developed world. The duplication of effort between the Territory and Commonwealth is ludicrous and an agency in Darwin funded directly by the Federal Parliament to conduct all outgoing expenses would be a far more efficient way of conducting remote Aboriginal business.
The notion that “mainstreaming” programs is best has proved to be a fallacy as the cultures that are the targets are so distinctively different.
In 2007 there is a situation where it is being quoted that half the money through the Commonwealth Department of Family, Community Services and Indigenous Affairs goes back into consolidated revenue as overhead expenses; one third of the education dollars hit the ground at a remote community; and, a health service gets its money from 27 different programs.
This has got to stop so local governing councils can concentrate on the things that matter – the people they represent. If the Prime Minister can shock people with strong arm tactics to restore law and order surely he can take an equally sharp axe to the red tape that surrounds the same communities.
Ends

Literacy is the key to the future

2007-06-25T08:29:00.000+09:30

A life with literacy is a life of dreams, hopes, choices and opportunities - at least in the developed world. For those in disadvantaged situations either in Third World countries or urban ghettos of otherwise rich countries no literacy means a life of boredom. The life of thousands of Aboriginal people is one doomed to a path of despair as they struggle to come to terms with the new way of living in the developed world after thousands of years of a nomadic existence. This in turn leads to substance abuse, limited food choices and a constant state of poverty.

The 1967 Referendum gave full citizenship rights to Australia’s first people. This then lead to welfare benefits for the unemployed in 1976 with the subsequent access to the broader markets through colour television and the powerful advertising of beer, aerated soft drinks and fast food. The party had started but the hangover is getting bigger and we have all been bombarded with rhetoric about why the failures continue to occur and get worse – in the case of end stage renal failure there are more Aboriginal people needing renal dialysis every year.
Imagine how your life would have been if you had never learnt to read. It would be frustrating seeing all the wonderful things out there through the medium of television, cinemas or billboards but never able to access any of them because of the inability to get a job, always sick and time to burn driving you to concentrate only on the people around you and the relationships that are going on. Drinking, taking drugs or gambling on card games are as attractive as watching X-rated videos or looking at the pictures in a porn magazine. A breeding ground is developed for unhealthy living through poor personal and domestic hygiene, inadequate foodstuffs as well as social unrest through disharmony, anti-social behaviour and risk taking outside the law.

The solution to this disadvantage – literacy.
Yes just the simple task of reading and talking English will give a new generation of people who are able to enjoy life’s pleasures. It will mean people with self esteem and pride in their own ability to move on and take up study, university and employment opportunities along with everybody else. No longer will there be a marginalised group who are regarded as being lazy, bored, dumb and a burden on the rest of the population.
Fix literacy and you improve health, understand hygiene and housing, give transport options and have access to employment to fill the idle hours of the day.

For more on filling the idle hours go to
http://www.onlineopinion.com.au/print.asp?article=5361

Violence and indicator of despair

2006-12-17T12:01:00.000+09:30

This story has now been published in On Line Opinion.
Follow this link to add a comment on the content.
http://www.onlineopinion.com.au/print.asp?article=5361

VIOLENCE AN INDICATOR OF DESPAIR

Family violence is an indicator of an underlying problem of disharmony in remote Aboriginal communities. It is a big adjustment for people who led a nomadic existence (in some cases only 50 years ago) and are now expected to live in harmony in a community urban-like setting.

Older people in the community are unable to counsel the young on how to deal with this new world because they themselves have not lived through it. The world the 50-60 year old person was brought up in was totally different to the one today that the 15-30 year olds are facing. Alcohol was not available then and ganja (marijuana) was a far cry away.

When these two dangerous chemicals are added to a community smoldering with unrest from confused relationships an explosion occurs. On top of the drunk and stoned people warring with each other come the tribal differences between groups (clans or tribes). These groups were not living together in their traditional way but are now being expected to live happily in a community that was never part of their world view. Back in the “old days” they would walk away from each other and avoid contact.

Community or urban living carries with it a new set of values, laws and customs that have to be developed. The western world is moulded on the experience of thousands of years with the learning of the growing child framed by its parents. Customs and practices are passed on from generation to generation. This is taken for granted by the dominant culture while it assumes everyone must do the same (as it). Simple things like personal hygiene, eating behaviour, dress sense and the value of property are all factors which white man learnt from his parents. The Aboriginal child has no such help from parents or grandparents who may not have had a house, no knives and forks or toilet and certainly not the range of choices in what to wear for clothes. Personal property was kept to a minimum.

In 1976 the government decided to give Aboriginal people money to sit down and not work that provided the resource to buy utility and luxury goods never before made possible on a notional wage supplemented with the benefits to live such as shelter, food and clothing. Colour television opened a whole new world, artificial as it might have been, and new money gave the opportunity to move ahead and meet the challenges of a world not before explored by this race of people.

Up until the “sit down” money came in Aboriginal people were remunerated in cash or kind from the people who employed them. Missions, schools, local councils and other services provided a remuneration package that seemed to suit the needs of the people. There was full employment and 95% of the jobs in communities were done by local people. Today the reverse applies and the white workforce in communities has expanded to take over the jobs previously done by local people.
The future does not augur well for the baby born tomorrow. Governments have to acknowledge that they have disempowered these people by taking away their traditional culture and replaced it with a way of life but no awareness of how to manage it. It will take generations to achieve full harmony through a staged approach treating each generation as another step forward.
The past has not worked and must be replaced with new policies and actions framed from a view of the world as seen through the eyes of the Aboriginal people and not the world that the dominant culture wants them to have.

In 1979 the noted entrepreneur and advertising guru John Singleton, after a tour of Northern Australia wrote:
“…every time I look at one of those bearded university-trained southern do-gooders, I wonder if they will ever realise that they can never solve the Aboriginal problem because they are the problem”. (The Bulletin 9th October 1979) It now appears these words are as applicable in 2006 as they were then.

When will the government acknowledge where past policies have gone wrong and decide to start afresh taking the Aboriginal people with them in their planning for the future? There are too many talk fests, conferences, workshops and the like with the agenda being to discuss the “Aboriginal problem” and yet with few Aboriginal people present. We must work with them, trust and respect them.

Before any real advances can be made to alleviating the extent of family violence including sexual abuse the following issues need to be addressed:
Education has to be restored with full attendance sought from children who are helped to understand the future and start living it. A child needs to have a purpose for going to school otherwise the adverse role model of older people will be hard to resist.
Health has to be firmly linked to combating the social determinants with all parties to health policy planning making a commitment to this as a part of their own culture of change.
Housing must reflect the way people want to live and put an end to the “over crowding” syndrome which simply means the house was not big enough from the outset.
Transport from remote communities must be subsidized to make it more affordable for Aboriginal people to visit the “new world”.
Urbanization has to be explained so people whose ancestors lived a nomadic existence will understand the new rules, laws and customs that have to be adopted when living in a closed community setting.
Governance must be properly structured so each participant can utilise their own ability and interest and not forced into a management structure they have no understand of or a desire to learn.
Crime and imprisonment must be seen for what it should be and not a place for a relaxed and well fed holiday. Prisoners need rehabilitation and concentrated learning while in “Her Majesty’s custody” so that when released they come out as role models rather than looking for a way back inside.

It (the dominant culture) has taken away the old world and now has a responsibility to the people themselves to help them frame a new world which they help to design and not what the government wants for them. It is only when this new approach to improving life choices that family violence will be overcome.

Personal conflict stems from an overdose of “MDD” – Motivational Deficit Disorder – and can only be remedied by smart thinking and strategic planning towards a future where the rebuilding of social capital is seen as the way ahead and in itself create employment opportunities and a move to self esteem and pride in ones own community and lifestyle.

Much of the trouble is caused by people having too much time to think about nothing but themselves as they wile away the idle hours of the day. Jealousy, money arguments, gambling, use of drugs and alcohol all consume the scarce resources and leave little energy for improving the way people live. The lack of an ability to read and use numbers immediately shuts a person out of a host of activities and turns them in the direction of personally appealing magazines and X-rated videos that put sex on the top of the list of exciting things to do. For the younger testosterone laden youths it is fighting and mimicking a violent culture portrayed in so many modern day videos and DVDs.

In the words of Gabriel Mistral, the Nobel Prize winning Chilean poet
“Many things we need can wait, the child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being developed. To him we cannot say tomorrow, his name is today.”

To the Aboriginal persons of Australia and especially those living in remote communities in the North we must treat the situation with the urgency of a natural disaster, tsunami or disease pandemic. To them the future starts tomorrow – not at some distant time that suits the power players of today.

Ends

Economic Development does not mean better social conditions

2006-10-13T08:49:00.000+09:30

GET THE BALANCE RIGHT
Social development as part of economic development
By Rollo Manning

Tiwi suicide exposed - "Land of the dead" - UK Guardian newspaper
Having the highest suicide rate "in the world" came as a surprise and shock to close observers of the plight of the Tiwi people.

This small community of 2,500 people on the two islands, Melville and Bathurst Islands, had already won the award for the highest rate of kidney disease in Australia (Professor Wendy Hoy The Health Report: 2 June 1997 - Kidney Disease in Aboriginal Communities).

Bathurst/Melville Islands were rated the most disadvantaged in Australia by a report in The Weekend Australian on 22 April 2006.

While these statements, statistics and reports do nothing for the morale of the Tiwi people their plight is a sad reflection of many remote Aboriginal communities across the North of Australia. These normally happy, friendly and fun loving people, who produce brilliant Australian Rules footballers, welcome tourists to their islands with great pride. Politicians use the islands for getting a picture opportunity and grabbing a headline for what is another government program claimed to be going to change the way they live.

Nothing has worked. It is getting worse.
The sooner government policy makers can come to terms with the fact that the problems start at the ground level and cannot be solved by pouring in money through government sponsored programs the better everyone will be.

The way to fix the disastrous situation is through social development - the rebuilding of the social capital that has been desecrated over the past 30 years by previous policy approaches that have failed to take account of the views of the people themselves.

In 1979 when noted publicist/entrepreneur John Singleton travelled the north of Australia he observed “…the do-gooders insist the Aboriginal people live exactly like us whites. It is obviously ludicrous.” And further “…every time I look at one of those bearded university-trained southern do-gooders, I wonder if they will ever realise that they can never solve the Aboriginal problem because they are the problem”. (The Bulletin 9th October 1979)
The question that has to be asked is why an Aboriginal community of people with one of the best developed economic resources through forestry, fish breeding, tourism, art and mineral mining should still be so socially disadvantaged.
Could it be that the money accruing to the Tiwi Islanders is not getting down to the real causes of social malaise?
Maybe it is time for the government to do something useful and look into why the social problems are getting worse in the face of more money coming in through private enterprise economic development.
Could it be that the people who govern the enterprises are profiting to an extent that needs changing for the sake of the majority. This was pointed to in a paper by former Tiwi Island Local Government CEO John Cleary in a paper done for the Centre for Independent Studies in April 2005. A full copy of this CIS Issues Analysis can be read at http://www.cis.org.au/IssueAnalysis/ia55/IA55.pdf It is an example that must be explored for the common belief is that improve the economy and lifestyle will improve. This is not the case with the Tiwi.
The motto should be:
"Gain economic strength through social development - build social capital and build a healthy community."

20th July 2006

Where is the money going on Tiwi Islands?

2006-08-12T16:38:00.000+09:30

Tiwi development begs the question-"where is the money going?"

LETTER TO EDITOR – NT NEWS

Dear Editor

Your feature on the Tiwi Islands “Reaching for the sky” (31 July 2006) needs a follow-up on why it is that such successful economic development can be taking place while there are such poor social circumstances in the same communities. The UK Guardian newspaper (24th June 2006) rated the Tiwi Islands the worst in the world for suicides; renal disease is rated the worst in the world (Professor Wendy Hoy – ABC Radio National 7th November 2005); and The Weekend Australian newspaper (22nd April 2006) rated the Tiwi Islands the worst in Australia for welfare dependency.
The question must be asked why this is so especially at a time when Governments are relying on economic development as the grand saviour of social depravity in remote Aboriginal communities.
Where is the money going from these successful commercial ventures?
How it is that a community with sound industrial developments (forest, fish breeding, tourism and art) can still have such poor social capital?
This is a question that must be answered before any more praises are leveled on the Tiwi Islands - still living in day to day circumstances that would never be tolerated in a white urban community.

Rollo Manning
PO Box 98
Parap NT 0804

Phone: 8942 2101 or 0411 049 872

Minister Vanstone taken to task

2005-12-29T19:23:00.000+09:30

In an address given at the Australian National University 7th December 2005 the Minister for Indigenous Affairs, Senator Amanda Vanstone, declared (inter alia) that remote communities with a small population would not be viable in the future. Some points made by the Minister were acceptable but others had to be rejected as insulting to Aboriginal people.
I wrote the following letter to the Minister following the release of the text of her address and subsequent media coverage:

Senator Amanda Vanstone
Minister for Indigenous Affairs
Parliament House
Canberra ACT 2600
12th December 2005
Dear Minister

Re: Aboriginal Affairs and your address “Beyond Conspicuous Compassion”

I want to bring to your attention some thoughts I have had since reading your address delivered at the ANU on 7th December 2005.

Firstly, I commend you on bringing forward the following points in your address:
That life for too many First Australians continues to be unhealthy, unhappy, violent and short.
Indigenous people have to accept responsibility and play their part (in opportunity to change).
We must back Indigenous Australians in their aspirations and in building their future.
Greater transparency in how money is spent by State/Territory Governments from GST revenue which is meant to be providing improved outcomes but may not be reaching where the people live. You say that you want to ensure this money is not being spent to bloat bureaucracies, both government and non-government, or being used for other things.
The fact that many Aboriginal people live in a feudal system at the pleasure of traditional owners who are but a subset of the people who live on Aboriginal land
The extraordinary opportunity for change and the need to grasp this and have a robust debate on the merits of different approaches. I would like to be a contributor to the debate.

Secondly, I must challenge you on some aspects of your address which I believe are “off the mark”. These are:
The notion of a “cultural museum” – as stated by Marion Scrymgour MLA for Arafura this is “insulting and ignorant[1]”. I am not sure of Marion’s reasons but for me a museum is a place where things, people and animals are put to be recorded for history and usually after they are extinct or dead. Our Aboriginal Australians are a living culture and an ancient one but certainly not “museum” status. They are very much alive as you well know and deserve greater respect.
The notion of “viable” communities – I presume you mean financially viable. The maintenance of a unique lifestyle for Aboriginal people in their own communities should not be expected to be financially self supporting. In a time span of 40,000 years before being exposed to the “developed world” the short term is certainly a lot longer than 30 years since “sit down money” was given to them; 38 years since full citizenship rights; 217 years since colonisation; and, in fact it could be 1,000 years in the short term. The government through the Australian people must understand that this ancient culture (which did not know the meaning of work, money, possessions, housing, education or the perils of the developed world) will take a long time to adjust to a strategic plan for change or maintenance of their “status quo”. It is going to cost money – lots of money – and society as a whole must acknowledge this and assist the process.

The notion of treating Indigenous Australians like every other citizen – they are not and never will be “like every other citizen”. You must acknowledge, as stated above, it will take many many years for remote living Aboriginals to become accustomed to the mainstream way of living – if in fact they want to “normalise” into our culture. The “assimilation” policy of the 1960s failed them and the “reconciliation” policy is not doing much better. In 1979 when noted publicist/entrepreneur John Singleton travelled the north of Australia he observed[2] “…the do-gooders insist the Aboriginal people live exactly like us whites. It is obviously ludicrous.” And further “…every time I look at one of those bearded university-trained southern do-gooders, I wonder if they will ever realise that they can never solve the Aboriginal problem because they are the problem”. Little has changed and 26 years have passed. The remote Aboriginal Australians are too used to expecting governments to fix it and sadly this has failed them. It is time for government to realise that only the Aboriginal people can decide how they want to live – we cannot do that for them.

Thirdly – what would I like to see happen?
Robust debate involving people who have spent time working and living with remote Aboriginal people and have experienced at first hand the conditions and developed an understanding of their needs from their viewpoint. I would rate highly in such a group John Cleary[3] from his position as CEO of the Tiwi Islands Local Government for three years and his wife Veronica[4] who recently wrote an expose on the educational needs of remote Aboriginal children. Too often the audience for discussion on Aboriginal issues is taken up with public servants who do nothing but fly in and fly out of communities. There is a large number of persons who could participate and give an opinion from first hand experience. Another such person is Mary Ellen Jordan[5], whose book “Balanda” is a fine description of the current situation in Maningrida.
Scrutiny of money spending – not just GST revenue to State/Territory Governments but also the land councils who receive large sums from a number of sources and yet seem to have no accountability back to the people of the spending from Trusts and private companies established under their aegis. You rightfully point to the fact that “traditional owners are but a subset of people who live on Aboriginal lands” and unfortunately these are the people benefiting from money that should be the property of the whole population.
Social capital building should be a priority using funds that belong to the community and dispersed based on priorities based on the community’s own assessment of their social needs and education of children. The money could be paid from Centrelink benefits or land council royalty payments or money gained from commercial trading – such as the revenue of the Tiwi Land Council from the sale of the Sylvatech forests to Great Southern Plantation. There would be the need for a proper financial management agency managing the funds but the direction of spend would be for the people to decide. I refer you here to the Australian Assistance Plan 1972-75 of the Social Welfare Commission that was a model based on regional social development and would be as applicable today to remote Aboriginal living as it was then.

I look forward to your consideration of these matters and would welcome the opportunity of discussing them with you sometime when you are in Darwin or I am in Canberra.

Yours sincerely
ROLLO MANNING
Principal
[1] Vanstone comments branded insulting. Northern Territory News, 10-12-2005, Ed: 1 -, Pg: 002

[2] Stone, Gerald. Singo: A biography of John Singleton. p120. Harper Collins 2002
[3] CIS issue analysis No. 55: Lessons from the Tiwi Islands: The need for radical improvement in remote Aboriginal communities John Cleary
[4] CIS Issue Analysis No. 65 Education and Learning in an Aboriginal Community Veronica Cleary
[5] Jordan, Mary Ellen. “Balanda – my year in Arnhem Land”. Allen & Unwin. 2005

Bio - Rollo Manning

2005-07-03T09:25:00.000+09:30

Rollo Manning has had over 50 years of life time experiences through work, education, relaxation and travel that have allowed him to develop some well rounded views on a variety of subjects in current affairs. From sport and sex to Aboriginal life in Australia and health promoting practices, he has lived a life of memorable experiences.
As a writer Rollo has carved out a niche commenting on rugby football and occasionally steering to other sports. A book is well under way describing the players who submitted to the opportunity to move from the amateur rugby to the professional rugby league after the second world’s war.
Rollo is a regular contributor to http://www.e-sportsmediagroup.com/
The practice of pharmacy has been his main money earner and this too has come under some scrutiny through his articles in the e-zine Pharmacy i2P at http://www.i2p.com.au/.
In more recent years his interest in Aboriginal health in the Northern Territory of Australia has inspired him to try harder to make an equal opportunity for the two cultures. His writing in this area is posted in his own “blog” that can be accessed from the site http://www.rollomanning.com/.

Money is a tool for problems when not explained

2005-05-21T08:54:00.000+09:30

The use of money as a form of exchange for the receipt of goods and services is a relatively new tool for remote living Aboriginals. Until "work for the dole" or "sit down" money was given to them in 1976 many had never used money.
Immediately they were introduced to this white man tool to get things. Thet were told that with money - dollars and cents - they could purchase whatever they wanted and have enough left over for food, clothing and other essentials of life.
The trouble was their life did not have anything that required money. Their clothes were limited in range - usually enough to fit into a shopping plastic bag - their food was gained from the bush - and their housing was under a tree protected by a roof of bark.
Yes this was their way of living 50 years ago. Sanitation was achieved by going to the beach at low tide and bathing and washing was in the sea or at the clear and clean fresh water streams that abound their islands.
The degree to which money has changed their lives cannot be underestimated. It has produced a vehicle for creating conflict in families who together with the access to grog (1967) had a new thing to argue about. Domestic and family violence has been fuelled by arguments over how money is spent and sadly, it has been the direct cause of suicides among young people who have not been able to get the money they need for another hit of Gunja (Marihuana).
Just how we (white people) now go back and educate these people on the use of money is not and easy task and the author will be pleased to share any ideas with readers.
A Commonwealth Government sponsored Consumer and Financial Literacy Taskforce looked at the effectiveness of current educational processes and information programs to help consumers understand money. This seemed the opportunity to have the plight of remote Aboriginals put on the agenda and by making a submission to the task force the author hoped this may happen.
The following is the submission made to the Taskforce:

Paul Clitheroe
Chairman
CFL Taskforce,
SCGSDDepartment of the Treasury
Langton Crescent
PARKES ACT 2600
16th August 2004

Dear Mr Clitheroe

Submission to Australian Consumers and Money Task Force

I am pleased to submit to you the attached for consideration by your task force.

The fact I am pointing to the needs of remote living Aboriginal Australians I hope will make you want to focus your attention to this group of people, who although not large in numbers (circa 100,000 in total) are of significant value to all Australians for their cultural heritage. This culture is being diminished in stature every day as a result of their failure to live in “two worlds” which in the main is due to the dominant culture’s inability to assist them in a proper fashion.

I hope that after reading my submission you will agree that an understanding of money is essential to the ongoing ability of Aboriginal people to manage a life in “our world” and deserves special attention through agencies such as the Traditional Credit Union in Darwin. I am sending a copy of this to the TCU and will be pleased to work with them in mounting a wider consultation on this issue.

Please advise if your Task Force is visiting Darwin and I will make sure I am available to meet with you.

Yours sincerely

ROLLO MANNING

SUBMISSION
To
Consumer and Financial Literacy Taskforce

This submission will focus on the section of the Australian population that live in remote communities in the Top End of the Northern Territory. In particular it draws attention to the needs covered by the following “Terms of Reference”.
The current availability and adequacy of financial education and information in schools;
The availability of financial information in the broader community, especially the capacity of Australians to understand and manage credit risk.
Without attention to these there is little point in assessing an understanding of other products such as superannuation, retirement benefits, tax planning, and credit management.
Summary of importance
One of the eleven accepted “determinants of ill health” is poverty.
Poverty is brought about by an inadequate way of managing the personal needs of a developed society.
Aboriginal Australians living in remote communities suffer from poverty but not from an inadequate amount of money but by being inadequately equipped with the knowledge to manage money.
The result of remote Aboriginal poverty is a low life expectancy due to bad lifestyle choices exacerbated by an inability to manage money. This causes an outlook on life (as a whole) of hopelessness due to a low life expectancy.
The attitude to money is to spend it “while you have it and as quickly as you can in case you are not here tomorrow.”
Further research is needed to establish a benchmark of knowledge to measure future change and success in educational programs.
RECOMMENDATIONS
1) Improved health outcomes should be promoted as the goal of all endeavors in improving the life of remote living Aboriginal Australians. Better money management will lead to better health.
2) A properly targeted research program is needed, conducted by trained local people, to determine a benchmark of knowledge on financial management skills before formulating educational programs.
3) Taking account of the outcomes of 2), develop an educational program that will enhance the ability of people to manage money.
4) Seek the support of the corporate sector in these endeavors.
5) Highlight in all work the fact that better money management skills will improve life and therefore improve health.
BACKGROUND
The problems of a dysfunctional society in remote Aboriginal communities will only have a chance of being turned around if the Commonwealth bite the bullet and change the way welfare payments are presented to the recipients. So long as money is handed out to people who have never had to use money for exchange a dismissive attitude will continue regarding its use.
The social problems that are now endemic are created by an overuse of substances such as tobacco products, alcohol and marijuana which could not continue without the surplus of money that is available for their purchase. While ever money is being spent on these products there will be a shortage for the individuals who do not consume these aggressive building substances and the children.
Unfortunately the more substance is abused the higher the stress levels and the greater the aggravation in the household – that will probably be inhabited by twice the number of people it was built for due to the sharing and caring nature of the traditional culture. This is the saddest symptom of all rising from the welfare dependant mentality that has been fostered since 1976 when unemployment benefits became available and has since earned the nickname of “sit down” money. Family allowance payments also became available in 1976.
Before its availability the majority of work done in remote communities was done by local people. Once they were told they would be paid if they did not have work the easy option to sit down became the preferred one and for the years since 1978 more and more work has been done by “outsiders”.
When the welfare money runs out other skills are used to obtain money and it is coerced from family, friends, visitors or unsuspecting white people in return for favors that do not eventuate. The sale of illegal Gunja is used as a way of making money by Aboriginal people who are able to buy it in bulk while visiting Darwin and return to their communities unchallenged to profit from their families and friends. The money gained will be used for immediate needs such as a “power card” and basic food with the balance going on more grog and gunja.
Begging is a common occurrence from people in Darwin or to visitors to remote communities. The degree of begging varies but the disappointing element is the early uptake of knowledge by young children (10 Years of age) in begging from older white people.
The above observations are anecdotal and a more detailed study is needed as outlined in Recommendation 2 above.

Specific comments on Task Force Discussion Paper

Who is to blame?
You say
Their vulnerable position is often exacerbated by poor health, low Socio-economic circumstances, geographical isolation and limited English.
I say
Poor health, low socio-economic circumstances and geographic isolation are caused by financial illiteracy.
It is too often when bureaucrats are commenting on Indigenous affairs that they try and find someone else to blame. Health is a ready target as if it is the fault of the health system that other things happen. The sooner it is recognised by all that the health system is a structure to deal with “ill health” and the promotion of good health is the responsibility of everyone else.

2. Consumer behaviour model

It is evident that the factors working against financial literacy among Aboriginal people is recognised. The fact that it is non-existent is a reflection on the capacity of previous educational programs to deliver. The large financial institutions should consider their social responsibility to consumers in disadvantaged situations and while clients of one of the four major banks cannot access ATM facilities in remote communities it is no wonder they cannot do anything else. There is a need for a far more service orientated mentality and funds made available to make this happen.
The Traditional Credit Union from Darwin would be the ideal vehicle to develop expanded services and the availability of funds should not be a barrier. Funds should be made available and if this cannot be found from the Australian Government then maybe there is a case to be put to the World Bank to assist these under-privileged people living in Third World conditions in a prosperous First World country.

3. External influences

Programs brought on by the institutions themselves who have obtained trust among Aboriginal people and then act against them are deplorable. Incidences are many and albeit sufficient here to cite just three examples of misuse of Trust.
a. The Centrelink trust is used to grant $500 loans that are spent, sometimes on good things, but also on bad. There are no conditions attached to the loan. The fact this loan is obtained without any reference to the client history of spending is something that should not be encouraged as it becomes part of growing the welfare mentality and fails to take the opportunity for positive education.
b. Deceptive advertising is part of the problem and whilst it is recognised that advertising has to meet certain standards and ethics these are formulated with the dominant culture in mind. An example is furniture for filling a house to be rented for $1 (one) dollar a month. Whilst this refers to the first month, and it is really a strategy to gain business, the small print explaining this is sometimes missed by the poor eye sight exacerbated by an inability to afford spectacles.
c. Keycard security- the fact that a “bank keycard” contains some money sometime is enough to consider it a valuable asset. Keycards are left with stores as a means of paying for groceries sent to remote places. Whilst this is an admirable gesture on the part of the stores it is not supported by accountability mechanisms to ensure the client is not being ripped off by the store. Not to say this is happening but in an age of technology and Internet banking it is not hard for a person to have Internet banking and check on every transaction being made to their account.

4. Common consumer problems

Superannuation – this does not enter the discussion as most are unemployed and those who are employed are not aware of the degree to which salary and deductions are calculated let alone the hourly rate at which they are being paid.
Buying a house – this is not an option for people in remote communities although there should be an attempt made, as is being done in Cape York, to build purchasing into the spending patterns. Given such a scheme - the quantum of money may not be enough to maintain a standard of living so each decision that will create more spending must be looked at against the costs and benefits of the deal.
Debt is continuous - ongoing and a part of the day. It must be acknowledged that the people to whom this submission refers may not have been receiving any money 50 years ago and the giant leap the dominant culture is expecting them to make into modern day white man’s world is enormous. The culture lives on sharing wealth – be it food, land, possessions or even wives. This sharing culture is taken through to the welfare handout every fortnight.
The people to whom this submission refers have customs many ancient years old and these cannot be changed with the flick of a switch, the telephoning of a call centre, or the showing of an advertisement for cash money.

The welfare dependence mentality

The “ordinary” Australian has to do something more than hand a form in to get money. There is a need to work. The culture of work and development of a work ethic is something that is gained from childhood and the success of a parent in working will determine the degree to which the sibling will face the world of work.
In remote Aboriginal communities there is now developing a third generation of people to be brought up in a culture of welfare dependency and void of any working role model. The fact that children are borne to young girls means that by the time a woman reaches 35 years of age she could be a grandmother – and so the generations are far more compressed than they are in the white Australian society as a whole.

CONCLUSION

The baby of today is the one who must be attended to with access to all the Rights of the Child. In the words of Nobel Peace Prize winner, Chilean born poet, Gabriel Mistral:

“Many things we need can wait, the child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being developed. To him we cannot say tomorrow, his name is today.”

Gabriel Mistral, the Nobel Prize winning Chilean poet

There is an urgent need to address this problem as it is a factor in accelerating the decrease in life expectancy with lifestyle choices being made that will be deleterious to an acceptable level of good health.

Institutions such as Traditional Credit Union in Darwin must be encouraged and supported in their work. The fact this organisation exists is the result of some people believing they have to take control of their own situation. To deny them the opportunity to continue their work is to deny the people they serve their access to basic human rights.

The Task Force has the opportunity to leave a mark in history for these people and it is encouraged to do so.

Rollo Manning
Darwin
16th August 2004

This website - Setting the scene

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This website has been constructed to store the interests of the author in his quest for a better life for remote living Aboriginal and Torres Strait Islanders in Australia.
On this site the word Aboriginal will be used to indicate all Australians from an Indigenous origin within Australia. This includes the Tiwi Islands and the Torres Strait Islands, all part of the Federation of Australian States.
The subjects are those which the author believes are of particular interest especially when discussing the “where have I come from” and “where am I going” in relation to Aboriginal people.
One element that should come through to the reader is the urgency of the situation and the need for quick action if Australia as a Nation is going to work as one in helping to arrest the downward spiral in the health status of its Aboriginal people.
The life expectancy of the 100,000 people that still live in remote and isolated communities across the North of Australia continue to fall. This will continue while they are unable to embrace modern European living. They need to be sensitized to the changes this needs to lifestyle, nutrition, exercise and an understanding of the language, values and customs of the modern day mainstream Australian.
The more the process of assimilation and reconciliation is seen at work the more one realizes that for those alive today it may be too late. Their lives have already been moulded into one which crosses two barriers and fails to properly reach a satisfactory balance of equilibrium. The two cultures will only be brought together after generations of trying, testing and developing. For the one alive today (2005) it may be too late and so the need to concentrate on the child. In the wonderful words of Chilean born poet and Nobel Peace Prize winner Gabriel Mistral:

Many things we need can wait, the child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being developed. To him we cannot say tomorrow, his name is today.

The needs of the child should come before all else.
The young mothers of today – often in their teenage years – have to be helped to understand the important role they are taking on as custodians of the next generation.
Through the pages of this website you will be able to get a view on how these challenges can be met and the actions that are needed to help make the change from ancient culture to a new world of beginning for a new race of people. These will be the true Aboriginal Australians – happy in the transition they have been able to make from their forefathers to their after fathers – those of us that want to help.

“Give us the fortitude to endure the things which cannot be changed, and the courage to change the things which should be changed, and the wisdom to know one from the other.”
– Oliver J Hart

An Introduction

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Australia

General
Australia is a prosperous country with 20 million people in 2004.
Read more about the Nation and its people at the Lonely Planet Worldguide and click on
Australasia + PacificGuide to Australia.

History
In 1770 Captain Cook discovered the continent that is now Australia.
England decided to be the mother of the thought to be uninhabited continent, which is apart from some black people who gave Cook and his mates a pretty hard time. Cook claimed the continent on behalf of the King of England in 1770. As easy as that – so everyone thought at the time.
In 1788 Governor Arthur Phillip sailed the First Fleet to the new found continent and settled in what is now known as Port Jackson in the state of New South Wales. Phillip checked out the more southern harbour entry point now known as Botany Bay first and decided it was too exposed to the weather and went on to Port Jackson. Sydney Harbour was settled and Sydney Cove became the first settlement.
A complete history of the Australian nation and its people follow this link to the Lonely Planet Worldguide and for students of the country the National Library of Australia has a guide to research on the Internet.

Aboriginal people of Australia
The original inhabitants of the continent of Australia are thought to have been on the landmass for 70,000 years before the arrival of the white men and women of England. There had been other stopovers on the Australian coastline by explorers from France, Portugal and Holland as well as traders and fisher people fron the nearby Asian countries to the north.
It was the arrival of the first English settlers in 1778 that caused immediate concern to the natives who did not find their new visitors friendly and many of them died at the hands of the unwanted invaders.
Over 200 years later present day Australians are still trying to come to terms with the disruption their forebears caused to these people who had been on the island continent for so long. There is no treaty between black and white Australia and it was not until 1967 that the new citizens of the country agreed through voting at a referendum (by 90% in favor) for the first Australians to be recognised as full citizens of their own country. That should read “countries” as each Aboriginal tribe has its own nation or country in the area where they come from. The land means a lot to them and is their place of worship. A full account of the history of Australia’s Aboriginals is given in the Lonely Planet Worldguide.
Australia is unique in being the largest island continent in the world. Unlike so many other natives of countries around the world that have some land connecting them as continents, This means that before Governor Phillip and the settlement that followed around the Nation the indigenous Aboriginal had not seen white people ever before – in fact apart from the few stray explorers the vast majority had never seen anyone other than their own people. The result of this was that they had lived for so long off the land with no metal weapons or tools. Their navigation was by the stars, rivers and land features. Because of this nomadic existence they had no reason to collect possessions or build permanent homes. Life was drifting in search of food, water and to have ceremonies with neighboring tribes or clans. Without a currency - trade was bartering with each other as the way of exchanging goods and chattels while the men, being the dominant sex with power over the political system exhibited their wealth through the number of wives they had.
A look at the List of Livestock and Provisions that was brought on the eleven ships of the First Fleet in 1788 gives a startling reminder of what a shock it must have been for the Aboriginal Australians around Sydney Cove to see all of these things for the very first time.
It is hard for the modern 21st century Australian to understand that it is only as recently as the 1980s that the last Australian is believed to have been found in Central Australia who had never seen white man. For some groups in Northern Australia the traditional attire for women was no tops into the 1970s.The Aboriginal people were treated with scorn by the early settlers and even 150 years after the first fleet arrived they were still being massacred as a nuisance to the pastoralists who seized the land for the farming of sheep and cattle from one end of the country to the other. Despite the slaughter of their own immediate forebears the Aboriginal people worked hard helping the pastoralists and later the mission stations that began to emerge in the late 1800s. Apart from wanting to spread the word of God to the indigenous ones the missionaries were also protecting the natives from the invasion by settlers. The coming of the Missionaries of the Sacred Heart is an example of the dedication to the people of Northern Australia demonstrated through the work of the Catholic Church in the Diocese of Darwin.
Whilst the work of the missionaries is sometimes derided for breaking down the culture of these proud people, there is no doubt that under their tutelage the Aboriginals began to learn a sense of white man’s values that was a useful forerunner to the process of assimilation that was followed by the government of Australia around the time of the referendum in 1967.
Aboriginal people fought in all the wars Australia as a nation has been involved in since the Boer war of the 1890s, and yet in 2004 the government is still just hanging on to a program of reconciliation – an attempt to have a sharing of the country and its resources through Reconciliation Australia by acknowledging the past and building a framework for a shared future.

What follows is an expose of the thoughts of Rollo Manning after eight years in Darwin (since 1996) seven of which have been spent in the health care arena and since 2001 working directly with the people of the Tiwi Islands firstly with the Tiwi Health Board and following its demise as a social entrepreneur assisting Tiwi people to regain control of their own future.

In the pages following you will find some stimulating suggestions on how white Australia can reconcile with black Australia through action projects that will help the remote living Aboriginal find a better way of combining life in the two cultures.

DISCLAIMER
Every attempt has been made to state matters of fact as they are.
The experiences behind any assertions made by the author are gleaned from being with the people of the Tiwi Islands. If these do not extrapolate directly to other Aboriginal people of Northern Australia it is unintentional and no offence should be taken at statements that do not equate with other people’s thinking.
The text of this site has been shown to senior Tiwi people and they agree with the general approach to Aboriginal reconciliation as stated through these pages.
Photographs are used with the knowledge of the persons in the pictures and apologies are made for the depiction of anyone who is no longer with us.

R W Manning

© Darwin Northern Territory Australia July 2004