more_vertEven the most colourless clinical description of schistosomiasis comes across like a pitch for an early David Lynch body horror. Waterborne flatworm larvae penetrate the skin, and move in the bloodstream through the heart and lungs to the liver. Here they mature and mate in the portal circulation, before laying eggs that lodge in the liver—occasionally the spinal cord or genitals—or leave the body via the bladder or intestinal walls. The framing of schistosomiasis as a parasitic tropical disease emerged from a series of global encounters—between medicine and science, between industrial nations competing for dominance, and between imperial governments and their indigenous subjects.
Preference: Indigenous Health
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Thank you letters from recipients of the AMA Indigenous Medical Scholarship
It has made a huge difference
I am writing to you today to inform you that I have officially completed my studies at the University of Newcastle in the Bachelor of Medicine program as of the 7th December 2018, and I would like to take this opportunity to say thank you to the Australian Medical Association for their support throughout my time at Newcastle University that made this endeavour possible with the Indigenous Peoples’ Medical Scholarship 2016.
I can still remember the day I received the phone call that I had been awarded the scholarship. I was studying in the library, trying to finish off that week’s ‘Working Problem’. I saw it was a Canberra phone number, and instantly became nervous. I can still remember saying to myself ‘is this real?’ as I never expected to be even considered for such an award, but nonetheless, it has made a huge difference to where I am today.
As a mature aged student with a family, the scholarship took the pressure off the financial strain of attending university, and allowed me to focus more on my studies at the time when it was needed the most. Previous to the scholarship, my usual routine was to attend university Monday to Friday, then work Friday and Saturday night shifts in as a Registered Nurse in the Intensive Care Unit at the Newcastle Mater Hospital. This left me with one day to spend time with my family, and catch up on any extra reading. The scholarship enabled me to scale back work, spend more time studying, but it also allowed me to spend extra time with my boys.
I was fortunate enough to secure a position as a Junior Medical Officer in the Hunter New England Local Health District, commencing on the 21st January in 2019. This will keep me close to home at the present time, and I am looking forward to the challenge. Being an active member of the Wollotuka Institute at the University of Newcastle, I am also now looking forward to mentoring and tutoring Indigenous medical students in a new capacity so as to foster the next generation of Indigenous medical graduates.
Thank you once again to all the staff at the Australian Medical Association for making this dream possible.
Regards
Dr Darren Hartnett
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Continues to be the source of support that facilitates my passion to pursue medicine
This year was my first clinical year of medicine, where I was placed in Wagga-Wagga NSW. I have always been sure about pursuing rural and remote medicine – but being immersed in clinical medicine in rural NSW has only reaffirmed this more and made me more motivated!
Reading about the UNSW medicine program before I even gained entry, I was always very keen to be placed in Wagga. I placed it as my first preference and was lucky enough to get it [Wagga is becoming very popular among students!].
The relocation to Wagga from Wollongong was always going to be an expensive exercise; however, it was very comforting knowing that the transition would be supported by the AMA Indigenous medical scholarship. Throughout various placements this year, both within the hospital and the community, I have been exposed to the spectrum of health – and in particular health issues common in rural Australia such as Indigenous health and mental health.
An interest of mine has always been obstetrics, and I have made sure that this year I have had as much exposure as possible. As part of the UNSW medicine program, students are required to complete a 30-week independent learning project in their 4th year of study. I have been fortunate enough to have my proposal approved and will also be completing my research project in Wagga during 2019.
My research has an obstetric focus and will be assessing Indigenous foetal-maternal outcomes. I have not had much exposure to research however I am excited to learn more about rural obstetric medicine and am looking forward to the challenge next year! This year has also seen the budget allocate funding of a new medical school in Wagga-Wagga. I firmly believe this is a great opportunity to increase Indigenous medical student numbers as well as improving retention. As this has involved the current Wagga-Wagga rural clinical school I have been lucky enough to share my thoughts with the Dean of rural medicine.
This is something I have become quite passionate about as I truly believe that increasing the amount of Indigenous medical and allied health professionals will only aid in closing the gap between Indigenous and non-Indigenous health status. This is a passion which I will continue to lobby for. The AMA Indigenous scholarship has, and continues to be, the source of support that facilitates my passion to pursue medicine. Medicine is a challenging experience and sometimes a little daunting and overwhelming. Being a recipient of the AMA Indigenous Medical Scholarship is a constant source of motivation and an opportunity I am and will always be grateful for! Thank you again for your support and in assisting me throughout my medical studies and I look forward to 2019 as a proud recipient of the AMA Indigenous Scholarship.
Regards
James Chapman
indigenous-medical-scholarship-2019
Occurrence of and referral to specialists for pain-related diagnoses in First Nations and non-First Nations children and youth [Research]
BACKGROUND:
Indigenous youth have higher rates of chronic health conditions interfering with healthy development, including high rates of ear, dental, chest and musculoskeletal pain, as well as headache, arthritis and mental health issues. This study explores differences in pain-related diagnoses in First Nations and non–First Nations children.
METHODS:
Data from a study population of age- and sex-matched First Nations and non–First Nations children and youth were accessed from a specific region of Atlantic Canada. The primary objective of the study was to compare diagnosis rates of painful conditions and specialist visits between cohorts. The secondary objective was to determine whether there were correlations between early physical pain exposure and pain in adolescence (physical and mental health).
RESULTS:
Although ear- and throat-related diagnoses were more likely in the First Nations group than in the non–First Nations group (ear 67.3% v. 56.8%, p < 0.001; throat 89.3% v. 78.8%, p < 0.001, respectively), children in the First Nations group were less likely to see a relevant specialist (ear 11.8% v. 15.5%, p < 0.001; throat 12.7% v. 16.1%, p < 0.001, respectively). First Nations newborns were more likely to experience an admission to the neonatal intensive care unit (NICU) than non–First Nations newborns (24.4% v. 18.4%, p < 0.001, respectively). Non–First Nations newborns experiencing an NICU admission were more likely to receive a mental health diagnosis in adolescence, but the same was not found with the First Nations group (3.4% v. 5.7%, p < 0.03, respectively). First Nations children with a diagnosis of an ear or urinary tract infection in early childhood were almost twice as likely to have a diagnosis of headache or abdominal pain as adolescents (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1–3.0, and OR 1.7, 95% CI 1.2–2.3, respectively).
INTERPRETATION:
First Nations children were diagnosed with more pain than non–First Nations children, but did not access specific specialists or mental health services, and were not diagnosed with mental health conditions, at the same rate as their non–First Nations counterparts. Discrepancies in pain-related diagnoses and treatment are evident in these specific comparative cohorts. Community-based health care access and treatment inquiries are required to determine ways to improve care delivery for common childhood conditions that affect health and development.
[Correspondence] Canada’s global leadership and Indigenous people
The systemic roots of health inequities for Indigenous people in Canada are land theft and broken agreements. Colonialism and racism are the fertilisers which feed and perpetuate these inequities, supported by the country, a settler state. The authors of the Lancet Series about Canada’s global leadership on health (April 28, p 1718)1,2 hardly mentioned the return of land as being foundational for the health of Indigenous people, and instead championed Canada’s fair approach to the social determinants of health, continuing the rhetoric of settlers’ paternalistic benevolence.
[Correspondence] Canada’s global leadership and Indigenous people – Authors’ reply
We thank Bjorn Stime and colleagues for their thoughtful correspondence, which raises a broader conversation about the link between colonisation, land, and health. Although a full exploration of these issues was beyond the scope of our Series paper,1 we agree that no conversation about health can be limited solely to discussions of health system reform. We aimed to provide an overview of the health-care systems of Canada, their challenges, and solutions under debate. We also endeavoured to highlight the tremendous effects of the social determinants of health, particularly (but not exclusively) for Indigenous people.
Government expands football partnership aimed at young Indigenous health
The health, wellbeing and future prospects for children in remote communities will be winners, through a major extension of the successful John Moriarty Football program to 12 centres across New South Wales and Queensland.
The Federal Government is committing up to $4.5 million for the expansion, to be driven through a partnership between the Football Federation of Australia (FFA) and John Moriarty Football (JMF).
JMF and FFA will work together to provide senior coaching staff, mentoring, training and education for children involved in the program. FFA will also identify and support pathways to national football programs.
“This is a game-changing move for Aboriginal and Torres Strait Islander communities, designed to help children between two and 16 to reach their full potential in football, in education and in life,” Indigenous Health Minister Ken Wyatt said.
“We have seen the success in the remote Northern Territory centres of Borroloola and Robinson River, which have been involved in the program since it was established in 2012, with more than 90 per cent of children in Borroloola now participating.
“Two hundred children have enrolled each year, including Shay Evans who is now playing with the Westfield Young Matildas.
“I congratulate Shay and her fellow JMF scholarship winners, but scores of other participants are also continuing to kick personal and life goals, both on and off the field.”
The JMF program is community driven, with children supported to attend school and make healthier lifestyle choices.
The expanded program will focus on primary health through:
- Nutrition programs, with meal plans developed by a sports dietitian;
- Mental wellbeing, through emotional self-regulation training, with coaches focussing on building resilience;
- Community cohesion, through gatherings to support tournaments and holiday clinics encouraging community interest and participation; and
- Parental involvement to enable families to improve health through physical activity.
JMF Managing Director Ros Moriarty said the Foundation was “extremely grateful” for this “very significant” funding commitment.
“We look forward to replicating our model of football as a powerful tool for wellbeing, supporting resilient, healthier outcomes for young players, their families and communities,” Ms Moriarty said.
NSW and Queensland communities to participate will be selected on the basis of evidence of strong local interest and intention to embrace the program.
“Our game has a deep history of Indigenous participation, and this step will allow us to do so much more to improve health outcomes for Indigenous children,” said Moriarty Foundation Board Member and FFA Board nominee Craig Foster.
“Football has the power to unite the whole community to support opportunity for all young Australians.”
FFA Chief Executive David Gallop said FFA had been a keen supporter of John Moriarty Football for several years.
“Matildas Head Coach Alen Stajcic has visited Borroloola on a number of occasions and scouted Shay Evans back in 2014,” he said.
“This announcement will help achieve our vision of involving more Indigenous Australians in football, as players, coaches, referees and administrators.
“We look forward to working closely with John Moriarty Football to generate significant health and community benefits while offering a pathway for Indigenous footballers to emulate the success of Young Matilda Shay.”
Mr Wyatt said regular sport and physical activity, particularly for young children, has documented and far reaching health benefits.
“It reduces the risk of obesity, increases cardiovascular fitness, promotes healthy growth of bones and muscles, improves coordination and balance, and gives children a greater self-confidence and belief in their abilities, on and off the sporting field,” the Minister said.
“The JMF program has the potential to contribute to Closing the Gap in health equality, education and employment, and positively impact on the high chronic disease prevalence rates among First Nations people.”
The three-year funding will be provided through the Indigenous Australians’ Health Program over 2018–19 and 2020.
Government releases new national plan for FASD
The Government has unveiled a new national plan to ramp up the fight against fetal alcohol spectrum disorder (FASD), and has allocated more than $7 million to the initiative.
FASD is often an outcome of parents either not being aware of the dangers of alcohol use when pregnant or planning a pregnancy, or not being supported to stay healthy and strong during pregnancy.
The disorder can inflict lifelong physical and neurodevelopmental impairments that can result from fetal alcohol exposure.
Health Minister Greg Hunt said the aim of the new national plan was to significantly help reduce the impact of FASD on individuals, families and communities.
“This plan will show us the way forward to tackle the tragic problem of FASD – guiding future actions for governments, service providers and communities in the priority areas of prevention, screening and diagnosis, support and management, and tailoring needs to communities,” he said.
“Alongside the plan’s release, I am pleased to announce a new investment of $7.2 million to support activities that align with these priority areas.
“This funding will enable work to start immediately and help protect future generations and give children the best start possible.”
Funding includes $1.47 million for prevention; $1.2 million for screening and diagnosis; $1.2 million to inform schools and workplaces and support the justice system; $1.2 million to tailor solutions to local communities; and $1.55 million to continue developing a one-stop digital hub for information and support.
Indigenous Health Minister Ken Wyatt said the Government’s approach to FASD was to invest in activities which have been shown to be effective.
“Success is underpinned by a team effort, with collaboration between families, communities, service providers and governments,” Mr Wyatt said.
“FASD requires a national approach, linking in closely with local solutions. We are acknowledging the scale of the issue in Australia and intensifying efforts to address it.”
IT IS MEMBERSHIP RENEWAL TIME
Thank you for being an AMA member. Your membership keeps us strong.
There will be a Federal Election in 2019. Health policy will help determine the next Government.
Your AMA will be advocating for:
- Significant new investment in general practice
- MBS review outcomes that improve the delivery of health care
- Increased public hospital funding
- National Mandatory Reporting laws that help doctors and patients
- Better value and more transparent private health insurance
- A My Health Record that protects patient privacy and confidentiality
- Better health care for asylum seekers and refugees
- A greater focus on mental health
- Urgent action on aged care reform
- Strategic funding and programs to improve Indigenous health
- A reinvigorated approach to public health and prevention
- Cohesive medical workforce and training policies across all governments
The AMA is the only organisation that can cover the depth and breadth of health policy across the Federal, State/Territory, and local levels. The AMA is your partner to influence and improve health policy, and to provide advice and resources to support you in your practice and career.
The AMA is the voice of the medical profession and the voice of the patients in our care. The AMA is your voice.
Simply renew your tax-deductible membership online or contact your local AMA office.
The gap isn’t closing
The nation is failing in its efforts to close the health and life expectancy gap between Indigenous and non-Indigenous Australians.
The AMA Indigenous Health Report Card 2018, launched in Brisbane on November 22, scrutinises the 10-year-old Closing the Gap Strategy and concludes that it is unravelling.
The strategy must now be rebuilt, not refreshed, said AMA President Dr Tony Bartone.
One of the strategy’s main targets was to close the life expectancy gap by 2031, but Dr Bartone said it was obvious Australia is not on track to meet that goal.
“Ten years on, progress is limited, mixed, and disappointing,” he said.
“If anything, the gap is widening as Aboriginal and Torres Strait Islander health gains are outpaced by improvement in non-Indigenous health outcomes.
“The strategy has all but unravelled, and efforts underway now to refresh the strategy run the risk of simply perpetuating the current implementation failures.
“The strategy needs to be rebuilt from the ground up, not simply refreshed without adequate funding and commitment from all governments to a national approach.”
Political leadership and increased funding are lacking on the issue, Dr Bartone said.
A refocussing of effort and priorities is needed.
“It is time to address the myth that it is some form of special treatment to provide additional health funding to address additional health needs in the Aboriginal and Torres Strait Islander population,” he said.
“Government spends proportionally more on the health of older Australians when compared to young Australians, simply because elderly people’s health needs are proportionally greater.
“The same principle should be applied when assessing what equitable Indigenous health spending is, relative to non-Indigenous health expenditure.”
The Australian Institute of Health and Welfare estimates that the Aboriginal and Torres Strait Islander burden of disease is 2.3 times greater than the non-Indigenous burden, meaning that the Indigenous population has 2.3 times the health needs of the non-Indigenous population.
This means that for every $1 spent on health care for a non-Indigenous person, $2.30 should be spent on care for an Indigenous person.
But this is not the case, Dr Bartone said. For every $1 spent by the Commonwealth on primary health care, including Medicare, for a non-Indigenous person, only 90 cents is spent on an Indigenous person – a 61 per cent shortfall.
For the Pharmaceutical Benefits Scheme, the gap is even greater – 63 cents for every dollar, or a 73 per cent shortfall from the equitable spend.
“Spending less per capita on those with worse health, and particularly on their primary health care services, is dysfunctional national policy,” he said.
“It leads to us spending six times more on hospital care for Indigenous Australians than we do on prevention-oriented care from GPs and other doctors.”
The Report Card outlines six areas where the Closing the Gap Strategy can be rebuilt.
These include: equitable, needs-based expenditure; implementing health and mental health plans; filling primary health care service gaps; environmental health and housing; addressing social determinants; and placing Aboriginal health in Aboriginal hands.
“We need those leaders, those health leaders in those various communities, to come together with the peak bodies, with the Aboriginal controlled community health organisations, and all the other people as stakeholders in this space to come together to work collaboratively and with common purpose,” Dr Bartone said.
“We will not close the gap until we provide equitable levels of health funding. We need our political leaders and commentators to tackle the irresponsible equating of equitable expenditure with ‘special treatment’ that has hindered efforts to secure the level of funding needed to close the health and life expectancy gap.”
National Aboriginal Community Controlled Health Organisation (NACCHO) welcomed the release of the Report Card and joined the AMA in calling for the Closing the Gap Strategy to be rebuilt from the ground up.
NACCHO Chairwoman Donnella Mills called for the immediate adoption of the Report Card’s recommendations.
“We congratulate the AMA on their work to support closing the gap and endorse the recommendations in the Report,” she said.
“The Report highlights research which indicates the mortality gaps between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians are widening, not narrowing.
“Urgent and systematic action is needed to reverse these failures and to have any prospect of meeting the Council of Australian Governments’ goal to Close the Gap in life expectancy by 2031.”
The AMA 2018 Indigenous Health Report Card is on the AMA website.
WILLINGNESS GROWS TO END RHD
BY AMA PRESIDENT DR TONY BARTONE
Rheumatic heart disease (RHD) is a preventable illness affecting about 6,000 Australians, with Indigenous children 55 times more likely to die from the disease than their non-Indigenous peers.
The AMA recognises the role RHD contributes to the widening of the life expectancy gap between Indigenous and non-Indigenous Australians. In 2016, we launched a Report Card on Indigenous Health, A call to action to prevent new cases of RHD in Indigenous Australia by 2031 (target year for ‘closing the gap’ in Indigenous life expectancy).
Our Report Card made a strong statement on the devastating impact of RHD and the importance of new, collaborative strategies to control the disease. Its recommendations included calling for Australian Governments to commit to a target to prevent RHD. It also recommended that governments work in partnership with the Indigenous community to fund and implement a strategy to end RHD.
The Report Card also provided an opportunity for a group of leading health, community, and research organisations to form a coalition END RHD. The purpose of the coalition is to advocate for urgent, comprehensive action on this preventable disease of inequality, and to support those living with the disease and prevent new cases arising.
The founding members of END RHD are the AMA, Heart Foundation, RHD Australia (based at the Menzies School of Health Research), the END RHD Centre of Research Excellence (based at Telethon Kids Institute), the National Aboriginal Community Controlled Health Organisation (NACCHO), the Aboriginal Medical Services Alliance Northern Territory (AMSANT), the Aboriginal Health Council of Western Australia (AHCWA), the Aboriginal Health Council of South Australia (AHCSA), the Queensland Aboriginal and Islander Health Council (QAIHC), and the Aboriginal Health and Medical Research Council of NSW (AH&MRC).
To eliminate rheumatic heart disease in Australia, the coalition calls on the Federal Government to:
- guarantee that the Aboriginal and Torres Strait Islander leadership drives the development and implementation of RHD prevention strategies;
- set targets to end RHD in Australia;
- fund a roadmap to end RHD by 2031;
- commit to immediate action in communities at high risk of rheumatic heart disease; and
- invest in strategic research and technology to prevent and treat acute rheumatic fever and rheumatic heart disease.
In the two years since the Alliance was formed, END RHD has been working with the communities at risk, securing funding and political will to translate research into action and educating Australians to play a role in ending RHD.
I believe the momentum is growing. RHD was discussed at the COAG meetings in August and October 2018. This has been further helped by the recent commitment from Indigenous Health Minister Ken Wyatt, to a Roadmap to end RHD in Australia, which is due to be completed by early 2019.
There is no doubt that funding is a crucial part of the equation to ending RHD. Recent developments include $3.7m being allocated to five Aboriginal medical services for local community-led pilot Acute Rheumatic Fever (ARF) and RHD prevention programs.
A further $950,000 has been granted to the Telethon Kids Institute to work with the Kimberley Aboriginal Medical Services to establish an innovative END RHD community program focussed on environmental health and local workforce development.
On 23rd October 2018 an advocacy event at Parliament House, co-hosted by END RHD and the Snow Foundation, where the Government was asked for non-partisan commitment to eliminate RHD in Australia. Minister Wyatt and Shadow Assistant Minister for Indigenous Health Warren Snowden both made commitments in public to tackle RHD as a non-partisan issue. It is an important step for political leaders to acknowledge the seriousness of the problem.
Now, with community-driven change and funding to enable the change, we can hopefully start to bring about the end for RHD in Australia.