Health Needs of the Region

baby-steamingThe health profile of the Indigenous population of the Miwatj region accords with the generally poor health status of Aboriginal people in the NT as a whole. Sometimes disadvantaged from the start by a low birthweight, an Aboriginal child from this region typically faces a much higher risk of infectious disease, anaemia, pneumonia, otitis media, skin diseases such as scabies, rheumatic heart disease, lack of dental care and so on than a non-Indigenous counterpart.

In the causal interplay between child health and chronic illness, the longer-term outcome is high rates of chronic disease, particularly type 2 diabetes, cardiovascular disease, renal disease, lung and other cancers.

One Community

To illustrate the issues which Miwatj faces, consider the situation of a large Aboriginal community in the region, population approximately 2500 people. Around one-third of this community is aged under 15 years. The people live in a central township area and are afflicted by ‘lifestyle’ diseases similar to those of other people in urban areas of Australia. However, this community has poor infrastructure including inadequate housing, limited sporting facilities and an over-abundance of fatty fried foods and sugar drinks. The estimated ‘sugar drink’ consumption in this community is 666 litres per day (link to no sugar drinks clips). Smoking rates are between 70 -80% (link to tobacco clips). The BMI (Body Mass Index, a measure of obesity), has been increasing for adults aged 18-55 years over the last few years.

Lifestyle diseases are, to a large extent, preventable. The health service in this community works hard to achieve good results for many health indicators such as clinic attendance, blood pressure control and diabetes control. However, to maximize good health outcomes the main need is for a broader community and public health agenda.

Chronic illnesses dominate the client files at Miwatj Health. But it was not always like this: 50 or 60 years ago these diseases were rare among the Aboriginal people of this region. In this sense some of the more important causes of today’s poor health is obvious – the creation of centralized settlements, the ready access to junk food, sugar-based soft drinks, and tailor-made cigarettes – these and other aspects of western society undermined the resilience which traditional lifestyles had developed over a very long period.

A traditional Yolngu view of health is that an underlying cause of illness is disruption in social relationships – which are ultimately based on the relationships between humans and the natural world. Many see the poor health they have experienced since the opening of the mines and the construction of the mining towns in the late 1960s/early 1970s as evidence of this.

Historically, the main response of Yolngu to threats to their health and wellbeing has been to develop their homeland centres, small family-based settlements on traditional land away from the alcohol and other harmful influences of Nhulunbuy and the ex-missions. The understanding that homeland centres are a way to counter illness continues among Yolngu today.

As a community-controlled organization, Miwatj health is bound to take this community perspective into account, and so must provide clinical individualized medicine while also tackling the social determinants of health.

Unusual diseases of high prevalence in the Miwatj Region

In addition to the more commonly -described chronic illnesses, a number of diseases have unusually-high prevalence rates in this region.

Machado Joseph Disease (MJD)
MJD is a rare autosomal dominant (inherited by 50% of children of affected parents) neurological disease – like Motor Neurone Disease – which occurs in a small number of clusters around the world. Prevalence rates in east Arnhem Land are the highest in the world, and 150 times higher than prevalence in most western countries. Further information can be found at www.mjd.org.au.

Vulval Carcinoma
The incidence of Vulval Carcinoma in East Arnhem Land Aboriginal women aged less than 50 years is around 50 times that of all Australian women aged under 50.

Strongyloides
Strongyloides is a parasitic helminthic infection. Screening and research undertaken by Miwatj Health staff indicate that prevalence rates in the East Arnhem Land region are the highest in the world, at 40%. A crucial point is that while Strongyloides has been identified as an underlying contributor to the high morbidity and mortality rates in our population, it is both preventable and able to treated if diagnosed early. Further information can be found here (Download Strongyloides Flipchart).

From a public health perspective, the key point is that most of the chronic illnesses which fill the files of Miwatj Health are preventable. The evidence from many populations over many decades is overwhelming: many chronic illnesses can be prevented, and also to a large extent managed once contracted, by modifying lifestyles – in particular, we know that changes in exercise, diet and cigarette smoking would prevent a major portion of the deaths we see today from chronic illness. Achieving such change is not easy, but it is important to note the agreement between the western view that diet and exercise are the answer and the Yolngu view that homeland centre life is the answer.

The conclusion from the above discussion is that an important part of of Miwatj health’s service provision must involve taking health outside the town-based clinics, delivering health services as close as possible to where people live – to bring it into people’s daily lives through education, health promotion and related activities.

Improvements in medicine over recent decades have meant that it is now possible to manage many chronic diseases far more effectively than in the past. Modern drugs can drastically reduce mortality from such previously-fatal illnesses as cardio-vascular disease, and the idea that patients can now self-manage their illnesses through compliance with medication regimes is seen as best practice in chronic disease care.

Recently-published data shows clearly that the nature of health problems has changed greatly in recent decades. The situation in the NT now is not only that Aboriginal people are dying at a relatively young age, but that much larger numbers of Aboriginal people are living longer while carrying a greater burden of ill-health. Any improvement in the burden of fatal outcomes has been more than offset by significant increases in the prevalence and severity of non-fatal conditions. This change has big implications for any primary health care service – more health care resources must now be devoted to longer-term conditions, and the method of delivery of health care must be more focused on prevention and patient self-management.

visitingIn the past two years Miwatj Health has made a deliberate effort to increase the staff resources allocated to longer-term prevention, and to access people who do not normally attend a fixed clinic.

The mix of services provided by Miwatj Health is therefore a combination of clinical services with a focus on long-term care planning, and the provision of acute care services when necessary. This is complemented by community-based programs aimed at the risk factors underlying chronic illness and poor child and maternal health.

Miwatj is confident we are on the right track with this mix of services – the causes of the main illnesses affecting our Aboriginal clients are not a scientific mystery, and our programs are based on strong evidence of what works. But having the evidence is often not enough – to successfully deliver primary health care in remote parts of the NT requires an approach which is flexible and which recognizes the decentralized nature of Aboriginal populations. The challenge lies in applying the evidence in the context of a highly mobile population which has its own way of viewing the world, and where the social determinants of health – housing, access to good food, land tenure, smoking habits, employment and so on – mean the odds are stacked against us.

More information can be found in the ‘what we do’ section of this site.

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