Measure 5: Improving Child and Family Health
5.1 Child Health Checks, Medical Follow-Up and Treatment
The clinic for this community is run by Territory Health Services and funded for two full time nurses and part time Aboriginal Health Worker. In practice it is staffed by one full time nurse, a relief nurse when available, an Aboriginal Health Worker who works on a casual basis and an Aboriginal Liaison person who also works on a casual basis. Various programs dealing with health across the lifespan operate and the health of all permanent Indigenous members of the community is well known to the permanent clinic nurse. With the commencement of the NTER the young people and children in particular were subjected to extra checks which impacted upon their ability to attend school, as most checks were carried out during school term. Unfortunately the skill levels of the NTER staff performing these tests were variable. The clinic already had an ongoing management system for all permanent and semi-permanent children in the community so the child health checks in many cases seemed to duplicate work which had already been done.
The data from the child health checks was placed into a NTER system to be followed up. There seemed to be little acknowledgment that clinics already had systems and procedures in place to follow up children so two duplicate data systems are operating. In this community due to the longevity of the permanent nurse, children needing medical follow up were already in the clinic recall system. Some children needing general anesthetic for dental reviews received them earlier than they would have otherwise thanks to the NTER. However there has been no groundwork done by the NTER staff in education to ensure that children’s teeth do not disintegrate and require surgery. It would have been good to see a sustained promotion and education regarding dental care, rather than tertiary intervention. Similarly with ENT surgery. Some children have received ENT reviews sooner than they would have without the NTER. However there was limited education and follow-up so much of the surgery done has already broken down.
Hearing as a sense does not appear to be valued by Indigenous parents in this community for their children. Indigenous children are held upright and taught to use the sense of sight to orientate themselves. When they are walking around and playing they need to be able to locate themselves to their environment. Non-indigenous children are taught to ask questions to orientate themselves whereas Indigenous children are taught by observation and repetition. When a child is brought to the clinic with infected ears it usually has a high temperature, which is the reason the child is brought to the clinic. The nurse gives panadol which aids in reducing the pain and temperature and parents do not see the correlation between infected ears and the temperature. The reason they brought the child to the clinic has been addressed. We therefore see repeated episodes of infected ears. It would have been good to see much more education and health promotion activities around ear health before surgery commenced. People attended surgery at the good will of the permanent nurse. However it is unclear how much education carers received about the follow up care needed. On returning to the community the nurse endeavored to follow up the children who had had surgery and encourage post operative care. Some children were not in the community, some children and parents refused to continue with the post operative care and all seemed to lose interest. The main impression received was that the parents had taken the children for surgery to please the permanent clinic staff and felt they had done their part in doing this. To be an effective use of resources much more fundamental education needs to be done before surgery is attempted. I would suggest that children and parents who show commitment and understanding to ear health, whose children use hearing aids in school and value them, should receive surgery prior to children whose parents show limited understanding of ear health. It should be noted that many parents in this community have a degree of deafness and have learnt to live and manage their lives with this disability. There is also a large non-verbal area of communication amongst the local Indigenous population. I feel that these factors also play a part in the value parents place on ear health for their children.
One of the big impacts for the clinic and I suspect many other services is the sense of de-value staff who had been living and working in remote communities, some for many years, feel at this duplication of their work. A respected specialist who has been traveling out to remote communities and working for many years said he feels professionally de-valued by the NTER in the health area. Another professional who also has been traveling out to and working in remote communities for many years said she had never seen so much angst and stress among the permanent nursing staff in communities. From my own experience I can say that staff coming out as part of the NTER requires input from staff on the ground, as these visiting staff do not know communities. They require time, taken away from what is already full time work. They are focused upon their one task and work regular hours. They do not seem to understand that the clinic has many tasks going on across the lifespan and that the nurse has to cope with many different issues and possibly be up during the night, whilst they are only out to do one specific task. The NTER staff seems to find it difficult to acknowledge that they are only one of multiple visitors, coming out to communities from all areas of service.
I would recommend much more work be put into health promotion, education, health hardware in housing and mental health in children and adolescents before tertiary level procedures. These are from the preventative health arena and require long term sustainable effort. Children need consistent, nurturing care, which is partly why long term stable staff in areas such as education and health need to be valued and supported. Staff on the ground are vastly under resourced to provide health promotion as well as clinical health services across the life span. As a consequence the acute issues will tend to take priority. Unfortunately effective health promotion requires a level of trust and credibility in the presenter which short term visiting services are unable to provide. Thus visiting services tend to be a “negative” force for good as their needs for assistance from long term staff in any area, including clinic’s, schools, youth groups and councils, is not cancelled out by the benefit they bring.
5.2 Child Special Services
5.3 Drug and Alcohol Response