• New national history curriculum allows students to look at nation’s story from indigenous & non-indigenous perspective http://bit.ly/curt2m
• Students from primary school through to Year 10 be taught the scientific knowledge of indigenous culture http://bit.ly/cvtkg8
• THE UNIVERSITY of Southern Queensland has the highest number of indigenous nursing completions in the nation http://bit.ly/bO1z2w
• Could MySchool website assist eduction ourcomes in Indigenous education? http://bit.ly/9WKAAX
• Wendell Sailor working with the Achieving Results Through Indigenous Education program to reduce school bullying http://bit.ly/9cqkYk

The Indigenous News Updates are sourced from news and other articles from around the country that I have posted on Twitter.



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The second, on Australian Pharmacists using social media is below. .

9 October 2009 | by Fran Molloy

It’s no longer hype: the term ‘Web 2.0′ is now firmly ensconced in the mainstream as a description of today’s internet, a place where social media, participatory commentary, self publishing and blogging rule the digital roost.

Fifteen years after the World Wide Web first emerged, comments posted to newspaper articles are often as interesting as the articles themselves, and every industry seems to have its own internet gurus liberally dispensing news, opinion, criticism and ridicule.

‘Social networking’ describes the plethora of web-based applications like Facebook, MySpace and YouTube with large online communities of people with shared interests. These sites usually allow members to build a profile, in the form of a web page where you display information about yourself, your interests and your activities. Most of the sites also offer different ways for users to communicate with each other. For example, you can allow others to write a message on your profile, send messages, join a live chat or forum, share and rate other internet sites or share and comment on files (often audio, image or video.)

At the heart of social media is the blog, an online diary where news, gossip, industry issues, opinion and scandal jostle for space.

But where are the pharmacists? While member-only industry forums (like AusPharmList) attract a healthy audience happy to comment behind closed doors, few Australian pharmacists are writing blogs and there is little public commentary on pharmacy issues from pharmacists themselves.

Biting the dust

One of the best-known Australian pharmacists in the blogosphere is Andrew ‘Robbo’ Roberts, whose BiteTheDust blog attracts visitors and comments from all over the world.

“My job’s a bit broader than a standard pharmacist, I deal with a broad range of professionals, pharmacy academics, consultants, other pharmacists, remote nurses and so on,” he says.

He believes that Australian pharmacists are well qualified to take a larger role in primary health care teams – and they need to speak out more to make that happen, because the general community isn’t aware of their expertise.

“One of the reasons I started to blog was that I got frustrated at the Guild and the PSA issuing media releases about ‘incontinence week’, but when there’s a big public health issue that might involve a drug, they’d never comment. Other professions are on the news commenting on drugs, when pharmacists understand this topic better than anyone.”

As a professional pharmacist writing a blog, he says, he can make informed comment on newsworthy issues.

But he recognises there are certain issues that may be too sensitive to blog about under your real identity.

“Unlike America, in Australia, we’ve got just the one script insurer, Medicare — who seems to reject scripts for seemingly inane reasons — so if you’re criticising them, you might as well put your hand up saying, ‘please come and investigate and give me a hard time’.”

Criticising hospitals or individual drug companies could also have job-impacting repercussions, he admits. But Robbo believes that by blogging under his own name, he’s backing his own claims that pharmacy should play a bigger role in primary health outside the dispensary and he can also speak out about issues around medications and pharmaceutical care.

“Blogging under my real name means what I’m saying can be verified. I write about a bit of everything really, from car racing in Alice Springs to indigenous health to everything in between, and sometimes I throw in something of interest about life in remote health, to give people who might want to work out here a bit of an idea.”

He believes that pharmacists in Australia spend too much time talking among themselves rather than letting the rest of the population know what they do.

In other social media, Robbo uses LinkedIn and Facebook — “there’s a lot more Australian pharmacists in Facebook than there are on Twitter,” — but finds blogging the most effective platform.

“It’s also been good in terms of reducing the isolation. You can have a conversation at any time. I can respond to a few messages in the middle of the night and other people can join in, so it’s a conversation that can cross many people over time.”

Social media

“The phrase ’social network’ sometimes has a really negative connotation,” says Laurel Papworth, a Sydney-based business consultant regularly engaged by companies all over the world to advise on implementing Web 2.0 technologies.

“We used to call them virtual communities or online communities but quite often when I’m talking to companies, I use the word ‘customer communities’ — because once they understand that’s where their customer is, then it makes it a lot easier to talk about working with them and not banning access,” she adds.

She believes that while there are plenty of pharmacists interacting on the web, they tend to stay within closed communities — or they don’t identify their profession.

“There are always heaps of pharmacists on medical forums,” she says.

She identifies several types of social media bloggers in industries. First are the ’social media marketing’ bloggers – “Everything is sprinkled in gold-dust and is positive, vibrant and all about sales.” Then there are what she calls the ‘deep-throat’ bloggers – who make strong critical comments and leak information. And finally, professional information providers, who aren’t anonymous but reveal a lot of information freely.

Papworth agrees with Robbo — Australian pharmacists are behind the eight-ball.

“It’s worth looking at what is going on in other countries,” she says.

For example, in Singapore, some pharmacies offer remote consultation about drug use with the in-house pharmacist using web-cam and Skype technologies.

“It’s all about connecting with your communities — not just getting out from behind the dispensary counter but also getting out to where people are communicating, which is increasingly on the web.”

The troublemaker

Dr David More has produced the Australian Health Information Technology blog for more than four years, commenting and criticising e-health policy.

“It’s fair to say that these days, I’m mainly a troublemaker,” he says.

Hundreds of people read his blog each day — many are senior health policy-makers, he adds — and he’ll often get a dozen comments on a post before lunchtime.

A former anaesthetist who headed the Accident and Emergency Department at Royal North Shore Hospital, More is now a semi-retired e-health consultant; just as well, he jokes, because he’s annoyed so many people in government that he is rarely offered work these days.

“The main reason that I can get away with being outspoken is that no-one can threaten me. I have no commercial interests, so I’m free to say what I think.”

More says he wouldn’t be surprised if commercial pressures are dissuading professional pharmacists from commenting on controversial topics — (though he also suggests that finding the time to write regularly can be a struggle.)

The real live pharmacy

Shayne Power is an employee pharmacist at the Castletown Chemist in Esperance, WA, who has been regularly blogging health information for customers since 2004.

“I don’t get much feedback,” he admits. “I do it mostly because I take a personal interest in blogging.”

Power writes some blog posts from scratch, while others are republished PSA ‘Pharmacy Self Care’ information.

But recent posts on swine flu received comments from local residents — and he believes it’s great to have the framework there to communicate important information to customers when it’s needed.

Second Life

Dr Ian Larson, a senior lecturer in the Faculty of Pharmacy at Monash University, says that while the incoming generation of pharmacy students is highly computer-literate, the social kinds of virtual worlds are ‘not their thing.’

Larson is part of a teaching team using the web-based virtual world ‘Second Life’ to run a critical series of practical training sessions on tablet manufacture in a virtual laboratory outfitted with equipment that mimics up-to-the-minute real-world technology.

He agrees that pharmacists have been slow to adopt social media in their workplaces — but points out that in this case, the virtual world reflects real life.

“When it comes to medicines, pharmacists are far more qualified to talk about the actual effect of medicines on a body than doctors; yet when issues are raised about drug policy, you’ll hear comments from the head of the AMA or other doctors, when it should be the pharmacists taking the lead in community debate,” he says.

“We’d like to encourage pharmacists to be more active in these kinds of community debates — perhaps it needs to start with blogging.”

Where’s the evidence?

One anonymous Australian blogger is a pharmacist now working in health informatics who posts under the assumed name Diego Luego. His blog is called Evidence Based Only and it’s highly critical of many of the products typically found on pharmacy shelves.

“Ear candles — what sort of criminal nonsense is that?! No pharmacist could recommend anything like this.”

He says that his blogs are often sparked by irritation with ‘the way things are’ in Australia’s pharmacy hierarchy.

Like Robbo, he believes that the industry’s professional bodies need to speak out more about consumer drug issues rather than focussing on the business side of pharmacy.

“There’s a real disconnect in pharmacy, we don’t get paid for advice, we only get paid for selling products, it’s not an ideal model for primary health care,” he says.

Luego says that it’s not possible for him to blog under his real name as he is now working for a reasonably large organisation — and his comments are very much his personal opinion.

Halfway house

Pharmacist Neil Johnson runs a blog called i2P (information to pharmacists) which publishes articles written by a variety of Australian pharmacists.

He believes the nature of pharmacy doesn’t leave much time for blogging.

“People are more likely to comment on a pharmacy bulletin board, they pick up a thread and follow it through — because really you’re talking about a maximum of a three minute time span to make a comment.”

Johnson, who is now semi-retired, used to run a management consultant practice, and is a former contributor to Pharmacy News. He set up i2P more than a decade ago so that he could comment on various issues in the profession.

“It very quickly became apparent that when you were commenting on things about pharmacy, the Pharmacy Guild of Australia became one of the prime targets, so they don’t like me very much.”

Johnson says he’s had more than 30 pharmacists write various pieces for the blog over the years and he only screens for libel, spelling and grammar.

“There’s been a lot of criticism of AusPharm over the years because it’s a bit too careful not to upset the Pharmacy Guild and they don’t publish everything that is sent in,” he says.

“Even though we might have two or three pieces violently opposed to each other at the same time, we just let the freedom of thought run through.”

The anonymous blogger

Part-time Australian pharmacist and now medical student ‘Henry’ was inspired by reading other pharmacy blogs from the US (such as The Angry Pharmacist and Drug Monkey), to start his own blog, titled Degranulated, early last year.

“They inspired me to get my creative hat on and get into blogging,” he says, adding that while he enjoyed the cynical wit of these bloggers, he didn’t think he was angry enough to do the same thing.

“I really enjoy my pharmacy work, I like the chance to help people, and perhaps that’s partly because in 18 months, when I graduate from medicine, I won’t be a pharmacist any more,” he says.

His blog has a different aim to more sarcastic fellow-bloggers.

“I’m trying to demystify that weird profession that pharmacists have. They’re not the doctor, not the patient, not the Government — but stuck in the middle between the three,” he says.

As a locum pharmacist, Henry says he has the advantage of independence from any commercial pressure that employer pharmacists often face — but still keeps his anonymity to avoid embarrassing his employers.

“On the internet, pharmacy gets a bad rap because all you see is the warehouse pharmacies — or the spam trying to sell you Viagra or Xanax or whatever, so I think it’s nice to put the more human face of a real community pharmacist out there,” he says.

Henry says it’s a shame that the pharmacist bloggers with the widest exposure are cynical and jaded.

“It just shows what working in a dispensary for 35 years without doing much else can do to you!”

He’d like to see more blogs from the many optimistic young pharmacists he meets, who really enjoy their work, he says.

“It would be great to get more sensible information out there on drug uses and interactions, from people who answer questions about this stuff all the time.”

After a few months, Degranulated was approved by a group called Health Care Blogger Code of Ethics, giving the blog more credibility. He believes that, as blogging becomes more mainstream, it’s important to establish credibility – and that community pharmacists need to feel confident in speaking out about issues in which they have expertise.

He has used his own blog to state his opinion that over-the-counter analgesics containing codeine are heavily promoted by certain pharma companies, despite known problems with overuse and addiction.

“I don’t say anything on my blog that I wouldn’t say to a patient in a consult — and you need to be frank and honest. One of my more popular posts is about Nurofen Plus, which I have pretty strong opinions about. I realise that coming out publicly making those statements could put commercial pressure on my employer, so in respect for them, I stay relatively anonymous.”

He says he’s surprised how many people still respond to his year-old blog post about Nurofen Plus — many of them consumers who comment about their experience with codeine addiction, and believes pharmacists can really make a difference to consumers by making informed commentary about any concerns they have about the products on their shelves.

Henry also uses Twitter, but says that the immediacy of the medium can be a problem as it’s easy not to think things through before posting.

He believes that a major problem with blogs and Twitter is that it’s difficult to trust the quality of the information and suggests that the Pharmacy Guild and the PSA should run Twitter accounts.

But overall, says Henry, pharmacists are way behind many other professions in their adoption of Web 2.0.

However, he expects that it won’t be long before there are more pharmacists blogging and speaking out.

“As with many things in pharmacy, there’s a bit of cautious optimism; but as social media becomes increasingly acceptable, people in pharmacy are starting to follow suit and mix their professional and private lives.”

Top pharmacy bloggers

Bite the Dust www.bitethedust.com.au

Subtitled “A view of pharmacy and health from a very remote pharmacist,” Andrew ‘Robbo’ Roberts’ blog is a wonderful mix of personal tales about working in the remote Gibson Desert and policy commentary on pharmacy and health bureaucracies. Robbo is also on Twitter at www.twitter.com/bitethedust

Australian Health Information Technology www.aushealthit.blogspot.com

Written by e-health consultant Dr David More.

Croakey http://blogs.crikey.com.au/croakey

Medical blog, written by health journalist Melissa Sweet, includes regular pieces on pharmacy topics making the news.

Rick Samimi’s Pharmacy Blog http://ricksamimi-pharmacy.blogspot.com/

Discussion and analysis of retail pharmacy issues in Australia from Sydney pharmacist Rick Samimi, partner in the People’s Choice Pharmacy of the Year for 2009, the YouSave Chemist Macquarie Centre in North Ryde, NSW.

Castletown Chemist www.castletownchemist.com

Written by employee pharmacist Shayne Power from a pharmacy in Esperance, WA, mostly republishing PSA ‘Pharmacy Self Care’ information.

Evidence Based Only www.evidencebasedonly.blogspot.com

Written by an Australian pharmacist working in health informatics, this blog is a pharmacy-based news commentary.

Degranulated (Captain Atopic) www.captainatopic.com

Henry is a medical student who works part-time as a pharmacist and writes wry commentary about both worlds.

Some Pharmacy Guy www.somepharmacyguy.blogspot.com

An irreverent blog by an anonymous pharmacist, who responded to an email enquiry by advising that the blog is currently on hold. Still, plenty of interesting stuff in the archives.

Science-based Pharmacy www.sciencebasedpharmacy.wordpress.com

Edited by Scott Gavura, a community pharmacist in Ontario, Canada, this blog takes a thorough and critical look at a range of products sold in pharmacies. The author aligns strongly with Skeptics groups.

Pharmamotion www.pharmamotion.com.ar

Flavio Guzmán teaches pharmacology at the University of Mendoza, Argentina and produces this purely educational site with unbiased drug information.

Pharmalot www.pharmalot.com

US journalist Ed Silverman’s popular pharmacy industry blog closed in January this year, but the news side of the site continues.

Hooked: Ethics, Medicine and Pharma www.brodyhooked.blogspot.com

US Professor, MD and medical ethicist Howard Brody regularly posts commentary on the ethics of a variety of issues within pharmacy.

The Angry Pharmacist www.theangrypharmacist.com

A Californian community pharmacist posts scathing and rudely funny commentary on work-related frustrations. Similar sites include Your Pharmacist Might Hate You: www.drugmonkey.blogspot.com

Social networking groups in pharmacy

Linked In www.linkedin.com/groups

Association of People Working Within Pharmacy (Australian group)

Facebook www.facebook.com

Australian Pharmacists group More than 1000 members; popular topics include pharmacist salaries and PGA issues.

Australian Pharmacy Assistants group Sponsored by Contact magazine. A place to share stories, photos, ideas and questions.

The Disgruntled Pharmacy Students: The Anti-Weigh-Balance Group. Around 130 members in Australia, the UK and US.

Plus several groups for staff at various Australian pharmacy franchises and university pharmacy student groups.

Twitter www.twitter.com/pharmacy_news

Breaking news and interesting tidbits from the editorial team at Pharmacy News.

• Plan to force non-Aboriginal welfare recipients to have their income managed by Centrelink has split the welfare lobby http://bit.ly/af3mQA
• Watchdog consisting solely of Aboriginal politicians to monitor Government Indigenous spending labelled as racist http://bit.ly/bwHr87
• Abbott plans crackdown on alcohol abuse in Aboriginal communities including nationwide ban on community takeaway sales http://bit.ly/cZ9okk
• Australian govt program imposing radical restrictions on Aborigines in crackdown on child abuse is inherently racist http://bit.ly/djfSXg
• United Nations queries whether federal governments reforms to Intervention will ensure Australia meets its UN obligations http://bit.ly/aJalJI

The Indigenous News Updates are sourced from news and other articles from around the country that I have posted on Twitter.



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• Nuclear waste dump plans are dividing an Aboriginal clan $12m to be paid to some ownes of Ngapa clan http://bit.ly/cl1QaB
• Broome Aborigines will sign off on a native title deal worth nearly $200 million with the West Australian Government. http://bit.ly/a4VKTY
• After 10 years Broome Aborigines will sign off on a native title deal worth nearly $200 million http://bit.ly/dkUICj
• Native title agreements signed in Broome will dramatically increase the town’s supply of land http://bit.ly/baCnMp
• Sandhills Advancement Aboriginal Corporation links people to community support services. Administrator appointed http://bit.ly/d4vFKX

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• Program to employ Aboriginal high school students at stations in the western NSW will help to recruit more officers http://bit.ly/bfPk9e
• Rudd praises business leaders for indigenous jobs’ effort http://bit.ly/9hVGSu
• SA Equal Opportunity Tribunal grants exemption Aboriginal Health Worker positions filled only by Aboriginal people http://bit.ly/bDVx5c
• AGFORCE meeting the agricultural employee shortage by forging partnerships between indigenous youth & grazing industry http://bit.ly/aTeVld
• The country’s only commercial vineyard owned by Aboriginal people has just harvested its first vintage in five years. http://bit.ly/bpWxE1

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For alendronate and risedronate, weekly administration is as effective as once daily dosing. More recently, a presentation of risedronate has become available in a format that allows treatment to be administered once a month, and it is expected that this will further improve ease of administration and patient compliance.

Download (PDF, 8.64KB)

The 2009 RGH E-Bulletins are archived here.

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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

• Australian Aborigines are the custodians of some of the oldest performing traditions in the world says Grabowsky http://bit.ly/daKJgd
• Aboriginal culture faces perils in the land down under http://bit.ly/clFtsG – video from WorldFocus
• Indigenous people to be recognised as ‘first Queenslanders’ http://bit.ly/drbrVn
• Recognising indigenous people in Queensland preamble ‘divisive’ according to Qld Opposition leader Langbroek http://bit.ly/aNIJKY
• Constitutional preamble opposed by Indigenous leaders and Opposition. Indigenous say it is offensive as symbolic only http://bit.ly/b7XzMa

The Indigenous News Updates are sourced from news and other articles from around the country that I have posted on Twitter.



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Every now and then a bulldozer or grader comes along and pushes them, along with other roadside debri back into the scrub.

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• Search has begun to find six Australian Indigenous athletes to run in the New York marathon in 2010 http://bit.ly/8lI17S
• Indigenous youth Australian rules team, the Flying Boomerangs to tour South Africa http://bit.ly/55SqVV
• Sport has been demonstrated to be a remarkable way to improve well-being of indigenous communities. http://bit.ly/7hOswj
• Byron Bay local helps out Australia’s first Indigenous surf club in Gove http://bit.ly/aRZRpc
• AARON Davey is in the mix to become the first indigenous captain of the world’s oldest football club. http://bit.ly/a4Ii2T

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• Barkly Shire rejects housing maintenance contract as would be prevented from talking about housing program http://bit.ly/aI4CTP
• Aboriginal Town camps revamp better late than never: Snowdon http://bit.ly/d2Pwz5
• Town camp’s first house being built http://bit.ly/aYkgt8
• WORK has started on the first of 85 houses to be built in the Alice Springs town camps http://bit.ly/bksms5
• Town camps revamp better late than never: Snowdon http://bit.ly/d2Pwz5

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• TIME released their list of the worst dressed ice dancers. Russian ‘aboriginal’ costume wins! http://bit.ly/d0EKBc
• Aboriginal cultural theft in Olympic ice skating labelled as ridiculous http://bit.ly/do3NZp
• The movie Australia has sparked a new international audience for indigenous performing arts. http://bit.ly/a4g4UX
• Aboriginal flag was raised in Shoalhaven City Council’s chambers for the first time http://bit.ly/cUV1nO
• Indigenous people to be recognised as ‘first Queenslanders’ http://bit.ly/drbrVn

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• O’Donoghue launches research institute. Will seek philanthropic funding for research into health problems http://bit.ly/9BaYpr
• GPs Fear Consequences Of handing over Indigenous Health Records to crime commission http://bit.ly/dqPzXp
• New research program to be launched investigate ways to achieve healthy pregnancies for Aboriginal women. http://bit.ly/c1gVyL
• Difficulties of dialysis in the centre for those in the border regions of SA and WA as they move to capital cities http://bit.ly/avFCqa
• Moree will receive one new indigenous outreach worker as a result of the outreach positions funded by the government http://bit.ly/cd0t8F

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They have kindly allowed me to reproduce the articles. This is the article on remote pharmacy.

Andrew Roberts lost his real name on his first day in his new job “out bush” as a remote area pharmacist. His workplace spans a quarter of a million kilometres in Central Australia — and there, for the last four years, he’s been known simply as “Robbo”.

When he first introduced himself as Andrew, the local Aboriginal health worker responded, horrified, “That’s a Kunmarnarra name!”

“I had not considered that Andrew might be a truly horrible name before this day,” Robbo recalls, explaining that Kunmarnarra refers to a similar-sounding name to that of someone who has died — and in the local culture, the name cannot be used.

Not wanting to be known as “Mr Roberts”, he’s been Robbo ever since; throughout the area served by the 11 clinics of the Ngaanyatjarra Health Service (the Aboriginal Community Controlled Health Organisation which employs him), to hospital staff, Government bureaucrats and pretty much everyone he meets.

From that significant first encounter onwards, Robbo reckons that each day he’s learned at least as much about Aboriginal culture as he has been able to teach his indigenous patients about “white man’s health”.

Working with indigenous people in remote health involves a big cultural shift for white health workers as well as their clientele, he says.

“A chronic condition that might get managed very well in a suburban white population raises a whole lot of cultural issues with disease management in indigenous communities — and you really have to listen and understand where they are coming from,” he explains.

Robbo is clearly pretty good at explaining his role, as evidenced by a coterie of international fans who comment regularly on the stories, photos and videos of outback life that he publishes via his blog, www.bitethedust.com.au.

But he reckons the best person to ask about his work is Fran Vaughan, the force behind his employment with the Ngaanyatjarra Health Service.

Vaughan: the pilot

Vaughan’s first visit as a pharmacist to a remote Aboriginal community was more than 20 years ago, and for the last eight years she’s provided visiting pharmacy health services to several different Aboriginal health services.

But her main role is as a remote pharmacy academic at the Centre for Remote Health; she also teaches pharmacy at Charles Darwin University.

In 2005, Vaughan helped to set up a one-year pilot project to test-run a model of full-time pharmacy services within a remote Aboriginal health service.

“We obtained a grant for the project which would cover the salary of a pharmacist employed by a health service, plus some funds to run an evaluation,” she says.

That’s where Robbo came in.

“He was employed for a year to start with. It’s not a long time to make a difference, really; but by the end of the 12 months, he was starting to educate staff, he was starting to crack the surface with clinical services,” she recalls.

“What we hadn’t predicted was that he would actually save money,” she adds.

“Before, a clinic nurse would put an order in, then a locum would do another order — but Robbo went in and cleaned everything up, standardised the impress list across all the different clinics, got rid of expired stock, developed guidelines for ordering; and even over a six-month period, the spend on drugs went down quite significantly.”

After the first year, the health service concluded that the clinical input of a pharmacist was really valuable, and funded the position permanently.

“It was only when they actually experienced a pharmacist’s work that the health service realised what they had been missing out on, because nurses generally do all the dispensing and the doctors can check the drug interactions,” she says.

But Vaughan believes dispensing is barely on the radar in the role of the pharmacist in remote health — and cleaning up a drug room is just the start, she says. Education, clinical advice and on-site home medicines reviews are where the real value lies; and having a pharmacist on staff improves the skill of everyone else on the team. And, she adds, it needs continuity to be effective.

On Robbo’s hard drive

I ask Robbo to describe his average day and he laughs — there’s no such thing. He covers more than 50,000km a year, driving between health clinics in his dusty troop carrier. The roads are hard; an average thousand-kilometre round trip often involves a couple of hours by the side of the road helping someone whose car has broken down.

With 11 health clinics to service, spread out over a vast area, it’s impossible for Robbo to provide a traditional, on-site dispensary function, so each clinic still sources drugs from an Alice Springs pharmacy and the clinic nurses then supply individual patients.

Robbo provides education and information for health workers at the clinics and their patients, and he also keeps on top of the processes for ordering, storage and supply —a critical role in an extreme environment where power supplies are unpredictable.

While valuable information can (and does) come from looking at population statistics in his office, Robbo says there are great advantages in having a pharmacist sit down and talk with patients about their medications and disease states — and out bush, talking takes time.

“Even though I’ve been out here for so long and I’m quite well-known, it still takes a day or two to build up a rapport in communities,” Robbo says.

He will run education sessions on topics such as medication for diabetes and other chronic conditions for patients, or information sessions for clinic health workers as well as home medicines reviews.

“I might sit down with someone’s family group to talk about their medication. Yes, it throws patient confidentiality out, but often someone who doesn’t speak English will invite their whole family around; it’s good because it means the disease states are understood by the family a lot better, and they will support things like making sure the person keeps taking their medication, even when they’re not feeling sick.”

While the challenges are enormous, he sees the most significant value in his role is the continuity of care he gives the people in his communities.

“In our northern-most community, it was only 1984 when the last mob walked in from losing their traditional way of life. There’s a totally different understanding of health and language, of health literacy. You can only achieve change with consistent, repeated visits and discussions.”

And that change is desperately needed. Health statistics show little improvement in Aboriginal health despite decades of programs and promises. The most recent government report on the subject, the December 2008 Interim Report of the National Health and Hospitals Reform Commission, acknowledged the “inequitable health outcomes and access to health services” for indigenous Australians and the need for universal entitlement to medical and pharmaceutical services under Medicare.

A statistical overview published by the Human Rights and Equal Opportunity Commission in 2006 showed that the average life expectancy for indigenous men is 60 years, 65 for indigenous women — that’s about 17 years less than life expectancy for non-indigenous Australians. Aboriginal people have almost 10 times the rate of diabetes and three times the rate of heart disease as other Australians; infant mortality rates for indigenous babies in the NT are more than three times the national rate.

Risk factors are higher; obesity affects around 28 per cent of indigenous adults, compared to around 16 per cent of non-indigenous; and 49 per cent of indigenous adults smoke compared with around 24 per cent of the general adult population.

Second-class PBS

Robbo believes he’s the only pharmacist in Australia living and working in an indigenous community, although there are many supplying medications and consulting in indigenous health.

“Most pharmacists in indigenous health are doing Section 100 support, which is a supply service, not a service where you work with indigenous people full-time,” he explains.

Under Section 100 of the National Health Act, remote Aboriginal and Torres Strait Islander Health Services can order PBS medicine in bulk through retail pharmacies and dispense as needed to patients. The dispensing usually occurs without direct involvement of a pharmacist and there is no charge to the patient.

After many years of working within the system, pharmacist and lobbyist Rollo Manning is convinced that the existing infrastructure supporting PBS delivery is inadequate.

“Look, medicine without information is just a bottle of chemicals,” he argues.

“There’s no line of communication between the pharmacist supplying the medicine and the Aboriginal person in the community who goes to the health clinic and gets one of those packets of medicine,” he says.

“Straightaway, you’ve got a huge difference in the way the PBS is delivered there compared to the urban setting.”

Pharmacists providing a PBS medication to a remote community health clinic are paid a dispensing fee of $1.14, a fraction of the $6.00 PBS dispensing fee paid in a direct retail pharmacy.

Manning believes that the huge saving in dispensing fees to the government (he estimates it at well over $1.5 million in the NT alone) creates a second-class PBS for Aboriginal people in remote places.

“With the $1.5 million the Commonwealth saves on remote dispensing fees, we could employ quite a few pharmacists to go out to those communities and explain to people what the hell they’re getting the stuff for,” he says, adding that to his knowledge, Robbo is probably the only pharmacist in Australia employed by a health service to do outreach work in remote health clinics, rather than simply dispense medication.

In most parts of Australia, pharmacy (like the rest of the health system) targets middle-class, well- educated people who already have a pretty good idea of how to stay healthy, Manning says.

But, he says, pharmacies that supply remote indigenous communities need to be looked at as part of the primary health care system — rather than “a shop somewhere that puts stuff in a box and ships it out.”

New speciality needed

Professor Patrick Ball took up the Foundation Chair of Rural Pharmacy at Charles Sturt University in Wagga Wagga in 2005. A year later, he travelled with Rollo Manning to visit various outback centres in the NT, calling in on a number of remote Aboriginal health services. Ball had come from the UK and New Zealand, where he had many years of experience with multidisciplinary teams working in hospital support, and was accustomed to remote dispensing.

But he admits he was shocked when he saw what really happens with drugs dispensed to the Aboriginal health clinics.

“What really struck me was how little pharmacy was really involved. There’s an awful lot of packing of Webster packs and supply functions and so on, but little support in terms of medication adherence —actually getting people to take their medicines,” he says.

He said health workers estimated that only 10 to 20 per cent of the Webster packs prepared for the remote clinics were collected by patients; the rest were eventually shipped back to the pharmacy.

Many patients with chronic diseases had multiple medications which in city health services would usually involve pharmacists making regular interventions with doctors and other health professionals, he says.

“In these centres, there’s a real need for the involvement of somebody who can speak the local language,” Ball says, describing a need for a new type of Aboriginal health worker, a medication compliance health specialist.

This role would involve an indigenous person who speaks the local language who has pharmacy training in medications, particularly for chronic disease states.

Ball says several programs currently in place for indigenous communities in Kenya, Nigeria and Malaysia could provide a model for programs that would work effectively in Australia.

In traditional Aboriginal culture, there’s little understanding of chronic disease and little incentive to take medication when the patient may be feeling well — making the cultural transition to long-term disease management needs the involvement of a person who can cross the language barrier, he says.

At the same time, there will remain a need for qualified pharmacists in outreach positions to support such Aboriginal health worker posts through ongoing follow up, refreshers, training in new disease states and new medicines and there will be scope for pharmacists to be involved in home medicine reviews.

Highest need, worst shortage

The need for pharmacists in indigenous communities where chronic disease is rife is starkly apparent — yet there’s an alarming shortage.

The Australian Institute of Health and Welfare (AIHW) reported in 2008 that the rate of employed pharmacists nationally was lowest in areas where more than 20 per cent of the population was indigenous, averaging 21 pharmacists for every 100,000 people.

Areas with less than one per cent of indigenous people in the population had more than four times as many pharmacists per capita, with 94 for every 100,000 people.

The same report revealed just nine indigenous pharmacy students out of a total of more than 4000 enrolled in undergraduate pharmacy courses in 2006.

Robbo says a vacant position for a community pharmacist in his region remains unfilled after months of advertising — and believes potential applicants are fearful of the unknown.

“The hardest thing for pharmacists working in indigenous health is they have to get out of their comfort zones, leave Darwin or Alice Springs or Adelaide, and do work where they’re not sitting in a pharmacy but they are out there on the ground.”

Hope on the horizon

While pharmacists are thin on the ground in rural Australia, and few indigenous people will graduate in coming years, there’s better news when it comes to pharmacy assistant roles.

The Government-funded Aboriginal and Torres Strait Islander Pharmacy Assistant Traineeship Scheme (ATSIPATS) reports a fivefold increase in indigenous pharmacy assistant trainees, with 27 traineeships approved since the assistance package was launched a year ago.

Some pharmacy training is beginning to address the issue, too.

Professor Patrick Ball now takes third-year pharmacy students on remote health tours where they visit Aboriginal health services clinics.

“On the way to Katherine, students are taken out by a guide who talks all about Aboriginal medicines and effectively shows them the medicine section of what they call the biggest pharmacy in the world,” Ball continues.

Students are shown natural treatments, such as the use of termite mounds for treating diarrhoea.

Ball says this part of the tour strongly demonstrates the cultural divide between traditional medicine, which to indigenous people seems to have a real, meaningful explanation and origin, and the “white man’s medicine”, which isn’t well explained and is often associated with hospitals where their relatives may have gone — and then died.

Fran Vaughan believes remote area pharmacy is in its infancy, and compares it to the early days of clinical pharmacy in hospital wards, around 30 years ago in Australia.

“Clinical pharmacists started out really having to convince people that they could fulfil a need; now, in any major hospital, pharmacists are just accepted as part of the scene — they have developed standards of practice, formulas for how many beds per pharmacist and so on.”

Vaughan believes that training indigenous health workers as technicians or “medicines workers” to provide basic dispensing services in remote communities could be very beneficial. But, she points out, it’s difficult to justify training when there are currently no positions for such medicines workers, and it’s difficult to argue for such positions when there is no training.

She’s hopeful that the introduction of a new third-year unit, Rural and Remote Pharmacy Practice, which she co-teaches in the undergraduate pharmacy degree at Charles Darwin University, may be a watershed.

“Our first graduates will be out this year, so it will be very interesting to see how many go back and work in indigenous health.”

Island hopping for health

Lynn Short bought the Thursday Island retail pharmacy about a decade ago and her clients include the island’s residents, plus another 20 small health clinics in outlying islands.

“We’re the only pharmacy for about 1000 kilometres,” she says.

Much of her work is supplying medications to the health clinics and to local indigenous people under Section 100 arrangements and providing clinical support.

“In the beginning, I used to fly around the Straits clinics with a medical team on a plane — there would be doctors and midwives and podiatrists and the optometrists,” she explains.

Short had just four hours to spend at remote clinics and the staff were kept busy with other professionals, so her role was limited to sorting the dispensary.

She has since bought a boat, and with her partner (a boat captain) she now visits each clinic for a full day without other medical teams visiting.

The morning is spent tidying and date-checking stock. “After lunch is my quality time with the health centre staff. We have education modules that we create and we trade with other pharmacists, because nothing exists, so we make our own,” she says.

Visiting each clinic twice a year means two months at sea because it takes a month to get around to each of the twenty clinics. But between visits, remote clinic staff constantly phone and email her four staff pharmacists.

Of her 20 staff, 15 are indigenous. “A lot of our people are second-language English, so it’s terribly important for both the cultural benefit, but also to actually communicate properly.”

Short says proudly that when the ATSIPAT scheme was first released a year ago, 10 of the first 12 applicants nationally were her employees.

“I’m down to six assistants now, but I expected that,” she says, adding that the long commitment can be difficult culturally for many indigenous people.

Short also has indigenous staff who have privately obtained their pharmacy assistant qualifications, she says. “Judy is a grade four and qualified about 10 years ago, with her full dispensary tech.”

The ATSIPAT program will help Short build a pool of trained, experienced staff to handle growing demand for blister-packed medications.

Her pharmacy business even has a dedicated staff training area (which often doubles as a nursery for staff with very young children) and Short flies Guild trainers up for a few days at the beginning, middle and end of each grade.

“I’ve seen my staff come and go, but they come back,” she says, adding that many Islanders move to the mainland for a few years but then return; and when they do, “They will be trained and I’ll be ready for them!”

Remote placement ignites a spark

Elise Taylor is doing her honours year as a Bachelor of Pharmacy student at Charles Sturt University in Wagga Wagga, after completing a placement in Alice Springs.

Originally from the city, Taylor became enthused about the idea of working in remote indigenous communities when she travelled to remote communities as part of Professor Patrick Ball’s course.

She says that she learned an enormous amount while on placement in Alice Springs, where she worked with a retail pharmacy and with an Aboriginal health care centre with a multi-disciplinary team that included pharmacy.

“Diabetes and blood pressure management were the two most common health conditions for Aboriginal people,” Taylor says.

A recurring issue for indigenous patients was non-compliance, she says.

“A condition of the free Webster packs was that people had to bring back their old ones, and a lot of the time, they might not have taken their medication; or they were selective, they may not like the big pill for their diabetes but don’t mind taking the little ones for their blood pressure.”

Taylor says that she was surprised by the language barrier; English was a second or third language to a lot of her clients, and often they were too shy to speak to her.

Many of the patients at the Aboriginal health care centre didn’t have a formal address, she says; and because of their beliefs, they may not have a consistent name.

“It was very much a case of trusting the patients and looking at the dose that they’d brought back last time to identify who they were in the system,” she says.

• Indigenous job agency indigcareers.com.au makes the news http://bit.ly/9kDGPa others are out there such as aboriginaljobz.com.au
• APY Indigenous horrified at waste in camel cull and will set up own processing plant to export camel meat http://bit.ly/c1RLDJ
• Leaders from APY lands travel with Brough to Tiwi to look at radical changes to employment, education, housing http://bit.ly/dfl2VI
• Qld commits to 2800 indigenous public sector jobs as part of Australian Employment Covenant http://bit.ly/d8a7iK

The Indigenous News Updates are sourced from news and other articles from around the country that I have posted on Twitter.

Image source: OpenClipArt.org, public domain.

If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.

This picture is from his 2009 trip along one of Australia’s most famous routes, the Oodnadatta Track. As well as today’s Wreck Of The Week picture Wolf also has a blog post up of this trip at his blog “Insert Clever Title Here” which includes video of the 166km trip condensed into 6 minutes.

• $6.1m payout made on native title claim 14 years after event! http://bit.ly/b1la2q
• Queensland Aboriginal community scammed by rental rip-off One person, no home renting a washing machine?! http://bit.ly/akILC3
• Commentary by Larissa Behrendt and Richard Downs on Rudd’s Closing The Gap report http://bit.ly/b3cqmx
• Group of joyriding friends committed to trial for Ryder’s murder http://bit.ly/bMl0Mh

The Indigenous News Updates are sourced from news and other articles from around the country that I have posted on Twitter.

Image source: OpenClipArt.org, public domain.

If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.

• Plunge in rate of childhood vaccinations . At risk groups include indigenous Australians http://bit.ly/bS5lZh
• Morbidities & deaths from noncommunicable chronic disease are greatly increased in remote Aus Aboriginal communities http://bit.ly/d7oog4
• Trends in chronic disease mortality in the Northern Territory Aboriginal population, 1997-2004 http://bit.ly/9smtE8
• Show support for ending ATSI health crisis by holding an event for 4th annual Close the Gap Day on Thurs, March 25.http://bit.ly/9yZGx0
• South Australian Government has committed to funding renal dialysis services on the APY Lands. http://bit.ly/bytP3P

The Indigenous News Updates are sourced from news and other articles from around the country that I have posted on Twitter.



Image source: OpenClipArt.org, public domain.

If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.

However I have discovered this slide show showing what Winnunga Nimmityjah Aboriginal Health Service in Canberra provides and also lists their hopes for the future.

Julie-Tongs_Supporting-Indigenous-Communities