In thIS ISSUE · 1. Richard Osborne: Health literacy – a complex concept and key component of patient-centred care that will drive quality improvement Richard Osborne is the Professor

D E PA R T M E N T O F H E A LT H A N D F A M I L I E S www.chronicdiseasesnetwork.nt.gov.au

PUBLICATION OF THE CHRONIC DISEASES NET WORKVOLUME: 19, ISSUE: 4, DECEMBER 2010

ISSN 1836-5299

The Chronic Diseases Network

The Chronic Diseases Network was set up in 1997 in response to the rising impact of chronic diseases in the NT. The network is made up of organisations and individuals who have an interest in chronic disease, with Steering Committee membership from:

• AboriginalMedicalServicesoftheNT

• Arthritis&OsteoporosisFoundation of the NT

• AsthmaFoundationoftheNT

• CancerCounciloftheNT

• HealthyLivingNT

• HeartFoundation-NTDivision

• GeneralPracticeNetworkNT

• MenziesSchoolofHealthResearch

• NTDHFAlliedHealth/EnvironmentalHealth

• NTDHFCommunityHealth

• NTDHFHealthPromotion

• NTDHFNutritionandPhysicalActivity

• NTDHFPreventableChronicDiseaseProgram

The CHRONICLE

CDN EDITORIAL COMMITTEE

CHRONICDISEASESNETWORK

Tel: 08 8922 7770

FAX: 08 8985 8016

EMAIL: [email protected]

Contributions appearing in The Chronicle do notnecessarilyreflecttheviewsoftheeditororDHF.Contributionsareconsistentwiththeaims of the Chronic Disease Network and are intended to:

Inform and stimulate thought and action•encourage discussion and comment•promote communication, collaboration, •coordinationandcollectivememory.

In thIS ISSUE...Health Literacy: Opening Doors to health and WellbeingCDn Conference 1-28

KeynoteSpeakers 3

Conference Evaluation 10

OATSIH 13

Conference CQI 27

health Literacy in East Arnhem 29-35

Chronic Disease at Miwatj 30

ARDSInterpreters 33

Yirrkala Clinic 34

themed Resources 36

General Articles 37- 40

Combined Networks 42

CCPMSUpdate 43

“JUST KEEPS GETTING BETTER EVERY YEAR”JASMIN SMITH CDN Member Services Officer

The Chronic Diseases Network Conference had humble beginnings as a smallhalfdayworkshopin1997.Overthepast14yearsithasdevelopedintoalargescaletwodayconferenceknownforitshighstandardofpresentersandqualityworkshops.

Delegatescamefromalloverthecountrywith 256 registering for the 2010 event. TheNorthernTerritorywasbyfarthebestStateorTerritoryrepresentedwith187ofthe total number of delegates attending.

Thisyearseemstobeoneforsettingrecords with the most ever registered AboriginalandTorresStraitIslanderdelegates being supported with funding toattendbytheOfficeofAboriginalandTorresStraightIslanderHealth(OATSIH);and 2010 was also the first time there has beenaformalisedAboriginalReferenceGroupfortheconference.

Feedbackfrompreviousyearsindicatedthatthereweretoomanykeynotespeakers and not enough sessions deliveredbydirectserviceproviders,sothisyearwestruckagoodbalancebetweenthenumberofkeynotepresenters(4),concurrentsessions(40),plenarysessions(6)andinteractiveworkshops(6)whicheveryoneenjoyed.

Thisyearstheme,“Health Literacy: Opening Doors to Health and Wellbeing” was acknowledgedbyalldelegatesasbeingcentraltotheirwork.Thekeymessagesfrom the conference were that:

Therearealreadystrongefforts•underwaytostrengthenpeoplesunderstanding of health and health messages, but that there were also areas thatneeddevelopment;

Understanding health is not just about •communication, it is about education, socialchange,technologyandeconomic change to support improved health;and

Thereneedstobeatwowaylearning•process with both health professionals and clients to support understandings of health, and health concepts across cultures, ages and genders.

Some of the feedback from delegates has highlighted the value of the conference tothewayhealthprofessionalsdeliverhealth care and plan their service delivery.Onepersonquotedassaying“I really plan to change the way I do my work based on what I learned at the conference, I think I could be doing things differently to see a big change in my clients health”.

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Thisyear’swelcometocountrywasperformedbylocalartistAliMills,whograciouslytoldusthestoryofherfamilyandherhistoryaroundDarwininaninformalandrelaxedwelcometocountryceremony.Shethenwentontowelcomeustothelandof the Larrakia people and talk a little about her music.

WhenAli,aLarrakiawoman,wasalittleherfatherusedtotakeherfromroomtoroomsohecouldpointoutthedifferentsounds each ceiling fan made. In fact, her father heard music in everythingandmadesurehisdaughtersdid,too.Asaresult,Alihasbeenentertainingpeoplethroughmusicfordecades.Alidescribes Music and song as her dreaming and performed for usherselfproclaimed“oneandonlyhit”WaltjimBatMatilda,whichisWaltzingMatildasunginCreolealongwithsomeothersongssuchastheArafuraPearl.

Thewelcometocountryandsongswereenjoyedbytheaudienceverymuch,withpeopleclappingalongtothebeatandjoininginwhentheyknewthewords.ThankyouAli.

Ali Mills welcomes us to country

ALI MILLS WELCOMES US TO COUNTRY!

The audience gets involved

AfterthewelcometoCountry,JennyCleary,ActingChiefExecutiveoftheDHF,officiallyopenedtheConferenceandwelcomedtherecordnumberofdelegatestothisyear’sconference.TheCEmadesomeveryimportantremarksaboutthe importance and impact of chronic diseases in the NT and highlightedsomeofthekeyworkbeingdonetheNTtoreducetheburdenofChronicDiseaseintheNT.ThankyouverymuchtoJennyClearyforhersupportandparticipationinthisyearsconference.

Acting CE Jenny Cleary Opens the Conference

3The Chronicle December 2010

The Chronic Diseases NetworkPublication of

The 2009 CDN conference was always going to be a hard act to follow, but somehow we did it! Here is a summary of the keynote speakers from the 2010 CDN conference:

2010 CDN CONFERENCE KEYNOTES

Day 1

1. Ian Anderson: Health Literacy: an emerging agenda for Aboriginal and Torres Strait Islander health?

ProfessorIanAndersonistheDirectorResearchandInnovationattheLowitjaInstitute,DirectorofMurrupBarakMelbourneInstituteforIndigenousDevelopment&OnemdaVicHealthKooriHealthUnit,UniversityofMelbourne.

Ian Anderson addressing the delegates

Asalways,Iangaveusa‘quietlychallenging’andthoughtfulperspective on the conference theme presented in an engaging andthoughtprovokingway.Thefocusofthepresentationwasonthecontextforthehealthliteracyagenda;theAboriginalandTorresStraitIslanderBurdenofDiseaseandtheAboriginalandTorresStraitIslanderPolicyAgenda.Thetheoryofthispresentationwasexploredindepthwithtworelevantcasestudies from the literature.

Hepointedtotheneedtofocusonkeyprocessesandinterventions which support patient engagement and empowermentincarepathways;andtheimportanceofhealthliteracyinthedevelopmentofframeworksforpracticewhichsupport this.

One of the highlights of this presentation was when Ian providedaninsightfulanddisarmingpersonalexampleofahealthliteracychallenge.Ifsomeonelikehim,whoisaneducated, articulate medical doctor and researcher, has problemsunderstandingthehealthsystem,thenwhathopeisthere for a member of the general public, someone who has varyingculturalunderstandingsorsomeonewhodoesnotspeak the same language as their health professional?

2. Anne Johnson: Improving Health Literacy - Challenges for Health Professionals

DrAnneJohnsonisaCommunityEngagementConsultantfromSouthAustralia.

Anneprovidedachangeofpaceandadifferentbutcomplementaryperspectiveonhealthliteracy.Shespokeoftwo main challenges for health professionals in relation to improvinghealthliteracy:

1) Clarityofunderstandingofthemeaningofhealthliteracy;and

2) Improvinghealthliteracyinpractice.

Inanarticulateandengagingmanner,Anneinformedandremindedusofseveralkeymessagesinrelationtothechallengesassociatedwithhealthliteracy.

These included:

The need to understand how people obtain and use health •information,

Assessingwhetherhealthprofessionalsshouldscreenfor•lowhealthliteracyornot,ashealthliteracyisnotstatic-itisdynamicandevolving,and

Strategiesforimprovinghealthcommunication(oraland•written).

Annelinkedthestrategieswithkeydocumentsandleftuswithplentyof‘foodforthought’,nicelyencapsulatedin‘TheNewestVitalSign’,anexerciseforpatientsbasedonnutritioninformation contained on an ice-cream label.

Anne Johnson presenting at the conference

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The ChronicleDay 2

1. Richard Osborne: Health literacy – a complex concept and key component of patient-centred care that will drive quality improvement

RichardOsborneistheProfessorofPublicHealthandDirector,PublicHealthInnovationPopulationHealthStrategicResearchCentre,DeakinUniversity.

Therewasawealthofinformationandexperienceframedinnationalandinternationalcontextsinthispresentation.Thekeymessages included the following:

healthliteracyismorethanreadingandwritinganditisthe•foundationofeffectivehealtheducationandempowermentofpeopletoselfmanagetheirhealth;

newmeasuresofhealthliteracywillbeimportantresearch•tools,andwillguidepolicyandpractice;

theimplementationofhealthliteracytoolsandconcepts•requires local adaptation and development of local ownership,andshouldimprovequalityofcareandhealthoutcomes.

Richard Osborne keynote presentation was well attended on day 2

2. Della Yarnold: NT Medical Program

DrDellaYarnoldistheNTIndigenousTransitionPathwaysDirectorfortheNTClinicalSchool,FlindersUniversity.SheisaKooriwomanfromtheCentralCoastofNSW.DespitethefactthatshewasunwellshedeliveredanoutstandingkeynotepresentationDella’sdeceptivelysimplestyleofpresenting,made an impact and was informative, entertaining and engaging. The presentation itself was themed around the how theproposedNTMedicalProgramforIndigenousHealthwilladdresslearningoutcomesby:

Introducing innovative approaches to the Indigenous health •curriculum

Incorporatinglocalcontextcurriculum•

ImprovingeffectivecommunicationIntroducingholistic•health practices

ApplyingIndigenoushealthknowledge•

Developingacontinuousqualityimprovementapproach.•

Thesekeypointsframedthelargerquestionofhowtrainingand education should provide opportunities for ongoing reflectionofpersonalandprofessionalpractice.

Della Yarnold from the NT Medical School

IfyouwouldlikesomemoreinformationontheKeynotePresentationsyoucanvisittheConferencewebsitehttp://www.cdnconference.com.au/

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Based on feedback from participants at conferences in previous years, this year the Chronic Diseases Network Conference had a greater focus on concurrent sessions to increase the exposure of ‘coal face’ or direct service delivery programs and projects.

Care and Management of Chronic Disease- This stream wasdesignedtohighlightkeyinitiativesinwhichhealthprofessionals have begun to support self management of chronicdiseasesintheirclients,includingusingtechnologytosupport self management in remote areas and encouraging communityownershipoveraprogram.Sessionsincluded:

Addressing Health Literacy Through Telehealth •Technology: Combining High Tech Care with A Human Nursing Touch-JanetL.Grady,DrPH,RN,ANEF,JaneGetsy,BSN,RN

Improving Health Literacy in an Indigenous population •who have diabetes-MaureenToner,ToniGabelish,AlexandraWalker,DougRosas,AlisonWilliams

PCD management group models: A remote Central •Australian community pilot-SharonJohnson,ValmaiMcDonald,JessicaAbbott

Eat Better, Move More• -Tamie Needham

Workforce and Training Perspectives- this stream highlightedkeyworkforceandtrainingprogramsandprojectsfrom across the NT. Including:

Health Literacy for Health Staff – Child Health messages •embedded into standard use forms-TinaMcKinnon,LesleyNuttall,SharynHofer

Pathways to Rural and Remote Orientation and Training• - MaryKing

Building the Remote Early Childhood Development •Workforce in the Northern Territory-BarbaraMurray(MA,DipSEN,DipEd),EmilyRaso(MPH,BoT)

Developing Health Literacy “On the Job’. Transfer of skills •and knowledge between members of the Chronic Health Disease Prevention Team in the workplace.-AllanDonnelly,TracySpillman,PatriciaNundhirribala

Resource DevelopmentThis stream looked at the development of resources which areculturallyappropriatefortheirintendedtargetaudience.Sessions included:

Film making to talk about stress, grief and substance •use on Groote Eylandt-MurielJaragba,DrKylieLee,GloriaO’Hare,HelenLalara,LenaMamarika,MatthewWurrawilya,DavidHansen,JenniLangrell

Developing a localised diabetes resource with the •Victorian Koorie community to improve health literacy in the prevention and management of diabetes.-KerryWilson

The Power of Pictures in Indigenous Health Education• .- JulieTaylor

CONCURRENT SESSIONS

Bernie Shields and Alana Booth Presenting

COnCURREnt SESSIOnS

Theprogramwasstructuredbytopicstreamsandeachconcurrent session was built into this.

The Streams included a broad range of topics which provided a comprehensive overview of Chronic Disease in the NT.

thursdays Stream topics: Aboriginal Perspectives - provided a comprehensive overviewofsomeworkbeingdoneinhealthLiteracyforAboriginalpeoples.Afocuswasplacedonculturalconceptsof and core understandings of health and wellbeing among aboriginal people. The session included:

Literate/ Illiterate, What Are We Talking About?• -BernieShields,AlanaBooth

HEALTH LITERACY –what does it mean to remote •communities-GwendolynPaterson-Walley,CoralieAchterberg,LouiseDennis

An Aboriginal Community worker’s job• -ElizabethWurrulnga

Health Literacy and Indigenous Health Workers; what •does this mean?-KarrinaDeMasi,SharonWallace,AnnBolton



The ChronicleContinuous Quality ImprovementThisstreamdetailskeyContinuousqualityimprovementinitiatives in the NT

Kanyini Guidelines Adherence with the Poly Pill Study• - ConsentDVD-RickyMentha

Sharing the story about our store to improve the food •supply for our people-JimSmith,JacobSpencer

How can Continuous Quality Improvement (CQI) •approaches improve health literacy and health outcomes, when we are time poor and overburdened with chronic disease?”-MelissaRoberts,KerryCopley

Product or Process: The role of process in health literacy • - MarilynMcLellan,YurranydjilDhurrkay

Fridays Stream topics:InterpretingThisstreamexaminedtheuseofinterpretersintheNTinhealth.Keyissuescoveredincludedchallengesandopportunitiesforusing interpreters.

The Aboriginal Interpreter Service – how it’s working and •where it’s going 10 years on - Lauren Campbell, Colleen Rosas

Opening doors in communication: working with •interpreters.-FrancesAbbott

Chronic Hearing Loss Considerations in Health Literacy• - KathyCurrie

Taking on a pro-active role as an AHW in a specialist •team-SumariaCorpus,CherieWhitbread,MichelleWalding

Health PromotionThis stream demonstrated the important role of health promotioninhealthliteracy.

Reflections on addressing health literacy in remote •communities–ahealthpromotionperspective.-JeanettePastor

Daphne’s story about surviving breast cancer• - Daphne Munurrgitj,KayCoppa

Families as First Teachers (FaFT) Playgroup sets a •solid foundation for health and learning.-RosalindDjuwandaynguRuluminy,KayCoppa

DiversityThisstreamexaminedthecomplexrangeofissuesinhealthliteracyforsociallyandculturallydiversepeople.

Women’s Voices From the Heart• - Val Dearman

Health Literacy: What can we learn from other nation’s •experiences?-AliceMitchell.

BE ACTIVE – BE HEALTHY - Health literacy and Physical •Activity program for CALD communities-BalwinderSidhu,MarlinBabakhan,HienLe,RavyHeng

Health Literacy in the Refugee Population• - Le Smith, JeannieO’Carroll

Care and Management of Chronic DiseaseThis stream looked at a diverse aspects of chronic disease management

Ngawurayamangamiya-Look After Ourselves• -JaneBryant,AmanBajania,ReneeGwee

Medicines Literacy - how can we improve it? - shedding •some light-MargaretCraig,FrancisVaughan

The Best Practice Model For the Management of Type 2 •Diabetes-Shirley-AnnRowley

Health Literacy: The Big Picture Thisstreamlookedathealthliteracyonalargerscale.Itdrawson a range of concepts including the social determinants of health,adultlearningprocessesandhealthliteracyonanintentional scale.

The Cultural Eye – a two- way learning sequence• -AnneHanning,BonnieMoss,EmilyRaso

Reflections on health literacy from the World Health •Promotion Conference-JamesSmith

participants getting involved in the ‘Cultural Eye’

For more information on these presentations and on the conference in general please see the conference website www.cdnconference.com.au


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Taking control of chronic disease: strengthening communication and education strategies for Indigenous consumers.Anne Lowell, Lawurrpa Maypilama, Stephanie Yikaniwuy, Elizabeth Rrapa, Robyn Williams, Sandra Dunn

AchievingeffectivecommunicationinIndigenoushealthcareisparticularlychallenginggiventheculturalandlinguisticdiversityintheNT.ThispresentationreportedontherecentstudyofcommunicationandeducationpracticesrelatedtochronicdiseasefromtheperspectiveofIndigenousconsumersandhealthstaffinaremoteregionoftheNT.

PLENARY SESSIONS

getting ready to present

Health Literacy as Shared UnderstandingsProfessor Michael Christie, Juli Cathcart, Trevor van Weeren

Thispresentationlookedatwaystore-defineHealthLiteracywhichcentreupontheexperiencesandneedsofremoteAboriginalpatients,theirfamiliesandcommunities,andatthesametimeworktowardsaddressingthebureaucraticcomplexitiesandchangingpolicyenvironmentofhealthdelivery?

Exploring the possibilities: the role of language and culture in health literacy.Dr Alyssa Vass

DrVassdetailedrecentARDShealtheducationprojectsinNEArnhemLand,whichfocusedonhealthliteracywithIndigenouspeople.TheplenarywillexploredthedifferencesbetweenYolnguandWesternhealthunderstandings–theimpacts,challengesandopportunitiesofthesedifferencesforhealthcommunication,chronicdiseasemanagementandhealthpromotionpractices.

Perinatal Project - Improving Mental Health literacy in remote communitiesLorin James, Pip Kelly, Cathy Chapple

ThePerinatalMentalHealthProjectaimedtoidentifywomenintheperinatalperiodsufferingfromdepressionoranxiety.UsingOneTalktechnology,theEdinburghPostnatalDepressionScaleisbeingtranslatedintoIndigenouslanguagetoaidunderstandingandtreatmentofperinatalmentalhealthissues,particularlyinremoteNorthernTerritorycommunities.

Getting the message: Health literacy projects in Yolngu Matha by year 12 students at Ramingining School.Alvin Marrpindiwuy Gaykamangu, Geoff Guymer, Sharon Gaykamangu, Arlene Wanybarrnga, Jerome Lilipiyana

‘How to help our community?’

Anumberofprojectsbyyear12studentsatRaminginingSchoolweredesignedaroundthespecifichealthneedsoftheRaminginingcommunity.InoneprojectstudentscreatedAudioPostersor‘talkingsigns’withrecordedanti-smokingmessagesinYolnguMatha.InanothertheclassmadeaHealthycookingDVDfilmedentirelyinYolnguMatha.Studentsfoundtheseprojectstohavenumeroushealthbenefitstotheircommunity.



The ChronicleWORKSHOPSDay 1Sharp stick or message stick? - Health literacy and analogiesDr Hugh Heggie

Thisinteractivesessionexploredhowweengageandcommunicate with our clients around chronic disease. There is theopportunitytosharestoriesandreflectonclinicalpracticeinthebroadercontextofchronicdiseaseinordertogiveclarityandavoidconfusioninthemanythingsweaskofourclientsincluding giving truthful accounts of disease origins.

Day 2Microscopy: Foundations of Health LiteracyDr Alyssa Vass, Mr Yasunori Hayashi

In this workshop, participants will learn practical skills relating to using microscopes to teach the foundational health concept of themicroscopicworld,includinggermtheoryandcelltheory.Theprinciplesofthis“handson”educationprocesswillbeexplained,includingitsrelevancetohealthliteracyandchronicdisease education.

Dr Hugh Heggie presenting at the conference

'WHEN TALKING FAILS' and how to communicate better with Indigenous clients with hearing lossDr Damien Howard

HealthpractitionerscanimprovecommunicationsoutcomesandhealthliteracybyconsideringIndigenousclientshearingloss.Theworkshopcoveredwaystodothis.Inparticular:

Signs of hearing loss among Indigenous clients•

Helpingclientswithhearinglossgetthemostoutofwhat•theycanhear

Usingculturallybased'visualliteracy'toimprove'health•literacy'-theimportanceofusingnonverbalandothervisualcommunication mediums for clients with listening problems.

Utilisingotherculturallypreferredcommunicationprocesses•

Understanding and managing acoustics•

Useofamplificationdevices(notjusthearingaids)•

Crossing The Cultural Divide Through The Effective Use Of Indigenous InterpretersSue Stewart, Gillian Dadswell

In this interactive workshop shared the materials that were developedanddemonstratedthedifficultiesfacedbyAboriginalpeopleinunderstandingWesternhealthmedicineandinbecominghealthliterate.Participantswereinvitedtoworkwithsomeoftheinterpreterstoexperienceforthemselvesthe challenges involved in crossing the cultural divide and opening doors to health and well being.

Alyssa and Yasunori running the Microscopy workshop

A Workshop to Design Health Literacy Survey QuestionsProfessor Michael Christie, James Smith

ParticipantsareinvitedtoattendaworkshoptodiscussanddeveloppossiblesurveyquestionsonhealthliteracyforaplannedNT-wideHouseholdSurvey.

(Pleaseseearticle)

Communication and education with Indigenous consumers: strategies for improvement.Anne Lowell, Lawurrpa Maypilama, Stephanie Yikaniwuy, Elizabeth Rrapa, Jane Galathi, Rachel Baker, Robyn Williams

Thisworkshopwillexplorekeyfeaturesofeffectivecommunication and education from a Yolngu perspective, providing guidelines and demonstrating specific strategies for improving communication, including production of appropriate resources and working with interpreters. The workshop is also an important component of our commitment to research transfer and improving health outcomes.

For more information on these plenary sessions and workshops please see the CDN Conference website: www.cdnconference.com.au

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On Day 1oftheconference,ahypotheticalQuestionandAnswerpanelwasheld,entitled“Health Literacy, the Conversation Australia Needs to Have”. HostedbyLetitiaLemke,presenteronABCStateline,thepanelconsistedofNTexpertsinarangeoffieldsincluding:

DorothyMorrison–CEOoftheHeartFoundationNT, •MarkBowling-NTDirectoroftheABC,•

RebeccaForrest–ManagingDirector,ForrestPR, •GrantGalvin-GeneralManager,NTNews,and•

JoMoyle-Reiter–CreativeDirector,Adzu•

PANEL DISCUSSION

The panel is convened

The panel opened with the statement ““Literacy” is defined by the Oxford dictionary as the ability to read and write, but comprehension forms no part of the equation.”

This set the scene for an interesting and thought provoking discussionaroundthewaysinwhichhealthprofessionalsandhealthsystemscanencourageandsupportpeopletogain a better understanding of their health, the factors which influencetheirhealth,andtobeempoweredtoimprovetheirhealth.

ThediscussionfocusedonpreventioninthreekeypriorityareasidentifiedintheNationalPreventativeHealthStrategy’sRoadmapforAction,Australia: The healthiest Country by 2020, Obesity,AlcoholandSmoking.

Alcohol – The discussion around alcohol focused on the recent NTinitiativesoftheAlcoholManagementPlanandthereportreleasedfromMenziesSchoolofHealthResearchonthecostofalcohol related harm in the NT. The social and financial cost of alcohol in the NT in 2004 and 2005 was identified from health services data, crime statistics and statistics related to road accidents. It was discovered that per adult the cost of alcohol in the NT is $4197, compared to the National average of $943 per adult.Clearlythisisanareainneedofsignificantimprovementin the NT - with measures needing to be implemented to help reduce the level of alcohol abuse, and development of programsandcampaignstolookatwaysofchangingpeoplesdrinking behaviours.

Smoking- Tobacco legislation in the NT is moving at a rapid pace.TheNTbyfarhasthehighestrateoftobaccouseinAustraliaandthistranslatesintoasignificanthealthoutcome.Tobacco use is estimated to be responsible for 8.1% of the burdenofdiseaseand4%ofhospitalisationsintheNT.Recentinitiatives around smoke free venues and plain packaging forcigarettes(tobeintroducedinJuly2012)aresignificantstructural steps forward in reducing tobacco related harm. Howeverthepaneldiscussedoptionsforothermeasuresincluding the banning of tobacco sales in supermarkets, andensurethattobaccoproductsarenotdisplayedinnewsagents and service stations. The role of media campaigns andthedevelopmentofpartnershipsbetweenGovernmentdepartments,NGOandkeylocalmediacompanieswerealsomentioned with the aim of providing a coordinated approach to the improvement of health and the dissemination of good health information to the general public.

Obesity-Thenationaltrendofincreasingobesityisofconcern,bothinchildrenandadults.TherearecurrentlynoNTspecificdatasourcesonobesity,howeverkeynationalreportsindicatethealarmingnumbersofpeoplewhoareoverweightand/orobese.Thepaneldiscussedthewaysinwhichobesitycouldbeaddressed in childhood with legislative measures that could be introducedtobanunhealthyfoodsadvertisingthataretargetedatchildrenandbroadcastedduringchildren’sprogramming.Othersuggestedwaystotacklethistopiswastointroducetaxationmeasurestoincreasethecostofpurchasingunhealthyfoods,makinghealthyfoodchoicesamoreaffordableandeasyoption.


The ChronicleALANA BOOTHHealthPromotionCoordinatorOralHealthDAGMAR SCHMITTResearch&EvaluationOfficer-DHF

CONFERENCE EVALUATION REPORT

Visual Evaluation Banner

Thisyeartheconferenceorganisingcommitteedecidedtoconduct a multi – modal evaluation of the conference. This was achievedbyanoverallconferenceevaluationformgiventoalldelegates, observational evaluation of each session, a visual evaluation banner and a guestbook for general comments about the conference. Delegates were able to participate in boththevisualevaluationandtheguestbookatanytimethroughouttheconference.Thisyearwealsolinkedthelearning needs of the conference to the evaluation and enabled delegates to claim continuing professional development pointsfacilitatedbyGPNNT.Aphotoofthevisualevaluationisincludedwiththisarticle.Thefollowingarticleisasummaryoftheevaluationformsfilledoutbydelegatesandtheobservational evaluation.

TheKeynotespeakerswereabletoentirelymeetorpartiallymeetmostofthekeylearningobjectivesoftheconference.Delegatesratedtheoverallconferenceexperience,overallrateofconferenceandmixofkeynote,plenaryandbreakoutsessionsasgood,andsomeratedthesecategoriesasexcellent.No-oneratedthesecategoriesaspoor,withveryfewratingthemasaverage.Ingeneral,theoverallevaluationpresentsverypositive feedback of the 2010 CDN Conference.

Karen Duxfeild from Sunrise Health Service signing the Guestbook

WhilstthemajorityofdelegateswerefromtheNT(74.8%),theconferencehadgoodrepresentationfrominterstate(NSW,Tasmania,Queensland,VictoriaandWesternAustralia)and3overseasdelegatesfromoverseas(2fromUSAand1fromBangladesh).Themajorityofdelegates(74)chosetoattendthe 2010 CDN Conference because of the conference theme. Ingeneraldelegatesratedtheregistrationandpaymentprocessing, communication and information provided prior to theconference,conferencevenue&conferencecateringeitherexcellentorgood.Thedelegateswhoattendedpre-conferenceworkshopsalsomostlyratedtheseasgoodorexcellent.

Jason Bonson contributing to the banner

Therewereawidevarietyofindividualsessionsmentionedwhendelegateswereaskedwhatsessiontheyenjoyedthemost.Keynotespeakersingeneralwereenjoyedandmentionedbyseveraldelegates,themostpopularkeynotepresentationwasDellaYarnold,followedbyRichardOsborne.Manypeopleenjoyedtheconcurrentsessions.StandoutstreamswereAboriginalPerspectives,ResourceDevelopment,Interpreting,HealthPromotionandCareandManagementofChronicDisease.Astandoutindividualsessionwasthepresentationtitled,‘AnAboriginalCommunityWorker’sJob’intheAboriginalPerspectivesstreamonday1.Theplenarysessionswerewellliked,inparticulartheThursdayafternoonsession,whichincludedpresentationsaboutaPerinatalProject,HealthLiteracyandGenderAnalysisandthepresentationfromRaminginingSchool.Thestandoutindividualplenarysessionwasthe‘Gettingthemessage:HealthLiteracyprojectsinYolnguMathabyyear12studentsatRaminginingSchool’presentation.Ingeneralthedelegateswerecomplimentaryoftheopportunitytoattendinteractiveworkshops;therewasnoparticularstandoutindividualworkshop.TheWelcometoCountrybyAliMillswaswellreceivedandcommentedonbyacoupleofdelegates;theMediaDiscussionPanelalsoratedamention. Several delegates made comment about the huge varietyofpresentationsandthedifficultytopickastandoutfortheconference.Ingeneral,commentswerecomplimentaryofeachstyleofpresentationanddelegatesenjoyedthevarietyofsessions.

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The suggestions for the conference in 2011 can be categorised into 4 main topics: suggestions for change, compliments, suggestionsforconferencetheme/sessiontopicsandcomments on catering. Suggestions for change will be taken intoconsiderationbythe2011CDNconferencecommitteeduringtheplanningfornextyear’sconference.Therewereanumber of compliments made about the conference in general or about the conference organisers. In particular delegates likedtheUSBlanyardsandtheexhibitiondisplaydownstairs.Anumberofpeopletookthisevaluationformasanopportunitytoexpressaninterestintheconferencethemeorsessiontopicsfornextyear.Mentalhealthortopicsassociatedwithgoodmentalhealthandtheearlyyearsinfluencesonchronicdiseasewere mentioned more than once. Most delegates rated the conferencecateringasexcellentorgood,however,thereweresomesuggestionsmadeforchangemostlyaboutthelogisticsof obtaining or accessing food and drink.

More banner painting

The observational evaluation from the breakout sessions informed the conference committee about the streams thatweremosthighlyattended,issuesontimekeepingandallocationforquestions.Feedbackfromthispartoftheevaluation also suggested the need for questions at the end of each presentation rather than at the end of all presentations. Other observations also provided feedback on audience participationandattentivenessduringpresentation.WhetherpresentationswererelevanttotheHealthLiteracythemewasassessed in this evaluation. In general, most presentations were relevant to the theme and were able to provide some on the groundexamplesoftheinformationpresentedbythekeynotespeakers.

Belowisasnapshotofsomecommentsfromtheevaluationforms:

“BiggerVenue–DarwinRoomtosmall.OtherthanthatExcellentJob,welldone!!!”

“Longersessionsthan20minutes(30min?)–allranoutoftime.”

“Itwasreallygoodandverywellorganized.”

“Morenetworkingopportunitiesbyhavingdifferentgroupingsofdelegateseg:GPs,

"Academics;HealthCareWorkersetcand move through rooms and have discussion with these groups would aid networkingopportunities.”

“Breadrollswithlunch(veryimportanttoIndigenousmob).SeconddayfoodwasGreat.Fantastictoseesimilaritiesanddifferencesfromotherstates,continuetoinvitepeoplefrominterstate.”

“TheUSBforpaperswasanexcellentidea. Zumba was a good active interlude. Verylaidback,afeworganisationalglitchesbutgenerallygood.”

“Justgetsbettereveryyear!”

“Include registered delegate details intheConferenceWorkbook–goodforfuturereference/contacts;includecontactdetailsandpositionheld.”

IfyouwouldlikeacopyofthefullevaluationresultspleasecontacttheCDNon(08)[email protected]



The Chronicle

HELEN BARNARDCDN Coordinator

The seed of an idea for the 2010 Conference theme was sown at the 2009 CDN Conference.

In2009,keynotespeaker,HelenKeleherfromMonashUniversitypresentedapaper“Turningthekeyonhealthliteracytoachieve better health outcomes", posing the challenge to delegatestoreflectontheirpracticehealthserviceproviderstoworktowardsimprovinghealthliteracyintheircommunities.Conferenceevaluationindicatedthatmanypeoplewereinterestedinexploringthistopicingreaterdepth.Withtheseedsownandreadytosprout,theplanningbeganfor-“HealthLiteracy:OpeningDoorstoHealthandWellbeing”2010.

In addition to this feedback, the other factors supported the adoption of health literacy as the theme for 2010:

TheNThasthehighestburdenofdisease(BOD)inAustralia,•identifiedintheNorthernTerritoryChronicConditionsPreventionandManagementStrategy2010–2020(CCPMS); 1

TheBurdenofDiseaseandInjuryReportidentifiestheleading•BODforbothmalesandfemalesintheNTarementalhealthconditions(16.3%),cardiovasculardisease(12.4%),diabetes(10.5%),cancer(9.4%)andchronicrespiratorydisease(7%);2

Australian Bureau of Statistics provides evidence that:

Peoplearelivinglongerwithmultipleco-morbidities;•

Increasing rates of chronic conditions places high demands •onthehealthcaresystem.Governmentandotherorganisationsarefocusedonensuringtheeffectiveuseofservicesandresourcestoaddressthis;

There is an increased emphasis on reducing hospitalisation •rates and on people being responsible for self management ofchroniccondition(s).ThisisbecomingapriorityfortheNT;

That there are more people providing care for others with •chronicconditions;

Thatthepatientjourneythroughthehealthsystemisoften•complexandconfusing;

Themazeofhealthinformationandadvicegrows,with•anexpectationthatpeoplewillbeabletonavigateandunderstandit;

Healthliteracyisessentialforindividuals,familiesand•communities to have the skills and knowledge to find, understandanduseinformationtomanagetheirownhealth;

TheliteratureandresearchabouthealthliteracyinAustraliaisstillfairlynew,butitisanareathatisattractingmoreattention.Researchersandacademicsinthefieldhavediscussedthelinkbetweenhealthliteracy,healthoutcomesandchronicconditions.

“Health Literacy: Opening Doors to Health and Wellbeing”A behind the scenes look at choosing the theme of the

2010 CDN Conference

Key messages from recent research indicate that:

lowhealthliteracypredictspoorhealthstatus,including•poorer self-management and knowledge about chronic conditions;

healthliteracyisessentialintheplanninganddeliveryof•health services, and to the self-management of chronic conditions

healthliteracyisnotjusttheresponsibilityofthehealth•sector-othergovernmentdepartments,non-Governmentorganisations,communityservicesandindustrymustworktogether to address the issue.

TheimportanceofhealthliteracytoimprovinghealthisbecomingwidelyrecognisedandstronglyalignswithcurrentstrategicandpolicydirectionsintheNT,including:

theTerritory2030StrategicPlankeyidentifieshealthliteracy•as a potential benchmarking tool for health services and the importance of Territorians having a better understanding of theirownhealthandthehealthsysteminordertobemoreengaged in their own healthcare. 3

theNorthernTerritoryChronicConditionsPreventionand•ManagementStrategy2010–2020,outlinesthesocialdeterminantsofhealthasoneofthekeypriorityareasandpromotessupporting‘selfmanagement’inclients.

Giventhelevelofinterestandactivityintheareaofhealthliteracyinbothresearchandpolicyfields,theHealthLiteracytheme was endorsed.

Using a range of presentation formats, the Conference program was developed to provide delegates with a variety of learning and development opportunities that would enable them to build their awareness, knowledge and skills to:

Discusstheoverallconceptofhealthliteracyandits1. relevance to managing chronic conditions

Outlinetheimpactoflowhealthliteracyonhealth2. outcomes of clients with chronic conditions

Usetheprinciplesofhealthliteracytomoreeffectively3. manage and promote the prevention and management of chronicconditions,particularlyself-management

Contributetoimprovingthehealthliteracyofindividuals,4. familiesandcommunitiesparticularlythoseinIndigenousandrural/remotepopulationsintheNT

Identifyopportunitiesavailableforinter-sectoralstrategies5. thatpromotehealthliteracyandcontributetoaddressingsocial determinants of health in the NT

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Evaluation feedback indicates that overall, these learning outcomeswereachieved.Wenowneedtocontinueourdiscussions in the NT, take this information and learning and putitintopractice.–whatdoeshealthliteracymeanforourcommunities;howdowemeasureit?;howcanitbeimproved?Howdowebuilditintoourplanningandservicedelivery?


OFFICE OF ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH FUnDInG SUPPORt OPEnS DOORS tO PARtICIPAtIOn AnD OPPORtUnItY

References:1. Territory Chronic Conditions Prevention and Management Strategy 2010 – 2020.

Department of Health and Families: Darwin, 2009.

2. Zhao Y, You J and Guthridge S. “Burden of Disease and Injury in the Northern Territory. 1999-2003”, Department of Health and Families: Darwin, 2009

3. Territory 2030 Strategic Plan; Northern Territory Government 2009


TheAustralianGovernmentDepartmentofHealthandAgeing(DoHA),OfficeofAboriginalandTorresStraitIslanderHealth(OATSIH)wasamajorsponsorofthe2010CDNConference.TheCDNwouldliketotakethisopportunitytothankDoHA/OATSIHfortheirongoingsupport,whichin2010enabledthesponsorship of 52 people.

The sponsorship that successful applicants receive is significant, covering full Conference registration, travel and accommodation costs.

EachandeveryrecipientexpressedappreciationforthesupporttheyreceivedandinparticularacknowledgedthegreatopportunitythatattendingtheConferencegavethemtolearn,meetothersandforsome,experiencetheirfirsteverConference.

Thisyear,theCDNreceived90applicationsforsponsorshipfromalloverAustralia,withthebreakdownbeing:

NorthernTerritory 61 Queensland 5NewSouthWales 18 WesternAustralia 6

Of the 52 successful applications:

12 people presented or co-presented a paper•15peoplewerestudents;and•8werenomineesfortheCDNAnnualRecognitionAwards.•

Arangeoforganisationsandsectorswererepresentedbythesuccessful applicants:

Health sector-AboriginalControlledHealthOrganisations,Governmentservices,Hospitals,PrimaryHealthCare,YouthandJusticeHealthservices.

Education - NT Department of Education and Training, BachelorInstituteofIndigenousTertiaryEducation,NTClinicalSchool

Research-BakerIDIandaTranslatorandLanguageService.

Some of the OATSIH sponsored delegates

The CDN is proud to present this overview of the success and reachthatthisfantasticsponsorshipopportunityprovides.ThefollowingisanexcerptfromaletterofthankstotheCDN/OATSIHreceivedfromSharonWallace,AHWLecturerandCourseCoordinator;BatchelorInstituteofIndigenousTertiaryEducation

“Thestudentsenjoyedtheirexperienceandmanygotinvolvedinthesessionsparticipatinginroleplaysandaddingtoroomdiscussions.

During the feedback in class on the following week students said it was a great place to network and to see what was happeninginotherplacesofAustraliaandtheNT.Thestudentsalso noted admiration for the Indigenous Doctors who spoke duringplenarysessions.

AtthebeginningstudentswerenotquitesureoftheConferencetheme‘HealthLiteracy’butbytheendofittheywereholdingdiscussionsonthebustriphome.ManymetRegisteredAHW’swhoarefamilyandtheyenjoyedtheinformationstandsandfreepensetc!”

Onceagain,thankstoOATSIHfortheirsupport.


The ChronicleThis year’s conference had a range of additional workshops and activities that happened in conjunction with the conference.

CONFERENCE EXTRA CURRICULAR ACTIVITIES

PRE COnFEREnCE WORKShOPS

AhW CAnCER tRAInInG

The Cancer Council NT ran a pre-Conference workshop for AboriginalHealthWorkersontheWednesdayprior.SchedulingtheworkshoponthisdaymaximizedthetraininganddevelopmentopportunitiesavailabletoAboriginalhealthworkersatthistimeandprovidedanextraincentivetomakethe trip to Darwin.

The workshop was based around peer support and trained selectedAboriginalHealthWorkers(AHW’s)inthecancerdisease process, treatment and service options and mentoring forongoingsupport.TheworkshopalsodevelopedAHWknowledge around understanding the impact of cancer in their communities, and how best to assist patients through their cancerjourney.

Thisworkshopwasasuccesswith25AHWinattendance.

RESPIRAtORY WORKShOP

ThispreconferenceworkshopwasdevelopedbyChronicConditionsStrategyUnitandtherespiratorycoordinatorsoftheChronicDiseaseUnitatRDH.Theworkshopwasdevelopedto provide an avenue for health professionals working within thecommunitysettingtoimprovetheirknowledgeandskillswhendealingwithclientswithrespiratorydisorders.Itis recognised the limited avenues for health professionals to gain the knowledge and skills when dealing with clients with complicated chronic conditions.

Thecontentoftheonedaycourseincluded:

Identifyingthepublichealthandsocialdeterminants•ofhealththatinfluencetheratesofchronicrespiratoryconditions

Defining the current appropriate clinical skills and theoretical •applicationinmanagingrespiratoryconditionsinapopulation health framework.

Discussingtheimperativeofeffectivelydiagnosingand•managingclientswithrespiratorydisordersinordertoachieveimprovedhealthoutcomesinaprimaryhealthcaresetting;

Identifyingthepsycho-socialeffectsoflivingwithchronic•lungconditionsandthesystemsandsupportsthatcanassistclients to self manage their chronic condition

Feedbackfromtheworkshopwaspositive.TheChronicConditionsStrategyUnitandtherespiratoryeducatorsinAliceSpringsandtheChronicDiseaseUnitatRDHplantoofferthis

trainingin2011inbothAliceSpringsandDarwin.Forfurtherinformationonthesecoursesfor2011contactJeanetteBoland

[email protected] Phone:(08) 8926990

COnFEREnCE FIELD tRIP

TheconferencefieldtripwasaninterestingitineraryofsomeofthekeyhealthservicesaroundtheDarwinandPalmerstonRegion.TheFieldTripwasanafternoontourthatencompassed:

DanilaDilbaMainHealthClinic,•

TheBarbaraJamesAccommodation-whichsupportspeople•attendingTheAlanWalkerCancerCareCentrefortreatment,

NightcliffeRenalUnit,•

TheAlanWalkerCancerCareCentre,and•

ThePalmerstonSuperclinicsiteandAfterHoursCare•Service.

LunchwaspicnicboxesprovidedforattendeesandeatenattheNightcliffeForeshore.TheConferenceOrganisingCommitteewouldliketoextendabigthankyoutoJasonBonsonforstepping in to guide the tour at the last minute.

POSt COnFEREnCE WORKShOP“HealthLiteracy–apracticalapproach” washeldonSaturday10thSeptemberfrom 9am–12:30pmattheHolidayInnDarwin.

PresentedbyDrNikosThomacosthisworkshop was designed to reinforce the information and knowledge people gained from the conference and provide opportunities for practical application of that knowledge. The workshopwasagreatsuccess,withapproximately20peopleinattendance.

The workshop learning outcomes included to:

Understandwhathealthliteracyis,andwhyit’simportant?•

Understandhowhealthliteracyismeasuredandbefamiliar•withhealthliteracylevelsinAustralia.

Exploretherelationshipbetweenhealthliteracyandchronic•conditions

Puttogetheradevelopmentplantobetteraddressthe•healthliteracychallengesintheirpracticeandintheirorganisations/agencies

Havecompletedanumberofhealthliteracypractical•exercises

Everyonewhoattendedsaidtheworkshopwasworthwhileandthattheygainedsomethingusefulfromthemorning.

For more information on these events please visit the Conference website: www.cdnconference.com.au

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ROSALIE SCHULTzRemoteHealth-DHF

TheCDNconferencethemewashealthliteracy,achallengingconcept to understand and deliver. It was great that the workshop after the conference provided a practical approach. Ihopedtheworkshopwouldbringtogetherthedifferentunderstandingsofhealthliteracy,andgiveadirectionforresponse.

What is health literacy?There are meanings related to clients:

Health literacy refers to an individual’s ability to read, understand, and use the information necessary to enjoy good health and to obtain adequate health care in order to maintain their health1

There are meanings related to health professionals:

Providing culturally sensitive and linguistically congruent communication practices to reach and influence vulnerable populations1

Andmeaningsrelatedtoourhealthcaresystem:

Clear signage, implementing an ‘easy flow’ approach to the navigation of health care facilities, and, training staff to create and maintain a respectful and shame free environment1

Manypeopleattheconferencewereworriedabouttheterm“healthliteracy”,anditslinkstopoverty,disadvantageanddisease.Iflowhealthliteracyleadstodisease,andliteracymeanslearningtoread,thenwouldweexpectpeopletoimprovetheirhealthbylearningtoread?Andtheniftheydon’t,couldweblamethemforfailingtoimprovetheirhealthliteracy?However,ifhealthliteracyrequireseffectivecommunication and interaction between providers and clients, itbecomestheresponsibilityofhealthprofessionalsandtheirhealthsystem.Shouldwechoosedifferentwordstoreflectthis?“Sharingstories”?

the workshopThe workshop brought together these concepts and problems, and encouraged us to develop our own answers and strategies.

Forme,thekeywashowpresentersdescribedfourelementsofhealthliteracy:

Fundamental literacy1. =abilitytoread,write,speak,andwork with numbers.

Scientific literacy2. = skills and abilities to understand and usescienceandtechnology.

Civil literacy3. = skills and abilities that enable us to recognise importantissues,andparticipateinsociety.

Cultural literacy4. =abilitytorecognise,understand,anduseeachother’sbeliefs,customs,worldview,andidentitytounderstand and respond to information.

Chronic Disease Network Conference Workshop 2010- Health literacy: a practical approach – Dr Nikos Thomacos

These four elements were brought together in a model ofhealthliteracymodel.Thislinkseachofelementwithinterventionstoimprovehealthliteracy.

Improvinghealthliteracystartsatthebottom:

Interpersonal interventions1. = these enhance and develop functionalliteracy,andculturalliteracy.Theyincludeculturalawareness training, and improving communication skills.

Practice-level interventions2. =improvingthewaysweshareinformationwithclients–exchangingfunctionaland scientific literacies. These could improve mutual understandings of biomedical and non-biomedical health concepts,andabilitiestonavigatehealthcaresystems.

Structural interventions3. = interventions that can change thewaythingsaredoneorthoughtaboutstructurallywithin government, government agencies, and health care providers.Theyincludeenablingcommunityinvolvementinthe development of health services, and developing health services around the needs of communities.

Societal interventions4. = interventions to enable fullparticipationofallpeopleinsociety,throughtheenhancementanddevelopmentofpeople’sknowledgeandcapacities.

Using this format enables us to consider what is needed toimprovehealthliteracyofindividualsandofsystems.Developinghealthliteracyisameanstohealthpromotion–whichisimprovingpeople’scontroloverthefactorsthatdetermine their health, and improving their health.

Afewearlyinterventionswecandonowinclude:

Activereflectiononourcurrentpractice•

“Teachback”whereweaskourclientstoteachbacktous•what we think we have taught to them.

Useofdiagramsandmodelstoaidinexplainingand•discussing concepts

Nikoshighlightedthatkeypeopleinresearch–includinghim–areausefulresourceforpeoplewhoworkinservicedelivery.Thetwosectorsshouldengagewitheachothermorestrongly.

Reference 1.Thomacos,N.&Keleher,H.(2009).Healthliteracyandvulnerablegroups:Whatworks?Melbourne:DepartmentofHealthSocialScience,MonashUniversity.DrRosalieSchultz,SeniorRuralMedicalPractitioner,MaternalandChildHealthCentralAustraliaRemoteHealthServices,AliceSprings

Structural interventions

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nsInterpersonal interventions

Societal interventions

ScientificLiteracy

CivilLiteracy

FundamentalLiteracy

CulturalLiteracy

health Literacy


The ChronicleMICHAEL CHRISTIESchoolofEducation,CharlesDarwinUniversity

JAMES SMITH, ACTING PROGRAM LEADERHealthPromotionStrategyUnit,NTDepartmentofHealthandFamilies

Workshop Report: IndigenousHealthLiteracyBenchmarkingfortheNT

TheworkshopattheChronicDiseaseNetworkconferenceofferedanopportunityforIndigenousandnon-indigenoushealthprofessionals,academicsandpolicy-makerstoprovideinputintotheHealthLiteracyactionhighlightedintheTerritory 2030 Strategic Plan.

Twentyfivepeoplecamealongtotheworkshop.Here’sashortsummaryofkeyideas.

PrintLiteracyiswellestablishedasasocialdeterminantofhealth.MaybethenotionofHealthLiteracymightbedistractingusfromtheimportanceofprintliteracy.Butthere’snonecessarylinkbetweenthetwo.Havinggoodliteracyisonething.Havingtheconfidencetospeakupinfrontofateamofwhiteprofessionalsorknowingwheretogo to get the right sort of care at the right time is another.

Manyhealthprofessionalsfinditdifficulttonavigatethehealthsystemtheyarepartof.Thevariousrolesandstructurestheyfacewithinthehealthsystemaredaunting.Therearenumerousdemandsonhealthprofessionals–competingworkpriorities,complexhealthissuestoaddress,andchallengingworkschedules.Theyarenotalwaysinapositiontoworkthesystemeffectivelyortoreorientitsfocus.TheytoohavepoorHealthLiteracy.

TalkingaboutHealthLiteracycouldmakepeoplefeelbadaboutthemselves,especiallyiftheydon’thavehighprintliteracylevelsthemselves.WhenusedinregardtoAboriginalpeopleitisoftenusedinanegativesense,anewwayofdressing up the old idea of compliance.

ThequestionofhowweworkwiththetraditionalAboriginalsystemsoffamilyandhealingdisappearwhenwestarttalkingaboutHealthLiteracy.SodothewaysinwhichAboriginalcommunitiesaredoingthingsdifferently,increativeandinnovativeways.Besides,healthmeansdifferentthingstodifferentpeople.Itisnotjustbiomedicallydetermined.

HowmightwebenchmarkHealthLiteracy?CouldweuseKeyPerformanceIndicators?Itwouldbebettertouseexistingonesthancreatenewones.Forexample:accesstoanduptakeofhealthservices,healthpromotionandeducation, cultural awareness training, monitoring of chronic diseases, immunisation rates, interpreter engagement, ‘absconding’rates,theproportionofAboriginalstaffintheworkplace,inclusionoffamilyinassessments,provisionforhearing loss.

Maybeachecklisttoassessdifferentserviceswouldbeagoodidea.Butwewouldneedtostartbytalkingtopeopleindifferentcontexts–remoteclinics,hospitalwards,topend,desert,homelands,townshipsaskingthemtotellthegovernmentwhattheythinkHealthLiteracyactuallyis.

TheCanadianshaveframedHealthLiteracyaspartofanationaldiscussion.Butifweworktoimprovethewholesystem,maybetheAboriginalclientsandtheirfamilieswillstillfallthroughthecracks.WeneedmoretalkingtogethertodefinewhatwemeanbyHealthLiteracyindifferentcontexts.

[email protected]@nt.gov.au

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Heart Foundation1.

EXHIBITORSDepartment of Veterans Affairs 2. One Twenty One Seventy (MSHR)3.

Exercise & Sport Science Australia4. General Practice Network NT5. DHF - Closing the Gap - Child Oral Health 6.

Australian Indigenous Health Infonet 7. DHF - Territory Palliative Care 8. Dept of Education and Training 9.

Remote Area Health Corps 10. NT Aids & Hepatitis Council 11. Good Health Alliance NT 12.

ARDS 13. Centre for Remote Health – CARPA14. IBERA15.


The ChronicleQIPPS16.

EXHIBITORSNiche Medical17. DHF - CDN / CCPMS18.

DHF – Acute – CanNet, Renal19. Charles Darwin University20. NT Clinical School21.

Health Living NT22.

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SnAP into Life – A health education board gameAlice Tippetts, Julia Broadley

SNAPintoLIFEisafun,interactiveandculturallyappropriategameforplayersages7andup.ItaimstodevelopawarenessoflifestylehealthriskfactorssuchasSmoking,Nutrition,AlcoholandPhysicalActivity(SNAP).Italsocoversbasichealtheducationtopicsincluding‘OurBodies’,MentalHealth,EnvironmentalHealthandRoadSafety.

CONFERENCE POSTERS

Community Voices Coming through the Chronic Disease Story Board

Bernadette Sheilds, Dagmar Schmitt,

TheChronicDiseaseStoryBoardisaninteractive,portablecommunicationtooltoshare health information around preventable chronic conditions, developed with and forAboriginalcommunitiesintheNorthernTerritory

Care Plan health Promotion Posters: A way of Reading and Learning Chronic Condition Self Management in Aboriginal Communities

Patricia Mitiel Gahanao, Dr Inge Kowanko, Penny Van Pelt

DevelopinghealthpromotionandhealthliteracythroughstoriesofChronicDiseaseclients‘stars’inself-managementthroughcareplanpartnershipswithanAboriginalHealthService.Combiningclientgoals,successes,healtheducationandrepresentativeindividualdatasuchasHbA1c,BMI,cholesterolonposterstopromotecareplanningand self-management in the clinic.

Barriers and Enablers to Shared Care

Kate Race, Megan Evans, Fiona Nash, Courtney Gardener

Webelievethathealthliteracyplaysamajorroleinunderpinningconsumermotivationandaccesstoservices.‘BarrierstoprimaryhealthcareintegrationforpatientswithType2DiabetesandChronicHeartDisease’aredepictedasaFishboneDiagram(rootcauseanalysis)inaposterpresentationforthisconference.


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MAJOR SPONSORS-

Department of Health and Ageing

Platinum Sponsors General Practice Network

NT

Silver Sponsors

Heart Foundation NT NT - Department of Education and Training

NT Clinical School

Bronze Sponsor Hesta

Satchel Sponsor Healthy Living NT

Keynote Speaker Sponsors

Lanyard Sponsors Chronic Diseases Network

Health Promotion Strategy Unit

Australian Health Promotion Association-

NT

Thank you to the Conference Sponsors

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For more information on these Sponsors please see theConference website: www.cdnconference.com.au/sponsors.html



TheHon.KonVatskalis,MinisterforHealthhostedaConferenceWelcomeReceptionatParliamentHouseintheeveningofthefirstdayoftheconference.ThereceptionwasanAlcoholfree event in keeping with the conference principles. In his addresstheMinisterthankedthemanypeopleinvolvedinorganisingtheconferenceandthemanyconferencesponsors;acknowledgedthekeynotespeakersandwelcomeddelegatesandpresenterstotheconferenceandtoParliamentHouse.

WELCOME RECEPTION

Robyn Williams, Helen Barnard and Hon Kin Vastkalis, Minister for Health at the Welcome reception

The Minister discussed the conference theme and talked about its importance in health, and in particular chronic disease. The MinisterhighlightedtheChronicConditionsPreventionandManagementStrategy(CCPMS)anditsfocusonthesocialdeterminantsofhealth,theimportanceofamultidisciplinaryteam approach to self management in chronic disease and howimportanthealthliteracyisforconsumersandhealthprofessionals as part of this.

The evening included two awards ceremoniesTheannualChronicDiseasesNetworkRecognitionAwards,1. andTheHeartFoundationAnnualAwards2.

Bernie Shields having a great time at the Welcome Reception

ThesepresentationswerefollowedbysomeinformalnetworkingandthensomeentertainmentbytheAfricanNationsgospelchoir.Thechoirwasextremelywellreceivedbyeveryoneatthereceptionwithmanypeopleinthecrowddancing along to the songs.

Christine Connors, Hugh Heggie and Jenny Cleary enjoying the reception.

ANNUAL CHRONIC DISEASE RECOGNITION AWARDS

TheChronicDiseaseNetworkRecognitionAwardscelebratetheachievements and outstanding contributions of NT individuals, teams and organisations. The awards are a testament to the diversity;commitmentandvalueofworkbeingdoneinthefield of chronic disease. The annual awards were presented bytheHon.KonVatskalis,MinisterforHealthataceremonyatParliamentHouse,followingtheopeningofthe14thAnnualChronic Diseases Network Conference.

PeoplefromacrosstheTerritorywerenominatedbytheirpeersand colleagues in recognition of their valuable and tireless workandcontributionstothefieldofchronicdiseasein4keycategories.

1. Chronic Disease Program Delivery AwardThis award recognises a team or an organisation that has implemented a program that:

Isbasedonthekeyprinciplesofhealthpromotionandthat•activelyaddresseschronicdiseaseriskfactorsortheimpactof chronic disease

Hasachievedsignificantimprovementand/orinnovationin•healthservicedelivery(qualityinitiatives)

Theprogramdemonstratessustainability,engagementwiththecommunity,isbaseduponcurrentevidenceandincorporatescomprehensive evaluation.

The2010WinnerofthisawardisTheAsthmaFoundationNT-for innovation in project implementation addressing chronic lungdiseaseintheNorthernTerritory–“BetterOutcomesforLungDisease”(BOLD)project.

The team from the Asthma Foundation with their award



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2. Aboriginal and Torres Strait Islander Health & Leadership AwardTwoawards,onemaleandonefemaleAboriginalandTorresStraitIslanderperson,whocurrentlyworkinthefieldofChronicDisease and have made an outstanding contribution to Aboriginalchronicdisease/healthintheNT.

The person must work in an urban, rural or remote setting and acrossarangeofrolessuchasLiaisonOfficer,HealthPromotionOfficer,HealthWorker,Communityworkers,Women’s/Men’sHealth,MentalHealth,DrugandAlcohol,Nursing,Trainees,planning,policyorresearchworkers.

Female

The2010WinnerisBora Sarah Bukulatjpi -Forexcellenceandleadershipinengagingherteamandcommunitymemberstoimprovechronicdiseasemanagementinthecommunity.

Male

The 2010 winner is Terrence Guyula-Formanyyearsofcommitment and outstanding achievement in reducing chronic diseaseinAboriginalmeninthecommunity.UnfortunatelyTerrence was not present to receive his award however it was presentedtohimattheconferencethefollowingday.

Bora with her award

3. Individual outstanding Contribution to the Field of Chronic DiseaseAwardedtoanindividualwhohasmadeoutstandingcontributions in the field of chronic disease, considering factors such as best practice, innovation, leadership, mentoring, advocacyrolesandcontributionstostrategicplanning,policyand research.

ThisyearthiscategoryhadjointWinners

Estrella Munoz• -Forleadershipinchronicdiseasemanagementandexcellenceinprovidinganevidencebaseto inform health practice, and

Hilary Bloomfield• -Forleadershipindevelopingandimplementingamultidisciplinarychronicdiseasemanagement program.

The ARDS Team at the awards ceremony.

Estrella and Hillary

4. Conference Theme AwardAwardedtoateamorindividualthathasachievedsignificantinnovationand/orcontributionintheareaofworkdirectlyrelatedtothatparticularyear’sconferencetheme.

The 2010 winner is Aboriginal Resource Development Services-Fortheirextensiveworkindevelopingculturallyappropriate health education resources to improve the health literacyofAboriginalpeople

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ANNUAL CHRONIC DISEASE RECOGNITION AWARDS



TheHeartFoundationLocalGovernmentAwards,establishedin1992, are national awards that recognise initiatives that build a senseofcommunity,encouragepeopletobephysicallyactive,besmoke-free,andmakehealthyfoodchoices.

Award Categories include:

Employee Health & Wellbeing1. - recognises Local Governmentsthatimprovetheiremployee’shearthealththroughintroducingphysicalactivity,healthyeatingorsmoke-free initiatives in the workplace.

Facilities2. -LocalGovernmentsthatdevelopandimplementinitiatives that encourage the use of their facilities to improve heart health.

Healthy Weight3. -forLocalGovernmentsthateffectivelyimplementinitiativesthatpromotehealthyeatingand/orphysicalactivitytoachieveandmaintainahealthyweight.

Planning for Active Living4. -thiscategoryrecognisesLocalGovernmentsthatencourageactivelivingthroughurbanplanning initiatives.

Priority Groups 5. -recognisesLocalGovernmentsthatdevelop and implement initiatives in collaboration with the communitytoimprovethehearthealthofprioritygroups

Tobacco-forLocalGovernmentsthatimprovetheircommunity’shealththroughreducingexposuretoenvironmental tobacco smoke and providing assistance to help them quit smoking.Two NT entries were successful in achieving recognitioninthisyear’sHeartFoundationLocalGovernmentAwards:

TheCentralDesertShire’sSoftballTournamentfor•IndigenousWomenProgramwasnamedtheNorthernTerritoryOverallWinnerandalsoreceivedthecategoryaward for Priority Groupsinthe2010HeartFoundationLocalGovernmentAwards;and

ActivateNT–HealthyLifestyleChallengewhichwasrun•jointlybytheDarwinandPalmerstonCityCouncilsreceivedahighlycommendedawardintheHealthy Weight Category.

Award

ForfurtherinformationontheHeartFoundationLocalGovernmentAwardsvisitwww.heartfoundation.org.au/lga

FormoreinformationpleasecontactHeartFoundationNT: AngelaPanagopoulos,Programs&EventsCoordinator,on T:(08)89822702

The Softball for Indigenous Women program team with their award at parliament house

The Central Desert Shire then went on to be named 2010 Joint National Winner of the National Priority Groups Category for their ‘Softball Tournament for Indigenous Women’ initiative for which received a sum of $2,000 to support the program and a commemorative photo frame. The awardswerepresentedbyMsHelenEgan,PresidentHeartFoundationNT,torepresentativesfromtheCentralDesertShireandActivateNTattheCDNConferencefunctionatParliamentHouseon9thSeptember.

TheCentralDesertShire’s‘SoftballTournamentforIndigenousWomen’offersaplaceforIndigenouswomentocometogether and socialise while competing and celebrating theirsportingabilities.TheHeartFoundationjudgingpanelwasimpressedwiththeprogram’shighparticipationlevels.Thetournamentisagoodexampleoflocalgovernmentplanning and implementing initiatives to improve the health oftheircommunity.Localgovernmentsplayapivotalroleinintroducing structural change, implementing policies and creating supportive environments which allow people to be healthy.

Central Desert Shire Wins NATIONAL


The ChronicleThisyear’sconferenceentertainmentwasamixedbagwithrangeofinterestinganddifferententertainmentideas

TherewasthebeautifulvoiceofAliMillssingingsomeofherfavouritesandplayingherUkulele,bothtowelcomeustocountryandtoclosetheconference.Shetalkedalotofherchildhood and how growing up in Darwin meant that she had tomakeherownfunandinventwaystoentertainpeople.ApparentlytheHulawasapopularwaytodothis,andshesucceededingettingBernadetteShieldsandChristineConnorsgetting on stage to demonstrate.

CONFERENCE ENTERTAINMENT

Learning the Handshake Dance

Alihadawayofgettingheraudienceengagedwithherperformance and keeping them entertained. She had the entire audienceupdoingthe“HandshakeDance”whichinvolvedlaughter and a complete lack of coordination on the part of some.

TheAfricanGospelChoirwhoentertainedthewelcomereceptionwithsinging,colourfulcostumingandsomeexcellentdancemoveswasenjoyedbyeveryonewithsomecheeringand dancing along with the music.

The choir starting the Party

GaynorGarstone,diabeteseducatorforthetopendwowedand encouraged the crowd with some fantastic Latin dance stylingsintheformofZumba.Gaynorusesthedancestyleasawaytomotivatesomeofherclientstoexerciseandenjoyexercising.Therewasmuchlaughterfromthecrowdandacouple of red faces from the conference organising committee (whowereenthusiasticvolunteers)uponstagewithGaynordemonstratingtheirrhythmicabilities.

Like Lambs to the slaughter – the conference organising committee learn that they are going to be demonstrating the dance Zumba to the crowd

The crowd bust a move.

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Chronic Diseases networkConference Organising Committee 2010

CHRONIC

DISEASES

NETWORK –

CONFERENCE

ORGANISING

COMMITTEE

2010

THANK YOU

AND WELL

DONE!

Helen Barnard

Chronic Diseases

Network

Dagmar Schmitt

Department of

Health and

Families

Angela Panagopoulos

Eventuate

Robyn Williams

Charles Darwin

University

Alyssa Vass

Aboriginal

Resource

Development

Service

Julie Cook

Department of

Health and

Families

Jasmin Smith

Chronic

Diseases

Network

Alana Booth

Department

of Health and

Families

Maureen Toner

Wurli Wurlijang

Aboriginal Health

Service

Kristine Holmes

General Practice

Network NT

Sharon Johnson

Department of

Health and

Families

Thank youAnd Well

Done!


The Chronicle


Thisyear,2010,theConferencecommitteedevelopedasetof“Conferenceprinciples”thatprovidedaframeworktotheplanning of the event. This was to ensure that the Conference modelled positive practices that are health promoting, environmentallyfriendlyandculturallysafe.TheCDNhasastrongcommitmenttotheprinciplesandtheywillcontinuetobe an important part of the planning process for the future.

THE CDN CONFERENCE PRINCIPLES ARE TO PROMOTEPOSITIVE PRACTICES THAT ARE

health Promoting, EnVIROnMEntALLY FRIEnDLY / Green & Culturally safe

We are committed to being a Health Promoting Conference by:

Providinghealthyfoodoptions,includingmeetingspecial•dietaryrequirements;

Beingasmokeandalcoholfreeevent,inparticular,the•Conferencereception;

Providingreadilyavailabledrinkingwateratalltimes;and•

Incorporatingphysicalactivityintotheprogramwith•walkingsessionsatlunchtimesandstretchingexercisesbetween sessions.

We aim to minimise the environmental footprint of the Conference by:

Usingre-cycledpaperforallprinting;•

Providingreusablewaterbottles;•

Establishingarecyclingprogramtocaterforunwanted•conference items including:

name tags•lanyards•brochures/paper•

Providingareusablebaginsteadofasatchel,madefrom•environmentallysustainablematerials;

Sourcingconferencebagsandotheritemsfromlocal/•NTsources,therebyreducingtheamountoffreightandConferencemiles;

Reducingpaperusagebyprovidingalldelegateswith•alanyardcontainingaUSBstickthatcontainssponsorinformation, abstracts and presentations and CDN information,therebyreducingthesizeoftheConferenceprogrambookandamountofprintingrequired;and

Usingrecycled/environmentallyfriendlyofficeand•stationaryproductsforallCDNpromotionalmaterials.

PRACTICING WHAT WE PREACH! CDNConferencePRINCIPLES

We aim to ensure the cultural safety of the Conference for delegates by:

EstablishinganAboriginalTorresStraitIslanderConference•ReferencegrouptocontributetotheplanninganddevelopmentoftheConferenceandprogram;

ApplyingforsponsorshipfromDoHA/OATSIHtosupport•Aboriginalworkers,studentsandpresenterstoattend;

Havinga“Buddysystem”inplacetoprovideasupport•person for first time delegates or people from remote places thatwouldliketoteamupwithsomeone;

Havingaflexibleabstractprocessincludingarangeof•abstract formats and submission options and ensuring that assistancetodevelopabstractsisavailable;

IncorporatingAboriginalkeynotespeakersandpresentersin•allsessions,particularlyfromtheNT;

Developingaprogramstructurethatincorporatesavariety•offormatstylesandsessionlengths;

Providing“yarningplaces”forpeopletositandbetogether•andtalkabouttheirwork;

Ensuringtheavailabilityofinterpretersthroughoutthe•abstract submission process, for presenters and during the event,ifrequiredand/orrequested;and

Usingavarietyofdifferentmethodsofevaluationand•feedback mechanisms

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CONTINUOUS QUALITY IMPROVEMENT – AN IMPORTANT PART OF THE CDN CONFERENCE PLANNING CYCLE

HELEN BARNARD, CDN Coordinator

Evaluation is important to the Conference. All feedback is read and where possible your suggestions are taken on board for the following year. On the whole the feedback from the 2010 Conference is very positive. For more of the feedback please see the Conference Evaluation Article. The Conference Organising Committee would like to provide a response to some of the feedback.

2. Modelling positive behavioursPlease try and be more green• P• lease see the Conference principles article.In response to a suggestion of offsetting fligh• ts to the Conference, we will encourage people to do this for next year on the Conference website.

Please serve alcoholic drinks at Conference • functionsG• iven that this is a Chronic Disease Conference and based on the new Conference principles, the Committee decided not to serve alcohol at any related Conference events.

1. VenueAir conditioning – too hot, too cold• The CDN is exploring venue options for 2011•

People were not able to access sessions that • they wanted to attendIt is difficult to predict who will want to • attend which sessions and which rooms to allocate the session to. Room allocation was done considering a range of issues including requests from some presenters to be put into a small room, as they did not feel comfortable to present in a large space. We tried to respect presenters’ requests where possible in an attempt to support their needs.

Knowing where to go for sessions was • confusing – need Directions / mapReally good idea, we will include a map in the • Conference satchels next year.

3. Indigenous involvementMore Indigenous people in attendance• The CDN is an NT wide network. While our • work explores issues around Indigenous health and Indigenous people are encouraged and supported to participate, the CDN is a network for all Territorians78 of the 250 delegates identified as • Aboriginal.26 out of 49 papers accepted this year were • presented or co-presented by Aboriginal people.An Aboriginal Torres Strait Islander Conference • Reference group was convened for the first time in 2010OATSIH Sponsorship meant that, 52 Aboriginal • people from across the Australia were sponsored to attend the Conference. Please see OATSIH article

4. LocationHave it in Alice Springs• The CDN Conference is held in Alice Springs • every 5 years. The next Conference to be held in the Centre will be in 2013

5. RegistrationReduced registration for presenters• Reduced registration for presenters was • available

Open registration the afternoon before the • start of the Conference to avoid “flood” on the first dayPre-registration will be available for 2011. • A number of strategies are being explored to assist with streamlining the registration process for 2011.

NOTICE BOARD

We hope it is helpful for you to get some insight into considerations that go into the planning of a big event such as this and how important feedback is to our planning. Constructive feedback, positive or negative is helpful feedback.

If you would like to join the Conference Organising Committee for 2011, please feel free to contact the CDN on (08) 8922 8280 or [email protected]


The ChronicleNOTICE BOARD


6. OrganisationInclude registered delegate details in the • Conference bookIt was intended to include a delegate list • on the complementary USB stick that was provided to all delegates (on their lanyards), in an attempt to minimise paper usage.- Due to unforeseen circumstances, this was not able to happen this year.

Include sessions lists at entry of rooms• Great idea. Will do!•

Keep to timing• Session chairs were all provided with information • about how to run a session and the importance of keeping to time.

If possible, synchronise concurrent session • between the rooms, so that you can move between rooms to hear topics you want to learn more aboutThis would be difficult, and although it would • be great, it would mean loosing a considerable amount of time in the program.

People should always be free to move between • sessions at any timeIt is always hard to choose which sessions to • attend. Moving around to different sessions is fine, but we ask people to consider the presenters. if you do plan to move, sit near the exit so that you can leave quietly and without too much disruption to the session.

7. ProgramBuild in more local examples presented by the • practitioners / link up expert and a community to develop a collaborative presentation.The program had a strong focus on NT based • initiatives. This year, 68 abstract submissions were received, an increase of 119% from 2009 Of the 40 programmed concurrent sessions, 30 • featured NT projects, All of the interactive workshops and 5 of 6 plenary sessions were NT basedA number of presentations were co-presented and • were based on collaboration between community members, community based workers and “experts” / health professionals.

Increase number of interactive workshops• 6 interactive workshops were incorporated into • the program this year – this is a new initiative, based on feedback from 2009. In addition, 2 pre-conference workshops and 1 post-conference workshop were held.

Less policy and more coal face please• Within the program, 5 presentations focused on • policy initiatives. The CDN considers it important to provide a balance of topics in the program and to incorporate big picture issues relating to the broader health system that impact on service providers.

More networking opportunities, especially with • specific groups eg. AHW’s, GP’s, Academics etcNetworking is integral to all Conferences, in • particular the CDN Conference. Incorporating some innovative ways to encourage networking will be considered for the 2011 program.It is also important for all delegates to take the • opportunities to meet and talk with others – make it happen!

Different ending to encourage people to stay• Getting people to stay until the end is a • problem! Any ideas gratefully received.

8. Support and guidance for presenters

Greater guidance for presenters on how to • conduct workshopsGuidelines for abstract submission were available • and widely distributed.Support to develop abstracts was freely available • and promoted and was taken up by a number of abstract authors.

Clearer presenter instructions required?• Information and tips about developing presentations • were available on the Conference website.

Keynote speakers had their slides cluttered • with information – which we needed to hear but it was not presented to effect….

ALL presenters w

ere provided wit

h a briefing

• about str

ucturing their pre

sentation, Conferenc

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learning outcomes

, audience demog

raphics and

other background

information.

Interpreters so A

HW can give presen

tations in

• language

Interpreters were

available to all ab

stract

• authors,

presenters and de

legates, if require

d.

On this occasion, no

-one chose to tak

e up this

option

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Location:TheEastArnhemRegionislocatedinthefarnorthoftheNorthernTerritory,boundedbytheArafuraSeatothenorthandtheGulfofCarpentariato the east.

Size:Approximately41,000sqkm.-TheEastArnhemRegionisuniqueamongtheregionsintheNorthernTerritoryinthatalllandisheldintrustbytheAboriginalLandTrust,whichisenactedundertheAboriginalLandRights(NT)Act.

Major Towns:Nhulunbuy(alsotheregionalservicecentreofEastArnhemLand),AlyangulaonGrooteEylandt,Galiwin'kuandMilingimbi.

Climate:TheclimateofArnhemLandistropicalmonsoonwithawetanddryseason.Temperaturescan range from overnight lows of 15 degrees Celsius inthedryseason(ApriltoSeptember)todailyhighsof33degreesCelsiusinthewetseason(OctobertoMarch).Theclimatemakestransportthroughouttheregion difficult as most roads become impassable during the wet.

Population:ThepopulationoftheEastArnhemregion at the time of the 2006 census was 13 942 persons.Nhulunbuyishometoanestimated4111people, or 29% of the total population in the East Arnhemregion.

Traditional Owners:TheYolngu,aretheAboriginalAustraliansofnortheastofArnhemLand.Yolngupeoplearelinkedbylanguageandarichandcomplexculture.Thesocialstructureisbasedonclansandmoieties.ClansareextendedfamilygroupsandtheyarethefoundationofYolngusocialorganization.Clanmembershipispatrilineal.Yolngugroupsareconnectedbyacomplexkinshipsystem.Thissystemgovernsfundamentalaspectsoflife,includingresponsibilitiesforceremonyandmarriagerules.

Industry:ComprisesmainlyofMiningwhichmaintains a value of $1 600 000 000.00, making it asignificantemployerintheregion.Tourismandassociated industries such as leisure and fishing servicethe230000visitorstotheregioneachyear.

References:NTG,(30thApril2010)“InvestNT”[online]Availablefrom: www.investnt.com.au/research-your-investment/northern-territory-regions/east-arnhem-nhulunbuy.shtml

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The ChronicleJASMIN SMITHMember Services Officer - CDN

Miwatj health provides outreach services in chronic diseases, men’s,childandmaternalhealthtocommunitiesintheEastArnhemregion,includingTownBeach,Nhulunbuy,Gunyangara,GalupaandWallabyBeach.MiwatjHealthalsoprovidesaclinicserviceinNhulunbuyandGaluwinku.Miwatjprovidesapproximately10000consultationswithkeyhealthstaffandgenerateapproximately22000Medicareitemsperyear.IntheNhulunbuyregionaloneMiwatjprovideshealthservicesto1800people.MoreclientsareseenatGunyangaraandatGaluwinku.

MIWATJ hEALth ABORIGInAL CORPORAtIOn CHRONIC DISEASE

Miwatj Health Clinic in Nhulunbuy

HealthLiteracyisintegraltotheworkdoneatMiwatjHealthAboriginalCorporation.Ithasbeenpartoftheorganisationalplanning process for some time and has continued to strengthen health and wellbeing of clients. There are organisational policies and procedures that support clients to understand and improve their access to health care. The Miwatjclinichasadedicatedspaceformen’shealth,includingtheirownwaitingarea(forthosethatfeelmorecomfortable),ashowerandseparatetoiletsfacilityandmalehealthprofessionals.SimilarlyallclientsthatpresentattheclinicarefirstseenbyanAboriginalHealthWorkerandthencanbereferred to other health professionals as needed. Clients are alsoabletorequesthavingtheAboriginalCommunityWorkerattend appointments. In addition to this Miwatj has a robust orientationprocesstofullyeducatestaffaboutYonguculture,kinshipssystems,andtheimportanceoftheenvironmentonhealthandwellbeing,thisensurestheyhaveabroadunderstanding of the issues facing their clients, enabling to better interact with their clients. This organisational culture ofindigenousculturalsecurityextendstoAboriginalstaffmembers, with favourable working conditions that include cultural leave entitlements to provide a supportive working environment.

Angela Woltman, director of medical services at Miwatj

Miwatjhealthintotalhas120staffmembersintotalincludingCatherineHampton,anIndigenousRegisteredNurse,whoistheChronicDiseaseProgramCoordinatorhasadedicatedpositionworkingwithclientswhohaveChronicDiseases.Herworkreflectsadedicationtoaddressingthesocialdeterminantsofhealthandimprovingthehealthliteracyofherclients.

ThefocusofCatherine’sworkistoensurecareplansaredrawnup and implemented for people with chronic diseases, monitor the health of her clients and provide education and support to improvehealth.AspartofthistheChronicDiseaseoutreachservice Catherine travels in the Miwatj van- which is kitted out to be a mobile clinic to perform regular check-ups and screeningvisitsforclientswithchronicdiseases.Whilepeoplearebeingscreened,Catherineandcommunityworkerswilltalktothemabouthowtheyarefeeling,howtheyaremanagingtheir medications and other aspects of their health. Often group education sessions are organised as part of these visits. One of the biggest challenges Catherine has talking to clients abouttheirhealthisalanguagebarrier.Manyclientsdonotspeak English as a first or second language and communicating effectivelysometimesneedstobethroughthirdparties.

WewenttovisitoneoftheoutstationstowhichCatherineprovidesservices.Thescenerywasabsolutelystunningwithawhitesandybeachthatthecommunitysitsjustbackfrom.Inthatsamecommunitywemetaladywhoalongwithhersisters had diabetes and had developed a local support group to encourage and facilitate progress in self-managing their diabetesThesixsistersmakeahabitofcomparingtheirregularscreening test results to compete for the best results. This friendlysiblingrivalryhasmeantthattheseladiesforthemostpartsuccessfullymanagediabetes.

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Catherine Hampton from Miwatj

WatchingCatherinetalktothisladyitisclearhowdedicatedshe is to her work. She takes a broad interest in the health andsocialissuesofherclientsandtheirfamilies.Whilethereshe arranged for a financial advisor to come and talk to the communityaboutmanagingmoneyandthebasicscard,atimeforanalcoholanddrugcounsellingsessionforthecommunityandchasedupontheadulthealthchecksforthecommunitywhilechattingtotheladyaboutwhatshewasdoingandhow


TraceySheehanisaPreventableChronicDisease(PCD)EducatorworkingintheEastArnhemregionofNhulunbuyfortheDepartmentofHealthandFamilies(DHF)..ARegisteredNurse,,TraceycompletedhernursingdegreeatAustralianCatholicUniversityandisworkingtowardshermastersofPublicHealthwithMenziesSchoolofHealthResearch

OriginallyfromMelbourne,TraceyandherfamilyendedupintheNTviaunusualmethods.DecidingtoseeabitofAustralia,theSheehan’sbroughtayacht,packedthingsupandsaileduptheeastcoastofAustraliaworkingastheywent.Tracey’shusbandwasofferedajobinNhulunbuyandthefamilymovedthere.

TraceyquicklyestablishedherselfasaregisterednurseworkingintheemergencydepartmentofGoveDistrictHospital..Shebegan to notice a pattern of people presenting at the ED with healthissuesthatreallydidnotrequireemergencycare.Theyeithercouldhavebeenmanagedmuchbetterinaprimaryhealth care setting, their health issues could have been preventedorwithsomeeducationtheycouldhaveeasilyselfmanaged their own health. This pattern tweaked an interest in acareerchange.TheroleofactingPCDeducatorcameupandTraceywontheposition.

APCDEducator’smainroleistoprovidesupport,guidanceand to update the skills of health workers working in

remote communities. This can be as simple as a debrief phone call with a health worker or as formal as running a training session to maintain or improve clinical skills relating to chronic disease prevention andmanagement.Traceyissometimesinvolvedingroupandcommunityeducationsessionsforvariouscommunities around chronic conditions prevention and self management.

TRACEY SHEEHAN Nurse, Sailor and Preventable Chronic Disease Educator

shewasgoingwithherfamily.AswewereleavingCatherinetook the trouble of pointing out 6 of the 20 or more homes there.Thesewerethehomesthatdidn’thavesomeonelivinginthemwhohadachronicdisease,andtwoofthesesixdidn’thaveanyonelivinginthehomeatall.

SomeofthekeyfuturedirectionsofCatherine’sworkincludestrengtheninghealthliteracyinherworkandinherclients.Someofthekeytargetsareasshehasidentifiedtoworktowards include:

Increasingfoodsecurity-workingwiththelocal•supermarketstoencouragetheprovisionhealthyfoodchoices,scopingforaprojecttohaveasimpleratingsystemfor food, depending on their nutritional value for clients.

Increasing client understanding about medications and their •management.

Increasing care and education around diabetes, as this is •the chronic disease that has the highest burden of disease. This includes improving the number of adult and aged care healthchecks,completingcyclesofcare,increasingbriefinterventionsanddevelopingstepbystepeducationalguides to thing like medicine and insulin use.

TocontactCatherineorMiwatjHealthAboriginalCorporationpleasecall:(08)89391900orvisitthewebsite: www.miwatj.com.au/

Someofthekeyservices,intheareaofchronicconditions,aPCDeducatorprovidesare:

Provisionofsupportandguidancetoclinicalstaffand•service providers working in remote settings.Providingsometrainingandup-skillingforremotehealth•professionals to maintain or improve their clinical skills.Somegroupand/orcommunityeducationsessionsaround•chronicdiseaseandhealthylifestyles,however primarily the role is supporting remote service providers to do this.Monitor the progression of chronic disease management in •theEastArnhemregion.

TheroleofthePCDeducatorisprimarilyforDHFclinicsandstaffmembers;howeverTraceybelievesthattoachievethebestpossible outcome for clients a cross sectoral approach and team workisrequiredtofullyaddressacommunity’shealthneeds.

TraceyworksaspartofatwopersonteamwithTraceySpillman–theotherPCDeducatorinEastArnhem.Theyworkmostoftencollaborativelytoachievethebestoutcomespossibleforremoteareahealthworkersandthecommunity.ForexamplewhenaclinichasaskedforaPCDeducatortocomeandprovideaneducationsessiontoacommunitygrouparounddiabetesbothTracey’swillattend.WhileonetalkstothecommunityaboutdiabetestheotherTraceywillvisitacommunitygrouporcommunitycentretotalkaboutanotherhealth issue, or provide support and training at the local clinic.

CurrentlythePCDteam’smajorroleistohelpsupportclinicstaffmemberstoinputtheirclientdataintothePrimaryCareInformationSystem(PCIS),anelectronicsystemnewtotheEastArnhemregion.PCDalsoplayanimportantroleintobaccocessationprogramsincollaborationwithAlcoholandOtherDrugs(AOD)andMiwatj,(anongovernmentorganisation),andrenal case coordination.


The ChronicleOncethestoryisdeveloped,thepeopleinvolvedwillrecordaconversationaboutthestory.Thisconversationisthenstoredonthecentralcomputerdriveandaccessedbytechnicalstaffmembers to prepare it for broadcasting.

Editing and mastering the sound files.

The editing and mastering process is done on a computer usingspecialisedsoftware.Itinvolvessomeonephysicallywearing headphones, listening to the broadcast and deleting longpauses,‘umms’and‘ahhs’andmakingsuretheflowoftheconversation, and the volume of the conversation is good and easytolistento.Oncethisisdonethesoundfileisstoredinthecomputer database.

AnotheraspectofYolnguradioisaroundmusic.CareistakentoensurethemusicisrelevanttotheYolngupeople.GaiaOsborne, sources a lot of the music. Most of it is Indigenous music,bothtraditional(recordedfromceremoniesandotherkeycommunityevents)andcontemporary.HoweverthereisaJohnnyCashandElvisrevivalwiththerebeingahighnumber of requests for both. Music is sourced through a series of partnerships with local and national bands and record companies.Oncethesesongsaresourcedtheyarealsostoredon the database and the broadcasting programmer allocates whenfilesshouldbe‘played’onairandhowoften.

Thisprogrammingaspectiskey,asfeedbackandquestionsfromcommunitiesoftendeterminewhattypeofinformationshould go on the radio and at what times. It is all managed through a comprehensive software program that makes theprocesssimple.Oncetheprogrammesaresettheyareautomaticallysentoutbythetransmittertoallofthelocalisedbroadcastingstations(placedinthelocationsmentionedabove),andontopeoplesradios.

What happens in Yolngu Radio

Yolnguradiostationisafantasticexampleofusingmoderntechnologytodisseminatekeyhealthmessagestoawiderangeof people.

FormoreinformationortolistentoYolnguradioonlinepleasevisittheARDSwebsite:www.ards.com.au/radio.htm

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In2006,ARDSestablishedaradiostationdesignedtodeliverkeyeducationalmessages.Educationalmaterialisprimarilyaroundhealthbutalsoimportantlyonlaw,economics,politicsand some other topics. These messages are in the form of storiestopeoplelivinginNorthEastArnhemLand.YolnguRadioServiceaimstomeettheinformationaccess,self-learningandadulteducationneedsoftheYolngupeople.AllstoriesaretoldinLanguage,orinamixofEnglishandLanguage.

Yolngu radio was developed and is maintained through a series of government grants and charitable donations. Yolngu radio is currentlybroadcastfromtheDarwinARDSofficeinWinnellie;toapproximately20locationsintheNTincludingDarwin,Nhulunbuy,Yirrkala,Galiwin’ku,Milingimbi,Gapuwiyak,Mapuru,Banthula,Gurrumurru,Garrathalala,GanGan,BalmaDhuruputjpi,Donydji,Yilpara,Ramingining,Wandawuy,Ŋadayun,Mirrŋatja&MataMata.Thisisahighlyeffectivetooltodispersekeyhealthmessagesandimportantinformationtoawiderangeofpeoplethatmaynothaveaccesstothisinformation otherwise.

YolnguRadiowasdevelopedbecausecontemporarymediaand education services are not meeting the needs of Yolngu people.Primarilybecausetheydonotcommunicateinthelanguageofthepeopleandtheydonotworkfromthepeople'sculturalknowledge.Yolnguradiodoesthis.ThereisadeeplyconsultativestorydevelopmentprocessinwhichkeyYolngucommunityeldersandtranslatorsworkwithARDSeducatorstodevelopthestory(seeARDSstory).Thiscaninvolveaphoneconversationoraworkshoponcommunity.OftenitoccursintheWinnellieofficerecordingstudio.Thestudioissetuptobeafriendlycomfortablespacewherethestorydevelopmentcanhappeninformally.ThisisbestsuitedtothewayYolngupeoplework.Oftentherearecushionsandeveryonesitsonthefloorwith a big piece of butchers paper and some markers to talk and note the important points.

AT ARDS

Gaia Osborne at ARDS, using the recording equipment.



HOW INTERPRETERS WORK WITH ARDS

ARDSusesahighlyconsultative,twowaylearningprocesstodevelopkeyhealthmessageswhichareinvariablyinthelanguageappropriatetothecommunitytheyareworkingwith.OftenpeopleworkingatARDSwilllearntheYolngulanguages;howeveritisextremelyimportantthattheyworkwithinterpretersandculturalexperts.YurranydjilandWängarr aretwowomenwhoworkwithARDStoimprovethehealthoftheir people.

YurranydjilDhurrkayisaWangurriwomanwhoworksasaninterpreter,andSandraWängarr-aDjambarrpuynguwomanwhoisascripture-in-useworker,bothworkattheGaliwin‘kutranslationcentreonElchoIsland.TheyagreedtobeinterviewedbyDrAlyssaVassforthechroniclewhiletheywerein Darwin for work.

YurranydjilandWängarrbothworkwithARDStodevelophealth messages for a range of mediums including radio, print andaudiovisualinlocallanguage.Yolnguoftenfeeltheylackallof the relevant information needed to know about their health and make informed choices about their health. These women worktogetherwithARDSeducatorstobreakahealthconceptdownanddevelopfromthatakeymessagewhichfitswithYolngu understanding of the world and helps to provide Yolngu people with the much needed information around their health and wellbeing.

WäŋgarrandYurranydjildescribethisprocessofcomingintoworkatARDSandlearningwhatdifferentpicturesshowabouthealth,andunderstandingwhattheysay.ThentheysitandlearntogetherwiththeARDSeducatorstonamethemostimportantpartsofthestory.“You[ARDSeducators]revealtheEnglishwordstous.Atfirstwedon'tknowthesewords,andthenyougiveusthemeaning.Butthenweseethemeaningfromour[Yolŋu]worldvieworperspectiveandthenyouanduscan find the match between the words and meanings.“

Teamworkisincrediblyimportanttothisprocess.Yurranydjildescribesthisasfollows“Wedon'tcomehere[Darwin]onourown,wecomeonlywhenweareaskedtocome,todoworkhere. If we tried to work alone we would have no programs or ideas,sowhenwegethereweseethewordsandwestudyanddothisworkalltogether”[YurranydjilandWäŋgarrandARDSeducatorsAnnaandAlyssaienon-IndigenousandYolŋu].“Weworkasateam,soourworkis“spoton”.Alonewecannotachievethework.”

YurranydjilandWängarr are in the often unique position of beingabletoseetheimpactoftheirworkfirsthand.Theyhave some interesting stories around where that has worked extremelywellandsomewheretherehavebeenafewmisunderstandings. The two ladies recount a number of stories abouttheirsuccesses.OnestoryWäŋgarrtalkedaboutwashelpingherfamilytolearnaboutRheumaticHeartDisease.

ShetaughttheparentstowatchoutforthesignsofRheumaticHeartDiseaseintheirchildrenandkeepinginlinewiththeARDSphilosophy,talkedtothemaboutwhattheycandotopreventRheumaticHeartDisease.Wängarrsaidthatherfamilyisconfident,happyandknowwhattodowhentheyspotthesignsofRheumaticHeartDiseaseintheirchildren.

TheAntibioticsstorydevelopedbyARDStotellthestoryofbacteriaandhowantibioticsworkinthebodyhasbeensuccessfulinanumberofways.

ManyYolngusaytheydon’tlikegoingtothehospitaltobetreatedbecauseoftentheyneedtowaithourstoseeadoctorandtheygiveupwaiting.AcommunitygroupwatchedtheAntibioticsDVDandtalkedtohealtheducatorsandinterpretersfromARDS.Thesepeoplehavelearnedthatwhentheygetacuttheshouldwashitinsaltwatersothatitdoesn’tgetinfected or use bush medicines as appropriate to prevent infection,andonlyifitdoesgetinfectedshouldpeopleseetheclinic.

InterestinglytheAntibioticsDVDhashelpedonefamilytoconsistentlybrushtheirteeth;howeverithasalsoledtoamisunderstanding.OneyoungboywhohadwatchedtheAntibioticsStoryhadtakenparticularnoteofthehistoryofpenicillin. It is important to remember that traditional healing practices of Yolngu people encompassed collecting bush fruits, Whenhegotaninfectedcuthewentandfoundanumberoforanges with mould and fungi growing on them, believing theywouldcontainpenicillinandthiswouldfixhiscut.Yurranydjilfoundhimintheprocessofeatingtheorangesandexplainedtohimthedangersofwhathewasdoing.Itisclearlyimportanttorememberthatshowingacommunitygroupor person a resource or DVD is not enough as it can lead to misunderstandings when knowledge and practices outside of anexistingworldviewareintroduced.Thereforeitisextremelyimportanttomakesureyoualsotalktopeopleandensuretheyhaveunderstoodthekeymessagesyouweretryingtogetacross.

TherolesthatWäŋgarrandYurranydjilplayatARDSarebeyondthatofaninterpreterorculturalbroker.Theyarecompletelyengaged in the planning and development process of a project fromtheverybeginning.ThiscompleteconsultationgivesARDSitsstrengthandrelevancetothecommunityandpeopletheyaretryingtoreach.


The ChronicleJASMIN SMITHCDN

YIRRKALA CLINIC - Chronic Diseases Team

The chronic disease team at Yirrkala clinic is made up of AnaseiniMalupoRN,TerenceGuyulaAboriginalHealthWorker,aGPwhohasrecentlystartedand3otherAboriginalHealthWorkers.TheclinichasdedicatedchronicdiseasedaysonMondaysandFridayswhereapproximately10peopleeachdaywithexistingcareplansarefollowedupandscreenedasnecessaryandnewpeoplearestartedoncareplans.

Eachvisitaclienthasisusedasanopportunitytotalkabouthealth and wellbeing. Most education is done on an individual basisbecauseofclientconfidentiality;howeverAnaandTerrencenotehowusefulitcanbesometimestotalktofamilymembers about the health of their loved one. Terrence gave an exampleofwhenpeoplearequittingsmoking,itisimportanttotalktothefamilyabouthowthepersonmightreacttotheirwithdrawal, so the environment can be more supportive at home.

Terrence,AnaandKayRamsay,theRNstudentworkingatYirrkalaonhercommunityhealthplacementsatandtalkedtomeforawhileabouthowtheytalkwiththeirclientsabouthealth.

From left Kay, Ana, Jasmin & Terrence with the CDN Chronic Disease Recognition Award Terrence won

TerrenceandAnarelatedanexampleofaclientthatdidn’thave good health knowledge around their medications. The person was taking some medication and had memorised theirdailyintakeaccordingtothecoloursofthetabletsandnotthename/purposeofthetablet.Theprescribingdoctorhadexplainedthepurposesofthetabletsbutitwasn’twellunderstoodbytheperson.Thispersonwasmanagingtheirmedications quite well until the supplier changed and the tabletsalteredcolour.Theyceasedtotaketheirmedications,believing someone had sent them the wrong ones and their healthgotworse.Theycameinfortheirregularscreeningcheckup(aspartoftheircareplan)andtheirlackofmedicationwasnotedthroughabloodtest.Aftertalkingtothepersonaboutwhytheystoppedtakingtheirmedicines,andhavingalookatthemedicines,theyexplainedthatitwasthesamemedication.Theyalsoexplainedhowimportantitisthatiftheyarenotsure

abouttheirmedicationstheyshouldcometotheclinic(orcall)andaskaboutthem.Theyalsodevelopedsomestrategiesaroundensuringtherightmedicationswouldalwaysbetaken,usingdailydispensingbox,

ThisexamplehighlightedsomeofthethingswhichareessentialtohealthliteracyinYirrkala:

To ensure the health messages and education is delivered in •aneasilyunderstoodformat-Thiscanmean:

Delivering education in language, using interpreters or •Aboriginalhealthworkersetc

Usingwords/phrasesthatareataleveltheperson•understands well, without being condescending or superior

Usingpicturesandconceptsthatareeasilyrecognisable•andunderstoodbytheperson.

Creating an environment which is supportive and safe for •the person to manage their health. This can include visiting people in their homes, working with the local supermarket andtakeawaycafetoensuretherearehealthyfoodoptionsavailableandinaneasilyavailablepositioninstore;

Healthstaffmakingsuretheymakerecommendationsabout•health that make sense and are appropriate and within the person’scultureorlifestylecontext.

Healthprofessionalsneedtoalwaysgivethepersonthe•‘fullstory’,forexampleinsteadofjusttellingsomeonetheyneedtoexerciseandeatwell,explainwhyandwhathappenwhenpeoplechoosetoexerciseorchoosenottoexercise.It is important to give peoplethetwooptions(healthyandunhealthy)andtheconsequencesofthis,letthemdecideand respect that decision.

Some of the Yirrkala Clinic staff hard at work.

The CD team at Yirrkala clinic talked about some of their clients withdiabetes.Waystogetpeopleexercisingandeatingwellis to encourage them to hunt for traditional foods, dance at ceremonies and talk to them about how this is the better optionfortheirhealth.Theteamfindspeoplearegenerallyhappiertoadoptthehealthierlifestylewhentheoptionsforthisalreadyexistintheireverydaylife.

Some of the best achievements the chronic disease team have include seeing people become more aware of their health andwhattheirtestresultsmean.Morefrequentlypeopleareactivelymonitoringtheirhealthandbecomingmoreengagedin their care plans.

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MARION WHEATHERLEY

WELL WOMEN’S WORKSHOP AT YIRRKALA 21ST SEPTEMBER 2010

FundingwassecuredfromtheNBOCCtoholdaBreastAwarenessDayinYirrkalaMulti-purposeHall.Apartnershipbetween:BreastscreenNT;CancerCouncilNT;DepartmentofHealthandFamilies;LaynhapuyHomelands;MiwatjAboriginalCorporation;YirrkalaHealthCentreandothersworkedtogethertoputonthisverysuccessfulday.

Tobegintheday,planeswerecharteredfromthehomelandstobring the ladies in to take part as well as the Yolngu ladies from aroundtheNhulunbuyareathatwerepickedupbyvehicletoattend the event.

Arackofprelovedpinkclothingwasavailablefortheladiestoselectonregistrationwithpinkbracelets,pinkhairspray,pinkballoons,pinkstreamersandpinkflowersalsoonhand(actuallyanythingthatwasPINK!).

Firstlywhentheladiesarriveditwastimeformorningteawithfreshfruitandsomenutsservedasahealthysnack.FormalitiesbeganwithLynneWalkerandEunisMarikawelcomingthe80peoplethatattendedtocountryandMarrpalawuyMarikaandGundimulkMarawilibothassistedinculturalbrokeragethroughouttheday.

TheworkshopconsistedoffiveeducationsessionsonBreastAwarenessandHealth.Betweenthesessionswereballoongames,celebrityboobsandprizedraws.Aftersessiontwothere was a break for lunch with sandwiches, fruit and cupcake boobsservedtokeepwiththetheme.Theladiesenjoyedmusicanddancingatthistimewitheveryonehavinglotsoffun.ThroughoutthedaytheladiesalsoenjoyedhavingtheirnailspaintedbyChristie.

Backtobusiness,theremainderofthedaytherewasa–DVDand sharing stories of breast cancer. It was moving to hear the storiesofbreastcancersurvivors.Wealsotalkedaboutwhatwehadlearntetc.andthenlastofallevaluationsandthankyou.

In-betweenthelastsessionstheirwereseveralprizedrawsandthetwomainprizesofValourblanketswereforTHEMOSTCREATIVEladyinPINKandLUCKYLAST.

Theevaluationofthedaybytheladiesshowedthattheyenjoyedthedayandespeciallythemusicwiththedancing.


The Chronicle

SNAP into LIFEisafun,interactiveandculturallyappropriategameforplayersages7andup.Theaimofthegameistosupportandencouragehealthylifestylechoicesinyoungpeopleforimprovedhealthinadultlife.Whenplayingthegame:

Playersdevelopawarenessoflifestylehealthriskfactors•suchasSmoking,Nutrition,AlcoholandPhysicalActivity(SNAP)andtopicsincluding‘OurBodies’,MentalHealth,EnvironmentalHealthandRoadSafety.

Playerslearnmoreabouthealthyeatingandhowtheir•bodies work.

Healthylifestylechoicesarerewardedbyplayersmoving•forwardinthegametothesportsacademy,goingoutbush, getting a place in a training course, further education or a job.

Theyalsofacecriseswhenthelongtermconsequencesof•unhealthylifestylechoicesbecomeobvious–andtheyaresentofftothehospital,tothealcoholrehabilitationcentreand sometimes even to prison.

ThegamehasbeenspecificallydevelopedforandtrialledintheKimberley(WA)howevermaybeappropriateforotherareas.

TofindoutmoreaboutSNAPintoLifepleasecontactSNAPProjectOfficer JustineHolmeson0417904538or email: [email protected]

Dhawu Diabetespuy IsaDVDdesignedtoassistYolngupeoplefromGapuwitaktolearnaboutDiabetes.Thisprojecthastakenoverayeartodevelop and is spoken in language, with English Subtitles.

IttellsthestoryofDiabetesandhowitimpactsonthebodyatthephysiologicallevel.

PleaserefertoarticleANewDiabetesDVDinYolnguformore information

DVD’sare$10each.Toobtaincopypleasecontact:SandraWoodward:[email protected]

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ES ONE TALK TECHNOLOGYOneTalkTechnologyhasidentifiedthatamajorbarrierincommunication of health messages is the language barrier. Ifonesideoftheequationislefttoconstantlyguessatwhattheothersideistryingtosay,misunderstandingsoccur.These misunderstandings and issues around culture and literacycanleadtodisharmonyanddistrustandthegapwidens. The difficulties involved in communicating with traditional Indigenous and multilingual audiences are well documented. Conventional communication tools do not provideaneffectivemeansofcommunicatingwithanaudiencethathasalimitedproficiencyinwrittenandspokenEnglishlanguage.

The OneTalk suite of products enable people to access informationintheirowntimeand,mostimportantly,intheirown language.

•talkingposters, •talkingalbum/books, •talkingflipchart/storyboards, •talkinganimationsMMS/TVC/online,and •translation,recording,illustration,andartwork services

OneTalkisconstantlyseekingoutinnovativewaystogetyourmessagesacross–ifyouwishtobeinformed of our new developments please email us.

Contact: BillUlstrup,OneTalkTechnologyPtyLtd(IPAustraliaPatents) Indigenous and international communications T:0414393775,E:[email protected] www.onetalktechnology.com.au



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AttheheartofARDShealtheducationishealthliteracy.AsARDS’sSeniorHealthEducator,Iworkwithadedicatedteamto create health education resources – radio programs, DVDs, booksandtherecentlylaunchedDictionaryofAnatomy.Wealso conduct health education workshops in communities throughoutNorthEastArnhemLand,Yolŋucountry.Weseek to build understandings between two worldviews – thebiomedicalorWesternhealthworldview,andtheYolŋuworldview.Thismeans,newinformationaboutWesternhealthcanbeintegratedintoexistingculturalpracticesandknowledge,thusbuildinghealthliteracy.

Duringmywork,thequestionIhavebeenaskedthemostbyYolŋuis“Whatiscancer?”ManyYolŋufeeltheydon’tgetenoughinformationaboutwhatarenewdiseasesforthem.AsaresultARDShasprioritisedcancereducation.Thisinvolvesaseries of radio programs that attempt to answer that question forYolŋu–“Whatiscancer”-inawaythatismeaningful,relevantandinlanguage.WeaimforthistoresultinYolŋupeoplebeingsatisfiedthattheyhavethedhudi dhäwu – the deeperstory,afullunderstanding.

TheveryfirststepinARDSeducationisnottoteachanythingatallbuttospendtimefindingoutwhatYolŋualreadyknow.Thiscanbebothtraditionalknowledgeandcontemporaryunderstandings.WhenIfirstaskedYolŋuwhattheyknewaboutcancer,theysaid“nothing”.Iwasn’tconvinced,sowesatdowntogetherinsmallgroupswithcommunitymembers,elders,interpretersandtalkedsomemore.WhatwasrevealedisthatYolŋuhavealargebodyofknowledgeaboutcancer.Forexample,mostYolŋucanconfidentlylistthegeneralsymptomsofcancerintheirownlanguage–weightloss(binydjitjthirr ŋayi),lossofappetite(bäyŋu ŋayi djäl ŋathaw),fatigueandweakness(djawaryun ŋayi).Thehaveaveryrealexperienceofthehighdeathrate,whichisreflectedincancermorbidityandmortalitydata in Indigenous communities. There are also understandings fromthetraditional“health”orspiritualsystemsaboutwhyandhow someone might get cancer.

ThenextstepinARDSeducationistofindwaystoanswerYolŋuquestionsbyconnectingtheanswerstowhattheyalreadyknow.Westartconversationsaroundwhypeoplegetthesymptomstheydo.Fromthere,people’squestionsaboutcancerbegantochange–wetalkedabout“lumps”ortumoursthat“steal”fromthebodysotheycangrow.Peoplewantedtoknowwhatexactlywasthe“lump”thatgrows,andhow.BeforeweknewitweweretalkingaboutcellsandDNA.WefoundwordsinYolŋulanguages,andconceptsfromtheYolŋuworldthat

hEALth LItERACY At ARDS: THETWOWAYLEARNINGPROCESSBY DR ALYSSA VASS, AboriginalResourceandDevelopmentServices(ARDS)

accuratelyandeffectivelycommunicatewhatthesethingsare;andhowtheycansitalongsidebiomedicalconceptstogivedepthtothenewknowledge.Examplesofthisinclude:

Burukpili• is a native fruit that has seeds piled up inside – much like a bunch of cells grouping together to create a largerorgan;&

DNAhasbeentranslatedas• wäyuk – which denote both the spiraled, patterned strings which hang from ceremonial armbands, and law of the strictest order. If the pattern or string is broken, it can mean serious trouble – much like damagetothe“pattern”ofDNAcanleadtocancer.

Thesewordsandconceptsmustbeusedintherightcontext.Byitself,burukpiliwillnotinstantaneouslygivesomeoneapictureof“cell”.

ARDSvaluesthesaying:“The process is more important than the outcome”.Thismeansthatthetwo-waydialoguebecomes the empowering element, and thus the outcome. The explorationthroughYolŋulanguagesgivesYolŋutheabilitytonameforthemselvesthethingstheyarelearning.TherespectforwhattheyknowalreadyallowsYolŋutobeasmuchteachersastheyarelearners.ARDSdonotbeginwithpre-determined‘list’ofthingsthatwewanttheparticipantstohavelearntbytheend.Westartandendwithaconversationandtheoutcomeisthateveryone,includingtheeducator,haslearntsomethingnew,andhopefullybeenempoweredintheprocess.

ARDShasjustrecordedaseriesofnineaudioprogramsoncancer–thesearecurrentlyplayingonYolŋuRadioandwillbeavailable on our website as podcasts soon. These are just the firststep–withfeedbackfromthecommunity,andasmorepeoplehearthestory,weknowmorequestionswillarise,andYolŋuwillfindmoreandbetterwaystotalkaboutthesenewconcepts for themselves. The process never stops!

ARDSeducatorsspendmanymonthslearningthemethodologydescribedabove,Yolŋulanguageandworldviewandbuildingrelationships.Ifyourorganisationisinterestedintheprocessesweuse,andwanttobuildhealthliteracyintothecoreoftheworkyoudo,ARDScanconductprofessionaldevelopmentin-services.WeareplanningtorunHealthWorkshopsonthesetopics.Youcanregisteryourinterestbycontacting [email protected].

FormoreinformationonARDS’healthworkpleasevisit: www.ards.com.au/health.htm


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In1997,mywifeandIloadedeverythingweowned(includinganewbabyson)intoasecondhandLandcruiserandheadedfortheNT.Wesoonfoundourselvesworkingwithaquiet,dignified and gracious people known as the Yolngu.

It became clear to us that one of the major challenges of workinginEastArnhemwastryingtoexplainverynewandaliendiseasestoYolngupatients.Whilewemadeprogressinsomeareaswith(forexample)picturesofblockedcoronaryarteriesorshrunkenkidneys,thediseasethatalwaysstumpedus was Diabetes.

There are 3 basic problems when educating about diabetes. One,thereisnopre-existinginformationaboutthisillnessinYolngutraditionalculture;two,itisaninvisibleillness–becauseeverythinghappensatamicroscopiclevel;threepeopleintheearlystagesofdiabetesoftenfeelquitewellanddon’trealisetheyaresick.

ANEWDIABETESDVD IN YOLnGULANGUAGE

DR STEPHEN BRYCE – G.P. GapuwiyakHealthCentre,EastArnhem

Local men increasing their physical activity through traditional dancing

Becauseofthis,Isecretlyhopedthatdiabeteswouldremainanot-too-commonillnessinEastArnhem-soIwouldnothavetoexplainitoften.Howeveratthetimethatwewereinthebeginningofa“diabetestsunami”-thatisaffectingnotonlyArnhemLandbutmuchoftheworld.Yolnguhadbeenaskingmeveryprobingquestionsaboutdiabetesthatdidnothaveeasyanswers.(eg.Doctor,ifIhavediabetesbutstopmymedicine,whyismybloodsugarstillhigh-evenifIdon’teatsugar?).Icouldn’tfindanydetailedresourcesintheYolngulanguage that we could use.

Whenattemptingtotranslatethestoryintolanguage,wehitmanychallenges.ThebiggestistheYolngulanguageis“built”

entirelydifferentlyfromEnglish.Ithasitsownidiomsandreflectsanentirelydifferentwayofthinking.Forexample,thewordwedecidedonfor“organ”or“bodypart”madenosensetoYolnguduringfocusgroups(itwasatraditionaltermreferringtocookedportionsofananimalsharedoutatmealstimes).Asaresult, we had to re-shoot significant sections of the DVD.

In2009,mywifeSharon(anRNwhospeaksYolngulanguage)beganworkingasaHealthEducatoratGapuwiyak.Shespentmonthsworkingoutthestoryofdiabetes&daysworking(1-on-1)withthe70Gupuwiyakdiabeticpatients,werealisedthatthestoryneededtoberecorded.InconsultationwiththeCommunityandhealthstaffatGapuwiyakwedecidedtomakea‘movie’–whichfeaturescomputeranimatedgraphicstobringtolifetheinvisiblemicroscopicworldofdiabetes.WefoundthataDVDwaslikelytobeusedaseveryhouseholdintheareahasaDVDplayerandtheformatisfamiliartothecommunity.

OATSIHfundedmostoftheproject,throughtheNTDHF,andNTGPE(N.T.GeneralPracticeEducation)providedtherest.Withthismoneyweaccessedhighqualityclinicalimages,hiredprofessional3Danimators,andhadtheDVDprofessionallymasteredtoenhancethequalityoftheDVD.

Managingdiabeteswellincommunityinvolvesmanythings,includingproperlystaffedclinicsandworkingchronicdiseaserecallsystems.However,theaspectthatwasmissingaswesawitisthatdiabetesremainsamysteryandnotunderstoodbyYolnguinremoteareas.WehopethisDVD–“DhawuDiabetespuy”(TheStoryofDiabetes)willhelpwiththis.

BecauseexplainingdiabetesinvolvessomuchcompletelynewinformationforYolngu(egconceptssuchas“cells”and“insulin”)- the DVD is divided into five stories, each is 20 minutes long. Eachstorybuildsontheknowledgeintheonebeforeitsothateachstorybediscussedand“digested”beforemovingontothenext.



Organisational Profile

AboriginalResourceandDevelopmentServicesInc(ARDS)isanon-Government,not-for-profitIndigenouscommunitydevelopmentorganisation.ARDSisgovernedbyanall-Yolŋuboard.

OurclientsareprimarilyYolŋu,thepeopleofNEArnhemLand.However,ARDShasconducteditsprogramsinothercommunitiesinNTandSA.Wealsoworkwithnon-IndigenousstaffwhoworkwithIndigenouscommunities.

Ourstaffareasmallanddedicatedteamincludinghealthprofessionals,linguists,adulteducationspecialists,Yolŋulanguageandculturalconsultants,mediaandsupportstaff.

Our core services are:

Yolŋu Radio – a regional, language based community •development radio service delivering community education and cultural sustainability

Community Education•

Healthliteracy,legalandgovernanceliteracy,economic•literacy

Communityworkshops,resourcesdevelopment(audio•education-radio/CD,DVDs,books,dictionaries)

Professional Development•

“Trainthetrainer”resourcesinEnglishtoassistnon-•Indigenousstaffwitheducationandcommunicationwith Indigenous communities

Professionaldevelopmentin-servicesonhealthliteracy•andARDSeducationprocesses

HealthWorkshops•

AsasmallNGO,thelargebulkofourfundingisproject-specified.OurfundingpartnersincludeNTandFederalGovernments,privatecorporations,regionalNGOsandserviceproviders(suchasprimaryhealthcareproviders,legalservicesetc).Wewelcomecollaborationandareseekingfurtherfinancialsupport for our work.

TofullyexplaindiabetestotheYolngupeople,theDVDisdivided into five stories. Each builds on the knowledge in the previousonesothateachstorybediscussedand“digested”beforemovingontothenext.

scene from the DVD

StoryOnedescribesthethreemainorgansaffectedin•diabetes:heart,brainandkidneys.

StoryTwomovesincloserandshowshowthesethree•organs are made of cells.


StoryThreelookscloseratthe“celldoor”(ietheinsulin•receptor)andhowitcanbedamaged.

StoryFourdemonstrateshowdiabetesdamagesendorgans.•And

StoryFivedescribesthetwokeymedicationsusedtotreat•diabetes – insulin and metformin.

TheDVDisentirelybilingual.EachpointiseithermadeinEnglishandYolngulanguage-orisfullysubtitled.Ourhopeisthatitcanbeusedbyclinicstaffasastartingpointwithpatients to answer questions and discuss broader issues like exerciseanddiet.

IamgratefulforthesupportandinvolvementfromDHFmanagement-particularlyKacyKohnandWilliamCostigan-whohelpedusgetfunding,NTGeneralPracticeEducation,theGapuwiyakHealthTeam,JudithWunungmurra(aretiredHealthWorkerandInterpreter)forhelpingtoworkoutthestory(includingtheappropriateYolnguphrases,illustrationsandanalogies),mywifeSharon,andtheYolnguPeopleofGupuwiyakwhoenthusiasticallysupportedandparticipatedinthe project.


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TheYolŋuStudiesDepartmentatCharlesDarwinUniversitywascommissionedbygovernmenttodevelopaproject:HealthliteracyandhealthinterpretingintheEastArnhemregion.Weproposed three new approaches:

1: Systemic Health Literacy

Effectivehealthliteracyhaslargelytodowitheffectivecommunication, taking into account the demands of health servicedeliveryandthedemandsofeverydaylifeinaremoteAboriginalcommunity.Itisnotsomuchwhattheindividualclient knows about biomedicine, but more the working together of the people and resources which generate shared understandings and agreement.1 It involves honest respectful discussion across the divide between providers and consumers. Healthliteracyisanotastructuralproblemsotherearenostructural solutions.

2: Front line policy work.

PresentattemptstoimproveAboriginalhealthcommunicationandliteracytendtoutilizeatop-downpolicyapproachwhichseems to blame the client for irresponsible life choices and ways,andfrontlineworkersforpoordelivery.Yethealthprofessionals, clients and families are often using their discretion tocreategoodopencollaborativewaysofworkingtogether.

Weunderstand“policy”asthecumulativeeffectoftheindividualdecisionsmadebyfrontlineworkersproducingslowbuteffectiveandevidence-basedbottom-upchangestopolicy.(SeetheworkofLipsky1980.2)Wefindwhat’sworkingon the ground, we support it, we join up people and resources, and we celebrate, document and publicise successful practices together.Goodpolicypromotesgoodlocalorganisationalculture and vice versa.

3: Conversations across borders

Resourcesthatcontainhealthmessagesseldomstimulateconversations which promote new productive collaborations across the boundaries between health professionals, service usersandtheirfamilies.Theytendtoentrenchdefinitions,rolesandattitudesratherthanmodifythem.Weproposeanadditional,radicallydifferentresource,3auser-friendlytouch-padanimationofahumanbodywhichhasnomessage,nosequence.Itismanipulable,zoomable,transparent,detailedinparticularareas(heart,lungs,kidneys,liver,pancreas,ears),yetde-emphasisesbiomedicalassumptions:nottellingyouhowtobehave,butcryingoutforaconversation–inanylanguage.In all this piecemeal work, we promote new consistencies in

1 Seeourpreviousresearch,Cassetal,2002,andwww.cdu.edu.au/stts2 Seealsowww.cdu.edu.au/ice3 Anearlierversiondescribedat

www.cdu.edu.au/centres/hl/PDF/CHEI-iPad-SpecS.pdf

RE-THINKING HEALTH LITERACY IN REMOTE COMMUNITIES

MICHAEL CHRISTIECharlesDarwinUniversity

thewaysinwhichserviceusersandprovidersapproachtheirwork.Realchangecomeswhencategoriesareunsettled,where we have conversations which allow us all to rethink our assumptions and our possibilities.

Graphics from the touch pad resource

Cass,A,Lowell,A,Christie,M,Snelling,P,Flack,M,Marrnganyin,B&Brown,I(2002),'Sharingthetruestories:improvingcommunicationbetweenAboriginalpatientsandhealthcareworkers',TheMedicalJournalofAustralia,vol.176,no.10,pp.466-70.

Lipsky,M.(1980).Streetlevelbureaucracy:dilemmasoftheindividualinpublicservices.NewYork:RussellSageFoundation.



What is the course about?

TheBHScisathreeyearfulltimecoursethatprovidesstudents with the knowledge and skills required to work in areasofHealthPromotion,CommunityHealthDevelopment,IndigenousHealth,andHealthServicesManagement.Developed in partnership with current health practitioners, this courseisbasedonthecurrenthealth,policy,andsocialcontextoftheNTandisextremelyrelevanttopeoplewantingtoliveand work in the NT.

There is an emphasis on understanding the challenges of workinginthediversecontextsofurban,ruralandremotecommunities.ThecourseoffersanongoingpathwayforVETgraduates.Thecourseunitsalsoofferprerequisiteknowledgeandskills,whichwerebenchmarkedagainstexistinggraduateprogrammessuchastheMasterofPublicHealthandMasterofRemoteHealthPractice.

how can I study this course?

Studentscanchoosetoeitherstudyoncampus(internally)inDarwinorstudyathome(externally)ontheinternetviaLearnLine.

COMMEnCInG In 2011 IS thE nEW BACHELOR OF HEALTH SCIENCE (BhSC) At ChARLES DARWIn UnIVERSItY

Who might be interested in this course?

Year 12 School leavers who are interested in health •promotion, remote health and Indigenous health

VET graduates who have completed Level 4 or 5 health and •communitydevelopmentrelatedcourses

Indigenoushealthorcommunityworkers•

StudentscurrentlyenrolledinHealthorAlliedHealthcourses•whowishtotransfertotheBHSc

Internationalstudentsarealsoencouragedtoapply.•

What job might I get after completing the BhSc?

ABachelorofHealthSciencecanqualifyyoutoworkin:

HealthPromotion,CommunityDevelopment,PublicHealth,IndigenousHealthPromotion,HealthPolicy,ResearchandEvaluation,HealthManagement,StrongWomen’sPrograms,MaleHealth,HealthEducation,Sport&Recreation,AlcoholandOtherDrugs,RemoteHealthandothers.

For further information about the BHSc please contact:Professor Rose McEldowneyHead of School – Health SciencesFaculty of Education, Health & ScienceCharles Darwin University, NT Email: [email protected]

The Theme for next year’s conference was voted on by this years delegates; it will be Mental Health and Wellbeing. The next CDN conference will be held on 6th – 8th September 2011.

Don’t forget to put them in your calendar.

Updates and more information will be coming soon so keep an eye out in future editions of The Chronicle and e-CDNews

For more information please contact the CDN: T (08) 8922 8280Email: [email protected]

2011 CDN Conference

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The ChronicleThecombinednetworksareacollaborativeefforttoprovidea coordinated approach to supporting community service providers to:

find out more about the health services that are available in •theirlocalcommunityandregionnetwork with other local service providers•participateinlocallybasedandtraininganddevelopment•opportunitiesaccess multiple services at the one meeting•

OurmostrecentmeetingshaveincludedDarwin(August),Nhulunbuy(September),AndKatherine(October).

THE Combined Network UpDATE

The Combined network Committee getting lost in Yirrkala (who would have thought it possible?)

Traditional Tongan Dancing at the Hungi

The format has included a networking, information sharing, guest speakers, and of course nibblies and catching up with newandfamiliarfaces.Wehavebeenluckyenoughtocatchsome interesting events and have some great guest speakers. AtYirrkala(nearNhulunbuy)wepickedadaywhenalocalgentleman of Tongan descent was being awarded the Order ofAustralia.TherewasatraditionalHungiincelebrationofthisevent with several dignitaries including the Crown prince of Tonga. The meetings themselves have been useful to engage localserviceprovidersandkeyprofessionalsinnetworkingandsharingofinformation.WehavehadsomereallyfascinatingguestspeakersincludingRobynWilliamsfromCharlesDarwinUniversitycomeandtalktousaboutthetopicofherPhDresearch,EffectiveCommunicationandBestPracticetrainingforHealthProfessionalsinCommunication.

Robyn Williams presenting at Katherine

Where to next and when?The Meeting dates for 2011 have been scheduled:

8th –9th March Tennant Creek12th–13th April Nhulunbuy10th-11th May Katherine14th-15th June AliceSprings9th-10th August TennantCreek6th-7th September Nhulunbuy11th-12th October Katherine8th-9th November AliceSprings

Who comes? Anyoneinterested,Nurses-PublicHealth,Clinical,Remote,CommunityHealth,AboriginalHealthworkers,PracticeManagers,GP’s,AlliedHealth-SocialWorker,Nutritionists,SpeechPathologists,RemoteHealthworkers,ClinicalEducators,ChronicDiseaseCoordinators,DiabetesEducators,ProjectOfficers,CommunityWorkers………..Anyone

Formoreinformationpleasecontact:

Helen BarnardChronic Diseases [email protected]: 08 8922 8280

Jo [email protected]: 08 8922 6915

Debbie [email protected]: 08 8999 2572

Sarah McInnes GeneralPracticeNetworkNT [email protected]: 08 8982 1050

Jill NaylorCancer Council [email protected]: 08 8927 6389

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NT CCPMS Implementation 2010-2012 has arrived!

UPDATE: NT CHRONIC CONDITIONS PREVENTION & MANAGEMENT STRATEGY 2010-2020

What is it?

TheNTCCPMSImplementationPlanisasupplementarydocumentthataccompaniestheStrategy.WhiletheStrategygives an overall framework for an organised approach to chronicconditions,theImplementationPlansupportsthisbyproviding a detailed outline of what activities and actions can beimplementedbyarangeofsectorstopreventandmanagechronic conditions in the NT.

What is in it?

TheImplementationPlanisstructuredaroundtheeightkeyaction areas:

ActiononSocialDeterminantsofHealth1.

PrimaryPrevention2.

SecondaryPreventionandEarlyIntervention3.

Self Management Support4.

CareforPeoplewithChronicConditions5.

WorkforcePlanningandDevelopment6.

Information, Communication and Disease Management 7. Systems

QualityImprovements8.

Withineachkeyactionareaisthefollowinginformation:

Whatwewanttoachieve-Listofobjectivesattachedtoeach•action area

Whywearedoingit-Briefsummaryofcurrentevidenceand•rationale for actions

Howwillwedoit-Listofevidencebasedactivities/actions•to be undertaken to achieve our objectives

Whowilldoit-Listofkeystakeholderswhowillhaveroles•inimplementingactions/activities.Thesearedividedintosevenkeygroupsandarerepresentedbythefollowingsymbolsintheplan:

Communities/schools/workplaces

Researchers/educators

NonGovernmentalOrganisations

Policy makers

Other government departments

Policymakers

Hospitalservices&otheracuteCarePolicy makers

Other government departments

Other government departments Hospital services & other acute

Care

Primary Health Care services

PrimaryHealthCareservices

Howwillwecheckprogress?Listofprocessindicatorstomonitor progress against each action area

What is the implementation schedule?

ThecurrentImplementationPlanwillprovidedirectionforcollaborative action from 2010 until 2013. It will be updated everythreeyearsthroughoutthelifeoftheStrategydependingonourprogressagainstachievingobjectivesandanychangesin evidence.

how can it be used?

EachkeygrouparestronglyencouragedtousetheImplementationPlaninbusinessplanningandidentifyopportunitiestoworkcollaborativelywithothers.

AseriesofworkshopsonhowtousetheImplementationPlaneffectivelywillbeconductedthroughouttheyearinvariousplaces across the NT

ItisonlythroughanorganisedandconcertedeffortbyeveryoneintheNTthatourcollectivevisionofimprovingthehealthandwellbeingofallTerritoriansbyreducingtheincidence and impact of chronic conditions can be achieved.

CopiesoftheStrategyandImplementationcanbeaccessedelectronicallyathttp://www.health.nt.gov.au/Chronic_Conditions/NT_CCPMS/index.aspx

PleasecontacttheChronicConditionsStrategyUnitforhardcopies or further information on T: 08 8985 8176.


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Documents

In thIS ISSUE · 1. Richard Osborne: Health literacy – a complex concept and key component of patient-centred care that will drive quality improvement Richard Osborne is the Professor