The Snake, the Staff and the Rainbow Serpent : A Call to ‘Fill the Gap’ in research relating to infection, prevention and control and Aboriginal and Torres Strait Islander People.

(Written by Victoria Gregory)

Aboriginal and Torres Strait Islander people are the oldest surviving culture in the world, yet they will live approximately 10 years less than other Australians. Some contributing factors include indigenous people are at higher risk for emerging infectious diseases compared to other populations (Butler et al 2001). Examples of infectious diseases include respiratory tract infections, infections with antimicrobial-resistant organisms, and bacteremia and meningitis caused by Streptococcus pneumoniae, zoonotic diseases, viral hepatitis, Helicobacter pylori and respiratory syncytial virus infections, diseases caused by Group A and B streptococcus, tuberculosis, Haemophilus influenzae type b, and Neisseria meningitides (Butler et al 2001).

Here are some specific examples:

• According to data from ‘healthinfonet’ between 2009 and 2013 tuberculosis notifications were 11 times higher for Indigenous people than for Australian born non-Indigenous people.
• In 2014-15, Aboriginal and Torres Strait Islander people were three times more likely that non-indigenous people to be admitted to hospital for influenza and pneumonia.
• In 2014, there were 170 cases of invasive meningococcal disease notified in Australia with 21 cases (12%) identified as Aboriginal; an increase from 2013 where 13 cases (8.7%) were identified as Aboriginal and one identified as Torres Strait Islander (0.7%).
• In 2015, hepatitis C notifications were five times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people and the rate of HIV diagnosis was just over twice as high for Aboriginal and Torres Strait Islander people than non-Indigenous people. Notification rates for gonorrhoea were also 10 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people. For syphilis, notification rates were six times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people. For chlamydia, notification rates were three times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
• Skin infections are also common in Aboriginal and Torres strait Islander Communities (The Lowitja Institute).

These data paint a real and bleak picture, but there are many success stories, including:

• An initiative by Australians for Native Title and Reconciliation group in 2007 which reported on successful Aboriginal and Torres Strait Islander health projects, such as:
  • ‘Tune into your health: Nunkawarrin Yunti Aboriginal Health Service’ where young people developed lyrics and songs about health issues affecting their community, a song called ‘It’s in your blood’ increased knowledge and awareness of Hepatitis C.
  • ‘Keeping safe with a snake: Marie Stropes International Australia’ an initiative raising awareness of sexual health.
  • ‘Mooditj: Sexual health and positive life skills’ an initiative by the Family Planning Association of Western Australia.
  • Healthworkforce Project and the Shalom Gamarada Ngiyani Yana Residential Scholarship program which has increased the numbers of Aboriginal and Torres Strait Islander students studying medicine and health at UNSW.
• The implementation of the nationally funded Hib disease vaccination in 1993 which resulted in decrease of notifications of invasive Hib disease by more than 95%.
• The painting above, ‘Healthcare in the Western Desert’ was created as part of an innovative project building mutual trust and respect involving Aboriginal artists from the Wankatjunka, Kakutja and Walpirri language groups and second year medical students from the University of Notre Dame during the students’ Remote Area Health Placement in the Kimberly. It highlights the 3 ‘snake and staff’ images representing the medical profession as well as symbols depicting women and children from the local communities and coloured squares representing the medical clinics and a number of circular jila (waterholes). The act of painting together transcended cultural differences and led to an evolution of knowledge and understanding for all participants.

Indigenous communities are at high risk for many infectious diseases, but there is limited research specifically relating to Indigenous health in relation to infection, prevention and control in Australia. Culturally appropriate research and ‘bottom-up’ prevention and control strategies, as well as long term commitment to their implementation is urgently required. It is our responsibility to mainstream Aboriginal and Torres Strait Islander equality in all the valuable work that we do in the infection, prevention and control sphere. This blog is a reminder of the alarming statistics around infections and a call to work on closing the gap in health outcomes in Australia.

This blog was written by Victoria Gregory.

References

1. Australians for Native Title and Reconciliation. antar.org.au
2. Closing the Gap Prime Minister’s Report 2017. Closing the gap.pmc.gov.au
3. Australian Indigenous HealthInfonet.http://healthinfonet.ecu.edu.au/ Retrieved 29.11.17
4.  Butler, J. C., Crengle, S., Cheek, J. E., Leach, A. J., Lennon, D., O’Brien, K. L., & Santosham, M. (2001). Emerging infectious diseases among indigenous peoples. Emerging infectious diseases, 7(3 Suppl), 554.
5. The Lowitja Institute. http://www.crcah.org.au/search/site/infection
6. The University of Notre Dame, Australia. http://www.nd.edu.au/news/media-releases/2017/077