Crikey

The Federal Government’s medical checks of Aboriginal children in the Northern Territory are failing to reach more than 10% of the target ”at risk” population, according to a confidential document obtained by Crikey.

According to the document, the Child Health Check component of the National Emergency Response is largely incompetent, probably unethical, underfunded and absolutely ignores the long term. It appears unlikely it will help the children that the National Emergency Response is supposed to be all about.

In particular, the document raises major concerns that the $83 million medical intervention is in serious and ongoing breach of medical ethics, including National Health and Medical Research Guidelines, Medicare and guidelines on health screening issued by the Royal Australian College of General Practice. The document, prepared as an internal discussion paper by the Aboriginal Medical Services Alliance of the Northern Territory (AMSANT), reflects growing dismay amongst Aboriginal-controlled health services, as well as an increasing number of government and non-government health professionals. View the full document here.

The document also spells out in further detail the major shortcomings of the so-called “screening” being carried out on Aboriginal kids in remote areas of the Territory, some of which have already been touched on by Crikey.

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According to the AMSANT paper, the Intervention Child Health Check “is inconsistent with evidence-based practice … and is potentially unethical by undermining existing care … (and) providing false expectations for the community”:

Preventive interventions (such as AG-CHC) are required to have specific resources for follow-up (local clinics, regional specialists and hospitals), and evaluation framework of the program, plans for feedback to communities, and addressing the sustainability of future checks, none of which have yet to be established.

The document confirms that as of early September there have been 1700 children “checked”, from a target population of 17,000. On that basis, after two months the medical intervention has only captured 10% of its target. However, the average “participation rate” is only 67%. More extraordinary is the revelation that at least a thousand children who have already had the Medicare Item 708 screening carried out in the past nine months - by the Aboriginal health services so reviled by Brough - will not be screened. This means this data will not be included in the final assessment of childhood ill health in the Territory, and therefore the resources required to meet these problems.

Bizarrely, the much vaunted federal medical intervention is entirely paper-based, and they do not have the training to access digital medical histories and pathologies of the children they are screening.

The document says “there is a significant underestimation of disease burdens in the largest two disease categories, ENT and dental pathology”, and provides details:

1) Only 30% of all children required follow-up of any type (of which ear disease is only one). NT researchers have shown the prevalence of Ear Disease alone, is 91% in NT Indigenous Children (Morris et al 2005).

2) 10% of AG-CHC children were referred to ENT surgeon, but no audiology or tympanometry was done (which is usually part of the method of determining need for referral).

3) 20% of children have had Dental referrals (but the screening did not include proper dental review – it was only doctors and nurses looking in childrens’ mouths). NT DHCS Dental research has shown prevalence of dental disease in Indigenous children to be 60-70%.

According to the AMSANT paper, “this suggests visiting health teams are failing to identify treatable disease in children”:

This reason is likely to be poor training/skills on the part of the health teams and/or a tendency for the team to miss children who are in need of treatment. Both options have unsatisfactory outcomes.

Unsatisfactory outcomes indeed. The medico on the National Emergency Response Taskforce, ex-AMA president Bill Glasson now acknowledges, after revelations by Crikey, that conditions such as ear disease are probably well above the 30% he has previously acknowledged. According to ABC radio last Friday:

Dr Glasson says it is likely the rate of infection is higher, but there is a lack of specialised teams to pick it up. He says there is (sic) only two ear, nose and throat surgeons in the Territory.

“The NT surgeons up there are drowning in the fact that they just can’t handle a burden of disease that’s there,” he said. “So we need to have surgeons coming up there to assist them, visiting probably initially, but hopefully living up there in the long term if ever we’re going to meet the requirements for ear surgery in the long term.”

Of course this misses the point – by a long way. By the time you need a ear surgeon the damage has well and truly been done. Neither Glasson, Major General Chalmers – nor indeed Brough, Abbott and Howard – have said anything about properly resourcing primary health care in the first instance, so that ear disease does not lead to surgery.

For obvious reasons, AMSANT is concerned that its involvement in the Intervention might be compromised “while there remain unresolved medical and medico-ethical issues”.

AMSANT, initially excluded from consultation over the medical side of the intervention, is currently negotiating an memorandum of understanding with the federal government’s Office of Aboriginal and Torres Strait Islander Health (OATSIH), which would include data sharing.

However, initial indications from Canberra that long term primary health care funding of an extra $65 million a year would be provided beyond the 30 June 2008 cut off for the medical side of the intervention have apparently been reversed. Although OATSIH is known to be sympathetic to the need for long term primary health care funding, the zealots in the Howard/Brough camp—ideologically opposed to funding any Aboriginal organisations—have pulled the pin: “Negotiations have been occurring … but no money is on the table”.

There’ll be a few questions asked of the OATSIH boss when she hits Alice Springs this Thursday, with not much hope of positive answers.