Report of the 6th National Conference

Queensland Health Takes on the Challenge: Our Evolving Role in Aboriginal & Torres Strait Islander Environmental Health

Page last updated: 07 July 2008

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Paul Endres, Director Environmental Health Services, Tropical Population Health Services

Sonja Carmichael, Senior Policy Advisor Aboriginal and Torres Strait Islander Environmental Health, Environmental Health Unit

Paul Endres

“I appreciate being on the Irukandjii’s land where we are meeting this week, and particularly for the opportunity to speak to all my friends and colleagues in this place. I also pay my respects to the Elders who are here as well. To my friends and colleagues here, I have been really looking forward to this week, and it is fantastic to see some old faces. I have had the privilege of watching you all achieve amazing things over the years and in this wonderful region, and I have really genuinely been looking forward to seeing everyone to talk about how far we have come and to share information about some of the projects that we have been working on. I would like to acknowledge my good mate, colleague and mentor, Stuart Heggie, who is here today from Tasmania. He went to Pundamara in 1990 to the conference, and that pretty much changed all our lives. At the time we were looking for direction, and I know Stuart has presented to you at these conferences and said we weren’t sure and wanted to find our way. We knew there were major problems in these communities, but we didn’t really know how best to tackle them. Our white fella way of thinking wasn’t working. Stuart saw at the conference that WA had the EHWs, and he thought ‘what’s this’? He then looked around at this new thing and thought that it might be the answer we were looking for.

That was in 1990, and all those people with the government and community working with us helped turn this EHW program around into the success it is now. We have won awards for it, and looking at the program we have today we certainly have come a long way.

I would also like to acknowledge Ross Spark, Director of TPHU. I am sure Ross is known not only to those in this room, but also in the Northern Territory and WA. He is also my mentor and my friend. Ross said that he visited the Kimberley Health Unit when he was on holidays, and people came to him and said they knew Stuart took their idea and that they really appreciated what you have done with it, and where it has gone. Now they want to learn more about it, and I suppose that is why we are here today - to say what we have achieved, and where we can go from here. Are there any people here from the Kimberleys? Good, maybe you know Ross, and can catch up with him later.

I am really pleased to see all the EHWs who have been trained - particularly those people from Queensland - because I know all of those who are speaking to you this week. To see them getting up at a national forums and workshops - getting up and presenting is extremely gratifying to me. I actually asked for the time change which you might have noticed. I was supposed to be on tomorrow with Sonja, and I said we would really like to be on before our colleagues because we wanted to publicly acknowledge how important their contributions have been to their people, and to thank them for their work, because they are really humble people and I am humbled by them. I really do want to thank them for the work they have been doing. I just wanted to say it is nice to be able to get up early. I know Walter has already spoken, but this was the first slot we could do it, and I really want to thank them for the work that they have been doing before you hear about it from the people themselves. Stephen Canendo, you will notice, is a keynote speaker at this conference. He was in the first group of EHWs to graduate many years ago. Eddie Bobongie, Walter Morgan, Clayton Abreu, Ronald Williams, Alan Blackman, Chris Gyemore are all Qld EHWs program graduates who are all presenting this week. I think that is what we have been aiming for in these conferences, and we are now seeing it happen - and I am only talking about Queensland. Aunty Mena David from Iama in the Torres Strait and Freddie David from Poruma from the heart of the Torres Strait are here. I will be talking about their communities. Toshi Kris, Chairman of the TSRA, was in the first group of EHW graduates in Queensland, and he has never forgotten us, I can assure you. He is a very strong advocate for EH, and we will be approaching him to get his organisation even more involved in enHealth Council’s Working Group.

As Eddie said, I began my career in 1987, when I transferred to Cairns from Brisbane. Soon after I was driven up to Hope Vale in 1987 with my boss. So coming out of Brisbane and going up to Hopevale was an incredible experience. I can tell you I was shocked, coming from Brisbane - I couldn’t believe people in Australia lived like that. I asked a lot of questions as to why these people were living in these houses. I just knew they were going to get sick if they lived in these houses. It was very unacceptable to me to see those conditions then, and it still is. Those of you who know me, know I like to challenge things even if it means being a bit controversial - so I don’t want to let you down today at this national forum. What I would like you to do is to all stand up in your placesfor me. I am not going to give you a load of statistics, but just read through this slide. You have all seen this before. Tom Calma, the gentleman who spoke this morning, is the bloke who wrote it. I will leave this up while we do this short little exercise. Cleveland Fagan mentioned that this is now 19-20 years - this statistic is from 2002. Now I am looking at that with a lot of concern, as it has gone up, and we are trying to get it to go down!
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So what’s going on? I don’t know how it can go up in five years, and that is a big concern to me. So I put it to you - if we don’t have some action, and we don’t action the things out of this conference, then we will continue to see this figure increase. We want it to go down to zero, and that’s what I am after. I want to see that happen in my life time. I want all of you who think the government has done enough about this gap between mainstream and Aboriginal and Torres Strait Islander people, to sit down. Second, do you think the community councils have done enough about this gap? Sit down if you think they have. Hmm, interesting, now think about this really hard and be honest with yourself. Do you think you are doing enough about it? Sit down if you think you are doing enough about it. Well I actually thought that might happen - I didn’t think anyone would sit down. I would be quite happy with that and if you felt that you had done enough, that’s good. There are people here who have, but it’s good to see so many committed people in the room.

I won’t ask you to remain standing for the whole talk, so take a seat.

The reason I did that is because what I am saying to you all today is that it is up to all of us. If you can’t believe that we can reduce this gap by improving EH conditions, let’s have a look at what can be done. I just want to show you a few photos. This is Jim Larry, a friend at Poruma, and an EHW. The photos I am showing are from Poruma and Iama because you are going to see over the next days other people talking about their communities and what they have done. So I am talking about two communities where the people are here, but they haven’t had the opportunity to speak. I have asked them if they mind, and they both said ‘No, go for it’.

This is Jim’s house, and this is what I first saw when I went to Poruma some years ago. We worked a lot with the council, and this council had a really good understanding of what hygiene and improving environmental health conditions can do, because we had workshops there. The TPHU holds workshops twice a year, where all EHWs come together. We don’t have them in Cairns - we have them in the communities and the islands. This island has only 40 houses or so. It is a very small community, but they hosted a workshop for three days. The community cooked, and the council attended for the three days, which was an incredible commitment. They got a very good understanding of what hygiene means, which previously wasn’t there. When I first used to go up there people thought if they had a bad house or a dirty septic or whatever, they just might get sick. They thought they might go to the doctor, then would be right. People didn’t see that if they got rid of the dirty septic they could improve those conditions in those houses, and they wouldn’t have to go to the doctor in the first place.

I think for a long time they just accepted that they get sick and then went to the doctor. They didn’t question why they were getting sick. This slide is the same bathroom area we were looking at in Jim’s house. The council took the limited money they had - and I can tell you it wasn’t enough – then with their knowledge they used local people to make these improvements. They realised that fixing up the shower blocks is going to help Jim’s health, his family and his kids - that they should spend the money there, instead of spending it on an airstrip. They put the money into this as they saw it as a priority. It was a big turning point for us. At Yam Island, Mena brought in a dog program. She asked us what we could do about dogs. I said ‘There’s a lot we can do’. She said ‘The dog is my totem – I want to do something about these dogs’. I said ‘You can register them, and track how many there are and how many people have a dog, and then you can get a vet to help look after it’. She said ‘What’s this registration’? I said ‘Well, you know, they just get them tagged’, so she did. She had it organised in a couple of days. Mena did something really smart - she got a really fancy collar and charged everyone $10 each for one. It only cost her $10, but because everyone got a tag, she was able to keep record of who owned what dog (they were only allowed to have two dogs). She kept track of them, and if they went outside of that she went and talked to the people. Mena said she might have to go and take a couple of the dogs away if they were sick, or whatever. So simple. We have people working in animal management, and we will talk more about that. These were simple things which I wouldn’t have thought of, in that culture, and we learned a lot from it.

(Running through slides) - Hot water systems were a part of the improvement program. Before and after of the grease trap. That is the same grease trap, and I can tell you that kids were playing in it about five minutes after I took the shot. Old houses to new houses. Streets with dust being thrown up and dogs walking about with people getting sick – so they paved the streets. They all did it – they used bricks, and they all did it. It is a very tidy town in the end. Look at the picnic areas – notice the bins. The bins were getting knocked over by dogs, so they secured them. So simple, but look at how clean it is - no litter - and there is a lot of pride on this island now!

I think the way we approached it with proper community engagement was what led to some of the improvements, and you are going to see a lot more over the next couple of days. I think we are using community engagement. I don’t think we use any of the big words you see in all the documents - there is a place for that - but I don’t think we are using that. We are talking to people on the communities, we engage people and have engagement, planning and delivery of services. It’s like Mr Calma said this morning, because it is a right, and it’s the law.

We’ve got limited plans and they are time limited. We are developing one at the moment and the project officer who is doing that is in the room. Andrew D’Addona - in consultation with everybody. We have a one-year plan and a five-year plan, then we are going to have other five-year plans until it is sorted. Rolling plans. We are developing these while listening to the people wework with in the Cape York and Torres Strait. We take time to listen to these people. We listen to what community people say. We listen in big capitals. I talk a lot but I do listen sometimes. I can do both. We sit with the Elders – at night – whenever – not on our time. We no fly in for one day for two hours. We sit. We go for days and we wait until they are ready to talk. Some of us use digital recorders to record what they have to say so we can listen to it, and so that the other people in the office can listen to it. We do it on TI time and community time, not white fella time. I don’t go out in a boat with EHWs to catch a fish, contrary to popular belief. That’s when they tell me about their people. That’s when they tell me things. If I catch a fish that’s great, but I don’t do it for that reason. Some of the best things I’ve heard have been out in a boat or sitting under a tree with someone, because it is comfortable - not sitting in big capital cities or Cairns. People get intimidated. We sit in that community, at that place, and hear about that place.
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Other examples of us listening and what it turns into – the EHWs said in the early intakes (of the Diploma course) that they wanted to get together and share their ideas and help their own people. So we held community workshops twice a year (funded by John Scott, TPHU Manager at the time, in Brisbane, but these workshops are now funded by Qld Health). It isn’t much money – just $6,000. We achieve a hell of a lot. and people share their ideas. The EHWs said they wanted to bring back community cleanups. I think Freddie might have said to me in the old days, actually I think it was an Elder said to me that “In the old days when the policeman said ‘You clean this place up’, you cleaned it up - people did it, and people felt pride in their community”.

We wondered how we would do this, so we held a workshop about tidy towns, and that’s what the result is. Look at that. Look at how much rubbish was picked up on that beautiful island by all those kids. Freddie organised it with the council. EHWs organised it with the councils. They understood how important that work was. Grand stuff. Good fun, simple with great healthy outcomes - fewer injuries, no rubbish, no flies, there are so many things I can go into. What that means - and I am not telling you anything you don’t already know - as EH professionals you know what that can lead to.

The coordinators - the IEHIT team – the EHWs – they are our liaison officers who Sonja will talk about. They are the link between the community’s knowledge and our knowledge. They are the interpreters who assist us with understandings between our two cultures. The EHWs are the link between the councils and the communities, and the other agencies who visit the communities. They are translating their cultural ways, white fella cultural ways and knowledge to their people, and we are learning from their cultural ways. We are learning how best to give the communities an understanding about those links between poor health standards and disease. Brisbane Corporate Office EH Unit is the link to the Ministers of State and Federal - the people who give the money, the funding bodies and produce and ratify the policy decisions that affect the strategic direction we are taking.

This collaboration is very powerful. It makes us strong and it makes us one. One vision, one focus. Get rid of that gap”!

Sonja Carmichael

“I would like to acknowledge the traditional owners, the Irukandjii people, and pay respects to Elders here today. Before sharing what we do in respect to EH in our communities, I would like to give a bit of an overview of the changes that are currently taking place in communities as a whole. Our conference theme ‘Taking on the Challenge – Aboriginal and Torres Strait Islander environmental health’ is based on the Meeting Challenges Making Choices (MCMC) Strategy. Some of you may be aware that making environmental health a priority was not the only thing that resulted from this strategy. MCMC also had major outcomes which related to community governance - the most important outcome being that our Aboriginal Local Governments and Island Councils are no longer differentiated from mainstream local governments. This signals a major transition in terms of council status under the Community Governments Improvement Strategy. This means that all Aboriginal Councils are now required to comply with the requirements of the Local Government Act 1993. With respect to environmental health, this will include obligations under the Public Health Act 2005 and Food Act 2006, and others that are administered by environmental health units in Local Governments such as the environmental protection and dangerous goods legislation.

Most recently the State Government has announced the amalgamation of all Queensland shire councils. This is still being finalised, and recommendations will not be known until the end of the year. However, it does mean that environmental health must be considered as a key function and responsibility of Councils. It also means that as the lead environmental health agency, Queensland Health will be working more closely with other agencies who are responsible for aspects of environmental health that are outside the jurisdiction of the health portfolio. This includes agencies such as EPA, DES, DPI & F, DLGPSR, for example.

So, what does this mean for the future direction of the Queensland Health Aboriginal and Torres Strait Islander Environmental Health Strategy? Firstly, I’ll briefly mention our existing strategy. This Strategy spanned from 2001 to 2006, and aimed to provide a strategic direction for the development of partnerships with other stakeholders both at a state and local level. It also provided a framework for action to address EH outcomes through a whole-of-government approach. Goals included fostering and supporting active participation of Aboriginal and Torres Strait Islander people in the management of their environmental health needs within communities, and to initiate and enhance Aboriginal and Torres Strait Islander programs that ensure the standard of environmental health in Aboriginal and Torres Strait Islander communities is equal to that of the broader community.

The strategy had six key action areas:

  • Community participation.
  • Coordination and collaboration between agencies.
  • A sustainable environmental health workforce.
  • Healthy housing and infrastructure.
  • Information networks.
  • Optimal environmental health programs.
We have commenced a review and evaluation of the Strategy, and initial feedback indicates that we have made significant progress in meeting the goals and objectives of the Strategy. However, we are also aware that there is a lot more work to be done.
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The Strategy: Where to from Here? We have had a number of brainstorming sessions with a number of stakeholders and are in the process of developing draft plans, so that‘s a work in progress that Queensland Health is supporting through the appointment of our Senior EH Officer, Andrew D’Addona. This is a new position created to manage the EHW and Animal Management programs. Andrew will be coordinating the planning, and liaising closely with us. We have learned a lot from the past and we are all working together, as Paul mentioned, to come up with a new plan. That new plan needs to be community-driven, and that’s the key to responding to what the needs are at the local level.

I would also like to draw on the importance of Commissioner Calma’s principles of participation FPIC that he mentioned this morning – free prior informed consent – the basis for consultation and Aboriginal and Torres Strait Islander participation.

The foundations have now been laid, and have provided a base on which we can build and extend. Areas which will be of great importance over the next five-year period will be the introduction of the new Population Health training competencies. As councils take on all the responsibilities expected of Local Governments, this can be expected to be reflected in the level of professionalism of council services. Supporting EHWs in their Council’s new responsibilities and role they play will be a major goal. As you may be aware, the Health Training Package has been reviewed and one very exciting outcome is the development of an Indigenousspecific environmental health range of competencies. EHWs will be encouraged to view environmental health not only as a job, but as a career path that may lead to other exciting opportunities.

The need for coordination and collaboration between agencies must continue to be strengthened. This is more so now given the broader range of environmental health responsibilities that EHWs will be undertaking.

The Environmental Health Unit of Queensland Health provides secretariat support and is represented on a number of stakeholder groups, both within and outside Queensland Health. Internally we have the HIT team - Indigenous Environmental Health Implementation Team (IEHIT), which consists of all our Indigenous environmental health coordinators. Key roles of this group include providing advice to the Population Health Units on environmental health policy, and providing advice and information to community stakeholders.

The HIT team reports up to the SIEHCG – Strategic Indigenous Environmental Health Coordination Group. This group consists of the Senior Director EHU, myself, the Directors of EHS of each Population Health Unit and the three Zonal Coordinators. This group drives the implementation, monitoring and review of the Strategy. It also provides collaborative input and direction into existing and future culturally-appropriate Aboriginal and Torres Strait Islander environmental health projects, policies, programs and strategies.

Some issues that arise out of SIEGC meetings may be fed up through the NIEHRF – Northern Indigenous Environmental Health Regional Forum and what is affectionately known as the GAG – Indigenous Environmental Health Government Agencies Group (IEHGAG). The members of IEHGAG represent their respective departmental interests, provide access to appropriate networks and have knowledge of their agency’s interface with Indigenous communities and environmental health-related matters. On a National Level we participate in the Working Group on Aboriginal and Torres Strait Islander environmental health.

Of course, much of the work that has been taking place is due to the valuable input, dedication and passion of our QHealth Indigenous EH Coordinators and EHWs. In the area of EH, they are a valuable conduit between QH and communities. I personally would like to say a big thank you to Merle, Clay, Chris, Alan, Richard, Eddie, Nicky and Dallas for their contribution to EH and to QHealth. Thank you”.

Paul Endres

“There are two programs - the EHW program which has been going since 1990, and the Animal Management Program. We provide support through training and resources. The big thing is - and this is what Stuart drove, and everyone knows that it was not just Stuart - it was a huge group of people involved, who we would train to work in their own communities. We would not just put them in an office, but we would stock that office with everything they would need in order to do their job. There was funding for a position -a A $14M grant. There was one position per community, and there are 34 communities in Queensland. Plus resources - vehicle, office, equipment, and all the things they need. There were two key things - we had the resources and we had the position, so we just started off with that. This came in only a couple of years ago. We are always looking at new ways to solve problems. EHWs need training and professional mentors. We’ve (Environmental health staff) tried to fill that role but we can’t do it any more. There used to be only a few (EHW’s) but now there are a lot, and we haven’t enough people to help. We are under-resourced in this area, so we are looking at different ways that we can do it. We can do certain things and I think we do them pretty well. I know that my staff are extremely
committed to helping, including putting their family life on hold sometimes to travel up to the communities.

So we are looking at whether we go outside to get resources. There are still a lot of deficiencies, and we are planning to manage this. The Animal Management Project cultural needs are communicated through our coordinators and our EHOs. The Animal Management Project Officer is actually called a Project Advisor, and has extensive experience working in the NT. He is Scott McIntyre, and I’d say a few people here probably know him. He came to us from northern NT. This is promoting greater governance and promotes more jobs, and that’s the important thing about it. We are not getting the EHWs to do this dog work, as they are too busy. These are extra jobs. It is the first time a project of this scale has been undertaken on this level in Australia. A lot of people talk about it. A lot of ministers said they would solve the problem, but nothing much happened, so Queensland Health is taking it on and we will give it our best shot. It will work because EHWs have been a driving force behind this. I really believe it is going to work - we are learning a lot, and I think we are playing it smart. The best thing about the animal management project is that they allocated a large proportion of the grant to training. We are going to use that money wisely, and that’s why I reckon it will work. It’s not just training when it starts - its ongoing training. When those people finish their course they’re just not going to be left by themselves. They will have mentors, and they will continue to be trained.
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To finish up, we have a lot more to do. I think we are on the right track, but we can do better. We are definitely under- resourced but that’s no secret and everyone is under-resourced. You just don’t complain about it you do what you can with the people you’ve got, and work out how to do things better. If we want to attract the type of funding our work will require, we will have to show that we are producing effective and sustainable outcomes - prove it. It is not easy. It is a big challenge and it is up to us. No-one else can do it for us. It is our responsibility. You want to do something about this problem, - you have to do it, I have to do it, we have to do it. We don’t complain and wait for someone else because it ain’t going to happen. Don’t wait around for that. We are the ones setting the direction, and we are lucky that we can. So let’s get on with it. We all need to do it together. You all stood up, and no-one sat down. You don’t think you are doing enough, that’s great. I like seeing that, because everyone’s keen. Excellent stuff!

There’s a lot of talent in this room. We have just seen it. Let’s just get out there and continue that work and finish off the job. If Mr Calma was here I would ask him if he thinks we are passing the reality test. I think we are getting there, but I don’t know if we have got there yet. I really like the way he thinks. He is a pretty smart man. If we are not doing it right, let us know. We will ask Mr Calma later if we are doing it right. We can learn from him and adapt our programs. I think 25 years is way too long. I can’t stand up for that long. I am tired. When that gap gets to zero I will sit down. I will retire and be very happy, but I can’t keep standing up. Let us set a challenge that 25 years is ridiculous. I don’t want to see kids waiting 25 years – let’s pull that gap down in the next … I won’t put a time on it, but let’s make it a lot less than 25 years. Now if anyone in the room might know of anyone who wants to help us with this, or work in this area, we have a job going, so there’s a quick plug. It’s there if you want to go to places like this, and do the sort of work we are doing.

I don’t want to be standing up all my life. I want a rest. Help me out. I will be sitting down looking at things when we close the gap. I will keep standing up until we do. Thanks”.

For Further Information

Paul Endres
Director Environmental Health Services
Tropical Population Health Unit – Cairns
PO Box 1103, Cairns, QLD 4870
Ph: 0429 487 827 Email: Paul_Endres@health.qld.gov.au

Sonja Carmichael
Senior Policy Officer Aboriginal and Torres Strait Islander
Environmental Health
Environmental Health Unit, Queensland Health
PO Box 48
Brisbane Qld 4001
Ph: 07 32341483 Email: Sonja_Carmichael@health.qld.gov.au
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