The Federal Government published its landmark pandemic planning blueprint for Aboriginal and Torres Strait Islander communities this week, laying out key principles, messages and considerations for protecting Indigenous people from the novel coronavirus outbreak.
It emphasises shared decision-making, community control and highlights the importance of centering responses on Aboriginal and Torres Strait Islander perspectives, culture and ways of living, appreciating the unique ways these may intersect with and come up against “command and control” public health approaches that will have unwelcome resonance with legacies of harm.
Ensuring cultural safety, proportionality, equity and inclusion of Indigenous knowledges should be a feature of the pandemic response, according to the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19): Management Plan For Aboriginal and Torres Strait Islander Populations, which was published on Monday.
It singles out a number of specific issues for special consideration in formulating outbreak responses and messaging for Aboriginal and Torres Strait Islander communities, including but not limited to:
- high levels of mobility, with travel frequent and over long distances for family, cultural and community obligations, and prolonged periods of close contact during events such as sorry business and cultural ceremony
- significant visitor flows through communities, whether these are tourists, tradies, medical staff or FIFO workers
- social determinants of health such as poor quality and crowding of housing, homelessness, restricted access to water, hygiene products and fresh foods, low levels of literacy, and poverty
- health care issues spanning access and transport, racism, stigma and mistrust, cultural safety and appropriateness, existing burden of chronic and infectious disease, and primary care services, evacuation and recipient tertiary facilities that are already at or beyond capacity under business-as-usual conditions
- specific at-risk Indigenous populations, including those in hostels, detention centres, aged care, town camps, and homeless
It comes as reports emerge from Western Australia of five health care workers testing positive for COVID-19 in the remote Kimberley, where a significant proportion of the population are Indigenous.
For remote clinics, the plan paints a stark picture, warning of staffing issues due to travel bans and isolation that are difficult to overcome with telehealth solutions given infrastructure problems in these locations. Many such clinics already have an inadequate supply of PPE, face significant evacuation challenges, and due to delays of a week or more in turnaround of a COVID-19 test from remote areas, will have to treat all respiratory infections as a suspected coronavirus case.
Strains on remote clinics may see non-COVID mortality increase, and in a worst case scenario, could force the service to close, leaving communities without local care, the plan says.
A number of high profile Aboriginal and Torres Strait Islanders have also spoken out, calling for anyone who has benefited over the years from research on and time in Indigenous communities to give back by assisting at this crucial time.
The federal management plan details a number of priority messages that should be delivered in local language as well as visually, via various formats including TV, radio, social media, posters and waiting room materials.
Broadly, these include
- travel restrictions to communities
- effective hygiene practices
- vaccines (emphasis on influenza and pneumococcal coverage ahead of this winter)
- reporting illness, seeking advice and/or attending health services early, especially if vulnerable
- appropriate use of PPE
- isolation and quarantine (highlighted as a major issue for remote communities where there is a fixed housing supply and crowding is already an issue)
- maintaining food and essential services and supplies
Don’t miss this earlier piece from Kristy Crooks and Julie Leask arguing for Aboriginal and Torres Strait Islander Australians to be central to the nation’s pandemic response, drawing on lessons from previous outbreaks.
Cultural strengths, solidarity and resistance
In the several weeks between Australia activating its national pandemic plan and approving this management plan for Aboriginal and Torres Strait Islander communities, Indigenous organisations have stepped into the breach, getting their messages out there in ways that emphasise cultural strengths, solidarity and resilience.
Minister for Indigenous Australians Ken Wyatt has been sharing some simplified, targeted messaging from the Department of Health urging Aboriginal and Torres Strait Islander Australians to “stay in your community, and if you can, stay home”.
The department has developed some radio resources in a few languages (Warlpiri, Western Arrernte, Pitjantjatjara) and created a video with comedian Sean Choolburra for dissemination in communities.
The government is urging people to share messages and resources using the hashtag #KeepOurMobSafe. State and territory governments have also developed specific resources for their jurisdictions (see here for NSW, Vic, Queensland, SA, WA).
The Northern Territory government has recorded simple public health messages into 17 languages for broadcast on community radio, with plans to add more, and it has specific advice for remote communities at its coronavirus resource hub.
But the heavy lifting is being done by and within the community sector, with NACCHO out on the front foot from the very earliest days of the outbreak, sharing a daily Coronavirus News Alert with the latest developments and resources and launching a special COVID-19 hub.
The Aboriginal Health and Medical Research Council (AH&MRC) of NSW has developed a huge raft of resources for clinics and communities including factsheets and posters on social distancing, isolation, handwashing, cough and sneeze etiquette and keeping elders safe.
They’ve also filmed a number of short videos, including some explainers from renowned Aboriginal ENT surgeon Dr Kelvin Kong and Illawarra Hawks basketball star Tyson Demos.
Deadly Choices is running a #CleanAndDeadly competition across its social media platforms giving away North Queensland Cowboys merchandise, and is also featuring NRL legend Johnathan Thurston and others in a series of short simple public health videos.
A huge body of work has been done by the Northern Land Council to shoot short films in a range of NT languages on COVID-19 and translate key messages for dissemination across social media.
AMSANT also have a range of videos explaining what the virus is, how it will affect local health services, and how telehealth will be used. Yolngu Radio, from East Arnhem Land, are providing regular coronavirus updates via Facebook, and held a special coronavirus Q&A with the local health service, police and government officials which was filmed and can be seen below.
The Purple House, a dialysis service in the Northern Territory, is sharing this video in Pintupi/Luritja language.
— Aboriginal Medical Services Alliance NT🖤💛❤️ (@AMSANTaus) March 26, 2020
Many services are also maintaining a keen focus on social and emotional wellbeing as communities grapple with stern restrictions on movement and contact. We’ve included some examples below, including the National Indigenous Youth Education Coalition‘s Self Isolate in Solidarity Challenge and some wonderful suggestions from Seed Mob for time in quarantine. Wiradjuri author Anita Heiss is in on the NIYEC challenge, and has also recorded a plea for Elders to stay home.
The newly-established Gayaa Dhuwi (Proud Spirit) Australia coalition for social and emotional wellbeing, mental health and suicide prevention has crafted some simple coronavirus messaging, also clipped below.
A shout out to all our Elders during #covid_19
— 💧Prof Anita Heiss (@AnitaHeiss) March 29, 2020
Apunipima GP and public health MO Dr Mark Wenitong has been providing a masterclass in communication, posting popular video updates to Facebook which keep people informed but also stress messages of resilience and strength, putting historical truth-telling into practice.
Groups including Indigenous Allied Health Australia have been using technology to hold COVID-19 virtual yarning sessions, drawing on traditional ways of sharing experiences and knowledge.
IAHA Aboriginal & Torres Strait Islander Allied Health Members Yarning Circle
Hosted by IAHA’s own Tanja Hirvonen & Kylie Stothers
Thursday 2nd April – 1:00pm (AEDT) register by emailing membership@ https://t.co/yAG8lNIHLb for the links to attend. pic.twitter.com/N9lXfl1vLI
— IAHA (@IAHA_National) March 31, 2020
The Aboriginal Health Council of Western Australia has some great resources including a children’s book and infographics on symptoms and prevention in Kriol. In the ACT, Winnunga Nimmityjah have some simple explainers.
Thamarrurr Development Corporation in the remote community of Wadeye have developed a range of video resources in Murrinh Patha, as well as convening community meetings and formulating an outstations plan for coronavirus.
In the NSW town of Walgett, the Dharriwaa Elders Group are coordinating transport and supply runs for Elders, people in isolation, and other vulnerable groups and providing social media updates as public health measures evolve.
First Peoples Disability Network have some excellent video resources on their YouTube channel — one of their most popular and probably our favourite is below. You also don’t want to miss the ‘Bye Corona’ handwashing parody from Ngaarda Media in remote WA (also below).
— TDC (@ThamarrurrDC) March 31, 2020
Huge thanks to everyone who sent in suggestions for this post, which is only a serving suggestion of the huge volume of work going on around the clock in communities. If we’ve missed something you think we should include, please get in touch.
Most of all, stay safe, well, connected, and at home.