PCD Strategy Evaluation 2007.pdf - NT Health Digital Library ...
PCD Strategy Evaluation 2007.pdf - NT Health Digital Library ... PCD Strategy Evaluation 2007.pdf - NT Health Digital Library ...
Two communities in Arnhem land were selected to form case study sites. These communitieswere selected on the basis that they represented two quite different situations as regards tohealth service delivery. Also the researchers had already established good contacts in thecommunities. This is important as the time frame of this study allowed one week in eachcommunity. This is very minimal for an in-depth ethnographic study if the researchers had noprior experience in these specific communities.A number of methods were used including group discussions, semi structured interviews andparticipant observation. These were conducted generally within the community and specificallywithin the health centres and council offices. We also conducted interviews with health centrestaff, to obtain their perspective on the barriers to successfully engaging with the community.Permissions was sought from the Community council and the health board of each community.The settingsBoth communities were in Arnhem Land and were closely related in terms of movement of peopleand cultural beliefs and practices. Their current systems of health care delivery were quitedifferent.Community A has a population of approximately 900. The health services are provided by theNorthern Territory Department of Health and Community services through the health centreclinic. The clinic has a staff of two registered nurses, one doctor, four health workers, one driverand a receptionist.The clinic has a verandah which serves as an outside waiting area, a central consultation area, awomen‟s room, dentist‟s room, doctor‟s office, an emergency room and a tea room. The nursesand health workers consult initially in the central open area of the clinic and minor illnesses andchronic disease checkups are dealt with here. Patient files, which are filed under first name, arekept in the reception area. There is another separate set of files which are for the chronic diseasepatients; these are kept in the central consultation area.As an institution the clinic is an important focus of community attention. It is the place wherepeople put up posters and flyers advertising community events, for example while we were at theclinic, students from the school brought in posters advertising adult education. Because peopletend to drift in and out of the clinic building, it is difficult to determine who the patients actuallyare.Appendix 4: Ethnographic Field Study – Evaluation of the NT Preventable Chronic Disease Strategy 2007 122
Other services are provided to the health centre through visiting teams from the Department ofHealth and Community Services, from both Nhulumbuy and Darwin and also through Miwatj.During the week that we were in the community, the clinic had several visiting teams, includingan eye health team, a foot health team, a mental health team and a public health nurse. It wasnot clear if any of these groups knew that the others were going to be there, which suggests thatthere is the potential for improving the coordination of services.Community B has a population of 1000. It has recently become part of a regional communitycontrolled health service. Previously the clinic was run by the Department of Health andCommunity Services and was characterized by the long term employment of the RN. Subsequentto the resignation of this person, staffing has been more unstable. There has also been areduction in the number of health workers at the clinic. The clinic itself is very similar to that ofcommunity A. Much of the initial consultation and diagnosis is done in a public waiting area. Thispractice deters people from visiting the clinic, due to the potential for embarrassment. Unlikecommunity A, the clinic is at the edge of the community and it is not a place where peoplecongregate. Instead, a driver is employed to collect people to come to the clinic. There is noresident doctor in the community, although it is hoped that there will be one soon.Health concerns in the communityIn both communities, people compared the current state of health unfavourably with that of thepast.“In the past men were strong, they had big bodies, but now they are nothing, all thatMunanga food. In the old days they used to grow bananas, cabbages, carrots,everything, they even tried to grow rice. There was not much sickness then”Diet was mentioned in both communities as an important contributor to the poor health profile.In community A, people commented that there were very few healthy food options at the localtakeaway and that fresh fruit and vegetables were very expensive. The store carried a range offruits and vegetables, although these were expensive ($4.60 for an iceberg lettuce, $4.50 for halfa Chinese cabbage). Meat was reasonably priced, but the choice was limited. Only white breadwas available. The take away‟s most popular food was fried chicken, although some lower fatoptions such as chicken wraps and sandwiches were available.The health workers commented:“people know about good food, but sometimes they don‟t want to cook it, sometimesthey don‟t have the pots and pans to do the cooking in the house”Appendix 4: Ethnographic Field Study – Evaluation of the NT Preventable Chronic Disease Strategy 2007 123
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- Page 149 and 150: References1. Dunham, H., Ministeria
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Other services are provided to the health centre through visiting teams from the Department of<strong>Health</strong> and Community Services, from both Nhulumbuy and Darwin and also through Miwatj.During the week that we were in the community, the clinic had several visiting teams, includingan eye health team, a foot health team, a mental health team and a public health nurse. It wasnot clear if any of these groups knew that the others were going to be there, which suggests thatthere is the potential for improving the coordination of services.Community B has a population of 1000. It has recently become part of a regional communitycontrolled health service. Previously the clinic was run by the Department of <strong>Health</strong> andCommunity Services and was characterized by the long term employment of the RN. Subsequentto the resignation of this person, staffing has been more unstable. There has also been areduction in the number of health workers at the clinic. The clinic itself is very similar to that ofcommunity A. Much of the initial consultation and diagnosis is done in a public waiting area. Thispractice deters people from visiting the clinic, due to the potential for embarrassment. Unlikecommunity A, the clinic is at the edge of the community and it is not a place where peoplecongregate. Instead, a driver is employed to collect people to come to the clinic. There is noresident doctor in the community, although it is hoped that there will be one soon.<strong>Health</strong> concerns in the communityIn both communities, people compared the current state of health unfavourably with that of thepast.“In the past men were strong, they had big bodies, but now they are nothing, all thatMunanga food. In the old days they used to grow bananas, cabbages, carrots,everything, they even tried to grow rice. There was not much sickness then”Diet was mentioned in both communities as an important contributor to the poor health profile.In community A, people commented that there were very few healthy food options at the localtakeaway and that fresh fruit and vegetables were very expensive. The store carried a range offruits and vegetables, although these were expensive ($4.60 for an iceberg lettuce, $4.50 for halfa Chinese cabbage). Meat was reasonably priced, but the choice was limited. Only white breadwas available. The take away‟s most popular food was fried chicken, although some lower fatoptions such as chicken wraps and sandwiches were available.The health workers commented:“people know about good food, but sometimes they don‟t want to cook it, sometimesthey don‟t have the pots and pans to do the cooking in the house”Appendix 4: Ethnographic Field Study – <strong>Evaluation</strong> of the <strong>NT</strong> Preventable Chronic Disease <strong>Strategy</strong> 2007 123