A central strategy in addressing health disparities experienced by Indigenous people has been based on a concern with workforce improvement. In this paper, the Indigenous Australian healthcare workforce literature since 1977 is reviewed and its scope of concern, as being often limited to questions of ‘supply’, is critiqued. The pipeline metaphor, whether used explicitly or implied, regularly focuses attention on closing the gap on Indigenous representation within the health workforce. The exception though is the discourse concerning Indigenous Health Workers (IHWs), where questions concerning the legitimacy of the role continue to abound within a workforce hierarchy where community knowledge, though shown to be crucial to culturally safe health service provision, is trumped by the other health professions whose knowledges and legitimacy are not in question. This contrast exemplifies the need to examine the working of power not just ‘supply’. The pipeline metaphor is disrupted with concerns about a range of other ‘gaps’ – gaps in the recognition of Indigenous knowledges, in organisational structures, in governance and in self-awareness by the health professions of their whiteness. As the health system continues to measure workforce development in terms of pipeline capacity, our study questions what happens beyond the pipeline.
Objective: To determine the prevalence of community‐acquired methicillin‐resistant Staphylococcus aureus (CA‐MRSA) carriage and infection among children living in an Indigenous community in Queensland.
Design, setting and participants: Swabs for culture of S. aureus were collected from the nose, throat and skin wounds of primary school children.
Main outcome measures: MRSA carriage, antibiotic sensitivity, genotype, and presence of the virulence factor Panton–Valentine leukocidin (PVL); and epidemiological risk factors for MRSA carriage.
Results: 92 (59%) of 157 eligible children were included in the study. Twenty‐seven (29%) carried S. aureus; 14 of these (15% of total) carried MRSA. MRSA was isolated from 29% of wound swabs, 8% of nose swabs, and 1% of throat swabs. Fourteen of 15 MRSA isolates were sensitive to all non‐β‐lactam antibiotics tested. Eight children (9%) carried CA‐MRSA clonal types: six carried the Queensland clone (ST93), and two carried the South West Pacific clone (ST30). All these isolates carried the virulence factor PVL. The remaining six children carried a hospital‐associated MRSA strain (ST5), negative for PVL.
Conclusions: We have identified a high prevalence of CA‐MRSA carriage in school children from a Queensland Indigenous community. In this setting, antibiotics with activity against CA‐MRSA should be considered for empiric therapy of suspected staphylococcal infection. Larger community‐based studies are needed to improve our understanding of the epidemiology of CA‐MRSA, and to assist in the development of therapeutic guidelines for this important infection.
The National Health and Medical Research Council, Research Agenda Working Group (RAWG), and the literature on Indigenous health have identified the need to fill gaps in descriptive data on Aboriginal and Torres Strait Islander health and noted both the lack of research with urban populations and the need for longitudinal studies. This paper presents some of the broad ethical and methodological challenges associated with longitudinal research in Indigenous health and focuses particularly on national studies and studies in urban areas. Our goal is to advance debate in the public health arena about the application of ethical guidelines and the conduct of longitudinal studies in Aboriginal and Torres Strait Islander communities. We encourage others to offer their experiences in this field.
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