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STANDING COMMITTEE ON ABORIGINAL AND TORRES STRAIT ISLANDER AFFAIRS - 23/07/2009 - Community stores in remote Aboriginal and Torres Strait Islander communities

ACTING CHAIR —What would you like to tell the committee?

Ms Kovack —There is a very large community there and I want everyone to know that there is a handful of us that are working on the health of this community. There are about 3,000 people and there is a handful of nurses who want to see a lot of these issues go forward. Right now we are working on a one-to-one basis; one person has an education session with one client or patient. From my public health background I do not think this works. I think it has to be done at a population level, which means we really need to go after the education in larger groups. One-on-one is just not enough; not for a part-time position, for this many people. I do agree that if there were subsidies for the food people would buy it—I sit and listen to people every day, all day—and it is expensive to buy fruit and vegetables. I know there are alternatives like frozen and canned food but, as Mark from BAC was saying, when all that money was out there—and I saw it as well—carts and carts of fresh food were going out of the shops. So if it was available I know that more would be purchased.

ACTING CHAIR —In terms of the program that you are working with one-on-one, is that a federal or a Northern Territory government project?

Ms Kovack —That is the clinic. There are eight nurses in the clinic at the moment. We each have a program that we look after. I have about 600-plus people with a chronic disease—we are talking about diabetes, kidney health and chronic lung disease. There are many, many issues and many, many sick people here.

I will tell you a quick little story: I took about 15 ladies, who are diabetics, to the beach and we had a little education session on diabetes and eating well. They listened and we spent a couple of hours together. They said, ‘Thank you very much, Sue-Ellen, but how do you want us to feed 12 people with this much money?’ It made me feel quite small, when I am spouting on about having to have fresh fruit and vegetables and whole-wheat bread. In a couple of words they asked, ‘How can we do it?’ This was just after the quarantining of the money had started and people did not know how to make that go very far. If you buy a bag of fresh fruit, which could be $50 or $60, when you have large families it is not going to go very far.

The other issue is that a lot of people do not cook from recipes. We are starting a program where we want to have cooking classes to show people how to cook rice and how to put recipes together. It is called the Flower Drum cookbook. We need the human resources. We need people to come out and help us start these programs because the nurses in the clinic are flat out from Monday to Friday nine to five seeing acute sick people. We work on call a couple of times a week and we do not have any resources so if we could have—

Mrs VALE —Obviously, like Helen said, there was a program at some time which had stoves available. I imagined it was in the women’s centre, I do not know, but it looks like when that program was cut it was never ever reinstated and it should have been.

Ms Kovack —The smoking and nutrition program was funded for only six months. We got so far with the smoking, we got so far with the nutrition and then everything fell apart.

Mrs VALE —Six months is not enough. I see what you mean. You were saying that the women you spoke to said that they had many people in their families. How big are the families here? How big are the households? Are you talking about more than two adults being in that household, in that family?

Ms Kovack —Yes. They have their grandmothers, aunties, sisters and children.

Mrs VALE —Wouldn’t the adults also be receiving some support? Wouldn’t there be a combined income coming into a household that would be greater than one’s welfare cheque?

Ms Kovack —Greater than one person putting in. I do not get into cutting that down. I do not understand how people put that together. I just felt a little condescending. I felt really bad after that.

Mrs VALE —It is awfully hard—like you were saying—if you do not know how to prepare meals anyway.

Ms Kovack —That is one thing I would like to get onto, and we are getting onto it. We have not had a nutritionist for many months. We finally have one coming out in the next couple of weeks, I believe. We have cookbooks ready; we have got the Flower Drum. We are going to start doing things but we need the human resources to get things started.

ACTING CHAIR —In terms of your current role, what percentage of your time would you spend on acute health care—dealing with emergencies or problems—as opposed to primary health care when you are doing proactive education and those sorts of activities?

Ms Kovack —My profile is that I have 600 people on the chronic disease list, and all those people need check-ups every three to six months. During the chronic disease check-up, I will bring up the issues of smoking or nutrition, but it is such a small amount of time. You can imagine the number of people you need to see.

ACTING CHAIR —That is your program and that is the way you have to run through it. I do understand what you are doing. Part of my background was in the training area, and I do understand the motivation to get out of working in groups as compared to working with people individually. Often you need to provide people with individual support but often you can get people sharing ideas and information that can motivate each other to make changes as well.

Ms Kovack —Yes. We started action with smoking; we are getting little groups together and people are supporting each other to quit smoking. With nutrition, we are trying to do the same thing but it is labour intensive for what we have to work with. We are trying to start it up.

ACTING CHAIR —I think we will make some recommendations. We have got an inquiry into stores and the like; providing fruit and vegies or healthy food is one thing, but the other thing is being able to use it—and having the equipment and the facilities to be able to use it is important as well. Sandy, did you want to say some things as well?

Ms Smyth —Because I am relatively new to remote health and to the community, probably the most helpful comment that I would make is one that seems to be supportive of others, which is that there is a need for education to work alongside the provision of the healthy foods, the stocking and availability and reasonable cost of all of those things. Subsidising that is obviously something that would have a very positive impact because with limited resources you are going to always choose that which is going to feed more people. The spirit is very willing to be involved with education. It is the ability, with limited resources human wise, to be able to implement that, so a lot of our work at the clinic is probably done on the run and opportunistic rather than by a planned and systematic approach because of the limited human resources. There is a collaborative approach within the community with the retail providers and the other places like the women’s centre and the creche. There are new positions being created at the moment which will help us to be—

Mrs VALE —Multipurpose?

Ms Smyth —Yes, to network together, which I would really look forward to. In terms of child health, I know that in the past there have been feed-in programs which have been connected to things like playgroups and creches, which again would be one of those programs in the past that perhaps have the inconsistency of people—again, human resources—being available to run those programs, so that they have not continued. But it is something that we are looking at at the moment to improve the consistency of food for children. So, yes, in short it is the collaborative educational approach, working alongside the availability of foods that are going to be consistently and reasonably priced and available to the community, that will perhaps make a difference.

ACTING CHAIR —Thank you very much for that. Have you got any other comments?

Ms Kovack —There is one more thing. A man from Darwin called me a couple of days ago. He had been around the communities in the Northern Territory looking at the shops and the fast food outlets, and he said, ‘Look, I just want you to know that the Good Food Kitchen here in Maningrida is a benchmark for the Northern Territory; they are doing a very good job of providing very nutritious and safe food for the community.’ So I just wanted to pass that on.

ACTING CHAIR —You have that on the record; it will be there in perpetuity. We have heard that and we are looking forward to going to have a look at it. I think they might be feeding us tonight; is that correct?

Mrs VALE —Sue-Ellen, how long have you been working within the community?

Ms Kovack —Four years.

Mrs VALE —It is part time? Did you say you are part time or full time?

Ms Kovack —The program is part time. I work weekends and evenings. I look after the pharmacy. There are 3,000 people. A lot of communities this big have hospitals, doctors and that kind of thing. It is a lot of work. If I could do it full time five days a week, it would still need quite a few of us to get on top of the situation.

Mrs VALE —It still would not be enough. I noticed—I think Bill told us—that, compared to the $13,000 a week worth of fruit and vegetables that they sold, there was a turnover on cigarettes of $130,000, which is just unbelievable—but we do believe it. Have you had any success in trying to get people to quit smoking at all? I understand that you are part time and that you have many other balls that you are juggling, but I was just wondering if you have had any success and, if so, what your secret was.

Ms Kovack —We are making small baby steps. We do not have any evidence as yet, but each of us, when we see someone as a nurse in the clinic, will do a brief intervention about a patient’s smoking status. We find that just that five minutes talking about it or handing out a leaflet will put a little grain in the back of their mind. If we continue to do this, studies have shown that it is the best way to have people eventually come around and maybe come and ask you for patches. I have no evidence to give you, but I can see that people do come to me out of the blue and say, ‘I’m ready for those patches.’ Smoking will be something that I talk about six, seven or eight times a day with patients. Yet again, we need a program and people to run it. It has to be full time.

Mrs VALE —Can you say to the committee that you can genuinely recommend a ‘quit smoking’ program as beneficial in this community?

Ms Kovack —Absolutely. I think our numbers are 72 per cent or something like that; do not quote me. I think the rest of the country is 21 per cent. Look at the rates of diabetes, kidney health and cardiovascular. If you add smoking to diabetes, it is time bomb stuff.

Mrs VALE —Yes, it is.

Ms Smyth —Smoking in the community also has a direct impact on child health through the impact of passive smoking, so obviously that has an across-the-board implication.

Mrs VALE —Sue-Ellen, would you say that there is an urgent need for a ‘quit smoking’ funded program here in Maningrida?

Ms Kovack —Very urgent, yes.

ACTING CHAIR —I think we could say that that is the case across all Aboriginal communities. I think it has been recognised by the government; we are putting a lot of money in this year’s budget. That probably has not been rolled out as well, but clearly if we get serious about closing the gap—and I think I made this statement early on—all of the evidence shows that smoking is the No. 1 reason for the gap in life expectancy between Aboriginal people and non-Aboriginal people.

Mrs VALE —Absolutely.

ACTING CHAIR —Before we let you go, since the BasicsCard and since the licensing of stores have you seen any changes in the stores from a health perspective or any change within the community?

Ms Kovack —In the last two years?

ACTING CHAIR —Yes.

Ms Kovack —I think there has been a small change in eating habits. I think people are interested in coming to learn about cooking and about their health in general. I have no concrete evidence of anything; it is just a feeling that I have.

Mrs VALE —Are people using the ‘nutrition’ word more often?

Ms Kovack —Yes, absolutely, but then again I am working one to one. With 600 people, you need people in a room; you need groups of people. You need population shifts, not one-on-one shifts. Small steps are good, but we need an across-the-board approach.

ACTING CHAIR —Thank you very much, Sue-Ellen and Sandi, for your presentation today. Michelle, Noeletta and Kingsley, do you have any comment to make on the capacity in which you appear?

Ms Thumm —I have been in this position only about six weeks. I have worked on various other Aboriginal communities, but this is a very new position for me and for the board as well.

Ms McKenzie —I have been in my position for three years.

Mr Murphy —I am also doing training—cert III—in youth work.

ACTING CHAIR —Thank you. What would you all like to say to the committee today?

Ms Thumm —I would basically like to say what Malabam is doing for the community about the nutritionist. There was a nutritionist here about 18 months ago. She was only here for six months and then there was no more funding for her. While she was here, she also did a Smoke-busters program, which was extremely successful. Because there was no more funding, it stopped. That is right, isn’t it?

Ms McKenzie —That is correct.

Ms Thumm —Noeletta is more up to date than I am.

Ms McKenzie —The Green Tick program came out of Malabam Health Board as well. The issue seems to be lack of funding and short-term funding for programs that are successful in the communities.

Ms Thumm —At the moment, I am waiting for the public health nutritionist to come out next month. We are looking at revamping the Green Tick program within the stores and talking about that. We will also talk about the Flower Drum cooking and getting that revamped again, which will be more than likely out in the open rather than in a closed-in area.

Mrs VALE —That is one-pot style cooking?

Ms Thumm —Yes, one-pot style cooking. We are looking at that. But the problem with the nutritionist coming out is that it is two days a month and that is all.

ACTING CHAIR —So you get a fly-in fly-out nutritionist for two days a month.

Ms Thumm —Yes, and that will be all. I will be working with her to try and get other programs up and running and then I will get local people on board so that they are educated to take those programs out to the community. They will be local men and women, more so local women.

ACTING CHAIR —Is your position funded through the community organisation or is it government funded?

Ms Thumm —No, it is through Malabam Health Board.

ACTING CHAIR —Have they received a grant? How is it funded?

Ms Thumm —I have a contract for two years.

ACTING CHAIR —Where does the funding come from?

Ms Thumm —From OATSIH. I will also be looking at revamping the Maningrida Smoke-busters quit smoking program. There is a public health nurse, Alanna, again she is only coming out two days a month, and we are going to be working together to put Smoke-busters on the agenda again for the community.

ACTING CHAIR —I just want to clarify. You are getting funded through OATSIH which is federal government funding. Where does the funding come from for the nutritionists?

Ms Thumm —It comes from the Northern Territory department of health.

ACTING CHAIR —Are they working with the clinic?

Ms Thumm —Yes.

ACTING CHAIR —They are funded through the clinic.

Ms Thumm —So Alanna will be going to the clinic but she will also be liaising with me.

ACTING CHAIR —One of the frustrations I see in Indigenous communities is the number of programs, the silo basis of some of the programs and the lack of integration when we are all working in a smallish community where everybody knows everybody else and things need to be better integrated. Have you got any comments on that in terms of the way that the federal and NT governments are delivering health services? Is that a problem?

Ms Thumm —It is not a problem working with them but what I am planning to do is to draw up a spreadsheet of what is available within the community so that programs do not overlap and people know exactly what is going on.

ACTING CHAIR —I hear what you are saying. I see this in my electorate in Queensland where health professionals have to meet with each other to work out who is doing what when they go into a community and the reality is that it is a small community. Government people should not have to meet with each other to work out how not to step on each other’s toes in a community, we should actually just be working on how to integrate effectively with the community. I am getting off the track little bit from the inquiry, but it is interesting to hear that there are similar issues arising here. Would anybody else like to make a comment on that?

Ms McKenzie —The biggest issue in Maningrida is lack of communication between service providers. Everyone is saying, ‘Let’s do cooking.’ I have been running a program for the last six months on a Saturday grog day, a nutrition program, where mind you—sorry, shop owners—I had to go outside of Maningrida to get funding to run the nutrition program for young people in this hall every alcohol day. We are feeding up to 70 kids and it is just me and my youth team that are running it. We are making $8 million profit, but I have to go outside of Maningrida to get a measly $4,000 to buy food to feed these kids. The kids are being taught to cook. It was the same when I asked both shops for a donation of a fridge and a freezer to put into the town hall so that we could make ice cups of kids, I was told, ‘No because we are a not-for-profit organisation.’

Mrs VALE —Do not both the community stores here return profits back to the community?

Ms McKenzie —Apparently so. I just ran a festival that catered for 3½ thousand people. Again, I went outside of Maningrida to secure funding.

Mrs VALE —From a government department?

Ms McKenzie —From FaHCSIA. They milk youth diversionary money down into the Red Cross and again—no sponsorship. I got $500 from the AC outdoor shop and then nothing from MPA.

Mrs VALE —Have you put a request in to the committee who run the shop?

Ms McKenzie —I sent sponsorship packages out to all the organisations that can provide to the festival, yes.

Mrs VALE —We really cannot make a comment about internal management of that, sorry, but at least you are getting your funding from FaHCSIA. Obviously, they can see the value of the programs you are running.

Ms McKenzie —Well, as of 30 June we do not have any recurrent funding so—yes.

ACTING CHAIR —What sorts of programs are you running? You say you are doing—

Ms McKenzie —We get alcohol into the community every second Saturday.

ACTING CHAIR —So you get alcohol into the community—

Ms McKenzie —Yes, it is called a wet barge grog day.

ACTING CHAIR —Okay.

Ms McKenzie —We open the hall for the kids so they have a safe place to come.

ACTING CHAIR —You open the hall for the kids to have a safe place to come?

Ms McKenzie —Yes. It is run most barge days. Some barge days it does not happen due to staff or human resources.

ACTING CHAIR —And you do not get funding from the community organisations who support that? You have to get—

Ms McKenzie —No. That has been funded from outside Maningrida.

ACTING CHAIR —And you have taken that up with the community reference group and with the different organisations in town?

Ms McKenzie —I have spoken to a few people on the community reference group about different issues with the youth services, yes.

ACTING CHAIR —Have you spoken to the government manager here?

Ms McKenzie —Yes. I have lots of conversations with Michael Rotumah.

ACTING CHAIR —Yes. Kingsley, did you have any comments that you wanted to add?

Mr Murphy —No.

ACTING CHAIR —I appreciate your frankness, Noeletta—often you scratch the surface and there can be different issues within communities. Obviously, you are running a program and you are clearly frustrated by that. Similarly, Michelle, for the comments you have made in terms of what we can possibly recommend to ensure that government is effectively coordinating the effort that it is making in communities to support that effort. Have you got any other comments that you would like to add?

Ms Thumm —I did a very, very basic grocery comparison for BAC, MPA, Coles and Woolworths, which I would like to table.

ACTING CHAIR —We would love you to table that and we will have a look at it. Would you like to make some general comments about your brief analysis of it?

Ms Thumm —Initially, when you total everything up, BAC comes out as being very expensive and Coles and Woolworths are fine. But when you look at delivery charges to the barge and freight charges, BAC and MPA come up cheaper than Coles and Woolworths.

ACTING CHAIR —So when you add the cost of freight on—

Ms Thumm —Freight, and the delivery charge. To get your groceries from the Coles store to the actual barge is $27.50. To get just one box—the minimum—from Darwin to Maningrida is $42.00. Basically, it backs up what BAC and MPA say, that their prices are what they are because of the freight cost. A subsidised freight cost, or some more competition to get another freight service in or whatever would be really good to reduce that cost.

ACTING CHAIR —Thank you very much for that, Michelle. We will have you table that. Thank you very much for your comments today and your contribution to this hearing. Is there anybody else that we would like to hear from?

Mr Kiely —I would like to pick up on a couple of points. Starting from the observations about BAC and MPA and the comparison to Coles and the price of groceries in communities, I would like the committee to consider the zone rebate and how that has not moved over the years—zone A and zone B and what that means.  Years and years ago that was really worth something. It helped defray some of the costs of living in remote areas—costs for electricity and food. That has not moved. While we see different moves in the tax scales in all sorts of areas, we have not seen that zone rebate moved. That would be something that we would hope would act as an incentive for all people in remote communities to come out here. The government has a fiscal equalisation model. I think it is really unfair that, while we see moves on income tax and moves on all sorts of good and services occurring in larger communities and capital city based communities, we do not see that in the most remote and most disadvantaged areas of Australia.

ACTING CHAIR —Len, are most Indigenous people in this community paying tax?

Mr Kiely —You see our CDEP participants on top-up pay tax; of course; everyone on wages pay tax. There is a pretty big tax base here.

ACTING CHAIR —Wouldn’t it be that most people on welfare or a transfer payment would not be paying tax, so a change in a tax rebate would not necessarily provide any additional money to those on the lowest incomes in this community?

Mr Kiely —The whole thrust of government is that we get people onto real wages—I think that is the term. To presuppose that everyone around here is always going to be a welfare basket case is not right. We are moving towards a larger income base. We hope that there will come a day when those on higher income brackets are local people. There is a large welfare base here, but maybe the application of a zone allowance should be taken into the welfare stream. Perhaps those in zone A should get a special consideration of some sort. Maybe not doing it effectively through tax breaks will help those on the welfare, fixed income stream.  You raise a good point. There are a large number of recipients on welfare who would not be getting the advantage of a zone A, zone B tax break, and that too should be taken into consideration.

ACTING CHAIR —Thanks, Len. Would you like to make any other comments?

Mr Kiely —BAC has been in the fortunate position of being on the panel for the Indigenous Employment Program. We manage the new CDEP schemes.  I think Mark from Barlmarrk Supermarket and others have mentioned how we feel about the changes that the new CDEP will make for the individual. There are some good programs, such as the Indigenous Employment Program. Picking up on Bill’s comment on market gardens, we have been considering trying these out as new Indigenous enterprises. Depending on soil type, we may be able to get some sort of market gardening going—not one which has one row of cabbages and one row of cauliflowers. I think we have got to learn from the Humpty Doo experience. People from the north who have come down and settled in the Top End are growing Asian type vegetables, which are more suited to the climate. We might even be able to find a way of harvesting traditional bush foods.

There is a lot of work being done by John Altman and others on Indigenous enterprise and in working through traditional food sources. While we could not extend ourselves to an external market such as Darwin or beyond, certainly if we could find one or two crops that will grow on one homeland and one or two crops that will grow on the other, with the surplus we might be able to start up some sort of Saturday market in town. He said that we would not only be meeting the traditional needs of the community but we might also be looking at fixing up some of the economic needs as well. Those are the main points that I wanted to throw into the mix for you.

ACTING CHAIR —Thank you, Len. Mark did a pretty good job of outlining some of the other issues early on. Is there anybody else who would like to make any comments to the committee? If not, I thank people for coming along this afternoon. I do again apologise for the lateness of our arrival, and I do know that this has been a difficult day, running into show day in Darwin. Last week we had Cairns show day last week and many people travelled down from Indigenous communities in Cape York to come to show day, and it is a big part of the annual event.

Just to let you know what happens from here, we have been travelling across Australia to remote communities to hear directly from people. Some of the things that you have said today have been similar to what we have heard in other places, but it helps to inform us. We have gone to communities with corporate stores in the NT and Queensland, we have gone to communities with individual stores. The good thing about this community that is a bit different is that you have got two stores. We have gone to small communities and large communities, so we have been getting around talking to a range of different people about the situation in remote Indigenous stores.

The transcripts of all of those conversations are up on the Parliament House website and, if people are interested, they can have a look and a read of not only the conversations that we have had today and the submissions that have been put in today, but also all the submissions that are being contributed to the inquiry. We are going back to parliament in a few weeks, and we will be having another hearing with FaHCSIA. Following on from that, we will be starting to deliberate and come up with a series of recommendations. We are planning to bring down our report and table it in the federal parliament in October. We are a committee made up of the Labor Party, the Liberal Party and also Independent member Mr Katter. So we are a cross-party committee. We will be looking to try to bring down a bipartisan report. Many of the issues that have been raised go across communities. I think that we can make some recommendations that will be useful to the government.

In the end, it will be a decision of the minister, who will make a recommendation  to the parliament, and Minister Macklin will have to respond to the report. We are hoping that the hearings that we have had and the input that we have had will provide some input into the development of the food security policy that is being developed by the Rudd government at the moment. I certainly hope so. The information that you have provided today and the submissions that you provided will help inform us and guide us in our recommendations. We hear the calls for freight subsidies and in terms of the difficulties particularly in small communities around the sustainability of stores. So there are a range of different challenges that we face in terms of making recommendations.

Again I thank you for your contribution today. If you are interested in this committee then you can follow the results of it on the internet or you can get in touch with the secretariat through the government business manager here, with whom we have been working in terms of pulling the program together today. Danna and I really appreciate the efforts that you have made to come today. I thank the traditional owners and Helen for the welcome and again we pay our respects to the elders. Thank you to Hansard for the work that they have done today. We look forward to overnighting in your community. I always like to overnight in communities—there is too much flying in and flying out—and trying some of your good seafood that I understand we are going to experience tonight. Thank you very much, and also thank you to the secretariat that has organised today.

Committee adjourned at 6.39 pm