Healthy Skin Program Update June – Nov 2013

Building better lives together

2 Building better lives together Healthy Skin Program update 3

Why our organisation exists 3

Healthy Skin Program Highlights 4Best start for kids 4Improvements in quality of life 5

Activities and outcomes across East Arnhem Land 6Snapshot of Healthy Skin Program activity 7

Healthy Skin Events 8

Supporters 10

Our vision is to redefine the way we and other Australians partner with Indigenous communities to solve challenges in a positive and empowering way.

Seven out of 10 indigenous kids in East Arnhem suffer from scabies at least once before their first birthday even though there is

a very simple tablet and cream to treat the disease. The reasons for this are complex and multifaceted, but we believe they can be overcome.

Scabies is a mite that burrows under your skin causing itching and discomfort. It can contribute to secondary infections that may lead to heart valve damage and kidney disease.

Crusted scabies is the most severe form of the disease; patients can have thousands to millions of mites (rather than 5-10 for simple scabies). They act as core transmitters of the disease and not only suffer physically with thick, crumbling crusting and constant discomfort, but they can also become shunned as modern day lepers within their community.

We believe no Australian should suffer from this debilitating disease. Our aim is to eliminate scabies and crusted scabies as a public health issue. This initiative is known as the Healthy Skin Program; it has been active in East Arnhem Land since August 2011.

Why our organisation exists

Contents

4 5Building better lives together Healthy Skin Program update

Photo collage of happy kids (at least 3 photos) – incl. group of kids after lyclear application on P22 of last report

Best start for kidsRecognising the importance in giving kids the best start in life, one of our core program goals is to reduce scabies rates in children under 5 years old.

Source: Gove Hospital Admission data 2013

Improvements in quality of life

All known crusted scabies patients in East Arnhem that participate in the chronic care management plan

continue to be supported in self managing their condition. Not only have we seen medical successes as demonstrated in our last report (with a 65% and 76% reduction in number of days that scabies and crusted scabies patients had been hospitalised in the previous year), we have also seen great measured improvements in patients’ mental well-being and quality of life.

healthy skin Program highlights 66%

REDUCTION

75%REDUCTION

100%REDUCTION

Patients reporting skin condition impacts their social activities or personal relationships with family and friends

Patients reporting feelings of shame and embarrassment

Patients whose skin condition impacted their ability to undertake work

88%REDUCTION

Amongst children living in households with crusted scabies, the average number of days spent in hospital has decreased from 16 to 2 days per child per year (compared with previous 3 years)

6 7Building better lives together Healthy Skin Program update

Treat core transmitters

� Providing direct case management support to seven crusted scabies patients in Yirrkala and Gunyangara with no serious relapses since Aug 2011.

� Supporting existing health services to manage one case in Gapuwiyak, and three cases in more remote (homeland) communities.

� Formal identification of four more cases of crusted scabies in East Arnhem. We are working in partnership with local health services in developing chronic care management plans.

� Confirming or ruling out all suspected cases of crusted scabies in Yirrkala, Gunyangara, Gapuwiyak, Galiwin’ku and Milingimbi.

� Development of learning resources for clinical staff to assist with management of crusted scabies cases (working with NT Centre for Disease Control to include these resources in their guidelines).

� Direct support to households with recurrent scabies issues (including mini-skin days, outreach visits and treatment), and advising health centres throughout the Arnhem Land region on how to manage these situations.

Point in time prevalence reduction

� Coordinating and supporting Healthy Skin events in Yirrkala, Ramingining and Galiwin’ku.

� Yirrkala Healthy Skin event in particular involved an extensive process of community engagement and partnering with key influential families, which

will continue to bear fruit as the program continues into 2014.

� Gaining approval to prescribe Ivermectin as an orally administered scabies treatment (from the Therapeutic Goods Administration). Nurses are now able to administer Ivermectin for problem cases of scabies without the approval of a doctor (via inclusion in the 6th edition of the CARPA treatment manual).

Sustained reduction of reproductive rate

� Local community workers establish surveillance and treatment systems of kids under 5 in Yirrkala and Birritjimi, including weekly visits to the school and early learning centre.

� Regular scabies education sessions with expectant mothers from the maternity ward at Gove District Hospital.

Operational enhancers and enablers

� Building a community-based workforce which has included up to six Yolngu staff members, two of which have been with us for over a year.

� Delivering numerous training and education sessions to local clinics at various locations including Yirrkala, Gunyangara, Gapuwiyak, Maningrida, Milingimbi, Galiwin’ku , as well as Gove District Hospital, Miwatj Health Aboriginal Corporation and Laynhapuy Homelands Health Service.

The Healthy Skin Program is a multifaceted approach in partnership with Indigenous Australians. Here is a summary of key activities and outcomes over the past 6 months relating to our 5 core objectives:

aCtivities and outComes aCross east arnhem land

JABIRU

GULF OFCARPENTARIA

ARNHEMLAND

NHULUNBUYRamingining

Gapuwiyak

Yirrkala

Not to scale

DARWIN

KATHERINE

CENTRALARN

HEMRD

Maningrida Gunyangara, Galupa,Biritjimi

Milingimbi

Galiwin’ku

� Continuation of the Spin project, aimed at improving functionality rates of household washing machines, a fundamental component of health hardware that can limit the spread of scabies and skin infections:

- Two rounds of washing machine repairs across Gapuwiyak, Galiwin’ku, Milingimbi, Ramingining, Yirrkala and Gunyangara. In total 165 washing machines have been repaired back to a fully functioning status, lifting rates of access to a fully functioning washing machine from 51% of households to 63%.

- Educating households on how to operate and maintain machines.

- Training local workers in four communities to correctly install washing machines when purchased.

� Commissioning the development of education resources to support clinics in the management of crusted scabies and families with recurrent scabies. Creation of a crusted scabies fact sheet for Gove

District Hospital to better coordinate hospital and community based treatment.

Scaling up impact

� Presented program lessons and results at various conferences and workshops including the Australian Society for Infectious Diseases Conference, Telethon Healthy Skin Workshop, National Aboriginal and Torres Strait Islander Environmental Health Worker Conference and the AMSANT CQI Collaborative Workshop.

� Two patient case studies being prepared for publication in peer-reviewed medical journals based on findings and results in the first 12 months of the Healthy Skin Program. These will be powerful tools to promote the success of chronic condition management for crusted scabies and help to control this debilitating disease in Indigenous communities throughout Australia.

8 9Building better lives together Healthy Skin Program update

Why do we do them?

The identification and chronic condition management of crusted scabies is the single most important method to control scabies rates. In communities where crusted scabies patients are being managed and are no longer core transmitters of the disease, Healthy Skin Events are an important strategy to target simple scabies.

What do they achieve?

There are four core outcomes community wide for such events:

1. Education about the cause, consequences, identification and treatment of scabies

2. Point in time treatment and clean up

3. Establish relationships and involve community leaders and influencers, a crucial step towards the longer term goal of community ownership of the program.

4. Engage with multiple agencies to run the event, making scabies everyones’ business.

IIn partnership with our community workforce, we’ve developed a brand in language that will become synonymous with our goal of healthy skin and a positive outlook: Healthy Skin (ḏarrtjalk rumbal) and Clean homes (ḏarrtjalk

healthy skin events

10 11

Subway NSW & ACT

Platinum Speakers

Commonwealth Youth Forum

Innovation ACT

Australian Medical Students Association

AVANT Insurance

Indigenous Construction Resource Group

Office for Aboriginal & Torres Strait Islander Health

University of Wollongong

George Hicks Foundation

The Kimberley Foundation

The Snow Foundation

Wildfire – Monash University Rural Health Club

Rotary Club Great Lakes

The Jibber Trust

Rees Family Foundation

The Cameron Foundation

Bray Kargas Family Fund

Aspen Medical Foundation

Sunshine Foundation

Gourlay Charitable Trust

John James Memorial Foundation

6A Foundation

St George Foundation

The Myer Foundation

John & Myriam Wylie Foundation

Azure Capital Foundation

Jewish Communal Appeal

Gandel Philanthropy

Smith Charitable Fund

Dorothy & Bill Irwin Charitable Trust

Charlie Perkins Trust

Mary MacKillop Foundation

Newman’s Own Foundation

Zambrero

Eltham World Harmonies Inc.

Aerapay

Bolin Accountants

Canberra Design House

Digital Press

Minter Ellison

Kelly & Partners Chartered Accountants

We would like to acknowledge and

thank our generous supporters. We are

very grateful for their investment in a healthier

and happier future for all Australians.

Samantha CranChief Executive Officer

e samantha.cran@1disease.org t 0409 228 524

or visit us onine at www.1disease.org