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July 2011July 2011July 2011July 2011
the
newsletter
joiNTNTNTNTed rthritis & Osteoporosis NT
INSIDE
Build Muscle and Increase Strength
Medications
Challenging Pain Program
Conversation Café
Corporate Membership
Falls Seminar
Library News
…... and more
Pip and Ruth
at the
Katherine
Community
Expo in June
Cost: Gold coin donation Tea and coffee will be provided
Content • Falls prevention: including measures such
as risk assessments of the home e.g. slippery mats, loose electrical cords and choosing appropriate foot wear and clothing.
• Developing a Fall Emergency Plan: knowing how and who to summon for help.
• Practical demonstrations of the best way to get up off the ground after a fall (very important so another fracture doesn’t occur after the initial fall).
Presented by a qualified Physiotherapist from
To register interest contact Pip at
AONT on 8948 5232
10 am to 11.30 am Community Room Palmerston Library
2 pm to 3.30 pm Meeting Room
Casuarina Library
Falls and Fracture
Prevention Seminar Tuesday 2nd August
From the Board
Last month all members were advised that our submission made to NT Government last year for an increase in funding was unsuccessful. This newsletter reaches many more people than our membership and we feel it’s time to inform the wider community that AONT is struggling to maintain services.
Our current situation:
• we have 2 part-time paid staff (book-keeper – 10 hrs per week, development officer – 25 hr per week).
• the bulk of our activities are carried out by volunteers -
∗ reception, office organisation, newsletter, self management courses
∗ directing people to relevant services
∗ running special activities such as Arthritis Awareness Week and Seniors Month
∗ speaking to community groups
• we are unable to fully support the activities and need for support groups
• we have had many good offers of help from members but we are unable to follow them up because of insufficient staff to support or train them in office procedures
• we are currently applying for grants but these are for specific projects and rely on volunteers to fulfil their requirements.
• a very small number of volunteers are carrying the load of day-to-day running of the organisation and all its activities.
The AONT Board (all honorary positions) accepts that volunteer contribution will always play an important part in service delivery, and strives to recruit, train and support volunteers. However, it is unrealistic to expect:
• a high level of expertise among those willing to commit time,
• volunteers to commit more than a few hours per week on a long term basis, or
• volunteer management to be the responsibility of other volunteers
Funding & the future of the organisation:
• Discretionary income includes membership fees, donations (including bequests) and fundraising. Most other income is tied to specific projects eg. agreements with national bodies Arthritis Australia and Osteoporosis Australia, and a range of NT grant schemes which are always project specific
• Various measures have been taken over recent years to reduce expenses and increase income, with limited success. This includes downsizing to current premises in September 2009 from combined office space of 80 square metres to one single office of 50 square metres. Previous rationalization of resources included discontinuing burdensome programs (warm water exercise, falls prevention exercise and tai chi). Fundraising capacity is limited, due both to the limited resources to organise traditional events, and the vulnerable health status of most of AONT membership
• a submission was made in Oct 2010 to the Department of Health for a further $75,000 per year (we currently receive $60,104) to ensure viability
• AONT were advised on 25 May 2011 that no increase would be forthcoming
• on 29th June 2011 representatives of the Board met with the Senior Advisor of the Health Minister to discuss the situation. The following points were emphasised:
∗ the increase of $75,000 is necessary to maintain services and ensure stability and viability
∗ the nominal dollar value of volunteer contribution is estimated at $60,000 pa ($20 per hours for 250 hours per month). It is unlikely that $20 per hour would attract suitably skilled people to take on many of the tasks undertaken
∗ a further $180,000 would be needed to create another position for AONT to have a more proactive role in health care, rather than the current reactive model of simply responding to demand. This is a real costing developed in a recent grant application to establish an Information and Education Outreach Program
∗ to maintain a current level of staffing we will have a significant operating loss for 2011-2012, using all our reserves
∗ sourcing other major funding should be the responsibility of a suitably experienced and qualified employee rather than well meaning volunteers of limited experiences
Where to now?
We hope to have a response from the Department of Health in the next two weeks and will advise members of the outcome.
Ruth Garden, Secretary 29/06/2011
The Arthritis Foundation of the
Northern Territory Inc.
Arthritis & Osteoporosis NT
ABN 67 099 326 608
Patrons: His Honour Mr Tom Pauling AO QC Administrator of the NT, and Mrs Tessa Pauling
Shop 18 Rapid Creek Business
Village 48 Trower Rd Millner
PO Box 452, Nightcliff 0814
Phone (08) 8948 5232
Fax (08) 8948 5234
Email [email protected]
Website www.aont.org.au
Staff Development Officer Pip Henderson
Accounts Natalie Valastro
Board President / Public Officer
Charles Atherton
Vice President Gail Keddie
Secretary Ruth Garden
Treasurer Mary Willis
Board Members Ash Dally Janet Durling
John Edwards Hilary Fowler
Newsletter Editor Peg Gellert
Members are invited to contribute articles, news, views, photos and items of interest for inclusion in future editions. Normal editorial prerogatives
apply.
The opinions expressed in joiNTed are those of the authors and advertisers respectively and do not necessarily reflect the
view of AONT.
Well, it’s been busy couple of months since I last wrote in
March!
First of all, I would like to thank everybody who took the time to fill in and return the Satisfaction Survey enclosed with the last edition of joiNTed. I have been busy working through the responses and taking on the feedback to work out how we can better serve you, our members. Overwhelmingly, our newsletter received great reviews so a big CONGRATULATIONS to Peg Gellert, Editor of joiNTed for her amazing work, week in and week out,
putting together such a well-loved publication!
One member pointed out to us that it is difficult to participate in some of our programs if you are a full-time worker. We agreed that that was a very fair point, and so are pleased to announce that we have scheduled an after-hours Challenging Pain Program for September! It is a rewarding program which helps people in chronic pain learn techniques and develop skills to manage this pain and regain control of their lives. Please ring the AONT office to book your
place!
Another member requested more information about arthritis medications in the newsletter. This was a tricky one because with so many different treatment options out there, it was hard to know where to start! In the AONT office at the Rapid Creek Business Village, we have a large folder full of Information Sheets co-produced by Arthritis Australia and the Australian Rheumatology Association. These describe specific medications, the benefits, possible side effects and precautions. A full list of the medications for which we have Information Sheets is on Page 4. Please call in to pick up a copy relevant to you, or phone the AONT office between Monday to Thursday, 9.30 – 2.00 and we can pop them in the
post for you.
Several members pointed out that it would be nice if more programs and activities could be held in areas outside Darwin. We agree and are currently working on grants and applications to secure funding which
will help us do exactly this! Fingers crossed.
Amidst the nagging funding issues, we were fortunate to receive a generous grant from the Ian Potter Foundation for a new and improved website and enable us to better serve members and the wider community online, especially those not in our immediate reach. If you have any ideas, hints, suggestions of what services and features you would like to see on our new website, I would love to hear from you. Please call me on 8948 5232 or email me at [email protected] – any feedback would be
greatly appreciated!
Speaking of online… AONT is now on Facebook! Search for us under ‘Arthritis & Osteoporosis NT’
and “like” our page.
In other recent happenings, earlier in June, Ruth and I travelled to Katherine for the Community Expo hosted by Alzheimer’s Australia. We had a great day and it was a wonderful opportunity for us to provide nurses, physiotherapists and other local health agencies with arthritis and osteoporosis information and resources. We also enjoyed meeting other health organisations, as well as some of our Katherine
members!
Also in June, AONT hosted the Consumer Forum: Practical Ways of Managing Your Pain, which you may remember was advertised in our last newsletter. Although some of us found parking near the Darwin Convention Centre a little tricky, overall the feedback from those who attended (and it was a full-house!) indicated the day was an over-whelming success. I was moved by the number of phone calls and messages from people in the week after the Forum telling me how much they had taken on board and had really benefited from attending. A big thank you to all our volunteers who helped make the day run as smoothly as possible – and also to His Honour Tom Pauling who welcomed attendees and officially
opened the event.
Recognising our wonderful volunteers is vitally important. In May, I nominated Gail Keddie, Hilary Fowler, Maureen Archbold, Peg Gellert and Ruth Garden for the Administrator’s Medal for Primary Health Care Team 2011. Ruth and Charles have been invited to attend the ceremony in July so fingers crossed! After all, without our volunteers AONT would cease to be the wonderful organisation that it
is.
Just enough room for another big thank you – this time to the Casuarina Lions for their barbeque fundraiser for AONT held at Home Hardware. Their time and energy raised $280 for AONT, which is greatly appreciated. Thank you to all those involved
on the day and in the planning.
I hope to see some of your friendly faces out at St Mary’s primary School Expo on Saturday 27th August. We will be there from 10.00 – 2.00 at St Mary’s Primary School Lindsay Street, Darwin so pop through and say hello! And don’t forget to book into one of our Falls and Fracture Prevention
Seminars on August 2nd. See front page for details!
Best wishes,
Pip
3
“Arthritis - twinges in the hinges.” G B Howard
ARTHRITIS AND OSTEOPOROSIS
MEDICATIONS From our recent survey, one member requested we “…. provide info, pros & cons (side effects) of the various drugs and creams and pain killers”. As we know of over 35 different forms of medication it would be difficult to achieve this. However, we have included a list of all the medicinal information sheets we have available, and can provide copies of
any on request. Just call the office on 8948 5232.
Patient information from the Australian
Rheumatology Association
www.rheumatology.org.au
(Brand name/s) ABATACEPT Orencia ADALIMUMAB Humira ALLOPURINOL Allohexal, Progout, Zyloprim ANAKINRA Kineret AZATHIOPRINE Azahexal, Azapin, Imuran, Thioprine BISPHOSPHONATES (I/V) Aclasta, Aredia BIOPHOSPHONATES (tablets) Actonel,, Actonel Combi, Actonel Combi D, Fosamax, Fosamax Plus BOSENTAN Tracleer CERTOLIZUMAB Cimzia COLCHICINE Colgout, Lengout CORTICOSTEROIDS Examples: Pafcort, Predsone, Predsolone, Panafcortelone, Solone, Sone CYCLOPHOSPHAMIDE Cycloblastin, Endoxan CYCLOSPORIN Cicloral, Neoral, Sandimmun D-PENICILLAMINE D-Penamine ETANERCEPT Enbrel GOLD Myocrisin, Ridaura GOLIMUMAB Simponi HYDROXYCHLOROQUINE Plaquenil INFLIXIMAB Remicade LEFLUNOMIDE Arabloc, Arava METHOTREXATE Methoblastin MYCOPHENOLATE MOFETIL CellCept N.S.A.I.Ds Examples: Brufen, Celebrex, Mobic, Naprosyn, Nurofen, Orudis, Voltarin PARACETAMOL Examples: Dymadon, Febridol, Panadol, Panamax, Duatrol, Panadol Osteo, Panadol Extend PROBENECID Pro-Cid RALOXIFENE Evista RITUXIMAB Mabthera STRONTIUM Protos SULFASALAZINE PyralinEN, Salazopyrin, SalazopyrinEN TERIPARATIDE FORTEO
TOCILIZUMAB Actemra
From NPS (National Prescribing Service)
Medicine Updates
www.nps.org.au DABIGITRAN (Praxada) For Osteoporosis: ALENDRONATE STRONTIUM RANELATE (Protos) ZOLEDRONIC ACID (Aclasta)
Other ZOSTRIX
TUNA TOPPING Makes enough for 24 to 32 toppings to go on crackers, crispbreads, toasts, etc.
4—6 potatoes, peeled and quartered 1 tbsp margarine 2—3 tbsp low fat milk ½ cup tuna in brine, drained and lightly mashed 1 tbsp each of finely chopped chives, thyme, and parsley 1 clove garlic, crushed 1 egg, lightly beaten
• Steam or boil potatoes until cooked but not too soft. Remove from heat and drain.
• Toss potatoes in pan over low heat for a few seconds to dry. Remove from heat, add margarine and milk and mash until potato is creamy and light.
• Combine tuna, herbs and garlic in a bowl. Mix thoroughly then add egg.
• Stir the mixture into the potato. • Serve hot or cold.
4
New in the Library The MOVE IT OR LOSE IT DVD series
We have 2 copies each of - #1 Movement to Music #2 Chair Based Exercise #3 Chair based and More #4 Flexibility and Stretching #5 Low Impact Aerobics
available from AONT for members to borrow.
#1 & #2 are designed for anyone new to exercise, or is looking for a fun way to exercise without leaving the support of their chair. #3 is for anyone who can stand with the support of a chair and is looking for more of a challenge than purely chair-based exercises. #4 is for anyone comfortable with exercising while standing. #5 is for anyone who is comfortable with faster movement and changes in direction when walking.
BOOKS Taking Care of Yourself and Your Family - a Resource Book for Good mental Health A Guide to What Works for Depression - from Beyond Blue, the national depression initiative
DVD Ankylosing Spondylitis - Exercises with Michael Slater
DEPOSIT For the borrowing of all DVDs, Videos and CDs a fully refundable deposit will apply (no deposit required for books).
DVDs from Arthritis Victoria
Conversation Café Starting July 25th
What is a “Conversation Café”? Conversation Cafes is a generic name for activities that involve informal, hosted, drop-in discussions in
cafes, bookshops and other public places.
So what is the AONT Conversation Café? An opportunity for members to get together over a cuppa and have a chat, if you wish, about your experiences with arthritis, osteoporosis, other conditions or about any other topics. This is not an official support group, rather an opportunity to meet other people and share thoughts, ideas and experiences.
Our first Conversation Café begins
Monday July 25th at 11.30
At the Rapid Creek Cafe (and we hope to continue it monthly)
Call Pip if you are coming so that we have enough chairs.
Challenging Pain Program Learn skills and techniques to manage
your chronic pain and regain
control of your life.
�Relaxation �Breathing techniques �Benefits of exercise
�How to get the best care and support from your health specialist
�and much more
Challenging Pain is a short course delivered
in 2 x 2.5 hour sessions, a week apart.
Wednesdays 7th and 14th September
6.00 to 8.30 pm
Free for members of AONT
Venue: Electorate Office of Chris Burns,
Rapid Creek Business Village
Bookings essential
Phone 1800 011 041
CORPORATE MEMBERSHIP
Arthritis & Osteoporosis NT is - for the first time ever - inviting organisations and businesses to
join our organisation as Corporate Members.
Becoming a Corporate Member of AONT will provide a business with plenty of benefits, but most of all Corporate Members will know that they are supporting a local, non-profit organisation which is devoted to supporting people with arthritis and/or osteoporosis in the
Northern Territory.
Benefits of Corporate Membership:
• Free delivery of our quarterly publication, joiNTed, plus up to ten additional copies to share
with members, staff, customers, etc.
• A public ‘thank you’ on Facebook
and the AONT website
• Subscription to our monthly e-bulletin (coming
soon)
• A Certificate of Support.
Organisations/businesses who are Corporate
Members of AONT will also be:
• Entitled to 25% on advertising rates in joiNTed
• Notified of any upcoming courses or workshops
The Corporate Member fee is $60.00 per year.
5
CAMP FREEDOM Last newsletter we asked about families, NT wide, living with Juvenile Idiopathic Arthritis or some other musculoskeletal condition, whose child (aged 8 - 11 or 12 - 16) would be interested in attending
Camp Freedom later this year.
What is Camp Freedom?
Camp Freedom is a fun filled 5 day activity camp
specifically designed for kids with Juvenile Arthritis,
related rheumatologic and other musculoskeletal
conditions, conducted by Arthritis WA.
Camp Freedom encourages kids to reach their full
potential by participating in exciting activities that
teach new skills to help improve the quality of
everyday life.
In a safe, professional and caring team environment,
trained leaders guide each child towards independent
management and understanding of their condition.
Camp Freedom is a time for forming new friendships
with other kids, who understand and enjoying new
experiences while having loads of fun.
The Arthritis WA Camp Coordinator, team leaders
and health professionals including nurses and
physiotherapists remain onsite for the duration of the
camp. All supervisors and health professionals
attending the camp undergo WA Police Service
clearance.
If you are a business-owner or know someone who is and you want to help support this great project and sponsor a child to attend Camp Freedom, please contact the office on 8948 5232 – we would love to
hear from you.
Your Health Have a say, make a difference
Australia’s health system is undergoing major change to make it more efficient
and accessible.
To help influence those changes and improve the health system the Consumers Health Forum of Australia (CHF) needs to hear and learn from your personal experiences – both good and bad.
We want you to have a say.
The Australian Government has asked CHF to help give consumers (you) a stronger voice in national health reform through the Our Health, Our Community Project. This project will provide consumers with the information and resources they need to help them better navigate the health system, and allow them to have a say about how their health
services can be improved.
The first step is the establishment of a website – www.ourhealth.org.au – to give consumers easy access to information and to allow them to share with others their experiences of the health system. On ourhealth.org.au is a survey that will help develop the website. Tell CHF what you think either through the
survey or by contacting us directly.
The Our Health, Our Community Project will also provide information and support for those who are, or decide to become, more active health consumer representatives. CHF will train and support 120 health consumers who can become members of the Governing Councils of Local Hospital Networks
(LHNs) and Medicare Locals.
Reforming and improving our complex health system is not an easy process. But it will be made easier if you, the health consumer, are actively involved.
Please have your say at www.ourhealth.org.au.
6
2011 Tax Appeal A recent national survey revealed the impact of
arthritis on Australians.
The Voice of Arthritis 2011 exposed the alarming figure that less than a third of Australians with arthritis feel that they are
coping.
The survey also discovered that what impacts someone with arthritis is NOT the severity of their arthritis. It is NOT how long they have had arthritis. It is NOT their age, income, other
illness or whether they have private health cover.
What is hurting people with arthritis is their perceived standard of care, the information made
available to them and the associated access.
This is where Arthritis & Osteoporosis
NT can help.
We exist to offer support, management information and educational services to those who suffer from arthritis and osteoporosis. We also strive to raise awareness and understanding within the community and amongst local business groups, organisations and health professionals in order to develop support and
consideration for those who are suffering.
Arthritis & Osteoporosis NT relies, almost entirely, on volunteers – and on the generosity of
its members and the community.
This year when you
receive your tax
return, please
consider a donation
to Arthritis &
Osteoporosis NT.
100% of your donation will go
towards supporting sufferers in the
Northern Territory.
Donations over $2.00 are tax-deductible
Post: PO Box 452, NIGHTCLIFF, NT, 0814 Phone: 08 8948 5232
Country freecall: 1800 011 041 Fax: 08 8948 5234 Email: [email protected]
Website: www.aont.org.au
Hi members,
Thank you for your positive feedback about our newsletter. It’s pleasing to know that so many of you
are enjoying its content.
Now, here’s a challenge—how about some of you
making a contribution?
I’d love to be able to include a “My Story” from one of you. There are times when reading of the experiences of other can be of benefit or even inspire
the reader. Your story could be one of those.
I’d even appreciate any little anecdote you may have,
or a recipe (healthy, of course!)
Contact me by email at [email protected] or on the
office number 8958 5232 on Thursdays.
Peg Gellert, Newsletter Editor
Not only can adults fight the battle of strength and
muscle loss that comes with age, they can even
grow stronger with the right kind of exercise.
Resistance exercise is a great way to increase lean muscle tissue and strength capacity so that people can
function more readily in daily life,
In progressive resistance training, the amount of weight used and the frequency and duration of training sessions is altered over time to accommodate an individual’s improvements. Through resistance training, adults can improve their ability to stand up out of a chair, walk across the floor or climb a flight of stairs – anything that requires manipulating their
own body mass through a full range of motions.
Normally, adults who are sedentary beyond age 50
can expect muscle loss of up to 180g a year.
That only worsens as people age. But even earlier in adulthood – the 30s, 40s and 50s – you can begin to see declines if you do not engage in any strengthening activities. Analyses of current research show that the most important factor in somebody’s function is their strength capacity. No matter what age an individual is, they can experience significant strength improvement with progressive resistance exercise
even into the eighth and ninth decades of life.
A review article published in The American Journal of Medicine, shows that after an average of 18-20 weeks of progressive resistance training, an adult can add 1.1kg of lean muscle to their body mass and
increases their overall strength by 25-30 percent
Recommendations for Adults Over 50 Anyone over age 50 strongly should consider participating in resistance exercise. A good way for people to start on such a program, especially for those who are relatively sedentary (after getting permission from their doctor to do so) is to use their body mass
as a load for various exercises.
Exercises that use your own body weight include squats, standing up out of a chair, modified push-ups and lying hip bridges, as well as non-traditional exercises that progress through a full range of motion,
such as Tai Chi, Pilates and yoga.
After getting accustomed to these activities, older adults can move on to more advanced resistance training in a fitness facility. A certified trainer or fitness professional who has experience with special populations can help with the transition. Before beginning any fitness routine, however, ask the trainer whether he or she has experience working
with aging adults.
Working out at age 20 is not the same as at age 70. A fitness professional who understands those differences is important for your safety. In addition, current recommendations suggest that an older individual participate in strengthening exercise 2 days per week. Based on the results of studies, that should
be thought of as the minimum.
Gaining Strength As resistance training progresses and weights and machines are introduced, incorporating full body exercises and exercises that use more than one joint and muscle group at a time, such as the leg press, chest press and rows is recommended. These are safer
and more effective in building muscle mass.
You should also keep in mind the need for increased resistance and intensity of your training to continue
building muscle mass and strength .
Based on research, progressive resistance training should be encouraged among healthy older adults to help minimize the loss of muscle mass and strength as
they age.
Progressive Resistance Training for Older Adults to Build Muscle Progressive Resistance Training for Older Adults to Build Muscle Progressive Resistance Training for Older Adults to Build Muscle Progressive Resistance Training for Older Adults to Build Muscle and Increase Strengthand Increase Strengthand Increase Strengthand Increase Strength
Total cost of arthritis in 2007 In 2007, the total cost of arthritis to the Australian economy is estimated to be $23.9 billion, an increase of more than $4 billion on the cost calculated by Access Economics in 2004. Almost half of this is due to the non-financial (burden of disease) costs, while health system costs including hospitals, pharmaceuticals and aged care account for 20%. The main bearers of arthritis costs in Australia are the individuals with the condition themselves who, it is estimated, shoulder 61% of the total cost. The Federal Government is the second biggest cost bearer, a consequence of funding the lion’s share of the large health system expenditures on arthritis and also bearing the lost taxation revenues associated with the considerable productivity losses arising from the condition. A further 17% of total costs are productivity costs, reflecting the impact of arthritis on employment and workforce participation in Australia. From: Painful Realities: The economic impact of arthritis in Australia in 2007. 7
The rate of hip fractures due to osteoporosis has decreased, according to a report released by the Australian Institute of Health and Welfare. The report, A snapshot of osteoporosis in
Australia, shows that the rate of osteoporotic hip fractures fell by 8% for men and 15% for women
between 1998–99 and 2007–08.
Don’t forget the Darwin Lions Beer Can Regatta Sunday July 10 at Mindil Beach.
Top End Troupers A Darwin Lung Support Group
For those who have a moderate to severe lung condition or care for someone who does. Meet: 10 am, alternative Thursdays
July meetings 14th and 28 Casuarina Uniting Church Resource Centre
Vanderlin Drive, Wanguri Cost—gold coin donation.
For more information contact Ann Buckley 8948 0448.
Thank You To all the wonderful people who sold the
Community Lottery tickets which are now almost all finalised.
For those who purchased tickets winners will be announced in the NT News on August 12.
Arthritis & Osteoporosis NT is now on Facebook. Search for us under “Arthritis & Osteoporosis NT”.
Feed back from the Consumer Pain
Forum on June 12
“Excellent speakers. Good topics. Now have
a lot to think about.”
“Thought it was well balanced with good in
depth information, and gave us the ability to
discuss questions with appropriate
presenters during discussion in the breaks.”
“Pain is with us all and many of us need the
help and education provided by AONT.”
“Interactive forum with informative
speakers.”
“Would be nice to attend another one—not
too long away.”
“I have joined up as a member as a result of
this seminar.”
Arthritis and Massage Therapy – improving mobility and managing pain Did you know that massage therapy may help alleviate some of the symptoms and pain of arthritis? The benefits vary depending on a person’s condition, but generally remedial massage can help reduce swelling, improve circulation, reduce muscle tension, alleviate pain, and improve flexibility.
Ensure remedial massage therapy is an appropriate treatment option by talking to your GP.
Five facts about massage therapy for people with arthritis:
• Remedial massage can help alleviate pain, improve flexibility and reduce muscle tension
• It is common for hand and knee areas to benefit from massage
• Massage is not appropriate when joints are inflamed
• Massage therapists can work with your GP to complement your treatment plan
• Massage therapists have different qualifications, check yours is accredited and a member of AAMT. Visit www.aamt.com.au or call 1300 138 872.
Ionian Club—a friendship group for women Next meeting is July 28 at 10 am for morning tea
at Jingili Water Gardens. Ring Patricia on 8945 7338 to let them know you
are coming.