Flinders Medical Centre Foundation
Flinders Medical Centre Foundation




Flinders Helps to Close the Gap

Salt Water Solution for Kids Hearing
Bleak Picture for Indigenous Cardiac Patients



Flinders Helps to Close the Gap
First Published: Enews - July 2010


A system to ensure better communication between hospital and patient is improving the journey for remote Aboriginal patients coming to Flinders Medical Centre (FMC) for cardiac procedures, and is currently informing national policy.

The system, developed at FMC by Monica Lawrence as part of her Masters of Nursing project between 2005 and 2007, is currently the only culturally-specific consent program for Aboriginal patients in Australia and has become standard practice in the ward at Flinders.

The project stemmed from observations made by Ms Lawrence, who is now Regional Manager of Clinical Services Development in Aboriginal health in Southern Adelaide, while working as a nurse in the cardio-thoracic ward at FMC.

"Aboriginal patients living in remote Northern Territory and South Australian communities travel over vast cultural or geographic distances to come to Flinders for cardiac surgery," Ms Lawrence said.

"When I first started this project, during a six month period 21 out of 48 Aboriginal people coming for heart surgery at Flinders did not show up for the operation.

"Other patients were inadequately prepared physically or psychologically and the surgery could not be undertaken."

Based on recommendations by Ms Lawrence, a Remote Area Liaison Nurse position was established at FMC to ensure Aboriginal patients are better informed about the  treatment they will be having before they arrive at Flinders for surgery.

Daphne Perry is currently appointed in the role and ensures the patient is psychologically and physically prepared for surgery before they arrive in Adelaide; that appropriate carers accompany the patient to Adelaide; and that patient care is continued once they return home.

"Since these changes have been made and patients have been properly briefed in their own language, all of the patients have presented for surgery," Ms Lawrence said.

"While the figures may not always remain at 100 per cent it is certainly a significant improvement."

The findings of Ms Lawrence's research project are now informing a senate enquiry and she is now working with Australian Health Care and Hospital Association to develop a national policy which will translate to other speciality areas such as to sight and hearing health in the Anangu Pitjantjatjara and Yankunytjatjara (APY) lands.


Salt Water Solution for Kids Hearing
First Published: Enews - May 2010


A Flinders team hope to prove something as simple as swimming in salt water chlorinated pools can reduce the alarming number of middle ear infections in children in remote Indigenous communities.

Supported by a $662,000 Federal Department of Health and Ageing grant, five staff and eight students from Flinders travel to the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands of northern South Australia and to the western Yalata community twice per year to assesses children for middle ear disease and related hearing loss.
The study is based on research led by audiologist Associate Professor Linnett Sanchez and ear, nose and throat surgeon Associate Professor Simon Carney which has shown about 70 per cent of school-age children living in Anangu communities in South Australia fail a screening hearing test.

30 per cent of these children have eardrum perforations (when injury to the ear or fluid accumulation from infection causes the thin membrane of the ear drum to rupture) compared to about 1 per cent of children living in Adelaide. 

"We are seeing in Indigenous children persistent, significant hearing loss right through their educational years," Associate Professor Sanchez said.  "This hearing loss can impact on children‘s education and social development, with serious consequences throughout life."

Last year the team tested 702 indigenous children from four communities which have swimming pools and seven which do not.  Data are collected in autumn (at the end of the swimming season) and again in spring to examine whether there has been an effect on infections during the time the children have been unable to swim.

The large-scale study over three years hopes to replicate the positive findings of a small scale study by a Western Australian research team. The Flinders team believe any benefits established by the trial may be attributed to the combination of the irrigatory effect of the saline and the chemical effect of chlorination.

If findings show a benefit from swimming, it is expected that more remote communities will be able to better argue for government funding to install salt water pools.


Bleak picture for Indigenous cardiac patients
First Published: Investigator - June 2009


Flinders research has painted a bleak picture for outcomes of cardiac surgery in Indigenous Australians.

The study, published in the Medical Journal of Australia, found that Indigenous Australians present for cardiac surgery nearly two decades earlier than non-indigenous Australians, and that patient outcomes for those aged under 55 are significantly less favourable.

Survival rates at one and five years are also lower for Indigenous patients – 94 percent and 80 percent for Indigenous patients compared with 97 percent and 88 percent for non-Indigenous patients.

The Flinders research group studied data for 2,635 consecutive patients who underwent cardiac surgery at Flinders Medical Centre between January 2000 and December 2005. The data included baseline patient characteristics, operation details, post-operative complications and late mortality.

The team found that around one in 10 patients undergoing cardiac surgery at Flinders is Indigenous and Indigenous patients are substantially younger (mean average of 47 years, compared to 65 years for non-Indigenous patients). Indigenous patients awaiting surgery are also more likely to have diabetes, renal dysfunction and valvular surgery.

Lead author Dr Sam Lehman said the findings were disturbing, if not expected.

‘Cardiovascular disease is more prevalent among Indigenous Australians and this group is likely to present for cardiac surgery about 20 years earlier, on average.’ He said previous research suggested this is likely to be due both to higher rates of traditional cardiovascular risk factors and the persistence of rheumatic heart disease.

The authors said improving access of Indigenous Australians to advanced cardiovascular therapies was a major public health priority.

‘Improvements in outcomes will require comprehensive strategies that include attention to the primary and secondary prevention of both coronary artery and rheumatic heart disease,’ they said.


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