An Australian initiative has helped so many Indigenous Australians better manage diabetes that it has been adopted by several other countries to deliver better healthcare to their Indigenous populations.

The Quality Assurance for Aboriginal and Torres Strait Islander Medical Services (QAAMS) Program addresses the spiraling rate of diabetes among Indigenous Australians.

The rate of diabetes is three to four times higher among this group than the general Australian population. Indigenous Australians also have higher rates of related deaths and complications such as kidney disease and limb amputations.

The QAAMS Program provides on-the-spot blood testing for diabetes. The tests are completed by trained Aboriginal Health Workers using a small, portable device that tests the patient’s level of haemoglobin A1c (HbA1c).

This test can be used to diagnose and monitor the condition. Lower results reflect better controlled diabetes.

Results are returned to the patient within minutes of sample collection. This eliminates the need for travel back to the clinic to collect results for patients who live far from testing laboratories.

A 2014 study in remote Australia found 40 diabetes patients whose HbA1c had dropped more than 1.5% across 15 months since their health services joined QAAMS. Prior to QAAMS the patients had not shown any reduction in their HbA1c.1

To place this in context, a drop of just 1% in HbA1c over five years reduces the patient’s risk of diabetes-related limb amputation by 21%.2

QAAMS began in 1999 with 45 participating Aboriginal medical services. After 17 years of federal funding, the program has overseen the training of more than 1,500 Aboriginal Health Workers and nurses across 200 sites.

Aboriginal Health Workers are central to the program’s enduring success. They ensure that the entire process is performed with scientific accuracy and in a culturally safe manner.

Professor Mark Shepherd manages the QAAMS Program. He says,

“Point-of-care diabetes technology was in its infancy when this program began. QAAMS has shown that, when used with appropriate training, point-of-care testing can significantly help to improve diabetes control in Indigenous populations.”

The group recently received a coveted Projects That Work award from FAIMER International. QAAMS was recognised as one of the top five projects globally out of a field of 100 nominations.

Communities in seven other countries have adopted the QAAMS model in their approach to Indigenous diabetes care; these are South Africa, Canada, East Timor, Papua New Guinea, Western Samoa, the Solomon Islands and Thailand.

Reference:

1. Spaeth BA, Shephard MDS, Schatz S, Point-of-care testing for haemoglobin A1c in remote Australian Indigenous communities improves timeliness of diabetes care. Rural and Remote Health 14: 2849. (Online) 2014
2. The Economic Value of Pathology, CIE & PAA 2016

The post Closing the gap on diabetes one test at a time first appeared on Know Pathology Know Healthcare.

Poor access to health services in rural and remote communities presents a huge problem to people living outside metropolitan areas. Fortunately Australian pathology is addressing the issue.

John Callahan, a medical scientist based in Melbourne, has previously worked as a Senior Scientist in Nhulunbuy, a small mining town in remote Northern Territory. The town has changed a lot recently – the closure of a nearby smelter cut the population from nearly 5,000 to just 1,000.

The hospital provides healthcare services to remote Aboriginal communities and previously, to a substantial transient mining population. With 40 beds and a pathology laboratory staffed by only two people it’s a totally different world to that of a city hospital.

John’s work in the laboratory was essential to managing the health of the local Aboriginal community, at high risk of diabetes, renal failure and tuberculosis. It also taught him a lot;

“Nhulunbuy Hospital was such a rewarding place to work. All the staff knew one another and you really felt part of the wider healthcare team.  You also got to know a patient’s health story a lot more intimately than you typically would in a larger laboratory.

Although we dealt with less than 20 samples each day, a lot of the tests had to be done manually due to the reliability of equipment, so we were always busy. You rely heavily on the foundations of your training and you become pretty self-sufficient when it comes to fixing equipment.”

His experiences in Nhulunbuy emphasised the importance of communicating complex medical topics to patients in simple terms;

“I remember one case where a young Aboriginal lady was told she had an iron deficiency. It was a bad case and the doctor wanted to treat her with an iron infusion. She became extremely agitated, thinking they’d be pumping iron filings into her wrist. Good communication of test results and treatment is vital, particularly when there is a different culture involved.”

Cultural differences arose frequently. Local Aboriginal populations had complex naming systems and some patients would provide a different name each time they came in; a real problem for record-keeping. Many patients were unaccustomed to sleeping under a roof so they spent most of their time in the grounds. If an Aboriginal patient died in the hospital, hundreds of community members would arrive to take them home.

“From a scientific point of view the work was quite different from what you’d expect elsewhere. I was often testing for diseases that are largely non-existent in the Caucasian population – tuberculosis, leprosy, and scabies. Before coming to Nhulunbuy I was not even aware of Melioidosis – an infectious disease caught from walking on wet sand.”

One issue in places like Nhulunbuy is physically reaching the patients. Teams of doctors and nurses would drive or fly out to remote homelands for a week or longer to perform on-site check-ups and collect samples to bring back to John for analysis.

For four months of each year, the town is cut off due to flooded roads. Residents rely on planes for supplies, and pathology is no different. Complex tests that could not be performed in the lab were flown to Darwin each night at 10pm so John could have the results the next day.

Fortunately, the emergence of drones in recent years has opened up the possibility of retrieving pathology samples from remote patients in a fast and cost-effective way.

This year Australia’s CSIRO have made this the focus of their annual unmanned aerial vehicle challenge. The organisation has been running the challenges since 2007 and decided to make 2015’s competition all about pathology.

The challenge is based around a character called Outback Joe. Each year he is placed in a fictional scenario in outback Queensland and teams of engineers and drone enthusiasts from around the world compete to help him. In previous years scenarios have revolved around search and rescue but this year, Outback Joe needs to have a sample retrieved for urgent testing.

Entrants will need to fly a drone fitted with a camera through a 20 kilometre transit corridor to reach him, land safely so he can place the sample in a small compartment on the drone, then return the sample to the start point.

Doug Froubisher, from CSIRO, is one of the main organisers.

“Pathology testing is integral to many branches of healthcare and speed of results can mean life or death, so we knew we wanted to use this in a challenge. Because pathology samples are often small, collection by drone is a genuine possibility in the near future.”

The top prize is $50,000 and is based on completing the challenge and scoring the most points for aspects like technical expertise and team coordination. It’s possible though that CSIRO may not even get a winner – it sometimes takes up to two years to complete the challenge well enough!

To find out more about the competition visit the UAV Challenge website.

The post Bringing the lab to the bush: pathology in rural and remote communities first appeared on Know Pathology Know Healthcare.