Developing the future Indigenous health workforce: The feasibility and impact of a student-led placement programme in remote Indigenous communities.

OBJECTIVE: To describe and evaluate a programme where medical students designed and implemented Indigenous health placements for students with an interest in rural/Indigenous health. DESIGN, SETTING AND PARTICIPANTS: In 2011, a student-led programme at the University of Adelaide was set up to give medical students the opportunity to undertake outreach trips and clinical placements in remote Indigenous communities. Twenty-four medical students attended trips to remote communities between 2012 and 2014. Here we evaluate our programme using a single-arm experimental design. MAIN OUTCOME MEASURES: Responses to questionnaire items before and after attending an outreach placement, scored on 6-point Likert scales. RESULTS: Following their remote Indigenous health placement, participants expressed a significantly higher mean likelihood of working in an Indigenous community in the future (3.17 (2.69-3.64) versus 4.00 (3.65-4.35); P < 0.007). Furthermore, after their placement participants felt better prepared to work in Indigenous communities (mean 1.79 (1.44-2.14) versus 3.21 (2.88-3.54); P < 0.001). CONCLUSIONS: A placement programme initiated and run by medical students can provide meaningful exposure to Indigenous health. Implementation of this student-led model in other medical schools may encourage nationwide development of the Indigenous health workforce.

Trachoma in remote Indigenous Australia: a review and public health perspective.

OBJECTIVES: Trachoma remains a major health concern in many remote Indigenous Australian communities, despite behaviour-modifying and biomedical strategies. This review aims to examine the social epidemiology of trachoma in remote Indigenous communities and identify practical, sustainable strategies to alter the social determinants of the disease. METHODS: A systematic search and critical review explored the proximal, intermediate and distal determinants of trachoma. The impact of swimming pools in remote Indigenous communities on trachoma and other infectious diseases was further examined. RESULTS: Having a clean face was found to be protective for trachoma, but face-washing education programs have produced no significant benefits. Sanitation infrastructure in a community was the key determinant of facial cleanliness. Installation of swimming pools in remote Indigenous communities has been demonstrated to reduce the prevalence of several common childhood infections. However, minimal research has explored the impact of pools on trachoma rates. CONCLUSIONS: The locally supported construction of pools in remote Indigenous communities may contribute to a decline in trachoma. A prospective, controlled trial is needed to test this hypothesis in endemic communities. IMPLICATIONS: If validated by a well-designed study, pool construction may provide a much sought-after practical government strategy to combat trachoma in remote Indigenous communities.