This project was developed as a rapid response to rising concerns in remote Aboriginal communities during the H1N1 Influenza Pandemic in 2009.

Within 5 days including a weekend, a team of clinicians, support personnel and managers from as far afield as Newcastle and Moree were consulting with local communities, had arranged delivery of medical supplies and were on site at Toomelah assessing and treating flu clinic attendees with culturally appropriate clinical services.

The mobile flu team strategy was part of an innovative response to escalating cases of H1N1 and the challenges of reaching the more rural and remote areas within HNEAHS.

Guided by Senior Aboriginal Health Workers, key priorities and actions were identified under the main themes:

• Preparing the community
• Selection of the team
• Location
• Logistic requirements
• Timeframes

The Community Response Grid established:

• location of significant community groups
• identity of leaders (Elders)
• collaborative partnerships

Preparatory consultation with key community leaders and agencies and the role they played in disseminating information and relaying support was critical to ensuring the engagement of community with the strategy.

A mobile flu team was established to visit the Toomelah and Boggabilla communities and carry out appropriate health checks. Two Aboriginal Registered Nurses were selected to have active roles as the clinical and cultural leaders due to their superior cultural understanding and the clinical needs of these communities.

The mobile team comprised:

• a Doctor
• non-Aboriginal Registered Nurses
• Aboriginal Registered Nurses
• Aboriginal Health Workers

Each member of the team had specific duties to perform. They:

• provided adequate health checks
• arranged for further assessment
• treated conditions which did not require hospitalisation

Action plans which included standard clinical procedures such as a waiting area with a separate area for 'sicker' individuals, triage area, assessment /treatment area, safe exit and personal protection equipment were implemented. Issues such as transport and coordination were also included.

The flexibility of the mobile flu clinic model enabled greater alignment to local community needs. Culturally appropriate methods were employed to ensure safety for the workers and a friendly service. These included methods such as:

• Clients waiting for triaging or assessment outside in the sunshine
• Home visits to Elders who were unable to attend the clinic
• Utilising the inquisitiveness of young children walking home from school who stop for a 'chat' to inform their own families of the Mobile Flu Clinic
• Having a mix of both Aboriginal and non-Aboriginal team members
• The team was also comprised of a mix of local staff, regularly visiting outreach staff or known staff members and visiting or non local team members
• Comprehensive Community consultation prior to the team deployment

A toolkit consisting of generic posters was an initiative arising from the consultation process with six Aboriginal communities in the HNEAHS area. These emphasised key infection control messages and could be supported with photo inserts of 'local' indigenous community members for greater impact. These resources were used to assist in providing meaningful information to patients attending the clinics. The posters were distributed to local stores, schools (for inclusion in newsletters), daycare centres and police stations.

The clinics were an effective way of rapidly assessing large numbers of people in the communities. They identified not only any cases of H1N1 or other influenza, but also a number of other health issues.

The main outcomes included:

• Communities were better informed about influenza through the consultation
  • key issues were identified
  • resources such as the posters were developed that reflected the community key issues shared with the team
• Paper was published to share the findings with other Indigenous people and health workers. Massey, PD, et al, Reducing the risk of pandemic influenza in Aboriginal communities, Journal Rural & Remote Health, 2009.
• Information formed the basis of two National Health and Medical Research Council (NHMRC) funded research projects to more fully explore this space with communities.

This model was implemented again for another mobile clinic in Wee Waa and Pilliga, two other small, relatively remote communities, following similar consultation and planning protocols.

Aboriginal Health Coordinator
Mehi and Peel Clusters
Hunter New England Local Health Network
Phone: 02 6751 1606