Mind In Cyberspace, Feet On The Ground

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					 Mind In Cyberspace, Feet On The Ground:
Utilising New And Existing Communications
 Technology For Health Service Delivery To
      Aboriginal People In Remote Areas
        Peter Toyne and Robin Japanangka Granites
                     Tanami Network

           3rd National Rural Health Conference
               Mt Beauty, 3-5 February 1995

                      Proceedings
         Mind In Cyberspace, Feet On The Ground:
 Utilising New And Existing Communications Technology
   For Health Service Delivery To Aboriginal People In
                      Remote Areas
                     Peter Toyne and Robin Japanangka Granites
                                  Tanami Network

This paper will talk about the existing and potential impact of the information
superhighway on the remote, and largely Aboriginal, communities of Australia. It
will do so in the context of working relationships between remote-living people and
those responsible for the provision of health services to the communities. Since no
technology is socially neutral, two main possibilities exist as to the effects of
advanced communications use on such relationships.

The technologies can quite easily promote intrusive, invasive processes which are
capable of posing a threat to culture, impede the empowerment of Aboriginal people,
and attack the general integrity of community life. Equally, they can alleviate the
dysfunctions of isolation and produce a more sensitive and interactive relationship
between agency and community in which information and opinion is used to better
define the terms of delivery.

The origins of these different outcomes lie both in the inherent characteristics of the
technologies, and in the operational arrangements in which their use is embedded.
The potential uses of communications should therefore be considered as an integral
part of technical capabilities and social relationships and this will be the approach
which will be adopted in this paper.

The Potential Form Of An Information Society In Remote Australia
1.     Interactive networking of people and places

A group of technologies exist which allows the two-way exchange of information in
the form of picture, sound or text between sites of equal technical capability. Such
technologies provide the basis for the creation of strong dialogues, in real time,
between people and locations in contexts which run from the most specific to the most
global.

In order of their power to perform this task, the two-way technologies are HF radio,
telephone and facsimile, interactive computer links, video conferencing and finally
multimedia platforms incorporating interactive picture, sound and text. The impact of
each will now be considered within its remote and Aboriginal social context.




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HF radio

In 1978-79, an extensive HF radio network was set up in the Pitjantjatjarra
communities in SA and the NT by the Pitjantjatjarra Council. The network was used
for medical and administrative contacts but, equally, it became an open radio channel
for Aboriginal community members which was heavily used for the exchange of
family and community news throughout the day. The exclusive use of the
Pitjantjatjarra language offered privacy to the group as a whole, broth from other
listeners outside the communities, and from almost all non-Aboriginal people based in
the Pitjantjatjarra communities of the Council. This use of HF radio as a public social
network was duplicated by other remote Aboriginal groups. Despite the arrival of
telephone services, the HF radio network continues to be heavily used for social
communication by the Pitjantjatjarra people.

However, in other places the removal of radio equipment with the arrival of
telephones has largely destroyed broad participation by remote-living people in the
open radio networks set up by the Flying Doctor Regional Services and replaced them
with communications which have different dynamics with regard to the needs of
remote living Aboriginal groups.

It is our belief that HF radio and HF radio-telephone hybrids could still make an
important contribution to remote health service delivery.

Telephones and facsimile

The introduction of telephones and facsimile under Telecom’s Rural and Remote
Area Program (RRAP) has seen a dramatic increase in the levels of communication
traffic passing into and out of remote communities. This has occurred to the extent
that facsimile use has replaced mail for many purposes and the capacity of many of
the Digital Radio Concentrator Systems (DRCS) routes has been overloaded.

This increase in communication use has offered greater access to resources and
expertise to the remote Aboriginal communities but is not necessarily synonymous
with greater communication use by the Aboriginal people themselves. The majority
of telephone and facsimile services in Aboriginal communities are held in institutional
settings and under the control of non-Aboriginal staff and Aboriginal community
members may only be given very restricted access to them.

Attempts to operate private lines in Aboriginal homes are made extremely difficult
when large bills are run up by the extended family on the account holder with no
agreed mechanism for contributing to the payment. This leaves public payphones as
the only reliable point of access, and here there are difficulties in keeping them in
working order and in gaining access to the telephone numbers of other remote and
specialised Aboriginal locations to which the caller would want to be connected. Low
literacy levels make telephone books difficult to use even if they are available, and
directory assistance staff are often unfamiliar with Aboriginal place names and their
alternatives. This has led to the practice by Aboriginal people of turning the walls of
payphone boxes into specialised directories of frequently used telephone numbers,
many of which are handed on by word of mouth.



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Interactive computer links

Computer programs such as electronic classroom which allow real time interaction
through text between sites, and which are usually supported by voice contacts, have
proved an effective means of tutoring small groups in mainstream educational
contexts.

Such technology would have potential application to the in-servicing of remote
nursing staff and Aboriginal health workers. However, trial course delivery by the
NT Department of Education to Aboriginal students in remote communities using this
technology has delineated predictable constraints beyond those associated with the
technical operation of the system. The delivery is heavily dependent on the quality of
on-site professional support of the students and this, in turn, is related to the widely
divergent social and cultural background of the students and the need to support them
in a cross-cultural and often bilingual learning situation. Being based on text, the
delivery method is also constrained by the literacy levels of the students.

Video conferencing

One remote Aboriginal group to look beyond basic telephone services to the potential
of broadband communications are the communities in the Tanami region northwest of
Alice Springs. The Tanami Network, a 7-site, satellite-based video conferencing
network, has been set up to restore the open social network lost when the use of HF
radio diminished, and to greatly enhance service delivery to the remote communities.

The network carries a large number of family, community, and ceremonial contacts
each year, and these include contacts with family members in prison, in hospital, and
away studying. Areas of service delivery in which video conferencing is involved
include the delivery of secondary and adult education, telemedicine applications, staff
recruitment and in-servicing, consultation and planning meetings, court hearings, and
management support. Open learning and cultural exchange sessions have been
conducted with urban Aboriginal groups in Australia, and with indigenous groups
overseas.

The project is owned by the communities through a trust in which they have invested
$750,000 to date, and controlled directly by an Aboriginal Board. This preference for
localised control is a common feature of most Aboriginal initiatives in remote
communities. Another important aspect of the development is that, by establishing
sites in the urban centres of the NT to facilitate service delivery, the project has
introduced the use of video conferencing to the largely non-Aboriginal, urban NT
population. It thus provides an important example of positive Aboriginal intervention
in the development of mainstream Australian communication infrastructure.

Attempts are now being made to duplicate the Tanami Network initiative throughout
remote Australia. A trial link has been established between Doomadgee community
and Cairns and a proposal for a 60 site permanent network has been developed and
presented to the Federal Government with the suggestion that it be considered in the
next stage of the social justice package.




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The establishment of a national, remote area video conferencing network would offer
a number of major potential benefits to health delivery in remote areas:

1) Professional networking between health practitioners in all levels and specialities
   could be greatly improved.

2) Consultation between Aboriginal people and health service agencies aimed at
   improving the effectiveness and relevance of the services could be made easier
   and more representative.

3) Direct delivery of specialist services such as psychiatric assessment could be
   facilitated.

4) On-going in-service training of remote staff could often be done in-situ.

Multi-media platforms

Equipment which can provide interactive picture, sound and text within the one
platform is potentially the most powerful communication technology.

The major concern, with regard to the interests of remote Aboriginal communities, is
that this communication technology may not support the social and communal
processes which have been demonstrated in the Tanami Network project. Equipment
has been designed around normal computer screen formats which prevents its use by
larger numbers of people. Additionally, the lower cost of the equipment will make it
likely that it will be introduced on an agency by agency basis into separate work
spaces, rather than on a communal basis.

These features mean that the dialogue between agencies and the community as a
whole which has been established through room video conferencing formats could be
jeopardised if the current format is supplanted by individual uses of multi-media
equipment. In many ways this occurrence would parallel the loss of the public
networking when HF radio was supplanted by telephones.

2.     Broadcasting

The advent of satellite-delivered television and radio services to the remote and rural
areas of Australia has produced two distinct responses from Aboriginal groups. Both
were prompted by concerns about the impact of mainstream TV and radio
broadcasting on Aboriginal culture and language.

Regional Commercial Broadcasting

The first was a campaign by the Central Australian Aboriginal Media Association
(CAAMA) to have the needs of the remote Aboriginal audience included in licence
provisions for the Central Australian commercial television licence. The group
inadvertently won the licence and Imparja television was set up as a result. The
station
has provided an important symbol of the contemporary Aboriginal presence in the
region and has installed Aboriginal control and some Aboriginal employment in the


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organisation. However, the aim of producing and broadcasting programs on
Aboriginal life remains largely impaired by financial constraints, and a regional
format which takes in 26 Aboriginal language areas and thus makes the representation
of individual groups difficult.

Community Broadcasting

At the same time as Imparja television was being set up, the Central Australian
communities of Yuendumu and Ernabella established low power pirate TV
transmitters and began broadcasting locally produced programs based on culture,
language and community life and shot on the VHS format. Each community
established a Media Association which controlled the production and broadcasting
and brokered the relationship between the community and mainstream media. The
model which was established has since been applied by Aboriginal groups in many
other remote and urban locations under the federal government Broadcasting in
Remote Aboriginal Communities Scheme (BRACS), and has been extended to radio.
In all cases, the operations exist on shoestring budgets and with the emphasis of any
government support being on the provision of equipment rather than on the
development of effective community organisations with which to support media
activities, and the related need for the training and employment of Aboriginal media
workers.

The present situation is that the BRACS programs have generally failed to realise
their potential to provide socially relevant broadcasting in Aboriginal communities
with any regularity despite the fact that the technical infrastructure has been in place
for many years now. This illustrates the fact that a viable community broadcasting
operation needs clear organisational arrangements for social support such as a media
association, systematic development of technical skills, and local media forums in
which a good working knowledge of media processes can be developed. It has also
been very difficult for the groups to effectively combine in order to promote the
causes which they embody, or to exchange programming where this was appropriate.
Without such networking, the individual production sites are too weak and
unsupported to stand alone.

Pay TV

Current attempts to find a viable formula for Aboriginal involvement in broadcasting
revolve around the advent of pay TV. This development has vastly increased the
potential for intrusion of mainstream content into remote Aboriginal life but has also
opened up the potential for an Aboriginal niche market.

The 250,000 Aboriginal people in Australia, combined with the supply of an
Aboriginal channel to tourism, academia and others with an interest in the area would
provide a potential basis for a development and such broadcasting. Such a channel
would also provide a powerful context for the publicising of community health issues
and of health programs to Aboriginal clients. The use of additional bandwidth within
the proposed national remote area video conferencing network would be a cost-
effective way of carrying such broadcasting to remote areas within structures which
allow for Aboriginal control



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3.     Database access

Where quality, high-speed transmission routes are available in remote locations, direct
access to government agency, corporate, and academic data bases can be facilitated.
This creates the possibility for many developments which are of potential benefit to
the communities.

Electronic banking services could be introduced within the operating structure of a
community council or store as a means of stabilising money management in localities
where bank agencies have proved to be uneconomic.

Local access to agency data bases would support an expanded and more responsive
agency presence in the community by combining the basis for employment of agents
with strong local knowledge with full access to the information on which the service
is based.

Access to the vast academic resources of the internet would greatly improve the
resources available to remote Aboriginal tertiary students and create a remote area
equivalent of the extensive library facilities which support academic studies
elsewhere.

A New Relationship With Service Providers
Although it is only spanning part of the information superhighway, the Tanami
Network Project has demonstrated the valuable dynamics which flow from Aboriginal
ownership and development of communications infrastructure. The terms of
development have established conditions in which technology adoption, rather than
being imposed and fragmented, is negotiated through meaningful dialogue and is
cohesive.

Partnerships in Developing Service Delivery Strategies

Several helpful tendencies exist in cases where Aboriginal people have achieved
ownership and meaningful control of communications infrastructure.

The arrangement guarantees that, within their preferred way of doing things,
Aboriginal people will want to use the technology and will seek to have service
agencies use it for their work. This has been clearly demonstrated by the long and
active negotiations with service agencies which has been undertaken by the Tanami
Network as part of its business development.

Such a negotiated process contains many strong Aboriginal priorities. These include
the importance of reaching a position which everyone understands and accepts, one
which recognises the particular aspects of the people and of the country, and one
which respects the formal levels of culture. The inclusion of these considerations will
not only make service delivery more relevant and effective, but also provide new
viewpoints regarding the aims and methodology of service delivery in general.

The inclusion of community viewpoints is also a strong medium for the co-ordination
of various service inputs. The average remote community has service relationships


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with upwards of 70 service agencies and the normal instinct in a community is to
attempt to align these inputs around socially meaningful local initiatives. This holistic
and integrated approach to service delivery is of great potential benefit to service
providers since it is capable of grouping agency initiatives to greater effect and
identifying gaps and dysfunctions. This relationship is not in conflict with the broad
policy intent of agencies as it is acting at the level of effective local arrangements.

The partnership inherent when Aboriginal ownership of new communications
infrastructure is combined with the need for service agency use is also beneficial to
the handling of changes in service delivery arrangements. This is because the agency
staff and Aboriginal people become the co-developers of the new arrangements and
are therefore less likely to feel a sense of imposition of change.

Technology Cost and Cost Benefit

The business plan of the Tanami Network, in which the adoption of the technology is
justified against costs, assumes the active and co-ordinated participation of some 30
service agencies, as well as use by private enterprise and the communities themselves.
None of these groups could justify the costs of the infrastructure if it were to be put in
for their use alone.

The initiative taken by the communities has therefore broken a strong tendency on the
part of service agencies to align the choice of the technology to be adopted to the
scale of their operating budgets rather than to a projected ideal of what should be
achieved. It has done this by providing an independent structure which can
accommodate appropriate levels of adoption of the technology by each agency.

The relationship between the service agencies and Tanami Network has also allowed
the question of cost benefit to be broken free from any initial outlay by the agency
itself on the infrastructure being evaluated. Specific areas of delivery can be trialed,
and evaluated against conventional arrangements in cost benefit terms, without the
need for adoption for the sake of covering infrastructure outlays.

With these tendencies in place it is hoped that, over time and working in partnership,
we will arrive at the best mix of communications use and a highly focussed practice in
the cost effective use of each within service delivery arrangements.

Mind In Cyberspace, Feet On The Ground
The foregoing discussion has given some indication of the immense power of the new
communications technologies, and of the critical role of social and operational
arrangements in shaping the impact that they will have in remote Aboriginal
communities.

The current developments are rapidly projecting community members into
information networks which are global in scope and capable of drawing the affairs of
the community into an infinity of external agendas. The remote communities are not
alone in facing these possibilities - it is an issue for us all.




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Given these global and globalising tendencies, there is no better broker of the interests
of people and places in these developments than the Aboriginal people of the remote
communities. While isolation creates its own problems it also preserves a strong and
cohesive sense of community, one which has proved capable of surviving in a context
of universal possibilities.

When the Warlpiri people linked with the Sami people of Northern Sweden, they did
not go there. In fact the event gave them a chance to show that they had an absolute
belief in who they were, where they belonged, and what they should say. These
qualities will offer increasing value within the future for which we are preparing.




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