A rapid anthropological assessment of tuberculosis in a remote Aboriginal community in Northern Australia

In the Northern Territory (NT) of Australia, the rate of active tuberculosis (TB) is thirty four times higher in the Indigenous than the non-Indigenous Australian-born population. In 2000, of the 38 notified cases, 14 (37 percent) were associated with one of a number of Aboriginal communities where TB is endemic. Despite effective treatment of patients with active TB over the past decade, compliance with latent TB infection (LTBI)1 has remained low. In 2003-04 a qualitative study was conducted in order to assess the level of awareness and understanding of TB and latent TB infection (LTBI) in this community, and identify the factors that militate against early presentation with active TB, and acceptance and/or compliance with treatment for LTBI. We found there to be a low level of knowledge about TB, and even less of LTBI. While the seriously ill usually seek treatment at the local health clinic, early presentation is not the norm. Late or non-presentation with active TB appears to be due to a combinationof Indigenous attitudes toward illness and a reluctance to seek attention at the local clinic unless absolutely necessary. Many residents are said to feel uncomfortable discussing their physical problems with the clinic's non-Indigenous medical staff, and in some cases communication is difficult as the level of English literacy varies, being low among some groups resident there. Local Council and Health Board members interviewed believe the best way to deal with this problem is to have more local people working in the clinic and engaged in outreach activities informing those most at risk about the symptoms of active TB. Unfortunately there is no point at present in encouraging those with LTBI to accept treatment, as there are insufficient resources available at the clinic to offer it to those at risk. The local chnic has a range of chronic and acute case loads to manage with limited staff, and preventative programs are time consuming, and not of immediate, critical concern. At the same time, local council and health board members have little power to influence policy and/or funding decisions that are made at the Territory level and determine what medical services are offered, nor how they are delivered in their "community." Copyright � 2006 by the Society for Applied Anthropology.