Journal articles on the topic 'Pain Treatment Queensland Townsville'

Introduction: The Queensland Remote Chemotherapy Supervision (QReCS) model enables rural nurses to administer chemotherapy in smaller rural towns under supervision by health professionals from larger centers using telehealth. Its implementation began in North Queensland, Australia (population, 650,000), in 2014 between two regional cancer centers (Townsville and Cairns as primary sites) and six rural sites (125 to 1,000 kilometers from primary sites). Our study examined the implementation processes, feasibility, and safety of this model. Methods: Details of implementation and patients’ clinical details for the period of 2014 to 2016 for descriptive analysis were extracted from telechemotherapy project notes and oncology information systems of North Queensland, respectively. Results: After a successful pilot study in Townsville Cancer Centre, statewide rural and cancer networks of Queensland Health, in collaboration with clinicians and managers across the state of Queensland, developed the QReCS model and a guide for operationalizing it. QReCS was implemented at six sites from 2014 to 2016. Main enablers across North Queensland included collaboration among clinicians and managers, availability of common electronic medical records, funding from Queensland Health, and installation of telehealth infrastructure by statewide telehealth services. Main barriers included turnover of senior management and nursing staff at two rural towns. Sixty-two patients received 327 cycles of low- to medium-risk chemotherapy agents. Rates of treatment delays, adverse events, and hospital admissions were similar to those in face-to-face care. Conclusion: Implementation of the QReCS model across a large geographic region is feasible with acceptable safety profiles. Leadership by and collaboration among clinicians and managers, adequacy of resources and common governance are key enablers.

2084 Background: The Teleoncology model of care, as developed and implemented across health services in Far North Queensland (Australia), improves access to specialist oncology services, including telehealth supervised administration of Oncology drugs for patients in rural/remote towns. There is limited published data regarding the safety of checkpoint inhibitor immunotherapy when it is administered via Teleoncology. Aim: Evaluate safety of immunotherapy administration via Teleoncology, including immune-related adverse events (irAE), treatment delays, hospital admissions and interhospital transfers, in comparison to a retrospective control population. Methods: Retrospective review of all patients treated with immunotherapy via Teleoncology as part of Cairns and Hinterland Hospital and Health Service (CHHHS) and the Townsville Teleoncology Network (TTN) between January 2015 and April 2019. A retrospective cohort treated at Townsville Cancer Centre over the same time period was used as a control group. Results: Fifty-one patients received a total of 624 cycles of immunotherapy (all single agent anti-PD-1/L-1) via Teleoncology. The control population included 142 patients who received 1697 cycles of immunotherapy. Baseline characteristics were well matched between groups. Compared to the control population, patients treated via telehealth did not have statistically significant differences in the rate of Grade 3+ irAE (13.7% v 8%), hospital admissions (13.7% v 7.4%) or protocol suspensions due to immune toxicity (16% v 10%). One patient with Grade 3+ irAE required interhospital transfer for investigation and management, which occurred within 24 hours of presentation to hospital. There were no treatment-related mortalities in either group. Conclusions: Checkpoint inhibitor immunotherapy can safely be delivered using the Teleoncology model of care in rural and remote centres. The incidence of toxicity for single agent immunotherapy was predictably low and not significantly different between groups, however the numbers in this retrospective study were small. The time to recognition and management of immune mediated toxicity in rural and remote centres is an important factor that was not assessed in this study and will be considered in future work.

e17558 Background: The best treatment option for most cancers is participation in clinical trials. Participation in trials is generally low and among rural patients it is likely to be even lower. The aim of this study was to assess knowledge about and attitudes towards clinical trials among rural and regional cancer patients of North Queensland. Methods: A questionnaire-based survey was conducted in outpatient clinics at the Townsville Cancer Centre on all types of cancer patients. Results: The mean age of the 178 participants was 56 years and 45.4% lived in rural or remote areas. Median distance to the trial centre (Townsville) for rural participants was 180 km (range 80 - 1300 km). Being asked whether they would take part in a RCT, 13.2% of participants said no, 56.3% said yes, and 30.5% were unsure. There were no significant relationships between willingness to participate and rurality (p = 0.896) or education level (p = 0.943). For the majority of patients, the number of clinic visits and blood tests required did not matter. Cost of travel (41.1% rural/remote; 23.5% regional; p < 0.001) and the need for family or friends to accompany (38.9% rural/remote; 24.1% regional; p = 0.021) were more important for rural/remote than regional patients as factors affecting participation. Only 16.4% of participants were aware of early studies. After education, percentage of patients willing to participate in phase I and II studies were 57% and 84%, respectively. Rural patients were less willing to participate in phase I studies than regional patients (33.9% vs 52.6%, p = 0.029). Conclusions: Rural patients are as interested in participating in clinical trials as urban patients except for phase 1 trials and should not be excluded because of rurality. Knowledge of trials is poor and there is a need for education early. Cost of travel seems more important for rural patients and as such budgets should include cost of travel to encourage participation of rural patients. No significant financial relationships to disclose.

Background To assess a mailed self-collection kit for chlamydia testing as an intervention to increase post-treatment retesting rates. Methods: This prospective intervention study took place at a sexual health clinic in Townsville, North Queensland (Australia) between 2006 and 2008. The intervention consisted of offering to mail a self-collection kit for retesting 3 months after treatment. The achieved retesting rates were compared to those from the previous year and to concurrent controls who did not participate in the intervention. Both control groups received standard advice on retesting. Results: Of the 46 participants in the intervention group, 34.8% returned the sample for retesting 3 to 4 months after initial treatment, in comparison to 6.8% of the historic control groups (n = 206) and 1.4% of the concurrent control group (n = 142) (P < 0.001, respectively). Conclusions: Retesting rates for Chlamydia trachomatis were substantially and significantly improved using the mailed self-collection kit evidencing that the kit could deliver a much needed intervention to improve notoriously low retesting rates.

IntroductionHaycocknema perplexum is an exceedingly rare cause of parasitic myositis endemic to Australia, more specifically, Tasmania and North Queensland. There is a paucity of literature regarding this diagnosis, with only nine previously described cases.DiagnosisThis report details two cases of biopsy-confirmed H. perplexum myositis from Townsville University Hospital and describes the first-ever case of subclinical infection. There is limited known information regarding the H. perplexum life cycle and a definitive host which has hindered the development of a non-invasive diagnostic test. A review of the previously described cases has identified the hallmark features of this enigmatic condition: a triad of serological markers including deranged hepatic function, persistent eosinophilia and an elevated creatine kinase.ConclusionsThis report aimed to raise awareness of H. perplexum myositis and the possibility of subclinical infection, which suggests a protracted disease course. Further research is required to identify a non-invasive diagnostic test, given that early diagnosis and timely initiation of albendazole treatment may drastically limit patient disability.

Introduction:Cyclones are expected to increase in frequency and intensity, significantly impacting communities and healthcare services. During these times, those with chronic diseases such as opioid dependence are at an increased risk of disease exacerbation due to treatment regimen interruptions. Disruptions to the continuity of the opioid replacement therapy (ORT) service can be detrimental to both clients and the community which can potentially lead to relapse, withdrawal, and risky behaviors.Aim:To explore the impacts of cyclones on opioid treatment programs within community and hospital pharmacies in Queensland.Methods:Qualitative research methods were used in this study with two methods of data analysis employed: the text analytics software, Leximancer®, and manual coding. Interviews were conducted with five hospital and five community pharmacists and four Queensland opioid treatment program (QOTP) employees. Participants worked in Mackay, Rockhampton, Townsville, and Yeppoon in a community impacted by a cyclone and involved with ORT supply.Results:The themes developed in the manual coding were “impact on essential services,” “human experience,” “healthcare infrastructure,” “preparedness,” and “interprofessional networks.” These themes were aligned with those identified in the Leximancer® analysis. The community pharmacists focused on client stability, whereas, the hospital pharmacists and QOTP employees focused on the need for disaster plans to be implemented.Discussion:The greatest concern for participants was maintaining the stability of their clients. Communication amongst the dosing sites and ORT stakeholders was most concerning. This led to a lack of dosing information in a timely manner with pharmacists being hesitant to provide doses and takeaways due to legislative restrictions. A review of coordinated efforts and the legislative constraints is recommended to ensure continuity of ORT supply during cyclones.

Research on parental adaptation to a child's chronic illness is still scant, and this is particularly so in relation to theexperience of treatment for paediatric Acute Lymphoblastic Leukaemia (ALL). The work that does exist on parentalreactions tends to conflate maternal responses with paternal responses, as fathers are usually seen as having a secondaryrole. Consequently, little is known about how fathers cope with treatment for childhood ALL. The present discussionseeks to make a contribution to this area by presenting findings on the paternal experience of treatment for paediatricALL from a longitudinal study conducted at Royal Children's Hospital in Brisbane, Queensland. The findings fromthis research clearly indicate the emotional pain that fathers face in their struggle to accept the diagnosis of a serious,life-threatening illness such as ALL in their child. The findings challenge the notion of the male stereotype by showingthat the shock of diagnosis, the emotional pain of coping with the illness, the expression of pain through tears, thedesire to be with the child, the struggle to cope with the medical interventions, and concerns about other familymembers are not gender specific, but are rather issues common to both parents.

Background: A prospective study was undertaken to develop an evidence-based outreach chlamydia screening program and to assess the viability and efficiency of this complementary approach to chlamydia testing within the routine operations of a primary healthcare service. Methods: A primary healthcare service based in Townsville, Queensland, Australia, identified high-prevalence groups for chlamydia in the community. Subsequently, a series of outreach clinics were established and conducted between August 2004 and November 2005 at a defence force unit, a university, high school leavers’ festivities, a high school catering for Indigenous students, youth service programs, and backpacker accommodations. Results: All target groups were easily accessible and yielded high participation. Chlamydia prevalence ranged between 5 and 15% for five of the six groups; high school leavers had no chlamydia. All participants were notified of their results and all positive cases were treated (median treatment interval 7 days). Five of the six assessed groups were identified as viable for screening and form the basis for the ongoing outreach chlamydia screening program. Conclusion: The present study developed an evidence-based outreach chlamydia screening program and demonstrated its viability as a complementary approach to chlamydia testing within the routine operations of the primary healthcare service, i.e. without the need for additional funding. It contributes to the evidence base necessary for a viable and efficient chlamydia management program. Although the presented particulars may not be directly transferable to other communities or health systems, the general two-step approach of identifying local high-risk populations and then collaborating with community groups to access these populations is.

IntroductionAlemtuzumab is a highly effective therapy for multiple sclerosis that has a significant, but well-defined adverse event profile. We report cases treated since the commercial release of alemtuzumab at two centres in Queensland with the aim of comparing real-world experience with trial data.MethodsThis was a retrospective case note review of patients treated with alemtuzumab for multiple sclerosis since becoming commercially available in Australia. The two sites were the Gold Coast University Hospital and the Townsville Hospital. Demographic, clinical and MRI data were systematically collected from the available records at each site. De-identified aggregated data were analysed using descriptive statistics (mean (±SD), median (range)) and compared with phase III clinical trial data.Results104 cases treated with alemtuzumab were identified at the two sites. The median age at first treatment was 3817–55 years, slightly older than the trial populations (33 and 35 years) and two-thirds were female. The mean disease duration was 8.4 (±7.0) years, which is longer that seen in the trials (2.1 and 4.5 years). The median number of prior relapses was 31–12 with 1 (0–3) in the prior 2 years. The median number of prior treatments for MS was 1.5. The median follow up was 201–35 months. The median EDSS at time of first treatment was 2 (0–7) and at last follow up was 1.5 (0–7). At last follow up, 24/104 (23%) had improved, 61/104 (58%) were stable and 9/104 (9%) had worsened. Autoimmune adverse events were seen in 18/104 (17%) with autoimmune thyroid disease being the most common (13/104 (13%).ConclusionAlemtuzumab is an effective therapy for MS. Clinical outcomes in a real world setting were similar to those seen in phase III clinical trials. Autoimmune diseases occurred in a similar proportion to those seen in clinical trials.References. Cohen JA, Coles AJ, Arnold DL, et al. Alemtuzumab versus interferon beta 1a as first-line treatment for patients with relapsing-remitting multiple sclerosis: A randomised controlled phase 3 trial. Lancet2012;380(9856):1819–28.. Coles AJ, Twyman CL, Arnold DL, et al. Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy: A randomised controlled phase 3 trial. Lancet2012;380(9856):1829–39.

AbstractObjectiveThis pilot trial compared the feasibility, tolerability, acceptability, and effects of group-delivered mindfulness meditation (MM), cognitive therapy (CT), and mindfulness-based cognitive therapy (MBCT) for chronic low back pain (CLBP).SettingUniversity of Queensland Psychology Clinic.SubjectsParticipants were N = 69 (intent-to-treat [ITT] sample) adults with CLBP.DesignA pilot, assessor-blinded randomized controlled trial.MethodsParticipants were randomized to treatments. The primary outcome was pain interference; secondary outcomes were pain intensity, physical function, depression, and opioid medication use. The primary study end point was post-treatment; maintenance of gains was evaluated at three- and six-month follow-up.ResultsRatings of acceptability, and ratios of dropout and attendance showed that MBCT was acceptable, feasible, and well tolerated, with similar results found across conditions. For the ITT sample, large improvements in post-treatment scores for pain interference, pain intensity, physical function, and depression were found (P < 0.001), with no significant between-group differences. Analysis of the follow-up data (N = 43), however, revealed that MBCT participants improved significantly more than MM participants on pain interference, physical function, and depression. The CT group improved more than MM in physical function. The MBCT and CT groups did not differ significantly on any measures.ConclusionsThis is the first study to examine MBCT for CLBP management. The findings show that MBCT is a feasible, tolerable, acceptable, and potentially efficacious treatment option for CLBP. Further, MBCT, and possibly CT, could have sustained benefits that exceed MM on some important CLBP outcomes. A future definitive randomized controlled trial is needed to evaluate these treatments and their differences.

Seasonal heat stress is known to significantly diminish reproductive performance in pigs, particularly in the tropics, costing the industry millions in annual losses. The boar’s reduced capacity to sweat and non-pendulous scrotum, combined with the widespread use of European breeds in the tropics, makes this species particularly vulnerable to heat stress. Although heat stress is traditionally considered a sow problem, recent mouse studies demonstrate that heat stress-induced sperm DNA damage can result in arrested development and loss of early embryos. Our study investigated the impact of tropical summer heat stress on the quality and DNA integrity of boar sperm, and trialled antioxidant supplementation to alleviate the problem. Data, expressed as mean ± SEM, were analysed by one-way repeated-measures ANOVA with pairwise Bonferroni tests. Motility of sperm obtained from Large White boars (n = 5) housed in the dry tropics of Townsville, North Queensland, Australia, was characterised by computer-assisted sperm analysis but did not differ between summer, winter, or spring (total motility: 71.3 ± 8.1 v. 90.2 ± 4.2 v. 70.8 ± 5.5%, respectively; P > 0.05; progressive motility: 35.4 ± 7.0 v. 46.6 ± 4.0 v. 41.7 ± 2.8%, respectively; P > 0.05). Sperm DNA integrity in 20,000 sperm/boar per season, evaluated using TUNEL and flow cytometry, revealed 16-fold more DNA-damaged sperm in summer than winter, and nearly 9-fold more than spring (16.1 ± 4.8 v. 1.0 ± 0.2 v. 1.9 ± 0.5%, respectively; P ≤ 0.05). However, boar feed supplemented with 100 g/boar per day of proprietary custom-made antioxidants during summer significantly reduced sperm DNA damage to 9.9 ± 4.5% and 7.2 ± 1.6% (P ≤ 0.05) after 42 and 84 days of treatment respectively. Total and progressive motility were not altered by the supplement. In summary, sperm DNA integrity is compromised in boars during summer, suggesting that boar factors may contribute to seasonal embryo loss in sows. Moreover, such damage appears undetectable using traditional measures of sperm motility. Antioxidant supplementation during summer appears to mitigate the negative impact of heat stress on sperm DNA integrity.

Background: Although newborn hearing screening programs have been introduced in most states in Australia, the prevalence of conductive hearing loss and middle ear pathology in the infants referred through these programs is not known. Purpose: This study was designed to (1) evaluate the prevalence of conductive hearing loss and middle ear pathology in infants referred by a newborn hearing screening program in north Queensland, (2) compare prevalence rates of conductive hearing loss and middle ear pathology in indigenous and nonindigenous infants, and (3) review the outcomes of those infants diagnosed with conductive hearing loss and middle ear pathology. Research Design: Retrospective chart review of infants referred to the Audiology Department of The Townsville Hospital was conducted. Study Sample: Chart review of 234 infants referred for one or both ears from a newborn hearing screening program in north Queensland was conducted. A total of 211 infants attended the diagnostic appointment. Review appointments to monitor hearing status were completed for 46 infants with middle ear pathology or conductive hearing loss. Data Collection and Analysis: Diagnosis of hearing impairment was made using an age-appropriate battery of audiological tests. Results were analyzed for both initial and review appointments. Results: Mean age at initial diagnostic assessment was 47.5 days (SD = 31.3). Of the 69 infants with middle ear pathology during initial diagnostic assessment, 18 had middle ear pathology with normal hearing, 47 had conductive hearing loss, and 4 had mixed hearing loss. Prevalence of conductive hearing loss in the newborns was 2.97 per 1,000 while prevalence of middle ear pathology (with or without conductive hearing loss) was 4.36 per 1,000. Indigenous Australians or Aboriginal and Torres Strait Islander (ATSI) infants had a significantly higher prevalence of conductive hearing loss and middle ear pathology than non-ATSI infants (35.19 and 44.45% vs 17.83 and 28.66%, respectively). ATSI infants also showed poor resolution of conductive hearing loss over time with 66.67% of ATSI infants reviewed showing persistent conductive hearing loss compared to 17.86% of non-ATSI infants. Medical management of 17 infants with persistent conductive hearing loss included monitoring, antibiotic treatment, examination under anesthesia, and grommet insertion. Conclusions: Conductive hearing loss was found to be a common diagnosis among infants referred through screening. ATSI infants had significantly higher rates of middle ear pathology and conductive hearing loss at birth and showed poor resolution of middle ear pathology over time compared to non-ATSI infants. Future research using a direct measure of middle ear function as an adjunct to the automated auditory brainstem response screening tool to distinguish conductive from sensorineural hearing loss may facilitate prioritization of infants for assessment, thus reducing parental anxiety and streamlining the management strategies for the respective types of hearing loss.

The purpose of this study was to compare the physical, psychological and social dimensions associated with quality-of-life outcomes over the last year of life, between advanced cancer users and nonusers of complementary and alternative medicine. One hundred and eleven patients were identified through Queensland Cancer Registry records, and followed up every four to six weeks until close to death using standardized protocols. Outcome measures were symptom burden, psychological distress, subjective wellbeing, satisfaction with conventional medicine and need for control over treatment decisions. At the initial interview, 36 (32%) participants had used complementary/alternative medicine the previous week; mainly vitamins, minerals and tonics and herbal remedies. Among all participants, 53 (48%) used at least one form of complementary/alternative medicine over the study period. Only six (11%) visited alternative practitioners on a regular basis. Overall, complementary/alternative medicine users reported higher levels of anxiety and pain, less satisfaction with conventional medicine and lower need for control over treatment decisions compared with nonusers. These differences tend to change as death approaches. A more rigorous assessment of complementary/alternative medicine use, psychological distress, pain and subjective wellbeing among patients with advanced cancer is needed in the clinical setting.

ObjectiveTo compare the effectiveness of two acute burn dressings, Burnaid hydrogel dressing and plasticised polyvinylchloride film, on reducing acute pain scores in paediatric burn patients following appropriate first aid.DesignSingle-centre, superiority, two-arm, parallel-group, prospective randomised controlled trial.Participants and settingPaediatric patients (aged ≤16) presenting to the Emergency Department at the Queensland Children’s Hospital, Brisbane, Australia, with an acute thermal burn were approached for participation in the trial from September 2017–September 2018.InterventionsPatients were randomised to receive either (1) Burnaid hydrogel dressing (intervention) or (2) plasticised polyvinylchloride film (Control) as an acute burn dressing.Primary and secondary outcomesObservational pain scores from nursing staff assessed 5 min post application of the randomised dressing, measured using the Face Legs Activity Cry and Consolability Scale was the primary outcome. Repeated measures of pain, stress and re-epithelialisation were also collected at follow-up dressing changes until 95% wound re-epithelialisation occurred.ResultsSeventy-two children were recruited and randomised (n=37 intervention; n=35 control). No significant between-group differences in nursing (mean difference: −0.1, 95% CI −0.7 to 0.5, p=0.72) or caregiver (MD: 1, 95% CI −8 to 11, p=0.78) observational pain scores were identified. Moreover, no significant differences in child self-report pain (MD: 0.3, 95% CI −1.7 to 2.2, p=0.78), heart rate (MD: −3, 95% CI −11 to 5, p=0.41), temperature (MD: 0.6, 95% CI −0.13 to 0.24, p=0.53), stress (geometric mean ratio: 1.53, 95% CI 0.93 to 2.53, p=0.10), or re-epithelialisation rates (MD: −1, 95% CI −3 to 1, p=0.26) were identified between the two groups.ConclusionsA clear benefit of Burnaid hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burns was not identified in this investigation.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12617001274369).

IntroductionEndometriosis is a common gynaecological disease associated with pelvic pain and subfertility. There are no non-invasive diagnostic tests, medical management requires suppression of oestrogens and surgical removal is associated with risk. Endometriosis is a complex genetic disease with variants in at least 27 genetic regions associated with susceptibility. Previous research has implicated a variety of biological mechanisms in multiple cell types. Endometrial and endometriotic epithelial cells acquire somatic mutations at frequency higher than expected in normal tissue. Stromal cells have altered adhesive capacity and immune cells show altered cytotoxicity. Understanding the functional consequences of these genetic variants on each cell type requires the collection of patient symptoms, clinical and genetic data and disease-relevant tissue in an integrated program.Methods and analysisThe aims of this study are to collect tissue associated with endometriosis, chart the genetic architecture related to endometriosis in this tissue, isolate and propagate patient-specific cellular models, understand the functional consequence of these genetic variants and how they interact with environmental factors in pathogenesis and treatment response.We will collect patient information from online questionnaires prior to surgery and at 6 and 12 months postsurgery. Treating physicians will document detailed surgical data. During surgery, we will collect blood, peritoneal fluid, endometrium and endometriotic tissue. Tissue will be used to isolate and propagate in vitro models of individual cells. Genome wide genotyping and gene expression data will be generated. Somatic mutations will be identified via whole genome sequencing.Ethics and disseminationThe study has been approved and will be monitored by the Metro North Human Research Ethics committee (HREC) and research activities at the University of Queensland (UQ) will be overseen by the UQ HREC with annual reports submitted. Research results will be published in peer-reviewed journals and presented at conferences were appropriate. This study involves human participants and was approved by RBWH Human Research Ethics Committee; HREC/2019/QRBW/56763.The University of Queensland; 2017002744. Participants gave informed consent to participate in the study before taking part.

IntroductionPeripheral intravenous catheters (PIVCs) frequently fail during therapy administration, resulting in infusates pooling in the surrounding tissue. These extravasation injuries can cause significant pain, tissue destruction and scarring. ivWatch is a biosensor that uses visible and near-infrared light to measure tissue changes surrounding the PIVC and alert clinicians when extravasation may occur. The effectiveness of ivWatch, in comparison to clinical observation, in decreasing injury severity is unknown. The present study aims to investigate whether using ivWatch may potentially detect injury earlier and decrease the severity of PIVC extravasation injuries.Methods and analysisA single centre, parallel group, open-label superiority randomised controlled trial comparing (a) standard care (clinical observation) to (b) ivWatch monitoring in addition to standard care, to decrease the severity of extravasation injuries. 200 children with PIVCs inserted in the distal half of the limb, receiving intermediate-risk to high-risk infusates for ≥24 hours, will be consecutively recruited at a paediatric intensive care unit in Queensland, Australia. The primary outcome is extravasation severity, measured by the Cincinnati Children’s Extravasation Harm Scale. Secondary outcomes include severity assessed with three-dimensional camera imaging, extravasation volume, treatment sequelae, the number of PIVCs used and dwell time, quality of life and healthcare costs. The between treatment difference in extravasation severity will be compared using ordinal logistic regression, with the treatment group included as the main effect, and reported with corresponding 95% CIs. Estimates of value will be presented as net monetary benefits and cost per reduction in extravasation injury severity, both presented with corresponding 95% credible intervals.Ethics and disseminationThis study received approval from the Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC) (reference number: HREC/20/QCHQ/60867) and the Griffith University HREC (reference number: 2020/310) and will be disseminated via peer-reviewed publications and conference presentations.Trial registration numberACTRN12620000317998.

IntroductionDespite the prevalence of low back pain (LBP) worldwide, many people with the condition do not receive evidence-based care or achieve the best possible outcomes. There is a gap in the dissemination of evidence-based information across the globe. The advent of the internet has changed the way people obtain health information. As such, trustworthy, tailored and validated LBP resources may help bridge the gap. This study aims to measure the effectiveness of a new website (MyBackPain) in improving spinal health literacy, treatment preferences and clinical outcomes for people with LBP, in comparison with other online resources.Methods and analysisThis online, pragmatic, randomised controlled trial will comprise 440 people with non-specific LBP of any duration. In addition to access to publicly available online information (control group), the intervention group will be given access to the MyBackPain.org.au website. Participants and research staff, including the biostatistician, will be blinded to treatment allocation. Data will be collected at baseline, 1, 3 (primary end-point), 6 and 12 months via online surveys and questionnaires. The primary outcome is spinal health literacy. Secondary outcomes include quality of treatment preferences (stated and observed) and LBP clinical outcomes (pain, disability and quality of life). Analyses will be by intention-to-treat and include outcome data on all randomised participants. Descriptive statistics will be presented for demographic and clinical characteristics.Ethics and disseminationThis trial has been prospectively registered with the Australian New Zealand Clinical Trials Registry and has ethical approval from the University of Queensland Human Research Ethics Committee (2017000995). Trial outcomes will be shared via national and international conference presentations and peer-reviewed journal publications.Trial registration numberACTRN12617001292369; Pre-results.

ObjectivesTo investigate health practitioners’ understanding and practice behaviours with regards to clinical prediction rules (CPRs) and explore their perceptions of adopting a new whiplash CPR.DesignQualitative study using six semistructured focus groups.SettingPrimary and secondary care in New South Wales and Queensland, Australia.ParticipantsPhysiotherapists (n=19), chiropractors (n=6) and osteopaths (n=3) were purposively sampled to include health practitioners who provide routine treatment to people with whiplash-associated disorders.MethodsFocus group discussions (n=6) were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach.ResultsHealth practitioners’ understanding and use of CPRs were mixed. Clinicians considered components relating to acceptability (‘whether I agree with it’) and implementation (‘how I'll use it’) when deciding on whether to adopt a new CPR. Acceptability was informed by four themes: knowledge and understanding, CPR type, congruence and weighted value. Consideration of matters that promote implementation occurred once a CPR was deemed to be acceptable. Three themes were identified as potentially enhancing whiplash CPR implementation: the presence of an external driver of adoption, flexibility in how the CPR could be administered and guidance regarding communication of CPR output to patients.ConclusionsEducation on CPR purpose and fit with practice is needed to enhance the perceived acceptability of CPRs. Strategies that facilitate practitioner motivation, enable administrative flexibility and assist clinicians in communicating the results of the whiplash CPR could promote adoption of the whiplash CPR.

Background:Biological and targeted synthetic disease modifying anti-rheumatic agents (bDMARDs) increase the risk of serious infections (SIs), however there is limited ‘real-world’ evidence comparing the relative risk of SI for individual bDMARDs. (1,2)Objectives:This study examines the rates of SIs in a non-select Australian Northern Queensland (NQ) cohort of patients with various rheumatic diseases receiving treatment with a bDMARD, to define predisposing factors and directly compare the bDMARDs.Methods:A retrospective review was performed for all patients who received a bDMARD through the Townsville Hospital Rheumatology Department over the 5-year period between June 2013 and May 2018. Episodes of a SI were defined as infection requiring admission or use of intravenous antibiotics. For each bDMARD the rate of SI per 100 patient years (PYs) was calculated and patient demographics and comorbidities were analysed. Between group differences were assessed using independent samples t-tests or ANOVA. Where assumptions were violated, Mann-Whitney U tests or Kruskal-Wallis tests were used. For categorical variables, chi-square tests were used, except when assumptions were violated when Fisher’s Exact tests were used.Results:296 patients received bDMARDs with an overall SI rate of 11.7/100PYs. There was no significant difference in presence of SI by disease type with 24% of patients with rheumatoid arthritis versus 19% with psoriatic arthritis, 14% with ankylosing spondylitis and 29% with “other” (X2=3.11; df=3; p=0.37). Respiratory tract infections were the most common infection (46%) followed by skin and soft tissue infections (23%). The highest incidence rate of SI occurred with rituximab (29.72 SI/100PYs) followed by certolizumab (22.50 SI/100PYs) and tocilizumab (15.00 SI/100PYs). Duration of time on a bDMARD, disease duration and use of methotrexate or leflunomide were not shown to significantly increase the risk of SI for the entire cohort. The characteristics which were shown to significantly increase SI rates were; prednisone use, increasing age, chronic pulmonary comorbidity and specifically in those with rheumatoid arthritis male gender and total duration of bDMARD use.Conclusion:In this real-world NQ cohort of patients treated with a bDMARD for a rheumatic disease, we have identified a number of factors potentially contributing to the risk of the development of SIs. This study provides valuable data on SI rates in an Australian ‘real-world’ cohort that may assist clinicians’ choice of bDMARD in patients with a high baseline risk of infection and highlights the importance of minimising prednisone use in patients on bDMARDs.References:[1]Ramiro S, Sepriano A, Chatzidionysiou K, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis. 2017;76:1093–1101.[2]Singh J, Wells G, Christensen R, et al. Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev. 2011;16:CD008794.Disclosure of Interests: :Kate Celkys: None declared, Jason Ly: None declared, Muriel Soden Speakers bureau: Speaker Fees from Pfizer in 2016

ObjectiveEar disease in rural and remote communities is occurring at high rates, with limited access to health services and health providers contributing to the problem. Community pharmacists are well-placed to provide expanded services to improve ear health in rural communities. We aimed to evaluate the feasibility, accessibility and acceptability of a pharmacist-led intervention for ear disease in consumers presenting to community pharmacy.DesignProspective preintervention and postintervention mixed-methods study. An ethnographic lens of rural culture was applied to the descriptive qualitative component of the study.SettingTwo rural community pharmacies in Queensland, Australia.ParticipantsPeople aged 6 months or older, who present with an ear complaint to a participating community pharmacy.InterventionLISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Programme) is a community pharmacy-based intervention to improve the management of ear health. Trained pharmacists conducted ear examinations using otoscopy and tympanometry on consumers following a LISTEN UP protocol. They made recommendations including no treatment, pharmacy only products or general practitioner (GP) referral. Consumers were contacted 7 days later for follow-up.Results55 rural consumers participated in the study. The most commonly reported complaints were ‘blocked ear’ and ‘ear pain’. Pharmacists recommended over-the-counter products to two-thirds of the participants and referred one quarter to a GP. 90% (50/55) of the consumers were highly satisfied with the service and would recommend the service. All consumers described the service positively with particular reference to convenience, improved confidence and appreciation of the knowledge gained about their ear complaint. Pharmacists were motivated to upskill and manage workflow to incorporate the service and expected both consumers and GPs to be more accepting of future expanded services as a result of LISTEN UP. However, without funding to provide the service, during the study other remunerated pharmacy tasks took priority over providing LISTEN UP.ConclusionRural community pharmacists can provide an acceptable and accessible ear health service; however, it is not feasible without a clear funding structure to provide resources including additional pharmacists, equipment and training.Trial registration numberACTRN12620001297910.

ObjectivesHuman T-cell leukaemia virus type 1 (HTLV-1), an STI, is reported to be highly prevalent in Indigenous communities in Central Australia. HTLV-1 is an incurable, chronic infection which can cause Adult T-cell leukaemia/lymphoma (ATL). ATL is associated with high morbidity and mortality, with limited treatment options. We studied the prevalence of HTLV-1 and ATL in the state of Queensland, Australia.MethodsSerum samples stored at healthcare services in Brisbane, Townsville and Cairns and at haemodialysis units in Brisbane (2018–2019) were screened for HTLV-1/2 antibodies using the Abbott ARCHITECT chemiluminescent microparticle immunoassay (CMIA) for antibodies against gp46-I, gp46-II and GD21 (Abbott CMIA, ARCHITECT). Reactive samples were confirmed through Western blot. Pooled Australian National Cancer Registry surveillance data reporting on cases coded for ATL (2004–2015) were analysed.ResultsTwo out of 2000 hospital and health services samples were confirmed HTLV-1-positive (0.1%, 95% CI 0.02% to 0.4%), both in older women, one Indigenous and one non-Indigenous. All 540 haemodialysis samples tested negative for HTLV. All samples were HTLV-2-negative. Ten out of 42 (24.8%) reported cases of ATL in Australia were from Queensland (crude incidence rate 0.025/100 000; 95% CI 0.011 to 0.045); most cases were seen in adult men of non-Indigenous origin. Nineteen deaths due to ATL were recorded in Australia.ConclusionWe confirm that HTLV-1 and ATL were detected in Queensland in Indigenous and non-Indigenous people. These results highlight the need for HTLV-1 prevalence studies in populations at risk of STIs to allow the implementation of focused public health sexual and mother-to-child transmission prevention strategies.

BackgroundPain management requires a multidisciplinary approach and a collaborative relationship between patient-provider in which communication is crucial. This study examines the communication experiences of Aboriginal and Torres Strait Islander patients and Aboriginal and Torres Strait Islander Hospital Liaison Officers (ATSIHLOs), to improve understanding of how pain is managed in and through patient-health professional communication.MethodsThis qualitative study involved a purposive sample of patients attending three persistent pain clinics and ATSIHLOs working in two hospitals in Queensland, Australia. Focus groups and in-depth interviews explored the communication experiences of patients managing pain and ATSIHLOs supporting patients with pain. This study adopted a descriptive phenomenological methodology, as described by Colaizzi (1978). Relevant statements (patient and ATSIHLOs quotes) about the phenomenon were extracted from the transcripts to formulate meanings. The formulated meanings were subsequently sorted into thematic clusters and then integrated into themes. The themes were then incorporated into a concise description of the phenomenon of communication within pain management. Findings were validated by participants.ResultsA total of 21 Aboriginal and Torres Strait Islander participants were involved in this study. Exploration of the communication experiences of patients and ATSIHLOs revealed overlapping themes of important barriers to and enablers of communication that affected access to care while managing pain. Acknowledging historical and cultural factors were particularly important to build trust between patients and health professionals. Some patients reported feeling stigmatized for identifying as Aboriginal and Torres Strait Islander, while others were reluctant to disclose their background for fear of not having the same opportunity for treatment. Differences in the expression of pain and the difficulty to use standard pain measurement scales were identified. Communication was described as more than the content delivered, it is visual and emotional expressed through body language, voice intonation, language and the speed of the conversation.ConclusionCommunication can significantly affect access to pain management services. Aboriginal and Torres Strait Islander patients highlighted the burden of emotional pain caused by historical factors, negative stereotypes and the fear of discrimination. Pain management services and their health professionals need to acknowledge how these factors impact patients trust and care.

IntroductionThere is an absence of evidence regarding predictors of moderate to severe pain in children undergoing acute burn treatment. This investigation aimed to determine if relationships existed between patient and clinical characteristics, and pain at first dressing change for children with acute burn injuries.MethodsA retrospective cohort investigation was conducted using clinical data from pediatric burn patients treated at the Queensland Children’s Hospital, Brisbane, Australia. Data extracted included patient and burn characteristics, first aid, and follow-up care. Observational pain scores were categorized into three groups (mild, moderate, and severe pain), and bivariate and multivariable relationships were examined using proportional odds ordinal logistic regression. Data from 2013 pediatric burns patients were extracted from the database.ResultsFactors associated with increased odds of procedural pain included: hand burns (OR 1.7, 95% CI 1.3 to 2.1, p<0.001), foot burns (OR 1.5, 95% CI 1.1 to 2.1, p<0.01), baseline pain (OR 5.5, 95% CI 2.8 to 10.8, p<0.001), deep dermal partial-thickness injuries (OR 7.9, 95% CI 4.0 to 15.6, p<0.001), increased burn size (OR 1.1, 95% CI 1.0 to 1.2, p<0.01), four or more anatomical regions burned (OR 3.6, 95% CI 1.5 to 8.6, p<0.01), initial treatment at a non-burns center (OR 1.8, 95% CI 1.4 to 2.3, p<0.001), and time to hospital presentation (OR 0.9, 95% CI 0.8 to 0.9, p<0.001). These burn characteristics are associated with increased odds of moderate to severe procedural pain during a child’s first dressings change.DiscussionIt is recommended that patients presenting with one or more of the aforementioned factors are identified before their first dressing change, so additional pain control methods can be implemented.

Abstract Objective Psychological treatments for chronic low back pain (CLBP) are effective. However, limited research has investigated their neurophysiological mechanisms. This study examined electroencephalography- (EEG-) assessed brain oscillation changes as potential mechanisms of cognitive therapy (CT), mindfulness-meditation (MM), and mindfulness-based cognitive therapy (MBCT) for CLBP. The a priori bandwidths of interest were changes in theta, alpha and beta power, measured at pre- and post-treatment. Design A secondary analysis of a clinical trial. Setting University of Queensland Psychology Clinic. Subjects Adults (N = 57) with CLBP who completed pre- and post-treatment EEG and pain outcome assessments. Methods EEG data were examined for five regions of interest (ROIs); the primary outcome was pain intensity. Results A significant reduction in theta (P=.015) and alpha (P=.006) power in the left frontal ROI across all treatments was found, although change in theta and alpha power in this region was not differentially associated with outcome across treatments. There were significant reductions in beta power in all five ROIs across all treatments (P≤.013). Beta power reduction in the central ROI showed a significant association with reduced pain intensity in MBCT only (P=.028). Changes in other regions were not statistically significant. Conclusions These findings provide support for the capacity of psychological CLBP treatments to induce changes in brain activity. The reduced beta power in all five ROIs indicated that all three treatments engendered a state of lowered cortical arousal. The growing body of research in this area could potentially inform novel directions towards remedying central nervous system abnormalities associated with CLBP.

IntroductionIn 2006, the Queensland Ambulance Service (QAS) approved the use of magnesium sulphate for the management of patients with Irukandji syndrome (IS). The aim of this study was to compare pain scores and hypertensive (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg) patients who received intravenous morphine as their treatment (morphine group) over those who received a combination of intravenous morphine and magnesium (magnesium group).MethodsA retrospective case review of all IS patients attended by the QAS between 2007 and 2014. A search of the QAS electronic data base found 112 patients had IS. Analyses in IBM SPSS v.22 was undertaken to determine the outcome in final pain scores and blood pressure between the two groups.ResultsPain reduction was statistically different (F=29.18; p<.01), between the morphine group and the magnesium group with mean numerical pain scores post-treatment of 4.91 (95% CI: 4.02–5.81) and 2.21 (95% CI: 1.66–2.76) respectively. There was a lower frequency of patients in the magnesium group who remained hypertensive on arrival at a medical facility, with a significant difference between mean arterial BP of 101 mmHg (95% CI: 96–105; p=.028) and diastolic BP of 84 mmHg (95% CI: 80–88; p=.029) post-treatment. Of the 54 cases in the magnesium group, 32 were normotensive post-treatment compared to only six from the morphine group (n=17).ConclusionThere has been considerable difference of opinion as to the utility of magnesium in IS and a marked difference in the results of case series versus a small randomised control trial. This study suggests that the combination of morphine and magnesium is more effective in treating patients with IS than morphine alone.

Background: Sea snakes are venomous snakes found in the warm parts of the Indo-Pacific, including around Australia. Most sea snake envenoming causes myotoxicity, but previous Australian case reports describe neurotoxicity. We aimed to describe the epidemiology and clinical presentation of Australian sea snake envenoming and the effectiveness of antivenom.Methods: Patients were recruited to the Australian Snakebite Project (ASP), an Australia-wide prospective observational study recruiting all patients with suspected or confirmed snakebite &gt;2 years. Information about demographics, bite circumstances, species involved, clinical and laboratory features of envenoming, and treatment is collected and entered into a purpose-built database.Results: Between January 2002 and August 2020, 13 patients with suspected sea snake bite were recruited to ASP, 11 were male; median age was 30 years. Bites occurred in Queensland and Western Australia. All patients were in or around, coastal waters at the time of bite. The species involved was identified in two cases (both Hydrophis zweifeli). Local effects occurred in 9 patients: pain (5), swelling (5), bleeding (2), bruising (1). Envenoming occurred in eight patients and was characterised by non-specific systemic features (6) and myotoxicity (2). Myotoxicity was severe (peak CK 28200 and 48100 U/L) and rapid in onset (time to peak CK 13.5 and 15.1 h) in these two patients. Non-specific systemic features included nausea (6), headache (6), abdominal pain (3), and diaphoresis (2). Leukocytosis, neutrophilia, and lymphopenia occurred in both patients with myotoxicity and was evident on the first blood test. No patients developed neurotoxicity or coagulopathy. Early Seqirus antivenom therapy was associated with a lower peak creatine kinase.Conclusion: While relatively rare, sea snake envenoming is associated with significant morbidity and risk of mortality. Early antivenom appears to have a role in preventing severe myotoxicity and should be a goal of therapy.

Abstract Background Burns and related procedures are painful and distressing for children, exposing them to acute and chronic sequelae that can negatively affect their physiological, psychological, and social functions. Non-pharmacological interventions such as distraction techniques are beneficial adjuncts to pharmacological agents for procedural pain, state anxiety, and itch in children with burns but have limitations (e.g. lack of research on burn-related itch, tailoring, and consensus on optimal treatment). Hypnotherapy is a non-pharmacological intervention that can be tailored for varied settings and populations with evidence of benefit for itch and superior effectiveness in comparison to other non-pharmacological interventions for children’s procedural pain and state anxiety. Thus, children with burns can benefit from hypnotherapy as an adjunct to pharmacological agents. Yet, in paediatric burns, rigorous studies of effectiveness are limited and no studies have been identified that screen for hypnotic suggestibility, an important predictor of hypnotherapy outcomes. Considering potential barriers to the delivery of hypnotherapy in paediatric burns, the proposed study will examine the feasibility and acceptability of hypnotic suggestibility screening followed by hypnotherapy for procedural pain, state anxiety, and itch in children with acute burns. Methods An observational mixed-methods feasibility and acceptability study will be conducted over 15 weeks. Eligible children (N = 30) aged 4 to 16 years presenting to a paediatric burns outpatient centre in a metropolitan children’s hospital in Australia with acute burns requiring dressing changes will be included. Eligible parents of children (N = up to 30) and clinicians who perform dressing changes (N = up to 20) will also be included. Child participants screened as having medium to high suggestibility as assessed by behavioural measures will receive hypnotherapy during dressing changes. A process evaluation will target feasibility and acceptability as primary outcomes and implementation (i.e. fidelity in delivery), reach, potential effectiveness, and adoption of evaluation procedures and intervention as secondary outcomes. Discussion Ethical approval was obtained from the Queensland Children’s Hospital and Health Service ethics committee. Results will be published in peer-reviewed publications and conference proceedings. The findings will guide the design of future trials on the effectiveness of hypnotherapy and inform the development of child-centred hypnotic interventions in children with burns. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620000988954

IntroductionIn July 1997, the Mackay campus of Central Queensland University hosted a conference with the theme Regional Australia: Visions of Mackay. It was the first academic conference to be held at the young campus, and its aim was to provide an opportunity for academics, business people, government officials, and other interested parties to discuss their visions for the development of Mackay, a regional community of 75,000 people situated on the Central Queensland coast (Danaher). I delivered a presentation at that conference and authored a chapter in the book that emerged from its proceedings. The chapter entitled “Mackay Online” explored the potential impact that the Internet could have on the Mackay region, particularly in the areas of regional business, education, health, and entertainment (Pace). Two decades later, how does the reality compare with that vision?Broadband BluesAt the time of the Visions of Mackay conference, public commercial use of the Internet was in its infancy. Many Internet services and technologies that users take for granted today were uncommon or non-existent then. Examples include online video, video-conferencing, Voice over Internet Protocol (VoIP), blogs, social media, peer-to-peer file sharing, payment gateways, content management systems, wireless data communications, smartphones, mobile applications, and tablet computers. In 1997, most users connected to the Internet using slow dial-up modems with speeds ranging from 28.8 Kbps to 33.6 Kbps. 56 Kbps modems had just become available. Lamenting these slow data transmission speeds, I looked forward to a time when widespread availability of high-bandwidth networks would allow the Internet’s services to “expand to include electronic commerce, home entertainment and desktop video-conferencing” (Pace 103). Although that future eventually arrived, I incorrectly anticipated how it would arrive.In 1997, Optus and Telstra were engaged in the rollout of hybrid fibre coaxial (HFC) networks in Sydney, Melbourne, and Brisbane for the Optus Vision and Foxtel pay TV services (Meredith). These HFC networks had a large amount of unused bandwidth, which both Telstra and Optus planned to use to provide broadband Internet services. Telstra's Big Pond Cable broadband service was already available to approximately one million households in Sydney and Melbourne (Taylor), and Optus was considering extending its cable network into regional Australia through partnerships with smaller regional telecommunications companies (Lewis). These promising developments seemed to point the way forward to a future high-bandwidth network, but that was not the case. A short time after the Visions of Mackay conference, Telstra and Optus ceased the rollout of their HFC networks in response to the invention of Asynchronous Digital Subscriber Line (ADSL), a technology that increases the bandwidth of copper wire and enables Internet connections of up to 6 Mbps over the existing phone network. ADSL was significantly faster than a dial-up service, it was broadly available to homes and businesses across the country, and it did not require enormous investment in infrastructure. However, ADSL could not offer speeds anywhere near the 27 Mbps of the HFC networks. When it came to broadband provision, Australia seemed destined to continue playing catch-up with the rest of the world. According to data from the Organisation for Economic Cooperation and Development (OECD), in 2009 Australia ranked 18th in the world for broadband penetration, with 24.1 percent of Australians having a fixed-line broadband subscription. Statistics like these eventually prompted the federal government to commit to the deployment of a National Broadband Network (NBN). In 2009, the Kevin Rudd Government announced that the NBN would combine fibre-to-the-premises (FTTP), fixed wireless, and satellite technologies to deliver Internet speeds of up to 100 Mbps to 90 percent of Australian homes, schools, and workplaces (Rudd).The rollout of the NBN in Mackay commenced in 2013 and continued, suburb by suburb, until its completion in 2017 (Frost, “Mackay”; Garvey). The rollout was anything but smooth. After a change of government in 2013, the NBN was redesigned to reduce costs. A mixed copper/optical technology known as fibre-to-the-node (FTTN) replaced FTTP as the preferred approach for providing most NBN connections. The resulting connection speeds were significantly slower than the 100 Mbps that was originally proposed. Many Mackay premises could only achieve a maximum speed of 40 Mbps, which led to some overcharging by Internet service providers, and subsequent compensation for failing to deliver services they had promised (“Optus”). Some Mackay residents even complained that their new NBN connections were slower than their former ADSL connections. NBN Co representatives claimed that the problems were due to “service providers not buying enough space in the network to provide the service they had promised to customers” (“Telcos”). Unsurprisingly, the number of complaints about the NBN that were lodged with the Telecommunications Industry Ombudsman skyrocketed during the last six months of 2017. Queensland complaints increased by approximately 40 percent when compared with the same period during the previous year (“Qld”).Despite the challenges presented by infrastructure limitations, the rollout of the NBN was a boost for the Mackay region. For some rural residents, it meant having reliable Internet access for the first time. Frost, for example, reports on the experiences of a Mackay couple who could not get an ADSL service at their rural home because it was too far away from the nearest telephone exchange. Unreliable 3G mobile broadband was the only option for operating their air-conditioning business. All of that changed with the arrival of the NBN. “It’s so fast we can run a number of things at the same time”, the couple reported (“NBN”).Networking the NationOne factor that contributed to the uptake of Internet services in the Mackay region after the Visions of Mackay conference was the Australian Government’s Networking the Nation (NTN) program. When the national telecommunications carrier Telstra was partially privatised in 1997, and further sold in 1999, proceeds from the sale were used to fund an ambitious communications infrastructure program named Networking the Nation (Department of Communications, Information Technology and the Arts). The program funded projects that improved the availability, accessibility, affordability, and use of communications facilities and services throughout regional Australia. Eligibility for funding was limited to not-for-profit organisations, including local councils, regional development organisations, community groups, local government associations, and state and territory governments.In 1998, the Mackay region received $930,000 in Networking the Nation funding for Mackay Regionlink, a project that aimed to provide equitable community access to online services, skills development for local residents, an affordable online presence for local business and community organisations, and increased external awareness of the Mackay region (Jewell et al.). One element of the project was a training program that provided basic Internet skills to 2,168 people across the region over a period of two years. A second element of the project involved the establishment of 20 public Internet access centres in locations throughout the region, such as libraries, community centres, and tourist information centres. The centres provided free Internet access to users and encouraged local participation and skill development. More than 9,200 users were recorded in these centres during the first year of the project, and the facilities remained active until 2006. A third element of the project was a regional web portal that provided a free easily-updated online presence for community organisations. The project aimed to have every business and community group in the Mackay region represented on the website, with hosting fees for the business web pages funding its ongoing operation and development. More than 6,000 organisations were listed on the site, and the project remained financially viable until 2005.The availability, affordability and use of communications facilities and services in Mackay increased significantly during the period of the Regionlink project. Changes in technology, services, markets, competition, and many other factors contributed to this increase, so it is difficult to ascertain the extent to which Mackay Regionlink fostered those outcomes. However, the large number of people who participated in the Regionlink training program and made use of the public Internet access centres, suggests that the project had a positive influence on digital literacy in the Mackay region.The Impact on BusinessThe Internet has transformed regional business for both consumers and business owners alike since the Visions of Mackay conference. When Mackay residents made a purchase in 1997, their choice of suppliers was limited to a few local businesses. Today they can shop online in a global market. Security concerns were initially a major obstacle to the growth of electronic commerce. Consumers were slow to adopt the Internet as a place for doing business, fearing that their credit card details would be vulnerable to hackers once they were placed online. After observing the efforts that finance and software companies were making to eliminate those obstacles, I anticipated that it would only be a matter of time before online transactions became commonplace:Consumers seeking a particular product will be able to quickly find the names of suitable suppliers around the world, compare their prices, and place an order with the one that can deliver the product at the cheapest price. (Pace 106)This expectation was soon fulfilled by the arrival of online payment systems such as PayPal in 1998, and online shopping services such as eBay in 1997. eBay is a global online auction and shopping website where individuals and businesses buy and sell goods and services worldwide. The eBay service is free to use for buyers, but sellers are charged modest fees when they make a sale. It exemplifies the notion of “friction-free capitalism” articulated by Gates (157).In 1997, regional Australian business owners were largely sceptical about the potential benefits the Internet could bring to their businesses. Only 11 percent of Australian businesses had some form of web presence, and less than 35 percent of those early adopters felt that their website was significant to their business (Department of Industry, Science and Tourism). Anticipating the significant opportunities that the Internet offered Mackay businesses to compete in new markets, I recommended that they work “towards the goal of providing products and services that meet the needs of international consumers as well as local ones” (107). In the two decades that have passed since that time, many Mackay businesses have been doing just that. One prime example is Big on Shoes (bigonshoes.com.au), a retailer of ladies’ shoes from sizes five to fifteen (Plane). Big on Shoes has physical shopfronts in Mackay and Moranbah, an online store that has been operating since 2009, and more than 12,000 followers on Facebook. This speciality store caters for women who have traditionally been unable to find shoes in their size. As the store’s customer base has grown within Australia and internationally, an unexpected transgender market has also emerged. In 2018 Big on Shoes was one of 30 regional businesses featured in the first Facebook and Instagram Annual Gift Guide, and it continues to build on its strengths (Cureton).The Impact on HealthThe growth of the Internet has improved the availability of specialist health services for people in the Mackay region. Traditionally, access to surgical services in Mackay has been much more limited than in metropolitan areas because of the shortage of specialists willing to practise in regional areas (Green). In 2003, a senior informant from the Royal Australasian College of Surgeons bluntly described the Central Queensland region from Mackay to Gladstone as “a black hole in terms of surgery” (Birrell et al. 15). In 1997 I anticipated that, although the Internet would never completely replace a visit to a local doctor or hospital, it would provide tools that improve the availability of specialist medical services for people living in regional areas. Using these tools, doctors would be able to “analyse medical images captured from patients living in remote locations” and “diagnose patients at a distance” (Pace 108).These expectations have been realised in the form of Queensland Health’s Telehealth initiative, which permits medical specialists in Brisbane and Townsville to conduct consultations with patients at the Mackay Base Hospital using video-conference technology. Telehealth reduces the need for patients to travel for specialist advice, and it provides health professionals with access to peer support. Averill (7), for example, reports on the experience of a breast cancer patient at the Mackay Base Hospital who was able to participate in a drug trial with a Townsville oncologist through the Telehealth network. Mackay health professionals organised the patient’s scans, administered blood tests, and checked her lymph nodes, blood pressure and weight. Townsville health professionals then used this information to advise the Mackay team about her ongoing treatment. The patient expressed appreciation that the service allowed her to avoid the lengthy round-trip to Townsville. Prior to being offered the Telehealth option, she had refused to participate in the trial because “the trip was just too much of a stumbling block” (Averill 7).The Impact on Media and EntertainmentThe field of media and entertainment is another aspect of regional life that has been reshaped by the Internet since the Visions of Mackay conference. Most of these changes have been equally apparent in both regional and metropolitan areas. Over the past decade, the way individuals consume media has been transformed by new online services offering user-generated video, video-on-demand, and catch-up TV. These developments were among the changes I anticipated in 1997:The convergence of television and the Internet will stimulate the creation of new services such as video-on-demand. Today television is a synchronous media—programs are usually viewed while they are being broadcast. When high-quality video can be transmitted over the information superhighway, users will be able to watch what they want, when and where they like. […] Newly released movies will continue to be rented, but probably not from stores. Instead, consumers will shop on the information superhighway for movies that can be delivered on demand.In the mid-2000s, free online video-sharing services such as YouTube and Vimeo began to emerge. These websites allow users to freely upload, view, share, comment on, and curate online videos. Subscription-based streaming services such as Netflix and Amazon Prime have also become increasingly popular since that time. These services offer online streaming of a library of films and television programs for a fee of less than 20 dollars per month. Computers, smart TVs, Blu-ray players, game consoles, mobile phones, tablets, and other devices provide a multitude of ways of accessing streaming services. Some of these devices cost less than 100 dollars, while higher-end electronic devices include the capability as a bundled feature. Netflix became available in Mackay at the time of its Australian launch in 2015. The growth of streaming services greatly reduced the demand for video rental shops in the region, and all closed down as a result. The last remaining video rental store in Mackay closed its doors in 2018 after trading for 26 years (“Last”).Some of the most dramatic transformations that have occurred the field of media and entertainment were not anticipated in 1997. The rise of mobile technology, including wireless data communications, smartphones, mobile applications, and tablet computers, was largely unforeseen at that time. Some Internet luminaries such as Vinton Cerf expected that mobile access to the Internet via laptop computers would become commonplace (Lange), but this view did not encompass the evolution of smartphones, and it was not widely held. Similarly, the rise of social media services and the impact they have had on the way people share content and communicate was generally unexpected. In some respects, these phenomena resemble the Black Swan events described by Nassim Nicholas Taleb (xvii)—surprising events with a major effect that are often inappropriately rationalised after the fact. They remind us of how difficult it is to predict the future media landscape by extrapolating from things we know, while failing to take into consideration what we do not know.The Challenge for MackayIn 1997, when exploring the potential impact that the Internet could have on the Mackay region, I identified a special challenge that the community faced if it wanted to be competitive in this new environment:The region has traditionally prospered from industries that control physical resources such as coal, sugar and tourism, but over the last two decades there has been a global ‘shift away from physical assets and towards information as the principal driver of wealth creation’ (Petre and Harrington 1996). The risk for Mackay is that its residents may be inclined to believe that wealth can only be created by means of industries that control physical assets. The community must realise that its value-added information is at least as precious as its abundant natural resources. (110)The Mackay region has not responded well to this challenge, as evidenced by measures such as the Knowledge City Index (KCI), a collection of six indicators that assess how well a city is positioned to grow and advance in today’s technology-driven, knowledge-based economy. A 2017 study used the KCI to conduct a comparative analysis of 25 Australian cities (Pratchett, Hu, Walsh, and Tuli). Mackay rated reasonably well in the areas of Income and Digital Access. But the city’s ratings were “very limited across all the other measures of the KCI”: Knowledge Capacity, Knowledge Mobility, Knowledge Industries and Smart Work (44).The need to be competitive in a technology-driven, knowledge-based economy is likely to become even more pressing in the years ahead. The 2017 World Energy Outlook Report estimated that China’s coal use is likely to have peaked in 2013 amid a rapid shift toward renewable energy, which means that demand for Mackay’s coal will continue to decline (International Energy Agency). The sugar industry is in crisis, finding itself unable to diversify its revenue base or increase production enough to offset falling global sugar prices (Rynne). The region’s biggest tourism drawcard, the Great Barrier Reef, continues to be degraded by mass coral bleaching events and ongoing threats posed by climate change and poor water quality (Great Barrier Reef Marine Park Authority). All of these developments have disturbing implications for Mackay’s regional economy and its reliance on coal, sugar, and tourism. Diversifying the local economy through the introduction of new knowledge industries would be one way of preparing the Mackay region for the impact of new technologies and the economic challenges that lie ahead.ReferencesAverill, Zizi. “Webcam Consultations.” Daily Mercury 22 Nov. 2018: 7.Birrell, Bob, Lesleyanne Hawthorne, and Virginia Rapson. The Outlook for Surgical Services in Australasia. Melbourne: Monash University Centre for Population and Urban Research, 2003.Cureton, Aidan. “Big Shoes, Big Ideas.” Daily Mercury 8 Dec. 2018: 12.Danaher, Geoff. Ed. Visions of Mackay: Conference Papers. Rockhampton: Central Queensland UP, 1998.Department of Communications, Information Technology and the Arts. Networking the Nation: Evaluation of Outcomes and Impacts. Canberra: Australian Government, 2005.Department of Industry, Science and Tourism. Electronic Commerce in Australia. Canberra: Australian Government, 1998.Frost, Pamela. “Mackay Is Up with Switch to Speed to NBN.” Daily Mercury 15 Aug. 2013: 8.———. “NBN Boost to Business.” Daily Mercury 29 Oct. 2013: 3.Gates, Bill. The Road Ahead. New York: Viking Penguin, 1995.Garvey, Cas. “NBN Rollout Hit, Miss in Mackay.” Daily Mercury 11 Jul. 2017: 6.Great Barrier Reef Marine Park Authority. Reef Blueprint: Great Barrier Reef Blueprint for Resilience. Townsville: Great Barrier Reef Marine Park Authority, 2017.Green, Anthony. “Surgical Services and Referrals in Rural and Remote Australia.” Medical Journal of Australia 177.2 (2002): 110–11.International Energy Agency. World Energy Outlook 2017. France: IEA Publications, 2017.Jewell, Roderick, Mary O’Flynn, Fiorella De Cindio, and Margaret Cameron. “RCM and MRL—A Reflection on Two Approaches to Constructing Communication Memory.” Constructing and Sharing Memory: Community Informatics, Identity and Empowerment. Eds. Larry Stillman and Graeme Johanson. Newcastle: Cambridge Scholars Publishing, 2007. 73–86.Lange, Larry. “The Internet: Where’s It All Going?” Information Week 17 Jul. 1995: 30.“Last Man Standing Shuts Doors after 26 Years of Trade.” Daily Mercury 28 Aug. 2018: 7.Lewis, Steve. “Optus Plans to Share Cost Burden.” Australian Financial Review 22 May 1997: 26.Meredith, Helen. “Time Short for Cable Modem.” Australian Financial Review 10 Apr. 1997: 42Nassim Nicholas Taleb. The Black Swan: The Impact of the Highly Improbable. New York: Random House, 2007.“Optus Offers Comp for Slow NBN.” Daily Mercury 10 Nov. 2017: 15.Organisation for Economic Cooperation and Development. “Fixed Broadband Subscriptions.” OECD Data, n.d. <https://data.oecd.org/broadband/fixed-broadband-subscriptions.htm>.Pace, Steven. “Mackay Online.” Visions of Mackay: Conference Papers. Ed. Geoff Danaher. Rockhampton: Central Queensland University Press, 1998. 111–19.Petre, Daniel and David Harrington. The Clever Country? Australia’s Digital Future. Sydney: Lansdown Publishing, 1996.Plane, Melanie. “A Shoe-In for Big Success.” Daily Mercury 9 Sep. 2017: 6.Pratchett, Lawrence, Richard Hu, Michael Walsh, and Sajeda Tuli. The Knowledge City Index: A Tale of 25 Cities in Australia. Canberra: University of Canberra neXus Research Centre, 2017.“Qld Customers NB-uN Happy Complaints about NBN Service Double in 12 Months.” Daily Mercury 17 Apr. 2018: 1.Rudd, Kevin. “Media Release: New National Broadband Network.” Parliament of Australia Press Release, 7 Apr. 2009 <https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id:"media/pressrel/PS8T6">.Rynne, David. “Revitalising the Sugar Industry.” Sugar Policy Insights Feb. 2019: 2–3.Taylor, Emma. “A Dip in the Pond.” Sydney Morning Herald 16 Aug. 1997: 12.“Telcos and NBN Co in a Crisis.” Daily Mercury 27 Jul. 2017: 6.

Abstract Background For more than the last two decades, older Australians travelling domestically in self-sufficient accommodation and recreational vehicles for extended periods of time have been referred to as ‘Grey Nomads’. By 2021 more than 750,000 such recreational vehicles were registered in Australia. Tourism data for the year to September 2017 show 11.8 million domestic camping and caravanning trips in Australia, 29% of which were people aged 55 and over. As the ‘baby boomer’ generation increasingly comes to retirement, the size of this travelling population is growing. This term applies to the spike in birth rates after World War II from 1946–1964. This growing group of domestic travellers are potential healthcare consumers in remote areas but relatively little is known about their travel, healthcare needs or care seeking practices. Grey nomads have been described as reflective of the age-comparable sector of the Australian population in that many live with chronic illness. Early concerns were raised that they may “burden” already stretched rural and remote healthcare services but relatively little is known about the impact of these travellers. Methods The aim of this study was to explore the utilisation of healthcare services in remote locations in Australia by grey nomads including women travellers, from the perspective of healthcare professionals working in these settings. The study objective was to interview healthcare professionals to seek their experience and details of service delivery to grey nomads. In March 2020 [prior to state border closures due to the COVID-19 pandemic] a field study was conducted to identify the impact of grey nomads on healthcare services in remote New South Wales and Queensland. A qualitative approach was taken to explore the perspectives of nursing healthcare managers working in remote towns along a popular travel route. With appropriate Research Ethics Committee approval, managers were purposively sampled and sample size was determined by data saturation. Thirteen managers were contacted and twelve interviews were scheduled to take place face to face in the healthcare facilities (small hospitals with acute care and aged care services) at mutually convenient times. A semi-structured interview schedule was developed in line with the research aim. The interviews were audio-recorded, transcribed and thematic analysis was undertaken concurrently with data collection for ongoing refinement of questions and to address emerging issues. Results These nursing managers described a strong service and community ethos. They regarded travellers’ healthcare needs no differently to those of local people and described their strong commitment to the provision of healthcare services for their local communities, applying an inclusive definition of community. Traveller presentations were described as predominantly exacerbations of chronic illness such as chest pain, medication-related attendances, and accidents and injuries. No hospital activity data for traveller presentations were available as no reports were routinely generated. Travellers were reported as not always having realistic expectations about what healthcare is available in remote areas and arriving with mixed levels of preparedness. Most travellers were said to be well-prepared for their travel and self-management of their health. However, the healthcare services that can be provided in rural and remote areas needed to be better understood by travellers from metropolitan areas and their urban healthcare providers. Conclusion Participants did not perceive travellers as a burden on health services but recommendations were made regarding their expectations and preparedness. Australia’s national transition to electronic health records including a patient—held record was identified as a future support for continuity of care for travellers and to facilitate treatment planning. With no current information to characterise traveller presentations, routinely collected hospital data could be extracted to characterise this patient population, their presentations and the resources required to meet their care needs.

In early 1888, Miss Margaret Pearson arrived in Melbourne under engagement to the Working Men’s College there to give cookery lessons to young women. The College committee had applied to the National School of Cookery in London—an establishment effusively praised in the colonial press—for a suitable culinary educator, and Pearson, a graduate of that institute, was dispatched. After six months or so spent educating her antipodean pupils she published a cookbook, Cookery Recipes For The People, which she described in the preface as a handbook of “plain wholesome cookery” (Pearson 3). The book ran to three editions and sold more than 13,000 copies. A decade later, Hanna Maclurcan, co-proprietor of the popular Queen’s Hotel in Townsville, published Mrs Maclurcan’s Cookery Book: A Collection of Practical Recipes, Specially Suitable for Australia. A review of this work in the Brisbane Courier described it, positively, as a book of “good plain cooking”. Maclurcan had gained some renown as a cook after the Governor of Queensland, Lord Lamington, publicly praised the meals he had eaten at the Queen’s as “exceptionally good and above the average of Australian hotels” (Morning Bulletin 5). The first print run of Mrs Maclurcan’s Cookery Book sold out in weeks, and a second edition was swiftly produced. By 1903 there were 26,000 copies of Maclurcan’s book in print—one of which was deposited in the library of Queen Victoria. While the existence of any particular cookbook does not constitute evidence that any person ever reproduced a recipe from it, the not immodest sales enjoyed by Pearson and Maclurcan can, at the least, be taken to indicate a popular interest in the style of cookery, that is “plain cookery”, delineated in their respective works. If those who bought these books never actually turned them into working copies—that is, cooked from them—they likely aspired to do so. Practical classes in plain cookery were also popular in Australia in the latter part of the nineteenth century. The adjectival coupling of the word “plain” to “cookery” in colonial Australia can be seen then to have formed an appealing duet at that time If a modern author or reviewer described the body of recipes encapsulated in a cookbook as “plain cookery”, it would not serve to recommend it to the contemporary market—indeed it would likely condemn such a publication to pulping, rather than sales of many thousands—as the term would be understood by most modern cooks, and eaters, to describe food that was dull and lacking in flavour and cosmopolitan appeal. We now prefer cookery books that offer instruction on the preparation of dishes that are described as “exotic”, “global”, “ethnic”, “seasonal”, “local”, and “full of flavour”, and that lend those that prepare and consume the dishes they contain the “glamour of culinary ethnicity” (Appadurai 10). It would seem to be stating the obvious then to say that “plain cookery” meant something entirely different to colonial Australians, except that modern Australians commonly believe that their nineteenth century brethren ate an “abominable”, “monotonous”, “low standard” diet (Santich, The High and The Low 37), and therefore if they preferred their meals to be plain cooked, that these would have been exactly as our present-day interpretation would have them. Yet Pearson describes plain cookery as an “art” (3), arguably a rhetorical epithet, but she was a zealous educator and would not have used such a term to describe a style of cookery that she expected to turn out low quality dishes that were vile and dull. What Pearson and Maclurcan actually present in their respective books is English cookery: which was also known as plain cookery. The Anglo-Celtic population of Australia in the nineteenth century held varied opinions—ranging from obsequious to hateful—about England, depending on their background. The majority, however, considered it their natural home—including many who were colonial born—and the cultural model they reproduced, with local modifications, was that of the “mother country” (Abbott 10) some 10,000 long miles away. English political, legal, economic, and social systems were the foundation of white Australian society. In keeping with this, colonial cooks “perpetuated an English style of cookery, English food values, [and] an English meal structure” (Santich, Looking for Flavour 6) and English cookbooks were the models that colonial cooks and cookery writers drew upon. When Polly, the heroine of Henry Handel Richardson’s novel The Fortunes of Richard Mahoney, teaches herself to make pastry from a cookbook in her rudimentary kitchen on the Victorian goldfields circa 1853, historical accuracy requires her to have employed an imported publication to guide her. It was another decade before the first Australian cookbook, Edward Abbott’s The English And Australian Cookery Book, was published in 1864. Prior to the appearance of Abbott’s work, colonial cooks wanting the guidance of a culinary manual were reliant on the imported English titles stocked by Australian booksellers, such as Eliza Acton’s Modern Cookery for Private Families, Beeton’s Book of Household Management and William Kitchiner’s The Cook’s Oracle. These three particular cookbooks were amongst the most successful and influential works in the nineteenth century Anglo-sphere and were commonly considered as manuals of plain cookery: Acton’s particular work is also the source of the most commonly quoted definition of “plain cookery” as “the principles of roasting, boiling, stewing and baking” (Acton 167) and I am going let it stand as the model of such in this piece. If a curt literary catalogue, such as that used by Acton to delineate plain cookery, were used to describe any cuisine it would serve to make it seem austere, and the reputation of English food and cookery has likely suffered from a face value acceptance of it (and by association so has its Australian culinary doppelganger). A considered inspection of Acton’s work shows that her instructions for the plain methods of roasting, boiling, and stewing of food, cover 13 pages, followed by more than 100 pages of recipes for 19 different varieties of meat, poultry, and game that are further divided into numerous variant cuts. Three pages were dedicated to instruction for boiling potatoes properly. When preparing any of these dishes she enjoins her readers to follow the “slow methods of cooking recommended” (167) to ensure a superior end product. The principles of baking were elucidated across several chapters, taking under this classification the preparation of various types of pastry and a multitude of baked puddings, cakes and biscuits: all prepared from base ingredients—not a packet harmed in their production. We now venerate the taste of so-called “slow cooked” food, so to discover that this was the method prescribed for producing plain cooked dishes suggests that plain cookery potentially had more flavour than we imagine. Acton’s work also challenges the charge that the product of plain cookery was monotonous. We have developed a view that we must have a multitudinous array of different types of food available, all year round, for it to be satisfactory to us. Acton demonstrates that variety in cookery can be achieved in other ways such as in types and cuts of meat, and that “plain” was not necessarily synonymous with sameness. The celebrated twentieth century English food writer Elizabeth David says that Modern Cookery was the “most admired and copied English cookery book of the nineteenth century” (305). As the aspiration of most colonial cooks was the reproduction of English cookery it is not unreasonable to expect that Acton’s work might have had some influence on those that wrote cookery manuals for them. We know that Edward Abbott borrowed from her as he writes in his introduction that he has combined “the advantages of Acton’s work” (5) into this own. Neither Pearson or Maclurcan acknowledge any influence at all upon their works but their respective manuals are not particularly original in content—with the exception of some unique regional recipes in Maclurcan—and they must have drawn upon other cookery manuals of the same style to develop their repertoire. By the time they were writing, “large portions [of Acton’s] volume [had] been appropriated [by] contemporary [cookbook] authors [such as Abbott] without the slightest acknowledgment” (Acton 4): the famous Mrs. Beeton is generally considered to have borrowed heavily from Acton for the cookery section of her successful tome Household Management. If Pearson and Maclurcan did not draw directly on Acton—and they well might have—then they likely used culinary sources that had subsumed her influence as their inspiration. What was considered to constitute plain cookery was not as straightforward as Acton’s definition; it was also “generally understood” to be free of any French influence (David 35). It was a commonly held suspicion amongst nineteenth century English men and women that Gallic cooks employed sauces and strong flavourings such as garlic and other “low and treacherous devices” (Saunders 4), to disguise the fact that they had such poor quality ingredients to work with. On the other hand, the English “had such faith” in the superior quality of their native produce that they considered it only required treatment with plain cookery techniques to be rendered toothsome: this culinary Francophobia persisted in the colonies. In the novel, The Three Miss Kings, set in Melbourne in 1880, the trio of the title take lodgings with a landlady, who informs them from the outset that she is “only a plain cook, and can’t make them French things which spile [sic] the stomach” (Cambridge 36). While a good plain cook might have defined herself by the absence of any Gallic, or indeed any other “foreign”, influence in the meals she created, there had been a significant absorption of elements of both of these in the plain cookery she practised, but these had become so far embedded in English cookery that she was unaware of it. A telling example of this is the unremarked inclusion of curry in the plain cookery cannon. While the name and homogenised form of this dish is of British invention, it retained the varied spices, including pungent chillies, of the Indian cuisine it simulated. Pearson and Maclurcan, and Abbott, all included recipes for curries and curried dishes in their respective cookery books. Over time, plain cookery seems to have become conflated with “plain food”, but the latter was not necessarily the result of the former. There was little of Pearson’s “art” involved in creating plain food, except perhaps an ability to keep this style of food so flavourless and dull that it offered neither pleasure nor temptation to eat any more than that required to sustain life. This very real plainness was actively sought by some as “plain food was synonymous with moral rectitude […] and the plainer the food the more virtuous the eater” (Santich, Looking 28). A common societal appreciation of moral virtue is barely perceptible in modern Australian society but it was an attribute that was greatly valued in the nineteenth century Anglo-world and the consumption of plain food a necessary practice in the achievement of good character. (Our modern habit of labelling of foods “good” or “bad” shows that we continue to imbue food with moral overtones.) The list of “gustatory temptations” “proscribed by the plain food lobby” included “salt, spices, sauces and any flavourings that might have cheered the senses” (Santich, Looking 28). If this were the case then both Pearson and Maclurcan’s cookbooks would have dramatically failed to qualify as manuals of plain food. The recipes contained in their respective works feature a much greater use of components associated with flavour enhancement than we imagine to have been employed in plain cookery, particularly if we erroneously believe it to be analogous to plain food. Spices are used extensively in sweet and savoury dishes, as are various fresh green herbs and lemon juice and rind; homemade condiments such as mushroom ketchup (a type of essence pressed from a seasonal abundance of fungi), and a liberal employment of sherry, port, Madeira, and brandy that a “virtuous” plain food advocate would have considered most intemperate. Pearson and Maclurcan both give instructions for preparing rich stocks and gravies drawn from meat, bones and aromatic vegetables, and prescribe the end product of this process as the foundation for a variety of soups, sauces, and stews. Recipes are given for a greater diversity of vegetables than the stereotyped cabbage and potatoes of colonial culinary legend. Maclurcan displays a distinct tropical regionalism in her book providing recipes that use green bananas and pawpaw as vegetables, alongside other exotic species—for that time—such as eggplant, choko, mango, granadilla, passionfruit, rosella, prickly pear, and guava. Her distinct location, the coastal city of Townsville, is also reflected in the extensive selection of recipes for local species of fish and seafood such as beche-de-mer, prawns, and barramundi, which won Maclurcan a reputation as an expert on seafood. Ultimately, to gain a respectably informed understanding as to the taste, aroma, and texture of the plain cookery presented in the respective works of Pearson and Maclurcan one needs to prepare their recipes: I have done so, reproducing a wide selection of dishes from both books. Admittedly, I am a professionally trained cook with the skills to execute recipes to a high standard, but my practice is to scrupulously maintain the original listing of ingredients in the reproduction and follow the method as best I can. Through this practice I have made some delicious discoveries, which have helped inform my opinion that some colonial Australians, and perhaps significant numbers of them, must have been eating meals that were a long way from dull, flavourless and monotonous. It has been said that we employ our tongues for the “twin offices of rhetoric and taste” (Jaine 61). Words can exercise a significant influence on how we value the taste of—or actually taste—any particular food or indeed a cuisine. In the case of the popularly held opinion about the unappetizing state of colonial meals, it might be that the absence of rhetoric has contributed to this. Colonial food writers such as Pearson and Maclurcan did not “mince words” (Bannerman 166) and chose to use “plain titling” (David 306) and language that lacked the excessive adjectives and laudatory hyperbole typically employed by modern food writers. Perhaps if Pearson or Maclurcan had indulged in anointing their own works with enthusiastic recommendation and reference to international influences in their recipes, this might have contributed to a more positive impression of the food of our Anglo-Celtic ancestors. As an experiment with this idea I have taken a recipe from Cookery Recipes For The People and reframed its title and description in a modern food writing style. The recipe in question is titled “White Sauce” and Pearson writes that “this sauce will answer well for boiled fowl” (48): hardly language to make the dish sound appealing to the modern cook, and likely to confirm an expectation of plain cookery as tasteless and boring. But what if the recipe remained the same but the words used to describe it were changed, for example: the title to “Salsa Blanca” and the introductory remark to “this luxurious silky sauce infused with eschalot, mace, lemon, and sherry wine is perfect for perking up poached free-range chicken”. How much better might it then taste? References Abbott, Edward. The English And Australian Cookery Book: Cookery For The Many, As Well As The Upper Ten Thousand. London: Sampson Low, Son, & Marston, 1864. Acton, Eliza. Modern Cookery for Private Families. London: Longman, Brown, Green, Longmans, and Roberts, 1858. Appadurai, Arjun. “How to Make a National Cuisine: Cookbooks in Contemporary India”. Comparative Studies in Society and History 30 (1988): 3–24. Bannerman, Colin. A Friend In The Kitchen. Kenthurst NSW: Kangaroo Press, 1996. Brisbane Courier. “Mrs Maclurcan’s Cookery Book: A Collection of Practical Recipes, Specially Suitable for Australia [review].” Brisbane Courier c.1898. [Author’s manuscript collection.] Cambridge, Ada. The Three Miss Kings. London: Virago Press, 1987 (1st pub. Melbourne, 1891). David, Elizabeth. An Omelette and a Glass of Wine. London: Penguin, 1986. Freeman, Sarah. Mutton and Oysters: The Victorians and their Food. London: Victor Golllancz, 1989. Humble, Nicola. Culinary Pleasures. London, Faber & Faber, 2005. Jaine, Tom. “Banquets and Meals”. Pleasures of the Table: Proceedings of the Fifth Symposium of Australian Gastronomy (1991): 61–4. Jones, Shar, and Otto, Kirsten. Colonial Food and Drink 1788-1901. Sydney: Historic Houses Trust of New South Wales, 1985. Hartley, Dorothy. Food in England. London: Macdonald General, 1979. Hughes, Kathryn. The Short Life & Long Times of Mrs Beeton. London: Harper Perennial, 2006. Maclurcah, Hannah. Mrs Maclurcan’s Cookery Book: A Collection of Practical Recipes, Specially Suitable for Australia. Melbourne: George Robertson, 1905 (1st pub. Townsville, 1898). Morning Bulletin. “Gossip.” Morning Bulletin (Rockhampton) 10 May 1898: 5. Pearson, Margaret. Cookery Recipes for the People. Melbourne: Hutchinson, 1888. Richardson, Henry Handel. The Fortunes of Richard Mahony. London: Heinemann, 1954. Santich, Barbara. What the Doctors Ordered: 150 Years of Dietary Advice in Australia. Melbourne: Hyland House, 1995. ---. “The High and the Low: Australian Cuisine in the Late Nineteenth and Early Twentieth Centuries”. Journal of Australian Studies 30 (2006): 37–49. ---. Looking For Flavour. Kent Town: Wakefield, 1996 Saunders, Alan. “Why Do We Want An Australian Cuisine?”. Journal of Australian Studies 30 (2006): 1-17. Young, Linda. Middle-Class Culture in the Nineteenth Century: America, Australia and Britain. Basingstoke: Palgrave Macmilian, 2002.

Our capacity to tell stories is a skill that can be considered both natural and learned. Storytelling and oral history are parts of all human societies, and we seek to understand ourselves and each other through our stories. Our individual and collective memories collide in our stories, and reconcile to construct what Kansteiner calls our "collectively shared representations of the past" (182). It is our personal narratives that are the building blocks to public understanding, and as Harter, Japp and Beck maintain in Narratives, Health and Healing, "narrative is a fundamental human way of giving meaning to experience" (3). Adding to this idea of narrative as way of illuminating meaning, Goodall posits narrative as also being a way of knowing and as a research methodology, stating "narrative provides us with a range of forms and styles for discovering meaning and communicating it to readers through stories. It is an epistemology" (13). This re-imaging and re-purposing of narrative and storytelling has the capacity to significantly influence and shift the ways in which cultural and social research is carried out. This emerging approach can also influence the ways we understand the experiences of marginalised groups, and consequently how we respond to issues around social inclusion through policy and community based solutions. For researchers personal stories and narratives have the capacity to illuminate the nuances of broad issues; this potential also means that seemingly intractable social problems are given a human face with which to engage. It is in this way that personal narratives energise public narratives and shape our ways of thinking and collective understandings (Harter et al. 4). This paper investigates a digital storytelling project conducted in late 2009 with a group of Forgotten Australians in the months leading up to the public apology in the Australian Parliament, and how the personal stories of the participants brought to life previous research about the marginalisation of individuals who had experienced out-of-home care as children. This paper also explores how the endemic, institutionalised abuse of a group of people was translated to the broader community and galvanised support through the impact of their personal stories. Digital Storytelling As a dynamic practice storytelling, in all its forms, must be nurtured and developed if it is to contribute to the lives of individuals and communities. The number of storytelling, and in particular digital storytelling, initiatives and projects in Australia has increased rapidly since the early 2000s, and are utilised by various public and community organisations for a variety of reasons. Digital technology has had a profound impact on the ability for "ordinary" people to tell their stories, and research has identified the potential of digital storytelling in these contexts to assist in the representation of multiple voices and viewpoints in society through inclusive processes of co-creation (cf. see Burgess; Hartley, Uses and "TV"; Klaebe and Burgess). The storytelling project that forms the basis for this paper used some traditional written storytelling practices but was mainly concerned with digital storytelling. Digital stories are generally a two to four minute multi-media story that uses photographs, film and drawings to convey a personal story which the author narrates in their own voice over the series of images. Much has been, and continues to be written, about digital storytelling as a site of participatory culture and as a means of improving digital literacy in pockets of the community traditionally absent in the realm of digital citizenship (cf. Hartley, Uses; Hartley and McWilliam; Burgess; Meadows; Lundby). As Hartley points out digital storytelling has become such a compelling medium in which to record stories in communities because it "fills a gap between everyday cultural practice and professional media" (Uses 122). As a means of creating narratives digital storytelling has proven to be a significant mode, due in part to its ability to reach a large number of people relatively easily. The rise of digital storytelling partially mirrors the broad shift towards more participatory online culture that privileges user generated content and ordinary voices over official content. The origins of digital storytelling lie in a response to the absence of "ordinary" voices in mainstream media and policy making and grew with the increasing affordability of digital technology. The potential for social inclusion and participation along with the promise of self-representation is implicit in the discourse surrounding digital storytelling. "The ability to express oneself in digital media and in the case of digital storytelling using digital video editing, has become a central literary for full participation in society" (Lambert 85). Social Inclusion in an Australian context is defined by the Australian Government as all Australians feeling valued and having "the opportunity to participate fully in the life of our society. Achieving this vision means that all Australians will have the resources, opportunities and capability to" learn, work, engage in the community and have a voice (Social Inclusion Unit). The aims articulated by Lambert in the previous paragraph and the philosophy of social inclusion and the belief that individual stories have the capacity to impact on national agendas and policy lay at the heart of the digital storytelling project outlined later in this paper. The Forgotten Australians As cohort the Forgotten Australians are defined as individuals who were removed from their families, or were orphaned or child immigrants from the United Kingdom. These children were placed in institutions where they suffered abuse or neglect between 1930 and 1970, and it is estimated that up approximately 500,000 children were placed in out of home care during this time. In November 2009 the Australian Parliament delivered a bi-partisan apology to the Forgotten Australians for the pain and suffering they experienced in church and state run institutions. The stories of the Forgotten Australians were beginning to make their way into the consciousness of the Australian public in the lead up to the apology through documentaries on the national broadcasting service and stories in the mainstream media. Like most large groups the demographic of the Forgotten Australians is diverse, within those who identify as part of this group are successful and well-known Australians, along with ordinary Australians many of whom have struggled significantly as a direct result of their childhood experiences. Those involved in this project were considered to be individuals who were quite profoundly marginalised in mainstream society. A number lived with mental illness, the majority lacked stable housing and all had been severely emotionally, physically and sexually abused during their time in State or Church run institutions as children. The apology to the Forgotten Australians was preceded many years of advocacy and activism by community groups and individuals. They utilised personal stories, the digitisation of records and as the apology drew closer a number of digital storytelling projects to bring the personal narratives into the public arena in the hope of affecting change. Stories from these projects were broadcast across a variety of platforms such as YouTube, the websites for the major advocacy groups and community organisations and more recently the National Library Australia website. The stories differed from site to site and served different functions depending on the place from which they were disseminated. Hildebrand identifies the role of YouTube as a site for the intersection of personal experience, popular culture and historical narratives, and, as such, a vehicle for cultural memory "allow[ing] users to seek out the media texts that have shaped them and that would otherwise be forgotten in 'objective' histories" (54). YouTube videos relevant to the Forgotten Australians ranged from locally made stories and documentation, news items and presentations recorded by major organisations, but uploaded by individuals, and also those posted by these institutions themselves. A notable feature of all of these contributions is their role in the representation of witnesses' stories. In the case of reports on Forgotten Australians from major news organisations the commentary they attracted was largely from those who identified as fellow forgotten Australians attesting to—and corroborating—the interviewees' stories. Whether they were posted by survivors themselves or by mainstream media or other institutions, they exhibited a unity around a particular will to memory: setting the record straight through testimony. Here, the clips and posts were characterised by the provision of information as evidence for the assertion of cultural trauma as a shared experience and focus of identification (Adkins et al. 15). Storytelling functions as one of our most powerful forms for experiencing, expressing, and enacting sorrow and pain...it is pivotal in the process of sense making, allowing individuals to cope with chaotic, equivocal, and confusing conditions of everyday life, including illness and suffering. (152) Advocacy and community groups such as CLAN were focused on creating a sense of community amongst survivors with no story or artefact too small or insignificant to be included, which differed slightly from the agenda of the National Library of Australia—the institution of public memory that has been most closely involved in recording and disseminating the stories of the Forgotten Australians. The Forgotten Australians and Former Child Migrants Oral History Project conducted by the National Library Australia was one of the recommendations of the two Senate Community Affairs References Committee reports following the Senate Inquiries and receives funding from the Commonwealth Department of Families, Housing, Community Services and Indigenous Affairs. According to the National Library Australia website, this oral history project will run for three years and aims to document a rounded history of the experiences of the children in institutional care and the lifelong impact of these experiences on their lives and their families. This project will also interview a selection of advocates, and allied professionals including welfare officers, employees of institutions and administrators. (Project Team) In many important ways the purposes served in this project were those of the governments—previous and present, which was to capture and keep the stories, memories, documents and artefacts, and to share the officially selected stories with the rest of the nation, and those stories would support and affirm the government's roadmap for moving on from the apology. These digital storytelling projects, to varying degrees and levels of impact, served to provide the public with the personal narratives behind the issue being presented in the media and by advocacy groups as a large scale issue concerning hundreds of thousands of victims. Although the sheer size of the numbers of children affected was confronting, it was the personal stories that created a momentum towards the public apology. The findings of both Senate Inquiries recommended a formal apology; however this did not occur until the individual experiences of the Forgotten Australians were translated and represented in narratives and, through this, the construction of a sense of cultural memory resulting in formal recognition. Many Australians were sceptical about the importance of a public apology to the Forgotten Australians, as they had been of the apology to the Stolen Generation in 2008. To be a genuine act of reconciliation an apology requires the act of listening as much as speaking, fittingly Prime Minister Rudd quoted predominantly from personal oral history testimonies that had been collected over the years and that were of public record, but had not been digitally accessible to all, as many stories now are in the Bringing Them Home report. The Case Study In August 2009 I was funded by the Australasian Centre for Interactive Design (ACID) to conduct a series of digital storytelling and writing workshops in conjunction with Micah Projects, a community building and social justice organisation based in Brisbane. Micah delivers services for people experiencing homelessness, runs programmes for young mothers and is responsible for the Historical Abuse Network which is a network servicing the Forgotten Australians. After some discussion with the CEO of Micah it was decided that the clients involved with the Historical Abuse Network would benefit most from this project. Many of the participants had been involved in the 2003 senate inquiry into the treatment of children in institutional care. In the intervening years they had told the story of their abuse many times in official contexts and provided statements of harm for the inquiry. However, for this project we wanted to encourage the participants to create stories that allowed them some agency in their own lives rather, to re-claim some of their story from the official framework of abuse, and to use digital storytelling as a tool for this. The participants were between 45 and 65 in age, and were divided equally between women and men. There were a number of complexities inherent in this project, some of which were specific to this particular cohort and some specific to all marginalised individuals and groups. The most significant problem arose out the expectation that the "authors" will bring with them photographs and keepsakes from their lives to use in the stories. Many of the participants did not have photographs of their childhoods or of their families; some did not know how old they were (in many institutions all birthdays were celebrated on a single day, and consequently most lost track of their age and birth date) or had not had contact with their biological family for decades and as a result had few keepsakes. These hallmarks of legitimate biography were absent from their pasts and their presents. The combination of these factors meant that for many the ability to create a coherent narrative about their life or to feel ownership over their life had been seriously compromised. However, it became apparent that by using sounds and images in the digital story the technology was able to create a materiality out of memory for the participants. As it became clearer that the foundation of the stories was memory rather than a narrative arc, the more it became imperative to embrace the fragmentation, inconsistency and incoherence of the memories, and to incorporate these aspects into the digital stories. Instead of being easy to follow or emotionally satisfying narratives, some of the stories had much more in common with what is referred to in psychology and health frameworks as "chaos narratives". A chaos narrative has a sense of disconnected events characterised by a lack of closure and the presence of day-to-day uncertainty (Harter 4). Often such stories seem too incoherent to be told and too painful to be heard by others, as was certainly the case with some of the stories created for this project. Conclusion The Finding a Voice digital storytelling project led by Professor Jo Tacchi aligns with the aims of this project in its social innovation, and the role of storytelling and voice as having the genuine potential to impact on the understanding of poverty and disadvantage. Tacchi states that it "is an approach that allows those who are living in conditions that might constitute 'poverty' to tell those who are not what this experience is like, in their own words. Such an approach might challenge our 'expert' conceptions of poverty itself" (170), and confront mainstream or approved versions of social issues. Carabas posits that the agency embedded in the narrative act reforms or reframes the meanings of events through counter narratives and the act of telling transformed personal and social suffering. Those who had been objects of other's reports started to tell their own stories and rewrite official history in the first person singular (154). For the Forgotten Australians, those involved in this project and in similar ones the opportunity to tell their stories in their own words allowed them to push past the detached, impersonal representation of their experiences. Instead they could re-position the debate to being about individuals and the effect of government policy on their lives, and in doing so agitate for a formal apology. Storytelling and narrative as a research methodology, and as a way of knowing, is continuing to be refined by social and cultural researchers and by community organisations. Despite the emerging and nebulous nature of this field one thing is clear: our human desire to tell stories has the ability to be harnessed to build narratives which create understanding and insight and consequently demand that as communities and nations we respond to injustice and disadvantage accordingly. References Adkins, Barbara, Donna Hancox, and Helen Klaebe. "The Role of the Internet and Digital Technologies in the Struggle for Recognition of the Forgotten Australians." Proceedings of the A Decade in Internet Time: OII Symposium on the Dynamics of the Internet and Society, 21-24 September 2011. Oxford U of Oxford, 2011: 1-23. Burgess, Jean. "Hearing Ordinary Voices: Cultural Studies, Vernacular Creativity and Digital Storytelling." Continuum 20.2 (2006): 201-14. Carabas, Teodora, and Lynn Harter. "State-Induced Illness and Forbidden Stories: The Role of Storytelling in Healing, Individual and Social Traumas in Romania." Narratives, Health and Healing. Eds. Lynn Harter, Linda Japp, and Christina Beck. New York: Taylor and Francis, 2005. 149-69. Harter, Lynn, Linda Japp, and Christina Beck, eds. Narratives, Health & Healing. New York: Taylor & Francis. 2005. Hartley, John. "TV Stories: From Representation to Productivity." Story Circle: Digital Storytelling around the World. Eds. John Hartley and Kelly McWilliam. Oxford: Blackwell, 2009. 16-37.———. Uses of Digital Literacy. St. Lucia: U of Queensland P. 2009. Hildebrand, Lucas. "YouTube: Where Cultural Memory and Copyright Converge." Film Quarterly 61.1 (2007): 48-57. Kansteiner, Wolf. "Finding Meaning in Memory: A Methodological Critique of Collective Memory Studies." History & Theory 41 (2002): 179-97. Klaebe, Helen, and Jean Burgess. "Mediatisation and Institutions of Public Memory: Digital Storytelling and the Apology." Australian Historical Studies 41 (2002): 149-65. Lambert, Joe. "Where It All Started: The Centre of Digital Storytelling in California." Story Circle: Digital Storytelling around the World. Eds. John Hartley and Kelly McWilliam. Oxford: Blackwell, 2010. 79-90. Lundby, Kunt. Digital Storytelling, Mediatized Stories: Self-Representations in New Media. New York: Peter Lang, 2008. Meadows, Daniel. "Digital Storytelling - Research Based Practice in New Media." Visual Communication 2.2 (2003): 189-93. McWilliam, Kelly. "The Global Diffusion of a Community Media Practice: Digital Storytelling Online." Eds. John Hartley and Kelly McWilliam. Oxford: Blackwell, 2010. 37-77. Project Team. "Forgotten Australians and Former Child Migrants Oral History Project." National Library of Australia. 16 Sep. 2011 ‹http://www.nla.gov.au/oral-history/forgotten-australians-and-former-child-migrants-oral-history-project›. Social Inclusion Unit. "The Social Inclusion Agenda." Social Inclusion. Australian Government, 2011. 19 Sep. 2011 ‹http://www.socialinclusion.gov.au/›. Tacchi, Jo. "Finding a Voice: Participatory Development in Southeast Asia." Story Circle: Digital Storytelling around the World. Eds. John Hartley and Kelly McWilliam. Oxford: Blackwell, 2009. 167-75.

“People live here, they die here so they must leave traces.” (Read 140) “Whatever colonialism was and is, it has made this place unsettling and unsettled.” (Gibson, Badland 2) Introduction What does it mean for [a] country to be haunted? In much theoretical work in film and Cultural Studies since the 1990s, the Australian continent, more often than not, bears traces of long suppressed traumas which inevitably resurface to haunt the present (Gelder and Jacobs; Gibson; Read; Collins and Davis). Felicity Collins and Therese Davis illuminate the ways Australian cinema acts as a public sphere, or “vernacular modernity,” for rethinking settler/indigenous relations. Their term “backtracking” serves as a mode of “collective mourning” in numerous films of the last decade which render unspoken colonial violence meaningful in contemporary Australia, and account for the “aftershocks” of the Mabo decision that overturned the founding fiction of terra nullius (7). Ray Lawrence’s 2006 film Jindabyne is another after-Mabo film in this sense; its focus on conflict within settler/indigenous relations in a small local town in the alpine region explores a traumatised ecology and drowned country. More than this, in our paper’s investigation of country and its attendant politics, Jindabyne country is the space of excessive haunting and resurfacing - engaging in the hard work of what Gibson (Transformations) has termed “historical backfill”, imaginative speculations “that make manifest an urge to account for the disconnected fragments” of country. Based on an adaptation by Beatrix Christian of the Raymond Carver story, So Much Water, So Close to Home, Jindabyne centres on the ethical dilemma produced when a group of fishermen find the floating, murdered body of a beautiful indigenous woman on a weekend trip, but decide to stay on and continue fishing. In Jindabyne, “'country' […] is made to do much discursive work” (Gorman-Murray). In this paper, we use the word as a metonym for the nation, where macro-political issues are played out and fought over. But we also use ‘country’ to signal the ‘wilderness’ alpine areas that appear in Jindabyne, where country is “a notion encompassing nature and human obligation that white Australia has learned slowly from indigenous Australia” (Gibson, Badland 178). This meaning enables a slippage between ‘land’ and ‘country’. Our discussion of country draws heavily on concepts from Ross Gibson’s theorisation of badlands. Gibson claims that originally, ‘badland’ was a term used by Europeans in North America when they came across “a tract of country that would not succumb to colonial ambition” (Badland 14). Using Collins and Davis’s “vernacular modernity” as a starting point, a film such as Jindabyne invites us to work through the productive possibilities of postcolonial haunting; to move from backtracking (going over old ground) to imaginative backfill (where holes and gaps in the ground are refilled in unconventional and creative returns to the past). Jindabyne (as place and filmic space) signifies “the special place that the Australian Alps occupy for so many Australians”, and the film engages in the discursive work of promoting “shared understanding” and the possibility of both Aboriginal and non-Aboriginal being “in country” (Baird, Egloff and Lebehan 35). We argue specifically that Jindabyne is a product of “aftermath culture” (Gibson Transformations); a culture living within the ongoing effects of the past, where various levels of filmic haunting make manifest multiple levels of habitation, in turn the product of numerous historical and physical aftermaths. Colonial history, environmental change, expanding wire towers and overflowing dams all lend meaning in the film to personal dilemmas, communal conflict and horrific recent crimes. The discovery of a murdered indigenous woman in water high in the mountains lays bare the fragility of a relocated community founded in the drowning of the town of old Jindabyne which created Lake Jindabyne. Beatrix Christian (in Trbic 61), the film’s writer, explains “everybody in the story is haunted by something. […] There is this group of haunted people, and then you have the serial killer who emerges in his season to create havoc.” “What’s in this compulsion to know the negative space?” asks Gibson (Badland 14). It’s the desire to better know and more deeply understand where we live. And haunting gives us cause to investigate further. Drowned, Murderous Country Jindabyne rewrites “the iconic wilderness of Australia’s High Country” (McHugh online) and replaces it with “a vast, historical crime scene” (Gibson, Badland 2). Along with nearby Adaminaby, the township of Old Jindabyne was drowned and its inhabitants relocated to the new town in the 1960s as part of the Snowy Mountains Hydro-electric Scheme. When Jindabyne was made in 2006 the scheme no longer represented an uncontested example of Western technological progress ‘taming’ the vast mountainous country. Early on in the film a teacher shows a short documentary about the town’s history in which Old Jindabyne locals lament the houses that will soon be sacrificed to the Snowy River’s torrents. These sentiments sit in opposition to Manning Clark’s grand vision of the scheme as “an inspiration to all who dream dreams about Australia” (McHugh online). With a 100,000-strong workforce, mostly migrated from war-ravaged Europe, the post-war Snowy project took 25 years and was completed in 1974. Such was this engineering feat that 121 workmen “died for the dream, of turning the rivers back through the mountains, to irrigate the dry inland” (McHugh online). Jindabyne re-presents this romantic narrative of progress as nothing less than an environmental crime. The high-tension wires scar the ‘pristine’ high country and the lake haunts every aspect of the characters’ interactions, hinting at the high country’s intractability that will “not succumb to colonial ambition” (Gibson, Badland 14). Describing his critical excavation of places haunted, out-of-balance or simply badlands, Gibson explains: Rummaging in Australia's aftermath cultures, I try to re-dress the disintegration in our story-systems, in our traditional knowledge caches, our landscapes and ecologies […] recuperate scenes and collections […] torn by landgrabbing, let's say, or by accidents, or exploitation that ignores rituals of preservation and restoration (Transformations). Tourism is now the predominant focus of Lake Jindabyne and the surrounding areas but in the film, as in history, the area does not “succumb to the temptations of pictorialism” (McFarlane 10), that is, it cannot be framed solely by the picture postcard qualities that resort towns often engender and promote. Jindabyne’s sense of menace signals the transformation of the landscape that has taken place – from ‘untouched’ to country town, and from drowned old town to the relocated, damned and electrified new one. Soon after the opening of the film, a moment of fishing offers a reminder that a town once existed beneath the waters of the eerily still Lake Jindabyne. Hooking a rusty old alarm clock out of the lake, Stuart explains to Tom, his suitably puzzled young son: underneath the water is the town where all the old men sit in rocking chairs and there’s houses and shops. […] There was a night […] I heard this noise — boing, boing, boing. And it was a bell coming from under the water. ‘Cause the old church is still down there and sometimes when the water’s really low, you can see the tip of the spire. Jindabyne’s lake thus functions as “a revelation of horrors past” (Gibson Badland 2). It’s not the first time this man-made lake is filmically positioned as a place where “violence begins to seem natural” (Gibson, Badland 13). Cate Shortland’s Somersault (2004) also uses Lake Jindabyne and its surrounds to create a bleak and menacing ambience that heightens young Heidi’s sense of alienation (Simpson, ‘Reconfiguring rusticity’). In Somersault, the male-dominated Jindabyne is far from welcoming for the emotionally vulnerable out-of-towner, who is threatened by her friend’s father beside the Lake, then menaced again by boys she meets at a local pub. These scenes undermine the alpine region’s touristic image, inundated in the summer with tourists coming to fish and water ski, and likewise, with snow skiers in the winter. Even away from the Lake, there is no fleeing its spectre. “The high-tension wires marching down the hillside from the hydro-station” hum to such an extent that in one scene, “reminiscent of Picnic at Hanging Rock (Peter Weir, 1975)”, a member of the fishing party is spooked (Ryan 52). This violence wrought upon the landscape contextualises the murder of the young indigenous woman, Susan, by Greg, an electrician who after murdering Susan, seems to hover in the background of several scenes of the film. Close to the opening of Jindabyne, through binoculars from his rocky ridge, Greg spots Susan’s lone car coursing along the plain; he chases her in his vehicle, and forces her to stop. Before (we are lead to assume) he drags her from the vehicle and murders her, he rants madly through her window, “It all comes down from the power station, the electricity!” That the murder/murderer is connected with the hydro-electric project is emphasised by the location scout in the film’s pre-production: We had one location in the scene where Greg dumps the body in some water and Ray [Lawrence] had his heart set on filming that next to some huge pipelines on a dam near Talbingo but Snowy Hydro didn’t […] like that negative content […] in association with their facility and […] said ‘no’ they wouldn’t let us do it.” (Jindabyne DVD extras) “Tales of murder and itinerancy in wild country are as old as the story of Cain in the killing fields of Eden” (Badlands 14). In Jindabyne we never really get to meet Greg but he is a familiar figure in Australian film and culture. Like many before him, he is the lone Road Warrior, a ubiquitous white male presence roaming the de-populated country where the road constantly produces acts of (accidental and intentional) violence (Simpson, ‘Antipodean Automobility’). And after a litany of murders in recent films such as Wolf Creek (Greg McLean, 2005) and Gone (Ringan Ledwidge, 2007) the “violence begins to seem natural” (Gibson Transformations 13) in the isolating landscape. The murderer in Jindabyne, unlike those who have migrated here as adults (the Irish Stuart and his American wife, Claire), is autochthonous in a landscape familiar with a trauma that cannot remain hidden or submerged. Contested High Country The unsinkability of Susan’s body, now an ‘indigenous murdered body’, holds further metaphorical value for resurfacing as a necessary component of aftermath culture. Such movement is not always intelligible within non-indigenous relations to country, though the men’s initial response to the body frames its drifting in terms of ascension: they question whether they have “broken her journey by tying her up”. The film reconfigures terra nullius as the ultimate badland, one that can never truly suppress continuing forms of physical, spiritual, historical and cultural engagement with country, and the alpine areas of Jindabyne and the Snowy River in particular. Lennon (14) points to “the legacy of biased recording and analysis” that “constitutes a threat to the cultural significance of Aboriginal heritage in alpine areas” (15). This significance is central to the film, prompting Lawrence to state that “mountains in any country have a spiritual quality about them […] in Aboriginal culture the highest point in the landscape is the most significant and this is the highest point of our country” (in Cordaiy 40). So whilst the Jindabyne area is contested country, it is the surfacing, upward mobility and unsinkable quality of Aboriginal memory that Brewster argues “is unsettling the past in post-invasion Australia” (in Lambert, Balayi 7). As the agent of backfill, the indigenous body (Susan) unsettles Jindabyne country by offering both evidence of immediate violence and reigniting the memory of it, before the film can find even the smallest possibility of its characters being ‘in country’. Claire illustrates her understanding of this in a conversation with her young son, as she attempts to contact the dead girls’ family. “When a bad thing happens,” she says, “we all have to do a good thing, no matter how small, alright? Otherwise the bad things, they just pile up and up and up.” Her persistent yet clumsy enactment of the cross-cultural go-between illuminates the ways “the small town community move through the terms of recent debate: shame and denial, repressed grief and paternalism” (Ryan 53). It is the movement of backfill within the aftermath: The movement of a foreign non-Aboriginal woman into Aboriginal space intertextually re-animates the processes of ‘settlement’, resolution and environmental assimilation for its still ‘unsettled’ white protagonists. […] Claire attempts an apology to the woman’s family and the Aboriginal community – in an Australia before Kevin Rudd where official apologies for the travesties of Australian/colonial history had not been forthcoming […] her movement towards reconciliation here is reflective of the ‘moral failure’ of a disconnection from Aboriginal history. (Lambert, Diasporas) The shift from dead white girl in Carver’s story to young Aboriginal woman speaks of a political focus on the ‘significance’ of the alpine region at a given moment in time. The corpse functions “as the trigger for crisis and panic in an Australia after native title, the stolen generation and the war-on-terror” (Lambert, Diasporas). The process of reconnecting with country and history must confront its ghosts if the community is to move forward. Gibson (Transformations) argues that “if we continue to close our imaginations to the aberrations and insufficiencies in our historical records. […] It’s likely we won’t dwell in the joy till we get real about the darkness.” In the post-colonial, multicultural but still divided geographies and cultures of Jindabyne, “genocidal displacement” comes face to face with the “irreconciled relation” to land “that refuses to remain half-seen […] a measure of non-indigenous failure to move from being on the land to being in country” (Ryan 52), evidenced by water harvesting in the Snowy Mountains Scheme, and the more recent crises in water and land management. Aftermath Country Haunted by historical, cultural and environmental change, Jindabyne constitutes a post-traumatic screen space. In aftermath culture, bodies and landscapes offer the “traces” (Gibson, Transformations) of “the social consequences” of a “heritage of catastrophe” that people “suffer, witness, or even perpetrate” so that “the legacy of trauma is bequeathed” (Walker i). The youth of Jindabyne are charged with traumatic heritage. The young Susan’s body predictably bears the semiotic weight of colonial atrocity and non-indigenous environmental development. Evidence of witnesses, perpetrators and sufferers is still being revealed after the corpse is taken to the town morgue, where Claire (in a culturally improper viewing) is horrified by Susan’s marks from being secured in the water by Stuart and the other men. Other young characters are likewise haunted by a past that is environmental and tragically personal. Claire and Stuart’s young son, Tom (left by his mother for a period in early infancy and the witness of his parents strained marital relations), has an intense fear of drowning. This personal/historical fear is played with by his seven year old friend, Caylin-Calandria, who expresses her own grief from the death of her young mother environmentally - by escaping into the surrounding nature at night, by dabbling in the dark arts and sacrificing small animals. The two characters “have a lot to believe in and a lot of things to express – belief in zombies and ghosts, ritual death, drowning” (Cordaiy 42). As Boris Trbic (64) observes of the film’s characters, “communal and familial harmony is closely related to their intense perceptions of the natural world and their often distorted understanding of the ways their partners, friends and children cope with the grieving process.” Hence the legacy of trauma in Jindabyne is not limited to the young but pervades a community that must deal with unresolved ecologies no longer concealed by watery artifice. Backfilling works through unsettled aspects of country by moving, however unsteadily, toward healing and reconciliation. Within the aftermath of colonialism, 9/11 and the final years of the Howard era, Jindabyne uses race and place to foreground the “fallout” of an indigenous “condemnation to invisibility” and the “long years of neglect by the state” (Ryan 52). Claire’s unrelenting need to apologise to the indigenous family and Stuart’s final admission of impropriety are key gestures in the film’s “microcosm of reconciliation” (53), when “the notion of reconciliation, if it had occupied any substantial space in the public imagination, was largely gone” (Rundell 44). Likewise, the invisibility of Aboriginal significance has specificity in the Jindabyne area – indigeneity is absent from narratives recounting the Snowy Mountains Scheme which “recruited some 60,000 Europeans,” providing “a basis for Australia’s postwar multicultural society” (Lennon 15); both ‘schemes’ evidencing some of the “unrecognised implications” of colonialism for indigenous people (Curthoys 36). The fading of Aboriginal issues from public view and political discourse in the Howard era was serviced by the then governmental focus on “practical reconciliation” (Rundell 44), and post 9/11 by “the broad brushstrokes of western coalition and domestic political compliance” (Lambert, CMC 252), with its renewed focus on border control, and increased suspicion of non-Western, non-Anglo-European difference. Aftermath culture grapples with the country’s complicated multicultural and globalised self-understanding in and beyond Howard’s Australia and Jindabyne is one of a series of texts, along with “refugee plays” and Australian 9/11 novels, “that mobilised themselves against the Howard government” (Rundell 43-44). Although the film may well be seen as a “profoundly embarrassing” display of left-liberal “emotional politics” (44-45), it is precisely these politics that foreground aftermath: local neglect and invisibility, terror without and within, suspect American leadership and shaky Australian-American relations, the return of history through marked bodies and landscapes. Aftermath country is simultaneously local and global – both the disappearance and the ‘problem’ of Aboriginality post-Mabo and post-9/11 are backfilled by the traces and fragments of a hidden country that rises to the surface. Conclusion What can be made of this place now? What can we know about its piecemeal ecology, its choppy geomorphics and scarified townscapes? […] What can we make of the documents that have been generated in response to this country? (Gibson, Transformations). Amidst the apologies and potentialities of settler-indigenous recognition, the murdering electrician Gregory is left to roam the haunted alpine wilderness in Jindabyne. His allegorical presence in the landscape means there is work to be done before this badland can truly become something more. Gibson (Badland 178) suggests country gets “called bad […] partly because the law needs the outlaw for reassuring citizens that the unruly and the unknown can be named and contained even if they cannot be annihilated.” In Jindabyne the movement from backtracking to backfilling (as a speculative and fragmental approach to the bodies and landscapes of aftermath culture) undermines the institutional framing of country that still seeks to conceal shared historical, environmental and global trauma. The haunting of Jindabyne country undoes the ‘official’ production of outlaw/negative space and its discursively good double by realising the complexity of resurfacing – electricity is everywhere and the land is “uncanny” not in the least because “the town of Jindabyne itself is the living double of the drowned original” (Ryan 53). The imaginative backfill of Jindabyne reorients a confused, purgatorial Australia toward the “small light of home” (53) – the hope of one day being “in country,” and as Gibson (Badland 3) suggests, the “remembering,” that is “something good we can do in response to the bad in our lands.” References Baird, Warwick, Brian Egloff and Rachel Lenehan. “Sharing the mountains: joint management of Australia’s alpine region with Aboriginal people.” historic environment 17.2 (2003): 32-36. Collins, Felicity and Therese Davis. Australian Cinema after Mabo. Cambridge: Cambridge UP, 2005. Cordaiy, Hunter. “Man, Woman and Death: Ray Lawrence on Jindabyne.” Metro 149 (2006): 38-42. Curthoys, Anne. “An Uneasy Conversation: The Multicultural and the Indigenous.” Race Colour and Identity in Australia and New Zealand. Ed. John Docker and Gerhard Fischer. Sydney, UNSW P, 2000. 21-36. Gelder, Ken and Jane M. Jacobs. Uncanny Australia: Sacredness an Identity in a Postcolonial Nation. Carlton: Melbourne UP, 1998. Gibson, Ross. Seven Versions of an Australian Badland. St Lucia: U of Queensland P, 2002. Gibson, Ross. “Places, Past, Disappearance.” Transformations 13 (2006). Aug. 11 2008 transformations.cqu.edu.au/journal/issue_13/article_01.shtml. Gorman-Murray, Andrew. “Country.” M/C Journal 11.5 (this issue). Kitson, Michael. “Carver Country: Adapting Raymond Carver in Australia.” Metro150 (2006): 54-60. Lambert, Anthony. “Movement within a Filmic terra nullius: Woman, Land and Identity in Australian Cinema.” Balayi, Culture, Law and Colonialism 1.2 (2001): 7-17. Lambert, Anthony. “White Aborigines: Women, Mimicry, Mobility and Space.” Diasporas of Australian Cinema. Eds. Catherine Simpson, Renata Murawska, and Anthony Lambert. UK: Intellectbooks, 2009. Forthcoming. Lambert, Anthony. “Mediating Crime, Mediating Culture.” Crime, Media, Culture 4.2 (2008): 237-255. Lennon, Jane. “The cultural significance of Australian alpine areas.” Historic environment 17.2 (2003): 14-17. McFarlane, Brian. “Locations and Relocations: Jindabyne & MacBeth.” Metro Magazine 150 (Spring 2006): 10-15. McHugh, Siobhan. The Snowy: The People Behind the Power. William Heinemann Australia, 1999. http://www.mchugh.org/books/snowy.html. Read, Peter. Haunted Earth. Sydney: UNSW Press, 2003. Rundle, Guy. “Goodbye to all that: The end of Australian left-liberalism and the revival of a radical politics.” Arena Magazine 88 (2007): 40-46. Ryan, Matthew. “On the treatment of non-indigenous belonging.” Arena Magazine 84 (2006): 52-53. Simpson, Catherine. “Reconfiguring Rusticity: feminizing Australian Cinema’s country towns’. Studies in Australasian Cinemas 2.1 (2008): forthcoming. Simpson, Catherine. “Antipodean Automobility & Crash: Treachery, Trespass and Transformation of the Open Road.” Australian Humanities Review 39-40 (2006). http://www.australianhumanitiesreview.org/archive/Issue-September-2006/simpson.html. Trbic, Boris. “Ray Lawrence’s Jindabyne: So Much Pain, So Close to Home.” Screen Education 44 (2006): 58–64. Walker, Janet. Trauma Cinema: Documenting Incest and the Holocaust. Berkley, Los Angeles and London: U of California P, 2005.