Guest: David Mcintosh
Guest Bio: David McIntosh is a Paediatric ENT specialist and is experienced in working with remote aboriginal population in regions throughout the northern territory, including places surrounding the Alice Springs, Arnhem Land, and other island communities along Australia’s northern coast and remote Queensland. He has witnessed quite a few issues that is faced by the indigenous population of Australia.
Health Professional Radio – Indigenous Health Ear Disease
Katherine: Today, joining us is David McIntosh. He is a Paediatric ENT specialist and is experienced in working with remote aboriginal population in regions throughout the northern territory, including places surrounding the Alice Springs, Arnhem Land, and other island communities along Australia’s northern coast and remote Queensland. He has witnessed quite a few issues that is faced by the indigenous population of Australia. Welcome to our show, David.
(David McIntosh: Thank you very much for having me.
Katherine: Now, can you tell us a little bit about your background and how you came to be a surgeon up north?
David: Yes, certainly, absolutely. My background is I’m from South Australia initially, and part of that involves doing work in the northern territory. So, that was working predominantly in and around Darwin and then using Darwin as a base to go out to visit communities by road and by air. And we would see a lot of children that had significant problems that… really, sort of the Third World kind of [indecipherable 0:01:10] problems and [indecipherable 0:01:15] of it all and get an insight into that, and also just great background insight into a lot of the challenges faced with not only indigenous health, but also just rural and regional health.
So that’s the background to that. And those are the areas that I have a great love and passion for and keep fighting the cause for.
Katherine: Yeah. You see similar— what issues come up time and time again, for example, in our indigenous population, typically the life expectancy is lower, there’s pregnancy-related problems, heart disease, kidney disease, diabetes, eye disease – it’s among the worst in the world actually, isn’t it David?
David: It is, and like I said, it’s sort of reflecting the Third World statistics, really unfortunately. And it’s not an easy problem to solve. There’s a large number of reasons why these things are going on with regard to these sorts of illnesses. And the solutions are not simple and straightforward. It really comes down to a team approach, looking at everything. But it’s a mountain rather than a molehill in terms of what you need to climb. So, you take small bite sizes as you make progress rather than expecting overnight miracles with these sorts of problems.
Katherine: Exactly, yeah. And one of the most critical problems is actually ear disease. The World Health Organisation classes this disease as serious, and it affects more than four percent of the worldwide population. However, surveys have shown that ear disease is greater than 90% in Australian indigenous communities – that’s a staggering…
David: Yeah, it is. And what you got to do is put these numbers into some sort of perspective that people can understand. You’ve got a normal class of kids in a classroom, say, 20 kids, 18 – which is 90% – 18 of those kids have got some sort of ear problem, with sort of hearing problem, which then has some sort of education and learning problem.
David: That puts it into perspective. And if you want to start from the ground up – you look at education being one of those foundations for the rest of your life. We are talking about children in a classroom environment where they can’t hear properly. The class itself may not be in their first language. There are a lot of communities, English is their fourth or fifth language, it’s not their primary language. And we know, and it’s all very well established, and there was an Australian Senate Committee investigation into hearing loss in general. And one of the areas it looked at was indigenous, and its implications.
And we know that the implications from hearing loss is problems then with job opportunities, problems with truancy, problems with the law. There are surveys that have shown that about 20% of indigenous people within prison have hearing problems. So, there’s a massive knock-on effect with all of these sorts of things, and because it’s such a large part of the population at a young age, the flow-on consequences of it are just enormous.
Katherine: Right. Can you explain to us why it’s so prevalent in the indigenous community – like, why is it so high? Is it hereditary, or what is it exactly that…?
David: We don’t think it’s probably hereditary per se. It’s all related to infections. So, what we need to is look at why these infections come about. And we look at it from a general point of view, the same as we did for anyone else with ear disease. So, we know that there are certain things that are good and protective against ear disease. So, we know that if the pregnancy went well, that’s a factor in your favour. We know that if you were breastfed for a prolonged period of time, the longer the better, then that’s a protective effect against ear disease.
We know that parental smoking is a bad factor with regards to getting ear disease. We also know that nutrition is important. There’s nice little studies around in Australia which have shown that the simple intervention of organising to indigenous families to have access to fresh fruit every week, which is subsidised, actually reduces the ear disease rate from around 70% – 80%, way down to 20%/25%. And that’s just pure nutrition. So, there’s a handful of perfect examples of issues at hand. We also know that living circumstances, overcrowding is a problem.
Then, the other one really is just general access to medical care – getting kids in where they’re sick and getting them better, stop things taking hold and becoming chronic – pretty much everything that I’ve alluded to there, you can put on the list of issues that are over-represented amongst indigenous people and populations. So, one of those is enough, but unfortunately, it’s often a lot of those all at once.
Katherine: Yeah. And ear disease is a treatable disease, isn’t it?
David: This is all treatable. This is one of those – the greatest things and saddest things is that it’s all treatable and manageable. But it takes a fair bit of effort and motivation with regards to people identifying that there’s a problem. And one of the issues, realistically, is that if you’ve got 70%/80%/90% of your kids running around with a snotty nose and an ear that weeps and runs muck out, and the kids aren’t hearing and listening properly, it’s all normal.
So, it’s just sort of taken for granted as being that’s what everyone else did, that’s what their brother did, that’s what their uncle did. And it’s just left to be. Unfortunately, what’s left to be is then paid for down the track.
Katherine: Yeah. And what is it about young children – and when I say “young children” I’m talking about both indigenous and otherwise – what is it about young children that makes them more susceptible to ear infections than adults?
David: Yeah. There’s a whole range of features, and everyone will tell you they think they know why, but we sort of realistically don’t. There’s a lot of things that make a lot of sense though. So, with regards to kids, we know that kids are good at catching bugs and sharing them amongst themselves, and certainly in the day-care setting, that’s a far more common scenario. From that point of view, that’s a contributing factor as to that being the case. We know with kids that at the back of their nose they have these things called adenoids.
The adenoids sit next to the tubes that go into the ears themselves. And we know that you can find the same infection in the adenoids as you can find in the ears. The adenoids naturally shrink away by themselves in most people by the time you are a teenager. So, you’re removing one of the sources possibly of infection by doing so naturally. So, ear disease disappears in a lot of people as time goes by. Your immune system gets exposed to different bugs and gets used to dealing with those bugs, so it might be a problem the first time around, but not so much the second, third and fourth time around.
Immunisations also help to some degree with illness and infection in general, specific to the immunisation, but also just across the board in terms of cross-protection for some things sometimes. So, these are the factors involved. The other factor then is just the kid themselves. We wondered maybe if it’s just the orientation of the tube that drains the ear may not be quite right with regards to its function. And as we get older, it changes its orientation and drains better, so perhaps that helps as well.
Katherine: Right, okay. And David, I know you’re a Member of the Aboriginal Indigenous Doctors Association and also Queensland Health ‘Deadly Ears Outreach’ program. I gather these programs are partly or fully government-funded. What do these programs entail? What activities do they do in the community?
David: The Aboriginal Indigenous Doctors Association really is more of a representative group identifying issues within indigenous healthcare and then being involved in presenting structure and appropriate means of looking at these problems and suggesting ways that it can be approached. It is also a support network, really. I think it would be fantastic if we had more indigenous doctors amongst our ranks. And it’s a great support mechanism there.
They help kids at the time that they’re at school, just sort of show them the way as to the option of medicine as a career path, and then supporting people beyond that point in terms of when they’re medical students and doctors, so it helps from that point of view. The ‘Deadly Ears’ program – it’s got a bit of a funny name, which, if people aren’t familiar with “deadly” in its colloquial sense, it sort of basically means “cool” as opposed to “nasty,” which is what people might make the first association with. And it’s a Queensland government service, which basically, it’s the same thing that we keep in the northern territory.
It’s quite common sense really – if you can mobilise the people that offer the treatment and take the treatment to the people, they’re more likely to access it, simply because it’s there on their doorstep. If you try and say, “Well, I’m here, you’ve got to come here,” the people in remote areas – [indecipherable 0:11:21] of time with regards to getting on a plane, organising people to look after their other kids, going somewhere that they’re not familiar with, travelling around – of course, [indecipherable 11:31] anyone else, they have to travel from somewhere to the big city, for example, but [indecipherable 0:11:37] effect that we know that the problem’s there.
We know that we sort of go out there do it. One, it’s more effective, and two, it’s actually cheaper. It’s actually cheaper just to bring the team to the people and fix lots of people there and then, rather than the resources involved in moving one patient and parents at a time into the city to help them out.
Katherine: Sounds like a great program and I hope it keeps going. Thank you so much for your time today, David.
David: It’s been my pleasure, thank you.
Katherine: And for those of you that would like to learn more, you can go to entspecialists.com.au. Thank you.