EHOs and EHWs will be more effective if they have an ongoing relationship with health centre staff and are part of the broader community health team. They can support your work and you can support theirs.
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Get to know your local EHOs and EHWs. Find out what they do and how you can work together | |
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Let people know how the environment they live in can affect their health | |
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Advocate to Council for an Environmental Health Worker if there isn’t one in your community | |
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If you notice environmental health related problems or potential problems in your community which you are unable to deal with yourself inform community authorities (see the section ‘What to do in the case of an environmental health hazard’) | |
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Get in touch with the EHO for your area | |
| Mapping the trouble spots Thirteen years ago there was an Indian doctor working on this community. While he was here he thought that it would be a good idea to put a map up on the Health Centre wall. As cases of diarrhoea came up he put a cross on the map to mark the house where the case came from. He wanted to get a better understanding of where the problem spots were. If there was a cluster of spots he could go out to see what was happening, follow it up. That’s what we Environmental Health staff need from other Health staff. We need their support, and to let us know when there’s something transmissible going around that could be prevented. In town, people contact the Communicable Disease Centre. Out bush we rely on health staff to help us trace and track down problems - even though health centres are busy - we need staff to keep in touch with us to let us know about any problems as they arise. EHO, Top End |
| I thought you worked for health A lot of people don’t understand the link between health and their living conditions. This is the classic story. I was in the bathroom testing taps and one of the residents walked in and said "I thought you worked for health". EHO, East Arnhem |
The following case study looks at how things can go wrong in a complex, crisis situation, and then be turned around through cooperative effort.
| An environmental health hazard When the new Remote Area Nurse (RAN) arrived at the community, she found a lot of environmental health conditions that she knew were not acceptable. She found pools of smelly water around the septic tank systems of some houses and saw children and dogs running through effluent to reach the verandah of their houses. Health Centre staff saw several new cases of diarrhoea every day and cases could be traced back to the houses with broken septic tanks. The RAN and the Health Workers were concerned and approached the Council Clerk who said that the truck used to pump out the septic systems had broken down. The Council had no resources to fix it. Over the next few days the Health Workers and the RAN became really worried about the cases of diarrhoea and had to arrange medical evacuations to town for two children. They decided to call the Director of Nursing (DON). When the DON heard the story about the number of cases of diarrhoea, the medivacs, the puddles of sewage outside the houses and the lack of Council resources to fix the problems, she recognised the urgency of the situation and the need to draw in specific expertise. She approached the Environmental Health Unit for advice. Presented with the evidence, the Environmental Health Officer agreed that there was a serious problem. That day the EHO and DON organised a teleconference with the Health Centre staff to talk about the problem and work out a plan of what to do. Together they drafted out a list of things that needed to happen. |
| Environmental Health Action Plan | ||
| What needs to happen | Who will do what | When |
| Provide information to community members about the health problems linked to puddles of effluent around houses | Community health staff to talk to occupiers of affected houses about trying to keep children away from the puddles of water and personal, home and food hygiene issues | Today |
| Short term solutions | ||
| Removal of effluent from around houses | EHO will ring community contacts to seek immediate and short term solutions | Today |
| EHO will visit to provide on-site advice | Next week | |
| Long term solutions | ||
| Repair of dangerous septic tank systems | EHO will work with Council to prepare submission to seek funding for repairs | Next week |
| Assessment of viability of septic tank systems and future options, ie: common effluent or sewerage system | EHO to network with responsible organisations to promote need for long term assessment | Ongoing |
| Armed with an action plan, the Health Workers, RAN and EHO went to work. Health staff treated the really sick patients that were waiting and then sat down for an hour to write out the hygiene messages they wanted to give to the community. Then they went to visit the houses with puddles of effluent. The EHO rang his contacts in the community. The Essential Services Officer and the Works Supervisor agreed that there was a major problem but nothing could be done until parts for the sludge pump arrived - perhaps in a week or two. During several more phone calls to the community the option of using the council road watering truck and pump to remove effluent from the damaged soil absorption drains was arranged. This would prevent effluent accumulating around houses and provide a temporary solution until the sludge pump was repaired. Pumping water from the absorption drains started that day and would continue as required until the septic tank systems were reconstructed. When the EHO visited the community a week later he was able to bring some taps and fittings to replace those that were continually leaking and contributing to the effluent accumulation problems. By this time pumping of the drains had removed the accumulations of effluent and the ground around the septic tanks had started to dry. Another week of dry season sunshine would dry up the ground and make it safe to play on. The EHO and health staff also had discussions with the Council Clerk about repairing the broken septic tank systems. He was also under a lot of pressure from councillors to solve the problems. He was able to use Health Centre information about the numbers of sick children to access funding for housing maintenance. He organised a contractor to come in a week later to repair the broken septic tank systems. By this time, the number of cases of diarrhoea had dropped and children were returning from their short stay in hospital. These actions solved the immediate problems. A detailed report prepared by the EHO during his visit indicated that many of the existing septic tank systems had a limited life because of poor construction, unsuitable soil conditions for effluent absorption and severe pressure of use from the large number of people in each house. The problems experienced by the community were just waiting to happen all over again. The EHOs report was circulated around several Government departments and eventually formed part of an assessment project carried out to allocate funding under the National Aboriginal Health Strategy - Environmental Health Program. The assessment placed the recommendation for a community sewerage system about halfway down the priority list with a very good chance of being constructed under the next round of funding. |
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Immediately alert the local Environmental Health Worker and council staff to the problem and work out a plan of action | |
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Talk to community members about the problem | |
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Brief the local environmental health office and ask for advice and support if necessary | |