THS food and nutrition program

The Nutrition Team includes the Food and Nutrition Unit in Health House, Darwin, and operational staff in the five major centres and in some remote communities. The Nutrition Team coordinates and works closely with other health service providers, communities, non-government agencies and the food industry.

The Team has a strong mix of staff including Community Nutritionists, Hospital Dietitians, Aboriginal Community Nutrition Workers, and Aboriginal Nutrition Advisers (Aboriginal Health Workers who specialise in nutrition and hold designated positions in nutrition).

One of the priorities for the Nutrition Team is the implementation of the Northern Territory Food and Nutrition Policy.

The Northern Territory Food and Nutrition Policy and Strategic Plan 1995-2000

The overall goal of the Policy is to encourage action and co-operation throughout the food and nutrition system to ensure that all Territorians have access to enough good quality food and information to improve their nutritional status and health.

The strength of the Policy lies in the 12 month consultation process that took place during its development. It involved an Aboriginal Advisory Committee, NT Nutritionists, an Intersectoral Advisory Committee and four project staff who travelled and consulted within most communities across the Territory.

The Policy represents the collective thoughts and work of many people and sets a forward direction for nutrition until the year 2000. The Policy is easy to read.

Obtain a copy of the Policy from the local Nutrition Team

The Territory Food Project

The focus of this project is to implement the NT Food and Nutrition Policy. The Food and Nutrition Unit is responsible for The Territory Food Project. It is based in Health House, Darwin.

The Unit's main activities involve:

• developing educational resources around healthy eating, lifestyle disease, consumer rights and market gardens
• developing guidelines and resources to assist communities to develop healthy store policies
• in conjunction with the NT Department of Education, implementing the 'Hands on Food' nutrition education unit in schools and developing school canteen guidelines
• identifying and developing training programs for community based nutrition workers
• developing training programs (in nutrition) for store workers
• developing tools to monitor food supply in remote communities
• investigating and working on issues which affect food supply in remote communities such as store management, transport, food storage and store infrastructure

For more information about the project, contact the Food and Nutrition Unit on 8999 2534

Community nutritionists

Community Nutritionists are based in town but work with remote communities. The main role of Community Nutritionists is to implement the NT Food and Nutrition Policy and to provide support and training to Aboriginal people in the area of nutrition.

Community Nutritionists are only able to work with a couple of communities at any one time. Some of their other tasks include:

• analysing and feeding back information about food, nutrition and related health problems to communities
• conducting, or assisting with, related needs assessments
• advocating for, and contributing to, the development of policies which support good nutrition, for example community store policies, healthy school canteens
• assisting communities and nutrition workers to develop local food and nutrition plans
• providing nutrition training, advice and support to health service providers and food service staff
• coordinating and supporting community education and awareness activities in the food and nutrition area

See the 'Contact list' in Section 2 of this chapter

Aboriginal Community Nutrition Workers

There is a small but growing number of Aboriginal Community Nutrition Workers (CNWs) in the Northern Territory. CNWs are based in their own community and are supported in their work by the Community Nutritionists. They work with their community and other members of the health team on priority areas of the NT Food and Nutrition Policy. They promote good food and nutrition in the community and facilitate community initiated action.

Some of their main activities are:

• talking to individuals and families and school children about healthy tucker
• preparing training resources
• working with food service providers to make sure healthy food choices are available (women's centre, Meals on Wheels, school canteens, the community store, takeaway)
• organising bush tucker trips with different groups
• working with people who have special needs, for example pregnant women, diabetics
• acting as representatives on the store committee
• supporting the nutrition training of other community based workers, for example aged care workers, childcare workers
• assisting with health promotion activities or theme days, for example in the community store, at the school
• helping at the health centre, for example doing growth monitoring and promotion
• organising or doing cooking demonstrations
• taking people shopping - 'healthy store food hunting'

A Nutrition Worker's Story We have done lots of things in Yuendumu community this year. We started a cooking program for the skinny kids and their families. We cooked outside the Health Centre on the BBQ and involved some of the grandmothers. When winter came, we had to stop the program because it was too cold. We asked the school council if we could use the school kitchen. Over 20 kids and their families came to the program. Families gave us $20 a week. The social club donated some pots and pans and some money. When the multi purpose building was built we cooked in there. The post primary girls helped us out during the school break. Next year we hope to have our own office and building to cook in and also to have training and education sessions for the young mothers. This will be like a dream come true for us. We have been waiting a long time. The Social Club and the Council support our program. We do scattergrams of all the kids in the community every three months with Heather. This shows us how well they and we are doing. When Heather comes out we all work together. We teach the post primary girls about good nutrition and the three food groups. We had a Three Food Groups Damper Day. All the post primary girls cooked different dampers with vegetables, nuts and fruit in them. They really enjoyed doing the cooking and also learning about nutrition. They asked us to come back. We will. Lottie Nabangardi Robertson, Community Nutrition Worker, Yuendumu, November 1995

Aboriginal Community Nutrition Worker Training Program

Until recently there has been no formal training in the NT for CNWs. Community Nutritionists provided support and worked in partnership with CNWs. Now there is a nationally accredited 'Certificate 1 in Health: Aboriginal Communities' which has a heavy focus on nutrition. This certificate course is delivered by Community Nutritionists in the community.

Growth Assessment and Action

One of the Food and Nutrition Program's main areas of work is Growth Assessment and Action (GAA). A growing child is a healthy child. Weight loss or slow growth in children is a sign that something is wrong with the child's general health. Regular growth assessment or monitoring is one of the best ways to assess the general health of a child. It also provides a worthwhile opportunity to find problems early and share information.

A priority of the Nutrition Team is to train and support new and existing health staff in the implementation of regular growth assessment and advise on appropriate action for children who are not growing well.

The 'Growth Assessment and Action Guidelines' have been developed by a group of health professionals from THS. Responsibility for implementation varies across the NT.

The Growth Assessment and Action Guidelines aim to:

• ensure that growth promotion and assessment occurs in a more coordinated way across the NT
• ensure that appropriate intervention is taken at an individual level in children who are failing to grow
• provide a mechanism for feeding back community level information to communities and Territory Health Services to assist with planning, decision making and resource allocation (THS 1998)

To meet the goals of the Guidelines:

• health centres will be provided with well maintained, standard equipment
• new and existing staff will be trained and supported to implement regular growth monitoring and growth promotion in communities
• an information system will be developed. This system will assist with monitoring individual children. Information will also be collated and fed back at the community, district, and regional level

Growth monitoring is an essential part of caring for an infant. It is important for the prevention of long term chronic disabilities such as renal disease and diabetes.

		See 'Improving the growth and development of young children from 0-3' in Section 2 of this chapter
		Contact the local GAA Team or Paediatric Liaison Nurses for copies of the Growth Assessment and Action Guidelines
		Also refer to 'Growth promotion in children' in the CARPA Standard Treatment Manual (3rd Edition)

The Strong Women, Strong Babies, Strong Culture Project

The Strong Women, Strong Babies, Strong Culture project was set up in 1992. It first began operating in three communities in the Top End. It came about as a result of many years of sharing information between dietitians, remote area nurses, Aboriginal Health Workers and other Aboriginal women in remote communities.

With strong direction and guidance from Aboriginal women both in remote communities and Darwin, the coordinator produced a Strong Women's Story. The Story interested and excited Aboriginal women and influenced them to:

• reinstate traditional ceremonies related to pregnancy and young infants
• create their own form of pictorial presentation of the project to share with other Aboriginal women
• access antenatal care much earlier than they did previously
• encourage women to eat healthy food in order to increase pregnancy weight gains

The Strong Women's Story reflects how Aboriginal women see their situation. The whole idea of antenatal care was woven into a holistic picture of women as nurturers of their culture. The Strong Women story validates and encourages women's cultural practices.

The Strong Women project is based on partnership, culture and cultural renewal. Aboriginal women have been the teachers of traditional knowledge to their non Aboriginal partners to the extent that they felt appropriate.

The success of the project lies with the Aboriginal women in remote communities who not only identified with the subject matter, but have also committed themselves to participating in, and ultimately controlling the process. (Fejo & Rae 1996)

Participation of Aboriginal women came about for a number of reasons:

• the development of a shared vision
• the opportunity to plan together and set an agenda
• the project focus was on community based rather than community oriented programs

New developments

The goals of the Strong Women, Strong Babies, Strong Culture Program have been expanded to include improving the health of children in the 0-3 year age group.

The project is now extending from the three original communities to a number of other communities in the NT. Basically the same approach will be used across the NT, but local differences will mean that not all projects will be the same, in either their design or the way they are carried out.

		For more information about the project, contact the regional SWSBSC Coordinators

About the Strong Women, Strong Babies, Strong Culture Project It got started because there was a need and concern by the community women. The women were concerned about the small babies being born, and I mean really small babies being born. They wanted to know why this was happening and what could be done about it. They had this concern and they wanted to improve the health of the little ones, because if they were born very small they would always be sick. Cheryl Rae and Dr Christine Connors put in a submission for a RESET grant for 18 months. They got that grant and the structure was that they have a nurse developing the program. But when they formed the committee of Aboriginal people, the committee said "no", we must have an elderly Aboriginal person to do it. So I was chosen for the job. Maybe I was chosen because I've got relationships and contact all throughout the Northern Territory with different tribal groups, I've got a skin name, an Aboriginal name, I can relate to their cultural way of life. What gives me the authority is that I'm an elder myself. Sure I didn't know too much about education white-man's way, but I survived. I learnt a lot. I learnt because I was determined. The Strong Women Program started with health information. There were six pictures to show the women the information on reasons why babies were small. Talk about health reasons and community's cultural reasons. When it's a new community, first start by presenting the story. We work with the nutritionist. They think about it. We also utilise health information from the community health centre. We give messages our way to people, then they give the information back to the community in their way. Give messages on health, on being strong. We talk about the fact that everything begins with the foetus, talk about smoking [tobacco], exercise, alcohol and diet. Give a plain message. We use the kit to help give the message. Strong Women Workers are not Health Workers. There is a need for jobs on communities so we get community based workers who are selected by the elders on the community. And they work in partnership with Health [THS]. Once a week they report to the Health Workers or to DMOs that go to communities, or nursing staff on what they've achieved during that time frame. They always work in partnership with the elders, Health Workers, the school, the council, and the women's resource centre. They always work together. The program has been successful and sure we have a hard time in communities, but the Strong Women Workers have really come out on top as decision makers for the communities. I'm only a figurehead there. I give the women free reign to make their own decisions. If they've got problems I don't sort it out for them, but I'm there to sit down and talk about it with them. They've got answers when they really sit down and think about it. They know how to solve their own problems. That is working in partnership. Who am I to tell them what to do? That's their community, that's their people. They speak the language and they can relay the message back to their own people in their own language, so there'll be no misunderstanding of messages being passed to them. Lorna Fejo, Coordinator, Strong Women, Strong Babies, Strong Culture,1996