7th National Aboriginal and Torres Strait Islander Environmental Health Conference Kalgoorlie, WA
Building Environmental Health through Community Partnership
Chicky Clements & Louie Bin Maarus, Nirrumbuk Aboriginal Corporation, WA
Kullari Regional Environmental Health Services is a program of Nirrumbuk Aboriginal Corporation, funded by contract, through the Office of Aboriginal Health. Nirrumbuk Aboriginal Corporation is an Indigenous owned, non-government organisation that has experienced a high level of success in the delivery of services to discrete Aboriginal communities. This in part, can be attributed to the Indigenous membership of the organisation and the organisational philosophy which maintains social inclusion, cultural relevance and appropriateness.
The organisation utilises a similar structure to local government, where corporate governance is established with the Committee members who ensure that the organisations vision and primary decision-making evolves, to remain relevant and in-line with current community needs and concerns. The Directorship (predominantly local Aboriginal Australians) have understanding and involvement with community and cultural life and are able to exercise appropriate, flexible management of arising issues for the organisation and its employees, as well as sustain relevant and practical on-the-ground management of day to day work concerns.
In keeping with the Aboriginal and Torres Strait Islander Health Performance Framework Measure 3.09 Aboriginal and Torres Strait Islander Australians in the health work force, the majority of Nirrumbuk and Kullari Regional Environmental Health Services employees are Aboriginal (this is at all levels of employment, including the directorship and upper management). Indigenous employment is a priority for the organisation, as is employee professional development and career progression.
The Environmental Health Team is comprised of:
- Managing Director Environmental Health and Municipal Services
- Finance and Administration Manager (non-Indigenous) 0.5 FTE
- Supervisor Aboriginal Environmental Health (as part of regional team)
- Six Aboriginal Environmental Health Workers (AEHW ), including two roving regional team members and four community-based AEHW
- Environmental Health Officer, Aboriginal Communities (non-Indigenous)
- Environmental Health Trainer and Educator.
- Staff retention is increased
- environmental health workers report an ability to give greater focus on the specific job role (with fewer diversions)
- increased ease of resourcing e.g. major equipment ad materials are now shared between communities and retained solely for environmental health purposes
- Environmental Health staff are freely available to support each other as the positions are no longer isolated or confined to the one community
- mentoring between staff – each member has a different background, sharing knowledge and experience
- ability to travel and learn from experiences in neighbouring communities
- increased collaboration and ability to work together on designated projects
- greater variety of tasks, in line with training and exposure to the environmental health field
- same standard of service is delivered across the region
- an ability to tailor program projects to individual community needs (offering flexibility and variation)
- one system of management and financing
- ease of reporting
- ability to achieve a continuous presence in the region, through combination of community-based environmental health workers, a regional crew and roving staff of Environmental Health Officer, Educator and Management.
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The Kullari Regional Environmental Health Services management have undertaken and completed the Environmental Health certificates along side the other members of the team. This was a measure to ensure management has a sound understanding of the funded program, expectations of employees and the environmental health field. The outcome is that management are appropriate and capable support personnel for their team. In addition, the majority of the accredited training provided has given specific relevance and attention to Aboriginal and Torres Strait Islander needs, resulting in a workforce well equipped to address the needs of discrete Aboriginal communities. Both outcomes are in line with the Aboriginal and Torres Strait Islander Health Performance Framework Measure 3.13 Accreditation.
Further to the Measure 3.13 Accreditation, on-going qualification is fully supported by the organisation. An example is the Environmental Health Educator’s career pathway which started as Environmental Health Field Support Officer, progressed to Environmental Health Trainer and is currently completing the Degree (Bachelor of Applied Science in Environmental Health). This will see the region have an Aboriginal Environmental Health Officer, able to be gazetted and authorised under legislation to investigate health issues (e.g. such as an outbreak of communicable disease). Within this field there is currently under-representation of Aboriginal and Torres Strait Islander Australians (reference Aboriginal and Torres Strait Islander Health Performance Framework Measure 3.14 Aboriginal and Torres Strait Islander peoples training for health related disciplines). Any team member who wishes to further their career, expand their knowledge and expertise is encouraged to investigate and undertake the required study.
The Aboriginal and Torres Strait Island Health Performance Framework 2006 Report references a customer satisfaction survey which “found that the presence of an Aboriginal and Torres Strait Islander doctor at a community health centres was a main reason that Indigenous Australians attended the clinic (Hayman 1998)” and that “Patients report that an Indigenous doctor was “more understanding of their needs”. Similarly, a large proportion of the opportunities, partnership projects and successful outcomes experienced by Kullari Regional Environmental Health Services can be attributed to the reflection of the local demographic in the organisations staffing. This assists the Environmental Health Services in maintaining a direct link with the Aboriginal and Torres Strait Islander Australians accessing the service, and in maintaining up-to-date knowledge of the community issues and concerns. With the majority of employees being local community members or with strong familial links to community, Kullari Regional Environmental Health Services is highly approachable and accessible in its service. The recent employment of a female team member has increased access to the service for some of the sensitive environmental health concerns, particularly for community women. Although a non-indigenous employee, this has been partially overcome by being a community- based position, which has significantly improved community links, accessibility and the responsiveness of the position. This difference is pronounced when compared to the more traditional basing of Environmental Health Officer for Aboriginal Communities in near- by major town centres.
The employment of local people has had associated benefits through increasing participation and access by the target groups. This can partially be attributed to the ability to use appropriate communication, the inherent knowledge of timing, who to speak to, when to seek information, the right questions to ask and when to take action and how. Through the innate existing knowledge of community and ability to access people and places, mis- understandings are significantly reduced. This basic knowledge and ability has instilled a heightened sense of community confidence in the service. It has also contributed to the ability of Kullari Regional Environmental Health Services to efficiently deliver outcomes, within reasonable time frames. This is particularly relevant when compared to time frames and outcomes of non-local, non- Indigenous organisations who have of necessity to invest greater resources into consultation and investigation, in order to ensure service delivery adequately meets the needs of the target group.
The Nirrumbuk Aboriginal Corporation and Kullari Regional Environmental Health Services model has seen significant success in delivering basic environmental health services, on a minimum budget. As highlighted in the Aboriginal and Torres Strait Island Health Performance Framework 2006 Report (Health System Performance Measure 3.15 Expenditure on Aboriginal and Torres Strait Islander health compared to need) there remains outstanding need in the regions discrete Aboriginal communities, and overall current health expenditure per Aboriginal and Torres Strait Islander person is not sufficient to match need. This is the case in primary health care, as well as within the environmental health field incorporating housing, utilities and infrastructure. With increased appropriate funding and expenditure environmental health programs such as Kullari Regional Environmental Health Services would be better equipped to expand their preventative health model and make significant impact on health status and outcomes for their service communities.
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Case Study – A Holistic Approach: Community Partnership with Djarindjin Aboriginal CorporationThe Aboriginal and Torres Strait Islander Health Performance Framework establishes key measures of health for the Aboriginal and Torres Strait Islander people of Australia. The report documents the importance of each measure, tables findings and provides discussion of the finding implications.
A number of the Frameworks Measures of Health, (including health conditions and status e.g. reasons for hospitalisation, acute rheumatic fever, rheumatic heart disease, end stage renal disease, children’s hearing loss; life expectancy and wellbeing; and deaths), show a significant and re-occurring link to the quality of environment and living conditions experienced by many Aboriginal and Torres Strait Islander communities. Referenced throughout the document is the disparity between basic environmental health standards observed by Australia as a complete nation, and that of discrete Aboriginal and Torres Strait Islander communities. Infection and communicable disease are consistently reported at a higher rate for Aboriginal and Torres Strait Islander Australians, and the key finding given is the difference between environment, housing and living conditions.
The relationship between environmental health and health status (and outcomes) has been formalized by the Report under the Frameworks Tier 2: Determinants of Health. Environmental Factors referenced as Health Performance Framework Measures are 2.01 Access to functional housing with utilities and 2.02 Overcrowding in the house. Discussed as part of these measures are basic environmental health standards such as access to potable water, functional sewage systems, appropriate and functioning housing and the established nine Healthy Living Practices:
- Washing people
- Washing clothing and bedding
- Removing waste safely
- Improving nutrition: the ability to store prepare and cook food
- Reducing crowding and the potential for the spread of infectious disease
- Reducing negative contact between people and animals, vermin or insects
- Reducing the negative impact of dust
- Controlling the temperature of the living environment
- Reducing trauma (or minor injury) around the house and living environment.
Kullari Regional Environmental Health Services, a funded program division of Nirrumbuk Aboriginal Corporation, has developed a close working relationship with the Djarindjin Community. This informal partnership has made steps to overcome the difficult reality of “no one organization, level of government or sector [holding] responsibility for environmental health” (Aboriginal and Torres Strait Islander Health Performance Framework 2006 Report). Just as “the strategy seeks to streamline government responsibilities and better coordinate all parties” (Aboriginal and Torres Strait Islander Health Performance Framework 2006 Report: Determinants of Health, Environmental Factors), the relationship developed between the Djarindjin Community, it’s governing body and Kullari Regional Environmental Health Services has seen the open flow of information and discussion increase, with a strong core of trust. The result has been the inception of and collaboration on a number of environmental and living condition projects, with the outcome of significantly improved environmental health for the community as
Djarindjin Community and the governing body, Djarindjin Aboriginal Corporation, initially worked with Nirrumbuk and Kullari Regional Environmental Health Services to establish a ‘Health and Housing’ project. This project was education-based and supported through one-off funding from the Office of Aboriginal Health. The project was developed with key input from the community’s Housing Officers and Nirrumbuk’s Environmental Health Educator. A series of environmental health and ‘health hardware for housing’ education sessions were delivered on community for community members.
The Community Housing Officers advocated for at least one resident per house to attend (preferably the primary tenant), with the main focus being how to maintain functioning health hardware in the home. Links between environment, living conditions, healthy homes and personal/community health were included in the training. The relevance of maintaining housing and infrastructure was highlighted in terms of health, and information was partnered with the respective roles and responsibilities defined by tenancy agreements.
The Health and Housing Education progressed to raise community awareness of local health, environment and living conditions. This increased awareness triggered further collaboration between the two organizations, with the Community Council committing finance and Kullari Regional Environmental Health providing in- kind support for a number of projects, resulting in significant improvements to environment and living conditions. These projects are summarised below.
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Kullari Regional Environmental Health was invited to partner with the community’s existing Tidy Town program in order to further raise awareness of the importance of dog health. This included newsletter articles, a more detailed focus in the Health and Housing education program, posters, and a Gorrna Illa competition. Dog spaying was conducted over two days, with the support of the Environmental Health Team. The Community Council covered the veterinary fee, and utilized the spaying program as a component in the introduction of a two-dog per house policy. This project and partner projects are detailed below in the following case study.
As an extension of the Tidy Town collaboration, Kullari Regional Environmental Health assisted with the design and construction of ‘dog-proof’ community bins and re-modelling a recreational shed into a breeze-way, creating a shady and sheltered community meeting place.
Creating a cool & shaded community meeting place
Community confidence in the Environmental Health Team increased with our strong, on the ground presence and through the successful implementation of short projects, providing practical outcomes, and tangible benefits for community members. With confidence and new depth of environmental health knowledge three major projects were developed, all having potential to positively to impact on health status of Djarindjin community members. These projects were investigating waste management and recycling options, pest management for housing and the community road upgrade.
Djarindjin is located off of the Cape Leveque Road, two hundred kilometres north of Broome. Adjacent to the ocean, and separated from the beach by sand dunes, the community roads were mostly deep sand and difficult to negotiate – for cars and people alike. This created access difficulty for the community members in every day tasks; such as getting to the school, the office, the shop or the clinic. Dust could also be a problem, with fine sand thrown up by vehicles and wind. In partnership with the Djarindjin Aboriginal Corporation and on a cost recovery basis, Kullari Regional Environmental Health Services completed road works to create a solid road base (by removing sand and replacing with compacted pindan and gravel).
Trying out the new road!
The result of this project has been a marked decrease in dust and an increase in ease of access throughout the community. One of the most visible results and constant reminder of improvement has been the use of the new road by parents with prams and the community kids. The children have been able to move their bike, scooter and skateboard riding out from the house veranda and into the community – smiles all round!
Djarindjin Traditional Owners, CEO and Kullari Regional Environmental Health
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The Community has had a focus of improving their living environment for some time; this can be seen through their ongoing commitment to the Tidy Towns project, the openness to environmental health initiatives and the use of existing momentum to take action. In many communities, one of the main obstacles to improving environment and living conditions is the access to resources – often this is in the form of complete funding and access to appropriate expertise. Through the links between environmental health and waste, and Kullari Regional Environmental Health Services and the Djarindjin Aboriginal Corporation’s respective roles in waste management, options for improving waste management and implementing recycling were investigated.
Kullari Regional Environmental Health Services had provided feedback to the Shire of Broome on the needs of the regions discrete Aboriginal communities. As part of the Shires tender and contract process for metal recycling in the area. This consultation process has led to a new contract and service provider, which will now see metal recyclers access the Dampier Peninsula and the local discrete Aboriginal communities. The Environmental Health Team introduced the new service provider (CMA Recycling) to the area and to the Djarindjin community, and facilitated discussions for metal recycling options - from tin cans to building and construction waste, through to the breakdown of car parts and car crushing. The project evolved and the partnership expanded to include an on-site induction to recycling for the Community Waste Management Worker (on-site at CMA Recycling in Port Hedland) and Kullari Regional Environmental Health Services transporting tin cans and/or similar metal via backload to Broome, in an effort to see the recycling effort remain economically viable. Recycling bales are now placed through out the community, and with continued promotion and program success the load of waste to landfill should be significantly reduced overall. This project will continue to develop, with the benefits being a reduction of loose waste in the community, less litter to be scavenged by animals, a reduction in flies, an increased awareness of waste and recycling, an increase in life of landfill (with the associated environmental benefits) and an overall increase in community pride. A recent outcome of this project was the community’s success in winning the Tidy Town Regional Award for Waste Management and Recycling. Waste management processes are a key community and housing service that assists in improving hygiene, environment and living conditions. This in turn, becomes a preventative health measure contributing towards reducing the burden of infectious disease.
The partnership between the Djarindjin Housing Office and Kullari Regional Environmental Health Services has recently progressed to include pest management for the community homes. The Djarindjin community are financing pesticide and basic equipment to target cockroaches and Singapore ants (which attack both food items, plastic and wiring in the home), and the pesticide-trained Environmental Health staff are applying the treatments. Pre- application information has been provided to each household detailing how to prepare for the treatment, as well as non-chemical measures to prevent both pests. The Environmental Health Workers are utilising the opportunity to provide informal education, face to face, on the best practice to discourage cockroaches and ants from the house.
Treating houses for cockroaches and ants
Due to the ongoing presence of Kullari Regional Environmental Health within the area and increase in profile, the service was able to provide assistance to the Department of Housing and Works and their contractor as part of an emergency response to loss of water for the community outstation, Ngamakoon. The community had been without access to water and carting drinking water from Djarindjin for a number of weeks. While the Department of Housing and Works had organized access to a neighbouring bore, due to the remote location and lack of easy access to appropriate equipment and machinery, the Environmental Health Team provided assistance to the contractor by clearing a track to lay the new water line. While the community has experienced on-going water related issues for an extended period of time, the impact of assistance from Kullari Regional Environmental Health was that on approval of new water supply by Department of Housing & Works, the outstation was able to have access to water, prior to the weekend and at a time of increased population – restoring access to functional housing and the associated water utility.
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Kullari Regional Environmental Health Services has been able to make a positive impact on the environment and living conditions, with the partnership of the Djarindjin Community. Although there is no statistical data to correlate the project outcomes directly with the Aboriginal and Torres Strait Islander Health Performance Framework, it is reasonable to expect to see a continuation in the improvement of community health (through improvements to the living environment) and a decrease in associated infection and infectious disease, with positive impact on health status and outcomes.
The evolution of environmental health at Djarindjin is largely due to the partnership between Kullari Regional Environmental Health with Housing Officers and the initial impact of Health and Housing education; an increase in confidence and community awareness through short and tangible projects; and a continued on-the-ground presence. The environmental health improvements and completed projects were possible through the Djarindjin community’s willingness to commit and the Environmental Health Teams ability to support the community with appropriate resources, including equipment, machinery and expertise.
An additional outcome has been the communities increased willingness to approach the different members of the Environmental Health Team with their health concerns, examples have included advice for hygiene and odour concerns in the community members own home; wastewater overflows in the house; tackling children’s sickness; and talking to Elders about living with lots of dogs.
The partnership is looking forward to new challenges and projects, with the aim of further improving environmental health within the region.
Case Study Healthy Dog Program for Indigenous CommunitiesThe Aboriginal and Torres Strait Islander Health Performance Framework documents measures of performance against health status and outcomes, the determinants of health and health system performance. The relationship between health, housing and hygiene are consistently incorporated as relevant to health status and outcomes. Living conditions and environment are documented as key elements in the determinants of health. One of the nine Healthy Living Practices, referenced under the Health Performance Framework Measure ‘2.01 Access to functional housing with utilities’ is ‘reducing negative contact between people and animals, vermin or insects’.
For a number of years Kullari Regional Environmental Health Services has implemented a dog health and population control program for the regions discrete Aboriginal communities. This program has been included in the routine environmental health services in recognition of the impact of community dog populations on community health. While dogs have a strong and positive role in community life, dog populations can also negatively impact on community health. With large dog populations there is an increase in camp dogs (with no singular owner), a reduction in food availability, increase in dog fights and noise, a proportion of ‘cheeky’ dogs and dog bites, and an increase bin and rubbish tip scavenging.
Through studies conducted by Murdoch University and the University of Sydney, it has been demonstrated that dogs including companion dogs, carry a number of zoonotic diseases. Examples include giardia, cryptosporidium, salmonella and worms (e.g. hookworm, roundworm, tapeworm). Dog populations particularly unhealthy dogs and those living in close quarters with humans, have been attributed to spread of skin infections. This is due to the introduction of skin lesions on humans from scabies, flea and tick bites (and the associated scratching) and as carriers of the bacteria streptococcus. The impact of bacterial skin infection for Aboriginal and Torres Strait Islander communities is referenced throughout the Health Status and Outcomes detailed in the Report against Aboriginal and Torres Strait Islander Health Performance Framework Measures (e.g. including reasons for hospitalisation, acute rheumatic fever and rheumatic heart disease, end stage renal disease, children’s hearing loss).
The community and environmental health impacts of large and unhealthy dog populations was incorporated in a community- based Housing and Health education project, delivered by Kullari Regional Environmental Health Services. The education project was developed in collaboration with the Djarindjin Community Housing Officers, and aimed to raise community and housing tenant awareness of the link between housing, personal and community health, and the respective roles and responsibilities of both Housing Office and the tenant. The Community Housing Officer advocated for at least one person per house attend the education sessions, with preference for the primary tenant. The community members and the Housing Officers gained an increased awareness and knowledge of the link between health and living conditions, which led to the decision to improve the community management of dog health and population.
The Housing Officers consulted with Kullari Regional Environmental Health Services to establish an action plan to address the community concerns. Initially dog health articles were included in community newsletter and Djarindjin’s Gorrna Illa (Deadly Dog) Competition was held as part of the monthly Tidy Town Awards. The Environmental Health Team judged entrants on dog health, including a lack of mange (scabies), lack of infected sores and ticks, a healthy weight with shiny coat, and a friendly temperament that listens to their owner (i.e. comes when called). Gorrna Illa Prizes were presented at the monthly community barbeque, along with other Tidy Town awards.
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As interest in dog health and population control measures grew, Djarindjin Community Council passed that the housing tenancy agreement would include a two dog per house policy. It was agreed that at policy commencement, a ‘grandfather clause’ for owners with more than two dogs could register all their dogs, but could not increase their dog numbers with ‘new’ companion animals and over time, could not replace any dogs beyond the ‘two dogs per house’ maximum. The Housing Officer gathered data including house number, tenant, number of dogs, sex of dog and whether the owner wanted any dogs euthanased or spayed.
Kullari Regional Environmental Health Services organised a dog spaying program with the local Broome Veterinary Hospital. In recognition of the community-based trial, Broome Veterinary Hospital agreed to subsidise their fees and charges, and bill based on a daily rate. The Environmental Health Team provided in-kind and resource support (e.g. providing transport and accommodation for veterinary staff, while the community covered the two day veterinary fee). The community’s municipal service shed was converted into a surgical studio by the Environmental Health Team and Veterinary Staff. This included building temporary pre-operation and post-operation observation cages, setting up a sterilising unit, ensuring the operating table was well equipped and had enough light for procedures and potable water for cleaning.
On the day, the environmental health workers & the rest of the Kullari team were actively involved in the process. This included collection and return of dogs, assisting with preparation of animals for operation, giving post operation care to animals, cleaning and sterilising surgical equipment, and explaining post-operation home care instructions to owners. Throughout the two days, the local radio announcer for BRACs broadcast reminder messages to the community about the dog de-sexing and micro-chipping, encouraging people to make use of the service. The combined effort of the community, Djarindjin Housing Officers, Broome Veterinary Hospital and Kullari Regional Environmental Health Team lead to a highly successful project with positive outcomes.
The dog spaying program was held over two days, resulting in eighteen female spays and two male spays. The community had elected to give priority to female sterilisation, in the interests of reducing the number of litters born and the dog population over time. Based on veterinary projection, this de-sexing program has prevented the potential for a hundred and eighty (180) puppies being born annually (i.e. this is based on a female dog having an average litter of five puppies, twice per year). The reduction in the community dog numbers has the potential to result in a healthier dog population (through greater access to food, reduced dog fights, ease of administering routine healthy dog program to capture entire dog population). When coupled with the existing healthy dog program and treatment, there is a marked reduction in the potential for transmission of zoonotic disease within the community.
The dog micro-chipping component of the project was conducted by Kullari Regional Environmental Health Services, with the assistance of the Djarindjin Housing Office. A total of fifty-six (56) companion dogs were micro-chipped. Micro-chip information has been stored on a local database (for ease of access and use for the environmental health team and Djarindjin community) and registered against the national database. This process is to assist the Djarindjin Community Office, and Housing Officers to monitor the dog population against their Tenancy Agreements and the two-dog per house policy.
Part of the success of the program can be attributed to the community’s confidence in the Kullari Environmental Health Team. The discussion in the Aboriginal and Torres Strait Islander Health Performance Framework (Health System Performance Measure 3.09 Aboriginal and Torres Strait Islander Australians in the health workforce), references the inherent community trust born from employing Aboriginal and Torres Strait Islander Australians in the health workforce. All Environmental Health Workers, the Environmental Health Educator and the Director/Manager of Environmental Health Services are local Aboriginal people, who have lived and worked in the region for many years and hold a strong connection with the community. Utilising local knowledge, existing relationships and the inherent community confidence led to an engaged community and allowed the expansion of the dog health program to run smoothly, with no major hurdles arising.
As a result of the success of the dog health education, dog spay and micro-chipping program the Djarindjin community has decided to continue with Djarindjin’s Gorrna Illa Program. This will include on-going education through school projects, raising community awareness (utilizing newsletters, the Tidy Town projects and local BRACs radio) and a continuation of the dog spay days (on an annual basis).
The on-flow affect of Djarindjin’s Gorrna Illa Program, has been the neighbouring communities up-take of the project. Ardyaloon (One Arm Point) recently held a two-day dog spay program with the Environmental Health Team and Broome Veterinary Hospital, with similar statistical results (13 female and 7 male dogs de- sexed). Beagle Bay Community has referred to their Steering Committee and Reference Group for funding support. Similarly the Bidyadanga community has recently embarked on a three year research program (which includes dog spaying) partnering with AMRRIC, University of Sydney, Kullari Regional Environmental Health Services and Broome Veterinary Hospital to investigate the link between dog health and infectious disease, with the project including a dog spaying component.
This case study show cases a highly accessible service, which was developed through response to community need. The project has now expanded to be part of the continuous or cyclic program undertaken by Kullari Regional Environmental Health Services and the communities which continue to support the program. Many environmental health projects such as this are directly linked to primary health (status and outcomes). Utilising responsive consultation during project development, this project and others similar to it, address community health concerns in an effective and appropriate manner, and with minimal expenditure. The program demonstrates a sustainable preventative measure to improve the overall health of Aboriginal and Torres Strait Islander Australians.
For more informationChicky Clements Environmental Health Officer
Nirrumbuk Aboriginal Corporation
PO Box 1678, Broome, WA 6725
Ph: 08 9193 7100