CARPA Publications
 
The artwork is by Aboriginal artist Tjamtitjinpa Nolan. It tells the story of some women who are ill due to the loss of their 'souls' (kurrunpa). They are being healed by Ngangkaris (traditional healers) who are restoring their 'souls'.
Introduction to the Standard Treatment Manual (STM)

The STM has been one of CARPA's main activities, it has an established role as:
- a population health approach to primary care in remote and Indigenous Central Australia
- a resource for most appropriate clinical practice
- a guide for practitioner training programs
- a tool for standardising practice across the range of service providers
- a tool for updating 'best practice'
- reassurance and checklist for experienced remote practitioners.
The concept is that the manual will be constantly reviewed, and this process relies on feedback to the STM editorial committee.
Remote primary health care practice has evolved in recent decades, and so too have the demands and expectations of those providing clinical services. There is a greater recognition of the public health aspects of clinical management, more proactive health care and a strong push for evidence based practice. The STM has also evolved, partly in response to these changes and partly as a leader and agent of change.

Many practitioners arrive in Central and Northern Australia without any specific relevant training for remote practice. The STM helps them to cope with a range of health, social and work conditions that for many are a great shock.

The STM has a very strong reputation among its users, and further afield, as an outstanding tool to support evidence based practice. An evaluation of the 3rd edition in 2001 found that it was being used in every remote health centre in the Northern Territory. There is also strong support and use of the STM in other states of Australia.
The style of the STM has been essentially preserved in the 4th edition, the evaluation of the 3rd edition having supported the continued use of:
· One manual for Aboriginal health workers, nurses and doctors
· Simple language, without critical compromise in the content
· Brief, easy-to-read cookbook style
· Focus on what will make a difference to clinical practice and health outcomes
· A process of producing a manual by the users for the users

The 4th edition now has more than 100 topics, with expanded sections on mental health, chronic diseases and some additional general practice topics. The focus is on what to do, with previous detail on how to do it being replaced with references to the CRANA Clinical Procedures Manual for Remote and Rural Practice.

The CARPA STM does not stand alone, and does not claim to be comprehensive. It covers conditions that:
· are common in remote practice
· have different presentations and management issues to those in 'mainstream' practice
· are dangerous or are frightening to practitioners
· have important public health considerations
· need coordinated, standardised care

Women's health issues are dealt with separately in the Women's Business Manual, which covers obstetrics, gynaecology, well women's screening, menopause, infertility and contraception.
It remains crucial to safe practice for any practitioner who is unsure of what they are dealing with to talk to someone more experienced or skilled. Thankfully this is easier to do now in the days of telephones rather than radio.

The STM should be used in conjunction with:
· The CARPA Manual Reference Book
· The Women's Business Manual (Congress Alukura and Nganampa Health Council)
· The Public Health Bush Books (Northern Territory Department of Health and Community Services - NTDHCS)
· The Clinical Procedures Manual for Remote Area Practice (Council of Remote Area Nurses of Australia)
· Local Centre for Disease Control Guidelines (where relevant)
· The Australian Immunisation Handbook
· The Australian Medicines Handbook or abbreviated version for Aboriginal health workers, due for publication in 2003.

The Process of making the manual

Feedback on the 3rd edition has been collected since its publication. This was augmented by the Territory-wide evaluation undertaken in 2001. The most significant change has been the equal and active involvement of both Central Australia and the Top End in all aspects of the manual's development, making it truly a manual for both regions.

Recognition of a particular need to expand and develop the mental health topics came out of the expressed needs of remote practitioners. These protocols were developed in a related research project carried out by the Centre for Remote Health. In recent years the importance and management of preventable chronic diseases has been given greater emphasis. Screening and management guidelines developed by the NTDHCS were in use in the Top End, but less so elsewhere, so these were revised and incorporated into this STM edition.
The manual is written and developed by the users: remote practitioners, for the users. It results from a process of reviewing all existing protocols and then developing new ones in conjunction with recognised Australian authorities, current evidence, expert advice and practice wisdom on specific topics. This represents best practice for the common presenting problems in remote areas of Australia.

The latest edition, the 4th edition follows the success of the first, second and third editions. It is fully revised as a result of extensive evaluation and supersedes previous editions. As with the 3rd edition the content includes tropical northern Australia.

In this edition the task for authors included revision of the current protocol, preparing a detailed reference document describing the background and rationale for the revised or newly developed protocols, which is to be published as a separate companion book (the CARPA Manual Reference Book). Combined with the push for a stronger evidence base for the content of the protocols, this led to more of the primary authors being specialists than has previously been the case.

To maintain the philosophy of the STM being written 'by the users for the users', great efforts were made to ensure that each topic was reviewed by both technical experts and a number of remote practitioners (users). The practicality and acceptability of the protocols was kept at the forefront in the editing process. This extensive review and editing process means that the final authorship of each topic cannot be attributed to a particular person.

Sponsorship

The vast bulk of the time and effort required to produce the STM is donated by the hundreds of contributors. These people, from all over Australia, donate their time and expertise in recognition of the valuable contribution the STM makes to rural and remote practice in Central and Northern Australia.
Funding for coordination, editing and initial printing came from the Commonwealth Department of Health and Aging, Office of Aboriginal and Torres Strait Islander Health, and the Northern Territory Department of Health and Community Services. Additional in-kind support was also given by the Central Australian Aboriginal Congress, Central Australian Division of Primary Health Care, the Centre for Remote Health and the Northern Territory Department of Health and Community Services. Contributions have been made by practitioners from all health services in the Northern Territory and from a number of services in Western Australia, South Australia and Queensland.

The users of the STM

The STM is intended for use by trained health professionals including Aboriginal health workers, nurses and doctors. It is not intended as a layperson's manual. It is primarily intended to be used in remote Indigenous communities, rural and urban Aboriginal health services and for non-Indigenous people living in these communities.
We have continued to try to make the manual as easy to use for everyone in remote areas with illustrations and simple English where possible.


Editor: Dan Ewald
Editorial committee: Christine Connors, Cecelia Cuttler, Michelle Evison-Rose, Marea Fittock, Michael Howard, Sabina Knight (chair), Rosemary Lee, Simon Morgan, Steven Skov, Peter Tait, John Wakerman.

Special thanks to: Marcus Tabart, Naz Remtulla (project officer for mental health topics), Bart Currie, Andrew White, David Brewster, Ilan Warchivker, Nick Williams, Alex Hope (practitioner proofreading).

More detailed information regarding the manual and how it be purchased can be accessed via the menu at the top of this page.