In one of the Northern Territory's remotest communities, Indigenous residents are accusing the region's Aboriginal health service of failing to respond to emergencies on a regular basis.

Key points: Remote residents allege poor responses from health clinics have contributed to deaths

Remote residents allege poor responses from health clinics have contributed to deaths Indigenous health service says government funding problems have forced services rationing

Indigenous health service says government funding problems have forced services rationing The murder of a remote nurse in South Australia led to changes that contribute to staff shortages

They allege it has contributed to at least one premature death, and damaged long-term health outcomes for other patients.

The Sunrise Health Service said it was struggling to recruit enough staff to man its Indigenous community clinics in the Katherine region, and it is a problem common to many remote health organisations.

In Ngukurr, in southern Arnhem Land, the nearest hospital in Katherine is four hours' drive away.

Ngukurr teenager Shanara Roberts said she was still suffering regular abdominal pain which was stopping her playing the sports she loves, after her appendix burst two years ago.

Her Aunt Priscilla Dixon said when she first took her niece to the Ngukurr clinic, run by Sunrise Health, with abdominal pain, she was worried about the treatment offered.

"She was told to take some painkillers for the pain and told maybe the cause of it was just from her tight clothing," Ms Dixon said.

Shanara said when the pain became unbearable two weeks later, she was airlifted to Darwin Hospital.

She said her appendix burst on the way.

"I couldn't walk, stand on my feet," she said. It was painful. I was very scared."

She said it became infected, and in recent months she had to travel to Katherine Hospital for further treatment.

"I felt very upset at them. When it turned out that it was the appendix, ruptured appendix, and she was very sick, I was afraid I was going to lose her," Ms Dixon said.

Priscilla Dixon (left) said her niece Shanara Roberts (right) was told her abdominal pain may be caused by her tight clothing. ( ABC News: Jane Bardon )

Clinic could not send staff to terminally ill man

In the neighbouring community of Urapunga residents also depend on the Ngukurr clinic, because the Sunrise Health clinic is only funded to open one day a week.

Many of the 100 community members ask the Urapunga store manager Jim Williams to call the Ngukurr clinic to try to get them help.

"When we ring up for someone we get the response 'Oh we haven't got a driver. There's no-one here to operate a vehicle' or there's no-one that can see us," he said.

"Recently the clinic it was shut because of fatigue.

"Well, we can't work around fatigue, if someone's sick, someone cuts themselves, someone breaks a leg."

He said he was regularly asked by Ngukurr clinic staff to assess patients, and drive them to the clinic, neither of which he was qualified or insured to do.

"We've got a beautiful clinic but it's only open on a Wednesday, so don't get sick on Thursday," he said.

"To rectify this all I can see is that they need to man the clinic fully."

Urapunga resident Annie Daniels said her terminally ill nephew Mr Crew, died in August, after the Ngukurr clinic was unable to send help when her family called to say he could not breathe.

"We knew the doctor said that he was dying, but a little bit of help would have helped him stay longer," she said.

Her partner Richard Collins said the clinic had regularly been unable to respond to calls for help.

"When we had sick kids here all they ever talk about is Panadol, take Panadol," he said.

"They ask you questions, and the questions they ask belong to them. I mean we're not a doctor."

Annie Daniels, pictured with her partner Richard Collins, had her nephew Mr Crew die in August, after the clinic was unable to respond to calls for help. ( ABC News: Jane Bardon )

'Serious presentations treated as well as possible'

Along with the Ngukurr and Urapunga clinic, most of the Katherine region's Indigenous health centres are run by the Sunrise Health Service.

Sunrise Health would not comment on individual cases when asked for a response by the ABC, but said 13 per cent of its services were provided after hours.

"After hours requests are triaged and all assessed as serious presentations are treated as well as possible," the service said.

It said "obtaining an accurate history from the caller can be difficult" and "miscommunication" in reporting emergencies "appears to have caused tensions".

Sunrise Health said it was "developing better intercultural staff training" and was trying to recruit more Aboriginal health practitioners in the face of a national shortage.

Daphne Daniels' nephew died of a heart attack when clinic staff mistook his symptoms for dehydration. ( ABC News: Jane Bardon )

The Ngukurr clinic has been under scrutiny since 2014, when the Northern Territory coroner found that 24-year-old Ngukurr man Mr Daniels died of a heart attack because the clinic staff mistook his symptoms as dehydration.

The coroner found the clinic staff did not test his blood pressure, monitor his heart or call a doctor to get further advice.

"I felt they wasn't doing their job, according to their, you know, responsibilities," his Aunt Daphne Daniels told the ABC.

She said she used to be on the Sunrise Health Ngukurr community board before it was disbanded, and still receives regular community complaints which suggest services have not improved since her nephew's death.

"They don't have time to open the clinic after hours. They just say 'you have to take Panadol'," she said.

"Anyone who goes to a clinic, they should get proper treatment, like everybody else, whether you're black or white, or whatever."

Post-inquest improvements

Sunrise Health said since the inquest it has employed a new clinical educator, increased clinical oversight and quality assurance, developed a new after-hours procedure, and "been accredited three times (most recently in 2017) against the Royal Australian College of General Practice Standards for General Practice since 2010".

"Sunrise Health Service is committed to continuous improvements to all clinical practices and related activities and services," it said.

"Sunrise Health has adopted a systems-based approach to embed any needed improvements throughout the organisation."

Ngukurr community leader Bobby Nungamajbarr thinks there has been little change since Mr Daniels' death. ( ABC News: Jane Bardon )

Ngukurr community leader and chairman of its Yugil Mangi Aboriginal Corporation, Bobby Nungamajbarr, said he did not agree with that.

"I thought since that report it had been followed up and I thought everything was working in a good way, caring for my community, but it wasn't. It was still the same," he said.

"This death happened in Urapunga [shows] it's still was the same since the coroner's report."

Last month Mr Nungamajbarr carried the community's anger about Mr Crew's death in Urapunga, and a string of other complaints, to a meeting between Yugil Mangi Aboriginal Corporation executives and Sunrise Health representatives.

He said he was not satisfied with assurances of improvements that he said he was given by Sunrise Health.

"Now a lot of our community, they're talking about the Health Department taking over our clinic now," he said.

The Territory Government Health Minister Natasha Fyles has rejected that push from Ngukurr and Urapunga.

"We believe that Aboriginal people are best in charge of their healthcare, making the decisions, and that's why we're working with them to strengthen those services and transition more of our remote clinics to Aboriginal medical organisations," she said.

"I do understand that there's been questions raised around specific clinics and those organisations have my full support."

Children in Urapunga at times depend on the remote health clinics. ( ABC News: Jane Bardon )

National recruitment challenges

The Sunrise Health Service said "the recruitment and retention of mainly remote area nurses" and drivers "is one of the biggest challenges facing organisations such as Sunrise Health Service".

"We are exploring a number of options that may improve recruitment and retention … we are currently assessing the Pintubi Homelands model — four weeks on, four weeks off," it said.

"This model appears costly, but has resulted in high staff retention."

Sunrise Health said as well as facing punishing workloads dealing with late night domestic and alcohol-fuelled violence in some communities, its staff were suffering burnout because of personal attacks, sometimes in their accommodation.

It said a lack of staff accommodation in remote communities was "also a limiting factor in Sunrise Health Service's capacity to provide sufficient services to match needs".

The health service said inadequate federal funding forced it "to ration resources".

"The recent murder of a remote area nurse at a solo health post in South Australia has resulted in Gayle's Law — all after hours call-outs now require two persons," Sunrise Health said.

"The new practice has significantly added to on-call and overtime costs … this is not reflected in the funding forumulae."

Richard Collins and Annie Daniels' daughter Devina Collins is studying medicine at Bachelor College near Darwin. ( ABC News: Jane Bardon )

Indigenous health services from across Australia told the Federal Indigenous Health Minister Ken Wyatt in Alice Springs in August there was a national staffing and funding crisis.

Aboriginal Medical Services Alliance NT (AMSANT) chief executive John Paterson said he did not think transferring Indigenous health services back to governments would solve any problems.

"I think it's about us advocating strongly to get the required amount of resourcing that's required to deliver services to some of those remote and harsh areas," he said.

Mr Wyatt told the ABC at the Council of Australian Governments meeting in Alice Springs, federal, state and territory governments "agreed to the immediate preparation of a national Indigenous health workforce plan to increase the number of Aboriginal doctors, nurses and health workers, especially on country".

"This plan is being taken forward through the COAG process and we can expect further announcements in coming months," he added.

Mr Paterson is staying hopeful "we will be able to identify all of those gaps and persuade governments to fill those gaps".

He said long-term, one of the best ways communities would be able to ensure the gaps were filled was by encouraging young people to train as health professionals who were committed to, and would remain working in their communities.

Mr Collins and Ms Daniels' daughter Devina Collins is doing just that, studying medicine at Bachelor College near Darwin.