NEWSLETTER OF THE NATIONAL RURAL HEALTH ALLIANCE Alva … · 2011. 7. 12. · Not on my own: part...

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N E W S L E T T E R O F T H E N A T I O N A L R U R A L H E A L T H A L L I A N C E

Alva Springs into Alice

8 T H C O N F E R E N C E

Alva Courtis and Moya Sandow enjoy golfin Alice

◗ JUST OFF THE PLANE FROMholidaying in Sri Lanka, Alva Courtisarrived in Alice Springs for the8th National Rural Health Conferenceready to discuss rural health issues, renewacquaintances – and enjoy the activitiesof The Red Centre. Between conferencesessions, 86-year old Alva wasted no timeenjoying a round of golf, a sunset camelride and dancing the night away to theWarren Williams Band at theconference dinner.

In a nursing career spanning more thansixty years, Alva, from Esperance WA, hasexperience that health students, educatorsand policy makers can only imagine,including as an army nurse during theDarwin air raids, caring for returnedprisoners of war from Changi and asa midwife and child health nurse in rural Victoria and Western Australia.

Further to these remarkable achievements,and while maintaining a three thousandacre farm, Alva continues to advocate forthe improvement of health services inEsperance and the surroundingcommunities. One of her

accomplishments is successfullyadvocating for the first nursing homein the Esperance area.

Alva is currently a member of the HealthConsumers Council of WA anda committee member of HealthConsumers of Rural and Remote Australia(HCRRA). Alva also finds time oncea month to assist the Legal Aid Office indetermining eligibility for legal aid.

Speaking from a wealth of experience,Alva’s advice to all health students andprofessionals is to find the opportunity

to serve a community in rural Australia,and take it.

“I strongly recommend that all healthstudents and professionals considerworking in regional and remote Australia atsome stage during their career,” Alva said.

Alva said she was delighted to attend theconference and exchange ideas on theimprovement of rural and remote health.

“The conference rejuvenates my mind andambitions for the region. It’s greatmeeting people who have similar goals fortheir communities,” she said. ❖

By special Conference correspondent, Lindsay Peak

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in this issue:◗ 8th Conference

◗ Budget brief

◗ Remote and rural cancer

◗ Men's health

◗ International links

NUMBER 22, MAY 2005

EDITORIAL >>>>>>>>>>>>>>>>>>>>>>>

◗ HEALTH REFORM IS IN THE AIR.The first thing to say is that it is anopportunity, not a crisis. We havea generally good health system but itcould be even better. Some of thedeficiencies are caused by fault-lines:between Commonwealth and State,between acute and aged care, home andinstitution, and between professions.

These result in poor continuity of care,cost- and blame-shifting, and a ‘failureto thrive’ of the multi-disciplinary

workforce. Other deficiencies arecaused by funding shortfalls

(eg waiting lists) and imperfectsafety and quality systems (wehave alarming evidence of“the paradox of unintendedconsequences” in our hospitals

and aged care facilities).

A number of inquiries, formal andinformal, have brought “health reform” tothe surface, encouraged by some seniorthrow-away lines and kite-flying.Medicare was reviewed and altered andremains very much in the news. Despite

the protestations of our leaders (some of

which may even be core protestations),

many people are deeply suspicious about

what is intended for Medicare in future.

Both the House of Reps and the Senate

have current inquiries on aspects of the

health system. The Australian Healthcare

Reform Alliance and others are trying to

work with governments on “jurisdictional

inefficiencies”.

The Productivity Commission is the latest

body to focus on the health workforce.

This bastion of economic rectitude has

identified the health sector as one needing

to change, both to be ready for the future

and because it can be significantly more

cost-effective:

Health care is therefore a prime

candidate for a nationally coordinated

reform approach under the auspices of

CoAG or another national leadership

body … there is little agreement evident

across jurisdictions about the best way

forward. A circuit breaker is needed.

Those interested in the rationale forhealth care reform and the way forwardshould read pages 325-334 of theProductivity Commission’s Review ofNational Competition Policy Reforms:

… a precondition for significant reformis the willingness of governmentscollectively to address the serviceinterface and funding issues thatcurrently plague Australian health carearrangements.

Another precondition is to involve thepublic in the debate – to have what hasbeen called The Big Conversation onhealth. The 8th Conference in AliceSprings revealed much about what isright and wrong with the health systemin remote and rural areas. But we needstill more open debate. This should bethe start of something big for theconsumers of health services – and thatmeans all of us. ❖

Reflections on health reform

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Editorial detailsPARTYline is the Newsletter of the National Rural Health Alliance, the peak body working to improve health and well-being in rural and remote Australia. The Editorial Group for this PARTYline was Lexia Smallwood (Editor), Gordon Gregory, Leanne Coleman, Lindsay Peak and the friends Advisory Committee.

Articles, letters to the Editor, photographs, and any other contributions are always welcome. Please send these to: Lexia Smallwood, Editor, PARTYline, PO Box 280, Deakin West, ACT 2600; Phone (02) 6825 4660; Fax (02) 6285 4670; Email: [email protected]

As indicated, Northern Territory images courtesy of the Northern Territory Tourist Commission.

The opinions expressed in PARTYline are those of contributors and not necessarily of the National Rural Health Alliance or its individual Member Bodies. PARTYlineis distributed free. To subscribe, email your contact details to [email protected] PARTYline is also available online at www.ruralhealth.org.au

ISBN 0 9751220 9 6

National Rural Health Alliance, Number 22, May 20052

Rainbow Valley Conservation Reserve – Northern Territory (NTTC)

mailto:[email protected]


http://www.ruralhealth.org.au

Not on my own: part of a team

National Rural Health Alliance, Number 22, May 2005 3

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Alice Springs Strings Group

◗ MY NAME IS JANE KEATING andI am an Occupational Therapistcurrently working for Robinvale DistrictHealth Services (RDHS). I was luckyenough to be sponsored to attend the8th National Rural Health Conferenceby the National Rural Health Alliancepaying for my registration andaccommodation and my employer(RDHS) paying for my flights.To both these parties I owe ahuge thank you.

For the past fourteen months I haveworked for RDHS. Working ina country region where facilities areminimal and the geographical area wecover is vast has meant that I have lotsof responsibilities. I have been the solepractitioner for a minimum of twogeographical sites and at many timeshave been the sole occupational therapistfor our organisation, in charge of allfive geographical sites. Very daunting!

The 8th National Rural Health

Conference was pleasantly much bigger

than I had anticipated and surprisingly

more inspirational than I had expected.

It exposed me to many amazing people

and organisations achieving ordinary or

phenomenal feats that were relevant to me

and that I could relate to. I know that

working in the country demands vast

knowledge and expertise, and can at

times make you feel isolated, helpless

and alone. The conference, however,

did anything but. It made me feel part

of a team. It reminded me of all the

satisfying challenges, opportunities and

experience that working in the country

provides. It allowed me to make some

fantastic friends and reminded me that

remarkable things can be achieved in

the country.

I know there is a need to provideopportunities like this as an incentive foryoung people to practise and live in thecountry. For me, I went to the country asa new graduate to change the world.I may not have got far; however, I am yetto look back. I hope that youngpractitioners reading this may feelsomewhat inspired to practise in thecountry also. ❖

Jane Keating

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◗ IT WAS A CONFERENCE WHICHrecognised the futility of continuing tofollow unproductive paths. We wereencouraged to challenge our comfortablehabits and established ways of thinking inan endeavour to achieve the healthoutcomes for people in remote and ruralAustralia that we all desire so passionately.

Neill Wright, RegionalRepresentative of the UnitedNations High Commissioner

for Refugees, advocated a newapproach to health services for

refugees and asylum seekers.He described the detention of asylumseekers as inherently undesirable. The

UNHCR recognises that it is necessary tocarry out some health and security checks,

but any detention should be for theshortest possible time and only in theabsence of any other alternative. In viewof the trauma already experienced bythose seeking asylum, it is important tohelp them avoid further stress. Barbedwire fencing, intensive security and severecurtailment of freedom of movement areakin to prison conditions and are notappropriate for refugees. Neill argued thatservices available to refugees should beequitable with those available to othernationals.

John Humphreys, Professor of RuralHealth Research at Monash University inBendigo, challenged governments to viewhealth services differently. Rather thanviewing health services as ‘consumption’,Treasuries should view them as

‘investment’. A natural tension existsbetween the free movement of capital andthe well-being of communities.

Peter Sutton, ARC Professorial Fellow atthe University of Adelaide and the SouthAustralian Museum, provoked delegates tore-examine their assumptions about thefactors that contribute to the seriousIndigenous health differential.He challenged the view that the cause issocio-economic status. The healthoutcomes of poor white people and poorIndigenous people are not the same.This implies that in Indigenouscommunities “there are other things goingon”. Those “other things” include the“collision of established behaviour withthe environment” and connectionsbetween culture and illness. He identifieda need to change established behaviourand this could not be brought aboutmerely by advocacy or political change.Historically, improved mortality hasresulted more from improved publicsanitation, hygiene and nutrition thanfrom increased medical intervention.He asserted that improved health statusfor Indigenous people would be achievedby changes – in environments, householdpatterns and lifestyle behaviours.

Pat Anderson, CEO of the AboriginalMedical Services Alliance of the NorthernTerritory and Chairperson of the Co-operative Research Centre for AboriginalHealth, urged a new way of funding forAboriginal health services. It isunsatisfactory that Aboriginal people mustcompete with each other as well asfighting against the government in orderto “get the small scraps” of funding that

KEYNOTES >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

thinking in new ways, daring to do things differently…

The overwhelming emphasis of the Keynote Addresses at the 8th National Rural Health Conference was on

Following the beat of a different drum –

Drum Atweme youth drum group at the Opening Ceremony in the Todd River Bed

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>>>>>>>>>>>>

are available. She said that despite30 years of struggling to gain self-determination, it had not yet been fullyachieved. So the struggle was continuing.It is difficult for Aboriginal people tochallenge their own culture: they are seenas “playing into the hands of the enemy”or even being the enemy.

Helen Milroy, President of the AustralianIndigenous Doctors’ Association and medicalacademic at the University of WesternAustralia, emphasised the importance ofbeing good to everyone and the uniquecontribution Indigenous people can maketo society considering their culture, skillsand strengths.

Tony Gleeson, from Synapse Research andConsulting in Brisbane, called fora fundamental reassessment of the role ofagriculture in the Australian psyche andlandscape. He challenged agriculturalfundamentalism, that disproportionatelyvalues agricultural production, and theinstitutional arrangements in ruralAustralia which mitigate against sociallyconstructive meanings of landscapes.“Politicians and community and industryleaders encourage farmers to believe in thespecial importance of their contributionto economic growth and exports. Farmers,

their organisations and their publicsupport agencies build on these culturalnorms, closing their minds and those ofthe nation to other ways of conceiving ofrural Australia.” From his own life andwith pictures, he illustrated how thelandscape can be therapeutic foremotional illness and advocated newsystems of land management in Australiathat allow a closer connection with theland. Large bodies of literature showa relationship between land, spirit andhuman well-being.

Fay Johnston, general practitioner andpublic health physician, used the exampleof bushfire disasters to explain thecomplexities of addressing ecologicalhealth problems and the need fortransdisciplinary approaches.Understanding fire management, forexample, requires information fromdisciplines such as health, economics,ecology, anthropology and archeology.To explain the place of fire in Australia,Fay outlined three “great ages” of the

Australian bushfire: wild, tame and feral.She asserted that suppression of fire andfear of fire are at the root of thecontemporary bushfire problem.The highest death rates from naturaldisasters occur in bushfires (259 in thelast 40 years), with significant long-termmorbidity consequences for survivors.She spoke about the management burden,the economic impacts and the adverse

health effects of bushfire, andprovided information on disastermanagement, prevention andmitigation, including an outlineof the benefits and risks ofprescribed burning. “Ecologicalhealth issues are complex. Thereis a lot to be learnt, andsolutions need to beregionally specific.”

Robert Wells, Director of Policyand Planning (Health) at theAustralian National University,advocated new approaches toworkforce and health fundingwhich will include:

◗ multidisciplinary healthteams;

◗ new ‘non-doctor’ professionssuch as nurse practitionersand physician’s assistants;

◗ reforms to education andtraining; and

◗ expansion of the education, trainingand research infrastructure providedthrough rural clinical schools anduniversity departments of rural health.

There is also a need to reconsider the fee-for-service model, which at present sees

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Tony Gleeson

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Continued on page 6

5

Fay Johnston

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Debra Humphris

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KEYNOTES >>>>>>>>>>>>>>>>>>>>>>>

the flow of health funds run too stronglythrough Medicare and GPs.

Debra Humphris, Professor of Health CareDevelopment at the University ofSouthampton, UK, promoted the need forinterprofessional learning in which “twoor more professions learn with, from andabout one another to improvecollaboration and the quality of care”.Where employees work together ina team, patient death rates are lower,therefore it is important to trainprofessionals in a team situation. Inter-professionalism must be central(not optional) to the way learning is done.Our national health service “needs morepeople working differently” – not justmore of the same.

Ruth McNair, GP and Senior Lecturer atthe University of Melbourne, also endorseda team approach to health service deliveryand the need to begin interprofessionaleducation at the undergraduate level.Ruth claimed that a “silo approach” toeducation creates barriers to effective,professional teamwork. Teamwork is notan innate skill (for most people). It issomething that needs to be learned.

Steve Morton, Group Executive, CSIROEnvironment and Natural Resources,Canberra, argued that, after a generationof specialisation that has built up thesilos, the next generation of scientificbreakthroughs will be from those who

bring things together. “Things are gettingbetter and better, and worse and worse,faster and faster.” Data tend towardseconomics because it’s easily measuredand that reflects the power base that hasbeen dominant for the last 200 years.This makes it difficult to get the sort ofinformation that is needed.

Paul van Buynder, Principal MedicalConsultant, Department of Health, WA,described a new approach to industry inwhich health assessments consider the fullimpact of development rather than justparticular risks. People are not onlyinterested in whether a proposeddevelopment will increase the risk ofdisease (eg cancer, liver failure), but alsoin its broader impact on the quality of lifein their community (eg dust in the air,bad smell). They also want to know aboutthe potential range of impacts that are notyet fully understood (eg chemicalsensitivities, possible relationship betweendepression and pollution). “Scienceinforms, the Government decides and thepublic is involved,” Paul said, with someindustries finding this difficult tolive with.

Megan McNicholl, Chair of RuralEducation Forum Australia, challengedrural and remote people to move beyondtheir tendency to focus on local issues soas not to lose sight of the big picture.

The “disease of politicisation” breedscynicism and causes active disengagementat a local level. Many rural people feel

that the professionals in theircommunities are “tourists” – with bagspacked, ready for their departure. We allneed to transfer to new ways of thinkingabout rural and remote challenges.

The most challenging Keynote proposalswere made by Ted Egan, Administrator ofthe Northern Territory, who focused onsome of the underlying causes of poorIndigenous health among tribalAboriginals in remote communities.He asked whether the current situationshould be likened to genocide or suicide.He proposed three controversial plans:a campaign to promote a ‘dog-free’ societyon Aboriginal communities;encouragement for Aboriginal families tobe housed more appropriately; and theprovision of one free nutritious meal perday wherever this is desirable on healthgrounds. His Honour Ted Egan’srecommendations met with a mixedresponse from delegates, and were thesubject of much discussion andmedia coverage.

The 9th Key Recommendation from theConference challenges delegates and theirorganisations to question existingparadigms, be prepared to put new ideasto the test and discard old ways that arenot working.❖

6 National Rural Health Alliance, Number 21, March 2005

NT Administrator Ted Egan

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Desert grass-tree –

Northern Territory (NTTC)

Continued from page 5

Janganpa Dancers at the Opening

Ceremony in the Todd River Bed

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By Jenine Bailey, Primary Health CareResearch, Evaluation and DevelopmentProgram, James Cook University

◗ I AM A YAGGERAH ABORIGINALwoman from the Moreton Bay area andhave been working extensively in thenorth Queensland Indigenouscommunities and with communitycontrolled medical services on the socialand emotional (mental health) well-beingof individuals, families and communitiesas a whole.

I have extensive experience in policy

development, and in implementing and

co-ordinating culturally appropriate

programs. During this time my main

outputs were in the development and

implementation of a range of community-

based mental health strategies for both

youths and adults. I have also had

experience in the development of

educational activities for workers within

community controlled health services.

I am planning to further my research

skills in 2005 undertaking my PhD in the

area of Aboriginal and Torres Strait

Islander holistic health provision and its

impact in mainstream services.

Central to Health: sustaining well-being in

remote and rural Australia was an

appropriate theme for the 8th National

Rural Health Conference.

The conference was overwhelming and

was attended and addressed by an array of

professional people who work within the

diverse fields of rural health primary

health care services, with a large majority

of professionals, including myself, who

work within the area of Aboriginal and

Torres Strait Islander Health.

You’re not listening to me! Aboriginal

mental health is different – don’t you

understand? was the title of my

presentation, which was attended by

approximately 50 people at the Crowne

Plaza lounge area. It brought about

stimulating questions in regards to the

understanding of Aboriginal mental

health differences and treatments.

My desire as an Aboriginal and Torres

Strait Islander researcher at the Rural

Health Research Unit is to further

develop and implement programs, policies

and delivery of services as well as enhance

my own knowledge and experience in

ways of knowing and doing culturally

appropriate health practices within health

services. I am also keen to contribute to

the professional status of Aboriginal and

Torres Strait Islander research projects,

publications and writings. ❖


INDIGENOUS >>>>

Aboriginal and Torres Strait IslanderMental Health Research

7

“Oh my word,” he said. “Wecouldn’t get along without theGolden Casket in Queensland. It’sthe lottery that gets the moneyto build hospitals. … I alwaystake a ticket in every Casket likeeverybody else because if youdon’t get a prize you geta hospital and there’s times whenthat’s more useful. You ought tosee the hospital the Casket builtat Willstown. Three wards it’sgot, with two beds in each, andtwo rooms for the sisters, and aseparate house for the doctor onlywe can’t get a doctor to come yetbecause Willstown’s a bit isolated,you see…”Joe Harman in A Town Like Alice by

Nevil Shute ©1949

RECOMMENDATIONS >>>>>>>>>>>>>>>>>>>>


◗ IT IS BOTH A BURDEN ANDA DELIGHT to be the custodian of anevent that can change a person’s life.Before Alice Springs the National RuralHealth Alliance heard from a number ofpeople desperate to attend. One had beenassured by a colleague that this biennialconference would change her life. Anotherhad been told that to get to even oneNational Rural Health Conference wasa privilege.

One of the reasons for the Conference’sreputation is its focus on action and

outcomes. A major feature is therecommendations it produces and the

action that has resulted from themor been supported by them overthe years. Managing the

recommendations process inplenary sessions is alwaysa challenge. They are not as

inspiring as the keynoteaddresses; not as entertaining as theperformers; nor as engaging as theforums. It’s hard to do with a committeeof a thousand! However the process ofrefining, clarifying and prioritising therecommendations is important. A lot ofwork is done behind the scenes, but it isessential that, ultimately, therecommendations are owned andendorsed by delegates.

The recommendations are designed forhigh-level action. They are sent togovernments, universities and professionalbodies that need to understand what iswanted in the language of their trade. Inthis context they need to be unambiguousand comprehensive. But they are also forthe media, individuals, consumers andremote and rural communities, and for this

purpose they need to be simple,informative, concise and plain in meaning.

The 8th Conference endorseda Communiqué and ten KeyRecommendations. These are available infull at www.ruralhealth.org.au and thefollowing paragraphs describe theirgeneral intent.

The first recommendation calls forfurther changes to Medicare to ensure thatinvestment in health is driven by healthneeds and not by service availability.This may require Medicare to beextended to cover more healthprofessionals than just doctors.

The second recommendation seeks toreduce development of chronic disease inAboriginal people by implementingpreventive programs and strategies fromearly childhood. This would include extratraining and support for Aboriginalhealth.

The third recommendation seeks fairtransport and accommodation allowancesfor sick people and their carers who needaccess to services not available in theirown communities.

The fourth recommendation urges theAustralian Government to review thealcohol taxation system so that all types of

“A conference to change your life”

The NRHA is the custodian but not the ‘owner’ of the National Rural Health Conference. The first one was inToowoomba in 1991 and the Alliance sprang from it. The NRHCs belong to rural and remote Australia and arefunded by the Department of Health and Ageing. The Conferences’ success has been due to the commitment ofthose who live and work in rural and remote areas and care about health outcomes.

An awesome welcome –

Fire Twirlers at the Opening Ceremony

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9National Rural Health Alliance, Number 22, May 2005

alcohol are taxed equitably and so thatrevenue from these taxes is invested inprograms aimed at reducing harmassociated with alcohol misuse.

The fifth recommendation aims to makea significant contribution to collaborationfor better health by calling on non-government organisations to worktogether to develop a project on humanand environmental well-being in remotesettlements.

The sixth recommendation is shaped bythe current focus on Telstra and nationalwater management. It calls onGovernments to substantially re-invest inaspects of infrastructure that have a directimpact on health in rural and remoteareas.

The seventh recommendation endorsesinter-professional education as an essentialcomponent in training rural health teams,and urges its immediate introduction intohigher education institutions.

The eighth recommendation calls formore funding for national research onhealth in remote and rural areas that isrelevant, strategic, useful and well co-ordinated.

The ninth recommendation asks peopleto challenge the way they think and thehabits of their practice. Do our culturalvalues, accepted wisdom, traditionaleducation and routine responsescontribute to successful health outcomes?Are there new ways of thinking anddifferent ways of doing things that mightbe more helpful? Are we prepared to re-assess this fundamental aspect of ourselvesand our professional approach – compareit against the evidence – and to change ifnecessary?

The final Key Recommendationencourages all delegates to make a CentralCommitment to use ideas from AliceSprings in their home, community andworkplace to strive for equivalent healthfor people in remote and rural areasby 2020.

For more on the “Central Commitment”see back cover of this issue.

Rural HealthCurriculumDevelopmentConference“Looking Ahead – Building on theFoundations”, 16–18 September 2005,Tamworth

Rural health is now well established as animportant aspect of the curriculum ofa wide range of health professionalprograms at undergraduate andpostgraduate level. While excellentmechanisms for teaching andlearning about rural healthexist, there is always the need toreview, revise and refresh whatwe do and how we do it. Thisupcoming Conference is anopportunity to reflect on what has beendone so far in the development of ruralhealth curriculum content, share ourknowledge and beliefs about rural healtheducation, and plan for future programimplementation that is responsive toconsumer needs and those of the broadercommunity.

To find out more visit the website atwww.newcastle.edu.au/udhr/conf orcontact Helen Smith [email protected] orphone 02 6767 8477. ❖

Conference Dinner Photo: Mark Miller

http://www.newcastle.edu.au/udhr/conf


◗ About 120 full-time students attendedthe 8th National Rural HealthConference. PARTYline has receivedmany comments about their experiencesand here are some excerpts.

Jasmine Bowie, second year Medical RuralBonded scholar

For me, the conference’s greatest gift wasinspiration …

Not every medical student thinks ofworking in a rural or remote town as‘funky’. In fact, at university I amsurrounded by fellow students who haveeither grown up overseas or spent theirwhole life in Sydney. It is easy, evenfor a rural student, to lose sight ofrural issues.

At this conference, where rural andremote issues wereparamount, I was able toembrace the energy and

passion of those surroundingfellow students and professionalsalike who all shared similar goals

and dreams to somehow improve thehealth of rural and remote Australians.

Keynote speakers such as Ted Eganwith his concise, practical ideas onIndigenous health were worthy of thestanding ovation received, and the words(and awesome stage demonstration) ofAustralian Commonwealth Games goldmedal gymnast Brennon Dowrick weretruly inspirational. It was also interestingto hear from Director-General of DefenceHealth Services Tony Austin in relation tohis co-ordination of tsunami relief efforts.His quote from Ralph Waldo Emmersonin relation to ‘self versus service’ remainsin my mind: “There is no limit to what

can be accomplished if it doesn’t matterwho gets the credit.”

I am very fortunate to have been giventhe opportunity to attend throughfunding from ACRRM. This wasallocated as part of a pilot project tosupport Medical Rural BondedScholarship holders in their pursuitof a rural career.

Joseph Turner, medical student at JCUand Secretary, National Rural HealthNetwork

There is no doubt that the conferenceachieved its aim of benefiting the cause ofrural and remote healthcare in Australia.I personally gained a great deal ona number of levels.

As a speaker I gained experience inpresenting information and responding toquestions from a multi-disciplinaryaudience. As a session chair I had practiceintroducing speakers, controlling talk anddiscussion time, and summarising keypoints for the audience. As a sessionscribe I extracted recommendations frompresentations and composed them intoa document for the recommendationscommittee.

As secretary of the National Rural HealthNetwork (NRHN) I met with many keyfigures in rural health, was involved withmanagement of the NRHN delegation,fielded questions at the NRHN booth,and developed links between the NRHNand other stakeholders in rural health.

“… simply inspirational”Health students re-invigorated for rural and remote practice


Sturt Desert rose –

Northern Territory

(NTTC)

STUDENTS >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

As a representative of TROHPIQ(Towards Rural & Outback Professionalsin Queensland) I was in communicationwith other students and organisations,making contacts, gaining ideas andrepresenting TROHPIQ’s viewpoint.

My live interview on ABC Radio gave meexperience in dealing with the media aswell as developing skills in presentinginformation and discussing issues viathat medium.

The Conference has further fostered mydesire to work within and promote ruraland remote health both locally and ata national level and given me contacts ofmutual benefit now and in the future.

Heith Waddell, Indigenous Americanstudent, currently studying medicine atFlinders University of South Australia

The conference opening was like noother. I stood in a crowd of overa thousand people who circled around tolisten, watch and feel the sounds oftraditional music, dance and take in thewarm night air. I later read through myprogram and reviewed what sessionsI might attend and began to feel a bitoverwhelmed; there were hundreds ofpossibilities. And attend I did – issuesrelated to Indigenous health, mentalhealth, maternal health andmultidisciplinary workforce all seemed tobe at the forefront of this conference.

As an international student who came toAustralia primarily to study medicinewith intentions of working in a rural area,I have to admit I am rather jealous of allthe opportunities and rural and remoteincentive programs afforded toAustralian students.

I felt re-energized by meeting the fifty orso students who share my passion anddesire to practise in rural areas. I lookforward to working with these individualsin the future and can plainly see that ifthis is the quality of health professionals

going into rural practice, then the statusof rural healthcare is going to greatlyimprove in the not too distant future.

Nicholas Moore, medical student UNSWand representative of RAHMS

I grew up in the Blue Mountains, justwest of Sydney, and established aninterest in rural issues during my first yearof medicine. It was the rural health clubwhich gave me my first impressions ofwhat being ‘rural’ was about.

The NRHN sponsored me to attend theNRHC in Alice Springs, for which I amso grateful. Being on a student budgetand with a student mindset, there was noother way I would or could have had this

marvellous experience. To see health asa wider picture, not just from a student’sperspective, has reaffirmed my reasonsfor choosing a career in medicine, mostprobably in a rural location.

The presentations, particularly fromspeakers whose backgrounds were not inmedicine, further convinced me of thereasons why multi-disciplinary practice isso important – even schooling hasa profound effect on health outcomes.Finally, to meet so many passionatepeople at the NRHC who were soconcerned about the health of allAustralians, without regard to theirremoteness or cultural background,was simply inspirational. ❖

Student recovery at Anzac Hill

>>>>>>>>>


"There’s only one good [outback town] for a woman," he said. "AliceSprings. Alice is a bonza place, oh my word. A girl’s got everything inAlice – two picture houses, shops for everything, fruit, ice cream, freshmilk, Eddie Maclean’s swimming pool, plenty of girls and young marriedwomen in the place, and nice houses to live in. Alice is a bonza town."Joe Harman in A Town Like Alice by Nevil Shute ©1949

NATIONAL RURAL HEALTH NETWORK >>>>>

Kamels, Kangaroos, Kids, Kactus tyres… KINTORE!

12 National Rural Health Alliance, Number 22, May 2005

By Bek Ledingham (FURHS), Mel Flint(FURHS) and Jane Barton (CARAH)

◗ 550KMS, A BUSH FIRE, A FAIRFEW CAMELS, a gorgeous sunset, someawesome stars and two flat tyres later wefound ourselves in Kintore, a smallAboriginal NT community 40kms east ofthe Western Australian border. Makingthe most of our trip to Alice Springs forthe 8th Conference we decided to come

a few days early to visitAngela Titmuss, NRHNCouncillor 2003–2004,

who has deferred 5th yearMedicine at UNSW to take upthe position of Children, Youth,

Sport and Recreation Officer inKintore. When the school heard wewere interested in doing some healthpromotion and chatting about health

careers they called off the normal schoolday and Wednesday 9 March 2005 was“Health Day” in Kintore.

In the morning three groups of childrenrotated through different activities. Melgot well and truly plastered when the 60-odd kids came through and plasteredvarious limbs, painting some beautiful

designs as they dried, often withtheir non-plastered, non-dominanthands….amazing talent! Bek was at“The Green Shed”, Ange’s youthand recreation base, getting dustyas the kids demonstrated their balland Frisbee skills and zoomedthrough an obstacle course muchfaster than she and Ange could.Jane, with the help of Gutsy-Gus(aka ‘Kevin’) talked about thehuman body, different organs andhow to keep them healthy. Super-Jane also managed to talk about

various health professions and one of thekids even knew what a podiatrist was.They had much fun with Jane’sstethoscope, a surgical gown, gloves,bandages and other medical ‘toys’.

After a big morning’s activities everyonewent home for lunch, to relax and to getready for the main event…the disco.Meanwhile, in the company of Ange’s petcamel, Camelot, and puppy, Toby, andunder the watchful, macho, not-overcome-with-offers-of-help eyes of sixblokes, the girls changed not one butTWO flat tyres!And it onlytook half anhour…thanksguys! Theaudience wasdisappointed withour lack ofgirliness and afterthe first capablechange, interestand laughter linesseemed to disappear.Here’s to bushwomen!

After some decorating, cooking andtransporting a giant paper machekangaroo on the roof of the troopieaccompanied by two kids on the roof and20 in the back, the disco and the hipwiggling began. There was a massiveturnout of adults and kids alike withsome fantastic nutritious food on offerthanks to the dedicated teachers at theschool. Photos of the day were projectedonto a sheet and held the attention of thecrowd for ages as they relived theexcitement of “Kintore Health Day”.

Prizes from The Central AustralianRemote and Aboriginal Health Club,Flinders University Rural Health Societyand the Department of Health andAgeing were handed out to kids who werestandout performers during the day’sactivities and were received with big,beautiful smiles. Dancing continued intothe night and we began to digest theamazing experience we were living!

This trip was beneficial on so many levels.It was fantastic for us to get out bush andremember why it is

Kintore School

"Health Day" in Kintore

continued next page

we’re hitting the books at uni and whathealth is all about. It was also great to visitAnge and offer her support in thisfantastic venture that she has undertaken.She is an inspirational woman ofconviction, who has some great ideas andphilosophies on health – but even better,acts on them. The kids in Kintoreobviously love her and she’s only been

there 7 weeks. It is clear that she will doa great job in the next year and she hasinspired us all. It was also great to workclosely with the school and get to knowthe teachers. We often talk about howhealth problems cannot be solved byhealth professionals alone, but alsothrough education. As such it was good tobranch out and collaborate with the

community school and council on a funand successful project. It was also great tohave three health clubs FURHS, CARAHand RAHMS working together. We meteach other at the 7th and 8th NURHC.It is amazing what is possible when youcan network and meet like-minded peoplefrom across Australia. ❖

By Michelle Moreau

◗ I HAVE JUST HAD the absoluteexperience of a lifetime. I work for a ruraldrug and alcohol service which offersoutreach groups and counselling for anarea of the central West of NSW.

I applied for a scholarship from theAustralian Rural Centre for AddictiveBehaviours and the Alcohol and OtherDrugs Council of Australia to attenda conference in Alice Springs in Marchand to my surprise and delight I wassuccessful. I arrived in the centre ofAustralia on Wednesday 9 March, only tobe greeted by the intense heat (I think itwas about 40 degrees), and was shuttledto the Novotel. Incredibly swish!! Musttry and remember that I am actually hereto learn and network. At 4.30 thatevening I was introduced to 22 of thegreatest people I have ever met – and thegreen hats… well you just had to be thereto see 22 brightly-coloured green-hattedalcohol and other drug workers take overthe conference!

The days which followed were full oflearning and networking. There were

about 1100 other delegates in attendance,all wanting to participate in exactly thesame thing – learning and networking.We were privileged to hear speakers whoare leaders in their field, and after hearingwhat they had to say we actually had theopportunity to contribute and askquestions on a one-on-one basis. Whereelse would a grassroots, frontline worker

such as myself have the opportunity toactually converse with speakers ofthis stature?

It was an opportunity to feel truly valuedas a worker. VERY EMPOWERING!

I strongly urge all rural health workers toapply for similar opportunities – putyourself forward, NEVER LETA CHANCE GO BY! ❖


‘Green hat’ scholarships

Some of the ARCAB and ADCA scholarship holders

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…KINTORE! continued from page 12

AJRH Editor’s positionThe Australian Journal of Rural Health (AJRH) seeks to appoint an Honorary Editor in early 2006. The AJRH isa multidisciplinary peer-reviewed Journal which focuses on rural and remote health issues. It is the official journal for theNRHA, AARN, ACRRM, CRANA and SARRAH. Further information from [email protected] or 02 6285 4660.



SEEN…

Photos Mark Miller and Leanne Coleman

…AND HEARD


"It’s great that the Alliance hasbeen prepared to venture out intoAustralia's backyard again withthis, the largest Conference of theeight thus far, and it's great to seethat we can hold these conferencessuccessfully outside metropolitanAustralia. Because of where we are,there is a focus on remote healthhere and on Indigenous health inthe program.” John Wakerman, Convenor, Conference

Organising Committee

“In rural and remote Australia,when you have seen one community- you have seen one community.”John Humphreys

“If anything in life is worthstriving for it is going to take a lotof hard work, and when you’veachieved it, you can aim forsomething higher the next year.” Brennon Dowrick

“Rural women are prepared toforego a lot – including continuityof care – in order to be able tohave their babies in their owncommunity.” Lucie Walters

“One of the problems is that alcoholdoes not taste like alcoholanymore.” Cheryl Wilson

“Rural services are historicallybased on a city model. One sizedoes not fit all. Research must bedone that is relevant to policy.” Robert Wells

“Things are going to get worse, thenthey are going to get worse again.” Robert Wells

“Why did you not allow some timefor questions? The best bits alwayscome out during the questions.” cross member of the audience – and she

had a good point

“The health sector has to beinvolved in advocacy on the bigticket items: population andsettlement policy, the tax system,transport and IT infrastructure.” John Humphreys

“We don't need a national alcoholstrategy: we need a national drugstrategy that recognises alcohol asthe most common and dangerousdrug.” Daryl Smeaton

“If safety was the only issue wewould not fly in planes; you shouldbe able to trade off a degree ofsafety (eg in maternity choices) forsocial and cultural elements.”Tony Austin

“Impossible is nothing.” Paul van Buynder

“I have been blown away by all theIndigenous health stuff: we have noIndigenous people in our town.”(anon)

“We have a very valuable ruralhealth infrastructure; its use shouldbe expanded both geographically andprofesssionally, for the whole ofprofesssionals' working lives.” Robert Wells

“While things have improvedsomewhat in the last fewyears, there is still considerableinertia in the bureaucracy to doingthings that may be seen to beendorsing the concept of communitycontrol and Aboriginal selfdetermination. There's a realpsychological fear here.” Pat Anderson

“Good health requires more thanhealth services. Society should besupportive of the right of Maori tolive as Maori, with a secure andmeaningful identity, in order enjoygood health and a sense of well-being. For many Maori, anassociation with their ancestralland is valuable.” David Sheppard

“One of the exciting things aboutthis conference will be therecommendations that come out ofit. Over the next 12 months theywill be a framework for ruralhealth, not just for the Alliance toact upon, but other organisations aswell.” Sue McAlpin, Chair, National Rural Health

Alliance

INTERNATIONAL LINKS >>>>>>>>>>>>>>>>>>>

Timor-Leste Guests◗ THE CONFERENCE WAS VERYPLEASED to host two special delegatesfrom the Health Department of theworld’s newest nation, Timor-Leste.Madalena Hanjan Costa Soares isManager of Quality Control Service at theHospital National Guido Valadares, andLeonel Guterres is Manager of the HealthCentre in Quelicai. Their attendance was

made possible followingcontact between the NRHAand the Office of the

Minister for Health, the HonDr Rui Maria de Araujo. TheNRHA sponsored their

attendance.

Madalena trained at the School ofnursing in Timor-Leste and then did

three years of further nursing training inAustralia. Part of Madalena’s responsibilityis to provide nurse training in thehospital. She has determined a minimumstandard of care that she believes isnecessary in a hospital, and is working toachieve that level. The city hospital willthen serve as a model of care for sixRegional Hospitals. This influence willthen flow on to 68 Community HealthCentres around the country, and thenfurther to 200 Health Posts in the more

rural areas. Additionally, there are 150

mobile clinics which will also benefit. But

there are many obstacles to be overcome

before even a minimum level of care can

be achieved.

Although only 1 hour 35 minutes by

plane from Darwin, Timor-Leste has

living conditions that are vastly different.

Madalena described some of the

conditions in her hospital.

“Hygiene is a constant challenge. In the

hospital there is no water pressure

available during the mornings: therefore

there is no hand washing between

patients. Even when water is available,

there is no hand scrub or towels. I have

a personal goal of providing one hand

towel for each nurse. This is better than

having paper towels, which need constant

replacing; hand towels can be taken home

and washed. For the patients we need

pyjamas and gowns for delivery. Currently

there is no infection control because

patients wear their everyday sarongs.

There is no screening for TB and

Hepatitis B and a high number of nurses

have these diseases.”

Also on the hospital ‘needs’ list are

surgical gloves, watches for nurses,

Betadine, scales (for body weight of

babies), sanitary pads, bags for medical

equipment and MIMS books so the

nurses can check instructions relating to

different drugs.

Leonel is a Community Health Centre

Manager in the District of Baucau. His

responsibility is to supervise four health

posts and seventeen mobile clinics which

serve a population of 16,000 people.

He undertakes his supervisory role by

motorbike. Leonel’s office has no

computer – just a typewriter. The health

posts have no electricity. They all use

candles. The major problems in the

Baucau district are respiratory infection,

malaria, dermatitis and diarrhoea. Most

of these problems are a direct result of

the lack of water supply for washing

and cleaning.

Postscript: By purchasing ‘Central

Commitment’ mugs at the Conference,

delegates raised $1,000 to provide hand

towels and surgical gloves. If PARTYline

readers want to provide further assistance,

contact the Timor-Leste Ministry of

Health directly or through the Alliance. ❖


Madalena and Leonel from Timor-Leste

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>>>>>>>>>>>>


By special Conference correspondent,Lindsay Peak

◗ HASIA LUBETZKY IS THE Head ofOccupational Therapy Services, SorokaMedical University Center at Beer-Sheva,Israel. She is also a DevelopmentOccupational Therapist, ChildDevelopmental Center in Soroka and isdoing a PhD in Health Management atthe Ben-Gurion University of Negev.

Hasia decided to attend the NationalRural Health Conference after researchingon the internet for her PhD. She foundmany sites from all over the world butkept coming back to the site of theNational Rural Health Alliance. Hasiasaid, “It was very clear from searching theweb that the Alliance’s site was the best.The information is clear and there arelinks to other relevant sites.”

Hasia funded the trip herself. Her initialchoice was the United States but, “itbecame very clear that Australia is the

leader in rural health issues, and hasmodels that could be used to developrural health programs in other countries,including Israel.”

Even though Israel is a small country incomparison with Australia, there are somesimilar issues, especially issues likeshortage in workforce, isolation of thehealth worker and their family, theimportance of networks and the use ofvideo-conferencing.

Hasia’s PhD is on ‘Suggesting a model forrural health in Israel’. The issue of ‘ruralhealth’ in Israel is developing only noweven though people who live more than50 kilometers from medical centres haveproblems accessing health services.

The Soroka University Medical Center inBeer-Sheva provides health services toa large and heterogeneous populationacross the south of Israel. The citizenscome from many ethnic, cultural, andreligious groups.

For example:

◗ The ‘Kibbutzim’ are co-operativecommunities whose members believe'from each according to their ability,to each according to their need'. Thekibbutz looks after all the needs of itsmembers and their families andusually provides communal dining,laundry and other services andfacilities for its members. Thiscommunity is very strong and manyhealth services are provided on-site.

◗ The Bedouins of the Negev are intransition from a Nomadic life tomore permanent settlements. They arean ethnic, religious and culturalminority in south Israel. Their way oflife is similar to other minorities in theworld. They get only basic healthservices in their community.

◗ There are new immigrants from Araband Islamic countries who live in“development towns” which wereestablished during the 1950s. Thesecommunities have socio-economicproblems but are now formallyrecognised, which allows them toreceive substantial assistance from theState.

◗ The haredim (ultra-orthodox)communities are the poorest Jewishcommunities in Israel because themen learn the Torah all the week anddon’t work.

◗ There is a community of Jews whoimmigrated from the former SovietUnion and from Ethiopia towards theend of 1990. They are characterizedby high levels of education and priorexperience in high-skilled jobs.

◗ Immigrant Ethiopians have manyreligious, cultural and socio-economical problems.

The medical services offered by the healthauthorities to all these groups are not fullyused due to language, cultural, orgeographical scattering. A holisticmodel for health services has beensuggested to increase their use.

Hasia found the Conferencevery interesting and well worthattending. She will take back withher lots of new information and ideas,and hopes to keep in touch withConference delegates. ❖

The Alice-Negev connectionHasia Lubetzky from Israel

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National Rural Health Alliance, Number 21, March 200518

AWARD WINNERS >>>>>>>>>>>>>>>>>>>>>>>>>

Remote and rural recognition

The DES MURRAY AWARD waspresented by Mary Murray to MilliePearse and Amanda Colyer.

◗ THE DES MURRAY AWARD allowsone or two young people from a remotearea to attend the Conference as its specialguests. They must have a demonstratedcommitment to improving rural health andadvocating for young people in their area.

When nominated, Millie Pearse wasworking as a dietitian – planning,implementing, evaluating and reporting

on a project called CommunityKitchens which supports youngAboriginal women in northern

New South Wales and addressesthe high levels of chronic disease andlifestyle-related illness through

improved nutrition. “At 22, Millie isquite young to be embracing such achallenging project,” her nominator said.

Now back at work, Millie writes: "WhenI was told that I was going to receive theDes Murray Scholarship and attend theconference in Alice Springs, I expectedthat I would have a quiet and isolatedtime. What a misconception! Going toAlice ‘not knowing anyone’ translated to

meeting other scholarship winners, spyingmy cousins from across the Todd Malland running into an old friend… and thatwas only the first day!

“I am thinking back to my days in Alice… they seem like a lifetime ago but inreality it is only a month. Whilst mostconference delegates are probably gettingback into the swing of things, I havefound myself moving full circle: finishinga 6 month stint running a CommunityKitchens project and starting afresh in anexciting new environment. I am now aDietitian with the Barwon Division ofGeneral Practice, based in Moree, butservicing an area of 44,132 sq kms and53,611 people in Northwest NSW. WhilstI am primarily in a clinical role I will stillbe involved in running and developingcommunity nutrition programs focusedon improving nutrition and lifestyle andpromoting healthy weight.

"I am confident that the ideas I tookhome from the conference will help meimprove and increase CommunityNutrition programs in this area. I realisethat one dietitian can’t change the world’shealth; however the Conference was

a great reassurance that through workingtogether and being innovative we canmake a difference to the health of ruraland remote communities!"

Amanda Colyer is an occupationaltherapist at Avon and Central PrimaryHealth Service in Northam WA, whodevelops and implements a range ofprograms to promote health. Hernominator said: “Amanda is committed tofurthering her knowledge and skills andhas undertaken further training in infantmassage, paediatric interventions,palliative care and neurology.”

Amanda wrote to PARTYline: "Like otheryoung therapists working in a rural areaI face many challenges in my day-to-daywork including access to services andresource allocation. I really enjoy thediversity and community spirit that comeswith my job as, together with mycolleagues, we face such challenges.

“Being able to attend the Conference inAlice Springs was a valuable step infurthering my understanding of ruralhealth and enhancing my appreciation forthe wonderful setting in which I work.

“When I arrived at the Conference I waspleasantly surprised to learn that theparticipants were from all facets of thehealth industry. I was delighted by thediversity and excellent quality of thespeakers, presentations and discussions.As a base-grade health professional it wasfantastic to be given the opportunity to beamong such a vibrant and diverse group.I learnt that we all face similar issues andthat we all had common goals and thebest interests of our communities at heart.I left the Conference inspired to continuewith the resilience, dedication andingenuity that we all work with each day.”

Mary Murray with Amanda Colyer and Millie Pearse

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>>>>>>>>>>>>>>>>>


The LOUIS ARIOTTI AWARD was presented by Ans van Erp to Sharon Davis.

◗ THE LOUIS ARIOTTI AWARD is sponsored by the Toowoomba HospitalFoundation and the Cunningham Centre. It recognises innovation, excellence anda national contribution in Australian rural and remote health. Sharon Davis is theRegional Manager for Frontier Services in the Northern Territory. The award recognisesSharon’s contributions to the development of services for the frail aged and her nationaladvisory work.

In presenting the award, Ans described Sharon as a passionate advocate forservices for the aged, particularly elderly Indigenous people. Her work haschanged the face of aged care in the Northern Territory. In her response, Sharonsaid, “I couldn’t have done it without a team with whom I have the privilege ofworking. Frontier Services is an organisation that works with me, encourages meand believes in me.”

Ans van Erp congratulates Sharon Davis

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Paul Burgess and Emma KennedyThe REGISTRAR RESEARCH PRIZE was presented by Dr Emma Kennedy to Paul Burgess.

◗ THE AWARD IS in recognition of high quality research relevant to remote healthand comprises a medal, a certificate and support to attend the Conference. In presentingthe award Emma Kennedy said, “Research is an important part of the work of GPs andthe College. The aim is to encourage registrars to become involved in research activitiesand to recognise the value of research.” Paul Burgess is currently doing his PhD on theconnection between health and country. In accepting the award Paul said, “Ten yearsago I was a medical student who travelled through the lands of the Arrernte and Luritjapeople, speaking with them and spending time with them. It was a time which changedmy life forever.” He thanked his Indigenous patients and colleagues for their gentleguidance. ❖

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Conferencesponsors

By Daniel Bolger, Conference MediaOfficer

◗ A TEAM OF MEDIA STUDENTSseconded from the media studies unit ofBatchelor Institute of Indigenous TertiaryEducation near Darwin did themselvesand the industry proud during the 8thConference at the Alice SpringsConvention Centre.

A timely offer of assistance from Unit Co-ordinator Mark Bradley was taken up bythe Conference team at the Alliance,which was only too pleased to give thestudents some vital hands-on experience.At the conclusion of the event Mark said,“It was empowering for the students, notonly for them but their industry.It allowed them to work in a professionalmedia production environment, showinitiative, work under pressure andinteract with a wide range of healthprofessionals and officials. Thisexperience was a huge challenge for thestudents, who have neverbeen exposed to thistype of mediaactivity.”

The team wasselectedfrom

students currently studying the CertificateIII in Broadcasting at the IndigenousMedia Unit of the Batchelor Institute ofIndigenous Tertiary Education. Thestudents come from remote broadcastingcommunities and rural and urbanIndigenous media associations throughoutAustralia. They are studying mediaproduction and broadcasting as well ashow the industry works and ways toexpand their role in it.

“The opportunity for them to work withthe NRHA covering the selectedpresentations, keynote speakers,conducting interviews and picking up voxpops helped them achieve a vast numberof educational goals,” Mark said.

The students, Chelsea Aniba fromThursday Island, Kenneth Martin fromHalls Creek, Ruth Dunn, Mary Morris,Daniel DeBono and Arthur Kelly (Fred)all from Gimbisi Mediain Kempsey, were very

excited to be partof the team

and to work in a media environment atthe conference.

“I recall Ruth on entering the ConventionCentre saying, ‘I feel so proud to be here.I have never been in this kind of placebefore … I will never forget this.’ ….herexcitement, like that of the whole group,was there before the work started and didnot diminish for a moment. The teamtook on the responsibility, doingthemselves and their industry proud,”Mark said.

The range of tasks the students performedin this work environment connected withthe units of competence they are studyingas part of their qualification in CertificateIII in Broadcasting. They demonstrateda high level of competence andprofessionalism in performing their roles.They relished the responsibility and thepositive feedback from people theyinteracted with. It was a great experiencefor all concerned and we wish them well

in their futurestudies. ❖

Shooting stars at Alice Springs

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20 National Rural Health Alliance, Number 21, March 2005

◗ ONE OF THE SPECIALFEATURES at the Conference for friendsof the Alliance was the friends’ raffle.friends attending the Conference had beeninvited to contribute goods from theirlocal area. The response wasoverwhelming, with friends from aroundAustralia proudly donating so muchproduce that there were enough items forthree hampers! On Sunday there wasa ripple of excitement in the MacDonnellRoom as Madalena Soares stepped to themicrophone to draw the winners of thefriends raffle.

Two winners talk to PARTYline. “My children were thrilled when I cameback from the conference with a box ofgoodies from all over Australia (includingour local Kangaroo Island honey!) It wasa bit challenging getting it all back butwe spread it through the luggage andmanaged. We have been enjoying thetasty delights of central Australia, a niceCoonawarra red wine and T-shirts andhats. My four year old son is mesmerisedby the crocodile tail key-ring (“are yousure it came from a real crocodileMum?”). I also was the happy recipient of

a book on outback women from acrossSouth Australia which tells stories fromvarious women in different places,situations and stages of life. I already havestaff lining up to borrow it when I havefinished reading it.

“I had not given the concept of the rafflemuch thought other than to grab a jar ofhoney on the way out of the house. Onreflection it is a great concept. It has givenme another view of the different areaspeople at the conference were drawn fromand made the conference last a bit longerand kept the awareness in the forefront ofmy mind every time I open a jar atbreakfast or use the lovely soaps! It allhelps to keep me strategically planning asto how we can send more people to thenext conference. Thank you to everyonewho contributed.”Sara Mill, CEO/DON of Kangaroo IslandHealth Service, SA.

“The friends raffle was a great idea and tobe a winner was a nice surprise. I am stillenjoying the edible treats and varietyof other goodies from far-flungparts of Australia. The conferenceback pack came in handy to carryeverything back to WA!”Alison Liebenberg, Director ofNursing and Primary Health Carewith RFDS in Jandakot, WA.

The third winner was Gary Stewart fromSouth Australia. ❖

A remote and rural raffle

FRIENDS >>>>

Irene Mills, Chair of friends, with the remote or rural produce donated for the prize hamper

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“friends is for the grassroots, giving us a chance to support the Alliance, influence its policies and in theend to help us improve our own health” Irene Mills, Chair of friends

“friends of the Alliance is the human side to the advocacy that is largely done by national organisations.”Michael Bishop, Father of friends

“friends of the Alliance are like my family that I meet up with every two years so that I don’t feel soisolated in my workplace.” ." Chris Shoemaker, who describes herself as the ‘baby’ of friends

By Dr Hugh Heggie, (aka Dr Kamaraand Dr Havachat)

◗ EVERYONE WOULD LIKE TOLIVE IN UTOPIA!

Well, if you plan a visit to the UrapuntjaHomelands, home to some 1500Alyawarre Aboriginal and 15 non-Aboriginal people, you will find out thatthe Dreamtime spirits did create Utopia.It’s some 300 kms north-east of AliceSprings in the Sandover region, an areathat captures the essence of CentralAustralia – with red sand and rockyridges, covered with spinifex, Mulga

and Gidgee.

Get into the Troopie and beginto have a rich cultural

experience and understand thechallenges that face the UrapuntjaHealth Service (UHS) in providing

comprehensive health care to a remote,decentralised community spread oversome 5000 sq kms. There might be some

of the Aboriginal Health Workers whowill show you where the best bushmedicine can be found and treat you to afeast of bush tucker and kangaroo cookedin the traditional way. You might seesome of that world famous Utopian dotart being created under the bush shelterswhere many in the community live.

We have just completed another cycle ofinitiation corroborees, where you arewelcomed to participate, in the scrub

under the dreamtime stars. The threeRemote Area Nurses, Cheryle, Sue andTricia (who, as the midwife, found herselfdelivering the last baby here in the backseat of a car outside her house with theaid of a garden light!) will be glad toaccompany you on a tour of some of the15 small outstations that they visit eachday. We also might have to make roomfor one of the many interns, medical ornursing students who visit the UHS eachyear. On the way we may have to dropone of the visiting specialist medical orallied health teams back to the airstrip.

Now if it has been raining (it doessometimes!) you might see the unusualsight of the symbol of the UHS, theSandover Lily, along the edges of themighty but usually dry Sandover river bed

which winds through the middle of thehomelands. We might also have to make astop at one of the tiny homeland primaryschools with which the UHS has workedclosely to improve health outcomes ofthe children.

Now that the car is very full, your tour ofUtopia can begin and it is likely also to befull of conversation and humour coveringanything from community and culturalissues to health, from the trees to the stateof the road. Then it is a quick trip back tothe clinic to do some X-rays and anultrasound, but no RFDS evacuationtoday. Your trip will be rewarded with oneof the many spectacular Sandover sunsetsas you rest under the big ghost gumoutside the clinic ready to return home.But please come back again! ❖

TRAVEL >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Postcard from Urapuntja

Sandover Highway

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Hugh Heggie

Poorer health, higher risk outside major cities ◗ THE HEADLINE for this wide-ranging Institute of Health and Welfare report might be “It looks like bad news all round for theBush”. But we can alter lifestyle factors and improve health services through good policies, and this must be our national goal.

The AIHW has assembled data from a variety of sources and provided comparisons between city and rural/remote areas on diseases,education, housing, happiness, income, employment and much more. This report will be quoted for years to come by students ofcity:country difference. It shows how urgent it is to tailor health promotion work to fit country areas, and to continue to providespecial support for rural and remote health services and workforces.

It’s called Rural, Regional and Remote Health: Indicators of Health, AIHW, May 2005.www.aihw.gov.au/publications/index.cfm/title/10123 ❖


By Georgia Brown, Rural Officer 2005,

Australian Medical Students’ Association

◗ THE AUSTRALIAN MEDICALStudents’ Association (AMSA), inconjunction with the CanadianFederation of Medical Students and theInternational Federation of MedicalStudents’ Associations (IFMSA), hopes toorganise a professional exchange programbetween Australia and Canada, witha particular focus on Indigenous health.AMSA is the peak representative body formedical students in Australia.

The concept of such an exchange was

introduced when the AMSA delegation

attended the IFMSA General Assembly in

Turkey 2005. Whilst Australia and

Canada have pre-existing exchange

contracts, it was felt that an exchange that

focused solely on Indigenous health care

delivery was a mechanism by which

medical students could help to improve

the health status of Indigenous people

both locally and internationally.

Worldwide, there are vast differences in

Indigenous culture, the history of

Indigenous-non Indigenous relations, and

the quantity and quality of research

available in each country. Thus

international comparisons of Indigenous

affairs are difficult to make. Nevertheless,

Australia is not alone in its struggle to

address many Indigenous health issues,

and there is potential to learn from

countries facing similar issues.

The exchange will provide an opportunity

for students to learn about the

organisation and delivery of Indigenous

health care within the country of

exchange, and to provide and develop

new perspectives that could promote,

support or improve the delivery of

Indigenous health care in both countries.It is expected that participants wouldbenefit by experiencing and examiningthe Indigenous health care system ofanother country facing similar issues totheir own, and in doing so design,promote and lead change back home.

The AMSA delegation is hoping to attendthe IFMSA Assembly, in August 2005, tofurther discuss and finalise details of theexchange process. Whilst AMSA and itsaffiliates have the passion and dedicationto commit to such a project, our resourcebase is very small. We would very much appreciate anysupport, financial and academic, toturn this project from concept toreality. For further information,please contact Georgia Brown,Rural Officer AMSA 2005, [email protected] ❖

>>>>>>>>>>

Australia and Canada IndigenousProfessional Exchange Program

Workshop on PainManagement◗ The Managing Pain Using Self-Management Approaches: Evidence andImplementation half-day Workshop isbeing hosted by the AustralianGovernment Department of Health andAgeing’s Sharing Health Care Initiativeon 19 August 2005 in Sydney. The Workshop is to provide the latestresearch and evidence for ChronicCondition Self-Management in Australiaand internationally. Cost $100. Forinformation and to register contact DCConferences on 02 9954 4400 or visit

Canadian delegates at the Conference

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www.dcconferences.com.au/pinp2005 ❖



http://www.dcconferences.com.au/pinp2005

◗ THE SPECIAL DIFFICULTIES indelivering services to cancer sufferers inremote and rural areas was the topic of anafternoon workshop at the 8th NationalRural Health Conference.

The recommendations arising from theworkshop included a proposal to minimiseworkforce shortages by improvingefficiency in existing cancer units whilecontinuing to deliver care withcompassion. Realistic levels of service

delivery need to be defined, andgovernments and communities need to beaware of these. Stronger links need to bedeveloped between regional and remoteGPs and specialists located in centraltreatment facilities.

The proposals recommended thatpriority be given to remote and ruralareas as these are most vulnerable toworkforce and service shortages, andpatients from remote and rural

communities are most in need of lowcost accommodation close to treatmentcentres. The Conference as a wholecalled for an immediate national reviewof the state schemes that assist patientand carer transport andaccommodation. The purpose would beto introduce a uniform approach toprovide people from remote and ruralareas with reasonable reimbursement foraccessing services not available in theirown communities.

It was also agreed at the cancer workshopthat greater efficiency could be promotedby the co-ordination of chemotherapytreatment protocols and their publicationon the Internet.

The Clinical Oncological Society ofAustralia (COSA), through its Council,and its Rural and Remote Group, iscommitted to promoting therecommendations from the8th Conference, and from the Cancerin the Bush Workshop (2001), and urgesother organisations to make a similarcommitment. The current Senate Inquiryinto cancer services will provide an earlyopportunity for positive responses fromgovernments to these issues.

(See the ‘Service Delivery’ section in theFull Recommendations atwww.ruralhealth.org.au) ❖

Stop press: See cancer initiatives inBudget 2005–6 at www.health.gov.au

CANCER >>>>>>>>>>>>>>>>>>>>>>


Ghost gum, John Flynn’s Memorial – Northern Territory (NTTC)

◗ THE MAIN FOCUS of ACROSSnetis to enable community workers to gainaccess to information fact sheets,resources, peer support and mentoringon all aspects of suicide prevention,intervention and postvention. This isdone through expert chat forums, emailand teleconferences, networks, and up-to-date information on an interactivewebsite www.acrossnet.net.au

In May and June 2005 the ACROSSnetteam will be conducting focus groupsin several rural and remote Queenslandtowns so that workers can provideinput into the website design andfeedback to help improve utility andfunctionality of current resources.The principal aim of the research is toevaluate the effectiveness andtransferability of the ACROSSnet

model as a means of providing onlinesupport for isolated workers. If you arewilling to provide feedback and inputinto the development of the website,please contact Danielle Penn [email protected], 07 3864 2274 orKarolina Krysinska [email protected], 07 3875 3393. ❖

Remote and rural priority for cancer services

ACROSSnet – Australians Creating Rural Online Support Systems Network

http://www.ruralhealth.org.au

http://www.health.gov.au



◗ ANDROLOGY AUSTRALIA, funded

by the Australian Government

Department of Health and Ageing, is

a national program committed to

better educating community and

health professionals about male

reproductive health.

The 8th National Rural Health

Conference provided a unique

opportunity to network with relevant

individuals and organisations, and to

better understand the health needs of

men living in rural, regional and

remote Australia.

With accessibility to health services

recognised as more difficult in rural,

regional and remote areas, the lack of

education and understanding about

particular health issues may further

exacerbate access to health care. Even

though an association between erectile

dysfunction and other serious health

conditions such as heart disease and

diabetes exists, a recent survey showed

that men in regional and remote Australia

are less likely to talk to their doctor about

erectile dysfunction compared with men

living in urban areas. While the possible

reason for this difference may be related

to availability of services, education, and

awareness within both the general and

professional community, Andrology

Australia believes that working together to

enhance understanding of these

conditions will enable men to be more

proactive in improving and maintaining

their general health and well-being.

It is important to ensure that men have

access to quality health information in a

variety of forms. To receive information

booklets on a variety of men’s

reproductive health issues, please contact

Andrology Australia on 1300 303 878, or

email: [email protected] ❖

HEALTH EDUCATION >>>>

Helping men keep healthy

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◗ THE GET TO KNOW YOURMEDICINES KIT was launched at theConference by National Prescribing ServiceLtd (NPS), and 112 kits were distributed.“People who collected a kit includedconsumers who have never run activitiesbefore, nurses who think the kit will helpthem with their community work, andscholarship students who are undertakingplacement in rural areas and want to usethe kit on their next community visit,” saidHannah Baird from NPS.

The kit includes:

◗ a guide to help you organise and planan activity;

◗ a guide to help promote the activity toencourage people to attend;

◗ a 24-slide presentation; and

◗ a guide to help you collect feedbackincluding forms for participantsto complete.

NPS developed the Get to Know YourMedicines Kit in collaboration withConsumers’ Health Forum of Australia,National Rural Health Alliance andHealth Consumers of Rural and RemoteAustralia. The kit assists with the runningof community activities to help peoplebetter understand their medicines.

You can order a free boxed kit or a CDversion at www.nps.org.au/consumers, orby writing to Hannah Baird, Kit orders,PO Box 1147, Strawberry HillsNSW 2012.

NPS provides independent, evidence-based information and services to healthprofessionals and the community onQuality Use of Medicines. To achieve thiswe work in partnership with GPs,pharmacists, specialists, other health professionals, Government,

pharmaceutical industry,consumer organisations and thecommunity. NPS is anindependent, non-profitorganisation funded by theAustralian Government Department ofHealth and Ageing. ❖

Get to Know Your Medicines Kitlaunched by NPS



http://www.nps.org.au/consumers

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Complementing the team◗ An excellent job and congratulations toall for a superb conference. A thought fornext time, about workforce problems:there is a large force of healthcareprofessionals out there being ignored andexcluded form these forums. I mean of

course the many complementaryand alternative therapists, whoare doing some very goodthings in promoting wellness,

but whom my profession, amongothers, is determined to keep out.

It is high time we all grew up, realisedthat millions of health consumers usetheir services, and let them become part

of the team.

RH, South Asutralia

Include the men◗ I am disappointed about the wordingof point 2 in the Key Recommendations.There is no reason to focus solely onmaternal and child health; there is

another equally sick cohort amongstIndigenous people – their menfolk.These men are also an integral part of thedevelopment of the next generation andas such their needs should also beaddressed. This point was clearly made atthe time of the Conference, but I see thishas been ignored. There is no place forgender bias in this debate. I think thisKey Recommendation is flawed and goesagainst the ethos of the NRHA.

JR, Victoria

Of sunsets and men in suits◗ It was a great event! Lots to thinkabout, be challenged by and to act on!The venue, keynotes, content anddiversity of sessions were fantastic.The opening night could have been sowonderful, except that we were latestarting, the men in suits talked for too

long, and consequently sunset passed andnight fell before the dancing had finished.A great shame! It was a pity all thewomen’s sessions were on Sunday. I knowa lot of people were in the same boat asme and couldn’t stay for Sunday. Havingthem spread over the three days wouldhave meant better access for numbers ofwomen. Looking forward to the CDROM of the proceedings and toAlbury/Wodonga.

RG, Victoria

Expanding horizons◗ Congratulations on the Conference –a job exceedingly well done! Yourattention to both broad strategy and alsoto fine detail over many months is a greatcredit to you. The conference would haveto be the one conference that should beon every remote practitioner’s agenda asa means of both expanding horizons andbeing pragmatic about realities. You leftme further energised for remote work.

SM, Northern Territory ❖

YOUR RESPONSES >>>>>>>>>>>>>>

e-feedback

Outback sunset – Northern Territory (NTTC)

Red Centre Dreaming (Aboriginal Dance) – Northern Territory (NTTC)

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BUDGET >>>>

◗THE TREASURER’S SPEECH dealt

at surprising length with health issues,

and Budget 2005 delivered on the health

promises made in the Election campaign.

Over five years there will be an extra

$189 million for cancer, $151m for

mental health, $321m for dementia, and

$207m for carers and respite. There are

some good rural angles in these too, and

this is pleasing.

But the serious new money is still in the

pillars of the system: $2.8 billion for

changes to Medicare (increasing the

rebate to 100 per cent of the Schedule

Fee) and $616m for changes to the

Private Health Insurance rebate for those

65 and over. Thanks to the unexpected

growth in company tax revenues from

a commodities boom, the Election

promises will not bankrupt the nation; in

fact we have personal tax cuts too.

Several of the Election commitments will

benefit particular places or institutions –

including Dubbo, Gippsland, Scottsdale

and Darwin.

The health sector will welcome extra

resources for cancer, mental health and

the other areas, but the main game is still

about the structure of Medicare, the PBS

(where savings are being made) and the

PHI rebate. Surprisingly, post-Budget

health commentaries have included very

little consideration of these three major

issues. So the debate about ‘major health

reform’ is still to be had (see Editorial,

this issue).

In welcome news, the 2005 Budget also

provided an extra $40 million over four

years for Indigenous health

services –“four new primary health care

clinics in communities where they are

not currently available” and the

professionals to staff them. It is expected

that this will cover 50 more Aboriginal

Health Workers, GPs and nurses by year

4. The money will also help to

strengthen established clinics.

The initiative will have its main focus in

rural and remote areas, but recognises

that there are many disadvantaged

Indigenous people in urban areas too.

Some of the commentary on the Budget

has focused on fairness and the

opportunity cost of the tax cuts, ie what

else might have been done with

$24.2 billion over four years and whether

that “something else” would have been

better “for us” in the long term. (Years

ago we might have asked what would

have been best “in the national interest”

but that notion is out of fashion, like

social justice and thermal faxes.) The

Future Fund looks like prudent

housekeeping now but may later frustrate

those who would like to see proceeds

from the sale of Telstra spent on regional

infrastructure.

As those of us who are well-paid become

even better off we should spare a thought

for the health of the nation’s Indigenous

peoples, migrants, refugees and long-

term unemployed; for the damage being

done by drought, cane toads and wild

pigs; for people in really remote

communities who have no services; and

for the grandchildren who will inherit

this rich land. Or we can look beyond

our own borders to East Timor.

Our income, home and lifestyle should

protect our own personal health for

a while. But when we do finally need

health care, what sort of system will we

be able to turn to? Will we be happy to

buy it, as in the US, or will we expect

low-cost, universal access to a high

quality health system? Let’s talk to each

other now and move the health system in

directions that will suit us and coming

generations. ❖

Budget delivers on Election healthpromises: the money’s in Medicare

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Brennon Dowrick performing the routine which earned him Commonwealth gold in 1990 and 1994

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A central commitment

Delegate’s Commitment to Action

◗ “By being a delegate at the 8thNational Rural Health Conference I haveshown a commitment to the health ofpeople in remote and rural Australia. I leave the Conference with more ideasabout how health services are coping invarious parts of non-metropolitanAustralia and I intend to use thisinformation in my own areas of activity. I recognise the contributions I can maketo better health, both individually andwithin my organisation, at home and at work. The Conference hasdemonstrated the place of Australianremote and rural health in a wider global context and has reminded us of the potential contributions thatAustralia can make in its region andthroughout the world. I intend to act onany of those Conferencerecommendations which relate to activityin my workplace and future career. I will

carry forward my general commitment toimproved health and, when I can, I willcollaborate with others in work tocontribute to better health for remote andrural people.” ❖

"What we do as individualsdirectly affects the team."

Brennon Dowrick

◗ SEVERAL PAPERS INCLUDED

a challenge to Conference delegates to

make a personal commitment for change

and it was also directly proposed from the

podium. Brief statements of commitment

were printed on small reminder cards and

these were made available to all delegates

who wished to take them. A “central

commitment” mug was also available

for sale.

This commitment to action wasintended:

◗ to add value to the standardrecommendations process;

◗ to encourage delegates in their desireto contribute meaningfully asindividuals;

◗ to involve all organisations in actionon the conference recommendations;and

◗ to show Governments that manyparties want to work collaborativelyon improving rural health outcomes,and don’t expect Governments to do it all. ❖

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"Individually we may lackthe clout that is required tobring about a change ofdirection, but collectivelymuch is possible.”

John Humphreys

NEWSLETTER OF THE NATIONAL RURAL HEALTH ALLIANCE Alva … · 2011. 7. 12. · Not on my own: part...

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Transcript of NEWSLETTER OF THE NATIONAL RURAL HEALTH ALLIANCE Alva … · 2011. 7. 12. · Not on my own: part...