GP Speak April 2012 by Echo Publications

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A publication of the Northern Rivers General Practice Network

k a e p S P G f o n o i t i d E t s a L l a i c e p S

See Pag

ED myths dispelled Page 4

Antibiotic resistance to RTIs Page 5

The new ipad Page 7

Act, Belong, Commit Page 17

The future comes one day at a time

GP Management Committee: David Guest, Chair: 6625 0000 Rita Vinten: 6622 5030 Vahid Saberi: 6620 2462 Professor Lesley Barclay: 6620 7570 Nathan Kesteven: 6689 5485

Chris Mitchell: 66877444 Gillian Smith: 6620 2980 Adam Wilson: 66621555 Brian Witt: 6621 2502 Tony Lembke: 6628 0505

Staff: Angela Andrews: Mental Health Social Worker, Tarmons Tricia Atkin: Mental Health Social Worker, Tarmons James Bennett Levy: Psychologist Andrew Binns: Medical Editor, GPSpeak Chris Clark: Chief Executive Officer Marilyn Copeland: Receptionist Rachel Crowley: Project Manager Rachelle Deaker: Project Officer, Immunisation Jessica Dennis: CTG Project Officer Dan Ewald: GP Executive Advisor Donna Griffiths: Project Officer, Practice Support Janet Grist: Media & Communications Manager John Gable: Project Officer IM/IT Sally Herbert: Project Officer NPS Sandi Hill: Project Officer Collaboratives Robyn Hill: Gurgun receptionist Deborah Hogan: Accounts & Payroll Officer Marika Ilic: Receptionist Cherie Leon: Care Coordinator, CTG Phil Manieri: Financial Controller Clare Mason-Binns: Gurgun PN Catriona McCormish: Clinical Psychologist, Tarmons Anne McLean: Project Officer, Aged Care, Rural Workforce Support Martin Morgan: Project Officer IM/IT Linda Muscat: Administrative Officer and CPD PO Teri Richardson: Gurgun receptionist Georgina Robinson, Receptionist, Family Care Centre Catriona Smith: Project Officer Closing the Gap Leanne Tully: Administrative Assistant & RVCS PO Roshanak Vahdani, Psychologist, Tarmons Viv Walkington: Project Officer Practice Support Vickie Williams: Tarmons Practice Manager Jamie Wimbus: Indigenous Health Outreach Worker PO

GPSpeak Contacts: Editor: Janet Grist Phone: (02) 6622 4453, Fax: (02) 6622 3185, Email: media@nrgpn.org.au Medical editor: Andrew Binns Email: abinns@gmc.net.au Display and classified advertising at attractive rates. Subscription rates (non-members): 1 year $44.00, 2 years $80.00 (incl GST) GPSpeak is published six times a year by the Northern Rivers General Practice Network (NSW) Ltd. Articles appearing in GPSpeak do not necessarily reflect the views of the NRGPN. The NRGPN accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. © Copyright 2012 Northern Rivers General Practice Network (NSW) Ltd Magazine designed by Graphiti Design Studio Printed by Quality Plus Printers of Ballina

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Janet Grist

while we have been talking about the vision and our mission for some time, the reality is that it will take a little time for NCML to really take flight and for the community to experience the changes we hope to make. As part of the change, this is also the final GPSpeak magazine. It’s been a privilege to edit this publication which really came to full life under the editorship of Katherine Breen Kuruczev. Her talent, drive and sheer hard work created a vibrant and relevant magazine for general practice. The good news is that a brand new publication to be called HealthSpeak will take its place. It will be an important mouthpiece for NCML and I look forward to presenting you with the first issue. Until then...

Past work creates new horizons It is with a mixture of pride and sorrow that I write the last CEO report for GPSpeak on the activities of the Northern Rivers General Practice Network (NRGPN). Primary health care reform has been central to NRGPN activities over the past 18 years, culminating in taking the lead in transitioning to the North Coast NSW Medicare Local (NCML). Over the years, the NRGPN has ensured general practice is well placed to deliver value to the community and to take a central role in the NCML. The NCML will build upon well established programs and relationships with other organisations due to our: Combined successful delivery on over 200 programs and projects Success in change management / quality improvement Rural location and using IT systems to overcome distance Successful culture of innovation for local solutions Ability to create and deliver important training infrastructure Ability to partner with research organi-

Chris Clark

PO Box 519, 20 Dalley Street Lismore, NSW 2480 Phone (02) 6622 4453 Fax (02) 6622 3185 Email: manager@nrgpn.org.au www.nrgpn.org.au

Just after I started at NRGPN a couple of years back was the first time I heard about the impending federal government changes to primary health care organisations. At the time it seemed something off in the future, and now it’s arrived. The NRGPN as we know it has ceased to be. On Monday April 2, NRGPN staff and the staff of three other former Divisions of General Practice merged to form the new North Coast Medicare Local (NCML). It’s exciting to be part of a bigger challenge in improving health care in our region. But

sations such as universities Ability to partner with state public health services Capacity to augment the established general practice infrastructure to improve the scope and quality of services Ability to adapt and expand successful initiatives beyond general practice to the wider health community Past success in engaging with a wide range of stakeholders and a clear strategy for strengthening and sustaining engagement of non-general practice primary care stakeholders While the NCML commenced in early April, the NRGPN now has an important role as an organisational member of the NCML and will continue to provide support and advocacy for both GPs and general practice. I take this opportunity to thank those who have made the NRGPN the success that it has been. The inclusive approach of this organisation together with the collaborative involvement of GPs, practice staff and divisional staff in implementing effective, useful initiatives have been the foundation for its success and will form the building blocks for a successful NCML. Thank you all and I look forward to achieving great things in the future.

GPSpeak is kindly delivered to local doctors by

Andrew Binns

Farewell from gpspeak

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It is with some emotion that I must announce this GPSpeak to be the last edition, as we see the NRGPN becoming part of the much larger North Coast Medicare Local footprint in accordance with the Commonwealth Government’s national health reform agenda. GPSpeak began its 20-year life as a monthly four-page newsletter under the editorship of Dr Hilton Koppe back in November 1993. In the first issue, Hilton wrote: “It is to be hoped that as time goes on this newsletter will evolve into an informative source of local information for health care practitioners in our area.” This vision gradually grew and in time came to greatly exceed Hilton’s – indeed, everyone’s – humble hopes. One year after its inception, GPSpeak had evolved into an eight-page newsletter; another 12 months later it had grown to 20 pages, and would steadily morph into the glossy, full colour 28-page magazine of today. Much of this earlier work was made possible by our then Communications Officer, later GPSpeak Editor, Katherine Breen Kuruczev who will be remembered for her great skills as a medical journalist as well as her spirited support of NRGPN staff, GP members and allied health professionals. Our next editor was Aaron Bertram who brought about some major changes in readability and led us to a totally new and creative magazine format with the help of graphics company Graphiti Design Studio. Our current editor Janet Grist has overseen further evolutionary change, including regular features such as The Koori Grapevine and Arts Health and Wellbeing. The regular columnists have also been popular, with David Tomlinson keeping us up to date with finance and economics,

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Robin Osborne with his book reviews, Chris Ingall enlightening us about the pleasures (in moderation, of course) and subtleties of wine, and David Miller on a wide range of thought provoking medical topics. This magazine has enabled NRGPN to have an editorial voice in the local primary health care system and to keep general practice up to date with health politics, practice improvement, events, important figures in the local health landscape and their views, and a myriad of other issues related to delivering primary health care to the Northern Rivers. I have no hesitation in admitting that, on occasions, we have used GPSpeak for political lobbying, and am pleased to note that its voice has gained some influence with important decision makers. Published six times per year, GPSpeak has been distributed to all GPs and practice managers in the NRGPN footprint as well as to MPs, media outlets, SCU health academics, UCHR staff, medical students and registrars, specialists and some allied health practitioners. It is also distributed electronically to Northern NSW Local Health District staff. I firmly believe that in a climate of major health system

change, such as the move to a new primary care coordinating organisation, a magazine like GPSpeak is needed to keep all of us engaged and informed about relevant health matters. In order to bring about major systemic and cultural change, it is vital to disseminate knowledge and promote the vision. From the discussions I have had, I know I am not alone in this view. The big question is how? Discussion is underway with the NCML to see what our future communication systems may look like. One thing for sure is that there will need to be a strong voice to get the messages out there, to where they count to clinicians at all levels, to community leaders, health workers in both the public and private sectors, and, not least, to the general community who are not only our patients/clients, but the ultimate influencers of opinion. We have been advised that a magazine filling this expanded role needs to be conceptualised, probably in hard-copy form and surely as an online presence. Your feedback would be most welcome, and in this regard I may be contacted at abinns@nrg. com.au

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Meet North Coast Medicare Local’s new CEO Vahid Saberi is the first CEO of the new North Coast Medicare Local. He took up his new position on April 2. Vahid’s immediate past position was the General Manager of Richmond Clarence Health Service Group. In this position Vahid was responsible for the management of 10 hospitals including Lismore Base, Ballina, Grafton, Casino and Maclean Hospitals and a range of Community and Allied Health Services. In the position prior to this, Vahid, was in charge

Vahid Saberi

of Area Health clinical operations on the North Coast, overseeing

Effective Ways of Engaging Men

Social worker and health educator Greg Millan is holding a training seminar on how to effectively communicate health and wellbeing messages to men. The one-day seminar runs on Wednesday May 16 in Coffs Harbour from 9am to 4pm. The seminar will also deal with what agencies and organisations need to know about making their services, programs and resources more men friendly in order to achieve the best outcomes for men and boys. The program is for men and women who work in health, welfare or community services for men and boys. Topics include the National Male Health Policy 2010, How to increase your knowledge and skills in men’s health work, how to use the HEALTH model for engag-

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ing men and ways to develop effective men friendly programs and resources. Greg Millan has more than 20 years experience in the men’s health promotion area. He is an Executive Member of the Australasian Men’s health Forum Inc – Australia’s peak body implementing a social approach to male health and a Member of the Board of Advisors of the Men’s Health Network USA, The cost is $220 for the one-day training program and a copy of Greg’s book “Men’s Health and Wellbeing: An A to Z Guide.” Refreshments and lunch will be provided along with a three-month follow up support with your program or project. To register, email Greg at: greg@menshealthservices.com. au or phone him on 0417 772 390.

the management of 22 hospitals, community and allied health services and a range of ancillary and satellite services. He has worked for NSW Health for 18 years – with more than 12 years on the North Coast of NSW. Vahid has had a long career in Strategic Development, Planning and Population Health. As the Executive Director of Population Health, Planning and Performance, in addition to health promotion, public health, planning,

Aboriginal health, telemedicine and community engagement, Vahid managed Capital Works which involved major infrastructure development projects (hospitals, community health centres and other facilities). Additionally, Vahid is extensively involved in education and research. Currently he is an Adjunct Professor at the School of Health & Human Science, Southern Cross University and a Senior Research Fellow, Sydney University.

Research into emergency demand increase dispels myths Demand for public emergency department (ED) care across Australia increased by 37 per cent throughout the decade ending in early 2010. This is the finding of a Queensland University of Technology (QUT) study published in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine. “The growth in demand for ED services is a partial contributor to the crowding being experienced in EDs in Australia,” said Professor Gerry FitzGerald from QUT's School of Public Health. “This growth in demand exceeds general population growth.” The QUT researchers said demand had been consistently increasing over the past decade in all locations except the ACT. They said the ED usage rate in Australia, currently 331 per 1000 persons, had been growing at an average of 1.8 per cent per annum over the past decade. These are some of the preliminary findings of a three-year research project being funded by the Australian Research Council and the Queensland Ambulance Service. The researchers will now work on identifying the factors underlying these increasing usage rates,

by analysing in detail the characteristics of users and their reasons for using EDs and ambulance services. Initial analysis has dispelled some common myths about the reasons for high ED demand. The so-called ‘inappropriate users’ or ‘GP’ patients have been commonly blamed for increasing demand for ED services. However, Professor FitzGerald said there was no evidence that increased demand was due to overuse by patients with lowacuity, or less urgency. “The growth is among patients in genuine need of emergency health care,” he said. Prof FitzGerald said it is also commonly assumed that the elderly are more likely to require health services, including emergency health services, than younger people. “However, the ageing population might not necessarily explain the whole trend of increasing ED usage. For instance, although the ACT had the highest growth – 7.65 per cent - in the number of persons aged 85 and over, its ED presentation rates did not change significantly,” he said. The results of this ongoing research may result in alternative service delivery models that might appropriately and safely manage future demand.

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A posy for the Feds By David Guest, NRGPN Chairman After nearly 20 years “the Division” is free. Free of government funding and, hence, also free of the restrictions that that entails. Free is not easy, however. There are significant challenges ahead. From 1 April 2012, the NRGPN will no longer receive block or project grants from the Federal Government. Its staff, resources and liabilities for all projects have been transferred to the North Coast Medicare Local (NCML). This will be the last NRGPN edition of GP Speak. The NRGPN is not dead, however. The organisation will maintain its links to Northern Rivers GPs and will continue to represent them through the NRGPN Board. We have some cash in the bank and have been granted some limited secretarial support from the NCML. Our raison d'être is unchanged. Our aim is to support general practice and foster communica-

tion between GPs, health services, community groups and the public. We will further our role as the voice of Northern Rivers GPs. “Follow the money” is wise advice. Primary health care will have a 50% increase in funding under Medicare Local arrangements. The next few months will be a settling in period for the NCML, but once its start up issues are resolved it will be looking at new initiatives. While general practitioners are the corner stone of primary care, there is, and will remain, a significant under supply. Efficient and effective use of doctors, nurses and other health care workers through general practice has the potential to provide better care for those in the community, particularly those with chronic diseases and for the elderly. Despite their quango status, it is becoming clear that Medicare Locals will be under much more direct control by the Federal Government than Divisions ever were. The governments preferred model for Medicare Locals is

unknown. Judging by the large variety of differing ML structures being funded it would seem that the government itself is unsure of the preferred model. “Letting a hundred flowers blossom and a hundred schools of thought contend” may be a policy for promoting progress in the arts and the sciences, but things do not always end well. While having made no official statements, The North Coast Medicare Local seems attuned to the needs and concerns of general practice. Whether it can and will maintain that focus in the long term is unknown. The NRGPN sees advocating for local general practices within the NCML as one of its most important roles in the future. How we restructure the organisation for that role will be debated over the next few months and decided at the AGM before the end of the year. Rosebud or thorn? We need your help in deciding.

Antibiotic resistance and respiratory tract infections By Pharmacist Sally Herbert Acute respiratory tract infections are one of the most common conditions managed in general practice. The strong association between antibiotic prescribing practices in primary care and the rate of antibiotic resistance suggests GPs have an important role to play in preserving the “miracle of antibiotics.” Fewer truly new antibiotics are being developed and even when they do become available, they are reserved for severe infections and resistance can emerge quickly. GPs often have limited time to counsel patients about the self-limiting nature of RTI’s and the potential adverse effects of antibiotics including antibiotic resistance. Sally Herbert, local pharmacist and National Prescribing Service (NPS) facilitator will commence educational visits to local surgeries this month delivering a new program which focuses on antimicrobial resistance

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being an increasing public health issue, ways to reassure patients as opposed to offering antibiotic prescriptions unless they are truly indicated and when to order diagnostic tests or imaging for respiratory tract infections. Evidence suggests patients are not always seeking an antibiotic prescription, and patient satisfaction is more likely influenced by a physician’s communication skills which allow a patient to elicit their concerns and expectations of treatment. With the use of patient information materials, and symptomatic management this is unlikely to impact consultation time. I look forward to seeing the local GPs, nurses and practice staff again in the next four to six months as “Antibiotic resistance and respiratory tract infections” is delivered throughout the Northern Rivers. If you have any queries about an upcoming visit, clinical audits, case studies, CPD or anything NPS please contact Sally at the Northern Rivers GP Network on 02-6622 4453 or sherbert@ncml.org.au

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Change is gonna come... GPSpeak’s book reviewer Robin Osborne shares some thoughts about Australia’s health reform agenda.

To managerialists – a title not seen on business cards – the health system is often seen as just another product or service deliverer where many workers are ‘change resistant’ about new ways of doing business. Insiders may prefer the French view of system reform - plus ca change, plus c’est la meme chose, or “the more things change, the more they remain the same”. The latter view was put more bluntly in the song “Won’t get fooled again” by The Who “Meet the old boss/same as the new boss...” The song was on the album Who’s Next whose cover bore a photo of the band members zipping up their flies after urinating on a concrete piling in a colliery slag heap at Easington (nowadays regarded as the obesity capital of the UK). Many have felt that way at times about Australian health care delivery, some of them employees, not a few of them doctors, and it would a brave person, however change resistant, who suggested that aspects of the system don’t deserve a good hosing down. Back in Kevin Rudd’s time, the Australian Government started to have similar thoughts, not least because Australians were still eating and boozing too much, using tobacco, not exercising enough, and then expecting costly medical care that must often be delivered, at least to start with, in the acute setting. Enter the Health and Hospitals Reform Commission, which consulted and consulted, then released a report noting, inter alia, that we need to take better care of ourselves because the hospital system simply could not afford to continue picking up the pieces for unhealthy lifestyles, especially as we were going to live longer than ever with our chronic disease. The result of this justifiable exercise, driven initially by 6

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We can’t expect the system to change if we aren’t making changes too.

The cover of Who’s Next ...

Rudd and Roxon, now by PM Gillard and Minister Plibersek, is known as the National Health Reform Agreement. Its visibilities, some still only evident to those within the system, include Local Hospital Networks and Medicare Locals, the Australian National Preventive Health Agency, the GP Super Clinic program, the coming PCEHR, Health Workforce Australia, and the infrastructure and strategic investment body, the Health and Hospitals Fund. Legislated changes to private health cover subsidisation are another aspect. Going are the old ways of doing things; coming, or in some cases here already, are the complex structural and funding arrangements, performance data collection and records management, clinical workforce planning, and, somewhere in the mix, social marketing campaigns encouraging us to “Swap it, don’t stop it” (big for small, fried for fresh), keep a tape measure close by, and walk, not drive to the shops for the low-fat milk. We can’t expect the system to change if we’re not making changes, too. So, where is it all heading, and perhaps more importantly, how

much of it will be carved in stone by the next federal election in late 2013? Would politically driven changes only mean new stationery, or a further restructuring of the health system? Hopefully Australia’s changes in the primary care sector will not be as fraught as in the UK, where, as The Guardian reported

under the heading, ‘Patients lose out as GPs focus on health reforms’, senior doctors are spending as little as one day a week with their patients because they are too busy setting up new organisations as part of the coalition’s health reforms. From April 2013, the new Clinical Commissioning Groups will direct NHS funding in commissioning and paying for treatments on behalf of patients. All in the name of efficiency, it is said. There’s only one thing certain about change, as Sam Cooke sang: “it’s a gonna come”. Managing what comes with it is the challenge.

Welcoming new gastroenterologist NRGPN would like to welcome Dr Angus Thomson, MBBS (Syd), FRACP, to Lismore and Ballina. He is a gastroenterologist and will be working full-time as part of the team at Northern Rivers Gastroenterology. Angus’s gastroenterology experience includes periods of junior training in gastroenterology and liver transplant at Royal Prince Alfred Hospital and Bankstown Hospital in Sydney. He completed his advanced gastroenterology training at Liverpool, Nepean, Blacktown and Westmead hospitals. His time at Westmead gave him excellent exposure to

advanced endoscopic techniques under the supervision of Dr Michael Bourke, an internationally recognised endoscopist. He will also be part of the Lismore Base Hospital staff with a weekly public endoscopy list and will take part in the oncall roster for gastroenterology and viral hepatitis clinics. Angus will consult in rooms in Lismore and Ballina and have private lists at Ballina Day Surgery and at St Vincents Private Hospital in Lismore, including open access. He is committed to a longterm involvement in our area. To make an appointment with Dr Angus Thomson, phone 6622 0388.

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One more thing ... the new iPad The new iPad looks the same as the iPad 2. It is the same size, except that it is 0.6mm thicker. A man on a galloping horse wouldn’t know the difference. It has a higher resolution ‘retina display’ screen – movies and photos and print all look clearer, and it is easier to read (I don’t think my real retinae will be able to tell the difference, however) The new iPad has a much faster processor, so will be more responsive. It will leave the original iPad for dead – increasingly new Apps won’t run well on the original version. (being used to the iPad 2, it is already annoying to use an iPad 1) The back-facing camera is of much higher quality (5 megapixel compared to about 2). It has other features that improve the

Tony Lembke

Should you get one? Ten points of interest

l - files quality of photographs, including in-built face recognition. It is able to shoot high definition video. The front facing camera (for video calls) is the same. The iPad 1 has no camera. But have you ever found a use for the iPad 2 camera? The iPad 3 has 3G and 4G, so will be faster in areas where 4G is available. Currently, this is only on the Telstra network and only in the middle of the city. The new iPad starts at $539 for the 16Gb Wifi model, and $679

for the 16Gb 4G Model. The top of the range is the 64Gb 4G Model at $899. This is a decrease in what the iPad 2 cost last week. The iPad2 16Gb model will remain for sale at $429 for the Wifi version and $569 for the 3G version.

Well, should you get one?

If you don’t own an iPad – yes, definitely. Using an iPad changes the way you think about web

browsing, email, movies and books. If you own the original iPad – yes, and hand your current model on to your kids. If you own an iPad 2 – no, unless work will buy you a new one, or you have someone else in your family who needs one and who would be happy to have your hand-me-down A comparison of the new iPad and iPad 2 is at: http://store. apple.com/au/browse/overlay/ipad/ compare

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Local registrars number 120 NSW GPs are training the majority of the 1000 GP training places allocated for 2012. A record 1289 junior doctors applied to be part of the 2012 program, which General Practice Education and Training (GPET) chair Prof Simon Willcock said reflected the popularity of general practice as a career option.

The 2012 AGPT program offered 335 places in NSW, 225 in Victoria and 204 in Queensland. Western Australia and South Australia offered 89 and 76 places respectively, while Tasmania, Northern Territory and the ACT each offered fewer than 30 places. This year’s intake includes

nine Aboriginal and Torres Strait Islander people and 24 people from the Australian Defence Force. Locally, North Coast GP Training (NCGPT) had 41 registrars joining its program this year. NCGPT now has 120 doctors at various stages of their training working across the Northern

Rivers region. This is due to the teamwork of NCGPT’s 50 accredited training practices, nearly 100 GP supervisors and NCGPT’s medical education team. Additionally, NCGPT’s GP Placement Program (PGPPP) which commenced in 2010 has seven posts this year.

Registrar Dr Linda Burnett – Casino AMS Linda came to medicine after working for seven years as a radiographer. She told GPSpeak she wanted more of a challenge in her career and sat for the GAMSAT in London before an interview in Australia where she was accepted into medicine at the University of Sydney. Originally from Brisbane, Linda worked at Lismore Base Hospital during her internship and residency and is happy to be working as a registrar at Casino Aboriginal Medical Service. An interest in medical work runs in the family. “I was always interested in

Linda Burnett

anatomy and science and my mum was an EEG clinician and keen for me to enter the medical workforce. Initially I was interest-

ed in radiography and vet science, but I decided I’d rather work with people than animals,” she said. Linda lives at Bexhill with her two ‘very spoilt dogs’ – a beagle and a corgi cross terrier. They take up much of her time outside of work with beach walks. Two PGPPP rotations that Linda did in Ballina – at the Grant St Clinic and Bullinah – gave her an interest in GP training. “I wasn’t sure, I was thinking about GP training or some kind of physician training, but I was more interested in the lifestyle of being a GP. While I was doing

the PGPPP I thought ‘I can do this’.” Linda says Casino AMS staff have been very supportive and she’s learnt a great deal since she started there in late January. “Here there is a lot of chronic disease and the patients present with multiple problems. You get to do a lot of preventive medicine and a lot of screening. It seems some patients don’t look after themselves very much so it’s our job to step in. It’s been challenging because it’s all new and I’m still learning, but hopefully I make a difference,” she said with a broad smile.

Registrar Dr Luke Hogan – Goonellabah Medical Centre Growing up on a farm at Stratheden, near Casino, and seeing so many animal births, Luke originally wanted to be a vet. That all changed though when he saw his 103-year old grandmother, who lived with his family, go through palliative care at home. “That made me realise I really wanted to work with people,” he said. With a natural bent towards science and maths Luke was accepted into Medicine at the University of NSW and he went to the Rural Clinical School at Port Macquarie during his 4th and 6th years of study “That was a great move, it’s where I met my wife Lucy,” said Luke. Lucy is now at home looking after the couple’s two small children – a 22-month old son 8

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Elijah and a 2-month old daughter Bonnie. Luke and Lucy have just bought the property they’ve been renting at Lindendale and are looking forward to planting fruit trees and getting their vege garden established. His first few months at Goonellabah Medical Centre have given Luke a different perspective on treating patients. “When you are working in hospital you are wondering about some of the decisions the patient’s GP made around medication, but when you are working in general practice you can see why the GP prescribed certain things – he was trying to keep the patient at home and keep them well rather than having them in hospital.” Luke also really enjoys seeing the same families coming into the practice.

Luke Hogan with family

“I like that continuity, seeing members of the same families and you can start building relationships with them.” It’s only recently that Luke made the decision to become a GP. Up till then he’d been quite certain he wanted to be an obstetrician.

“But what changed things was getting married and having children. I didn’t want to spend six years not seeing them while I was training to do Obstetrics. And after I graduated and started working I realised that as a GP you can be whatever you want to be, so my aim is to do some Obstetrics training and incorporate that into my practice. “I love the idea that as a GP I can choose my own adventure.” Luke’s also interested in working in Aboriginal health at some point. And he has an unusual role lined up after retirement. “My wife’s always wanted to be a painter, I have some of her artworks hanging in my room here, and she’d like to make a career of that when the kids are older. And my aim is to retire and become her framer,” he laughed. w w w. nrgpn . o rg . au

Learning on the walk: a local Eduventure By Garry Egger – Professor in Lifestyle Medicine, SCU Nothing compares with experience in the field. I decided some time ago that my CPD courses in Lifestyle Medicine run through Southern Cross University were best done on the run – or walk, or cycle or paddle, or whatever – so long as it was active. Over the last five years this has translated into walks along the Larapinta Trail in Central Australia, kayaking down the Great Lakes from Forster to Nelson Bay, paddling up the Shoalhaven River in the Kangaroo Valley and bivouacking at Sport and Rec camps on the Hawkesbury River. GPs, their partners and allied health professionals are all welcome. CPD points can be earned (40 category A points in the case of GPs) from learning and

The coastal emu is one of the animals encountered on the Yuraygir Coastal Walk.

contributing along the way with RACGP accredited providers including yours truly. Like any other CPD activity, pre and postevent assessments are part of the requirement. Now it’s time to bring it all back home to the North Coast where the Lifestyle Medicine concept began. The classroom is one of the most beautiful sections

of the North Coast – and one that even some of the locals don’t know about, namely The Yuraygir Coastal Walk from Angourie to Red Rock. The topic is: ‘Evidence based complementary medicine and the link with Lifestyle Medicine’ hosted by Professor Stephen Myers who is one of a few medical practitioners in the country also trained in comple-

mentary medicine. As someone who has walked or run in many of the most beautiful places in the world, I can attest this would have to be one of the best and pristine coastlines anywhere. While active learning takes place through daily discussions such as energy balance systems involving the nutritional quality of bush tucker and the day’s hiking fare, the formal component of the educational program happens in eco-village cabins at night. A bus will carry the bulk of the gear which will reconnect with the walkers at night. A moderate fitness level is required as the daily distances covered are around 20-25km at a comfortable pace mainly along beaches. With CPD points, spectacular scenery, improved fitness and specialist teachers what more could you want from an educational adventure. For more detail contact Carla Robinson on 07 55069269 ext 19269 or carla. robinson@scu.edu.au.

Dental affordability survey A new survey of 6600 Australian adults based on phone interviews found that while nearly 60% of adult Australians visited the dentist in the previous 12 months, one in three said they delayed dental visits because of the cost. Only one in five who made a dental visit in the previous year said that cost prevented them undergoing recommended treatment. The Australian Institute of Health and Welfare (AIHW) report Oral health and use of services: Findings from the National Dental Telephone Interview Survey 2008 also found that on average, 25% of those who visited a public clinic waited between one and two years for their appointment, and 32% waited more than two years. Among dentate adults (those with at least one or more natural teeth) who visited in the prew w w. nrgpn . o rg . au

vious 12 months, about 56% went for a dental check-up and 44% for a dental problem at their most recent visit. AIHW spokesperson Dr Jane Harford said the report find-

ings showed that affordability of dental care was a prominent factor for those who didn’t make a dental visit. “These adults were also more likely to visit for a dental prob-

lem than a check-up, and were more likely to require treatment, especially extraction of teeth,” Dr Harford said. Australians with a Commonwealth Concession card were more likely than noncardholders to have avoided or delayed visiting a dentist because of cost, to have cost prevent them from having recommended treatment, and to have had a lot of difficulty in paying a $150 dental bill. Although cardholders are eligible for public-funded dental care, only 25% of cardholders visited a public dental clinic at their last visit. Cardholders had twice as many missing teeth as non-cardholders and were more likely to experience toothache, be uncomfortable with the appearance of their mouth and avoid some foods because of oral problems.

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New holistic psychotherapy practice Psychotherapist Graham Gillard is well known in the Northern Rivers as he’s worked at a number of different medical centres, including Gurgun Bulahnggelah Aboriginal Medical Service in Lismore. He provides services to clients in three communities within the electorate of Page. After juggling a working life spent commuting to various medical centres and mental health services, he’s excited to announce the opening of his private practise in Lismore. “I thought it was time to settle down and not work on three different computer systems”, he smiled. Graham’s new rooms are at 2/7 Carrington Street - around the corner from the Lismore Tursa offices, upstairs and opposite the Lismore Arcade ‘Coffee Shots’. With 18 years experience working in the acute mental health services, and three degrees in allied health, Graham has a wide spectrum of paradigms from which he meets the specific needs of the individual, including Gestalt therapy and Cognitive Behavioural Training. He’s currently completing his second Master’s degree. He can provide psychological services under Medicare funding as a Mental Health Social

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Graham is planning to run workshops at his new practice.

I work in a way that encourages moderation and finding a balance Worker. He reports that he is also auspiced by institutions that provide private health insurance. He works from a model that says ‘you can’t be what you are, until you stop being what you’re not’. Graham says that it’s challenging working within a limiting environment where people are labelled with a diagnosis that they often resist. He says he works more holistically. “The accepted model often tells

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people ‘you are this …(a diagnostic or whatever)’, not always that ‘you are a person experiencing this…(whatever) currently’. There is usually a resistance to a mental health label and people don’t always take on board what that could mean and what they could do with it. “At this level – and there are always exceptions – people don’t always engage and back away. I work very differently,” Graham explained. “What I may do with some

clients is refer to any of their accentuated personality traits as ‘bigness’ and encourage that person to accept that ‘bigness’ from the viewpoint of others. Graham says he works in a way that encourages moderation and finding a balance – finding new life skills. “It’s about how do I manage me in this restrictive culture and society. How do I manage others managing me and how do I manage me managing others – it’s really all about managing life.” Graham’s new space has two rooms and one is big enough to run workshops for up to 12 people, which he is currently planning for anxiety and depression. He specialises in couples/relationship counselling, people experiencing post trauma and people operating within an autistic/ Asperger ‘sspectrum. Adolescents may also be referred following consultation. Graham will charge what he describes as a modest fee for his services. Clients will require a GP or Psychiatrist referral and a ‘Better Access Care Plan’ to receive a Medicare rebate. Clients with private health insurance are also welcome. To make an appointment, phone Graham on 0412 407 868. Care plans may be emailed to: grahamjohngillard@gmail.com

Jobs in Jeopardy service Do you know someone whose job is in jeopardy because of disability, injury or poor health? Help is at hand for patients of GPs who are currently working but likely to lose their jobs or their employment is at risk in the near future as a result of injury, disability or poor health, including depression and anxiety. Wesley Uniting Employment are contracted to deliver Jobs in Jeopardy services through the federal government across the Northern Rivers. Jobs in Jeopardy clients can register directly with Wesley

Uniting Employment - disability employment service provider . No referral is required but WorkCover cases are excluded from the service. Wesley Uniting Employment has access to funding for counselling, re-training, to purchase special equipment, and carry out workplace modifications based on individual assessments. Free, confidentially and individually tailored support will be offered for up to 12 months to help maintain employment. For further information, phone 1800 631 132.

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Jimmy Chiu: a melodic life As I sit in the waiting room at Alstonville Medical Clinic waiting to interview Dr Jimmy Chiu, I can’t help but be impressed by the friendly atmosphere and the caring way in which staff and doctors interact with their patients. When Jimmy appears, he gives me a broad smile, shakes my hand and directs me to his spacious and comfortably furnished consulting room. This popular and respected Northern Rivers GP was born in 1953 in Hong Kong of Chinese parents, but life for this family changed in 1967 when an uprising by pro-communist leftists caused violent riots. Later the leftists also resorted to terrorist attacks, planting fake and real bombs in the city-state and murdering some members of the press who voiced their opposition to violence.

feature

Dr Jimmy Chiu with photos of his wife Mascha and parents beside him.

Off to Australia

“My parents became concerned for the safety of their three children, myself, my older brother and older sister. My brother decided he wanted to go to boarding school in England, but in those days it was a long journey, sometimes by ship and my parents thought it was too far away. They knew some people in Brisbane who suggested Toowoomba Grammar School and my brother was sent to school in Australia,” Jimmy told GPSpeak. Later that year, Jimmy’s parents asked him if he’d like to join his brother in Toowoomba, but he told them he was happy at his Hong Kong School. However, the planting of a bomb at his school altered Jimmy’s mind and he too was sent to Queensland. It was his father’s advice about his career possibilities that saw Jimmy studying medicine at the University of Queensland. “He suggested I study medicine, saying that it was a profession where I could take my nameplate with me and set up anywhere and I could also be master of my destiny. I thought w w w. nrgpn . o rg . au

From left: The members of Acid Bleed: Andrew Horowitz, Adam Blenkhorn, Jimmy Chiu, Josh Kirk & Pete Costin-Neilsen. The couple at the front are David & Laura Moore who recently left the band and returned to Sydney.

that sounded pretty good.” Student years During the course of his studies, the young Jimmy took a year off to ‘have some fun’ and work in the field of medical science, in particular conducting some research into Huntington’s disease. This proved to be a good move in settling Jimmy’s mind on the course of his medical career. “I decided research was not for me, so I went back and finished medicine. It was while I was doing an internship at Princess Alexandra Hospital in Brisbane that I thought of physician training, but a surgeon advised me not to do it if I wasn’t sure,” Jimmy explained. Around this time Jimmy married his Dutch Australian wife

Mascha and the couple went back to Hong Kong. Jimmy explained that he had a notion to go back to Hong Kong for a period of 10 years because his parents had seen him through medical school and he felt it was the right thing to do. But after 18 months back in Hong Kong, Jimmy and Mascha returned to Australia.

Starting out

Jimmy’s first position was as a resident at Lismore Base Hospital where he met long-time colleague Dr Paul Earner. “I was Paul’s RMO at the time and he involved me closely in his in-hospital activities. Paul was instrumental in my eventually choosing a path in general

practice.” However, the conservative attitude of the hospital’s then Chief Superintendent saw Jimmy and Mascha – who was then working as a dietitian - move to Gosford to work in the hospital there. “This Chief Superintendent said he would rather not have couples working in the same establishment, so we went to Gosford for a couple of years and then Paul Earner rang me and asked me to come and join the Alstonville practice. That was 27 years ago and I’ve been here ever since.” Jimmy loves his work as a general practitioner and said if given the chance, he’d do it all again. “I really enjoy the continuity of treating patients long-term, the friendship and the comradeship – being able to work in a group practice is totally invaluable. You realise you are not the only person that is important and that you are very replaceable,” he smiled.

A great team

Jimmy said it was the team spirit at Alstonville Medical Clinic that he really appreciated. “We are very fortunate to have wonderful practitioners in this practice whom you can rely upon for your patients, your family and yourself.” After working 27 years as a GP, Jimmy says the patients he sees have not really changed – people remain the same. But the biggest changes he’s witnessed have been in the administrative side of running a practice. “Things have become cumbersome. We are lucky in our practice that we have a good system in place with the experience of many years to guide us and can readily embrace all the administrative requirements, but it must be very difficult for young practitioners,” he said. Continued page 22 apr i l 2 0 1 2

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Banging the drum for good IT By Andrew Binns To the non ‘tech head’ IT conferences can be rather dry, but that was certainly not the case at the Best Practice (BP) Summit in the wonderful Queensland City of Bundaberg. Two highlights before I even get into the IT side involved night time activities of diverse kinds. The first was witnessing about 120 hatchling turtles at Mon Repos beach, seeing them enter the world by climbing out of their sand-buried eggs using purpose built teeth, scampering to the water’s edge and then to beginning their mammoth journey with a swim lasting three days and nights. The hatchlings then join the currents where they can drift and feed at the same time. They make their way past Lord Howe Island, past the north of NZ and toward the equator as they head off to the Americas, with hazards such as sharks and plastic debris to contend with. There is sadly only a 1 in 1000 chance the females will ever make it back to Bundaberg 20-30 years later to breed. Another evening highlight was to see the founder of Best Practice, Frank Pyefinch, a Bundaberg GP, joining the band at the conference dinner. He played a couple of numbers as guest drummer and is clearly a talented musician not to mention

Heading off for the big swim

Bundaberg GP Frank Pyefinch on drums.

his many IT achievements. How paradoxical that I should write about medical software programs. I have never understood computer systems and yet totally rely on them for my daily func-

40% more cancer cases by 2020 The number of new cancer cases diagnosed in Australia each year is predicted to rise by almost 40% from 2007, mainly due to population growth and the ageing of the population. The Institute of Health and Welfare (AIHW) report, Cancer incidence projections, Australia 2011 to 2020, examines trends to 2007 to estimate the number and rate of new cases in Australia to 2020. The total number of new

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cancer cases diagnosed each year is projected to rise from an expected 118,000 in 2011 to about 150,000 in 2020. “This increase is expected to be most evident in older people,” said AIHW spokesperson Ms Chris Sturrock. “Prostate cancer is expected to remain the most common cancer in males followed by bowel cancer, melanoma and lung cancer.”Increases are expected in rates of melanoma as well as liver.”

tioning as a GP. Having braved the conversion from Medical Director to BP 12 months ago, I believe that if I can do it then anyone can. It was a small amount of pain for a lot of gain (at least for me). As an ageing GP I need all the help I can get in general practice particularly with all the changes afoot. A good recent example of impending change is the PCEHR (Patient Controlled Electronic Health Record) which launches in July 2012 and about which our patients may well be asking many key questions, not least in regard to accuracy and privacy. BP is addressing the bureaucratic processes to help with the administration of the PCEHR and to minimise what GPs and their staff need to do. Despite that we do need to start doing some work on data cleansing.

This will ensure that what goes up on the record is pertinent and helpful. Allergies, medications, coded past history (avoid free texting), ATSI and ethnicity coding, family and social history, smoking and alcohol status etc needs to be up to date. Data cleansing is also needed for accreditation and leads to better and more meaningful referral letters and recall systems. This is not that hard to do if you chip away at it. A good time to check the record is before writing a referral letter or before calling in your next patient from the waiting room, particularly if they have chronic disease and/or are on multiple medications. Are PCEHRs going to be a major advance in health care as has been found in Denmark for example? There are many advantages in patients ‘opting in’ to have their medical records placed securely somewhere in cyberspace, there to be accessed only by designated and authorised professionals; eg their GPs, carers and treating specialists. In the NT and increasingly in remote WA and SA there is a well implemented system that does this and has been paying significant dividends particularly for Indigenous people many of whom for cultural reasons are quite mobile and often present to different primary health facilities. If they have chronic and complex diseases and are on many medications then having ready access to these records is very helpful for treating clinicians. The same could be said for anyone with chronic disease. I would definitely look closely at putting my own medical records into a centralised data base before joining the ‘grey nomads’ or venturing off to darkest Africa or Antarctica. If you are thinking of expanding your medical software program capability, my advice is to seek good advice – consult an IT expert who can help you choose the system that is most likely to become your friendly practising companion and do its share of the thinking, prompting and admin work for you. w w w. nrgpn . o rg . au

New Technology for Glaucoma Management By Chris Buckley FRCS (Eng) FRACS FRANZCO Diagnosis of glaucoma, both the commoner open angle variety, and the rarer (in Australia, being common in Asia) closed angle type can be problematic in their early stages. Technology is helping ophthalmologists come to a diagnosis before visual field loss is obvious to the patient.

Retinal thickness measurement for open angle glaucoma.

This has been available for some time via Ocular Coherence Tomography (OCT). Note flattening of the inferior peak (at site of arrow) in the right eye image.

Anterior segment OCT and Pentacam anterior chamber volume

measurement for assessment of risk of angle closure.

A volume of less than 100 cu mm is considered a risk on Pentacam measurement. This patient has an anterior chamber depth of 2.15 mm and volume of 84 cmm, and is at some risk of chamber angle closure. Note also the angle measurements of approx. 25 degreesNote flattening of the inferior peak (at site of arrow) in the right eye image.

The image below shows a more normal anterior chamber depth (3.02mm)and volume (181cmm). The angles are wide open, measuring between 32 and 58 degrees. New â&#x20AC;&#x2DC;Asymmetry Analysisâ&#x20AC;&#x2122; software allows for earlier recognition of asymmetry between the two eyes This is the same patient as above.

Anterior segment OCT shows the chamber angle anatomy which can be measured before and after prophylactic peripheral iridotomy with the YAG laser. Before: Angle is 28 degrees

After: Angle is 33 degrees Thinned inferior retina in the right eye. Shown most easily in the asymmetry analysis (the B&W diagram to the side & below). Corresponds to upper visual field loss as follows After: Site of peripheral iridotomy visualised and seen to be patent

Chris Buckley has been a regular locum in Ballina for the past eight years. Trained at the Royal Victorian Eye and Ear Hospital and at the Oxford Eye Hospital, UK, he is based in Melbourne where he has a general ophthalmic surgical practice, and runs East Melbourne Ocular Imaging Services. His current specialty interests are glaucoma diagnosis and treatment, especially surgical management; all corneal diseases; and therapeutic uses of soft contact lenses. w w w. nrgpn . o rg . au

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The Koori Grapevine Meet Gurgun’s new PM In late February, Githabul woman Tristan Charles took up the position of Practice Manager at Gurgun Bulahnggelah Aboriginal Medical Service in Lismore. “I’m looking forward to the challenge of this new job,” Tristan said. Tristan has worked in the field of Aboriginal health for some years. She was previously at Casino AMS as medical receptionist and transport officer.

During this time she also worked as practice manager occasionally. More recently, Tristan was Medical Receptionist at Bullinah AMS in Ballina. She is studying externally through the University of Northern England in Armidale. “I have already completed my Certificate III and Certificate IV in Practice Management and am part way through my Diploma of Practice Management,” she told GPSpeak.

Tristan said she enjoys working for her own people and making a difference to the health of Aboriginal and Torres Strait Islander people locally. She is kept busy at home with four sons aged between 7 and 16. “They’ve all signed up for footy so there are interesting times ahead,” she said. Gurgun is also pleased to announce that well-known GP Dr Ant Solomon is now working at Gurgun on Tuesday afternoon.

Tristan Charles

To make a booking with any of the Gurgun practitioners, phone 6620 2741.

Inroads made in Closing the Gap The Australian Government has admitted it has more work to do to achieve at least three of the six targets it has set itself to close the huge disadvantage gap between Indigenous and non-Indigenous Australians. Tabling the 2012 Closing the Gap report, Prime Minister Julia Gillard said the government was on track to halve infant mortality rates for Indigenous children by 2018, and ensure early childhood education for all indigenous fouryear-olds by 2013. Ms Gillard said the government was also “generally on track” towards halving the literacy and numeracy outcomes for Indigenous children by 2018. However, she also told parliament that “faster improvement” was required to boost the number of Indigenous students completing year 12, and to lift indigenous employment rates. Closing the life expectancy gap between Indigenous and nonIndigenous Australians remained the most challenging target of all, Ms Gillard said. She said the foundations for overcoming indigenous disadvantage were in place. “The report shows that we are 14

Indigenous children are doing better at school, including in literacy and numeracy.

seeing progress, we are making gradual gains.” The Closing the Gap report talked about progress in three areas: Programs on track to meet the under-five mortality target with a continued decline in mortality rates for Indigenous children — falling by 48 per cent from 1991 to 2010 across the three jurisdictions in which

Koori Grapevine

long-term comparison is possible (Western Australia, South Australia and the Northern Territory). Overall Indigenous mortality rates have declined by 36 per cent from 1991 to 2010 in the three jurisdictions for which reliable data are available for this period (Western Australia, South Australia and the Northern Territory). Indigenous children are doing better at school including strong improvements in National

Assessment Program – Literacy and Numeracy (NAPLAN) results for Indigenous students. In seven of the eight areas in which the government can assess progress at the national level, the gap with non-Indigenous students narrowed from 2008 to 2011. Download the report at: http:// www.fahcsia.gov.au/sa/indigenous/ pubs/closing_the_gap/Pages/default. aspx

Free booklet on depression & anxiety The national not for profit organisation Beyondblue, which works to address issues associated with anxiety and depression, has produced a new booklet providing clear and comprehensive information about depression and anxiety, including: What the conditions are Common symptoms and how to recognise them

How to get help for yourself or for someone you know How to stay well Caring for someone with depression or anxiety. Free copies of this booklet are available to download at: http://www.beyondblue.org.au/ index.aspx?link_id=7.980&tmp =FileDownload&fid=241

Staff stage a DonateLife Week barbecue NRGPN’s Closing the Gap team held a community barbecue lunch in Heritage Park in Lismore recently to mark DonateLife Week 2012. DonateLife Week is held each year to encourage more Australians to become organ and tissue donors. Its main message is for Australians to have a conversation and let their families know if they have decided to donate their organs. The Federal Parliamentary Secretary for Health and Ageing, Catherine King said more needed to be done to normalise organ and tissue donation in the community. “Very few Australians will die in the specific circumstances in hospital where organ donation is possible – in reality it is a rare event – whereas many more will be able to donate tissue. That is

From left: Jamie Wimbus, Jessica Dennis, Cati Smith and Cherie Leon tuck into the lunch after serving community members and handing out information bags on organ and tissue donation.

why every family conversation about donation wishes matters – every conversation could one day save lives," said Ms King. During DonateLife Week, a

Flexibility and support vital to improve Indigenous job rates New information on what works to increase Indigenous employment, has been released by the Closing the Gap Clearinghouse. The paper, Increasing Indigenous employment rates, looks at measures shown to improve Indigenous employment prospects. Indigenous Australians have much lower rates of employment than other Australians for a number of reasons, including lower levels of education and training, poorer health, and living in areas with fewer job opportunities. A number of measures, including increased formal education and training, pre-employment assessment and training programs, and non-standard, Indigenous-specific recruitment strategies are effective in overcoming this disadvantage. Ongoing measures are also helpful to ensure employment retention, such as the provision of cross-cultural training, flexible working arrangements, ongoing

mentoring, and anti-racism initiatives. The problem of low Indigenous employment rates is magnified by the over-representation of Indigenous Australians in correctional systems – an issue examined in a second paper: Strategies to enhance employment of Indigenous ex-offenders after release from correctional institutions. There are a number of prisonbased and community-based programs aimed at improving employment prospects for exprisoners, however, there are only a small number of Indigenousspecific programs. To address the problem, a long-term, transitional focus is essential, with programs ideally adopting a personalised, casemanagement approach. Programs incorporating Indigenous knowledge and practices, or involving Indigenous facilitators or elders are also helpful, as is mentoring or other support options. For more information, go to: www.aihw.gov.au/closingthegap

special plea was made to young Australians to talk about donation wishes by Melanie Plant, who shared her family's story about teenage brother Mitchell,

who became an organ donor after a sudden fatal car accident and saved the lives of four others. "I know it is a difficult subject and one that most parents or kids don't want to discuss, but it is so important for young Australians to ask and know the wishes of their loved ones and friends. We made a decision that day as a family, based on our beliefs and what we thought Mitch would have wanted. However it would have been made so much easier if we had known his wishes. We urge people to have the discussion today – with your parents, your friends, your family and your kids" said Melanie. DonateLife Week is led by the Organ and Tissue Authority as part of the Australian Government's national reform agenda to increase organ and tissue donation for transplantation.

Grants available to improve Indigenous cancer outcomes The Cancer Institute of New South Wales (NSW) is seeking expressions of interest in three new grants to support organisations working to improve cancer outcomes. As part of the Institute's Cancer services and information (CSI) cross-divisional program, grants will be provided to stakeholders, to either extend a current activity, or undertake a discrete small piece of work that are consistent with the below initiatives: improving cancer outcomes for Aboriginal people improving cancer outcomes for people from culturally and linguistically diverse backgrounds improving cancer outcomes for people in rural and remote NSW

greater system-wide engagement with primary care. The Institute will work through the provision of $600,000 to provide grants, which will be allocated via an expression of interest process. The grants are one-off and any activities undertaken must be sustainable without further funding from the Cancer Institute NSW. Expressions of interest must be submitted by 9 April 2012. Further information, including forms, can be found on the Cancer Institute NSW website. Contact: Yvonne Weldon, Aboriginal Program Coordinator at the Cancer Institute NSW on (02) 8374 3655 or email: Yvonne.weldon@cancerinstitute.org.au

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Arts, Health & Wellbeing Creating Connections debut The first exhibition for the new Creating Connections Arts and Disability North Coast project has been a huge success with the launch featuring some fun elements. Arts and Disability Officer for Accessible Arts NSW in Northern NSW, artist Julie Barratt, said in staging the arts exhibition at Northern Rivers Community Gallery in Ballina she was mindful of showcasing some of the things that Accessible Arts is about. As well as an exciting collection of paintings, photography, ceramics and other visual arts, there was an Auslan interpreter at the launch, an electronic music collective called Tra La La Blip and the Bridge Street band performed as well. Julie’s appointment runs for three years , funded by the NSW Department of Communities, and her territory goes from Tweed down to Taree. Julie explained how she’s managing the difficulties of such a large footprint. “I’ve been organising community forums to get feedback from some of the key players as to what they see as some of the issues around access to the arts for those with disabilities and some of the potential projects and initiatives . I’ve organised two steering committees as well. “I’m mindful that as one person it’s a huge job. I could just spend a year building a data base and mapping the region. So basically I put a call out really early for anyone interested in the steering committees to help me to map out. They are volunteers working in Arts Disability and have a vested interest in partnering in some of the projects,” she told GPSpeak. Well-known as the former owner of Barratt Galleries in Alstonville, Julie is very commu-

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From left: artist and apiarist Scott Trevelyan with his artwork T315 Chapter II – Artist Book, a drypoint etching, beeswax, resin and timber with Julie Barratt at the Creative Connections exhibition opening. Photo by Lisa Knight.

Julie Barratt with the artwork she produced from handmade paper she brought back from Nepal.

nity minded. “I love community projects and this has to be very community driven to have the most benefit and for sustainability. I’m very keen on getting projects off the ground that are ongoing. So at the end of three years, everything doesn’t just stop. Hopefully, there will be a whole lot of stuff that just keeps going. And it’s also about raising awareness – I really love it, Julie is working out of the former Barratt Galleries space in the Arts Northern Rivers office. She said Arts Northern Rivers CEO Peter Wood had been tremendously supportive and while it is a little odd to be back in her

former gallery space, she will use it to advantage and stage some exhibitions there. Last year, Julie took a break to set up a printmaking studio in Nepal for young deaf women, which reinforced her belief in the importance of access to the arts for all people. The studio is auspiced by a children’s charity called the Esther Benjamins Trust which rescues Nepalese children who have been trafficked or displaced into India – including many who are sold into Indian circuses and forced to perform. For more information, go to: www.ebtrust.org.uk The printed handmade paper

and books are sent to the UK and sold to raise money for the Trust’s children’s home in Nepal. Julie set up the print workshop, sourcing materials and training a young deaf Nepalese woman to manage it. “We got together a lot of product and put together a catalogue and by the time I left we had a company in the UK that was taking anything we could produce so then we had four girls that are now paid to go and work in the studio from Monday to Friday and it’s growing, Julie said with a broad smile. Julie very much enjoyed and valued her experience in Nepal. “I loved working with the girls and it was such a different experience from teaching. I’d get there in the morning and they’d say ‘thank you so much for coming again today’. They’d be rearranging my hair and fussing around me. I’d love to go back.” Julie also brought back handmade paper to produce some artwork that featured in the end of year graduate student exhibition at the visual arts gallery at Southern Cross University late last year. (see photo left). We look forward to the next stage of the Creating Connections project. w w w. nrgpn . o rg . au

Act, belong, commit for a healthy lifestyle What makes you really happy? It seems the answer is simple things. When Professor Rob Donovan of Mentally Healthy WA at Curtin University did some research into this topic he found people did not talk about possessions – a spa bath and some champagne - but about things that built a good sense of self. And this was the basis for the beginning of Act-Belong-Commit – a unique community-based health promotion campaign that encourages people to take action to improve their mental health and wellbeing. Rob visited Lismore recently to try to get community organisations, health professionals and government departments on board to roll out the program here. At a recent talk at the UCRH, Rob talked about the three easy steps to better mental health that

Act-Belong-Commit embodies. “As the brand name suggests, people can build positive mental health by keeping physically mentally and socially active (ACT), by keeping involved in family and community activities and taking part in community events (BELONG) and by taking on challenges or causes that give their lives purpose and meaning

by helping others (COMMIT),” said Rob. Rob’s message is that keeping mentally healthy is just as important as keeping physically fit and you will simply feel happier too. Some of the responses to the question of what makes a person happy were things like fixing the washing machine when your partner thought you were a dunce in that department, graduating from a course, looking after the kid next door whose parents were doing a lot of drugs – things that promote a feeling of wellbeing and a sense of being useful. “We’re not telling people to quit anything, because that’s hard, we’re telling them to go out and enjoy life,” said Rob. But how can we use ACT BELONG COMMIT to enhance our mental health in the Northern Rivers? It would appear that our region could use ACT BELONG COMMIT effectively

because it already has a strong network of community organisations and NGOs. First of all, there’s no cost involved. A community group like a sports club, for instance, is invited to sign a memorandum of understanding with Act Belong Commit to promote their message. A project officer is then assigned to help that club promote improved mental health through the ACT BELONG COMMIT model and the payoff is often that the group attracts more members or volunteers. These people then reap the benefits of an improved social life and more involvement in the community, leading to an enhanced sense of wellbeing. So why not get involved today? You can read more about ACT BELONG COMMIT on their website – http://www.actbelongcommit.org.au/.

Pilot program for cancer patients Northern Rivers Arts Health and Wellbeing Inc. (NRAHW) Is planning its first pilot program – a 10-week creative arts workshop for cancer patients funded by the Cancer Council of NSW. NRAHW’s public officer Dawn Thirlaway said the management committee was delighted to receive its first grant for such an interesting and worthwhile project. “I’m certain the five facilitators will learn a great deal and we look forward to our time with the workshop participants to give them an opportunity to express themselves in a variety of creative ways,” she said. NRAHW recently held its first Annual General Meeting with guest speaker Professor Judy Atkinson, former head of Gnibi College of Indigenous Australian Peoples at Southern Cross University (SCU). Judy is a Jiman – an Aboriginal

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Prof Judy Atkinson

Australian (from Central west Queensland) / Bundjalung (Northern New South Wales) woman, who also has AngloCeltic, and German heritage. Her primary academic and research focus has been in the

area of violence, with its relational trauma, and healing or recovery for Indigenous, and indeed all peoples. In 2006, while at SCU, she won the Carrick Neville Bonner Award for her curriculum development and innovative teaching practice. In 2011 she was awarded the Fritz Redlich Memorial Award for Human Rights and Mental Health from the Harvard University Program for Refugee Trauma. Judy gave a fascinating address, talking about her own story and some of the work she has been involved with including working with trauma and healing through art. She opened by mentioning that the archives of the now defunct Rozelle Psychiatric Hospital contain all of the artwork created by the institution’s inmates over the course of its history. “A couple of researchers have

applied to access the art and to look at what the inmates were saying through their art. Some are still alive and have continued to make art. I was stunned to learn that all of the art had been kept. What a rich archive to learn more about Australian history through art,” Judy told her audience. And it was back in 1991 that Judy rang the alarm bell on violence against children and women in Aboriginal communities by speaking out about the issue on ABC Radio. Unfortunately, there’s not room here to report more fully on Judy’s speech. To find out more about this impressive woman and her work, you can read her book: Trauma Trails, Recreating Song Lines: The Transgenerational Effects of Trauma in Indigenous Australia. The AGM was also treated to some moving music from Indigenous muso Ash Dargan.

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RSL Lifecare buys former hospital RSL LifeCare has bought the former Lismore Private Hospital site and plans to open a state-of-the-art residential care home mid-year if development applications go smoothly. RSL LifeCare is a charity providing retirement living, residential aged care and in-home community care to 1400 people across northern NSW. It recently celebrated 100 years of aged care in Australia. The new home will comprise 64 single bed rooms with ensuite bathrooms, lounge and dining facilities and a chapel. RSL LifeCare Northern Region’s General Manager and Chief Clinical Supervisor, Matthew Ashby told GPSpeak that the new facility would be available to all local residents. “I’m delighted to be helping to create a new aged care service

From left: RSL Lifecare Northern Region GM Matthew Ashby & staff.

from the ground up, offering a combination of low and high care for the people of Lismore,” said Mr Ashby. As well as 24-hour care, Mr Ashby said residents would benefit from modern facilities, new furniture and a central location.

Meals will be prepared on the premises . Mr Ashby said residents would enjoy the care and compassion that RSL LifeCare is renowned for. “RSL LifeCare is committed to putting the needs of our valued

Retinal surgeon now in Lismore, Ballina and Brunswick Heads Dr Augustino “Gus” Clark (BMedSci, MBBS, MOphth, FRANZCO) has recently joined the Northern Rivers Eye Surgeons with Dr Niall Aboud and is a permanent addition to the local ophthalmology community. Gus is a fellowship trained vitreoretinal surgeon, having undertaken medical and surgical retinal fellowships at the Princess Alexandra Hospital in Brisbane (2009) and St. Orsola Ospedale Malpighi, Bologna, Italy (2011). In Europe he gained exposure to all aspects vitreoretinal disease including experience with a number of new intravitreal therapies for Macular Degeneration, Diabetic Retinopathy and Retinal Vein Occlusion. During this time he also presented and published research on intraoperative Ocular Coherence Tomography and Epiretinal Membrane Surgery. Prior to his fellowships, Gus obtained a Masters of Ophthalmology at The Save Sight Institute in Sydney with Associate Professor Kathy McClellan. He undertook four years of general 18

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Augustino “Gus” Clark

ophthalmology training in New Zealand with Professor Anthony Molteno with a particular focus on complicated glaucoma surgery, becoming proficient in Molteno shunt surgery for glaucoma. Gus specialises in diseases of the retina, vitreous and macula. These include the assessment and management of Age Related Macular Degeneration, Diabetic Retinopathy, and Retinal Vein Occlusion. In conjunction with St Vincents Hospital, Lismore, which has pur-

chased the Constellation vitrectomy system, he is now able to offer a comprehensive surgical retinal service to patients for the first time to patients from across the Northern Rivers. Patients are no longer required to be transferred to the Gold Coast or Brisbane for Vitreoretinal Surgery. Gus is able to offer emergency surgery to both public and private patients for retinal detachment, posterior segment trauma, complicated cataract and complicated glaucoma at St Vincents Hospital, Lismore. Epiretinal membrane and macular hole surgery is now available for the first time in the Northern Rivers. He is consulting at 11 Dalley St., Lismore ( Monday, Tuesday and Thursday), 85 Tamar St., Ballina (Wednesday and Friday), and Shop 3/30 Mullumbimbi Street, Brunswick Heads (Wednesday). Appointments can be arranged by telephoning 6622 5999 or 6622 5888. Referrals electronically via Argus are welcome.

clients first, and our care philosophy is centred on respect for the dignity and wellbeing of all people in our care,” he added. The new home will be named ‘Fromelles’ in keeping with RSL LifeCare’s tradition of naming facilities in honour of Australia’s military heritage. Fromelles is named to commemorate the first major battle fought by Australian troops on the Western front. Anyone wishing to make inquiries about Fromelles is asked to contact RSL LifeCare’s Ballina office on 6681 9006.

Hierarchies fail Gen Y nurses Research led by Southern Cross University has found the hierarchical style of management in the health system is failing Generation Y nurses, forcing some of them to leave Australia’s hospitals. In a paper published in the Nursing Outlook journal co-authored by Prof Yvonne Brunetto, she said Gen Y were not as committed to an organisation. “If they are not happy in the workplace they will leave and even change career paths, whereas Baby Boomers are much more likely to stay. Generation X-ers are somewhere in the middle.” Prof Brunetto said Generation Y nurses had different expectations. “Generation Y come into nursing with the belief that they are professionals and their tasks should be clinical in nature - eg it is going to be a Baby Boomer nurse who will do the flowers for a patient; Gen Ys will, but only if they have time,” she said. “Gen Ys are more achievement orientated. Notably, they dislike hierarchy and are more likely to have difficulty with superiors and less likely to accept the leadership of the nurse supervisor.”

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New oil â&#x20AC;&#x201C; a game changer?

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It is now possible to tap vast quantities of oil & gas previously too costly to consider makers had to take seriously. After all, every major oil shock in the past 100 years or so has resulted in a world economic recession. And countries such as the United States that relied on huge quantities of imported oil from politically unstable areas in the Middle East were unnerved. But it has not come to that. Admittedly, oil prices have risen and are much higher than they were 15

years ago. The real story is that the outlook for the supply of oil has changed dramatically. Since oil prices soared in the early 2000s oil companies have ramped up their exploration efforts, found new supplies and invested more sophisticated techniques to extract existing supplies of oil at a reasonable price. It is now possible to tap vast quantities of oil and gas that

previously were too costly to consider. In the Americas alone the untapped reserves are vast. In deep undersea reserves off the coast of Brazil one field alone has an estimated 5 to 8 billion barrels of oil. Gas reserves around the world are also immense. Australia has huge quantities of gas in the form of coal seam methane. All that is needed is a safe way to extract it. If oil prices stay

where they are then the incentive will be to develop technologies that will enable the oil companies to exploit them, As oil-insider Daniel Yergin points out in his new book: The Quest: Energy, Security, and the Remaking of the Modern World, new techniques involving 3D underground imaging, new CAD computer techniques and horizontal drilling at huge depths has

David Tomlinson

You may not have noticed, but a fundamental change is occurring in the energy market. It has the potential to change the way we think of the world, alter prevailing power structures and according to some, lead to a revitalisation of the United States. If it goes according to plan the political landscape of the world will change including the downgrading of the Middle East as a cause of world friction. The cause? Itâ&#x20AC;&#x2122;s new oil, a paradigm shift that makes the old notion of Peak Oil obsolete. Over the past 30 years there have been numerous stories about the looming spectre of peak oil and its potentially devastating consequences. It was based on the idea that our entire economy depends on cheap and plentiful supplies of oil to thrive but that unfortunately we were consuming oil faster than we were finding new supplies. The easy oil was already being extracted and it would become increasingly difficult and expensive to extract the remainder. The latest versions of the story point to the huge demands for energy coming from the emerging underdeveloped giants of the world. Aircraft would be grounded as aircraft fuel became too expensive, economies would sink into recession and stagnation, we would be forced to become more reliant on our local communities for food and services (maybe not such a bad thing) and the suburban sprawl would end. It would be too expensive to operate a car and commuting would die. Of course we were never actually going to run out of oil. Even if the demand and supply forecasts had been correct we would have seen sharply higher oil prices followed by a substitution effect as alternative fuels become more economic. But even so, it was something that policy

ec o n o my

changed the nature of the energy equation. There is now a new oil rush in full swing. It will probably mean for example that the US will become independent in energy. Its trade balance will turn positive and it will no longer have to involve itself in the treacherous machinations of the Middle East. Of course there are problems with this scenario. A lot of the new techniques involve fracking, a process that involves drilling deep underground and then using explosives, sand and chemicals to fracture the surrounding rock to release the oil and gas. There is a great deal of opposition to the process with issues relating to land use, chemical contamination and the pollution of ground water. And this new world order does nothing to address the problem of climate change and the effect it will have on moving towards a cleaner energy future. Yergin believes that while climate change is a pressing issue, the demand for energy is expected to grow by 30 per cent or so over the next 20 years. He believes it will not be possible to change the mix of energy sources much before then. After this, however, new technologies should make it easier and more economical to produce much large quantities of clean energy. Presumably it wonâ&#x20AC;&#x2122;t be too late by then.

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GPSpeak

Tackling the health effects of csg liver and haematological disease including leukaemias, lymphoma and myeloma. Methanol is a volatile organic compound, highly toxic to humans and causes central nervous system depression and degenerative changes in the brain and visual system.

By GP Ben Ticehurst of Doctors for the Environment, Australia

The issue

There’s an enormous potential health hazard on our doorstep, and it’s going to get a lot worse, rapidly, unless public resistance can affect the current course of action. Coal Seam Gas (CSG) mining has been introduced into the Northern Rivers area, and large companies are forging ahead, unchecked, with no restrictions on their activity, while posing a major risk to health and the environment. General practitioners will be at the forefront in diagnosing and managing patients harmed by CSG mining. This article provides some information on the adverse health effects occurring from CSG mining.

Toxicity with csg mining

CSG largely consists of methane, bound to the surface of coal. The mining processes involve a pressurised injection of hydraulic fracturing (fracking) fluids into the ground to open upt or enlarge earth cracks. Associated with the drilling process, about 2.5 million litres of fluid is applied underground at high pressure to release trapped gas. The fluids used contain water, sand and undisclosed toxic chemicals, biocides and radioactive tracers. Data from the US confirms over 980 chemical products are used, with a total of 640 chemicals. To obtain the gas, water is injected, then withdrawn and depressurised, releasing the gas. The depressurisation process can interconnect with overlying aquifers and water bores, contaminating these water supplies. A proportion of the fracking fluids are returned to the surface along with other mobilised compounds and held in evaporation ponds. The chemicals in fracking fluid are a trade secret and not publicly disclosed. Of the chemicals used, 44% in the US and there-

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Hundreds of people turned up to an ANTI CSG meeting at the Lismore Workers Club in early March. Photo: Sue Stock

fore here, do not have identifying chemical names or registry numbers. Therefore, we have minimal information available to assess environmental and health effects. This lack of disclosure is permitted in Australia, and there is no mandatory chemical and environmental assessment required when CSG mining occurs. From the general list of the types of chemicals used, we know many are known toxic, allergenic, mutagenic and carcinogenic substances. Waste water returning to the surface contains additional volatile organic compounds, high concentrations of ions, heavy metals and radioactive substances, but in unknown quantities.

Health concerns

The greatest concern for public health is chemical contamination of drinking water. The CSG companies claim that many of these chemicals are benign as they already exist in household products. Air contaminants also poison our air during and after the mining process. Air samples collected surrounding CSG mining sites have found toxins present in the air of levels up to 3000 times higher those deemed acceptable by public health standards. As a result of contaminant exposure, patients can present with headaches, eye irritation, sore throat, rashes, nausea, vomiting and diarrhoea, sinusitis, asthma-like respiratory illness, and seizures. The non-specific nature

of patient signs and symptoms may make definitive diagnosis difficult and, exposure to chemical “cocktails” produces more complex disease, further hampering diagnosis. Unfortunately, many of the routine investigations we would organise for diagnosis may yield unhelpful normal results, as standard tests will not detect the causative agent(s). Patients may also present with more specific organ system dysfunction. Some of the more dangerous known toxic substances include: ethylene glycol, a respiratory toxicant and causative of spontaneous abortion and a known teratogen; 2-butyoxyethanol causes hemolysis, pulmonary oedema, infertility and birth defects; ethoxylated 4-nonlyphenol (NPE) is bioaccumulative, disrupts the endocrine system and is associated with breast cancer; it causes cataracts and haemolytic anaemia, nausea, vomiting and diarrhoea. In animal models it causes lung disease, lung tumours and nasal tumours. Benzene (in BTEX) has been detected as a contaminant of surrounding water, air and soil. BTEX compounds are hazardous chemicals and prolonged exposure can cause kidney,

Animals exposed to fracking fluids have suffered sudden death, kidney and liver failure, infertility, stillbirth and birth defects. It is important that we remain alert to the fact that CSG associated toxins may be responsible. CSG adverse effects also include psychological harm. Many farmers who have negotiated for CSG mining to access their properties are now suffering with depression. They face the reality that their agricultural endeavours are in jeopardy as a direct result of the mines. CSG mined properties have been devalued, and increasing financial worries in the face of diminished return, worsen the stress. The constant noise of the mines contributes to poor sleep. Concerns for family members and farm animals compound the problem. Community members differ in their opinions on CSG and divided participation in CSG mining fractures communities and social support.

Addressing the issue

With the rapid expansion of CSG into our local area, general practitioners will be the first to see associated health effects. Doctors for the Environment, Australia, are working to address the concerns for human health, which can occur as a result of the CSG mining processes. I hope this article will help you in identifying potential diseases which may occur from the introduction of CSG mining to our local area. If you feel strongly about preventing the expansion of these mines into our area we would welcome your support. For more information, go to: www. dea.org.au/resources w w w. nrgpn . o rg . au

Modelling for Manhood

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Control of impulses and emotions was the unspoken way to go

that the other 5% were possibly lying. He openly admitted that he didn’t know the answer but suggested voluntary limits, say once every 8 days. Personal conscious control genders self-respect, according to this author. Who knows? In any case, I can’t remember any patient raising the topic. ‘I’m not saying that you bring 3 times a day down to once a week overnight’. I remember that bit. This guy has balls. Ritual matters. Everybody knows strong feelings emerge at weddings and funerals. Initiation and rite of passage is a neglected ritual in Caucasian society, although vestiges do exist in the major religions, demonstrating that it was once considered important. I vaguely remember the sacrament of Catholic Confirmation, during which I, the adolescent, knelt to kiss the ring of a seated bishop who then delivered the boy-become-man a gentle slap on the face. What did this achieve other than saying ‘obey’? In real life, lost young men can be inadvertently initiated by women, for example the only male child to a mother who has suffered everything for her boy, or the older influential first girlfriend who can spoil him for his female peers. Memories of my own boyhood are pretty sketchy but I do recall puberty as a lonely and uncomfortable time, a shock awakening from the dreamtime of boyhood and no-one to talk with, except equally confused school friends. My father had recently returned from his hospital posting in Bethlehem after the Second World War. Many of my friends had war generation dads and they were very masculine

David Miller

Driving back from visiting grandchildren in Brisbane on a recent early morning I turned on Radio National lifestyle. I did try to podcast the program later, but have to admit to a lack of proficiency in the cyber world. Please forgive me, but it seems the purpose of the speaker was promotion of his latest book. He was questioning the current trend of men trying to get in touch with their feminine sides, an aspiration for the modern man. Why should men look for their sensitive side by adulating women? Is the feminine intrinsically superior? Some people say there would be fewer wars if women were in charge. He brought up a refreshing idea that men can aspire to be in touch with their masculine side, as this is after all the core of man, and can be nurtured without shame. He added that respect for women is more likely in the man with a well formed male psyche but remarked that the usual heroes for this role are professional sportsmen who perform dishonourable acts in public associated with alcohol, usually late at night. He asked ‘Where do we turn for honourable role models for boys?’ Some boys have an active father, wise uncle or grandparent to give guidance. Many don’t. This is not a word for word account of the talk and I have to own filling in gaps with my own thoughts, but the radio discussion was food for thought as can happen when driving alone at an odd hour. The speaker touched on a subject mostly taboo, about boys masturbating. He quoted a survey saying that 95% of boys masturbate and the researchers suggested

light airs

indeed. War and Victory created the distant father model for baby boomer children. As a child growing up, I craved the approval of my own dad. He was a good father and we went to his farm and boiled the billy over a fire which I helped him make and he allowed me to light. But even then, there was an invisible barrier that I did not know was there and had no skills to penetrate. ‘Because I said so,’ was a common negative answer to requests to hire a boat, let me drive, a day off school. Deeper questions about testosterone-based anxieties were not on the agenda. Control of impulses and emotions was the unspoken way to go. The needs of young men in middle class society were generally unmet until the old fable of ‘Iron John’ was popularised by Robert Bly in the 1990s. That parable was instrumental in spawning the men’s movement. In this story, the young prince has to steal the precious key (to manhood) from under his mother’s pillow. In the living laboratory of Byron and in other seminal parts of the western world, the challenge to enact the rituals for initiation into manhood have been taken up by men’s groups, such as ‘Pathways to Manhood.’ What happens in these rituals? I don’t really know. It’s secret Men’s business.

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GPSpeak

A new seat of learning A men’s health and suicide prevention expert, writer Julian Krieg, from Western Australia, has found a new seat of learning far away from the computer, gossip, family distractions and work. It’s the dunny – as he puts it – and the few minutes of isolation spent on it daily is being targeted as the ideal opportunity to provide both men and their partners with a quick, no-frills, high-quality lesson on what is best for health. Krieg’s book on physical and mental health and relationship advice is titled: “We are all in it, it’s only the depth that varies” in keeping with his dunny theme. It has a hole punched in it so that string can be attached and it can be tied to the toilet roll holder. The book which was put together by the group Wheatbelt Men’s Health covers issues from obesity, bad backs, fatigue, making time for children, to alcohol, depression and suicide prevention in a down to earth manner. “The idea came from years of ‘my own personal experience’ and visiting houses and noticing that most toilets had some reading material," Mr Krieg said. “We all live very busy lives and time in the dunny is a moment to be by yourself and it allows a few minutes to think about things for contemplation.”

From page 13

Love of music

There is also a creative side to Jimmy Chiu that has blossomed in the past couple of years – his love of playing music. At the age of 10 back in Hong Kong, Jimmy’s father became very concerned about his youngest son’s love of the Beatles – he was always singing pop songs and listening to music. As a young man, Jimmy took up guitar and enjoyed strumming and singing along to his favourite songs. “But I never developed my musical ability and at uni I’d play

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According to Mr Krieg, mounting pressures from a fastpaced modern lifestyle meant few people had the hours to

spare needed to read up on and research a health issue and sift through and digest all the information available online and off.

three chords in a cupboard now and then – just playing guitar and mucking around and a bit of singing. It was a comment from Mascha that prompted Jimmy to explore his love of music only recently. “I was playing my usual songs one day and Mascha pleaded with me to go and get some lessons and play something different!’” It was just the impetus Jimmy needed to go and learn how to play jazz from a teacher and three years ago he and his friend Andrew Horowitz decided to get a band together. Gradually they met other musicians and Acid Bleed evolved.

“We are just so lucky that we are the same sort of age group and not too precious about what we do, so there’s no conflict at all in the group,” Jimmy laughed. “We can tell each other ‘that was crap,that was terrible’, have a laugh and start over. “When it comes to choosing material, we mingle. I try to elbow my stuff in and other people try to elbow their stuff in and by mutual agreement we decide on our repertoire.” Acid Bleed labels their music as “pulp jazz”, a self-stylised genre. It is mainly groove, manouche (gypsy jazz – Django Reinhardt), Latin improvisation and bossa.

And much of what was available, said Mr Krieg, was either poor quality or too academic, too detailed and ‘too overdone’. “There are those who still just want the raw facts. They want it distilled down. “They will say ‘Just tell me what I need to do, not all the background to it’.” To “get the ball rolling”, Mr Krieg said he had inserted yellowcoloured pages in the middle of the book that encouraged those contemplating life while on the dunny to try to identify the physical and mental health ‘traps’ they were falling into. There are also lists of suitable help lines and a “shock absorber quiz” for those feeling overwhelmed or having problems sleeping or coping. “When things are not going well, it is not often that people slow down and try to identify what is giving them the most trouble and what they can do about it. “Men in particular, they just work on rather than regroup,” said Mr Krieg. We are all in it, it’s only the depth that varies was written and published by Julian Krieg. Price $9.95. It can be ordered by emailing menshealth@agric.wa.gov. au or writing to Wheatbelt Men’s Health, PO Box 768 Northam WA 6401.

The ‘pulp’ bit is because it sounds different every time, and not traditional to the theme. The band appears regularly at the New Tattersalls Hotel in Lismore monthly and is also available for functions. Jimmy cautions that the band is not suitable for intimate gatherings. “We’re quite a big group and we have a loud sound. But we are definitely open to playing for a range of functions. “We just love playing. It’s a wonderful relief from the demands of the day job!”

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Mummies, Cannibals and Vampires book review

Richard Sugg Routledge First, the cover, by which this extraordinary book may be judged: The portrait is of John Tradescant the Younger, botanist and head gardener to Charles I, with a moss-capped skull, which, as the author explains, was “perhaps most typically used in powdered form against nosebleeds, inserted directly into the nostrils, and into bleeding cuts or wounds in cases of accident, violence or warfare” Sugg goes on to explain, citing one of his vast sources, that Sphagnum moss, mildly antiseptic and highly absorbent, had been used “as a wound dressing as long ago as the battle of Clontarf in 1014 and as recently as World War 1 and World War II.” This moss, we learn, was one of the more effective and less gruesome “cures” prescribed for (and often forced upon) the ailing citizenry between the European Renaissance and the Victorian era. As the sub-title has it, this is the “History of Corpse Medicine,” and a truly bizarre history it is. Although not the easiest book to read – more of which later – this prodigiously researched and entertainingly penned work can be dipped into at random with great satisfaction and morbid curiosity. In his introduction, Sugg, a Renaissance Literature academic and distinguished author (Murder after Death: Literature and Anatomy in Early Modern England, being one title), states his challenging thesis: “For well over 200 years in early modern Europe, the rich and the poor, the educated and the illiterate, all participated in cannibalism on a more or less routine basis.” What! Weren’t they the ones colonising the globe, bringing civilisation and anti-cannibalism to the world’s primitive people eaters? “Drugs were made from Egyptian mummies and from the dried bodies of those drowned in North African desert sandstorms. Later in the era the corpses of hanged criminals offered a new w w w. nrgpn . o rg . au

by Robin Osborne

and less exotic source of human flesh. Human blood was also swallowed: sometimes fresh and hot, direct from a donor’s body; sometimes dried, powdered or distilled with a chemical precision. “Human fat was one of the most enduring substances of all... Certain parts of the bone of the skull were swallowed as powder or in liquid distillations. In Long chemists’ shops one cold see entire human skulls for sale... “For certain practitioners and patients, there was almost nothing between the head and the feet which could not be used in some way: hair, brain, heart, skin, liver, menstrual blood, placenta, earwax, saliva and [wait for it!] faeces.” He adds that in a “nice irony” such practices “became most popular and pervasive in the era when reports of New World cannibals were circulating amidst the outraged Christians of Rome, Madrid, London and Wittenberg.” As if these substances were not enough in themselves, the method of administering them is even more cringe worthy. As well as being added to food or drink, they were forced into every bodily orifice, including the anus, often despite the protesta-

tions of hapless patients often too ill or weak to resist, and who mostly died anyway, possibly sooner because of being purged with camel dung, fed the blood of executed criminals or the liver of an exhumed corpse. The cannibalism practised by various people for spiritual reasons, mostly in South America and the Pacific, are also examined, but it is the healing potential of body parts, real or otherwise, that is the book’s focus. Monarchs and their subjects lived in circumstances that were “open cauldrons of disease, with smallpox, cholera and tuberculosis patiently simmering in innumerable corners. “In London in 1858, and in Paris in 1880, there were summers of such intolerable stench that the accompanying outrage and media coverage threatened to rival modern attention to terrorist atrocities.” Desperate times made for desperate measures, and perhaps the greatest irony of using the human body and its various excreta as medicine was that these remedies simply didn’t work, whatever people’s faith, and however costly. I will let the reader consider whether some of the herbal rem-

edies so popular today may have taken up this role. A key question remains – why did so few speak out against these practices at the time, and, as Sugg raises, why has there been so little written since? The answer, he believes, is that, corpse medicine is generally seen as belonging to ‘the days of superstition’, with one popular book on Egyptian mummies telling us that “stolen pieces of mummy were used to make medicine and paint in the Middle Ages (from about AD 1000 to AD 1450)”. However, the end point for that author is actually when the mummy trade began in earnest, and “in terms of corpse materials more generally, there was very possibly more on sale in Britain in 1750 that in 1450 or 1550. The point would apply all the more strongly to Germany.” Sugg, who does not reveal whether he became vegetarian before or after writing this book, suggests that medical historians “have sought to protect medicine as a whole, and perhaps the past itself, from the slur of cannibalism. Like good anthropologists, those studying medical history need to see the past as interestingly different, rather than dangerously wrong.” My only issue with his exceptional work is that it is set in a challengingly small typeface. Perhaps it is my eyes that are at fault, but if so, I have no desire to apply preparations made from the marrow of a goose wing, the ashes of a burnt snail, or most notably, some human excrement dried into powder and blow into the eye – the latter being “another colourful remedy proposed by that pioneering chemist Robert Boyle,” a name doubtless well known to readers. Robin Osborne is Media Director for the Northern Territory Department of Health.

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GPSpeak

Lesbians still seeking equity in local health services Around 50 lesbian and same sex attracted women attended a community consultation evening at the ACON Northern RIvers office in Lismore recently. ACON is the largest communitybased gay, lesbian, bisexual and transgender health and HIV/ AIDS organisation in NSW. The consultation was part of the Pink LACE Project exploring the experience of lesbians and same sex attracted women who have experienced cancer. The project aims to identify barriers to services and accessing support networks. The project, funded by Cancer Australia, is being coordinated by Rose Hogan. As well as community consultations, survey questionnaires have gone out to 50 cancer-related providers between the Tweed and Grafton and to lesbians living in the area. Research has shown that lesbians and same sex attracted women are not having the same health outcomes as heterosexual women with much higher rates of smoking and risky alcohol and other drug use. Relating to cancer, these women present later and are less likely to access services, often because they feel

uncomfortable about having to ‘come out’ in a doctor’s waiting room by staff who assume the woman is married. Rose said anecdotally a lesbian was told two years ago by a local GP that: “Lesbians didn’t need pap smears” and there was a report of a lesbian being asked by a GP: ‘You’re gay, how have you ended up with cervical cancer?’ Rose told GPSpeak some of

Healthy living network The Healthy Living Network registration portal is now live. It’s at: www.healthylivingnetwork.com.au Healthy lifestyle service providers and programs wishing to register are now able to do so on the Healthy Living Network registration portal. The Healthy Communities Quality Framework,

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Service Provider and Program Registration guides are available as PDFs on the site by clicking on the links within the Providers area or within the Resources area. If you are unsure whether or not you should register and are unsure whether you should register as a Service Provider and/or Program, use the Do I Need to Register wizard. If you have any questions please contact QMS at info@ healthylivingnetwork. com.au

the preliminary findings of the research showed that the women surveyed wanted improved after hours GP services and a more sensitive front-of-house environment with reception staff more attuned to individual clients, rather than jumping to assumptions. “Staff can make a comment like ‘Is hubby coming to pick you up?’ which then puts pressure on the woman to have to ‘come out’. While many services insisted they were non-discriminatory, often that translates to treating everyone the same. What we want staff to be aware of is that individuals make different lifestyle choices and to be aware of varying cultures within society,” Rose explained. Some services providers indicated they would like Rose to hold education sessions for their staff and these have been well received. She is giving staff background knowledge on how to deal with lesbians in a way that makes them feel acknowledged and accepted and raise their awareness of a different culture. One woman at the beginning of an education session told Rose that she didn’t know why she was there because her workplace was really good at what they did. “I thanked her and asked if she

would allow us to have a conversation and then feed back to me whether it was useful. After an hour this worker was able to say: ‘I am really glad I stayed, I can see now something I can do differently, I wasn’t aware of the issues.’” This worker was pleased she was able to put up a poster relating to lesbians and cancer in her waiting room to make lesbian women feel more comfortable. ACON manager Marie Reilly said key to raising awareness of the issues surrounding lesbian clients was to work from a basic policy framework around inclusion and equity which filters down to inclusive language in administrative processes and staff training. She is keen to hold an educational event for GPs and practice managers. “We know from working in other program areas on homophobia that when we can work on a policy framework from management down the impact is so much bigger as it becomes a whole organisation approach to a shift in thinking,” said Marie. Sadly the information gathered from this survey wasn’t very different from information gathered in 2005. Common themes include a sense of discrimination and fear of confronting homophobia. The final phase of the Pink LACE Project will involve a report with recommendations. Rose and Marie are excited by the findings of the project and what these will enable them to do. “We’ve had some very positive feedback from the trainings Rose has done so far and we see these sessions as pilot trainings. We will then develop a comprehensive training package that can also be implemented in other communities as well as ours,” Marie said. Rose’s main message for front of house staff is to pull back from any assumptions. “Women want to be asked about themselves without anyone jumping to conclusions about their lifestyle choices.”

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Reviewed by Chris Ingall

In the grip of the grape

Wine Tip Invivo sauvignon blanc is going out for a song from Kemenys. Brilliant wine, so grab some. Dan Murphyâ&#x20AC;&#x2122;s in Lismore and Ballina have the only good range locally of French wines....worth a look. Cellar Tip Get age-worthy reds with a screw cap if you can, as the bottle variation and the longevity will be optimal. Red and white Burgundy sadly is mostly still under cork, as are the better Bordeaux wines.

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I thought it was about time to take a look at what was about in the www (world wide wine) lake we have at the moment, and compare what we have here to what is out there. The main reason for this is our strong dollar, causing a flood of wine made overseas to be imported at competitive prices. We could travel to Chile or Argentina, Spain or Italy, and while there are wines there worthy of mention they are often made with different varietals (grape types), such as sangiovese and moscato. So Iâ&#x20AC;&#x2122;ve chosen to travel to France, where it is much easier to compare our wines, perhaps because many of our vines originated there. We share a number of varietals with France, chiefly cabernet (and the wines it blends well with), shiraz, riesling, sauvignon blanc, chardonnay and pinot noir. How do our wines shape up at a given price point? Well, it depends what you want in a wine, but if you like a beautifully made fruit-driven wine, with plenty of luscious flavours and some good acid, we are hard to beat. Great wines for a social occasion, medium cellaring potential and at prices we will not see again, especially an export-cancelled tranche. If, however, you are looking for wines which will age and become more interesting over time, then French wines are for you. They may not be immediately accessible (or even nice) but given some cellaring, say twice as long as a price-pointed Aussie drop, they will develop complexity and mouth feel better than any other wine on the planet. As a rule, I rarely drink an Oz red (bought for under $20) over seven years old, as they often falter, while the French equivalent presently at the same price will often go 15 to 20 years. Remember, these French drops used to be twice the price. Comparing a favourite of mine, Seppelts shiraz, with a Rhone valley syrah, I love the clear bell note of the Seppelts and the good structure. The shiraz from the south of France, in contrast, will

often be mixed with a little viogner and will be more aromatic, yet has a slaty character from the type of soil found there and will live longer in the bottle. My pick is the Seppelts to have on its own, and the Rhone with a meal. Similarly a cabernet from the Coonawarra will have a lovely spectrum of mint or eucalypt, and long fine tannins, but will drink best at 7 to 10 years, while a Bordeaux blend of cabernet will sniff of cigar box and will have the structure to last 10 to 20 years, even if a fifth growth (the fifth best level of wine). At the moment such reds are very close in price, so it is a window of opportunity to try the French, and to have it in your cellar if you like it. White wines are a little different, as our rieslings are delicious with lime notes and great structure. They are less delicate than rieslings from the Alsace, and have higher alcohol content, but overall are a better drop, particularly with food. Our chardonnays too are becoming more sophisticated, picked earlier and with better acid and structure than even 10 years ago. They are aging better as a result, but still struggle to gain the depth of flavour and interest over time of say a white Burgundy. The wines from Montrachet and Mersault are hard to beat at the moment, as they have a sweetness matched by a savoury note and minerality which make them delicious with and without food. As for sauvignon blanc, kiwi wines are tax exempt, so go the Marlborough. For dry minerality (again) and interest with food, rather than passionfruit and gooseberry, go the French. Finally to pinot noir, which our friends across the ditch are doing very well indeed, particularly in the Martinborough and Central Otago regions. Our best pinots are found in the Mornington Peninsula region, near Melbourne, with Gary Farr a leading light, and Stonierâ&#x20AC;&#x2122;s Reserve pinot also glorious. By contrast, the lesser pinots

in Burgundy can be mean and astringent in a wet or cold year, due to poor ripening, but when the weather gods smile these wines are glorious, especially in the $50-60 bracket. A few years ago you would be paying the equivalent of $100 for the same wine, and these French reds, while delicious young, can age for decades. Try the Premier cru level if serious.

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diary

In the TV series Dr Who, what does the T in TARDIS stand for?

Janis Joplin, Jimi Hendrix and Kurt Cobain all died at what age?

In what year did Cyclone Tracey hit Darwin?

What is the world’s oldest currency still in use?

Hansen’s Disease is more commonly known by what name?

In which country was the ancient city Ecbatana?

What type of creature is a crappie?

Roman numeral LXXXVII is what number?

A third wedding anniversary is traditionally represented by what material?

How many stars are on the national flag of New Zealand?

What is the largest sand island on Earth?

Nancy Shevell married which English singer/songwriter in October 2011?

starring Angelina Jolie did Clint Eastwood direct?

Which artist is known for his ‘Blue Period’?

Name the ballet dancer who requested asylum in France while in Paris with the Kirov Ballet, in June 1961?

Philophobia is the irrational fear of which emotion?

Who did Marilyn Monroe marry in January 1954?

28-1 11th Global Conference on Ageing Ageing Connects To be held in Prague, Czech Republic Visit: www.ifa-fiv.org

trivia q uiz

June

2-3 Australian Practice Nurses Association (APNA) National Conference Venue: The Sebel, Albert Park Melbourne Register at www.apna.asn.au Topics include Closing the Gap, governance, mental health, fertility, advanced PN’s leading into nurse practitioners, chronic disease management, nurse-led clinics, PNIP update, data management, and more. Pluse panel discussion with Tony Jones from ABC’s Q&A – “Primary health care nursing: Hero not handmaiden” 4-6 Second International Conference on Nutrition in Medicine and Healthcare To be held at the Grand Hyatt in Melbourne Themes include • Epigenetics and nutrigenomics • Gastrointestinal metabolism • Mood and anxiety disorders For more info, go to: www. nutritionmedicine.org.au 5-6 55th Clinical Update Weekend – RACGP General Practice Kaleidoscope To be held in Brisbane Convention Centre Keynote speaker: Dr Jenny Brockie To register phone Georgina on 07 3456 8941 12-13 ‘Finding Balance’ Conference with keynote speaker Stephanie Dowrick Byron Bay Community Centre, 69 Jonson Street, Byron Bay Presented by Infinity Coaching Networking and Training Phone Sue on 0410 665 189 or Cate on 0417 867 815 Or visit www. infiitycoachingandnetworking.com 17-19 2012 World Congress of Dermoscopy Particularly aimed at GPs, with sessions on dermoscopy in primary care Brisbane Convention and Exhibition Centre Organised by the Australasian College of Dermotologists Go to www.dermoscopycongress2012. org

August 8-9 Sydney CAREX 2012 Billed as Australia’s premier Health, Aged Care & Disability Expo. To be held at Sydney’s Rosehill Racecourse. Admission is free. Open from 9.30 am to 4pm. Attendance can earn CPD hours. For other information regarding the expo, use the following link: www. totalagedservices.com.au/carex.asp

featuring in Enid Blyton’s Famous Five books? 2

October

A photovoltaic module is more commonly known as what?

The fruit in tarte tatin?

Roman goddess of the hearth?

A maker of arrows?

What was the title assumed by an ancient British chief claiming supreme power?

What is the name of a lively Spanish dance by a couple usually accompanied by castanets and guitar?

September 14-16 Skin Cancer Conference 2012 Millennium Hotel, Queenstown, New Zealand Organised by the University of Queensland Register your interest online at www. skincancerconference.com.au

What is the name of the dog

Who said “I don’t care what anybody says about me as long as it isn’t true”?

What successful 2008 film

19-22 16th South Pacific Nurses Forum 2012 To be held in Melbourne at Leonda by the Yarra. More information on the conference will be provided as it becomes available. Visit: www.spnf.org.au

November 16-18 Melbourne General Practitioner Conference & Exhibition To be held at Melbourne Convention Centre The Melbourne General Practitioner Conference & Exhibition (GPCE) is Australia’s premier Primary Healthcare event. The GPCE delivers innovative solutions and practical strategies to improve patient care. The GPCE Melbourne offers an unmatched diversity of sessions including Seminars and hands-on Workshops delivered by Expert speakers. It also provides access to the leading healthcare products and services all in the one location. Now in its 10th year of delivering a superior learning experience, the GPCE is recognised by GPs as the major clinical educational event on the GP calendar. Registration will open in August 2012. To register your interest in attending please email emma.radford@ reedmedicaleducation.com.au

14. 1974 15. Pound sterling 16. Leprosy 17. Iran 18. Fish 19. 87 20. Leather 21. Four 22. Fraser Island in Queensland 23. Sir Paul McCartney 24. Pablo Picasso 25. Love

2-4 ANZGM Annual Scientific Meeting 2012 ‘Dementia: Managing not to Forget’ To be held at the Hilton Hotel, Sydney. Find out more at: www.anzsgm2012sydney.org.au

6-8 2nd National Indigenous Drug and Alcohol Conference Beyond 2012: Leading the Way to Action To be held in Fremantle, Western Australia Visit: www.nidacconference.com.au

1. Timothy or Timmy or Tim 2. A solar panel 3. Apples 4. Vesta 5. Fletcher 6. Pendragon 7. Fandango 8. Dorothy Parker 9. Changeling 10. Rudolf Nureyev 11. Joe Dimaggio 12. Time 13. 27

May

more services · quality facilities

Anne Criner Clinical Nutritionist

Specialising in dietary advice for: Gastrointestinal Disorders Food Allergy and Chemical Sensitivities Appts available Alstonville/Lismore Some Health Fund Rebates Apply P :6628 5464 M: 0429 844 835

PATHOLOGICAL WASTE DISPOSAL Container Collection/Exchange

RICHMOND WASTE SERVICES Phone 6621 7431 – 6687 2559 Lismore • Ballina • Casino • Byron

OPEN extended hours MON, TUE, WED & FRI - 8.30am to 7pm Thursday - 8.30am to 9pm SATURDAY - 8.30am to 5pm SUN - 9am-1pm

Goonellabah Pharmacy

Goonellabah Village, Oliver Ave, Phone 6624 2449

Goonellabah Physiotherapy Centre

GOLD COAST VASECTOMY CLINIC Providing Vasectomies since 1993 Dr Greg Anderson Phone: (07) 5530 2822 Suite 5, Bell Place, Cnr Bell Place and Link Way Mudgeeraba Qld www.goldcoastvasectomy.com.au

CONSULTING ROOMS FOR RENT One to three consulting rooms available for rent for medical practitioners or allied health professionals in specialist medical practice, close to Lismore Base hospital. Car parking available and rooms furnished. Located at 44 Hunter Street, Lismore. Contact Dr Sabrina Pit – email: seabewi.services@gmail.com or phone 6621 6397

BEAUTIFUL BALLINA! GP WANTED DWS APPROVED

FT/PT for a busy, friendly, family oriented accredited practice Excellent remuneration & incentives Practice nurse, shared on-call Not open weekends Call Shannon on 6681 1333

Gabrielle Boyce and Associates 581 Ballina Road, Goonellabah Phone (02) 6625 2888 Open Extended Hours

NORTHERN RIVERS OCCUPATIONAL THERAPY Offering medico-legal assessments, home assessments, equipment prescriptions, OT driving assessments, RTW and occupational therapy consultation services. Area serviced from Tweed south to Grafton and west to Tenterfield. Reasonable rates, phone Kathryn Cooper on 0417 913 354.

•Sports & Orthopaedic Conditions •Treat Spinal Pain with mob/ manipulation and Sarah Key Method •Acupuncture for myofascial pain/ muscle spasm •Gym & Pool rehabilitation •Biomechanical analysis for runners and dancers •Orthotics using Gaitscan Technology •Waterproof casts / braces / splints •Vertigo & Balance Disorders Tony Morley & Emile du Plessis and Associates Physiotherapists MAPA

Lismore & Ballina Free Call 1800 662 125

BALLINA HOSPITAL SEEKING GP-VMOs Ballina Hospital is keen to have you join them as a GP-VMO. The hospital continues to experience a growth in attendances and admissions, and is a dynamic environment in which to practice clinically, and access clinical education. Consultant Emergency Physicians are also employed at the hospital, in addition to CMOs. You will join a group of committed clinicians and be able to manage the continuum of care for your patients. Please contact Maryanne Garrett on 6620 2170 or by email at Maryanne.garrett@ ncahs.health.nsw.gov.au to obtain further information and an application.

GPSpeak is kindly delivered to local doctors by

S P I K E S AY S

“Vax ’em.” www.vaccination.org.au

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