ISSUE 3 autumn 2013
HealthSpeak A publication of North Coast NSW Medicare Local
! l a c i s u M e It’s GP th page 15
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Telehealth road show
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Headspace news
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Refugee health feature
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Focus on nursing
HealthSpeak’s reach expanding Janet Grist Head Office
Editor
Suite 6 85 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncml.org.au Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 General Manager: Paul Ward Email: hm@ncml.org.au Mid North Coast Suite 2, Level 1, 92 Harbour Drive Coffs Harbour 2450 Ph: 6651 5774 General Manager: Sandhya Fernandez Email: mnc@ncml.org.au Northern Rivers Tarmons House 20 Dalley Street Lismore 2480 Ph: 6622 4453 General Manager: Chris Clark Email: nr@ncml.org.au Tweed Valley 7 Nullum Street Murwillumbah 2484 Ph: 6672 5158 General Manager: Gary Southey Email: tv@ncml.org.au
Contacts Editor: Janet Grist Ph: 6622 4453 Email: media@ncml.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Display and classified advertising at attractive rates HealthSpeak is published four times a year by North Coast NSW Medicare Local Ltd. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCML. The NCML 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 2013 North Coast NSW Medicare Local Ltd Magazine designed by Graphiti Design Studio Printed by Quality Plus Printers of Ballina
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We hope you enjoy this third issue of HealthSpeak magazine. Since our launch,
interest has continued to grow in the magazine and I’m pleased to report that our circulation is now around 4,500 readers per issue. Our feature article this issue is Caring for Refugees. The North Coast of NSW has opened its arms to refugees from war-torn nations and we look at a number of providers and services working to improve the health of our refugees.
Through HealthSpeak you can expect to learn about a variety of new programs, services and initiatives brought about by North Coast Medicare Local staff during the course of this year. We always welcome feedback and story suggestions. Don’t forget, if you’d like to be included in our mailing list to read HealthSpeak online, send your email address to: media@ncml.org.au
What your Medicare Local is up to Vahid Saberi Chief Executive Officer
It’s now 11 months since the doors opened and the North Coast Medicare Local established. I am pleased to bring you up to date on some of what we’ve been working on over this time. A great deal of energy and time during 2012 was spent laying the organisation’s foundations and in 2013 we will pursue a full action agenda to improve health outcomes. We have continued delivering services, including Aboriginal medical and other services, general practice support, specialist medical outreach programs, psychology and other mental health services, Closing the Gap programs for the Aboriginal community. and family care services. There are also many exciting projects in the pipeline. As we grow, we are expanding our offices – a new office is being leased in Tweed Heads to complement our Murwillumbah office. We are also leasing further space in Ballina as programs commence. One innovative project that will be housed here is the Palliative Medicine Registrar. Collaboration between North Coast GP Training and NNSWLHD and
North Coast Medicare Local has resulted in the establishment of the first Palliative Medicine Registrar who will work in the Ballina area. This is an exciting pilot project. At the same time we are increasing the workforce in Branch offices. Our Practice and Liaison (PAL) teams, which offer support and information to general practice, pharmacists, psychologists and aged care facilities, have been expanded significantly. In turn we hope to expand support incrementally to all health care providers. To ensure GP input into our health programs, we are setting up a General Practice Council. At the same time, we continue to consult with general practice, including holding a number of meetings in various towns, about the best way to increase access to after-hours services. NCML enters the social media world in April with the launch of ‘Healthy North Coast’, designed to be the ‘go to’ place for the community and clinicians on everything to do with health. Incorporating Facebook, Twitter, Google+ and YouTube, it will be an interactive platform including health directories, hangout sessions, information on healthy living, healthy eating guides and much more. In other activities, NCML has negotiated with the Local Health District to take over the running of Gurgun Aboriginal Medical Service in Lismore with support
from the University Centre for Rural Health, allowing NCML to expand services at this important clinic. We have also begun delivering GP services to the homeless in Coffs Harbour and residents of Balund-a, an Indigenous Correctional Facility. It’s our intention to provide medical care to the homeless in the Tweed Valley, Lismore, Coffs and Port Macquarie. The roll out of eHealth was boosted by a ‘blitz’, early this year - 80% of general practices have signed up and eligible for the government’s eHealth incentives. In March, NCML will hold a Telehealth road show to enhance communication between GPs, specialists, local health districts and patients. Plans are being developed for the establishment of ‘Health Pathways’ on the North Coast. These are locally developed clinical guidelines for specific conditions. Additionally, a Project Officer is working on a model to embed multidisciplinary primary health teams in general practice settings, incorporating allied health and community health providers. We have applied for a number of grants to bring more services to the region. We are also working collaboratively and positively with the two Local Health Districts to strengthen health care and to pool resources. I look forward to sharing more about what NCML is up to in the next issue.
HealthSpeak is kindly delivered by HealthSpeak
autumn 2013
Group consultations
These days GPs are no doubt feeling the burden of chronic disease management in an ageing population. Much of this chronic disease has a cause based on unhealthy lifestyles. While modern pharmaceutical interventions are helpful they often struggle to keep up with disease progression as the patient ages. Our type 2 diabetic patients are a classic example of this. More and more, we work through the ever increasing number of pharmaceuticals and often end up with the use of insulin with all its inherent problems. We know that patients who do best are those who make significant changes to their lifestyles with improved nutrition, increased physical activity
Peer interactions help facilitate positive lifestyle changes. and reduction of other risky habits. Whilst the traditional 15minute consultation may be adequate for prescribing and explaining the role of medications there is very little time left for bringing about the behaviour change needed for a healthier lifestyle. Since the introduction of chronic care management systems through Medicare, there are other options for these
patients that are supported by a team approach with the help of other health professionals such as diabetes educators, dieticians, exercise physiologists etc. With the increasing numbers of our patients directed into these systems there is likely to be more clogging up of the waiting lists as time goes on. Is there another way to deal with this problem? After all, much of our advice and encouragement for behavior change is common for all patients and most chronic diseases. Have a conversation with the Professor of Lifestyle Medicine at SCU Garry Egger and he will inspire you about another concept. After a trip to the US to attend their Lifestyle Medicine conference last year he came back enthused by Dr Ed Noffsinger who since 1996 has pioneered what is called Shared Medical Appointments (group consultations) for improving chronic care management. (Ref: The ABC of Group Visits, Edward Noffsinger, Oct 2012) These group visits involve fellow chronic disease sufferers all contributing to their health experiences with peer support. These have been defined as “… comprehensive medical visits (billable at individual rates) focusing on
Opinion
Andrew Binns
chronic disease and self management, but run in a supportive group setting of consenting patients with similar concerns, and run with 2-4 appropriate health professionals, including a GP or medical or surgical specialist.” At first glance this might seem like a rather bizarre approach but it has been shown to work well with good evidence to back it up in the US, Canada and Holland. Such peer interactions help with facilitating positive lifestyle and behavior changes by creating a supportive clinical and social environment. Having run GutBuster and Professor Trim groups in the past I am well aware of the positive and motivating influence of group dynamics. How this could be applied to group consultations for sufferers of chronic diseases in the Australian setting remains to be seen. Published evaluations in the US show improved efficiency
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NCML’s Telehealth Road Show Technical solutions are being put in place to improve the Australian health care system. One of these is Telehealth. Telehealth is the delivery of healthcare via telecommunications technology. It aims to tackle the increased cost and time associated with patients, particularly those based in rural areas, attending appointments. Telehealth also strives to improve monitoring capability, increase health and encourage a co-ordinated healthcare delivery approach. Telehealth can enable realtime diagnosis through the fast transfer of large files including radiology results. It also allows
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a patient to attend an appointment with a GP, specialist, nurse and allied health professional at the same time from the comfort of their home. A more advanced method of Telehealth is Telemonitoring which works by monitoring systems collecting data from a patient based at home or at a local health facility through miniature sensors. Wireless technology provides this information to a health professional working from a different location. The health professional reviews the electronically supplied information and provides diagnosis and treatment. The outcome is transmitted back to the patient. In addition, the data
is electronically stored to enable comparison in the future, to judge whether treatment was satisfactory. Telehealth has proven effective in the management of chronic and acute health issues, delivering equal and improved care to rural and remote areas and reducing costs of delivering healthcare for both the organisations and patients. During March, North Coast Medicare Local will be conducting a Telehealth Road Show. This will involve a 25minute information session to GPs, specialists, nurses, allied health professionals and administration staff. The presentations will take place at general
Telehealth can connect health professionals and patients in different locations to ensure rapid diagnosis and treatment.
practices, residential aged care facilities, specialists’ consultation rooms and Aboriginal Medical Services. Topics will be the Medicare Benefits Scheme, Telehealth Eligible Areas, technical requirements and privacy and consent. To book a presentation, contact Shelly Fletcher on 6618 5418, or eHealth@ncml.org.au
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Social media and health – introducing NCML’s Healthy North Coast By Alex Lewers For most people social media is about talking to friends, catching up with gossip and figuring out what to do after the work/school week has finished. Yet for health promotion, social media can mean so much more. This year North Coast NSW Medicare Local will make its first foray into the realm of social media through its ambitious initiative Healthy North Coast online presence. Healthy North Coast will include social media and a website, and was born out of a need for the North Coast community to be able to access high quality, up-to-date, health information quickly and easily. This initiative is built for the community and will be run by the community. A recent study by the Centre for Health Promotion conducted in South Australia found that social media was fast becoming a powerful tool for health promotion, especially for those targeting youth. It suggested while traditional forms of health promotion relied on an outdated ‘top down’ approach of printed materials, posters, pamphlets and advertisements; social
Alex Lewers
media allowed more interactive and engaging methods. Social media can open up spaces where people can talk, share and learn about health without feeling they are being force-fed information by ‘Big Brother’. In terms of health promotion, social media can blur the line between the social and learning, the work and the play, and create a more engaged, better informed public. Social media invades the traditional barriers for health promotion and allows a community to start a better health conversation. While social media can improve interaction and conversation about health, its true power is often best illustrated during major health events. During the 2009 influenza A
(H1N1) pandemic, the World Health Organisation used Twitter to inform its nearly 12,000 followers from around the world of the outbreak, as well as to provide accurate, up to date information about the pandemic. Instantly, 12,000 followers were alerted to the outbreak and given the best information about what to do. These followers, many of whom included news organisations and health bodies, were able to repost this information on their own social media platforms to alert their own audience. Such information then tends to snowball throughout the wider social media community, creating mass exposure. Despite the potential for social media and health promotion, scepticism around its use and benefits remains, particularly the perception of users not having enough time. My response to this is that social media is like eating dessert – you can always make room for it. With 89% of the Australian population online and 62% of those using social media sites, social media is a critical resource for health promotion. While target audiences may be those outside the social media user
group, the information generated can still trickle through. Like every person or business, health promotion needs to practice caution when using social media in order to avoid pitfalls such as loss of productivity and increased risk of public relations concerns. However, these are minor hurdles when weighed up against the potential of the medium. If health promotion/services are to meet the needs of the community, then a vehicle to collaborate and share with the community must be found. That medium for now is social media. Projects like Healthy North Coast that embrace social media are critical to delivering better health outcomes for the community. While social media may not seem relevant to many health professionals, it is essential that it is embraced. for it is as much a strategy for the future as it is a strategy for today. Healthynorthcoast.org.au will be launched in April with a date yet to be announced. If you are interested in contributing, please contact Alex on 02 66185419 or alewers@ncml. org.au
Autism therapy services Autism Spectrum Australia (ASPECT) based at Alstonville is a not for profit organisation offering services and assistance to individuals with Autism Spectrum Disorders and their families. ASPECT offers psychological services to develop emotional regulation skills and skills to help families manage and understand challenging behaviours social skills training for children and adolescents anxiety management and explaining a person’s diagnosis
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GPs can refer to ASPECT using a Chronic Disease Management Plan or through private health insurance. Paediatricians and psychiatrists can refer patients through the Better Start for Children with Disabilities scheme or the HCWA scheme. Speech and language therapy is also available. Group programs are also available such as the Secret Agent Society social skills group for children aged 8 to 12, a PEERS social skills group for 13 to 17 year olds. ASPECT also runs programs in Grafton and will soon be offering them in Coffs Harbour. To find out more, phone 6628.3660.
Perinatal Depression Service North Coast NSW Medicare Local has established a Perinatal Depression Service in Lismore, to provide perinatal mental health treatment under the National Perinatal Depression Initiative. Highly qualified mental health professionals from Tarmons House Mental Health Service and Northern Rivers Family Care Centre will be working together to provide this service. Please note the perinatal period is defined as being from pregnancy and includes the first year after a childs’ birth. If you have any patients you believe would benefit from this initiative, please refer them to Tarmons House Mental Health Service, via a Mental Health Treatment Plan. Referrals can be faxed to 02 6621 7319. For further information please call Tarmons House Mental Health Service on 02 6621 7319 or the Family Care Centre on 02 6622 8705.
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The Medical Home model of care By Dr Tony Lembke NCML Chair When looking at effective ways to improve access and equity in our primary health care system, North Coast Medicare Local (NCML) uses the Medical Home model of care as its blueprint. The model of the patient centred Medical Home has repeatedly been demonstrated to be the most effective and efficient way to achieve these aims. In the Medical Home model, a person and their family form a partnership with a particular primary care provider (in most cases a GP) and their team, and other services ‘wrap around’ as required. In some circumstances, the care provider will be another professional, such as an Aboriginal Health Worker or Remote Area Nurse. What do we want from our health care system? Our health care system aims to promote, restore or maintain health by ensuring that every person and their family can access the resources and care that they need, when and where they need it. We want people to live well by helping them to make healthy choices, to be well supported by their local health care team, and to have access to specialised services and treatments when needed. The Circles of the Health System 1. The Home In all but the most acute situations, the ‘Real Work’ is done by the family in the home. Better lifestyle choices and improved self-management skills are the key to better health outcomes. 2. The Medical Home There is growing evidence that people benefit from having an ongoing relationship with a trusted GP supported by a practice team, forming the Medical Home. General practice provides person centred, HealthSpeak
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continuing, comprehensive, whole person health care to individuals and families in their communities. Chronic Disease Management and the Medical Home Wagner’s Chronic Disease Model (reference in online article cited above) emphasises the importance of the informed, motivated patient working in partnership with an available, activated primary care team. To a great extent, success in Chronic Disease Management requires skills in managing multi-morbidity – two or more chronic conditions in one patient. Better outcomes are achieved by taking care of patients, rather than disease-states. The evidence supports the generalist approach of the Medical Home – chronic condition management built around longitudinal relationships over time shared, informed decision making comprehensive, wholeperson goal setting improved self management skills team based care and excellent access
ordinators and new allied health and health coaching roles. A practice nurse in the role of Care Manager is a very important new member of the Medical Home team. The Care Manager has a special relationship with each patient and with their usual general practitioner – working as a three-tiered partnership. Care Manager roles include: developing, maintaining and managing registers of patients with a chronic disease developing systems to identify patients at risk of a chronic disease improving patient selfmanagement skills motivational interviewing and goal setting developing and implementing cycles of care ensuring recall and follow up identifying changes in a patient’s condition that require review by the GP managing quality improvement processes using collated wholeof-practice data to guide practice improvement improving clinical data quality
Medical Home Team The Medical Home benefits from team members with new roles, including complex care co-
There is also a growing role in the medical home team for ‘behaviourists’ who can assist people with lifestyle modifica-
tion and self-management skills such as exercise physiologists, diabetic educators and dieticians. 3. Community Based Care As a person’s care needs increase, they benefit from extending their care team. The expanded team may include medical specialists, physiotherapists, community pharmacists, optometrists, psychologists, and other allied health providers. It may also include community nursing, home care and personal care providers. The medical home acts as a gateway to these more specialised parts of the health system, with the patient an informed partner in decision-making. The medical home has a special role in coordinating care, and in maintaining a source of accurate and complete clinical information about each person. Care from the patient’s point of view should feel ‘joined up’, or integrated. All members of the care team should be working with the knowledge of the complete set of goals for each patient, and be aware of their own role in helping to achieve these goals. 4. Hospital Based Care When required, hospital care should be accessible in a timely manner. Over and above the provision of acute and/or highly specialised care, the role of the hospital is to support care in the community. Cost and safety are greatly improved when hospital care is connected to ongoing community based care. It would be logical for the usual provider to be involved in the care planning for the patient at the time of admission, during the inpatient period, and at discharge – a ‘GP inreach program’. Each person benefits from partnering with a well-defined care team. As their acuity and needs increase, this team will expand with different members. As acuity diminishes the team will contract. Therefore, patients are not transferred from one team to another team and the Medical Home always remains their core
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After hours incentive payments available from NCML After much consultation and planning, progress on the After Hours program is accelerating as NCML gets ready to offer interim incentives to accredited general practices providing after hours care. With after hours incentive payments from the Department of Health and Ageing (DoHA) (Practice Incentives Program (PIP)) ceasing later this year, DOHA will channel this funding through Medicare Locals to support the efforts of local GPs in providing genuine access to after hours primary care. Reforming after hours services on the North Coast is complex. Each town and community is unique with different factors influencing GPs’ ability and willingness to provide after hours care. North Coast Medicare local
(NCML) has begun consulting with GPs in the larger towns and will consult widely to develop new funding arrangements that make sense for the region. NCML is committed to ensuring that the current PIP funding continues to be invested in after hours care and is keen to provide practices with the security to continue offering after hours care, and NCML intends to offer incentives directly to accredited general practices. A plan has been submitted to DoHA, and pending their approval, these incentives should be available in time for a seamless transition. These will be interim incentives – based on the current PIP rules – to maintain services while the careful work of developing new arrangements is under-
taken. Practices will need to apply to NCML for the interim incentives and enter into a formal funding agreement so that the payments can be made. This is a requirement of the funding Medicare Local receives from DoHA. During March, practices will receive information telling them exactly what they need to do. Queries can be directed to your NCML branch office or afterhours@ncml.org.au In other after hours news, in the coming months NCML will be circulating information to the community about the national after hours GP helpline. We are working with our regional steering group and seeking advice from practitioners to ensure we promote the helpline in a way that complements local after hours care.
based care, including inpatient and emergency services, and to ensure that this care is integrated with ongoing community based care. It works across the Hospital and to some extent the Community ‘circles’. To achieve person centred, coordinated care in the community requires the Medicare Local and the Local Health District to work in close partnership and to be well connected to other sector services and their communities. Strengthening the Inner Circles We aim for
From previous page care team. Role of the Medicare Local and Local Health Network The Medicare Local works across the Home, Medical Home and Community ‘circles’ of the health system. Its aim is to make sure that every person and their family can partner with the care team 6
that they need to better manage their health. The Medicare Local improves access to services, and helps providers to improve capacity and quality of care. It has an important role in identifying and closing service gaps, particularly for vulnerable and disadvantaged people. The Local Health Network is responsible for safe, accessible, effective and efficient hospital-
Most care to be delivered in the Home Each person to partner with a ‘Medical Home’ A range of accessible community based providers and services available to be part of a person’s integrated care team Accessible, safe, efficient and integrated hospital services that are required less often
Reforming after hours services on the North Coast is complex.
than they are now. Our aim should be to strengthen each layer of the health system to deliver optimal care. If people ‘drift’ into receiving care in the outer circles inappropriately, it is detrimental to their own health outcomes, reduces the availability of specialised care when it is required, and escalates costs unnecessarily. Build a system, not a service Creating services that do not fit into the existing relationships of the patient-centred model of care can disrupt the system and produce worse health outcomes. The best way to improve the system is to place resources as close to the centre of the circle as possible. It has been clearly demonstrated internationally that better outcomes and greater equity are achieved by health systems that invest in better systems of primary care. For references and further reading, go to: http://medicalhome.org.au/theperson-centred-health-system-andthe-medical-home/
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Supporting general practices as the health care home By Monika Wheeler NCML Special Senior Program Officer A challenge with the current health care system, expressed by patients, carers and providers, is that it is multilayered - with many providers at various sites - making navigation and access confusing and burdensome. It is said that everyone should have an elderly parent experience (EPE) to see how tough it is to navigate the health system. As many people in our communities are elderly with a number of chronic ailments, they are required to access multiple primary health care providers such as general practitioners, allied health, community nursing and so forth over a long period of time. These services are currently located at different sites, with unconnected intake systems and often fragmented from one another. It would be much easier for patients to access health care services if they were co-located, had a single intake system and even better if each clinician providing care was aware of who was doing what and consulted each other about patient care. One way of achieving this would be to co-locate general practitioners, allied health and community health services. This is not a new idea; however, it has not been attempted on a scale larger than a few recently established GP Super Clinics and the HealthOne centres. A project was undertaken in January and February this year by the North Coast Medicare Local to explore how to integrate multidisciplinary teams into general practices as the ‘health care home’; and the barriers and enablers to co-location. The project was an important first step in the implementation of the Patient-Centred Medical Home model in the North Coast region. The Medical Home model emphasises the importance of comprehensive whole person health care and has been championed internationally as well as locally by people such as Dr Tony Lembke, Chair HealthSpeak
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Co-locating a range of primary health services under one roof results in ease of access and convenience for patients.
Many GPs indicated a strong interest in working more collaboratively with community health. of the North Coast Medicare Local Board. Health care needs are supported by a generalist primary care provider whom the patient has an established strong relationship with, and a team of other health professionals which comprise the medical home. Patient participation and access to services is critical, as is leadership and accountability on the part of the medical home team. Targeted consultations were held with general practitioners, allied health professionals and the Northern NSW and Mid North Coast Local Health Districts as a part of the project. An analysis of existing integrated primary health care models in the region, a needs assessment and current funding arrangements for primary health care services was also considered. The project found that many general practice teams on the North Coast offer allied health services such as practice nurses, psychologists, dieticians, exercise
physiologists and diabetes educators. For example, practice nurses are provided in 66 per cent of general practices. The provision of these services, however, is not uniform or always well integrated with NSW Health provided community services. Physical space and capital infrastructure was identified by many general practices as being a principal barrier to offering allied health services. While the Federal Government’s Primary Care Infrastructure Grant program, which assisted 17 general practices in the region expand their services, many practices still face the logistical problem of not having enough physical space to accommodate additional clinicians. The business case was also identified as a barrier, with some general practitioners arguing it was not financially viable to host allied health staff. Conversely the general practices that did offer allied health services said that it strengthened their business because it was convenient and rapport and trust between patients and the general practice team was strengthened due to patients visiting the centre more often. In addition, the Medicare Benefits Schedule (MBS) Primary Care program, which includes Chronic Disease Management items, provided a financial incentive for eligible patients to use allied health services co-located at the general practice meaning
services were well utilised. Different referral systems, operating structures and funding were identified as barriers to general practitioners and community health services provided by NSW Health integrating and co-locating. Many general practitioners did, however, indicate a strong interest in working more collaboratively with community health and in hosting clinicians on a regular basis to consult patients and skill-up practice staff. The NSW Health purpose-built HealthOne centre in Pottsville, scheduled to open this year, will be one of the only sites in the region where general practitioners, allied health and community health staff will operate on a co-located basis. The report recommended the establishment of two pilots to create stronger links between general practitioners and community health as well as a range of other actions related to improving the integration of primary health care and further implementing the Patient-Centred Medical Home model in the North Coast region.
Briefs
Boys get Gardasil Australian schoolboys have begun receiving the first of three vaccinations to protect them against cancers and disease caused by the human papillomavirus (HPV). More than 280,000 boys will be eligible for the free Gardasil vaccine this year, which is estimated to prevent a quarter of new HPV infections. Vaccination will protect boys from cancer and genital warts, and continue to reduce the rates of cervical cancer among women. Schoolboys will join more than one million Australian girls aged 12-16 years who have already been fully vaccinated against HPV under the school vaccination program.
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Connecting Australian healthcare North Coast Medicare Local in collaboration with the Australian Government is striving for a more streamlined and effective healthcare system by assisting providers and consumers to implement the personally controlled electronic health (eHealth) record. Currently, health records are mainly paper based and stored in different locations with little connection; resulting in consumers having to repeat information to multiple health professionals. This will be eliminated by the eHealth record as it is a central and secure repository which enables consumers and authorised healthcare providers to access useful information when most needed. As the eHealth record system
matures, health organisations such as a general practice or hospital will be able to rapidly view a summary of health information, helping them to make an informed decision about relevant treatment. Consumers will be able to better manage their health due to information being readily available. Privacy and security is an important aspect of the eHealth record. A consumer can set
access flags to ensure only authorised providers have access to confidential information. The consumer also has the right to request for information not to be uploaded to the eHealth record. This has sparked concern that the eHealth record will be a biased presentation of information. It is important to recognise that consumers can withhold information in the paper record system and that all health information should be supported by evidence based practice. The eHealth record is a summary of health information and is not designed to replace current existing records. There are also systems in place to monitor who has accessed eHealth records, an improvement from the current
Campaign to end HIV
(l-r) ACON President Mark Orr, Bill Whittaker, NSW Health Minister Jillian Skinner, Professor Chris Puplick and ACON CEO Nicolas Parkhill at the launch of the new ‘ENDING HIV’ Campaign at ACON.
The NSW Government has launched a ground-breaking education initiative designed to help end the HIV epidemic in the state, timed to coincide with this year’s 35th Sydney Mardi Gras festival. The Ending HIV campaign aims to educate gay men about the real possibility that HIV transmission in NSW could be virtually eliminated by 2020 as a result of advances in testing technologies and HIV treatments. The campaign focuses on three key activities needed to help end the epidemic: 1) Test More – sexually active gay men need to 8
get tested for HIV at least twice a year 2) Treat Early – advances in HIV medicines offer improved health benefits for people with HIV and can reduce the virus in their body to an undetectable level, significantly reducing the likelihood of them transmitting HIV 3) Stay Safe – with condoms and other risk reduction strategies - gay men need to maintain a culture of safe sex Produced by ACON, NSW’s largest community-based HIV and GLBT health organisation,
paper based system. The NCML eHealth team has been assisting general practices to register for the eHealth record. Work is commencing to support residential aged care facilities, Aboriginal Medical Services, pharmacists and allied health professionals. If an organisation or healthcare provider is interested in participating, contact the eHealth program officer at the local branch office. Alternatively, contact Shelly Fletcher on 6618 5418, or email eHealth@ncml.org.au For consumers wishing to register, call 1800 723 471, visit ehealth.gov.au or attend a Medicare Office. You will be required to verify identity and to have the date you last visited a doctor and the doctor’s full name.
From page 3 the campaign will be heavily promoted throughout the Mardi Gras festival. It will then be promoted across GLBT, mainstream and social media for the next 12 months. Marie Reilly, Acting Manager of ACON Northern Rivers said: “In this region we have the highest population of gay men in NSW outside of Sydney corresponding to a relatively high prevalence of HIV in this population group compared to other regional areas. This has not, however, meant a higher incidence of new infections but rather that positive gay men are choosing to live healthy lives up here on the beautiful North Coast. “We would encourage all health practitioners who work with gay men to come on board with the Ending HIV campaign by promoting its key messages of testing more - so people know their HIV status, treating early and maintaining current levels of safe behaviours such as using condoms. Together we can all work to help end the HIV epidemic in NSW,” said Marie. The campaign can be viewed at www.endinghiv.org.au.
and productivity, increased patient and provider satisfaction, decreased phone call volume and need to double book patients and reduced costs all round. GPs hearing about this may initially be concerned about privacy and billing issues through Medicare. Privacy matters can be addressed by patients signing a confidentiality agreement. Preliminary enquiries with Medicare have approved in principal this approach. However more thought is needed on the business case viability that has written support from Medicare authorities. There is also much work to be done on the logistics of organising and the cost of running such group consults. Pilot trials of how this could work in our region and beyond are needed. To cope with the future projections of chronic disease we will no doubt need to find more efficient and effective management approaches. Reference: The ABC of Group Visits, Edward Noffsinger, Oct 2012
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A D V E R TO R I A L – S E E W W W. B R E A S T R E D U C T I O N . CO M . AU
Reclaiming Joy: Life after a breast reduction Any fool can make things bigger, more complex, and more violent. It takes a touch of genius – and a lot of courage – to move in the opposite direction – Albert Einstein years ago, this beautiful watercolour was presented to oncoplastic surgeon Dr Guy Hingston by a grateful patient, six months after her breast reduction operation – without him being aware that it was being painted. Portraying the patient’s journey, it goes from the faceless, low self esteem and poor body image that a lot of women with large breasts endure, through to the perioperative phase, depicted with fresh surgical scars. Finally, a beautiful whole woman emerges – transformed, happy and complete. “The artwork nicely captures the metamorphosis that occurs and the tremendous improvement in quality of life that women enjoy following a bilateral breast reduction,” said Guy. Having successfully operated on over one thousand women, he continues to enjoy helping them go through this transformation.
About Dr Guy Hingston
D
r Guy is a North Coast surgeon, specialising in oncoplastic breast surgery. He completed his Royal Australasian College of Surgery Fellowship in Brisbane back in 1997 and became a full member of the Breast Section of the Royal Australasian College of Surgeons in 1998. He was also a Foundation Member of BreastSurgANZ. After completing his FRACS, he worked for a year at St Marks Breast Centre subspecialising in oncoplastic breast surgery, and then went on to Glasgow as the Lister Fellow at the Glasgow Royal Infirmary to further his research in sentinel node biopsy in breast cancer. Dr Guy has acquired extensive experience in breast reduction surgery,
having performed this operation now for more than 15 years. Ten years ago, in 2003, he was invited to join the specialist surgeons in Port Macquarie, and moved with his family to the North Coast. Guy’s busy private specialist practice in Port Macquarie and Lismore caters for women all over the North Coast who require breast reduction and breast reconstruction surgery. He also devotes a large amount of clinical time to both bowel and breast cancer screening - as he believes that the 30-50% reduction in death rate from these two diseases is quite achievable through modern prevention services (as per his innovative Gold Book Service Manuals – see www.gold-book.net).
His practice has the following aims: To enhance the lives of large breasted women To help remove the daily back neck and shoulder discomfort that large-breasted women experience To help remove the barriers that prevent large-breasted women from functioning normally in society Continued overleaf
A D V E R TO R I A L – S E E W W W. B R E A S T R E D U C T I O N . CO M . AU
Reclaiming Joy: Life after a breast reduction The Procedure Breast reduction surgery involves the surgeon moving the nipple to a higher position on the breast, but not removing it from its
adjoined tissue. The lower portion of the breast is cut open along the base of the
breast and an amount of tissue is removed from the base and mid section of each breast using dissection. Once the excess tissue is removed the two sides of the incision are joined to form the base of the new breast (joining A to B to C to D as per the diagram). The incision is closed with internal dissolving 3/0 Monocryl sutures to complete the surgery. The wounds are then dressed with Comfeel dressings. The operation is covered by DVT prophylaxis (blood clot prevention), antibiotics and antiinflammatories where able.
Why have a breast reduction? The main reason for undertaking bilateral breast reduction surgery is to dramatically reduce the back, shoulder and neck discomfort/ pain that women experience. For many women with what would be considered overly large breasts, reduction surgery nearly always brings relief from a great number of symptoms. It enables unrestricted physical exercise and activity. It improves clothing options and allows women to return to a normal bra size. It also improves personal confidence and self esteem, as attention is now drawn to the woman’s face rather than her breasts. Posture and physical activity can both be much affected as well, leaving women open to a more limited lifestyle in sport, in their careers or family lives. In terms of reducing chest pain, irritation and restoring shape, positioning and confidence, breast reduction is proven to be the most effective treatment available.
Life after Breast Reduction is wonderful A story of transformation by Joy Before the operation Life with large breasts was both uncomfortable and miserable. Fashion was a problem. I could never find a bra that fitted well and that was also feminine. No matter where I shopped and in what city I was, I always ended up with the same beige style of bra. My clothes also had to be baggy to hide the fact that I had large breasts. I dressed much older than my age and this started in my teens. The sheer weight of my breasts would cause backache and I also suffered from bad posture. In the summer months, I would have a sweat rash as my breasts had a tendency to sit on my stomach. The elasticity of the breast tissue had gone and I was left with several unsightly stretch marks. When I played sports I had to wear two bras.
Life today Clothes shopping is fun. To go and try on a C cup and be able to choose between several lacy bras is fantastic. I have bras of all different colours in my drawer now and nice lingerie. I am now able to keep up with my teenage kids when we are at the beach or mucking around with a ball. I love looking at my new breasts in the mirror. They are not perfect, but a lot better than they were. The nipples are in the right place for a start. My self esteem has improved and all the physical symptoms have gone. My one regret is I wish I had done it earlier, in my 20s.
Dr Guy’s Note Joy’s experience is common among women undergoing breast reduction surgery. ‘My one regret is I wish I had done it in my 20s’ is a familiar theme. The sad reality is that most women are forced to wait until around the age of 40 when they are in a better financial position to afford the surgery. However, my own personal recommendation is
aligned with Joy. Most (but not all) women who have this surgery at a younger age, should be able to successfully breast feed as the nipples remain connected to the underlying breast ducts beneath. A significant portion of these ducts still stay connected to the remaining part of the glandular milkproducing tissue.
To find out more about Dr Guy’s work visit www.breastreduction.com.au Port Macquarie Clinic – 02 6583 4479 Lismore Clinic – 02 6621 5007
Lismore headspace taking shape By Jem Mills NCML Mental Health Coordinator In 2007 more than a quarter of young Australians experienced mental health problems but only 1 in 4 of them accessed treatment. This means, over half a million 16 to 24 year olds and their families dealing with mental health problems are unsupported. The agencies listed below are coming together to do something unique and long lasting about this problem, specifically for young people living in the Lismore area. North Cost NSW Medicare Local Lismore City Council NORTEC Ltd, Youth Training & Employment Programs Ngunya Jarjum Aboriginal Child and Family Network Southern Cross University, School of health and Human Sciences NNSW Local Health District, Mental Health Service Child & Adolescent Specialist Programs and Accommodation CASPA The Buttery Alcohol & Other Drugs service Northern Rivers Social Development Council
Lismore’s new headspace will have a similar interior to this.
On Track Community Programs Byron Youth Service Interrelate Children and Family Support Youth Connections North Coast The vision is to create a relaxed, inviting venue in the heart of Lismore where young people can feel safe about asking for help - all the health and wellbeing services a young person in distress might need provided from the same centre. This is headspace - the National Youth Mental Health Foundation established it in 2006, with support from the Department of Health and Ageing, to improve the health and mental health of young Australians. Headspace centres act as a hub for agencies involved in supporting young people to come together and work collabora-
tively under the same roof. They are guided by youth advisory councils, YACs and often work alongside schools, colleges and community groups to raise funds and promote awareness of youth mental health issues. The centres provide evidencebased support with an emphasis on early detection and intervention. If you can support a young person to identify and deal with emotional distress early and then provide opportunities to engage in meaningful training and employment opportunities, then years of burden for them and their families can be reduced or avoided. The Lismore headspace services will include a general practitioner, psychologists, drug and alcohol workers, youth employment workers, family and housing support. The process of strengthening existing partnerships among
health and wellbeing agencies to the point of sharing offices, clinical information systems, training events and community events leads to new opportunities for learning and innovation. Sustainable, long term development of the local healthcare system’s response to young people is a clear aim of the headspace model and local agencies are eager to be involved. In February 2013, following an initial expression of interest, North Coast Medicare Local was invited by headspace National Office to present a business plan for a new headspace centre in Lismore CBD. The next few weeks will see an intense planning process to work out exactly where the centre will be situated and how it will run. The level of commitment to this project among health and wellbeing agencies in the area is so great that the Medicare Local has had to seek special agreement with headspace National Office to increase the number of agencies involved. Each one of these agencies is committed to offering a range of services at no cost to the young person or the headspace centre. By capturing the creativity and energy of young people in the Lismore area and seeking unique and novel partnerships with agencies, organisations and the community, the Lismore headspace centre promises to be a great example of how to help young people deal with distress and discover new opportunities.
GP Chris Mitchell awarded OAM Lennox Head GP and past president of the Royal Australian College of General Practitioners, Chris Mitchell, has been recognised with the honour of member (OAM) in the Australia Day Honours List. Chris was recognised for significant service to medicine as a general practitioner through leadership roles in clinical practice, education and profes-
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sional organisations. After the award ceremony, he said: “General practice is the best job in medicine and this award recognises the central place of our profession in the health of the community. I’ve had the honour of being able to work with GPs from inner city practices to regional and remote areas, and those working in Aboriginal and Torres Strait
Islander settings, and I am so proud of what our profession is and does. This is an award that recognises all of our work commitment and achievements.” Dr Liz Marles, RACGP President, said the public recognition was testament to Chris’s ongoing commitment to enhancing the quality of care and access to health services for all Australians.
Chris Mitchell
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Caring for Refugees feature
Caring for the health of refugees The Australian immigration budget has increased by $1.3 billion over four years
By Janet Grist
North Coast refugee populations The North Coast of NSW has an impressive recent history when it comes to sponsoring and welcoming refugees and a range of charities, agencies and community groups work hard to support and assist these new arrivals. As a signatory to the 1951 Convention and 1967 Protocol relating to the status of refugees, Australia is obligated to welcome and offer on-going friendship to all asylum seekers. The Australian immigration budget has increased by $1.3 billion over four years, as the government prepares to expand the humanitarian visa program to 20,000 each year. While there are refugee families living all over NSW, here is a brief summary of the refugee populations in the major North Coast centres.
area. The majority were from Burma, with some from the Congo. They settled mainly in the Kingscliff area, however most of the Burmese eventually relocated to Brisbane where they were offered great government assistance and support.
Tweed Valley
Lismore
During the early part of this century, The Tweed Valley experienced increasing numbers of refugees settling in the
Since Sanctuary Northern Rivers was founded in 2003, around 150 African refugees from Sudan, the Congo and Sierra Leone, have
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been settled in Lismore. It’s part of a loose collective of similar groups around Australia. During this period, Sanctuary Northern Rivers has endeavoured to support African refugees in camps who ask for assistance, mainly through providing sponsorship to those who seek refuge in Australia. Sanctuary advocates have been communicating with these people and working on their behalf to gain a visa although no offshore applications have been successful for the past two years. While most applications are unsuccessful, for those who succeed, Sanctuary supports their settlement and integration into the local community.
Coffs Harbour and surrounds The Sanctuary Australia Foundation (based in Coffs Harbour) was founded in 1988 by Sue and Peter Hallam, after what they describe as ‘a life-changing experience’ in Mexico, where they spent time with a priest who was sheltering destitute Salvadoran refugees. The Hallam family migrated to Australia in November 1987, settling in Coffs Harbour and soon
established Sanctuary, working for the Government’s Community Refugee Settlement Scheme, welcoming and helping refugees. In 1997, the group became a registered charity and began to send money directly to refugees suffering overseas, as well as clothing, shoes and medicines. The Foundation sponsors and assists refugees who are in desperate situations overseas, and over 25 years they have helped thousands of refugees from many war-torn nations. On arrival, refugees are assisted with accommodation, furniture, food, clothing and are generally welcomed into the community. Since then they have created and trained a network of affiliated Sanctuary Refugee Support groups around the country. In 2004 the federal government made Coffs Harbour an official resettlement area for refugees, including asylum seekers, building on Sanctuary’s work. Mark Hallam told HealthSpeak that Sanctuary focus is mainly on assisting refugees overseas and family re-unification. The Sanctuary network has welcomed and settled around 3,000 across Australia. In recent years, most Sanctuary Foundation sponsored arrivals to Coffs Harbour have come from Congo, Burma and Ethiopia.
Port Macquarie While there are pockets of refugee families all over the North Coast, there is no significant refugee population living in the Hastings-Macleay region. HealthSpeak
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Caring for Refugees feature
Lismore’s Sanctuary Public health physician, Dr Michael Douglas, was one of the founding members of Sanctuary Northern Rivers, a community organisation committed to supporting refugees to live in a fulfilled manner, respectful of their dignity and aspirations. Since 2003, Sanctuary Northern Rivers has endeavoured to support African refugees in camps who ask for assistance, mainly through providing sponsorship to those who seek refuge in Australia. Sanctuary advocates have been communicating with these people and working on their behalf to gain a visa. While most applications are unsuccessful, Sanctuary has settled around 150 African refugees in Lismore. For those who succeed, Sanctuary supports their settlement and integration into the local community. There are many heartwarming stories of the new lives experienced by these refugees on the North Coast. One young Sudanese man who settled in Lismore, Gabriel Thiongkol, was accepted into the Australian College of Basketball last year – attaining his long-held dream. Michael Douglas told HealthSpeak that, sadly, no new African refugees have been settled in Lismore for the past two years. However, with the federal government announcing it would increase the yearly refugee intake from 13,000 to 20,000 in October last year he’s been advised to encourage some Lismore refugees to resubmit applications for family reunion visas and he’s hopeful that some will succeed. “We are delighted that there has been an increase, and hope that future governments
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autumn 2013
Michael Douglas
There are many heartwarming stories of the new lives experienced by refugees.
respect the plight of refugees and maintain generosity of commitment.” Michael explained there was a priority system for family reunion visas. “First priority is the spouse, then dependent children, then parents and siblings. So we will getting amongst the community to encourage them to reapply on behalf of family members. “The situation of these people can be absolutely dire. A lot of families here might have a mother still alive and they have tried to gain a visa for her, and for them to be rejected upsets me. It’s been very sad to hear the stories of how these family members are living and the dangers they face,” he said. With no new African refugees being settled in Lismore for two years, the nature of
the care of the area’s African population has changed somewhat. “When a refugee family first arrives from Sub-Saharan Africa there are lots of health concerns and an approach to these was developed firstly through Kingsley Pearson at Prema House and now Rita Vinten and David Stirling, as well as GPs from the Lismore Clinic and other practices. These GPs took it on themselves to serve the refugee community. “The initial assessment and complexity and mix of health problems has declined. Now we are seeing health issues more related to trauma and persecution, a lot of grief and people discovering that family members have died or are still alive, but living in terrible circumstances. So this situation can bring psychological issues to the surface. “But, overwhelmingly, I walk with a settled community that is bright, cheerful, selfless, compassionate, grateful and optimistic about their new lives,” said Michael. The Immigration Department has also approached Sanctuary about taking onshore applicants in Lismore but Michael said the requirement to have an employer guarantee employment for 12 months and for accommodation to be made available was problematic. “A lot of these people are young men from the Middle East wanting to bring their families over here and it’s hard to find a house for six men. But we will look at our options.” At this point Michael is somewhat optimistic that things will look up for offshore applicants after being at a standstill for two years. Only time will tell.
The GP perspective Phillip Whish-Wilson works at Coffs Harbour Central Medical Centre and has become the GP for a substantial number of refugee arrivals over recent years. He feels he is helping to meet a need, and finds it interesting and educational to help people from diverse cultures. “Their health problems may not be all that different to our other patients, but there are some special challenges”. He said many of their health problems were undertreated prior to their arrival in Australia - such as diabetes, eyes, ears, teeth, and past fractures. Anxiety, depression and PTSD are also common. Recent arrivals have been largely from Afghanistan & Burma. Others are from various African countries, including Sudan, Eritrea, Togo, Liberia and Congo. Many have spent years in refugee camps in other countries. Phillip uses the phone interpreter when consulting, finds it straight forward to use, and recommends its use whenever a GP needs an interpreter.
What is a refugee? A refugee is legally defined as a person who is outside his or her country of nationality and is unable to return due to a well-founded fear of persecution because of his or her race, religion, nationality, political opinion, or membership in a particular social group. By receiving refugee status, individuals are guaranteed protection of their basic human rights, and cannot be forced to return to a country where they fear persecution.
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Caring for Refugees feature
A compassionate vision made real Harriet Playle, Dr Raju Lalani and Dr Gillian Gould who support the clinic,” Michele told HealthSpeak. Michele developed a Health Assessment screening tool used at the clinic and has modified it many times since. Health assessments for new arrivals can take several hours to complete. “The nurses do all the health assessments from head to toe, we document past and present health conditions and then make appointments as appropriate dental, women’s health (including Pap Smears and contraceptive advice), early childhood, , vaccinations, audiometry,
Health assessments for new arrivals can take hours to complete. Dr John Kramer with a young patient at the New Arrivals Clinic.
This unique health clinic located on the campus of Coffs Harbour Hospital came about when Public Health nurse Michele Greenwood saw the need for a new model of care for Humanitarian refugees and set about making it happen. The need for the clinic was really brought home to Michele when she was working as the chest clinic (tuberculosis) nurse. In 2000, one of the first refugee families to arrive from Sudan had a family member who had contracted TB overseas and was on a health undertaking and were under Michele’s care. “Sanctuary (a not for profit Humanitarian Refugee agency) were sponsoring families to the area at that time. We looked after that family for quite a while and so from that time Peter Hallam (from Sanctuary) thought I should see every single family who arrived,” said Michele. In the years up to 2004, refugee arrivals were sporadic, 14
but that all changed when in the same year the federal government designated Coffs Harbour as an official resettlement area for refugees. Anglicare won the tender to be the settlement support agency for new arrivals. Michele helped forge links between the Mid North Coast Division of General Practice and the local health service, where she worked, to establish this special community facility. Consultations with Anglicare staff, Refugee community members, GPs and area health staff followed. From there her immediate boss, Paul Corben supported the concept and Michele then wrote to her senior manager Vahid Saberi, (now CEO of NCML), who advised her to “Go for it!” The Division of General Practice put an item in their newsletter asking for doctors to support the clinic. There are six GP ‘s John Kramer, Dr Carol Chan, Dr Whish-Wilson, Dr
optometry and everyone goes to the Chest Clinic,” Michele explained. In addition Michele can refer patients to STARTTS (Service for the Treatment and Rehabilitation of Torture Trauma Survivors) physiotherapists, speech therapists and the limb prosthesis expert, as some have
lost legs. “We also do general observations and a suite of blood tests that are recommended by the ASID Australian Society of Infectious Diseases, as well as a full blood count , LFT’s , UEC’s, Vitamin D level, Thalassemia screen, Helicobacter pylori and urine test. “ When all the results have come back the patient is seen at the Refugee GP clinic which operates every Monday from 1pm to 5pm. However, if the If the patient is unwell at the first nurse visit or they have abnormal pathology they are taken to the Emergency department or a GP whichever is appropriate at the time. A qualified health care interpreter is used at every nurse and doctor consultation. The six GPs rotate through the clinic; they conduct a physical exam and write up any required scripts. Often refugees have low vitamin D, are anaemic, present with ear and skin infections, parasites, helicobacter pylori infection and PTSD. The GP can then refer them onto an orthopod, gastroenterologist or gynaecologist as needed. “If the patients have a blood borne virus they are referred to the hospital specialist clinics after the appropriate work-up is completed, for example recommended specialised blood tests and an ultrasound. Within 10
Refugees cross from Congo into Uganda at the border village of Busanza in 2008. HealthSpeak
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Caring for Refugees feature
Some Clinic Facts: paces of our clinic are all the specialist services and pregnancy care. If someone is pregnant their pregnancy bloods and ultrasound are organised through the clinic and then they are referred to the pregnancy care clinic,” said Michele. In addition, if people present with overseas vaccination records, they are faxed off to the interpreter service for translation. Of course, getting the medical side sorted is just one aspect of care. Clinic staff arrange all the patient appointments, put them in writing to the patient and their caseworker is emailed about the appointments to assist them to get to there. In addition an interpreter often calls patients the day before to remind them (in their language) of the upcoming appointment. Patients’ initial medication is paid for by the clinic through a local pharmacy.
Referred some 75 to 190 Humanitarian refugees per year Refugees come from eight African countries, Iran, Iraq, Burma (single biggest group) and most recently Afghanistan. Primary health issues include low Vitamin D, anaemia, Strongyloides, Shistosomiasis, hypertension, diabetes, missing legs, ear and fungal skin infections Michele said some patients want the GP they’ve seen at the clinic to be their regular doctor, but this isn’t always possible. “We negotiate a GP for them. We now have refugees going to five different medical practices. Over the past few years we have
also negotiated with most specialists to charge Medicare for these patients and our local GPs who see refugees don’t charge a gap, which is really important as most of these people are living on a $250 NewStart allowance a week,” Michele told HealthSpeak. It’s pleasing to know that Michele’s hard work, assisted by her valued staff, has resulted in the clinic being recognised as a model of Best Practice for refugee health services in NSW. Since 2004 there have been waves of refugee arrivals. Coffs Harbour and surrounds has seen refugees from Burma (the biggest group), eight African countries, Iran, Iraq, and most recently Afghanistan. The Afghan arrivals are presenting with somewhat different symptoms to previous groups. “Nearly every Afghan family here is headed up by a single mother whose husband has been
killed or died. These women are presenting with a lot of pain and it appears to be as a result of trauma and post-traumatic stress disorder (PTSD). “Only in the past six months have we seen many people presenting. We have found quite a lot of physical illness among our Burmese and African populations, but relatively, the Afghan women appear to be far more traumatised and really struggling. A lot of it appears to be somatic pain with the GPs and allied health workers, such as physiotherapists, ruling out everything but PTSD,” Michele said. She explained that for some it’s hard to accept that their pain is not physical, but Michele said it’s unfortunate that most are reluctant to visit the people at Coffs Harbour STARTTS to talk about their experiences.
Continued page 34
Specialist trauma service The Coffs Harbour STARTTS office (The NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors) was set up in 2005 and is staffed by counsellors Denise Tunks and Tracy Tierney. STARTTS was founded in 1988 and provides bi-cultural counselling services to people in NSW who have survived torture and trauma related to their refugee experience. They also offer a range of other impressive training programs designed to help people work effectively with refugees, and community development programs to strengthen refugee communities. Denise and Tracy are happy to provide tailored training for local organisations who request it and they can do this in Coffs Harbour, Lismore and Armidale. Outreach workers also drive to these locations to
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It seems a number of GPs are not aware of the STARTTS service. provide counselling services to those areas every month or six weeks and stay for a couple of days. . The Coffs staff are well supported by the Sydney office where they go for regular training every two months. Staff there have a lot of knowledge and Tracy and Denise can ring and speak to a colleague about a particular case and about the background of the person. Another popular program is the Families in Cultural Transition Program where
bi-cultural trainers support and deliver this program to their own community. Topics include settling into a new culture, gender issues, DOCS and trauma issues. It’s been run in Coffs for the Congolese, Burundi, Sudanese, Burmese, Liberian and Tongolese refugees. STARTTS enjoys working with other organisations and ran a six-week program to encourage local refugee children to access library resources. This included a talk from a local GP and the kids produced videos as well. The New Arrivals Clinic and settlement services are the main source of referrals to STARTTS,
although Denise and Tracey are sure that there are GPs who are not aware of the existence of their service. Denise explained that the refugees they see are often facing very complex situations.
Continued page 34
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The Koori Grapevine Indigenous Health Planning Day
The workshop was the biggest gathering of Aboriginal agencies on the North Coast.
NCML hosted a Many Rivers Alliance Aboriginal Health Planning Day in mid-December attended by representatives from 18 agencies and services including Aboriginal Medical Services, Indigenous medical clinics and Medicare Local staff. Chaired by Mark Moore, Acting Chair of the Many Rivers Aboriginal Health Service Alliance and facilitated by NCML CEO Vahid Saberi, the day-long workshop held in Coffs Harbour was the largest gathering of Aboriginal agencies ever held on the North Coast. Agency representatives introduced themselves and listed two priorities for progress on Indigenous health. From this list a group of priorities were worked out. These were: Providing effective,
accessible care for Aboriginal people Strengthening the Aboriginal health workforce Health promotion and disease prevention Regional partnerships focussing on chronic disease Strong Aboriginal governance within the region Consistent cross-sector planning and service delivery From these priorities a set of actions were developed for agencies to pursue. The Many Rivers Alliance is also considering setting up a steering committee and implementation groups to act on these priorities. There will be another planning meeting in June.
NCML at Taree Festival
The Medicare Local stall – staffed by North Coast Medicare Local Closing the Gap team and staff from Hunter Medicare Local, was a big hit at the Festival.
On January 26, working alongside the Hunter Medicare Local, the Closing the Gap team at NCML’s Mid North Coast branch held an information stall at the Saltwater Freshwater Festival in Taree. Despite the rain and mud, the festival attracted more than 4000 people, many of whom visited the NCML stall and took information away with them about particular health programs or signed up to E-Health. The Festival, run by the Saltwater Freshwater Arts alliance Aboriginal Corporation, a regional body for Aboriginal arts and culture on the Mid North Coast, aims to position Aborigi-
nal art and culture as the foundation for the long-term social, economic and cultural development of the region’s Aboriginal communities. The Saltwater Freshwater Festival is a showcase of the best Aboriginal talent in the country, and most importantly, in the region. It is a culmination of a range of arts and cultural activities undertaken by Saltwater Freshwater Arts during each calendar year, providing an authentic Aboriginal experience for visitors and local communities. The Alliance is governed by ten Local Aboriginal Land Councils across seven shires from Karuah to Coffs Harbour.
Funding for rheumatic heart disease vaccine Prime Minister Julia Gillard amd the New Zealand Prime Minister, John Key, have agreed to support the development of a potential vaccine for rheumatic fever. In a joint statement the Prime Ministers agreed to provide A$2.4 million in matched funding over two years to support a Trans-Tasman collaboration. “This joint Australian and
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New Zealand Government investment will fund the evaluation of three potential vaccine candidates currently under development to identify one that could then proceed to clinical trials,” Ms Gillard said. The University of Western Australia and its affiliate, the Telethon Institute for Child Health Research have welcomed the commitment. The Director
Koori Grapevine
of the Telethon Institute, Professor Jonathan Carapetis, said while rheumatic heart disease was now rare in wealthy countries, Aboriginal and Torres Strait Islander, Maori and Pacific communities have among the highest rates of the disease in the world. “While treatments for patients with rheumatic heart disease are improving, it's critical that we stop the disease from occurring
in the first place and the quickest way to achieve that will be with a rheumatic fever vaccine,” Professor Carapetis said. “A vaccine resulting from this initiative will not only be critical in eradicating this disease in Australia and New Zealand - a disease of yesteryear for most, but not for Indigenous people but will also be a vaccine for the world.”
Finding satisfaction and self-esteem through art Kathleen Richardson was born in 1933 in the bush near Boomi and belongs to the Gamilraay language group. Her mother died just after she was born and she was raised by her Aunty while her father was a soldier in World War Two. She grew up on the old and new Toomelah Mission where she went to school and later worked as a domestic servant on properties in surrounding districts. Kathleen had eight children while living at Toomelah and Boggabilla, and then moved to Woy Woy in 1973 and on to Lismore in 1981 where she discovered a whole new world of creativity and self-esteem. From 1998 to 2004 she completed certificates in Aboriginal Arts and Cultural Practices at the North Coast Institute of TAFE in Lismore. Kathleen exhibited with TAFE throughout this period and in 2002 she was a participant in a mural project for Lismore Courthouse. In 2010 she was a finalist in the Bundjalung National Parks Indigenous Art Award, Lismore Gallery and also the Parliament of NSW Aboriginal Art Prize where Kathleen’s work the ‘Toomelah Mission Truck’ was the work exhibited for this prize. Kathleen described the back-
ground to this stunning artwork for the Parliament Art Prize award. “The Toomelah Mission truck was used to transport the Murries of the Toomelah community to and from Goondiwindi, 20 miles away where they would do their shopping. The truck was also used for many tasks on the Mission including rubbish clean up and fetching wood. On one particularly hot day in November 1955 I started to go into labour with my second child not long before the truck was due to leave. I quickly changed and waddled off to where the truck always departed from, where I was met by my cousins who were waiting to help me climb on to the back of the truck. It was a long, hot, dusty and bumpy ride along the dirt track to Boggabilla but the road was tarred the rest of the way to Goondiwindi where the local hospital is. Well thank God I made it to the hospital before the arrival of my beautiful baby daughter. I stayed in hospital for a week then back home and my baby daughter’s first ride on the Toomelah Mission truck.” HealthSpeak was lucky enough to catch up with Kathleen when
Deadly Tucker Bush tomato (akudjura) scones
Kath Richardson and Dr Andrew Binns wtith the Toomelah painting.
she was visiting Goonellabah Medical Practice where the Toomelah Mission truck painting now hangs. She pointed out the pregnant figure on the left of the painting was herself, walking calmly towards the truck even though she was in labour. Generally she rode the truck to go shopping at Boggabilla. Kathleen said she started TAFE art classes for something to do and to meet people when she moved to Lismore. She also enjoys sewing. In the photo (above), Dr Andrew Binns is wearing one of Kathleen’s designs, with material she sources from Indigenous artists in Alice Springs.
Preparation: Pre-heat the oven to 200°C. Add salt and baking powder to the flour. Rub the fat (butter) into the flour until it resembles breadcrumbs. Add bush tomato and mix through. Gradually add the milk, a little at a time, until you have a soft dough. Knead for a few minutes.Cut into scones and rest for 10 minutes.
Ingredients: 4 cups plain flour 1 tbsp baking
powder 3 tbsp butter 3 cups milk (approximately)
1 cup akudjura (bush tomato), finely chopped Pinch of salt
With a pastry brush, brush the tops of the scones with a little milk and bake for approximately 20 minutes at 200° C or until brown on the top. Enjoy! (With thanks to the SBS website Food.)
Kathleen’s eight children all have artistic talent. She told HealthSpeak that her daughter Carmel, who lives in Kempsey does some exquisite work painting emu eggs. When asked about her life on Toomelah Mission, Kathleen said she went to work for a local property owner when she was 17 and received very little pay. She said the family was good to her, but some of her friends at the mission found themselves pregnant to their employers and many of them were taken advantage of. Kathleen said her art has played an important role in developing her confidence and in telling stories about her life.
Got a story? HealthSpeak is for the entire community and we are always happy to receive story ideas and submissions. Please direct your ideas and articles to the editor at jgrist@ncml.org.au
Koori Grapevine
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Transport is the Link The Northern Rivers Social Development Council (NRSDC), in collaboration with NCOSS, recently held a Health Transport Workshop where it was revealed that people often miss medical appointments due to a lack of transport. This is particularly the case when appointments are made to see specialists in south-east Queensland. When a patient arranges a medical appointment, they are not routinely asked about their transport choices or told what their options might be. If they are experiencing transport disadvantage this is not flagged in the system. As a result, appointments are often booked at times when transport is difficult. It’s a huge issue but largely unrecognised within the health professions. Often the timing of appointments is critical for
transport availability but the person making the appointment for the client doesn’t think to check, and the client doesn’t feel confident to request a more suitable time. Hence, they often don’t get to their appointment and miss out on the health care that they need. NRSDC staff were selected for the first Medicare Local ‘Pitch’ series, to present a role play around this theme (see page 4). So, what transport is available and how does one find out about it? NRSDC maintains a website witha range of transport information for the Northern Rivers region at www.goingplaces.org. au. NRSDC has also produced an Accessible Transport booklet which can be accessed on the front page of the goingplaces
New Orthopaedic Surgeon Shane Prodger is an Orthopaedic Surgeon who has moved back to Lismore from Brisbane with his wife Bec and three young daughters, to work as a VMO at Lismore Base Hospital (LBH) and set up private practice. He told HealthSpeak that he grew up and went to school in Lismore and his family still live locally. It was for family reasons that he and Bec decided to return to the Northern Rivers. After 20 years in Brisbane the timing was right when an opportunity to work as a VMO at LBH presented. Shane explained that since completing his training at the beginning of 2012 he has worked in the public health system in south-east Queensland. He very much enjoyed working in public health last year and part of the pull to come to Lismore was the VMO job at LBH. Initially Shane qualified and worked as a physiotherapist for four years. He then undertook and completed his medical and specialist
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training in Queensland. He started his VMO work at the end of January and is renting rooms in Hunter Street for his private practice. Shane’s particular orthopaedic interests are in trauma and lower limb work – hip and knee replacements and sports injuries to the knee. However he is more than happy to consult on general orthopaedic and upper limb conditions. Enjoying the laidback lifestyle and the beach, the Prodgers are looking to buy some acreage between Lismore and Ballina and keep some cows, a horse and some chooks. Shane is also aware of the cultural activities that Lismore has to offer, including the revamped Star Court Theatre, and doesn’t feel the family will miss out on much not living in a capital city. “We’re really looking forward to having our hobby farm and enjoying the Northern Rivers lifestyle.” Contact Shane Prodger on 6621 6462.
website. Hard copies can be mailed on request. One important transport option for medical appointments is Community Transport. There are three such services across the Northern Rivers – details and contacts are on the goingplaces website. There is also a trial shuttle bus service to major Brisbane hospitals that picks up people from their homes - the North Coast Shuttle. There is a link to
the brochure on the home page of the goingplaces website and bookings can be made through the local Community Transport service. Affordability can be an issue for people who need to travel long distances on public transport. NRSDC is currently compiling a Health Transport Directory which will be available early in 2013. For more information call Linda or Kate on 6620 1800.
Cracking cancer ride
The Annual Crackin’ Cancer Three Waters Horse Trail Ride is on again, from April 13 to 20, 2013. This 3rd trail ride will traverse rivers, creeks, bush and historic mining areas around the wild New England ranges. Each day will see riders cover from 25 to 30 km going into different areas of magnificent countryside and at night there will be live entertainment at the gunyah. The rides raise much needed
funds for Cancer Research and the ride is sponsored by the Cancer Council NSW. Last year’s Crackin’ Cancer ride raised more than $8000. Participants do not need to have their own horse, horses can be hired for the week-long adventure. Well known GP Dr Sue Page is Crackin’ Cancer’s Medical Advisor. To find out more, phone Marshall Fittler on 0411 840 797 or Laurie Cooper on 0429 626 912. HealthSpeak
autumn 2013
Arts Health and Wellbeing It was always Genevieve’s dream to write a musical and this is now a reality. General Practitioner, Dr Genevieve Yates, is no stranger to the arts. She has her own website and is an accomplished writer in many spheres. She’s had five of her plays produced and one published, has written a novel and writes for medical publications as a columnist. Genevieve is a medical educator at North Coast GP Training and combines her passion for writing and performing with her educational role. “One of the plays I wrote, Physician Heal Thyself, is about doctors and self-care and it’s being performed all around the country as part of doctors’ educational sessions. It’s about a day in the life of a general practice clinic. “I have produced a short film and videos as teaching aids and last year presented some short play readings in the US at an international medical humanities conference. Such readings really allow the participants to get into the patient’s shoes,” she explained. Genevieve’s plays are staged all over the country, but it was always her dream to write a musical and this has now become a reality, with GP The Musical being performed at the upcoming Melbourne Comedy Festival. It was Genevieve’s collaboration with fellow GP and Victorian medical educator Gerard Ingham that brought the musical to life. “I was actually in a rock band with Gerard; it was a band of medical educators called the GPettes. I’ve been involved in musical theatre for years, but never thought I’d be able to write one. But Gerard and I said ‘Let’s do it.’” HealthSpeak
autumn 2013
GP The Musical
So it was that GP The Musical was co-written in 2011, with Gerard and Genevieve both writing songs and featuring original lyrics and music. In September 2012 it premiered at the GPET conference in Melbourne and was also performed at Daylesford. Gerard and Genevieve are producing as well which is an enormous amount of work. She said the musical side adds another whole layer. One of the songs is performed live with a cello and guitar, and the rest is pre-recorded. Although they wanted a live band, it was too difficult to organise. The entire cast is made up of GPs drawn from face to face auditions from all over Australia. There were two face to face rehearsals before the premiere and rehearsals via Skype. Gerard and Genevieve approached the Melbourne Comedy Festival who were very supportive and said the show would be a great asset to the festival. “It is comedic but has serious aspects, so there’s a lot in the musical about burnout, doctors’ health and the stresses about working in general practice. But it’s done in a fun way so people can laugh and cry at the
same time. “It is particularly targeted towards GPs and we use some acronyms, so we thought: ‘how are the general public going to take it?’ But those who have seen it got enough out of it to really enjoy it. Because anyone who’s ever been to a GP can relate to sitting in the waiting room for a long time,” laughed Genevieve. The musical has now been extended to include some material about naturopathy and ehealth and the cast will perform five shows at the Melbourne Comedy Festival in April. There are 10 medical educators in the cast, including North Coast GP Training’s Dr Christine Ahearn who is playing Crystal, a patient who has a close relationship with her naturopath. The cast let the audience know that they are not professional actors. One of the lines is: ‘We hope you enjoyed our musical, don’t be too critical, it’s not our day job.’ Genevieve says so far the audiences have been kind and she believes GP The Musical is a unique undertaking. “I’ve done some research and there doesn’t seem to be anywhere in the world where they’ve written a musical about
general practice. So this is a world first and very Australian specific with Medicare references, and it’s nice to be involved in something so different,” said Genevieve. With songs such as Eternity Waiting Room, Stop Your Complaining, You Don’t Listen to a Word I Say, Come Back Again (the Medicare Dance), Trust Me I’m a Naturopath and E-health Records are the Way to Go, there is something for everyone to enjoy! Above all, the production has been a lot of fun for the cast and Genevieve is sure it’s enhanced their wellbeing. “It’s such a really good collegiate atmosphere. And everyone is equal, which is unusual, because if you go to a medical function there can be that feeling of a hierarchy. It’s helped our own wellbeing and hopefully also enhanced our audiences’ wellbeing.” Who knows? GP the Musical might play on the North Coast some time soon. If you happen to be going to Melbourne in April (17 to 20) book here: www.gasworks.org.au/buy-tickets or phone (03) 9699 3253. View some clips at: www.genevieveyates.com
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Health care workers campaign against CSG By Dr Kieran Mutimer In the April 2012 edition of GP Speak Ben Ticehurst outlined the health risks associated with Coal Seam Gas (CSG) mining. Doctors were alerted to a wide range of illness which local people could present with following exposure to a plethora of toxic chemicals used in the mining process or released by it. The psychological impacts of environmental degradation, concern for personal and family health, loss of livelihood and decreased property values were likely to cause a significant burden of anxiety and depression. A large grassroots movement to keep the Northern Rivers CSG free is gathering in strength. There is optimism that the current drilling of exploratory GSC wells can be halted and a moratorium imposed on any further drilling until a full environmental assessment including health impacts is
undertaken. A number of local Health Care Workers are in the process of forming a group to become active in the campaign against CSG. Possible activities of the group and its members include: Collection, preparation and dissemination of information on health and environmental issues related to CSG, Organising professional meetings, Speaking at public meetings Lobbying local politicians, health and environmental government agencies And being an informed resource for our families, friends and neighbours. As a responsible and respected group , health care workers have a powerful voice to add to the fight for a CSG free North-
ern Rivers and an important role to play in safeguarding the community’s health. If you would like to make contact with us with offers of support, ideas , suggestions, proposals or to keep informed of our activities as they evolve please contact me on 6688 2233 or email: nrhealthandgasfields@ gmail.com.
Help for older parents caring for an adult child with a disability Richmond Community Options can provide support and advice for older parents (over 60, or over 45 if identify as Aboriginal or Torres Strait Islander) still caring for an adult son or daughter with a physical or psychiatric disability. This assistance includes: Help to make plans in the event of a health crisis that results in the parent being admitted to hospital Help to find additional support as they get older and the caring role gets harder Equipment and household items, including modifications, to support caring in the home. Help to determine realistic plans for the future when the parent is no longer able to be the main carer The staff at Richmond Com20
munity Options provide case management support, linking with both formal and informal community supports, as well as planning and preparing for transition from parental care (future’s planning). The service can also fund legal consultations for wills and enduring POA’s and guardianship. Some parents will want the transition from parental care to start while they are still around, while other parents will just want the comfort of having a plan in place. “I am amazed that we are hearing from parents in their late 80s who are still the primary carer for their disabled son/ daughter, mainly with an intellectual or psychiatric disability, but also acquired brain injury, and quadriplegia. Some do not even have a formal diagnosis; rather the family has been providing care for 50-60 years, because “Joe has never been any different,” said Richmond Community Options Manager,
Jan Dilli. “A number of these people are not known to the service network, and the first presentation can be when they are assisted out of the ambulance when mum or dad has a health crisis and is being carted into ED. This then presents a major management problem for the acute facility, which is not the best place for the disabled son or daughter. “Often the person in the community with the best knowledge of the existence of these carers is the local GP or pharmacist. Hence we are asking for your assistance. Please inform elderly parents of the service,” Jan said. For more information, ring Jan Dilli at Northern NSW Local Health District on 6686 9829. Richmond Community Options covers the Byron, Ballina, Lismore, Richmond Valley and Kyogle LGAs. In the Tweed Valley, phone Tweed Community Options on 07 5569 3110 and contact Clarence Community Options on 6645 3669.
New support for Overseas Trained Doctors North Coast GP Training is now offering help to overseas trained doctors (OTDs) working in the general practice environment to gain their Fellowship through mentoring, support and assistance with exam preparation. This support comes through a federally funded national program called OTDnet which helps OTDs gain General Medical Registration - assisting them to prepare for their College exams. NCGPT invites any overseas trained doctors working on the NSW North Coast to enrol in this new program. NCGPT Medical Educator Dr Genevieve Yates said particular attention would be given to ensuring current knowledge of Australia’s health system with specific reference to NSW, a focus on communication skills and an emphasis on cultural issues given Australia’s social, cultural, political and religious diversity. Particular emphasis will be given to building professional networks and providing exam support. A dedicated NCGPT Support Officer will work with each OTD and there will be online training modules available. NCGPT is also happy to offer specialised medical education and tailored training to North Coast’s OTDs to cater for particular learning needs. To enrol, email: sharyn@ncgpt.org.au or phone her NCGPT Program Manager Sharyn Corben on 6681 5711.
HealthSpeak
autumn 2013
Focus on Nursing
Blazing a trial in psycho-geriatrics Janet Grist spoke to Psycho-geriatric Nurse Practitioner Anne Moehead about her 40-year nursing career and her chosen specialty. It seems Anne Moehead’s career was always going to focus around her interest in ‘caring’. Anne’s desire to work in a caring profession saw her start work as a veterinary nurse. And it was the vet’s wife, a nurse herself, who suggested that Anne study nursing, which set her on a stellar career path, achieving a number of milestones. After starting her psychiatric nurse training at Sydney’s Gladesville hospital in the early ‘70s, Anne moved up to the North Coast where her husband’s family lived and completed her general registration at Lismore Base Hospital (LBH). She then worked for some years in mental health, both in the hospital setting and in the community, as a psycho-geriatric clinical nurse consultant. During this period Anne worked for the Aged Care Assessment Team and alongside Dr Hugh Fairfull-Smith. “He’s the loveliest man and a great supporter of me, and of nursing. When you do your nurse practitioner study you are expected to have a senior colleague who supports you, guides you and reflects on your practice. We’d worked together since 1986 and Hugh has been that mentor for me,” Anne told HealthSpeak. Anne started in the position of nurse practitioner in 2004 and was endorsed in 2006, completing a Masters in Old Age Psychiatry through the NSW Institute of Psychiatry. She became the very first psycho-geriatric nurse practitioner in Australia. Because of her extensive experience, Anne’s motivation to become a nurse practitioner came from her knowledge that more could be done for the mental health of the older person in the acute hospital setting, and the belief that she could help bridge that gap. HealthSpeak
autumn 2013
Anne is one of only 10 Psyho Geriatric Nurse Practitioners in NSW.
“Up until last August when Dr Fairfull-Smith returned to LBH, we didn’t have a geriatrician working in the hospital setting, and our hospitals have huge populations of older people. When I talk about mental health in the older person I include presentations like dementia and delirium,” she said. Being the first psycho geriatric nurse practitioner in the country, Anne had to map the way forward. She achieved this through her experience of working in the health system for a long time, seeing the outcomes being achieved for patients and talking with colleagues about gaps in the system. “People were saying ‘we don’t manage delirium very well in older people, we bring people in and fix their broken legs, but we often don’t think about the complexity of the older person and often that includes dementia and delirium.” Anne’s insight into the lives her patients and her compassion for their circumstances have also shaped her work. “Often they’ve had a pretty rocky road, they’ve travelled through wars and Depressions and experiences like that and they’ve done it tough often. There’s the complexity of aging and life in general and then they become unwell,” she explained.
People were saying ‘we don’t manage delirium very well in older people’. Seven years ago, Anne was recognised with an Order of Australia Medal for her services to dementia. She describes this as an exciting time. “When you’ve worked through your career you’ve put a few checks and balances in place, and for me it’s about having developed the role of the psycho geriatric nurse practitioner and having other people take on that career path as well.” Anne explained that the difference between working as a registered nurse or a clinical nurse consultant and a nurse practitioner was all about autonomous practice. “Being able to go that little bit extra in terms of my specialty only – doing investigations or another blood test that’s been missed, ceasing and starting new medications indicated for their presentation, and working as part of the senior team in managing the presentation.” Currently in regards to the geriatric team at LBH there’s
Anne, Dr Hugh Fairfull-Smith, and a career MO or registrar on the team to manage older people during their acute stay in hospital. A new geriatrician, Dr Alison Semmonds, joins the team in late February. Anne sees patients in Lismore Base, Kyogle, Casino, Bonalbo, Urbenville, Nimbin and Ballina hospitals. She used to see patients all the way from Tweed to Grafton, but after lobbying hard there are now three nurse practitioners in psycho-geriatrics in Tweed, Grafton/Maclean and at Port Macquarie, a highly unusual situation. “There are only 10 psycho geriatric nurse practitioners in the state. So to have four of the 10 in our coastal strip is fantastic,” said Anne with a smile. Last year, Anne started an outpatients clinic with Dr FairfullSmith’s support. She has a room next to his and sees his patients for follow-ups, which allows him to see new patients a little earlier. Anne also believes it’s helpful to be situated within Lismore Base Hospital, close to the health decision makers. “My colleague Vicki Rose, with whom I worked in ACAT for many years, has been working hard with a few of us to enhance geriatric services. And let’s face it, 52% of the people who come to hospital are older and we need staff with expertise to support these people.” With baby boomers coming through, Anne believes there are lots of things North Coast Medicare Local can do to better support GPs in the aged care field. She believes GPs and nurse practitioners could work better together to relieve the workload of GPs. “Particularly in residential aged care – GPs have many demands on their time - and it can be fairly mundane work. Nurse practitioners could work closely with GPs, having responsibility for a particular nursing home or patients belonging to a practice,
Continued next page 21
Letters to the Editor
More Australians jogging
Congratulations HealthSpeak When my colleague Bob Anderson and myself set up the medical student journal Panacea 45 years ago, we had little thought that it would still be around today, and I am pleased to say that it still is. However, there is nothing more certain than that health care has changed and some of the major changes are at the forefront of so-called Telehealth medicine. At every professional level, from accounts to dentists, optometrists, dry cleaners etc, people do not want to have to move from the cities and there are many reasons for this. While Telehealth is not going to help the dry cleaners, publications such as HealthSpeak will improve the communication between members of the health industry and I use that word widely. I hope that HealthSpeak will be made available to all specialists as well, be they public or private. There is nothing more
From previous page managing medications, monitoring patients and getting back to the GP when needed if the patient is exhibiting symptoms that are beyond their scope. “The nurse practitioner can make further investigations, order referrals to OTs, physios and review and manage medications. Because a lot of the issues in nursing homes are nursing issues - falls, continence, skin tears, chest infections etc. “I also have a number of NP colleagues who work in private practice and again relieve the GP to do more complex things.” Anne very much enjoys the complexity of working in geriatric health. “It’s challenging, you have to be a good problem solver and work out what it is about this person that is the real issue. It may not necessarily be their broken leg, it might be other psychosocial issues. I have earned the respect of other staff and I 22
certain than that medicine in 50 years time will be different to what it was when my father graduated in 1926, when I graduated in 1970, and that most of the technologies being used have not as yet been invented. What will not have changed, however, is the need for interpersonal collegiate camaraderie and, more particularly, effective communication. I commend North Coast NSW Medicare Local. I commend HealthSpeak and all of its contributors. I wish you well for the future and hope that forthcoming editions are fruitful and lead to better health outcomes for our clients, that is to say, our patients, if one wants to be an old fuddy duddy (which I am). I wish HealthSpeak all the very best and hope to hear more from you. A/Professor Geoffrey M Boyce, Neurologist
like that the physicians ask me to see complicated cases. I think ‘I hope I make a difference’. I’ve got more time to sit and talk to the person, ring the family, ring the GP, put the pieces of the puzzle together.” Being a leader in a new health career path, Anne is a valued member of several NSW health committees and finds this work ‘a bit of fun’. “Last November I went down to Canberra to add my voice to a ministerial inquiry into how we manage dementia in the hospital setting. I’m also on the state advisory committee for the Agency of Clinical Innovation and the NSW Dementia Advisory Committee. Having the rural perspective as well is very valuable.” This nurse practitioner pioneer also has a strong commitment to ‘handing on the baton’. “I mentor other NPs, I have a colleague from Darwin I’m mentoring who is doing her psychogeriatric nurse practitioner study
The number of Australians jogging or running as a sport or recreation has almost doubled since 2005–06, according to an Australian Bureau of Statistics (ABS) publication. ABS Director of Culture Recreation and Migrant Statistics, Andrew Middleton, said the Participation in Sport and Physical Recreation survey showed that running had definitely increased in popularity. “We found that nearly eight per cent of Australians 15 years old or over participated in running or jogging in the last 12 months, up from just over four per cent in 2005–06.” The survey also indicated a decrease in the popularity of swimming and diving. Overall 65 per cent of Australians aged 15 and over participated in at least one form of sport or physical recreational activity. Walking topped the list as the most popular activity with 24 per
and I’ve mentored people from Sydney and locally as well. “All this knowledge and experience I’ve developed over 40 years, I can’t just keep it in my top pocket. You have to share that with other people, the passion, the support you’ve had and hand over to these new people,” she said. Towards the end of our interview, Anne mentions how proud she is of her only child, Renee, who was recently appointed as Lismore City Centre Manager. “She’s been working at the Opera House for seven years and has a degree in stage management and technical production. She‘s also worked on the Asian Games the Commonwealth Games. She has a partner from Uruguay and they are both bringing their expertise here. “The new job will be a challenge for her, and for me it’s very exciting to have Renee come back home,” said Anne.
cent of Australians walking as a form of exercise. “Young adults were the most likely to participate in sport and physical recreation,” Mr Middleton said. “People between the ages of 15 to 17 years had the highest levels of participation at 78 per cent, while people aged 65 and over had the lowest participation rate, 50 per cent.” The two most popular sport or physical recreational activities participated in by Australians were walking (24 per cent) and fitness or gym activities (17 per cent). The participation rates of men were slightly higher than women, with 66 per cent and 64 per cent respectively. About 52 per cent of Australians who participated in sport and physical recreational activities participated 105 times or more during the 12 months prior to interview.
Briefs
Palliative meds trials Australians with life-limiting illnesses are helping others around the country and worldwide by taking part in trials of palliative medicines. Late last year the Australian Government-funded clinical trials had recruited their 1,000th participant. It’s hoped these world-leading studies by the Palliative Care Clinical Studies Collaborative, led by Flinders University in South Australia, will answer many questions on the most effective use of medicines. The Minister for Mental Health Mark Butler said the trials were significant.
HealthSpeak
autumn 2013
HIV Rapid Tests a reality By Dr David Smith SHAIDS Medical Director The diagnosis of HIV in Australia became a little easier in December 2012 with the approval by The Therapeutic Goods Administration of a Point of Care or Rapid HIV test (RHT). RHTs employ on the spot testing to provide a result in 10 to 20 minutes, usually while the patient waits. Specimens used include oral fluid, finger prick whole blood or venepuncture serum or plasma. The United Nations 2011 Political Declaration on HIV/AIDS Australia has signed this declaration committing to bold action and targets including the reduction by 2015 of the sexual transmission of HIV by 50%, dramatically expanding access to HIV treatments and a 50% reduction in HIV transmission among people who inject drugs. “The Melbourne Declara-
tion 2012” is an initiative of HIV sector workers and communities aimed at galvanising the political and general communities to achieve the broad aims of this UN declaration prior to the International AIDS Conference being held in Melbourne in 2014. Behind these declarations is a growing body of evidence that HIV treatment can prevent transmission of HIV as well as preserve the immune system and provide near normal longevity. A key plank of this declaration is to find those infected with the virus by increasing the number of persons tested and therefore increasing the numbers on treatment. Being aware of one’s infection is also thought to modify behaviours that potentially lead to transmission to others. Initial studies carried out through several Sexual Health Services in Australia have demonstrated excellent sensitivity/ specificity (>99%) and negative predictive value (99.78%) of the
approved RHT, along with good acceptance by patients and service providers. The most important finding was that availability of RHT increased the likelihood of testing among those at highest risk of the infection and who might otherwise avoid testing for various reasons. The RHT is not an over the counter test but only available for use by appropriately trained clinicians. Initially, training will be made available to service
providers within clinical and community settings with high HIV prevalence. The training is being co-ordinated through the Australasian Society for HIV Medicine (ASHM) and was expected to roll out in late February, although no timetable for broader use has been confirmed. Locally, Lismore Sexual Health is participating in the third phase of RHT, studying a newer test that delivers the result within 10 minutes. This study is supported by the NSW Ministry of Health and is available to the highest HIV risk group of men who have sex with other men. Participants will also be offered concurrent testing for chlamydia, gonorrhoea and syphilis, infections shown to enhance HIV transmission. We anticipate partnering with ACON to foster an innovative approach in reaching this at risk community. For more information, call Lismore Sexual Health on 6620 2980.
Podiatry benefits to patient care The Australian Podiatry Association (NSW & ACT) recently launched a short presentation on Podiatry Scope of Practice which is available on the Association’s website. The presentation has been produced to help alleviate confusiona about the services podiatrists provide. It is also designed to be of particular help when developing a patient treatment plan that requires a multidisciplinary approach. Executive Officer of the Australian Podiatry Association, Janice Jones, said the Association was looking to Medicare Locals to help spread the word. “The Association has worked closely with many Medicare Locals in NSW, initially supporting their applications for funding and being involved in their strategic planning events, so we are grateful for the recip-
HealthSpeak
autumn 2013
Podiatrists deliver care for illnesses which affect the lower limbs.
rocation,” she said. “We have also encouraged our members to be involved with and support their Medicare Local because it’s imperative that podiatry is considered when planning good health care. Podiatrists
should be involved in planning and delivering care for chronic illnesses such as diabetes, arthritis and neuropathy which affect the feet and lower limbs. This is even more relevant when providing services for the elderly, indigenous and
disenfranchised communities. “Podiatrists are the specialists in lower limb health, they complete four years of university training on this specific topic and treat many aspects of foot and ankle conditions. Fields of practice include: paediatrics, sports medicine, diabetes, aged care, biomechanics, bunions and nail surgery as well as general foot and nail care,” Ms Jones explained. The presentation can be found at this link http://www. podiatry.asn.au/quick-linksresources/resources/generalpractitioners-and-allied-health/ podiatry-scope-of-practice/ or email pr@podiatry.asn.au for a copy of the PowerPoint presentation. You can find a member podiatrist in your area at this link http://www.podiatry.asn. au/public-health-information/ find-a-podiatrist-near-you/
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Tweed Practice Managers focus on eHealth The Tweed branch of NCML hosted a networking and information event for practice managers in late January, focusing on eHealth. NCML’s Senior Project Officer – eHealth, Shelly Fletcher gave a presentation on what general practice needed to do to sign up for eHealth incentives and other important information related to the topic and also took questions. Organised by Practice and Liaison team member Vicki McGowan (Vicki now works as a mental health program officer), said it was well attended, despite being held when floods were occurring along the North Coast. Vicki said in the past regular Practice Manager events were staged at the Tweed branch office and proved popular. There are plans to hold more such func-
Listen out for Lung Cancer Campaign Lung cancer is the leading cause of cancer-related deaths in Australia. High mortality is associated with late diagnosis and recent work by the State’s peak cancer control agency, the Cancer Institute NSW, has shown significant variation in the diagnosis and treatment of lung cancer across the State. In response, Cancer Institute NSW has established a lung cancer program which aims to increase early detection of lung cancer and contribute to better cancer outcomes. As part of this program, the Institute has developed a public education campaign. It is well known that some patients are asymptomatic in the early stages of lung cancer and others present with symptoms relating to the primary tumour. This campaign aims to increase awareness in the community of key symptoms consistent with lung cancer,
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Tweed NCML staff after a celebratory cake morning tea to mark NCML’s work in supporting general practice to sign up to eHealth. Top from left: Tony Seto and Wendy Pannach, Front: Vicki McGowan, Ros Mulcahy and Lisa World.
tions this year. General Manager Gary Southey and Program Manager Wendy Pannach also came along
to introduce themselves to the Practice Managers and welcome them to the New Year.
Vaccine Scheduler app Vaccination Scheduler is a simple iphone app that sends reminders to parents about when their children’s vaccinations are due. With vaccinations now tied to childcare benefits, the app is a helpful device to ensure parents adhere to vaccination schedules. The app also tracks the vaccination history of up to six children and can email a PDF report directly from the mobile phone. Pre-Installed with all vaccination information, all that is required is to enter the child’s name and date of birth. Visit www.vaccinationscheduler.com. https://itunes.apple.com/ app/vaccination-scheduler/ id563213898?mt=8
Talking about mental illness cancerinstitute.org.au
and encourage people to see their GP if they experience any of these symptoms. The campaign centres around three key symptoms that may be consistent with lung cancer, these are Persistent cough Change in cough Coughing up blood The multi-media campaign will run between March and April 2013. For further info: www.cancerinstitute.org.au. In addition, Cancer Australia has released GP guidelines on investigating symptoms of lung cancer. To order hard copies or to download a PDF version of Investigating symptoms of lung cancer: a guide for GPs, please visit: www.canceraustralia.gov. au/publications-resources/ cancer-australia-publications/ investigating-symptoms-lungcancer-guide-gps.
A new DVD for parents with mental illness will help them to be open and talk about their mental health issues with their children. Launching the DVD, The Minister for Mental Health and Ageing Mark Butler said over a million Australian children live in a household where at least one parent has a mental illness and this was a significant indicator that a child may grow up with their own mental health challenges. “We know that these children are at greater risk of developing a mental health or substance abuse issue and we’re encouraging parents to be open and talk about their mental health issue with their children and the DVD is designed to help start the conversation,” he said.
Mr Butler said many parents found it tough to talk about their experience of depression and anxiety with their children, yet talking about the problem helped the whole family to manage together. Funded by the Australian Government, the DVD, called Family Focus, was developed in collaboration with Australian psychiatrists, psychologists, mental health nurses, occupational therapists, social workers, researchers and Australian parents and children with lived experience of parental depression/anxiety. Mr Butler said it was the first time the Australian Government had provided such a resource. The DVD is available for free from the Family Focus website at: http://www.copmi.net.au/familyfocusdvd HealthSpeak
autumn 2013
Port headspace rocks open When the manager of the new headspace in Port Macquarie, David Allan, entrusted the organising of the centre’s launch to his young staff and youth, he knew it would be a fun event. On February 22, the Port Macquarie headspace officially opened in real rock ‘n’ roll style with local rock legend and Grinspoon front man, Phil Jamieson attending off the back of January’s Rock N Ride tour, a motorcycle journey between the Gold Coast and Adelaide Big Day Out’s to raise awareness of headspace. “After visiting half a dozen headspace centres and seeing the incredible work being done to improve young people’s lives, we really wanted to continue the journey with headspace,” said Phil. Fellow Rock N Riders Adam Zammit (CEO of Big Day Out), Paul Mac (DJ/music producer) and Chris Joannu (Silverchair bass player) also rode from Sydney to be part of the event. The new headspace was officially opened by the Minister for Mental Health Mark Butler. The centre is a consortium of services led by each Social and Community Health. Other consortium members include: North Coast Medicare Local Drug and Alcohol Ser-
Federal Mental Health Minister Mark Butler with Bob BossWalker, Acting General Manager of NCML’s Hastings Macleay branch office at the headspace opening.
Grinspoon frontman Phil Jamieson (centre) with some of the youth of Port Macquarie who celebrated the headspace opening.
vice (Port Macquarie/ Kempsey) Mid North Coast Local Health District. Mental Health Service Mid North Coast Local Health District Enterprise & Training Company Limited (ETC) Port Macquarie-Hastings Shire Council The Independent Chair of headspace is well known local identity Mort Shearer. Headspace CEO Chris Tanti said that the centre in Port Macquarie would be a tremendous asset to the Hastings region.
“Headspace centres around the country have already helped more than 85,000 young people going through a tough time. This new centre in Port Macquarie will provide someone else to talk to for young people who are struggling with things like, depression, anxiety, bullying, and relationship problems,” he said. Headspace Port Macquarie will offer youth-friendly services for people aged between 12 and 25, including mental health support and counselling; general health and sexual health services; education, employment and other social and vocational services; alcohol and other drug services. Mr Tanti said the decision to
locate a headspace centre in Port Macquarie was based on range of factors including, community need, population size and growth and will service more than 13,000 young people in the Port Macquarie area. Manager David Allan will be in charge of the day-to-day operations of the service. “Headspace Port Macquarie is aiming to become a focal point for young people in the Hastings area, having built its reputation as a service that has ‘no wrong door’ for the kinds of unmet needs that are present for young people in this community,” he said. Port Macquarie’s headspace is part of the $78 million funding package for headspace that will see a total of 15 new centres in operation in 2013. For more information about headspace Port Macquarie visit: http://www. headspace.org.au/headspace-centres/headspace-port-macquarie
More generalists needed The AMA has released a Position Statement on Fostering Generalism in the Medical Workforce, responding to the trend of fewer medical graduates choosing a generalist career path. The term ‘generalist medical practitioner’ refers to GPs, rural generalists and general specialists who retain a broad scope of practice. The statement recommends better training programs and career pathways, and greater recognition and support for the important work provided
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autumn 2013
by generalists across the health system. AMA president Dr Steve Hambelton said the allure of generalist medical practice was in decline. “The number of medical graduates choosing a generalist career path has decreased significantly, which means patients in some areas may not be getting the best access to the type of care they need when they need it. We need to rebuild our generalist workforce. “This requires a renewed focus on training programs, and
solid research and planning to meet generalist career requirements and ensure proper distribution of generalists to where they are most needed around the country,” Dr Hambleton said. The Position Statement, which sets out actions to arrest the trend towards subspecialisation and the decline of generalists in public and private practice, recommends: Clearly defined training programs and pathways for GPs
Greater recognition and support for generalist practitioners More comparable remuneration for generalist medical practitioners Further work to quantify and predict generalist workforce requirements and distribution as a matter of urgency. Health Workforce Australia will be focusing on how to train more generalists in 2013.
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Beating up on nanny Government actions to promote better lifestyle practices are being attacked as unwelcome interventions by a ‘nanny state’, as Robin Osborne discusses. Russian leaders have been called many things, but never the promoters of a nanny state… until now. As the New Year dawned, Russians awoke to news that beer was to declared an alcoholic drink (previously it had been a “foodstuff ”) and would not be sold at street outlets, nor between 11pm and 8am. The restrictions are an attempt to address a “national calamity” deriving from the average adult consumption of the equivalent of 18 litres of pure alcohol a year. (Australia’s highest consumption, 14 litresplus, twice the national average, takes place in the NT). The backlash included the liquor industry’s claim that, “Stocking beer is more problematic than stocking vodka. It’s bulky, there’s no room for it in small homes. It’s much easier to buy two bottles of vodka.” Does this remind you of anything? For example, the howls of outrage from the tobacco industry when Canberra mooted the plain-pack tobacco legislation? At the time we were told that smokers would be “confused” about the lack of branding – while still being offended by the gruesome photo images – and retailers would need to spend money redesigning shelves and engaging extra staff because of the difficulty of locating requested brands. The media, especially the popular end, weighed in with reports on how plain packaged cigarettes would make no difference to smokers’ habits. Readers were told the whole thing was a waste of time, a futile attempt to reduce smoking – a personal responsibility – by government fiat. Typical of the encroaching “nanny state”. Since then, the cries of “nanny statism” have risen, fuelled 26
by the tobacco industry’s overt campaign - see www.nonannystate.com.au - and a number of legislative moves at both federal and state level. NSW is greatly extending smoking bans, SA is to restrict two-for-one drinks at Ladies Nights, and limit access to noteto-coin dispensing machines at gaming venues, and Victoria will ban tanning salons by year’s end. Then there’s the federal Government’s Human Rights and Anti-Discrimination Bill aimed at outlawing comment that insults people’s religion, social origin, nationality and political opinions. The charge against these “nanny state” moves has been led by certain arms of the media, notably The Australian, and the political right, for instance Katter’s Australian Party - http:// www.ausparty.org.au/issues/endto-nanny-state.html KAP opines that, “Laws exist constantly telling us where we can and can't go, what we can and can't do and when we can and can't do it… [this is not] the 'free country' we like to claim, but… an overly controlling nanny state that treats us like children.” The Australian’s “nanny state” fixation finds its way into the paper’s editorials (“Bit by bit, the state is assuming the position of moral guardian…”), and its op-ed columns: “Nanny Roxon won’t let you spit the dummy,” Janet Albrechtsen fumed. A cynical Nick Cater wrote, “If smoking was really costing the nation $31.5 billion a year, and that wasn’t just a cooked-up figure, then a responsible government would have no hesitation in banning tobacco”. A director of the Institute of Public Affairs, Tim Wilson, suggested that, “similarly spectacular calculations have been made that purport to show that the social costs of alcohol consumption are about $15 billion a year.” Over at the SMH, columnist Paul Sheehan, wrote of the “cul-
tural and creative asphyxiation of red tape, the accumulating intrusions by a society increasingly obsessed with regulation.” Previously quiet on the subject – perhaps thinking that by year’s end they may wish to do some nannying of their own – the Opposition’s leadership has now joined the fray. Preventive health spokesman Dr Andrew Southcoot said: “The Opposition’s first response is always to encourage personal responsibility. We prefer voluntary codes of conduct over more nanny state regulation.” Whilst it may be tempting to accept The Australian’s view that, “it is impossible to legislate for common sense,” the uncomfortable reality is that many people do not behave in a sensible way. Smoking is not sensible, but the rates have dropped largely because of government actions, and the plain pack move is the envy of the sensible world. As it is impossible for any single country to ban tobacco sales, then restrictions should be put and kept in place, and social marketing campaigns maintained. The same applies to unhealthy foods, given the rising rates of obesity, although it may be hard to argue that the words ‘double cheeseburger with fries’ could be substituted in the slogan, “Every cigarette is killing you”. As with the mandating of seatbelt use and road speed limits, establishing injecting rooms and needle exchange programs, the Grim Reaper and Drink-Drive campaigns, and more, the “nanny state”, or its state/territory equivalents, may continue to be needed for the public good. If we weren’t so sceptical of government actions, however well-intentioned, perhaps we might embrace the sentiments of the two harried mothers depicted in a recent New Yorker cartoon, pushing their twins in strollers through Central Park. As one remarks, “Personally, I wouldn’t have a problem with a nanny state.”
Cries of nanny state have risen, fuelled by the tobacco industry’s campaign.
HealthSpeak
autumn 2013
Band-aids or plaster cast? You can almost feel it: that warm glow of optimism that has permeated financial markets since December. The change was swift and caught many analysts by surprise. From gloom and doom in November, the mood changed dramatically in December and continued to develop into a happier and more positive outlook as 2013 began to unfold. The fund managers have taken up the call, the stockbrokers are talking the markets up and even normally party-killing economists are saying the worst is over. The hedge funds and market vultures have retreated, bruised by the overwhelming firepower of the printing presses. No-one wants to take on the Central Banks. The Central Banks say there is no crisis any longer and maybe they have actually pulled it off. Trillions of dollars and their equivalent in Euros and Yen have been pushed into the markets as the world’s printing presses worked overtime. We have never seen anything like it. While it will undoubtedly cause the rewriting of the economic textbooks, what the ultimate judgment of history will be remains to be seen. The underlying problems still exist. Europe remains in severe recession, unemployment is rising and government debt in continues to rise. Countries such as Greece can still borrow money even though there is no prospect of it ever being repaid. The US economy is staggering along and Government debt boggles the imagination as the budget deficit continues to top $US1 trillion a year. Japan is having another attempt to stimulate itself out of a quarter of a century of stagnation. So why has all this optimism emerged? Some analysts see the situation manufactured by the Central Banks as a band-aid solution at the best. They are holding the world economy together for now simply by weight of money, but this, they say, is unsustainable - there are too many imbalances for the world to hold together
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autumn 2013
It could be a hard landing in China, the 2nd largest economy. indefinitely. Something is likely to happen at some time that will see another crisis, a return to pessimism and recession. What would cause this to happen? It could be a hard landing in China, now the world’s second largest economy. It could be a sharp hike in the world oil price if some sort of war erupts involving Iran. It could be the failure of a major bank in Europe or it could be a return to recession in the US. A recession in the US could be triggered if the US Government acts too quickly to rein in the budget deficit and reduce debt. The optimists however (in the majority at present) see the workings of the Central Banks as more than just a band-aid solution. They see it more as a plaster cast on a broken limb that simply needs time to mend. If the Central Banks can hold the world economy together for long enough, growth will re-emerge and the economy will start to heal itself. Income will rise, confidence will grow and government debt will fall. One of the key differences between the two groups relates to leverage. Since 2008 most of the developed world, apart from governments, has been deleveraging after decades of high borrowings. In other words, consumers and businesses have been reducing debt and trying to save. The financial industry too has been repairing its balance sheet. In Australia, even though we escaped the worst of the crisis, consumers have been saving around 10 per cent of their incomes, causing a slowdown in the Australian economy. A decade ago we were
Economy
David Tomlinson
spending more than we earned and borrowing the difference. The pessimists see this deleveraging as continuing for another few years. Some say another five or six years at least. They believe that lower interest rates will not encourage people to borrow and spend but force people to actually save more to compensate for lower interest income. The optimists however see this deleveraging as coming to an end. In the US and Australia they are expecting consumers to spend up once again. They may even start to borrow in greater numbers to buy new homes and other consumer items. They point to rising house prices as evidence of this – both here and in the US. This higher spending will flow into more jobs, higher incomes, less government debt and higher company profits. And this will justify the higher prices now being seen on world share markets. They say while share markets do look a little expensive at present this is because the brokers and others have not factored in the big jump in company profits that is likely to occur. So it seems we are at a turning point. Which way will it go? This writer has been around for too long to try to predict what will happen. However if you are venturing out in the world with investment intentions it would be best to do so cautiously. Be ready for a quick retreat.
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New drugs available to increase Hep C cure rates By Nikki Keefe Clinical Nurse Specialist Lismore Liver Clinic Although Hepatitis C is one of the chronic viral infections we have treatment for which often leads to a cure, only about 2% of those who carry it are treated in Australia. It is estimated that 297,000 Australians are known to be infected with the Hep C virus, and it is four times more prevalent in the Indigenous community than the non Indigenous community. National and state data also shows that NNSW and MNC LHDs have higher than average rates of Hep C compared to other NSW LHDs.. The Lismore Liver Clinic is a free, multidisciplinary service that provides assessment, management and treatment to people with Chronic Hepatitis C (CHC). We are not funded to provide a service for people with alcohol-related liver disease, nor can we provide ongoing cirrhotic management for clients not on treatment. All these clients require GP follow up and
referral to local gastroenterologists. Until recently, the standard therapy for CHC has been combination therapy with pegylated interferon and ribavirin, with treatment spanning 24 to 48 weeks, depending on genotype and response. The exciting news is that two new direct acting agents called protease inhibitors - boceprevir (Victrelis) and telaprevir (Incivo) are now available in conjunction with peg interferon and ribavirin for people with genotype 1. (Editor’s Note: Just before HealthSpeak went to print it was announced that these new drugs – boceprevir and telaprevir – are to be listed on the Pharmaceutical Benefits Scheme.) Genotype 1 is more prevalent in Australia and has historically been more difficult to treat than other genotypes. Sustained Virological Response (SVR) rates with standard therapy over 48 weeks have been around 40 to 50 %, however with the these new medications SVR rates of up to 70% are now seen with the potential of a shorter treatment
regime. This is a great advancement in the treatment of Hep C and the future is looking brighter still with newer treatments promised in the next three to five years with fewer side effects and higher SVR rates. While the main treating centre is at 3/29 Molesworth St Lismore, we provide weekly outreach services to Byron Bay and monthly outreach services to Casino, Tweed Heads and Maclean. All appointments and referrals can be made through the Lismore office on 6620 7539 or fax 6620 7661. We encourage GPs to refer any clients with a detected HCV PCR to the clinic for assessment and review. Initial referrals to the service are generally through GPs but a referral is always required prior to seeing the specialist as these appointments are bulk billed. We appreciate the completion of appropriate tests prior to referral. These are available on request. Please do not hesitate to contact one of the clinicians if you require further information or advice on 6620 7539.
Best Practice Care for Transgender Care Five Simple Things You Can Do To Provide Best Practice Care for Transgender Clients By Edda Lampis 1. Respect the choice of gender identity of your client- use client directed language. 2. Change your service forms and records to fit with the client’s gender identity. 3. Use your client’s chosen name rather than their birth name. 4. Inform yourself about transgender issues and the difficulties faced by gender diverse people in health care settings. 5. Train front line staff in awareness of gender diversity.
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TRANSGENDER, GENDER diverse and gender questioning people need access to a range of services across their lifespan. Studies show that a practitioner’s lack of knowledge about transgender issues and perceived and real discrimination of those with transgender identities can create significant access barriers to health services and correlate with poorer health outcomes. General practitioners can play a crucial role in providing and coordinating medical care and ongoing support and counselling for transgender people.
With a growing transgender population on the North Coast, it is important that general practitioners are informed and resourced to effectively service their transgender and gender diverse service users. “If doctors were informed, the families would have coped a lot better in the early stages of coming to terms with the initial diagnosis of Gender Dysphoria” (Gender Centres Parents Support Group). ACON Northern Rivers, in collaboration with The Gender Centre, is holding a workshop which will explore a wide range of issues relevant to general practitioners servicing transgender clients. The workshop will
cover current theories of gender identity development, medical transitioning, ageing and models of best practice care. The workshop is aimed specifically at health and allied health professionals and will be held for a full day in Lismore on 12 and again on 13 June 2013. Places are limited. For more information or to reserve a place call Edda Lampis at ACON Northern Rivers on 02 6622 1555. For referral, support or information for a transgendered or gender diverse client contact ACON Northern Rivers 02 6622 1555 or The Gender Centre on 02 9569 2366. Edda Lampis is Community Health Promotion Officer at ACON Northern Rivers
HealthSpeak
autumn 2013
Medical myths
Walking my daughter’s old dogs on a leash free area at Brunswick Heads, my reverie was shaken by the wail of a woman nearby. These dogs are usually well behaved and friendly in public, so I was surprised to see the younger one called Zoe intently sniffing the woman’s leg. Strangely, the lady showed no intention of backing away, but just seemed mesmerised, a strange fear etched on her face. I walked over to reassure her about the dog and to whistle it back to me. “Oh no” she said, “if a strange dog sniffs a person, it can smell cancer. I must have cancer”. I felt I had to reassure her. I told her that as a doctor living among an alternative community, I had heard of just about every mumbo-jumbo, but never this dog smelling cancer thing. Unconvinced, she announced: “That’s how my aunt discovered her cancer. Its very well known”. I couldn’t leave it at that, and with our feet still in swirling seawater, I gave her some gratuitous medical advice - that if she believed in this myth so strongly, it might be a good idea to see her doctor and to request a full body CAT scan, which might detect asymptomatic cancers. When I saw my daughter Leah to hand over the dogs, and told her of the incident, she said that “maybe Zoe did her a favour and saved her life. She’s had a DOGSCAN Dad and now you are sending her for a CATSCAN.” Dogs are very controversial in their health relationships with people. Some people think that letting a dog lick a wound helps it to HealthSpeak
autumn 2013
Light Airs
heal, but when a casualty doctor sees a patient with a dog bite, infection is always an issue. A granddaughter loves animals, but even a bit of dog hair around any house she visits is enough to trigger a severe allergic reaction. Dogs aside, folklore comes from a time long before Medicare. My mother told me when she was a girl in 1930 with her large working class family in Balmain: “The worst thing any of us could do was to get sick or injured and need a doctor”. Her father treated his bad back with a hot iron over brown paper. A lot of contemporary health myth concerns what is taken by way of food and supplements. Is there any limit to the amount of products with glowing testimonials? As all doctors know, some patients spend a fortune on charlatans, and even run into trouble with inappropriate combinations and prescription medicines. The incompatibility of St Johns Wort with antidepressants is a wellknown example. Modern vitamin pills and tonics are purchased in great quantities. Detractors say it’s rubbish and the result is just yellow urine, but among the alternative medicines are there any that might be useful? On the other hand, great claims were made for now extinct preparations, which could be very harmful, such as BEX and APC powders. ‘Bex is Better’. One very old preparation has survived in a different identity. Angostura Bitters, popular as
‘lemon lime and bitters’ in the pub, was initially launched in 1824 as a herbal tonic for gastro intestinal disorders, because it contained Gentian in 44.7% alcohol. The familiar oversized label is a fascinating read. As a herbal medicine it has impeccable credentials - by appointment to Her Majesty the Queen. That fits. The Royal Family is well known for its predilection towards alternative medicines and homeopathics. From the kitchen, some herbs and spices are commonly recognised as beneficial to health. Turmeric, which is in lots of Indian dishes, is said to be good for brain, sinew and heart. All very old-fashioned, but for those who believe, is there harm in open-mindedness to the fears and beliefs of patients? Cinnamon is said to help blood pressure and the list goes on. Where problems can arise is when a patient decides to stop the prescribed Ramipril in the quest for a natural cure without talking to the doctor. It happens. The quest for balance between ‘Western’ and alternatives, still in search of a name - ‘complementary’ or ‘holistic’ is still an uneasy truce. There is so much on offer and whether something is evidence-based seems to be a movable feast and about who controls the evidence. Can we do better than follow the advice Dr Hippocrates gave so long ago? ‘First, do no harm.’ Still, it’s hard not to wonder how the lady at the beach got on with her CAT scan. Enquiries: theshipsdoctor@gmail. com
David Miller
Her father treated his bad back with a hot iron over brown paper.
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NCML welcomes registrars
The Port Macquarie NCML staff who organised the dinner . Left to right: Shirley Rawnsley, Paula Hicks, Libby Mackintosh-Sallawa, Bob Boss-Walker, Aacting General Manager, and Christine Cox.
In late January, North Coast Medicare Local staff in Port Macquarie organised a dinner for new medical registrars. Sponsored by North Coast GP training, these dinners have been held twice a year for some years to welcome young doctors in training to the region. Currently there are 18 North Coast GP Training registrars in the Hastings
Briefs
More organs donated There was a steady increase in Australian organ donation during 2012, resulting in more lives being saved through transplantation. During 2012, the generosity of 354 organ donors and their families who agreed to donation gave 1,052 Australians a second chance at life. The 2012 figures were 5% higher than in 2011, while the national donation rate increased to 15.6 donors per million population - an increase of 38 per cent in the national donation rate since 2009, when the Federal Government established the Organ and Tissue Authority.
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Macleay region, working in practices in Port Macquarie, North Haven, Laurieton and Kempsey. It’s a great opportunity for the registrars to mix with their peers and meet NCML staff. They are also provided with updated GP lists, specialist practice lists and information about NCML staff and their projects.
Pregnancy, birth and baby website
The Australian government’s Pregnancy, Birth and Baby helpline has launched a website (www.pregnancybirthbaby.org.au) to provide expert online help and support for women, partners and families. CEO of Healthdirect Australia, Colin Seery, said first-time mothers were increasingly using the internet as a principal research tool for health and wellbeing information. “This broadening of the national Pregnancy, Birth and Baby Service ensures that it caters to an audience more comfortable with searching for information on the internet, as well as those
CMs need explanation
Alzheimer’s: supplement trial
The Pharmacy Board of Australia is urging pharmacists to consider the complementary medicine (CM) products they stock and exclude those with absurd claims. Writing in the Consumers’ Health Forum’s HealthVoices newsletter, Board Chair Stephen Marty urged pharmacists to encourage consumers to seek advice when buying CMs. “The public would also benefit if there were a sign near the shelves where CMs are stored informing them of the deficiency of the AUST R (register) regime together with an invitation to ask for advice. “It is therefore incumbent on pharmacists and other health professionals to act as gatekeepers, especially in regard to claims for efficacy,” he said.
A WORLD-first clinical trial in WA will combine testosterone and fish oil to try to prevent or delay Alzheimer’s disease. About 400 men over the age of 60 are needed for the trial, which will investigate the effects of the combined supplementation on people with memory problems, but who have not been diagnosed with dementia. Led by Professor Ralph Martins from McCusker Alzheimer’s Research Foundation, participants would be asked to make contact with the research centre every 10 to 12 weeks for an injection. He said the new treatment was aimed at getting in early before any primary damage to brain cells.
seeking the personal touch of a phone call,” said Mr Seery. The Pregnancy, Birth and Baby website holds 130 pages of content from trusted and approved partners. This content has been reviewed and endorsed by clinicians from Healthdirect Australia’s clinical governance unit. Women and their families facing other challenges, such as emotional distress, perinatal issues, and questions about pregnancy options, can call the helpline on 1800 882 436. Qualified counsellors are available from 7am to 12pm midnight daily, free of charge.
MedicineWise launched
NPS MedicineWise recently launched its new program,” Achieving Good Anticoagulant Practice”. This program will provide clarity about the newer oral anticoagulants and their place in therapy. It will provide tips for optimising warfarin management and discuss the recommended monitoring for all patients taking oral anticoagulants - newer agents included. The North Coast Medicare Local NPS facilitators will be delivering this NPS program from February- March onwards. Watch out for upcoming invitations to participate in one-onone visits or small group discussions, arriving via fax or email. If you would like more information please contact your local NCML. HealthSpeak
autumn 2013
Books with Robin Robin Osborne
Swallow Mary Cappello The New Press – $29.00 Chevalier Jackson (1865-1958), “the man with a first name that sounds like a last name, and vice versa”, whose middle initial ‘Q’ stood for Quixote, is the star performer of this extraordinary book, subtitled Foreign Bodies, their Ingestion, Inspiration, and the Curious Doctor who extracted them. The Post-It flag is a vital tool in book reviewing, enabling a quick return to usable quotes, but during my reading of this relatively short (262 pp) paperback the orange stickers began sprouting like weeds in a North Coast rainy season. Where to start? As we’ve covered the odd name of the “sensitive, bullied boy who grew up to be the father of endoscopy,” let’s enjoy some of the author’s words. “The Great Chevalier”. So he was hailed by reporters, an appellation that might lead us to place him alongside the Bearded Lady, the World’s Tallest Man, and the Tocci Brothers [dicephalic conjoined twins exhibited at fairs in the 19th century]. “In the course of his lifetime, newspaper accounts called him a ‘saint’, a ‘wizard’, a ‘magician’, and a ‘modern miracle man’… He found such forms of reference to himself ‘nauseating’,” notes Cappello, a Guggenheim Fellow and University of Rhode Island scholar. When a three year-old Australian boy was taken to the US in 1936 to have a nail removed from his lung with the aid of a bronchoscope, the Philadelphia Bulletin asked, rhetorically, why there weren’t more such instruments in the world to help children.
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It answered that there were thousands, and nearly 2,000 physicians trained personally by Dr Jackson in their use, before concluding, “And there’s Chevalier Jackson.” The author sees the “fabulous specimens” in the Mutter Museum’s Foreign Body Collection of swallowed objects extracted by Dr Jackson and his colleagues as treading “a fine line between the didactic and the entertaining, the spectacular and the edifying, the odd and the commonplace, the freakish and the pathological, the circus and the medical amphitheatre.” They include double-pointed staples, plenty of pins, needles and nails, the brass foot of an alarm clock, a half dollar dated 1892, one toy wristwatch and one real wristwatch, the metallic letter Z from a toy airplane, tiny binoculars (shown in one of the x-ray photos), a poker chip and
A lifelong ascetic who regarded alcohol as a ‘diluted poison’, he ate like a bird. much more. “Each object found its unhappy place in a person’s trachea, larynx, bronchus, esophagus, stomach, pleural cavity, lung tissue, pharynx, or tonsil. No region of the aerodigestive tract was beyond this doctor’s ingeniously delicate reach.” A lifelong ascetic who regarded alcohol as a ‘diluted poison’, he ate like a bird (favouring ‘postage stamp’ sandwiches of paper-thin bread with a single lettuce leaf) and in 1937, insisting that everyone ate too fast, urged the American public to “Chew your milk!” He was also a noted aesthete, painting and drawing superbly, as the illustrations in the book
show. But it was his inventiveness that reigned supreme. At the age of 12, Jackson devised a multi-barbed harpoon for retrieving tools lost in an oil well run by his father. It worked a treat, later becoming a standard implement for the fishing industry, although never leading to a patent or any income. “The retrieval of a cork caught inside one of his mother’s oliveoil bottles counts as Jackson’s second foreign-body prototype – to everyone’s amazement he fished out the cork in a few minutes with a wire loop.” Later, he progressed to unclogging a gas-driven light and water system in the family’s hotel, working in the dark at the end of a rope lowered into the bowels of the system. All this prepared him for developing what the author calls “his famous bronchoscopes”, which featured handmade battery-charged lamps the size of a grain of wheat mounted at the end of an exceedingly thin rod that was slipped inside the scope. “Sleekly penetrating and perfectly luminous, it’s no wonder that Jackson named one of his scopes ‘the velvet eye’,” she writes. From sideshow sword swallowers to the scenes in Jackson’s “operating rooms” - even though his procedures involved no cutting and thus were not operations in the true sense - to the fantastic array of objects swallowed by accident or intention, and subsequently retrieved, this is a remarkable profile of a unique practitioner. “In the person of Chevalier Jackson the physician and the instrument maker came together…An artist whose instruments are practical devices and works of art.” This book does great justice to both the man and his lifesaving legacy. HealthSpeak contributor Robin Osborne is media and communications adviser, formerly with NT Health and NSW North Coast Health.
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Making yourself heard The Shed Online – a
There are more than 400,000 Australians with severe hearing impairments, and as the population ages this number will only increase. As people lose their hearing they often rely on others to make phone calls for them – losing privacy, independence and control over what is said. They may start to lose contact with friends and family and feel isolated. It could be hard for them to get help in an emergency. The National Relay Service is an Australia-wide phone relay service that can help people with hearing or speech impairments have good phone conversations with less misunderstanding and repetition. They can get things
done, such as making appointments and business calls and keep in touch with friends and family. The service uses specially trained relay officers who act as a bridge between callers. For people with hearing loss, the relay officer types the words of the other person in the call. The person with hearing loss then reads the words on the screen of a special phone called a TTY, or, in the case of an internet relay call, on a computer screen. All calls via the NRS are confidential and cost about the same as a local call. TTYs can usually be rented for the same cost as an ordinary phone. Training is free. This three-minute video http://www.relayservice.com.au/ resources/what-is-a-relay-call/ shows how relay calls work and how they help those with severe hearing or speech impairments retain their independence and quality of life. Contact the NRS Helpdesk on 1800 555 660 or email: helpdesk@relayservice.com.au to obtain free brochures, posters or videos. Or visit the website www.relayservice.com.au.
Dose Aid sachets safer and better labelled In the last issue of HealthSpeak there was an article on APHS Packaging winning a Medicine Wise award for the detailed labelling of its sachet-style Dose Administration Aid. To clarify, the award was given in the Excellence in Labelling and Packaging category. The sachets were praised for being one of the most comprehensively labelled medication aids available. This was deemed to make the product safer and APHS Packaging are considered to be an advocate of medication literacy in the community. The APHS sachets come ready packed, rolled up in chronological date and time order to ensure the right medications are taken at the
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right time. Each sachet is the size of a tea bag and has an easy to tear perforated edge which makes it more convenient and transportable than bulky medication boxes. All the details needed are on each sachet – the drug name, the generic name and a medication description with room for a customer to have up to eight medication times per day, in comparison to other DAA systems which have only four. To get a community pharmacy customer set up with the sachets, a customer or carer needs to call APHS and provide a signed medication chart from their GP and APHS will do the rest. For more information, call Joan France at APHS on 6624 0600.
handy place to meet
The Shed Online is just like a Men’s Shed but one that can be accessed at home from a keyboard at any time of the day or night. Men can socialise, share skills, start a new DIY project and it’s all free. The Shed Online was founded by beyondblue, the national depression initiative, the Movember Foundation and the Australian Men’s Shed Association. It aims to recreate the
atmosphere of ‘real life’ Men’s Sheds – a safe place where men can feel confident to discuss and exchange information. The Shed Online can foster a sense of community and build men’s social networks. As well as being a place to interact, the Shed Online also provides men with information on health and well-being. Take a look at the Shed Online. It’s at: www.theshedonline.org.au
Supporting smoking cessation The Royal Australian College of General Practice (RACGP) has developed a onepage treatment algorithm to assist GPs and other health professionals help their patients quit smoking. Professor Nicholas Zwar, lead author of the guidelines and RACGP spokesman, said it was hoped the algorithm would simplify dealing with a patient wanting to quit smoking. “Health practitioners are fortunately now exposed to a wide range of treatment options when it comes to assisting their patients quit smoking. However, often identifying the most appropriate treatment option, or combination of, can be somewhat of a challenge,” Professor Zwar said. “The newly developed one-page treatment algorithm, narrows down suitable treatment options taking into account nicotine dependency and whether the patient is willing to use pharmacotherapy or not.
“The flip side of the treatment algorithm has clear pharmacotherapy advice for more challenging treatment groups, for example, mental health patients, and pregnant women who are smokers, amongst others.” Health professionals can now refer to a clearly labelled table listing three commonly prescribed smoking cessation medications (Varenicline, Bupropion and nicotine replacement therapy), viewing indications and contraindications when prescribing for special population groups,” Professor Zwar added. A 2008 Cochrane Review on smoking cessation stated that all health professionals should systematically identify smokers, assess their smoking status and offer them advice and cessation treatment at every opportunity. To order complementary copies of Supporting smoking cessation, call 1800 331 626 or email your details to publications@racgp. org.au HealthSpeak
autumn 2013
Wine and good health Chris Ingall
How sweet it is Around the world for two decades our wine was described as ‘sunshine in a bottle’ and was the go-to drink for oenophiles on many continents. They loved the voluptuous flavours, the bold structure and the value for money. French wine, more closed and austere, took a back seat, especially in England where sunshine is in short supply. The sweetness of our wines, both red and white, was irresistible, which is perhaps understandable given our human condition, which seeks out sweetness for succour. Babies undergoing a painful procedure can endure more pain with sucrose on their dummy, and we all go to carbs for our comfort fix. My personal weakness is for chocolate, its calming sweetness a balm for the vicissitudes of life. Ah!! (But I digress) You are all well aware of the miracle of photosynthesis dear reader, and its ability to transform carbon dioxide and water into glucose and oxygen. Grapes benefit from this, as the sugar is stored in the juice, waiting for its next transformation into alcohol. Our sunshine makes for high levels of sugar in wonderfully ripe grapes most years, and by the time the alcohol has killed the yeast at the end of ferment there are molecules of glucose and fructose still about. Simple sugars make for fairly narrow bands of sweetness, monodimensional and unexciting, and even sucrose is a bit boring. It is the complex orchestra of all the sugars, amines and of course alcohol (ethanol) itself which together offer a more interesting sweetness, and this is offset by the tannins and acids which come from the skin of the grape and any wood which may have been added in the winery. This HealthSpeak
autumn 2013
description of how we perceive a wine was best articulated by Emile Peynaud, in his lovely and scholarly read The Taste of Wine, worth a look. But (shock, horror!) not everyone likes this delicate balance, having what is called a sweet tooth. These people, who are otherwise quite normal, drink [Yellow Tail] instead, and love the shift to sweetness achieved by decreasing the amount of acid and tannin in the wine. It is a craftily made fermented grape juice to my palate, and one which has won over the American public in spades. Similarly, my daughters like rosé because it lacks tannins and acid, which they perceive as sweetness. Limiting the time grape juice spends on its skins produces such a wine, the blush of colour suggesting its (relative) viginity. Our love affair with sweetness is nothing new. In Virgil’s Rome, must in lead containers was heated to create sapa, which was added to wine. This brew was popular due to its sweet
The wine should be sweeter than the dessert, and always enjoy chocolate with port. taste, but produced the predictable symptoms of lead poisoning, chiefly (painter’s) colic and delirium. Luckily we now know it is not only lead in bullets which is fatal, but nevertheless winemakers still try their hand at making wine more attractive by sweetening it up. Stopping the ferment creates many a sweet Alsatian riesling, and you can tell how sweet it is by looking at the alcohol level of the wine, some of these delicious wines showing
just 8 or 9 percent alcohol on bottling. Locally, our vignerons are trying their hands at off-dry rieslings, which are not yet as classy. Sometimes it occurs naturally, as in Sauternes, where the botrytis fungus punches holes in the grape skins and allows water out, ‘raisining’ the grape and driving sugar levels higher. The resultant ferment sees the yeast die with a reasonable alcohol level and lots of residual sugar, a good wine with cheese or dessert. Grapes left to wither on the vine will similarly produce a sweeter wine, and stopping the ferment with brandy (wine) spirit will create ports, muscats and tokays, depending on the grapes used. Such wines exhibit ‘legs’ down the side of the glass when swirled around, due to the mix of alcohol and sugars producing high viscosity. Only you will know your palate, dear reader, and I hope I have given you a sufficient mud map to find your way around sugars in wine. Enjoy!
Wine Tip The rule for wines which have added sweetness is to have them with dessert, and in general the wine should be sweeter than the sweet on offer, otherwise the wine will taste dry and hard. And always chocolate with port!
Cellar Tip Grab some muscats, ports and tokays from any Northeast Victorian producer (think Campbells, Seppelts and Brown Bros) and lay them down. The spirit in them will see them good for a decade or two, and these wines make excellent 21st gifts for your children, less expensive than Grange and to my mind more delicious and predictable. Buy them back from your kids when they hit 30, and drink them alone (slowly).
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Caring for Refugees feature From page 15
A compassionate vision made real In an encouraging move, GP Gillian Gould is going to start treating some of the Afghan women with acupuncture which she hopes might relieve their pain. Michele said Foundation House (similar to STARTTS) in Melbourne has offered alternative therapy work with refugees such as physiotherapy and massage for many years and many new arrivals have found these
From page 15
Specialist trauma service “They are not just dealing with the trauma or torture but also have had to flee their home country and relocate. There is a lot of loss and grief experienced in leaving family members, losing all your qualifications and having to start from scratch without a common language. “So while people are safe in Australia they often have family members who are missing or lost or they’ve seen things which affect their ability to settle in well here, and that’s where we can help.” Tracey said that every refugee’s story is different and that while some arrive with significant symptoms of PTSD, others are remarkably resilient and function well in the community. Some of the manifestations of 34
therapies very helpful. Michele said one of the things that trouble her about attitudes to refugees is the racism she often experiences when community members discover what she does. “An elderly acquaintance of my partner asked me what work I did. As soon as I told her she was going on about ‘bloody refugees, what are they doing in our country?’ And I told her I wanted to end the conversation. I love my job, I do a good job and I find these types of comments ignorant and upsetting.
their traumatic experiences include sleep disorder, nightmares, very poor concentration, difficulty absorbing new information and learning a new language. Denise pointed out that as a new arrival there is a myriad of things to negotiate, a new culture and a new system which can make it very stressful to try to navigate services. “Until you try to work with someone, you don’t realise how complex their situation can be,” Denise added. One of the major issues faced by refugees is when service providers, especially doctors, do not make use of interpreters. “Doctors can get an interpreter, they can do it by phone using a TIS code and it’s simple to do. We use telephone interpreters mostly here because often the local interpreters are related to the client. And I can’t imagine, because of the medico-legal
Unfortunately, it happens quite frequently that I hear these sort of racist comments.” While Michele’s energy and commitment to her patients and their health and wellbeing is obvious, the workload must become burdensome at times. Happily, funding has come through for a second nurse to assist Michele. Patti Condon is now working at the clinic four days a week – a terrific development for both staff and patients. And Michele will be able to do more public health work; talking
to other health professionals about the particular health issues faced by refugees and conducting health information sessions for refugees. “I look forward to once more being able to get up to Prema House in Lismore and talk to the GPs there who work with the settled refugees and to Lismore Base Hospital and to Tweed, Mullumbimby and Byron Bay hospitals to talk about the particular health issues and needs of refugees and the health professional’s duty of care to use qualified health interpreters.”
A woman may have been raped and not want her husband to know.
ment programs,” said Tracy. One of these programs is a twice yearly or annual camp for young refugees from around NSW – 14 to 17 years of age who have recently arrived or are having trouble settling into school. “It’s a four-day camp and gives them the opportunity for fun in their lives. “Most of these kids don’t have general school holiday activities, something other kids take for granted. We go to the Great Aussie Bush Camp at Tea Gardens or to Lake Ainsworth at Lennox Head,” said Tracy. The camp offers a wide range of outward bound activities. Most refugee families are not usually able to enjoy such things in their day to day life, so it’s a great opportunity for the kids to enjoy themselves and socialise with people from their own culture. “With a group of 14 to 17 year old boys and girls there is not much rest. But the camps are great fun and can be very healing,” said Denise. Coffs Harbour STARTTS is also taking on a new part-time employee soon, a youth worker with a focus on sports and arts to broaden what it can offer younger refugees. Many STARTTS resources are available online at PsycheVisual.com, where for a small fee peole are able to access lectures by top clinicians in many fields. Contact STARTTS on 6650 9195 or view the website at: www.startts.org.au
complications, seeing these people and diagnosing their problems without having a common language. “Some use telephone interpreters and not family members or children. That can put kids in the position of being burdened with their parents’ problems. And the same with spouses, the client needs to have autonomy,” Tracy explained. She said that a woman may have been raped and not want her husband to know, and if their child is interpreting they may wish to protect them from knowledge or reminders of their past. Denise also pointed out that when referring refugees to a private counsellor, it was important to enquire about whether that person was able to provide an interpreter in that setting. The Sydney office of STARTTS is also a big help with significant expertise and resources on tap. “They have good clinical resources and people we can refer to. Staff from Sydney also come up to speak to refugees of the same ethnic background and to assist in community develop-
HealthSpeak
autumn 2013
Vacancy for GP VR GP wanted for busy, well-established 12dr family practice + skin clinic. Fully accredited and computerised, mixed billing, rural incentives, FT RN, friendly work atmosphere. No on call required. Please email CV to admin@oceanshoresmedical.com
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 Gabrielle Boyce and Associates 581 Ballina Road, Goonellabah Phone (02) 6625 2888 Open Extended Hours
P/T RN Vacancy in Casino We are an accredited general practice of long standing in Casino with 5 doctors, 3 nurses, 2 allied health professionals, and clerical support staff. We need a P/T RN to start ASAP, working five days a fortnight from 9am to 5.30pm Wednesday toThursday. No weekends or nights. Experience in general practice desirable but not essential.
Enquiries: 6662 1555 or nunbripl@bigpond.net.au
more services · quality facilities
•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
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
GP VACANCY BALLINA Family Medical Centre www.ballinamedical.com.au
Seeking a full-time GP, 8-10sessions, M/F &/ or husband /wife team. Assistant with view to Associateship. Five doctor practice, currently 4 male,1 female. Happy workplace, long term loyal staff, supportive environment .Mixed billing. Modern purpose-built surgery, 5 consulting rooms, 2 bed treatment area and minor theatre. Opportunity to practice all aspects of Family Medicine in relaxed North Coast Lifestyle VMO position at Ballina Hospital optional. Well run, efficient practice. Enquiries pm@ballinamedical.com.au or phone 02 6686 3299
GOONELLABAH MEDICAL CENTRE www.gmc.net.au
GP VACANCY GP full or partime wanted. Large accredited and teaching practice 11 consulting rooms, 2 theatres, 7 bed nursing treatment area. Full nursing support, diabetes educator, psychologists Contact practice manager on 02 6625 0000
A/Prof Geoffrey Boyce Neurologist Practising neurology and neurophysiology in Lismore. Dr Boyce has a full-time neurophysiology technician available to do electroencephalograms with little waiting time. Also nerve conduction studies and electromyography. The practice is Medical Objects friendly and welcomes referrals this way. Phone the practice on 6621 8245 or email: nrneurol.com.au For more information and links to other sub-specialty groups, view the website at: www.nrneurol.com.au
HealthSpeak is the perfect place to let the north coast health community know about your practice, company, rooms for rent or anything at all! With a readership of around 4,000 and a footprint from the Queensland border to just south of Port Macquarie, your message will get out to GPs, allied health practitioners, pharmacists and those working in the health care community. Display advertising is attractively priced. Simply email the editor to get a copy of our rates at: media@ncml.org.au We look forward to hearing from you.
HealthSpeak
autumn 2013
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