HealthSpeak Autumn 2014

ISSUE 7 autumn 2014

HealthSpeak

A publication of North Coast NSW Medicare Local

Coming home

Specialist counselling for veterans page 17

5

Fred’s Place Clinic

9

First aid in communities

16

What is speech pathology?

24

Vascular disease

Partnerships improving health care Vahid Saberi Head Office Suite 6 85 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncml.org.au

Chief Executive Officer

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 Unit 4, 8 Corporation Circuit Tweed Heads South 2486 Ph: (07) 5523 5501 Acting General Manager: Wendy Pannach 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 2014 North Coast NSW Medicare Local Ltd Magazine designed by Graphiti Design Studio Printed by Quality Plus Printers of Ballina

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If asked, many people would not know what Medicare Locals do or stand for. So it’s timely to highlight some of North Coast Medicare Local’s activities.

What we stand for is ‘to keep people healthy and out of hospital’ and our vision is ‘better health for North Coast residents’.

We have invested the overwhelming share of funding in direct clinical services. In the 12 month period to June 30, 2013, we provided 38,273 occasions of service including 13,373 occasions of General Practice services; 10,102 occasions of Medical Specialist Outreach Services; 6,420 psychology services; 7,000 occasions of allied health services; and 1,480 occasions of service to families with young babies in need of support.

Filling the gap in services, NCML operates the only Medical Centre at Nimbin. We run Aboriginal Medical Services at Lismore and Tweed Heads, providing general practice, nursing, allied health, psychology and specialist services to thousands of Aboriginal clients each year.

In mid-2012 we set up a health clinic for Balund-a residents, a corrections facility for Aboriginal men.

We have invested time and energy in building and consolidating partnerships, especially with the two Local Health Districts with whom we’ve jointly established a number of projects.

We set up the Partnership for Health System Reform and Improvement and a joint vision for health has been established,

fostering a system where service delivery is complementary, integrated and mutually supportive.

In partnership with NNSW LHD and North Coast GP Training, we created the first Palliative Care Registrar position outside the hospital system, reducing hospital admissions and increasing care capacity outside hospital. In partnership with MNCLHD and the NSW Agency for Clinical Innovation, we now have the Health Pathways program, which has created much excitement. It is developing more than 35 web-based clinical pathways, with plans to roll out on the Far North Coast in June.

Filling the gap in services, NCML operates the only Medical Centre at Nimbin We established initiatives to bring clinicians together: The Tweed Link Project - clinicians from various disciplines networking and linking services; North Coast Oral Health Leaders Forum - the first dentistry private and public leaders’ forum; the Palliative Care Network and the North Coast Health Promotion Alliance with 70 participants.

We are also part of the Alliance for Service Provision for Vulnerable People and have established clinics for homeless people across the region.

We implement programs to improve access to specialist medical services, medical equipment and transport for Aboriginal people, especially those with chronic disease. We provide care coordination to 571 Aboriginal people and have held four Closing the Gap events attended by

more than 1,000 people.

Supporting general practices and allied health, we visited over 360 clinicians and providers on 1,386 occasions, implemented support plans and agreements with over 77% of general practices, 45% of pharmacies, and 65% of residential aged care facilities.

We provided 108 education sessions with 2,368 participants and completed eHealth readiness assessments for 152 general practices, 126 pharmacies and 58 other healthcare providers, including residential aged care facilities (RACFs). We are in the process of establishing the North Coast NSW Allied Health Association, to provide this sector with a single regional voice.

We continue to administer after-hours GP services with all qualified practices having now registered and providing more after hours care than before.

As a result of our 2012 Roadshow consultations, we have established a single reservoir of reliable local health information at www.HealthyNorthCoast.org. au. Healthy North Coast keeps the community up-to-date with all local health news, events, activities, programs and services.

We continue to build partnerships and bring new services to the region. We have attracted funding from beyondblue and set up a cognitive therapy program (NewAccess) right across the region. And in order to help address the gap in youth mental health services at Tweed, we have put in a submission to establish the Tweed Heads headspace, similar to the one now operating in Lismore.

I hope this provides you with a sense of what your Medicare Local is doing. This year we will be taking steps to engage further with you, continue to advocate for the region, and work tirelessly to keep North Coast residents healthy and out of hospital.

Cover photo: Private Mitchell Cass in Afghanistan, Corporal Mark Doran, ADF. Photo courtesy of ADF

HealthSpeak is kindly supported by HealthSpeak

autumn 2014

Better access needed to longacting reversible contraceptives A recent paper published in the MJA(1) discussed concerns expressed at the National Sexual and Reproductive Health Conference in 2012 relating to the high rate of unintended pregnancies and associated costs in Australia. Compared with countries in Northern Europe we have a relatively high rate of unintended pregnancy and abortion (19.7 per 1000 women aged 15-44 years compared with 17 per 1000 in Northern Europe).

At the same time, we have a low uptake of the most effective methods of contraception – namely long-acting reversible contraceptives (LARCS), used by only 6% of women using contraception versus 14.8% in northern Europe. LARCS include three- monthly injections (depot medroxy-progesterone acetate); a progestogen-only (etonogestrel) subdermal implant with duration of action up to three years; and IUDs - the hormonal levonorgestrel device effective for five years or copper devices effective up to 10 years.

It seems from US studies that adolescents and young women are especially vulnerable to unintended pregnancies as they are highly fertile and less reliable in their use of the oral contraceptive pill. Unintended pregnancies have enormous social, psychological and physical consequences as well as significant financial costs to the health system.

One of the key strategies promoted by international public health bodies to reduce the number of unintended pregnancies is for increased uptake of LARCS methods. They are very cost effective largely through preventing unintended pregnancy.

While prescribing a pill is an easy and quick way to deal with a young woman requesting contraception, the compliance with all the directions for daily use is often not adhered to because of lifestyle factors, and an unintended pregnancy may result.

More time discussing LARCS as an alternative may be beneficial.

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Then there is the issue of what method of LARCS could be used. There are pros and cons around all these methods and time is needed to go through these and longer consultation time is needed. Delaying whatever method chosen may in itself lead to an unplanned pregnancy.

So there are some barriers in promoting LARCS in the general practice setting: 1) Time to discuss the options 2) Encouraging the patient to come back for further discussion 3) Getting the patient to return for the procedure and checking that the woman is not already pregnant.

4) While a depot injection is easy to give and many GPs are skilled in insertion and removal of Implanons, this is not so with insertion of IUDs, although more training is now happening through some family planning clinics and some GPs are now skilled in insertion of IUDs.

widely used reversible contraceptives in the world. Data from 2003 showed use by only 1.2% of women using contraceptives in Australia compared with 17% in France and 21% in Sweden.

The percentage in Australia may be a bit higher now but still significantly lagging behind many other countries.

There is now good evidence that modern IUD devices present minimal risk of infection and no increased risk of subsequent infertility. There is increasing experience of their use in younger women and nulliparity is not

Opinion Andrew Binns

considered a contraindication.

All LARCS can be used in women who suffer migraine with aura and in older women who smoke. Overall LARCS have fewer contraindications than the combined hormonal pill. The levanorgestrel IUD (Mirena) is also very effective for treatment of menorrhagia.

Increasing the usage of LARCS can only happen with changing attitudes from health professionals and the general community. A lot of myths about IUDs still exist and are based on outdated research relating to serious problems with devices that have not been used for more than 30 years.

The current IUD devices have improved a great deal over the last few decades and this trend is likely to continue along with increased acceptance and usage worldwide. In Australia the emphasis needs to be on more LARCS education and insertion training for GPs.

(1) Black K, Bateson D, Harvey C. Australian women need increased access to long-acting reversible contraception. MJA, 199 (5), Sept 2013.

IUD use in Australia is very low compared with other countries even though they are the most 3

Lismore headspace opens On Wednesday January 30, a ‘soft launch’ was held at the Lismore headspace at 2A Carrington Street to celebrate the opening of the youth mental health service. NCML is the lead agency in a consortium of 13 local organisations overseeing headspace.

A bigger street carnival opening will be taking place in March.

Since the lease was signed late last year, NCML’s Michael Carter and headspace’s Lisa Hampson and Katrina Alexander have worked tirelessly to ensure it opened on time with renovations, furnishings and office equipment complete.

Special mention should also be given to the former Federal Member for Page, Janelle Saffin, who worked hard to ensure Lismore received funding for a headspace service.

At the opening, NCML’s CEO Vahid Saberi said that in this round of headspace open-

From left: Chris Clark, Katrina Alexander, Terri King, Lisa Hampson, Tanya Jackson, Tony Lembke, Samantha James, Jenny Dowell.

ings, Lismore was one of only three in the 15 which opened on time, a great achievement.

Lismore’s Mayor Jenny Dowell was impressed with the youth

oriented, welcoming space.

“It’s a great location and a fabulous space. The bottom line is headspace has got your back and this is a place of ‘we’, where

young people will feel supported by the staff and find some ways forward with whatever’s troubling them,” she added.

NCML’s Chair Tony Lembke said the need for such a consortium to come together and provide a headspace service was very strong in all regional areas.

“I don’t think we’ll realise how much we needed this facility until the next few months when our young people find a home that they can come to and be supported and somewhere we can refer them safely to a service that welcomes and embraces our young people to whom we all have a responsibility as a community,” he said.

Katrina Alexander, headspace’s Operations Manager, also took the opportunity to introduce staff members Samantha James, senior clinician; Terri King, Youth Access clinician; Tanya Jackson, Youth Access clinician and Lisa Hampson, Administration Manager.

HealthPathways website coming soon In late January, an official Memorandum of Understanding (MOU) was signed between North Coast Medicare Local (NCML) and Mid North Coast Local Health District (MNCLHD) to develop HealthPathways on the Mid North Coast.

Negotiations are continuing with Northern NSW local Health District about a similar MOU. Each HealthPathway starts with a particular health problem and defines a pathway for management that reflects evidence-based best practice in the context of local resources and facilities.

The development of HealthPathways is driven by clinicians as part of a patient management process that will promote fast and timely care of patients as well as more effective referral of patients to secondary care clinicians.

For some months now, NCML and MNCLHD have been working collaboratively to develop 35 different HealthPathways, with some nearing completion.

And on March 31, NCML’s HealthPathways website will go ‘live’, providing a valuable resource for primary health care clinicians to provide the best local care

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Stewart Dowrick and Vahid Saberi at the signing of the HealthPathways MOU.

referral pathways for their patients for a number of conditions. GPs and primary health care clinicians will be notified about how to access the site at this time.

The development of HealthPathways is driven by clinicians to promote fast and timely care of patients in primary care settings as well as more effective referral of patients to specialists and allied health care providers.

The HealthPathways program provides an opportunity to link general practitioners, hospital clinicians, allied health professionals and private medical specialists

into the reform process. Representatives from all health sectors involved in the development of relevant HealthPathways are identified in the published product.

NCML’s CEO Vahid Saberi said HealthPathways was an exciting joint project which would improve patient care, efficiency, quality and clinician engagement.

“The process of developing a locallydefined HealthPathway may also lead to new solutions as clinicians work across the hospital-community interface,” Mr Saberi said.

Mr Dowrick said that HealthPathways was an exciting opportunity for the MNCLHD to work in collaboration with the NCML to improve links between health professionals.

HealthPathways are published on an on-line information password-protected portal to be used at the point of care for GPs but are also available to specialists, nurses and allied health providers. The website is not designed for use by patients or community members, however resources will be available on the portal that GPs and health professionals can provide to patients.

HealthSpeak

autumn 2014

New monthly GP Clinic at Tweed homeless service Helping the socially disadvantaged in our community is a priority for North Coast Medicare Local and a new partnership between NCML and the St Vincent De Paul Society has resulted in a monthly GP Clinic being run at a homeless support service at Tweed Heads.

The clinic, held at Fred’s Place, opened in December and is staffed by local GPs Dr Diane Blanckensee and Dr Austin Sterne, practice nurse Mary Lynch and NCML’s Kelli Babovic.

Fred’s Place is an intervention and support service for people experiencing homelessness or those in need, run by the St Vincent de Paul Society. It’s open to guests from 10am to 3pm. It’s a comfortable three bedroom home with three bathrooms, laundry, internet and telephone, television, staffed kitchen, inside and outside areas to socialise, storage and mailing facilities.

Case management with outreach availability is also offered along with emergency accommodation and all services are at no cost. The centre receives no government funding.

When HealthSpeak visited the GP clinic, Fred’s Place was bustling - the TV room was full to capacity, and guests were enjoying some lunch or a cuppa while socialising with others.

The Services Manager at Fred’s Place, Jason McDonald, said the clinic was a welcome

From left: Services Manager, Jason McDonald, nurse Mary Lynch, NCML’s Kelli Babovic and Dr Diane Blanckensee.

addition to Fred’s Place, along with the two psychologists that North Coast Medicare Local had contracted to work at the centre through the ATAPS program.

“We average seven clients per clinic over about three hours.

The GPs can’t handle any more than that as the patients are complex presentations. On the morning before the clinic I’ll go around and make an appointments list for those who want to see the doctor,” he explained.

Nurse Mary Lynch prescreens the patients before they see the GP on duty and Kelli sets up the clinic rooms (normally used for other purposes), works with Jason to fill in Medicare and other forms, and liaises with Mary and the GPs to contact

other health services and make referrals as required.

It’s hoped the clinic will become a fortnightly occurrence as there are more patients needing treatment than can be seen in one monthly session.

Jason emphasised that the success of the clinic was due to the successful partnership between North Coast Medicare Local and the St Vincent de Paul Society (which paid for the equipment required to set up the clinic).

“This is what true partnership is all about - working together.

It’s not always easy, but if there’s a commitment on both sides to the project, we get there.”

Kelli said Fred’s Place clients were very grateful to be able to see a doctor as most were not

MLs funded to provide Forced Adoption Counselling One off funding has been provided to Medicare Locals to support the anticipated demand for ATAPS services from people affected by past forced adoption practices following the National Apology in March last year.

The incremental funding boost is to support people in the immediate post-apology period while the Department of Family, Housing, Community Services and Indigenous Affairs (FaHCSIA) establishes a range of services to support

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autumn 2014

individuals in the medium to long term.

The additional funding is to deliver ATAPS services to eligible people who are referred by their general practitioner or psychiatrist and who have a diagnosed mental disorder of mild to moderate severity. People affected by past forced adoption practices should be given priority under ATAPS Tier 1.

Doctors can refer patients through the ATAPS Tier I

program as normal with the inclusion of a mental health treatment plan.

A range of guidelines and training material to assist in specialised treatment of affected people is being developed for GPs, specialists and allied health professionals. These resources will provide best practice advice on diagnosis, treatment and management options and will be disseminated once developed. More on this topic in the next issue of HealthSpeak.

linked in with a general practice.

“One lady came out of the consultation with tears in her eyes. She told me that the doctor she’d seen had given her the best care she’d ever had.”

During HealthSpeak’s visit, the President of the St Vincent de Paul Society’s Lismore Diocesan Council, Brian Goodall, stopped by. In the course of a chat, he said that since Fred’s Place opened in June last year it had become an extension of the hospital, and it was apparent respite care was needed in the area for hospital patients discharged with nowhere to go.

“We get a lot of people coming here after they’ve come out of hospital and they are often really unwell. We’ve been talking to the hospital about this, and we would like to see the state government provide some respite care for these people as they need more help than we can give them,” Brian said.

By the time HealthSpeak is published, a North Coast Medicare Local run GP Clinic at Port Macquarie for those experiencing homelessness will also have opened.

Briefs

Health literacy guide NSW Health’s Directorate of Patient Based Care has released an online health literacy guide.

Developed as a practical resource to support implementing care strategies, the guide will help address barriers to health literacy and help health services meet new performance goals. The guide is a living online document and includes best available evidence at the time of release. The majority of vignette examples within the publication have been sourced internationally.

Download the guide at: http://www.cec.health.nsw. gov.au/hlg

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Consumers embrace eHealth The North Coast Medicare Local consumer engagement teams have been working tirelessly to promote eHealth to consumers and provide assisted registration. The team has worked directly with providers such as general practices and pharmacies, while also having a presence at community events and hospitals throughout the region.

NCML can provide a fully resourced consumer registration assistant (CRA) to interested provider organisations free of charge. The CRA will engage with patients while they are waiting to see their health care provider. The CRA is trained to provide eHealth education to consumers, answer questions about eHealth and provide support to providers to implement assisted registration.

Since August the NCML team has engaged almost 6000 consumers and registered 4200. The Team has averaged a 70% success

Ehealth NCML team member Josephine Saunders with staff from the Evans Head Soul Pattinson Pharmacy. The team spent about 15 days during January and February at Evans Head Pharmacy where owner Steven Hoole is very enthusiastic about eHealth.

rate registering consumers, demonstrating the public’s interest and enthusiasm for eHealth.

NCML spent time at Evans Head pharmacy siging up consumers to eHealth, where Retail Nanager Cathy Clark was very supportive of the campaign.

“I think it went particularly

well and we were very happy to have the NCML team here.

They were especially busy over the holiday period when so many tourists were in town,” she told HealthSpeak.

If you would like to know more about how the team can help you to register your patients

Consumer engagement team member Noni Kubowicz helping Libby MackintoshSallaway register for eHealth in Port Macquarie.

or you have an event that you would like our team to attend, contact the eHealth project officer situated in your NCML branch office. Tweed Heads: 07 5523 5500; Northern Rivers: 02 6622 4453; Coffs Harbour: 02 6659 1800; and Port Macquarie: 02 6583 3600.

Carers enjoy the Craft Studio North Coast Medicare Local is thrilled about the popularity of the Craft Studio for Carers that it has funded in Coffs Harbour since its opening in July last year.

Around nine carers attend each fortnightly session with 30 expressing interest in the project.

Ruth Weston from Carers NSW, Coffs Harbour, demonstrated her proposal for a Craft Studio for Carers at North Coast Medicare Local’s PITCH evening early last year. (PITCH stands for Practical Ideas to Connect Healthcare.)

Ruth won the PITCH presentation evening with her craft studio proposal, and NCML agreed to fund the implementation of the project.

The Craft Studio provides carers with an opportunity to socialise and enjoy a range of arts and crafts activities in a welcoming atmosphere.

Ruth Weston told HealthSpeak that she’d been over-

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whelmed and humbled by the response to the craft sessions.

“It’s just been wonderful. We have a very diverse group and we have lots of fun and lots of laughter, we leave our troubles at the door,” she said.

One woman has proven to be so skilled at showing others what to do, that Ruth is applying for funding for her to do a Certificate in Training and Asssessment.

And on April 6, the Craft Studio will hold its first market stall at the Made with Love market in Coffs Harbour.

Ruth explained that one of the reasons for setting up the craft studio was to give carers an opportunity to earn some extra money from their labours.

“I’ll take out the market expenses, but after that each person gets to keep the money they make selling their craft work,” she said.

Feedback gathered from craft studio participants has been very positive:

This is a wonderful opportunity for me to use my creative ability whilst having a break from my caring role. It is WONDERFUL. The carers craft studio has been the best thing that has come along in my life for so many reasons. It has given me a reason to

get up in the morning and have a shower, put on clothes, not worry about my boys as much and somewhere important, exciting to go!

The three-hour craft sessions are run fortnightly at the Carers NSW Coffs Harbour office at 2/2 Lyster Street. To find out more, phone 6650 0512.

HealthSpeak

autumn 2014

NewAccess: a new no cost mental health service NCML’s NewAccess Program Manager Dawn Macintyre is excited to be improving referral pathways for the mild and moderately anxious in the community.

“NewAccess provides an easy to access, guided self-help service for people who might otherwise not receive care. It is important to provide a service that is free, effective and timely,” she said.

Accessing NewAccess

There are two referral pathways.

From left: Justine Cox, Ros Mulcahy, Martin Tedeschi, Dianne Robinson, Christopher Barratt, Shirley Kent, Dawn MacIntyre, Nyssa Lonergan and Joanne McAnally.

There are currently a great many people in Northern NSW with mild to moderate anxiety and depression who do not recognise or seek support.

A new beyondblue program, NewAccess, is now available on the North Coast through North Coast Medicare Local, chosen as one of three demonstration sites for the program.

NewAccess is a free and confidential support service to help tackle day to day pressures.

It’s for people over 18 years of age with early symptoms or mild to moderate depression and/or anxiety who are not accessing mental health services.

The NewAccess service will go a long way towards addressing the region’s unmet need for mental health services, providing guided self-help, based on low intensity cognitive behavioural therapy.

It is particularly focused on improving access to men, with beyondblue and the Movember Foundation contributing to funding.

An Access Coach, specially trained and experienced, will support clients in setting practical goals to get them back on track. Eight Access Coaches have been employed by NCML to deliver the program. Two Access Coaches are each based in Tweed Heads, Lismore, Coffs Harbour and Port Macquarie. Services will be available from 8am to 6pm Monday to Friday.

The program includes up to six free sessions. At the first appointment, the NewAccess Coach will complete an initial assessment with the client and develop a program tailored to the client’s needs. Phone or face to face sessions are available to suit the client.

Those assessed with complex or severe mental health conditions will be stepped up to highintensity and specialist services.

NewAccess Coaches can also direct clients to employment, financial, housing, educational and other community services as required.

Briefs

Prostate cancer rates Australian and New Zealand men have the highest incidence of cancer in the world, largely driven by high rates of prostate cancer, new international data shows.

The data, published by the cancer research division of the World Health Organiza-

People can self-refer by calling 1300 137 934 or emailing newaccess@ ncml.org.au Doctors and health professionals can refer patients by calling 1300 137 934 Ph: 1300 137 934 or visit: www. ncml.org.au/index.php/programsservices/our-services/item/566

tion, shows that Australia and New Zealand have a cancer incidence rate of 318 per 100,000, excluding nonmelanoma skin cancer.

The report, estimating 28 cancer types in 184 countries, shows the age-standardised rates of prostate cancer are 111 per 100,000 in Australia and New Zealand, ahead of breast cancer, the next most common cancer, with an incidence of 85.8 per 100,000.

IT’S BETTER SEEDLESS

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HealthSpeak

autumn 2014

Call 07 5530 2822

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Most happy with After Hours service access An online survey conducted over the holiday season shows most respondents are ‘neutral’ to ‘very satisified’ with after hours GP services on the North Coast.

The North Coast Medicare Local survey sample size was 105, so some caution is needed in interpreting the results; however the opinions of 26 postcodes were gathered. The information obtained will be useful in the planning of additional after hours services in the region.

The survey was done over the holidays to capture the opinions of both locals and visitors to the North Coast; it was advertised through NCML’s Healthy North Coast Facebook page and attracted media coverage in newspapers

and on radio.

Not surprisingly, the larger regional communities of Alstonville, Ballina, Coffs Harbour, Kempsey, Lismore and Port Macquarie were well represented in the survey, as well as the smaller South West Rocks community.

Seventy-one percent of respondents had a need to access a doctor in the after hours period (after 6pm Monday to Friday and after 12 noon on Saturday) on one to three occasions over the past 12 months.

And nearly 25% had a need to access an after hours GP four to five times over the past year.

Nearly 60% of respondents attended the after hours emergency services at a hospital, their only access to after hours care. A further third of respon-

dents accessed services in an after hours clinic that was not their usual general practice.

It’s encouraging to learn that nearly 16% called the After Hours GP Helpline as a complementary first level triage service, given the 2012 promotional investment made to the service by North Coast Medicare Local.

Importantly, the majority (70%) of survey respondents indicated that they did not have a chronic health condition that necessitated potential regular after hours care. While expressing a general satisfaction with access to existing services, the commonly disclosed barriers to access remain availability (82%) and waiting time (64%). This waiting period is not surprising given

that most respondents accessed after hours services at hospital accident and emergency units.

North Coast Medicare local takes this opportunity to thank the community for taking their time to share their views on existing access to after hours services. The After Hours Program in consultation with general practitioners, pharmacy, residential aged care and local health districts continues to work with providers to improve access and service availability, specifically in communities with limited general practice providers or remote in distance to the significant services of the Base hospitals.

The number for the After Hours GP Helpline is 1800 022 222.

ADVERTORIAL

Keeping it local with Sullivan Nicolaides Pathology Although Sullivan Nicolaides Pathology is one of the largest members of the Sonic Healthcare Group, we are an independent, Australian owned, publicly listed company.

Sonic practices are medically managed and are thus well placed to appreciate the special needs of doctors and their patients. This means that in the Northern Rivers for over 30 years we have been employing local people made up of specialist pathologists, scientists, couriers, collection and administration staff to serve the needs of our community. Most of our testing is performed locally at our Lismore laboratory, meaning that we can ensure a fast turn around and a personalised service to you.

We support our local doctors and patients by providing 21 collection rooms based between Tenterfield and Ocean Shores with our main procedure room in Lismore which performs bone marrows, skin allergies, paternity 8

testing, arterial blood gases and various other tests. Our collection staff all undergo a Certificate III training program with an added emphasis on customer service to ensure all patient needs are met.

Our SNP courier cars cover around 3,000 kms a day from Grafton to Brisbane to ensure specimens reach our labs in the fastest possible timeframe.

We have four pathologists residing in the area with our newest team member being Dr Andrew Bettington. Of course, their expertise is underpinned by the fact that our practice is managed by doctors for doctors. Our CEO, Dr Michael Harrison, is a pathologist. All department directors are pathologists, and pathologists are represented at all levels of management.

Finally, on a local level, we continue to sponsor our local doctors with ongoing education events and training and continue to support Southern Cross University science events. As part of your local community we also support various local groups and events including Our Kids, Westpac Rescue Helicopter, local community school awards and underprivileged families at Christmas.

By supporting us you are not only receiving the highest clinical and ethical pathology service, but you are keeping our locals that have a vested interest and love of the community employed. Our pathologists and senior staff encourage doctors to contact them for information, consultation or advice at any time. Our local Medical Liaison Manager, Vanessa, is available to assist clinicians and their staff with the practicalities of using our services.

Phone Vanessa on 6620 1200 to find out more.

HealthSpeak

autumn 2014

Land councils embrace First Aid program A total of 13 Local Aboriginal Land Councils across Northern NSW have signed up with North Coast Medicare Local (NCML) to receive First Aid and CPR training in their communities.

The training will be administered through NCML’s Vulnerable and Disadvantaged Communities program staff.

This First Aid program was initiated to strengthen resilience and build capacity in our Aboriginal communities. Smaller Aboriginal communities are isolated with limited access to reliable health care and limited First Aid response capacity, putting these communities at risk due to delays in ambulance response times.

NCML’s Senior Program Manager for Aboriginal Health Emma Walke said that providing First Aid skills to communities that are isolated or that cannot access GP services easily, will assist them to prevent minor incidents from becoming major ones.

“These events can escalate to become major or chronic problems. In some areas, the ambulance service refuses to attend without a police escort which results in delays in providing care or missed opportunities.”

Emma told HealthSpeak that as well as First Aid training for physical injuries, it was also identified that providing training on how to respond to a mental health crisis, and how to seek appropriate support, could also be useful in isolated communities.

NCML will identify participants interested in becoming first aiders in their community.

We will support these people with regular meeting, further training, refresher courses etc. and where possible link them up with an Aboriginal Medical Service to provide further support as a mentor.

Emma said NCML had organised the first training session which had taken place in the Jubullum community near Tabulam, with another eight communities booked to receive training over the next few months.

“We will the support these HealthSpeak

autumn 2014

at a later date,” she said.

Participants put forward through Jubullum Land Council have completed a certified First Aid and CPR session near Tabulam and agreed to take part in follow up refresher courses.

They were enthusiastic about learning new skills to help community members.

Participating communities in the First Aid program include Jubullum at Tabulam, Jali at Cabbage Tree Island, Gugin Gudduba at Kyogle, Tweed Byron, Nambucca Heads, Thungutti at Bellbrook, Coffs Harbour, South Grafton, Biripa at Port Macquarie, Muli Muli at Woodenbong, Casino Boolangle, Yaegl at Maclean and Birrigan Gargle at Yamba.

The training day held for Jubullum was enthusiastically received.

people with regular meetings, further training, refresher sessions etc and where possible link them to an Aboriginal Medical

Service which may be able to act as a mentor. They may also be given other training which could include Mental Health First Aid

eHealth myth-busting disappear.

The Australian Government has passed legislation to support the PCEHR system.

This includes the Personally Controlled Electronic Health Records Act 2012 and the Healthcare Identifiers Act 2010.

Compiled by Casey Guthrie, NCML eHealth Project Officer

1. The PCEHR is a privacy risk for consumers Increasingly, patients have higher expectations of the health care system, and privacy of information is an important factor. While patient’s expectation for privacy is increasing, so too is the expectation that healthcare information be shared if and when it’s needed.

Much work has gone into developing systems to allow sharing between healthcare providers, while also providing autonomy to patients through the use of access controls.

Existing privacy obligations and duties of confidentiality will generally continue to apply. In addition, specific laws relating to access, use and disclosure of patient information in the eHealth record system will be introduced in legislation. Patients will be able to control aspects of the information contained in their eHealth record, including which organisations can access

their record and which documents are visible to healthcare professionals.

The national eHealth record system also offers electronic security features such as authentication and audit trails which make the electronic record arguably safer than the paper record.

2. The PCEHR is a medico-legal risk The same concerns that apply now to the safe care of patients will apply in the future. There will be new risks associated with the new world, but some of the old risks, particularly those related to missing and misplaced information, will

3. Patients can edit information you upload A patient is able to set access controls, as discussed in point 1, however the document the healthcare provider uploads cannot be edited by the patient.

A patient can however have a whole document removed from their ehealth record if they choose. They do this by calling the system operator and requesting that the document be removed. This document may be restored at a later date if the patient wishes.

Information for this section is compiled from ehealth.gov.au , RACGP and ‘The harsh realities of e-health’ by Dr Chris Pearce 06/06/2010.

9

Safe use of medicines in older people Did you know two-thirds of Australians over 65 take FIVE or more regular medicines?

Did you know that 1 in 4 adverse drug events in older people are considered preventable?

NPS Medicinewise in partnership with North Coast Medicare Local, has launched an educational program titled Older and Wiser – Safe use of medicines in older people.

The program focuses on effective strategies to assist GPs, pharma-

cists, practice nurses and RACF staff to manage polypharmacy and prevent medicine-related problems in patients over 75.

Sally Herbert, Michael Driscoll and Lesley Burrett are local pharmacists who have recently commenced educational visits to local practices delivering this program. It details risks associated with medicines use in older people and strategies to identify and manage these risks to ensure benefits of medicines are realised.

Prescribing in older people is a

Resources for carers and people living with mental illness

balance between managing conditions according to disease based guidelines and addressing patient goals, while at the same time preventing adverse events.

While some medicines increase the risk of adverse events, few adverse events are clearly preventable at the stage of prescribing, which highlights the importance of monitoring and follow up.

The program encourages health professionals to consider current medicines as the cause of new symptoms and not just old age.

Sometimes this may require medicines to be ceased or the dose reduced to see if symptoms improve.

The difficulty is there are no prescribing guidelines for older people - the evidence supporting prescribing guidelines has been performed in younger, healthy patients in clinical trials.

Therefore, identifying changes that can affect medicines use, as well identifying and addressing potential and actual medicines related problems are paramount to ensure quality use of medicines

SLEEP CLINIC AYS Ann Main has worked hard to build up the resource room.

The GROW community centre in Lismore has set up a well-stocked resource room for carers, friends and people living with mental illness.

Located at 125 Ballina Street Lismore (corner of Wyrallah Road), the Resource Room is the brainchild of mental health carer and GROW volunteer Ann Main.

It is open every Friday from 10am to 2pm.

Ann has collected a broad

10

range of material about all aspects of mental health.

Resources include a lending library with books, DVDs, VHS tapes and CDs available for loan.

Flyers, brochures and cards from organisations involved in mental health care are available free of charge. Fact sheets may be copied for a gold coin donation to GROW. Call Ann on 0421 302 495.

OPEN D

FREE consultation

is achieved.

Importantly, NPS Medicinewise is encouraging GPs, practice nurses, pharmacists and RACF staff to adopt a co-ordinated approach to medicines management, and to engage older people, their family and carers as active partners in health decisions. The use of an up to date medicines list and regular review by GPs, pharmacists and nurses ensures good communication and close monitoring when starting, continuing or ceasing treatment.

Download a medicines list from www.nps.org.au/medicineslist If you are interested in an educational visit or a case study meeting for your practice or RACF please contact: Sally Herbert at Northern Rivers on 6622 4453 sherbert@ncml.org.au Michael Driscoll at Mid North Coast on 6651 5774 mdriscoll@ncml.org.au Lesley Burrett at Hastings/ Macleay on 6583 3600 lburrett@ncml.org.au

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HealthSpeak

autumn 2014

Partnership improves Aboriginal health transport North Coast Medicare Local (NCML) and Tweed Byron & Ballina Community Transport Inc (TBBCT) have signed a Memorandum of Understanding (MOU) to improve access to transport for Aboriginal patients attending specialist referrals and hospital visits.

The MOU outlines the agreed arrangements between North Coast Medicare Local’s Closing the Gap Team and TBBCT. Some of the agreed roles and responsibilities in the MOU include: That TBBCT will provide reliable, timely and cost effective transport between 7am and 7pm Mondays to Fridays That TBBCT will provide a culturally appropriate service and endeavour to meet short notice transport requests where practicable That TBBCT will ensure that transport officers have completed first aid and manual handing training and working with children clearance and police checks

From left: The signing of the MOU at the Ballina office of TBBCT. From left: Emma Walke, NCML’s Senior Program Officer in Aboriginal Health; Donna Burns, NCML’s Southern Region General Manager; Phil Barron, TBBCT; Vahid Saberi, NCML CEO; Dave Kapeen, Aboriginal Transport Develoment Officer, TBBCT; Aunty Bertha Kapeen; Paul O’Reilly TBBCT Committee member; and Jamie Wimbus NCML’s Care Coordination and Supplementary Services Project Officer.

That NCML will inform TBBCT of patients’ mobility, fitness and any special requirements.

NCML’s Senior Program Officer in Aboriginal Health, Emma Walke, said with public transport sadly lacking on the far North Coast, non-emergency health transport had been a difficult issue.

“However, this MOU will support our Aboriginal and

Torres Strait Islander clients to attend specialist and allied health appointments as they happen, or even attend hospital on the Gold Coast for procedures if needs be,” said Emma.

NCML’s CEO Vahid Saberi said North Coast Medicare Local was proud to partner with staff at TBBCT in signing this MOU as they had a genuine desire to remove health transport barriers for people living on the far North Coast.

“Transport is a major health

The depth of the Wishing Well An inspiring project which brought together women to create art out of their experiences of living with mental health and weight gain has resulted in a beautiful and informative book.

The Wishing Well project, run by the Lismore & District Women’s Health Centre, was the brainchild of Eating Disorder Assessor and Art Therapist Susan Joyce. Kristine Ubergang and Ginnette Kenney helped develop the idea and shape the successful grant submission.

Art therapist Rohini Agnew coordinated the project which saw women in three communities, Lismore, Casino and Ballina nurtured to create art, which was then exhibited within the communities.

Susan Joyce told HealthSpeak

HealthSpeak

autumn 2014

The launch of the Wishing Well book: From left – art therapist Rohini Agnew, Dr Susan Joyce, Kristine Ubergang and Ginnette Kenney.

that Wishing Well was primarily designed to help communities ask some questions: Do we accept and embrace all our local

people without prejudice?

Challenge the social stigma around mental health Make an effort to

challenge and barrier to access to services. Even if our region has the best health care it is of little good if people who need it the most can't get to it.

“The challenge is that within our system no one’s owning the problem of non-emergency medical transport. Studies have shown that it is the poor, the socio-economically disadvantage, older population and females whose suffer the most from lack of transport to access services,” said Vahid.

At the signing, he praised Tweed Byron & Ballina Community Transport Inc. “This organisation has a great track record in customer service and an excellent management committee. Last year they delivered just under 60,000 passengers trips overall with a dedicated team of 140 volunteers led by Manager Phil Barron.

“TBBCT’s Aboriginal Transport Development Officer Dave Kapeen has been untiring in his efforts to expand and advance the service offered to Aboriginal clients, and with this new MOU, the service will no doubt further improve health transport access for our Aboriginal population,” he added

understand the impact of mental health and obesity issues on local people Help these people become integral members of our communities Chair of the Council of Women, Lismore Women’s Health Centre, Julie Hornibrook, wrote in the foreword that the Wishing Well book would enable the experiences of women living with mental health issues and weight gain, due to the medication used to manage their conditions, to be shared.

“Other women who may have similar feelings can see that there is a way to find positive change through exploring creative processes and making connections in their community,” Julie said.

11

New dental care benefits for the young North Coast dentists have welcomed a new scheme, the Child Dental Benefits Schedule (CBDS), which began in January. It means many, although not all, children and teenagers (aged 2 to 17 years) will be able to access the preventative dental care they need at no cost using their regular dentist.

No GP referral is required.

Dentist Brendan White, who’s the North Coast’s Australian Dental Association representative, told HealthSpeak that dentists are excited about the scheme.

“The CBDS has already in its first few weeks allowed many children to access care that they would not have been able to afford. It has been a pleasure to be able to provide simple restorative and preventive care for these children, often to the delight and relief of their families,” he said.

This initiative also means quicker access to dental care.

Parents can choose to see the dentist of their choice, including the public dental clinics.

Eligibility basics Eligible families, teenagers and approved organisations should have received a letter early this year confirming that they may take advantage of this new scheme.

A child aged 2 to 17 years is eligible if covered under a Medicare card and if they are part of a family receiving a Family Tax Benefit Part A. Eligibility is determined each calendar year. In 2014, benefits for basic dental services are capped at $1,000 per child over two consecutive calendar years.

What is covered?

Benefits will cover services including examinations, x-rays, cleaning, fissure sealing, fillings, root canals and extractions.

Benefits are not available for orthodontic or cosmetic dental work and cannot be paid for any services provided in a hospital.

Child Dental Benefits Schedule services will not count towards the Medicare Safety Net or the Extended Medicare Safety Net thresholds. Consumers can confirm their child’s eligibility 12

Who can bill/claim?

If you are a dentist or dental specialist you can bill/claim benefits for the Child Dental Benefits Schedule services using your Medicare provider number.

and balance amount by accessing their Medicare online account at my.gov.au or calling the Medicare general enquiries line on 13 2011.

care provider number (as most dentists do) you do not need to re-register to use the Child Dental Benefits Schedule service items.

How it works

Who can perform services?

Dental hygienists, dental therapists, oral health therapists and dental prosthetists registered with the Dental Board of Australia are eligible to provide Child Dental Benefits Schedule services on behalf of a dentist or dental specialist.

Dentists Dentists and other providers need to enrol in the CBDS program so that you have all the paperwork needed when treating a patient. You are also required to write out a care plan and quote to each patient before commencing any work. (See link at bottom of story for more information on enrolling.)

You are eligible to provide Child Dental Benefits Schedule services if you are a dentist or dental specialist in either the public and private dental sectors.

In order to satisfy the provider eligibility requirements, you must: hold ‘general or ‘specialist’ registration with the Dental Board of Australia; and have a Medicare provider number.

You can check your registration with the Dental Board of Australia online at: http://www.ahpra.gov.au/ Registration/RegistersofPractitioners.aspx If you already have a Medi-

Consumers Patients make an appointment with either a private or public dental provider and let them know they are eligible for the Child Dental Benefits Schedule.

Bring your letter of confirmation from Medicare if you have one.

At the time of the appointment, the dentist must discuss treatment and any associated costs before providing the services. After this has been discussed, the parent will need to sign a consent form.

When the dentist has provided the services agreed for the child, they will either bulk bill you or charge for the services. If the account is paid at the time of service, the benefit can be claimed through Medicare.

For further details of the scheme, refer to the Department of Health’s official guide at: www.health.gov.au/internet/ main/publishing.nsf/Content/ childdental/$File/Guide-to-CDBSv2.pdf

Domestic violence flip chart has been updated An updated version of the Northern NSW Local Health District’s Domestic Violence Flip Chart tool will help health workers from Taree to Tweed Heads to support women experiencing domestic and family violence.

Ellie Saberi, Women and Child Health Program Coordinator, said it was time to update the Flip Chart tool from the 2010 version. The new edition provides up-todate information for people working in both govern-

ment and non-government agencies who encounter a client they know, or suspect is experiencing domestic and family violence.

NNSW LHD Chief Executive Chris Crawford said that the resource would assist front line workers to recognise and respond appropriately to domestic violence.

A webpage has been developed using the information from the Flip Chart and is available on this link http:// nnswlhd.health.nsw.gov.au/ about/domestic-family-violence/

HealthSpeak

autumn 2014

Lismore Base scans new horizons So far up to 800 patients have have received PET scans.

Robin Osborne visits Lismore Base Hospital’s Imaging Department, which recently marked its first birthday.

The names Positron Emission Tomography (PET), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) hardly roll off the tongue, nor will they be household words to those not needing such high-level diagnostics. But for many patients, and their consulting clinicians, this suite of offerings at Lismore Base Hospital (LBH) is now a vital part of the care regimen.

Barely a year old the hospital’s enhanced imaging department is already regarded as the technological leader in regional/ rural NSW, making it one of the best in Australia.

So far up to 800 patients have received PET scans, according to the department’s manager, Denys Wynn, while Senior Nuclear Medicine Technologist Andrew Dixon was keen to demonstrate the difference between a 2D nuclear bone scan and the extraordinary 3D definition offered by the $3M PET equipment.

That there is a ‘wow’ factor is not only evident to the lay observer but to specialists in the field: later in the day I chanced across a leading North Coast radiologist who described the facility in glowing terms.

While the majority of patients are being investigated for cancers, the system is also “a brilliant tool in looking for infections, and myocardial viability,” Andrew explained.

As the LBH patient information leaflet says, “PET is an advanced molecular imaging procedure which can identify metabolic activity within the body.” Following the intravenous introduction of FDG [Fluorodeoxyglucose], the amount of activity taken up by the organs indicates whether the function of that organ is normal or abnormal, thus allowing for the early detection of disease.

CT scanning, done as part of the procedure, shows exactly where the FDG has been taken up by the body.

HealthSpeak

autumn 2014

Andrew Dixon inspecting a PET scanner.

Senior nuclear medicine technologist Andrew Dixon with LBH’s PET equipment.

LBH radiographers Doug Thompson and Dean Hunt view the results of an MRI scan.

MRI, which uses a magnetic field and radio waves, rather than a nuclear process, to see inside the body, is being increasingly accessed directly by GPs for adult patients (>16 year old) with a range of suspected neurological and musculaskel-

etal conditions, including unexplained seizures, chronic headaches, C spine, and knee/ ACL injury.

These are Medicare rebatable items, while other scans can be performed on a fee for service basis.

Around ten patients a day, ranging from elderly outpatients to neonates born in LBH, are serviced by the MRI facility. Although the noise of the procedure can be somewhat harrowing, the information obtained is vital to patients’ ongoing care.

GPs linked to the PACS storage system have direct access to the scan results, otherwise patients can be given a takeaway CD. The results of PET/CT scans are provided to the relevant specialists, or to staff clinicians in the case of inpatients.

LBH’s state-of-the-art imaging department is more than a clinical success: without the commitment of the local community, medical staff and political representatives, and other advocates, it would never have happened.

Financial contributions ranged from the Ballina branch of the Scopes Club of Australia ($10,500) to the Federal and State governments ($13M and $3.3M respectively), making it a true partnership.

At the sod-turning in late 2011, NNSW LHD Chief Executive Chris Crawford said, “This takes the hospital to the next level.”

One year later, in December 2012, the purpose-built facility was opened, with Scopes Ballina President Leonie Dahl saying, “We have members and their families with cancer and they’d have to travel for treatment and testing…the community pushed for it and made it happen.”

LBH medical imaging is further proof (think, the radiation oncology unit, cardiac cath lab, and more) that ‘Better health care, closer to home’ is no longer a political platitude, but a reality that is prolonging local lives and improving patients’ wellbeing.

13

14

ncml film workshops foster talent

Study: probiotics benefit neonates

Last October’s PITCH held in Lismore screened short films from primary, high school and tertiary students contributing ideas to promote a healthier North Coast.

St Joseph’s Primary School in Tweed Heads won the most outstanding PITCH for their Healthy Eating Healthy Living video.

And in an exciting development, students from Kempsey High School, were awarded the inaugural North Coast Medicare Local’s Chairman’s Award for excellence in health promotion as a result of their enthusiasm and creativity in making a number of short films for the PITCH. Along with some great prizes to help creative films, all the finalists, including Kempsey High school students, were invited to attend media skills workshops in Tweed Heads and Kempsey.

The workshops, run by NCML’s videographer Sara Momtazian, included discussion and reflection on the process of film production, advancing the students’ understanding of story development through storyboarding, and brainstorming exercises. The participants gained hands on experience with the cameras after learning more about the execution and purpose of varying shot types and angles.

“The workshop built confidence in the North Coast students to help tell their stories through film, we will be interested to see how they progress with their film-making,” said Sara.

Italian researchers have found that giving probiotics during the first three months of life may reduce common gastrointestinal disorders in infants.

The study involved 589 fullterm babies less than a week old. Half received Lactobacillus reuteri 17938, given in the form of a daily oral supplement for three months, and half received a placebo.

In both groups parents recorded the number of episodes per day of regurgitation, periods of inconsolable crying (colic) and the number of bowel motions passed. At the end of the three months, the babies who received the probiotic demonstrated significant reductions in average crying time compared to placebo, a significant increase in bowel motions per day and a significant reduction in the average number of regurgitation episodes.

JAMA Paediatrics 2014; online 13 January

From left: Teacher Michael Martin with NCML’s Regional Manager South Donna Burns, with with Kempsey High School students holding their Chairman’s Award plaque.

HealthSpeak

autumn 2014

Organising Clinical Learning

By Prof Iain Graham Dean, School of Health and Human Sciences Southern Cross University

A fundamental question for any university school involved in the education of health practitioners is, “what constitutes a good clinical learning experience?”

The School of Health and Human Science at SCU has been fortunate over the last few years to receive substantive amounts of money to support this aspect of our educational programs from Health Workforce Australia, an agency we have worked closely with. You may have seen our mobile research and learning facility running along the highway providing resources to students on clinical placement in more remote and rural locations. Just one way we seek to answer this question.

We also work closely with the state body, HETI, through the inter-professional clinical training network to create and plan new models of clinical learning which encourage greater inter professional learning among health students; essential for effective teamwork and communication as well as skill development so as to ensure safer patient care.

I always find it curious, that for some people, the fact that nursing, midwifery and allied health students are educated in university courses - not the old Nightingale hospital system - is something they disapprove of.

This isn’t the concern of the general public necessarily. There is some misconception that students today don’t engage in clinical care. I can assure you, and furthermore it is mandated and regulated by each discipline’s accreditation council prescribed by the Commonwealth, that clinical learning is an integral aspect of curricula. As a result, in order to allow students to gain the broadest experience of clinical care the school must carefully consider the organisation of these experiences and meaningfully portray a clinical plan to students.

Such a plan has to be sensitive HealthSpeak

autumn 2014

to social, curricular and instructional criteria so as to guide either the placement based clinical teachers or the academics in the systematic selection of experiences across the curriculum. It also helps with the clinical preparation of students to the various agencies who receive them across the community.

The evolution and reform of healthcare, which I spoke of in an earlier column, is also at our forefront of thinking when considering the needs of students engaged in clinical aspects of their development. In order to address this and answer the question stated, the School is in the fortunate position of running its own health care clinic.

The clinic, at two of the universities campuses, Gold Coast and Lismore, serves as a laboratory for learning for many of our students. There are five services run by the clinic all open to the public and funded through Medicare.

The services are: 1 The student led clinics, osteopathy, exercise physiology, etc.

2 General Practice and Primary Healthcare nursing services 3 Student Counselling and disability services 4 Allied Health Services, podiatry, dietician, remedial massage 5 Faculty Practice and research, Psychology, Mental Health Nurse Practitioner, Diabetic educator This is an exciting way by

SCU’s mobile health facility is a wonderful teaching tool.

I find it curious that some disapprove of health students being educated at university which the school is addressing the challenge of designing clinical learning.

Students are exposed to all services and practitioners as either observers or hands on treatment providers. We are working with public health agencies to provide models of learning, termed service learning, whereby students under supervision, provide direct care to the public, e.g. the occupational therapy paediatric clinic at the Gold Coast.

It is through this means, and others, that we are instilling practice skills and knowledge supporting the emerging primary care model of health care. The contemporary world of healthcare is a complex place. Greater issues of acuity among patients or multiple pathologies, ageing and lifestyle factors require healthcare students today to grapple with cultural, demographic ,gender and social issues that I, when a student nurse with Florence Nightingale didn’t need to think about; and we thought it complex then.

The clinic allows students to provide supervised service to the

public in a place that, although compliant with the standards set by the Australian Patient Safety and Quality Commission, is framed by a different context of care. Inter professional and multiagency working is to be found. The gradual evolution of care pathways and care protocols guides students to best practice guidelines and evidence for practice. The development of relevant IT support and its utilisation in the care plan is also gradually appearing. The clinic’s internal and growing external activities provide unique opportunities for learning and professional development.

The clinic is helping students to gain confidence, capability, and competence, ready to negotiate the changing world of health care provision, as grounded practitioners. What a fabulous way we have at SCU to meet some of the challenges in designing clinical learning experiences.

Bookmark HealthSpeak and read it online HealthSpeak is now online and proving popular with a growing number of readers.

Bookmark it now at: www.issuu.com/ healthspeak

15

Understanding health professionals: Looking at speech pathology What is a speech pathologist?

Speech pathologists study, diagnose and treat communication disorders, including difficulties with speech, language, swallowing, fluency and voice.

They work with people who have difficulty communicating because of developmental delays, stroke, brain injuries, learning disability, intellectual disability, cerebral palsy, dementia and hearing loss, as well as other problems that can affect speech and language.

People who experience difficulties swallowing food and drink safely can also be helped by a speech pathologist. Using assessment tools, speech pathologists are able to diagnose each person’s specific problem and devise a treatment plan that best suits their needs.

Speech pathologists are specialists who work with people across their entire lifespan. An adult

Profile

might visit a speech pathologist to help them understand and find the right words to use after a stroke, while a child might need treatment to help their expressive language or receptive language

(understanding instructions and meanings).

Speech pathologists also work with Augmentative and Alternative Communication (AAC), devices that help people who find

Speech Pathologist Craig Suosaari

Craig came to speech pathology through his leaning towards doing something in the health field while still at high school.

“I remember reading Oliver Sacks and being fascinated by case studies, and I suppose I was originally drawn to the rehabilitation side of the profession, but I currently work primarily with pre-school aged kids.”

Working with Rural Primary Health Services in Port Macquarie, Craig’s job involves providing outreach services to small communities across the Hastings/Macleay area. This year he’ll visit 12 different communities.

His work days regularly start with Craig behind the wheel, driving to a pre-school.

He says his primary focus is to provide universal strategies benefiting the entire preschool population rather than the one on one model tradi-

16

Speech pathologist Craig Suossari with son William in Paris.

tionally used by therapists.

“This occurs through consultancy and capacity building with centre staff or parents and demonstrating group therapy activities targeting various communication skills.

I typically do two to three visits in a day – then drive back to my base at Port Macquarie to tidy up the inevitable administrative duties.”

Craig says he’s had a busy time recently as he’s been on the ACI Rural Health Network RICH Forum working party, and last year he was setting up Video Examples of Speech Pathology Activities that could be accessed online by parents and pre-school teachers.

After 20 years working as a speech pathologist, Craig is still enjoying his work.

“Working within the preschool environment with younger kids is very fun and the outcomes can be significant for relatively little effort.

Kids are constantly amusing and pre-school staff are very appreciative of the service, which makes it very worthwhile.”

Craig says speech pathology also allows him to work in a variety of clinical areas and he’s been able to take up peripheral jobs along the way.

Recently, for example, he’s been doing some part-time lecturing With men representing only three per cent of speech pathologists in Australia, Craig would encourage male high school students to consider speech pathology as a career choice.

And he says he’d encourage parents to act early if they have any concerns or questions about their child’s communication as a relatively small issue could snowball and these are often easily dealt with using simple strategies.

it difficult to speak or write to communicate more easily. This can include ‘unaided systems’ like signing and gestures or ‘aided systems’ like picture charts, books and special computers or devices.

Speech pathology is practised in a wide variety of settings – schools, hospitals, aged care homes, universities, kindergartens, rehabilitation centres, community health centres, private practice and mental health services. Some speech pathologists specialise in areas of ‘complex need’, such as autism or cerebral palsy and may work in specialist intervention services for people with these disabilities.

Speech pathology is studied at undergraduate or masters degree level and is offered at many major Australian universities.

Who do they work with?

Speech pathologists work with many different people with lots of different communication challenges. They could include: Giving feeding advice to a mother whose baby has a cleft palate Working with children who are difficult to understand in a child care centre Helping a primary school student understand what their teacher is telling them Working with a high school student with a stutter to speak more fluently and with confidence Training a teacher who constantly loses their voice to use it more effectively Working with a young man with severe brain injury due to a motorcycle accident to speak clearly again Helping an elderly man with dementia to communicate with his family and carers To find a speech pathologist in your area, go to: www.speechpathologyaustralia.org.au and click on ‘Find a Speech Pathologist’.

(Information from Speech Pathology Australia’s website.)

HealthSpeak

autumn 2014

Veteran Mental Health feature

Specialised Veterans’

mental health support

By Janet Grist The Veterans and Veterans Families Counselling Service (VVCS) provides counselling and group programs to Australian veterans, peacekeepers, F-111 fuel tank maintenance workers and their families. It is a specialised, free and confidential Australia-wide service. It was founded to look after Vietnam veterans, who lobbied for such a service, after the difficulties they faced in returning to Australia after their tour of duty.

VVCS staff are qualified psychologists or social workers with skills in working with veterans, peacekeepers and their families.

They provide support by working through lifestyle, health and family matters as well as issues related to military service or peacekeeping operations.

The only VCSS office on the NSW North Coast is located in Lismore, but there are 24 outreach workers — either social workers or psychologists — who operate from the Queensland border down to south of Coffs Harbour. The VVCS Newcastle HealthSpeak

autumn 2014

office looks after veterans further south in the Medicare Local footprint. There is also an office in Sydney.

HealthSpeak visited VVCS counsellor Kylie Watson in the spacious Lismore premises to find out more about the work of VVCS counsellors and the issues and challenges faced by returned defence personnel.

HealthSpeak: Kylie, how did you come to work in this particular field?

Kylie: I was working as a Community health social worker in the Hunter V alley and the fulltime VVCS counsellor wanted to run a Partners of Veterans Group Program and needed a co-facilitator. I worked with him and found it really interesting work.

For me the time was right, I was ready to move, and a job came up in Sydney. I started working in the Sydney office 11 years ago and I’ve been in Lismore for about nine years now.

HealthSpeak: What’s the profile of the veterans you see?

Kylie: In the Lismore office it has similarities to the national picture. VVCS is a service that sees all veterans from all conflicts.

The difference with the North Coast is that we still see a lot of Vietnam veterans coming to the service for the first time, and statistically it’s a little anomalous from the national picture. Elsewhere the figure is lower, but the North Coast and Tasmania have a similar profile. We have a larger proportion of Vietnam veterans and their partners and wives, possibly because of the sea change/ tree change phenomenon.

HealthSpeak: What makes these veterans come to you after so long?

Kylie: They are often saying they need to get a bit more of an understanding of what might be going on in their relationship or for their partner. Vietnam veterans are an important group to mention because their coming home experience was very traumatic, and probably for a lot of them that’s the issue that they

Many feel there’s a lack of appreciation for their service

Continued next page 17

feature Veteran Mental Health

Most of us walk around and don’t give these people a thought

From previous page bring into counselling, as well as the trauma they experienced during their service.

Over the past few years we are seeing a lot of contemporary veterans — a lot of Timor, Iraq, Afghanistan, Gulf War One and Two veterans and those involved in peacekeeping operations deployed in places such as Somalia and Cambodia. We know, of course, that these operations were often not peaceful at all, but their rules of engagement were around being there as a peacekeeping presence which really impacts on how they present clinically. In their duties, they are holding a weapon they are trained to use, but not able to use it.

We also see partners of the younger contemporary conflict personnel. Personally, I have all of these veterans as clients. I also have Vietnam veterans who served in peace time but didn’t get to deploy, which can also cause some adjustment or mental heath issues. I also see the more contemporary veterans from Timor right through to now with the withdrawal from Afghanistan.

HealthSpeak: What sort of conditions do they present with?

Kylie: VVCS is a mental health service delivery agency so counsellors see a range of mental health conditions. The classic things we see are anxiety, depression and Post Traumatic Stress Disorder (PTSD).

We also see a lot of psychologi-

18

cal adjustment issues — adjustment to living in the civilian world when you’ve been living in a military world which operates very differently, not wearing a uniform and identity issues are all symptomatic of a detachment from military life. Apart from the more obvious mental health issues we also deal with relationship issues, loss and grief, parenting and family issues. The COPMI / Children of Parent/s with Mental Illness Model is useful in promoting better mental health outcomes for children who have a parent with mental illness and dealing with its impacts on the child. Some individuals also have physical health issues like chronic pain. With men in particular this can show as anger management and relationship issues.

Fortunately VVCS runs group programs that can assist — groups that deal with anger management, anxiety, depression, lifestyle issues and sleeping better.

HealthSpeak: These sound like significant burdens.

Kylie: It must be very difficult to walk in some of those shoes.

You really get an insight into the world of conflict being so different to ours. And that’s another issue that brings them to counselling, the fact that the civilian world is such a different world to live in. They sense that the majority of people just don’t understand what their world is like now because of the impact of their military training and because of the adjustment to living

in a civilian world. For instance, they might hear the classic things like a car backfire and they’ll be in ‘rote mode’ — they’ll hit the deck and go to draw their weapon. For some, they’ll do all these military activities and it takes a long time to adjust to normal life. While most serving personnel do cope, a lot of the veterans we see are still dealing with those issues and still having to ground themselves and reduce their anxious arousal.

HealthSpeak: Are there particular differences in veterans from earlier and later conflicts?

Kylie: The major difference is that people living in the nonmilitary world have been able to separate politics from the troops issue. There are welcome home parades and an honouring of th e individuals wearing the uniform and doing the jobs that the politicians decided they would do. It makes a significant difference to their sense of feeling appreciated and valued for doing these jobs which most people wouldn’t want to do. Most of us walk around in our day-to-day world and don’t give these people a thought.

Many Vietnam veterans feel that there’s a complete lack of appreciation and acknowledgement of the service they gave to this country. In fact, because of the politics, there wasn’t that ability to separate the individuals who put the uniform on to go and do the job — and some of them were conscripted. That seems to have shifted now.

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autumn 2014

Veteran Mental Health feature

Photos courtesy of ADF

HealthSpeak: It sounds like challenging, but fulfilling work.

that realm of emotion. It might be what some might see as quite small goals, like being able to tell a family member that they love and care about them. Or it might be about becoming the Dad they want to be to their child or the other end of the spectrum, to have an ability to manage what happens in their minds when they try to lay their head down and go to sleep at night.

The big difficulty for VVCS is we are constantly hearing from veterans, particularly young guys who didn’t know that the counselling service existed. Defence and DVA actively promote VVCS counselling services and the online self-help resources that are available on DVA’s At Ease website on social media and through advertising campaigns.

The trouble is that often people do not recall that a service exists until they are in crisis.

Kylie: I think we are very privileged in that we do see people significantly change in their life. It might be that a person can’t engage on an intimate or emotional level with anybody because they are so cut off from

More information For crisis support and counselling, phone 1800 011 046. In business hours this will connect with the nearest VVCS centre. Outside business hours it connects with Veterans Line,

HealthSpeak: This is clearly very specialised work.

Kylie: These are a unique set of clients to work with and there’s cultural knowledge that the counsellor needs to have to assist to engage with the client.

There are all those challenges, but I think VVCS counsellors are a unique bunch of people. They generally work in this field for quite a while and recently I heard the Secretary of the Department of Veterans’ Affairs say that “The view within the Department is that the counsellors who work for VVCS are very passionate about the work they do because it’s such a unique opportunity and a privilege to work with these people.”

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the VVCS after hours telephone counselling service.

DVA’s At Ease website: (www. at-ease.dva.gov.au) has mental health information and resources for the veteran community and providers.

Members of the veteran community experiencing physical or mental health symptoms are encouraged to see their GP. To help overcome the stigma associated with mental health, DVA has developed a series of short videos featuring current serving men and women, veterans and family members, sharing their experiences. These can be viewed at www.youtube. com/DVAAus or at DVA’s Facebook page www.facebook.com/ DVAAUS.

We do see people significantly change in their life

If you would like more information on related topics such as Combat Experience in Vietnam and its Effects, Effects on Military-Related Stress on Relationships and in the Civilian Work Environment, the Department of Veterans Affairs has a series of fact sheets. They can be found here: http://www.dva.gov.au/health_and_ wellbeing/health_programs/vvcs/ Pages/VVCS_factsheets.aspx

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The Koori Grapevine 6,066 pairs of glasses to fix eye health... ...And, along with that, we need 39,292 annual eye examinations for diabetic retinopathy and 4,382 cataract surgeries!

These are some of the findings of two ground-breaking studies lead by Dr Ya-seng Hsueh and Professor Hugh Taylor of the University of Melbourne published in the Australian Journal of Rural Health (AJRH).

The studies are the first to estimate the extent of spending needed to overcome the serious eye health gap faced by Aboriginal and Torres Strait Islander people in Australia.

“Although Indigenous Australian children have better vision than non-Indigenous children, the rate of blindness aged 40 and above is six times higher than for non-Indigenous Australians.

Moreover, 94 per cent of this vision loss is either preventable or treatable,” Prof Taylor said.

“We know that 35 per cent of Indigenous adults report that they have never had an eye examination, compared with just 8.9 per cent of the general population.

There are an estimated 3,300 Indigenous adults who are blind

and another 15,000 with low vision.

“Four conditions – cataract, refractive error, diabetic retinopathy and trachoma – cause the vast majority of vision loss in Indigenous Australians.” (As specific funding is allocated for trachoma, it was excluded from the reported studies.)

The first study developed a sophisticated costing model to estimate the current spending and additional funds required to close the gap for vision. It considered the three major eye conditions that cause vision loss (cataract surgery, refractive error and diabetic retinopathy) and found that $45.5 million a year was required to fully meet the eye care required for the three conditions.

The current expenditure for treating these eye conditions is

estimated at $17.4 million a year.

Therefore, an additional $28 million a year is required to close the gap in eye health.

“This is only a small fraction of the overall annual Australian health budget. What is an even bigger challenge is making it easier for Indigenous patients to access services which already exist. That’s where our companion study is really important,” Prof Taylor said.

“There are Government programs to meet the challenges of the eye health gap, but many Indigenous Australians do not use them.

“Accessing eye care is complex: there are multiple layers of service and multiple entry points to eye services. Clinical pathways for treatment of eye conditions often involve multiple steps and

appointments for appropriate treatment.

“Appropriate referrals are difficult to make when health staff are not aware of the steps involved, and referral is particularly difficult in locations with limited services and infrequent visiting services.

The patient journey is like a ‘leaky pipe’ where individual users, like water, tend to leak from the system at each step along the way,” Prof Taylor explained.

The second study estimates that the workforce required for eye care coordination is 8.3 EFT per 10,000 Aboriginal and Torres Strait Islander people which would require approximately $21.3m – part of the extra $45.5 million needed.

“This would provide critical resources to make the eye gap effectively closed by assisting patients with ancillary tasks including transport, organising clinics and assisting with hospital attendances,” Dr Hsueh said.

Learn more about AJRH at www. ruralhealth.org.au/ajrh and access AJRH contents listing at onlinelibrary.wiley.com/journal/10.1111/ (ISSN)1440-1584

Ken Bolt: Volunteer of the Year

Ken Bolt

Late last year Tweed Byron & Ballina Community Transport (TBBCT) driver Ken Bolt, who works in their Aboriginal transport team,was honoured with the NSW Volunteer of the Year award at

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a ceremony in Sydney.

TBBCT Manager Phil Barron said Ken’s volunteer work was important as it immediately benefits Aboriginal health inequity, helping to ‘close the gap’ between Aboriginal and non-Aboriginal life expectancy.

“Without Ken’s commitment, TBBCT would find it difficult to provide culturally appropriate options for Aboriginal people who feel comfortable having a driver they can relate to,” he said.

Ken has worked as a volunteer with TBBCT’s Aboriginal transport program since it began, more than ten years ago.

During this time he has com-

Koori Grapevine

pleted more than 3,500 trips, driving frail and sick people nearly 150,000 kilometres.

There have been many times where clients have cancelled at the door, because they are too unwell to travel. Ken takes this all in his stride without judgment, and does not complain.

He will be there for the next trip or to help out in any way he can.

He drives patients to their renal dialysis treatment three days per week using his own vehicle or a community car.

His passengers are frail and have chronic disease. He drives about 100 kilometres each day to and from isolated com-

munities and either Ballina or Lismore Base Hospital. There is a wait of four to six hours for the treatment, and Ken then helps patients back into the car and drives them home.

“Ken is regarded as a role model for his community because of his commitment and dedication to the service.

TBBCT has been able to grow its service to the Aboriginal and Torres Strait Islander community over the past 10 years largely because of the dedication of Ken and our Aboriginal Transport team,” Phil said.

Congratulations to Ken from all at North Coast Medicare Local.

New Aboriginal Partnership Agreement A new health partnership agreement aims to improve health outcomes for the Aboriginal population in Northern NSW and boost efficiencies in the health system through joint projects and shared information.

The Northern NSW Local Health District (NNSW LHD), the North Coast NSW Medicare Local (NCML) and the three community controlled Aboriginal Medical Services (AMSes) within the LHD footprint signed a new Aboriginal Partnership Agreement at Casino District Hospital in early February.

The three AMSes are Casino AMS in the Richmond Valley, Bulgarr Ngaru AMS in the Clarence Valley and Bullinah AMS in Ballina.

The Lismore AMS will be an observer member, while it works towards becoming an Aboriginal Community Controlled organisation.

The Aboriginal Partnership is a forum of Board Chairs and Chief Executives of the Member Organisations and the work of the Partnership will include:

At back Greg Telford, Managing Director Rekindling the Spirit; Jeff Richardson, Rekindling the Spirit; Scott Monaghan, CEO Bulgarr Ngaru; Jenny Smith, NNSW LHD Aboriginal Health Manager; Vahid Saberi, CEO North Coast Medicare Local; Chris Crawford, CEO NNSW LHD; Nancy Walke, Bullinah AMS Chair; Chris Clark, General Manager North, North Coast Medicare Local; Mark Moore CE Bullinah, Monika Wheeler, Aboriginal Program Manager, North Coast Medicare Local. Kneeling: Christine Wilson, Practice Manager Lismore AMS At desk: Steve Blunden, CEO Casino AMS and Brian Pezzutti, NNSW LHD Chair.

co-operating in identifying service gaps and developing shared solutions developing agreed positions relating to Aboriginal health policy, strategic planning, equity in service allocation and distribution of resources

First Taste, exploring the social history of alcohol use Maggie Brady, a social anthropologist from the Australian National University, has written a series of short books called First Taste, which explores the social history of alcohol use in Australia.

The series of six booklets investigates the factors that have been a foundation for Indigenous drinking habits.

The booklets provide a complete analysis of the history relating to the introduction of alcohol to Indigenous Australians.

Topics covered by the booklets include: the first taste of alcohol strong liquor arriving in the northern region of Australia how the English taught the Aborigi-

nal people drinking customs effects of the ban on drinking alcohol.

In a summary of the booklets, the Foundation for Alcohol Research and Education (FARE) says stereotyped ideas about the history of alcohol use and Aboriginal and Torres Strait Islander people can create fatalism, and these booklets take a more positive approach to the past.

The booklets are designed for students, health workers and those working in alcohol and other drug issues, and for anyone wanting to learn more about this history.

Obtain a copy of First Taste from the Foundation for Alcohol Research and Education at: http://www.fare.org.au/shopping/ first-taste/

negotiating agreed positions to undertake joint projects sharing information concerning proposed activities, including intended funding applications that may impact

on other members of the Partnership monitoring national and state health reforms. ensuring that Aboriginal health retains a high priority.

Sports, recreation good for health A paper released on the Closing the Gap Clearinghouse website (http://www.aihw.gov.au/ closingthegap) shows that there are many benefits to Aboriginal and Torres Strait Islander communities from participation in sport and recreational programs.

These include improvements in school retention, attitudes towards learning, social and cognitive skills, physical and mental health and wellbeing; increased social inclusion and cohesion; increased validation of and connection to culture; and some evidence of crime reduction.

The paper, Supporting healthy communities through sports and recreation programs, reviewed more than 30 studies, covering all geographic areas from inner city to remote regions, and age groups ranging from primary school to young adult.

The paper shows that although the effects of sports and recreation programs can be powerful and transformative, these effects tend to be indirect and therefore

hard to measure.

For example, programs to reduce juvenile antisocial behaviour largely work through diversion. These can provide alternative and safer opportunities for risk-taking, for maintenance of social status, and in building healthy relationships with elders.

The paper’s authors focussed on some of the principles that can help ensure that such programs are successful. These include: Linking sports and recreation programs with other services and opportunities; Promoting a program rather than a desired outcome; Engaging the community in the planning and implementation of programs, as this will ensure that the program is culturally appropriate, and potentially sustainable.

Koori Grapevine

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Arts Health and Wellbeing The Art of Refuge

By Janis Balodis Dear refuge of my weary soul, On thee, when sorrows rise, On thee, when waves of trouble roll, My fainting hope relies.

These devotional words are from Anne Steele, an eighteenth century writer of hymns. However, the sentiment just as readily applies to the place that art has played in the wild and sometimes troubled life of indigenous artist Adrian ‘Cheesy’ Cameron. Art has ever been, and continues to be his hope and his refuge.

A quietly spoken, even shy man, Adrian has lived in Lismore all his life - when not in boys’ homes or gaols. He was born at Lismore Base Hospital as a ward of the state and immediately fostered out to a local family. By the time he was admitted to Maitland Jail at 16 he had been to every boys’ home in New South Wales where he bears testament to their emerging sorrowful history of routine thrashings, abuse and racial vilification.

What followed was years of drug and alcohol addiction, and a seemingly unbreakable cycle of drug-related crime followed by prison time. Yet break it he did with the assistance of a former parole officer, Pat Coughlan, the Lismore Aboriginal Medical Service and support from the Rekindling the Spirit men’s group.

When looking at Adrian’s art it is hard to

When he has not been able to paint it was because his life was too wild Adrian Cameron, Bundjalung artist, with some of his paintings.

imagine the impossibly hectic and chaotic pace of the several lives that he has crammed into forty plus years. At the heart of his paintings is a quiet beauty and sense of peace that belies the turbulence of his life.

Adrian has always liked art from when he was at school, where it was fostered by default. By his own admission he was not much of a student and the teacher would give him pencils and paper and send him to draw out the back. He continued to make art in the boys’ homes and took up painting in earnest while in jail.

Self-taught and despite everything, Adrian has been painting for most of his life. He says it calms him right down and that he gets depressed if he cannot paint. When he has not been able to paint it was either because his life was too wild or because of a lack of materials.

A collection of his gaol paintings from 1996 resurfaced recently. They have been restored and reframed and presented to the Lismore Aboriginal Medical Service where his painting “The Four Jullums” graces the entry and provides the image for their logo. Adrian usually sells his work by word of mouth when he finishes them, so to see a group of them together is to get to appreciate their delicacy and stillness, whether it is “Two Fishes Meeting” or “Tucki Tucki Bora Ring”. To see Adrian look at these works after 15 years is to witness a deep connection to some inner place.

His most recent work “The Goanna Headland” took him eight weeks to complete, one match-head paint dot at a time, chainsmoking to keep his anxiety at bay. It contains a compelling and meditative power.

Life is good at the moment for Adrian. He is working on a commission and there are plans to collect digital prints of his paintings in an e-booklet so that we can all share in his hard-won refuge.

Goanna Headland. This painting depicts the goanna and snake in battle at Coraki. They fought each other from Coraki to Evans Head.

When the snake went out to sea the goanna rested on top of the headland and is still there waiting for the snake to come back.

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HealthSpeak autumn 2014

A dynamic collaboration

By Clare McGregor My Radio Heart is a ground-breaking new theatre show commissioned by Lismorebased theatre company NORPA. Developed in collaboration with Western Sydney based Urban Theatre Projects (UTP), the show features a mixed abilities experimental sound ensemble – Tralala Blip – as both actors and composers.

The show will premiere at Lismore City Hall this month before travelling to Sydney for a season at Bankstown Arts Centre in April.

Two years in the making, My Radio Heart immerses audiences in a breathtaking fantasy world of cinematic audio-visuals powered by an original soundtrack of rock, pop and electronic music. Traversing natural and virtual worlds in the search for love, My Radio Heart promises to be an up close and personal theatre experience like no other.

My Radio Heart director and designer Rosie Dennis from UTP has more than 10 years’ experience working with people living with a disability.

Dennis and NORPA’s Artistic Director Julian Louis have brought together a formidable creative team including acclaimed sound artists Lawrence HealthSpeak autumn 2014

English (Room40) and Randolph Reimann (Tralala Blip) and video designer Sam James. Joining the ensemble is Claudie Frock, whom Northern Rivers locals may know as her alter ego Peggy Popart.

Students from Wilson Park School in Lismore have also been involved in the creative process, contributing to Samuel James’ extraordinary video design.

Director Rosie Dennis said she couldn’t ask for a more generous group of performers and collaborators.

“They’ve dived into an unfamiliar process and have embraced it with gusto and humour. I think audiences are in for a real treat,” she said.

NORPA’s artistic director Julian Louis said he’d wanted to create a show with Tralala Blip from the first time he saw them perform in 2011.

“To see them working with Rosie and a team of this calibre is very exciting. It’s inspiring to see what has grown out of this work on so many levels: the collaboration with our local community of people living with disability; the urban-regional crossover; the positive creative and personal effect on each of the project artists involved. And of course the effect My Radio Heart will have on the audience. We can’t wait to share it.”

What sets My Radio Heart apart from existing disability art programs is that the project offers all participants a highly professional theatrical engagement that not only focuses on skills development and exchange, but also provides the necessary support for them to feel a strong sense of achievement and ownership throughout the creative process.

An integral part to the My Radio Heart project has been creative workshops with Wilson Park Public School - a Lismore school catering for students with disability from Kindergarten through to Year 12, providing quality education through personalised learning plans.

With the support of the teaching staff, the creative team worked with students, teaching them new choreographies using Tralala Blip’s original beats and music to bring out the ‘dance’ in everyday movements.

The school principal, Helen Rea, recognised the project as an incredible opportunity for her students to be exposed to new art making practices that have a significant impact on their daily lives and provide a lasting legacy.

Working with internationally renowned ensemble Tralala Blip proved particularly inspirational for the students.

My Radio Heart is an ambitious project that acts as a catalyst for

Phoebe Kate Rose and Lydia Dunbar, My Radio Heart.

Background by video artist Sam James, photo by Donatella Parisini.

conversation between artists living with disability and the wider community, both in regional and metropolitan Australia. The work challenges the perceptions of what it is to live with disability and our own perceptions of the world around us. My Radio Heart celebrates diversity and transcends the social stigma and stereotype surrounding people living with disability.

My Radio Heart performances: Lismore season (NORPA) Wed 26 March at 7.30pm (NORPA fundraiser. Money raised goes to NORPA’s Bundjalung Project, creating a new work engaging with the local community and Bundjalung stories). Thurs 27 March, 7.30pm, Fri 28 and Sat 29 March at 11am and 7.30 pm at Lismore City Hall.

Sydney Season (UTP) Wed 9 April, at 11am and 7.30pm, Thurs 10, Fri 11 and Sat 12 April at 7.30pm at Bankstown Arts Centre.

For more information, go to: www.norpa.org.au

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Treating lower limb ulcers leading to clawing of toes and prominence of the metatarsal heads. Loss of sensory nerves leads to repeated trauma and loss of autonomic nerves leads to loss of skin turgor.

Neuropathy combined with poor healing in diabetics will go on to ulceration and infection which can get out of control very quickly.

By Dr Deepak Williams This is the first in a series of articles from North Coast vascular surgeons on advances in the management of peripheral vascular disease. Dr Williams, a vascular surgeon practising at St Vincent's Hospital in Lismore, starts off with an overview of the subject.

Lower limb ulceration affects 1% of the adult population, and 3.6 % of people over the age of 65. Leg ulcers are debilitating and can be painful, and greatly reduce patients’ quality of life. They also have a great impact on the economy as significant resources are spent to treat, prevent or decelerate the progression of disease.

The causes of lower limb ulceration are many: Venous disease Arterial disease Mixed venous-arterial disease Neuropathy Trauma Obesity or immobility Vasculitis Malignancy Underlying osteomyelitis Blood dyscrasias Lymphoedema Necrobiosis lipoidica diabetecorum Pyoderma gangrenosum Self-inflicted

CVI is a serious and progressive disease and severity is classified according to CEAP Classification, as shown in the diagram above, and is based on the clinical classification, etiology, anatomy and the underlying pathology.

There is excellent data now that the best way to treat superficial venous reflux is surgery, whereas deep venous reflux is best treated with compression bandages or stockings in the community.

The recurrence rate of VLUs has been reported to be between 40 to 69%. The majority of recurrences can be prevented with Grade II compression stockings, but for severe venous hypertension and large diameter calves Grade III stockings are required.

have heightened endothelial and platelet activation secondary to pro-inflammatory/pro-thrombotic state, among other complex processes.

Some risk factors for PAD include smoking, diabetes mellitus, hypertension, elevated LDL, elevated fibrinogen and advanced age.. Thrombotic events due to emboli from heart, aneurysms, plaques, and hypercoagulable states may also be responsible for developing ischaemic ulcers.

Typical investigations include measurement of the ankle brachial index (the ratio of the blood pressure in the lower legs to the blood pressure in the arm), ultrasonography and arteriography. Treatment requires lower limb revascularization, best done by angioplasty and occasionally bypass surgery.

Arterial Leg Ulcers Neuropathic Ulcers

However 90% of all ulcers are caused by venous disease, arterial disease and neuropathy.

Venous Leg Ulcers Venous leg ulcers (VLUs) constitute nearly 70% of all lower limb ulcers. The main cause of VLUs is chronic venous insufficiency (CVI). This can be due to reflux in superficial veins or in the deep veins or both. These ulcers are typically found in the ‘gaiter area’ above the medial malleolus and are accompanied by tell-tale skin changes and pigmentation. VLUs can also be caused by venous outflow obstruction or a combination of both reflux and obstruction. Venous ultrasonography is an essential tool in delineating site of reflux or obstruction.

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Arterial ulcers are caused by arterial insufficiency, usually due to atherosclerosis. Many arterial pathologies can lead to arterial ulcers, but one unifying cause is arterial obstruction. Arterial ulcers constitute 10 to 30% of all ulcers. They are typically painful and affect the toes and/ or pressure points such as heel, malleoli, and shin. Patients with peripheral arterial disease (PAD)

These are the next most common type of leg ulcers, comprising of 15 to 20% 0f all ulcers. Typically these are patients with diabetes which is poorly controlled and/or longstanding. Nearly 60 to 70% of all diabetics have neuropathy, 15 to 20% have PAD only, and 15 to 20% have both. The neuropathy involves all three kinds of nerves – motor, sensory and autonomic. The involvement of motor nerves causes atrophy of the muscles of the foot and leg,

Mixed Aetiologies About 14% of all ulcers have mixed arterio-venous aetiology and rarely about 2% have mixed venous and lymphatic disease.

Obesity With rising obesity in the developed world, there is an increasing incidence of lower limb ulceration in these patients which is often due to undetected venous outflow obstruction.

When to Refer The general recommendation is that specialist opinion should be sought if an ulcer is not showing signs of healing in 4 to 8 weeks’ time. Early intervention not only promotes prompt healing but also reduces recurrence.

The majority of VLUs can be treated in the primary setting.

Specialist opinion should be sought if: There is diagnostic uncertainty Atypical ulcer characteristics and location Suspicion of malignancy Treatment of underlying conditions, including diabetes mellitus, rheumatoid arthritis and vasculitis PAD indicated by ABPI less than 0.8 or more than 1.2 Ulcers have not healed within three months Recurring Ulcer Healed Ulcer with a view to venous surgery Antibiotic resistant infected ulcers Ulcers with uncontrollable pain Patients with traumatic injury with history of venous disease

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autumn 2014

St Vincent’s new theatres bring capacity and scope to North Coast “We now offer sophisticated medical and surgical services at St Vincent that you would normally find in a major city.”

This is how Chief Executive Officer, Mr Tim Allsopp, describes the new theatre development at St Vincent’s Private Hospital in Lismore.

The upgrade of three theatres and construction of two new theatres at St Vincent’s means an increase in scope for new and more complex procedures at the Hospital.

“We can offer specialists more flexibility and availability in our surgical session timetable, as our capacity is much greater,” he said.

Mr Allsopp said the new hybrid theatre allowed for more intricate procedures.

“And with the combination of the interventional and imaging equipment, there is faster patient recovery,” he added.

The angiography hybrid machine has a five axis movement which enables a full body image without moving the patient or the table.

“It’s different from conventional operating rooms as the hybrid machine enables specialists to perform procedures using real time direction and to manage peri-operative complications all in one encounter.”

The theatres include modular, radiotranslucent surgical tables synchronised with the state-ofthe-art angiographic equipment.

This means specialists can perform multiple interventions in one session.

The hybrid theatre provides

Briefs

Herpes vax trials prove safe Australian Professor Ian Frazer says a vaccine he developed to treat the herpes simplex virus (HSV-2) has been proved safe in a phase 1 clinical trial.

According to interim

HealthSpeak

autumn 2014

One of three theatres which St Vincent’s hospital has refurbished.

opportunities for collaboration between specialists such as cardiologists, cardiac surgeons, interventional radiologists and vascular surgeons. This results in more efficient workflow and more streamlined, coordinated care for the patients.

“With the imaging and surgery taking place in the same room there is no need for transportation from the operating room to radiology and back to the theatre. This reduces treatment time for the patient.

“We can give our patients not only improved outcomes but also peace of mind that they are being treated with the latest technology with the support of St Vincent’s highly reputable and dedicated care,” Mr Allsopp said.

He said St Vincent’s new theatres provided opportunities for specialists to perform new

results, the vaccine was found safe in 20 Brisbane patients who received three injected doses. The study also found the vaccine generates T-cell response to eradicate the virus.

Prof Frazer described the results as very encouraging and said a second clinical study would be progressing with patients infected with HSV-2. Further data should be available later this year.

combinations of endovascular, laparoscopic and open procedures in the same operating room.

“It’s important for patients to have access to state of the art hospital care in their local area as travelling outside the North Coast adds extra challenges for patients, not just financially but also comfort and emotional costs.”

The equipment in the hybrid theatre is the first time two large organisations, Toshiba and Maquet, have worked collectively

on a hospital project, bringing together two world leaders in imaging and interventional surgical machines.

Coordinated by Nurse Unit Manager and project supervisor, Desiree Bryant, the $8 million development includes two additional theatres, a new eight-bed recovery room and a new staff room, in addition to the upgrade of the three theatres.

“Having Desiree work closely with the project managers and builders has meant staff input into decisions including layout of rooms and patient flows, to the number of equipment charging bays in the recovery room. Details like this make a difference to patient comfort and enhance staff performance,” Mr Allsopp said.

The theatres are the final stage in a four-year plan that has included the expansion of the medical suites, the new conference centre facilities and the development of St Joseph’s Nursing Home.

Mr Allsopp said patient satisfaction ratings tell St Vincent’s that its nursing care is among the best in Australia.

“But we can now say the technology we offer is at international standard,” he added.

Indigenous vax rates continue to improve Vaccination programs are helping to reduce the high rates of communicable diseases among Indigenous Australians, according to a national report.

Hepatitis A is now less prevalent in Aboriginal and Torres Strait Islander children than their non-Indigenous counterparts, according to the National Centre for Immunisation Research and Surveillance (NCIRS) report.

From 2006 to 2010, no Indigenous children under 6 were hospitalised for hepatitis A, compared with 20 children admitted to hospital between

2002 and 2005.This follows a targeted vaccination program which commenced in 2005.

The report also states that meningoccocal C rates have also dropped since an infants and high-school catch up program commenced in 2003.

Unfortunately there are still very high rates of meningococcal B in young Aboriginal children.

On the down side, hospitalisation rates for severe rotavirus disease, pneumonia and influenza remain far higher among the Indigenous population.

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Online exam prep reaps rewards

By Amanda Shoebridge NCGPT

North Coast GP Training (NCGPT) has been helping registrars prepare for the College’s fellowship exams since NCGPT began more than 10 years ago.

Last year we introduced additional exam preparation tutorials which were eagerly received.

Face-to-face and hands-on learning have always been a critical component of our teaching program, and will remain so. However, there are access issues with face-to-face learning for people who are geographically challenged or with pressing priorities such as parenthood. To combat this, NCGPT introduced online webinars in 2013 allowing registrars to participate from their homes or practices.

The beauty of webinars is the interactive component - you can ask questions and share ideas

Inaugural RICH Forum The first Rural Innovations Changing Healthcare or RICH Forum will be run on March 14 Presented by the ACI Rural Health network, the forum will be virtual in design linking up to two rural or regional satellite groups per LHD via videoconference. Presentations will showcase innovative rural working models of care which have potential for broader implementation. To share lessons learned, decrease duplication and increase collaboration across rural health sectors.

Find our more at: https:// www.facebook.com/groups/ rich2014 Enquries about this and future forums to Jenny Preece: jenny.preece@aci.health.nsw. gov.au

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GotoMeeting Video Teleconferencing

with other participants.

Our webinars helped overcome issues of geography; however the difficulty of scheduling a time for the webinars for those rostered on call, or swept away by the demands of family or life, remained.

And so began our entrée into the e-Learning space. Our new Exam Preparation Program, run

by NCGPT’s Associate Director of Training, Dr Genevieve Yates, blends components of online tutorials, webinars and face-to-face learning into a mix she hopes will suit all.

“This is multifaceted learning.

We are still offering face-to-face learning options and interactive webinars, but our new online component provides a branch into asynchronous learning where people can learn independently, in their own time and in any location that suits,” she said.

The new asynchronous learning environment provides teaching materials and tools, including a common conference space, where users can post questions which are answered daily by a Medical Educator, and can read and respond to messages. Learners can share resources, lecture notes or journal articles and create a growing knowledge space.

There are advantages and disadvantages to online learning.

It’s flexible and allows learners to breeze over topics they know and concentrate on those they don’t. However not everybody learns well this way. It requires self-motivation, there is no immediate access to a trainer for

help with difficult or technical content and, although there is interaction through facilitated forums and chat boards, there isn’t always the ability to learn through collaboration. This is why creating a mix of differ-

NET Program helps OTDs to prepare for their relevant exams.

Initiatives such as the Areas of Need Program, which encourages these doctors to work in areas of workforce shortage, has seen many migrate to remote or regional areas where issues of distance, access to support and training and professional isolation can be more pronounced.

Now OTDs have a better chance of accessing training assistance and advice to help them along the road towards Fellowship.

To top off our online expedition, this year NCGPT will launch its e-Learning platform, Moodle. Moodle is a collaborative, open source learning platform which will house NCGPT’s learning manuals, programs, policies, documents, articles, journals and exams.

NCGPT has moved cau-

“For some time Overseas Trained Doctors have struggled to establish study groups to support them in their examination preparation and the online program meets this need.

In addition, the Overseas Trained Doctor can identify the benchmark for success against Australian trained registrars and this has proven to be most beneficial. The program also assists in refining communication skills so vital to successful examination outcomes”. Sharyn Corben, Program Manager NCGPT. ent learning media, and access to collaborative learning is so important.

And it seems our exam preparation workshops are starting to pay dividends. Just last month one of our registrars, Dr Luke Hogan from Alstonville Clinic, received news that he had topped the state of NSW and also the ACT in his recent RACGP OSCE exam.

“The support and teaching from NCGPT has been outstanding. The GP medical educators have been encouraging and enthusiastic throughout training. I particularly appreciated the extra exam preparation workshops that kept me motivated towards the exam,” said Dr Hogan.

Some of the first to benefit from NCGPT’s e-Learning opportunities are our Overseas Trained Doctors (OTDs).

Recognising the additional barriers they face, the OTD-

tiously into the e-Learning space. We have adopted the ‘Blended Learning’ approach where on-line activities complement face-to-face training, not replace it. Because, while we are enthusiastic about the value of online learning, we are still keen to preserve our focus on face-toface teaching and personalised support for the doctors in our programs.

To find out more about NCGPT’s medical education programs, call 6681 5711 or email info@ncgpt.org.au.

Limited places are available for the 2014 OTDNET program.

Call Program Manager Sharyn Corben on 6681 5711 or email sharync@ncgpt.org.au North Coast GP Training is the Commonwealth funded Regional Training Provider delivering the Australian General Practice Training and Prevocational General Practice Placements programs on the North Coast of NSW. HealthSpeak

autumn 2014

First regional pop up hiv testing The North Coast hosted Australia’s first regional pop-up rapid HIV testing site, with staff from ACON and the Mid North Coast and Northern NSW Local Health Districts operating the service at Lismore in late December.

The NSW HIV Strategy reports 20-30% of HIV infection in the State is undiagnosed.

Expanded HIV screening to men who have sex with men (MSM) is key to reaching the Strategy’s target of an 80% reduction in HIV transmissions among MSM by 2020.

The pop-up testing caravan was set up at the Tropical Fruits Festival (a GLBTI community group) at Lismore Showground from 10.30am on December 30 until 4pm on New Year’s Eve. The pop-up site was a partnership between the NSW Ministry of Health, Northern NSW and Mid North Coast Local Health Districts, ACON and SydPath, St Vincent’s Pathology.

The collaborative approach to hosting the service in a community setting and use of peer educators offered a non-medicalised option of HIV screening intended to appeal to men who were at high risk of HIV transmission or who were not otherwise testing at recommended frequency of twice a year.

Back from left: Tobin Saunders, Samara Kitchener, Deb Wilson, David Smith, Jenny Dowell, Jenny Heslop, Marie Reilly. Front left: Neil McKellar-Stewart, Dermot Ryan.

In total, 274 people, mainly gay men, engaged with peer educators during the pop-up and 49 were tested. A significant number of men who tested reported several factors which put them at high risk of HIV transmission. Of people surveyed, 75% reported learning more about testing frequency and 58% indicated that they were previously not aware that rapid HIV testing was available in NSW. All indicated that they were comfortable testing for HIV in that setting.

Rapid HIV tests are now available at Lismore Sexual HealthService, with a result available within 30 minutes. Testing leads to early diagnosis, enabling early treatment with antiretrovirals, which not only improve health and wellbeing but also reduce the risk of transmitting HIV to others.

ACON’s Northern Rivers General Manager, Marie Reilly, said making rapid HIV testing available at a regional gay community event was successful in raising awareness of this new

Smoking rate 14% on the North Coast The National Health Performance Authority (NHPA) has for the first time presented statistics on smoking rates across Australia.

In North Coast Medicare Local’s footprint, during 2011/2012 smoking rates were estimated at 14 per cent for adult daily smokers. It is pleasing that the report noted that this percentage rate was statistically significantly different from the peer group result (other Regional 2 Medicare Locals, which ranged from 28 per cent down to 15 per cent.)

NCML was at the bottom of this group.

In this Regional 2 group,

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The Grampians was at the top of the ladder and New England was on 21 per cent.

The lowest smoking rates in Australia were on Sydney’s North Shore and Beaches (6 per cent).

All four areas with the high-

est percentages of adults who were daily smokers were in regional and rural catchments (Grampians Vic; GoldfieldsMidwest WA; Far North Queensland and the Northern Territory. All four areas with the lowest percentages of adult smokers were in the wealthiest inner city suburbs in NSW and Victoria.

In 2008, the Council of Australian Governments established a target national smoking rate of 10 per cent by 2018, which Australia continues to work towards.

To view this and other NHPA reports, go to: www.nhpa.gov.au

service and contributing towards increased HIV screening.

“The pop-up was successful at reaching gay men who are a priority population for rapid testing and also demonstrated a willingness to engage with HIV testing in this setting,” she told HealthSpeak.

Marie said further testing in gay community settings and continued health promotion around the use of condoms will be important steps in achieving the targets set out in the NSW HIV Strategy.

Medical Director of the Lismore Sexual Health Service, Dr David Smith, said that while there are 18 established rapid testing centres in NSW, the popup site was an eye-catching way to raise awareness, especially among regional communities.

“It is a big difference if you compare this to a decade ago when people would be forced to wait anxiously for many days or weeks before an HIV test result was known,” he said.

Local GPs are encouraged to get in touch with ACON to discuss being an active part of the Ending HIV Campaign.

Link to ABC feature http://www.abc.net.au/local/ videos/2013/12/31/3918904. htm?site=sydney View the new Ending HIV video here: http://endinghiv.org.au 27

Double honours for Casino GP Dr Juriaan Beek received the Medal of the Order of Australia in January, along with being named as Richmond Valley Council’s ‘Citizen of the Year’.

Born in The Netherlands, Dr Beek has practised as a GP in Casino, specialising in obstetrics, since 1980, and feels that over this time he has probably ‘delivered half the town.’

Dr Beek enrolled in medicine at the age of 28, after graduating in science, working as an industrial chemist and completing a Masters in Physics. It was a visit to the Karkar hospital in PNG as an overseas volunteer in the 1960s that sparked his desire for a medical career.

Due to a reduction in birthing mothers, along with the difficulty of attracting other GPs with obstetrics skills to share the unpredictable hours of the workload, and the limited training opportunities for midwives at Casino Hospital, local birthing services were recently consolidated at

Lismore Base Hospital.

Dr Beek remains closely involved with the education of medical students and has been a Fellow of ACRRM since 2000. He’s a Diploma Examiner for the Royal Australian and New Zealand College of Obstetrics and Gynaecology Board, and has a lecturing role at the University of Sydney’s School of Medicine.

He told The Northern Star that although the award was an honour, public recognition for his work was not something he set out to achieve through his medical career.

“You don’t do medicine for the award, you do medicine to help people,” said Dr Beek.

HealthSpeak warmly congratulates Juriaan Beek on his commitment to the health of so many women and babies in the Richmond Valley and beyond and his continued service as a respected GP.

John Walker, General Manager of Richmond Valley Council with Dr Juriaan Beek at the Australia Day ceremony at Casino. Credit: Kate Crockett, Richmond Valley Council

Raising epilepsy awareness disease.

Research has identified that in many cases genetics plays a role in very young children.

With national Epilepsy Awareness Day (Purple Day) coming up on March 26, and 10 per cent of the population at risk of experiencing a seizure during their lifetime, it’s timely to look at this often misunderstood condition.

How is epilepsy diagnosed?

What is epilepsy?

Epilepsy is a family of disorders of brain function that takes the form of recurring convulsive or non-convulsive seizures. There are seizures that are not epileptic such as those that result from diabetes, kinked blood vessels and other health conditions.

Who gets epilepsy?

Epilepsy is a common condition and can develop at any age.

Once considered a disorder of the young, the over 55 year age group is now being recognised as the most vulnerable group.

This group is subject to the kinds of cerebrovascular, respiratory and cardiac events that can lead to epileptic seizures.

What causes epilepsy?

There are many causes of epilepsy, which vary with the age at which seizures begin and 28

their nature. However in 50% of cases, the cause is unknown.

We know that structural abnormalities in the developing brain, infections such as meningitis or encephalitis, or lack of oxygen to the brain during birth or after a stroke, can cause epilepsy. A brain injury, which results in scar tissue, predisposes individuals to developing epilepsy, although there can be a long period between the damage occurring and the seizures commencing. Why this occurs, we still do not know. Epilepsy can result from a tumour, and, in the over 65s from degenerative conditions such as Alzheimer's

In diagnosing epilepsy, the presence of seizures is often the determining factor. An eyewitness report of the event and the person's description of what happened prior to the event and how they felt afterwards can be the best diagnostic tools. All the tests the doctor might order are to gather specific data on the kind of seizures experienced and to confirm what is basically diagnosed through observation.

A neurological examination will be conducted that generally includes a test to measure the electrical activity of the brain [EEG]. This will help determine where in the brain the electrochemical activity that is generating the seizure activity is occurring. Specialised imaging tests such as CT scans and MRI scans may be required, along with blood tests. Some tests may require hospitalisation while the seizures are observed and recordings taken during the event.

With the advance in mobile phone technology, by capturing the event or behaviour when it occurs on video, parents/carers can provide their doctor with recorded evidence to support their observations. Such recordings can be extremely helpful when determining a diagnosis.

Training and education programs

Epilepsy Australia member associations provide responsive education and training programs, including sessions to community organisations, health and welfare groups, disability and aged care service providers, businesses, education providers, students, state institutions and other groups.

Programs cover a range of topics and can be tailored to suit the education and training needs of individual organisations, if required.

To arrange a training session for your organisation call the Epilepsy Australia National Helpline on 1300 852 853 This information was compiled from Epilepsy Australia’s website: www.epilepsyaustralia.net

HealthSpeak

autumn 2014

The South India ‘starters tour’ The bea utiful French history of Pudu cherry

By Janet Grist

When you say you’ve just come back from India, you often hear ‘I’d love to go to India, but I think I’d be a bit daunted’.

Well, the group trip I went on recently is one that I can recommend as an excellent ‘taster’ for those wanting to take the plunge.

South India is less populous than the north and easy to navigate by road, with truly lush landscapes.

It’s comprised of thousands of during the day of the full moon between November kilometres of coastline framing fertile plains and and December, and a huge beacon is lit atop the sasweeping hills, all kept glisteningly green by the cred Aranachula hill. The event is witnessed by three double-barrelled monsoons. million pilgrims.

It is also a great deal easier to fly into Chennai than When I visited the area it was less busy. I set out India’s northern cities. Chennai airport is like that of a early and with scores of bearded, barefoot sadhus large regional Australian town – no queues, no hassle (Indian holy men) circumnavigated the temple base and you are out of Customs in no time. and the hill in a practice called Girivalam. It was During this 10-day trip we visited four destinaquite a social event with chai stops and street vendors tions in Tamil Nadu, each fascinating with its own cooking snacks such as pakora and idli. But by 9am I particular charms. was ready for a sit down and breakfast, the cool of the The first was Pondicherry, affectionately called early morning had vanished.

Pondy, but officially named Puducherry From Thiru, we hired a driver and in 2006. For those who saw the movie travelled north to the ancient town of Life of Pi, the richly coloured opening Mahabalipuram, a UNESCO World scenes were shot in the city’s Botanic Heritage Site. Once a bustling seaport Gardens. Designed on the French grid during Roman times, today it is purely pattern and featuring perpendicular a tourist town. Be prepared to fight streets, the town is divided into the your way through clutches of gypsies, French Quarter and the Indian Quarter. beggars, guides, snakes charmers and Unlike any other Indian city, in the elephant e so on, all of which is an essential part th i French quarter the wide streets retain m laksh h temple of the experience. They can be a nuiFrench names and French-style villas at ganest sance but they’re harmless. with plenty of shady trees. A broad bouleI recommend you hire a guide at vard sweeps along the city’s edge adjacent the Temple Site entrance (about $15) to the beautiful Bay of Bengal. When we visited it was Gandhi’s birthday and the boulevard was as it’s well worth hearing the extraordinary stories of awash with colour and movement as locals gathered to the five main temple sites, some of which have been reclaimed from the sands of the ocean after recent celebrate the great man and to climb a set of steps to tsunamis. touch his bronze statue.

Downtown Mahabalipuram is full of hippy style The French in India are an artefact of the French shops, with ambling street musicians and good presence there, which began in 1673 with French value eateries to choose from, a fun place India and continued until 1962 when the French terto spend a couple of nights. ritory was transferred back. A sizeable French populaCertainly, India can be overtion remains and Pondy has boutique hotels, patisserwhelming, but this ‘starters ies, boulangeries and French-influenced restaurants. tour’ is a soft landing Not far from Pondy is Auroville, an intentional with plenty of memocommunity set up in 1968 as ‘an ideal township ries to take home. devoted to an experiment in human unity’. Full of So why not fascinating architecture and a talented and diverse take the plunge? arts community, Auroville’s most famous structure is Who knows you the Matrimandir, a unique golf ball shaped structure could be the which took 37 years to build. Visitors can go into this one recomextraordinary space and experience the wonderful mending a tranquillity of its inner rooms. trip to India Our next stop was Thiruvannamalai, the most next time. important pilgrimage place for devotees of Shiva in India. The history of Thiruvannamalai revolves around the magnificent Annamalaiyar Temple which More on this tour at: dates back to the ninth century. www.judyarpana.com.au Here the Karthigai Deepam festival is celebrated HealthSpeak

Travel

autumn 2014

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For those who saw the movie Life of Pi, the richly coloured opening scenes were shot in the city’s Botanic Gardens.

The amazing Matrimandi r in Auroville

Becoming a bone marrow donor Each year, many Australians are diagnosed with leukaemia or other fatal blood disorders. A bone marrow or haemopoietic stem cell transplant is the only possibility of cure for many of these patients.

Donors need to be specifically matched to the patient which can make it very difficult to find a donor for certain patients with rare tissue types. Only 1 in 1000 donors will be asked to donate for a patient requiring a transplant in any given year.

Siblings are the ideal donors for a patient in need of a bone marrow transplant (BMT), but only one patient in three will find a match within their family. The other two rely on the Australian Bone Marrow Donor Registry or other international registries to find a match.

What is bone marrow?

Bone marrow is a spongy tissue found inside bones. The bone marrow contains stem cells which produce the body's blood cells. These include: White blood cells which fight disease and infection Red blood cells which carry oxygen Platelets which enable the blood to clot Bone marrow transplant is an accepted treatment for patients diagnosed with leukaemia, certain immune system and genetic disorders.

How do I join the register?

If you are between 18 and 45 years old, in good health and prepared to donate for anyone in the world, call the Australian Red Cross Blood Service on 13 14 95 to make an appointment to donate blood and join the registry.

When you go to donate blood, ask the nurse at reception for the Australian Bone Marrow Donor Registry (ABMDR) form and complete this before donating blood.

Once you are registered It is most likely that the next 30

time the registry contacts you, it will be if you are identified as a suitable match for a patient.

Bone anatomy

Donation methods There are two ways you can donate: bone marrow or peripheral blood stem cells (PBSC).

The medical specialist looking after you will assess the donation method that is best for you.

However, the final decision is up to you.

Bone marrow collection Marrow donation is a surgical procedure and usually means a night in hospital, but some collection centres will schedule a same-day stay. You will have a general anaesthetic and the doctors use special, hollow Continued page 32

Meet donor Richard Webb Richard works in Community Relations for the Australian Red Cross Blood Service in Sydney and as a regular blood donor put his name on the bone marrow registry when he was in his 20s.

“I knew at the time that the odds were pretty slim of being found a match, but as it turned out I was a perfect match for someone in The Netherlands.

But that wasn’t until I was in my 40s.”

After agreeing to donate, Richard went through the process of receiving the G-CSF injections over four days to increase the supply of stem cells in his body.

“It was fascinating having the injections, which resulted in me having an overflow of

stem cells in my bloodstream.

By the fifth day, I was pacing the floor, I was really hyperactive.”

Richard made his stem cell donation through the process of apheresis and found the experience easy and interesting.

“After I finished donating my stem cells it was like someone had flicked a switch in my body, I felt more relaxed, less hyper.”

For Richard the only discomfort in the apheresis process was the feeling of being ‘hyped up’ for a day or two due to the G-CSF’s effect.

While Richard doesn’t know the name of the recipient or how he is going now, he treasures a hand written note of gratitude he received

from the recipient’s wife.

“I keep the note handy, and whenever I’m having a bad day, I get it out and re-read it,” said Richard.

He said he always feels good after giving blood because it is probably helping to save someone’s life, but he said becoming a bone marrow donor took things to a whole new level.

“You are helping someone you will never know or see, but the fact that the relied on you to get through their illness is really rewarding. To be able to help someone is a way to share the goodness in the world around,” he explained.

Richard said that most bone marrow donations are made through the apheresis method which he found minimally uncomfortable.

“Some people think that bone marrow is always collected through a surgical procedure, but this rarely happens. You don’t need to be frightened and you are giving another person their only chance of getting well. It’s a great feeling.”

HealthSpeak

autumn 2014

Economists at war The Stages of an Economy Effect of Government Intervention

PRICES

There is a war of words going on out there and it’s been getting nasty.

It’s being waged between the various ideological schools of economics. Terms like idiots, fools and socialists are being tossed from the various bunkers.

It is fascinating stuff and the stakes are high.

The protagonists occupy powerful positions in the bureaucracy, government, the world’s central banks, the IMF, the universities, businesses and trade unions. They are in powerful positions to influence policy. It has spilt over into the political sphere where politicians have identified with the economic ideology that fits their world view.

Hence the passionate arguments in recent years over budget deficits, subsidies, tariffs, government debt and climate change policies. Interestingly the ultimate goals of most of them are to reduce cyclical unemployment and control inflation. But they just cannot agree on the right policy prescriptions. The battle is particularly important now.

We have one group claiming great success at avoiding another Great Depression following the GFC. The world has averted disaster and is on its way to a slow but sustained recovery they say.

Others say nonsense. This lull is but temporary. As a result of government deficit spending, unprecedented money printing and zero interest rates, huge imbalances exist in the world economy. It will inevitably come crashing down and when it does it will be

Economy David Tomlinson

Keynesian Period

Intermediate Period

Recession High unemployment

Some growth Falling unemployment Rising prices

Classical Period

High growth Low unemployment Skyrocketing inflation

OUTPUT worse than ever.

So which group is right? Are we headed for a long period of sustained growth or are we charging over an abyss? Ahh, if it was only that simple.

To make some sense of it all we need to take a quick look at the evidence and the opposing forces.

Classical Camp Classical economists are powerful and trace their ancestry back to the first great economists including Adam Smith and John Stuart Mill. They have a great belief in the market and they loathe Government intervention in the economy for any reason.

If an economy turns down for cyclical reasons they say it will automatically self-correct as prices and wages adjust up or down.

When governments intervene via budget deficits, interest rates, setting minimum wages or introducing new taxes such as a carbon price, then they prevent the

economy from working correctly. This economic philosophy held sway throughout the western world until the Great Depression when the economy failed to self-correct.

keynesians Enter the Keynesians in the latter part of the 1930s led by UK economist John Maynard Keynes. While they agreed there are self-correcting mechanisms, Keynesians say these are overwhelmed by an adverse income effect, ie that the lower wages led to lower demand which leads to more job losses, even further falls in demand and so on in a downward spiral.

They proposed Government intervention in the form of increased spending, budget deficits and adjusting interest rates to encourage investment.

This seemed to work exceedingly well for several decades until we hit the stagflation era of the 1970s when oil prices tripled and unemployment and inflation both rose. This was not supposed to ever happen – these had always gone in opposite directions. In the 1970s Keynesian policies failed.

monetarists Enter the monetarists under Milton Friedman who had a lot in common with the classical tradition with a few twists.

They believe in no government HealthSpeak

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intervention apart from strictly ensuring that the money supply rises no faster than the growth of the economy. It caught on and for several decades central banks around the world adopted money supply and later inflation targeting.

Under Obama, the Keynesians took charge again and massive stimulus was applied via government spending, trillion dollar rescues of key industries and a money printing programme that has had no equal.

This seems to have worked.

Growth has been very slow but at least the US and the world avoided another Great depression.

So where are we in our quest for understanding?

All camps can show evidence that their policies work – sometimes. In other cases they seem to fail. Maybe its horses for courses.

The accompanying graph shows an economy recovering from recession. Is this a possible compromise?

In the Keynesian period the Government can intervene and stimulate growth without pushing up prices. In the second period, growth has resumed, unemployment is falling and further stimulus sees further growth but also a modest increase in inflation. In the last period, the economy is fully employed and any further stimulus by way of budget deficits or lower interest rates will only result in rapid inflation and no growth.

It seems the US Federal Reserve thinks we are just entering Stage 2. It has started to wind back its money printing program and is hoping for a small rise in inflation. If they don’t get it right we could see a return to recession or at the other extreme, a huge inflationary surge that will lead to a crash.

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Q4NL helps households become smoke-free

In just five months, the Northern NSW Quit for New Life program (Q4NL) has made a difference, helping pregnant Aboriginal and Torres Strait Islander women reduce and quit smoking.

With support from North Coast Medicare Local, three training sessions have been conducted – two in Lismore and two in Kingscliff, with 52 people attending.

Q4NL is a smoking cessation support initiative and also targets family household members with the aim of reducing smoking rates within families and creating smoke-free environment’s during a woman’s pregnancy.

With consent, women and household members who identify as nicotine dependent are referred to the Q4NL program. Both women and household members have ac-

cess to 12 weeks free Nicotine Replacement Therapy (NRT). As well as NRT, the clients are provided with ongoing cessation support by the Q4NL team and are referred to the NSW Quitline.

Currently, the Quit for New Life team has 22 clients (three household members). All have stated that they have reduced the number of cigarettes smoked daily since enrolling in the program and three have stated they have gone smoke-free.

‘First time in our lives that we have money left at the end of the week. We just bought a heap of groceries and still had money left over – that has never happened, so we bought a treat for the family – a fish tank.’

To find out more about the program and how to refer clients; or if you would like to organise a training session or order some Q4NL brochures for your practice, please contact Christine Sullivan, Cessation Support Leader on 6674 9517 or 0417 474 417. Email: christine.sullivan@ncahs.health.nsw.gov.au

From page 30

Donor retirement You will be automatically retired on your 60th birthday when you are no longer eligible to donate or you can ask at any time to be retired by contacting your donor coordinator.

needles to withdraw liquid marrow from your pelvic bones. Following collection, the bone marrow stem cells will be filtered to remove any unwanted particles and then mixed with an anti-clotting agent. The bone marrow will then be given intravenously to the patient just like a blood transfusion.

After the procedure you may feel somewhat stiff and sore in the lower back for a few days.

Serious complications are rare.

Peripheral blood stem cell (PBSC) donation Most people's perception is that a traditional bone marrow collection is the only way of collecting blood stem cells, but there are other sources. One of these is stimulated or mobilised peripheral blood stem cells (PBSCs) and another is cord blood stem cells or blood stem cells taken from the umbilical cord and placenta after the birth of the baby.

In this context ‘peripheral’ means that the collection is made from veins in your arms.

‘Stimulated or ‘mobilised’ means that stem cells are created in higher than normal

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A GCSF molecule

quantities in the bone marrow and released into the blood stream. Under normal circumstances there are too few blood stem cells in the peripheral blood for transplant purposes.

However administration of a hormone-like treatment known as G-CSF by a small injection under the skin daily for four days stimulates the bone marrow to produce white cells more quickly and in larger numbers.

The PBSC donation takes place at an apheresis centre.

Apheresis is a process of collecting blood from a vein in one arm and passing it through a cell separator machine, which collects the cells needed for the transplant. The remaining blood is returned through a vein in your other arm. During the collection some donors experience nausea, a tingling feeling or chills. These effects go away shortly after donating.

The gift of life There may be a temporary disruption to your daily routine, and you may experience some emotional ups and downs, especially if the transplant is not successful and you receive bad news about your recipient.

However it is important to remember the value of your gift.

In cases where the recipient does not survive, you can be comforted by the fact that you gave their family peace of mind that everything was done to try to save the life of the loved one. This in itself is a true gift.

For more information on bone marrow donation, go to: http:// www.abmdr.org.au/ To make an online appointment to give blood and join the bone marrow registry, phone 13 14 95 or go to: https://www.donateblood. com.au/ready-to-donate/makeappointment

HealthSpeak

autumn 2014

The Locum’s Lunchtime

It was the locum’s lunchtime and he had half an hour to kill before returning to the busy clinic. ‘A negative cliché,’ he reflected. To avoid this form of temporal suicide he wandered into the local tourist office in the hope of discovering something about the district during his short job.

Behind the counter was a smiling enthusiastic woman called Debra T who seemed very happy to share her knowledge about St Helens, a small seaside town in the northeast of Tasmania. As an old yachtie and encouraged by the friendly welcome, he enquired on a whim whether the region offered any yachting activities.

Imagine his surprise because after a rummage under the counter, Debra T produced a brochure for the Yacht Volant.

She looked a beauty. To cap it off the area of operation was in the waterway of Freycinet National Park, allowing visitors to experience a world heritage area from the deck of a yacht.

Irresistible bait!

The brochure advised that several options were on offer, a twilight sail, an overnight voy-

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autumn 2014

age or a daysail.

At around $400 per couple, the daysail seemed good value.

Within minutes the efficient Debra T had booked a passage for two.

The arrangement went very smoothly. Starting with a two hour drive along the magical coast road in the hire car provided by the agency IPN, there was the yacht, rolling gently alongside the Coles Bay jetty, engine ticking over in readiness.

To a sailor’s eye the yacht presented as a very sophisticated 41 foot Beneteau Oceanus, with a comfortable cosy layout and in impeccable condition.

The owner captain Graeme and first mate Kathryn gave a friendly welcome and safety briefing as they smoothly cast off from the jetty.

It was a lucky day for the guests who were the only ones on board and the weather was mild, to start with at least.

‘The boat is yours,’ Said Kathryn, ‘ for the day,’ the captain corrected with a guffaw.

After a lazy run down the protected waters of Great Oyster Bay under full sail, Volant anchored at a sheltered beach

‘The boat is yours,’ said Kathryn. ‘For the day,’ the captain corrected with a guffaw. where Kathryn produced a wonderful spread, after dutifully checking on dietary restrictions.

A chilled local crisp white was included, which Dr Ingall might have even enjoyed. After lunch Graeme dropped anchor in a secret fishing spot and his guests hauled in masses of flathead, using only a silly looking plastic prawn lure with wobbly legs.

How did the fish fall for that?

Would this trip suit a nonsailor? On this summer afternoon, the temperature dropped quite low. Wind and rain got up in the afternoon for the trip back to Coles bay and it was a

Light Airs David Miller

brisk sail with the boat heeling into the wind under reefed sail, but her cockpit provided easy shelter. The captain’s quiet confidence was reassuring. He said that he always looks to the comfort of his guests and if he thought they were not happy would have used the motor or remained in shelter until the breeze dropped. For an old salt, to join a proper yacht, even for a day, was like meeting an old friend.

In summary, it’s a trip for people who don’t mind a bit of action and mild adventure in style. The waterway is sheltered and windproof jackets are provided against the cold and wet.

In asking about the usual sort of sail in which Volant engaged, it was a surprise to hear that ‘Proposal Voyages’ are popular, in which a happy couple are dropped off by dinghy on the beach for a short walk to wineglass bay to declare their love and pop the question.

‘We are rainbow accredited as well,’ added the first mate.

Volant has three cabins with a hot water bathroom, which makes this yacht very comfortable for one or more nights and suitable for two couples. The crew tuck up in the foc’s’le, so privacy is assured That night back in the St Helens house, also provided by IPN, the locum and his lady enjoyed the catch of the day, expertly filleted by Graeme at the dockside. There was not a bone and with flour and breadcrumbs included in the deal, who could ask for more than that in a daysail?

More on the yacht trip at: www.

Sailfreycinet.com.au

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Understanding Health Professionals: Looking at pharmacy Pharmacy is not just about filling prescriptions. It is about promoting health awareness and contributing to the betterment of the community.

Pharmacists may: prepare or supervise the dispensing of medicines, ointments and tablets advise patients on how medicines are to be taken or used in the safest and most effective way advise members of the public and other health professionals about medicines (both prescription and over-thecounter medicines), including appropriate selection, dosage and drug interactions, potential side effects and therapeutic effects select, give advice on and supply nonprescription medicine, sick room supplies and other products develop legally recognised standards, and advise on government controls and regulations concerning the manufacture and supply of medicines work in the research and development of medicines and other health-related products be involved in the management of pharmaceutical companies.

Community pharmacists dispense prescriptions, provide advice on drug selection and usage to doctors and other health professionals, give primary healthcare advice and support, and educate customers on health promotion, disease prevention and the proper use of medicines.

Consultant pharmacists are either employed by community pharmacies or hospitals, or are self- employed and contract with community pharmacies to provide medication reviews and/or other medication-related 34

cognitive services.

Hospital pharmacists operate as part of a health care team and are involved in monitoring medication usage, counselling patients, providing drug information and advice to health professionals and the community, conducting clinical trials and preparing products for patient use.

Industrial pharmacists undertake research and the

Profile

development, manufacture, testing, analysis and marketing of pharmaceutical and medical products.

Outside the square: Pharmacists also work as locums and in fields such as the military, law, journalism, academic teaching, research and pharmaceu tical policy.

Information from the Pharmaceutical Society of Australia’s website: www.psa.org.au

Pharmacist Sally Herbert

Sally’s entry into pharmacy study came after she’d completed a Bachelor of Science degree at the University of Queensland.

“During this time, I became interested in pharmacology and was considering an honours year in this area. However, being in a lab was not for me, I like people! Pharmacy is perfect as it combines science with the opportunity to develop and nurture relationships within the local community. I graduated with a Bachelor of Pharmacy degree from the University of Sydney in 2003.”

Working in the Northern Rivers, Sally said she’d had many opportunities as a pharmacist. Currently, she works as a pharmacist at Southside Pharmacy in South Lismore one and a half days a week and also works for North Coast Medicare Local two days per week.

“The South Lismore community is very supportive of their pharmacy and we offer a number of unique services.

These include surgical and medical equipment, sleep apnoea services, fitness equipment, compression stockings, a hiring service for gym equipment, home health care aids and a naturopathic dispensary.

Sally says she enjoys the

diversity of her two roles, also working as a Clinical Services specialist for the NPS. “I provide unbiased, up to date, evidence-based information to health professionals and consumers. I also deliver educational services to GPs, practice nurses and RACF staff in the form of visits and small group meetings on current NPS programs.”

Although the work is challenging, Sally says she feels privileged to be able to present this information to health professionals and believes she has the best of both worlds with her two roles.

“The continuation of care at the pharmacy is truly rewarding. Many patients feel quite comfortable talking to their local pharmacist and they may tell us information they would not tell their GP,” she explains.

“In many cases at Southside Pharmacy, we are the ‘first port of call’ for illness, and making the decision whether or not to refer the

patient to their GP or not can be tricky,” Sally added.

She appreciates the mentors who have helped her reach her potential in pharmacy.

“Pharmacy is unique as we are a small profession and experienced pharmacists are often guiding the younger generation.

“However, pharmacy is a changing animal. Price disclosure and the high cost of purchasing a pharmacy make it more difficult for young pharmacists to achieve pharmacy ownership. The discount model of community pharmacy is here to stay, which is leading to pharmacists working harder and faster with perhaps lower pharmacy staff support.”

While Sally would recommend that others study pharmacy for its every day rewards, she warns that the pharmacy landscape has changed.

“With the increasing number of pharmacy schools opening, there is an oversupply of pharmacists in urban and regional areas, which ten years ago would have been laughable.

“New grads today may not have the job and training opportunities they hoped for and will have to be prepared to stay focused on what they hope to get out of their working life.”

HealthSpeak

autumn 2014

Books with Robin Robin Osborne

How to Think About Exercise Damon Young The School of Life Given that Damon Young is an Honorary Fellow in Philosophy at the University of Melbourne, it is hardly surprising that his paean to physical exertion is infused with a strong emphasis on mindfulness.

However, he may not have succeeded entirely, given that the book is for the general [if well educated] reader, rather than the professional market, because he is hardly an ‘everyman’ when it comes to exercise – not that one should resent such fitness!

Perhaps inspired by his name, Young does uphill sprints, describing them as ‘quite frankly, a buzz’, jogs long distances, rock climbs, practises martial arts, yoga and tennis, hence the cute cover, and enjoys a swim: ‘As a teenager… I usually swam to the third reef of our local cove, marked by a high wooden pole stuck with mussels…. The whole world was waves, blurry blacknesses and solitude.’

The modest photos of the author dotting the text confirm that

in middle age his exercise regime has served him well.

More interesting, however, are the other images, which begin with Chad, the narcissistic personal trainer from the Coen brothers’ film Burn After Reading, and progress through the ancient Greeks and Romans, Scottish philosopher David Hume, and the noted Japanese writer Haruki Murakami, no spring chicken, who has run a marathon a year for the past 25 years.

Formerly, he ran a jazz bar and smoked 100 fags a day. Now he is one of the world’s most acclaimed writers, and insists he could not have so achieved without the running.

The point of introducing such a cast, and many others mentioned in the text, is that exercise without mindfulness – a la Chad - may improve one’s fitness levels, or body shape, but do little to advance, as Young puts it, ‘a fuller ideal of human wholeness.’

For this reason, the chapters of this slender, notebook-like volume, part of a ‘how to’ series, do not carry headings such as ‘running’, ‘tennis’, ‘martial arts’ and so on, but Reverie, Pride, Sacrifice, Beauty, Humility, Pain, Consistency, The Sublime and Oneness.

‘The Chad stereotype comes from a conflict: between the mind and the body, thinking and doing, spirit and flesh,’ he writes.

‘This prejudice is behind the myth that sports stars must be stupid, and philosophers or

New bird flu risks Australian researchers have warned that new strains of bird flu which killed 45 people in China over the past year would hit Aboriginal Australians hardest if the strains came to Australia.

In PNAS online, immunologists from Melbourne University talked about their discovery and pointed out that the genetic make-up of Aboriginal Australians left them more likely to be affected by the H7N9 strain of avian flu HealthSpeak

autumn 2014

than other ethnic groups.

The findings come at the same time as reports of another death in China from H7N9 in January and the identification of another new strain – H10N8 – that killed a 73-year old Chinese woman in December.

The researchers say time is of the essence in developing a universal T-cell vaccine to complement the recommended yearly flu vaccine to protect the most vulnerable from bird flu.

writers weak and anaemic. It is an outlook that sees physical and mental exertion as somehow in conflict.’

The design of this book, and much of the content, with its series of ‘tips’ for mindfulness/ exercise, is unlike anything I have encountered before, perhaps because its genesis lies in a unique organisation, The School of Life (http://www.theschooloflife. com), founded by well-known thinker Alain de Botton (The Art of Travel, The Consolations of Philosophy, et al).

The ‘school’ is also behind the initiative known as the Sunday Sermon, currently sweeping the UK, which brings together groups of the non- but not antireligious to hear guest speakers and discuss their views.

Others in the book series include How to Age, How to Develop Emotional Health, and How to be Alone, all by specialist authors, and costing around $12.00.

Stressing that his work ‘is not a ‘how to’ manual for exercise,’ Young suggests it is ‘an introduction to the psychological rewards, and ethical virtues, of fitness; a companion to exercise, which shows how our minds can thrive as we sweat and strain – how our muscles swell and flex with the right mindset.’

There may be nothing new in stating the emotional benefits of exercise, but this thoughtful combination of words and photos shows how our next walk, run or game might best be approached.

Botox for migraines on PBS THE PBS is now subsidising Botox injections (Allergan) for people who suffer chronic headaches at least 15 days a month, with migraines on at least eight days.

Patients must also have unsuccessfully tried at least three other preventive medications and will require a referral to a neurologist to receive injections into their head and neck every 12 weeks.

Chronic migraine is estimated to affect 450,000 Australians and can lead to depression, anxiety and loss of income due to time off work.

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Safe Use of Medicines in Older People Older people are at greater risk of medicines-related problems due to co-morbidities, age-related changes and polypharmacy, with potentially undesirable consequences.

NPS Medicine Wise is offering this program to general practice staff. It provides an opportunity to discuss accurate, independent and practical information about the safe use of medicines in older people.

The program will focus on: Age-related factors that can impact on medicines Reducing medicines-related problems in older people Stopping medicines safely

Learning objectives Explore treatment goals with your older patients Identify triggers for reviewing your older patient’s medicines Recognise specific medicines-related problems in older patients and identify potential contributing medicines Use a step-wise approach when stopping medicines Document health decisions agreed with the patient and update regularly

What’s in it for you?

Unbiased evidence, information and resources Education delivered to you at a convenient time at your practice A Quality Prescribing Incentive (QPI) activity within the Practice Incentives Program and accredited for RACGP QI & CPD and ACRRM PDP points

To participate please provide your details: Contact person: Preferred time/s

Phone:

Practice name: Before 9am 9am to 12 noon Lunch time 2pm to 5pm After 5pm

Preferred day/s

Tuesday Wednesday

Practice stamp:

Please send details to Sally Herbert BSc BPharm North Coast Medicare Local – Northern Rivers “Tarmons House”, Dalley St, East Lismore 2480 Ph 02 66 224453/ 0488281712 Fax 02 66223185 Email sherbert@nps.org.au or sherbert@ncml.org.au

36

HealthSpeak

autumn 2014

Wine and good health The sensuality of wine Whenever I travelled as a young lad, be it hitching around Australia (before Milat) or taking fishing boats through the islands to our north, my mother would give me a small journal, blank pages onto which she had lovingly added the words “I saw, I heard, I tasted, I touched, I smelt”, each suggestion on a separate line. This of course encouraged me to write down the most memorable vision or aroma etc on a given day, an evocative way to remember a journey even decades later. It also encouraged me to open my senses to the world, to notice the sights, sounds, tastes, textures and smells which greeted me each moment.

I get about far less these days, so instead use Mum’s system to help me travel through the world of wine! So come with me dear reader as I share with you the habits I have built up over a lifetime of thoughtful imbibing; I guarantee it will add to your vinous pleasure and knowledge.

Sight...

A little difficult while the wine is in the bottle, but if there is ullage (the wine level slipping below the neck of the bottle) the wine may be oxidised. In general, green for whites and purple for reds are great colours for longevity. Yellows and browns (respectively) suggest ‘drink me’, while colours in between indicate a wine in its drinking plateau. If you hold the glass at an angle you can pick out the colour of the rim of the wine, and for reds in particular this is helpful. Go by the colour of the rim, as the body of wine in the glass may mask both purples and browns. Swirling a wine in the glass may make ‘legs’ appear down the sides, giving you a good idea how viscous it is, indicating the presence of alcohol and residual sugar. In sparkling wine, you pay more for small bubbles (it’s like lingerie that way) and the intensity of stream HealthSpeak

autumn 2014

Chris Ingall

is an indication of liveliness.

Sound...

Not much going on here, apart from that lovely party-starting pop as you open the bubbly.

There used to be the satisfying sound of the cork leaving the bottle, but with Stelvin closures we hear this less frequently. The contented sighs of your fellow drinkers are of course priceless.

Smell...

Well this is really where it’s at!

A wine taster with a cold rings in sick, and really you can’t taste much without a well-functioning olfactory bulb. Each grape has its own signature aroma, and then there is the type of wood (French or American oak) which has been involved in the winemaking. Like a rose, when a wine is young it is ‘closed’ and there is little on the nose, but as it ‘opens’ in the bottle the most glorious aromas start to emerge. In a well structured wine, these aromas last longer, and the primary fruit smells are joined by more sophisticated ones. Semillon is a case in point, with lemon and a mineral lift joined by toast and honey over

time. Riesling and pinot noir are also rewarding as they age, and it is well worthwhile taking some time over this step.

Taste...

This follows from the above, but of course wine is extravagant, and always offers more to the drinker as the experience unfolds. If you were blown away by the aromas in the glass, you now are doubly blessed by the taste sensation which unfolds in your mouth. The sweetness and savouriness of the wine, in both the fruit and vegetable

Wine Tip

Cellar Tip

Think about the ‘shape’ of the wine in your mouth. A young semillon will be like a javelin, while a middle aged merlot a sphere. A great wine will be like a fat cigar, enjoyable from the first sniff to the last play on the back palate.

Lesser wines are all sharp elbows and knees, and should be served cold to the rellos.

Bottles with Stelvin closures can be stored upright. Keeping them in their cardboard boxes helps longevity, as it stops temperature variation considerably. After keeping just about any white for five years, or a red for seven, savour a bottle and see where it is along its path. This way you won’t miss a drinking window, a most tragic experience.

spectrum, come to the fore, and mix with the continued olfactory input as the wine is held in the mouth and savoured. So taste and smell intermingle, and added to this are the splendid acids and tannins which give the wine its structure, and enable all those wonderful sensations to last longer. In general, allow the wine some time in your mouth (unless you are drinking with the rellos and need the alcohol) and it will tell you whether it is a fading rose or not, as it will tend to come up short as it ages.

Touch...

In the rag trade, it is said you pay for silken texture, and so it is with wine. Softness in the structure allows all the primary and secondary aromas and flavours to shine. The perfect unobtrusive backdrop. I for one enjoy these structural elements just as much as the more obvious ones, as they tell of care in the vineyard and the gentleness of the winemaker. The depth of fruit can also be sensed as fullness on the tongue, and ‘sticky’ wines, such as De Bortoli Noble One, are deliciously viscous in the mouth.

37

Port Macquarie X-Ray offers MRI rebates Port Macquarie X-Ray has been awarded a special licence from the Department of Health which allows patients to claim some of the cost of an MRI examination back from Medicare.

Owned and managed by doctors, Port Macquarie X-Ray uses the latest technology - its Ingenia 3T MRI system.

The facility’s management advises that GPs are now able to request MRI rebatable services for patients 16 years of age or older for the following indications: Item 63551: HEAD – Unexplained seizures, unexplained chronic headache with suspected intracranial pathology; Item 63554: CERVICAL SPINE – Cervical radiculopathy; Item 63557: CERVICAL SPINE – Cervical spine trauma; Item 63560: KNEE – Inability to extend

Item 63519: ELBOW – Scan of elbow following trauma; and Item 63522: WRIST – Scan of wrist for suspected scaphoid fracture.

the knee suggesting the possibility of acute meniscal tear; Clinical findings suggesting acute anterior cruciate ligament tear.

certain indications including unexplained seizures, unexplained headaches and paranasal sinus pathology; Item 63510: SPINE – Scan of spine for unexplained neck or back pain including for significant trauma; Item 63513: KNEE – Scan of knee for internal joint derangement; Item 63516: HIP – Scan of hip for suspected septic arthritis, slipped capital femoral epiphysis or Perthes’ disease;

Also, in November 2012, Medicare introduced MRI rebatable services for children under 16 years of age allowing GPs to request for the following indications, (which is good news because it reduces radiation to children): Item 63507: HEAD – Scan of the head for

Young women lack iodine Women of childbearing age (16 to 44 years) get enough folate but not enough iodine, according to figures released by the Australian Bureau of Statistics (ABS).

Dr Paul Jelfs, head of the Social, Health and Labour Division at the ABS, said the second release of results from the groundbreaking biomedical collection in the Australian Health Survey revealed that many Australian women were not getting some of the key nutrients they need in order to best prepare for pregnancy.

“We know that iodine, for example, is an essential nutrient required for a baby's brain development. Our test results showed that around one in every five (18 per cent) women of childbearing age had an iodine deficiency (defined as less 50 µg/L) and nearly two thirds (62 per cent) had an iodine level less than 150 µg/L, which is the recommended level 38

for all women who are pregnant, breastfeeding or considering pregnancy.” said Dr Jelfs.

Iodine can be found in kelp, seaweed, foods such as prawns, tinned salmon, oysters, fortified table salt and bread.

The survey did show that women of childbearing years were receiving enough folate, which is important for preventing neural tube defects (NTDs) in babies, most notably spina bifida.

“The good news is that the

vast majority of women of childbearing age had sufficient folate levels in 2011-12, with less than one per cent having folate levels in the at risk range of NTDs,” said Dr Jelfs.

Further information is available in Australian Health Survey: Biomedical Results for Nutrients, 2011–12 (cat. no. 4364.0.55.006) available for free download at: http://www. abs.gov.au/ausstats/abs@.nsf/Look up/4364.0.55.006main+features1 2011-12

It is important to note that a rebate for MRI of the spine, knee, hip, elbow and wrist will only apply after a plain film X-Ray is performed on children under 16 years of age.

For more information phone Port Macquarie X-Ray on 02 5525 3000 or view their website at: http://www. pmxray.com.au/

Sports physios wanted for Masters Games Expressions of interest are being sought from sports physiotherapists who would like to volunteer to be part of the Masters Games Clinic at this year’s Friendly Games in Alice Springs in October.

The Games are held from October 11 to 18, 2014. The Clinic provides a unique opportunity for sports physiotherapists to work in a team environment with experienced sports medicine professionals.

Volunteer sports physiotherapists will be provided with a return airfare from your nearest capital city to Alice Springs, shared accommodation for the duration of the Games, and meals while on duty in the clinic.

For more information and details about the selection criteria go to: http://sma. org.au/2014/01/calling-allsports-physiotherapists/ Expressions of interest close on March 30. For more information phone 08 8927 2333.

HealthSpeak

autumn 2014

more services · quality facilities

Trivia 1

Stringhalt is a nervous disorder which affects the legs of what animal?

2

In the UK TV series Absolutely Fabulous, what is Patsy’s surname?

3

Which modern day country was once known as Zipangu?

4

What is a male honey bee called?

5

The Scottish dish Kilted Sausages is sausages wrapped in what?

6

What does Australian TV station SBS stand for?

7

How many cards are in each suit of a standard deck of playing cards?

8

What is the name of Mickey Mouse’s pet dog?

9

By what name is British DJ Norman Cook better known?

10

11

It’s likely that Abraham Lincoln had a medical condition whose symptoms include extremely long bones, curved spine, an arm span that is longer than the persons height, eye problems, heart problems and very little fat. What is the condition?

The average human dream lasts how long?

12

What did Donald Duck always put on after a shower?

13

‘I Don’t Know How to Love Him’ is a song from which rock opera?

14

Who played police Inspector Javert in the 2012 film ‘Les Miserables’?

15

What was Australian rocker Johnny O’Keefe’s signature tune?

16

What is the floral emblem of Australia?

17

In what state is Uluru?

18

What is the name of the largest lizard found in Australia?

19

Away from light pollution how many stars are visible in the night sky?

20

What was the nickname of former NSW Premier Neville Wran?

21

Who said: ‘Any boss who sacks anyone for not turning up to work today is a bum!’

•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

1. Horse 2. Stone 3. Japan 4. A drone 5. Bacon 6. Special Broadcasting Service 7. 13 8. Pluto 9. Fatboy Slim 10. Marfans Syndrome 11. Two or three seconds 12. Although Donald never wore clothes, he always put a towel around his waist after taking a s shower.

13. Jesus Christ Superstar 14. Russell Crowe 15. ‘Shout’.

16. Wattle 17. The Northern Territory 18. The perentie is the largest monitor lizard found in Australia.

19. Between 2000 and 2500.

20. Nifty Nev 21. Former Prime Minister Bob Hawke during celebrations for Australia’s 1983 America’s Cup win.

autumn 2014

Situated in the Bangalow Medical Centre complex, rooms are available for Allied Health professionals on a permanent day/half day and casual hourly basis.

Fees are extremely reasonable for our friendly offices and reception is included during most office hours.

Please contact Jo at info@professionalcentre.com.au

YOUR CLASSIFIED AD GOES HERE

Physiotherapists MAPA

Lismore & Ballina Free Call 1800 662 125

Picturesque Ballina Female GP Wanted Ft/PT for a busy accredited practice Excellent Remuneration No weekends, but shared on call Dedicated staff and two practice nurses Please call Shannon on 6681 1333 We are not DWS or area of need

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

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

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

HealthSpeak

Rooms to Rent in Bangalow

Goonellabah Village, Oliver Ave, Phone 6624 2449

PATHOLOGICAL WASTE DISPOSAL Container Collection/Exchange

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

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 more than 20,000 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.

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