HealthSpeak April 2017 by North Coast Primary Health Network

HealthSpeak

issue 18 • April 2017

THE VOICE FOR HEALTH PROFESSIONALS – FROM TWEED TO PORT MACQUARIE

A WELLBEING PLAN BRINGS HOPE AND PURPOSE page 15

Ambulance referrals to GPs

Digital health

10 benefits pharmacy

Last Days of Life

13 toolkit pilot

Treating crystal

14 meth users

Our Healthy Clarence: a unique, inspiring plan

Head Office 106-108 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncphn.org.au Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 Cnr Forth and Yaelwood Sts Kempsey 2440 Email: enquiries@ncphn.org.au Mid North Coast 6/1 Duke Street Coffs Harbour 2450 Ph: 6659 1800 Email: enquiries@ncphn.org.au

editor Janet Grist

his issue highlights the incredible work done by the Clarence Valley community and local health and community organisations to develop and launch the Our Healthy Clar-

Health Speak Contacts Editor: Janet Grist Ph: 6618 5400 Email: media@ncphn.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Design and illustrations: Graphiti Design Studio Email: dougal@gdstudio.com.au Display and classified advertising at attractive rates HealthSpeak is published three times a year by North Coast Primary Health Network. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCPHN. The NCPHN 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 2017 North Coast Primary Health Network Magazine designed by Graphiti Design Studio www.gdstudio.com.au Printed by Quality Plus Printers

HealthSpeak is kindly supported by

forward. Read all about Our Healthy Clarence on page 14. The recent floods have devastated parts of the Northern Rivers and Tweed Valley. NCPHN has come up with initiatives to support general practice and pharmacies and in partnership with NNSWLHD is offering free mental health support to those in crisis as a result of the floods. Read more on page 6.

Embracing the New Power

Northern Rivers 2A Carrington Street Lismore 2480 Ph: 6627 3300 Email: enquiries@ncphn.org.au Tweed Valley 145 Wharf St, Tweed Heads 2486 Phone: 07 5589 0500 Email: enquiries@ncphn.org.au

ence Health & Wellbeing plan. The plan followed a higher than average number of suicides in the region over the past couple of years. The coming together of the community in anger to address these issues galvanised a body of people who have dedicated a great deal of time and labour to produce this impressive plan which provides hope for the community and a purposeful way

ceo Vahid Saberi

he emergence of internet media has moved the world to a place we could never have imagined 30 years ago. This new mode of communication has reconceptualised almost everything in the world – including the power structures. Some rightly argue that what we are seeing is the establishment of “new power”[1]. Historically, power has been harnessed through institutions and authority. This power is like currency – it is owned and controlled by a few. The elite few guard and protect it. In contrast, the new power is like a current or water – it flows, built on sharing and inclusivity. It is open, participatory and crowd driven. The more people who own it, the more powerful it is. Think of Facebook. Used to its full potential, the new power can be transforming. Consider crowdfunding through such sites as Kickstarter and Wefunder, which transform ideas into products without reliance on traditional institutions like banks and venture capitalists. Look at NikeID, a coming together of old and new power where the consumer designs the company’s shoes, producing some of Nike’s

best-selling designs. Or Hawaiian grandmother Teresa Shook who was outraged by Donald Trump’s election. She got on Facebook and wrote the first thing that came to her mind: “I think we should march.” She woke in the morning to 300,000 people interested in marching – the rest is history. The new power is built on ideologies and values that resonate with the ethos of health and human services. For example, underpinning the new power is collaboration and consultation. The potential of new power is harnessed through cooperation over competition, sharing instead of guarding and copyrighting. Additionally, value comes from reputation and feedback – selling on eBay is challenging for those who don’t keep their promises, advertise falsely and don’t deliver. We now live in a more customised world where individuals expect to be active participants in decisions that affect them, rather than passive recipients of decisions and products. The new power is also turning privacy on its head, challenging our concepts of what is public and what can be shared. In the healthcare sector, we understand that the nature of power is changing. We dabble in the new mediums - like websites and social media. We set Facebook “like” goals and count our Twitter followers – but to what end? In reality, we are struggling to use the new power to change the way

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we work. In other words, we are not deft in using the instruments of the new power. So what do we do? How can human services utilise the new power? Would we be willing to do what NikeID does and use the community to design healthcare programs? Would we be courageous enough to use social media to turn to a community and say, “We want to design a program to reduce smoking rates by 2% – here, have a go at helping us design it”? Would we put up the design of a children’s hospital and let the kids and parents shape the architecture? Almost all human services have minimal community and clinician engagement. The possibilities of mobilising and unleashing the power of a broad community of people is open to us. The reality is that we are not ready for this. Being ready requires us to change our culture, mindset, and structures. It requires us to see the power that exists in our community, to see the unlimited potential before us and embrace disruption. It means we give up control and authority – embrace the unknown. This can be scary. The new power is upon us. It is inevitable. We can either use it willingly and deliberately, or we will be swept away by the incoming tide like many enterprises before us. [1] Heiman J., Timms H., Understanding New Power, Harvard Business Review, Dec 2014

healthspeak April 2017

The health impacts of Australia’s assimilation policy

ttitudes to Aboriginal Australians’ health have changed enormously over the past 75 years. The Medical Journal of Australia which has been publishing since 1914 provides some insight into medical opinions in the first half of last century. Before 1950 there was a common belief in articles published in the MJA that Aboriginal people were doomed to extinction, and as a result medical services were neglected. (1) However, this belief apparently changed in 1945 when a serious review of diseases presenting to Aboriginal medical clinics in the Northern Territory was for the first time published in the MJA. The author was Raymond T Binns, an army doctor. (2) According to the review, during the army’s occupation of the Northern Territory (NT), a hospital was built on the banks of the Katherine River for the Aboriginal community accommodating 65 patients. The diseases presenting to this hospital and those encountered in remote visits to surrounding settlements were recorded. The medical conditions of the 400 patients treated fell into two groups. The first group was diseases predominantly found in Aboriginal patients - namely yaws, ankylostomiasis (hookworm infestation), granuloma venereum and leprosy. Trachoma was a common eye condition. The second group comprised diseases found in both Aboriginal and non-Aboriginal people – namely malaria, acute infectious diseases, acute respiratory disease, pulmonary tuberculosis, cardiovascular and renal diseases, anaemia, mental health disorders, gonorrhoea, non-specific venereal disease and other conditions. Interestingly, in these times there was no mention of obesity, April 2017 healthspeak

diabetes and its complications or alcohol related disease that would be so prevalent today in the same communities. Many of the infectious diseases mentioned have been significantly reduced or eliminated with the help of immunisation and antibiotics. However, it was in the 1970s and beyond that type 2 diabetes became prevalent and

when communicable diseases were decreasing? It was the time when Australia’s assimilation policy was being implemented and Aboriginal people were herded onto settlements and reserves against their will. One reason was to make way for stock-raising and agriculture by colonial settlers as well as xenophobic perceptions of

n the first half of the twentieth century, right up until the 1960s, the Australian government sought to create a single, uniform white Australian culture. This was pursued through assimilation policies, which destroyed Aboriginal identity and culture and justified the removal of children from their parents.

It was in the 1970s and beyond that type 2 diabetes became prevalent and has increased ever since has increased ever since. If there is one thing that radically changed in the period 1950-70 it was the Aboriginal diet, from the traditional hunter gathering diet to a much higher energy diet along with reduced physical activity. So, what was happening politically between WW2 and the 1970s that led to this dramatic change in diet and an upsurge in non-communicable diseases such as type 2 diabetes, at a time

other cultures. In addition to the mental trauma of dispossession from land and culture, obesogenic diets (largely junk food in today’s terms) were introduced through stores that were operating on settlements from the 1950s and there was not a choice of healthier food. The produce available was white flour, sugar, tea, rice, tinned meat and salt beef. That meant more refined carbohydrates, less protein and vitamins than traditional diets. There was a serious shortage of fruit and vegetables. The cost of such food in more remote communities is still a major concern today. In addition, the people were forced to give up their hunting and gathering. They were consuming processed food and exercise dwindled with sedentary lifestyles. Increasing consumption of alcohol and tobacco were

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clinical editor Andrew Binns

There was a serious shortage of fruit and vegetables. The cost of such food in more remote communities is still a major concern today also prevalent during this period. And so today we see diabetes rates three times higher among Aboriginal people than nonAboriginal with all the associated complications. Death and hospitalisation rates from diabetes are four times more likely among Aboriginal people. The assimilation policy of the 1950-70s has had a major impact on the large gap in life expectancy between Aboriginal and non-Aboriginal people seen today. The reasons are complex but poverty, dispossession, racial discrimination, as well as the mental trauma suffered by the stolen generation and their descendants are major determinants of this outcome. On page 35 in our Health and Lifestyle section, I describe a classic research paper by nutritionist Professor Kerin O’Dea on what would happen to carbohydrate and lipid metabolism if a group of type 2 diabetics from a Kimberley community were to return to a traditional hunter gatherer diet. 1) The Health of Aboriginal Australia edited by Janice Reid and Peggy Trampf. 1994, p 24 2) Binns R. T. (1945) A study of diseases of Australian Natives in the NT. MJA 1.p 421-6 (Dr Raymond Binns OBE 1901-1979 was my father)

Funding Boost for Namatjira Haven

n March 17, North Coast Primary Health Network announced funds of $83,186.00 for the expansion of existing services at Namatjira Haven at Alstonville. In addition, $31,910 in funding will be used to deliver Aboriginal mental health first aid using a train-the-trainer model for workforce training and community development. This package is provided via NCPHN’s mental health and drug and alcohol commissioning funds and will help the facility to: • Increase bed capacity from 14 to 16 • Increase timely access to evidence-based low-risk withdrawal management services for Aboriginal men, including those with cooccurring mental illness and substance misuse disorders • Improve the pathways to and from other services that meet participants’ physical, mental health and social needs First aid training will be delivered in partnership with

Rekindling the Spirit and be provided to Aboriginal community members and people delivering services to Aboriginal people from Tweed Heads out to Kyogle and down to the Richmond Valley. About Namatjira Haven

Namatjira Haven’s Gulgihwen Residential Program (meaning ‘change’) is unique in the Northern Rivers in that it seeks to re-attach Aboriginal men to their cultural history and community through culturally focused services. It also focuses on the importance of a healing place, to give the men the safety and peace they need to work on their issues and find their own strengths to take responsibility for their future choices. The funding of $83,186.00 will assist the expansion of the Withdrawal Management Project. The Withdrawal Management Project is for Aboriginal men who wish to address their drug and alcohol misuse and do not require a 7-day hospital detox, are unwilling to wait or feel unable to attend a hospital detox.

From left, back: Terry McGrath, Namatjira Haven Team Leader; Vicky Bardon, Namatjira Haven Board Member; Dian Edwards, Namatjira Haven Team Leader; Kevin Hogan, Federal Member for Page; Jeff Richardson, Rekindling the Spirit Service Manager. Front row from left: Colin Marsh, Namatjira Haven Mental Health Trainer; Sharmaine Keogh, Rekindling the Spirit Counsellor; Roger Bartholomew, Rekindling the Spirit Youth Worker; Vahid Saberi, Chief Executive NCPHN.

The program focuses on harm reduction and stages of change. “For various reasons, some men arrive at Namatjira Haven not fully detoxed,” Vicky Bardon, one of the Board of Directors for Namatjira Haven said at the event. “This funding will allow for

the Registered Nurse to work after hours and weekends to manage withdrawals, symptoms and medications, including working with men who have cooccurring mental illness. It will also give extra support worker hours to manage these complex clients’ needs,” she said.

Northern NSW Winter Strategy 2017 takes shape

ork is underway to finalise a Winter Strategy for health care in Northern NSW to meet the challenges of a significant surge in health care demands both in the community and hospital sectors over winter. Meetings and two workshops have already been held to discuss a proposed strategy. Senior GPs and representatives from Community Health, Chronic Disease Management Services, nursing services and Aboriginal Medical Services took part in these gatherings. On April 19, another workshop will be held to finalise outcomes and resources. Three aims have been identified for the Winter Strategy. They are: • To improve respiratory hygiene to slow the seasonal epidemic of such

conditions using a population-wide campaign • To provide support to general practices and community services to proactively manage patients at high risk of severe sickness • To establish an efficient, effective process to transfer the care patients from hospital to community during the winter months. Some of the ideas for the Winter Strategy include: - Providing sick day action plans where every at risk patient has an agreed action plan so they know what to do and who to call if they get sick, including after hours. - Regular appointments with GPs or practice nurses over winter for proac-

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tive management and to support self management. Care plans shared with all involved, including patients. Improved clarity of services available – GPs need a menu of services and ease of referral and need to know how to refer patients for comprehensive assessments by LHD staff. Home visits for high risk patients. Rapid response from nursing and allied health. Respiratory hygiene education campaign.

NCPHN is working collaboratively with interested GPs to develop the strategy. Broader engagement with general practice will take place in May.

healthspeak April 2017

Expect more patient referrals from ambulance paramedics

he NSW Ambulance roadshow evening held in Lismore in March organised by NCPHN provided details around ambulance paramedics using the P5 referral protocol to refer non-acute patients back to their general practice. NSW Ambulance Health Relationship Manager David Horseman told the gathering that GPs could soon expect to experience paramedics referring a patient back to their practice, perhaps around once a fortnight. “Where a paramedic is called out to a patient and the patient is deemed better treated outside of ED, the paramedic will ring up their doctor to see if they can see Mr Smith for a fall injury. Or perhaps the patient hasn’t been

David Horseman explaining GP referrals to the Lismore seminar.

compliant with medications and we ring to ask the GP to do a review. If the patient’s GP is happy to help, we can organise transport immediately, or Mr Smith can arrange to see his GP in a day or two.” David explained that the

paramedic referring the patient to his GP would provide a referral letter with a set of obs, what might be wrong with the patient, a word picture about the presentation and other information to guide the GP. This might include suggesting a referral to

an educator, and whether or not the patient requires an x-ray or medication review. At the seminar, NSW Ambulance paramedic Josh Smyth, who is working one day a week with North Coast Primary Health Network, said that NSW Ambulance wanted to strengthen its relationships with GPs to ensure the best care for the patient. “We want to take them to the right place in the care system, to provide the right care at the right time at the right place. Even if you refer one or two patients a day away from the ED and back to their own GP, that’s a good outcome.” For any queries, contact Josh Smyth on 0417 991 224.

Transition to retirement pensions – back to their true purpose Transition to retirement pensions must still meet the current pension minimum standards beyond 1 July 2017. This means a minimum pension withdrawal of 4% and a maximum pension withdrawal of 10% of your TTR balance.

ADVERTORIAL By Michael Carlton CEO & Senior Adviser, PECUNIA Private Wealth Management Superannuation changes announced in the 2016 Federal Budget have been passed by Parliament. Among these was legislation which will remove tax concessions for transition to retirement pensions (TTRs).The new rules will remove the tax exempt status that TTRs have long enjoyed on earnings on fund investments. Assets supporting a TTR will generally be taxed at 15% from 1 July 2017. The main issues to consider include: • Being clear about the purpose of maintaining a TTR or setting one up in your fund. Without the tax exempt status TTRs are no longer a ‘nobrainer’ for tax concessions. TTRs are still useful to help you: o Cut back on work hours and supplement income with pension payments as you move towards retirement. o Increase your income with pension payments while still in the workforce

April 2017 healthspeak

until a full condition of release is met. o Reduce taxable income and increase your super balance without affecting your take home pay through a salary sacrifice arrangement. • Reviewing your situation to determine if you have met or soon will be eligible to start an account based pension (which has tax-free earnings) instead of a TTR. • Ensuring that a condition of release (an event that allows you to access your super) has been met which allows a TTR to be commenced. • Determining eligibility and capacity to make salary sacrifice or deductible contributions pre and post 1 July 2017 will assist in a decision to start or maintain a TTR.

Transition to retirement pensions will also potentially have access to the transitional capital gains tax relief for superannuation assets affected by the new rules. This change will ensure that any capital gain on affected super assets will be disregarded or deferred when the asset is sold. This is a complex area of law that we encourage you to discuss with us in detail. How can we help? If you are concerned that these changes will affect you from 1 July 2017, Call 1300 112 676 to arrange an obligation and cost free initial consultation.

Important information and disclaimer This publication has been prepared by Michael Carlton, an Authorised Representative (AR No: 239724) and Carlton Family Trust ABN 51 283 954 577 t/a PECUNIA Private Wealth Management a Corporate Representative (CAR No: 1233485) of Dover Financial Advisers Pty (AFSL No: 307248). His advice is general in nature and readers should seek their own professional advice before making any financial decisions.

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‘Better Together’ Integrated Care initiatives

he second Integrated Care showcase event “Better Together” was held in Ballina on March 10 to present the great work being done through partnerships between the NNSWLHD, NCPHN, NSW Ambulance and United in Aboriginal Health Northern NSW. A number of Integrated Care projects and initiatives were highlighted with representatives of the Ministry of Health and the Agency for Clinical Innovation expressing their admiration for what these partnerships have created and how far NCPHN and the LHD had progressed on the long road to fully integrated care. From NCPHN, Vahid gave a presentation on the Centre for Healthcare Knowledge and Innovation; Sharyn White explained the journey of the Integrated Care Collaborative, Dan Ewald spoke about the Patient

Health professionals can access free online professional development training thanks to a partnership between North Coast Primary Health Network and North Coast Allied Health Association.

Presenters at the Better Together event in Ballina.

Centred Medical Home and Taya Prescott gave a presentation on the Health Literacy Project. Other presenters included UCRH’s Academic Lead, Aboriginal Health, Emma Walke on chronic disease; Graeme Turner, Clinical Nurse Specialist on supportive care for those with kidney disease; Anna Law and Dr Sue Veloski on End of Life care and NNSWLHD’s Senior IT

Project Coordinator Tim Marsh who spoke about connecting up clinicians. This annual event provides a valuable barometer for how far we have come with our partnered Integrated Care projects. See page 13 for the latest on the End of Life Care project and page 26 for a presentation on Life as a GP in 2022.

NCPHN support in wake of floods

Mental health support is available for those affected by the floods.

ecent floods in the Northern Rivers and Tweed Valley left families and businesses devastated. It’s inspiring to see how North Coast communities have come together to support each other in this time of need. NCPHN has initiated a number of activities to contribute to the clean-up and recovery process. These include: 6

Free online CPD training

• All general practices and pharmacies in flood effected areas (Lismore, Murwillumbah, Mullumbimby and Ocean Shores) were contacted by NCPHN staff to see if they needed help. This was followed up online via social media channels to other primary care providers. NCPHN has provided

on the ground support to one pharmacy, one general practice, the Lismore headspace and one primary care service for vulnerable groups to date. • Up to $100,000 is being provided for psychological and social support for people in crisis affected by the flood. This project is in partnership with the Northern NSW Local Health District via the Mental Health Access Line. • Consultation and coordination with NCPHN’s Northern Clinical Council and the City of Lismore regarding other ideas to assist and help. NCPHN extends its thanks to all the community members, health professionals and staff that helped to clean up the debris and get businesses back up and running.

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The short courses, delivered through the TAFE Now website, take around an hour to complete and are worth one Continuing Professional Development (CPD) point per hour. North Coast health professionals will have free access to more than 130 professional and lifestyle courses. These include: • Acute Pain Assessment • Clinical Leadership • Mental Health Triage • Paediatric Assessment • Communication Skills • Opioid use and withdrawal • Allied health topics • Healnet course topics for nurses • Generic topics for small business and self interest All topics are peerreviewed by industry professionals and endorsed by industry associations. Regular topic reviews are also conducted to ensure they incorporate current policies, legislation and Australia-wide guidelines. North Coast health professionals can access the NCPHN enrolment key and full course instructions at: www.healthynorthcoast. org.au/cpd

healthspeak April 2017

NCPHN managing major boost in mental health funding

NCPHN's Wendy Pannach addressing the media during the visit.

n late February, the Federal Minister for Health Greg Hunt visited Grafton and announced substantial funding for vital mental health services including a headspace centre for the city. Since early 2015 the Clarence Valley community has experienced higher than state average rates of suicide. Mr Hunt said a headspace centre, which provides mental health services to people under 25, would be opened in Grafton "in a matter of months". He said

$3.5 million would be spent on the centre across four years, but it would continue to be permanently funded. Mr Hunt said $600,000 would also be used to provide suicide prevention services across the Clarence Valley and the North Coast. Mr Hunt visited Grafton in response to the community putting together an Our Healthy Clarence plan to address mental health issues in the Clarence Valley. He also officially launched

Social Futures now lead agency for headspace Lismore

the community led plan during his visit. The funding is being managed by the North Coast Primary Health Network and will include: • $154,517 for suicide prevention measures specifically in the Clarence Valley – these have been contracted to CRANES Community Support Programs to deliver. • $333,384 for Aboriginal mental health and suicide prevention – CRANES will provide Mental Health First Aid, Youth Mental Health First Aid to Aboriginal community members and workers.as well as Applied Suicide Intervention Skills to community members and stakeholders. • $90,000 for post-suicide support for Clarence Valley families and communities as outlined in the Our Healthy Clarence Plan • $62,000 for improved access to psychiatry. This will include with bringing a twice-monthly child psychiatry service to Grafton via both face-to-face and

See Feature on page 14 for more about the Our Healthy Clarence Plan

Grafton headspace update

orth Coast Primary Health Network has responsibility for establishing the Grafton headspace including selecting the agency that will operate the centre and liaising with the community to ensure the service best meets local needs. Recognising the importance of this service to the Clarence Valley communities, NCPHN is working swiftly to ensure services are available as soon as possible. To expedite the establishment of headspace Grafton, NCPHN will select the premises at the same time as selecting the organisation (lead agency) that will operate this service. An Open Tender process will be used to select the lead agency and will be released via Tenderlink.

All organisations interested should register on Tenderlink, in order to be notified when the tender is released. This is expected to be in mid-April. Identification of possible sites has begun and a reference group will be engaged to consider the shortlisted options. NCPHN is committed to engaging the community, including young people and their families, in this process and to keep the community informed. To check progress of this important piece of work, go to: ncphn.org.au/headspace-grafton

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Pictured from left: Tony Davies, Federal MP for Page Kevin Hogan and NCPHN’s Chief Executive Vahid Saberi

A delighted Social Futures CEO Tony Davies speaks to the media at an event to mark a new chapter for Lismore headspace. Mr Davies’ organisation has taken over management of headspace from NCPHN following changes in the role of Primary Health Networks. Also announced was additional federal funding of $1.3 million over 18 months for the ongoing operation of the centre and to expand headspace Lismore’s youth mental health services into Casino and Kyogle.

April 2017 healthspeak

telehealth, and an existing adult Psychiatry service will be increased from two days per month to two days per fortnight. “The Our Healthy Clarence plan is built on a sense of hope but backed by practical action," Mr Hunt said. "It's an inspiring plan and our role now is to support that plan. So I am honoured to be able to announce the Australian Government will support the Our Healthy Clarence plan. "The local Primary Health Network will be working to get this up in a matter of months. This is about a one-stop-shop youth mental health services hub for our young people to give them a safe place and a supportive place,” he added. NCPHN is following a similar process to develop suicide prevention plans in Lismore, the Tweed Valley and Byron, which all experience significantly higher suicide rates than the state average.

For any questions, contact NCPHN’s Director of Mental Health Reform Megan Lawrance on 6583 3600 or email: mlawranace@ncphn.org.au

Tweed Superclinic grant to better measure patient outcomes

CPHN would like to congratulate the Director of Tweed Health for Everyone Superclinic, Dr Diane Blanckensee, for being awarded an Avant Quality Improvement Grant. This annual national award of up to $20,000 is allocated to two practices or hospitals across the country. The grant funds will be used to identify tools to assess patient reported measures and then build a user-friendly app that can integrate with the practice’s electronic medical records. At present, there is a real gap in tools to measure patient outcomes that are easily accessible, interface with practice software and are searchable. Dr Blanckensee said with the growing complexity of medical care it’s important that practices are able to measure and monitor patient care using evidence-based tools. “This application will also allow the patient to become more involved in directing their

Above: Tweed Super Clinic. Inset: Dr Diane Blanckensee

own care. Evidence shows that patients more involved in their own care have better outcomes.” she said. Dr Blanckensee will make use of internationally recognised standards for medical outcomes and the practice is going to focus on its osteoarthritis patients to develop the tools and app. “So, we’d be asking them to use the new tool on an iPad in our reception area to answer questions about their progress. They would then have measurable outcomes recorded and available before

they enter the GP’s room for their appointment. “It’s important that the tools we develop are meaningful to the patient and that they too have an understanding of how they are progressing in their care management,” she added. “ With such tools, those patients with conditions such as heart failure, chronic lung disease, heart disease, osteoarthritis and chronic pain could interact with the program while in a practice’s reception areas. “Not only will this tool en-

hance communication between the patient and their doctor, it could perhaps also be used as a teaching aid to improve patient health literacy. We would also hope that we might be involved in future research on the impact on patient care via the Primary Health Network or the Northern NSW Local Health District,” she said. Dr Blanckensee has enlisted the help of the Agency for Clinical Innovation (NSW Health) for the project. She has also started working with physiotherapist Luke Schultz from Lismore Base Hospital & NNSW LHD to focus on patients with osteoarthritis of the knee and hip. Currently, public patients have at least a 12-month wait for a hip or knee replacement. With the help of the new tool, patients could be triaged into those who require more urgent attention, those who need physiotherapy and those who only need educational information around their condition. It is hoped the new tools will be integrated into relevant HealthPathways and are expected to be completed by November this year.

Collaborating to improve women’s cancer screening rates

our out of 10 women on the North Coast are not adequately screened for cervical and breast cancer. Now 26 North Coast practices are leading the way in tackling this issue as part of Australia’s first Women’s Cancer Screening Collaborative (WCSC). In March, a series of workshops brought the practices together to hear from expert speakers and work on primary care led strategies to improve participation in breast cancer screening. In the Collaborative model working together to overcome common challenges and sharing ideas is encouraged so everyone improves faster. Lee Adendorff from Tintenbar Medical Centre has already seen the benefits of this approach. “I have shamelessly stolen 8

A Collaborative Women's Cancer Screening workshop held at Tweed Heads in March

some excellent ideas from Keen Street Clinic for improving our data quality that came to light during some group work. The Tintenbar crew is excited to be part of this new Collaborative,” she said. NCPHN's Women’s Cancer Screening Collaborative Program Manager Sara Gloede said general practice played a key role in

improving screening rates. “A pilot study by the Cancer Institute NSW found that women who were reminded by their practice to screen were 60% more likely to do so compared to women reminded by the registry only.” The findings of the pilot study have encouraged practices to begin strengthening their data

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management and to introduce a women’s cancer screening recall and reminder system. They are being supported in this work by NCPHN’s Quality Improvement Practice Support Officers. Practices will trial a number of change ideas during the life of the Collaborative. And The Women’s Cancer Screening Collaborative Handbook has been developed to support practices to record changes. This handbook is available on the Women’s Cancer Screening Collaborative website. The WCSC will run until June 2018 and is delivered by NCPHN with support from the Cancer Institute NSW. For more information and to download the handbook, visit: www.ncphn.org.au/wcsc healthspeak April 2017

Making it easy: accreditation and health literacy To assess how your health practice is going with health literacy, a specially designed tool is now available to look at your practice’s operations and the impact on the health literacy of your patients.

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Half of Australian adults are at risk of low health literacy. Health literacy changes when people are anxious, stressed or in pain. We should use health literacy best practice at all points of communication.

Effective communication involves:

Primary Care Health Literacy Assessment Tool

This tool is designed to help assess your practice’s operations and how they may impact on heath literacy. Health literacy is about people being able to access, understand and act on health information and services. The Northern NSW Health Literacy Project aims to improve how we communicate about health. The first step is to identify barriers to access and use of health information and services. You can then use health literacy improvement activities to address these barriers. These activities can also link to accreditation standards. The following tools

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prioritising key points using plain language, not medical terms using visual images to support spoken words encouraging questions arranging follow-up

here: http://healthliteracy. nnswlhd.health.nsw.gov.au/ written-communication/ 2.1 Patient feedback

can help you get started. Checklist for Health Literate Organisations

This tool looks at all aspects of an organisation to identify areas in which health literacy could be improved. It also suggests ideas for improvement. To download these tools, visit: http://healthliteracy. nnswlhd.health.nsw.gov.au/ organisational-health-literacy/

2017

RACGP standards and health literacy 1.2 Information about the practice

Using health literacy strategies such as the ‘Checklist for writing consumer friendly information’ can help you to develop information that is able to be accessed and understood. This supports people to access your practice. The Checklist is available

Using health literacy strategies can support you to gather feedback from consumers. This can be about health information, systems or accessibility. These tools can help: Consumer feedback form: http://healthliteracy.nnswlhd. health.nsw.gov.au/written-communication/ Assessing the Health Literacy Environment: https://www. hsph.harvard.edu/healthliteracy/practice/environmentalbarriers/

ARE YOU THE NEXT STAR OF PRIMARY HEALTH? Get ready and visit www.ncphn.org.au/excellence

2017 SUBMISSIONS OPENING SOON

My Health Record offers greatest benefits for pharmacy By Sheshtyn Paola

t the recent APP conference on the Gold Coast, presenters Shane Jackson and Vicki Ibrahim from the Australian Digital Health Agency urged pharmacists to sign up to access and upload information via My Health Record. “The Australian healthcare system is complex and we know its complexity is predicted to rise due to an ageing population and the burden of chronic illnesses,” said Ms Ibrahim. She said consumers wanted to be active participants in their health. “The intent of My Health Record is to provide additional sources for clinicians and better care for patients. It’s especially important for patients who access multiple doctors and multiple pharmacists.” While the system is gaining ground, there is still a need for pharmacies to sign up. Currently there are 4.6 million consumers registered with a My Health Record, and within just one week 13,000 discharge summaries were uploaded to the system. In NSW alone, almost 500,000 electronic medical records are opened every single day, according to Jonathan Di Michiel from eHealth NSW. But while nearly 6,000 general practices are registered with the system, about 1,200 retail pharmacies are signed up – out of 5,587 community pharmacies across Australia. My Health Record provides enhanced decision support, clinical documentation, medicines administration and more, Mr Di Michiel told delegates at this year’s eMedication Management Conference held in Sydney. “It’s the importance of gathering health information that will differentiate our health system into the future,” he says. Using the system is seamless, explains Mr Jackson, who 10

Steps to using My Health Record: 1. Register your pharmacy for access. If you want to use it through your clinical software, currently you will need to be using either Fred or Aquarius software to access the system. They can modify the software to ensure your access. However all clinical software vendors have been provided with a partnership offer to access My Health Record. 2. Link up the health professionals within your organisation. The pharmacists working within your pharmacy need to be added to the organisation certificate you will receive. 3. Access patients’ My Health Record. You will need their first name and last name, gender, Medicare number, date of birth. And with those identifiers you can search their individual healthcare identifier and then access their My Health Record.

dispensing information, which is really valuable information for other healthcare professionals,” he said. Mr Jackson emphasised that platforms such as MedView are not in competition with My Health Record, and the two are not mutually exclusive. “My Health Record is a facilitator for programs like MedView – it can take information from such programs and present it in a readable way,” he says. North Coast Primary Health network is supporting Pharmacists to register and start using the My Health Record platform. For more information on registering for this national platform which now has over 4.6 million Australians registered, go to www.myhealthrecord.gov.au or contact Tony Browne, Senior Project Officer, Digital Health on 6618 5405 or email: tbrowne@ ncphn.org.au

Reprinted with kind permission from AJP.

4. Record dispensing information.

is a former Tasmanian branch president for the PSA and now a branch committee member. “If I’m in the pharmacy dispensing and somebody’s got a My Health Record, when I put in a prescription it automatically comes up with the record. It’s seamless,” he says. “You can easily search within the system, it’s not an onerous task whatsoever.” Information accessible through My Health Record includes: • Prescription and dispensing information • Hospital discharge summaries • GP health summaries • Consumer entered information • Shared summaries with other healthcare providers “Pharmacy, in my view, has the greatest opportunity out of

any of the healthcare groups to benefit from this system, because we ordinarily don’t have access to the information that is in My Health Record,” said Mr Jackson. Accessing verified information through the My Health Record will allow pharmacists to deliver more efficient healthcare, he says. “It will allow us to deliver more effective and efficient care, and that’s what this is about. If we want to do this…we need to access information so we can tailor it to suit patients.” Pharmacists can and should add their own dispensing information to patients’ My Health Records, and in doing so will help to create a wider picture of a patient’s healthcare profile, said Mr Jackson. “At the moment we only have about 200 pharmacies adding

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briefs

Promising male contraceptive gel A male contraceptive gel has been found to work reliably in a trial in primates, bringing the prospect of an alternative form of birth control for humans closer. The product, called Vasalgel is a reversible and less invasive form of vasectomy and in the latest study was 100% effective at preventing conception. A blob of the gel is injected into the sperm-carrying tube, known as the vas deferens, and acts as a long-lasting barrier. The study was published in the journal Basic and Clinical Andrology.

healthspeak April 2017

Doctor, I need an MRI By Dr Brenda Rattray

t was a fairly routine afternoon in general practice, when I was confronted by a patient in her mid-forties very firmly asking for an MRI scan of her breast – certainly an investigation I had never before requested. The patient had a sister who had recently started treatment for breast cancer. She told me she had read an article in a women’s health magazine and was adamant that MRI was the way to go for her – and that there should be no charge. Immediately retreating into defensive mode and angry at the concept that a women’s

magazine was demonstrating a better knowledge of best practice and the Medicare rebate schedule for breast imaging, I went to HealthPathways for help. HealthPathways has

Coolplate allows people time to say goodbye

recently expanded to include a series of breast related topics. The breast screening Pathways provide a link to the Familial Risk Assessment – Breast and Ovarian Cancer (FRA-BOC) online tool. Women often feel their risk is significantly higher with only one relative diagnosed with breast or ovarian cancer, but forget that nine out of ten women who develop breast cancer have

no family history. The Breast Lump and Nipple Discharge Pathways recommend suitable breast imaging depending on age and also (my saving grace) a link to the updated Medicare information on funding of MRIs for high risk women under 50. So, with these tools and Pathways, I was able to confidently reassure my patient that despite her sister’s illness, her risks remained possibly the same as the general population. The recommendations would be for her to have annual mammograms through BreastScreen NSW but she would not meet the criteria for a Medicare rebate for an MRI scan of her breast. To view the pathways in this article, log on to: Mid and North Coast HealthPathways at: www. manc.healthpathways.org.au; Username: manchealth and Password: conn3ct3d

LOOKING FOR SOME NEW WHEELS? Lismore’s Southside Health and Hire Centre (in association with Southside Pharmacy) have a large range of quality BARIATRIC and standard equipment for hire or purchase including shower chairs, lifters, electric beds, wheelchairs, seating, walkers, commodes and more.

Anna Chetan Bloemhard (left) with the coolplate and a community member.

iindala, a volunteer organisation supporting people in grief and loss operating in Bellingen, Dorrigo and the Coffs Harbour area is making a Coolplate available for the local community. Coolplates are widely used in the Netherlands to keep the body of a deceased person cool at home prior to the funeral. Miindala is proud to offer this service as a non-commercial enterprise, empowering people to normalise death. Research shows that active participation in the keeping and preparation of a body is very healing and nurturing for all involved. The Coolplate makes this more April 2017 healthspeak

feasible by giving people the time and space they need to say goodbye in a meaningful way. For a suggested donation people will be able to use the Coolplate at home. Miindala’s spiritual care officer Anna Chetan Bloemhard says it is easy to use and comes with clear guidelines. Miindala supports people in loss and grief either in one on one sessions or by offering workshops and events in the Bellingen, Dorrigo and Coffs Harbour area. For more information phone Miindala on 0448 084 792 or email miindala2013@gmail.com

SOUTHSIDE HEALTH & HIRE CENTRE Call us today on (02) 6621 4440 or come in and say hello at 5 Casino Street, South Lismore. Southside Health & Hire Centre Where your health is our total concern.

Nurse on Duty www.southsidehealthandhire.com.au

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8:30am - 5pm Mon - Fri 8:30am - 12:00pm Sat Closed Sunday

NCPHN’s Art on Bundjalung Country Project and Me

By Sarah Bolt Senior Project Officer,Art on Bundjalung Country Project

rt on Country is a powerful tool with a focus on untold stories. These untold stories are shown in an amazing form through all types of art - painting, weaving, screen printing, singing, music, storytelling and dance. My name is Sarah Bolt, a descendant of the Bundjalung Nation. I lived away from country for 28 years. The journey I have taken was based on work, sports and my children and I gained many skills and experiences. Two of the prominent skills were leadership and dance. Leadership led me to challenge not only myself but also to take on other challenges - barriers that I faced in every day society. The barriers were fear – fear of rejection, of the unknown, of what is ahead, lateral violence, violation of my privacy, bullying and harassment, trauma and pain through loss of loved ones, my parents, my brother, nephews, my strengths. As an older sister, I had to be the strength for a lot of my family through these tough times. I even felt like an outsider. Outsider meant for me not sitting inside a circle with other people of similar interests. Outside meant for me as being different, a unique person that had qualities that defined me. I know now that I challenged myself to step out of my comfort zone and what was ahead of me. My future, my children’s future. This is where dance crossed my path, a passion to share my story, my feeling, and my culture. 12

Goanna Headland by Adrian Cameron

Dance healed me and took me to another place that grounded me Dance healed me and took me to another place that grounded me. It stimulated my mind, my soul, controlled my feelings and took away my pain. It made me believe, allowed me to share and teach others to believe in themselves but most importantly made me connect to my culture and gave me back my identity. Dance and leadership also gave me the strength to teach and guide my daughter who went through trauma and pain, fear and rejection. Through all this I knew my daughter and I had to go home to country, which led me to search for jobs back in Lismore. Two weeks before Christmas last year I found out that I had landed the role as Senior Project Officer for the Art on Bundjalung Country Project at NCPHN. The moment I received the call was the moment of joy and hap-

piness to a better future for me and my little girl. It would also take us to a place we call home, Bundjalung Country. I had dreams for home, dream to teach dance and leadership but also to make a change to someone else’s life, even if it is a little change. About the project

The Art on Bundjalung Country Project was driven by a group of enthusiastic health practitioners and art professionals with a passion for Aboriginal Art. This group were the inspiration that gave me the opportunity to take Aboriginal Art on Bundjalung Country Project for emerging artists to the next level. The Project aims to raise the profile of current and emerging artists within the footprint of the Bundjalung Nation from Grafton to Tweed heads, Tabulam to Ballina and towns in between. The project will deliver five art workshops throughout the Bundjalung Nation that will enhance health and wellbeing and build resilience through art therapy. People will have an avenue of expression and feelings of belonging through art. They will identify their culture through

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art and become known for their artwork within their community. As a result of the Art workshops, works will be selected to be exhibited at the special Exhibition that will be open in the new Lismore Art Gallery at the end of the year. The process and logistics to deliver the art workshops involve Aboriginal facilitators sharing and teaching the emerging artists skills, business management and how to present their individual art styles. As a result of a call for Expressions of Interest, 10 Aboriginal artists from Grafton/Clarence, Ballina, Lismore, Murwillumbah and Casino have applied to become facilitators. These workshops will be delivered around June 2017. Outside of these workshops I will be delivering a dance workshop and classes so that we can establish a dance troupe/group in Lismore that performs both traditional and contemporary Aboriginal dance. This troupe will also be performing as the opening of the Bundjalung Art Exhibition as well as at other community events throughout the year. Watch this space. healthspeak April 2017

End of Life Care Project

ith the help of funding from the Agency for Clinical Innovation, Northern NSW Integrated Care has appointed an Integrated Care – End of Life Care Project Officer, Anna Law. Anna brings extensive experience as a registered nurse including work as a Clinical Nurse Specialist (CNS) in Intensive Care – Portfolio End of Life Management. Anna heads up The End of Life Care (EOL) Project which aims to improve the care provided for our community in the Richmond Valley. The project will work in collaboration with acute and primary care services and improve the quality of patient/carer end of life experience. The goal is to work with existing services to improve the end of life care provided by clinicians in the Northern Rivers. These projects will be in collaboration with NNSW Integrated Care, NNSW Local Health District, NCPHN, the Agency for Clinical Innovation and the Clinical Excellence Commission. The four areas of initial focus are: 1. Digital Communication 2. Health Care Clinician Education 3. Community Engagement 4. Ambulance and Advance Care Plans. To improve and support the care of the dying patient in NSW health organisations, the Clinical Excellence Commission (CEC) End of Life (EOL) program, in collaboration with clinicians and consumer advisors, developed a Last Days of Life (LDOL) toolkit. The toolkit provides tools and resources to ensure all dying patients are recognised early, receive optimal symptom control, have social, spiritual and cultural needs addressed, both patient and families/carers are involved in decision-making, April 2017 healthspeak

and bereavement support occurs. They have been specifically developed for use by generalist clinicians and are not intended to replace either local Specialist Palliative Care guidelines or advice given by Specialist Palliative Care clinicians. As part of the Last Days of Life pilot, LBH agreed to pilot the following tools in nine medical units: Initiating last days of life planning; Comfort observation and symptom assessment chart (COSA) and Medication Guides. Pilot results

The LDOL toolkit was trialed at Lismore Base Hospital (LBH) from late 2016. The pilot’s main positive outcome being the improvement in comfort care provided. (See graph below.) During the pilot 152 patients were managed using the various tools across the nine sites. One of the main findings was that patients who were cared for using a standardised approach had a higher percent of their care being more structured - symptoms and comfort assessed routinely and receiving medications within a best practice model. This also saw a decrease in the harm to patients. Staff feedback included:

Medical staff were observed to be photocopying and recording the anticipatory prescribing guidelines onto their “smart” devices, so that the information could travel with them

Communication Tools Anna Law

“A common discussion among staff was 'not more paperwork,' but when they used the forms, especially the observation form, all agreed that it covered all aspects of caring for the patient and their families at end of life care

Medication Management Guides

The medication guides were some of the most popular tools piloted. They were seen as easy to use and useful in determining what medication and dose to prescribe. Barriers mainly related to lack of education / explanation around the use of the tools.

While not officially piloted, all sites were given access to the communication tools and encouraged to use as appropriate. Feedback was positive: The communication handouts were fantastic, they answered a lot of questions that the families had, and may not have known to ask. These handouts also were helpful for our new staff, who had no experience with palliative care

Next Steps

Overall the response was very positive and the tools were seen as appropriate and suitable for the care and management of the dying patient. Once reviewed and updated, the toolkit will be launched in April/May this year and available for use across NSW.

Comfort Observations and Symptom Assessment Chart • Prior to the pilot 22% of patients audited had a standardised care plan in place in the 24-72 hours prior to dying • During the pilot 93% of patients were managed with a standardised care plan – this saw a high percent of patient’s care being more structured i.e. symptoms and comfort assessed routinely and patients receiving medications within a best practice model – see graph below. 100%

93%

92%

90%

92%

89%

80% 70% 60%

Pre pilot Pilot

57%

50% 40% 30% 20% 10%

0% Patients with standardised care plan

Patients with medication management plan

0% Patients with symptoms assessed

a publication of North Coast Primary Health Network

0% Patients with comfort assessed

Responding to ICE in General Practice At an NCPHN seminar held at Port Macquarie in March, Kempsey addiction specialist Dr Fares Samara gave an address about crystal methamphetamine and the treatment of patients who use ICE. In a wide-ranging presentation, Dr Samara offered much useful advice.

Questioning the patient

Dr Samara stressed the need to build rapport with the patient. And he said don’t be fooled by a patient’s appearance, assuming they wouldn’t touch drugs. “I have a patient in Kempsey in her third episode of opiate treatment, she dabbles with opiates but her preferred drug is ICE. She is a very well spoken, well presented woman in her 50s. She uses ICE frequently and manages to keep it together, but knows she is dependent.” Dr Samara suggests that you start by asking the patient about their family and whether or not they smoke and drink alcohol. From there you can ask about recreational drug use and if you proceed in a gentle fashion, most patients will open up. At that point Dr Samara suggests asking the patient how crystal meth makes them feel, and what happens after they take it and when they are coming down. “Everyone will say ‘depressed and tired’. Let them tell us what they don’t like about the drug.” Dr Samara always talks to patients who express a wish to withdraw from ICE about ways to keep away from the drug. “Avoid the drug, avoid houses where people are using, block people with the drug from calling on your phone. We have to help them relapsing. Always refer them to the drug and alcohol unit or mental health services.” He said if GPs keep seeing a patient twice a week they can have an impact. He said there’s evidence that counselling works, even five to 10 minutes during a consult has proven to be useful. 14

People do listen to GPs, he said. “I always explain the big reason for giving up is to avoid “frying the brain”. I use that term and I also talk about the risk of stroke, of infarct, of ending up in a wheelchair and going to the “loony bin”. Not to mention legal problems, social and family problems and the danger of ending up in jail due to violent, erratic behaviour.” Managing the waiting room

Intoxicated people can come and cause havoc in the surgery. “You can’t reason with them, we just have to stay calm and it’s difficult if it happens in your waiting room. Take them aside and calm them or call the ambulance and police. A bit of first aid is Zyprexa (olanzapine). It works wonders, it’s what they use in ED. So 5mg or 10mg of diazepam and Zyprexa wafer is quite quick acting. The protocol is repeated in 15 minutes IMI.” Paperwork

“In the patient records, I always write down what I’ve done briefly. I write that I’ve educated, informed, discouraged and warned: about the use of Ice. That’s all you need to write.” Treatment

If psycho social intervention happens before dependency, it’s

With the crash, initially they can’t sleep, they eat more and crave the drug more likely to be effective. And GPs need to address other drug use too. “Please don’t ever prescribe Xanax (Alprazolam), send them to a psychiatrist. Thankfully Xanax is now schedule 8, but even long acting Benzodiazepines are not needed and cause more trouble than good. “For withdrawal, you can give them a short sharp period of diazepam. I prefer to use Neulactil (pericyazine) which doesn’t cause dependency or depression and treats anxiety and aggression. People can use up to 20mg a day. I prescribe the 2.5mg tablets and they can take up to eight during the day, and it’s on PBS.” “Counselling support is important and there are self-help groups (Narcotics Anonymous) and family support is also available. An organisation called Family Drug Support which is wonderful. You can find them online.” Actual withdrawal is longer than alcohol or heroin, it can go

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up to 10 days but effects on the brain can go on for six months. “With the crash, initially they can’t sleep, they eat more and crave the drug. But then they sleep for days and wake up and their brain and body is exhausted with aches and pains and so on. Because of the dopamine being over produced over a long period, it may get depleted and they may have early Parkinsonian symptoms if they use it long enough; but depression/anxiety and mood swings are most common even after they stop using. “Mood swings, we can do something about those: Epilim, a mood stabiliser, for a few days or weeks. Here 100 mg once or twice a day is quite useful. It helps that up and down mood swing but you have to watch the possible side effects.” “The earlier the intervention the better, and we can do mid-term or lengthy therapy and residential rehab. But it’s very difficult to get a rehab bed in NSW.” To refer a patient to Riverlands drug withdrawal unit in Lismore phone 6620 7600. Patients or GPs can call the NNSWLHD Drug & Alcohol Service - phone Tweed/ Byron 07 5506 7010 and Lismore/ Clarence 6620 7600. On the Mid North Coast, phone the LHD’s Drug and Alcohol services intake line on 1300 66 22 63.

healthspeak April 2017

n many ways this community driven exercise is unique, requiring an astonishing amount of work and commitment on the part of many and resulting in the Our Healthy Clarence Health & Wellbeing Plan. The Plan was launched by Federal Health Minister Greg Hunt during his visit to Grafton in February. As well as announcing a headspace youth mental health services for Grafton, Mr Hunt also announced a funding package of more than $500,000 for suicide prevention and response training and services both in the Clarence Valley and across the North Coast. (More details on page 7). NCPHN has contracted local services, organisations and clinicians to carry out this important work. HealthSpeak would like to pay tribute to the many people who worked so diligently to come up with the Our Healthy Clarence (OHC) plan which has given the community a purpose and an evidence-based, practical focus to educate and support the population. In particular, special commendation goes to the Our Healthy Clarence Steering Committee comprising: April 2017 healthspeak

Wendy Pannach, North Coast Primary Health Network (Chair); Skye Sear, New School of Arts; ; Mark McGrath, CRANES; Richard Buss, NNSWLHD; Gary Martin, Debrah Novak, community members; Scott Monaghan, Bulgarr Ngaru Aboriginal Medical Corporation; Shayne Rawson, CHESS; Dan Griffin, Giane Smajstr, Clarence Valley Council; Wendy Campbell, Mark O'Farrell, Clarence Valley Private School Representatives; Susan Howland, carer representative; Meghanne Wellard, Department of Education/ other Clarence Valley Public School representative; Sharon Monaghan, Department of Prime Minister and Cabinet; Inspector Joanne Reid, NSW Police; Megan Moore/Leon Beveridge, Partners in Recovery; Samantha Osbourne, Rural Adversity Mental Health program; Rose Hogan, Standby Response Service; Narelle Corless/ Gabi McMahon, headspace school support; Alister Donald, Lifeline North Coast; Background In early 2016, the need to address the issue really came to prominence and number of agencies had indicated their desire to plan and implement their provision of services within the Clarence Valley. Already existing was a Youth Mental Health Interagency Committee which chaired by the Clarence Valley Council Youth Liaison Officer. In consultation with that committee it was decided to establish a larger committee which included looking at the mental health services available for adults. This committee first met on 3 March

2016 and sent an open invitation to all agencies within the Clarence Valley to come together to examine the issue of mental health. The Committee was chaired by Richard Buss, General Manager Mental Health & Drug and Alcohol Service, NNSWLHD, and set about examining the best ways that the community response and the issues associated with recent tragic events could come together. During this period there had also been a number of media and community meetings which had highlighted relevant themes for mental health services. It was established at the first meeting that the community needed to be an interactive part of the process and it was decided that a consultant would gather together the thoughts and issues from community interviews. This would then be put into a document and this document would then be used as a focus for the community and organisations to come together and examine the themes. NNSWLHD Mental Health Services contacted the Centre for Rural and Remote Mental Health in Orange and Robin Considine was appointed as the consultant who met with a large range of community individuals and organisations to establish what were the needs, thoughts and aspects to consider for the Clarence Valley. Ms Considine’s report identified the following serious mental health concerns: • Depression • Anxiety • Substance Abuse • Eating disorders • Self-harm • Schizophrenia

a publication of North Coast Primary Health Network

OUR HEALTHY CLARENCE – A BLUEPRINT FOR HEALTHY MENTAL HEALTH

For the past 16 months, an extraordinary coordinated community/health and community services effort has been in place in the Clarence Valley to address a higher than state average rate of suicide in the Grafton/ Yamba/Maclean region since early 2015.

FEATURE

OUR HEALTHY CLARENCE – A BLUEPRINT FOR HEALTHY MENTAL HEALTH

It was at this meeting that a banner under which all organisations and activities was established. The name and banner were voted on and Our Healthy Clarence (OHC) became a reality. Since that time the OHC Steering Committee has taken charge of the development of the plan. On February 23, Federal Health Minister Greg Hunt officially launched the Our Healthy Clarence plan with its five objectives. (See breakout box.)

PERSPECTIVES OF KEY PLAYERS: FEATURE

OHC PLAN’S OBJECTIVES: 1. Improve access to evidencebased treatment, crisis care and coordinated care after a suicide attempt

OUR HEALTHY CLARENCE – A BLUEPRINT FOR HEALTHY MENTAL HEALTH

2. Improve the capacity of the workforce and the community to respond to people at risk of suicide 3. Increase the availability of evidence-based mental health and wellbeing programs within schools 4. Improve community awareness of mental health and how to access information and services 5. Improve community engagement, early intervention and prevention

Mark McGrath, Manager, Our Healthy Minds, CRANES For Mark it’s been a long haul to get to the launch of the OHC plan. He was at the first meeting of community members that formed the Clarence Valley Youth Mental Health & Wellbeing committee in 2015. “And in the interim, myself and others working in community service organisations have been the ones dealing with the general public on a daily basis. They walk in the door and say ‘What are you doing?’” While he thinks the OHC process was thorough and the model exceptionally good, he’d like to see an evaluation of the methodology to see if efficiencies could be made that would help other communities wanting to go down a similar track. While Mark acknowledges the community is now highly mobilised and supporting the plan, that’s not always been the case. And while at the moment community focus is on suicide prevention, like other members of the Steering Committee he’s keen to see that change. “I’m excited to think that when we start to meet some of our objectives and get activities occurring we can shirt that focus to broader community wellbeing.” CRANES won tenders to support objective two of the plan. For the past two years the organisation has been delivering education sessions around mental health and wellbeing and mental health first aid. Mark is keen to see that the agencies CRANES

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works with build in sustainability around training. “Organisations need to provide ongoing support and training for the mental health first aid officers we train for them. They are the ones who are actually responding to someone is in distress and we’ll be talking to them about this.” “I chuckle to myself because years ago we coined this phrase of everyone working under a recovery oriented service. I raised the point at a meeting once saying, “What about a recovery oriented community?’ and this plan is just that.” Approaching sporting clubs and other social organisations to engage has been central to ensuring a spread of expertise is built up within different sections of the community. Mark is pleased that there are a variety of levels at which the community can engage with the plan. However, he can see a lot of work that still needs to be done. “We have issues around a very transient GP population and that has to be addressed, because if we’re increasing the capacity of the community that’s likely to generate more referrals to GPs and often it’s difficult to get in to see a GP quickly.” Mark believes it’s because of the location of the Clarence Valley that a lot of really strong organisational relationships had been built over the years. “Because the Valley has always been at the bottom half of the NNSWLHD and the top half of the MNCLHD, we’ve always been out on the fringes. That forces us to work together and collaborate, particularly filling health and social needs gaps. I wonder if the same level of collaboration would be available in other communities?” Richard Buss, General Manager Mental Health & Drug and Alcohol Service, NNSWLHD As the original Chair of the Steering Committee, Richard said the key to the success of the OHC process was the realisation that not one agency or person has all the answers to mental health. “It has to be a collective approach, but one with purpose. We have to think about where best to put money, where best to change positions and to make sure all agencies are working together – a comprehensive approach.

healthspeak April 2017

OHC Committee Member Skye Sear (centre) at a community workshop late last year.

Success of the process has also hinged on inclusivity. “The issues are not one dimensional and don’t belong to any one organisation. To me it’s a bit like a puzzle. Every piece is important and if you want to complete a puzzle you have to have all the pieces fitting together without any one dominant part of it.” Richard told HealthSpeak that at the beginning of the process it wasn’t known what the community was wanting and it was essential to engage and bring all the various groups in the community together with a sense of purpose. “As a result, the community feels like they own the plan; it’s something that came from the grassroots. When Health Minister came up he was trying to understand OHC and I said it’s really easy: ‘OHC belongs to nobody and belongs to everybody. Nobody owns this, nobody has jurisdiction over it or bigger voting rights. It hasn’t got a constitution but it belongs to everybody, so in that way it’s been successful as it is seen as inclusive.” Keeping the community informed about

April 2017 healthspeak

• A headspace youth mental health service in Grafton • $154,517 for suicide prevention measures specifically in the Clarence Valley delivered by CRANES including Mental Health First Aid and Applied Suicide Intervention Skills

OUR HEALTHY CLARENCE – A BLUEPRINT FOR HEALTHY MENTAL HEALTH

IT TAKES SOME DOING, BUT THE EVIDENCE-BASED OHC PROCESS STOPS BLAME AND THE IDEA THAT IT'S UP TO ONE ORGANISATION TO SOLVE THE ISSUE.

what was going on has been crucial. A lot of time was spent compiling mailing lists of people who attended meetings and workshops – people who participated but were not on a committee. Richard acknowledged the support from NCPHN Chief Executive Vahid and hard work done by the PHN staff, in particular the Manager of Mental Health Reform, Wendy Pannach. “It was an enormous amount of work getting OHC up and running but it’s easier if everybody’s committed and the community was. “And then there was a great deal of work that Wendy did in keeping it going; getting the objectives consolidated and the plan together and into action. That’s been the second phase which Wendy has performed fantastically.” Richard believes the OHC process and plan is unique and would like to see it evolve. “It takes some doing to create something sustainable that brings community and organisations together in a constructive way, but is still seen as run by the community. It stops blame and the idea that it’s up to one organisation to solve the issue. “The way in which the PHN, NSW Health, schools, police, ambulance and the council all have come together and how the community has accepted us working with them has been great. It’s a really good model and now we have to grow OHC away from suicide prevention and into other areas of healthy mental health.” Richard is now working with the Centre for Rural and Remote Mental Health to look at whether the OHC model can be rolled out in other places.

FEATURE

NEW SERVICES

• $333,384 for Aboriginal mental health and suicide prevention delivered by CRANES both in the Clarence Valley and across the North Coast • $90,000 for post-suicide support for Clarence Valley families and communities • $62,000 for Improved access to psychiatry including a child psychiatrist clinic twice monthly in Grafton and an increase in adult psychiatry services

a publication of North Coast Primary Health Network

FEATURE OUR HEALTHY CLARENCE – A BLUEPRINT FOR HEALTHY MENTAL HEALTH

Skye Sear, Manager, The New School of Arts Now that the OHC Plan has been launched and things are moving ahead, Skye, like other Steering Committee member would like to change the messaging to the community. “We’ve been trying to shift the narrative away from suicide prevention to broader health and wellbeing conversations for a while. I was talking today to some community members and they were saying it’s really great all the stuff that’s happening behind the scenes and I got chatting to them about Robin Considine’s report. “Robin identified that our community had an abundance of protective factors both individual and community-based. We’re an incredibly resilient, connected community and some of that has been lost in the conversation,” said Skye. She’s pleased that the plan’s recommended activities are taking shape. “I feel really strongly now that we have to focus on the positive aspects of the plan. It’s great to see the community really rallying around this issue.”

THERE’S BEEN SOME PHENOMENAL WORK GOING ON IN GENERAL PRACTICE LOCALLY UNDER THE RADAR

Skye is mainly working on Objectives 4 and 5 around community engagement and communication and there are various ways for people to get involved. “Participating in the working group and communication workshops we run and getting onto the OHC mailing list so they are up to date information on our activities. They could also access the mental health first aid training rolling out. It’s starting to get really exciting now,” she said. Skye is keen to acknowledge the key role that GPs and other mental health professionals play in the community’s mental health and wellbeing. “I’d invite them to a call of action. The

expectation always is that GPs and other health practitioners will be involved at the pointy clinical end, but I’d like for them to be recognised for their roles in prevention and early intervention as well. And they are welcome to join our workgroups. “We’re a neighbourhood centre and a drop in centre and the first recommendation we make to a community member who presents with a mental health issue is to have a chat with their GP. And allied health staff, such as mental health nurses, have been critical in service flexibility and creating environments in which people feel comfortable. There’s been some phenomenal work going on in general practice under the radar.” Skye describes the mood of the community as ‘very hopeful’ and highly motivated to implement the changes needed. Since the Minister’s visit she’s noticed that more locals are hopeful rather than sceptical. Skye also believes that health literacy is improving as the OHC plan is talked about in the community. “People are speaking like us now,” she laughed. “And that is really significant because it demonstrates not only an improvement in health literacy but some trust in the quality of information that we are providing to them,” she said. Now according to Skye the focus is absolutely on all aspects of community health and wellbeing. “We’re hoping that the structure we’ve applied to that plan can be used on other complex issues in our community such as child health and early childhood development.” Debrah Novak, community member With a strong background in media and community advocacy, Debrah became involved with OHC over a year ago when she helped a local mother organise and publicise a public meeting about recent tragic events in the Clarence Valley. “One hundred and fifty people turned up but no councillors among them, except one who chaired the meeting. That was the trigger for me to run and be elected to council,” she told HealthSpeak. Debrah has been a community representative on the OHC Steering Committee since its inception. Over this time she has also

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WE’RE HOPING THE PLAN CAN BE USED ON OTHER COMPLEX ISSUES SUCH AS CHILD HEALTH AND EARLY CHILDHOOD DEVELOPMENT been busy lobbying MPs about the needs of this community. “Our community had faced some setbacks and were pretty worn down, so I’m pleased that through the OHC process the community has learned that you can fight the good fight. And we’ve given them the confidence to follow a process (the OHC Health & Wellbeing Plan) that will work.” Debrah administers Facebook pages to spread the word about community action and doesn’t have much time for people with defeatist attitudes. “There’s a very high illiteracy level in our community and they are often influenced by a few negative people. I want people to understand there are a lot of great things happening and as a community you’ve achieved some amazing things.” Now that the community has stepped up and has some answers, Debrah would like to see people taking more responsibility and becoming part of the conversation. She wants people to understand that when you post on Facebook you are a citizen journalist, so her advice is to stick to the facts (which she advises people to get from the Steering Committee) and keep posts positive. She said that things really started to gel after all the different service providers and community sectors came together in the one room. “It’s about bringing everyone together and making sure that our community is armed with evidence-based knowledge that can help them get the services and programs they need.” Debrah’s focus is on Objective 5 and she’s involved in creating communication assets including a website. “That’s my area of expertise, but I have the lived experience as well, so close to my heart. There are very, very few people who have not been touched by these deaths. I really want to empower our community to make the right choices to improve the Valley’s mental health and wellbeing.”

healthspeak April 2017

300 HealthPathways and more planned!

Ps across NCPHN’s footprint are warmly invited to help develop HealthPathways by lending their clinical expertise to local Workgroups as they meet to develop topics of interest. A total of 300 HealthPathways have now been developed for use on the Mid North Coast and North Coast. The success of HealthPathways is based on the fact that they are truly clinicianled and Clinical Editors from Tweed down to Port Macquarie meet to collectively plan future Pathways. In February a HealthPathways planning day was held in

From far left then around the table: Fiona Ryan, Senior HealthPathways Project Officer, MNC LHD; Catriona Wilson, Manager, Integrated Care, NNSW LHD; Sharyn White, Director, Integration NNSW, NCPHN; Brenda Rattray, HealthPathways Clinical Lead, NCPHN; Sally Howe, HealthPathways Project Officer, NCPHN; Helena Smetana, HealthPathways Clinical Editor, NCPHN; Ruth Heather, Director, Integration MNC, NCPHN; Dan Ewald, GP Advisor, NCPHN; John Roberts, HealthPathways Clinical Editor MNC LHD; Hilton Koppe, HealthPathways Clinical Editor, NCPHN; Kerrie Keyte, Senior HealthPathways Project

Coffs Harbour with clinicians, HealthPathways’ administrators

Workgroups planned to start in April 2017 include: Name of Workgroup

Pathways under development

Town

Mental Health

Anxiety, Depression

Byron Bay

Palliative Care

Palliative Care – A suite of 14 palliative care pathways being developed are nearing finalisation.

Wauchope

Paediatric

Headaches, Reflux/GORD in Children, Constipation in Children

Port Macquarie

Pre-Op

Pre-operative Care

Port Macquarie

Infectious Diseases

MRSA/MRO

Cancer Neurology

and managers from both LHDs and the NCPHN present. The team reviewed and discussed the progress of current Pathways and agreed on the establishment of further pathways over the next quarter to meet primary care, PHN and LHD priorities. These will be developed by Workgroups to

localise the Pathways and to look at any health reforms that may be required. If GPs would like to join a Workgroup, contact either Kerrie Keyte in NNSW, email kkeyte@ ncphn.org.au or Fiona Ryan on the Mid Norther Coast, email fryan@ncphn.org.au

The following Workgroups are underway: Name of Workgroup

Pathways

Town

Gynaecology

Port Macquarie

Dysmenorrhoea, Endometriosis, Heavy or Irregular Menses

Port Macquarie

ATSI

Aboriginal Health

Ballina

Ovarian Cancer Symptoms, Cervical Screening

Ballina

Breast

New Breast Lump, Nipple Discharge

Coffs Harbour

Parkinson’s Disease

Coffs Harbour

Diabetes

Diabetes Diagnosis in Children, Insulin

Ballina

Deflagging MRSA patients

etween 16 and 29% of Staphylococcus aureus isolated on the Mid and North Coast are methicillin resistant (MRSA). MRSA can cause disease in otherwise healthy people. MRSA can manifest as skin infections such as pimples and boils, impetigo or cellulitis, and more serious infections including osteomyelitis, bacteraemia and pneumonia. Bacteria are shed from the skin and infected draining wounds. Person to person

April 2017 healthspeak

transmission occurs by direct contact. Patients presenting to a local hospital who are infected or colonised by MRSA initially require isolation and barrier nursing. This is not ideal for the patient or the nursing staff and this is an additional cost to our health system. How GPs can help?

All patients identified as being MRSA positive are sent a letter of notification from the hospital as well as some useful

patient information brochures. These patients currently stay “flagged” in the hospital system as remaining positive, and will need to be treated accordingly on all subsequent admissions. General practitioners can offer these patients “clearance screening”, which allows them to be “deflagged” in the hos-

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pital system. HealthPathways has just localised the MRSA page with full guidelines of the procedure to follow. https://manc.healthpathways. org.au/40526.htm Username: manchealth Password: conn3ct3d

Koori Grapevine Expanded Aboriginal D & A Services at Alstonville

n March 17, North Coast Primary Health Network’s (NCPHN) Chief Executive Vahid Saberi and the Federal Member for Page Kevin Hogan visited Namatjira Haven Drug & Alcohol Healing Centre in Alstonville to mark the centre’s two successful tenders for new Commonwealth funding. NCPHN was delighted to announce funds of $83,186.00 for the expansion of existing services at Namatjira Haven, as well as $31,910 to deliver Aboriginal mental health first aid using a train-the-trainer model for workforce training and community development. This package has two components and is provided via NCPHN’s mental health and drug and alcohol commissioning funds. 1. 83,186.00 for the expansion of Namatjira Haven’s existing services

Namatjira Haven’s Withdrawal Management Project is an expansion to Namatjira Haven’s Gulgihwen Residential Program (meaning ‘change’ in local language). The Withdrawal Management Project is for Aboriginal men who wish to address their drug and alcohol misuse and did not require or felt unable to attend a hospital detox. The new funding will help the Program to: • Increase bed capacity from 14 to 16 beds • Increase timely access to evidence-based low-risk withdrawal management services for Aboriginal men, including men with some co-occurring mental illness and substance misuse disorders • Improve the pathways to 20

The Gulgihwen Program seeks to re-attach Aboriginal men to their cultural history and community by delivering services that are culturally focused

From left, back row: Terry McGrath, Namatjira Haven Team Leader; Vicky Bardon, Namatjira Haven Board Member and Mental Health First Aid Training mentor; Dian Edwards, Namatjira Haven Team Leader; Kevin Hogan, Federal MP for Page; Jeff Richardson, Rekindling the Spirit Service Manager. Front row: Colin Marsh, Namatjira Haven Mental Health Trainer; Sharmaine Keogh, Rekindling the Spirit Counsellor; Roger Bartholomew, Rekindling the Spirit Youth Worker; Vahid Saberi, NCPHN Chief Executive.

and from other services that meet participants’ physical, mental health and social needs “The Gulgihwen Program is unique in our area in that it seeks to re-attach Aboriginal men to their cultural history and community by delivering services that are culturally focused. “We are also unique in that we focus on the importance of a healing place (the land we are on) that allows men the safety and peace they need to work on their issues and find their own strengths and take responsibility for their choices into the future,” said Namatjira Haven’s Team Leader Dian Edwards. Dr Saberi said the program would meet the objectives of the Commonwealth Drug & Alcohol Treatment Services funding. “These funds will enhance the treatment at Namatjira Haven by

providing more accommodation and better linking the facility with appropriate health services and referral pathways,” he said. 2. $31,910 to deliver Aboriginal mental health first aid using a local train-the-trainer model for workforce training and community development.

Namatjira Haven, working in partnership with Rekindling the Spirit, will train staff members from these two Aboriginal Community Controlled Health Organisations to become accredited instructors in Aboriginal Mental Health First Aid. Aboriginal Mental Health First Aid training will also be provided to Aboriginal community members and people delivering services

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to Aboriginal people from Tweed Heads out to Kyogle and down to the Richmond Valley. “Mental health first aid is help provided to a person who is developing a mental health problem, or who is in a mental health crisis. People who have received the evidence-based mental health first aid training have the skills to support someone until professional assistance is available,” said Dr Megan Lawrance, Director of Mental Health Reform & Integration at NCPHN. Aboriginal mental health first aid is tailored to address Aboriginal and Torres Strait Islander social and emotional wellbeing. The training teaches strategies for working in a culturally appropriate way with Aboriginal and Torres Strait Islander communities. “This is an exciting project because it increases the number of local trainers; builds the skills of the local workforce to more confidently respond to mental health crises; as well as building community resilience, providing skills to support one another through healing and recovery,” added Dr Lawrance. healthspeak April 2017

Med students learn about Indigenous culture at two-day camp

he University Centre for Rural Health, (UCRH) hosted an Indigenous cultural immersion program in January for University of Sydney medical students. The program held at Camp Koinonia at Evans Head included an introduction to Aboriginal health, with guests talking about a variety of subjects including stolen generations, transgenerational trauma, Aboriginal community controlled health services and health promotion initiatives. “The program’s aim was to give a better understanding of how to build relationships when working clinically with Aboriginal people, and give the students an opportunity to talk with Aboriginal people about their real-life experiences,” UCRH’s Academic Lead/ Aboriginal Health, Emma Walke said. “The two days includes a yarning circle, and some tasks and challenges, such as making fishing nets and canoeing. Being on country, off the university

Sophie Wagner (orange top) with fellow medicine students learning how to make fish traps with Elder Monica Kapeen

campus may take them out of their comfort zone, but the experiences will be priceless, and a great benefit to their careers,” she added. UCHR Director Professor Ross Bailie said the cultural immersion program for medical students will help ensure that new generations of doctors have a sound understanding of Aboriginal culture and history.

“This program enables them to understand the underlying determinants of health and enhancing their ability to relate appropriately to Aboriginal and Torres Strait Islander patients and colleagues.” Prof Bailie said the UCRH is committed to addressing the gap in health status, access and quality of care between Aboriginal and Torres Strait Islander people.

Encouraging Indigenous students into health

n an educational first for the North Coast, the University Centre for Rural Health is running a program in schools to encourage Indigenous students from Year 8 upwards to consider a career in medicine, allied health and nursing. The move is part of UCRH’s commitment to improving the health of Aboriginal and Torres Strait Islander people in this region and Australia-wide. The program is called Baribunmani Wanyi Ngay – Bundjalung for “I dreamed about you” and it commenced in three local high schools in the first school term this year. It is being coordinated by Emma Walke and Darlene Rotumah, UCRH’s Academic Lead/ Aboriginal Health and draws on April 2017 healthspeak

Cultural program coordinators Darlene Rotumah (l) and Emma Walke with a picture of her extended family.

experiences from a health academy program at Broken Hill, with local adaptation. “We want to be able to show Goori students the gamut of

careers that are available in health and inspire their confidence to know they can do it,” Emma said. UCRH Director Professor Ross Bailie said the program is one of several UCRH initiatives aimed at increasing the numbers of Aboriginal and Torres Strait Islander people in the health workforce. “Encouraging and supporting school-aged children into health careers is a vital step in the systematic, multi-pronged and long-term approach to improving health among Aboriginal and Torres Strait Islander people." Another UCRH initiative is the hosting of The University of Sydney’s Graduate course in Indigenous Health Promotion, a year-long course which started in February.

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Improvements in Aboriginal health status On Close the Gap Day 2017 the Overview of Aboriginal and Torres Strait Islander Health Status was launched, showing that the health of Aboriginal and Torres Strait Islander people continues to improve slowly and that there has been a decline in death rates for Aboriginal and Torres Strait Islander people. At the launch Dr Michael Adams, Senior Research Fellow at Australian Indigenous HealthInfoNet,said there had also been a significant closing of the gap in death rates between Aboriginal and Torres Strait Islander and non-Indigenous people. The infant mortality rate had declined significantly, he added. The Overview provides an accurate, evidence based summary of many health conditions to help professionals keep up to date with the current health status of Aboriginal and Torres Strait Islander people throughout Australia. There have also been improvements in the proportion of Aboriginal and Torres Strait Islander mothers who smoked during pregnancy. To view key facts of the Overview, go to www. healthinfonet.ecu. edu.au/health-facts/ overviews

GPs can help lift bowel screening rates

ancer in Australia (2017) predicts that colorectal cancer will be the second most commonly diagnosed cancer this year for both males and females. Australia has one of the highest rates of bowel cancer in the world. According to comedian Dave O’Neill, the classic poo joke is key to boosting bowel cancer screening rates in NSW. “Embrace the poo! It is a very simple test. The government sends it to you in the mail, you get a little stick, you put it in the poo, you put it in a tube and then you send it through the mail. A turd! In the Post! To the Government! Haven’t you always wanted to do that?!” All jokes aside, NSW has the second worst participation rate in Australia for bowel cancer screening. 80 Australian die every week from bowel cancer, and with 90% of bowel cancers being treatable

Sit down comedian Dave O’Neill tackling bowel cancer screening rates. Check out the YouTube clip: https://www.youtube.com/ watch?v=AjtCRMSJTT8

with early detection, screening should be a top priority for all 50-74 year olds. Evidence suggests that greater involvement by primary healthcare providers in encouraging and supporting participation in the National Bowel Screening

Program (NBCSP) is required to complement the direct mail method. In 2014/15 only 39% of those invited to the NBCSP completed their test. Research consistently shows that a recommendation from a GP to screen for bowel cancer is an important motivator for participation. A Newspoll telephone survey conducted in 2015, showed that 92% of people surveyed stated they would be more likely to participate in bowel screening if recommended by their doctor. HealthPathways

Dr Hilton Koppe and the HealthPathways team have been busily working on numerous localised pathways, to help clinicians on the North Coast to assess, manage and refer patients in the local context of available services. The current HealthPathways available are:

BOWEL CANCER FACTS 33% in NSW participate in bowel screening. 92% would take part if their GP recommended it. 31% of bowel cancer is diagnosed at the localised stage.

• National Bowel Cancer Screening Program • Colorectal Cancer Symptoms • Positive Faecal Occult Blood Test (FOBT) • Assessing Family History Risk for Colorectal Cancer (CRC) • Previous Colorectal Cancer Colonoscopy Surveillance • Screening and Surveillance Colonoscopy Go to the HealthPathways website: www.manc. healthpathways.org.au. User: manchealth; password: conn3ctcd

Pulling our research together to support health and wellbeing By Professor Iain Graham Dean, School of Health and Human Sciences Southern Cross University

outhern Cross University has been steadily growing its research endeavours resulting in grant success, higher degree student recruitment, success in the Federal Government's research excellence exercise and international recognition. The long-term vision is to establish a process of development that will facilitate critical mass, quality outcomes, sustainable growth and successful collaborations supporting the University’s strategic global positioning. A large part of the university’s success is due to the personcentred approach we have adopted in both our research endeavours and teaching methods. We have made it our mission to clarify what holistic

'person-based care' means. I have spoken before of the changing nature of health and wellbeing, that the illnesses confronting society after the Second World War and the healthcare system that evolved to meet this are not what is required today. Practitioners need to know how people live, understand what choices they make in their lives and what responsibility they will take to attain good health. Often this is at odds with a system focussing on surgical and medical interventions. Therefore, SCU has been evolving a framework of research with the person at the centre of a 'cog wheel 'of interaction. Part of this endeavour involves building partnerships with organisations such as CHESS, the Primary Health Network, or providers of health services such as SCIA. We are also supporting

schools to provide health and wellbeing support to their students. With support from the local member for Lismore we placed occupational therapy and speech therapy students in a local public school to support teachers in dealing with learning difficulties. Research students too have been engaged in helping the School achieve its research goals. Both honours and PhD students are engaged in projects to better understand the lived experience of health and well-

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being. A recent study done in an aged care facility in Sawtell sought to investigate the role that family and friends played in the social connectedness of adults aged over 65. The study was based on socioemotional selectivity theory which suggests that as adults age they become more aware of the end of life which leads older adults to become more selective about how they spend their time. In designing a family supportive service the aged care facility wanted to know how it should adapt and refresh its processes in the light of the findings, which were significant! Sustaining such collaboration is complex. However, society is asking for a good life, achieved through enabling and empowering processes so that sustainability and resilience is achieved. The School is adopting activity which will help in this endeavour.

healthspeak April 2017

or the past nine months, The University Centre for Rural Health’s Academic Lead, Allied Health & Pharmacy Lindy Swain has been kept busy developing and putting in place an exciting program for allied health students on placement in the Northern Rivers. After the Commonwealth Government provided extra funding for allied health students to come to the region, Lindy drew up a strategic plan to provide the students with valuable work experience in areas of need. “As well as having more students come to us at the UCRH, I thought it would be really nice if we gave something back to the community,” Lindy told HealthSpeak. The result is a win for both students and the community. As part of the program, the UCRH allied health team has successfully placed Occupational Therapy (OT) students in schools at Casino and Kyogle – areas of need where there are few or no occupational therapists available. “And our students are doing incredible things in these schools. Some of these school children can’t sit still and our OT students are providing them with techniques and blankets to assist them. And some of them can’t hold pencils, but now they have help to write and both the students and the pupils are enjoying the interaction. THE UCRH OT Supervisor assists the OT students to assess need and develop programs for the school children,” Lindy said. In addition, OT students have April 2017 healthspeak

been placed in aged care at Casino and we’re just about to place some more in Grafton. We also have physiotherapy students in aged care in Lismore and at Biala Special School in Ballina. Lindy said the UCRH is gradually working through the allied health disciplines. “We’re now moving into putting speech pathology students into some of the same schools as the OT student and soon we hope to have some exercise physiology students working with some of our Aboriginal communities. Allied health is so amazing, every discipline has something different to offer in getting people back into work, back into the community and helping with every day living challenges.”

A student at Kyogle Public School working with young pupils.

My favourite part of the day was learning about the work being done with mindfulness in the local schools – student

Lindy Swain

Multidisciplinary education

As part of the program, each Wednesday the various cohorts of students on placement through UCRH come together for multidisciplinary teachings. The other four days of the week the students are on placement. “I am really keen for students to have a broad picture of health

and to understand each other’s disciplines, so they are not just working discipline specific. This multidisciplinary program aims to improve the students’ empathy and communication skills – for example, how to work with dementia patients or patients with addiction. We have wonderful clinicians and patients who come and share their journeys and experiences with our students. We try to cover

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or enhance topics that aren’t covered at the students’ parent university but that we can offer here at UCRH. “To become great clinicians, the students need a broader education than just clinical skills. They need to understand the patients’ perspectives and this is not always for healthy young people.” Because of the smallish numbers of students, the UCRH is the perfect environment for students to come together to learn and teach each other. Med students, pharmacy, physio, speech and OT students all have expertise they can share. For instance, talking about the different aspects of managing patients with stroke, Parkinson’s and mobility. Guest speakers from the NNSWLHD and private practice are also popular with students. They present on topics such as foetal alcohol syndrome, stroke, dementia, managing 23

Allied Health Students in Aged Care

Feature

Allied Health students filling a gap in schools and aged care

Feature Allied Health Students in Aged Care

patients with pain and trauma informed care. The Wednesday education also includes a debrief session for students about what they are doing on placement and the challenges they are facing. “Because some of these physio students in aged care are seeing death for the first time, which isn’t something they learn about. So we have to make sure they can debrief about that.” UCRH Clinical Psychologist Judy Rankin also runs presentations on health and wellbeing which the students find really helpful. Many students are away from home and in a rural environment for the first time, so some are anxious and need a lot of support. “Judy teaches the students about their own self care and she also teaches them skills such as low level Cognitive Behaviour Therapy (CBT) and motivational interviewing techniques.” Engaging students in discussions about Aboriginal health is an important part of the UCRH’s program. Emma Walke, UCHR Aboriginal Health Academic Lead, takes all the students for a session on Aboriginal health and cultural awareness and organises cultural immersion experiences for our students.

Occupational therapy students at Richmond Lodge.

Emma (Walke) engaged us in an interactive discussion about the very important and much needed topic of intergenerational trauma in Aboriginal health – student

Woodenbong Primary School where the students were required to present a health topic to the primary school pupils. “It’s a wonderful communication exercise as they have to learn to give complex health messages in simple language to these young school children. We know that health literacy for the average Australian is at about 10 to 12 years old, so it is great for students to practice communication at the appropriate level. “And the subject has to engage the kids, or else all hell breaks loose in the classroom,” Lindy said with a laugh. “It’s a

Farm stay

With research demonstrating that health students who have a positive experience on rural placement are more likely to return to work in the region, UCRH is keen to give city youth a taste of rural life. “We are funded to support rural workforce, so part of the program is about exposing students to the country and immersing them in a rural environment as well as teaching about the health challenges of our region,” said Lindy. Recently 22 pharmacy students were taken for an overnight stay to Dairy Flat Farm to experience life without internet or mobile phone coverage and to experience milking cows. “The next day we went to 24

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real two-way learning experience.” The UCRH as well as supporting student learning, also supports education for clinicians. On the evening of March 9 the UCRH hosted a special event – Inspiring Women in Allied Health – as part of Lismore Women’s Festival. Lindy explained that the event was held to showcase the exciting work and women in the allied health sphere. In addition, UCRH is organising a big multidisciplinary allied health workshop on COPD, a condition which is very debilitating, very prevalent on the North Coast and not often managed that well. “This event will give clinicians some much needed support around how to assist patients with managing their COPD,” said Lindy. Speaking with Lindy, her enthusiasm for what allied health offers the community is infectious. “It’s incredible what allied health can do. GPs can only do so much in primary health care. There’s no way one health professional can give a complex patient enough support and care when the health professionals are so busy. “We need to have an integrated team approach to patient care. We don’t do that as well as we could. There needs to be more collaboration between general practice and allied health. We still have a lot of work to do there.” Lindy is looking forward to the evaluation results of these new UCRH allied health programs. “It is so impressive what the students are achieving. We need to capture and share the outcomes. Staff in aged care facilities and schools are telling us that the students coming in are making a huge difference. In future, much of the employment for OTs and physiotherapists might be in these settings. Indeed, some of the students have already been offered jobs. healthspeak April 2017

Eating disorders and our youth

By Nina Kelly Accredited Practicing Dietitian

have been working as a dietitian on the Gold Coast and Tweed Coast for six years and have been working at Tweed headspace since August 2016. In late March I commenced work at Lismore headspace. In my practice I cover a broad range of nutritional issues from weight gain/loss, diabetes (T2/T1/ gestational), intolerances, eating disorders, disordered eating, and much more. I am starting to specialise in eating disorders and disordered eating. It is well known that negative body image and eating disorders are a big concern among our youth and are becoming more prevalent. Up to 1 in 10 Australians will experience an eating disorder in their lifetime with a general population point prevalence of around 5%. Many people experiencing an eating disorder suffer from depression and/or anxiety. Suicide rates for anorexia are 32 times higher than the general population. Body image concerns are one of the top three personal issues facing youth today (Mission Australia National Youth Survey). The Butterfly Foundation for eating disorders reports that one in five students say they have missed school because they feel they don’t look good enough and 31 per cent of teenagers are withdrawing from classroom conversations because they don’t want to draw attention to the way they look. Body dissatisfaction can be influenced by external factors such as social media, friends, school April 2017 healthspeak

etc., and by internal thoughts. Disordered eating behaviors, in particular dieting, are the most common indicators of the development of an eating disorder. Eating disorders are severe and life threatening mental illnesses. An eating disorder is not a lifestyle choice. Disordered eating can have a destructive impact upon a person’s life and has been linked to a reduced ability to cope with stressful situations. Examples of disordered eating include: fasting or chronic restrained eating, skipping meals, binge eating, self-induced vomiting, restrictive dieting, unbalanced eating (e.g. restricting a major food group such as ‘fatty’ foods or carbohydrates), laxative/diuretic/enema misuse, steroid and creatinine use (supplements designed to enhance athletic performance and alter physical appearance), and using diet pills. There are certain risk factors associated with developing an eating disorder. These include: being female, 15 to 25 years of age, low self-esteem, perfectionist personality, family history, traumatic childhood experiences, exposure to intense competition (e.g. gymnastics), high level of guilt/self-blame/shame, high stress reactivity, inability to label

emotions and poor interceptive awareness. It is believed that particular characteristics may predispose an individual to developing an eating disorder. Particular life events may initiate its onset and certain factors may act to maintain the illness. There are four main types of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not other specified (EDNOS). People with anorexia nervosa tend to: be perfectionists, introverted, experience obsessive patterns of thinking and behaviour, need to have a strong sense of control over themselves, have dichotomous thinking and, have noticeably high concern about how others view him/her. Anorexia nervosa is the third most common chronic disease in the 15 to 24-year-old age group. It can onset at any age; the ages 13 to 18 are high risk for onset, and the peak ages at which onset is more likely are 14 and 16 years. People with bulimia nervosa tend to be impulsive, have difficulty with mood modulation, have a low boredom tolerance, and have difficult interpersonal relationships. So, when does normal teenage dieting behavior become an eat-

a publication of North Coast Primary Health Network

ing disorder? When it interferes with normal functioning (tired, mood swings, no period), psychological wellbeing, social functioning (e.g. not staying at a friend’s houses as scared of what must eat) or occupation, then the presence of an eating disorder should be considered. The earlier the person engages in treatment the increased likelihood of recovery. In youth this is particularly important as malnutrition affects brain development and increases the likelihood of early onset osteoporosis. When referred a patient with an eating disorder (or suspected eating disorder) I will do a nutritional assessment and question the patient around restrictive behaviours and eating patterns. If I think an eating disorder is present I will ensure the involvement of a GP and a psychologist. The severity of the eating disorder and the youth’s age will depend on whether or not parental involvement is needed. Parental involvement is essential for young teens with a diagnosis of anorexia nervosa. Whatever the severity, the sooner treatment is initiated the more likely a recover will occur and lessen the incidence of relapse. With all my patients I focus on body positivity and acceptance, intuitive eating, positive dietary and lifestyle behaviours, individuality, and healthy eating throughout all age groups. I aim to change the mindset: weight does not define who they are, teach them to respect their body, re-discover the joy of eating, and help with making peace with food and their unique body. Nina is working at headspace Lismore. She sees young people aged 12 to 25. GPs referring to Nina need to provide their patient with a CDM plan. Phone headspace Lismore on 6625 0200 or Tweed Heads headspace on (07) 5589 8700 to make an appointment for an initial headspace assessment.

The world of general practice in 2022 NCPHN’s Clinical Advisor Dr Dan Ewald painted an inspiring picture of the possibilities for general practice in his presentation at the Better Together seminar in March. He looked back from the perspective of 2022. Here’s an edited version of Dan’s presentation.

Dan Ewald and the future US President

ood morning. I have been working with the PHN since we last met in March at the Ballina Surf Club in 2017 and I am still a practising GP. Life got much better back in 2020 when Michelle Obama was elected US President. I’m also pleased to report that things have moved on as a GP since that 2017 meeting. I feel much better connected with the other clinicians I work with now. Some of them are private, some public sector. We talk about a patient’s team now, so I’m in many teams, one for each of my complex patients. Each day starts with checking my electronic in-box for pathology reports and progress reports from the other clinicians I work with. Some of these updates will need action right away, like checking in with the hospital team looking after a patient admitted the previous night. Often I can help them understand what worked for that patient during previous exacerbations. Sometimes I join in the ward round by video conference for selected complex cases. This is paid for through the GP Inreach program. A few years ago in my practice we made sure all the patients with chronic relapsing conditions had self-care action plans and know who to contact if it’s not going well. Since the Commonwealth decreased the fee for service funding and introduced capitation payments, I now dedicate part of my day to a medical consulting role with other clinician teams caring for my patients. Some of them need a lot of social and nursing support so 26

their main point of contact is the nurse. We do this by tele/ video conference. Sometimes the community nurse linked to my practice video calls in from the patient’s home, with the patient. There is also part of the day set aside for phone calls to patients and carers, mostly unstable patients, to monitor how they are doing. Some patients have athome devices through which our practice nurse tracks their clinical markers from his office. Though my brain may be past its prime, I’m less stressed about caring for all these frail and complex patients because the local HealthPathways link me to evidence based care protocols that are updated regularly. The waiting times for specialists are less of a problem now because the HealthPathways referral system means they are well triaged for priority. Our practice data is so much better than it used to be. At last all clinicians are coding consultations accurately along with the medication lists. This means’ it’s easier for us to do our quality improvement work and get the payments, and secondly we can accurately report the progress of patients which links to some generous funding. I am lucky in that my practice sees being a Patient Centred Medical home as rewarding rather than an accreditation hurdle. Accreditation stress seems so pre-2020. The practice has a patient reference group that also appreciates

seeing the data. Some of their suggestions have greatly helped us get the patient reported measures working well. My practice watches a group of frail or complex patients very closely and delivers a pretty seamless range of services from hospital in the home, home monitoring, care navigation, emergency access, all in conjunction with Local Health District based providers. I am convinced this has saved a pile of hospital admissions. Once a month I review my complex mental health patients in a joint session with the mental health nurse from the mental health team. The patients love the whole person care they are getting.

briefs

Teens light up to slim down Many public health experts assume that people smoke cigarettes because they're addicted to nicotine. But Cornell University researchers have found that overweight and obese teens light up for a different reason: to lose weight. AmongUS. teens who are frequent smokers, 46 percent of girls and 30 percent of boys smoke in part to control their weight, according to the study.

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Last week one of my frail old patients had a big stroke and ended up in the ED. The Advance Care Directive was on hand and triggered a rapid assessment and arrangements for them to return home for palliative care on the same day in line with their wishes. I went to see them at home the next day, having been closely involved in their going home arrangements. I was a bit worried about how the future looked for some children in a family that was struggling with housing, relationship, financial and alcohol issues. Thankfully, they will be included in the early intervention program we reviewed last year in the Clinical Council. This was the first of our programs jointly funded by FACS, the LHD and the PHN. I am on the Clinical Council and that’s how I know about all this funding stuff. I don’t think we’ll ever be satisfied that we have made it, but I am more relaxed about integrated care being the journey rather than the destination. So, I generally go home around 5pm and spend one afternoon a week doing home visits on a few frail, unstable patients. And on my days off, I know they will be looked after.

And smoking to lose weight is significantly more common among teens who feel they must slim down. Girls who said they were "much too fat" were nearly 225 percent more likely to smoke to lose weight than girls who said their weight was about right. "This helps us better understand why people choose to engage in risky health behaviours. It's not always just about the immediate pleasure or enjoyment; sometimes it's a means to another end," said the study's author, Professor John Cawley.

healthspeak April 2017

Visiting endocrinologist will be missed

orth Coast Primary Health Network would like to express its sincere thanks to Sydney endocrinologist, Dr Soji Swaraj, who after visiting Port Macquarie for many years, conducted his last clinic in December last year. Dr Soji as he’s known, visited Port Macquarie each month to see patients through funding provided by the Rural Doctors Network. His patients were very fond of him, appreciating his kind manner and his professionalism. PHN staff also found Dr Soji a delight to work with. He was always very supportive of the Division of GPs, Medicare Locals and more recently of the Primary Health Network. Dr Soji specialises in PCOS, diabetic obesity and metabolic syndrome as well as general endocrinology issues. He told HealthSpeak that he thoroughly enjoyed the years he travelled each month to Port Macquarie.

Dr Soji Swaraj

“I initially agreed to come up until they found a local endocrinologist and only recently decided to stop coming when Port attracted a terrific young specialist, Lauren Baker, whom I was lucky enough to help train at Concord hospital.” Dr Soji said it had been extremely rewarding to be able to make a difference in patients’ journeys, especially in the area of diabesity and fat loss. “Given that I couldn’t see every one, I’d hoped that my care plans might be used as a template for GPs to use on other

patients, given how hard it is for patients to access specialists. “I’ve also enjoyed the opportunity to give lectures and workshops for local GPs and allied health colleagues and also was privileged to assist Professor McColl, the Dean of the medical school by delivering endocrinology lectures and hosting students in my clinics.” He said he would miss the clinics and the staff he worked with as well as the ‘cheery warmth’ of the patients and their amazing stories. However it seems Dr Soj has left Port Macquarie with a valuable legacy. “I understand I’ve managed to convince a large slice of the Port community to lift hand weights and decrease their waist lines while convincing their neighbours to do the same.” For more on Dr Soji’s strategy for treating patients with metabolic syndrome, see Page 36.

Concussions speed up genetic cognitive decline

ew research has found concussions accelerate Alzheimer's disease-related brain atrophy and cognitive decline in people at genetic risk for the condition. The findings, published in the journal Brain, show promise for detecting the influence of concussion on neurodegeneration. Moderate-to-severe traumatic brain injury is one of the strongest environmental risk factors for developing neurodegenerative diseases such as late-onset Alzheimer's disease, although it is unclear whether mild traumatic brain injury or concussion also increases this risk. Researchers from Boston University School of Medicine studied 160 Iraq and Afghanistan war veterans, some who had suffered one or more concussions and some who had never had a concussion. Using MRI imaging, the April 2017 healthspeak

thickness of their cerebral cortex was measured in seven regions that are the first to show atrophy in Alzheimer's disease, as well as seven control regions. "We found that having a concussion was associated with lower cortical thickness in brain regions that are the first to be affected in Alzheimer's disease,"

explained author Dr Jasmeet Hayes, assistant professor of psychiatry. “Our results suggest that when combined with genetic factors, concussions may be associated with accelerated cortical thickness and memory decline in Alzheimer's disease relevant areas." Of particular note was that these brain abnormalities were found in a relatively young group, with the average age being 32 years old. "These findings show promise for detecting the influence of concussion on neurodegeneration early in life and it’s clear that it’s important to document the occurrence and subsequent symptoms of a concussion, even if the person reports only having their "bell rung" and is able to shake it off fairly quickly,” said Dr Hayes.

a publication of North Coast Primary Health Network

briefs

More privacy concerns around faxes than e-health A US study says despite the fact digital health data breaches are attracting more and more media attention, patients are not spooked by this. The research by Ohio State looked at whether patients were more likely to withhold personal health information due to concerns over e-health record privacy and security. Their analysis compared patients’ responses to two surveys three years apart and found people had become increasingly aware of digital health records between 2011 and 2014. In both surveys, patients were more worried about the security of fax machines than e-health records, with 65% of patients in 2014 saying they were at least “somewhat concerned” about the safety of digital records and 70% saying the same thing about faxes. Journal of Medical Internet Research, 2017; online.

View past issues

Did you know you can read HealthSpeak online? Go to www.issuu.com/ healthspeak and see all 18 issues.

What is?

ental therapists examine and treat diseases of the teeth in pre-school, primary and secondary school children under the supervision of a dentist. The dentistry work performed is varied: from identifying the disease risk of the child, providing professionally applied preventive treatments, carrying out simple

Profile

What is a dental therapist restorative work in deciduous and permanent teeth, through to the extraction of teeth under local anaesthetic and the initial management of trauma. A dental therapy profession offers opportunities to work as clinicians, administrators, educators, researchers, sales and marketing managers, editors and

consultants. The public sector oral health services are the major employers of dental therapists. They work in fixed and mobile clinics promoting oral health care to children. There is a high demand for dental therapists in many regional, rural and remote locations throughout Australia.

Naomi Lane – Dental Therapist, Maven Dental, Tweed Heads

hile some health care graduates have a firm career direction in mind, Naomi, as she puts it, ‘stumbled’ into dental therapy. It was well into her Science Degree when she first heard about the Dental Therapy course. At the time she was studying in Melbourne in the early 1990s, the School of Dental Therapy was run by the Health Department and trained dental therapists were sent off to work for the School Dental Service. Today Dental Therapists attain a Bachelor of Oral Health and have dual qualifications in dental therapy and dental hygiene. When Naomi began working for the School Dental Service in Victoria in 1994 the only option for a dental therapist was to work for the government. However, later legislative changes meant therapists could practice privately. Naomi pursued further study as well, which allows her to work in Orthodontics. The first nine years of Naomi’s career was spent in Gippsland, working in mobile dental vans and small fixed clinics on a two year rotation of local schools. She later worked for a private practice and for an orthodontic clinic in Melbourne, experiencing some welcome

Dental assistant Sophie Hannan with Dental Therapist Naomi Lane

changes to her working day. “To have fully functioning equipment and a choice of materials was a highlight,” she said. Around seven years ago Naomi moved to the Northern Rivers and has worked at Maven Dental in Tweed Heads for more than six years. She has also worked in orthodontic practices. Since working in private practice, her focus has been on preventive dental care. “This is what you are supposed to focus on as a Dental Therapist, but in the public system we were so busy we mostly ““drilled, filled or extracted”. My current patients and their parents receive education about diet, tooth brushing and dental mainte-

nance, as well as any necessary restorative work.” With this regular care Naomi is confident that patients who leave her at the age of 18 with the knowledge to have a healthy dentition for life. Having always loved working with kids, Naomi has heard a lot of children’s stories. One that she can’t forget involved a young boy who when asked about his weekend said matter of factly ‘Me Dad got shot.’” “The staff gathered around in concern but he told us ‘He’s okay, he’s been shot before’.” “Not wanting to pry, but too inquisitive not to ask, we inquired if he knew who had shot his Dad. ‘The cops,’” he replied. Naomi’s satisfaction as a Dental Therapist comes from

a publication of North Coast Primary Health Network

seeing a patient improve. “Whether it’s oral hygiene, fewer cavities, less anxiety in the chair or an orthodontic improvement, anything that makes a child really shine with pride is a joy to see. From a strictly clinical perspective finishing a course of treatment is always rewarding. Once the plaque and decay have been eradicated and there’s a mouthful of clean healthy teeth I’m happy,” she told HealthSpeak. Naomi is passionate about the impact of good oral health on children and their overall health and wellbeing and the role of a Dental Therapist. “Often kids are unable to articulate well about pain and could be suffering from a dental abscess, cold sore, ulcer, eruption cyst, mobile tooth, hypo mineralised enamel causing sensitivity, food pack, impacted tooth and so on. “Unfortunately, a poor diet can result in cavities which can cause other medical issues. Parents need to be encouraged to take oral health seriously from the moment their baby arrives. Not sending baby to sleep with a bottle or nursing to sleep, not over using a dummy, cleaning teeth as soon as they erupt and commencing dental visits from one to two years of age.”

healthspeak April 2017

Call for greater diversity in medical workforce

he AMA has called for targets to increase the proportion of women in health leadership positions and the number of Aboriginal and Torres Strait Islander people in the medical workforce. AMA President Dr Michael Gannon said the workforce should reflect the diversity of patients it cares for. “Doctors from diverse backgrounds bring skills and perspectives that enable the medical workforce to be more responsive and empathetic, not only to individual patient needs but to broader community needs,” Dr Gannon said. “The AMA recognises that there is an under-representation of women in leadership positions in the medical workforce, and an under-representation of Aboriginal and Torres Strait Islander people throughout the health care sector. “The AMA supports targets to address the current underrepresentation in the medical workforce, including medical students, of women and Aboriginal and Torres Strait Islander

Byron Central Hospital now has dedicated mental health beds in the new Tuckeroo unit, the Byron Sub-Acute Mental Health Unit. NNSWLHD Chief Executive Wayne Jones said that by the middle of 2017 there would be an increase of 20 mental health beds across the Health District, bringing the total number to 93.

people.” Currently, fewer than 12.5 per cent of hospitals with 1000 employees or more have a female chief executive, and only 28 per cent of medical schools have female Deans. Women make up one-third of State and Federal chief medical officers or chief health officers. In 2012, there were 221 medical practitioners employed in Australia who identified as Aboriginal or Torres Strait Islander – representing 0.3 per cent of all employed medical practitio-

ners who chose to provide their Indigenous status. In 2015, the Medical Deans Australia and New Zealand reported that a total of 265 Aboriginal and Torres Strait Islander medical students were enrolled across all year levels. Of the 15 medical colleges, four have never had an Indigenous trainee. “Medical workplaces and training providers must find ways to support Indigenous trainees and medical practitioners,” Dr Gannon said.

MNC providers merge to meet NDIS, aged care needs

eals on Wheels Mid North Coast, Hastings District Respite Care, Parklands Cottage and Hastings Home Modifications have merged to become Omnicare Alliance Limited. With a commitment to aged and disability care, Omnicare Alliance will provide quick and easy access to a range of services from respite care to meal delivery, social outings and shopping assistance, along with home modifications, maintenance and gardening help. Joint CEOs Raymond Gouck and John Carroll said their shared vision was to create a April 2017 healthspeak

Boost for NNSW mental health services

John Carroll and Raymond Gouck of Omnicare Alliance

larger organisation that will be a single point of contact to support people through the NDIS and aged care systems. “Omnicare Alliance will be

a multi-service business model aimed at making it as easy as possible for older people and those living with a disability to access the services and support they need to remain living independently in their own homes for longer.” Omnicare Alliance will serve the communities of Port Macquarie, Sawtell, Kempsey, Wauchope, Camden Haven, Taree, and Great Lakes, with plans to significantly grow its geographical footprint in the next few years. Contact Omnicare Alliance on 6584 1115.

a publication of North Coast Primary Health Network

This number will include a 16-bed dedicated older persons’ mental health treatment space within Lismore Base Hospital’s Adult Mental Health Unit. It will be called Lilli-Pilli Older Persons’ Mental Health Unit. Existing mental health units within NNSWLHD have been renamed following input from staff and the consumer Mental Health Forum. The Child and Adolescent Mental Health Unit at Lismore Base will be called Kamala while the Adult Mental Health Unit has been named Tallowwood. The Tweed Valley Clinic is now Kurrajong – Tweed Mental Health Unit. Community mental health facilities have also been renamed. They are Tweed Mental Health Services, Byron Mental Health Services, Lismore Mental Health Services and Grafton Mental Health Services. More information can be found at: www. nnswlhd.health.nsw.gov. au or by phoning the 24-hour Mental Health Line on 1800 011 511.

Bone Marrow Registry needs ethnically diverse donors cally diverse donors to help save lives. Ethnic diversity is really important since patients are more likely to find a match with a donor from the same ethnic background.

however, donors are retired from the registry on their 60th birthday. For more information and eligibility criteria go to: www. abmdr.org.au

How it works

Tania Murphy is having a difficult time finding a bone marrow donor match as she has Croatian heritage.

Complete the form at an Australian Red Cross Blood Service centre. You will need to have given or be prepared to give blood. Call the Blood Service on 13 14 95 to make an appointment to donate and join the registry. The ABMDR then registers your details and tissue type on the donor database. You will be contacted if you are a match with someone whose life you could save through a bone marrow transplant. Your name will stay on the register for as long as you wish,

hen it comes to finding a match for someone needing a bone marrow transplant, if no one in the family is a match, searching for a match on the global registry is the next step. Sadly for people of non Anglo-

Celtic backgrounds, the search can prove disappointing because their ethnicity makes it harder to find a match. The Australian Bone Marrow Donor Registry (ABMDR) is always looking for young (18 to 45) committed, ethni-

Virtual Reality experience for dementia patients

lzheimer’s Australia has released an interactive program called Virtual Forest in order to better engage with people suffering from dementia and help them gain a sense of control over their lives. The Virtual Forest uses a gaming technology to create a sensory experience, using a large interactive screen. It is designed to immerse the user in a peaceful and enjoyable virtual environment. The Virtual Forest presents an expansive park-like setting, with colourful flowers, trees and a river with a bridge. The seasons can change with a clap of the hands, and animals can appear and move around the scene with a wave of the hands. It is designed to give back some control to people living with dementia – it is their forest, and they can experiment with it and enjoy it. This is a deliberately personal experience, but one that can be shared with carers or other residents. The requirements for the program include a projector, appropriate screen, Kinect sensor 30

(a motion capturing sensor usually associated with Microsoft’s X-Box video game platform) and a computer that has been enhanced for gaming (with a powerful graphics card). The combined cost of the hardware plus the software itself can range from $7,000 to $10,000 depending on your environment. The considerable up front cost might cause some

organisations to hesitate before making such an investment, but this could be the precursor to a more therapeutic use for Virtual Reality. For more information, contact Suzanne.McMeikin@alzheimers. org.au or phone 03 9816 5791 or Marie Norman at Marie. Norman@alzheimers.org.au or phone 03 9816 5716.

a publication of North Coast Primary Health Network

Online suicide prevention for farming men

In a typical year, 2500 Australians will die by suicide. Too many of these deaths are among the farming community. For every suicide and attempted suicide, a ripple effect impacts friends, family, colleagues and entire communities. Many of us have been affected by suicide in some way — and yet, because of the stigma surrounding suicide, most of these experiences remain untold. The Ripple Effect is an online intervention designed to investigate what works to reduce the negative attitudes men in the farming community have about themselves and the negative attitudes they believe others hold about them. It’s for men aged 30 to 64 who have been affected by suicide through friends or family. The project is funded by beyondblue. For more information, go to: www. therippleeffect.com.au

healthspeak April 2017

March of the Machines

few weeks ago, I received an alert on my smart phone to say that my flight was running late and that I needed to leave for the airport in 40 minutes. It also gave me a map to get there and driving instructions including traffic delays. I didn’t ask for this. My phone read my email booking of a few weeks earlier and did the rest by itself. Apparently, this is just the start. Automation and robotics are racing ahead and promise to transform just about everything – the way we work, socialise and live. As we know robots, computerised algorithms, mobile sensors, 3D printing and driverless vehicles are already here. The thing is, not a lot of us are taking much notice. But we should, and we need to plan. It will mean we need to rethink economics completely and forge a new social contract. If predictions come true then it will lead to either a hellish nightmare world of mass unemployment, poverty and unparalleled inequality or a utopian state where humans are freed from mundane work and all our basic necessities will be free and abundant. Either way, it will be extremely disruptive. Nothing will ever be the same. Over the last couple of years there have been disturbing studies about how, within 15 years, automation and robotics will take over 47 per cent of all existing jobs. Automation, already commonplace in agriculture, mining and manufacturing will move into the professions and service industries. If you believe the boffins in Silicon Valley, any job can be automated. Already we are seeing robotics in medicine, the law, and even caring professions. Robots are being used to comfort children in hospitals, be their friends at home and teach them at school. They are even in nursing homes and running April 2017 healthspeak

Within 15 years, automation and robotics will take over 47 per cent of all existing jobs hotels. We could well be looking at a world that is almost completely run by robots. What will this mean for economics? What will be the social implications? It may come as a surprise that economists disagree on this (ah, just kidding). Some just say: “Ho-hum, we’ve seen all this before. Yes, large numbers of jobs will go but something, we don’t know what, will turn up. This has always happened since the spinning Jenny.” Well maybe. But most of the jobs created recently have been low skilled and low paid in the service and hospitality sectors. These jobs are usually casual, insecure and ripe for automation. Yes, there have been great jobs created in the high-tech and information industries but these

are few in number. Then we have the pessimists who suggest that unemployment, crime, and social unrest will soar. The robot-owning rich will retreat to gated communities and life for the rest will become poverty-stricken, ugly, brutish and short. This is the stuff of revolution. But there is an optimistic scenario. Most of the cost of the things we buy represents the imbedded value of the human labour that went into producing it. So, if the whole process of producing say a vehicle, from its design through to the mining of raw materials, to its manufacture and distribution is done without human labour then everything should become cheap and abundant. Machines don’t need holidays. They can work 24/7, don’t go on strike or get sick. So how would an economy work in such an environment? Stuff might be cheap but in an economy where virtually no-one works who would be able to buy it? Now we are really entering unchartered waters. Humans, at least in the recent past, have never lived in a time of abundance where necessities can be

a publication of North Coast Primary Health Network

finance David Tomlinson met without the need to work. Bill Gates and others have suggested that we need to tax the machines and their owners and redistribute the proceeds to the rest of us so we can buy what is produced. A similar notion is the universal basic income – a minimum payment to every adult sufficient to meet their basic needs. The money could come from taxing the rich or controversially, by just printing it. If goods and services were abundant this would not necessarily spark rampant inflation. And if people had an income they could choose where to spend it. Presumably some jobs would still exist and people could choose whether they wanted leisure or extra income. But how would we fill our free time? Would we feel unvalued and useless? Maybe. But for many others it may free them up to create, volunteer, participate in cultural activities and dream. If the robots let us.

Frocking up and going bush with David Tomlinson travel

“

Let’s all take a train trip to Broken Hill,” suggested my sister on the phone in a moment of expansive enthusiasm. “There’s a festival on there in September and the trip only takes 12 hours.” “Only 12?” I said dubiously but aware Catherine was nodding furiously. “Well, OK. Count us in.” I don’t actually mind train trips. I’ve been on a few exotic trains in my travels and the experience has often been memorable. But a NSW train? It bought back memories of my student days in the late 1960s when hordes of boisterous teenagers and twenty-somethings would cram aboard the rattling North Coast Mail to go home for Easter or Christmas. It was an overnight service from Sydney to Murwillumbah that stopped at nearly every station and took hundreds of hours to get there. It was a pretty riotous journey with lots of shouting, laughing and cavorting before they turned off the lights at 10pm and we all crashed wherever there was a space to stretch out. My favourite was the overhead luggage rack. The Broken Hill journey promised to be different – and it was. It was a daytime trip, we booked first class and it had a buffet car that served meals and drinks. After a bleary 6am start, we climbed the Blue Mountains and then headed west. No boisterous teenagers here. The train was full of grey-topped baby-boomers consuming cafe lattes, Thai chicken curry and white wine. After recent rains, the country was spectacular: vast stretches of lush green grass as high as your thighs interspersed with fields of bright yellow canola flowers. Pools of water lay beside the 32

track and we could see brimming lakes in the distance. Being spring, we passed joeys, emu chicks and of course the legendary wild flowers. It was hardly recognisable after the last time I travelled this way during a drought when the land was cracked and brown. We arrived in Broken Hill about 7pm and headed for the famous Palace Hotel for dinner. Its big verandas loomed over the wide main street and inside, the garish murals on the walls and ceilings were even better than the photos. We ate and

A train to Broken Hill After recent rains, the country was spectacular

went for three days with the festivities centred on the Palace Hotel. Friday and Saturday nights featured a cabaret that went from 6pm to 2am. Drag queens frocked in from Sydney, Melbourne, Adelaide, Brisbane and even

Wilcannia. Stars such as Minnie Cooper, Hannah Conda, Jemima Handful, Shelita Buffet and the Sisters of Perpetual Indulgence put on quite a show. With a bit of opera, an ABBA cover band (of course), re-enactments of musical pieces from the movie, some fireworks in the desert sky and lots of dancing, they had to push us out at 2am. It was a hoot. A lot of the stayers were our fellow baby-boomers from the train and most seemed reluctant to go home. But on Tuesday morning we boarded the train, saw all our new friends and headed to Sydney. The Broken Heel Festival is on again this year during September 8, 9 and 10.

then struggled up the hill to our accommodation. We’d booked a miners cottage for a week that turned out to be adequate but not all that flash. Don’t believe the internet photos. Over the next few days we saw the sights – the old mines, the solar farm, the sculpture park, Menindee Lakes, numerous art galleries including Pro Hart’s and the stunning old granite buildings that date back over 100 years to the grand old days when mining here was at its peak. Sadly most of the 60 pubs that catered to the miners in 1906 have been closed or converted into art galleries or restaurants. The highlight though was the festival. Called Broken Heel and celebrating the 22nd birthday of the 1994 cult Australian film Priscilla Queen of the Desert, it

Top: Broken Heel Tribute concert to the cult movie Priscilla Queen of the Desert. Above: The Broken Hill Sculpture Park overlooking the desert - now a major tourist attraction

a publication of North Coast Primary Health Network

healthspeak April 2017

Ballsy doctor opens The Brewery

t Taverners Hill, the highest point in Sydney, an old pub has just closed, but nearby a newly opened brewery and bar of another kind is attracting a different clientele. The master brewers are the Ball family. Dr Matt Ball is a staff specialist surgeon at the Sydney Eye Hospital and his wife Lara is a graduate of fine arts. Together they have developed a business selling a drink popular with health-conscious customers kombucha. “ballsy” the bar is set in a heavy timbered old warehouse. A simple wooden bar with taps, it is decorated like an old laboratory with glass flasks, pipettes, burettes and weird retorts - the harvest from a laboratory garage sale. “Wild Kombucha” is available at the bar or in takeaway bottles and is in growing demand, with 20 ‘taps’ at other places in Sydney, as well as in the Gold Coast, Brisbane and Melbourne. Fermentation

Behind the sealed door of the ‘Collaboratory’ where the brewing takes place, the environmental controls in sterility and atmosphere would satisfy a really strict infection control nurse or scientist. A gas chromatographer monitors ethanol content.

“Wild Kombucha” is available at the bar or in takeaway bottles and is in growing demand

containers of Yakult inhabit Coles and Woollies and small bottles of flavoured kombucha are beginning to appear. ‘You have to be careful of pasteurised product,’ advised Matt, ‘as there will be no living organisms’. The Microbiome

Matt explains, “It’s different to brewing beer or wine where all the sugar is converted to alcohol by brewer’s yeast. In Kombucha the final product is organic acids. Our latest lab testing returned total sugars at 2.6/100ml. A fruit/vege juice contains 3-9% of sugars. The jury is still out as to whether Kombucha is food or medicine. The dosage is variable, but we suggest about 300ml/ day to start.” Probiotics

People are becoming more aware of probiotics, which have been on sale in capsule form in the health food section for a few years, the perception being they are good for the gut and also after a course of antibiotics. It seems there may be much more to it. Probiotics come in a large variety of forms, lactobacillus, Kefir and even yoghurt. Little sweet

Cultivation of a favourable bacterial environment in the gut can cause positive changes to health. It is postulated that the microbiome is a discrete body organ, communicating with the immune system and brain by hormone. If healthy, it can influence the inflammatory response associated with a variety of chronic diseases. It is calculated that the total mass of a healthy microbiome is equal to the weight of the brain. Prebiotic

The microbiome needs to be nurtured and fed, mainly through healthy diet, as in the recommended five fruit and veges per day. Jerusalem artichokes, cabbage and onions are particularly useful. Where is it going?

Considering the conservative nature of our medical family,

So what is it?

The website - wildkombucha. com explains that ‘Kombucha is a naturally energising and detoxifying living drink produced by the aerobic fermentation of green and black teas and organic raw cane sugar. A symbiotic culture of bacteria and yeast, known as SCOBY, converts the sugars into a range of organic acids, making a delicious brew used for centuries in Eastern Europe, Russia, China and Japan.’ The alcohol content is low, no more than 0.5% at the time of bottling, equivalent to cider vinegar, so no licensing is necessary. April 2017 healthspeak

a publication of North Coast Primary Health Network

light airs David Miller I asked Matt how his colleagues viewed the healthy brewing business. He indicated peer support, that the College of Ophthalmology was interested and the professor at Sydney Eye Hospital was reading from the same page. The Charles Perkins Centre at Sydney University has a $380 million grant to look at gut health and chronic disease in relation to the microbiome. “It is more and more respected, he said. “Texas University is looking at phenotypes and sequencing microflora.” I asked Matt if there were any specific eye conditions responding to this treatment. “It could be very helpful in Wet Macular degeneration and dry eye of Sjogren’s syndrome.” “What would you like to be doing now?” I enquired of this soft spoken gentle doctor. His answer, “Mostly I’m missing the sun and the surf.” Later, I was telling a hippie elder about this venture and she said, ‘Kombucha? I remember that from the eighties when it was a real craze. Everybody had that brown floating mushroom fermenting in a jar under the sink.’

Gastrophysics Charles Spence Viking (hardback and eBook)

t is highly unlikely that I will soon be eating at a multihatted restaurant, especially one of those world leaders cited frequently by the author, including Noma in Copenhagen, Heston Blumenthal’s The Fat Duck, and Ferran Adria’s El Bulli in Spain. Even if you haven’t savoured their ilk, you’ll be aware of the

routine - minimalist cuisine comprising esoteric, often unrecognisable ingredients with embellishments such as aromatic mists and blowtorched finishing-off at the table. And of course, astronomical prices. For that reason, I came to this examination of ‘The New Science of Eating’ with reservations, pardon the dining pun. Having now read it I must concede a willingness to eat my hat, which may be one of the few things that the mentioned chefs have yet to prepare for their customers. First, the clever, and most apt, name: “Gastrophysics can be defined as the scientific study of those factors that influence our multisensory experience while tasting food and drink,” explains Professor Spence who heads Oxford University’s Crossmodal Research Laboratory. A psychologist by training, he specialises in multi-disciplinary research that encompasses ex-

Top men’s sexual health issues Andrology Australia, a men’s health website, has published its top three men’s health issues based on views of its topic pages. They are: 1. Male infertility – It’s estimated that one in 20 men has some kind of fertility problem with low numbers of sperm. However only about 1 in 100 has no sperm in his ejaculate. 2. Blood in semen - a common problem which can affect men at any age. It may be caused by inflammation, infection, blockage, or injury anywhere along the male reproductive system. 3. Peyronie’s disease causes abnormal, fibrous plaques to form inside the erectile tissue of the penis. Over time, these plaques can grow and deform the erect penis and cause it to curve. About one in 11 men have Peyronie’s disease, however many will not need treatment. Find out more about men’s health at: www.andrologyaustralia.org

book review Robin Osborne perimental psychology, cognitive neuroscience, sensory science, neurogastronomy, marketing, design, behavioural economics and more. The myriad of food-related subjects he has investigated include the impact of plate shapes and sizes on quantities consumed, how airline travel affects taste (tomato juice is a standout favourite with passengers), the role of texture and design (cutlery, glassware, chairs and tables) in the enjoyment of meals, and how smell and sound can influence not only the dining experience but shopping patterns as well. For example, bottle shops and restaurants have noted that playing classical music brings higher sales, while potato crisps that have a louder crunch (‘sonic marketing’) outsell their competitors, as do those whose packets are the nosiest. Yes, there are people who measure these things. “The latest research [shows] that as the crunchiness of a food increases, so too does its perceived flavour…consumers the world over demand it!” he writes. Regarding sound, Spence muses on the addition of Melba toast to pâté, concluding this to be “a classic example of taking a great-tasting but silent food… and pairing it with a burst of noise…is it not really about injecting some sonic interest into the dish?” Pausing for a snack, I spread some blue cheese onto a crisp cracker… the choice was unconscious, and the result validated his conclusion. Indeed, the book has affected the way I now regard the preparation and consumption of meals and snacks, even if I’m not dining in places where thought is given

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to whether tables are round or square, plates are red, blue, white or black, whether plated ingredients are odd or even numbered, or the decorative shapes on coffee are sharp edged or rounded. A fascinating area with health implications is ‘imagined consumption’, illustrated by the M&Ms on the book’s cover. “Imagine yourself eating lots of M&Ms,” he asks. “Do you think this would affect how much you would end up eating if offered a bowl of the brilliantly coloured candies afterwards?” Research shows that subjects eat significantly fewer when subsequently offered the bowl. Hence, “The imagined consumption of food can reduce actual consumption.” However, as he notes, it doesn’t work if a different food, say cheese, to the one later offered, is imagined. The ‘customising’ of food by adding salt and pepper is seen as a way for diners to ’own’ their meal, much as the practice is often unnecessary and derided by chefs. The use of various types of cutlery, including chopsticks, and the preference of many cultures to eat by hand is also discussed. Good health tips include the well-known benefits of sharing meals with family members, avoiding dining alone if possible, not eating in front of television, storing snack foods out of sight, not drinking from a straw or having iced water with meals - the former conceals the smells, the latter dulls the tastes - and eating from smaller plates or bowls without a rim. “The more food sensations you can muster the better,” Spence advises. “The greater the aroma, the more the texture, it all helps your brain to decide when it has had enough.” Alternatively, you could patronise a three-hat establishment where the paucity of the meals will strip as much from your waistline as the bill does from your bank account. healthspeak April 2017

Reverting to a hunter-gatherer lifestyle

hat would happen to carbohydrate and lipid metabolism if a group of overweight Aboriginal people with type 2 diabetes living a typical urban lifestyle reverted to their traditional lifestyle? In 1984 nutrition scientist Professor Kerin O’Dea carried out this novel research on the beneficial health impacts of temporary reversion to traditional hunter-gatherer lifestyle. (1). She accompanied these Aboriginal people into the outback for field measurements and observation of their lifestyle. The study cohort

Ten diabetic Aboriginal people from the Mowanjum Community (Derby, Western Australia) agreed to be tested before and after living for seven weeks as hunter gatherers in their traditional country. They were middle aged and overweight and all lost weight over the seven-week period (average 8kg). They spent two weeks on the coast and three weeks inland. The diet contained 1200 calories per day of which 54% was protein, 33% carbohydrate and 13% fat. Despite the high percentage of animal food (64%) the diet was low in total fat due to the low-fat content of wild animals. Health improvements

Oral glucose tolerance tests (75g glucose) were conducted in the urban setting and repeated at the end of the 7 weeks of traditional lifestyle. There was a fall in fasting glucose (11.6 +/1.2mM before, 6.6 +/- 0.8 mM after) and an improvement of postprandial glucose clearance. April 2017 healthspeak

Fasting plasma insulin concentration fell and the insulin response to glucose improved. The was a marked fall in fasting plasma triglycerides (4.0 +/- 0.5 mM before, 1.2mM +/- 0.1 mM after). The omega 6 (n-6)/omega 3 (n-3) ratio in this traditional diet was approximately 1 Andrew (whereas the ratio Binns for the American diet is now about 20 and the Australian diet about 10). This changing trend with modern diets was due to both the advent of the modern vegetable oil industry and the increased use of cereal grains as feed for domestic livestock (which in turn altered the fatty acid profile of meat that humans consumed). What was consumed?

rich in long chain fatty acids and has negligible fat in the muscle (marbling) compared with say wagyu beef, which is very high in saturated fat.

Looking for Bush Tucker 2010 – by Kamilaroi Artist Kath Richardson Four women are sitting having a yarn having gathered a lizard, wichetty grubs, and bird eggs and carrying them in their coolamons (a multipurpose dish). They used the sticks for digging.

So, what were the changes observed amongst the participants Relevance for us all reverting to a traditional lifeSo, what can we learn from style? There was a wide range of these findings to encourage wild animals and plants eaten. healthier food consumption? To gather these lots of walking One piece of advice would was needed. Also, there was be to rely more on natural plant energy consumed chopping, food containing slower to digest winnowing and grinding seeds, carbohydrate. When eating digging pits for baking and gathmeat, choose leaner cuts and ering wood for fire etc. Plant remove the fat. Kangaroo foods were yams, seeds meat is inexpensive and wild plums. and leaner comWitchetty grubs pared with beef Despite the high (the larval stage or lamb. percentage of animal caterpillar of Perhaps food (64%) the diet was a large cossid most of all we low in total fat due to the wood moth) low-fat content of wild could through were also eaten. animals education better Animal food understand and comprised kangabuild respect for roo, goanna, snake, the pre-colonial settleemu, turtle and seafood. ment Aboriginal culture, land The study participants tended management and lifestyle. Their to eat every part of the animal knowledge of land care with the including offal. help of planned and controlled Even the lean meat of introfire stick agriculture for germiduced animals like wild rabbits nating seeds, extending savanand cats was eaten. Kangaroo is nah grasslands, processing nuts

and yams, ambushing animals etc is a topic worth learning about as an important part of Australia’s past social history. Recommended is Bruce Pascoe’s book Dark Emu (2) and Bill Gammage’s book The Biggest Estate on Earth (3). Both publications open one’s eyes to a very sophisticated land management system creating the best possible conditions for food production which sustained a civilisation in a largely arid land over 60,000 years. A significant amount of research for these books came from the reported observations of our early explorers and settlers.

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(1) Diabetes. 1984 Jun, 33(6) 596-603 (2) Dark Emu, Bruce Pascoe: 2014 Griffin Press (3) The Biggest Estate on Earth, Bill Gammage: 2012 Allen and Unwin

Health&Lifestyle Metabolic syndrome: a crippling health system tsunami? Or an opportunity to save lives and prevent suffering

a few years ago, in the NEJM demonstrated a clear reduction in cancer mortality in patients who lost substantial fat through weight loss surgery. Lean muscle secretes protective ‘mycocytot may be that half the Westkines’ and resistance exercise has ern world has metabolic been linked to improved diabesyndrome, that state of central tes and blood pressure control abdominal chubbiness that is as well as cancer survivorship linked with hypertension, high and depression. cholesterol, diabesity, Several hundred heart disease, stroke, years ago, our ancesdepression, sleep tors were working apnoea, arthritis, By Dr Soji seven days a week infertility and Swaraj endocrinologist on the farm lifting, cancer. carrying, pulling Metabolic and digging. Presumsyndrome generates ably, they were releasing a lot of costs in specialist lots of muscle hormones and clinics and pharmaceuticals and not secreting many of the fat risks crippling our hospitals and hormones that cause so much health system. disease. So called progress Our current medical culture means we’ve been taken off the is evidence-based and wellmeaning. In general practice and farms, into offices and desks and forced to eat several times more specialty clinics, we prescribe sugar, cereals and fat than them. drugs to lower BP, cholesterol, So, in my practice, for patients glucose, airway inflammation with metabolic syndrome, and dispense CPAP diabesity or PCOS machines. But, aside the mantra is to from advice to bring back the lose weight farm girl/ boy. and exercise, Patients are asked to Seven days a there is little experiment with food strategies to find the one week, I ask incentive for that suits them and their patients to ‘prescribing’ fat loss requirements simulate the the one key ‘farm work’ by intervention lifting dumbbells that may address or pulling resisall the components tance bands for 20 reps of metabolic syndrome in one fell swoop: reducing body three times a day before meals or squatting 20 time while brushing fat mass. their teeth or waiting for the In fact, several medications prescribed to ‘help’ including in- microwave to ding. A fit bit is welded on to the sulin, sulphonylureas and some patient’s wrist and 12,000 steps psychotropic medications can needs to be shown to a loved actually increase body fat mass and perpetuate a vicious cycle of one before they can go to bed. Patients are asked to experiment fat gain and further pharmaceuwith food strategies to find the tical escalation. one that suits them and their fat Central fat is hormonally acloss requirements. tive, secreting ‘adipocytokines’ For example, in women with that contribute to inflammation, PCOS who are insulin resistant, insulin resistance, blood vessel the common lament is “ I only stiffness and more than likely, need to look at food to gain cancer cell growth. The Swedweight’. In these women, the ish bariatric study published

standard advice to eat six meals a day and never skip breakfast can lead to further weight gain and

frustration. I ask them to try the following for 3 months or so (see below):

1. Eat only when hungry.

So called progress means we’ve been taken off the farms, into offices and desks

2. Increase carbohydrates from multi-coloured vegetables and restrict cereals to one day a week when bread, pasta etc are consumed as treats

3. Eat quality protein such as fish, chicken, lentils, lean meat, eggs alongside the vegetables 4. Have 5-6 quality fruits per week 5. Discuss with their GP the use of metformin to lower their insulin levels, appetite and assist in fat loss in conjunction with the food and exercise strategy 6. Measure 1 cm off their waist every Saturday 7. Ask their GP if they could be weaned off some medications carefully. and possibly off some forever if the waist line reduces sufficiently 8. Don’t get on the scales. As lean muscle goes on and fat comes off, the scales can disappoint and the tape measure is more rewarding 9. Ask their GP about sleep apnoea if tired all the time, depressed or have low libido 10. Have an annual breast examination (for women) 11. If they have type two diabetes and are overweight: a. Ask their GP about trying to lower their insulin dose with the strategies above and b. consider one of the newer diabetes medications that i. allow glucose to escape through the urine and cause fat loss ii. Allow weight loss by decreasing appetite c. Discuss weight loss surgery such as sleeve gastrectomy

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healthspeak April 2017

Health&Lifestyle

‘Virtuoso’ gamers prove a challenge for parents

ow many of you know of apart from dopamine? Well, if an adolescent, usually a you go to the various TED talks boy, who spends many hours a you hear gamers learn about day playing computer games? It collaboration and teamwork, may be a family member, a colproblem solving, negotiation, league’s or friend’s child, risk taking, empathy and and there may be tolerance and also angst about the way boosting their imagiit draws him into nation through the a simulated world narrative. Chris Ingall and takes him away While it’s clear from the real one. that all of these skills Computer games must be developed are often demonised as to help master the they are seen to reduce sleep, game, are they transferable to mainstream educational learnthe real world? At this point I ing and face-to-face interaction. must mention Dungeons and Studies reveal many children Dragons, which involves facespend up to 10,000 hours playto-face interaction and for many ing games by the time they are adolescents may be their main 21. If you spent 10,000 hours social contact arena. Dungeons practising the violin you would and Dragons also develops the be close to virtuoso, so these above-mentioned skills, probchildren are literally virtuoso ably why it has survived over gamers. five decades. Why do they do it? When you Gamification is the term used look at it, games are the ideal to describe the process of using dopamine-streaming vehicle. games to engage with other We all love achievement people and solve problems, and the thrill we get something the world winning at somevery much needs. thing. That’s There have dopamine. been a numShould we demonise Games are ber of highly these games? constructed successful atProbably not. They such that the tempts to use could lead to a skill set which could transfer level of skill games in the to the classroom and the level classroom to of challenge boost literacy are neck and and numeracy neck, so you can levels. (Take a look go up a level every time at teacher Ananth Pai at: you win, setting yourself up for https://www.youtube.com/ another dopamine surge. watch?v=e6KCgZY-7HU) Contrast this to the classIn my work as a paediatriroom, where the level of chalcian I find it is the children who lenge and skill may be poles struggle with the development apart, creating frustration or of their theory of mind who boredom, and little dopamine. are most attracted to games. Little wonder that parents shout The arm’s length relationships in exasperation at their children they form with other gamers telling them they are ‘addicted’ sits easily with them as they do to their games, because they not have to negotiate the often really are. Other drugs which sophisticated interactions of a boost dopamine are the stimuface-to-face conversation. lants, including ice, cocaine and Against this, they become nicotine, all highly addictive. masters of their cyber world, What do kids get out of it which is something they can April 2017 healthspeak

then use in real life as friendship collateral, often teaching their schoolmates how to play better. Sometimes these children fulfil the diagnostic criteria for autism, sometimes they have mild autistic traits, though many also have comorbid concentration difficulties and some social anxiety. I may medicate with a stimulant or atomoxetine to help them focus in the classroom, though when game time is taking up too much of their evening it is difficult to rationalise medication if they are neither doing homework nor getting a good night’s sleep. With these children, I suggest to parents they treat game-time as a reward or privilege, rather like dessert, and define a ‘main course’ which must be complete before the child can go back to playing. This main course may

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be the completion of homework, an hour of exercise with their mates or finishing household jobs. (Not all children who game are overweight, though the vast majority are not fit and will acknowledge this during the consultation). To say that parents find the task of treating game time as a reward as daunting is an understatement. Often the power has slipped to the adolescent and it is a very testing time for their relationship. Given they are dealing with an addiction, this is understandable. So, should we demonise these games? Probably not. Overuse can be destructive if it is impacting on learning and sleep, though if they are properly managed games they could lead to a good skill set which may transfer to the classroom. We live in interesting times. 37

Health&Lifestyle

The joy of clay

s Academic Lead for subsistence living back then. Aboriginal Health at the People can be talking to the University Centre for Rural students about some pretty Health in Lismore, Bundjalung difficult subjects and experiwoman Emma Walke finds ences that can be hard to hear, herself encouraging med and so the weaving is a great way to allied health students to support the students hear find a passion outside those stories. It’s good By Janet of their day to day work to have the light and the Grist and study that refreshes dark.” and nurtures them. Emma is aware of the Emma’s source of joy is her stressful things the students love of clay and creating pottery will be dealing with when they and ceramics. This creative esgraduate and suggests they encape began in her early twenties, gage in some kind of art or craft and was interested in art during as a form or release. high school and she is keen to “It’s important that they give young people an underhave another part to their life standing of what an artistic and understand the value of it. outlet can bring to their lives. Creating something is actually “Here at UCRH we projust as amazing as going to the vide students with a two-day gym and building big muscles,” cultural immersion and during she said with a laugh. that time we get some amazAfter completing an Ading people from the Aboriginal vanced Diploma of Ceramics community to come and talk to at Box Hill TAFE more than 20 students about their experience. years ago Emma now has her There will be people from the own studio on her property at Stolen Generations, people who Bagotville where she can inspecifically work in health – a dulge her creative side whenever range of people and experishe wants. ences. Hopefully students “Last year I got my own get to see a number of unique pottery - a shed with its own facets to these people rather kitchen and bathroom and than just one story…. there’s space for my wheel. It’s all inside not one carbon copy of an and I don’t get eaten by Aboriginal person or mozzies, like I did in their experience, my original shed. and during this I go up there There’s a huge online cultural eduat night after community to tap into cation we’ve work and because pottery itself can also been do a couple be quite isolating, you mixing in of hours of don’t really need anyone some cultural throwing or else to do it and art experimaking or ences. “ glazing. I might Emma knows also listen to the that people listen difpotters’ podcasts on ferently when they’re relaxed line which is really good to and so while Aboriginal guests keep you moving. There’s a huge at the cultural camp talk about online community to tap into their experiences, the students because pottery itself can be were doing some weaving with quite isolating, you don’t really reeds in a traditional manner. need anyone else to do it,” she “Weaving was a craft which said. was part of everyday life – makAfter being a visitor to the ing fishnets for example. So various potters on the North what is art now was actually Coast Mud Trail for some years, 38

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last year Emma opened her studio to others. She encouraged her visitors to create something to take home with them by decorating cups and pots she’d thrown and prepared. Emma has volunteered at the Northern Rivers Community Gallery in Ballina for more than six years and usually gives classEmma creates a diverse range of artworks and enjoys teaching children.

healthspeak April 2017

es during NAIDOC Week. This year she worked with kids and they made clay pendants. “We also had a class where my Mum came in and told a story and my cousin played the didgeridoo and the kids made something based on what they’d heard. Making animals or little pinch pots for instance.” Emma’s had work in four NAIDOC exhibitions and held her own exhibition with her sister and friend at the Gallery and her creations are based on her cultural ties to the North Coast landscape. “The river and the ocean and our cultural life here …that’s always been a part of what I’ve been doing. If you look at my designs they are generally around

the river or the ocean or the sea, interpreted in various ways.” Emma also enjoys experimenting with different clays, glazes and colour and sells some of her work online. “I love the fact that this work is so different from my day work. Even when something turns out pretty crap, which happens quite often, you have been trying something new, and something has been learned from that pot, even if it is “don’t do that combination again!”. “It’s all encompassing and when you are engaged like that your blood pressure goes down, you feel peaceful and sleep better. I definitely sleep better when I make pots and get up more excited because at the

end of the day I am going to do this thing that’s fun and different. It’s my joy, my passion, it really is and I would be lost without it.” Visit Emma’s website: http://dhirrawong.wixsite. com/emma-walke Instagram @ dhirrawongceramics #joyofclay

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