HealthSpeak August 2019 by North Coast Primary Health Network

25 T H IS SU E

HealthSpeak August 2019

THE VOICE FOR HEALTH PROFESSIONALS FROM TWEED TO PORT MACQUARIE

OUR VISION OUR VISION FOR DIGITAL TRANSFORMATION FOR DIGITAL

OUR VISION OUR VISION TRANSFORMATION FOR DIGITAL FOR DIGITAL TRANSFORMATION TRANSFORMATION OUR VISION Page 16

NCC Update

FOR DIGITAL TRANSFORMATION Helping the

12 homeless

Aboriginal health

20 conference

Cards for mental

37 illness

Thank you and farewell Head Office 106-108 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Julie Sturgess 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 Northern Rivers 2A Carrington Street Lismore 2480 Ph: 6627 3300 Email: enquiries@ncphn.org.au

editor Janet Grist

ere at NCPHN we’re celebrating 25 issues of HealthSpeak. This is also my last magazine as editor. It’s been a privilege to oversee the publication of the North

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 2019 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

readers across a myriad of topics. I’d also like to sincerely thank Clinical Editor Dr Andrew Binns for his thoughtful and learned stewardship of the magazine and Dougal Binns, the magazine’s designer and illustrator, for his fine work. Turn to page 7 for a potted history of the magazine so far. I look forward to seeing HealthSpeak evolve over coming years.

We must disrupt ourselves before somebody else does!

Tweed Valley 145 Wharf St, Tweed Heads 2486 Phone: 07 5589 0500 Email: enquiries@ncphn.org.au

Health Speak

Coast’s magazine for health professionals for 10 years and I’ve really enjoyed meeting the many talented and committed people across our region. I’d also like to acknowledge HealthSpeak’s fabulous contributors whose columns enhance each issue. Dr Chris Ingall, Dr David Miller, David Tomlinson and Robin Osborne’s contributions have lifted the magazine to another level and entertained

ceo Julie Sturgess

have shamelessly stolen this line from the CEO of CSIRO, Dr Larry Marshall because I think it sums up the current landscape for Primary Health in Australia right now, we need to take heed. Despite having some of the best health outcomes in the world (for some, and I won’t get started about the vast differentials for Aboriginal and Torres Strait Islander people), it is common knowledge we are facing a crisis of unprecedented proportions related to the continuing growing demand and consequent costs which are projected in our health system. Quite simply, we will not continue to enjoy high standards of care if we continue as we are. Those of you who know me will be familiar with one of my favourite quotes, that is, ’the definition of stupidity is to keep doing the same things and expect a different outcome’. With that in mind, our absolute focus at NCPHN is to challenge the current system design, understand what works well and build

on it, but just as importantly, calling out what doesn’t…and changing it. Redesigning a system takes courage to bet on a better future, courage to challenge the status quo, and the tenacity to continually lobby for improvements in the face of those who would prefer not to change. I both admire and congratulate the wonderful NCPHN team for taking up this gauntlet with the aim of providing better services to North Coast Communities.

Technology tsunami is forcing us to be much more proactive in this space, ensuring that primary care approaches reflect consumer expectations This edition of HealthSpeak epitomises this attitude, with an exploration of digital innovation and the possibilities that may help us on the North Coast deliver high quality, accessible and cost-effective healthcare to

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more people. As you will see from the articles in these pages, we are ‘dipping our toe in the water’ across a range of technology improvements focussed on the consumer at the centre of care. The reality is that the technology tsunami is forcing us to be much more proactive in this space, making sure that primary care approaches reflect consumer expectations. To this end we have an ambitious program of work to support both primary care practitioners and our community on this journey. We look forward to working with you in progressing this vision. As we celebrate this 25th issue of HealthSpeak, on behalf of everyone in our organisation I extend our gratitude and farewells to its editor Janet Grist who is finishing up with us this month. In the 12 months I have been here, Janet has been a delight to work with and we wish her all the very best for her future endeavours. I will leave you with the salient words of former General Electric CEO, Jack Welch, who said, “change before you have to”. If we wait for others to solve the challenges for us, we will be changing to adopt to their vision of the future. It is our sincere hope that the North Coast leads with its own vision.

healthspeak August 2019

Sick Jails: Implications of Incarceration on Public Health clinical editor Andrew Binns

The country’s largest and most expensive facility currently being built near Grafton in northern NSW.

The critical state of health in the national prison system calls for improved communication with GPs in the community, says Andrew Binns.

he nation’s prison system reveals a disturbing view of Australia’s public health. With increasing imprisonment rates, overrepresentation of vulnerable groups, incidents of unethical internal conditions, and the country’s largest and most expensive facility currently being built near Grafton in northern NSW, now is an appropriate time to reflect on the implications of incarceration on health in Australia. According to Australian Bureau of Statistics figures in December 2018 the number of people in prisons has increased for the seventh consecutive year. In a recent one-year period, the number in corrective service custody increased by 4 per cent in Australia (2017-2018) — this includes unsentenced prisoners. Similarly, there was a 3 per cent increase in the national imprisonment rate from 2017 to 2018, with female prisoners increasing by 10 per cent. Most alarming is the high rate August 2019 healthspeak

of Aboriginal and Torres Strait Islander people incarcerated—of the 42,779 full-time prisoners in Australia, 28 per cent are of Aboriginal and Torres Strait Islander descent, some 8 per cent of these women. Even more shocking is the proportion of juveniles in custody, of which 49 per cent are of Aboriginal or Torres Strait Islander descent. And, as outlined in an article from 2016 by criminologist Professor Chris Cunneen (UNSW), imprisonment rates have increased in the past 25 years since the Royal Commission into Aboriginal Deaths in Custody (1987-1991), despite its recommendations. Cunneen states that a move to a tougher, more intolerant criminal justice system—often increased by “political expedience and media-fuelled public alarm”— has resulted in jails becoming “human warehouses” for marginalised groups, especially Indigenous people. These figures are especially relevant now as Australia’s largest and most expensive jail — the Clarence Correctional Centre — is set to open in Lavadia near Grafton in 2020. A recent article in The Guardian noted that this

The number of people in prisons has increased for the seventh consecutive year. $798 million ‘mega-prison’ with 1700 beds will be the largest facility contract ever awarded. This is to a consortium called Northern Pathways, including Macquarie Bank, the NSW government, and Serco which stands for service corporation. Its operations for customers include aviation, military weapons, detention centres, prisons and schools. Northern Pathways tout the benefits of the Centre to the economy of the local community, with employment opportunities in the building and running phases. Meanwhile, community members express concern about potential adverse impacts of the jail, such as an overwhelming influx of employees and family of prisoners moving to the area, along with the financial and social stress this may cause. In a location with a large Indig-

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enous population, locals have also expressed valid concerns about the construction of such a facility, saying they would rather see money spent in diversion, prevention, and rehabilitation than an ongoing cycle of imprisonment. The opening of a facility like this one should encourage us to look further into the overall health of the nation’s prisoners. When looking at mental health, an Australian Institute of Health and Welfare report (AIHW) on prisoner health from 2018 outlined that approximately 40 per cent of prison entrants and 37 per cent of prison discharges reported a previous diagnosis of a mental health condition. In one example, the prevalence of schizophrenia has been estimated to be between 2 and 5 per cent; this compares with lifetime prevalence rates for schizophrenia and psychotic disorders of between 0.3 and 1 per cent. Likewise, drug and alcohol dependence rates are considerable in prisoners before going to prison, and this factor often contributes to criminal behaviour. In one example, Hepatitis C rates are high due to past injecting drug use, and this can be perpetuated through needle sharing among inmates. In turn, there is a lack of effective strategies to prevent viral transmission within jails. Researchers Jarryd Bartle (RMIT) and Nicole Lee (Curtin University) explained that the artificial environment of the prison system makes it difficult to know whether the skills learnt during treatment for drug and alcohol-related problems translate to the outside world, where there are a broader range of temptations and stresses.

Continued page 30 3

Refreshed Executive now in place Following a restructure, North Coast Primary Health Network is pleased to announce the appointment of new Executives.

Tony Hendry – Director, Corporate Services Tony is a CPA-qualified Chief Finance Officer with a considerable track record driving financial management and reporting reforms across public health systems. Tony has spent many years working within the Queensland and Northern Territory public health sector both at a corporate and facility level.

Marni Tuala – Deputy Director, Aboriginal Health Marni is a proud Bundjalung and Wonnarua woman who grew up in Northern NSW. She has studied both midwifery and the law. Marni has worked clinically as the Aboriginal liaison midwife at The Tweed Hospital and is passionate about improving cultural safety. As President of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives Marni has led and informed policy change at a national level.

Glen James – Executive Director, Mental Health & AOD

Mason Andrews – Director, Digital Health & Marketing

Monika Wheeler – Executive Director, Wellness

Glen has over 30 years’ practice and executive experience working in the community and mental health sectors in three states. Her roles include CEO of a youth and family welfare service, CE of a regional community health service, WA State Manager of a national mental health organisation, AOD and HIV counselling and Australian national quality assurance and training manager for an international corporate.

Mason has 10 years’ experience in digital health, specifically in transformation, innovation and implementation. .He has a background in youth and disability support, and his love for technology led him to bring the two together. I have worked on both corporate and clinical system implementations with NSW Health. Most recently I was working for the Queensland Government as Executive Director for Online Customer Service & Engagement Platforms.

In her Executive role, Monika is driving health system improvements to primary health care, Aboriginal health, chronic disease management, healthy ageing, workforce development, population health and vulnerable populations. Monika has 15 years’ experience leading social policy strategy and health service delivery and holds a Master of Public Policy from the University of Sydney. She has worked at the local, state, national and international levels in government and not-forprofit organisations.

Claudine Tule – Director, Commissioning

Bernadette Carter – Deputy Director, Patient Centred Medical Home

Claudine has over 19 years' experience in the mental health and addictions sector, in both clinical and funding planning roles. She is passionate about making a difference for people and systems design. Claudine began her career in the child adolescent mental health services in New Zealand. She later took on management and funder roles. Claudine has a specific interest in Indigenous services development for self-determination.

Bernadette joined NCPHN in 2014 when she was working on the Colocation project. She has extensive project management experience having worked for the Queensland Government in Disability and Mental Health. Bernadette enjoys working with the challenges of driving change in primary care and meeting the array of interesting people committed to this task. She is looking forward to the collaborative opportunities of her new role.

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STOP PRESS As HealthSpeak was going to print, the following staff announcements were made: Bron McCrae is the new Deputy Director of Healthy Living and Ageing; Alissa Reeve is the new Senior Manager for Digital Health and Sarah Robin is Acting Director, Integration Northern NSW.

healthspeak August 2019

Launch meeting of First 2000 Days Project Sullivan Nicolaides Pathology Lismore Laboratory Comprehensive pathology services across multiple disciplines 

24-hour on-call service at St Vincent’s Private Hospital 

Collective expertise of scientists and specialist pathologists  From left at rear: Sharyn White, Director Integration, NNSW, NCPHN; Scott Monaghan, CEO Bulgarr Ngaru; Robert Mills, Tresilian CEO; Dr John Eastwood, Director Community Paediatrics and Director HHAN, Sydney LHD. Front row from left: Cathy Powell, Youth & Adolescence Specialist & Aboriginal Health Worker, NNSWLHD; Vicki Rose, Director Integrated Care & Allied Health NNSWLHD; Samantha James, Youth & Adolescence Specialist & Aboriginal Health Worker, NNSWLHD; Jane Wear, Manager, Community Health, NNSWLHD; and Dr Elisabeth Murphy, Senior Clinical Advisor Child & Family Health NSW Ministry of Health.

orth Coast Primary Health Network (NCPHN) is pleased to announce it has funded an important program for vulnerable children and families in the Clarence Valley called First 2000 Days – referring to the period of conception to the age of five. It’s a partnership between Tresilian, Northern NSW Local Health District (NNSWLHD), Bulgarr Ngaru Aboriginal Medical Corporation and NCPHN. Advertise in HealthSpeak

HealthSpeak is the perfect place to let the north coast health community know about your practice, company, rooms for rent or anything at all! media@ncphn.org.au August 2019 healthspeak

There is overwhelming evidence showing that if real improvements are to be made in the health and wellbeing of children and families, it’s important to work with children during their first 2000 days. The project will develop partnerships across the health, education and community sectors. Partners will work together to design and deliver early intervention initiatives that support families and children. The focus of First 2000 Days will be on developing coordinated and person-centred services, working collaboratively to build a healthy foundation for life. The needs of Aboriginal residents will be a particular focus. The first meeting was held in June in Grafton where initial priorities were agreed upon. A second meeting has been held and there will be more news on First 2000 Days in coming months.

Serving the evolving needs of the region, employing more than 100 local staff 

Supporting and training new generations of medical scientists 

Backed by state-of-the-art facilities in Brisbane

Ph: 6620 1200

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5 26/03/2019 11:15:15 AM

North Coast Collective begins modelling work

n the April issue of HealthSpeak we introduced you to North Coast Collective. In its initial phase, North Coast Collective (NCC) is a regional collaboration between North Coast Primary Health Network (NCPHN), the Mid North Coast Local Health District (MNCLHD) and the Northern NSW Local Health District (NNSW LHD). We hope more organisations such as our Aboriginal Medical Services, FACS, the Department of Housing and the Department of Education will join as NCC broadens its scope. The NCC Project is being managed by NPCHN with support from The Sax Institute and GHD Advisory.

Key to the success of NCC is the development of a dynamic simulation model

accessing mental health services on the North Coast. While the modelling team captured a vast array of information in the recorded workshop sessions, below are a few of the key issues raised: 1. General practice – long wait times, not much access to bulk billing. Further education needed to deal with complex mental health issues. 2. Psychology – high out of pocket expenses, access through ‘better access’ scheme requires GP referral, not always helpful for complex issues/disorders, lack training in suicide crisis planning. 3. Psychiatry – rare throughout the region, expensive, long wait times.

Working holistically NCC aims to address not only the health concerns of a person, but also the social determinants affecting health by working hand in hand with all sections of the community to better address health care priorities. Social determinants include: education and literacy, social support networks, employment status, financial and social status and culture. The focus of the NCC initially will be improving the lives of those with mental health difficulties and/or misuse of alcohol and other drugs. NCC plans to change the way health and other organisations work together to optimise existing resources and their impact and develop more effective, tailored strategies for mental ill health and alcohol and other drugs care.

Workshops Introductory NCC workshops facilitated by the ABC’s Dr Norman Swan were held in Ballina and Coffs Harbour for both the community and health providers in April. An important key to the future success of NCC is the development of a dynamic 6

4. Inpatient units at hospitals – extremely difficult to

access unless experiencing mania or psychosis, lack of beds available, no discharge or care planning, no ongoing care.

5. Community mental health team at hospital – underParticipants taking part in the mapping exercise at the NCC workshop in Coffs Harbour.

simulation model to be used as a decision-making tool by NCC. This model will inform the selection of strategies and services to target investments that will achieve greater impacts on suicide and mental health outcomes among our population. To progress this important component of NCC a workshop

was held in Coffs Harbour in June to identify the model’s outcomes of interest and map its causal structure using a mapping exercise.

Building the model Workshop participants helped provide an understanding of the current service pathways and challenges associated with

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resourced

6. Private mental health unit/hospitals – long wait

times, expensive, won’t take people who are suicidal. Over coming months NCC's core model building team will incrementally construct the model. This may require data input from a variety of agencies, particularly population health, local government, primary health services and hospitals to reflect the mental health system and key outcomes. healthspeak August 2019

Workshops recalibrate prescription opioid use

he Northern NSW Local Health District (NNSWLHD) and North Coast Primary Health Network (NCPHN) are collaborating to address the issue of the escalating use of opioid medications in the management of non-cancer pain. While opioids can be very effective in relieving short-term pain, when used inappropriately they can give rise to dependence, addiction and death. A collaborative project between the NNSWLHD and NCPHN aims to increase public awareness of this problem, engage the community in seeking solutions, and provide additional education for clinical staff. A series of education workshops were recently held to bring together GPs, pharmacists, hospital staff including medical, nursing and allied health, and community staff to discuss alternatives to opioids in the management of pain. Also discussed were collaborative ces-

Panellists and participants at the Tweed Heads workshop. From left: Dr Peter Correa, anaesthetist and pain specialist at The Tweed Hospital; Dr Brett Lynam, Tweed GP; Dr Liam Ring, anaesthetist & pain specialist Lismore Base Hospital; Dr Nicole Stubbs, ED Specialist The Tweed Hospital; Dr Helena Smetana, Tweed GP; and Dr Abbey Perumpanani, Director Clinical Programs NNSWLHD.

sation plans for occasions when opioids need to be used. NNSWLHD Project Coordinator Dr Abbey Perumpanani said most of the opioid-induced deaths nationally are considered accidental (85%), with just onetenth recorded as intentional,

mirroring what is seen locally. “Opioid overdose deaths and errors are increasing, particularly among older Australians who are being prescribed opioid analgesics for pain conditions,” Dr Perumpanani said. “What complicates the pic-

ture for this group is that they may be on a number of medications, as well as have underlying health complications such as cardiac or breathing problems. These factors undoubtedly increase the risk of overdose. “ More people are also surviving accidents, major surgical interventions and medical treatments. This in turn leads to an increasing prevalence of chronic pain and an increasing number of prescriptions to manage that pain. “Through this project we hope to use a two-pronged approach to address the issue of opioid overdose and misuse in our community by engaging both consumers and health professionals.” The Agency for Clinical Innovation, through its Pain Management Network, also has resources to help patients and clinicians improve their pain management strategies. Go to: https://www.aci.health.nsw.gov. au/resources

Looking back: 25th edition of HealthSpeak

his edition of HealthSpeak will be the last for our editor Janet Grist who has announced her retirement. On a background of many years of experience as a journalist with the ABC and Sydney Morning Herald, Janet became editor of GPSpeak in 2009 when it was a publication of the Northern Rivers General Practice Network (previously the Northern Rivers Division of General Practice founded in August 2019 healthspeak

1993). The first editor of GPSpeak in 1994 was Hilton Koppe. In 2012 there was another name change to the North Coast Medical Local (NCML). This organisation had a broader footprint that went from Tweed Heads to as far south as Port Macquarie. It also had a broader agenda which included all aspects of primary care. In July 2015 NCML was restructured again to form the North

Coast Primary Health Network (NCPHN). NCPHN was aimed at partnering with general practice, Mid North Coast and North Coast Local Health Districts, medical specialists, allied health providers, pharmacists, nurses and other members of the health care team. A major change was the move to commissioning clinical services rather than service provision.

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HealthSpeak magazine has adapted to all these administrative and strategic government changes thanks to the skill of editor Janet Grist. NCPHN wishes to keep HealthSpeak going, which is good news as the need for health professionals to have a voice is of paramount importance. Clinical Editor Andrew Binns 7

Why Digital Health? By Mason Andrews NCPHN’s Director, Digital Health & Marketing

nyone who knows me is aware that I can turn a simple story into a full scale stage show. But in essence, when I took on my new role at NCPHN I was able to combine my two passions, technology and helping people. About 11 years ago I was working for NSW Health helping people to navigate the various systems – and at the time there were a lot. From there I naturally became interested in clinical systems. After five years I moved out of the government sector and ventured off to the dark side (private sector). It was a real pleasure working in a national delivery role for EMR systems for Telstra Health. From there I packed up the car and headed to North Queensland to embark on a full end to end digital transformation for a clinical service provider. Now I’ve landed back on the North Coast and I’m excited to

Mason’s Nan and Pop with grandson Scott enjoying connecting with friends on their iPad

be leading NCPHN and Healthy North Coast’s digital future. From a personal perspective I’ve seen first-hand the real and tangible impact that technology can play in healthcare. Pictured are my beautiful grandparents who live on the North Coast. As an elderly couple in a regional area, they have always found it difficult to connect with the right clinicians, and also family

and friends. A few years ago we got them an iPad, with 4G on it and a great tool we implemented up in North Queensland called The Diary. We set the iPad up and their clinical teams can now load in their care plans, medications, and even keep tabs on whether they are going for walks to stay active and whether they are drinking enough water.

And with the addition of an Apple Watch, clinicians can also monitor my grandparents’ vital signs in real time and use encrypted FaceTime for consultations. But what’s so important to them is they can use FaceTime to video call family and friends from around the country to say ‘hello’ and see them face to face. As a technology native, it’s easy to take these basic functions for granted and we can forget the impact that technology can have in connecting us, bringing us together and helping us improve our lives. I’m really excited to be on this journey - to discover the real issues and needs within our communities, our practices and among our stakeholders. Then we can work together to shape a forward thinking digital strategy that can engage and activate patient care, with a real focus on the patient. For more on NCPHN’s Digital Transformation of health care, turn to page 16.

Let us know what you think about HealthSpeak With this the 25th issue of HealthSpeak, it’s timely to ask you, our readers, your thoughts about the North Coast health community’s magazine and how it might better serve your needs. We are committed to keeping HealthSpeak relevant, topical and informative. Please help us by taking five minutes to fill out our online survey. You can find it here: http://bit.ly/healthspeak

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healthspeak August 2019

NSW Ambulance Authorised Care Plans

id and North Coast HealthPathways have recently published the NSW Ambulance Authorised Care Plans (ACP) that can be authorised by a GP or treating Practitioner in the case of a Paramedic attending to their patient. These plans enable paramedics to provide care to patients that is outside of the paramedics’ protocols. The program currently has the following plans: • Paediatric Palliative Care Plan • Adult Authorised Palliative Care Plan • Paediatric Authorised General Care Plan • Adult Authorised General Care Plan The authorised plans can benefit patients with disabilities, chronic conditions, or life-threatening illness. Some plans include the provision of resuscitation status, and provide

NOTE: To enable NSW Ambulance Paramedics to comply with the patient’s wishes, a copy of the endorsed plan must be provided. NSW Ambulance advises patients to keep a copy of their endorsed plan with them at all times.

paramedics with information on transport to pre-determined facilities for end of life care, and post death management. This provides an option for GPs and other treating clinicians to close the after-hours gap for this group of patients. Activating the Care Plan

1. The form is completed by the GP/practitioner in con-

sultation with the patient, family/carer. 2. The completed form is forwarded to NSW Ambulance via fax or email for registering. 3. Once the plan is endorsed by NSW Ambulance, paramedics can deliver tailored treatment based on the authorised advice.

The pathway provides detailed information about the plans. The management section provides a detailed description about the types of plans available and a step by step guide for completion and submission. The information section provides a link to the NSW Ambulance Authorised Care Plans (ACP) Clinicians Information Booklet. HealthPathways is at: manc. healthpathways.org.au User name: manchealth and password: conn3ct3d

An apple a day…. By Suzanne O’Donnell NCPHN Quality Improvement Support Officer

he highlight of Bowel Cancer Awareness Month is Red Apple Day which was held this year on Wednesday 19 June. Bowel cancer is Australia’s second deadliest cancer. Northside Health in Coffs Harbour certainly pulled out all the stops, decorating their surgery with red apples, apple shaped balloons and plenty of information about Australia’s second deadliest cancer. Karen Jackson, Northside Health’s Practice Manager, explained that this was the first of a series of monthly health awareness campaigns. “The aim of the Red Apple Day is awareness, making people understand that Bowel Cancer can strike at any age, and to start August 2019 healthspeak

people having the conversation with their doctor about regular screening”. With brochures on seats, posters festooning the walls and lots of questions for the receptionists and the clinical team, it certainly looks like they achieved their aim. Following the success of their first promotion, the team at Northside Health showcased diabetes as their monthly “Awareness Week”. This event coincided with National Diabetes Week from 14-20 July 2019. Northside Health also continue to be involved with the North Coast PHN on the North Coast Aboriginal Cancer Screening Project. So why an apple?

This was the question on everyone’s lips as they came into

Helen Cardwell and Sarah Johnson ready to spread the word

the surgery. Most people quite rightly thought about healthy eating and fibre, but there is more to it than that. According to Bowel Cancer Australia, the outline of their apple logo appears as an abstract of a human bowel. The small hole in the apple is caused by a worm. If detected early and removed, the worm is unable to continue

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affecting the apple or the health of the tree. It's the same with people. If bowel cancer is detected early it can be successfully treated, which means patients and their families can continue to enjoy a healthy life. 9

Childhood obesity: start the conversation

hile the obesity epidemic is a worsening global issue, some GPs don’t want to talk about weight. Childhood overweight and obesity is a strong predictor of adult overweight, and NSW Health has programs to assist GPs help children maintain a healthy weight. It is now mandatory to measure and record the height and weight of all children who are seen in NSW Public Health facilities at least every 3 months. This helps to monitor whether children are tracking above a healthy weight and opens the way for a conversation about the links between healthy weight and good health. Some GPs in private practice are also measuring children’s weight and height, but many are uncomfortable talking with a parent or carer about their child’s weight.

Many (GPs) are uncomfortable talking with a parent or carer about their child’s weight

The Healthy Kids for Professionals Website provides advice and video examples of how to talk sensitively to families about weight issues, and the steps to take if a child is above a healthy weight. The site also includes Weight4kids free professional development e-learning.

By focusing on positive messages about increasing physical activity and eating healthy foods, GPs can motivate parents to make simple lifestyle changes that can lead to significant health improvements. GPs can refer parents/carers of eligible children (above a healthy weight) aged 7-13 years to the

ACON’s RAP Plan launched By Edda Lampis Community Health Promotion, ACON

ACON Northern Rivers was delighted to launch its Reconciliation Action Plan (RAP) on July 22 at its offices in Uralba Street in Lismore. Uncle Roy Gordon opened proceedings with a Welcome to Country and smoking ceremony. Speakers included Troy Combo, Programs Manager at Bulgarr Ngaru Aboriginal Medical Corporation; Maryanne Brown, community member and long-time supporter of ACON; and Nic Parkhill, ACON CEO. The opening ceremony was followed by a moving performance by Aunty Dawn Daylight, a Jarrowair-Turrbal woman and

Celebrating the launch of the RAP Plan at ACON's office in Lismore.

respected Elder of Indigilez Leadership and Support Network. With the implementation of ACON’s first RAP, our intention is to create a more strategic, collaborative and whole of organisation approach to our work with Aboriginal and Torres Strait Islander peoples and organisations. We are looking forward

to strengthening our partnerships with Aboriginal community organisations and communities across the Northern Rivers. A copy of our RAP can be found here: https://bit.ly/2OFZc6e ACON Northern Rivers is happy to connect with any local services embarking on their first RAP to share our journey so far.

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Go4Fun program. Go4Fun is a successful, evidence-based program for helping children and their families to be more active and eat healthy food. Program results show significant, sustained improvements - reduction of BMI, waist measurement, improved nutrition, improved fitness and improved self-esteem. NSW Health regularly runs free Go4Fun after-school programs and Aboriginal specific Go4Fun programs across the Northern Rivers. The two-hour program for both children and their parents/ carers is held once a week during school term. For children in areas without Go4Fun programs, there is also Go4Fun online. The emphasis is on practical, fun learning and the program is designed to deliver sustained improvements in families’ diets, fitness levels and overall health. There are always spaces in our Go4Fun programs, and there are many more children and families who could benefit from this free program. If you know of such a family, please pass on the information about Go4Fun or directly refer . GPs can also refer adults to the free phone coaching services Get Healthy and Get Healthy in Pregnancy to help maintain a healthy weight. Phoebe Nicholls is the Go4Fun Coordinator for NNSW LHD. Contact her at Phoebe.nicholls@health.nsw.gov. au or on 02 6621 1932. www.pro.healthykids.nsw.gov.au www.go4fun.com.au www.go4funonline.com.au healthspeak August 2019

Respiratory Lab reopens at Lismore Base

he Lismore Base Hospital Outpatients Unit has reopened its respiratory testing facilities. Referrals are welcome. Appointments will be limited to Monday, Tuesday and Wednesday. A range of tests are available: Spirometry assesses the ventilatory capacity of the lungs. Results provide information about lung capacity and airway function and can identify obstructive or restrictive patterns. DlCO – The carbon monoxide transfer factor (diffusing capacity) provides a measure of the gas exchange ability of the lungs. Plethysmography provides lung volume measurements that cannot be traditionally measured by spirometry to include residual volume and

and can be used to help guide treatment with inhaled steroids.

Maximal respiratory pressures – this test is used to assess

Soon Lismore Base Hospital will also offer bronchial provocation testing.

total lung capacity. The TLC is the greatest volume achievable of the lungs and the RV is the

SNP now uploading path reports to MyHRs

Ps and medical specialists ordering diagnostic tests from Sullivan Nicolaides Pathology will now see the resulting reports uploaded to their patients’ My Health Record on a routine basis. To ensure the patient’s Individual Healthcare Identifier accompanies the request, doctors must send their orders electronically from compliant practice management systems such as Best Practice and MedicalDirector. Results of all pathology tests that are referred as an eOrder from a compatible practice management system will be uploaded to the My Health Record system. If your patient does not want their results uploaded, you will need to flag this in the eOrder. When the pathology results are finalised and sent to the August 2019 healthspeak

amount of air that remains after full exhalation. FeNO measures airway inflammation and provides results used to assess airways disease, in particular asthma where results are believed to correlate with eosinophilic airway inflammation

the strength of the inspiratory and expiratory muscles during an occlusion. Useful as diagnostic tool for diaphragmatic injuries or neuromuscular pathologies. 6 minute walk assessment of exercise capacity as a measurement of functional status. Soon the Base Hospital will also offer bronchial provocation testing. Referral forms are available, which include patient preparation instructions for the tests. Please direct all referrals to either Dr Mupunga or Dr Duncan. If you have any queries, Simon Fokes (Medical Technician) is contactable Monday, Tuesday and Wednesday on (02) 6620 7301 or (02) 6629 4665.

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.

referring doctor they will be uploaded in PDF format to the patient’s My Health Record. You will have a seven-day window for consultation and discussion of the results with the patient, after which they can access their results in their My Health Record. Patient access to pathology results after seven days is an agreed national approach. Individual doctors can choose to opt out and not upload pathology results for their patients. This is a customisation that SNP believe is very important – doctors can opt in or out at any time. For more information about enabling uploading of pathology results to the My Health Record system, please contact your Medical Liaison Manager on 1300 767 284 or email marketing@snp.com.au.

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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NORTH COAST PRIMARY HEALTH NETWORK

Mental Health Fact Sheet Tweed Heads

A key role of North Coast Primary Health Network (NCPHN) is to identify local health needs and service gaps and, based on this evidence, prioritise activity to address those needs. As a part of this objective, NCPHN has recently published health needs assessment reports which included an extensive and detailed summary of the most current and relevant health and service data available relating to General Population health; Aboriginal and Torres Strait Islander health; Primary mental health; and Alcohol and Other Drug Treatment.

Ballina

In addition to national and state health data, the reports include findings from the 2018 local health needs assessment community survey that was held in June 2018 and completed by 3372 North Coast locals from Port Macquarie to Tweed Heads. Based on information presented in the reports, NCPHN is now launching fact sheets in which health data is presented in a concise and visual way organised by location and health or priority group topics.

Coffs Harbour

This article highlights some of the mental health related findings for the North Coast footprint. To view the needs assessment report and fact sheets, including the full version of the mental health fact sheet, check: https://ncphn.org.au/needs-assessment. To stay up to date with new factsheet announcements, subscribe to one of NCPHNâ&#x20AC;&#x2122;s newsletters at: https://ncphn.org.au/subscribe-to-our-newsletter.

Port Macquarie

People of all ages can develop symptoms and behaviours that are distressing to themselves or others, and interfere with their social functioning and capacity to negotiate daily life. These symptoms and behaviours may require treatment, rehabilitation, or even hospitalisation. A diverse range of social, environmental, biological and psychological factors can impact on an individualâ&#x20AC;&#x2122;s mental health.

Psychological Distress

Mental Health and Behavioural Disorders

Measures of psychological distress are commonly used as an indication of the mental health and wellbeing of a population

1 in 5 Australians had a mental

NNSW LHD 18.4

rate per 100,000 population, Local Health District (LHD)

1 in 8

health or behavioural condition

MNC LHD 14.7 North Coast 16.9 NSW rate 15.1

1 in10 Australians had

depression or feelings of depression

13.1% of Australians had

an anxiety-related condition

Australian adults experienced high or very high levels of psychological distress

2.8x

Kempsey-Nambucca

26,200

Clarence Valley

23,582

Port Macquarie

19,887 19,403

Coffs Harbour

Richmond Valley-Hinterland Tweed Valley

17,144

12,674

Richmond Valley-Coastal 11,667 Aust. 10,780 NSW 13,588

2nd

highest in Australia

Antipsychotic Medicines under 17 years

ADHD Medicines under 17 years

Prescribing Medicines per 100,000 population, SA3* region

more than higher than Australia

Kempsey-Nambucca Port Macquarie Tweed Valley

5,982 5,822

2nd

highest in Australia

3,040

Clarence Valley 2,798 Richmond Valley-Coastal 2,746 Richmond Valley-Hinterland 2,706

3rd

highest in Australia

Coffs Harbour 2,694 *SA3 describes a geographic boundary developed Aust. 2,070 by the Australian Bureau of Statistics. SA3 regions have a population of between 30,000 and NSW 2,448 generally 130,000 people and often cluster around major regional towns and areas.

Mental Health Hospitalisations per 100,000 population Self-harm by age category All ages All ages NSW

2017-18

1. Kempsey (230.2) Highest 2. Coffs Harbour (194.3) rates for all ages in 3. Lismore (192.3) North 4. Tweed (192.0) Coast 5. Clarence Valley (176.0)

233.5 163.8

148.7 Northern NSW LHD

Mental health disorders

2016-17 to 2017-18

95.5

In 2017, intentional self-harm was the leading cause of death of people aged 15-44 years old in Australia

Mid North Coast LHD

1,855.6 NSW

2057.0

352.8

396.9

15-24 15-24 NSW

LGA regions:

1,094.5

2017-18

Northern NSW LHD

Mid North Coast LHD

Deaths by suicideby suicide Deaths Rate for Aboriginal and Torres Strait Islanders

Rate for all persons Richmond Valley-Hinterland Richmond Valley-Coastal Tweed Valley Coffs Harbour Clarence Valley Kempsey-Nambucca Port Macquarie

14.4

Coffs Harbour-Grafton

14.3 14.2 13.9

Mid North Coast

12.7

13.1

12.0 11.3 10.8

Richond-Tweed

12.6

18.4

14.3

NSW (Non-Aboriginal) 9.7

9.3

Aboriginal and Torres Strait Islander Non-Aboriginal

NSW (Aboriginal)12.0

NSW rate 9.8

per 100,000 population, SA4 region (crude rate for combined reference years 2008-16)

per 100,000 population, SA3 region (crude rate for combined reference years 2008-16)

Rate by age

LGBTI young people are:

SA3 regions in the North Coast with the highest rates of suicide by age group

35-44 45-54 Tweed Valley 55-64

15-24 Richmond Valley25-34 Coastal

more likely to attempt suicide and nearly twice as likely to engage in self-injury, than their peers.

Age groups

65-74

75+

Coffs Harbour KempseyNambucca

SA3 Region Richmond Valley Coastal Richmond Valley Hinterland Clarence Valley Kempsey-Nambucca Coffs Harbour Tweed Valley Port Macquarie NSW

per 100,000 population, SA3 region (age specific death rate for combined reference years 2008-16)

15-24 21.1 16 20 15.1 9.8 8.1 NA 8.3

25-34 26.1 23.3 15.7 19.5 21.8 24.3 14.1 11.7

35-44 19.7 21.6 23.6 19.7 25.1 26.1 19.1 14.3

45-54 20.5 23 13.8 14.4 22.6 24 9.7 14.7

55-64 12.3 15.2 9.9 13 13.6 15.5 10.4 11.6

65-74 13.3 10.5 12.7 11.2 16.8 11 NA 10.1

75+ 8.1 10.3 13.4 18.7 7.7 10.6 17.3 12.7

If you are thinking about suicide or experiencing a personal crisis, help is available. No one needs to face their problems alone.

To get help call Lifeline: 13 11 14 If life is in danger call 000 (Emergency Services)

2018 Local Health Needs Community Survey SpeakUp, the 2018 local health needs assessment community survey was held in June 2018 and completed by 3,372 North Coast locals from Port Macquarie to Tweed Heads.

783

Participants were asked which health challenges they face...

36.7%

Survey participants who told us they have a mental health challenge NORTH COAST

3,372

19.5% identified as LESBIAN, GAY, BISEXUAL,

QUEER, TRANSGENDER, NON-BINARY OR WITH A DIFFERENT GENDER OR SEXUAL IDENTITY

8.3% identified as ABORIGINAL

or TORRES STRAIT ISLANDER

44.2% said they wouldnâ&#x20AC;&#x2122;t be able to get $2,000 for something important within a WEEK

29.5% had PRIVATE HEALTH INSURANCE

Top 3 health challenges for people with a mental health challenge

1 1

# Weight #

No mental 22.1% health challenge

23.2% 21.5%

Dental/oral health

Alcohol/ drug use

No mental health challenge 11.1%

No mental health challenge 6.6%

Participants were asked what they think are the three most serious health concerns in their community...

13.5% were AGED between 15-24 YEARS

People with a mental health challenge 68.1% 1 Mental health issues 52.7% 2 Drug and alcohol misuse 26.6% 3 Ageing issues

16.9% needed help with SELF CARE activities

People without a mental health challenge 53.6% 1 Ageing issues 46.0% 2 Drug and alcohol misuse 41.0% 3 Mental health issues

8.7% were AGED 65 YEARS or over

22.5% WORKED 35 or more HOURS a week

Survey respondents told us which additional services are needed to meet health challenges in their community...

For an extended online version with references please go to: www.ncphn.org.au/needs-assessment/healthspeak-article-august2019

and why...

We can all do more to address homelessness

A message of warning and encouragement The Chair of the Northern NCPHN Clinical Council Dr Peter Silberberg kindly sent in this poem he found in a book called ‘Poems that Would Waylay a Wombat’ by Australian poet Philip R Rush.

Coughs, colds, bugs and ‘flu Of all the ills which don’t delight us, The worst, for me, was tonsillitis! I had it back in forty-six, Yet still a vivid memory sticks (Which may appear somewhat pathetic) Of chlororformic anaesthetic! Hospitalised for days on end, Then sent home to slowly mend From this traumatic operation Which caused me so much consternation! Pic: Aaron Hardaker (left) and Duncan Marchant from Coffs Health Club prepare for their night of sleeping outside.

hysio and Director of Mid North Coast Physiotherapy Aaron Hardaker was one of 120 locals who took part in the June Sleepout to support three local charities working to support the homeless in the Coffs Harbour area. A wide cross section of the community participated including sports teams, business people, families and children. The Sleepout at the Coffs Harbour Outdoor Sports Stadium raised nearly $70,000 which goes to The Men’s Resource Centre, Warina Women and Children’s Refuge and Backpack Beds for the Homeless. Aaron said with around 116,000 Australians without a home to go to each night, the issue is one that we all need to think more about. “As health professionals we all get wrapped up in the standard day to day impacts on health. Ut some of the biggest determinants of health are the social aspects – homelessness, poverty, lack of nutrition, unemployment. And working in health we become used to dealing with disease or injury. “But we all need to be more grateful for what we have and spending a night out is just one August 2019 healthspeak

thing that we who live in an affluent country can do.” Aaron said the representatives from the charities who spoke on the night were really inspiring. “The guy from The Men’s Resource Centre became quite emotional talking about the impact of mental ill health and suicide on the male population and the number of people who were coming to them for help. He said that the centre was often the difference between life and death for men, which is something to remember.” Aaron said while homelessness might not be apparent, it’s a big problem in regional areas. In particular more older women are finding themselves homeless, “I’d really like to encourage people to support the charities working with the homeless and the disadvantaged. Some of us might think that people end up homeless because of poor decisions – drugs or alcohol or whatever. But there are many more aspects to the problem. Mental ill health and PTSD among veterans, and a lot of people end up homeless due to family breakdown. “It’s a confronting issue and we need to do more to support these charities. Every little bit helps.”

And several other ills I had, Some severe, some not so bad, Measles, chickenpox and mumps, And my share of breaks, and bumps! And scarlet fever, too, I caught, An illness of the nastier sort! It meant our house was quarantined; That was the customary routine For scarlet fever sufferers then, I guess I was just nine or ten! From these, I think, I’m now immune, But, you will find, it’s all too soon; Coughs and colds and bugs and ‘flu In winter come to visit you! And since that seems to be our lot, I’ve had my influenza shot To keep at least, the ‘flu at bay Throughout each Tassie winter’s day! And I would recommend to you, That’s something each of you should do! And while you’re at it, there’s some more Unpleasant illnesses in store That no-one I’ve known has enjoyed But you can easily avoid! Whooping cough is one of these, A most insidious disease! It’s reared its ugly head again, Causing families grief and pain, So I implore, as I sign off, Vaccinate for whooping cough!

a publication of North Coast Primary Health Network

NCPHN’S VISION FOR DIGITAL HEALTH

NCPHN’S VISION FOR DIGITAL HEALTH NCPHN’S VISION FOR DIGITAL HEALTH

NCPHN’S VISION FOR DIGITAL HEALTH OUR VISION FOR DIGITAL TRANSFORMATION What comes to mind when you hear the words ‘digital health technology’? Most health professionals think of electronic health records, digital referrals and discharge summaries. But digital health technology is exploding in all directions and has enormous potential in the field of health and wellness. Health care is no longer about just prescribing care plans and interventions– now it’s possible to prescribe a digital device or app as a health solution.

BENEFITS FOR HEALTH PROFESSIONALS Digital health technology is here for us to use now, and with the costs of health care rising we need to work in cost effective ways. Digital health technology can play a major role in driving down health care costs, but without costing people jobs. It can save health professionals significant paperwork time, giving them more time to see patients. Technology can make clinicians’ jobs easier by providing them with personal health data and enabling them to use that data to deliver services in a more specialised way. Telehealth, used both in homes and aged care facilities, can reduce hospital admissions and presentations to Emergency Departments, and cut hospital bed days.

Health care ‘biosensing’ wearables include the Apple Watch and smartphones

through telehealth, and digital messages can also remind or alert patients to adhere to their medication regimen. North Coast Primary Health Network’s new Director of Digital Health and Marketing, Mason Andrews spoke to HealthSpeak about the organisation’s vision for Digital Health and the process of designing its Digital Health Strategy.

Mason Andrews

H E A LT H S P E A K | A U G U S T 2 0 1 9

2. NEW MODELS OF DIGITAL CARE:

Innovation will enable us to deliver digital models of care, and not just through the use of telehealth. For example, we’ll be using technology to better manage chronic disease and build better self-management, which ultimately results in a higher number of ‘activated’ consumers.

3. ENHANCING interoperability and SYSTEMS: It’s crazy that in 2019

we still have fragmented processes, the inability to share patients’ data to other clinicians involved in their care, or even to send referrals securely (not by fax!). We need to work with everyone involved across the health care journey and collaborate to break down these barriers.

BENEFITS FOR PATIENTS Already around 80% of the population goes online for health information with more and more open to using health care apps. Other notable developments are health care ‘biosensing’ wearables such as the Apple Watch and smartphones. Technology can improve access to health care for people with mobility problems. It can also monitor changes in the health status of patients at home

Business Intelligence (BI) technology, we can harness the possibilities together and look across our footprint with the data that we have to understand better the needs of communities, but also to measure programs and interventions in real time and adjust as required.

Mason: Digital technology underpins

and enables healthier communities and more efficient, effective care. Digital Transformation can be categorised in three ways. 1. BIG DATA: Using machine learning, Artificial Intelligence (AI) and

HS: Tell us about your vision for digital transformation? Mason: My vision is that, as a Primary

Health Network, whenever we make decisions we look at what can be done that is underpinned by Digital Health. For example, how can we address health

NCPHN’S VISION FOR DIGITAL HEALTH

NCPHN’S VISION FOR DIGITAL HEALTH NCPHN’S VISION FOR DIGITAL HEALTH NCPHN’S VISION FOR DIGITAL HEALTH NCPHN will consult with the community to find out if Digital Health literacy is up to par, and if necessary close the gap

issues in Coraki? And how can we use technology to better support that population? But the first step in drawing up a Digital Health Strategy for the North Coast is to go out and talk to people, both health professionals and consumers to find out how literate they are in Digital Health. We need to have frank discussions about how THEY see Digital Health changing their lives, or those of their patients. We can’t push out digital solutions if people don’t know how to use them and we need to ensure that Digital Transformation goes hand in hand with Digital Health literacy. And while Primary Health Networks have a limited amount of money, there are a lot of people in need. These people have an expectation that NCPHN will design and fund programs and services that will care for them. And one of the ways we can get better at this is introducing digital models of care. Looking to our established and successful programs and enhancing them with digital solutions to support them. So we’ll be talking to people to find out what Digital Health means to our clinicians and their patients and what their expectations are of its uses. We have to understand people’s needs and put in place solutions that will help everyone. If we first don’t consult and understand, we’ve failed before we have begun. And if we find that Digital

WE CAN’T PUSH OUT DIGITAL SOLUTIONS IF PEOPLE DON’T KNOW HOW TO USE THEM AND WE NEED TO ENSURE THAT DIGITAL TRANSFORMATION GOES HAND IN HAND WITH DIGITAL HEALTH LITERACY Health literacy is not up to par then we will need to close that gap. We need to build a strategy for the North Coast, one that is OWNED by the people of the North Coast.

HS: What do you see as the benefits of technology? Mason: Digital Health means we can

deliver more care to more people in more locations more effectively. And we can access people in ways that they prefer for example . wWe know that often people at most at risk of suicide don’t go to their GP and ask for help. So, how do we use technology to help people with severe mental illness? It’s not just about giving them an iPad or a telehealth consultation, it’s about interacting via social media in the ways these patients want and are accustomed to doing. We know that the Mental Health Disclosure rate is significantly higher when people interact with virtual assistants or chat bots because there’s no stigma attached to the interaction. We have to think differently.

HS: What does a Digital Health Strategy need to include? Mason: First we need to ask:

1 What are the key priorities in digital health? 2 What are we not delivering on now and why? 3 Is it because of the cost? 4 Is it because we don’t have the clinicians? 5 How do we use technology to underpin these concerns? The patient has to be at the centre of every solution. One of the key groups I’m setting up is a Digital Futures Community of Practice. We have started to set up this group and we’d love to hear from any health professionals who’d like to be part of it. We will be listening to clinicians and working through our Clinical Councils. Anyone interested in joining the Digital Futures Community of Practice should email digitalhealth@ ncphn.org.au There will also be consumers sitting on this group because everything NCPHN does has an effect on the community, and we need to design services and programs with the consumer at the centre. HS: Tell us more about your vision for Digital Health. Mason: It’s really exciting. There are

two areas of digital transformation that we need to focus on.

A U G U S T 2 0 1 9 | H E A LT H S P E A K

NCPHN’S VISION FOR DIGITAL HEALTH

NCPHN’S VISION FOR DIGITAL HEALTH NCPHN’S VISION FOR DIGITAL HEALTH

NCPHN’S VISION FOR DIGITAL HEALTH

Patients use The Diary app on their mobile phone to send through personal health data to their GP who keeps track of their progress remotely

1. Incremental change which is

expensive, difficult and takes a long time. This includes things like electronic medical records, system intraoperability and electronic referrals. Big pieces of work that evolve over time. Although these

changes are important, the public doesn’t see any return on investment for years and it will be the same with some aspects of what we do at NCPHN. 2. True transformation involves picking the low hanging fruit such

as patient engagement tools, Artificial Intelligence and machine learning for mental health and Digital Health. We can use social media to reach out to people about how they are feeling. One of the really exciting concepts in digital health is virtual assistance and AI. Patients can effectively use these tools 24 hours a day online, on their phone or even in a community setting like a pharmacy. True transformation puts the consumer in control of their health, and digital health plays a big part in facilitating that, making it easy to use and access, and enhancing health literacy. Just imagine a personal cubicle equipped with an iPad and connected via wifi. We could place such cubicles into small communities that don’t have GPs. We could put them in or in front of a late night pharmacy and when someone’s unwell they can use the specially equipped cubicle by providing their Medicare number and logging into the AI tool. to access some levels of care.

MAKING USE OF DIGITAL TECHNOLOGY TO IMPROVE HEALTH MAKING USE OF DIGITAL TECHNOLOGY TO IMPROVE HEALTH

MAKING USE OF DIGITAL TECHNOLOGY TO IMPROVE HEALTH EXERCISE AS MEDICINE There’s plenty of evidence that exercise can help manage long-term health conditions and prevent other health issues developing. NCPHN’s Exercise as Medicine program enables GPs and other health professionals to work with patients with chronic diseases to plan an exercise program tailored to individual needs. NCPHN is funding five general practices to develop exercise regimens so that patients over 50 with COPD, CCF and/or osteoarthritis improve their physical function. Digital technology is a key part of the program with Apple iPads used to collect patient measures and outcomes in various settings. NCPHN has partnered with Entag – a Telstra enterprise partner that provides transformative digital technology and the Diary Corporation

H E A LT H S P E A K | A U G U S T 2 0 1 9

which supplies iOS (Apple operating system) applications CarePro and The Diary. Clinicians at five general practices across the North Coast have been trained in the use of CarePro to record a patient’s physical assessment score and track their progress while involved in the Exercise as Medicine program. The practices are: Mullumbimby Medical Centre, Banora Shopping Village Medical Centre, Lake Cathie Medical Centre, Northside Health at Coffs Harbour and Werin Aboriginal Medical Centre in Port Macquarie. Entag’s Digital Health Project Specialist Alex Krinks explained her role in the design of the Exercise as Medicine model. “My role is aligning the right technology to make the program seamless for GPs, patients and practice staff and to make sure the data the team is capturing is valuable to everyone, especially the

PHN. The Diary Corporation’s two IOS (Apple) apps – CarePro and The Diary work together and are linked to a central dataset that allows all permitted users to view and/or edit data. If a patient has a Diary account on their mobile phone they can enter health data (blood pressure or distance walked for example) enabling patients to communicate and share their health information directly with their care team in the program. “All users then are reviewing the same patient data in either app to provide a clear view into how the patient is doing.” Alex said the platform being used can do a lot as it’s used for Hospital in the Home services. In that setting, nurses are armed with an iPad, the CarePro app, iHealth blood pressure cuffs and pulse oximeters to complete the entire occasion of service from referral to discharge. “For Exercise as Medicine we focused on one module on the CarePro platform. When a patient walks in, the

MAKING USE OF DIGITAL TECHNOLOGY TO IMPROVE HEALTH

Prescribing walking groups and exercise classes will become commonplace.

GP can add them as a patient on Care Pro and assess them by carrying out the Short Physical Performance Battery Test. This is done by navigating through a scored survey within the tool. “The weighted scores are calculated automatically and the GP views the result. There is no printing out or sending information back to the PHN because we’ve linked the CarePro platform to the analytics tool already used by the PHN. So the PHN receives anonymised data - for example that Northside Medical has enrolled 10 patients and their scores. The program then triggers automatic payments to the practices for the work they are doing,” she said. There are no limits on the practices around how often they use the assessment tool and Alex and PHN staff catch up fortnightly with a rep from each general practice to support them and receive feedback.” Alex said the feedback around adoption by GPs had been very positive. “The PHN has purchased the entire software and once GPs are comfortable using the app for Exercise as Medicine they are welcome to expand their use and receive training to support their extended use of the platform.” Alex continues to monitor people’s workloads and address any challenges around the use of the technology for everyone involved in the program right through to the ‘backend’ to the people at the PHN paying the participating practices.

THE DIGITAL HEALTH GUIDE NCPHN has contracted Semantic Consulting to give North Coast GPs access to The Digital Health Guide – a cutting edge platform that will enable general practitioners and allied health professionals to choose the right health app for their patients. More and more patients and carers are using mobile health apps, digital health communities and the web for self-diagnosis. In these instances, healthcare providers want a trusted

source of information that allows them to quickly find information about that solution – what it does, who created it, how credible it is, and whether the solution is trustworthy and helpful. The Digital Health Guide allows practitioners to “prescribe” suggested apps to help patients manage their health. The Digital Health Guide can be accessed on desktop, tablet or mobile devices and is updated weekly. It has a powerful search engine so GPs can find the right app for patients quickly and easily. It provides quality information about mobile health apps, including their capabilities, what conditions they have been created for and what evidence supports their claims. It also offers reviews and ratings from health providers and patients. The Digital Health Guide will be available for GPs and allied health professionals to use for free! Accounts will be created for everyone by late September, unless you choose to opt out via the link below. If you have a digital app-etite, we’re also looking for early adopters! Register now to try out the Digital Health Guide ahead of the pack. Visit: www.ncphn.org.au/digitalhealth-guide Continued page 28

Choosing the right medical app for your patient is easy with The Digital Health Guide

A U G U S T 2 0 1 9 | H E A LT H S P E A K

Goori Grapevine Conference focuses on healing trauma

n mid-June NCPHN hosted the second North Coast Aboriginal Chronic Conditions (NCACC) Conference at the Yarrawarra Aboriginal Culture Centre on Gumbayngirr Country at Corindi Beach, near Coffs Harbour over two days. The theme was ‘Prevention – Journey toward Wellness’. Fifty-seven people working in the Aboriginal Chronic Care and Integrated Team Care field from Tweed Heads to Port Macquarie attended including staff from the Local Health Districts, NCPHN, Aboriginal Medical Services, primary health services and local community organisations. Traditional Owner Elder Milton Duroux opened the event with a Welcome to Country. The first day focused on trauma informed care facilitated by Troy Combo from Bulgarr Ngaru MAC, NCPHN’s new Deputy Director of Aboriginal Health Marni Tuala opened the event with CEO Julie Sturgess giving an overview of NCPHN’s position on Aboriginal and Torres Strait Islander health. Day one presentations were delivered by Dr Derek Chong, a psychiatrist registrar speaking on Culture and Connection; David Haupte talking on ‘What Constitutes Trauma?; and Shelle Cowan who discussed a Trauma Informed Care model. Afternoon presenters concentrated on content about ensuring cultural safety. Workshops were offered by David Haupte on Epigenetics and Neuroplasticity as a Form of Reframing the Distorted Narrative; and Joanne Graham whose workshop Expressive Art Therapy was held out in the sun. In the evening a traditional dinner of crocodile, kangaroo and traditional herbs and plants was served and entertainment 20

It was a fantastic opportunity for knowledge sharing and networking from across the two Local Health Districts included didgeridoo and dance performances from local Traditional Owners. The second day began with a choice of cultural activities including a bush tucker and medicine walk or clay modelling or screen printing. Presentations included a Close the Gap Refresh which made us of NCPHN Needs Assessment results and indicators from an AMS and a mainstream general practice. A quality improvement project called Smashing Silos, Building Bridges was delivered, information was provided on End of Life Care, and Kim Gussy and Emily Thatcher discussed new changes to Integrated Team Care guidelines and staged a workshop. In the afternoon pharmacist Helene Wightman spoke about Where the Wheels Fall

off - Hospital to Home – GP to Home and Kylie Wyndham presented a session on early detection of renal disease. The conference finished on an inspirational note with Eileen Byers presenting on her journey as a health worker and how participating in the Indigenous Marathon Project changed her life. Feedback included: “I loved meeting people with my passion. I don’t feel so alone.” “We can change our future no matter the past.” “I will listen more intensely – allowing time for people to express themselves and understand more the importance of self-care and connection to self, land, commu-

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nity and family.” NCPHN’s Deputy Director of Aboriginal Health Marni Tuala said the conference was a great success. “And it was a fantastic opportunity for knowledge sharing and networking with service providers and clinicians from across the two Local Health Districts.”

healthspeak August 2019

Stories shared at Reconciliation Week gatherings

n late May events were held in NCPHN’s Tweed Heads, Ballina, Lismore, Coffs and Port Macquarie offices this week to mark Reconciliation Week. Staff from the Ballina office gathered in the board room on Thursday 30 May to enjoy a lunch with local Elder Uncle Ady Davies. Uncle Ady grew up in Kyogle and Woodenbong and has lived a colourful life with many adventures and tales to tell. He came back to Lismore/ Ballina to support his 94-year old Mum who was in aged care and died a few years ago. He also brought along some wonderful photos of family and significant times in his life. This included the story of the 1938 ambulance in which he was born by the side of the road in 1945. The ambulance featured recently in a commemorative celebration that Uncle Ady was invited to attend on April Fool’s Day (his birthday) this year. In Port Macquarie a special lunch was held on Monday 27 May. Staff member Lillian Moseley’s mother Phyllis Moseley-Corey came long. As did Uncle Richard Pacey – who had a long career working in Aboriginal Legal Aid – his wife Janice and daughter Karran. The Tweed Heads office held a special morning tea to mark Reconciliation Week on Monday 27 and staff also attended a movie and discussion at headspace Tweed Heads on Thursday May 30. The Lismore office held a Reconciliation Week Lunch on Wednesday 29 May where Elder Uncle Mick Roberts talked about his boyhood growing up in Tuncurry. He said although they had no electricity and no running water he had a good upbringing. Uncle Mick said he was good 99% of the time except when he August 2019 healthspeak

NCPHN staff held a special lunch with headspace Tweed Heads colleagues.

Reconciliation Week lunch in Port Macquarie – Uncle Richard with Dr Sarah Mollard.

Uncle Ady Davies had some wonderful tales to tell at the Ballina Reconciliation Week Lunch.

and some mates got into trouble with the station master over the creek for eating the fruit off the trees and vegies out of the station garden. He loved his life going barefoot without much money.

In Coffs Harbour, staff held a Reconciliation Week morning tea on Tuesday 28 May and shared what Reconciliation meant to them.

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Indigenous youth detention rate alarming The number and rate of young people under youth justice supervision in Australia has declined since 2013–14, however Indigenous young people make up 49% of those under youth justice supervision according to a report from the Australian Institute of Health and Welfare (AIHW). The report, Youth justice in Australia 2017–18, shows that there were about 5,500 young people under supervision on an average day in 2017–18, down from over 6,250 in 2013–14. AIHW spokeswoman Anna Ritson said Indigenous young people are now 17 times as likely as non-Indigenous young people to be under youth justice supervision. “And while there has been a drop in the rate of Indigenous young people under supervision in recent years, the decline for nonIndigenous young people was proportionally greater, effectively increasing Indigenous over-representation in the youth justice system.” ‘Each jurisdiction in Australia has its own youth justice legislation, policies and practices, which are reflected in differences in the rate of youth justice supervision,’ Ms Ritson added. In 2017–18, the rate of young people aged 10–17 under supervision on an average day was lowest in Victoria at 12 per 10,000 and highest in the Northern Territory at 59 per 10,000.

NCPHN presents at the Better Chances Forum By Orit Ben-Harush

n mid-June, Belinda Gardner and Orit Ben-Harush from North Coast Primary Health Network’s Tweed Heads office ran a workshop at the Better Chances Forum in Lennox Head. The Better Chances Forum was organised by Social Futures and focused on how organisations can support better chances for children, young people and their families. About 150 people attended the forum. The day focused on the skills, support and relationships local organisations need to do better. This was an opportunity to challenge attendees as workers, managers and organisations in community, health and educa-

NCPHN's Belinda Gardner gave a presentation on Youth Mental Health and Substance Use Challenges on the North Coast.

tion services, as well as community members, families and commissioning agencies (funders) to think about what we need to do differently. NCPHN’s presentation centred on ‘understanding local needs’. The presentation, Youth Mental Health and Substance Use Challenges in the North Coast, started with key findings from

the 2018 local Needs Assessment survey. The presentation continued with NCPHN’s response to the findings by commissioning new services, and ended with a discussion about the ‘missing middle’ – how organisations and individuals could support locals who aren’t being serviced through existing programs.

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SCU excels in health education Southern Cross University has been recognised in the Times Higher Education subject rankings in the top 4% of universities worldwide for physical sciences and psychology. The University also ranked in the top 6% of universities for the pre-clinical, clinical and health subject ranking. The rankings are based on the same range of 13 performance indicators used in the overall World University Rankings 2019. Southern Cross is offering new degrees in 2019 including the double degree in exercise science and psychological science.

Notes from the recent Higher Degree Research Symposium By Professor Iain Graham Dean, School of Health and Human Sciences Southern Cross University

he theme of the annual Symposium was,’ Standing on the Shoulders of Giants’ and what occurred was a rendition of insights, appreciations, reflections and revelations as Doctorate and other research students and their supervisors presented their work. It was very pleasing to hear of research activity done in partnership with various regional stakeholders who have funded research or support their staff to undertake study with the School at this level, besides hearing about joint initiatives. All the research is aimed at improving health care for regional people. This event is now in its sixth year and continues to

attract interest. Not only do faculty and students attend but members of the general public too. This perhaps is testament to our increased focus upon industry engagement. We believe this to be essential if we are to evolve our graduates to become drivers of innovation so to meet the government’s agenda of increasing research and research expertise in health care. The School has an active history of engagement with the Local Health Districts, both north and south of the border. Multiple pathways into higher degree training are being developed to facilitate cultural and capability change to better achieve safer patient care. The desire to ensure the patient comes to no harm is paramount, to paraphrase Florence Nightingale. With the onset of digital health platforms, other

variations of Artificial Intelligence and robotics, plus the genetic evolution, the need to use research in order to keep the patient safe is vital. All Academic Supervisors are encouraged to engage with industry in order to evolve potential partnerships. While the students themselves are seeking work experience in order to better realise the significance of translating their research findings into patient care outcomes and policy

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change. We see this as a winwin arrangement. Research needs to be relevant - be it blue sky or applied. The School has a goal of educating higher level research students in how to conduct research with the potential to make innovative contributions to industry, patients and for the benefit of the health and wellbeing practitioner. We will soon see the introduction of the Professional Doctorate in Health Practice and the expansion of a multibadged degree with overseas universities. The Professional Doctorate will provide a more graduated pathway from industry into a doctoral qualification thereby increasing academicindustry pathways. The multibadged Degrees open the opportunity to exchange ideas, in our increasingly globalised world.

healthspeak August 2019

End of Life Care Supporting people to die at home O

ddly enough, it was the difficulty of getting a job as a midwife that led to Debbie White working in palliative care. That was 30 years ago, and she credits a supportive Nurse Unit Manager when she was a new RN for developing her interest in caring for the dying. “It was an old Nightingale style ward that had been converted into bays with two cordoned off rooms where the dying patients were placed. The NUM taught me a lot about pain management and pain relief. At the time some people were reluctant to administer pain relief, but this NUM would encourage us to keep the patient comfortable by using appropriate analgesia.” “After completing my midwifery Nurse Practitioner Debbie White’s nurse-led community palliative care service in Port training at Manly, I went to BrisMacquarie works collaboratively with GPs. bane for 12 months and returned to Sydney unable to find a job as a ing to become a Palliative Care Nurse incidence of Motor Neurone Disease midwife, which is probably unheard of Practitioner. She works solely in the in our area. So we refer through to our today,” said Debbie. community alongside Clinical Nurse Allied Health colleagues, and Allied Living just down the road from the Consultant Pauline Smith and a team of Health is definitely an area where we newly rebuilt Sacred Heart Hospice in nurses. There is also a full-time Bereave- need services to be increased.” Darlinghurst, Debbie successfully apment Counsellor, a one day a week Being a nurse-led service, the complied for a job there. social worker, a Volunteer Coordinator munity palliative care team works “That was my introduction to paland a team of wonderful volunteers. collaboratively with GPs. liative care and I just loved it. I loved “The community need is so great that learning about palliative care, being I’m purely focused there. We have up to able to help people with their symp100 patients to care for at any one time. toms and playing a supportive role for I talk openly about death Pauline and I work across the Hastthe patient and their family in their end ings Macleay Clinical Network which and dying and reassure, of life journey.” includes support to the Kempsey area.” guide and educate people Debbie worked at Sacred Heart for The team receives referrals from GPs, a few years and then went to England through the process of dying other health professionals, the Mid where she worked at St Christopher’s North Coast Cancer Institute, Specialand that can make a really Hospice in London, considered the ists, and Hospitals. Working collaborafounding place of modern palliative big difference for both the tively with the Palliative Care Unit at care. After eight years working there, Wauchope Hospital, Debbie and the patient and their family. marriage and two children, Debbie and team aim to provide the type of care her family headed back to Australia. that enables patients and their families With her parents living in Port Macto move seamlessly between their home quarie the family settled in this coastal and the hospital setting. “We don’t have a Palliative Care town and Debbie has been part of the The palliative care team has access specialist, although that might change Community Palliative Care Team now to an Occupational Therapist and a next year. So the GP is our main go to in the Hastings Macleay region for the Physiotherapist through the Aged Care person. I’ll go out and assess somebody past 18 years. Team. These practitioners are particuand formulate a plan with the patient She started work in Port Macquarie larly involved with the Motor Neurone and family and then contact the GP with a Bachelor of Science (Palliative patients. and to discuss the plan and make any Nursing) and gained a Masters of Nurs“Interestingly, there’s quite a high changes for this person together.” August 2019 healthspeak

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End of Life Care Debbie’s job satisfaction comes from knowing that she is making a difference and from journeying alongside patients and their families at the end of life. “We can’t always control somebody’s pain totally, however I can make a difference to how that pain or symptom

The Silver Chain Service were involved in caring for the patient and family unit which provides another level of valuable support. It was a beautiful home death and the family managed really well is managed and make a difference in terms of supporting them to be in their place of choice and to meet their goals. I talk openly about death and dying and reassure, guide and educate them through the process of dying and that

can make a really big difference for both the patient and their family.” Debbie gives an example of a patient who died recently. “Recently, a community patient had deteriorated at home over a period of weeks. His choice was to remain at home if possible and his family were determined to honour his request. As with many families they had not cared for someone dying before. We spent time talking with the family and the patient about what to expect as the dying process emerged and developed. The family were able to have precious time with their loved one in a familiar and safe environment. I worked collaboratively with the GP to monitor and manage symptoms that arose.” “The Silver Chain Service were involved in caring for the patient and family unit which provides another level of valuable support. It was a beautiful home death and the family managed really well,” Debbie said. Debbie values her team and said they’re continually trying to develop

Helping people to live well and die peacefully

yron Shire’s Palliative Care Nurse Practitioner Lea-Anne Tuaoi has worked in oncology, haematology and palliative care over a career spanning 30 years. “When I went into nursing I was drawn to nursing the dying. I wasn’t drawn to saving people’s lives, I was drawn to alleviating people’s suffering. “When I was young my Mum died and she didn’t die well and although I didn’t realise it at the time, at that moment I think I may have made the decision that I wanted to use my life to alleviate suffering.” After working in Sydney for 12 years, Lea-Anne moved up to Brisbane in 2000 and spent 18 years working in community-based palliative care services, nine of which were as a Nurse Practitioner. From 2015 to 2018 she worked at Karuna Hospice Service in 24

Brisbane, whose patron is His Holiness the Dalai Lama. Karuna’s values follow those of the Dalai Lama – to serve others with universal compassion and kindness. Lea-Anne loved her work at Karuna which involved the role of Director of Clinical Services and Nurse Practitioner, and later as CEO, but couldn’t find the work life balance she needed to continue. In May 2018 she began her current position as the first Palliative Care Nurse Practitioner at Byron Central Hospital. “This new Nurse Practitioner position introduces a new model of care for palliative patients within the Byron Shire. Previously GPs relied on sending their patients to the Palliative Care Specialists either at The Tweed Hospital or Lismore Base Hospital – each about 50 kilometres away”.

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their model of care to be a sustainable service into the future, particularly with a large and growing elderly population. “The Palliative Care Teams across the LHD are extremely dedicated and passionate about what they do.” About 80% of the region’s palliative care patients have a malignancy diagnosis and the remainder are nonmalignant diagnoses including Motor Neurone Disease, Dementia and organ failure such as respiratory, renal, liver or heart failure. Debbie said the non-malignant proportion will continue to grow and an important part of her team’s efforts is to work collaboratively with the Chronic Care teams. As well as the autonomy, Debbie really enjoys the breadth of her nurse practitioner role. “The role offers a variety of benefits to patients. The Nurse Practitioner role enables our team to be responsive and meet the needs of the patient in a timely manner.”

The nurses who work in palliative care are given education every two weeks. We do a death review case each fortnight as a learning tool. This includes a time of remembrance for all the people who have died on the ward

“Now Northern NSW Local Health District has three Palliative Care Nurse Practitioners – one based in Grafton, one servicing Lismore/Casino and myself looking after Byron.” Within Byron Shire Lea-Anne’s role is a mix of Byron Central Hospital inpatient reviews, home visiting and healthspeak August 2019

End of Life Care I accept dying as a normal part of human experience. The important thing is to normalise dying for patients and families in a respectful way

Palliative Care Nurse Practitioner Lea-Anne Tuaoi’s work brings her great fulfilment.

residential aged care visiting. For patients to enter palliative care, a medical referral is needed from the GP or a specialist. Lea-Anne’s first visit to a person’s home takes around 90 minutes. “I will do a holistic assessment of the person, review their medications, look at their symptom management and do some Advance Care Planning. In that first visit I like to help the patient and family to plan for the future. I ask the person where they’d like to die. If they want to die at home then I have to do some pre-emptive prescribing, organise medical equipment and put nursing services in place. I also work with the patient’s GP.” If the patient doesn’t wish to die at home, I advise them of their options; one of which might involve coming into Byron Central Hospital’s Inpatient Unit. “At Byron Central Hospital we have two really lovely palliative care rooms; though it is not uncommon for me to have up to five patients on the ward receiving palliative care at any given time. August 2019 healthspeak

People can be admitted for symptom management or end of life care. For example, if someone’s got high calcium or they need a blood transfusion they’ll come in for that or to control their pain. Or they might come in because it’s the last few weeks or days of their lives,” Lea-Anne explained. Lea-Anne is part of a team – working with social workers, allied health, nurses, and with GP VMOs on the ward who often refer patients into her care. “These relationships work well and the nurses who work in palliative care are given education every two weeks. We do a death review case each fortnight as a learning tool. This includes a time of remembrance for all the people who have died on the ward and we take a moment to reflect on their lives and the fact that they are not here with us anymore.” The review is holistic where the nurses look at the whole person and their life, not just whether the medication given worked or not. It includes where the person was born, where they

lived, their family and children. A story is built so the nurses can get more of a sense of the person they nursed. “We also review how we managed that person’s death on the ward. We talk about the challenges, what we did well and not so well and what we might do differently in the future. And we look at ongoing care for the family. This process is something we started this year and it’s working well. “I’ve seen a lot of people die over 30 years, so I accept dying as a normal part of the human experience; the times when I feel most stressed are when I think people haven’t died peacefully. The important thing is to try to normalise dying for patients and families in a respectful way that doesn’t come across as patronising or hurtful to their experience”. Lea-Anne says she really loves her work and that it brings her great fulfilment. She’s enjoying working in the Byron Shire and her work life balance is much improved. I realised when I moved to Byron that successful palliative care also involves some creating thinking. “In my first few months here I was called to the outer borders of Byron Shire to a lady living off the grid. She needed an air mattress and an oxygen concentrator. I thought ‘how am I going to get this equipment to a person who lives off the electricity grid?’ But we managed to give this person what she needed in her home environment where she wanted to stay, and she died at home.” Lea-Anne says she has a catchphrase that she uses about the ultimate aim of palliative care – ‘to help people to live well and die peacefully’.

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What it’s like to be 12 and looking after a mentally ill Mum

et Up Mum by Justin Heazlewood is heartwrenching, tender, funny, devastating, and above all true. The Tasmanian writer, musician and comedian grew up in the small town of Burnie with his single Mum in a block of flats. Justin’s book – which has been turned into a radio podcast series on ABC radio – gives a warts and all account of his daily life over one year. Always wishing for a ‘normal life’, the reader shares Justin’s pain and occasional good times of living with his troubled mother in this intense and intimate story. The memoir is told in the present tense so that the reader gets to hang out with the 12-year old. Justin’s Mum was later diagnosed with schizophrenia, but at the time he only knew that she was often ill and wanting to end it all. He is particularly upset by her bouts of long sobbing alone in her bedroom and her frequent cackling and talking to herself or swearing under her breath. A quirky teen with a keen sense of humour, Justin uses a much-loved gift, his cassette recorder, to secretly record his life outside of the four walls of his home. He wants to be able to play back happy memories

during the more desolate times in his life and as he explains to his Nan: ‘I want to be able to remember how funny you were

when you are gone.’ While he loves his mother very much, Justin is always on alert at home. Regular weekends

the reader shares Justin’s pain and occasional good times of living with his troubled mother in this intense and intimate story at his grandparents are golden – where he can relax and enjoy routine morning walks and activities with his beloved Nan and Pop and not have to worry about his Mum. His telling is straight down the line, garnered from the tapes, diaries and school assignments – Justin’s mother kept every one - and memories of meals and outings. “Cooked Jacket Potato. Was Beautiful! Got home. Mum was in a bad way. She was talking of killin’ herself. Hell! Did 3 and a half laps of track.” Get Up Mum is a portrait of three generations of a family trying to get to grips with mental illness. At the time there was virtually no support for families in Justin’s situation and he shouldered a big responsibility. How many Justins are looking after sick parents across Australia today? Get Up Mum is published by Affirm Press.

CVD most deadly disease group for women Cardiovascular disease (CVD) is a leading cause of illness and death among Australian women, according to a report released today by the Australian Institute of Health and Welfare (AIHW). The report also notes that Aboriginal and Torres Strait Islander women are almost twice as likely as non-Indigenous women to have CVD, and four times as likely to have a CVD-related hospitalisation.

The report, Cardiovascular disease in women—a snapshot of national statistics shows more than half a million Australian women have cardiovascular disease, and that it accounts for almost one-third of deaths among women. “In 2016, more than 22,200 women died of CVD—making it the most deadly disease group for women,” said AIHW spokeswoman Miriam Lum On.

“Cardiovascular disease is often seen as an issue predominantly affecting men, but there is increasing recognition that aspects of its prevention, treatment and management are unique to women,” Ms Lum On added. Despite the impact of CVD on Australian women, rates of acute coronary events (heart attack or unstable angina) and deaths have fallen substantially over recent decades.

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Between 2001 and 2016, the rate among women fell by 57%, from 465 to 215 events per 100,000. ‘There have been smaller improvements in the incidence of CVD for younger women, but hospitalisation rates have increased,’ said Ms Lum On.

healthspeak August 2019

Amphetamines now a quarter of all treatment episodes

ne in 166 people aged 10 and over received specialist treatment for alcohol and other drug use in 2017/18, according to an Australian Institute of Health and Welfare (AIHW) report. The report Alcohol and other drug treatment services in Australia 2017–18: key findings, shows alcohol is the most commonly treated drug, accounting for 69,000 of the 210,000 closed treatment episodes provided. ‘Over the past five years, alcohol has consistently been the most common drug clients for which clients received treatment. However, this has declined from 40% in 2013/14 to 34% in 2017/18,’ said the AIHW’s Matthew James. “Amphetamines now account for a quarter of all treatment episodes, up from 17% in 2013–14. One in five treatment

episodes were for cannabis (21%) and treatment for heroin (5%) continues to decline.” More than half (54%) of all clients were aged 20–39, and two-thirds were male (66%). Clients seeking treatment for more than one drug most commonly reported cannabis or nicotine (both 16%) as an additional drug of concern.

“Across most states and territories, alcohol was also the most common drug for which people received treatment. However, for South Australia and Western Australia, the most common drug treated was amphetamines, and in Queensland, cannabis (32.3%) just edged out alcohol (31.9%),” Mr James added. Clients who identified as

Excellence in Nursing and Midwifery Awards

orthern NSW Local Health District’s annual Excellence in Nursing and Midwifery Awards recognise the significant contribution these highly skilled staff make to the health and wellbeing of our region. This year’s ceremony, falling between International Day of the Midwife and International Nurses’ Day, also saw the introduction of a new ‘Consumer Appreciation’ category, which for the first time encouraged members of the community to nominate a nurse or midwife for their outstanding care. “I would like to congratulate all the winners and nominees at this year’s ceremony,” said Katharine Duffy, Director Nursing, Midwifery and Aboriginal Health. “I would also like to acknowledge and congratulate all our nurses and midwives across the LHD that these awards represent. I was delighted with the

August 2019 healthspeak

From left: Winning midwives Vanessa Reidy, Robin Stabler and Debra Young with colleagues.

number of nomination from our community in response to our new Consumer Appreciation Award. “The recipient of this award was Debra Young, a midwife from Lismore who made a significant difference to one of our families during the birth of their child.” Ms Peta Crawford, Nurse Manager Community and Pa-

tient Care Initiatives, presented the award and read out the nomination from the couple who nominated Debra who cared for them before, during and after the birth of their son. “I feel honoured and humbled to receive this award,” Debra said. “I have the best job of all, I have the privilege of being part of the most incredible journey of a woman to motherhood.”

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Aboriginal and Torres Strait Islander Australians represented about 1 in 6 (16%) clients. Around 96% of clients received treatment for their own drug use, and the remainder received support for someone else's drug use. The most common types of treatment included counselling, assessment only and withdrawal management, with counselling accounting for two in five treatment episodes. The majority of clients received treatment in a non-residential facility. Read the full report here: https:// www.aihw.gov.au/reports/ alcohol-other-drug-treatmentservices/aodts-2017-18-keyfindings/contents/summary

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Vit C cuts ICU stays Vitamin C may help to reduce the length of stays in intensive care units, according to a new meta-analysis published in the journal Nutrients. The study included 18 trials, involving a total of 1835 patients, with vitamin C administered orally in seven trials and intravenously in 11 trials. Doses ranging from 0.5 to 110 g/ day reduced the length of an ICU stay on average by 7.8%, while doses of 1–3 g/day reduced the length of ICU stay by 8.6%. A previous metaanalysis of 11 trials on patients undergoing elective cardiac surgery found that vitamin C shortened hospital stay on average by 10%. Access the SydneyHelsinki study at: https:// www.mdpi.com/20726643/11/4/708

MAKING USE OF DIGITAL TECHNOLOGY TO IMPROVE HEALTH

MAKING USE OF DIGITAL TECHNOLOGY MAKING USE OF DIGITAL TECHNOLOGY TO IMPROVE HEALTH TO IMPROVE HEALTH

South West Rocks is the location where NCPHN will supply digital support to link children with speech pathologists

DIGITAL DELIVERY OF SPEECH PATHOLOGY Through its Healthy Towns program, North Coast Primary Health Network (NCPHN) has been engaging with small towns across our footprint to understand health service needs and design local solutions. One of these towns is South West Rocks on the Mid North Coast. South West Rocks is the location where NCPHN will supply digital support to link children with speech pathologists. For some years, South West Rocks residents have been concerned about the shortage of allied health services to support children in the community, particularly speech pathologists. There is strong evidence that early intervention for children experiencing language and developmental delays improves long term health outcomes and reduces cost to the health system. In order to remedy this healthcare gap, NCPHN has contracted Coviu Global to coordinate delivery of speech pathology services to children in South West Rocks preschools. The project will run for two years and will build local capacity to deliver and support programs into the future. NCPHN’s Healthy Towns Coordinator Sarah Robin explained that what is put in place in the town will be very much community driven. “Coviu will consult with the community, establish what their needs are and adapt evidence-based programs to meet these needs.” “The project will complement and

H E A LT H S P E A K | A U G U S T 2 0 1 9

support existing local services. For example, if there are speech pathologists with capacity to participate, they will be included. We will also work with preschools, educators and allied health assistants to ensure the community has the skills they need to deliver programs on the ground.” Coviu will partner with Royal Far West to offer group-based programs as well as individual telehealth consultations. “One program offered by Royal Far West is called SWAY which stands for Sounds, Words, Aboriginal Language and Yarning. It’s an oral language and literacy program that uses Aboriginal knowledge, culture and stories to improve language and literacy outcomes for preschool children. We hope to adapt this program to meet the needs of the South West Rocks community,” said Sarah. “Royal Far West Hospital also offers telehealth services for children in rural and regional Australia. Our intention is to provide individual services for children with severe or complex needs in South West Rocks.” The community is looking forward to seeing improved outcomes for young people in South West Rocks.

GP PSYCHIATRY SUPPORT LINE NCPHN has funded a psychiatry support line for North Coast GPs to access specialist advice for people under their care. The GP Psychiatry Support Line is free to use and connects GPs with a psychiatrist. The psychiatrist will provide advice

on diagnosis, investigation, medication and safety plans. NCPHN’s Chief Executive Julie Sturgess explained the decision behind the funding of this new mental health service. “The findings of our 2018 Needs Assessment highlighted community concerns about the difficulty of accessing psychiatrists and doctors with specific mental health knowledge in our region. “The GP Psychiatry Support Line will ensure that our GPs have timely access to experienced psychiatrists. It’s expected that more than 200 practitioners will take advantage of the new service to enhance the care they provide to people with a diagnosis of mental ill-health,” she said. NCPHN’s Quality Improvement Support Officers are visiting general practices and Aboriginal Medical Services to help practice staff register and access this new support service.

ORION SHARED CARE PROJECT

By Tim Marsh Project Lead, Northern NSW Local Health District

The Shared Care Project began in late 2016 after NNSW LHD and NCPHN gained funding from eHealth NSW and the Ministry of Health to test new Shared Care Planning concepts. The scope

The small scale 12-month Proof of Concept project aimed to test the Shared Care Planning model of care using the Orion Tool. Shared Care Planning is a government priority to better support patients with chronic and complex care needs. The project was a collaboration between the NNSW LHD, NCPHN and eHealth NSW with all partners providing funding for the project to extend to two years. The system allowed GPs and other

MAKING USE OF DIGITAL TECHNOLOGY TO IMPROVE HEALTH

members of a patient’s care team (invited into the record by the GP) to see the patient’s GP Management Plan uploaded by the GP and other clinical information. This included conditions, allergies, medications and other history as well as shared information about patient progress, goals and actions, patient services and the location of legal documents. It also offered a simple, secure messaging function. Valuable lessons

Although the project ended in June 2019, some very valuable learnings and data have been collected and included in an evaluation package for the Commonwealth and NSW Health. These lessons will greatly assist the government as they calibrate their approach to Shared Care Planning and how best to implement digital tools in support of patient outcomes and experience as well as clinician experience, in support of the Quadruple Aim. Overall, the project found the Shared Care Planning model of care has promise, and it is worth noting a small number of GPs derived benefit from non-remunerated use of the tool in Northern NSW because it solved a communication problem for them and the related LHD teams, while improving patient care. (Patients did not have access to the tool.) Some of the lessons are:

• Shared Care Planning problem definition needed: a definition of

the problem to be solved by Shared Care Planning – including a list of things SCP is, and those which is it not, is needed. Widespread agreement is essential.

• Common core requirements: na-

tionwide consulting piece with GPs, medical specialists, allied health, aged care, NGOs and other stakeholders to form a set of functional requirements based on the problem statement which help guide implementation of appropriate solutions, including evaluation and key success measures. Co-design with patients: by starting with patients it’s likely a more useful (and more used) solution will result. The requirements should satisfy the ‘what’s in it for me?’ paradigm for all users.

• The health system is not currently arranged to support Shared Care Planning: from funding for

use, through to measurement, clear benefits based on evidence and high level support, foundational work is needed to make the case for change. There is still much work to do in terms of integration.

• Shared Care Planning is a complex landscape: This means

embedding change is extremely complex, requiring long term support and change at a large scale.

• Shared Care Planning tools:

It might be beneficial to refocus Shared Care Planning tools towards being part of a more comprehensive set of a Case/Care Management Tools (CMT) for patients with chronic and complex care needs, including eReferrals, Secure Messaging and patient-focused initiatives. At a technical level, particularly in respect of GP use, the project found: • Shared Care Planning is a new con-

“THIS WAY OF WORKING HAS GIVEN ME SOME REALLY VALUABLE INFORMATION. HAVING SEEN THE ORION TOOL WORKING IN ACTION OVER THE LAST FEW MONTHS, IT REALLY IS A SHAME WE ARE LOSING SUCH A PLATFORM” – DR PS cept and time is needed to embed this and work out how best to get everyone on board • Gap analysis of what is actually needed to address communication gaps at the Federal, State and local levels. Necessary to locally determine what initiatives and services could be served by a solution to ensure a product-market fit and uptake. • As much as possible, support behind the scenes. For example, GP (and other) systems update the system in the background based on ongoing patient consent, and key hospital systems do the same. This maximises efficiency, accuracy, timeliness and reduces double entry and human error. • Avoidance of installation of GP software as much as possible, but where done, delivery of value and efficiency to the GP and practice by leveraging existing system logins, workflows and through delivery of value adding functions. Overall there is a lot of opportunity, but system and governance reforms need to manifest alongside some other work to help mature the concept. This will help make implementing future systems easier for regions, their clinicians and patients to adopt.

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These problems transfer to internal health care generally, as prisoners have no access to Medicare and their health care is managed and funded by NSW Justice Health and Forensic Mental Health Network. A GP is often asked for medical records for inmates when a person is imprisoned. However, when someone leaves the jail there is virtually no safe transfer of care through the Justice Health medical record system back to GPs, and this is a problem that needs to be addressed. Also lacking is adequate follow up of people leaving the justice system and integrating back into their community. Ideally there would be a proper handover of any medical issues managed in prison to a GP, as well as adequate follow up of the social determinants of health. The social needs of inmates

leaving the prison system also need to be taken into consideration. In fact, it is often the case that health and lifestyle improvements gained in prison can be lost when they are released. However, ensuring social needs are met once prisoners leave is easier said than done as the released prisoner is often homeless and frequently has no regular contact with a GP. If the prisoner is Aboriginal or Torres Strait Islander, they may have had contact with an Aboriginal Medical Service, and a handover to such a service would be helpful. Rehabilitation programs — such as drug and alcohol counselling, relationship and anger management, trade skills development, and assistance with housing matters — are helpful. For Aboriginal and Torres Strait Islanders, a cultural program, including input from Elders, is very well received and

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Vaccinations don’t raise risk of MS A large study has concluded that vaccinations are not a risk factor for multiple sclerosis (MS). Instead, the findings reveal a consistent link between higher vaccination rates and a lower likelihood of developing MS. Researchers at the Technical University of Munich studied data on more than 200,000 people who were representative of the general population. The records held people's vaccination history and diagnosed conditions and included data on 12,262 people with a diagnosis of MS. The dataset included dates of vaccinations for chickenpox, measles, mumps, rubella, influenza, meningococci, pneumococci, human

papillomavirus (HPV), tick-borne encephalitis (TBE), and hepatitis A and B. The researchers used statistical tools to assess any links between MS and vaccinations in the 5 years leading up to diagnosis. The results did "not reveal vaccination to be a risk factor for MS," the authors conclude in a recent Neurology paper on the study.

helps with the healing process. Non-Indigenous residents can benefit from similar programs

Children of people who have been in prison are six times more likely to also become prisoners

too, as they are highly likely to also come from a marginalised environment. In some regions there is a step-down process through a diversionary facility for completion of a sentencing; here programs lasting for six months are offered to make the transition back to community more manageable. The greatest contribution that could be made to help the mental and spiritual rehabilitation of people in the justice system is to provide them with hope for a better life in the future. This is not easy to achieve, but there are plenty of models in Australia, and around the world, where good progress has been made. For example, education for young offenders in custody, when done properly, has shown to be a ‘circuit breaker’ from a life of crime. There is an intergenerational element to this cycle, too, as children of people who have been in prison are six times more likely to also become prisoners. Youth detention centres should focus on education and there are good models for this. Also, follow-up education after detention is vital to prevent released prisoners reoffending. Of course, rehabilitation comes at a financial cost to the facility, but this has to be weighed up against the higher cost of recidivism. For example, the Institute of Public Affairs estimates the cost of putting one person behind bars for a year in Australia is nearly

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$110,000. The Organisation for Economic Co-operation and Development states the average annual cost per person is $69,000. Almost 60 per cent of prisoners have been imprisoned before, with 45 per cent of prisoners released during 2013 and 2014 returned within two years. The annual cost of Australia’s prison system is around $4 billion. These figures beg the question: do rising incarceration rates reflect crime rates? The answer is no: despite an increase in sexual assaults, drug and fraud-related crime, overall crime rates are falling. From my experience as a GP treating patients within this system, I can attest that Australian prisons are often places where people remain out of sight and out of mind. There is also a disturbing overrepresentation of vulnerable and marginalised groups, especially Aboriginal and Torres Strait Islander peoples, who require culturallyspecific care and pathways to recovery due to an ongoing experience of trauma, racism, poverty, and institutional neglect and abuse. Due to this, and other reasons outlined in this article, there is a dire need for better communication between Justice Health and GPs in the community. The current ‘tough on crime’ approach is clearly not working or contributing to community safety; other diversionary models for punishment and deterring crime need to be sought in Australia. This is not only a justice and corrective services issue; it is also a significant public health issue. If we are serious about public health in our community we need to give more consideration to those who are incarcerated, as the statistics for imprisonment and recidivism are alarming and worsening. Without an active reappraisal of this issue, the cycle will continue, requiring the construction of more “mega-jails” at great detriment to our nation and its health.

healthspeak August 2019

Investing: Income or Growth? F

alling interest rates, a share market that looks toppy, an uneasy property market and a lacklustre economy makes investing problematic at the moment. Interest rates are near rock bottom forcing investors to hunt higher yields elsewhere. Many are diving into the share market, snapping up shares and complex hybrid securities regardless of risks. Those living off their savings feel they can do little else. But is this the right thing to do? What are the risks? The answer depends on your investment time frame, your objectives (income or capital growth), what sort of risk you are prepared to endure and the likely seriousness of any potential downturn. But at least the election is over and negative gearing, capital gains tax and franking credits go on as before. Whatever the merit of these changes may have been, they now look like they have been put in the dust bin for the foreseeable future. But as the Government says, we are encountering other headwinds. A temporary truce has been called in the trade war between the US and China but it is a long way from over. The good news here is that a US Federal Election is looming late next year and traditionally an incumbent President, anxious for a second term, tries to ensure the economy is robust in the lead up. Elsewhere around the world, economies are slowing for other reasons and the effects will be felt here. The Reserve Bank and others are urging the Government to boost infrastructure spending to help the economy. Doing something however means that that forecast Budget surplus will have to be sacrificed once again or there will have to be cuts to services. So the outlook remains foggy, but then, that’s pretty much the August 2019 healthspeak

norm. In fact uncertainty is probably a good thing. The US economist Hyman Minsky once coined the phrase “economic stability breeds instability” meaning that stability makes us over confident. Perhaps US Fed chairman Ben Bernanke could have heeded the warning when he said in 2004 that the world economy was experiencing a great moderation – shortly before the GFC.

The US economist Hyman Minsky once coined the phrase “economic stability breeds instability” The big debate among share investors is whether to go for income or growth. Retirees tend to love high dividend stocks, particularly those that pay fully franked dividends. So do other investors who pay no tax. Even

tax-paying investors like fully franked dividends because they can reduce other tax due. They argue that the income stream with dividend stocks is much better than cash; that the franking credits are extra cream and they tend to be less volatile than growth stocks, especially during a downturn. All this is true but is it the best strategy? Let’s take two large Australian companies, Westpac and CSL. Westpac and the other banks are loved by retirees because of the dividends. Other investors love CSL because it is a growth stock with a large overseas operation. If you had invested $10,000 in Westpac shares five years ago, your total dividend take, including tax credits would have been around $4700. Certainly better than a term deposit. But in the same period your share value would have fallen by 17%. With a net gain of 30 per cent. You can argue the drop in the share price is no worry since you don’t intend to sell and maybe they’ll come good. But if the same amount had gone into CSL, dividends in

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finance David Tomlinson total, after five years, would have been much lower – less than $700. No franking credits either. So far it’s bad news. But the CSL share price has risen from $73 to $222 giving the investor a 310% return all up. And to make up for the income deficit, all you need to do is sell a few shares once a year or so. For some, growth stocks are common sense. Companies need capital to grow. Retaining earnings within the company is one way to get it. Of course some companies, although profitable, cannot see worthwhile growth opportunities. These should return profits to the investor by way of high dividend payouts. High dividend stocks may be less volatile but usually the returns overall are less than growth stocks. If you are investing for the next five years or more you may be able to take on some extra volatility in return for better gains.

SCU project helps reduce social isolation

wo Southern Cross University Allied Health students have embarked on a collaborative community project to help the elderly combat social isolation. Fourth-year occupational therapy student Mia Lefebvre and podiatry student Kyle Williams were one of 27 student groups who presented their community health projects at the University’s annual studentled Allied Health Conference on May 10. Kyle and Mia discussed their overall findings and future recommendations for the Virtual Senior Centre (VSC) online platform which was created to help reduce feelings of social isolation and loneliness through connecting likeminded seniors. Kyle Williams said while most seniors taking part were from the Gold Coast and Northern NSW, others from interstate were also joining in. “Through the platform, elderly participants can login to the website and participate in group programs,” said Kyle about the pilot stage of the Feros Care program.

I can attend a virtual church group, chat with friends whenever I want, and see the world through the remote-streaming sessions

Mia and Kyle are working to help the elderly combat feelings of isolation.

“Our role within the project was to support data collection, analysis and report writing, and our preliminary data shows the participants now have reduced feelings of social isolation by gaining a greater sense of belonging within the community. Many have also stated that they would recommend the program to people experiencing feelings of loneliness.”

Mia said while nothing beats face-to-face interaction, many elderly people miss out on social connection altogether if they have conditions which restrict them from leaving their home. “The long-term aim for the Virtual Senior Centre is to continue to grow in participants and increase the number of online programs it offers,” she said.

Prostate cancer screening scan hope Hundreds of UK men are trying out a new screening test for prostate cancer to see if it should eventually be offered routinely on the NHS. The test is a non-invasive MRI scan that takes images of the inside of the body to check for any abnormal growths. Scientists running the trial say it will take a few years to know if MRI will be better than available blood tests and biopsies at spotting cancers. NHS England said it would review this "potentially exciting" development. The experts from University College London who are running the screening trial

hope that MRI will detect serious cancers earlier while reassuring the majority of men that they don't have cancer. The College’s Professor Mark Emberton and

colleagues say MRI is a good tool because it is relatively cheap, widely available and reliable. Men found to have possible signs of cancer on the scan would be sent for more tests.

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“We have heard from many elderly people that they want to continue to stimulate their brains, have the opportunity to attend an exercise class and just communicate with others, all while being able to stay at home. This platform has been able to achieve this for them. They even have the option of watching the session later at their leisure if they are unable to attend the designated time it is running.” One participant from the region said they found genuine benefit in the friendly, warm, empathic conversation with others in the program, particularly when others shared the same interests in animals and landmark locations, and were willing to share ideas, views and laughter. “The Virtual Senior Centre is very accessible and despite people not being in the same room, or even same state, direct interaction and communication can take place – it’s the next best thing to being there together.” Another participant said that due to illness they had suffered isolation from not being able to go to church, visit friends or be actively involved in community. “The Virtual Senior Centre has been a lifeline. I can attend a virtual church group, chat with friends whenever I want, and see the world through the remote-streaming sessions, including one of my favourite sessions ‘Down on the Farm’.” healthspeak August 2019

Footprint Number Nine light airs David Miller

ver ritual coffee with the Saturday newspaper, my eye was arrested by ‘Counterculture’, a six-page spread by Tim Elliott (SMH Good Weekend 8 June). It featured a whimsical shot of a woman of chilled hippy appearance in diaphanous blouse, with child inhand, floating across Mullumbimby’s main street. The article was about anti-vaccination, an issue which has never gone off the boil during the decades that I have practised around here. For perspective, the community of 1975 was oil trying to mix with water. Newcomers, here for a back-to-earth lifestyle had the old locals labelled as the ‘straights’ and themselves as the ‘freaks’. To the old locals they were a just a bunch of long-haired hippy blow-ins. James Hardware shop had a different view. ‘They paid in cash for their irrigation equipment, while the dairy farmers were in trouble. We had to extend them credit.’ This was from an interview with a much older Noel James, reminiscing in Sharon Shostak’s documentary about the ‘70s, Mullumbimby Magic. Disillusionment and mistrust of authority was a palpable narrative amongst the ‘freaks’ who built un-approved and unconventional dwellings. Having their crops raided by aggressive aerial police tactics solidified distrust of all officials,

August 2019 healthspeak

including doctors. That had its moments, and I recall patients with curable cancers opting for unconventional therapies or fasts, resulting in some sad outcomes. The belief structures morphed with anti-vaccination. Vaccination resistance has a complex history. Even when Dr Jenner introduced the cowpox vaccine in 1798, many people could not tolerate the

Life expectancy, child mortality and rates of all cancers are higher in this region than the national average. Really? notion of pus from an infected cow’s tit being put into a human. In spite of these naysayers, the eradication of the smallpox scourge by vaccination is possibly the greatest public health achievement of humanity. Strangely though, France, where it all began, remains the least vaccinated of all developed countries. Diseases that disappear no longer terrify. Diagnosis of diphtheria or tetanus used to hold the terror of death

sentences, but these conditions are now unusual, having been vaccinated out of living memory. Even modern vaccination has a troubled evolution, so the waters can be muddied. A local senior paediatrician was quoted in Elliott’s article about the roll-out of a new vaccine for whooping cough in the late 1970s. ‘It was a bad vaccine, the worst one we’ve had. It wasn’t very effective and it had marked side effects, like high pitched crying and fever. The parents would take their children back to the doctor and say,” my child has had a bad reaction”, and the doctor would disregard them. It alienated a lot of people’. The cause was also not helped by stubbornly persistent misinformation about autism. When I contacted Tim Elliott for his sources he courteously supplied the evidence. According to Australian government figures, in 2016-17 the national immunisation rates were 93.5% for children up to the age of five. The overall child vaccination rate for the National Area Nine (the footprint of NCPHN) is 90.6% - not that far off that national percentage, but in the Mullumbimby bubble, the vaccination uptake drops

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sharply to 52%. Almost in passing, the article made reference to figures from the Australian Institute of Health and Welfare which showed that life expectancy, child mortality and rates of all cancers are higher in this region than the national average. Really? An astonishing outcome in an area of extreme health consciousness, underlined in the article by a photo of ‘Mullumbimby Herbals’ shopfront and its rainbow lettered ‘dispensary naturopathy’. What really are the outcomes in this bubble of the north and could it be that our Health Area Number Nine is a kingdom divided? Talk about vaccinating the young draws attention from another group seniors - many of whom don’t realise that the Shingles vaccine is free for over 70s. Another hidden problem is for active grandparents whose own childhood vaccinations have worn away. Inadvertently they may be carriers for pertussis. This is easily remedied by a shot of Boostrix, strangely not free, but $40 by prescription. Then add any doctor’s fee. But at a public hospital? It’s free in emergency after any scratch or cut in the garden.

The Breakthrough Charles Graeber Scribe 302pp

The Angina Monologues Dr Samer Hashef Scribe 275pp

briefs

Iron may not affect fertility A US study has found no consistent association between consuming iron and becoming pregnant. The study published in the Journal of Nutrition found that heme iron, which most comes from meat, has no effect on how long it takes a woman to conceive, while non-heme iron, found mainly in vegetables and supplements, has a modest effect on women with heavy menses or those who have

he “two Cs”, cardiac disease and cancer, debilitate or kill millions, and the challenge of defeating them, or mitigating their impacts, continues to motivate clinicians and researchers. These books focus on the battle against these too-common illnesses, charting efforts to improve and save the lives of patients who once faced a death sentence. Until recently, as Charles Graeber begins in his history of immunotherapy, the main techniques for combatting cancer were “cut, burn, and poison”, the third developed from a derivative of mustard gas. This troika continues to be used in the treatment of half the people affected by cancer, leaving a large cohort for whom medical science is investigating other methods. Enter immunotherapy, “the approach that works to defeat the tricks, unmask cancer, unleash the immune system, and restart the battle. It differs fundamentally from other approaches to kill cancer because it does not act upon cancer at all, not directly. Instead, it unlocks the killer cells in our own natural immune system and allows them to do the job they were made for.” Although the book can be as technically complex as its subject matter, Graeber leavens the narrative with profiles of previously given birth. "For the average pregnancy planner, it is probably wise to take a preconception multivitamin, but more for the folic acid than for the iron content," says study author Elizabeth Hatch, professor of epidemiology at Boston University School of Public Health. "If you have extremely heavy menstrual cycles, it might be a good idea to have your iron status checked by your healthcare provider." More information at: https://academic.oup.com/ jn/issue/149/6

book review Robin Osborne

Almost any doctor who is not totally cack-handed can become a technically competent heart surgeon patients who have undergone immunotherapy trials, as well as the researchers who designed and delivered them. We meet Jeff Schwartz, ex-banker and “a music guy” who’d attended a hundred-plus Grateful Dead gigs. Jeff became patient twelve of a 12-person study conducted in California, receiving an experimental drug MPDL3280A, which had worked in mice – “but 90 percent of all cancer drugs that work in mice fail in human trials.” Fortunately, he was a ten percenter and “lucky enough to have a physician connected to a place open to the potential of cancer immunotherapy and geared toward clinical trials.” We also meet Jim Allison, another music nut who played blues harp in Texan honkytonks while studying pre-med. Switching to a biochemistry PhD candidate, he was reading “all this immunology stuff in the library”, noting how B and T cells found their antigen and thinking, “That’s sorta how a vaccine works, right?” Dr James P. Allison won the 2018 Nobel Prize for Medicine for the discovery of cancer therapy by inhibition of negative immune regulation. Buoyed by like-minded researchers and considerable investment funding

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he is a leader in immunotherapy efforts. Ironically the book’s cover blurb extols his “cutting edge work”, a term better applied to cardiac surgeon Samer Nashef whose derivatively titled book is scalpel-driven. Despite a similar tendency to lapse into technicalities, it is an entertaining and moving portrait of his trade. He is internationally recognised for his skills, which he plies largely in the UK. As skilled a wordsmith as a surgeon, the author also compiles cryptic crosswords for The Guardian and Financial Times. His snapshots cover the gamut of cardiac intervention, from the routine to the complex and highly time-dependent, such as open-heart surgery and transplantation, his tone being one of compassion with flashes of humour. Acknowledging that people think heart surgery is difficult, he demurs: “The technical side of the job is no more than a set of skills, and like all skill sets, it can be learned. With enough practice and guidance, almost any doctor who is not totally cack-handed can become a technically competent heart surgeon.” He adds, “The part of the craft of heart surgery that is most demanding and most difficult to acquire is not the cutting and stitching, but the decisionmaking.” His no-nonsense advice about protecting ourselves from coronary artery disease includes accepting factors beyond our control - genetics, our age, gender (males fare a little worse) and bad luck. Factors we can control are smoking and being fat. We should modify high blood pressure, diabetes and high cholesterol, but can ignore media and health lobbyists’ warnings to shun red meat, butter, cheese, crisps and – “yes, of course” – salt. He eats these to his heart’s content, and “you can probably do the same thing as long as you do not become fat.”

healthspeak August 2019

Face-to-Face Not Facebook: Combatting Loneliness with Meaningful Connection

hile in some ways we false reality, leaving people feelare more connected ing left out, lonely, depressed, to each other than ever before, and anxious. The ease of comelectronic communication is not municating via a computer or a substitute for human contact. smart phone can also be an Facebook and other forms increasingly introverted pracof social media are not tice, and then there are those for everyone, and, even who don’t have access to By Andrew for those that use such the internet at all, due to Binns platforms, there is a cost, geographical isolation, limit to the emotional a lack of education, or fear of satisfaction one can gain from this technology. these ‘fast’ and often superficial And with more people living means of communication. alone than ever before, genuIn recent years, there has been ine human connectedness is a a great deal of research into the social priority. Statistics show effect of technological commuthat there is an increase in onenication on mental health. Deperson households, and whilst spite there being many positive some like it this way and cope attributes to these online modes well (to be alone is not necessar(such as a more democratic ily to be lonely), others can find representation of voices), they this situation isolating. With 25 can lack humanity. Email does per cent of people living alone, not conjure the same feeling as one in three experience chronic posting a letter; even handwritloneliness. And although loneliten aerograms sent overseas to ness can occur at any age, it is loved ones a few decades ago more common in the 15 to 25seemed to have more meaning. year age group and, not surprisSimilarly, the user-experience ingly, in an elderly demographic of online mass media differs over 75 years of age. from reading printed copy, and Professor of Psychology and quality journalism seems Neuroscience at Brigham to have suffered University, Utah, across the board. In Julianne Holtturn, as discussed Lunstad told the With 25 per cent recently on ABC 125th Annual of people living radio, we are Conventions of alone, one in three seeing a turning the American experience chronic away from ‘tooPsychological loneliness. much-ness’ and an Association in ‘attention economy’ August 2017 that with a return to ‘slow many nations around journalism’ and more meaningthe world are facing a loneliness ful forms of communication. epidemic. She drew on data So, what is it about these fastfrom two meta-analyses for her paced forms of communication presentation. The first found that have proven to be more that a greater social connecalienating than connecting? We tion conferred a 50 per cent could argue that the speed of reduced risk of early death. The electronic communication loses second examined 70 studies and something in translation. Social concluded that social isolation, media can generate a sense of loneliness, or living alone posed August 2019 healthspeak

risks for premature death that were as big or bigger than obesity and smoking less than 15 cigarettes per day. Solitary living is also associated with depression, inactivity, cardiovascular disease, and increased alcohol intake. What can be done about this problem? There are many support services for people experiencing loneliness, but one I recommend is based in Western Australia. It is called the Act-Belong-Commit campaign initiated at Curtin University. This service encourages people to take action to protect and promote their own wellbeing, as well as encouraging organisations to focus on mentallyhealthy activities, such as the Men’s Shed Association. These A-B-C guidelines for positive mental health are a simple way to get involved with other people in your community and reduce loneliness. ACT: Keep mentally, physically,

socially and spiritually active by doing things such as taking a walk, saying hello to people like neighbours or local traders, read a book, do a crossword, dance, play cards, stop for a chat. BELONG: Join a book club, sign

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up to an exercise class, take a cooking class, be more involved in groups you are already a member of, go along to community events. Keep up friendships and get involved with club and community events. If you don’t know where to start, contact your local council for help. COMMIT: Take up a cause, help a neighbour, learn something new, take on a challenge, volunteer. Committing to challenges or causes you believe in helps provide meaning and purpose — and beat loneliness. The Act-Belong-Commit group says being active, having a sense of belonging, and having a purpose in life all contribute to good mental health and wellbeing. By creating a simple and achievable process, this service has found an approach to combatting loneliness that is driven by the individual, but quickly forms healthy and positive connections with others. This is vital, especially in Australia where remoteness, a reliance on technology, an aging population, and increasing workloads could be seen as factors that increase our chances of experiencing loneliness.

Health&Lifestyle

What is the use of children? I

was reflecting on the different faces children bring to situations, like the one observed on a child when their sibling is being chastised. Smugness is too cerebral for this one, as it borders on unadulterated joy. The moment cannot last long enough for them, and they are incredibly still and focused. Then there is the face we see when the adolescent, who tolerates you for your provision of food, shelter and Internet, must hear you out. Your story may be fascinating to you, or instructive to them, but in their mind they are just paying their dues to maintain a steady supply of the necessities. Again, they the time and I feel little has become remarkably physically changed in the last 27 years. still, though become animated John argued there are three again when you are (finally) basic needs of children; to finished. be loved in the first few But the face I love the years of life, to be useful By Chris most is the one on the in childhood and to Ingall child who feels they have be respected in adolesdone something useful, not cence. The second naturally only in their eyes but yours as leads to the third he felt, and I well. Bringing the mail up from would agree with him. All we the letterbox, particularly if it is need do is get past the negacold or wet, or even tying their tive connotation of the word shoelaces for the first time, ‘use’, so strongly linked to the brings the best face of childhood abuse of the all. It is at once Dickens era. triumphant, If you agree expansive with his and loving, premise, “How can I help my their world and mine, child to be useful”? It touching you may be is really a very simple yours in asking the answer, as young the best question; children, certainly possible “How can from the age of four, way. As a carI help my like to help ing parent, it child to be useis impossible not ful”? It is really a to respond in like very simple answer, manner, and the moment is as young children, certainly treasured by both. from the age of four, like to It is this face we see far too help. We have such busy lives infrequently I feel, and that we may put off their entreatis the purpose of this article. ies so effectively it shuts them John Court wrote an Oration down, though if we have an ear in 1992[1], and I have borrowed for what they are asking and an his title for today’s piece, as eye for what they are doing you it struck a note with me at can utilise their willingness so 36

easily. In my rooms, the prebit of joyful fun. Before the school children bring me food industrial era children were from the ‘kitchen’ in my waiting more useful creatures within room, plastic pizza the family unit, be it on and cheesecake the farm or in towns, on plates, for performing houseme to savour. hold chores and To be loved in the Of course, I learning their first few years of respond to parents’ crafts life, to be useful their playful at their feet. We in childhood and imagination have taken this to be respected in and dutinatural situation adolescence fully eat the and uncoupled ‘food’, which of it, sending children course encourages to schools instead, and them, and creates a connecin doing so creating a much tion I can use to engage them more selfish goal of academic sufficiently to examine them advancement, sadly necessary without fuss. nowadays. What can you as parents and So if you would like your doctors do to help the children children to be loving, useful in your homes or practices be and respectful, I would argue useful? In your practices, the you can achieve this by meeting best purchase you can make is the needs of these three phases for one of those play kitchens in of their childhood. There are as your waiting room, as children many ways to make your child will spend hours mimicking feel useful as there are to love their parents’ cooking if you them, and natural self-respect run over time. At home, see will echo your own in adoleswhat it is your child enjoys and cence. John Court’s wise words bring that in as a necessary part stand up well over time, and I of what you are doing, so he or recommend them to you. she feels part of the action, and a genuine contributor. You do [1] What is the use of children? not have to be a Play School J M Court Journal of Paediatrics actor to play your part, just a and Child Health [1992] 28, person who does not mind a 418-423

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healthspeak August 2019

Greeting cards inject some humour into mental illness

Health&Lifestyle

he founders of Hope Street Cards are two sisters – Sam, a psychologist working in Northern NSW, and Trudy, a graphic designer living in Melbourne. The concept – producing greeting cards for those experiencing a mental health condition – was born out of a particularly difficult situation, Sam explained. “Trudy and I are big card senders and for nearly 20 years we have had a game where we send really great cards to each other. So when a colleague’s son attempted suicide I joked and said: ‘Oh what a shame that Hallmark doesn’t have a card that says something like, Sorry your son has been through that, that’s really awful.’ And then I thought ‘Why aren’t there those sorts of cards on the market?’ “Then Mum had cancer and Trudy and I both found all these cancer-related greeting cards that were funny and hopeful and heartfelt. Neither of us were living near home, so we were sending those cards to Mum and that’s when the idea for Hope Street Cards really blossomed.” Sam told HealthSpeak that it’s clear that people find it difficult to show support to a friend or loved one undergoing mental ill health. They find it hard to show that they care and that they are thinking of the person who is suffering. When Sam became ill with her third episode of a mental illness and was hospitalised in a private psychiatric hospital the sisters noticed how Sam was one of the few patients receiving flowers and well wishes. They realised her support was not the norm when compared with the rest of the hospital population. This social support was incredibly important to Sam. Having people who were willing to show their support during August 2019 healthspeak

Sam and Trudy

such a time of unwellthem to their clients. They go ness gave her hope and the all sorts of wonderful places. It’s knowledge that she was loved. pretty exciting. It was after this that the “And the cards provide a sisters decided to give the card great opportunity to talk about business a go. That was nearly mental health in a different way. four years ago now. Sam writes Sometimes people forget to, the words and Trudy is the iland I notice this with clients. lustrator and designer. But it’s a There’s lots of humour in mental broader family business with illness and we’re getting Father Ray acting as better at working with proofreader and the humour. For a editor and Mum long time it was With 25 per cent Cheryl doing all serious, it was of people living the packaging taboo, you didn’t alone, one in three and shipping. talk about it, but experience chronic The Hope actually there loneliness. Street card range can be funny mohas general cards ments.” to uplift and support Sam said feedback people and particular had been overwhelmingly ranges for people with anxiety, positive with bursts of media atdepression, post-natal deprestention that have boosted online sion and bipolar disorder. sales. “I’m very keen to do a range “And online it’s interesting for suicide bereavement. And because we probably get more if we get to that this year we’ll overseas orders than from probably put on a community within Australia. The cards are event around that as well. I think quite big in America. it’s a really neglected mental “The whole purpose of Hope health area, both in the greeting Street is about helping crecard market and within the ate better connections, more community,” said Sam. genuine connections in a fun “The compliments cards way. The big part of relation[business card sized] are by ships is just showing up and far our best sellers. People love when people are in a bad way, them and there have been stosome people need something to ries about teachers giving them show up with. Actually speaking to students and therapists giving about what’s going on for that a publication of North Coast Primary Health Network

person might be a bit tough. So the cards provide an avenue to help people show up and learn more about their friend or loved one’s diagnosis,” said Sam. A $1 donation from the sale of each Hope Street Card goes to the Black Dog Institute to support its mental health research. Hope Street Cards can be found online at: www. hopestreetcards.com.au 37

Health&Lifestyle

Mums the focus of unique Port Macquarie choir Rose Wilson is clearly a woman with a passion for music. She describes herself as vocalist, instrumentalist, choir director and singing teacher. HealthSpeak spoke to Rose about her latest musical adventure in Port Macquarie– the SingaMamma choir.

hile Rose enjoys going in lots of different directions with her musical activities, she explained that each contained common threads. “It all comes down to ‘what’s the point of singing?’ and for me it has to be about establishing connection. Because like so many things in our culture we’ve turned singing into another thing that you have to perfect and perform. We’ve turned into a product.” Singing is liberating

“And people feel they can’t sing because we have only one model of what singing should look like, something that’s perfected and performed. Fortunately, Rose has ways of dismantling this view of singing. She explains through the physicality of singing that if a person feels nervous, they can’t sing in a way that feels good. (It’s harder to sing in a way that feels good, as opposed to can’t.) 38

“The larynx is just a valve and all it wants to do is protect your airways if it thinks you are in danger of being eaten by a lion. So if you’re scared because you think your singing is crap and you’ll have no friends, you won’t be able to make a lovely singing noise as it won’t feel open and liberating, which is what singing can do. “That’s why people sing better in the car or in the shower because they don’t have that fight or flight reflex affecting their throat.” By sharing this information with her choristers, Rose says people start to trust that they will gradually be able to lean into singing and enjoy it. Rose also works to create a safe, joyful place. Everyone can sing

“Singing is something everyone can learn. And I enjoy helping people find the joy and connection in singing together.” Rose already had a day time women’s choir in Port Macquarie called The Song Circle made up of older women when she started thinking about running a choir for Mums with young kids. “I was trying to work out how to fit in running another choir when I realised that if I was catering for Mums and kids

and there’s this big, glorious mix of people crossing paths. That’s emerged as a lovely aspect of the choirs, connecting different sections of the community,” said Rose. Rose Wilson

would be there then the session didn’t have to be very long – 45 minutes would work. And so off we went in March this year.” SingaMamma happens at 9.15am on Fridays and it’s open to women with children from the age of six week to six years. A beautiful interchange

“On average we have about 15 Mums each week and we sing for 45 minutes, a selection of a capella two or three part things. We do some gentle things and some determined, fierce things. The session finishes at 10am and then the women take a rug outside and have a cup of tea on the grass and hang out. “In that 15 minutes there’s a beautiful interchange between the women for the next choir who are arriving. They are women at a different stage of life

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A unique space

Rose sees SingaMamma as a really important space for women that’s otherwise missing in society. “SingaMamma is explicitly for Mums. Kids are welcome, but the choir is not for the kids. We have some blocks and set up a table and support the kids, but we don’t sing kids’ songs. And that makes it a unique space that the women look forward to.” Rose said that often women who want to learn a skill or play a sport can’t take their little humans with them. “And sometimes in a Mums’ group people can get a little stir crazy. Everyone is sleep deprived and in a rather intense state. Whereas with SingaMamma, it’s something we are doing which nourishes the women and connects them to others.” Rose encourages anyone feeling isolated or needing connection to ‘go and find a choir’. To find out more about Rose’s choirs and activities, go to www.rosesong.com.au healthspeak August 2019

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Ebola trial improved survival Ebola may soon be a "preventable and treatable" disease after a trial of two drugs showed significantly improved survival rates, scientists have said. Four drugs were trialled on patients in the Democratic Republic (DR) of Congo, where there is a major outbreak of the virus. Two of those, named REGN-EB3 and mAb114, were more effective in treating the disease, the study found. The drugs will now be used to treat Ebola patients in DR Congo, according to health officials. The US National Institute of Allergy and Infectious Diseases (NIAID), which co-sponsored the trial, said the results were "very good news" for the fight against Ebola. The drugs work by attacking the Ebola virus with antibodies, neutralising its impact on human cells. They were developed using antibodies harvested from survivors of Ebola, which has killed more than 1,800 people in DR Congo in the past year.

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Blackmores updates CM interactions guide

End of endoscopy?

Blackmores Institute has released a new edition of its comprehensive online Complementary Medicine Interactions Guide. The updated guide contains the latest peer reviewed data and new herbal and nutritional ingredients. The latest version covers 75 complementary medicine ingredients, including additions such as valerian and bromelain. Details of 173 new interactions are featured, alongside 430 new supporting articles. Blackmores Institute Director Lesley Braun said education was fundamental in helping healthcare professionals to safely integrate natural medicine into patient care. View the Guide here: https://www. blackmoresinstitute.org/interactions

Breakthrough research showcases an innovative imaging technique that uses ultrasound to provide in depth images in a non-invasive way. Researchers at Carnegie Mellon University in Pennsylvania have devised a technique that promises to replace the endoscope. Endoscopies are an invasive procedure, albeit minimally so. They can create discomfort and are not without risks. Potential side effects of endoscopies include over-sedation, cramps, persistent pain, or even tissue perforation and minor internal bleeding. This new imaging technique may put an end to endoscopy altogether. The researchers detail their novel technique in the journal Light: Science and Applications.

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Aboriginal health opportunities Are you interested in knowing about vacancies at Aboriginal health organisations? Then go to https://nacchocommunique.com/ and sign up for their Wednesday job alerts. August 2019 healthspeak

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

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