ISSUE 11 autumn 2015
HealthSpeak
A publication of North Coast NSW Medicare Local
Dietitian
Diabetes Educator
Podiatris
Exercise Physiologis t
t
North Coast Allied Health Association
Psychologist
. 5 e g a p n o e r o Find out m
Physioth
erapist
7 Pharmacy’s
bigger vision
Occupational Therapist
9 Conjoint
lecturers sought
Aborigi na Health l Worker
17 Dr’s backyard observatory
Speech Pathologist
Pharmacist
25 Cold laser &
lymphoedema
Editor Janet Grist Head Office Suite 6 85 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncml.org.au Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 Cnr Forth and Yaelwood Streets Kempsey 2440 Acting Manager: Tracey Baker Email: tbaker@ncml.org.au Mid North Coast
Getting to meet so many interesting members of the North Coast health com-
munity is one of the pleasures of my job, and last month I was lucky enough to visit Dr Stephen Moore’s backyard observatory at his home in Bexhill. Stephen is a very busy physician and wisely has used his passion for astronomy as a rewarding way to escape from work pressures and literally take him into another world. I’m sure
you’ll enjoy the photos he’s taken of the nights skies in his observatory. See them on page 17. And thanks to physiotherapist Sharon Tilley for her interview about her success using cold laser on lymphoedema patients. Hopefully this useful tool will become more commonplace among allied health professionals. Happy reading!
Have you heard of ‘Commissioning’? CEO Vahid Saberi
6/1 Duke Street Coffs Harbour 2450 Ph: 6659 1899 Acting Manager: Tracey Baker Email: tbaker@ncml.org.au Northern Rivers Tarmons House 20 Dalley Street Lismore 2480 Ph: 6622 4453 Northern Region Manager: Chris Clark Email: cclark@ncml.org.au Tweed Valley Unit 4, 8 Corporation Circuit Tweed Heads South 2486 Ph: (07) 5523 5501 Northern Region Manager: Chris Clark Email: cclark@ncml.org.au
Contacts Editor: Janet Grist Ph: 6622 4453 Email: media@ncml.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Design and illustrations: Dougal Binns – Graphiti Design Studio Email: dougal@gdstudio.com.au Display and classified advertising at attractive rates
HealthSpeak is published four times a year by North Coast NSW Medicare Local Ltd. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCML. The NCML accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. ©Copyright 2015 North Coast NSW Medicare Local Ltd Magazine designed by Graphiti Design Studio Printed by Quality Plus Printers of Ballina
2
If you have not heard of commissioning you will surely hear about it in the next few months. I first heard about the concept of ‘commissioning’ a couple of years ago. I did not pay much attention to it at the time, except thinking that it was progressive and if done well could be transformative. Not knowing at the time, that ‘commissioning’ would soon be the new rage concept in health and social service planning, design and delivery in Australia. The concept of commissioning, which I find exciting, is focused on local collective design and delivery of services. It is a collaborative process, led by clinicians and providers and informed by users and community. These stakeholders shape the priority-setting, design and procurement of services and their ongoing monitoring and improvement. A simple scenario of commissioning in our region could be something like this. We receive funding to reduce the rates of smoking in our region by 2% over two years. We bring together the key providers and users around the table. We assess the need, plan and design and set priorities. We collectively decide the best mode for the delivery and procurement (contracting, purchasing, setting up a program or whatever). We then commission the service and have a process for assessment and
The Lismore consulting group was the beginning of commissioning forums on the North Coast.
improvement of the program. The intention of the process is to use the collective knowledge of those who understand the local reality the best (service providers and service users in the first instance), create a shared vision and design services in partnership. It is about local challenges and local solutions. The process, in my view, recognises the fact that unless we plan together we will not deliver care together and service delivery will remain fragmented. It is all commonsense, something we have been talking about for a long time. The commissioning concept was first implemented in the UK, during the Blair Government years. At the time, Primary Care Trusts (PCTs) were established as the commissioning organisations. The subsequent change in Government changed the PCTs to Clinical Commissioning Groups (CCGs). These Groups are now considered as the cornerstone of the new health system. There are about 211 CCGs, each caring for an average of about 220,000 people. CCGs in England are responsible for the commissioning of the vast majority of services including emergency care, hospital
care, maternity care and community and mental health services. In Australia, the Commonwealth’s agenda for Primary Health Networks (PHNs) is that these will be the commissioning organisations for out of hospital care – primary health care. I am excited by the outcomes that can be achieved through the commissioning process. This process gives voice to clinicians and community and is much better than what we have had in the past. Only this week I spent about two days at Lismore consulting with a group of professionals. We put down our organisational agendas, placing the patients, consumers and the community at the centre of our thoughts and deliberation. The conversation was dynamic and energising. Out of the process we have established two ‘action’ groups which are in some ways the beginnings of our commissioning forums on the North Coast. Planning and working together provides the best opportunity for reducing fragmentation of services across the health system and improving integration. Change will not be achieved by working alone, but by working ‘as one’.
HealthSpeak is kindly supported by
HealthSpeak
A publication of North Coast Medicare Local
autumn 2015
Pressure mounting to help job seekers
Opinion Andrew Binns
DMS Caseload by Primary Disability Type Neurological Intellectual Autism Specific learning
Dr Doitall titioner General Prac apy
her
rT eke
se
Job
Acquired brain injury Hearing Vision Speech Deaf & blind Unknown
Other 8% The federal government has begun placing greater demands on GPs and allied health professionals to help job seekers who have a disability, injury or other health conditions to gain employment. Similar pressure is being applied to individuals affected, while incentives are being provided to employment agencies for these clients to engage in paid work rather than continuing to receive payments through Newstart, Youth Allowance, disability support pensions or parenting support schemes. However, it is yet to be made clear just what role primary care providers are expected to play in the complex job search process. Disability Employment Services (DES) and Disability Management Services (DMS) are currently being contracted to employment organisations by Centrelink, Department of Human Services. More than 75,000 people are currently participating in DES–DMS. As can be seen in the chart, 59 per cent of the participants currently have physical disabilities, and 33 per cent have psychiatric disorders. All conditions on the chart are highly likely to bring these job seekers into contact with GPs who will often need to refer them on to allied health col-
leagues for further assistance to manage their health issue. These clients will invariably need a Centrelink certificate from the GP, with Centrelink then referring them to one of the contracted employment agencies in the area. GPs may already be noticing an increasing number of referrals from these agencies following implementation of the new government changes to the employment industry announced in the last Budget. It is not only the employment agencies that are expanding. There seems to be a whole new health industry developing around the need for primary care workers to play a crucial role in the often complex process of helping these job seekers gain employment. Despite this, there does not seem have been much talk or education to prepare GPs for this responsibility. No doubt it is assumed that they are already adept at this type of work. My personal experience in this area is that many of these job seekers have not had much access to GPs in the past. Indeed, there seems to be a whole new cohort of people coming to see a GP after being referred by an employment agency. The ability and willingness of GPs to take on these cases is likely to vary considerably.
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
Psychiatric 33%
Physical 59%
There seems to be a whole new cohort of people coming to see a GP after being referred by an employment agency People with psychiatric illness often come from a background where there has been post-traumatic stress from childhood onwards due to domestic violence, physical, verbal or sexual assault, alcohol and substance abuse and related social problems. Many come from culturally and linguistically diverse backgrounds, are homeless, perhaps ex-offenders, while many are Aboriginal and Torres Strait Islander people. Age groups vary from the younger, who have never had previous employment, to older people
who have lost their job and/ or fallen upon hard times for whatever reason. Although this caseload is challenging work for the primary health team, it can have its rewards when a needy person progresses and gains employment. Time will tell how successful these new measures are. Job creation and availability will limit what is possible in each region. At a time of business pressures and rising unemployment there must be real concerns about what solutions will be possible.
3
GP input vital to admissions study A ground-breaking research project that will result in a better understanding of so-called Potentially Preventable Hospital (PPH) admissions, and how to reduce them, is underway at two Mid North Coast hospitals. The DaPPHne project explores potentially preventable hospital admissions among people with chronic disease who are 45 years and older at Port Macquarie and Coffs Harbour Hospitals. The 12-month study is being run by the University Centre for Rural Health (UCRH) in close collaboration with, and funded by, North Coast Medicare Local, Mid North Coast Local Health District (MNC LHD) and the NSW Agency for Clinical Innovation. Lead investigator Dr Megan Passey told HealthSpeak that the aim of the research was to generate an evidence base identifying modifiable admissions for chronic conditions to develop effective interventions to reduce preventable admissions and improve measures of health system performance. “We are looking at the people admitted with unplanned admissions to our two hospitals with target conditions – COPD, chronic heart failure, angina and diabetes with its complications,” she said. A range of data will be collected about the patients including what brought them to hospital, what service patterns they had beforehand, their social circumstances and other important information about their daily life. “We collect data from hospital notes and we get the senior registrar and a nurse to fill in the preventability assessment tool we’ve developed and we also contact the GP and interview them about the patient and what care they’ve received. “There’s a focus on getting the GP’s opinion about what else could potentially be done for this patient or what were the factors that led them to be admitted to hospital. “The GP knows the patient better than hospital staff or 4
Left to right: Bronwyn Chalker (MNC LHD), Dr Jennifer Johnston (UCRH and DaPPHne study coordinator); Colleen Boyd (Port Macquarie Hospital, DaPPHne Research Nurse), Dr Steven Ross (FACEM), Drector Port Macquarie Base Hospital Emergency Department; A/Prof Megan Passey (UCRH, lead investigator).
anyone else so we need that GP opinion and input into what’s going on in that patient clinically, their world, and the complexity of other conditions. We want to capture all this information, bring it together and figure out what can be done differently so such patients don’t end up in hospital,” Me-
gan explained. “The findings will point to gaps in services or how to reframe services to make them more appropriate. Or that we need to look at and improve community health literacy. So it’s really exploratory work to see what’s going on, with the intention that we can come up
with some recommendations about how the system can be changed to improve people’s health and wellbeing and quality and life and also reduce unnecessary hospital admissions,” she added. PPHs are used in Australia as an indicator of quality of care, they are also used as currency in COAG agreements and in hospital funding arrangements – if a health district has too many PPHs it loses funding. No such research has been done in Australia and Megan is excited about the potential findings. “This work began in 2010 working with both Local Health Districts and the Northern Rivers General Practice Network in order to improve coordination of care and reduce PPHs,” Megan said. “At that stage a lot of clinicians were saying ‘these cases aren’t preventable, they are appropriate admissions’. That’s why we started the DaPPHne project in collaboration with our funding partners.” It’s anticipated the results of the study will be available in November.
Autism diagnostic and therapy services Autism Spectrum Australia (ASPECT) based at Alstonville is a not for profit organisation offering services and assistance to individuals with Autism Spectrum and their families. ASPECT offers diagnostic assessment of children under 13 years and Medicare rebates are available. Aspect also offers funded diagnostic assessments, however, the child and their family must meet these criteria: The child is between 18 months and 8 years. The family is low-income, i.e. parent/carers must hold a health care card in their name. The child is referred for
an autism assessment by a paediatrician ASPECT also offers psychological therapy services to develop emotional regulation skills and skills to help manage challenging behaviours Improve social skills Manage anxiety and explain a person’s diagnosis GPs can refer patients to ASPECT through the Better Access to Mental Healthcare scheme, using a Chronic
HealthSpeak
Disease Management Plan or through private health insurance. Paediatricians and psychiatrists can refer patients through the Better Start for Children with Disabilities scheme or the Department of Health’s HCWA scheme for therapy and for diagnosis. Speech and language therapy is also available from speech pathologist Sarah Rollison. ASPECT’s Sandra Evans said the speech therapy involved communication assessments, language development, play skills, receptive communication, stuttering, literacy skills and verbal dyspraxia. More info: Ph (02) 6628 3660.
A publication of North Coast Medicare Local
autumn 2015
Peak body for allied health now on North Coast The North Coast Allied Health Association (NCAHA) was formed last year with support from North Coast Medicare Local. It’s the peak body for allied health professionals across the North Coast region. Its Chair is Professor Susan Nancarrow who has a podiatry background and its Directors are occupational therapist Luisa Eckhardt and physiotherapist Robert Curry. The Association aims to advocate and represent the allied health sector on local, regional and state matters; Provide support for members with education, training and knowledgesharing; and help foster and advance an integrated delivery health system. Membership is open to all qualified health practitioners or those undergoing training in the following allied health professions: Aboriginal and Torres Strait Islander Health Practitioner Acupuncturist Allied Health assistants Audiologist Chiropractor Dental Therapist/Hygienist Diabetes Educator Diagnostic Radiographer Dietitian Exercise Physiologist Mental Health Worker Occupational Therapist Optometrist Orthoptist Osteopath Pharmacist Physiotherapist Podiatrist Psychologist Prosthetist/Orthotist Radiation Therapist Social Worker Sonographer Speech Pathologist Other professions as the Directors may determine. The Association is striving to improve the profile of allied health within the community and especially with health practitioners such as GPs. Members will enjoy more opportunities to connect with best evidencebased practice and other clinicians while increasing access
From left: Physiotherapist Arthur Thomas-Angelo, NCAHA Chair Professor Susan Nancarrow and Martin Frank, physiotherapist at the Tweed breakfast seminar.)
to local clinical professional development and clinicians of excellence. Importantly, the Association offers members a united, local voice for allied health on regional, state and national levels. In December last year, a series of breakfasts across the North Coast helped launch the North Coast Allied Health Association with good attendances at Murwillumbah, Coffs Harbour and Port Macquarie. Participants were given
information on the Association and asked their opinions on the strategic issues facing the allied health community. In the main, all groups applauded the initiative and could see value in networking opportunities to share case studies and interact more closely with GPs and each other. There was also a strong call for advocacy. Additionally, members of NCAHA have free and unlimited access to over 90 online professional development
courses through TAFE North Coast. All courses are peer reviewed by industry professionals and endorsed by industry associations. Examples include Ethical Practice for Health Professionals; Managing Conflict; Overview of Drugs used in Palliative Care and Opioid Use and Withdrawal. Instructions for registering and accessing the online courses can be found at http:// healthynorthcoast.org.au/cpd/ Check out the North Coast Allied Health Association website www.ncaha.org.au for further information and the membership application form. The Directors of NCAHA and North Coast NSW Medicare Local have been impressed with the up-take of membership of the Association and look forward to an inspiring and burgeoning North Coast Allied Health Association in 2015.
Bowraville residents take up weight loss challenge
Diabetes educator and nutritionist Dee Maxwell Hopper measures Rob Edwards while Kevin Ballangarry looks on.
Residents of Nambucca Valley who attended a Closing the Gap diabetes education seminar are taking part in a weight loss challenge to improve their health and wellbeing.
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
In January, a dozen participants gathered at Ngambaga Biindarry Girrwaa (NBG) in Bowraville to find out more about managing diabetes, its symptoms and complications. Each person was measured
and their details logged to take part in a three centimetres in three months weight loss challenge. Each month a Wellness day is held at Girrwaa in collaboration with North Coast Medicare Local (NCML). NBG provides support services to Aboriginal people who are elderly, frail aged, living with a disability or act as a carer in remote Bowraville. The monthly Girrwaa Wellness Days provide information on health topics of interest to the community. Health professionals are engaged to provide information, practical solutions, and answer questions. The information is delivered in an informal way which promotes interaction and participation.
5
HealthPathways’ achievements one year on It is 12 months since HealthPathways commenced as a partnership between North Coast Medicare Local (NCML) and the Mid North Coast Local Health District. Since then the program has expanded to Northern NSW with a second partnership between NCML and the Northern NSW Local Health District. There are now 85 localised referral pathways published on the HealthPathways website with a further 73 in development. Traffic to the website has been substantial with Google Analytics showing that from when the website went live at the end of March 2014 until 23 February 2015 there were 24,209 page views, 3,271 sessions and 1033 unique users.
What are HealthPathways?
HealthPathways are published on an online information password-protected portal to be used at the point of care by GPs, specialists, nurses and allied health provides. Each pathway starts with a particular health condition and defines a pathway for management that reflects evidence-based best practice in the context of locally available resources and facilities. The program links up general practitioners, hospital clinicians, allied health professionals and private medical specialists into the health reform process.
A Healthpathways Mid North Coast Paediatric working group: From left: Dr David McDonald, Staff Specialist Paediatrician, Port Macquarie Base Hospital; Dr David Gregory, GP and NCML Clinical Advisor and Dr Amanda Wijeratne, GP.
HealthPathways have proven to be effective in improving patients’ health journeys and enhancing efficiency, quality and clinician engagement. Developing HealthPathways is a multidisciplinary effort with representatives from all health sectors involved. The project has really created great interest among health professionals and there are 83 work
Predicting Alzheimer’s Scientists at the University of Queensland have discovered that magnetic resonance imaging (MRI) could be used to predict the risk of onset of Alzheimer’s disease. The discovery could greatly improve outcomes for Alzheimer’s patients, as early diagnosis could increase the effectiveness of drug treatments. The study, led by Associate Professor Elizabeth Coulson of UQ’s Queensland Brain Institute, found that people with a shrinking basal forebrain
6
were seven times more likely to have worsened cognitive function within 18 months. “Existing Alzheimer’s disease drugs try to enhance the function of the degenerating basal forebrain, but often too much damage is already done by the time drugs are administered,” Associate Prof Coulson said. “Early diagnosis is important in order to treat people with Alzheimer’s disease earlier, and work out a personal treatment course for them.
group members taking part in 14 HealthPathways work groups (48% GPs, 12% allied health and 26% specialists).
Key features
To quickly view newly published pathways, users can access the New to HealthPathways section on the site’s home page. (http://manc.healthpathways. org.au) The username for the
“If we can give the existing drugs to people earlier, when they first display evidence of a decline in their basal forebrain, even perhaps before they are diagnosed with Alzheimer’s disease, then hopefully those drugs will be more effective.” More than 330,000 Australians suffer from Alzheimer’s disease and are primarily treated with cholinergic drugs that target the basal forebrain, which degenerates with the condition. The study was published in the journal Neuroimage: Clinical.
HealthSpeak
website is manchealth and the password is conn3ct3d HealthPathways now offers information on 32 specialist services. This can be accessed in the Our Health System section of the website. A new pathway on the Ebola virus has been developed providing assessment, management and referral information and clinical resources for GPs. NCML would like to thank Paul Corben, Director the Public Health Unit and the Communicable Disease team, for providing their assistance with the development of this pathway. A special alert was recently added about Hepatitis A following the contaminated frozen berries outbreak. The work of the Northern workgroups continues apace with a draft of the Psychosis pathway in development including an examination of Anti-Psychotic Depot Medication. Renal and Drug and Alcohol topics are also progressing. Because HealthPathways needs to be current and relevant, a feedback button has also been incorporated into the portal. It’s located in the top right hand corner of every pathway. Feedback will be accessed and actioned by the HealthPathways team in a timely manner. There is also a handy desktop icon which can be installed on your PC for quick and easy access. This icon can be found under the HealthPathways Features section on the home page.
Making contact
The HealthPathways team is headed by Sharyn White, Manager Strategic Development and Program Design, NCML and includes Dr Dan Ewald, Clinical Advisor NCML, Dr David Gregory, Clinical Advisor NCML, Fiona Ryan, Project Officer NCML MNC and Kerrie Keyte, Project Officer NCML NNSW. If you would like to suggest improvements or topics or become involved in a workgroup for pathway development, contact Fiona: Ph 6583 3600, fryan@ncml.org.au, or Kerrie: Ph 0429 530 274, kkeyte@ncml.org.au
A publication of North Coast Medicare Local
autumn 2015
Broadening the role of pharmacy The Pharmacy Guild’s Executive Director David Quilty says it’s time for pharmacy to advocate strongly for a broadening of its role and the role of pharmacists in the wider health system. In the Guild’s newsletter Forefront Mr Quilty said pharmacies were the most accessible health destination and pharmacists were consistently rated among the most trusted health professionals. “For various reasons, Australia is lagging behind countries like the UK, Canada and New Zealand in recognising the role that pharmacies can play in delivering better and more cost-effective outcomes. “In the UK, for example, their college of GPs is working with the National Health Service (NHS) and the Royal Pharmaceutical Society to publicly encourage patients to make pharmacy their first port of call for treating minor ailments like coughs and colds,” he said. Mr Quilty said that in the
UK, doctors, pharmacists and government recognised that it was not a good use of GPs’ time or skills to have surgeries and emergency departments clogged up by patients who could readily be treated by pharmacists. He pointed to the successful flu vaccination pilot by pharmacists in Queensland, which is now being extended to measles and whooping cough, to demonstrate that pharmacies could provide improved access
to high quality health services. “We must now grasp the unprecedented opportunity to utilise the convenience of pharmacies and the skills of pharmacists to deliver faster, cost-effective and better patient outcomes, including in regional, rural and remote areas where health gaps and doctor waiting times are more pronounced. “At the same time, these pharmacy enhancements can take pressure off doctors and
emergency departments and reduce the need for more expensive health interventions down the track,” he added. Mr Quilty said that a plethora of studies showed that well-targeted health prevention through basic health checks, screening and tackling lifestyle issues such as poor diet and smoking, produced significant health benefits and savings. He also wants Australia to ‘get serious’ about medicine adherence and management. “Pharmacies are a common sense destination from which to deliver a healthy dose of prevention – trusted and frequently accessed by at-risk patients who might otherwise fall between the cracks. “Patients with stable, long term conditions like diabetes, blood pressure and high cholesterol should be able to be issued extended repeat prescriptions by their pharmacies, increasing the likelihood of compliance and reducing doctor visits,” Mr Quilty said.
Ballina gets new MRI Service North Coast Radiology Group (NCRG) is pleased to announce the installation of a new state-of-the-art Siemens Aera 1.5T Magnetic Resonance Imaging (MRI) unit at its Ballina branch. The MRI unit features a short wide bore & quieter exams meaning it can accommodate more types of patients as well as assist in increasing patient satisfaction. This MRI unit enables NCRG, with its accredited Radiologists and experienced team, to deliver the most comprehensive range of diagnostic imaging services in Ballina within the one location. Computed Tomography (CT) | Magnetic Resonance Imaging (MRI) | Ultrasound Mammography | Bone Densitometry (BMD) | General & Dental X-Ray
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
For bookings and appointments: 02 6618 2900 93 Tamar Street, Ballina NSW 2478 www.northcoastradiology.com.au
More locally delivered services making a difference. We see you.
7
Musculoskeletal health ‘the business of all’ Specialists, GPs, practice nurses, physiotherapists, a chiropractor and a dietitian were among the 110 health professionals who took part in North Coast Medicare Local’s recent Musculoskeletal Primary Health Care Initiative Symposium in Port Macquarie. The launch of the Musculoskeletal Primary Health Care Initiative was held at the University of NSW Clinical School and was video linked to Coffs Harbour. It featured keynote speaker eminent rheumatologist Professor Lyn March, along with rheumatologist Dr Chris Needs and GP Dr David Gregory. The Initiative is jointly funded by the North Coast Medicare Local, the Mid North Coast Local Health District and the NSW Agency for Clinical Innovation. Its aim is to improve the management and coordination
From left: Martin Cushing, Project Officer NCML; Fiona O’Meara, Program Officer, Health Services Reform, NCML; Sharyn White, Manager Strategic Development & Program Design, NCML; Robyn Speerin, Musculoskeletal Network Manager; Professor Lyn March; Tracey Baker, Acting Regional Manager, NCML; Stuart Dowrick, Chief Executive, MNC LHD.
of musculoskeletal health care by supporting GPs, their staff and allied health services such as physiotherapists, dietitians, occupational therapists and ex-
New Obstetrician & Gynaecologist in Coffs Dr Triveni Nanda is welcoming referrals at her new Women’s Specialist Centre in Albany House, 60-62 Albany Street Coffs Harbour. As a specialist obstetrician and gynaecologist she is accepting patients for a range of services including high-risk obstetrics, urogynaecology, infertility, laparoscopy, colposcopy and related surgeries. “I am hoping to provide a unique service for those who prefer to go to a woman for these particular medical issues”, Dr Nanda said. Dr Nanda, who moved to Coffs Harbour at the beginning of April 2014 to take up a post as a VMO in the Department of Obstetrics and Gynaecology, has more than 20 years of training and experience in this field in Australia and India. Having trained under some of Australia’s leading specialists at Royal North
8
Shore Hospital, she has held posts as a staff specialist at Nepean, Hornsby and Canberra Hospitals, building her expertise in urogynaecology, high-risk obstetrics, infertility and laparoscopic surgery. “I am passionate about ensuring women get equal access to services, and will be offering bulk billing gynaecology outpatient services twice a month on Fridays at the Women’s Health Centre in Victoria Street. I will be offering bulk billing antenatal services at Galambila Aboriginal Health Service,” she said. The clinic is open five days a week for consultation. Dr Nanda will continue to work as a VMO at Coffs Harbour Base Hospital and as a visiting specialist at Baringa Private Hospital.
ercise physiologists to provide conservative care measures. These include pain management, fracture prevention and improved physical functioning for people with chronic musculoskeletal conditions. Musculoskeletal conditions are the most common chronic conditions affecting Australians. In particular, osteoarthritis, osteoporosis, and acute low back pain are major contributors to the burden of disease. The evening symposium aimed to harness the collective knowledge in the room to bridge evidence based clinical practice gaps, coordinate health services
SLEEP CLINIC AYS OPEN D
FREE consultation
in a patient centred manner, improve clinical outcomes and the patient experience. Prof March, who was born and raised in Port Macquarie, believes that musculoskeletal health is the business of everyone in the community. She said musculoskeletal problems were often perceived as part of the normal ageing process with people ‘sufferring in silence’. However, she said such conditions could cause enormous disability and pain. North Coast Medicare Local’s Manager, Strategic Development Manager Sharyn White said the Initiative would improve the health and wellbeing of people with chronic musculoskeletal conditions. “Evidence has shown that the models of care developed by the Agency for Clinical Innovation can make a real difference to these patients. “We will be working to support GPs, their staff and allied health services to put these models of care in place so that patients no longer need to travel to a hospital clinic, which can be difficult for many,” she said. “To date these care models have only operated within hospitals. Through our partnership with the Mid North Coast Local Health District, we are ensuring that the care that people need is easier to access,” Sharyn added.
What would you do for
A GOOD NIGHT’S
SLEEP?
Phone for more information and ask about our next FREE education day. Have your questions answered, CPAP problems solved, receive support • Do you suffer from daytime sleepiness? • Do you snore? • Are you thinking about a sleep study soon? • Are you currently on CPAP? Come in and find out about:
Your health is our total concern
Referrals to Dr Nanda: Ph 02 6651 3848, fax 02 8208 3268 or email: info@cwsc.com.au
- Sleep hygiene – What is it? - Obstructive Sleep Apnoea - DVD - CPAP therapy - problems solved - Sleep studies - what is involved - Specialist in Fisher & Paykel and Respironics Sleep Apnoea Equipment
PH 6621 4440 13 Casino St, South Lismore in association with Southside Pharmacy
HealthSpeak
A publication of North Coast Medicare Local
autumn 2015
Call for Conjoint Lecturers North Coast Medicare Local in conjunction with the Port Macquarie Rural Medical School is encouraging local GPs in the Hastings Macleay area to become Conjoint Lecturers with the University of New South Wales Rural Clinical School. Conjoint Lecturers may participate in the UNSW medical curriculum either as clinical tutors in their rooms or as lecturers at the Rural Medical School (Practice Incentive Payments may be available for clinic sessions). As a Conjoint Lecturer, GPs will have access to the university’s resources, such as the UNSW library and eLearning tools as well as all educational events hosted at the Rural Clinical School. Associate Professor A. R. (Sandy) McColl and the Port Macquarie Rural Clinical School would like to thank the GPs who have already responded to the invitation to become a conjoint lecturer in the faculty
of medicine UNSW. Further information will be sent shortly. Any further queries, please contact Julianne Weatherley at: j.weatherley@UNSW.edu.au
Anatomage Table
This year the UNSW Rural Clinical School will be rolling out an innovative tool for anatomy teaching to undergraduate medical students. Anatomage is a fully interactive three-dimensional anatomy visualisation system for anatomy education,
The Anatomage Table was purchased with funding received from the Australian Government
developed at Stanford University and now being used by teachers and students at the Port Macquarie Rural Clinical School to explore, dissect and understand the body’s parts and systems. To see a demonstration of the capabilities of Anatomage, go to: http://youtu.be/HxMGItCnINE http://youtu.be/6FFd6VWIPrE
Briefs
Sun and exposure Sunlight continues to damage people’s skin and increase the risk of cancer for hours after they leave the beach and head indoors, a study shows. Scientists at Yale University discovered it was the supposedly protective pigment melanin that was causing the damage. The team say the findings may lead to better sunscreens that can prevent the extra damage. When UV radiation pummels our skin cells, it can cause mutations in the DNA. Melanin, the pigment behind a tan or natural skin tone, is the body’s defence as it absorbs the radiation. What scientists did not know previously was what happens to all the energy that the melanin has absorbed.
WANTED Aspiring Health Writers Are you a frustrated writer looking for a place to publish your articles about health? North Coast Medicare Local is seeking interested health practitioners to become guest bloggers for the community health hub Healthy North Coast. Writing for Healthy North Coast is a great way to explore your writing passion, share health information with the North Coast community and boost the profile of your health practice across the North Coast. Please email Daniel Mason at dmason@ ncml.org.au to express interest, or for more information about becoming a guest blogger.
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
9
Soup kitchen clinic turns one
The soup kitchen clinic operates in the grounds of St Thomas’s Anglican Church, Port Macquarie.
In late March, it will be 12 months since the medical clinic set up by North Coast Medicare Local opened adjacent to St Thomas’s Soup Kitchen in Port Macquarie. The Wednesday clinic is staffed by local GP Karen Counter and an NCML Project officer with Dr Counter seeing four to six patients per session. Since it opened, she has given soup kitchen clients around 200 occasions of service. The clinic which operates between 11.30am and 3pm is much appreciated by
both soup kitchen clients and the Anglican Church volunteers who run this important community project. NCML’s Caroline McCamley, who’s been setting up and packing up the consultation room for Dr Counter each week, and acting as her receptionist, said patients really appreciated her kindness and expert care. Caroline said Dr Counter was often spending 45 minutes to an hour with each patient due to their complex care needs. “Many haven’t seen a doctor
in some time and would feel uncomfortable visiting a mainstream medical clinic,” she said. “Having Karen there each Wednesday for them to pop in and see is a big help to these often marginalised people.” Other challenges include ensuring patients return for follow up appointments and getting them to attend medical tests. To assist soup kitchen clients, Dr Counter also refers Aboriginal patients to North Coast Medicare Local’s Closing the Gap and Care Coordination and Supplementary Services programs when required. Other challenges include ensuring patients return for follow up appointments and getting them to attend medical tests. Caroline said that she was impressed by Dr Counter’s commitment to her patients. “While I was there recently she asked me to call a patient she had not seen for three to four months to make sure he was okay. He was fine but promised to come to see her in the next couple of weeks for a follow up consultation,” said Caroline.
Briefs
Alzheimers and skin Scientists have proposed a new idea for detecting brain conditions including Alzheimer’s - a skin test. Their work, which is at an early stage, found the same abnormal proteins that accumulate in the brain in such disorders can also be found in skin. Early diagnosis is key to preventing the loss of brain tissue in dementia, which can go undetected for years. But experts said even more advanced tests, including ones of spinal fluid, were still not ready for use. If they were, then doctors could treat them at the earliest stages, before irreversible brain damage or mental decline has taken place.
Standby: Responding to suicide bereavement The North Coast NSW StandBy Response service has been running for more than 12 months, providing support, assistance and understanding for people bereaved as a result of suicide. The service is a program of the Northern Rivers Social Development Council and provides support to residents from the Queensland border down to Port Macquarie. StandBy Coordinator Rose Hogan and a dedicated crisis response team have travelled more than 36,000 kilometres over this time to support individuals, families and communities affected by suicide. They have worked to harness the willingness of local communities to reach out in a time of tragedy. “I feel incredibly proud of what has been achieved across such a large region since the 10
establishment of StandBy and equally humbled by the openness of people to share their stories as they invite us into their lives at such a difficult time. “Suicide has a significant and dramatic effect often causing distress and concern across the whole community,” said Rose. She said that in many cases those affected by suicide do not know where to turn for help or how to access existing support. “StandBy provides a vital single point of contact to a prearranged system of care developed for those grieving within the community. Grief is as individual as the person and response needs can vary in many different ways. Sometimes a referral
to a counselling service may be required, although it’s not always the case. Often attention to practical needs must occur first or a visit to their local GP,” said Rose. As the StandBy Coordinator, Rose ran a series of free workshops last year to equip professionals and community members to respond to these needs. “At StandBy we see suicide prevention and bereavement care as being a whole of community responsibility. Everyone, including emergency services, health providers and local community members, has a role in StandBy’s response,” Rose explained. National StandBy Response Coordinator Jill Fisher said research had demonstrated that HealthSpeak
providing comprehensive, locally based support resulted in improve health and wellbeing outcomes. “StandBy is also cost effective. We are pleased that other Australian communities such as North Coast NSW and our partners at NRSDC are part of this internationally recognised program and making a difference in the lives of those bereaved by suicide,” she said. Reflecting on the contribution NSW North Coast StandBy has made over 12 months, Rose said it was a privilege to be invited into someone’s life at a time of crisis and to experience the willingness of local communities to respond to their needs. Contact StandBy North Coast NSW on 0417 119 298. For additional support call the Suicide Call Back Service on 1300 659 467 or Lifeline on 131114.
A publication of North Coast Medicare Local
autumn 2015
Ward refurbishment at St Vincent’s
ASD Family Fun Days in Hastings area
A patient and staff member in the new dining area in the rehab and palliative care ward.
In order to better serve its staff and patients, St Vincent’s Private Hospital in Lismore recently renovated and reconfigured its rehab and palliative care wards. The Hospital’s Chief Executive Officer Steve Brierley said the changes were made over Christmas when operating theatres were closed and the impact on patients and staff minimised. “We now have state of the art theatres with equipment that takes the Hospital into new areas of surgical procedures. We wanted to ensure our wards met
the standards of care set by our nursing staff and the new facilities,” he told HealthSpeak. The extensive refurbishment included a total renovation of the ward area accommodating palliative care and rehab patients. The upgrade included new gym equipment, a dining area and an activities room where patients can practice their independence with activities for daily living prior to discharge. The new configuration also allows medical patients greater opportunity to be accommodated in a single room.
A not for profit resource group facilitated by families and service providers with experience with people with an Autism Spectrum Disorder (ASD) is supporting families and individuals in the Hastings region. HAARG (Hastings Autism and Aspergers Resource Group) Inc provides a network for parents, carers, families and individuals. It also raises community awareness about Autism Spectrum Disorders. Membership of HAARG Inc is free and open to anyone. As a member you receive a monthly newsletter and can come to Family Fun Days, register for Family Camps and enjoy voting rights at Annual
Briefs
Organ donations down More than 1100 Australian lives were transformed by the generosity of 378 organ donors in 2014. The Organ and Tissue Authority 2014 Performance Report showed that
General Meetings. HAARG President Karen Huf has two boys with an ASD. She told HealthSpeak that HAARG’s Family Fun Days were particularly popular as they offered a great way for families to connect with each other in a relaxed social environment. Hastings District Respite provides a number of support workers to help look after the kids and give parents a chance to relax on these fun days. Recently, HAARG ran a three-day Family Camp at South West Rocks. To check out future events and sign up for the newsletter, go to: www.hastingsautism.org.au/
the number of deceased organ donors has increased by 53 per cent since 2009, when the DonateLife Network was established. However, last year there was a fall in the number of people donating which meant the number of deceased organ donors nationally decreased by 3 per cent – to 378 organ donors from 391 in 2013.
Healthy North Coast Practitioner Events PRACTITIONER EVENTS
Healthy North Coast is the central hub for all health professionals to access information on learning and development events on the North Coast. You can search for a particular event, or register and upload your own event for free. Visit www.healthynorthcoast.org.au/practitioner-events Healthy North Coast....It’s all about health
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
11
A tick for Co-location from patients and clinicians A co-location pilot project where Local Health District allied health staff are collocated with general practices is demonstrating a range of benefits for both patients and health professionals. The pilot is being run in partnership with both Northern NSW and the Mid North Coast Local Health Districts. The program involves co-locating clinicians from each local health district into 11 participating general practices across the region. The pilot project is under evaluation by Southern Cross University but positive feedback has already been received from doctors, LHD allied health staff and patients. HealthSpeak visited Mullumbimby Medical Centre, one of the participating practices, to speak to practice manager Chiron Weber and NNSW LHD renal nurse practitioner Graeme Turner.
From left: Dr Annette Beisenherz, renal nurse practitioner Graeme Turner and medical student Catherine Stephan.
Chiron said co-location was working well, with the only difficult being finding space for Graeme to work. “Last week for instance, one of our GPs couldn’t work the day that Graeme was here
because there wasn’t the space for her,” he said. Apart from the issue of space, Chiron was upbeat about the co-location trial at the practice. “It’s great to be able to give
New Obstetrician & Gynaecologist in Coffs Dr Triveni Nanda, Specialist Obstetrician and Gynaecologist is now accepting patients for a range of services including urogynaecology, infertility and high-risk obstetrics at the ‘Women’s Specialist Centre’ at Albany House in Coffs Harbour. This specialist service has been operating for four months and is now taking referrals for colposcopy, urodynamics and high risk obstetrics. “We have been very busy starting out in our service, but now with a full complement of staff and having the specialist equipment such as our own ultrasound machine, a colposcopy machine and a range of other equipment in place to perform these specialist procedures I am very keen to take on referrals”, Dr Nanda said. Dr Nanda, who moved to Coffs Harbour at the begin-
12
Albany House
ning of April 2014 to take up a post as a Visiting Medical Officer in the Department of Obstetrics and Gynecology has completed over 12 years of training and experience in this field in Australia and India. Having trained under
some of Australia’s leading specialists, she has held posts at Royal North Shore, Nepean, Hornsby and Canberra hospitals, building her expertise in urogynaecology, high-risk obstetrics, infertility, laparoscopic surgery and gynaecological oncology. “I am also passionate about ensuring women can get equity of access to services and will be offering concession billing and no gap payment to your patients”, said Dr Nanda. The clinic will be open four days a week and Saturday mornings for surgical procedures. Dr Nanda will continue to work as a VMO at Coffs Harbour Base Hospital and as a visiting surgeon at Baringa Private Hospital. Referrals to Dr Nanda can be made via fax on: 02 8208 3268 or to contact the practice email: info@cwsc.com.au
HealthSpeak
patients access to a renal nurse on the premises and GPs are supportive of the project and have also benefited from Graeme’s knowledge,” he said. Chiron gave an example of how co-locating Graeme in the medical centre had been helpful for a patient. “One of our patients needed an urgent medication change and Graeme was able to call in one of our GPs and consult on the spot so that the patient went home with a script for the new medication. It was great to be able to get the problem sorted out for the patient immediately. “If Graeme hadn’t been in the same building, the patient would have had to make another appointment to come and see the GP and would have had to wait for the required medication change,” he told HealthSpeak. From Graeme’s point of view there are various benefits. “The patients get to see me in their home town, they don’t have to travel far and so there are fewer ‘no shows’. And from the clinical point of view we get to discuss with the doctors in the practice the clinical plans for the patient. So we’re on the same page with managing patients. I’d like to see the project expanded so that it’s available more widely,” he said.
Read HealthSpeak online Did you know you can read HealthSpeak online and catch up with previous issues too? Why not bookmark www.issuu. com/healthspeak to find and refer to HealthSpeak articles. If you wish to receive an email alert when a new HealthSpeak appears online, email to media@ ncml.org.au with the subject line Online alert.
A publication of North Coast Medicare Local
autumn 2015
Autism Support in Lismore A mother of two children on the autism spectrum has opened her own home up each month to provide a space for kids and parents with autism to come together in a welcoming setting. Wendy Briggs’ home in Goonellabah is also known as the Centre of Gravity – a community centre providing support for kids with high functioning autism and Aspergers’ syndrome and their parents. The next two support sessions at the Centre of Gravity - 26 Pineview Drive, Goonellabah – are on March 28 and May 23 from 10 to 2pm. Wendy told HealthSpeak that many parents of children with autism often find themselves isolated. “So many of us lose contact with our friends and family members because they just don’t understand the special needs of our children and don’t always want to stay in touch,” she said. “Centre of Gravity was set up
Youngsters enjoying the computer room at the Centre of Gravity.
to make the lives of these parents and children a little easier, so that they can mix with like minded people. The centre provides appropriate socialisation activities for children aged 5 to 15 with younger kids catered for as well. Activities include gaming sessions, free range arts and craft, pretend play, a Lego area, board games and books. There is also a Life Skills program there where health
professionals provide specific training for kids to improve their handwriting and other skills such as doing up buttons etc. In addition, volunteer parents are providing lessons on basic sewing, gardening, cooking and DIY skills. Recently, too, Centre of Gravity announced it had appointed a patron, clinical counsellor Dr Dawn Macintyre. Dawn also offers counselling for families attending the Centre.
Wendy is keen to raise community awareness about Autism and has organised the 2015 Autism Awareness Expo to be held at the Goonellabah RSL Sports Club on Thursday April 2 from 10am to 2pm. “There is still a lot of stigma around autism and a lot of misconceptions, so I’m hoping the Expo helps break down this stigma and that people go away understanding more about this developmental disability,” she said. Everyone in the community is invited to attend the April Expo and if an organisation wishes to have a stall there, please get in touch with Wendy on 0418 280 669. Wendy also runs Sensory Movie Days at Lismore’s Birch, Carroll and Coyle cinema. These sessions cater for families with special needs. Children are free to try every seat and the lighting stays on dim. It’s a positive, non-judgemental experience. Email her on centreofgravity@hotmail.com.au to find out more. The website is at: http://centreofgravity. wix.com/centreofgravity
Want to work with the disadvantaged? North Coast Medicare Local (NCML) is calling for expressions of interest from GPs and nurses located in the Northern Rivers to provide medical services at the Winsome Health Outreach Clinic in Lismore. Since April 2013, NCML in partnership with NNSWLHD, St. Vincent de Paul and the Winsome, has been providing an outreach health service on-site at The Winsome, a large facility owned and run by the Lismore Soup Kitchen Inc. The Winsome, predominately self-funded and reliant on a volunteer workforce, provides valuable support for some of the community’s most vulnerable people. It provides accommodation for men and daily meals for those in need. Every Wednesday morning, an Outreach Health clinic is held on-site, providing free GP and clinical nursing services to clientele of The Winsome. NNSWLHD provides a community nurse who works alongside the GP, chatting to patients beforehand to find out their history and organising follow ups and further appointments. The Clinic is well-established and more than 120 patients have accessed the clinic
What would you do if you had three months to live? This and other frequently unasked questions will be addressed at the Facing Death, Embracing Life seminar at Possum Creek, near Byron Bay on March 28 and 29. over the past 12 months, with almost 600 occasions of service during this period. In the next few months, NCML and Vinnie’s are working together to construct a purpose built clinic on the ground floor of The Winsome, comprising a doctor’s room, a nurse’s room and a reception/waiting area. NCML needs more health professionals, including GPs and nurses, to join the multidisciplinary team, on a contract basis. If you are interested, contact Monika Wheeler on 6622 4453 or via email: mwheeler@ncml. org.au
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
Led by spiritual care educator Judy Arpana, the workshop will help people face their fears about dying and as a result live a richer, fuller life. This seminar deals with the emotional, spiritual and practical aspects of preparing for death – your own and the death of others – including loss and grief. Judy has 30 years’ experience in grief and loss, palliative care and dying and has been a student of Buddhism for 35 years. COST: $250/Pensioner concession $200 Phone Judy on 02 6621 5058 or email: judyarpanaseminars@gmail.com
13
Understanding health professions Dentists aim to improve the quality of life for their patients by preventing and treating oral disorders. They are involved in: Educating patients in maintaining good oral health Diagnosing dental disease and general disease which may have oral manifestations Providing health care to prevent and treat tooth decay and gum disease. Preventing dental disease through scaling, cleaning, applying fluoride, pharmaceutical interventions and community health programs Restoring and replacing lost teeth Treating problems with the function of the mouth Performing surgical procedures Referring treatment to specialist dentists and/or other
health practitioners Providing orthodontic treatment and writing prescriptions In recent years the role of the dentist has changed considerably. Effective preventive measures, advances in biomedical and genetic research and new technologies and materials have altered the scope and challenges of modern dentistry. As well, the need for extraction of teeth, while still required on occasions, has considerably lessened. Orthodontics, surgical removal of wisdom teeth, dentistry to improve a patient’s aesthetics, implants and the use of complicated treatments have all increased in recent years. Dentistry is evolving rapidly, largely due to the use of lasers and CAD/CAM technology. Dentists need to keep up to date with research and
What is a dentist?
developments. With the ageing population, more patients have complex medical conditions that will influence treatment. Employment opportunities Employment opportunities are excellent. There is greater awareness of oral health care, and a greatly increased demand for aesthetic services. Possible career paths include: private general practice; public service; armed forces; specialist practice; teaching; research; international aid agencies. Most dentists work in the private sector. The cost of setting up a practice, buying a solo practice or a partnership (sharing both expenses and fees) will need to be planned for. Public sector employment includes areas such as hospitals, schools and health departments. Salaried dentists, both general and specialist, within
Profile Dr Scott Davis, Prosthodontist “I am the principal clinician at Davis Dental and work in Coffs Harbour and Port Macquarie. I started my dental career in Sydney, completing a Bachelor of dental surgery in 1984. There were more dental graduates than jobs in Sydney at that stage so I went to Port Hedland in WA and enjoyed the challenge of remote dental practice. I also gained wide experience due to the lack of specialist dental providers up there. I moved to Perth in late 1986 and established two general dental practices in the city. I also completed a Master’s degree in restorative dentistry at UWA in 1990 which included a research thesis on high strength dental ceramics. Upon finishing my Master’s I accepted a senior lecturer position at the dental school at UWA and progressed to be the senior restorative staff member at the university. I was also involved in rewriting the curriculum for the BDSc program.
14
In 1997 I moved to the North Coast of NSW to see more of this beautiful country we live in and enjoy the lifestyle. I have worked as a consultant prosthodontist in Forster, Nambucca Heads, Coffs Harbour, Port Macquarie and Woolgoolga. Now I work only in Port Macquarie and Coffs Harbour. Since becoming a dentist, I have been involved with the Australian Dental Association (ADA) and last year I was elected to the executive committee of the NSW branch of the Association. In 2014, I was also elected as a member of the Federal ADA council. I believe in giving my time and experience to a profession I love and attempting to develop policies that support equitable and ethical dentistry. I have had experience with a wide range of procedures in prosthodontics. This includes complex paediatric cases at Princess Margaret Hospital in Perth, maxillofacial prosthet-
ics, medically compromised people at UWA and complex prosthetic cases. My current primary interest is implant rehabilitation and full mouth reconstruction, however regional practice means that I am involved with a wide range of procedures. Additionally, I have lectured on Prosthodontics around Australia and in numerous countries around the world. I enjoy the fact that being a dentist involves a wide range
HealthSpeak
the public sector are concerned with managing the dental care of school children, the elderly, the socio-economically disadvantaged and people with intellectual and physical disabilities. Clinical leaders in the public sector manage activities that monitor oral health on a community basis. To be able to practice as a specialist dentist a person needs a higher degree of at least three years duration after graduating as a dentist and have expertise in a particular area over a period of time. Recognised specialists include: prosthodontists (whose area of speciality is prosthetics; dento-maxillofacial radiologists; endodontists who prevent, diagnose and treat the dental pulp - the soft tissues in the hollow of the tooth; oral and maxillofacial surgeons; oral physicians and oral pathologists.
of challenges. You need dexterity to be able to perform the intricate work and artistic skills to replicate natural tissues in both colour and form. Communication skills are also very important along with the skills required to run a small business. There is never a dull moment and even after 30 plus years I am still learning. It is very satisfying to create prosthetic devices for people that not only improve their appearance but help them feel whole again. I’d recommend dentistry as a career if a person has the passion to help and enjoys creating things with their hands. There is quite a bit of doom and gloom at present due to an oversupply of dentists which is a result of poor government decisions. However, there will always be work for the right person, and I would encourage anyone who strives for excellence and has an empathic nature to consider prosthodontics as a rewarding occupation.
A publication of North Coast Medicare Local
autumn 2015
Homeless service clients up 4% The number of Australians receiving support from homelessness services rose in 2013-14, with more assistance provided to people who risk falling into homelessness due to domestic and family violence and housing crisis, according to a report released by the Australian Institute of Health and Welfare (AIHW). The figures are in an Australian Institute of Health and Welfare (AIHW) report, Specialist homelessness services: 201314. They show about 254,000 Australians accessed specialist homelessness services in 201314, an increase of 4% from the previous year. One third of all clients - an estimated 84,774 adults and children - received assistance as
a result of experiencing family or domestic violence. ‘This was an increase of 9% from 2012-13, including an increase of 14% in the number of children being assisted due to family or domestic violence,’ said AIHW spokesman Geoff Neideck.
HealtheNet connects hospitals and primary health The HealtheNet program, led by eHealth NSW, has come to the North Coast. It provides major benefits to patients and clinicians by giving health providers immediate access to information about a patient’s recent health history. Part of the HealtheNet solution is the NSW Clinical Portal which has been integrated with the Personally Controlled Electronic Health Record (PCEHR) system. This improves information sharing between hospitals, community health, GPs, other health providers and consumers. It closes the loop between primary, community and acute patient care. As well as information contained in the PCeHR, the Clinical Portal provides clinicians with access to event summaries from Community Health visits, eDischarge summaries, visit histories, allergies and alerts and medical imaging. While these benefits apply to all patients, the elderly, those with complex and chronic disease, mothers, children Indigenous and culturally and linguistically diverse populations are expected to especially benefit
from HealtheNet.
How it works eDischarge summaries The eDischarge summary ensures that the details of a patient’s hospital care are immediately available to their regular GP. Shared heath summaries Shared health summaries, created by GPs, are sent to the PCEHR and can be viewed by clinicians through the NSW Clinical Portal in order to help plug the gap in patient information. For the first time, other participating health professionals will be able to access current health information about a registered patient. Clinical Portal The Clinical Portal provides NSW Health clinicians with access to NSW Health patient information which resides outside their normal electronic medical record, including information available in a patient’s PCEHR. It is a read only portal so no data entry is required.
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
Over the period, there was also a rise in the number of
clients who received help to maintain their housing, with 32% of clients identified as needing assistance to sustain tenancy or prevent tenancy failure or eviction-up from 28% in 2011-12. The proportion of clients identifying ‘housing crisis’ as the main reason for seeking assistance also increased from 13% in 2011-12 to 16% in 2013-14. Victoria recorded the largest increase in clients. Small increases were recorded for Queensland, South Australia, Tasmania and the Northern Territory and the other jurisdictions remained at similar levels to the previous year.
HIV: Treat Early campaign NSW Health Minister Jillian Skinner recently launched two initiatives to reduce HIV transmission in NSW – the state’s first permanent HIV testing facility and a campaign explaining how HIV treatment can help prevent HIV transmission. Launched to coincide with the Sydney Gay and Lesbian Mardi Gras in March, both initiatives are projects of ACON, NSW’s leading HIV and LGBTI health organisation. The permanent HIV rapid testing facility is located at 167 Oxford St, Sydney and will operate six days a week. Ms Skinner also launched ACON’s Treat Early campaign, the next stage of the Ending HIV initiative. The campaign promotes the health benefits of the latest HIV medicines as well as their capacity to reduce the amount of HIV in a person’s body to an undetectable level, significantly reducing the likelihood of the virus being transmitted. The Minister said making
HIV testing easier as well as encouraging people with HIV to consider the benefits of starting treatment are priorities of the NSW Government’s HIV Strategy. NSW Chief Medical Officer Kerry Chant said scientific and clinical evidence demonstrated the benefits of people with HIV starting treatment as soon as possible after their diagnosis. “These days, antiretroviral treatments are more effective and far better tolerated by the body. Untreated HIV also causes damage from the time a person becomes infected,” Dr Chant said. “Basically, controlling HIV with treatment as early as possible is good for the health of HIV positive people. And it dramatically reduces the risk of passing on HIV. So it’s really important for individuals to consider their readiness for treatment, the options available and to speak with their doctor about the most appropriate course of action.”
15
Professional network for musculo-skeletal care The Australian MusculoSkeletal Network (AMSN) was developed to provide quality inter-professional development and networking opportunities for practitioners, researchers and academics engaged in musculo-skeletal care. Based on the NSW North Coast, the AMSN grew out of practitioner frustrations at the lack of true multidisciplinary events and the cost and inconvenience of Continuing Professional Development. AMSN caters for practitioners with a clinical emphasis on musculoskeletal care such as GPs, chiropractors, osteopaths, physiotherapists, radiologists, radiographers, OTs, podiatrists, exercise physiologists and other interested health providers. AMSN is a professional network that is free to join. It keeps members informed of upcoming events and encourages interdisciplinary dialogue
Upcoming events
- the events that are run are generated by needs identified by the members. Events cost a lot less for members as well and there is a classified section for members looking to buy and sell equipment and for those looking for locums or referrals. There are more than 20 events so far on the 2015 calendar delivered in a range of formats including: afternoon and weekend seminars and workshops, human anatomy wet-labs and edu-ventures where education is provided in bits over a few days while undertaking a variety of adventures.
March 14 – Inflammatory Arthritis seminar at Byron Bay with rheumatologist Daniel Lewis and radiologist Ian Cappe March 18 – First aid update at Byron Bay March 28 – Anatomy Wet Lab - Head and neck MS clinicians’ Anatomy and Assessment Review with cadaver specimens on the Gold Coast March 28 – Anatomy Wet Lab: Head and neck anatomy for massage therapists and body workers – Anatomy and Assessment review with cadaver specimens on the Gold Coast April 4 – Shared Medical Appointments at Byron Bay – A/ Prof John Stevens introduces Shared Medical Appointments – a chance to network with practitioners coming to Byron Bay for the Bluesfest To join AMSN or find out more, go to www.amsn.com.au
How to be healthy, wealthy and wise! Our own health or that of those closest to us has to be seen as fundamental to our sense of well-being. How we live our lives impacts not only on ourselves but also on those around us. Health is the business of everything and everybody - from the personal activities we pursue, to community planning; all will have a health impact. Conscious of this and desirous of ensuring all students within the School of Health and Human Sciences have a thorough understanding of good health behaviour, the Southern Cross University Clinic is about to embark upon The Healthy University service implementation plan. The university welcomes students from over 80 countries and they, along with university staff, have various health care needs. The decision to adopt a service plan based on health promotion
16
By Prof Iain Graham Dean, School of Health and Human Sciences Southern Cross University and lifestyle planning was to encourage people to be more proactive in their health care. The university also wants to ensure that students who are reading health degrees are able to develop health promotion and health care management skills. Drawing upon the concepts from WHO’s types of ‘Healthy Settings’, the School believes that its integrated health clinic, which offers a range of services to the university and wider community, should support a health service model embodying such concepts. The challenges that all health care services are facing given the ageing population and increasing chronic health problems require us all to
embrace a more proactive approach to individual health care needs. To do that people need evidence based knowledge about what it is to be healthy and how health can be maintained. The Healthy University service plan provides a climate of positive health gain by fostering lifestyle knowledge along with societal and individual relationship building opportunities. This includes understanding personal responsibility for health gain
HealthSpeak
through ensuring resilience and thereby achieving a positive concept of self. Coming to university is a life changing event and SCU is proud to be a university where many students are the first in their families to attend university. It is incumbent on the university therefore to enable good health awareness and behaviour. For knowing how to keep healthy, is fundamental to successfully meeting the demands of contemporary higher education. For SCU, the University Clinic helps its health students gain the requisite skills and knowledge about lifestyle care and health promotion but also provides the entire university community with access to this health knowledge. Maintaining optimal health helps with academic achievement, quality of life and provides a clearer vision of what it means to be healthy, wealthy and wise.
A publication of North Coast Medicare Local
autumn 2015
The majestic wonders of the night sky The more of us that feel the universe, the better off we will be in this world. Neil deGrasse Tyson (American cosmologist) Lismore physician Dr Stephen Moore understands the value of an engaging hobby, although his is perhaps more unusual than most. Stephen has long been interested in astronomy and last year he achieved something he’d thought about for a long while – he had an observatory built in his back garden at Bexhill. “When you are working and have a family you keep putting such things off. But, eventually I thought I’d better start to do something with astronomy or I’ll never get around to doing it. “Astronomy is one of those hobbies whereby once you get going it tends to take on a life of its own. You start out with simple equipment and quickly find that you want bigger and better which usually means more costly,” he told HealthSpeak as we sat in his living room looking out onto the arctic white dome where he spends so many nocturnal hours. Stephen said the main reason he wanted his own observatory was to avoid the time and effort setting up all the gear required for star gazing. While Stephen’s observatory is a classic model, he says some astronomers may have a simple backyard shed with a roof that rolls back to
Stephen Moore outside his observatory. Background picture: Comet Lovejoy
expose the night sky. “One of the things that can slow your enjoyment of the hobby is that you have to lug all your gear out and set it up each night. If you just want to have a quick look that may not take very long, but if you are into it seriously and have heavy equipment, and especially if you are into photography, it can take hours to set up. So that may dampen your enthusiasm on a cold night. “But if it’s all set up then you just turn it on, make a few calibrations and away you go” he said. Another reason why Stephen was keen to have his own observatory was his increasing interest in astrophotography. “Photography has become the main interest. It didn’t start
You tend to stay up late as you don’t want to waste a good night, so you just keep going off like that, but has evolved in that direction. Even with everything ready to go you still need to have a clear, moonless night, a fairly still night, a night that you are not on call, a night that you don’t have to go to work the next morning and a night when you are not too tired. When all those factors
come together, which is not all that often, it’s an opportunity you can’t allow to pass. Once you get started you tend to stay up late as you don’t want to waste a good night, so you just keep going. It’s not a hobby for a group. It’s a solitary hobby,” he said with a smile. On his block of land on a ridge at Bexhill Stephen experiences dark nights with a broad view of the night sky, an ideal site for an observatory. While there are always things of interest in the night sky, Stephen plans in advance for special events – for instance the once in a lifetime event of the Transit of Venus, which his family and friends enjoyed seeing through his solar telescope. “If you are interested in a comet or an eclipse, it’s only going to be there for one night or a few nights. But otherwise everything’s up there at least once a year and there are usually one or two planets to see on any night.” But Stephen’s astronomical pursuits don’t have to wait till nightfall. “You might spend the night taking photographs, but you then have to spend equally as much time if not more processing them, and that can be a lot of fun. So through the day or if the weather’s bad there’s always plenty to do - raw photos to work on and processing to be done.” Stephen is also completing a Masters in Astronomy which has only increased his interest in the topic. Continued next page Turn page to see some of Stephen’s majestic photos
It surprises me how few people know what’s in the skies HealthSpeak A publication of North Coast Medicare Local
autumn 2015
17
Observing the night sky (continued) “The more you get into it, the more you realise that things that might look pretty boring to other people are actually very interesting. For instance if you look through a telescope at a quasar, an ancient and highly energetic galaxy, it’s appears like any other star, but when you know what it is it’s fascinating,” he explained. While astronomy is a rather solitary pursuit, Stephen’s passion has spread to family and friends who now appreciate the night skies in a way they’d never considered before. “It surprises me how few people know what’s in our skies. But the more you look the more you learn about what’s up there and the more humble you feel.” Stephen and his wife Gabrielle have travelled to Macchu Picchu, Stonehenge and Easter Island to enjoy another aspect of astronomy known as archeoastronomy. Essentially, archeoastronomy is the study of how people in the past have understood the phenomena in the sky, how they used these phenomena and the role the sky played in their cultural life. Aboriginal astronomy falls into this category. He describes a configuration of stones near Melbourne which could be compared in some ways to Stonehenge. The Wurdi Youang stone arrangement is an egg-shaped ring of stones, about 50m in diameter. Its major axis is almost exactly East-West and at
its western end are three prominent waist high stones. Some outlying stones to the west of the circle, as viewed from these three stones, seem to indicate the setting positions of the Sun at the equinoxes and solstices. A good way to get started in astronomy, especially if funds are limited, is to buy a good pair of binoculars. “You can be interested in astronomy and not have a telescope. A good set of binoculars can show you an awful lot if you know what you are looking at. There are a few galaxies you can see, you can see globular clusters and the moons around Jupiter. A good set of binoculars is a more powerful instrument than the early telescopes used by Galileo and Newton. Those interested could also take one of the astronomical themed tours in central Australia, where the inky sky is perfect for observing the night sky. And there are lots of publications and websites telling you what’s up in the sky, he advised. For Stephen, astronomy has provided him with a welcome and absorbing activity that takes him completely away from work worries. “Yes, it almost literally puts you into another world.” For more information on astronomy, go to the Astronomical Society of NSW website: http://www. asnsw.com/ Silent beauty: From top: Pleides, Orion Nebula, and Andromeda Photos by Stephen Moore.
About Alcohol Interlock An information pack for GPs is available to explain the new mandatory interlock program which commenced in NSW at the beginning of February. Under the program, people convicted of serious and repeat drink driving offences will be required to have a breath testing device called an alcohol interlock installed
18
in their vehicle, linked to the vehicle’s ignition. They will need to provide a breath sample to show that there is no alcohol present before the vehicle will start. The NSW Government is counting on GPs to play a critical role in delivering this program. GPs can be involved at three stages of the patient’s interlock program:
At program entry: each participant is required to attend a medical consultation to re-think their drinking before they can obtain an interlock licence. During the program: participants who continue to attempt to drink and drive may receive letters recommending a doctor’s visit to discuss their behaviour. This also gives doctors an opportunity to refer for further alcohol dependency
HealthSpeak
assessment and treatment. Last six months of program: participants who fail to show that they can separate drinking and driving may be referred to a Fitness to Drive Assessment before being allowed to drive without an interlock To find out more, view the fact sheet here: http://roadsafety.transport.nsw. gov.au/downloads/alcohol-interlock-medical-2015.pdf
A publication of North Coast Medicare Local
autumn 2015
Understanding health professions Occupational therapy is a client-centred health profession concerned with promoting health and wellbeing through occupation. The goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this by working with people and communities to enhance their ability to engage in their occupations or by modifying the occupation or the environment to better support their occupational engagement. To become a qualified occupational therapist, you need to complete an undergraduate or Masters entry-level course in occupational therapy. Courses are taught around Australia. Occupational therapists often
work as part of an integrated healthcare team. They work with clients in both public and private sectors. They work in a range of settings, including:
Occupational Therapy
environments Prescribing and educating clients and carers in the use of adaptive equipment
With children: Helping children achieve developmental milestones such as fine motor skills and hand-eye coordination. Educating, involving parents, carers and others to enable normal development and learning.
Acute care: Specialist interventions. Assessing clients’ cognition, function and psychosocial needs. Monitoring clients’ function and progress, prescribing adaptive equipment to ensure safety upon discharge from hospitals.
Rehabilitation and aged care: Helping clients regain or enhance their lives after specific events such as hip replacement or stroke. Assessing and modifying clients’ home and community
Injury management: Using specialised assessments to determine the functional requirements of various jobs, and clients’ capacity to return to work. Designing and coordinat-
ing graded return to work programs, educating clients in safe work practices. Modifying the work environment to suit the needs of individuals so as to prevent or minimise injuries. Mental health: Designing individual and group programs and activities to enhance clients’ independence Developing coping strategies for clients in overcoming mental health issues. Improving clients’ confidence and self-esteem in social situations. Information taken from the Occupational Therapy Australia website: http://www.otaus.com.au/
Profile Occupational Therapist Luisa Eckhardt Luisa holds a Bachelor of Applied Science in Occupational Therapy (OT) from the University of Western Sydney. She told HealthSpeak she really didn’t know what she wanted to do when she left school and it wasn’t until she opened the University Admissions Centre’s Guide to Health and read the OT career description that she applied to study this profession. She has never regretted her career choice and has had many and varied experiences within OT. “I have Level 1 and 2 training in Lymphoedema Management, a Diploma in Frontline Management, and more recently I completed my Cert IV in Training and Assessment,” she said. Luisa worked in Occupational Rehabilitation when she finished university, but felt the pull towards acute hospital OT. “I moved into a rotational position at Liverpool Hospital where I provided acute OT services to clients with respiratory, surgical (amputee’s and fractures), renal, and gen-
eral medical conditions. I really found my passion for OT when I moved into the clinical area of Oncology, Palliative Care and Lymphoedema at Nepean Cancer Care Centre. “There I learned what truly holistic client care means, what effective teamwork is, and how a multidisciplinary care process leads to better outcomes. As an OT you work so intimately with people at their most challenging times, to be accepted and involved is very humbling,” said Luisa. Since that time she’s gained extensive experience working across a couple of different health services in Sydney. Luisa also relieved as a Head of Department for 12 months. She found she really enjoyed managing staff and pursued departmental management. Luisa took on a Deputy Head of Department role back at Sydney’s Liverpool Hospital, now the biggest OT department in NSW. Luisa currently works casually with Feros Care providing community based aged care services which she finds really
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
rewarding and teaches in the Allied Health Assistant program with TAFE NSW. Last year Luisa became one of three Directors on the new North Coast Allied Health Association Board, established to drive best practice in allied health throughout the region. As an Occupational Therapist, Luisa loves meeting people and seeing them achieve personal goals. “Things such as seeing someone smile and feel competent because they can get off a toilet independently. These are daily care tasks we take for granted but become difficult due to injury, illness or changes associated with the
aging body,” said Luisa. Working with people with lymphoedema and those with tumours impacting on the lymphatic system is also very rewarding. “Cancer is often talked about in terms of treatment and prognosis. Lymphoedema is a condition that can develop due to cancer and needs to be managed long after remission or a cure is achieved.” Luisa has no hesitation in recommending OT as a profession. “It offers flexibility with employment and has scope to expand skills in many areas - acute, community, private, public, aged care, paediatrics, work rehab, teaching at TAFE/University etc. She recommends that new graduates complete at least two years in a rotating caseload position. “This allows the clinician to develop clinical reasoning skills, sharp analytical and problem solving abilities and teaches them to become dynamic within the learning process,” Luisa said.
19
The Koori Grapevine Big turnout for Aboriginal Australia Day Aboriginal kids get active
Welcome to Country by Aunty Bea Ballangarry at the Aboriginal Australia Day event organised by North Coast Medicare Local’s Closing the Gap team.
Around 80 people attended the Coffs Harbour community’s Aboriginal Australia Day - a day of remembrance and reflection on health and wellbeing for the people and communities in the Gumbayngirr Footprint on the Mid North Coast. North Coast Medicare Local hosted the day of yarning on January 23 to celebrate Aboriginal culture as a part of the history of Australia. The event at Coffs Harbour
Botanic Gardens focused on Australia’s Aboriginal past, present and future with a spotlight on the health of communities, chronic disease and what community members could do to improve their wellbeing. National Parks and Wildlife Aboriginal tour guide Mark Flanders gave a bush medicine/ bush food walking tour through the gardens and five people shared their stories with the audience. Morning tea was shared after the presentations.
Six Indigenous docs graduate from UNSW The largest cohort of Aboriginal graduate doctors will begin working in hospitals around Australia this year. Six Aboriginal students graduated in 2014 with a medicine degree at the University of New South Wales (UNSW). That’s the highest number of Aboriginal medicine graduates the university had ever recorded. Graduate doctor Jessica Wade said she would begin her career in Bankstown, in Sydney’s south-west. “Bankstown Hospital is my local hospital where I’ve grown up and all my family are from,” she said. “I think it’s important for 20
Aboriginal people to be in the health industry because for other Aboriginal people you can help create a safe environment.” UNSW has increased its recruitment drive in the hopes of getting more Indigenous high school students to study medicine, and there are now 49 students enrolled in the program. Aboriginal Graduate, Murray Haar, said he had chosen Albury in NSW to complete his internship. “It’s a degree which gives you a career where you can really make a difference. It’s lots of hard work along the way but it’s absolutely possible for everyone who has the desire to do it.”
Koori Grapevine
Aboriginal and Torres Strait Islander children are spending more time on physical activity than non-Indigenous children, according to figures released by the Australian Bureau of Statistics (ABS). “Overall, in 2012-13, Aboriginal and Torres Strait Islander children aged 5 to 17 spent around two hours per day on physical activity which is 25 minutes more than non-Indigenous children,” said Wendy Davis from the ABS “This means that almost half are meeting the physical activity recommendations an hour’s physical activity a day - compared to only one-third of non-Indigenous children. The most common activity for Aboriginal and Torres Strait Islander children was active play or children’s games, like running around, playing on playground equipment and skipping, followed by swimming and bike-riding. “But the amount of activity decreases with age; for
older teens - 15 to 17 - it dropped to an hour and twenty minutes per day, and for 18 to 24 year olds it was only 50 minutes. By the time people hit 55, over one-third did no physical activity at all in the week before interview,” said Ms Davis. For Aboriginal and Torres Strait Islander adults, the most common form of activity was walking for transport, contributing over half the total physical activity time. When it came to screen time - computers, TV, electronic games - Aboriginal and Torres Strait Islander children aged 5 to 17 were pretty consistent with nonIndigenous children, spending just over two and a half hours a day on their various devices. “Interestingly, both groups of children spent only a small part of this screen time on homework - three minutes and eight minutes respectively,” said Ms Davis.
A publication of North Coast Medicare Local
autumn 2015
First Aboriginal woman in Qld Parliament Queensland’s surprise election result has brought some historic moments with Leeanne Enoch, the new ALP member for Algester (south of Brisbane) being elected to parliament and to the Cabinet. Leeanne is Minister for Housing and Public Works as well as Minister for Science and Innovation. New Premier Annastais Palaszcuk has also named eight women as Ministers in her 14 person Cabinet and appointed a female Deputy Premier in Jackie Trad. Leeanne is a cousin of the acclaimed playwright Wesley Enoch and a proud Nunukul/ Nughi woman. She has had a successful career as a secondary
New portal for HealthInfoNet
Leeanne Enoch
teacher in Queensland and overseas, and has been involved in government policy development. Leeanne also worked at national executive level for the Australian Red Cross and more recently had been working with the Queensland Council of Unions, seeking justice for generations of Indigenous Queenslanders who were underpaid or not paid at all by successive state governments.
Commitment needed to Close the Gap The peak Aboriginal health organisation, NACCHO, said in reply to the Closing the Gap Report 2015 that Aboriginal health, commitment to programs that work, Aboriginal control and long-term funding were all necessary to close the ongoing gap between Aboriginal and other Australians. The National Aboriginal Community Controlled Health Organisation (NACCHO) Chair Matthew Cooke said closing the gap was achievable. “Closing the gap is about generational change and there are no quick fixes,” Mr Cooke said. “Real gains, although small, are already being made in life expectancy and other key areas like maternal and child health. “We need to see continued, long-term commitments from all levels of government in the programs that work. In health, it’s Aboriginal Community Controlled Health Services that are making the biggest inroads against the targets to close the gap.
autumn 2015
Matthew Cooke
“They are also contributing to other targets, such as in employment, as the largest employers of Aboriginal people.” Mr Cooke said the Federal government’s focus on getting kids into school, adults into work and community safety, is welcomed, but could not be achieved without a similar prioritisation of health issues. “Put simply, sick kids can’t go to school, sick workers can’t work. “Yet our health services continue to live with great uncertainty. The last funding allocation was for only 12 months and expires at the end of June this year. Without better funding certainty,
A publication of North Coast Medicare Local
we can’t provide certainty to our staff or to our patients.” Mr Cooke said Aboriginal Community Controlled Health Services were the primary health care sector that delivered the best results for Aboriginal and Torres Strait Islander People but were the least funded. “What we would like to see is a clever re-allocation of the Aboriginal health budget from mainstream services into community controlled health. “For example the government currently allocates Aboriginal health funding to Medicare Locals. We would like to see this redirected to our sector to ensure Aboriginal and Torres Strait Islander people continue to receive quality care during the transition to Primary Healthcare Networks. “The Abbott Government supported establishment of the Closing the Gap targets while in opposition and must continue to honour these commitments in government if we are to meet the targets for overcoming Indigenous disadvantage by 2031.”
Edith Cowan University’s Australian Indigenous HealthInfoNet, in partnership with the Healing Foundation, is developing a healing portal on the HealthInfoNet website. The healing portal will engage users from a broad range of areas including health, justice, child protection and family violence, and will include a free on-line yarning place to encourage a rich exchange of knowledge and information. At the heart of the portal and yarning place is the connection with culture, knowledge systems and information sharing. The Healing Foundation is a national Aboriginal and Torres Strait Islander organisation with a focus on community led healing solutions. Building culturally strong, community designed and delivered pathways to healing, the organisation: funds and supports healing programs targeting communities, families and individuals builds the evidence and knowledge base for best practice in Indigenous healing builds leadership and the capacity of communities and workers to respond to trauma through education and training. The Healing Foundation CEO, Richard Weston, said that the portal was an opportunity to access information about what is working when it comes to healing for Aboriginal and Torres Strait Islander people. It will share best practice examples of healing initiatives and create an online environment for the exchange of ideas will promote positive change for our communities, he said. “We look forward to working on this project and supporting the efforts of the Healing Foundation. The healing portal and yarning place will bring together information including cultural ways of healing, trauma, Stolen Generations and healing for children, young people, men and women,” said HealthInfoNet Director Professor Neil Drew. The portal will be established in early to mid-2015.
Koori Grapevine
21
Arts Health and Wellbeing Expression through music brings healing Music therapy is a researchbased practice and profession in which music is used to actively support people as they strive to improve their health, functioning and wellbeing. Australian Music Therapy Association One of music therapist Hannah Rowland’s most rewarding experiences was working with a 25-year-old man who’d suffered a severe brain injury as a result of an accident. “He could no longer walk independently and speaking was quite difficult for him. He’d suffered a fair degree of cognitive impairment due to his accident and because of the functional effects of the injury his emotional wellbeing was suffering,” she told HealthSpeak. Hannah used music therapy to help this young man become more mobile and motivate him to walk. “Walking was quite painful for him, so music really helped him in that respect. We used songs that he was familiar with that had a really strong beat. He walked in time to the songs, and through a process called entrainment, this helped coordinate his movements,” she explained. Hannah also worked with this client to write songs. “He really loved to improvise rap songs, so we did a lot of that and he used to express himself through the lyrics, which we wrote down. Through the songs he expressed his feelings of gratitude towards his girlfriend for looking after him through his experience and he was able to express his emotions around his accident and his recovery process and his hopes for the future. It was a really incredible experience for him.” Hannah, who runs a Music Therapy practice in Coffs Har22
Hannah Rowland
bour, Kempsey, Port Macquarie and South West Rocks, graduated from the University of Queensland with a Masters of Music Therapy after completing a Bachelor of Music Performance on the viola. She wasn’t sure where she was going in her music career after finishing her Bachelor degree, but said it was the therapeutic potential of music which drew her to apply for and complete her Masters. Hannah uses mainly guitar and her voice and works primarily with adults and children with disabilities. Her main area of interest is in working with people with Autism Spectrum Disorder, although she also works with people with Alzheimers’ and other age related diseases, stroke and brain injuries. She’s also running some early childhood music programs. She said while the music that was created during therapy sessions might not be incredible to listen to, the music is used to support the client.
He was able to express his emotions around his accident and his recovery process, and his hopes for the future. “We might use guitar to support the movement that the client is trying to achieve or to support them emotionally - to hold them, to contain their experience. That’s my instrumental participation. With the clients I use small percussion instruments, shakers and small hand drums. These small instruments are easy to play and can be used in a variety of interventions.” Hannah describes the benefits of music therapy as being
similar to some other allied health therapies which work to enhance communication, social skills, emotional wellbeing and motor skills. She’s also fascinated by the way the plasticity of the brain allows people with impairments to work with music. “Music is processed diffusely in the brain. Using music in conjunction with other activities can activate the brain in diverse ways and support nonmusical skills. For example, people with stroke often lose their ability to talk but they can still sing and that comes from a particular area of the brain being activated while engaging in music. If the speech area is damaged, the music areas associated with speech may not be damaged. So, it’s this capacity of the brain that makes music therapy so effective.” In her private practice, Hannah works with individuals or groups of children and adults with disabilities, and groups of older adults with dementia, in schools and in the client’s home. Working as a music therapist provides Hannah with a great deal of satisfaction and she would recommend it to musicians who don’t wish to pursue a performance career. “A lot of young people have a strong interest in music and are strong musicians but don’t necessarily want to follow the path of performance which can be very challenging. And music therapy is such an incredible way to use your music skills in a way that’s really able to give back and is constructive and useful. For people with an interest in the medical and therapeutic side of things, it’s a wonderful way to use your musical skills to work in areas of interest to you,” she said. To find a music therapist in your area, go to: www.austmta.org.au
HealthSpeak
autumn 2015
Inspired Voices take a
bow!
The Art of Creating Harmony By Janis Balodis A new study shows that singing in a choir could do a lot for your state of mind. The Huffington Post When you sing, musical vibrations move through you, altering your physical and emotional landscape. Group singing… is the most exhilarating and transformative of all. TIME magazine You don’t need to read TIME, The Huffington Post or scientific studies to confirm that singing in a group is associated with better health, mentally, physically and emotionally. Just turn up at UnitingCare Caroona Jarman in Goonellabah at 10am on a Thursday morning and catch the Inspired Voices Choir in action. Formed in 2009, the choir draws its members from residents of the aged care services, community clients, relatives and friends, volunteers and staff. Since its inception when there was the modest expectation that 10 residents might be interested in singing, the choir has maintained a regular membership of around 40 plus singers for the past five years.
Occupational Therapist Paula Vaughan facilitates the choir’s ongoing development. Directed by Deirdre Paillas, Lismore Citizen of the Year 2010 and accompanied by “local treasure” Gwenith Boland, members gather each week to share their love of singing and to experience a sense of belonging, friendship and wellbeing. The session begins at Caroona Jarman with morning tea as members arrive in groups and separately. Some are bussed up from the other two Caroona residential care services, Kalina and Marima, wheeled in by staff, family or other residents. Others arrive with walkers, or arm in arm, under their own steam, or with assistance. The buzz increases with the clink of cups on saucers and the clamour of catch-up conversations. The complex seating routine is organised according to safety needs, voice type and mobility, the most physically able at the back and wheelchairs to the fore. The rehearsals are open to all residents and there are always a few people sitting out front as a welcome audience. With the choir seated expectantly before Deirdre Paillas at her music stand, the atmosphere is like homeroom at school. New choir members, volunteers and staff are
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
welcomed. There is remembrance for dear members who have died, usually with a song; birthdays and grandchildren are announced and there is affirmation of the singing to come directed towards the goal of a mid-year concert. The singing begins with warm-up exercises and the beautiful round “One Voice” penned by Deirdre. It is a musical reminder that a choir is many voices singing as one, together in harmony, and also serves to tune them up as it tunes them in to each another. A song list for each rehearsal is chosen from the choir’s extensive repertoire of 120 items. Songs range from the traditional such as “The Skye Boat Song” and “The St Francis’ Prayer” to the contemporary “Do You Hear the People Sing?” from “Les Mis”. A brand new song for the concert program, “Remembrance Song” with lyrics by Deirdre set to a Scottish air, is introduced for the first time. It is not a sing-along around the piano. This is choir with serious musical chops that takes pride in its skill and experience. There is plenty of good-natured banter and laughter, and when Deirdre stops them and insists on a higher standard they are quick to respond. It is
not surprising that the choir is winning audience acclaim and received a Better Practice Award 2014 from the Australian Aged Care Quality Agency. Rehearsal ends with a poignant rendition of “Now is the Hour” and the departure routine begins. Choir members leave with straighter backs and bigger smiles of joy and satisfaction. Neuroscience proves that music – particularly singing – makes us happier, healthier, smarter and more creative. When we sing, we create new neural pathways and release oxytocin, the hormone responsible for love and bonding. Singing also releases endorphins, “feel good” chemicals that trigger enjoyment, happiness and relaxation. Scientists are just discovering what the Inspired Voices well know. Cheaper than therapy, healthier than alcohol and more fun than working out, group singing calms and soothes even as it lifts spirits and energizes the heart. I don’t sing because I am happy, I am happy because I sing. Rumi, 13th century The Inspired Voices concert is on June 4 at 6.30pm. See them on YouTube at https://m.youtube.com/ watch?v=x5MV14BBaQE
23
Busting myths around sleep apnoea
Diagnoses of sleep apnoea are rising steadily in Australia. Recently in one week, Lauren Stacey, a registered nurse and sleep apnoea equipment specialist saw 12 new patients needing to be supplied with a machine and mask. Lauren works at Southside Pharmacy in South Lismore which specialises in CPAP (Continuous Positive Airways Pressure) equipment to treat sleep apnoea. HealthSpeak visited Lauren to find out more about this condition about which people have some misconceptions. Sleep apnoea occurs when the walls of the throat come together or collapse during sleep, blocking off the upper part of the airway so that they stop breathing and the body is deprived of oxygen. A person with this disorder might have a sleep disturbance hundreds of times every night. Symptoms may include excessive loud snoring, daytime sleepiness, headaches and poor concentration or no symptoms at all. Four to five percent of the population has some degree of sleep apnoea. Conservative treatment includes weight loss and cutting back on alcohol, while active treatment includes nasal CPAP, mouthguards or surgical correction of upper airway obstruction. Lauren said what wasn’t well known is that sleep apnoea is a genetic condition and not caused by a person being overweight or a certain age or gender, although carrying too much weight wouldn’t be helpful. “Anyone from 12 to 80 can 24
have sleep apnoea, I see skinny 12 year-old soccer players coming in after being diagnosed. It can affect anyone,” she said. Lauren said that another myth about sleep apnoea was that it was ‘irritating’ but not serious. “Sleep apnoea can be a very serious condition which can result in a person having a heart attack during the night, so it pays to get tested if you think you might have sleep apnoea and get it treated,” she said. Lauren said it was possible for spouses to look for sleep apnoeas and symptoms in their sleeping partners. “Snoring is a big one, but some people with severe sleep apnoea don’t snore at all. Partners need to look out for literal apnoeas, you can actually see them, it’s when your partner stops breathing while asleep particularly snorers who snore like chainsaws and then do the gasping and the grunting, that’s an apnoea,” said Lauren. Sometimes, Lauren said people had only one symptom leading to a diagnosis of sleep apnoea – unexplained high blood pressure. “GPs are saying, ‘this per-
People often don’t realise how good they are feeling until they stop using the machine son’s got high blood pressure, they shouldn’t have high blood pressure, let’s send them for a sleep test’. Sleep tests are free at certain sites, so it doesn’t hurt to have it done. Because if it’s not sleep apnoea, doctors can focus on what is causing the high blood pressure,” she explained. Southside Pharmacy works with SNORE Australia who have a free sleep lab near Coolangatta airport where people can go for overnight tests. “People get a referral from their GP and have a diagnostic sleep test. They then go back to SNORE if they do have it and it’s severe enough to need a machine. SNORE conducts another titration test which works out at what pressure the CPAP machine needs to operate. HealthSpeak
“The machine pumps air at pressure, so the titration works out the pressure. SNORE sends the results directly to people in the mail and then two weeks after the titration test people get a prescription in the mail and then they come and see me or another CPAP specialist in their area.” Unlike decades ago where wearers of CPAP masks looked like they were about to pilot a fighter jet, CPAP machines are small and quiet these days with light, comfortable face masks. “The machines have a humidifier built into them which puts some moisture and warmth back into the air so the nose doesn’t dry out. If the nose does dry out, mucous membranes are going to crack and you open yourself up to infection,” said Lauren. The benefits of the CPAP machine are generally seen straight away. People feel less tired, have more energy and if they had headaches they go away. “Some people feel no different until they stop using the machine and realise the difference. Sleep apnoea is one of those things where you don’t realise how bad you were until you feel better. And people often don’t realise how good they are feeling until they stop using the machine.” At Southside Pharmacy, Lauren hires initially organises for patients to hire a new machine for a month and then they can purchase outright or pay it off in instalments. Contact Lauren for more information on 6621 4500.
A publication of North Coast Medicare Local
autumn 2015
The benefits of cold laser on lymphoedema The use of low-level or ‘cold laser’ by health professionals in treating lymphoedema is growing, with Australia having led the way in the use of this therapy for this distressing condition. HealthSpeak spoke to physiotherapist Sharon Tilley from the Lymphoedema and Laser Therapy Clinic in Adelaide to find out more. Sharon has worked in hospitals and private clinics and lectured at university level. She commenced at the clinic in 2001, initially as a staff physiotherapist, becoming a principal in 2009. She has also completed postgraduate studies in lymphoedema management; accredited through the Australasian Lymphology Association. “My first experience with low-level laser was while working as a Hand Rehabilitation Physiotherapist in Darwin - using it to assist in wound management. In the last five years, as interest in the clinical use of laser has grown and more robust research and meta-analysis has been published, I have been increasingly busy speaking for various professional groups, most recently at the World Laser conference in Washington DC,” Sharon said.
Australian research pivotal She explained that Australia had led the way in the use of laser for lymphoedema. In 2009 she was invited to write a paper for the UK Journal of Lymphoedema outlining the clinical methodology of laser use for the condition as their lymphoedema community’s interest began to gain momentum. She said that Professor Neil Piller, based at Flinders University, was a leading world expert in lymphology and his prolific speaking engagements and research had placed Adelaide in a prime position on the global lymphoedema map. It turns out that Sharon’s predecessor at the clinic Ann Thelander ‘accidentally’ discov-
Patient case study A 63 year old gentleman presented who had who undergone extensive excision and groin dissection for a pleomorphic sarcoma in the left adductor muscle. Due to a large seroma in his upper thigh his surgeon did not want a compression garment fitted initially. Massage was ineffective and painful because of the degree of hard fibrotic tissue throughout his thigh. Laser was the modality of choice and in one week with three laser treatments his L-Dex score had reduced from 69 to 52. (Normal scores are between -10 and +10). As his tissues were then much softer and his seroma drainage volume had reduced, a garment was then fitted six weeks after initial assessment, massage also commenced and his L-Dex score after two months of treatment (8 laser sessions and 2 manual lymphatic drainage sessions) had reduced to 17. After the first two months of intensive sessions he had monthly session of laser and massage and the L-Dex score is now stable at 14 with circumferential reduction of up to 7 cm at various leg segments.
ered the benefits of cold laser on lymphoedema while treating a musculoskeletal issue. “The patient returned with the unexpected news that her long standing lymphoedema in the affected limb had also improved. Ann sought out the only research available at the time involving the use of laser on medically induced oedema in rats in 1985 and used some of those basic parameters to form her own protocols. “To this day similar wavelengths and energy densities are used by clinicians around the world with some ‘tweaking’ as new laser units are manufactured and clinical responses documented.” The first research using laser for breast cancer related lymphoedema was undertaken by Ann Thelander in collaboration with Flinders University (Piller, et al, 1995). A scanning laser was used to treat the axilla and several 10 cm x 10 cm segments of the affected limb. Plethysmography measurements showed a mean decrease in volume of 19% following 16 treatments over 10 weeks. A randomised controlled trial in Adelaide finally followed in 2004 (Carati et al) which used the application of a handheld laser in the affected axilla alone. This showed no immediate improvement compared to the
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
control group, but interestingly, at three months follow-up, 31% of subjects shown had at least a 200ml volume reduction compared with only 2.8% in the placebo group. These ongoing and longer term improvements following treatment sessions are believed to be a result of reduction in tissue fibrosis through improved macrophage activity (which allows better lymph drainage) as well as stimulating collateral vessel regrowth. Bioimpedance Spectroscopy measurement is a sensitive and accurate method of determining changes in extracellular volume (ECV). Of interest is the fact that research has shown both immediate and sustained improvements in ECV following laser; even in areas such as trunk segments that have not directly been irradiated with laser!. This suggests there is a systemic affect in addition to the local response as a result of a cascade of chemical and enzyme changes that occurs through modulation of cellular activity when the light directly stimulates ATP production – the cells’ energy fuel.
Significant benefits Sharon told HealthSpeak that the first response that patients Continued next page
Physiotherapist Sharon Tilley using the cold laser on lymphoedema patients. 25
Allied health workforce growing The allied health workforce, which makes up about 25% of the health workforce, is growing, according to the Australian Institute of Health and Welfare (AIHW). ‘Nearly 154,000 allied health practitioners were registered in 2013, compared to just over 146,000 in 2012,’ said AIHW spokesman Dr Adrian Webster. There are 16 allied health professions registered through the National Registration and Accreditation Scheme, including psychologists, pharmacists,
Congrats Austin Curtin, Citizen of the Year North Coast Medicare Local is delighted that North Coast surgeon Dr Austin Curtin was named as Lismore’s Citizen of the Year in the city’s Australia Day awards. Dr Curtin is a general and laparoscopic surgeon, medical officer and educator, and a specialist medical officer with the rank of Major in the Australian Defence Force Active Reserve. He has been involved in clinical practice as a surgeon in rural NSW for the last 22 years and in 2005 he was appointed the inaugural chair of the NSW Institute of Rural Clinical Services. Dr Curtin is a member of the Rural Health Task Force, an Adjunct Professor at Southern Cross University and is acknowledged as an extremely empathetic and gifted medico
From page 25 usually reported was a reduction in symptoms such as limb heaviness, aching and tightness. This can be significant and immediate. Changes in bioimpedance measurement can also be immediate but circumferential change, using a tape measure for example, is a cruder method of objective change and often not seen for several months. At Sharon’s clinic laser is only one tool in the toolbox
26
From left: Lismore Australia Day Ambassador Clyde Campbell, Dr Austin Curtin and Lismore Mayor Jenny Dowell.
with a great interest in the wellbeing of all his patients. In the words of award nominator Graeme Davis, “This city owes people like Dr Curtin a great deal…recognition of his meritorious service and
and it is usually combined with other modalities such as lymphatic drainage massage, bandaging, compression garments and exercise therapy. Several patients have however elected to only have laser therapy as it’s been discovered through trial and error that the laser gives them the best result for the smallest financial outlay, an important factor in access to health care. In support of this, a small trial of 46 participants un-
devotion to the community as a general medical specialist (surgeon) since 1985 goes some way in acknowledging the man he is…Many patients owe their lives to his efficiency and skills.”
dertaken in the USA in 2013 showed that 20 minutes of laser was as effective in reducing symptoms as 40 minutes of manual lymph drainage.
Further advantages Apart from its effectiveness in reducing limb discomfort, swelling and fibrosis, the other advantages for the patient are that cold laser poses no negative impact on day to day lifestyle unlike other modali-
HealthSpeak
physiotherapists, dentists, dental hygienists, dental prosthetists, dental therapists, oral health therapists, occupational therapists, medical radiation practitioners, chiropractors, optometrists, Chinese medicine practitioners, podiatrists, osteopaths and Aboriginal and Torres Strait Islander health practitioners. Psychologists made up the largest proportion of registered allied health practitioners (19.8%), followed by pharmacists (18.2%), physiotherapists (16.6%) and dentists (10.1%). ‘The field of physiotherapy grew the most, with a full-time equivalent (FTE) rate of 83.3 employed physiotherapists per 100,000 people, up from 78.3 in 2011,’ Dr Webster said. Increases in supply were seen across most fields, including pharmacists (90.1 FTE per 100,000 people up from 87.1 in 2011) psychologists (86.2 FTE, up from 84.2 in 2011), and Aboriginal and Torres Strait Islander health practitioners (1.3 FTE, up from 1.1 in 2012). Average hours worked per week ranged from 29 hours for dental hygienists and dental therapists to 41 hours for Aboriginal and Torres Strait Islander health practitioners. Declines were seen in varous professions including dental therapists (3.2 FTE, down from 3.8 in 2012), dental prosthetists (5.0 FTE, down from 5.4 in 2012), and Chinese medicine practitioners(12.8 FTE, down from 13.2 in 2012).
ties such as thick multilayer bandaging which can affect ability to work, walk, dress, and even eat. Additionally, laser has no carcinogenic effect on normal tissue and several initial studies have even shown laser to have a ‘protective’ effect on normal tissue subjected to chemotherapy and ionising radiation as well as a proapoptotic affect on cancerous cells. Sharon said this would be one of the ‘hot topics’ for future research.
A publication of North Coast Medicare Local
autumn 2015
Partners in Recovery feature
Recovery through supportive partnering Partners in Recovery (PIR) is all about improving the Australian mental health system. It is funded by the Federal Government and is operating across the country. The program is based on two important notions. Firstly, that people experiencing difficulties with complex mental health issues can reclaim and build a meaningful life and contribute to the community with or without the presence of symptoms. Secondly, one of the main barriers to this process is just
Helping at end of life When PIR support facilitator Cristina Massia received an application from a palliative care nurse in Lismore asking for help on behalf of a patient, Cristina wasn’t sure that the case fitted the PIR model. “It was the first time that I’d received a referral from palliative care and when I saw it I thought ‘what exactly can I do for her?’ Initially, I didn’t think it was a referral for PIR – maybe she needed some home care. “I asked my practice leader and he said just because she has a terminal illness it doesn’t mean that she can’t ‘recover’. He said ‘of course she can be helped, we can help her to pass away in a good way’. And that was exactly what happened,”
how complicated the mental health system itself is. North Coast PIR is being delivered by a consortium of eight local agencies led by Mission Australia. The main work force on the ground is made up of support facilitators and peer workers. Peer workers bring lived experience expertise to the
Cristina told HealthSpeak. The woman referred to PIR – let’s call her Simone – had a number of concerns that PIR was able to resolve for her. Cristina said that Simone, a Buddhist and a poet, lived alone. She’d struggled with mental health issues her whole life and in the past 20 years this gentle woman had dealt with multiple myeloma (a blood cancer) and had gone through a stem cell transplant which unfortunately failed to halt the disease. Simone wished to remain at home until the final stage of life when she knew she might end up in hospital and wanted to be certain that her two cats, who were like her children, were looked after if she had to go into hospital. She asked Cristina for help and support so she could stay at home as
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
program by virtue of their personal experience of mental health recovery and their first hand understanding of complex health and support systems. Support facilitators work with individuals to identify and plan a personal route to recovery. This involves helping to integrate and coordinate all the various services and supports
Oh my darling, common sense is very uncommon long as possible. She also told Cristina that her biggest fear was to die suffering, as she saw her mother pass away in this way and wanted to do all she could to die at peace. Another concern was that while Simone wanted to stay at home as long as possible, there was talk around her of going to a nursing home, which was making her anxious. And the other factor causing Simone to worry was that
that the person might need. When the person feels able to manage the plan themselves PIR can gradually withdraw. Observations of the way the system does and doesn’t work are gathered from this work and from consultations with professionals and community members. Peer workers and support facilitators then help to build collaborative initiatives aimed at addressing particular issues. PIR staff in the Northern Rivers shared two cases with HealthSpeak readers to illustrate the nature of their work.
there was little communication between her various health professionals and care givers and she wanted the people looking after her to be in touch with each other and work in an organised fashion. The first thing that PIR was able to offer was for Cristina to organise a meeting of all of Simone’s health professionals and care givers. The meeting took place in the palliative care unit. “Nine individuals – including her psychiatrist, GP, community nurse, the PHAMS worker and social support worker came to the meeting and Simone chaired it, explaining what her needs were and that staying at home was very important to her. “Instead of people telling Continued next page
27
From page 27 Simone what they thought she needed, Simone was able to talk about what she needed and wanted and the whole group began really working together to ensure that Simone could stay at home and that her concerns would be met,” Cristina said. Simone was really grateful for the meeting and impressed that so many ‘important people’ had attended. “I told her that getting everyone to work together was really just common sense, but Simone said to me ‘Oh my darling, common sense is very uncommon,’ Cristina said with a smile. Partners in Recovery was able to play a key role in Simone’s ‘recovery’ by pulling all these services together as there was no one else who could have played the coordinating role for Simone. As a result of this meeting, Cristina was able to draw up a roster for services to visit Simone with one service attending every day except Sunday, which Simone wanted as her ‘day off ’, when she could stay in her pyjamas if she wanted. The local vet agreed to feed the cats if Simone was in hospital and if she was in for a longer period, he’d take the cats back to the vet clinic to be cared for.
Partners in Recovery feature
From left: PIR staff Debora Stafford, Jem Mills, Cristina Massia and Abby Brown
Cristina also set up an email group so that each member of Simone’s care team was able to communicate with everyone else about how Simone was going and what happened during their visits to her. Over the next few weeks Simone was able to relax in the knowledge that she could die in the way she wished with all her needs being met. When she died in palliative care, Simone had her sister and psychiatrist at her bedside and
Working holistically for the client Support Facilitator Amie Dutton joined PIR in November 2013. She describes her role in working for clients as being ‘kind of like Switzerland’. “I act as a neutral party for my clients, that’s my job. So I can hear from all the client’s services and communicate with them and others in a neutral way. Often there’s quite a bit of passion happening and some parties can get upset with various decisions. I can be the middle person who aims to communicate effectively with everyone, resulting in fewer concerns and issues for the client,” she explained. 28
Amie Dutton
Amie shared two client stories with HealthSpeak to help illustrate the breadth of PIR’s work. The first client, Joel, is coming up to 40 years of age and his mother is so pleased with what PIR has managed to achieve for Joel that she’s happy to share his story. Amie said that Joel has a
she passed away, after slipping into unconsciousness, in a peaceful way. PIR, helped by Simone’s PHAMS worker, was able to help her to die without suffering in the way she wished, and Cristina said that even after Simone died, her wishes were followed. “The funeral (which was held outside), the songs they played, even what the celebrant said and the poems she read were what Simone asked for.
The funeral was very beautiful because as the celebrant was reading the words, it started to storm and rain with a lot of thunder. The celebrant told the gathering that Buddhists believe that when a good spirit passes away, a storm comes. And there was this rain of leaves as well coming from the trees, it was just beautiful. “Normally after a funeral we can feel a bit heavy for a while, but Simone’s funeral left us feeling very different.”
diagnosis of schizophrenia and cognitive impairment and that Joel and his family had found it difficult to navigate the mental health system. When Joel was linked to PIR he’d been ‘off the radar’ for some time and was quite unwell. “His Mum had done a lot of hard work as any Mum would do in trying to advocate for the right services to come on board for her son and to support Jamie to live independently and feel part of the community,” said Amie. In order to help Joel become a citizen of his community, a number of organisations had been working with him, but for different reasons such as big workloads, budget cuts and organisational guidelines, none of them was talking to each other
about working with Joel. When Amie came into the picture, she worked predominantly with Joel’s Mum, who at this stage was feeling very unheard. “I organised a monthly case conference with representatives from the seven organisations working with Joel. Because Joel’s case is complex and his needs are great, I hold the meeting and write the agenda with the help of his Mum. Joel is invited to participate but because of his impairment rarely does, his mother usually speaks for him. “So we all sit around the table talking about his care, where there might be gaps and if something is being done particularly well,” Amie said. When Amie first became
HealthSpeak
A publication of North Coast Medicare Local
autumn 2015
Ability links – a new way to support people with disability Ability Links NSW is a model of support outside of the traditional disability service system, providing support for the person with disability, the family and carers. The service is delivered by Linkers, who work to help the person with the disability, their families and carers to plan for their future, build on strengths and skills and develop networks to do what they want with their lives. Ability Links NSW is specifically for those aged 9 to 64, who do not already access traditional disability support services, their carers and families. The service is now active throughout NSW.
Contacts: To access a Linker in Northern NSW, contact North West Alliance on 6620 1866. (Northern Rivers Social Development Council.) To access a Linker associated with Aboriginal service providers in Northern NSW, contact National Aboriginal
involved there were a lot of issues with Joel’s housing and gaps in service provision, but now his housing is stable. He was in danger of being evicted from his Department of Housing apartment because of some of his behaviours, but Amie was able to speak with the Department and they approached his neighbours and explained the situation. With Joel’s 40th birthday coming up, there’s a meeting planned followed by a lunch with all the different services involved with him and some of his friends. Amie said Joel’s Mum was very proud of how far Joel had come. Another case that Amie has taken up is a man in his 30s who is very isolated – he lives
and Torres Strait Islander Corporation Community Transport Network on 0427 779 992. To access a Linker associated with Aboriginal service providers in Kempsey and Nambucca and Port Macquarie, contact Booroongan Djugun Limited on 6560 2100.
To access a Linker associated with Aboriginal service providers in Bellingen and Coffs Harbour, contact Ngurrala Aboriginal Corporation on 6568 4400. To access a Linker on the Mid North Coast, contact North West Alliance on 6650 9771 (Mid Coast Communities.)
My role is to assist the client in their journey to recovery, whatever that may mean
has helped this client to trust. After spending time with her client, Amie approached a GP and asked if she’d visit the man at home. “This GP spent more than an hour and a half with the client and was just beautiful with him. She filled in all the Centrelink forms and provided the family with nutrition education. She is coming back for a second visit. Considering this family had not had one positive experience with a medical person this is real progress,” Amie said. The next steps are to organise some official ID for this client and Amie has social workers at Centrelink working on this. Then Amie will find a home visiting psychologist willing to work with someone who has
with his family effectively ‘off the grid’, suffers from agorophobia and is morbidly obese. This man has no ID except for being listed on his father’s Medicare card and is unable to leave the house. Through taking a ‘softly, softly’ approach and getting to know this man before making any suggestions for help, Amie
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
Briefs
Supplements for OA A multinational study adds weight to the evidence that taking a chondroitin and glucosamine supplement is just as effective for treating severe pain associated with knee osteoarthritis as the widely used anti-inflammatory drug celecoxib. Six hundred patients with knee osteoarthritis and moderate to severe pain found those randomised to receive chondroitin sulfate 400mg plus glucosamine hydrochloride 500mg three times a day experienced as much improvement in joint pain, stiffness and functional ability at six months as a group receiving daily celecoxib 200mg. The reduction in pain in the new study was both clinically important and statistically significant, with a 50% reduction observed in both groups, the researchers said.
severe agorophobia. “Working with such people through Partners in Recovery takes a great deal of time and knowing when to make a suggestion or just listen. I’m sure there are many people in similar positions to this man in our community. PIR can help, often by giving a client a positive experience. It helps that I am not from ‘The Department’, my role is to assist the client in their journey to recovery, whatever that may mean.”
Partners in Recovery are open to new client referrals. Please phone 1800 022 066.
29
Getting on a bike saved Michael’s life (twice) People’s paths to better health and wellbeing can be a little long and winding, certainly that’s been the case for North Coast photographer Michael Hanley. Indeed, just one month after he took up riding a bike, Michael suffered a heart attack. “I was 58 and a bit unfit, so I thought I’d get another bike. My GP had been suggesting I start exercising and eating better. I used to ride when I was younger but got busy with family and business, so first off I bought a training bike and within a month I suffered a heart attack. “At the time I didn’t realise it was a heart attack. I had throbbing shoulders and was hot and sweaty. I’d had a very hard massage the night before and thought that was the reason behind my pain. But I was feeling really tired and that night I drove myself to hospital at 4am and the doctor there gave me some painkillers, but didn’t test me for heart problems.” With Michael’s family history of heart attacks and his medical history including a small stroke, the lack of testing at the emergency department struck Michael as unusual. Fortunately, he had to see his GP for something else a few days later and after hearing about Michael’s pain and tiredness, a blood test was done, and on the basis of the results his doctor advised him to go straight to hospital. At John Flynn Hospital on the Gold Coast, surgeons performed a quadruple bypass on Michael and after recovering he got back on his bike, taking things slowly at first. He wasn’t put off because he said he realised he’d simply taken up
I lost about nine kilos in the first year I started riding
Michael regularly rides in events of 60 to 80 kilometres.
exercising too late and that he needed to recommence his exercise program after the surgery. In hospital he’d also filled out a questionnaire to gauge a patient’s level of depression. His results showed he wasn’t depressed. “I was rather surprised as my attitude was ‘I’m lucky to still be here – I should make the most of life,” said Michael. So he decided to give himself a goal and aimed to compete in the Sydney to Wollongong bike ride which was coming up later in the year.
“I gave myself this goal because otherwise I probably wouldn’t have done it. I ended up doing the shorter 60km course, although it still had a fair few hills,” he said with a smile. Since his first charity ride, Michael’s taken part in a number of long distance rides and credits his bike riding with saving his life a couple of times. His first brush with death came during a holiday in Fiji with family to celebrate his 60th birthday. “I was snorkelling and I
Michael encourges people to get more active in whatever way suits them.
30
HealthSpeak
sucked in some water and I drowned - my heart beat stopped, my breathing stopped and I went blue. “Fortunately, there was a nurse there and she came to my aid and then my brother in law performed CPI for about an hour until a helicopter arrived to take me to hospital. It was a close call as only seven per cent of people survive a drowning apparently.” Michael said the previous week he’d taken part in the Mt Coo-tha ride in Brisbane (80km) and because of his training he was fitter and carrying less weight than before. “I lost about eight or nine kilos in the year I started riding. If I hadn’t done that I would have drowned for sure. And shortly after that they decided to put a defibrillator in me, a pacemaker, just in case something like that happened again.” His second close call came during a go-kart riding event when he suffered a pulmonary oedema (fluid in the lungs). “I didn’t realise it could happen. I’d been to the heart specialist that morning, ridden my bike that morning, and my doctor reckoned I was one of his best patients as my heart capacity had improved by about 10 percent and I was exercising. But that afternoon I was competitive and I was overtaking a few people in my go kart and started getting really dizzy and Continued page 32
A publication of North Coast Medicare Local
autumn 2015
Risks are Rising After a period of relative stability, this year is shaping up to be one where financial risk will rise sharply as huge forces sweep through the world economy. The US economy is on the rise, which is good news. China appears to be slowing rapidly, which is not. The Euro zone is still depressed after years of financial austerity. Who can know the future of the heavily indebted nations such as Greece and how their fortunes will affect the Euro? Japan remains a basket case despite an eye-watering money printing program. Countries like Australia, Canada, Brazil, Russia and South Africa are suffering from a huge collapse in commodity prices that will put enormous strains on economies and budgets. The halving of the oil price may be good news for importing countries but it’s bad news for producers. It will also have huge geo-political consequences that are yet to emerge. At the same time interest rates are at record lows and world share prices are booming - fuelled by cheap money and an expectation that should anything go wrong, the central banks will step in and save the day. Unsurprisingly, there is no agreement amongst economists on how all this will pan out. Some suggest the good times in the US will continue and spread to the rest of the world. They say the risks have been overstated or are manageable. Others are saying these risks are rising rapidly and we are in for a period of rapid inflation, others suggest deflation. No wonder we are confused and nervous. One of the major risks relates to the outlook for the US economy when compared to the rest of the world. The US Federal Reserve has stated bluntly that its job is to do what is in the best interest of the US economy - and the rest
of the world should take heed. It is not, it says, a world central bank. This could mean rising US interest rates to curb a rise in inflation there that in turn could spark a huge surge in the value of the US dollar. As many countries and companies now have US dollar denominated debt, a rise in the US dollar will increase their debt loads leading to possible defaults. How this unfolds will have a major effect on investment markets and world economies.
Japan remains a basket case despite an eye-watering money printing program Another key risk is the inflation/ deflation scenario. Many central banks have embraced ambitious and unprecedented policies of money printing in an effort to get sluggish economies back to work. Orthodox economic theory suggests that inflation will rise if money printing occurs. But despite years of money printing since the start of the Global Financial Crisis, this has not happened - yet. In the US the Federal Reserves balance sheet grew from $US850 billion before the GFC to a staggering $US4.4 trillion today – all because of money printing. Japan embarked on an even more ambitious program and the European Central Bank is due to start one soon despite German opposition. Yet there is no sign of inflation. In fact, it’s the reverse. Consumer prices are rising more slowly in the US than they did before and in Europe and Japan the major threat apparently is deflation or
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
Economy David Tomlinson falling consumer prices. So why have we not seen rising inflation? The US Federal Reserve operates mainly through the banking system. The aim of Quantitative Easing was to help the banks get rid of questionable assets such as distressed mortgages by buying them thus freeing up cash that could be re-lent. But this has not happened as much as hoped. While some of this cash has found its way into the share market, a great deal has been hoarded by the banking system. In other words the banks have the cash but are not lending much of it out. Well, not yet anyway. Japan has a similar problem and Europe will probably be the same. If the mood turns positive then the banks may start lending freely and the inflation problem will re-emerge. Interest rates will have to rise and world share markets could be in for a major correction – the end of cheap money. But in the meantime, what about deflation? If deflation is caused by falling oil and commodity prices, this may not be a major issue. In fact it could probably boost the world economy and growth levels would rise. But if it is caused by falling demand, falling incomes and a weak
economy then serious problems emerge. Many governments and consumers are heavily indebted and falling incomes makes the debt problem worse. Borrowers will struggle to pay off debt, demand will fall even more and economies will slow even further. The problem for analysts is that both types of deflation are currently at work. In the meantime all eyes are on the US to figure out when the Fed will finally decide to push interest rates higher. This could be the year it happens.
31
Get with the program!
If you are feeling like an online dinosaur and want to ‘get with the program’, why not enrol in the North Coast NSW Aboriginal e-Social and Emotional Wellbeing Training Program, R U ‘Appy? This free three-day training offered by the University Centre for Rural Health North Coast will enable you to work and communicate better with Aboriginal clients and families, especially younger members. Participants will get confident with using apps and online programs. The program includes instruction in the use of iPads, Aboriginal specific apps and
From page 30 breathing very heavily. “So I pulled in and started coughing up blood. Fortunately thee was an off duty ambulance officer there who told me what to do – sit up and cough up the blood. I got an ambulance to hospital and there again being a little fitter helped too, because when I rang the off duty officer a few days later thanking him, he said he didn’t think I’d make it to the hospital. And even the ambulance guy said most people don’t survive this. So doing something – exercising on my bike helped.” These days Michael is less competitive and says while he
32
online therapy programs. Training is happening in the Tweed on March 11, 18 and 25 and in Lismore on March 12, 19 and 26. Training sessions will be rolled out in Coffs Harbour and Grafton between July and September. Following the training, participants get follow-up support through Aboriginal Health and Medical Research Council peer supervision groups that meet for two hours a month. For more information, contact Judy Singer at the University Centre for Rural Health at: judy.singer@ ucrh.edu.au or phone Judy on 6620 7570.
still keeps up with most bike riders, he can’t keep up with teenagers and racing professionals. “But at least I’m out there doing something.” When riding his push bike Michael uses a heart rate monitor to ensure his heart rate remains in an optimum range for his age and health status. He’s also on beta blocker medication to support his heart. He’s taken part in 130 kilometre rides and says he’s got more energy these days and his mood is better. “The tiredness has gone. Our business is doing school photography and we might photograph 1100 kids in a day and I still feel like going for
eBook: Enlightening Guide to PCOS A North Coast biomedical scientist and researcher has written an informative eBook on Polycystic Ovarian Syndrome, a common disorder affecting one in 10 women. Dr Linda Howland grew up in Lismore and now lives at Cumbalum. She has worked at universities and hospitals around Australia. Although common, PCOS is largely undiagnosed and often poorly managed. It affects women all over the world. PCOS is an hormonal imbalance that can affect a woman’s appearance, monthly cycles, fertility, mental health and longevity. Linda says that PCOS differs from person to person, so understanding what to look for and how to diagnose the condition is critical for good care and getting back on the right track to health and happiness. Linda is taking a break from work to raise her two
a ride when I get home. A few years ago I would have jumped on the couch and gone to sleep. “I feel much better than I did six years ago. It’s a little hard early on when you first start riding and you are not very fit. But after a month or two it becomes habitual.” Exercise is scientifically proven to improve a person’s mood and Michael’s noticed that bike riders are always happy, keen, ‘good to go’. “It just makes you feel better. You are out there pushing yourself, competing with yourself and that’s a good feeling. And because I’ve got a small business I often deliver things on my bike instead of taking
HealthSpeak
children and her passion for health science led her to pen the first of three eBooks on the topic of PCOS. The first in the series is called Enlightening Guide to PCOS and it includes Linda has PCOS herself and wanted to help other women, writing a simple and reliable guide on how to live well with this condition. To purchase her eBook, go to: www.healthhunterbooks.com
the car.” Michael recommends that anyone who is feeling unfit or a bit depressed should get up and do something. As he’s demonstrated there are many benefits. And Michael cites some evidence to prove it. “According to scientific data, riding a bike can increase your lifespan by up to five years and that includes the possibility of getting knocked over by a bus,” he said with a laugh. Michael lives at Skennars Head in Northern NSW and is keen to spread his message. He is available as a motivational speaker for schools and community organisations. Ph Michael on 6687 6911.
A publication of North Coast Medicare Local
autumn 2015
Travelling Outside the Guidelines It was such a beautiful day on the beach I did something unaccustomed and started to sprint but was soon stopped by a sharp blow to the calf. Before I had even half looked around for an assailant I realised it was my own unfit self – a torn Achilles tendon. After several weeks in a moon boot I was getting so seriously fed up with a lack of resolution, I contacted an orthopaedic friend for guidance. “It’s not really in the guidelines for this medication, but some people have reported favourably from using an angina patch directly over the injury. Theoretically it can improve blood flow to that difficult area. That’s not my professional advice so take it or leave it.” As we well know, Guidelines apply to procedures as well as medications and are designed to keep our patients safe and us out of court. Accessible Guidelines in complex or unfamiliar situations can be most useful, for example in the emergency department. Guidelines are good but they are only guidelines. The enmeshed inflexibility can stultify originality and useful experiment. Changes to embedded protocol can be difficult to absorb, for doctors and the public. When it was decided that chest compression in CPR outranks ventilation it was difficult to absorb. In my heart of hearts, I still have doubts about this but there is a bright side for the man and woman in the street, who no longer have to kiss unconscious strangers. Check out official British humour on the new guidelines. www.youtube. com/watch?v=ILxjxfB4zNk Closer to home, an anxious Mullumbimby midwife directed my attention to page 7 of the Byron shire news on 12 February, ‘Broken Head beckons for birth’. A starry-eyed couple having their first baby had made a
Roosters crowed and any ducks, dogs and cats around the home seemed to be very curious about human birth dash from Victoria to have their baby in the tea tree lake because ‘the lake has been a sacred birthing ground for thousands of years for Aboriginal people’. The midwife was concerned about safety aspects of meeting the request. This last case was of particular interest to me because of my homebirth practice in this region 30 odd years ago. It was a time so prior to the introduc-
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
Light Airs David Miller
tion of homebirth guidelines that common medical indemnity insurance did not even exclude the practice of home birth. Guidelines were built up on experience and close mishaps. Even then the lake would have been excluded due to a number of criteria: no phone, opaque water and poor access for transfer. A lack of privacy and difficulties setting up equipment would have contributed, although there was one case in which the mother wanted to labour alone in the surf and so the midwife and I had to observe her from the sandhills through binoculars. The guideline was clear that she had to move back home for the birth. In another case a woman was birthing in her claw foot chip heater bath and as the baby emerged a long and black glistening reptile with a small head charged out from under the bath between my feet, its tiny legs going like the clappers.
I got such a shock that the baby almost dropped back into the water. ‘That’s just George, ’reassured the husband next to me as he caught the baby, ‘he’s a perfectly harmless land mullet. The birth disturbance has brought him out. George was definitely outside the birth room guidelines which excluded animals. Roosters crowed and any ducks, dogs and cats around the home seemed to be very curious about human birth. It came to pass that ‘No animals in the birth room’ became etched as a guideline. What happened to today’s Lady at the sacred lake? This story has yet to be told. As with the Lady of the beach, she has been permitted by the wise midwife to have some labour at the water’s edge and then move into the mantle of safety at the Mullumbimby low risk birth unit for final delivery. Time will tell.
33
The OPG: recommended oro-facial diagnostic tool is significantly less than the radiation dose of a CT scan and while an OPG is complementary to CTs, it reveals more about the teeth and the immediate surrounding bone since CTs can produce significant scatter artifact around the tooth level, especially in patients with multiple amalgam fillings. The OPG should be considered as an initial evaluation of oro-facial pain as well as a screening tool in suspected cases of poor oral health and in suspected cases of impacted, non functional teeth, jaw cysts and tumours. With some training in the interpretation of panoramic images, GPs and other clinicians should be able to include this investigation into their clinical armentarium. Below are a couple of examples of the usefulness of an OPG.
By Dr Wojciech Bilski, Dr Arthur Bilski and Dr Mehmet Oztel
The OPG (orthopantomoram) is a panoramic radiograph of both the upper and lower jaws as well as all teeth present. Its usefulness in diagnosing oro-facial pain and disease can be compared to the usefulness of the CXR in general medical practice. The OPG is a very useful tool for GPs in the investigation of or-facial pain as well as screening of oral health. This wide view radiograph of the lower face demonstrates normal anatomy as well as pathology of the jaw bones, teeth and surrounding structures including para-nasal sinuses and temporo-mandibular joints. This imaging modality provides the best return on investment in the investigation, diagnosis and management of many oro-facial conditions. It should be ordered before considering a CT scan. Many patients visit their GP as the first point of contact for advice and management of dental conditions and oro-facial pain. In fact, many patients may attend general practice more frequently and often preferentially to dental
Impacted and decayed wisdom teeth
Bilateral mandibular fracture : right angle and left body of mandible
practitioners because of perceived barriers to oral health care. It is a conservative estimate that more than 50% of Australians do not attend routinely
for preventive oral health care, only attending a dental practice in case of emergency, ie severe pain or infection. . It’s interesting to note that the radiation dose of an OPG
Tweed group offers hands on support A not for profit organisation has been set up to support people living with mental illness in the Northern Rivers and on the Gold Coast by providing a range of healing therapies free of charge. Shambhala United Network Inc (SUN) has been operating since August last year and its founder Katrina Semple told HealthSpeak that SUN was made up of a team of qualified volunteers specialising in various therapies and modalities. These include chiropractic services, hypnotherapy, dance
34
therapy, nutritional advice, cognitive behavioural therapy, yoga, massage, meditation and art therapy. Katrina wants to alert local GPs to what SUN can offer
and says her organisation aims to complement treatment received from mental health practitioners. “Our treatments are designed to help people who are on a GP mental health plan and have a referral from either their GP, psychiatrist or a psychologist to SUN. We aim to help them keep their regular medical appointments and to stay on track with prescribed medications,” she said. Katrina said SUN works to improve the health and wellbeing of people with mental
HealthSpeak
Drs Arthur and Wojciech Bilski are qualified in medicine and dentistry and work in specialist oral and maxillo-facial surgery practice in Lismore, Ballina, Grafton & Coffs Harbour. Dr Mehmet Oztel is a medical practitioner currently completing a degree in dentistry at James Cook University in Cairns.
illness by providing them with supportive therapeutic services. “Once we assess a person’s circumstances we create an individual three-month program for them involving appointments with a range of volunteers.” Katrina has a long term vision of opening a half way house for those needing to make the transition between a mental health ward or a drug and alcohol rehab clinic to home. To find out more about the Shambhala United Network, go to: www.sun.org.au or email: info@sun.org.au
A publication of North Coast Medicare Local
autumn 2015
Books with Robin Robin Osborne
The Sick Rose Disease and the Art of Medical Illustration Richard Barnett Thames & Hudson While I loath to borrow from a jacket blurb, the following encapsulates what is aptly described as a “stunning volume”. The Sick Rose – the title is taken from verse penned by William Blake - is indeed “a beautifully gruesome and strangely fascinating visual tour through disease in an age before colour photography… [it] reveals the fears and obsessions of an era gripped by epidemics.” The tone is set by the cover illustration of a Viennese woman depicted during the later stages of cholera in the first European epidemic in 1831. It gives a taste, if that be the word, of the extraordinary,
Briefs
Breakthrough antibiotic Scientists have discovered a new class of antibiotic using a procedure hailed as a game changer in the hunt for medicines to fight drugresistant infections. The antibiotic, called teixobactin, kills a wide range of drug-resistant bacteria, including MRSA and bugs that cause TB and a host of other life-threatening infections.
It could become a powerful weapon in the battle against antimicrobial resistance, because it kills microbes by blocking their capacity to build their cell walls, making it extremely difficult for bacteria to evolve resistance. However, years more work lies ahead before the drug could be available. Human clinical trials could begin within two years but more development would follow that. At the moment the drug would have to be given as an injection, but an oral pill would be more attractive.
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
full-colour illustrations within. They are grouped in ten chapters ranging from Skin Diseases (‘The Boundary of the Body’), Smallpox, Tuberculosis and Cancer, through to Venereal Diseases (‘A Lifetime with Mercury’), Parasites and Gout (‘Fashionable Agony). Each disease group is accompanied by artistically anatomical illustrations of the highest order. People from all continents exhibit lumps and rashes, pustular eruptions and tumours, gouty outbreaks and ulcerated intestines. There are dissected hearts, mosquitoes and maggots, public health posters
Each time opening this book one encounters a visual cavalcade of diseases warning about syphilis, maps showing the global distribution of leprosy and the incidence of cholera in London in 1848-49. Each time opening this book one encounters a visual cavalcade of diseases, mostly in advanced stages, seldom, if ever, seen in modern society. The instinctive reaction – regardless of clinical detachment - is to recoil, but the counter response is to marvel at the excellence of the images. Then there is the text, albeit in miniscule type. While the histories of the various diseases and how they were managed (or mismanaged) is clear and chronological, the short, opening sections are outstanding in their style and erudition. Author Richard Barnett, whose accomplishments include Medical London – City of Diseases, City of Cures, and guiding walks on the cultural history of medicine in the city, begins with ‘Medicine and art in an age of revolution’. “This book is about a revolu-
tion in the ways that Western medical practitioners have seen the human body, and the ways in which they have known disease. “In the hundred years or so in which these images were made – from the last decade of the eighteenth century to the first decade of the twentieth – Western medicine began a conversation with modernity in many forms: science, technology, industrial society, urban life, mechanised warfare, the long shadow of imperialism. “In doing so it decisively abandoned an ancient consensus about the structure of the body and the meaning of disease.” The books in which these illustrations appeared were “the fruit of a sophisticated collaboration between anatomists and artists, engravers and printers, publishers, professors, teachers and students – not forgetting the bodies of the dead.” The adoption of photography may have “reflected the changing state of science and medicine at the end of a revolutionary century,” but “un-retouched photos gave near-equal emphasis to everything in the field of view.” In an engraving or lithograph “the artist could use shading and texture to bring out the significant parts of a specimen.” Despite this apparent advantage, on display clearly in this book, the mid-19th century monochrome woodcuts in Gray’s Anatomy by Henry Gray – later carried off by smallpox – and fellow surgeon/artist HV Carter, came to ‘”symbolise medical illustration in the first age of photography.” As Barnett explains, these were “closer in spirit to an engineering blueprint than a painterly still life,” seeming to “reach forward, evoking the kind of mechanical objectivity that by the end of the century would come to be associated with scientific photography.” The age of great medical illustration was ending, having played such a vital role in the development of an enlightened society. 35
Path to becoming a Rehab Physician By Dr Roslyn Avery
HealthSpeak approached Rehabilitation Physician Roslyn Avery who works in the Hastings/ Macleay area to tell readers how she came to be working in her specialty and what her work involves. My initial qualifications were an Honours degree in Science, working in research then changing to Clinical Biochemistry. After this, I lectured in Clinical Biochemistry and laboratory techniques. Because of my love of learning, I undertook postgraduate studies in Occupational Health and Safety and started a PhD in this field. However the clinical side of this work fascinated me more and I was accepted into Medicine. While my husband was supportive, my studies were not always easy and I had my third child while studying. After completing my degree, I toyed with being a GP but became interested in Rehabilitation Medicine as it was a specialty which was holistic, requiring specialized knowledge but working with a multidisciplinary team to ensure the best functional outcome. After gaining my fellowship in Rehabilitation Medicine, I worked at John Hunter Hospital as Stroke Fellow working with eminent stroke specialists Professors Chris Levi and Mark Parsons. This was a really stimulating period when I was involved
in acute care, research and rehabilitation of stroke patients. Following this I worked as staff specialist in Orthogeriatric Rehabilitation at John Hunter and established a private practice in Newcastle, specialising in neurological rehabilitation. In 2010, at a time in my life when I welcomed a change, I was approached to establish a new Rehabilitation Unit at Forster. I was happy to take up this challenge. As Director I was pivotal in the establishment of the Unit. We developed an enthusiastic and skilled allied health team there and there is now a successful 25 bed Rehabilitation Inpatient Unit with day therapy running in the Private Hospital at Forster. I was enticed to Port Macquarie to be Director of the Private Hospital Rehabilitation Unit and moved up here in 2011 with my partner. The Port Macquarie Rehabilitation Unit has been enlarged and includes 10 new beds, a beautiful hydrotherapy pool, an expanded gym and we plan to provide quality day therapy with top class facilities and a skilled team. We will provide a comprehensive Rehabilitation Service to the community of Port Macquarie, Kempsey and surrounds. After settling into Port Macquarie, I relinquished my role in Forster Rehab Unit this year. I currently work as Rehabilitation Specialist in the small Rehabilitation Unit at Wauchope District Hospital as part of the MNCLHD.
It’s a fascinating but challenging job
Roslyn Avery
The role of a Rehab Physician It’s a fascinating but challenging job. I diagnose and assess a person’s function associated with injury, illness or chronic conditions in order to either medically manage or set in place an individual treatment plan involving a therapy team. I provide specialist knowledge and expertise in the prevention, assessment, management and medical supervision of a person with disability. My specialist training includes paediatric, adult and geriatric rehabilitation. I work on a range of neurological disorders including stroke, cerebral palsy, spinal injury, brain injury, spasticity, Parkinson’s Disease and MS; musculoskeletal and orthopaedic conditions, acute and chronic pain (including back, neck and nerve pain); amputa-
tions; occupational injuries; cardiorespiratory disorders; and other conditions including cancer and burns. I am actively involved with the transition to adulthood via coordinated care and the management of patients with developmental disorders such as cerebral palsy and spina bifida, including spasticity management. My specialist interests are stroke, brain injury, spinal injury, degenerative back rehab, neuropathic pain management, spasticity including botulinum toxin injections, assessment and management of complex gait disorders and geriatric rehab and reconditioning. My work is very satisfying and I am constantly reading, learning and attending courses and conferences to maintain evidence -based best practice care for my patients. Some of my most rewarding work has been with patients with severe head injuries or strokes with severe spasticity and the inability to walk. To see these people walk after many years of wheelchair dependence is very satisfying. To contact Roslyn, phone her on 6581 5501 or email: drroslynavery@newstartrehab.com.au
Doctors for Refugees Doctors for Refugees is a not for profit organisation that welcomes all support in its campaign to improve the healthcare of asylum seekers and refugees in Australia. Its committee members and others work on a voluntary basis. Allied health practitioners and community members are welcome to join. The organisation exists because over the past decade or so Australian governments have imposed increas-
36
ingly harsh conditions on those seeking asylum under the UN Convention of 1951, to which Australia is a signatory. Doctors for Refugees says these conditions have had a devastating effect on the health of these individuals and believes that health care professionals have an obligation to speak out. To find out more or join, go to: www. doctors4refugees.org/
HealthSpeak
A publication of North Coast Medicare Local
autumn 2015
Wine and good health Savouring and storing slow wine I always thought ‘slow food’ was what emerged from a low temperature oven, perhaps a roast which had spent hours gently cooking through the day, to savour at dinner time. This is erroneous of course, but it got me thinking about ‘slow wine’, and how it may also make you healthy. The reality of the slow food movement dawned on me with a little research, with words like providence, connection and sustainability. I hadn’t heard of ‘slow wine’, so was delighted to find the Slow Wine magazine. It mainly showcases Italian wines, which is fitting given Carlo Petrini started the slow food movement there in 1986. Slow wine is also all about knowing where your drop has come from, who made it and whether it’s been made in a truly sustainable way. So let’s give this a twist, and redefine the concept of slow wine as depending not only on slow food ideas, but also on a number of other factors. I believe wine which is good for you comes from old vines, is picked when ripe and spends a good amount of time in old wood and then a bottle. It is brought to you slowly in fact. For me, the slower the better, though some wines demand to
Chris Ingall
Savour the aromas and tastes, texture and length, and see how they change in the glass over time. be drunk young, such is their trajectory. And how does this affect your health, dear reader? Well, slow wine tends to be balanced wine, as we can always trust in nature. This means lower alcohol and the need for fewer preservatives, such as sulphur, giving a tendency for the wine to live longer in the bottle. The use of biodynamic methods in the vineyard complement this, making for a better soil profile, improved vine vigour and better balance of sugar and tannins in the grapes. I prefer wines made from such grapes, as they seem to be both gentler on my liver and more delicious in my mouth.
HealthSpeak A publication of North Coast Medicare Local
autumn 2015
Win, win really. A good example is the Rockford Basket Press shiraz, made from unirrigated (60 to 120 years) old vines, pressed ever so gently, and the free run of juice is given just the right amount of time on skins and in oak. The wine is then bottled and continues its journey over the next 20 years or so in hibernation. Everything about this wine is sweet and gentle, but the compilation of parts is very powerful, verily a steel fist in a velvet glove. This sort of wine is so enjoyable to drink anywhere along its journey, but again waiting for it at least 10 years brings great rewards. Just having it in your cellar is a reward in anticipation! Lastly, try to get to know a little about where the grapes are grown. If you have visited the winery, met the winemaker and tasted the wines at the cellar door, all the better! Knowing the travails of any particular vintage adds to that connection, and over many vintages you will build a relationship with not only the vintners but also the wine itself, experiencing how it changes with the weather. Oh and there is one other slow bit I’d recommend … drink the wine slowly with friends, preferably ones you have known a while. Take time to savour the aromas and tastes, texture and length, and see how they change in the glass over time. You can even have it with slow food!
Wine Tip Some wines take time to show themselves in the glass, sometimes taking up to an hour to fully express themselves. Decant such wines (usually young reds) to hasten the process. In general, if a wine is slow to open, it will cellar well. And remember to have a half bottle handy, preferably one with a Stelvin cap if you want to go back to the wine in a week or so. Fill the half bottle to the very top to minimise the chance of oxidation and the wine may last a month for you!
Cellar Tip Want to be sure a wine will cellar well? Choose wine with a Stelvin closure. Green and purple (like Kendall’s bellbirds) augur well as colours for longevity for white and red wine respectively. Old vines usually give a measure of distillation which concentrates the end product and gives balance to the mix. Pick a wine with a lower alcohol content; it will last longer in the cellar. And lastly, look at the pedigree of the wine. The Langton’s classification is helpful here, with wines such as the better Penfolds’ reds, Tyrrells’ semillons and Clare valley Rieslings shining for a decade or more.
37
Travel An Australian Abroad
Turkey
Above and inset: Cappadocian ‘moonscape’ with houses and churches carved into the rock
By Alex Lewers Having spent the previous two weeks basking on Greek Islands, it was hard to imagine how life could get any better. Sun drenched beaches with postcard blue waters, largely deserted thanks to visiting at the end of the season, sure were going to be hard to beat. Yet, it didn’t take long for Turkey to nestle in and find a very special place in our hearts. From slurping mussels in Istanbul and walking through the historic Blue Mosque, to wandering the shores of Gallipoli and the ancient ruins of Ephesus, climbing barefoot up the white thermal pools of Pamukkale and diving into the warm aqua waters of the south (think cheaper Greek Islands with better food), Turkey was everything we wanted it to be and more. However, one place stood above all others and completely stole our hearts. Prior to visiting Turkey, we had never heard of Cappadocia let alone planned to visit. Yet, after speaking with locals, it was clear it was a place we simply had to see. Cappadocia is part of the central Anatolian region of Turkey and is a large volcanic landscape sculpted by thousands of years of erosion. Stepping off the bus there is like being dropped into a surreal moonscape in a far off ancient time. Every day we would set out on a new trail, hiking for hours through the different valleys (one aptly named Love Valley 38
which featured huge phallic rock formations), and exploring ancient churches and houses carved into volcanic rock and decorated with detailed frescoes. Wandering around you can still see the places local inhabitants would hide to protect themselves against neighbouring armies when they rampaged through town over a thousand years ago. All up, we spent five days in Cappadocia and we could have spent much more. On our last day, we stopped at a small church just outside the town of Goreme. We were greeted by a local Turkish man who maintained the church, and after showing us inside he invited us back for tea. We squeezed into his tiny working quarters where he had a pot of tea already on the boil. I should say here that Turkey is the largest consumer of tea per capita in the world and drinking tea is almost a second religion, so much so that any attempt to explain that I don’t drink tea or any hot drink, was met with confusion and usually followed by a glass of steaming hot tea. Through his broken English and our terrible Turkish, he proceeded to tell us that he also worked as a masseur at the Hamam in town and asked if we would like a demonstration massage (like tea, massages aren’t high on the list of things I love). So with tea in hand I again accepted, not wanting to appear ungrateful. Now, by this stage in most of Europe you’ve been fleeced of a couple of Euros for the pleasure,
so naturally I was curious about where the catch was to all this generosity. So when our new friend produced a small key and began telling us about a secret church up in the cliff face that was locked to the public, but that we could visit, I began to think ‘this is where we get robbed and lose a kidney’. But alas it was just one of many experiences of the incredible Turkish hospitality. Since beginning our European adventure over six months
ago, I can honestly say I haven’t experienced anything close to Turkey. The people we met in Turkey were all extraordinarily friendly, good humoured and generous (almost disconcertingly so at times), the landscape is some of the most diverse and striking I have ever seen, the region’s history surrounds you at every turn and, and perhaps best of all, the food is delicious.
The Famous Blue Mosque Istanbul
The white walls and hot springs of Pamukkale
HealthSpeak
A publication of North Coast Medicare Local
autumn 2015
more services · quality facilities
Trivia What is the name of the dog featuring in Enid Blyton’s Famous Five books? 2 A photovoltaic module is more commonly known as what? 3 The fruit in tarte tatin? 4 Roman goddess of the hearth? 5 A maker of arrows? 6 What was the title assumed by an ancient British chief claiming supreme power? 7 What is the name of a lively Spanish dance by a couple usually accompanied by castanets and guitar? 8 Who said “I don’t care what anybody says about me as long as it isn’t true”? 9 What successful 2008 film starring Angelina Jolie did Clint Eastwood direct? 10 Name the ballet dancer who requested asylum in France while in Paris with the Kirov Ballet, in June 1961? 11 Who did Marilyn Monroe marry in January 1954? 12 In the TV series Dr Who, what does the T in TARDIS stand for? 13 Janis Joplin, Jimi Hendrix and Kurt Cobain all died at what age? 14 In what year did Cyclone Tracey hit Darwin? 15 What is the world’s oldest currency still in use? 16 Hansen’s Disease is more commonly known by what name? 17 In which country was the ancient city Ecbatana? 18 What type of creature is a crappie? 19 Roman numeral LXXXVII is what number? 20 A third wedding anniversary is traditionally represented by what material? 21 How many stars are on the national flag of New Zealand? 22 What is the largest sand island on Earth? 23 Nancy Shevell married which English singer/ songwriter in October 2011? 24 Which artist is known for his ‘Blue Period’? 25 Philophobia is the irrational fear of which emotion? 1
•Sports & Orthopaedic Conditions •Treat Spinal Pain with mob/ manipulation and Sarah Key Method •Acupuncture for myofascial pain/ muscle spasm •Gym & Pool rehabilitation •Biomechanical analysis for runners and dancers •Orthotics using Gaitscan Technology •Waterproof casts / braces / splints •Vertigo & Balance Disorders Tony Morley & Emile du Plessis and Associates Physiotherapists MAPA
Lismore & Ballina Free Call 1800 662 125
KEEP CALM WORK WITH US AND
Calling all GP’s & AHP who have an interest in the health of young people: headspace Port Macquarie would love to hear from you. Contact Jenny Sinclair on 02 6588 7300 or jsinclair@each.com.au for an informal discussion.
Vacancy: Practice Nurse – Maclean Seeking a PT or FT registered nurse for wellestablished, busy practice Orientation and training provided. Practice nurse experience desirable. Position responsible for a range of work including triage, ECG, asthma,diabetes and wound care and immunisation.
Gabrielle Boyce and Associates 581 Ballina Road, Goonellabah Phone (02) 6625 2888 Open extended hours
OPEN extended hours Goonellabah pharmacy is now open: Monday to Friday – 8.30am to 7pm Saturdays – 9am to 4.30pm Sundays – 9.30am to 1pm
Goonellabah Pharmacy For all your health needs Goonellabah Village, Oliver Avenue Phone 6624 2449
Autism Awareness Expo 2015 At Goonellabah RSL Sports Club Thursday April 2, 2015 from 10am to 2pm Relevant stallholders invited to participate Contact Wendy on 0418 280 669
Part-Time GP Vacancy in Ballina Moon Street Medical Centre is looking for a GP to work three days a week in our busy practice. Position available now Contact: Tracey moonmedical@bigpond.com or Ph 02 6686 2611
GP Locum available Dr Mark Rathbone MB, BS, FACRRM is available from Monday 9th March to Friday 17th April 2015. A VR GP with 30 years’ experience in both group and solo rural general practice and unconditional registration. A Locum since 2005 Mark has worked at practices in Victoria, SA, Qld, NSW and WA. Coastal or inland locations possible.
Applications or queries to: manager@unionstmed.com.au
Please phone 0429 979 921 for more information. Or email btlocoums@bigpond.com
Urgently seeking GP Lismore Family Planning Service
Katt McDonald OT & DriverRehab
Lismore Family Planning offers specialist reproductive and sexual health services. We offer bulk billed services and are looking for a Medical Practitioner to join our clinic. In addition to the Thursday and Saturday clinics at Lismore, there is an option to work at our Kyogle Outreach clinic every second Friday. You should be registered with the NSW Medical Board with current authority and provider number for NSW, and hold the SH&FPA certificate in Sexual and Reproductive Health. This position offers casual hours in Lismore/Kyogle and above award conditions.
2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
TRIVIA ANSWER 1. Timothy or Timmy or Tim A solar panel Apples Vesta Fletcher Pendragon Fandango Dorothy Parker Changeling Rudolf Nureyev Joe Dimaggio
12. Time 13. 27 14. 1974 15. Pound sterling 16. Leprosy 17. Iran 18. Fish 19. 87 20. Leather 21. Four 22. Fraser Island in Queensland 23. Sir Paul McCartney 24. Pablo Picasso 25. Love
HealthSpeak A publication of North Coast Medicare Local
For further information contact Julie on 66201870 or applications@nrsdc.org.au
autumn 2015
Occupational Therapy and OT Driving Assessments Mobile service from Tweed to Grafton E-mail: kattcooper1975@gmail.com Ph: 0417 913 354 (Previously Kathryn Cooper DriverRehab)
PATHOLOGICAL WASTE DISPOSAL Container Collection/Exchange
RICHMOND WASTE SERVICES Phone 6621 7431 – 6687 2559 Lismore • Ballina • Casino • Byron
39
Care Services
CARE
SERVICES