HealthSpeak September 2017 by North Coast Primary Health Network

HealthSpeak THE VOICE FOR HEALTH PROFESSIONALS – FROM TWEED TO PORT MACQUARIE

issue 19 • September 2017

CELEBRATING THE STARS OF PRIMARY HEALTH CARE Highlights from the 2017 Primary Health Care Excellence Awards – from page 14

Special Feature p25

CHRONIC DISEASE MANAGED BETTER TOGETHER

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

n this issue we celebrate the many projects and programs on the North Coast that are improving the health and wellbeing of our population. Congratula-

ceo Vahid Saberi

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

Contacts Editor: Janet Grist Ph: 6618 5400 Email: media@ncphn.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Design and illustrations: Graphiti Design Studio Email: dougal@gdstudio.com.au Display and classified advertising at attractive rates HealthSpeak is published three times a year by North Coast Primary Health Network. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCPHN. The NCPHN accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. ©Copyright 2017 North Coast Primary Health Network Magazine designed by Graphiti Design Studio www.gdstudio.com.au Printed by Quality Plus Printers

HealthSpeak is kindly supported by

trust you will be encouraged to look at how you or your practice can provide even better care for patients with chronic conditions. We’re also excited to include a pamphlet outlining the various mental health and alcohol and other drug services commissioned by NCPHN over the past 16 months – just one part of the work we are doing to fill gaps in health services.

Joined-up healthcare unattainable without electronic records

Northern Rivers 2A Carrington Street Lismore 2480 Ph: 6627 3300 Email: enquiries@ncphn.org.au

Health Speak

tions to all finalists and award recipients, there is some truly inspiring work going on. Chronic disease care is also an area where health professionals are working together to improve people’s everyday lives. In our Chronic Disease Feature we meet North Coast allied health professionals really making a difference both in the acute setting and within the community. We

ome May 2018 and My Health Record will move to an opt-out model. Right now community members have to opt-in to activate their personal electronic records. From 1 May next year, a My Health Record will be activated for all, and those not wishing to participate will need to opt-out of the system. Considerable investment is being made to prepare the community and health providers for this change. Much of this work will be carried out by the Primary Health Networks (PHNs). Health care generates enormous volumes of data and information. This information is invaluable for a better understanding of demand, good planning, wise investment and continuous quality improvement. While, over the past two decades, health professionals have been reasonably quick to adopt computerisation and embrace customised software, the establishment of a nation-wide electronic health record has been

The person can access their own health records, allowing them to manage their health information. evasive. For clinicians and service providers electronic Health Records can improve efficiency and save time and money. They can also make care planning and referral between various clinicians and providers more manageable. At a time when half the population has one or more chronic diseases, accessing on many service providers, the ability to exchange health information electronically is essential for quality and safety. Indeed, integration and connecting up services are not attainable without a universal electronic health record platform – My Health Record. A digital record that is shared between multiple, authorised clinicians, saves time and reduces the need for clinicians to chase patient information. The record is gathered over time and provides

a good medical, diagnostic and personal information history to the clinician – it is more complete and legible. This information is also available to the person themselves. The person can access their own health records, allowing them to manage their health information in a private, secure and confidential environment. It is therefore surprising that some clinicians and services have still not made the move from a paper-based system to electronic. There are many incentives in the system to assist this transition. Some still hold reservations on the basis of privacy and security of information. Without a doubt privacy and protecting patient data are important and we have to take every step necessary to safeguard the information from cyber criminals and malicious hackers. But we have passed the time when these concerns can be barriers to change. We have also passed the early adopters’ time and many of the bugs and nasty things in the system have been ironed out. The time for dragging one’s feet is over and it is those who embrace this change that will reap the benefits for themselves and the community. NCPHN is here to support you through this change.

Cover image: Formed as a community response to the recent Lismore floods, Helping Hands wins the Community Choice Award at the 2017 Primary Health Care Excellence Awards a publication of North Coast Primary Health Network

healthspeak September 2017

The health impacts of the baby boomer bulge 1976

90 MALES

FEMALES

MALES

FEMALES

Age

40 30

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0.5

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Percentage at Each Age

Ps are finding the complexity of managing patients with chronic diseases is forever increasing along with the number of such patients presenting. While there's lots of talk about the ageing population and its impact on health services provision and the Budget, there is less talk about the baby boomer population who are now turning 70. They will bring with them not only a bulge around the waist but the many chronic diseases associated with obesity. One only has to look at the baby boomer pyramid to see the effect this may have on future health needs. According to the US Census Bureau, in 1946 roughly 2.4 million baby boomers were born, and by 1964 (the last year of the baby boom) there were 72.5 million baby boomers. Today, baby boomers range in age from 52 to 71 years old. Every five years each age cohort scales up the pyramid. Australia has similar trends. In a recent ABC RN Health Report, Dr Norman Swan interviewed health economist Professor Simon Ackerman about his new book Health Economics from Theory to Practice http://www. abc.net.au/radionational/programs/healthreport/the-healtheconomics-of-ageing/8738504 Ackerman suggests that in the face of a rapidly ageing population there is urgent need for reform in health and aged care. September 2017 healthspeak

1.0

MALES

FEMALES

Baby Boomers Source: Compiled by the author. 1976, 1996: ABS Census of Population and Dwellings; 2016: ABS 2000, Catalogue 3222.0, Series IIa

clinical editor Andrew Binns

2016

Age

1996

0 0.5

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Without this reform, the baby boomer bump will put unsustainable pressure on Australia’s health spending. He says one of the reasons for health cost blowouts is expensive new technologies and costly government policies. When you add in the baby boomer population bulge, the problem becomes even more critical. He says that “up until now we haven’t really experienced in terms of health expenditure the impact of ageing, because we’ve had such a large increase in life expectancy that it’s been protective of the ageing effect. There are fewer people dying in any given age cohort and a lot of our health expenditure is associated with proximity to death.” The oldest baby boomers are now 71 and the youngest 52. It is when this population gets older the health system will be strained. We need age and health care reform, because by 2050 we will have three times as many people over 85 and three times as many people with dementia. The predictions by the Productivity Commission in 2006 were that by 2050, 50 per cent of health expenditure will be explained by ageing costs, and a lot of that with end-of-life costs. Baby boomers have tended to be very assertive and that trend is likely to

continue with particular demands around successful ageing. So, the pressure will be on for better health promotion policies, and creating age and dementia friendly communities and cities. This will require social and environmental planning with lots of incentive to remain physically and socially active and engaged. Keeping people out of nursing homes will be a priority. Health Care Homes will need to involve Lifestyle Medicine rather than relying on excessive use of new technologies. GPs and the allied health teams they lead will play a central role in

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keeping people in their homes for as long as possible while trying to avoid hospital and nursing home admissions. High quality palliative care will be important. Shared Medical Appointments will become commonplace to complement one to one consultations. The sooner the government funds more training for the primary care workforce in these preventative health strategies the better. If we keep going as we are, aged care will simply become unaffordable over the next few decades.

The pressure will be on for better health promotion policies, and creating age and dementia friendly communities and cities

Art on Bundjalung nurtures new artists

series of eight art workshops with two or three sessions each has been held in the Northern Rivers for members of the Bundjalung community. These workshops encouraged both experienced and emerging artists to produce artworks for an exciting exhibition at the new Lismore Art Gallery later this year. NCPHN, Arts Northern Rivers, Lismore Regional Art Gallery, Bulgarr Ngaru and UCRH North Coast are sponsors of the Art on Bundjalung Country project. Some of the artworks produced during the workshops will be on sale at the December exhibition. Art on Bundjalung Country grew out of two Aboriginal art exhibitions held at the Lismore City Hall in 2004 and 2009. They were inspired by local doctors working in Aboriginal Medical Services and were successful on many fronts. There were sales of more than $50,000 for each of these exhibitions and

Vase produced in ceramics workshop led by Penny Evans.

this provided income for the artists along with some profit directed to further build an Aboriginal art industry and some for equipment for the Casino Aboriginal Medical Service. The workshops are being held until the end of September in Lismore, Brunswick Heads, Maclean, Casino, and Tweed Heads. The art forms include painting, basket weaving, and ceramics. It is envisaged that the exhibition will further stimulate the art industry to meet the growing market for Aboriginal work.

One of the basket weaving artworks being created by a workshop participant.

It is hoped such work will be seen in health facilities, foyers, waiting rooms, shops and homes in the region and beyond. Art on Bundjalung Country Project Officer Sarah Bolt said that the

PN Networks a welcome development IN MAY, North Coast Primary Health Network, in partnership with the Australian Primary Health Care Nurse Association (APNA), launched four professional nurse networks for the North Coast. The Primary Health Care Nurse Networks launched in the Hastings Macleay region, the Mid North Coast, the Northern Rivers and the Tweed. Each network will meet at least four times a year and the networks will be nurse-led. The new Networks came out of a survey conducted early this year by NCHPN and Southern Cross University, which identified support for such networks. The networks will • Expand professional

networks and peer support for PNs • Provide professional development opportunities • Involve nurses in quality improvement and health improvement initiatives • Increase leadership capability “I am so pleased NCPHN and APNA are establishing Primary Health Care Nurse Networks on the North

Coast,” said Susan Dodds, Registered Nurse and Nurse Network Coordinator. “Nurses are the glue that hold the health system together. It’s important we have spaces to come together and build our capacity so we can deliver quality care to our patients.” Topics to be presented at Network meetings include diabetes management, chronic disease management, Aboriginal health, COPD, renal failure management and cardiovascular disease management. For more information, contact Siobhan Breedon at NCPHN on 6562 1055 or email: sbreedon@ncphn. org.au

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next step would be for the Project’s Steering Committee to set up a selection process to choose the artworks that will make up the coming exhibition. There are plans to upskill the workshop facilitators in marketing and promotion so they can go back to their communities and help others. Sarah has enjoyed attending the workshops, hearing people’s stories and becoming inspired by the artworks they create to mark parts of their life’s journey. “It’s been wonderful to speak to these artists about their lives and the impact that grief and the loss of loved ones has had on their lives. They are getting a lot out of the creative process. One lady who has severe arthritis is also finding that the process of painting helps her body and mid to relax.” News of the workshops has spread to Bundjalung people attending the University of Queensland, and also people living in Sydney and Canberra. Workshops participants are keen to see the art workshops continue and Sarah is organising proposals for funding assistance in an effort to make this happen. healthspeak September 2017

TRANSFORMERS

CHANGING THE HEALTH SYSTEM FOR BETTER

TRANSFORMERS IS BACK!

SPECIAL INSERT CO-DESIGNING ENSURES FUNDING MEETS LOCAL NEEDS

NCPHN’s Centre for Health Care Knowledge & Innovation is pleased to announce that the Transformers Special Event Series is back for 2017, featuring local and international health experts. It runs from 6 to 10 November at the Ramada in Ballina. Sessions include Transforming Your Practice and Progressing Your Medical Home led by Dr Kirsten Meisinger, Dr Tony Lembke and Dr Dan Ewald. There will be a special session on Frailty, Intermediate Care and Complex Conditions led by Dr Nick Goodwin, Prof Anne Hendry, Dr Lucy Fergus, and Dr Peter McGeorge Download the full program here: http://ncphn.org.au/transformers-2/ Places are limited, so book early to avoid missing out on this international learning experience.

In this edition of HealthSpeak we’ve included a pamphlet summarising NCPHN’s commissioning activities in the areas of Mental Health & Alcohol and Other Drugs. Since July 2015 Primary Health Networks have been committed to the use of commissioning for meeting primary health care needs in our communities. The Department of Health has identified six priority areas for PHNs – mental health, Aboriginal & Torres Strait Islander health, population health, health workforce, eHealth and aged care. Last year, to inform our commissioning activities, NCPHN conducted a region-wide health needs assessment.

It was made up of four main activities: 1. Analysis of Population Statistics 2. Community Focus Groups & Clinician Interviews 3. Community Survey & Clinician Survey 4. Mapping the health workforce The results of the 2016 Needs Assessment can be found in handy fact sheets at: http://ncphn.org.au/needsassessment-2016/ The commissioning process has resulted in NCPHN contracting experienced health service providers across a broad range of health issues throughout the North Coast. More copies of the pamphlet are available by emailing media@ncphn.org. au

What is wrong with most ‘financial plans’ for Doctors? today were still valued in 1987 prices?

ADVERTORIAL By Michael Carlton CEO & Senior Adviser, PECUNIA Private Wealth Management

80% of ‘financial planners’ operate under the auspices of an institutional owner that makes most of its money selling managed funds and life insurance. Unsurprisingly, about 80% of financial plans are a waste of time and money, only dealing with managed funds and insurance products. Not the really important assets - the practice, the home, other property, direct shares and so on. They rarely deal with long-term financial strategies to maximise financial outcomes and happiness among the wider family and across the generations. To be blunt, they just flog second-rate managed funds to GPs. GPs are surprised to hear most financial planners are not allowed to recommend investments other than managed funds. Why? Simple: they do not generate income for the institutional owner. That

September 2017 healthspeak

is why you never see a financial plan prepared by an institutional financial adviser that discusses the GP’s income, their practice, their property, direct shares, investment property, etc.

But it is a problem for a doctor, who is looking towards a further 10 or 15 years of above average income, even if reduce hours or part time. With a high proportion of GPs over the age of 55, the Health Work Force initiative estimates that Australia will face a massive shortage of doctors by 2025 when many are set to retire. ‘Forced retirement’ on anything other than medical grounds is simply not going to happen. Seek out a professional who has specific knowledge of your profession.

Even worse, these plans ignore things like asset protection. The risk of patient litigation should not be overstated. But nor should it be ignored.

For specialised advice for Medical Professionals in our region Call 1300 112 676 to arrange your initial consultation. More information: www.pecunia.com.au.

Most financial plans also underestimate the income security of a doctor. Conventional financial planning theory says that a person aged 55 is due to retire soon and should be moving to a more conservative investment profile. This is a problem as many people can expect to live at least another 30 years. How would your current finances look if all your assets

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

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Mental health collaboration informs three pilots

n a first for NSW, in Coffs Harbour in June, internationally renowned experts, mental health professionals, GPs, people with lived experience of mental health conditions, representatives from community service organisations, and staff from community health came together to be “one team”. The Mental Health Symposium was a collaboration between three Primary Health Networks in NSW, working with International and National scholars, said Dr Vahid Saberi, Chief Executive of the North Coast Primary Health Network. “We brought together consumers, clinicians, and service providers to work together to decide how best to collaborate to provide good care to some of the most vulnerable people in our community. “We want to collaboratively develop a model that’s best suited to the Australian regional and rural context, one that will bolster psychiatry, general practice and psychological services,”

The Mental Health Symposium brought a number of groups together.

he said. Information gathered during the symposium is being used to develop three pilots in each participating Primary Health Network – NSW North Coast, the Murrumbidgee and Western NSW. Dusty Dempsey, who has struggled with mental health since she was a teenager, said the event helped health professionals get “one step closer to listening to a consumer’s perspective”. Stories of lived experience

We want to develop a model that suits the Australian regional and rural context reinforced the message that the current model/s need to be improved, and according to Ms Dempsey, the Whole Person Mental Health Care Model – Joining

Up Psychiatry, General Practice, Psychotherapy and Social Services Symposium was a unique event and “not just another talk fest”. People experiencing mental illness have a range of health and social needs. Not only are there gaps in services, additionally the services available are often fragmented and lack coordination. As most mental health care is delivered through general practice and other primary care services, GP clinics must be engaged with a person’s mental health team, irrespective of the severity and chronicity of the mental illness. The two-day symposium aimed to improve the capacity and the scope of work of general practice, as well as gain insight and understanding into national and international models delivering quality mental health care. For more information about the event, including videos and resources, visit www. ncphn.org.au/mental-healthsymposium-2017

Putting the person in the centre to improve mental health

n August a forum bringing together people working to improve mental health on the Mid North Coast was held at South West Rocks with the theme Partnerships for Empowering. This Mid North Coast Mental Health Integrated Care (IMHPACT) Forum brought together key players in the mental health arena and was hosted jointly by the Mid North Coast Local Health District and North Coast Primary Health Network. In line with the theme, everyone present appreciated Kim Hodges sharing her story of her journey through her mental health struggles. Kim’s presentation sparked lots of discussion around how to bet6

From left: Pamela Johnston, Project Manager, MNC Mental Health Integrated Care Collaborative; Bronwyn Chalker, Director, Allied Health & Integrated Care, MNCLHD; Megan Lawrance, Director, Mental Health Reform & Integration, NCPHN; Helen Glover, keynote speaker and Kim Hodges, MNCLHD Consumer Advisory Group member.

ter manage mental health and suggestions for improvement. Forum participants also

came away from the day much richer for taking part in Aboriginal Medical Service

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Galambila’s demonstration of a healing sit down circle. In a circle, people are encouraged to engage in deep and respectful listening, a process called ‘Dadirri’. Tiarni Latta, NCPHN’s integration Support Officer, Mental Health, said the healing circle was a unique experience for her and an empowering one. “It was the part of the day that really stood out for me. The ladies from Galambila who conducted the circle explained the concept of Dadirri, which means deep listening and quiet, still awareness.” Further Forums are planned to continue the collaborative work being done to improve mental health services in the region. healthspeak September 2017

Suicide Prevention training across North Coast Please change first sentence to 'NCPHN is delighted to fund Wesley Mission to deliver Wesley LifeForce suicide prevention training across the region. This program is supported by funding from the Australian Government under the PHN Program. Announcing this important program, the Assistant Minister for Health Dr David Gillespie said this training was part of the Government’s larger commitment to mental health, suicide prevention, and alcohol and other drugs in this region. “The North Coast has been given $13 million to help identify and address the needs of the local communities,” said Dr Gillespie. Wesley LifeForce training is evidence-based and designed for gatekeepers. Gatekeepers are community members who are well positioned to recognise a crisis and the warning signs of suicide risk and respond appropri-

NCPHN CEO Dr Vahid Saberi (left) and Assistant Health Minister Dr David Gillespie at the Port Macquarie media announcement.

ately. It includes a series of North Coast workshops, seminars and online forums which will run over the next 12 months. Over 280 people, the bulk of whom will be community members, as well as GPs, practice nurses, reception staff and regional frontline workers will receive training.

Reaching youth early with AOD program

In July, Federal MP Luke Hartsuyker and North Coast Primary Health Network announced funding for an early intervention drug and alcohol pilot program for young people enrolled in Hastings and Kempsey high schools. The evidence-based pilot is

being run by EACH Social and Community Health and will be delivered to 2 to 16 year olds. The funding is part of the $210,000 Australian Government’s Ice Action Strategy. It is operating in six schools Melville High School in South Kempsey; Nautilus Senior College in Port Macquarie; Westport Campus, Port Macquarie; Macleay Vocational College, South Kempsey; Wauchope High School and Kempsey High School. The program will provide counselling and coordinated care to a minimum of 60 young people (and their families) at different stages of the alcohol and other drugs trajectory. The priority will be those dependent on crystal methamphetamine (ICE) or other drugs such as alcohol, marijuana, and opiates, who have been suspended from school due to their substance misuse.

NORTH COAST VASCULAR Totally committed to patient care • Dr Williams specialises in Vascular and Endovascular procedures and has a strong interest in minimally invasive surgical techniques • North Coast Vascular has practice locations in Ballina, Lismore, Maclean and Tweed Heads • Urgent appointments are given priority for the next clinic • Dr Williams has VMO rights at Ballina District Hospital, Lismore Base Hospital and St Vincent’s Private Hospital (Lismore) • Dr Williams is a registered “No Gap Doctor” with all Private Health Funds, which means no out of pocket expenses for surgical procedures • North Coast Vascular treat both public and private patients • Educational events and training available for GPs and Nurses

Dr Deepak Williams has a passion to improve the lives of his patients so they can have an active and full life

For appointments: Lismore St Vincent’s Medical Suites Suite 2, Level 1 20 Dalley St

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Ballina North Coast Radiology 93 Tamar St

Maclean Sullivan & Nicolaides Building 1 Wharf St

Tweed Heads Tweed Banora Medical Centre 112 Minjungbal Drive

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Ph: 02 6621 2200 or 1300 278 379 admin@ncvascular.com.au www.ncvascular.com.au

Improving women’s cancer screening In order to encourage higher rates of screening for breast and cervical cancer, timely reminders from practice staff have proven effective. In fact, women are 60% more likely to screen when prompted by their GP. Below are summaries of how two practices put in place screening and care plan appointment reminder systems.

CASE STUDY: Macksville

VICKI Coombes, Practice Manager at Star Street Medical has led the introduction of an SMS recall and reminder service. “Prior to joining the Collaborative all of our reminders were sent via letter and our recalls were via a phone call. This approach was costly and time-consuming. Often staff had to make multiple calls to finalise a recall,” she explained. Vicki firstly met with GPs in the practice to ensure they were all managing their recalls/ reminders appropriately and understood the difference. “We asked patients through patient update forms and notes on reminder letters to opt out of SMS reminders. I then met with admin staff to develop a protocol for recalls and reminders. “We had an online training session with IT Medical to fine tune our understanding and procedures and set up SMS

Star Street Medical’s new reminder system is saving time and money.

templates within Medical Director for each GP. Now the process of sending an SMS takes only seconds for multiple patients.” The impact was significant. “Instead of multiple phone calls and/or leaving messages for patients, we are receiving an almost instant response to text messages. “With recalls, we send a second message, if this is not answered then we telephone, and if this fails, we send a registered letter. Unless the matter is critical, then we make a same day phone call,” said Vicki. The new system has meant savings in time and money. Monthly reminder letters have gone from 100 to 30 with the remainder going by SMS. “With recalls, we are receiving a response to the initial SMS within hours in most cases. This

has significantly reduced the time spent on the telephone by receptionists. Although the patient receives a generic SMS, they mostly know why we are calling, and this saves reception time explaining the call and making multiple calls to home or mobiles.” CASE STUDY: Trial Bay, South West Rocks

THE practice has worked hard over 18 months to introduce a gold standard recall and reminder system across a range of conditions – Pap smears, GP Management Plans, Health Assessments and Asthma Plans. They provided their team with advanced training in Medical Director. This incurred a cost, but income since generated through more effective reminders has been of real benefit.

Practice Manager Sonia Perry explained how the practice had previously managed recalls and reminders. “Under a previous Practice Manager we were on an old version of Medical Director and the process was to delete recalls from the system once we had sent out a letter. “Using Pap smears as an example, the staff only re-entered the recall if the patient presented for their next Pap smear after receiving the letter, otherwise they dropped off the system unless picked up when re-presenting for some reason,” she said. Sonia believes the new recall system allows the team to delivering better patient centred care and to link non-income generating activities such as breast screen reminders with other services and reminders. Women’s Health Conference

In November, NCPHN is hosting two Women’s Health Conferences – one at Port Macquarie on November 11 and one at Kingscliff on November 18. The program includes an introduction to the National Cervical Screening Program, new treatments in gynaecology oncology and Family Planning. To find out more go to www. ncphn.org.au and click on Events.

A first for the small community of Bundagen NCPHN’s COMMUNITY ENGAGEMENT team has been working in smaller, more isolated communities to improve the health and wellbeing of community members. Recent activities include providing free first aid training for communities with little or no access to health services or emergency support. These skills provide community members with the confidence to support someone in an emergency. Earlier this year Bundagen community came together to receive First Aid

Training, a first for this community. Bundagen has a population of around 120 people and the first round of training was provided to 25. The community is an intentional community guided by principles of social harmony, environmental responsibility and economic independence. Bundagen is about 30 minutes from Coffs Harbour Hospital in an isolated location. We hope to continue to work in small communities like Bundagen to improve health and wellbeing for all.

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healthspeak September 2017

Pharmacies benefit from MyHR training

“

The potential for having a complete patient record all in one place is fantastic” said Judy Plunkett from Plunkett’s Chemart Pharmacy Port Macquarie, who took part in professional development training offered by NCPHN. “Being able to quickly access discharge summaries and see any changes to medications after patients have been in hospital will be invaluable,” Judy added. In July, NCPHN partnered with the Pharmacy Guild of Australia and the Australian Digital Health Agency to offer My Health Record (MyHR) in pharmacy training in Tweed Heads, Ballina, Coffs Harbour and Port Macquarie. Shane Jackson, a rural pharmacist and President of the Pharmaceutical Society of Australia took pharmacy teams through the features and benefits of the MyHR platform. The training supported pharmacists to access, view and upload dispensing records to the MyHR system, and to communicate its benefits to staff and customers. Shane agrees that a key benefit of MyHR is helping patients better manage their medications. “The more healthcare information a patient can access about themselves with supporting resources such as apps, the more in control they are and the better care they can receive,” he said. “Pharmacists can add valuable dispensing information seamlessly to the MyHR system. They will be able to access information that they would not have had efficiently, resulting in better patient care. For example, when a patient leaves hospital the pharmacist can access their discharge summary which will optimise patient care and support. “If somebody has a MyHR, when I dispense their prescription, their health record automatically appears. You can easily search within the system, and it’s September 2017 healthspeak

this will grow to cover everyone (unless they choose to opt-out) by next May.” “Having this information readily available will reduce paperwork, phone calls and faxes and lead to more effective provider collaboration. “Most people assume that key components of their health history are already online. MyHR allow them to control this information and how they share it with people involved in their care.”

Judy Plunkett, Ashley Holmes and Ines Capizzi from Plunkett’s Chemmart Pharmacies at Port Macquarie and Wauchope.

not an onerous task.” NCPHN’s Digital Health Senior Project Officer, Tony Browne highlighted the growing value to providers and patients.

“In July alone there were over 20,000 documents added to patient records across our region. Over 5 million people across Australia now have a record and

Want to know more about MyHR? Go to https:// myhealthrecord.gov.au or contact: tbrowne@ncphn.org.au To remain updated on NCPHN’s news, events and training opportunities, sign up to our newsletter: http://ncphn.org.au/ practitioner-newsletter/

Community rehab program a big success A COMMUNITY REHAB program run by The Buttery and funded through Commonwealth funds distributed by NCPHN is proving enormously successful. The need for such as program is clear with demand for the CORE program exceeding available places in Lismore and Byron Bay. CORE is running in four locations over 12 months. The Program format is structured, group-based and combines psychoeducational and therapeutic elements. Program Coordinator Sam Hickingbotham said the program allows people requiring alcohol and other drug rehabilitation to attend on a daily basis while continuing to live in the community, maintaining their social connections, roles and responsibilities. “Each program accepts

Sam Hickingbotham

up to 15 participants and runs over six weeks on weekdays during school hours. Assistance can be provided with child care and transport. There is also an after care component which people find valuable. “An evaluation of the inaugural Byron Bay program showed impressive results

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with a previously unheard of 95% completion rate and highly positive primary outcomes,” said Sam. The CORE program was a finalist in NCPHN’s Primary Health Care Excellence Awards this year. Patient feedback includes: “This program is life changing…It was more than I could have imagined. It truly was one of the best experiences of my life.” “The psychological insight into addiction, the relaxation activities – Qi Gong, Yoga, juggling, meeting a diverse range of people, art therapy.” “I have done many different recovery groups, detoxes, rehabs etc. This CORE program outstrips anything I have ever done… The opposite of addiction is connection!” For more information, phone Sam Hickingbotham on 0477 016 030.

Community recovery after flood project T

he flood of April 2017 will long live in the memories of the Northern Rivers community because of its size and how quickly the water came into homes and businesses. Floods can have a major impact on people’s wellbeing for a long time. The University Centre for Rural Health (UCRH) is working with other local organisations and community members to assess the impact of the April flood on the wellbeing of people in our region. This information will help prepare for future floods. It will also inform health and social support services about the needs of the community. UCRH will be carrying out an online survey, beginning on September 25, asking about people’s experience of the flood. The survey is for all community members, whether or not flood affected, and will be the start of long-term research into the effects of flood on the people of the Northern Rivers. . The coordinator of the UCRH Flood Project research team, Dr Veronica Matthews, explained the survey’s relevance to their research. “It’s about gathering informa10

Maddy-Rose Braddon, Dr Veronica Matthews and Lee Duncan from the UCRH Flood Project.

tion about how the community is going six months after the flood. We want to build a picture of the mental health and wellbeing issues in the population so we can ensure relevant

services are available to community members now and into the future. “We’ll also be presenting the survey results and recommendations arising from the

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information gathered back to the community.” The project’s Communications Officer Lee Duncan explained what the survey covers. “We hear a lot about the physical costs of flood, the infrastructure costs and how the economy was damaged. We’re focused on the personal cost. For instance, if insurance doesn’t come through, the personal impact may be long lasting. This is an opportunity to translate personal experiences into measurable evidence of the effects of such a natural disaster.” Researcher Maddy-Rose Braddon said filling out the survey would also help future generations. “We will continue to flood in this region and if our infrastructure, emergency services and mental health services are not prepared, young people are less likely to stay here and buy homes in flood prone areas. We need to look ahead about the effects of such disasters and this survey is a wonderful way that community members can contribute to future preparedness,” she said. To fill out the survey online, go to: http://www.ucrh.edu.au/ healthspeak September 2017

April floods: visiting expert impressed by community resilience

n mid-July, Professor Virginia Murray, a consultant in Global Disaster Risk Reduction with Public Health England, visited Lismore and spoke at a community forum at UCRH about the impact of the April floods. Prior to her talk at the forum, Professor Murray walked around Lismore, chatting with business owners and locals about their flood experiences. She was impressed by community resilience and mentioned that it was unlikely that she would have seen so many smiling faces post flood if the event had occurred in many other parts of the world. Interested by simple but effective methods that local business owners had come up with to ensure they could move their stock quickly in the event of another flood, Professor Murray encouraged researchers to work with the local community to write up their experiences in peer-reviewed journals. She was also impressed by the Lismore Helping Hands Volunteer Hub set up at the old Lismore Railway Station. “The concept of Helping

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Cold water hand washing as good as hot US scientists have poured cold water on the theory that washing hands with hot water kills more germs than unheated water. A small study of 20 people found using water at 15C left hands as clean as water heated to 38C. The report, in the Journal of Food Protection, said researchers asked 20 people

September 2017 healthspeak

Hands and all the work that came together and the Facebook trail…should be written up to share. Equally important is to explain the risks, for example insurance of volunteers and making sure people worked in teams whether they were an advocate, a cleaner, a lifter or a shifter. “This information needs to be shared with other groups around the world, right up to the United Nations.” Describing her trip round the city as ‘incredibly illuminating’, Professor Murray said she was amazed at how engaged the community was in solving the problems raised by the floods. Professor Murray’s address took the audience through several major disasters in UK and elsewhere in recent times, highlighting the damaging effects of flood and other disasters on so many aspects of people’s lives. She said that there was a lack of research into the early and longer term impacts of flooding and that she was pleased that the UCRH would be conducting a population survey as early as six months after the flood, and is

to wash their hands 20 times each with water that was 15C or 26C. Volunteers were also asked to experiment with varying amounts of soap. Before they started the tests, their hands were covered in harmless bugs. Researchers say there was no difference in the amount of bugs removed as the temperature of the water or the amount of soap changed. However, the researchers accept their study is small and say more work is needed to determine the best ways to remove harmful bacteria.

This information needs to be shared with other groups around the world

From left: Ross Bailie, UCRH Director; Prof Virginia Murray and Tony Capon, Professor of Planetary Health, the University of Sydney.

planning a longer term program of research. Harking back to her tour of Lismore, Professor Murray said that aerial photos of the Lismore flood had really hit home how devastating it was. And while certain businesses had a plan and had responded well, others were having difficulty recovering from the flood damage. “Across the world in the last 30 years, floods and storms

have increased. The 2015 UN landmark agreement - Sendai Framework for Disaster Risk Reduction 2015-2030 – has the need to ‘Substantially increase the availability of and access to multi-hazard early warning systems and disaster risk information and assessments to people by 2030’. This is needed to improve how we alert and warn the community about an impending flood and other hazards.” It’s clear that the UCRH research will be important, not just locally in informing future planning and warning systems, but in providing models for other communities and business owners around the world to emulate.

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

Antenatal Shared Care in Northern NSW

ntenatal Shared Care Forums have been held over the past 12 months in Grafton, Lismore and Tweed Heads. North Coast Primary Health Network (NCPHN), in partnership with Northern NSW Local Health District hosted these exciting events open to all health professionals participating in Antenatal Shared Care. The most recent was in Tweed Heads in June and covered the last 20 weeks of pregnancy. Sixty-eight GPs and health professionals attended the interactive event. Participants gained an improved understanding of best practice; the skill to confidently follow the appropriate Pathways and a better understanding of the role of team members. Further sessions are planned for the Mid North Coast. The event facilitator was Dr Brett Lynam, GP Clinical Advisor, NCPHN, and the panel included Dr Steve Abbey, Director of Women’s Health, Tweed Byron Health Service Group; Sue Watson, Antenatal Clinic Midwife; Dr Helena Smetana; and HealthPathways Clinical Editor; and Dr Nichola Reich.

The panel presented a case study about a fictional character ‘Sally’ who endured a number of complications during her pregnancy. Throughout the study reference was made to how HealthPathways could be used to guide Sally through the later part of her pregnancy. A summary of Sally’s story unfolds…Sally returned to her GP for a routine visit at 20 weeks. The GP referred to HealthPathways and accessed the Antenatal Care Routine NNSW HealthPathway and the Schedule of Northern NSW Antenatal Checks best practice guide. This Pathway gave the GP local services and referral information, access to GP Shared Care Schedules, best practice information on which tests should be undertaken, links to other pregnancy HealthPathways and patient handouts on exercise, healthy eating and supplements. Sally had to deal with a number of complications. She had a history of epilepsy. The Epilepsy in Pregnancy HealthPathway provided best practice guidelines on management and referral Pathways to help moni-

The panel presented a case study about a fictional character ‘Sally’ who endured a number of complications during her pregnancy

tor her condition. At 28 weeks Sally’s bloods indicated she had iron deficiency anaemia and may require IV iron infusion. The panel referred to the Anaemia in Pregnancy Pathway for management guidance. Sally is also in a physically abusive relationship and her partner’s behaviour is affecting her four-year-old son. The panel invited Rosemaria Flaherty, NNSW LHD Child Protection Manager to advise how their

NNSW LHD acts on vending machine soft drinks IMPROVING NUTRITION and maintaining a healthy weight starts with making good choices. As part of a state-wide effort to create a healthier NSW, the Northern NSW Local Health District (NNSWLHD) is moving towards more nutritious food and drink choices for staff and visitors as part of a healthy lifestyle. The NNSWLHD has a responsibility as a health provider to set a good example by making healthier choices easy. That is by

increasing the offerings of nutritious foods and drinks available for purchase on site and reducing less healthy options. Over the coming months, visitors and staff at facilities throughout the local health

district will notice changes to drinks available for sale, as NNSWLHD works towards the removal of sugary drinks from sale by December 2017. With more than half of all adults and nearly one quarter of children overweight or obese, no single action will be able to tackle this issue, and offering healthier options is just one part of a range of initiatives designed to make healthy the new normal. For information head to www.makehealthynormal. nsw.gov.au

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service could help a woman in these circumstances and the child protection steps to take for services referral and support. For more information refer to: the Child or Young Person at Risk and Domestic and Family Violence HealthPathways. Vicki McGowan, Mental Health Project Officer, NCPHN, spoke about the Healthy Minds Program. Healthy Minds is a free counselling service for people experiencing mild to moderate mental health concerns unable to afford private services. This program also targets groups including Aboriginal and Torres Strait Islanders, children, people with perinatal depression, people who are homeless or at risk of homelessness, and people at risk of suicide and/or self-harm. More information can be found on the Healthy Minds NCPHN website." HealthPathways has more than 20 localised Pregnancy and Breastfeeding pathways. To view these, follow the link: https://manc.healthpathways. org.au/index.ht Username: manchealth Password: conn3ct3d

healthspeak September 2017

Sarah Miles, Occupational Therapist and Clinical Educator at UCRH, Lismore

efore attending an Open Day at the University of Sydney, Sarah had ideas of becoming a teacher or a nurse, or pursuing international studies. But a friend suggested she investigate the university’s Occupational Therapy (OT) course, and it was the placement to India that sealed her decision to follow this path. Sarah qualified as an OT in 2005 and her first role was parttime as an adult community OT in Sydney’s Merrylands. “Being a sole practitioner in my first professional position was challenging and interesting. I was working with anyone over 18 with a long-term disability or illness doing a lot of home modifications and equipment to enable people to stay at home. I was also involved in some community work around falls prevention but there were long waiting lists to see an OT which I found frustrating. “I worked with many people who had English as a second language – a lot of Italians and Afghani refugees as well as Maltese and Arabic speaking clients. It was fascinating to work with so many different community groups and to meet their families.” Often Sarah needed to work with an interpreter and found the experience she’d had working with interpreters during her student placement in India came in useful. In India, she worked at a small place called Coorg between Bangalore and Mangalore in the mountains on a communitybased rehab project. Her role included educating locals that people with disabilities can be involved in the community and educating them about typical child development. After her first job, Sarah took the opportunity to work overseas and went to the UK. September 2017 healthspeak

Sarah did short stints in Romanian orphanages, which she said was ‘very challenging’

Here she spent 18 months working in Scotland in the Yorkhill Children’s Hospital. This work involved clinics for prescription of equipment such as wheelchairs and seating systems as well as running groups around developing fine motor skills such as handwriting. “After this role, I worked for another year out of Glasgow in a Developmental Coordination Disorder Clinic working with kids with coordination difficulties. And for two years I worked for Nottingham County Council in their social work department on their disabled children’s team. This was mainly organising major home modifications for children with muscular dystrophy, cerebral palsy or severe autism. The modifications involved hoists and high-low baths, unique equipment we don’t much use in Australia.” Around this time Sarah did short stints in Romanian orphanages, which she said was ‘very challenging’. “Through the social worker I began working with the girls in these orphanages teaching them life skills, such as how to get a job, how to cook, all the things they’d never been taught to do.” Back home, Sarah worked for Lismore Community Health as

an adults’ OT and then worked at the Jumbunna Community Pre-School and Early Intervention Centre for some months before going into private practice. For Sarah, private practice proved too isolating and confronting with complex medicolegal issues and she was happy to return to community work. As a result of two OT student placement projects she managed at Southern Cross University in primary school and aged care, UCRH approached Sarah and she started in her current role in August last year. She is now supervising the UCRH OT students in placements across seven pre-schools/schools and

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Obese lack satiety hormone Severely overweight individuals have an inhibited sense of satiation, releasing fewer satiety hormones than people of normal weight. A report in the journal Scientific Reports states the reason is that the responsible cells in the gastrointestinal tract of obese people are severely reduced. Surgical weight-loss procedures can repair this disorder. Compared to lean people, the release of satiety hormones is reduced

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two aged care facilities in Ballina, Kyogle and Casino. These students are filling a big gap for Kyogle and Casino in particular, which have not had paediatric OT services for years. “I love mentoring and supporting the students. I have found that they consider their placements the most challenging they’ve experienced, but also the most rewarding. This is because they don’t have access to me as their supervisor all the time and have to think on their feet. It’s also wonderful that the school is getting an important service they’d otherwise miss out on.” As well as the placements giving the students valuable experience, Sarah sees the placements working to upskill teachers. “The students are able to give the teachers some OT training and demonstrate how they work in improving self-regulation among pupils. This is training that the teachers can use in the classroom to improve attention and concentration.” Contact Sarah at UCRH in Lismore on 6620 7570.

in obese people. After bariatric surgeries, such as a gastric bypass or sleeve gastrectomy the release of these hormones increases again. Lead researcher Dr Bettina Woinerhassen said it was unfortunate that obese people were often stigmatised because of the belief that they lacked selfcontrol and discipline. “There is no doubt that metabolic factors are playing an important part. The study shows that there are structural differences between lean and obese people, which can explain lack of satiation in the obese.”

CELEBRATING THE STARS OF PRIMARY HEALTH CARE ON THE NORTH COAST

n Thursday 7 September 2017, North Coast Primary Health Network (NCPHN) hosted the 2017 Primary Health Care Excellence Awards. The evening saw 120 health professionals and community members come together to recognise 14 Finalists seen to be bringing better health to the North Coast region. A fun and inspiring night was had by all. "The 2017 Primary Health Care Excellence Awards was an inspirational evening showcasing excellence and innovation in the primary health sector,” said Chris Bedford, Acting First Assistant Secretary, Department of Health. “The event allowed health leaders of the region to share experience and demonstrated the important role of the North Coast Primary Health Network in transforming the way health care is delivered to people in its region." In a first for Australia, the Awards were opened to GPs and general practices, allied health, community health, aged care and mental health professionals

and organisations, Local Health Districts, Aboriginal health workers and medical services, non governmental organisations, police and ambulance services, universities and TAFE, parliamentarians and community support groups. A total of 55 submissions were entered. “We are proud to have established this unique celebration bringing together and recognising excellence in primary health care and social services,” said Dr Vahid Saberi, Chief Executive, NCPHN. “Every submission put forward deserves recognition and is a testimony to the dedication, creativity and resourcefulness of those involved.”

All finalist and recipient videos can be viewed at www.ncphn.org.au/excellence. Highlights from the night and keynote address by Dr Louise Mahler also available.

Thank you to our sponsors

Award Finalists & Recipients

CATEGORY 1 - INTEGRATION AND PARTNERSHIP SPONSORED BY NORTHERN NSW LOCAL HEALTH DISTRICT Having good partnerships allows us to better respond to community needs. It also helps the health system cope with increasing demand. Decision Assist Linkage Project â&#x20AC;&#x201C; RECIPIENT During 2017, the Heritage Lodge Aged Care Facility in Murwillumbah introduced systems to improve end of life education and conversations between residents, families, General Practitioners (GPs) and staff to ensure residents wishes are known and honored, families and staff are supported, and care and palliation outcomes improved for residents. Heritage Lodge, through Decision Assist Linkages, has committed to developing stronger

integration between key care providers in the region, to enhance palliative care delivery for their residents and to develop new pathways and opportunities for networks and communities of practice. https://mckenzieacg.com/locations/ heritage-lodge Crystal Methamphetamine Project â&#x20AC;&#x201C; FINALIST The Crystal Methamphetamine Project (CMP) Community Conversations Model used innovative principles of co-design to work alongside Northern NSW communities and services to develop and implement sustainable strategies to reduce the impact of crystal methamphetamine.

L-R: Rachael Heath (RN) , Wayne Jones (NNSWLHD), Helen Bolt (RN).

CELEBRATING THE STARS OF PRIMARY HEALTH CARE ON THE NORTH COAST

CATEGORY 2 – INNOVATION SPONSORED BY THE NSW AGENCY FOR CLINICAL INNOVATION High quality health care requires fresh approaches and continued testing of ideas. Only then will we find better solutions to community health needs. Heroes Without Capes – RECIPIENT and COMMUNITY CHOICE FINALIST The Byron Bay Community Association is a not for profit organisation operating from a purpose-built community centre in the heart of Byron Bay. With very little local, state or Federal Government support, it

CATEGORY 3 – IMPROVING HEALTH CARE ACCESS AND/OR REDUCING HEALTH INEQUITY SPONSORED BY NORTH COAST VASCULAR

runs a number of programs specifically tailored to the community’s needs. Byron is home to high numbers of disadvantaged and BCC responds innovatively and quickly to local issues. www.byroncentre.com.au/ Eclipse – FINALIST After a member of the public approached Lifeline Mid Coast (LLMC) requesting help to stay alive, a committee formed to research and develop a program to support people who are struggling after a suicide attempt. Eclipse is the result of this first contact and to date the result has been extraordinary with Eclipse participants reporting significant reductions in thoughts of suicide and no re-admittance to ER or hospital. www.lifelinemidcoast.org.au/life-matters.php

The Buttery’s Community Rehab – FINALIST The Buttery’s Community Rehabilitation (CORE) Program offers an evidence based, mid-intensity day time intervention over six weeks that creatively addresses consumer barriers to treatment while also providing intensive individually tailored aftercare support to reduce relapse rates. www.buttery.org.au

The North Coast has a fast growing and ageing population. It also has high Aboriginal representation. Effective health care responds to the needs of the community for greater access and better health and wellbeing. Community Voices - RECIPIENT The Community Voices program facilitates empowerment, and connects the voices of isolated small communities across the North Coast of NSW. Established in 2014, the program’s vision is to build the capacity of small and isolated communities to become resilient, healthy communities. Working closely and consistently with community members has resulted in meaningful partnerships enabling the implementation of person-centred approaches to improving health and social outcomes for each small community in the program. www.ncphn.org.au

Thank you to our sponsors

L-R Sophie Gribble, Aimee McNeill and Anne-Maree Parry, NCPHN with Dr Deepak Williams, North Coast Vascular.

Award Finalists & Recipients

CATEGORY 4 – PROMOTING HEALTHY LIVING SPONSORED BY COMMONWEALTH BANK To stay out of hospital people must understand the health information they are given. There should be a focus on chronic disease prevention and a healthy lifestyle. The Life of Byron – RECIPIENT The Life of Byron had eight (8) key objectives, all relating to older people and healthy ageing, e.g. foster a sense of belonging and community connection for older people. Grant money was allocated to a variety of innovative projects such as weekly seniors drumming, singing and yoga classes, many of which continue today. “Digital Life Stories” was a significant activity and is available on the web. www. lifeofbyron.com

L-R Cat Seddon, BBCC, Glenn Triggs, Commonwealth Bank.

Aboriginal Women’s Heart Disease Awareness – FINALIST and PEOPLE’s CHOICE The goal of the AWHD program is to develop Aboriginal women as heart health champions to advocate and develop their own community health living awareness. Heart disease is an issue for Aboriginal women who are at least three times more likely to be hospitalised due to heart disease than non-Aboriginal and Torres Strait Islander women. L-R Tammy Johnson, On Track Community Programs, Anthony Franks, NNSWLHD and Chris Bedford, Department of Health.

CELEBRATING THE STARS OF PRIMARY HEALTH CARE ON THE NORTH COAST

COMMUNITY CHOICE SPONSORED BY BULGARR NGURU MEDICAL ABORIGINAL CORPORATION

L-R Naomi Tarrant, Steve Blunden, Maddy Braddon, Elly Bird, Brent McKallister, Jacob Stone, Mandie Kai, Del McAllister

North Coast Primary Health Network’s 2017 Community Choice Excellence Award recognises a project or program that has engaged deeply with the community, and understands its characteristics and needs. Community Choice finalists align with the community's principles and values and are seen to act with sensitivity, respect and insight. Lismore Helping Hands – RECIPIENT Lismore Helping Hands (LHH) was a spontaneous volunteer group that emerged after the major flood in Lismore on 31 March 2017; the most significant flood to hit the city in 43 years. The ability of LHH to rapidly organise and form partnerships, both informal and formal was critical to improving community health and well-being. LHH mobilised existing community networks to provide holistic support to impacted residents and businesses and to rapidly organise volunteers. These networks and methods evolved as LHH adapted to the changing needs of the community. www.facebook.com/groups/161370884384945

Thank you to our sponsors

Health Literacy Project – FINALIST The NNSW Health Literacy Project is an innovative project that responds to the needs of the community. It aims to improve person-centred care by providing consumer health information that is easily understood and supports people’s increased knowledge, empowerment and selfmanagement of their own conditions. www.healthliteracy.nnswlhd.health.nsw.gov.au Northern Rivers Vaccination Supporters – FINALIST The Northern Rivers Vaccination Supporters (NRVS) are a community group working to increase vaccination rates. Since forming in 2013, NRVS has gained significant insight into why vaccine hesitancy and refusal is so common in this area, developed a culturally appropriate approach to help people make informed decisions about vaccinating, and supported those who choose to vaccinate in a region where speaking out in favour of vaccination carries the risk of being ostracised. www.nrvs.info

Award Finalists & Recipients

OUTSTANDING SERVICE TO COMMUNITY AWARD SPONSORED BY MID NORTH COAST LOCAL HEALTH DISTRICT

L-R Dr Jay Ruthnam, Dr John Kramer (OAM) and Stewart Dowrick, MNCLHD

This award recognises a significant contribution to community over many years through time, actions, talents and dedication. Dr Jay Ruthnam, Palm Tree Medical Centre, Coffs Harbour Dr Ruthnam is recognised for his exemplary social commitment, his dedication to teaching medical students and graduates, and his attention to keeping abreast of medical developments. Dr Ruthnam is well-liked by his colleagues and patients and has a wonderful sense of humour. He has been in continuing General Practice in Coffs Harbour since 1994 and director of Emergency from 1987.

Dr John Kramer, Beach Street Family Practice, Woolgoolga Dr Kramer (OAM) is recognised for his dedicated approach to supporting the more vulnerable in the community, both as a GP and a valued contributor to the community. His work with early childhood behaviours such as autism, refugees and Aboriginal people is admirable. Dr Kramer has been a General Practitioner in Woolgoolga since 1981 and has been involved in the Rural Clinical School in Coffs Harbour since its establishment in 2002.

Submissions for the 2018 Primary Health Care Excellence Awards open April 2018. North Coast Primary Health Network encourages all those striving for excellence to submit and nominate their peers. If you would like to be notified when submissions open and kept up-to-date with Excellence Awards news, please email Bronwyn Thirkell: excellence@ncphn.org.au

Developing SCU’s Nurse Led Clinics

he Southern Cross University Medical Clinic in Lismore has grown quickly since it opened to the public in 2015. The practice team has been innovative in its approach to best serve its growing cohort of patients. Around 18 months ago, a series of Nurse Led Clinics were rolled out. Skin (established by Jenni Heuchmer and led by Alison Chessells); Diabetes (led by Judy Gatwood); Aboriginal Health (set up by Susan Dodds and led by Judy Gatwood); and Asthma (led by Kathy Lucic). The SCU Medical Clinic’s Acting Senior Nurse Jenni Heuchmer said the clinics were driven by nursing staff in collaboration with medical staff and The Improvement Foundation. Jenni also acknowledged the valuable support given by NCPHN’s GP Support Officer Sarah Simeoni. Engagement

To establish the clinics, the nurses used their data bases with the briefs

PSA screening effective After differences in implementation and settings were accounted for, two important prostate cancer screening trials provide compatible evidence that screening reduces prostate cancer mortality. These findings suggest that current US guidelines recommending against routine PSAbased screening may be reviewed. However, questions remain about how to implement screening so that the benefits outweigh the potential harms of overdiagnosis and overtreatment. The findings are published in Annals of Internal Medicine.

Feedback

The clinics are seeing the same people coming back every three months, which shows they happy to engage in the process and can see the value in it. Upskilling

Clinic staff, from left: Judy Gatwood (RN), Jenni Heuchmer (Acting Sn RN), Dr Tariq Mahmood (GP), Marlene Assim (Manager), Alison Chessells (RN), Emilee Devine (Admin).

help of the Pen Cat tool to identify potential patients for the four clinics. These patients were given a phone call and invited to come in. From there, patients, if eligible, were given an appointment to attend a Nurse-Led Clinic. Jenni said the initial phone calls were time-consuming, but now an effective automatic letter or text reminder system is in place to ensure patients attend regularly. Although with some patients there was initial resistance to seeing a nurse rather than a doctor, nurses have more time to educate the patient around chronic disease management. Every new patient is first seen by a nurse. “While there’s no one script for all, our nurses are able to explain the benefits of our clinics in line with their health literacy. We’re not telling people what to do about their health, we’re giving them information and offering them more responsibility around managing their health. “Our GPs are time poor and our clinics enable them to see more patients and generate more income. We are patient-centred, but we also have to sustain a business,” said Jenni.

Our GPs are time poor and our clinics enable them to see more patients and generate more income. Working with the GPs

Jenni said the Clinic’s GPs have been very amenable to making the best use of its nurses’ skills and appreciated the streamlining of processes that saved them time. “Part of what we do is to provide the patient with disease management information and generate pathology forms for them so they can have the path tests done before their next GP visit. So next time the whole process can be completed in one appointment.” Jenni stressed that the nurses were not telling the GPs what to do. “They can agree or disagree with our recommendation, but through this process they are developing confidence in our nurses’ skills and knowledge.”

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The SCU Clinic allocates at least one hour a month to its nurses to do some online study through APNA. Everyone is keen to acquire more knowledge about the conditions they manage. Kathy has been doing some study on her own and is keen to become an accredited Respiratory Nurse. Jenni said it makes sense for the Asthma Clinic to evolve into a Respiratory Clinic and include COPD patients and those with other lung conditions. Tips for others

Jenni said that while setting up the four clinics had been ‘organised chaos’, it had also been very satisfying. But not without some hiccups. One of these is getting the billing right. “The education process for the GPs around billing is a work in progress. We have developed some methods to help.” One of these is a billing slip which goes with the patient around the Clinic. The nurse writes the patient’s name, the GP’s name and the date on the slip and all billing is clearly written down on the slip. “If the GP doesn’t get the item numbers right, reception can talk to the nurse to clarify anything. It’s all about making sure we are getting the funds for the time we’ve spent with patients.” What’s next?

Research is the next step with SCU’s Dean of Health and Human Sciences, Professor Iain Graham, keen to integrate some research into the clinic’s activities. Jenni believes the Asthma Clinic is likely to be the big winner when it comes to research. healthspeak September 2017

NDIS in your area The NDIS on the North Coast

he Northern New South Wales district covers the local government areas of Ballina, Byron, Clarence Valley, Kyogle, Lismore, Richmond Valley, and Tweed. The NDIS has a number of ways to help people with disability to exercise choice and control in the planning and delivery of their supports to achieve their goals. One of the ways this is done is through Local Area Coordination (LAC). Local Area Coordination is delivered by partner organisations, selected because they align with the values of the NDIS, understand the needs of people with disability, their families and carers. Local Area Coordination will work with both individuals and the community in your area and will be skilled at working with people

2. Link to information and support

LACs will link clients up with options and support like education, health, housing, transport, training and employment. 3. Build inclusive communities

Social Futures CEO Tony Davies, Mid Coast Communities CEO Ruth Thompson and the Hon Luke Hartsuyker MP, Member for Cowper at a launch event at the Coffs Harbour NDIS LAC office on 28 June 2017.

with all kinds of disability from all walks of life. What do LACs do? 1. Link clients to the NDIS

Local Area Coordinators (LACs) help people link up

with the NDIS you as they move from stage to stage on their pathway. They help draw up a client’s plan of action and help obtain the required services, exploring options to get involved in the local community.

LACs work with both individuals and the community. Strong neighbourhoods, clubs and groups help create a sense of community, enabling people to work together and look out for each other. They can help clients go to training or encourage establishment of innovative programs. Local Area Coordination Contact the Local Area Coordinator in your area: Telephone: 1800 522 679; Lismore LAC office: 6617 4444 Email: lac-enquiries@ socialfutures.org.au

The NDIS on the Mid North Coast

he National Disability Insurance Scheme (NDIS) is the new way of providing support for people with disability, their families and carers in Australia. The NDIS is being rolled out in stages across Australia, and North Coast communities joined the Scheme on 1 July 2017. The NDIS replaces a system that was unfair and inequitable with one that maximises people’s independence and capacity to participate and contribute to their community. The NDIS Partners in the Community Program supports implementation of the NDIS at a local community level. This is achieved through partnerships with organisations that have strong local knowledge and understanding of what people with disability need. Mid Coast Communities is proud to be delivering the NDIS throughout the Mid North Coast on behalf of NDIS partner Social Futures September 2017 healthspeak

as part of this program. NDIS Local Area Coordination (LAC) services focus on participant capacity building, including plan development, implementation and review. As your local NDIS partner, Mid Coast Communities is excited to let you know that our doors are open at our four new LAC Service Centres in Coffs Harbour, Nambucca Heads, Kempsey and Port Macquarie. Our Nambucca Heads Service Centre also services the Bellingen local government area. Mid Coast Communities’ has recruited and trained 39 new staff this year, and we are working towards a total LAC team of 49 staff. Our Local Area Coordinators are ready to answer any questions you might have about the NDIS. We started pre-planning with some initial participants who are entering the NDIS during 2017-18 in early 2017.

We have also been extensively engaging with a diverse range of community groups and participants across the region to help our local communities prepare for the transition to the NDIS. NDIS Service Centres across the Mid North Coast are open at the following locations:

Suite 2, 38-40 Park Avenue Coffs Harbour, NSW 2450 Suite 7, First Floor, Harrington Building, 41 Belgrave Street Kempsey, NSW 2440 Shop 5B, Nambucca Plaza 10 Pacific Highway Nambucca Heads, NSW 2448 Suite 5, 53 Lord Street Port Macquarie, NSW 2444 People who want to talk to a Local Area Coordinator can call

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1800 522 679 or email lac-enquiries@socialfutures.org. au.

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Organ donor registry now online Australians can now register to become an organ donor using a mobile phone, tablet or computer. To fill out the registration form, visit www.donatelife.gov.au and follow the prompts. It’s a good idea to then have a chat with your loved ones about your decision. Australians can still join the Australian Organ Donor Register online via the myGov.au website by submitting printed forms.

Koori Grapevine NCPHN’s Annie Orenshaw’s work recognised

ongratulations to NCPHN’s Port Macquarie and Kempsey Indigenous Health Project Officer Annie Orenshaw who was one of the winners of a collaborative award at the Mid North Coast Local Health District’s (MNCLHD’s) Health Innovation Awards. Annie, along with the MNCLHD’s Kathleem Bohannon, won an award for her work under the Closing the Gap banner. The program, Bridging Cultures – partnering with patients in their health care journey, saw Annie and Kathleen working collaboratively to address the issue of the high re-admission hospital rates seen within the Aboriginal population at Port Macquarie Base Hospital. The aim of the project was to bring these re-admission rates into line with those of non-Indigenous patients. Using clinical practice improvement methodology Annie and Kathleen were able to identify, define and diagnose the problem.

From left: Port Maquarie Base Hospital RN Kathleen Bohannon, Nathan Schlesinger of sponsor PriceWaterhouseCooper and Annie Orenshaw, NCPHN’s Indigenous Health Project Officer.

From there they used appropriate solutions and interventions. These included: • Developing culturally sensitive information booklets and brochures • Simplifying referral processes to Aboriginal Community Health Services • Providing nursing education on cultural competency and safety strategies • Developing a staff education package

• Providing nursing staff with ongoing formal cultural awareness training Annie and Kathleen and the wider project team were able to achieve a 4.5% reduction in readmission rates for Aboriginal patients, and through patient surveys were able to measure some success in improving the care delivered to Aboriginal patients. In fact, patients reported more confidence and satisfaction in the

health system. Some of the reported better patient outcomes included: • Improved knowledge of their disorder, risk factors, lifestyle modifications and treatment • Improved knowledge and access to health services for Aboriginal people • Aboriginal patients feeling more empowered to reduce their risk of chronic disease through self-management • Reducing cultural boundaries in health care • Providing safe, inclusive and culturally sensitive care for Aboriginal patients • Building long-term relationships of trust, respect and honesty • Enhancing collaboration between community health services Thanks to Annie and Kathleen for their commitment to improving health outcomes for Aboriginal patients and their diligence in corunning this important project.

The importance of cultural awareness By Rhiannon Mitchell Indigenous Project Officer, Coffs Harbour

n late June, NCPHN provided Cultural Awareness Training to general practice and allied health staff on the Mid North Coast led by local Gumbaynggir man Clark Webb. The three-hour session spent discussing history, culture and how health professionals can work together to best support their Aboriginal and Torres Strait Islander patients. Cultural awareness educates and helps participants to

extend their knowledge about Aboriginal and Torres Strait Islander history and culture. The sessions also explore how attitudes and values can influence perceptions, assumptions and behaviours in a clinical setting. Participants also discuss how to ensure the practice team can be more aware of Aboriginal culture and behaviours. NCPHN will be providing another 12 Cultural Awareness sessions from Tweed down to Port Macquarie over the next 12 months. We are also working towards achieving RACGP accreditation for this training.

Clark Webb

Don’t be afraid to engage with the Aboriginal Health Team at NCPHN and enquire about practice visits, where we can provide support and knowledge about accessing the PBS Co- payment measure, the

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Indigenous practice incentive program (PIP). We can also provide practices with provision of Aboriginal posters and brochures for waiting rooms. The Aboriginal health team members are keen to work with general practices and Aboriginal and Torres Strait Islander people to Close the Gap. Contact NPHN Aboriginal Health team members on: Tweed Valley: 07 5589 0500; Lismore: 02 6627 3300; Coffs Harbour 02 6659 1800; Kempsey 02 6562 1055; and Port Macquarie 02 6583 3600.

healthspeak September 2017

Profile

Greg Telford, CEO, Rekindling The Spirit, Lismore Rekindling The Spirit (RTS) is a community organisation run by Aboriginal people that supports Indigenous men and women to find their own path of empowerment through spiritual, emotional, sexual and physical healing. RTS was founded in 1998 by CEO Greg Telford, who’d experienced similar problems to those addressed by his organisation. RTS has also recently expanded. This year the organisation took ownership of Jullums, Lismore’s Aboriginal Medical Service. Greg spoke to HealthSpeak about his life’s journey and his work with RTS.

hen HealthSpeak visits RTS, it’s a busy Friday afternoon, but Greg generously sets aside time to talk about his life that began in Chinderah in the Tweed Valley. Like many Australians, Greg describes his upbringing as somewhat dysfunctional, but at the same time he says, he grew up with love. These days Greg talks honestly and openly with emotion about his life, but it’s something he wasn’t able to do growing up. When Greg was eight the family moved to Kingscliff and they were made to feel that they didn’t fit in. Greg had to grow up fast and at 14 he moved into a flat. “I had to take on the role of an adult before I was an adult. I made a lot of mistakes, but it’s been a learning curve for where I am today. I shifted all around this side of Australia, not realising I was trying to run away from myself all the time. It took a while to realise that I took myself with me.” Greg said his behaviour at September 2017 healthspeak

the time was ‘not nice’ and he soon realised that if he stayed in one area too long he’d get into trouble. “So I moved around a lot and I got the opportunity to see difference and know difference. You want to have difference in your life; you need to be able to see difference and understand it and know it. And later make a choice to live it.” Throughout his teens and into his 20s Greg worked as a labourer on high rise projects and in his early 20s he returned to Tweed Heads where he met New Zealander Barb, who is now his wife of 31 years. They met while working at a restaurant where Greg was displaying what he calls ‘mischievous’ behaviour. “I was washing pots and

I had to take on the role of an adult before I was an adult

dishes, peeling potatoes and cleaning the kitchen. It wasn’t that hard compared to what I did before. I had issues with alcohol and other drugs so I’d go to work stoned and I had the chef on side so we’d have beer in the freezer and we’d have the bong out the back.” Despite some turbulent years, it was Barb who taught Greg how to love himself. “She taught me how to love me, so that I could love her and we could love our children and I’m very lucky and grateful to

have that. Sadly, when we were living together before we married, due to my earlier experiences I started to pick on Barb.” The pair were often behind in the rent as Greg was drinking a lot even though he couldn’t handle alcohol. Then he became aware that if he shot up speed he could drink alcohol without it controlling him, although this took quite a bit of money. “If I didn’t get the money I’d be violent and eventually she left me and went back to New Zealand. I loved the woman but didn’t know how to go about changing and I finished up shifting to New Zealand, and got into more trouble over there.” Like many others, for Greg alcohol was a sedative. “I was angry with the world, with the way we grew up and with what I saw as a child. And alcohol settled the rage, although when I became familiar with speed I got scared because I liked it too much. Greg finished up selling his possessions and moving to New Zealand, linking up again with Barb who had her own business as a hairdresser. “And I got into more trouble because I hung out with gang

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Greg Telford fronting the media at an event in July.

I was angry with the world, with the way we grew up and with what I saw as a child

continued page 33

Childhood obesity: tools to work with families

o help tackle childhood obesity, the NSW Government has created two tools for health professionals to use to educate parents. One is a video to teach families how to make healthy choices at the supermarket and the other is a healthy weight calculator for children. They can both be found on a new website Healthy kids for Professionals: www.pro. healthykids.nsw.gov.au Chief NSW Health Officer, Dr Kerry Chant, said more than one in five school-aged children was above a healthy weight and obesity remained unacceptably high. “We have to find new and clear ways of reaching the families of these children to improve their understanding of healthy weight ranges and healthy habits.” The new supermarket tour video, developed in collaboration with the Australian Medical

Association (NSW), takes viewers on a guided tour of a supermarket with a dietician, to help show how to make healthy food choices. Dr Chant said the healthy weight calculator was a simple way for parents to evaluate their children’s weight. “It’s not always easy to tell if your child is a healthy weight for their age and this was identified as an important issue in the latest NSW School Physical

Activity and Nutrition Survey (SPANS) report,” Dr Chant said. “The survey found almost three quarters of parents of primary school children who were in the overweight category, and one third of parents of obese children perceived their child to be ‘about the right weight’. This is critical as more than 80 per cent of obese children go on to become obese adults,” she added.

Push for electronic scripts Panel members on the Independent Review of Pharmacy Remuneration and Regulation believe the time is right to move from paper to electronic prescriptions and that the government should take the matter forward and legislate that electronic scripts are a legal record. Led by Monash University Professor of Economics Stephen King, the interim report on the review has raised a series of options rather than made any recommendations on the topic. However, the panel members stated that the government should set up a system enabling integrated electronic prescriptions and medicine records as a matter of urgency. They say the paper-based system is outdated and inhibits the creation of a universal medication record.

The Lusty Month of May By Professor Iain Graham Dean, School of Health and Human Sciences Southern Cross University

It’s May, it’s May, the lovely month of May…

o goes the song, by Learner and Lowe, who wrote Camelot! And for Southern Cross University’s School of Health & Human Sciences May marked a special time for Nursing and Midwifery. On 12 May, Florence Nightingale’s birthday, we marked International Nurses Day, preceded on 5 May by the International day of the Midwife. As usual we marked the days with activities coordinated with our service partners. For the events to mark the International Day of the Midwife, we were inspired by the

attendance, not only of health personnel, academics and students, but also the public who came to acknowledge the important role that midwives play in our communities. At the Gold Coast campus, a student-led conference was held where students and guest speakers talked about the nature midwifery support at a time of major change for a woman and her family. At the Coffs Harbour campus, a morning tea was held at the Hospital along with other women’s health focused activities. At both events awards were presented to midwives and midwifery students to recognise their excellence in pursuing the ideal of woman centred care in their practice. For International Nurses’ Day, the School joined forces

with Northern NSW Local Health District to host its annual Symposium. This year it was named after Ena Williams, a local Indigenous woman, who fought to train to be a Registered Nurse in the 1940s. She was a graduate of the former Lismore School of Nursing. The theme of this symposium was Cultural Safety and Professional Leadership. Once again, practitioners, academics and students presented their work

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to an audience of 120 people. Professor Chris Sarra of the Stronger Smarter Institute gave the key address with the Chief Nurse/Midwife for NSW, Ms Jacqui Cross, also in attendance. But there is more. The School was commissioned by North Coast Primary Health Network to establish a Network for practice nurses which was launched across May in various locations. The purpose of the Network is to provide peer support. For more information contact Siobhan Breedon at NCPHN on sbreedon@ncphn. org.au on 6562 1055. In addition to the Network the school will launch a post-graduate certificate course in Primary Care Nursing next year. Yes, May was a busy month for nursing and midwifery.

healthspeak September 2017

FEATURE

CHRONIC DISEASE MANAGED BETTER TOGETHER Managing chronic disease is a complex process, with various health professionals playing important roles in providing the best care management plan. This feature aims to bring health practitioners up to date on whatâ&#x20AC;&#x2122;s happening on the North Coast to help general practice and allied health professionals better serve the needs of chronic disease patients. We also showcase some innovative programs in the broader health community.

MNCLHD CHRONIC DISEASE MANAGEMENT

The Mid North Coast Local Health District (MNCLHD) Integrated Chronic Disease Management (ICDM) team works in partnership with GPs. It is a free program aiming to decrease readmission rates of patients with targeted chronic diseases (ischaemic heart disease, heart

failure, COPD & diabetes). This program was previously known as the Connecting Care Program, which has gone through a redesign after evaluation. ICDM is primarily telephone-based with some capacity for home visits. It is an individual-based program. After patient consent staff do an assessment of risk of readmission and then discuss with the patient a plan for their needs/goals in regards to health coaching, self-management &/or care coordination. Through consultation and liaising with GPs, timely follow-up of patients, assessment, education, addressing health goals, referring to other health professionals/ agencies as required we aim to help the patient better manage their chronic disease thus reducing risk of admission. To refer, phone 1300 361 465

THE PATIENT CENTRED MEDICAL HOME AND CHRONIC DISEASE The Patient Centred Medical Home (PCMH) model puts the patient at the centre of care, helping to ensure each patient has the care team they need. The patient enjoys ongoing, holistic care from various linked up health professionals including the GP, allied health, specialists and community health services. Internationally this model has demonstrated effectiveness and efficiencies in improving health outcomes, particularly for those with chronic disease conditions. Why not join the PCMH program? You will be supported by NCPHN with

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resources and tools to make changes to your practice that will improve patient experience, health outcomes, cost efficiency and clinician experience. To express your interest go to: http:// ncphn.org.au/medical-home/expressionsof-interest/

THE NNSWLHD CHRONIC DISEASE MANAGEMENT TEAM The Northern NSW Local Health District (NNSWLHD) Chronic Disease Management Service (CDM) provides GPs and health professionals with free short-term expertise to help manage chronic and complex patients. Their support can really enhance the care of chronic disease patients. CDM staff work from Tweed to Grafton under the Patient Centred Medical Home model. CDM uses strategies including care coordination, case management, health coaching and timely follow up after a hospital stay (including home visiting) in consultation with the general practice team. The CDM team also offers: - A self-management action plan plus support & education - Improved access to LHD services where possible - Help to patients to navigate the My Aged Care service - Admission/discharge GP notification by email - Encouragement and help to patients to attend referrals and medical appointments - A 48-hour follow up phone call after hospital discharge to ensure arrangements are in train. To refer a patient or request a practice visit by CDM staff, call 1300 361 465. Please include current medications and care plan where possible.

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THE 2017 WINTER STRATEGY Every winter, there is a surge in health care demand. Older and frail patients are especially vulnerable during this time. The Winter Strategy is a joint project by NCPHN and NNSWLHD, running from July through October. It supports general practices to keep their most vulnerable patients well and reduce hospitalisations. Twenty-seven practices in Northern NSW registered.

Practices created a Winter Watch List of adult patients likely to benefit from heightened care. Staff ensured these patients’ care plans were up to date, that each had a Sick Day Action Plan and that specialist services were involved if needed. A contact person was allotted to each patient so they could call and discuss concerns and receive care quickly. Practices also called patients once a week to check on their wellbeing.

Practice Nurses play a key role in the Strategy and NCPHN is providing payments to help practices meet these additional costs. In addition to Medicare billing, funding is available to refer patients to allied health where care cannot otherwise be accessed. Practices were also linked up with specialist chronic disease management nurses from the LHD and referral to Hospital in the Home was available seven days per week. The practice was notified electronically if a registered patient was admitted to or discharged from hospital.

FEATURE CHRONIC DISEASE MANAGED BETTER TOGETHER

THE CDM TEAM & THE WINTER STRATEGY

Patient teaching resources such as the Living Well with Heart Failure booklet are free here: www.heartfoundation.org.au/publications

The NNSWLHD manager of the Cardiac & Chronic Disease Management Service (CDM) Kerry Wilcox spoke to HealthSpeak about the Winter Strategy 2017 rollout, particularly around heart failure patients. Kerry said that although the Winter Strategy involved an enormous amount of work over a short time frame, the 27 general practices and the CDM staff had settled into it well. She described it as ‘groundbreaking’ – a practical application of the sort of integrative chronic disease management that’s been talked about for years. “We are all keen to repeat it next year, taking into account the lessons learned. But we’re seeing terrific benefits for patients. To have time set aside just for them with the practice nurse is gold.”

Hospital Admission & Discharge

Benefits

Another big benefit is that the NNSWLHD’s CDM Team is developing good relationships with practice staff and respect for each other’s work. The CDM team, as well as cardiac and respiratory nurses, have also been going out to practices and educating staff about Sick Day Action Plans and organising in-service training and support. “Action plans will be the focus of the next Practice Nurse (PN) Network meeting so we’ll have the chance for PNs to further network with our specialist nurses, share resources and answer any questions about action plans,” said Kerry. In addition, PNs are reporting that they 26

ABOUT THE STRATEGY

Kerry Wilcox

are feeling appreciated by all, and can really see the benefits of proactive case management, rather than simply reacting to daily patient demands. Resources

Action plans for heart failure, Chronic Obstructive Pulmonary Disease (COPD), asthma, kidney disease, diabetes, mental health and more are available on the Winter Strategy website (www.ncphn.org.au/winter-2017) under Tools & Resources. These plans teach patients to better look after themselves, how to recognise symptoms of deterioration and act early to see their GP rather than becoming unwell and presenting to hospital. A good example of this is teaching patients to manage their fluid retention through the diuretic titration booklet. “Doctors can prescribe an additional fluid tablet for when the patient puts on too much weight over a short period of time. Patients say they feel much more in control and know exactly when to go back to their GP. There is a lot of information on HealthPathways about managing these patients.”

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If patients registered under the Winter Strategy are admitted or discharged from an LHD hospital ward, an email notification (called an ADN) will be sent to both their usual GP and the CDM team. Not only does the ADN keep the GP informed of patients’ admissions and discharges, but it allows the GP to contribute information which may be valuable in the inpatient setting. ADNs also allow the CDM team to monitor the patient’s progress and follow up after discharge. This will be by phone or a home visit and done in collaboration with the patient’s GP findings relayed back to the practice. The Winter Strategy 2017 is a great example of the benefits of the Patient Centred Medical Home (PCMH) model. The Ministry of Health is keenly watching to see how the Strategy works this year in Northern NSW. The 27 practices who have enrolled in the Winter Strategy are forerunners in progressing the this model of care. Evaluation

Kerry is looking forward to the results of the Winter Strategy 2017 evaluation. “It will be interesting to see what impact it might have had on hospital admissions. Even if the impact is not noticeable this year, we will be able to explore the reasons why people were admitted and look for ways to fill the gaps and try to prevent unnecessary admissions next year.”

healthspeak September 2017

THE 2017 WINTER STRATEGY THE GP AND THE WINTER STRATEGY

September 2017 healthspeak

Goonellabah Medical Centre staff: PN Judy Sheldon, Dr David Guest and General Manager Diane Kerr.

DAVID SAID PATIENTS HAD BEEN QUITE KEEN TO GET INVOLVED AND APPRECIATED THE EXTRA ATTENTION AT THIS TIME OF YEAR

nurses are good at doing this, but the GPs not so much. There are techniques to help. One that I like is called Teach Back, where you go through the plan with the patient and then ask them to tell you how it works and what they need to do. With better education about plans, patients are more easily able to act when trouble strikes.” David said another important part of the Sick Day Management Plan was that patients are given permission to contact the surgery earlier than they might otherwise. “Each patient has a specified nurse, and they know they can contact their nurse if they have any queries and hopefully we get onto things earlier that way, avoiding patients ending up in hospital.”

FEATURE

HEALTHPATHWAYS: QUICK ACCESS TO ACTION PLANS HealthPathways now offers GPs a fast way to find the relevant Action Plans for your patients. After logging in there is direct access to the Action Plans from the home page. Look for the symbol to get to the Action Plan Pathway and go to that page. From there, simply select the plan you need and then select the option to either print a pdf form or upload a form into your clinical software. Action Plans are available for: • Asthma • Chest Pain • COPD • COPD for Indigenous Patients • Delirium • HARP Assessment Tool • Heart Failure • Keep Me Safe (Mental Health) • Type 1 Diabetes • Type 2 Diabetes

CHRONIC DISEASE MANAGED BETTER TOGETHER

Dr David Guest from Goonellabah Medical Centre (GMC) told HealthSpeak that staff had found enrolling patients into the Winter Strategy fairly easy because they’d been part of the Medicare Local Collaboratives. “Back then we’d set up our systems for diabetes patients and organised ourselves so that we could contact the people on care plans on a more regular basis.” With the aim of the Winter Strategy to take pressure off hospital beds, David has been working with staff to better manage lung patients such as chronic smokers. This cohort was selected through identifying sicker patients with little support, those likely to benefit most. “We were able to fairly easily sign up people for care plans and for the Winter Strategy.” According to David, a key part of the success of such programs is that GMC pays its nurses on a fee for service basis. “So the nurses do a care plan and GMC agrees to pay them a portion of the fee, the doctor involved a portion of the fee and a portion is retained for admin costs. That’s quite different from most practices. “And so with the Winter Strategy we were able to use the same approach to compensate nurses for the extra time involved. We have internal spreadsheets where they lodge their activity and we pay on a monthly basis.” David said patients had been quite keen to get involved and appreciated the extra attention at this time of year. With Sick Day Management Plans an important component of the Strategy, David was concerned about patients’ ability to get on top of what was required of them. He enlisted the help of the LHD’s specialist consultants. “The nurses from the LHD have developed their own disease-specific management plans and our staff have been working with them to start to talk to our lung patients about what they should be doing when they get sick.” And practice nurses play a major role in informing patients about the Strategy. “That’s a lot of education and the

To view all Mid and North Coast HealthPathways log on to: https:// manc.healthpathways.org.au/index.ht Username: manchealth Password: conn3ct3d

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THE 2017 WINTER STRATEGY PRACTICE STAFF AND THE WINTER STRATEGY

FEATURE

Practice staff say they’ve appreciated the support they’ve received from NCPHN’s Practice Support Officers and specialist LHD nursing staff to effectively implement the Strategy. They are finding the Strategy valuable. PN Aaron Sweeney works at Union Street Family Medical Practice in Yamba. The practice has 31 patients enrolled, most with COPD or diabetes. Aaron has found that patients tend to disclose more about their health status during the weekly phone call than they do in person. “We have one gentleman who was constipated but was too embarrassed to mention it while he was at the practice, but he was able to tell me during a phone call. According to Aaron, patients are enjoying the weekly phone contact and they are feeling the practice is invested in their health. It’s improving the relationship they have with both their nurse and doctor. At Yamba Private Clinic, Sarah Hope assists Practice Manager Diane Hope. The practice has registered 25 patients and Sarah has created a checklist for staff to

CHRONIC DISEASE MANAGED BETTER TOGETHER

ALLIED HEALTH’S ROLE IN ABORIGINAL HEALTH HealthSpeak approached Rob Curry, Mid North Coast physiotherapist, and a board member of the North Coast Allied Health Association, for his perspective on how allied health can benefit our Aboriginal population. Rob has worked in various roles in Aboriginal health and believes that allied health practitioners have much to offer Aboriginal patients. He said patients with conditions including diabetes, COPD, CVD, mental health and renal disease could all be reaping health benefits through seeing a range of allied health practitioners. These include nutritionists, physiotherapists, exercise physios and podiatrists. However, in Rob’s view the biggest

Diane and Sarah Hope of Yamba Private Clinic.

fill in when a Winter Strategy patient either phones in or calls in, which has been helpful to keep track of this cohort. Initially Sarah wondered if the patients would be annoyed by a weekly phone call, but they welcome the contact. “One patient mentioned to us on the phone that she thought she was due for a shingles vaccination and we were able to organise an appointment for her.” Ros Hollis is a {M at Clarence Medical

Centre in Maclean and said that their nine enrolled patients loved the weekly phone contact. One COPD patient’s carer is really appreciating being part of the Winter Strategy. She told Ros she now felt like she knew what she was doing. The carer reported that she was giving the patient more regular Ventolin when symptoms indicated it would be helpful to do so, and she was feeling more confident about when to give prednisone. Ros calls enrolled patients on Mondays to see how they’ve gone over the weekend. “I’ve called back two patients recently after speaking to them on the phone. They’d not improved as we would have liked, so it was necessary to get them back into the practice. “They know that we will squeeze them in and they are certainly feeling more valued,” said Ros. Another benefit of the Winter Strategy was that practice staff feel more ‘linked up’ to their cardiac rehab nurse. “During the Winter Strategy process, the cardiac rehab nurse has provided us with resources to manage CCF patients in daily ways and this is an extra benefit that’s come to the practice,” said Ros.

obstacle to more Aboriginal Rob would like to see patients receiving allied better health data availhealth care is the funding able for the North Coast model. While the ComAboriginal population. monwealth’s Medicare “What we have is mostly focus is on general practice, hospital data and data deallied health is largely veloped by Aboriginal conprovided privately, making trolled medical services. it difficult for the disadvanBut we know very little Rob Curry, Mid North taged to pay. about the broader picture Coast physiotherapist. In the same way he said of health and what allied that while the Commonhealth services Aboriginal wealth provided good funding and suppeople are using.” port to GPs through the Primary Health Rob said that NCPHN was doing some Networks, there was little funding and innovative work and that events such as support for allied health practitioners in speed dating and the establishment of the way of professional development and Clinical Councils allowed GPs to get actraining. quainted with local allied health practitio“And unfortunately when the support ners. He would like to see a permanent alisn’t adequate it becomes a blame shifting lied health staff member advising NCPHN game between the Commonwealth and the to ensure a voice for this health sector in State governments, which benefits no one.” program planning and commissioning.

a publication of North Coast Primary Health Network

healthspeak September 2017

CHRONIC DISEASE MANAGED BETTER TOGETHER

DIABETES MANAGEMENT: THE ROLE OF THE DENTIST By Dr Brendan White

Evidence is growing linking oral health to general health. Diabetic patients in particular benefit when the dentist and the GP work together. Smoking, poor diet and alcohol consumption – chronic disease risk factors - are also risk factors for gum disease and tooth decay. Periodontal disease is a chronic inflammatory disease of the gums, ultimately leading to tooth loss. Nearly 25% of adult Australians are diagnosed with moderate or severe periodontitis. A recent study has shown that of the patients presenting to the dentist with periodontitis, (radiographic bone loss >20%, pocket depths>5mm, or attachment loss>3mm) 57% were undiagnosed

September 2017 healthspeak

The Shady Ladies team were thrilled that most participants finished the program.

Community & Renal Dietitian Leesa Roach said nearly all the women who started the program finished it. “Each week we had a guest speaker – a diabetes educator, a women’s health nurse, a respiratory nurse. They’d talk for an hour, followed by an hour of nutrition education and then a shared meal was prepared. “We cooked lunch together and answered any questions raised dur-

pre-diabetic (HbA1c >5.7), and 7% were undiagnosed diabetic (HbA1c >6.5). This means that patients presenting with the common signs of periodontal disease - bleeding, inflammation and discolouration of the gums, possibly accompanied by loose, painful mobile teeth - should be assessed for diabetes. Periodontal disease is the oral equivalent of the diabetic ulcer and can result in a significant inflammatory burden affecting the regulation of insulin, leading to a greater risk of developing or progressing diabetes. A 2015 Cochrane review demonstrated that treating periodontal disease in diabetic patients with scaling and root planing led to improved glycaemic control for up to 4 months. This suggests that regular periodontal maintenance as part of diabetic care would be beneficial. Management of periodontal disease is much more successful when diabetes is well controlled. Those with normal blood glucose levels will have very similar treatment outcomes to the non-diabetic population. Poorly controlled diabetic patients will have worse outcomes, resulting in discomfort and tooth loss.

FEATURE

An 8-week pilot program, which engaged 15 Indigenous women living in the South Kempsey district with the aim of improving their health and wellbeing, has won a MNCLHD Health Innovation Award. It’s a great example of practitioners working together to motivate, educate and improve the health of Aboriginal women. The Shady Ladies nutrition and lifestyle pilot run late in 2015 was led by the Hastings Macleay Aboriginal Chronic Care and Nutrition Dietetics team. Two grants, including one from North Coast Primary Health Network got the pilot off the ground. The women selected for Shady Ladies had one or more chronic disease risk factors.

ing the morning. The following day the physiotherapist attended and the women enjoyed a hydrotherapy pool session or a circuit workout in the physiotherapy unit, followed by a healthy morning tea.” One unexpected benefit was the impact of the recipe book produced during the program. “The ladies told us they’d go home and cook the recipes with their grandchildren, so the kids were learning healthier behaviours. That was great to hear,” said Leesa. MNCLHD Governing Board Chair Warren Grimshaw AM is keen to attend a morning tea with the Shady Ladies to hear more about their experiences. And a focus group will be held to find out where the participating women would like to go from here. If the program is run again, Leesa would record a range of health measures t before and after the program to gauge the impact of the lifestyle education and exercise.

CHRONIC DISEASE MANAGED BETTER TOGETHER

ABORIGINAL HEALTH: SHADY LADIES PILOT WINS AWARD

Treating periodontal disease may make gylcaemic control more successful by avoiding tooth loss, ensuring adequate mastication and nutrition. The inter-related diseases of periodontitis and diabetes provide a great opportunity for dentists and GPs to work together to benefit patients. The health benefits are not limited to diabetes. Poor oral health is linked to increased CVD and nursing home-acquired pneumonia. In pregnant women it is linked to increased rates of caries for their children.

Key points • If patient presents with loose, wobbly teeth & bleeding gums, consider assessing for diabetes. • Inform diabetic patients they are at risk of periodontitis. • Dental practitioners have a role in early detection of pre diabetic and diabetic patients. • Periodontal treatment will have improved outcomes with good glycaemic control. • Combined treatment can avoid tooth loss

a publication of North Coast Primary Health Network

CHRONIC DISEASE MANAGED BETTER TOGETHER EXERCISE ON DIALYSIS PROGRAM

FEATURE

This pilot program, unique in NSW, was trialled at Lismore Base Hospital (LBH) late last year. And in July the program won a NNSW LHD Quality Award. Led by exercise physiologist Tiphanie Lloyd, such a program had been on the hospital’s radar for years. There is plenty of evidence about the value of dialysis patients being involved in exercise programs. Haemodialysis patients do around 65% less exercise than age matched norms and perform at a lower level in daily activities, which is associated with a 3.37 times higher risk of mortality.

CHRONIC DISEASE MANAGED BETTER TOGETHER

Benefits of an exercise program include: • Improved mobility and balance • Improved fitness and function • Improved blood pressure, heart rate and cardiac function • Improve muscle strength, reduced risk of falls • Reduced pain, improved sleep and quality of life When approached, LBH’s Renal Unit Nurse Unit Manager Jane Ruane was happy to put the pilot in place. LBH exercise physiologist Kylie Everman was also involved. After discussing the proposal with patients, the renal team and nephrologists, an exercise plan was drawn up for eight dialysis patients to take part in a 10-week resistance training program. “So the plan was that patients would exercise once a week with me and twice on their own with support from nursing staff,” Tiphanie explained. Fitness testing was done prior and after the 10-week period and in ‘sit and stand’ testing the patients had a 66% improvement in their leg strength. A 36% improvement was seen in their time to ‘get up and go’, (a good falls risk test) and there was a 35% improvement for the arm curl test, which measures upper body strength. Jane said the patients were thrilled to have something to pass the time that would also benefit their health. “The social aspect is also of great benefit. Social interaction really humanises the

Physiotherapist Kylie Everman, NUM Jane Ruane and patient Margaret Rigney.

THE SOCIAL ASPECT IS ALSO OF GREAT BENEFIT. SOCIAL INTERACTION REALLY HUMANISES THE PATIENT EXPERIENCE patient experience. A persons come into the hospital, they get a record number and get attached to a machine. This can be quite dehumanising and each time they’re reminded of their true morbidity and mortality. “If someone is using their dumbbell while on a machine and looks across and sees someone else lifting a weight, then it’s like you are actually at a gym and doing some exercise with others.” HealthSpeak spoke to one patient, Margaret Rigney, who enjoyed being part of the pilot and said that it really helped break the monotony of dialysis. Margaret has a tendency to fall and said that the strength training was helpful for her. Jane also appreciates that the training helps improve strength. “Dialysis patients have bone mineral density issues and because their bone minerals are leeched, if they have a fall that could be a catastrophic end of life situation. So anything to improve their balance,

a publication of North Coast Primary Health Network

their general condition and muscle tone helps to prevent a fall that could prematurely end their lives.” All the patients were enthusiastic about the program said Tiphanie, and in a survey at the end of the pilot all wanted it to continue. After its success, NNSWLHD Chief Executive Wayne Jones has said he’ll try to find funding for the program to come back. Ballina and Grafton Hospital renal unit patients are also keen to get an exercise program in place. If the program becomes ongoing Jane would like to inject some more fun into it. “We’d like to make a day a month where the nurses also get involved in some exercise. We could wear headbands and play some music and get that gym feel about the place. You don’t have to be Commando to get fit.” The pilot is being shared with other renal and allied health professionals and will be presented at the Exercise & Sport Science Australia Conference next year.

Results • 66% improvement in sit to stand test • 36% improvement in 3m timed up and to test • 35% improvement for arm curl test

healthspeak September 2017

Suicide, Young People and the Wisdom of an Aboriginal Elder By Lisa Brown Psychologist

This is a story borne out of a deep collective despair that as a society we are not better able to care for our young people in the face of increasing suicide rates.

n Australia, suicide is the leading cause of death for young people, with Aboriginal and Torres Strait Islander youth four times more likely to take their own lives than non-Indigenous youth. Eighty-six-year-old Uncle Charles Moran is a respected Bundjalung Elder who lives with wife Glennys in Northern NSW. In 2016, Charles and Glennys lost their 15-year-old great-grandson Byron to suicide. Byron had been in the care of the state following a breakdown of family and foster care placements. Attempts to reconnect with his mother had failed, and Byron was grieving the sudden death of his grandmother. Byron spent Christmas 2015 with the family and appeared to be okay, although Glennys recalled there were limited opportunities for deeper conversations. Byron’s death led to this conversation with Uncle Charles, who generously spoke about how we can better support, protect and take care of our youth. He also spoke of the need to instil a vital sense of hope for the future in our young people through an understanding of the capacity for resilience. His contribution to Australia is significant and documented in his book Talk Softly, Listen Well in which he states “with all my hardships, having to cope with racism, I don’t feel any bitterness towards anybody. I do not blame anyone else for my mistakes in life. I am in control of my own life, I am my own man”. In Australia, we continue to witness injustice and racism through systemic unconscious bias that underlies governSeptember 2017 healthspeak

ment policies and institutional rhetoric. Uncle Charles’ experience mirrors the secrecy, trauma and disconnection inflicted on families through governmental policies that enabled the Stolen Generations. He says that when he tried to find out information about Byron’s placements he was told the information could not be provided. Yet again he encountered a policy that reinforced a sense of disconnection from his great-grandson. Uncle Charles speaks of the importance of not just having a roof overhead or food on the table, but of human connection and attachment. He says in the old days “when young people went off track” they would be asked “what did you do wrong?” And if they had done something wrong, they’d be asked, “Would you do it again? And if so, why, if it is going to get you into trouble?” He speaks of the importance of looking beyond the behaviour to find the “actual person”. It is an important cultural perception, that people are basically good, in discord with the prevalent Western view that we are never good enough. During his formative years Uncle Charles was listening to initiated men and developing a deep respect for Bundjalung language. He talks of the importance of mastery of language, giving language a sacred place within culture. “Young people developed connection through language; the old people would teach until we got it right, learning to make mistakes, listen, be guided, develop connections, and to feel safe.” He recognises that young people need to be self-reliant and develop their resilience. Independence is important. “It’s the best thing you can give your kids. I don’t like excuses, I don’t like liars, and I don’t like broken promises. I was brought up by my Mum who was single,

Bundjalung Elder Charles Moran.

In his book Charles writes about fighting for fair compensation for ex-Baryulgil miners suffering from asbestos-related diseases

a publication of North Coast Primary Health Network

but I knew that if I didn’t do the right thing there would be consequences.” A strong advocate for the rights of Aboriginal people, in his book Charles writes about fighting for fair compensation for ex-Baryulgil miners suffering from asbestos-related diseases and those already passed away. He recalls being regularly covered in asbestos, and after four years working in the mine he said to the manager “Surely this can’t be good for you?” His boss replied: “It won’t affect you people’”. Uncle Charles’ son Charles died due to asbestos exposure when he was 52. According to Charles, “If people are racist, that’s just ignorance.” Suicide often comes from an overwhelming sense of disconnection and hopelessness. Remembering that we are not separate can bring a shift in perception and open up healing possibilities. 31

“Young people need to go to the river to fish. The time together is important to sit in stillness and connect back to a wider sense of ‘inter-connectedness,” says Charles. While change is constant, a return to stillness through acknowledging stories, listening deeply and cultivating respect for all life can provide hope and possibility amid overwhelming despair for the world. Uncle Charles learned to trust a sense of “knowing” developed from childhood, how to feel and sense oneness with all things. This knowing stemmed from listening and learning from the ‘old people’. Through conscious awareness we are reminded of the interconnectedness of all things. In Australia we have an opportunity to bring about a seismic shift in our approach to health and wellbeing. There is disunity between policies and the action that supports young people. Throughout a violent history, for too long decisions have been made that fail to acknowledge the wisdom of Indigenous healing traditions. In 2016 the Australian Psychological Society apologised for not acknowledging the importance of Aboriginal Australian cultural practices in therapeutic interventions. It recognised that dominant ‘white’ perspectives have the potential to cause harm, and do harm. Aunty Bea Ballangarry, a healer and respected Gumbaynggirr Elder acknowledges that “sometimes the clinical doesn’t work.” Speaking as a psychologist, the suffering we see in human beings is immense, as is the sense that collectively we need to speak up about what is not working and bring about change - change that ironically may end up saving public money and young lives. Change needs to come from within systems to facilitate honest conversations acknowledging our painful history. When we can turn towards our shame and collective pain with compassion we have the potential to deconstruct colonial mind states that influ32

Author Lisa Brown is a psychologist, yoga and mindfulness teacher living on the Mid North Coast.

I believe our young people need to turn back to their culture. It is only there that they will find their identity and a sense of purpose in life

ence policies and re-write the next part of our story. Sadly though, some of the wisdom of the past has been lost. “Today we do not have wooyun or murroogahn (doctors or lawmen) trained in the old ways to guide us,” says Charles. Colonisation meant language was forbidden by the State, children were removed and Aboriginal culture was viewed as worthless, says Uncle Charles. He adds that colonisation meant there was no one to educate boys about culture or teach respect. “It is the breaking down of respect – for Elders, for the law and for their culture – that has caused many young people today to lose respect for themselves.” He says that everything begins at home. “Respect yourself, respect others, respect the country you live in, be proud of who you are. If children grow up with healthy boundaries this can help create resilience and self-esteem, and makes life much easier.” Uncle Charles believes that there is no such thing as a silly question, adding that ‘shame and embarrassment’ get in the way of young people asking questions. Under the watchful presence of Elders, Uncle Charles developed self-reliance, independence,

a publication of North Coast Primary Health Network

resilience and respect through learning language. In Australia, we need to be serious about addressing suicide. Simply put, we need to work towards preventing it. The words of Uncle Charles can contribute to a dialogue about how government health and education policy needs to shift away from its white colonial bias – one that not only informs institutional responses but serves to perpetuate the devastating consequences of our past. In his book Charles states, “I believe our young people need to turn back to their culture. It is only there that they will find their identity and a sense of purpose in life…Survival of the group depended on the contributions of all its members. Everyone had a place, everyone had responsibilities. Our people lived in harmony with the land and their neighbours”. Glennys believes that when we are where we are meant to be, things fall into place, but when we are on the wrong path everything goes wrong. With this in mind, can we as Australians wake up to being “on the wrong path” with some of our policies, and get back on track to save and support young people? Many Elders suggest we have been born at this time for a reason. A new vision is required, broad enough to examine the systemic issues that underpin youth suicide with open and courageous hearts. A new vision could affect social change from a place of compassion through a deeper understanding of ourselves and the communities we serve. This article came about through conversations shared with Uncle Charles Moran, Glennys Moran and the kindness of Veronica Moore. Lisa Brown is a psychologist, yoga and mindfulness teacher living on the Mid North Coast. Reprints of Talk Softly, Listen Well are available for sale at mibunj@ gmail.com healthspeak September 2017

Profile

Greg Telford, CEO, Rekindling The Spirit, Lismore – continued

guys, they were the only people I knew how to behave like. Barb and I separated after I borrowed the car one day and wrote it off. I was drinking and selling and smoking a lot of dope.” The crash was Greg’s low point, the catalyst that at the age of 27 set him on his journey of change. He realises now that he beat Barb to push her away because of his own insecurity and feelings of inadequacy, believing he didn’t deserve her. But he never wanted her to go. “It was really crazy thinking, but Barb loved me and I saw characteristics in her that I really wanted. A friend helped me get into AA (Alcoholics Anonymous) where I went for nine months before going into rehab. I was a pretty loose cannon.” Although Greg started drinking again about two years later, he stopped again and has not had a drink since. As well as crediting Barb with turning his life around, Greg is very grateful to his Mother who died at 54, not long after Barb and Greg returned to Australia. “My Mum played a big role in my life and she still does. I talk to her every day. She guides, directs and helps me in my life. A lovely, lovely lady. “She saw something in me that I didn’t see myself. And in her passing she gave me a job, to look after my siblings. She said “I’ve watched you throughout your life. You get knocked down, but you get back up’. Today I’m very proud of my brothers and sisters.” It was during a spell of unemployment that Greg was given the opportunity to attend TAFE and study the very first alcohol and other drug course tailored for Aboriginal people.” At the end of the course Greg landed a job at Box Ridge as a Community Development Worker. And not long after he applied for a job at the DoCS office in Lismore. Greg was staying at the Koala Caravan Park in September 2017 healthspeak

Broadwater when any doubts he had about his capacity to do the DoCS job were wiped away. “That day coming into town up the Wyrallah Road I saw a koala, and that koala walked out onto the road, stood up on its hind legs and it looked straight at me. I thought ‘Whoa, you don’t see that often.’ I felt it was the ancestors giving me the right of

I’d realised that taking the alcohol and drugs out of your life is one thing, but changing behaviours is another way to do the work. “I wasn’t brought up with totems but I like to use the emblem of the koala for our program here. Our name, Rekindling The Spirit, just came to me. Within all of us there are sparks and embers of our Spirit and part of our role here is bringing it back to life so that people can see the Spirit and see that it shines.”

It was when Greg became working with DoCs that he became aware of the issues facing fathers and that nobody was working with them. “That was back in 1994. Around the same time, the anti-violence project started here in Lismore. I got involved with that as I could see that violence was one of the issues for these families. And I was wanting to change some of my behaviours so that I could become a better person. I’d realised that taking the alcohol and drugs out of your life is one thing, but changing behaviours is another.” Out of the antiviolence project, two organisations emerged, the Men and Family Centre in Lismore and Rekindling The Spirit. Greg was a public servant for 15 years before the NGO was set up and he was employed there. He recalls that while he was set up to work with men and their issues, he realised these men sorely needed better communication skills

RTS is excited about the opportunities to also address the physical health concerns of clients now that Jullums AMS is part of the organisation. A timely encounter between Greg and a koala resulted in the animal being used as the RTS logo.

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a publication of North Coast Primary Health Network

Preliminary study results on anti-vax parents

STIs on the rise in NSW Gonorrhoea and chlamydia cases are increasing in NSW, prompting health authorities to remind people to use a condom when having sex. There were nearly 7000 notifications of gonorrhoea, a serious infection of the genital tract, in 2016, up 28 per cent on 2015. The NSW Sexually Transmissible Infections Data Report for 2016 shows 81 per cent of gonorrhoea notifications were in men. Gonorrhoea is more common among men who have sex with men. But the largest relative increase in the gonorrhoea notification rate was in females – up 43 per cent, compared to 23 per cent for men. Chief Health Officer Dr Kerry Chant said condoms were the most effective way to prevent the transmission of STIs. "NSW Health has invested in a variety of programs promoting condom use across all age groups, through online and social media platforms as well as face-to-face education. This includes the ACON Condom and ACON Choose Prevention Campaigns, which target gay and homosexually active men," she said

ast year Catherine Helps began a PhD study exploring why a larger number than the national average of parents in the Byron shire chose not to vaccinate their children. At an Immunisation Update evening in mid-June, organised by NCPHN, Catherine shared some preliminary findings. Common themes found among 31 parents who refused to vaccinate their children were: • Transparency concerns, about everything from the motivation of people putting out policies to why it was a media magnate who set off No Jab, No Pay. • Concern about what’s in vaccines • Concern about how adverse events were demonstrated, why the community isn’t told about such events. • Profit versus health motivation –Is it about health outcomes or profits for big pharma? • Product quality concerns – people said ‘if I could get the best quality product I would

From previous page

to relate to their wives and children. “At the time I was teaching these guys ‘I’ statements, such as …’I feel angry when you do that, so what I’d like is…’ “And one of the guys came back and said, Greg that doesn’t work. I went home and I said to my partner that ‘I felt angry when you do this, and what I’d like is…’ and she said: ‘F--- you, you go and sort it out, that’s your crap.’ “So I realised that what was needed was for RTS to work with the women and children as well to break the cycles of violence in these homes and we’re doing that now.” RTS was incorporated in 2006 and bought the Uralba Street premises not long after

Catherine Helps

pay for it and I would get my child vaccinated.’ • Choosing not to vaccinate means more parental responsibility is required. Almost all parents expressed this view. They said they had a greater responsibility to both their child and the community to keep everyone safe. • Holistic view of health – a lot of parents said that they thought Western health standards were poor. They hear a lot about chronic illness and diabetes, half the kids are on Ritalin and half the women can’t get pregnant without IVF. Their re-

through a FACSIA program. In 2021 that building will become an RTS asset. A lot of the work Greg does today is breaking generational cycles of violence and dysfunction. “What we have is women and little girls and little boys growing up with violence. And sadly, I see that if little girls grow up with that, more often than not they allow their partners to beat them, and more often than not little boys grow up to be perpetrators of violence.” He said a lot of traditional Aboriginal people talk of the seven generations – that the gestures we make, every word that comes out of our mouths, has an impact on the next seven generations, and that’s

a publication of North Coast Primary Health Network

sponse is that they are going to remove everything from their child’s life that is not essential to their wellbeing. They will give them organic food, minimise screen time and make sure there are no toxic emotions in the house. • The belief that vaccinating is a decision for parents not governments. This feeling has become stronger since No Jab No Pay was introduced. • While parents agreed the risk of an adverse event was unlikely to remote, they believe that if an event were to occur that it would be catastrophic. Not a small fever or a rash. They believe the effect would be disastrous to the point where they might lose their healthy child to a vaccine. Catherine’s research will take some years to complete. GPs wishing to provide input or seek more information can contact Catherine Helps at research@ helps.com.au.

how Greg likes to think. “It’s not about me today, it’s about my children and their children and their children and their children. And one day hopefully we’ll have the parents that we’re hoping for.” Greg is excited about the future, and in particular RTS coming together with Jullums Aboriginal Medical Service. “Now that Jullums is under our ownership it will really enhance opportunities for Aboriginal people to heal. We can now ensure their physical health issues are taken care of alongside their social and emotional health issues. And we’ll be able to build a more significant relationship with the broader community through the work done by Jullums’ practitioners and staff.”

healthspeak September 2017

Labour market: back to the future?

HE Phillips curve has lost its curve. It’s now flatter than a pancake and central bank economists are flummoxed. It used to slope gently downwards, reflecting an inverse relationship between wage inflation and unemployment. When unemployment went down, inflation, particularly wage inflation would go up – and vice versa. Central banks could hike interest rates to reduce inflation and increase unemployment or they could cut them for the opposite effect. This relationship held for around 150 years - but over the past decade or so it has flattened out. The relationship has been lost. While this might sound a little esoteric, it has important policy implications and reflects profound and worrying changes in the structure of the labour market. We have already seen some political consequences and unless something changes, there will be more. In the US, UK and Australia, unemployment has been falling since the peak of the Global Financial Crisis (GFC). In the UK unemployment is now 4.5 per cent – the lowest since the 1970s. In the US unemployment is around 4.3 per cent. With the collapse of the mining boom Australia’s unemployment rate is still around 5.6 per cent but well below the GFC peak. Meanwhile, economic growth in all three countries has returned to the long term average. Normally this would mean a growing shortage of labour and subsequently higher wages as employers competed for workers. But it hasn’t happened. For the past few years wages growth in Australia has been at record lows – a phenomenon shared by the US and the UK (and others). At times wage growth has actually been below the inflation September 2017 healthspeak

Workers, many of whom also have high levels of debt, are feeling insecure, disempowered and in no position to bargain for higher wages rate, with real wages falling. Why is it a matter for concern? It’s important for both economic and social reasons. Low wage growth means low consumption spending and low future growth. It also means that business investment and government tax revenue will suffer. High levels of household debt make the situation even worse. There are social implications as well. Over the past decade we have seen economic growth and rising productivity - trillions of dollars of extra income. But almost all of the benefits have gone to capital. The rich are getting richer. An economy needs to be seen as both prosperous and fair, but if this situation continues, more and more people will become disillusioned. This, we are told, is what is sparking the inequality debates

around the world and giving rise, at least in part, to the populism of Trump and others. It is a major political and economic challenge. But why is capital getting the lion’s share of growth? The UK Government has launched an enquiry and the central banks admit they are puzzled. In a recent speech, the chief economist at the Bank of England, Andrew Haldane, had a stab at explaining it. Apart from the lingering effects of the GFC, increased automation and a reluctance of workers to change jobs, he sees big structural workforce change as a major contributor. In particular there have been big changes in the relationship between employees and employers. Employees have lost so much power over the past few decades that he likens the current labour market to the one that existed prior to the industrial revolution - from 1500 to 1700, positively mediaeval. He reckons that prior to the Industrial Revolution work was what he called divisible – something that is occurring now. Most workers back then were self-employed or worked in small businesses. There were no unions. Hours were flexible; work was artisanal, task-based and divisible. In the modern era, neoliberal economic policies from

a publication of North Coast Primary Health Network

finance David Tomlinson the 1980s - that saw measures introduced to increase labour market “flexibility”- have led to the collapse of trade unions, a huge surge in casual and parttime work, the gig economy and rising under-employment. For example, trade unionism has fallen dramatically in Australia, from 60 per cent in the 1970s to around 10 per cent today. It is about 35 per cent in the public sector. In the UK and the US it is a similar story. Workers, many of whom also have high levels of debt, are feeling insecure, disempowered and in no position to bargain for higher wages. All these developments have implications for wage growth, consumer spending, business investment and government revenue. Indeed it has implications for the type of society in which we live. Perhaps we need a radical new social contract to ensure that fairness is not lost? (Haldane, Andrew: “Work, Wages and Monetary Policy” Bank of England June 2017.)

Making the Invisible Visible: heart health for women By Nerida Colley Health Promotion Officer

t’s not well known but heart disease is the number one killer of women and it is three times more common than breast cancer. Rural women are more at-risk due to elements such as transport, conflicting priorities, access to medical services and opportunities for incidental exercise. The Lismore Women’s Health and Resource Centre, with the support of a grant from the Heart Foundation, has been working for 18 months to raise awareness in women of the dangers of heart disease. The key factors for rural women include not recognising the warning signs of a heart attack, presenting to emergency later, and having poorer outcomes than men, and not visiting their GP to discuss heart health. The project’s key aims are to support and enable women to: 1. Recognise the importance of heart disease 2. Have a heart health check 3. Know the warning signs of a heart attack More than 40% of women will not experience chest pain.

Nerida Colley (centre) presenting the 0utcomes of the Northern Rivers Project at the NSW Women and Heart Disease Forum, June 2017.

Although they are more likely to experience jaw, shoulder, neck and back pain when having a heart attack. And only one in four are aware of at least one symptom. Only one in two women are confident they would know what to do if they were having a heart attack. The key target groups for the project are: local women aged 30 to 55, including those from Aboriginal and culturally diverse communities and health professionals who provide heart health care. The project outcomes so far include recruiting champions in the community to share

messages about heart disease prevention and awareness of the signs and symptoms. These champions have attended community events with a specific heart health focus where testing and risk assessments are offered. Sharing messages through mainstream media (NBN television, ABC North Coast and print media) and social media have also formed part of the strategy. Many doctors’ surgeries and clinics in the Northern Rivers are now displaying posters about the atypical symptoms women may experience during a heart attack. Education sessions are also being provided to commu-

One stop website for aged care data

new Australian Institute of Health and Welfare website, GEN, was launched recently by the Indigenous Health Minister Ken Wyatt. GEN is a comprehensive ‘one stop shop’ for data and information about aged care services in Australia. It reports on capacity and activity in the aged care system focusing on the people, their care, assessments and the services they use. Particular regions can be explored and information found about the population of a region, the provision of aged care 36

services and the people who receive these services. GEN has been designed to cater for all manner of users, from students to data modellers and actuaries.

For an overview of GEN go to https://youtu.be/yDENwc89SxA www.gen-agedcaredata.gov.au

a publication of North Coast Primary Health Network

nity members and LHD staff. Women considered to be at risk are encouraged to visit their GP. Advice is given about nutrition and physical activity. Women are also given resources to take to the GP to remind them of the important questions to ask about their heart health. GPs are at the coalface in terms of helping women determine and understand their risks. Lismore Women’s Health & Resource Centre hopes to continue to work with the PHN to improve cardiac outcomes for women and the broader community. For more information, contact Nerida on 6621 9800.

briefs

Magnets quieten ‘voices’ A new study confirms the brain region involved in generating the "voices" that occur in schizophrenia. Using transcranial magnetic stimulation, researchers were able to reduce the severity of this disturbing symptom. A team of French researchers embarked on a project to understand and potentially reduce the frequency of auditory hallucinations. They used a non-invasive technique called transcranial magnetic stimulation (TMS) which sends pulses of magnetic energy into the brain. Fifty-nine schizophrenia patients were involved in the trial. An impressive 34.6 per cent of those receiving TMS had significantly reduced auditory hallucinations, compared with 9 per cent undergoing the sham procedure.

healthspeak September 2017

A postcard from Malawi Dear readers,

incidence of oesophageal cancer, possibly related to tobacco chewing. He has developed a regimen to reduce the associated dysphagia. Difficult to source locally, I found to my surprise that dexamethasone is very cheap in Australia, but not in the UK. With the willing help of a couple of chemists from the Northern Rivers, I was able to fulfil this request, luckily without problems

'm writing to you from Malawi, in southern central Africa. I am a guest at a palliative care centre there called Ndimoyo, meaning 'the place giving life'. This inland country is defined by the long and narrow Lake Malawi which borders its eastern side. Known as 'the calendar lake', it measures 52 miles across by 365 miles long. As I stand on the sandy shore in front of our house, a wave break and the distant watery horizon lends to the illusion of an ocean beach.

Much to my bafflement, the main request was for dexamethasone tablets â&#x20AC;&#x201C; lots of them

A local witch doctor.

September 2017 healthspeak

light airs David Miller from any Customs officials along the way. One difficulty the clinic faces is the number of non-palliative patients who turn up, looking

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It's hard to get my head around that this is a body of fresh water 474 metres above sea level. It is host to a large variety (over 1,000) of fish species called cichlids. They are remarkable in that the young shelter in their mothers' mouths. Across this waterway, a part of the Great African Rift Valley, is neighbouring Mozambique. Why am I in Malawi? It's a bit of a long story. I'm here with my partner who is a friend of the Finches. Lucy Finch is a Malawian. She and her English husband Tony set up and have run Ndimoyo for 11 years. It's very impressive, a calm oasis in a sea of vibrant life. I only wish I could be more useful but the disease profile is so unfamiliar. Malaria, tuberculosis and I'm sad to report its true, that HIV/ AIDS all take a huge toll. Average life expectancy is less than 60 years. There is good news for the newborn at risk with universal provision of HIV prophylaxis. Retrovirals and chemotherapy are free to patients. The generic medicines I saw have 'Made in India' labels. When I asked what I could pack to donate from home, much to my bafflement, the main request was for dexamethasone tablets-lots of them. What on earth for? Soon after arrival, I was lucky enough to sit in with a visiting oncologist, one of only two in a country of 17 million people. This Malawian doctor described the very high a publication of North Coast Primary Health Network

Thirty Days Mark Raphael Baker Text 243pp

s the title suggests, time plays a central role in this Melbourne author’s paean to his love for wife Kerryn Baker who died of a rare stomach cancer some 10 months after diagnosis. Thirty is the number of days it took for him to pen this deeply moving memoir following her death. It matches the number of days that Jewish law requires as the mourning period for a spouse (for a parent or child it is one year). “I would learn at the funeral that children rend their garments on the left side, the seat of the heart,” writes the director of the

Australian Centre for Jewish Civilisation and Assoc Prof of Holocaust and Genocide Studies at Monash University. “And, according to the same law, I would tear my shirt collar on the right side - the symbol that a husband or wife should be encouraged to remarry quickly. “Thirty days, one month. Is that all it takes for a husband to move on, after thirty-two years of marriage?” Time, which Dr Baker says “collapses when you’re dying… past, present and future… all appear to merge”, makes other appearances when he is considering the fragility of life: “Everyone should have cancer for a day,” he writes, noting the mediaeval philosopher Maimonides as saying “when we visit a house of mourning we should imagine an axe is hanging above our heads.” The Sephardic Rabbi (11351204 also gave us the much quoted “Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.” Both sides of the Baker family are no strangers to death, mourning and remembrance. Mark’s parents, Holocaust survivors, were the subjects of his ac-

book review Robin Osborne "Time collapses when you’re dying...past, present and future...all appear to merge" claimed earlier book, The Fiftieth Gate: A Journey Through Memory, to be reissued soon by the active Australian publisher Text. The Jewish forebears of his late wife had faced similar experiences back in Europe, and while not excessively religious, the couple married, and to an extent lived in accordance with Jewish traditions. Hebrew rituals and Yiddish folktales are interwoven through a narrative unavoidably marked by diagnostics, chemotherapy, pain management, hospitalisation and palliative care.

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for help. Following a visit to the nearby hospital in Salima, I can't say I blame them for seeking out Ndimoyo instead. The hospital buildings are in advanced decay. The beds and mattresses are quite gross. Large numbers of expectant mothers sit outside, a colourful crowd in their marvellous cloths. Patients have to bring their own food and those in the open need to watch out for marauding monkeys. These women, some from afar, are waiting for caesarean section, a procedure performed by clinical workers who are not doctors.

At Ndimoyo I was asked to see a few patients, including a child with ascites (fluid in the abdominal cavity) and a young adult woman who could hardly stand up.

When I asked about x-rays and blood tests, it seemed that such services are rare. As an elder doctor, I had to dig deep to revive traditional diagnostic skills half-forgotten in the latter

a publication of North Coast Primary Health Network

Kerryn Baker, a medical doctor who once worked in oncology, turned her hand to couples counselling later in her career. She was popular with her clients and loved deeply by the Bakers’ adult children, extended family and friends who comprised the one thousand people attending her funeral. “A week before Kerryn’s death, I wrote her eulogy. I had read it to her while she was in a state of semi-consciousness. “It’s too long”, she whispered. She was right, as usual.” Before long he would be writing this book, seeing it as “my way of restoring Kerryn to life, so we can have our one last dance of love… “ He writes, “Love after death is a magical illusion. I can cherish the memory of my wife, shed tears over her, dance with her ghost, but, in the end, her silence has turned our love into a monologue.” Musing on their time together, Baker adds, “One minute my wife was there. In a flash she was gone.” Kerryn may be gone, but thanks to this beautifully written book, she is certainly not forgotten.

part of my career. The drive from the clinic to the house takes about half an hour, through numerous tiny thatched village cottages. Hundreds of small children play in the dust amongst many goats and chickens. It's some relief to see that the young seem mostly active and fed, an observation from the hermetically sealed land cruiser. I am told that vaccination rates are on the rise. The staple food is gooey thick maize porridge which I have tried. I'm glad I don't have to live on that the whole time. Must fly. On safari to Liwonde National Park. Hope to see a hippo, maybe more.

healthspeak September 2017

Lifestyle Medicine – affordable medicine that works

Lifestyle Medicine co-editors - Garry Egger, Stephan Rossner and Andrew Binns.

n 2008, after a lengthy and prevention of chronic olinska Institute Stockholm) we involvement with managing disease, improve knowledge and seconded expert contributors obesity issues at the primary skills in lifestyle behavioural in the field to publish the first care level, Adjunct Professor of change, and encourage more edition of a Textbook on Lifestyle Lifestyle Medicine (Southern practitioners into this Medicine (McGraw Hill). The Cross University) Garry field. Indigenous health book has been well received. Egger and I decided it was was to be given special In July 2015, ALMA was By Andrew Binns time to focus more on the attention, particularly re-launched as the Australasian broader issue of lifestyleaddressing the social and Society of Lifestyle Medicine related chronic disease. cultural determinants of (ASLM). With links to similar This was partly in response to health. There was also to be organisations in many countries, the 2006 report by the Austrasignificant emphasis on educaincluding the American Collian Institute of Health and Wel- tion and evidence based lifestyle lege of LM and the European fare saying that up to 70 per cent medicine research. Society of LM, the first World of all GP visits were thought to While we received Conference was held in have a predominantly lifestyle strong support there Melbourne in Nocause. were significant vember 2016. We coined the term Lifestyle challenges, but The third We coined the term Medicine (LM) and set up the later that year edition of the Lifestyle Medicine (LM) Australian Lifestyle Medicine we held the LM textbook and set up the Australian Lifestyle Medicine Association (ALMA). The inau- first ALMA has now been Association (ALMA) gural meeting in May 2008 was conference, published by held at the University Centre for opened by Dr Elsevier. It will Rural Health in Lismore. The 50 Norman Swan be translated attendees comprised GPs and from ABC RN’s into many different allied health professionals from Health Report. Under Garlanguages, as the interest many disciplines. ry Egger’s leadership and with in this field is understandably The aim was to raise awareco-editor Swedish Professor growing. As populations age and ness of LM in the management Emeritus Stephan Rossner (Kar- chronic disease increases, driven September 2017 healthspeak

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Lifestyle Medicine is the application of environmental, behavioural, medical and motivational principles to the management of lifestylerelated health problems.

largely by lifestyle environmental factors, the need to focus on lifestyle medicine is increasingly urgent. From every perspective, the alternative is simply unsustainable. 39

Health&Lifestyle Physician improves neurological conditions with botox

r Roslyn Avery, a rehab longer and makes getting around physician based in Port difficult. I botoxed his legs and Macquarie, is passionate about he wears an AFO (ankle-foot using botulinum toxin (botox) orthosis for drop foot support) in concert with physiotherapy and so he can walk with the to improve the lives of people frame. It’s such a delight for him living with disability. to be able to walk.” Rehab physicians provide Another wheelchair bound specialist knowledge and experpatient that Ros treated gave tise in the prevention, assessher the most satisfaction of her ment, management and medical career. supervision of a person with a “It took about disability. eight weeks of Ros uses botox medicinally to treatment to Ros gains a lot address a variety of conditions get him out of satisfaction – to prevent spasticity following of being conthrough her stroke or due to cerebral palsy tracted and skilful use of function back, but or other neurological conditions it’s more difficult to wheelchair botox and follow such as MS and torticollis. It is bound. We’d up therapy do things like dressalso used to assist orthopaedic noticed he had ing.” surgeons to gauge whether tattoos he’d done Botox in combination surgery such as lengthening to himself. So instead of with other therapy can be a big exercises would be worthwhile. seeing him bored in hospital, we help to such people. Botox blocks signals from the sent him to drawing classes and “Botox takes some of the nerves to the muscles so that the spasticity out of the muscles now he’s an artist and that’s part injected muscles can no longer of who he is.” and with the physio and some contract. Ros has also treated people therapy, often we can help reWhile botox is a temporary fix turn the balance of the muscles with brain injuries as the result (it wears off in 3 to 12 months) of terrible incidents or assaults and we’ll get some movement and must be readminiswhose pain has been really reback. I rarely promise tered, for Ros the people that there’ll duced along with their sense of most satisfying loss. She also successfully treats a return of part of using MS patients who need their function. We For me it is about the botox is in usually inject hands to be available to use the pain, you can often see preventing computer. to relieve that patients are more contracRos gains a lot of satisfaction pain, help relaxed afterwards, they tions. Conthrough her skilful use of botox hygiene or need fewer painkillers and tractions are and follow up therapy. help a funccan move forward permanent “For me it is about the pain, tion.” fixations of you can often see that patients However, the limb where are more relaxed afterwards, some patients the muscles are they need fewer painkillers and have been helped to shortened with no can move forward. They can walk again. ability to stretch out. She said it go to the physio and do more “In recent years we’ve looked was wonderful to prevent these things than previously. And my after a gentleman who hadn’t negative outcomes of stroke role is often about preventing walked for 10 years and with and with botox and therapy for their pain getting too bad.” multidisciplinary input I bothem to get movement back in Ros would be happy to hear toxed this gent in his very tight that limb. from GPs who might have muscles in his legs and hands. Ros also explained how botox And with additional therapy he’s patients who could benefit from can be used to help patients botox treatment. She could also now able to walk with a frame. after a stroke. advise them on whether those “The botox allowed his arm, “Often a few months down patients are eligible for PBS which was flexed in, to be exthe track a stroke patient finds benefits. tended out and for him to hold that muscles that were week are on. With that release he can now now very tight and in the flex Contact Ros at her clinic at grip the walking frame. One position. They realise that not 2/10b Highfields Circuit, Port of his legs was pointing down only are they not getting their Macquarie, on 6581 5501. which naturally makes the foot 40

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healthspeak September 2017

Health&Lifestyle

Diets ‘R’ Us

oing back, the word ‘diet’ fats in particular, the more we are comes from the Greek seeing a rise in inflammation in ‘diaita’, which meant a way of livthe body. ing, referring specifically to that Phylogenetics tells us if we prescribed by a physician. don't use it we lose it, from our So we were in on it vasta medialis to lactase in from the start, but our villi, and the oppoin recent times site occurs as well. If dieting has been we gradually increase hijacked by every our intake of salt, Chris Ingall man and his dog, sugar or fat, we all self-proclaimed become 'acclimatised' ‘nutritional experts’. to the higher levels and In our corner, the nhmrc want more. The pathway website gives a reasonable map to addiction, and something the for a nutritious and sustainable fast food industry trades on. diet, but as a guideline it is difWe live in a first world bubble ficult to market. of plenty, and the plenty is killing So we have both the noun and us. So it is a war upon ourselves, the verb to discuss; the first to and the first casualty of war is my mind solved by us physitruth (another Greek, Aeschycians, but the second a much lus). Is there any good which more slippery customer. Over comes of having such a plethora one million Australians are on of lies? Well surprisingly, yes. some form of diet at any time I was recently speaking with a and some will be your patients. young colleague who has coeliac And increasingly 'fad' diets have (biopsy proven) disease, and become fashionable. she thanked the hipsters for the What to do when a person profile they have brought with ripped jeans tells to a low gluten diet, you they are on a which gives her gluten-free diet easy access to so and feel better, many gluten Phylogenetics tells us though have free products. if we don't use it we not had any I compare lose it, from our vasta blood work the present medialis to lactase in our villi, and the performed? to when I opposite occurs as well How hard was a resident, do you press and a Redfern them to go back bakery was the on gluten, have the only one in NSW necessary coeliac screen making gluten free bread, and then at least know the risk and only on a Friday! for their close relatives? CoI have lost faith in the weight eliac disease is constant at about loss industry as well. My daugh1:100 per capita, but gluten free ter was trying to lose weight for diets are multiplying, particularly about a year using the main playin Byron. ers, including Weight Watchers, For me, the Holy Trinity - eatJenny Craig and Terry White. ing foods packaged by nature, After some time (and expense) I embracing hunger and exercisasked her what she was actually ing regularly are all it takes to be doing each day. Her answer? healthy and the right weight. In Eating frequently to keep her truth we need to involve nothing metabolic rate up! As she hadn't 'marketable’. But everyone is dropped one kilo, I suggested she selling something, from paleo to get hungry, and exercise. Cheaplactose free, though the more we er, and more effective as it turned eat processed foods, meats and out. Yes, hunger and exercise will September 2017 healthspeak

do it every time, though hunger can be reached through satiety, as the Israeli Army diet of the ‘70s proved. For the young’uns reading, it was eating apples for the first two days, cheese for the next two etc. Very quickly you’d lose interest in the offering, and so hunger came into play! Having said that, the 5:2 diet seems to work when others fail, and it may be the psychology it We live in a first world brings to the table. If bubble of plenty, and you are hungry for the plenty is killing us. So it is a war upon two days a week, and ourselves, and the first you actually feel betcasualty of war is truth ter for it, this impacts on the other five days, encouraging moderation. It may be the best way of handling 'plenty', as this diet ensures we act as if there isn't plenty for two days every week. And fnally, history tells us not to stray too far from a balanced diet provided by nature. Unbalanced diets which promote conditions such as high cholesterol (paleo), cancer (paleo and other high meat diets), and allergies (fast foods and cooked meats), make long-term consequences more likely. Simple, really.

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Health&Lifestyle

Our Kids calendar gets a new lease of life

Photos by Jacklyn Wagner

hey say every idea has its tion and she is in a wheelchair. time, and the timing of a She is very excited to be on the phone call made by a Lismore other side of the camera and paediatrician to a local newspart of the calendar’s production paper photographer 16 years team. ago must have been spot on. “During the first shoot it was The fundraising calendar it kick pretty nerve wracking, but I very started has gone on to benefit much enjoyed it. I was nervous, the lives of thousands of NSW but the creative team here made North Coast families. it a lot easier.” At the time, Dr Chris Ingall On the day we visit, Kate is was lamenting a lack of funding working with energetic Dash to buy expensive but vital equip- Simpson, who’s six years old and ment to assist Lismore Base has leukaemia. Dash is loving Hospital’s newborns requiring the limelight and his mother specialised care. The calendar Sam explains that today is a was the first project of Our Kids, special day for both of them. a charity Dr Ingall founded, and “Normally we’re running which, as a result of the popular to and from medical appointcalendar, is now a household ments. He is two years through name in the region. a three-year treatment program. Jacklyn Wagner was the Today Dash is the star and it’s a photographer Dr Ingall enlisted great change for both of us. It’s to photograph kids who’d spent wonderful fun.” time in Lismore Base Hospital’s Our Kids’ Fundraising CoorNursery or Children’s Ward. dinator Rebekka Battista’s son Now after 15 editions of the also featured in the first calendar. Our Kids calendar, Jacklyn is “Isaake was born with renal handing on the photography bafailure and Chris was Isaake’s ton. Southern Cross University’s paediatrician. Chris suggested media department has gladly Isaake be part of the calendar, taken up the task. Two students and as my husband and I had were chosen to be mentored by a local restaurant we began Jacklyn to photograph promoting the calendar the kids, ably supand Our Kids in the ported by the community. And COST OF university’s after a while I NURSERY EQUIPMENT technical staff. was employed Ventilator Natalie by Our Kids.” $47,000 Foord and After hearIntensive care bed Kate Hepton ing about the $37,000 are the stumany benefits Humidicrib dents shootthe calendar $25,000 ing next year’s has brought to calendar in a creative the community, it’s studio at Southern Cross humbling to gain entry University in Lismore. Both are to Lismore Base Hospital’s delighted to have the opportuSpecial Care Nursery (SCN) nity to be part of the project. and meet Nurse Unit Manager Serendipity also stepped into Jo Ezzy. Meeting Jo you can feel next year’s calendar it seems, as her passion for the Nursery and Kate’s photo featured in the first her work. She explained that Our Kids calendar. not only does the unit provide Kate has spinal muscular atro- fantastic care for newborns, it phy, a genetic disease that causes means that local families don’t muscle weakness and deteriorahave to travel to Brisbane with 42

Photographers Kate Hepton (left) and Natale Foord with six-year old Dash Simpson at a photo session at SCU.

Dr Chris Ingall and Special Care Nursery Unit Manager Jo Ezzy.

their baby to receive first class health care. Jo’s worked as a neo natal nurse for 37 years, looking after around 25,000 babies during her career. “Our SCN sees one-third of the babies born in the Northern Rivers, but 16 years back we had very old cribs and second hand monitors passed on from Westmead Hospital. The hospital did its best with the funding it was given but we needed better equipment and Our Kids has ensured our newborns now enjoy

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the best quality care available.” Jo said the calendar has brought the community into the Nursery and opened up this closed off world to a big audience. “The calendar gives the Special Care Nursery a face, because people can’t just come in here. It advertises our work, our kids and lets people know what a hard slog it is for many when a child is born with health issues. And quite a few graduates of the Special Care Nursery have made it into the calendar. healthspeak September 2017

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Preventing stroke can reduce dementia Ontario's stroke prevention strategy appears to have had an unexpected, beneficial side effect: a reduction in the incidence of dementia among older seniors. Published in the journal Alzheimer’s & Dementia, a paper by researchers at Western University shows that over the past decade there’s been a drop in new diagnoses of both stroke and dementia in the most at-risk group -those aged 80 or older. "Some have said we're on the cusp of an epidemic of dementia as the population ages," said study author Joshua Cerasuolo. "What this data suggests is that by successfully fighting off the risks of stroke -- with a healthy diet, exercise, a tobacco-free life and high bloodpressure medication where needed -- we can also curtail the incidence of some dementias."

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