ISSUE 5 spring 2013
HealthSpeak
A publication of North Coast NSW Medicare Local
Working to make a difference GP clinic opens at soup kitchen
page 8 page 15
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eHealth promotion success
5
headspace milestone
12
Short film competition
17
Contraception for young women
Creating opportunities for partnerships Janet Grist Head Office
Editor
Suite 6 85 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncml.org.au Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 General Manager: Paul Ward Email: hm@ncml.org.au Mid North Coast Suite 2, Level 1, 92 Harbour Drive Coffs Harbour 2450 Ph: 6651 5774 General Manager: Sandhya Fernandez Email: mnc@ncml.org.au Northern Rivers Tarmons House 20 Dalley Street Lismore 2480 Ph: 6622 4453 General Manager: Chris Clark Email: nr@ncml.org.au Tweed Valley Unit 4, 8 Corporation Circuit Tweed Heads South 2486 Ph: (07) 5523 5501 Acting General Manager: Wendy Pannach Email: tv@ncml.org.au
Contacts Editor: Janet Grist Ph: 6622 4453 Email: media@ncml.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Display and classified advertising at attractive rates HealthSpeak is published four times a year by North Coast NSW Medicare Local Ltd. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCML. The NCML accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. ©Copyright 2013 North Coast NSW Medicare Local Ltd Magazine designed by Graphiti Design Studio Printed by Quality Plus Printers of Ballina
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Since HealthSpeak commenced 12 months ago, there’s been a steady increase in
the number of health services and organisations that have got in touch to share information, advice and services with our readers. In the last issue no fewer than 17 different external organisations were represented in the magazine. It’s this sharing of knowledge and information that creates new opportunities for partnerships and collaboration that result in
improved health outcomes for our North Coast community. So I’d encourage you to email me if you have anything you’d like to share with the wider health community – research, innovation, an outstanding colleague – or perhaps you’d like to write a story for our new Travel section. Email: media@ncml.org.au. I look forward to hearing your suggestions.
The Future of Medicare Locals Vahid Saberi Chief Executive Officer
There has been much discussion about the future of Medicare Locals leading up to the federal election, with the Government demanding that the opposition make their position clear, and subsequently, the opposition stating that while they are committed to these organisations there will be a review. This review is welcomed by the Medicare Local system. It is beneficial. However a few issues have to be kept in mind in the design and the expected outcomes of such a review. Foremost among these is the fact that Medicare Locals are nascent, and in many cases fledgling organisations. Medicare Locals were established in three waves or tranches. The North Coast Medicare Local was established as part of a tranche two roll out in April 2012. Hence the organisation is about 15 months old. Anyone who has operated a complex organisation readily recognises that 15 months is really not a long time in an organisational life span – in human terms I hazard a guess that it might be comparable to a four or five year old!
Additionally, using North Coast Medicare Local as a case in point, the organisation came about as the result of the merger of four former organisations – all with different processes, systems, cultures and approach to work. Naturally following such a substantial merger covering such a large geographical footprint (Tweed to Port Macquarie), it took eight to ten months of solid work to establish the foundations (information technology, financial structure, recruitments, strategic plan and other foundation work). We did all this while maintaining and expanding a significant suite of services. What many don’t realise is that we deliver clinical services in 25 towns across the North Coast. We deliver services through a diverse cohort of clinicians including: GPs, psychologists, mental health nurses, Aboriginal health workers, medical specialists, dieticians, speech pathologists, generalist nurses and many more. We run services such as General Practices, Aboriginal Medical Services, youth mental health, a Family care centre and a range of others. Additionally, we support primary health care providers such as general practitioners, psychologists and pharmacists with technology (including ehealth), immunisation, accreditation, education and training. We collaborate closely with Local Health Districts and Residential Aged Care Facilities to
make the patient care journey and navigation through the system easier. We have done our best to drive innovation to respond to local needs - and provide a free magazine on primary health care (the one you are reading). This of course is not an exhaustive list, but a select few. For a full list please go to www.healthnorthcoast.org.au. There are also areas of work that we are thinking deeply about and need to do better in. Among these is more effective community, consumer and clinician engagement. This is the next big frontier for us – and one that most forthright organisations readily accept they need to do better in. Here I am talking about aspiring to engage the community in real participation that results in real change. Simplistic approaches at the level of technique – for example the use of surveys or twitter blasts – while having merit, have limited utility in engaging the community. We aspire to engage with the community in generating ideas that will advance health and wellbeing; carried out in a process that aims to empower those who engage and raise their capacity and characterised by qualities of humility, honesty, tolerance, patience, and courtesy. I do hope that I will be able to engage with you in such a consultative environment in the months ahead.
HealthSpeak is kindly delivered by
HealthSpeak
spring 2013
1:1000 GPs to patients – too few, too many, or just right? The answer to how many GPs our community needs will depend on who you talk to. Which of course makes it more of an opinion than a valid response, although there’s nothing wrong with a debate, especially about such an important topic. If the respondent is a patient who is seeking an appointment only to be told there is a twoweek wait, they will no doubt say there needs to be more GPs in town. And they could well be right, as they may live in an ‘under doctored’ area. GPs themselves will doubtless agree. Ask a doctor in a town that has too few GPs and requires them to work long hours and see 50 or more patients per day, and there’s every chance he or she will be begging for more help. Conversely, a GP in an ‘over doctored’ town is likely to contend that that the community is adequately serviced and that more docs in town could threaten the viability of their practice. Both positions are perfectly logical, and understandable. Next come the views of the health economists. An opinion well publicised in the medical press suggested there were too many GPs, full stop. This report (1), regarded by many (including myself) as controversial, was released in March 2013 by Dr Bob Birrell, Monash University demographer from the Centre for Population and Urban Research. Dr Birrell, a well known figure, argued that there has been a sharp increase in the number of full-time work equivalent GPs (FWE GPs) billing on Medicare since the mid 2000s. Further, that the level of GP services in both urban and rural areas is well above that considered by medical staffing authorities in the past to be adequate. An indicator of this change, he said, was the number of services billed per person per year in Australia, which had increased from 4.9 in 2004-5 to 5.7 in 2011-12. The problem with his concern HealthSpeak
spring 2013
Opinion Andrew Binns
Health Status of Baby Boomers vs Parents in the US illustration 1 (NHANES 1988-1994 vs 2007-2010)
80 70
Previous generation Baby boomers
60 50 40 30 20 10 0 Hypertension
Hypercholesterolemia
Diabetes
Obesity
This US data from JAMA shows the significant increase in chronic disease, particularly in the baby boomer generation. Workforce planners and health economists in the past would not have foreseen this. Consequently we are now seeing the government needing to engage in catch up by rapidly increasing student intake numbers in medicine and the other allied health disciplines.
is that it takes no account of the burden of managing chronic disease within an ageing population. Among the baby boomer cohort alone, we see the steep rises in the prevalence of obesity, diabetes, heart disease, cancer and other illness. Practising GPs and the allied health teams with which they work are at the forefront of managing these conditions, and the trends are right before their eyes. They also deal with community expectations no doubt fuelled by the media’s fondness for ‘medical miracle’ stories - that the application of medical science will succeed in maintaining both our longevity and our health. So it is a fact, not merely opinion, that GP visitations per patient are on the increase. Yet there is unlikely to be the political will to reverse the current direction, and to significantly increase the numbers of practising GPs. The ageing nature of the GP work force with high rates of future retirements is another factor to be considered. One of Dr Birrell’s main focuses of attention is on the socio-
geographic maldistribution issue, which we know to be a problem. He suggests “the emphasis of Government manpower policy should switch to ensuring that GPs serve where they are needed. Part of the solution must be to restrict the right to practise in over serviced areas.” He goes on to suggest that this control could be affected through the issuance of provider numbers as already happens with International Medical Graduates who are forced to serve only in districts of workforce shortage, at least for some years. Such controls for Australian graduate GPs are likely to be strongly opposed by the profession. So what is the situation with GP workforce in the North Coast Medicare Local (NCML) footprint? FWEs take into account the differing work patterns of doctors. A GP with 50 per cent of the average billing of Medicare for full time doctors is counted as 0.5 GPs. Another doctor may bill 150 per cent of the average and be counted as 1.5
GP visitations per patient are on the increase
Continued page 12 3
NCML’s eHealth promotion success
Briefs
Brisbane Pain Management Centre In a trial to raise awareness, NCML employed nine eHealth promoters in July to engage with consumers; and with the aim of registering 300 consumers in 10 days, NCML more than delivered. In fact, a total of 447 consumers were successfully registered for eHealth over this time. The trial was coordinated by NCML’s Senior Project Officer eHealth, Shelly Fletcher, with 300 people applying for the promotional positions and a shortlisted 12 attending an information session on NCML and eHealth. The final team of nine were a diverse group, including retirees, university students and consumers who had extensively engaged with the health sector. They
NCML’s Christine Cox promoting eHealth registration at the Exchange Event in Port Macquarie.
attended a three-hour workshop and completed online eLearning modules. The promotional team took their message to a range of healthcare organisations (pharmacies, RACFs and general practices) as well as commu-
nity events (the Lismore 4WD Caravan and Camping Show, a post office, shopping centres and an Art expo). Around 950 consumers were engaged during the 10-day trial, resulting in the 447 successful registrations.
Patients suffering from debilitating and persistent pain now have access to the latest pain management technologies and procedures at St Vincent’s Private Hospital in Brisbane. The $3 million pain management centre is the first of its kind in the private health sector in Australia. It offers a comprehensive pain management service, which includes programs for adolescents and adults, expert pain specialists, and an operating theatre where complex pain management procedures can take place.
Continuing Professional Development Midwifery Forum
Practice Nurses’ Forum
Time
9.00am – 4.30pm
Time
9.00am – 4.30pm
Date
Thursday 7 November 2013
Date
Saturday 30 November 2013
Location
Southern Cross University Gold Coast campus Southern Cross Drive Bilinga QLD 4225
Location
Southern Cross University Gold Coast campus Southern Cross Drive Bilinga QLD 4225
Innovations in Midwifery
Current practice, evidence and the future of primary health care nursing
For more information or to request a registration form email carla.robinson@scu.edu.au
It’s all about U scu.edu.au
CRICOS Provider: NSW 01241G, QLD 03135E
4
SCU Health Forum Ad.indd 1
HealthSpeak
21/08/13 spring5:22 2013PM
Lismore headspace opening in January In late August a celebration was held to mark the signing of the lease on the home for headspace in Lismore, a spacious three-storey building in the heart of the CBD. The multidisciplinary youth mental health service, for young people aged 12 to 25, will open in January. Headspace Lismore, as part of a national headspace program, will provide evidence-based support with an emphasis on early detection and intervention. The lease milestone is the result of a great deal of work on the part of many people and the leadership and persistence of the Federal Member for Page, Janelle Saffin to secure the funding for the project. Chair of the headspace Lismore consortium Dr Chris Ingall told those at the celebratory event that he was excited about the tremendous potential for a number of youth focused health and service providers to work together in headspace to create a seamless service for the youth of the region. “Headspace will provide a welcoming environment for young people with no ‘hospital smells’,” he said. Led by North Coast Medicare Local, the headspace consortium is made up of Lismore City Council, NORTEC Ltd, Ngunya Jarjum Aboriginal Child and Family Network; Southern Cross University’s School of Health and Human Sciences; NNSW Local Health District’s Mental Health Service; CASPA (Child & Adolescent Specialists Programs & Accommoda-
come in and hang out”, he said. Headspace Lismore will provide young people with effective mental health education, advice, treatment and referral that is empowering and tailored to their individual needs. Services will include a general practitioner, psychologists, drug and alcohol workers, youth employment workers, family and housing support.
Eheadspace The ‘ringing of the bell’ to signify the signing of the lease. From left: Lisa Hampson, headspace clinic admin manager; Chris Clark, NCML Northern Rivers Manager; youth advisory group members; Janelle Saffin MP and Dr Chris Ingall, Chair of the headspace consortium.
tion); Northern Rivers Social Development Council; On Track Community programs; Byron Youth Service; Interrelate Children and Family Support, Youth Connections North Coast and The Buttery. The building at 2A Carrington Street was the preferred location for headspace’s youth advisory group. Kadina student Jake Collins told the gathering why young people liked the building. “It’s safe and comfortable and there aren’t many people walking around, so there won’t be a lot of people looking at you when you walk in the doors,” he said. NCML’s CEO Vahid Saberi said all the planning involved with headspace Lismore was focussed on what young people wanted and what would work for them. “The Lismore headspace’s
doors will be wide open to anyone between the ages of twelve to twenty five – no one will be turned away. Young people are also welcome to just
In the time before Lismore headspace opens, young people aged 12 to 25 experiencing problems can chat on the phone or email qualified health professionals to gain support and help. eheadspace is a confidential, free and secure space. Find it here: https:// www.eheadspace.org.au/ And to find out more about headspace, go to http://www.headspace. org.au/
Calling young film makers North Coast Medicare Local is inviting students from the North Coast region to take part in a short film competition to promote ‘A Healthier North Coast’. The competition is part of The PITCH - Practical Ideas to Change Health Care and applications are now open for proposals from students about a film up to five minutes in duration that features
a health issue relevant to them and their community. The proposal should be up to 200 words and adhere to The PITCH Short Film Competition Guidelines which can be viewed here: http://healthynorthcoast.org.au/ the-pitch-short-film-competition2013/ For more information, contact Gavin Dart on 6618 5413 or email; gdart@ncml.org.au
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HealthSpeak
spring 2013
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Health Minister opens new Tweed Branch Office On Friday July 5, the Federal Minister for Health and Medical Research Tanya Plibersek officially opened NCML’s new Tweed Branch office at 8 Corporation Circuit, Tweed Heads South. This followed the official opening of the Tweed South GP Super Clinic next door, of which NCML Board Member Dr Di Blanckensee is a managing partner. (More on the GP Super Clinics in our region in the next HealthSpeak). After an official Welcome to Country and a Dreamtime story from Uncle Victor, NCML’s Chair Dr Tony Lembke addressed the gathering which included politicians, Local Health District representatives, and Dr Austin Sterne and Dr Chris Ash from the Tweed Valley General Practice Network. Tony pointed out that health was local, built upon relation-
Cutting the cake: from left, Michael Carter, Manager Corporate Services NCML; Wendy Pannach, Acting Tweed Valley Branch Manager; Federal Health Minister Tanya Plibersek; Member for Richmond, Justine Elliot; and NCML Chair Dr Tony Lembke.
ships, and that Medicare Locals offered local solutions to local problems. He said NCML had already made a difference with psychol-
ogists going out to schools in the Tweed region and Bugalwena General Practice introducing an ATAPS mental health service. Local Federal Member Justine
Elliot spoke of her admiration for NCML in its approach to fixing health problems. “The approach is how do we fix this? Nothing is too hard, we can work this out through networking and collaboration,” she said. Health Minister Tanya Plibersek said how impressed she had been by the PITCH when she opened the Ballina office last year, with NCML starting conversations right across the community to find innovative ideas which can be nurtured to improve health. Ms Plibersek said it was important as Minister to have trust in Medicare Locals and devolve programs to them with the confidence that they would deliver good outcomes. She said she had this trust in NCML, and it was clear that NCML had that trust in its employees as well.
HealthPathways coming to the Mid North Coast North Coast Medicare Local is partnering with Mid North Coast Local Health District to develop HealthPathways on the Mid North Coast. HealthPathways is based on an initiative created by Canterbury District Health Board in Christchurch, New Zealand. It has resulted in significant improvements in the way hospital and general practice share the care and management of patients. As the name suggests, HealthPathways reflect the referral lines or pathways which link patients to the right care, in the right place and the right healthcare provider. Each HealthPathway starts with a particular health problem and defines a pathway for its management that reflects evidence-based best practice in the context of local resources and facilities. The process of developing a locally-defined HealthPathway may lead to new solutions as clinicians work across the hospital-community interface. 6
The HealthPathways program provides an opportunity to link GPs, hospital clinicians, allied health professionals and private medical specialists into the reform process. Representatives from all health sectors are able to be involved in the development of relevant HealthPathways, with their services identified in the published product. On the Mid North Coast, HealthPathways will be published on a password-protected website. GPs and health professionals can access the portal using a secure login and password. The portal is not designed for use by patients or community members, however there will be resources available on the portal that GPs and health professionals can provide to patients. North Coast Medicare Local and Mid North Coast Local Health District are in the process of identifying a number of clinical specialty areas to be covered by the HealthPathways program; these will be based on local health priority areas. As the program progresses, further
pathways will be developed based on local clinical need identified by local clinicians. When will HealthPathways be available on the Mid North Coast? Pathway Development Teams are currently being formed to localise pathways, which will be available for use by clinicians in early 2014. In the meantime, a HealthPathways project information site specifically for Mid North Coast is being developed. This site will include information about pathway development and progress, as well as meeting dates and other important information. This site will also provide the opportunity for practitioners to register their interest in developing a pathway or provide feedback about a specific pathway development. For further information, contact Tracy Baker, Program Coordinator, HealthPathways and Health Services Reform on 0448 852 902 or email tbaker@ncml.org.au
For GPs: HealthPathways provides information on appropriate referral and pre-referral workup, faster specialist access for their patients, educational resources and service directory For Specialists: HealthPathways provides better quality referrals, more appropriate referrals, management of long waiting times with their inherent danger and higher ratio of new versus review patients For patients: HealthPathways is about our patients receiving the right care at the right time as determined by local clinicians.
HealthSpeak
spring 2013
Tweed Valley Link Program North Coast Medicare Local’s Tweed Valley Link Program aims to link service providers to identify opportunities for improving the health system. NCML has hosted Link Program meetings and events recently for residential aged care, palliative care and pharmacy. These meetings focus on building consensus on issues which can be addressed through relationship building and improved collaboration. Meetings are also planned for Mental Health and Aboriginal Health.
Residential Aged Care
Tweed Valley residential aged care managers met in May to discuss priorities for health system reform with NCML and identified dialogue with acute care services as a key priority for improving care. There have since been two meetings with residential aged care and acute care providers to improve understanding of the challenges faced and to work on improving communication around patient transfer between hospital and aged care.
Pharmacy
Pharmacists in Tweed Valley met in August to discuss their priorities for health system reform. More than half the local pharmacies were represented, and they were rewarded with a CPD session covering oral anticoagulants delivered through the NPS MediWise Program.
Expert panel discussing a hypothetical case.
Palliative Care
Eighty people attended a palliative care link forum at Banora Point High School in July and were treated to music and dance from senior students. The forum included a presentation on palliative care from Associate Professor Rohan Vora from Gold Coast Hospital and a hypothetical panel discussion on issues and strategies surrounding dying at home. Participants also discussed key challenges facing practitioners in delivering palliative care services and support in the Tweed Valley. The panel discussion followed the hypothetical journey of Claire, a 44-year-old woman from Tweed Heads with two young children. Claire has terminal breast cancer and wants to die at home. A panel of GPs, nurses, social workers, a chaplain and a vol-
unteer palliative support service coordinator talked through services available to support patients like Claire and their families and carers. The discussion highlighted the importance of a multidisciplinary approach to palliative care including: encouraging and supporting more GPs to provide palliative care supporting families and reassuring patients that their family is being looked after children making strong bonds with extended family and encouraging cooperation among family to support shared care supporting patients to develop and access friendship networks flexibility for patients and families to change their mind about dying at home discussion about family members’ responsibilities for supporting the patient, both during and after the death at home. NCML is working with an advisory group of local palliative care practitioners and stakeholders to plan future events and to respond to issues in palliative care raised at his forum. For more information about the Tweed Valley link Program Phone (07) 855 235 501 or email tv@ ncml.org.au.
HelPing the NortheRn NSW mediCal prOfesSion grow Hi we’re Michael Scutt and Nathan White - the Owner-Managers of BOQ Lismore - and we offer banking, financial and insurance services to personal and business customers all along the Gold Coast, Tweed and northern New South Wales coast. We believe that it’s possible to love a bank. But don’t worry, we know it’s never going to be the head over heels, truly, madly, deeply sort of love. It’s more about having an open, honest, nomonkey business kind of relationship. We’re locals, and we’re passionate about helping our region grow. We believe the medical professional and allied health industry is a large part of our region’s growth story. That’s why we work to make your life easier whether you’re: • a PAYG employee, or self employed • looking to start your own, or buy into an existing practice or • interested in financing vehicles or other business equipment or assets. So why bank with us? We own BOQ Lismore, so we’re small-business owners too. We know how important it is to have flexible business partners that can change and adapt as your business needs change. As experienced bank branch managers, we go above and beyond for our customers, and pride ourselves on exceptional banking support and service. We also have a thorough understanding of our local market. We’ve been part of the community for more than 20 years, and our Business Development Manager Nicole Beazley has just spent a number of years as BOQ’s Assistant Regional Manager for southern Gold Coast and northern New South Wales. As an established part of the community that we live and work in, we believe in giving back to the community. We do this not just by supporting the region’s banking needs but also through community groups and sporting associations such as Our Kids (Northern Rivers Children’s Health Fund) and Lismore Thistles, Rovers and Lismore Workers soccer clubs and Marist Brothers Junior Rugby League Club. We’re open 9:00am – 4pm Monday to Thursday, and 9:00am – 5pm on Friday. We’d love to meet you and discuss how we can help you achieve your business and financial goals. So come in and say hello to us or one of our friendly staff members and experience the difference for yourself. This article is for general information purposes only and is not intended as financial or professional advice. The views expressed essed in this article are solely the views of the author. Equipment finance finance is provided by BOQ Equipment Finance Limited ABN 78 008 492 582 (BOQEF). BOQEF is a wholly owned subsidiary of Bank of Queensland Limited ABN 32 009 656 740 (BOQ) and a member of the BOQ group of companies.
HealthSpeak
spring 2013
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NCML runs GP clinic at soup kitchen A significant initiative at the former Winsome Hotel (now run by Lismore Soup Kitchen) has come about through a collaboration between North Coast Medicare Local, the University Centre for Rural Health, The Winsome, and the Northern NSW Local Health District. A GP clinic, which opened in November 2012, is operating once a week through Disadvantaged Communities funding. NCML’s CEO Vahid Saberi said improving the health of the community’s most socially disadvantaged was a priority for North Coast Medicare Local and he was thrilled that the clinic had commenced and was looking to extend its hours. Local GP, Dr Charlie Hew, is running the clinic at The Winsome for people who are homeless and marginalised once a week for one hour on
L to R: Soup kitchen manager Margaret Lord, Dr Charlie Hew, NCML’s Jane Conway and Outreach Worker Leanne Gilchrist.
Wednesdays with the assistance of Medicare Local staff, a community health nurse and Leanne Gilchrist. Dr Hew said he was more than happy to volunteer his time to provide easy access to a GP for Winsome folk. “The lives of these people can
be quite chaotic and by having a clinic on site they don’t have to wait a long time for appointments in other busy medical practices or organise transport to get there,” he said. Currently, Dr Hew sees around four patients a week, who make appointments ahead
Port hosts The PITCH and CIS The theme of this fourth PITCH (Practical Ideas to Change Healthcare) was ‘Improving Access to Health Services for Small Communities.” Hosted by the Hastings Macleay Branch office, the four short-listed presentations were: Mort Shearer, Independent Board Person, headspace, Port Macquarie whose presentation was on Capacity Building in Kempsey. Mort’s PITCH was a plan to provide outreach headspace services which included a number of roles for NCML. Craig Suosaari, Speech Pathologist, Mid North Coast Local Health District. Craig presented Video Examples of Speech Pathology Activities (VESPA) with the assistance of HealthEtube, an online video training program operated by MNCLHD. It allows preschool centre staff and parents to easily access video demonstrations of these Speech Pathology Activities. VESPA should provide a positive outcome for centres receiving RPHS Speech Pathology. 8
PITCH judges with the outstanding PITCH presenter. From left: Louise Robertson (Pfizer), Dr David Gregory (NCML Board), winner speech pathologist Craig Suosaari and Scott White, Communications Manager from Hunter Medicare Local.
Jackie Wilson, Health Worker, Bulgarr Ngaru Medical Aboriginal Corporation. Jackie’s presentation focussed on Bulgarr Ngaru Medical Aboriginal Corporation’s delivery of a healthy exercise and lifestyle program at the isolated communities of Baryulgil and Malabugilmah. Her PITCH proposal was to purchase outdoor exercise gym equipment for prolonged and ongoing workouts by local
community members who are benefiting from our current exercise program. Craig Willis, Youth and Family Team, Mid North Coast Local Health District presented on The ZONE: a trauma recovery and emotional regulation treatment program targeting young people between 12 and 17. The program improves access to health services for young
of time through St Vincent de Paul Outreach Worker Leanne Gilchrist. Dr Hew also sees patients who turn up without an appointment if he can fit them in. An upstairs room at the Winsome is the current location for the clinic and it’s been equipped with necessary medical supplies from funding by North Coast Medicare Local. It’s hoped that a more permanent clinic can be constructed over time. Additionally, In June, a flu vax clinic was run at the Winsome by North Coast Medicare Local in partnership with North Coast Community Health over two weeks and 18 people were vaccinated. The flu vax clinic was a great success as it also enabled health workers to engage with clients and answer questions about vaccination and other health issues.
people in small communities, by working across service boundaries (a kind of ‘no wrong door’ approach). So any young person deemed to be at risk, one of our team from Police, Education, Health (D&A and Mental Health), can refer the young person to our group, ‘the ZONE’. Judges voted the PITCH made by Craig Suosaari as the most outstanding, and NCML will help to implement his VESPA program and also provide assistance to the other short-listed finalists with their proposals. The CIS breakfast was well attended with two interesting speakers. The first was North Coast surgeon, Dr Guy Hingston who spoke about his personalised system of preventive healthcare, The Gold Book, and specifically on the day, about bowel cancer. For more details, go to: http://au.linkedin.com/ pub/guy-hingston/48/87/647). And the second presenter was Scott White, Communications Manager from Hunter Medical Local, who spoke about the Health Pathways project which is being rolled out on the North Coast over the next few months. HealthSpeak
spring 2013
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Health care for Balund-a residents Since November 2012, North Coast Medicare Local has been running a health clinic for residents of Balund-a, a Corrections Facility for Indigenous men aged 18 to 40, each Friday. The Balund-a Program is an innovative residential program for male offenders on remand located at Tabulam. Its aim is to reduce re-offending and enhance skills within a cultural and supportive community environment. Cultural activities include excursions to sacred sites, music, dance and art. Elders provide support and assist residents to recognise, restore and value cultural links with their land and history. The clinic for Balund-a residents is located at Gurgun Bulahnggelah Aboriginal Medicare Service in Lismore and is staffed by public health physician Michael Douglas, Practice Nurse Jenny Horsley, Mental Health Nurse John Llewellyn and Counsellor Grainne O’Brien. The mental health services for these residents are funded through ATAPS. Each Friday morning, around half a dozen Balund-a residents are driven to Lismore for an appointment with these clinicians. Dr Michael Douglas said new residents were provided with an initial health assessment and screening. Any particular shortterm or long-term health prob-
SLEEP CLINIC AYS OPEN D
FREE consultation
L to R: Dr Michael Douglas, Jenny Horsley, Receptionist Terrie Richardson and Grainne O’Brien outside Gurgun.
For many it’s the first time they’ve had any contact with the health system lems identified were discussed with the residents and steps to address these put into place. “For many it’s the first time they’ve had any contact with the health system. My observation is that the care is very much appreciated,” said Michael. “Usually, it’s a very positive encounter with the men and the continuing relationship with
Gurgun staff is important. Our Practice Nurse Jenny has a very good rapport with these men and can make them feel cared for and share a joke with them,” he added. Michael said typically there are concerns that stem from past injury, with inadequate treatment, anxiety disorders, infectious diseases and not infrequently evidence of chronic disease. “Often they have come from
disharmonious homes, fractured relationships or illicit drug use. A key approach is restoration of better sleep patterns. It is pleasing to see the progress that so many of the young men make. These men express gratitude for the help received. They want to be in that positive space and so often show pride in the progress that they make.” Currently there are very limited drug and alcohol services at Balund-a which causes residents some concern. “The residents are pleased to be clean and dry while at the facility, but worry about relapsing when they return to their communities. Strategies are needed to address these issues,” he said. Michael said while it was difficult to measure the success of the weekly clinic, he was confident that the health care provided to Balund-a residents at Gurgun brought some stability of mood and enhanced confidence. Coupled with the programs and efforts of the Balund-a facility and staff, he said this might provide a greater foundation for the wholesome life they desire.
Tweed celebrates NAIDOC Week
What would you do for
A GOOD NIGHT’S
SLEEP?
Phone for more information and ask about our next FREE education day. Have your questions answered, CPAP problems solved, receive support • Do you suffer from daytime sleepiness? • Do you snore? • Are you thinking about a sleep study soon? • Are you currently on CPAP? Come in and find out about:
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From left: NCML’s Corinne Martin and Cathy Downing at the health information stall they held at Mnidjabul Museum, the venue for Tweed Valley NAIDOC celebrations. On the right is Christine Sullivan from North Coast NSW Local Health District (Kingscliff Community Health).
HealthSpeak
spring 2013
Neonatology practice coming to Bangalow After 40 years working as a neonatologist (baby physician), Dr Howard Chilton has generously shared his knowledge and experience in his latest book Baby on Board. Howard is opening a parttime practice in Bangalow in October this year as he transitions from his busy working life in Sydney to the tranquillity of the North Coast. After studying medicine at St Mary’s Medical School at the University of London and some experience in the UK, Howard went to Southern Africa to broaden his horizons. His first neonatal residency in Rhodesia (now Zimbabwe) convinced him to pursue neonatology. He subsequently received training in prestigious centres in London, Oxford UK, and Denver, USA, before being appointed as Director of Newborn Care at Sydney’s Royal Hospital for Women, a position he held
Dr Howard Chilton
until 2000. Howard then resigned to concentrate on clinical work at the Royal Hospital for Women, Prince of Wales Private Hospital and Sydney Children’s Hospital. As his engagement with highlevel Intensive Care diminished, he was able to spend more time with clinical work and his central passion: parent education and what he terms “reassurology”. Howard devised ways of teaching parents how to care
for their baby by understanding what their baby needs using scientific information, rather than believing the commonly held myths on the subject. He regularly lectures on aspects of baby care at conferences and clinical meetings and was a keynote speaker at the International Lactation Consultants Associations Conference in Melbourne in July. Because he enjoys talking with the broad community, Howard holds a weekly talk/Q & A session “A Complete guide to Babies” at Sydney's Royal Hos-
pital for Women. He also has a Facebook page on which he answers parent’s questions about their baby issues. http://www.facebook.com/ howardchilton Howard enjoys the time he spends on his North Coast acreage with his wife Tamara and his daughters Georgina and Isabella. To make an appointment with Howard in Bangalow, call (02) 9650 4966 Monday to Thursday or fax (02) 9650 4908. And to find out more about Howard and his work, go to: http://www.babydoc.com.au/ author.html
NCML staffer wins Eureka photo prize
Connecting the homeless with care Over 300 guests attended the Homel ess Persons Week Tweed Shire Event at Vibe Care last month. The event was organised by the Tweed Shire Housing and Homelessness Network and On Track Community Programs. The Member for Richmond, the Hon Justine Elliot, opened the event and entertainment from local band Endangered Species created a welcoming atmosphere for guests and the 28 local services there to connect guests with services and support. The event also helped to raise awareness about homelessness in the Tweed Shire. Chris Edser (practice nurse) and Jessica McCormack (dietician) from North Coast Medicare Local’s Bugalwena General Practice offered health checks to guests. “It was a great opportunity
HealthSpeak
spring 2013
The winning image ‘Rampant spider webs’ by Helen Lambert.
to have a chat with people who may not have connected with someone in health for some time,” said Jess. Guests enjoyed a BBQ lunch and were offered clothing, food and sample bags including hygiene packs and service information. While many came to get groceries or other items they came away with much more, having connected with local services and support including counselling, legal advice, employment services, housing services, drug and alcohol services, dental care and first aid.
NCML Indigenous Project Officer in Coffs Harbour, Helen Lambert, uses her keen interest in photography to relax and unwind and her talents have been recognised with a prestigious national award - a high commendation in the Eureka Science Photography Prize. Her mesmerising image was taken near South West Rocks on the Mid North Coast. Here’s Helen’s description of her winning photo. “Rampant spider webs blanket vast stretches of farmland near South West Rocks, NSW. It is likely the webs are a dispersal mechanism that allows spiders to move out of places where they would otherwise drown. The massive quantities of silk
produced create a trampoline that supports the spiders as they escape the rising flood waters.” Helen told HealthSpeak she was incredibly excited and honoured to be highly commended for this national award. “The Eureka Prizes are a great acknowledgement of the role of science in the community. I took the photo early in the morning in July 2011 on Rainbow Beach Road near South West Rocks, where I used to live. “I have a strong interest in photography and have been taking photos for 35 years. The environment around South West Rocks is very conducive to photography. I always get great images when I visit the area to see friends,” said Helen. 11
Sisters make art about their sense of place
Briefs
Falls injuries rise
North Coast Medicare Local’s Senior Program Officer in Indigenous Health Emma Walke is one of three Indigenous women exhibiting contemporary artworks in an exhibition entitled Tiddas (Sisters) at the Northern Rivers Community Gallery in Ballina. Emma has created a number of porcelain artworks including a stingray, sculptural pieces, monoprint in clay, slab pieces, cups and bowls. Her sister Leah Walke will be showcasing her intricate lime work used in paintings and drawings, and friend Wendy Knight will be exhibiting her evocative dot paintings. Emma told HealthSpeak that her ceramic artwork provides her with a release from everything else going on in her life and gives her a great deal of enjoyment. “You can visualise the work that you are going to create and during the process it can change, so that when it eventually comes out of the kiln you can often find it’s turned out even better than your original idea, which is a great feeling,” said Emma. Emma is trying to find more time to devote to art and is excited about the three women
coming together to present the Tiddas exhibition. Tiddas runs from September 4 through to September 29 with
From page 3
Health Status of Baby Boomers vs Parents in the US
GPs. A head count of GPs would overstate the workforce, whereas FWEs adjusts for casual and parttime doctors. In our NCML region there are 538 FWE GPs for a population of 517,785, i.e. about 104 FWE GPs per 100, 000. This is very close to the state average of about 100 FWEs per 100,000. Obviously some areas have better doctor:patient ratios than others, while the situation gets worse the further you get away from the coast. The challenge is always to entice GPs, GP supervisors and GP training registrars to practise in these under-doctored areas. This is surely a more important and more challenging issue than just building up the total number of regional GPs in the workforce. 12
Artwork from the sisters exhibiting in Tiddas.
the launch on Sunday September 8 at 11am at Northern Rivers Community Gallery, 44 Cherry Street, Ballina.
illustration 2 (NHANES 1988-1994 vs 2007-2010)
Boomers % (born 1946-64)
Parents %
‘Excellent’ health Use walk device Functional limitation % Obese Get regular exercise No regular phys activity Hypertension Hypercholesterolemia Diabetes Smokers Moderate drinking Emphysema Have had MI
13.2 6.9 13.5 38.7 35 52.2 43 73.5 15.5 21.3 67.3 2.3 3.6
32 3.3 8.8 29.4 50 17.4 36.4 33.8 12 27.6 37.2 3.5 5.3
Encouraging our GPs, including younger GPs and trainees, to practise further away from
the coast would certainly help achieve a more even workforce distribution in our NCML
The overall rate of injuries resulting in hospital stays rose by about 1% per year between 1999 and 2011. The annual number of cases rose from 327,000 to 438,000 over this period. The rates of hospitalised injury due to falls rose by 2% per year, and intentional self-harm, by 1% per year, according to an Australian Institute of Health and Welfare report. And in 2010-11, injury hospitalisations were more common among males than females for all age groups except for people aged 65 and over, where the reverse was true. Two of the main causes of injury in 2010-11 were falls, at 39% of cases, and transport accidents, at 12%, followed by intentional self-harm at almost 6% and assault at 5%.
US Life expectancy at birth MALE 1990 2010 71.7 75.9
FEMALE 1990 2010 78.6 80.5
region. The ‘carrot method’ of attracting GPs west for more equitable distribution is far better than a ‘big stick’ method administered by government. Perhaps a compromise position would be for doctors who live on the coast to do at least some work further inland, which may free up the more inland doctors to do work in the more remote areas of our region. (1) http://artsonline.monash. edu.au/cpur/files/2013/03/Toomany-doctors-rapson-Mar-2013. pdf HealthSpeak
spring 2013
Training those trained overseas: OTDNET By Amanda Shoebridge North Coast GP Training
The Overseas Trained Doctor National Education and Training (OTDNET) Program, delivered throughout northern NSW by North Coast GP Training (NCGPT), is a Federal Government initiative designed to provide overseas trained doctors with access to specialised medical education and tailored training. Recognising the additional challenges faced by overseas trained doctors (OTDs), this program endeavours to assist OTDs toward gaining General Medical Registration and/or Specialist (General Practitioner) Registration by helping them to prepare for their relevant Australian Medical Council or college exams. Overseas Trained Doctors frequently face barriers in access to medical training in Australia. Stringent visa requirements, difficulties gaining recognition of prior learning, cultural variances and language skills – including gaining a grasp on the abundance of Australian colloquialisms in our dialect - are some of the many challenges facing OTDs. However, Australia relies heavily on OTDs in comparison to other OECD countries1. Health Workforce Australia (HWA) reports that in 2009 one quarter of all working doctors in Australia – almost 18,500 doctors – obtained their first medical qualification overseas2. Of the OTDs working
CORRECTION In the Winter 2013 issue of HealthSpeak there was an error in the article on the report ‘Northern NSW Health and Disease in the Aboriginal Community. The article should have read: ‘In Northern NSW, twice as many infants born to Aboriginal mothers (10%) are low birth weight compared with non-Aboriginal mothers (5.4%). Apologies for this mistake.
HealthSpeak
spring 2013
in Australia, a higher proportion work (on a full time workload equivalent basis) in outer regional (51%) and remote areas (47%) with 39% working in major cities and 44% in inner regional areas (HWA, 2012). The Areas of Need Program, which encourages OTDs to work in regions of workforce shortage, has been largely responsible for the migration of OTDs to remote and regional areas. However issues associated with remoteness and distance in these regions can make access to further training and support even more challenging. The OTDNET program was introduced in 2013 to help to ensure that OTDs have access to targeted GP training and education which is informed, supported and tailored to suit their needs and NCGPT accepted its first recruits in April 2013. NCGPT has given particular attention to ensuring the program delivers current knowledge of Australia’s health system with specific reference to NSW; a focus on communication skills; and an emphasis on cultural issues given Australia’s social, cultural, political and religious diversity. In addition to face-to-face workshops, participants have the opportunity to join regular web-based tutorials, and have access to numerous resources to assist in the exam preparation. The program has received a very positive response from participating doctors: “As I started to prepare for the RACGP exams, I felt lost without any support. I joined OTDNET and found the program immensely useful. I was guided through the preparation until the end of exams. I only wished
that I had joined sooner” – Dr Vinay Potumuthu. “While the OTDNET program is still in its initial stages, the sessions I have had have been very good and very practical. I’m sure it will be of great help to OTDs in passing their exams” – Dr Uzma Rasheed. NCGPT’s OTDNET Program is facilitated by medical educators, Dr Genevieve Yates and Dr Linda Brown, who, between them, have many years of experience in both the RACGP and ACCRM training pathways and exam processes. Dr Yates and Dr Brown each provide a personal contact point for participant doctors. “I have long been frustrated by the lack of support and education available to overseas trained doctors who do not have access to the registrar training program. I’m delighted to be part
of OTDNET which is helping to redress this imbalance. I have found it very rewarding to work with the lovely doctors on our program, and to feel like we’re making a difference” – Dr Yates. Limited placements are still available for the OTDNET program. If you or an eligible doctor3 you know are interested in further information, please call NCGPT Program Manager Sharyn Corben on 02 6681 5711, email sharync@ncgpt.org.au or contact your local Registered Training Provider. 1. Buchan J, Naccarella L, Brooks P, 2011, ‘Is health workforce sustainability in Australian and New Zealand a realistic policy goal?’, Australian Health Review, Vol 35, pp.152-155. 2. Health Workforce Australia 2012, Australia’s Heath Workforce Series - Doctors in focus, Health Workforce Australia: Adelaide 3. To be eligible to apply for OTDNET doctors must be permanent or temporary residents or Australian citizens who have general or limited medical registration in Australia, and do not hold a specialist (General Practitioner) registration in Australia.
Strengthening the Mind through Self-Compassion
Healthy North Coast's video crew attended a public talk by Professor Paul Gilbert on this fascinating topic in July. It was sponsored by North Coast Medicare Local and organised by Assoc Prof James Bennett-Levy from the University Centre for Rural Health. You can view Healthy North Coast's edited version of this talk here: healthynorthcoast.org.au/videos-2/
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CCSS: Supporting Aboriginal people with chronic disease general practice or Indigenous Health Service staff and Patients who are unable to manage a mix of multiple, communitybased services.
Jen Cook with colleagues Helen Lambert and Terry Donovan.
North Coast Medicare Local (NCML) employs staff in each of its Branch offices to coordinate the care of Aboriginal and Torres Strait Islander people with chronic disease to better access specialist, GP and allied health services. To be eligible for care coordination under the Care Coordination and Supplementary Services Program (CCSS), patients must: Have a care plan Be enrolled for chronic disease management in a general practice or Indigenous Health Service taking part in the PIP Indigenous Health Incentive and
Be recommended by their GP As a guide, patients most likely to benefit from the service include Patients at greatest risk of lengthy or frequent hospital admissions Patients at risk of hospital emergency presentations Patients not using community based services Patients needing help to overcome barriers to access services Patients requiring more intensive care coordination than provided by
Asbestos impact research project An innovative research project is investigating the social and psychological impacts of asbestos disease and how the development of an interactive online community could help reduce the impacts for sufferers, their families and carers. The project is being led by Southern Cross University’s Regional Initiative for Social Innovation and Research, with funding from the Asbestos Innovation Fund (AIF). The project has been extended to include a special focus on women affected by an asbestos -related diagnosis. Associate Professor Rick van der Zwan, who is leading the project, said around 3500 people died in Australia from asbestos related disease each year. An estimated 40,000 people will eventually die. “The medical effects of this 14
disease are well researched, but little is known about the social, psychological and economic implications for those diagnosed, their carers and their families,” Prof van der Zwan said. “Exposure to asbestos can result in a range of debilitating diseases, all of which can leave people physically and socially isolated.” Professor van der Zwan said the researchers, who are working closely with the Asbestos Disease Foundation Australia, would be using surveys, in-depth interviews and involvement in a new ‘online community’ to provide those affected by an asbestosrelated disease with a space to communicate, share and interact. Mr Barry Robson, from the Asbestos Disease Foundation Australia, welcomed the project which could also have huge benefits for carers.
Jen Cook, a CCSS Coordinator employed at NCML’s Coffs Harbour Branch office, explained that the role centres around coordinating the care of patients who need to see specialists and allied health professionals. “We get a referral from the patient’s GP , we set up a payment
process for them and ensure they have transport to get to and from the appointment, and if necessary, ask the NCML Outreach Worker to pay the patient a visit as a follow up check after their appointment,” Jen said. To contact NCML CCSS Coordinators, phone Tweed - Cath Downing (07) 5523 5513. Northern Rivers – Jamie Wimbus 6622 4453. Mid North Coast – Jen Cook 6651 5774 Hastings Macleay – Deb Cushing 6583 3600
Participants sought for cannabis use study Researchers from the University of Sydney, together with clinicians from Northern NSW Local Health District, have been funded by the Mental Health Drug and Alcohol Office, NSW Health, to undertake a study to explore health outcomes associated with long-term cannabis use. Although there is consensus that long-term, frequent cannabis smokers are at risk of experiencing adverse consequences, there is a considerable degree of uncertainty regarding the long-term effects as much of the evidence has been derived from studies with limited ability to adequately control for major confounders. There is also emerging evidence regarding the diverse and potentially clinically significant impact of cannabis use upon the endocannabinoid, endocrine and immune systems, and bone health. The aim of the study is to examine the physical health (including markers of general health, endocrine, respiratory and cardiac functioning, and bone health), mental health (including depression and anxiety), and cognitive functioning outcomes associated with long-term cannabis use, compared to matched non-
cannabis using controls. Two groups are currently being recruited to the study: 1 Cannabis smokers aged 40 years or older, who have been smoking cannabis at least four times a week for at least 10 years 2 Tobacco-only smokers aged 40 years or older, who have been smoking tobacco at least four times a week for at least 10 years Participants will be asked to attend Riverlands Drug and Alcohol Centre in Lismore for a research interview, to provide blood and urine samples, and have a lung function test. Participants will be reimbursed for their time and travel expenses, and the results of their clinical investigations will be available to them. If you are interested in finding out more about the study or have patients who may be eligible, Dr Jennifer Johnston (Principle Investigator) can be contacted on 1800 115 763 or email jennifer.johnston@ sydney.edu.au . All calls will be treated in confidence.
HealthSpeak
spring 2013
The changing face of health care By Prof Iain Graham Dean, School of Health and Human Sciences Southern Cross University
It is my pleasure to write this inaugural column for the School of Health and Human Sciences at Southern Cross University. In this column, I’d like to provide an update on how the School of Health and Human Sciences is responding to the demanding, changing world of health and social care within our locality. As a university school we need to challenge assumptions - iIn our case about how health is delivered, who delivers it, and when and where it takes place. It is time to think differently to stimulate debate about the changes needed to our health system. I hope this column will promote discussion and new thinking about innovative ways to deliver quality care, and support health leaders in their decision making.
Pressures for change
So, what pressures are there for change? One of the biggest challenges for today’s professional workforce is that it was trained to work in a model centred around single treatment episodes within hospital-based systems. However, those placing the greatest burden on services both now and in the future are older people with multiple mobility, mental and physical challenges needing integrated long-term health and social care in a convenient location. Additionally, the demand for care is changing. An ageing population presents us with lifestyle risk factors such as obesity, and physical inactivity is increasing the burden of chronic disease - a new reality for health workers. This new reality is being shaped by new drugs and technologies to treat disease and prolong life. . Thus, demand will rise for both technically less complex care, e.g. home care for frail older people, and technically more complex care, as new technologies emerge such as genomics, metabolic testing and computer assisted surgery.
HealthSpeak
spring 2013
These advances also challenge current professional boundaries. Increasingly, generalists and specialists working in an interdisciplinary team need to deliver patient-centred care. New medical and information technologies will also change the workforce, the nature of the work, where it can be done and who does it. Technology will put power into the hands of patients, resulting in more care happening outside of the hospital setting. For example, use portable monitors for patients at risk of stroke will remove the need to attend a busy outpatient clinic for check ups. The shift towards more protocol-driven care is a consequence of greater involvement and investment in research. For example, last year more than 20,000 randomised controlled trials were done, resulting in care based on that evidence rather than the whims and wishes of practitioners. Challenging health problems can now be addressed by clinical guidelines embedded in software and decision support tools. Health knowledge has changed from the general to the specific. In the future, better understanding of disease and particularly those linked to an individual’s genetic makeup, will result in more tailored treatments. This has big workplace implications, such an anticipated increase in the demand for specialists and generalists such as geneticists and genetic counsellors. While the relationship between professionals is changing, the nature of the health work done within traditional boundaries
is also being challenged by the emerging health care needs. As we extend and expand the roles of midwives, nurse practitioners and allied health professionals - so that they make diagnosis and prescribe medicines - we also introduce new health care workers into the system. The relationship between patient and clinician will change too. Boundaries are shifting with an increased requirement for greater inter-professional knowledge, understanding of communication systems and evidence-based care. The patient’s own engagement is also going to change. Currently many patients consult various search engines in order to better understand why they feel unwell or the implications of engaging a certain treatment modality as advocated by a particular health professional.
This shift away from a paternalistic model requires a cultural change We in University Health Schools and our service colleagues need to start planning a workforce that is future-orientated. If not, there is a risk that we remain a model of care driven by the available workforce, not the other way around. It is not possible to separate workforce redesign from work design, both need to be undertaken simultaneously. Universities should be driving collaborative practice development, not continuing professional development, as Obrit, 1913, suggests. The challenge is to work across professions, making health a team-based activity. So, in looking at the future and its challenges we need to pay attention to the redesign and the retraining of the health workforce so that workers have the skills needed to deliver and develop the health care system as required. Something akin to redesigning a modern airliner in mid-flight. We need to develop staff better
prepared to work with people with multiple morbidities, spanning mental and physical health. They need to have skills in order to partner and facilitate and to be able to coach patients to encourage positive health care behaviours and attitudes. This shift away from a traditional paternalistic model requires a cultural change. To achieve such a workforce we need to rethink how we train and prepare the health workforce now – not only for registration but throughout their professional lives. If one looks at the work of Kaiser Permanente they argue that self-care will increasingly become the centre of care provision, thereby reducing the impact and demand for professional care. The increasing use of self-monitoring and identification of those people at risk will significantly drive the need for professional care, so the challenge is how to support patients in a way that decreases rather than increases demand as we move into the future. So, taking these considerations on board, the School of Health and Human Sciences is starting to challenge the notion of how a curriculum is designed and how research can support innovation and practice. We have radically reviewed all curricula over the last five years and introduced new opportunities for people to become a variety of different health workers, trained to remain working in this region. We are also looking very hard at more flexible clinical training. We are introducing greater interprofessional and shared learning opportunities by which students may enter a particular framework of study, but migrate into other frameworks as their views on health care and their role within it change. This is at both undergraduate and post-graduate level. The school is actively providing an opportunity for continual collaborative education and research, all under its banner of a new generation of health workers in order to address the many challenges ahead.
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Breast cancer surgery and lymphoedema Breast cancer survivors who have extensive surgery are four times more likely to develop the debilitating disorder arm lymphoedema, a QUT study has found. The findings in a new paper Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis published in the journal The Lancet Oncology, reveal the invasiveness of surgery to treat breast cancer increases the risk of developing arm lymphoedema. Lead author of the study Tracey DiSipio, from QUT’s Institute of Health and Biomedical Innovation, said women who had undergone an axillary lymph node dissection – an invasive surgery to remove lymph nodes under the arm – were four times more likely to suffer swollen or disfigured arms.
New pelvic pain website A new pelvic pain website has been launched, Pelvic Pain SA, for people living with pelvic pain and for health professionals. The site, developed by a group of independent practitioners in South Australia led by gynaecologist and pain medicine specialist, Dr Susan Evans, offers a multidisciplinary pain management understanding to women and girls with pelvic pain. It offers reliable information about pelvic pain, as well as resources with activities and ex-
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most accurate incidence rate to date,” she said. “Until now the incidence rate has been reported anywhere from between zero to 94 per cent. With this information we can explore whether lymphoedema rates differ between breast cancer survivors.” Dr DiSipio said the study also pinpointed a number of risk factors linked to arm lymphoedema. “The risk factors increased when there was a lack of regular physical activity, or high bodymass index,” she said. “These factors are potential targets for future prevention strategies or for more effective management of the disorder.” Dr DiSipio said the results of the study added weight to calls to integrate prospective surveillance of arm lymphoedema into standard breast cancer care.
North Coast Health Transport Directory ercises people can do to improve their pain and maintain quality of life. There is information on treatment, from physiotherapy to medication, and on where to go for help. Dr Evans' eBook Pelvic Pain, written in conjunction with Ms Deborah Bush, is also available from the site. Visit the Pelvic Pain website at: http://www.pelvicpainsa.com.au/
BEAT IT starting soon in Grafton BEAT IT is a tailored physical activity and lifestyle program developed by the Australian Diabetes Council for people with diabetes and other chronic health problems. Participants part in a eightweek program made up of twice-weekly physical activity sessions and a fortnightly lifestyle education program. The program provides a safe and effective exercise option for people with/or at risk of diabetes
She said this was compared to women who had received a sentinel lymph node biopsy. “Arm lymphoedema is typically characterised by swelling in one or both arms, causing pain, heaviness, tightness and a decreased range of motion,” Dr DiSipio said. “The appearance of the swollen or disfigured arms provides an ever-present reminder of breast cancer and often contributes to anxiety, depression and emotional distress in effected women.” Dr DiSipio said the study, a systematic review of the incidence of arm lymphoedema after breast cancer, also found that one in five women (21.4 per cent) would be diagnosed with the condition. “This is a significant research finding and provides us with the
and other chronic lifestyle diseases and it’s conducted by an accredited fitness provider. The BEAT IT program starts at Grafton Aquatic Centre on Monday September 23 and Wednesday September 25 from 9.30am to 10.30am and runs for eight consecutive weeks. To register, phone Ann Armstrong Fitness on 0413 112 607. Enquiries to Patty Delaney, Healthy Clarence Communities Coordinator, phone 6643 0213.
The Northern Rivers Social Development Council in partnership with North Coast Medicare Local has produced a comprehensive transport directory for health professionals and consumers which provides information on patient transport through the Northern Rivers and Mid-North Coast. This directory contains information about services that either provide or can help find non-emergency trans-
port to get to a GP, specialist or hospital. One of the main problems identified as a barrier to equal access to health services on the North Coast has been transport for patients needing to visit specialists and other health professionals located a considerable distance from their homes. This handy online directory includes information on Community Transport Organisations and how to access these services, organisational transport supplied by groups such as the Leukaemia Foundation, state government funded services, public transport options and private transport options. It can be viewed at North Coast Medicare Local’s Healthy North Coast website: http://healthynorthcoast.org. au/wp-content/uploads/2013/07/ NR-Health-Directory-webversion.pdf
HealthSpeak
spring 2013
Contraception for young women – myths and misinformation By Dr Christine Read Sexual Health Physician
1. Unintended pregnancy is uncommon in women using contraception – FALSE Imperfect use of contraceptives is an important issue. In an Australian survey of two thousand women on contraception and unplanned pregnancy, more than half of the respondents (51%) reported having experienced an unplanned pregnancy and around 60% of these pregnancies were in women who indicated they were using contraception at the time. A body of research into discontinuation rates of reversible contraceptives and pregnancy rates for ‘typical’ and ‘perfect’ use of contraceptives indicates significant unintended pregnancies occur in women using user dependent easily reversible contraceptives such as oral contraceptives and barrier methods. Factors associated with imperfect use include young age, women who intend a pregnancy in the future and women who are single or cohabiting. 2. Long acting reversible contraceptives (LARCS) are suitable for young women – TRUE There is an international move to get as many young women using LARCs as possible. The contraceptive CHOICE project is examining a variety of ways to promote the effective use of contraceptives. It is a prospective cohort study of 10,000 women 14-45 years who want to avoid pregnancy for at least 1 year and are initiating a new form of reversible contraception. Among other issues they are examining the efficacy of counselling given by healthcare providers to women seeking combined oral contraceptive pills about alternative methods and also various barriers to the use of LARCs. Unfortunately, all too often prescribing a combined oral contraceptive pill is the easiest and probably best known HealthSpeak
spring 2013
Dr Christine Read
option for doctors – just reach for the script pad! However a recent unpublished online survey by a market research company of 1000 pill takers reported that 32% miss a pill a month. LARCs, on the other hand cannot be forgotten. The progestogen containing LARCs (Implanon®, Mirena® and Depo Provera®) also have fewer contraindications than combined hormonal contraceptives. For instance, they can be used in women who suffer migraine with aura and in older women who smoke. Financially they are a great alternative, being subsidised by the PBS for three years in the case of the implant, three months for the injection and five years for the hormonal IUD. Note that while there is some concern about bone density (BMD) in women under the age of 18 using the injection, it is still an option when other contraceptive methods are not suitable or desirable and where there are no risk factors for poor BMD. 3. Intrauterine contraceptive devices (IUD) can be used in nulliparous women – TRUE There is a long standing belief that nullips are not suitable for IUD insertion. In some instances this stems from a reluctance of inserters due to a perceived difficulty in passing the device through the nulliparous cervical os, and in others from the idea that in women who may change partners, there is a risk of pelvic infection, which is increased
Patient receiving a birth control implant
ers. However, they concluded that ‘the beliefs of HCPs have perhaps the most profound effect on uptake of these methods’.
Extra contraceptive protection is not required when taking common antibiotics.
with an IUD in situ. Clinical studies that examined the question of insertion into the nulliparous patient included a Swedish non interventional study of LNG-IUS (Mirena®) insertions in 224 nullips. Six insertions were unsuccessful, while more than 70% were regarded as ‘easy ’ by the inserting clinician. With regard to the issue of an increased risk of infection , in a randomised trial comparing the LNG-IUS with copper IUDs in more than 2500 women over a follow-up period of three years, the rate of pelvic inflammatory disease (PID) was significantly lower in LNG IUS users, and the rate of PID in copper IUD users was similar to the background risk of PID in non-users, suggesting that the LNG-IUS might protect against PID. The authors of a recent comprehensive review of the barriers to the more widespread use of IUDs in nullips identified a number of barriers including health care practitioners, the health system and user barri-
4. The emergency pill causes a pregnancy to abort – FALSE The emergency pill is a single dose of levonorgestrel given as soon as possible after unprotected intercourse. It primarily acts to prevent or delay ovulation by interfering with follicular development. Research studies have reported that it appears to be ineffective once the luteinising hormone (LH) surge has commenced. There is no evidence that it prevents fertilisation or inhibits implantation once ovulation has occurred. In addition, there is no evidence of harm to a developing foetus if it is inadvertently taken if the woman is already pregnant. 5. No extra protection is required if a woman on the oral contraception is prescribed antibiotics – TRUE The requirement to use extra protection when taking common broad spectrum antibiotics has been removed. Penicillins, cephalosporins and tetracyclines do not interfere with the effectiveness of hormonal contraceptives. Dr Christine Read works with younger clients at Lismore Family Planning and at Women’s Health Matters in Lismore, seeing clients aged 35 and above. She also does Telehealth consultations from home. References available on request. Email the editor: jgrist@ncml.org.au
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North Coast surgeon publishes Manuals for Life It seems there is a service manual for every appliance and machine, and now North Coast oncoplastic breast surgeon, Dr Guy Hingston, has produced ‘service manuals’ for men and women to help prevent diseases taking hold. Dr Guy as he’s known, was one of the short-listed PITCHers at North Coast Medicare Local’s event in July in Port Macquarie. These ground-breaking preventive health care manuals are aimed at those who want to increase their life-long health. Dr Guy’s hope is that with the help of his Gold Book for Men and Gold Book for Women diseases such as cancer can be successfully treated without getting to the stage where they threaten lives. As head of a busy surgical clinic, Dr Guy looks after women who need breast reduction and reconstruction surgery, as well as helping women manage breast cancer. He also lectures in surgery, breast cancer and preventive health at the University of
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NSW Rural Clinical School. These paperback books each have an introduction on preventive health followed by an ‘Age Page’ section made up of two-yearly service manual check ups from the ages of 4 to 48, and then yearly from ages 50 to 90. Dr Guy would like to see teenagers get into the habit of
using these service manuals regularly, so that when they are older they will be used to the concept. Gold Books can be purchased at: http://gold-book.net/purchase For each book purchased, one dollar will be donated to the Cancer Council.
Dr Guy Hingston
Guide to keeping quality health records The Royal Australian College of General Practitioners (RACGP) has launched a resource for primary health care professionals - Quality Health Records in Australian Primary Healthcare: a Guide. The Guide sets out common expectations on quality health records in the 21st century. RACGP President Dr Liz Marles said that up to now, there has been no single document setting out common expectations on quality
primary health care records in Australia. The Guide provides a foundation resource for health professionals to produce, manage and use high quality health records that are fit for a range of purposes including safe clinical decision making, good communication with other health professionals, trustworthy partnerships with patients and effective continuity of patient care. It covers electronic, paper-
based and hybrid health record systems, and in each section describes core principles, tips for compliance and clinical examples to illustrate application in day-to-day clinical practice. The Guide is a user-friendly source of information and is not designed to impose new professional obligations over and above recognised best practice. It is available from the RACGP’s website - www. racgp.org.au/
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Impacted teeth impacting people’s lives By Drs Arthur & Wojciech Bilski
Presentation
Problems with impacted teeth often present to the general dentist, however with the increasing difficulty accessing public dental services and the current general economic trends, many patients present acutely to the GP or directly to hospital A & E Departments. Since exposure to dentistry and oral pathology is minimal in the medical environment, the diverse presentations related to impacted teeth are often lumped into a general ‘dental pain or infection’ category and are either untreated or just given antibiotics. Without a proper diagnosis appropriate further treatment is often delayed resulting in advanced presentations with severe facial and neck infections, large cysts, possible pathological fractures. Untreated pain and oral infection can contribute to general malaise and the development of chronic facial pain. Awareness of the range of problems is needed in the wider medical community to ensure proper diagnosis and treatment.
Image 1: impacted tooth with cyst
Image 2: Impacted teeth with fracture
Definitions
Impacted teeth are teeth that are stuck and not fully functionally erupted into the mouth. These may be normal teeth or supernumerary teeth. The impaction may be fully in bone, partially in bone or against soft tissue or other teeth. Common impactions involve the third molars (wisdom teeth) and the maxillary canines but all teeth can get stuck. Supernumerary teeth are most common in the anterior maxilla but can present in any part of the jaws or facial skeleton including the maxillary sinuses and the palate.
Signs and Symptoms
Fully bony impacted teeth often present late with large cysts, pathological fractures and sudden severe infections once the disease breaches the bone into oral cavity, sinus or the nose. Partially erupted impacted teeth
HealthSpeak
spring 2013
Image 3: Impacted wisdom teeth
tend to present earlier with recurrent and escalating episodes of infections, pain, trismus, bad taste, halitosis etc. Many of the signs and symptoms can be compared to a presentation of an ingrown toe nail. Tooth impaction in modern societies is increasingly common and possibly contributed to by our soft diet and smaller jaws secondary to lower functional demand. Effectively develop-
ing teeth can run out of space for functional eruption. Only a minority of people in seem to have jaws large enough to accommodate the full complement of 32 teeth. Problems related to impacted teeth may manifest throughout the patient's life from early childhood (mixed dentition stage) into very old age. Since wisdom teeth and impacted canines are the most common culprits they often present in
the teenage years. Full bony impaction results in some chance of the normal dental follicle transforming into a dental cyst (dentigerous cyst or other varieties of cysts). Resorption of the impacted tooth or decay under the gums and damage to adjoining teeth is also quite common. Partial impactions also result in inability to clean around the stuck tooth with food and debris accumulating, resulting in soft tissue infections and bony inflammation. This can develop into a severe spreading facial and neck space infection. Periodontal tissues become inflamed and recede, resulting in bone loss and adjoining tooth mobility. Pressure on other teeth can result in direct damage of the contact points and both pain and increasing crowding of other teeth. Chronic pain and low grade infection has effects on other local tissues and sometimes distant and systemic effects. The common sites involve the jaw joint (TMJ) and muscles of mastication . In some patients distant infections can develop involving the salivary glands, lungs etc. Susceptible patients with congenital heart problems can develop bacterial endocarditis or infections of alloplastic implants such as artificial heart valves, total joint replacements, cardiac stents etc. All these problems can increase in frequency and severity in diabetes, pregnancy, and any other immuno-compromised states such as following systemic chemotherapy or radio- therapy resulting in xerostomia and neutropenia. Many commonly used drugs result in some xerostomia (dry mouth) further decreasing the body’s ability to keep infection at bay. MILD SYMPTOMS include low-grade pain, localised swelling and erythema , bad taste, halitosis and slight trismus ( restricted oral opening) MODERATE SYMPTOMS may include severe pain,increasing trismus, increasing facial/ neck
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The Koori Grapevine naidoc Week landmark agreement During NAIDOC Week a landmark agreement between the national organisations representing Aboriginal and Torres Strait Islander doctors and specialist medical colleges was signed. The Collaboration Agreement will make a contribution to closing the gap in health outcomes between Indigenous and nonIndigenous Australians by training more Aboriginal and Torres Strait Islander medical specialists, by improving the ways in which medical specialists work with Aboriginal and Torres Strait Islander people and by mentoring future Aboriginal and Torres Strait Islander leaders in medicine. Chair of the Committee of Presidents of Medical Colleges Professor Kate Leslie said “Australia graduated its first Aboriginal medical graduate 30 years ago,
100 years later than comparable countries such as New Zealand and Canada. Aboriginal and Torres Strait Islander doctors are significantly under-represented in the medical workforce and all 15 specialist medical college Presidents are absolutely committed to leading the change with our partners – the Australian Indigenous Doctors Association (AIDA).” AIDA President and GP, Dr Tammy Kimpton said this agreement completed the final piece in the continuum of medical education and training. “AIDA estimates that there are around 175 Indigenous medical graduates and 330 Indigenous medical students. To reach population parity in the medical profession would require over 1000 additional Indigenous doctors immediately” said Dr Kimpton.
Strong women showcased
Father Paul Gooley, Uncle Blue Smith and Aunty Liz Miller
Kempsey hospital focus for NAIDOC Week This year’s NAIDOC Week celebration in Kempsey included a farewell to the ‘gathering place’ as it’s known – in front of the the Kempsey District Hospital Emergency Department in the ambulance bay. This will disappear with the redevelopment of the hospital. It was also an opportunity for the local Indigenous community to do some “healing together” as people remembered lives lost and acknowledged the way that the community comes together when there is a tragedy. In the redevelopment of the Hospital there will be a new dedicated space as a gathering place for the Aboriginal community. During the ceremony there was a flag raising as
well as a traditional smoking ceremony – local Aboriginal people were chosen to perform tasks within this ceremony to acknowledge their years of service as former staff members of Kempsey District Hospital. Current staff were also involved as well as those from Durri Aboriginal Medical Service and Booroongen Djugun, to symbolise the partnerships on which the foundations were laid for Aboriginal health and healing. Following the ceremony there was be a morning tea and the cutting of the cake in the Centennial Garden. The ceremony was organised by Ro Stirling-Kelly, the Aboriginal Identification Project Officer at Kempsey District Hospital.
Deadly Dan makes an appearance
To celebrate NAIDOC Week at Bellingen Hospital, NCML’s Creative Arts Therapist, Ruth Nolan, created a stunning display showcasting some of the artwork created by Aboriginal women who attended the Gulbur Galban ‘Strong Women’ retreat recently.
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Koori Grapevine
At Grafton showground, NCML’s Helen Lambert and Terry Donovan created a lot of interest with a health information stall, but not as much interest as Deadly Dan the Smoking Man (Adrian Harrington) pictured here with Helen and Terry and some young fans.
NCML staff support Aboriginal outreach services at Yarrawarra Yarrawarra Aboriginal Corporation was established at Corindi Beach, south of Coffs Harbour, in the 1980s by Gumbaynggirr people, to ensure cultural continuity through stories and events associated with local sites. It provides economic, social and cultural opportunities for the Aboriginal community based at Corindi Beach. Yarrawarra Cultural Centre is making its mark as a first rate cultural ecotourism and education facility, with the Wadjar Art Gallery, Yuraal Coffee Shop, and a range of activities and information for day visitors as well as Nuralamee Accommodation and Conferencing. Dr John Kramer is based in Woolgoolga and established an outreach clinic at Yarrawarra about 20 years ago to help local Aboriginal people access medical treatment and he was joined soon after by Dr Helen Palmer. Today the centre operates on Wednesday mornings and an average of 25 people are seen in a month. This service provides the opportunity for preventative medicine e.g. fluvax, chronic illness education, smoking cessation, healthy lifestyle, mental health and diabetes education. Home visits are made fortnightly to residents in community housing under the Aboriginal Lands Council. Cath Wills, employed by Mid North Coast Local Health District is the clinic nurse and has worked at Yarrawarra every week, for the past four years. Cath's role is to assist the GPs, meet and greet patients, take observations and provide written health information to patients. She is also responsible for providing education, taking pathology samples and wound care, keeping the clinic organized and tidy and ordering stock and provisions. North Coast Medicare Local has improved access to a range of health services with staff Lyn Dalgliesh, a diabetes educator; Terry Donovan, Aboriginal Outreach Worker; and Helen Lambert from
Yarrawarra clinic - Front: Terry Donovan, Lyn Dalgleish, Dr John Kramer Back: Helen Lambert and students.
I always feel comfortable and confident about the service at Yarrawarra the Closing the Gap team either working at the clinic or supporting its patients. Yarrawarra also operates as a teaching centre with medical students visiting with Dr Kramer and sitting in on consultations when patients agree. Dr Kramer sees his work at Yarrawarra as a great opportunity to teach med students and young doctors a little about Aboriginal health. “It is a privilege to come to the home ground of the local community and deliver some much needed health care for them, whilst working with a growing team of community health workers. I have learnt so much about Aboriginal people in general by coming here,” he said. Dr Helen Palmer started coming out to Yarrawarra when she was working at Dr Kramer’s practice.
“We set up a room in what now is the Art Gallery. We decided to do alternate weeks to offer the community the option of a male or female GP. Prior to that I had done some outreach clinics at the Women’s Health Centre in the mid ‘90s. “When I ceased working at Dr Kramer’s I felt it was really important to continue my fortnightly clinics, so I visit as an outreach of Galambila and health workers often accompany me to support the service, performing health assessments and offering health care plans as needed. Dr Palmer said she felt it was important for the community to have continuity in their health care and to provide women with the option to see a female doctor. Providing an outreach service is vital, she said. “A lot of the mob out here can’t even get to Woolgoolga let alone Coffs Harbour and it has been great having Lyn Dalgleish out here to talk to patients about diabetes,” said Dr Palmer. Terry Donovan’s role sees him assist patients with transport and other support services. “It's important to help clients to access mainstream general practice to ease their journey with
chronic disease. I also support clients to access other health services such as specialist visits, and assist patients who need referral to other services such as Centrelink or Housing. Additionally, we provide advocacy services and network with other service providers. We also provide information and resources on Aboriginal Culture and health issues to practice staff,” he explained. Diabetes Educator Lyn Dalgliesh is able to provide free diabetes services to Yarrawarra patients through RPHS funding. “At Yarrawarra patients are often seen on an opportunistic basis and it is a privilege to work collaboratively with other health workers to support ‘Closing the Gap’ between the health of Indigenous and non-Indigenous Australians. My awareness and knowledge of Aboriginal culture has been broadened and I have developed a good rapport with the local indigenous community. A balanced diet is an integral component of good diabetes care and an important contributor to optimal health outcomes,” said Lyn. The clinic’s patients appreciate that they don’t have to travel to access health care. “When the medical service came to Corindi/Red Rock about twenty years ago the doctors and nurses came to Yarrawarra every Wednesday, and the people of the area got use to them coming and would be waiting. “It has been a really good chance for the Aboriginal people of this area to have access to medical help. I have been coming down here since it opened and always feel comfortable and confident about the service,” said one patient. Another patient has attended the clinic for 18 years with her children who are now aged 21, 20, 19, 17, 13, 12 and 10. “We have always been more comfortable attending these services than mainstream ones as the understanding of Aboriginal families is always considered,” she said.
Koori Grapevine
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Arts Health and Wellbeing The Mental Health Carers’ Journal A group of North Coast mental health carers have used their creative talents to produce a thoughtful journal of jottings which sheds light on their lives and experiences as family carers. The publisher of The Mental Health Carer’s Journal told HealthSpeak that the idea blossomed last year when a number of carers in Port Macquarie expressed a desire to write. The publisher, Michael Jenner, who’s the North Coast manager of the Family and Carer Mental Health program run by Mission Australia, said he organised for a novelist to educate these carers in the art of writing and they set up a Carers Writing Group which is still going. “It was decided to roll this idea out in Lismore as well. A four-week workshop was held so that mental health carers from Ballina and Lismore could learn about writing. At the end of this time the carers didn’t want to form a group, but did want to have some writing published, so myself, Anne Main [a carer and mental health resource volunteer in Lismore] and Dr Mim Weber, Mental Health Program Coordinator at the Northern NSW Local Health District, got together to make this happen,” Michael explained. Scarce funding meant that Michael published the Journal in a simple format and distributed it locally. The first edition contains evocative photographs by Ann Main and contributors are Debra Byron, Colleen Weir, Ruth Cotton, Elaine and Ann Main. The first issue was sponsored by Mission Australia’s Family and Carer Mental Health Program NSW, Northern NSW Local Health District and the Commonwealth Respite and Carelink Centre. Below is a piece from the Journal by Colleen Weir who cares for two family members experiencing mental health difficulties and lives on the 22
outskirts of Kyogle. Colleen told HealthSpeak that she gets a great deal of enjoyment out of writing
as it’s a way of escaping from her day to day life. She said she finds writing ‘therapeutic’. For a copy
of the Mental Health Carers Journal, phone Annne Main on 0421 302 495.
The Storm of Depression By Colleen Weir
Whilst sitting in an armchair in my lounge room attending to some paperwork, I happened to notice that outside something else was doing, a storm was brewing. The lightning and rumbles of thunder when all of a sudden lightning struck the transformer on the power pole diagonally opposite this room and from this strike came a ball of lightning about the size of a golf ball which headed straight towards me. It struck the lounge room light causing the light bulb to fall out and darkness to occur. Depression is like this in that it comes upon us as a form of darkness, with feelings of dejection, sadness, despair, loneliness, fear and fatigue. It deprives people of enjoying the brighter and lighter side of life. My instance: Past hurts and dysfunctional family life upbringing leaves one with a mixed bag of belief patterns and emotional hurts, and by heaping more onto the pile, the bigger it becomes until it reaches a height of insurmountability. A crisis point came of a complete emotional collapse just three months after the birth of our third child. When I was three months pregnant with our third child, my husband had a truck accident which was not his fault and the insurance company went into liquidation two weeks prior. A personal loan had to be obtained to get the truck repaired in Sydney. On top of this, when two of our children were only one and two years old, it became apparent that my younger brother was unwell, and he was diagnosed with schizophrenia. My parents could not come to grips with this, so it fell on my shoulders, a further responsibility. Enduring these and so many other problems and making the choice not to succumb totally in anti-depressants, and of wanting to be there for my children, and having to get up each day to attend to their needs, proved to be a blessing in disguise. A lot of support was needed and from many sources: my family doctor, psychologist, Minister, relatives and friends, and I slowly began to recover. It has been a challenging road where perseverance has prevailed and continues to prevail because of other challenges I have had to face. During this time of facing and handling challenges, I have found a solace in writing and with it come ideas about how one can make a difference. These gifts and talents have brought me through to where I am today.
HealthSpeak spring 2013
The ’eart in singing By Janis Balodis The famous actor Sir Peter Ustinov used to tell audiences about the one singing lesson he had with an Italian maestro, to aid his portrayal of Emperor Nero – singing while Rome burned. Surprisingly, he was advised to think with the stomach, to breathe with the forehead and to sing with the eye. No mention was made of the heart. Unsurprisingly, especially for Italians, the heart is always involved in singing. Luckily, as was to prove the case for Jessica McElroy, whose passion for singing not only gave her physical and moral strength, but also possibly saved her life. Jessica has a big, beautiful, free voice with a sweet and expressive tone. After completing her HSC Jessica went to Melbourne to study and build a performing career. Life has a way of interrupting our dreams and Jessica became pregnant at nineteen. She found the pregnancy and birth more physically challenging than expected and struggled to recover and cope afterwards, which she attributed to being an inexperienced mum and a failing relationship. Two years later she returned to the Northern Rivers to a supportive family and took up singing lessons again. In Melbourne, she had found herself struggling for breath and was diagnosed as asthmatic. Singing is a physical activity requiring breath control, and exercising lungs and respiratory muscles. It is considered beneficial for everyone’s health let alone for asthmatics. Ironically, asthma preventive drugs affect the vocal cords and Jessica tried to use them sparingly as she was determined to pursue her singing and complete AMEB exams in music. Yet strangely, despite greatly improved circumstances, with family, work, and a loving relationship, over the next five years, Jessica’s general health deteriorated. She went to the gym, ate well, and led a busy life. Still, each day she woke in pain, in her HealthSpeak spring 2013
Jessica singing at her wedding held at Jean Claude French Restaurant at Mallanganee in August 2011.
arms and legs, developed terrible headaches daily and became increasingly exhausted. An inconclusive battery of tests and a diagnosis of a weak constitution led to a breakdown. When a course of prednisone made Jessica realise what it was like to feel great again, further tests ensued, for rheumatoid arthritis and autoimmune diseases. And when Jessica started to get pins and needles in her hands her doctor listened to her heart, remarking upon its ‘weird rhythm’ but concluding it was probably a normal abnormality. All the while Jessica kept up her weekly singing lessons and practiced as best as she was able. She was preparing her 7th Grade recital when she succumbed to a virus and the exam was cancelled. A cold is understandable but this seemed unshakable. The gorgeous voice that once powered through operatic arias now struggled to get through folk songs. Jessica persisted, working on
Her parents took out a mortgage so she could have the operation as soon as possible her technique but did not have the voice for the exam the following year. And suddenly she had a heart attack at 28. Four days of hospital tests produced no diagnosis. A cardiac assessment showed damage to her heart but no one spotted the cause, clearly evident in retrospect. Told that she would feel better after a month, Jessica continued to get worse, with an elevated heart rate. Shortness of breath made singing more difficult but ‘Giving up on singing would be giving in.’ Jessica’s mother-in-law paid for her to visit a local GP. After
listening to Jessica’s medical history, his diagnosis of a hole in the heart was finally confirmed by further tests. Even though her heart was leaking all the time rather than just under pressure, and she had had one heart attack, the operation to repair Jessica’s heart was considered elective surgery. Not knowing how long Jessica could manage on the waiting list, her parents took out a mortgage so that she could have the operation as soon as possible. The happy ending is that Jessica has her life back. And the exquisite voice is working on the AMEB 7th Grade repertoire. Recuperation has been slow and steady. The pains in her arms and legs have gone. She has returned to the gym. A cake maker extraordinaire, out of the blue she just felt like baking a cake. And she has the energy and voice to dance and sing with her daughter again. As the great Ella Fitzgerald said, ‘The only thing better than singing is more singing.’ 23
The anti-inflammatory Lifestyle
By Prof Garry Egger
Of itself, stress is not a health issue, it’s the strain resulting from it
The discovery, about a decade ago, of a new form of inflammation throughout the arteries and organs of the body, has prompted suggestions about what causes the problem. We know that obesity is an associated factor, but could it be the things that cause obesity that directly cause the problem? Here’s the evidence for some of these:
Exercise As might be imagined, physical activity is something that humans have been doing for tens of thousands of years, and hence would be most likely to be anti-inflammatory, positive and healthy. But the evidence on metaflammation and exercise is somewhat confusing. Some studies show a positive, or anti-inflammatory effect and some show an acute increase in inflammation. Sifting through the available evidence to come 24
up with the facts is quite enlightening. Physical activity, it seems, has a ‘hormetic’ effect on metaflammation, where hormesis is a ‘U’ shaped function, suggesting that too little activity can be inflammatory, but so can too much. Being a ‘couch potato’ is clearly not healthy, but neither is being an extreme athlete. Interesting new research has shown that ultra-marathoners and extreme triathletes, who regularly (every two weeks or so) compete at a high level, can develop a marked pro-inflamma-
tory response. The middle road of moderate physical activity is logically and physiologically healthier and also anti-inflammatory. But there is another complication. For someone who is very unfit, through long periods or a lifetime of inactivity, any exercise is seen by the body as ‘foreign’ and hence the chemicals produced by this are acted upon in a pro-inflammatory manner. It’s only as fitness develops that this reaction decreases and the reverse, or anti-inflammatory effects of exercise kick in. What types of exercise? Research suggests it doesn’t really matter. Aerobic, or long, slow, distance-style activity to a level appropriate for the fitness of the individual is anti-inflammatory, just as is resistance or weight training, or any other form of activity involving large muscles of the body. And how often? All indications are that daily activity is best for about an hour in total. But if this can’t be managed daily, it should be done at least every other day, trying not to HealthSpeak
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miss two consecutive days.
Sleep
Inadequate sleep is a big cause of metaflammation. Pro-inflammatory chemical markers rise after even one night of missed sleep. When this is combined with binge drinking and manufactured high ‘energy’ drinks they are likely to go even higher. Research suggests that it is not the hours spent in bed, but the amount of good sleep that is important. Less than seven hours over 24 appears to be the bottom line, although this does differ, with some people only requiring three to four hours of good sleep a night. Like all other lifestyle factors causing metaflammation, exercise and sleep interact, to the extent that adequate exercise improves sleep, but inactivity, or excessive exercise, reduces sleep quality. Improvements in sleep have also been shown to be antiinflammatory.
Stress Stress is the body’s reaction to a ‘stressor’. It was designed to get us out of trouble through either ‘flight’ or ‘fight’ when faced with a dangerous situation. But throughout evolution, most stress has been acute. The body is primed for action through increased heart rate, sweating, increased muscle preparedness, adrenal reaction etc. Modern western lifestyles, however, are characterised by chronic stress. You can’t fight or flee from an imposing boss or uncompromising teenager – at least not usually. So the chemicals that are released to facilitate acute escape hang around in the body and become somewhat toxic, where they would otherwise be life-saving. Cortisol, for example, a typical stress hormone released from the adrenal glands, has enormous health benefits, but striking long-term side effects, one of which is an increase in ‘metaflammation’. Of itself, stress is not a health issue. It’s the strain resulting from this, and possibly anxiety and depression that occur with prolonged stress and these are linked with long-term diseases like heart disease, type 2 diabetes and cancers. Anxiety it has been said, “…is a thin stream of fear trickHealthSpeak
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ling through the mind. If encouraged, it cuts a channel into which all other thoughts are drained.” Anxiety is a response to a perceived threat to either body or psyche, when the individual is striving to overcome this. Depression on the other hand, occurs when the individual has given up striving. One writer has described this as ‘learned helplessness’, where anxiety is a type of ‘feared helplessness’. Another way to look at it is that depression results from living too much in the past, anxiety from worrying about the future. There is now a vast body of scientific literature showing a clear link between depression and inflammation, particularly in the parts of the brain associated with wellbeing. For example, see Shelton RC, Miller AH. Eating ourselves to death and despair: the contribution of adiposity and inflammation to depression.Prog Neurobiol 2010;91(4):275-299. Inflammation in parts of the hippocampus, for example, lead to neural atrophy, or the death of nerve fibre connections that release hormones (seratonin, dopamine, endorphin) when they fire together, helping to make us feel normal. When these connections break down, the feelings of normality are replaced by feelings of hopelessness. Sleep, diet and all the other inducers mentioned here need to be part of an anti-depression program that will also reduce metaflammation, at least in a significant sub-group of depressed individuals.
Particulate matter and air pollution Pollution in the air comes in the form of minute particles of different chemicals, largely through the combustion of organic fuels. As with other metaflammatory inducers, the body sees these as foreign invaders and, in the case of larger particles, will attack them in specific organs such as the lungs, to stop the spread. In the case of fine particle matter however (ie. <8µg diameter), which often come from industrial processes, the reaction is more systemic or widespread and the inflammatory reaction is less likely to be localised and more likely to be right throughout the body, such as in metaflammation.
Given that pollution is ubiquitous and very hard to avoid, how do we escape this? A good diet is a start to help ‘mop up’ particulate matter. Some is probably also exuded in sweat through exercise and even sauna baths. We are all faced with environmental pollutants and there’s probably not a human being on the planet who doesn’t have the remnants of some – whether from cleaning chemicals, cosmetics, pollution or even micro-particles from photocopy machines – in his or her blood. Toxicological analysis recommended by your doctor may indicate some directions for management.
Smoking If particulate matter is unhealthy, it’s a ‘no brainer’ to suggest that sucking some 300 chemicals in cigarette smoke into the body is going to have a similar, if not worse effect. It is only in the past decade though that we’ve realised that the effects of smoking are not localized but systemic, throughout the body with the potential to damage a range of organs. And you’re fooling yourself to think that social smoking is unlikely to be dangerous. Unlike food and obesity, there is no level of smoking that can be seen as anything but unhealthy.
Social Stress and insecurity It’s only recently that we’ve recognised the unhealthy effects of inequality and financial and employment related insecurity. This is a little more complicated than it might first appear. Outside the impact of poor nutrition, poverty per se is not of inflammatory concern, provided everyone else around you is poor at the same level. When incomes become vastly unequal, however, such as in modern day USA, Australia, NZ, Canada and the UK, something happens biochemically to ‘inflame’ the body, particularly, but not limited to, those at the bottom end of the income scale. Perceived social justice in the workplace has similarly been found to have a metaflammatory effect, as has ‘burn out’ in the workplace. For more information, visit: www.lifestylemedicine.com.au 25
Travel
The wonderful Kimberley By Vivianne Walkington
Magic!
The Kimberley tide changes go up to 12 metres, one of the largest on the planet.
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That is the only word to describe the experience of cruising through the majestic rivers of the Kimberley with every need catered for. Such was my experience cruising from Broome to Wyndham for 14 days aboard a luxurious 26-metre catamaran with eight others guests and six staff. As if set to a Hollywood script, the champagne was served as we left Broome’s Cable Beach. The sun sank slowly below the horizon and a kaleidoscope of colours filled the sky. Moments later a full moon rose in all its golden glory. And so began my adventure into one of the most isolated, unexplored wildernesses on the planet. I soon learnt to forget my watch and iphone. There is no internet connection in this piece of paradise. Man cannot control nature, and the tides rule this part of the world. The Kimberley tide changes go up to 12 metres, one of the largest on the planet. The beauty of the crew catering to such a small group means that the staff are able to respond to everyone’s unique needs. This includes the very active individuals, those with mobility issues, birdwatchers, Aboriginal art lovers and fishing fanatics. All the activities offered are optional and much of the long distant cruising happens at night, so each morning we awoke in another mysterious pristine location with a full day to explore. A typical day would see a 7am start with a light breakfast at the stern of the boat. Then guests boarded the three tenders for a fishing experience only the Kimberley could provide. Even novice fisher women were “hooked”. The spectacular scenery (complete with birdlife and a few wiley crocodiles or ‘salties’) and the variety, size and quantity of fish made it an enjoyable experience for all. Back on board, a ‘second breakfast; (eggs benedict or the like) or morning tea would await. The food was five-star and the chef considered guest weight gain to be a personal achievement. Back in the tenders there were excursions to Aboriginal art sites painted on red ochre rock walls. We were told that the Wandjina paintings are thought to go back 5000 years, with some still “touched up” by their Aboriginal
custodians. After a lunch of the freshest fish ever, (and the option of a chilled wine) there was time for a rest before heading off for an afternoon swim. Swimming in the rivers of the Kimberley often involves an easy scenic climb to a swimming hole above the waterfalls away from the salties! The water is cool and crystal clear among the rugged beauty of the gorges. Pre-dinner drinks and aperitifs include fresh oysters collected from the rocks or mud crabs caught that morning. Occasionally our dining location was a strip of white sand on a remote island, where once we saw turtle track marks in the sand. After sunset the bonfire would be lit and we could sit around the fire and talk about the ‘one that got away’ or just lie back and marvel at the night sky showcasing a magnitude of stars. Everyday I found myself saying ‘it can’t get better than this’ but somehow it did - the world famous Horizontal Waterfalls, Montgomery Reef, Kings Cascade and Vansittart Bay with the wreck of a DC3 still intact from WWII. Then King George River with its sheer brilliant red parapet cliffs. Having travelled extensively throughout Australia and overseas I was taken aback by the sheer untouched magnificence of this part of the world. My experience aboard the K2O discovering the Kimberley was my best ever holiday. I’d encourage you to tick this experience off your bucket list. Remember 20 years from now you will be more disappointed by the things you didn’t get around to than the things you did. To find out more about cruise holidays in the Kimberley, go to: www.kimberleycruise.com.au
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Suicide Prevention Resource The Outsider’s Inn: Saving Lives with Conscious Living
Suicide and the mindset and antecedents that lead to it are complex and multifaceted. Krista Fuller’s treatment of this
sensitive subject matter in The Outsider’s Inn is inspirational. Australian Bureau of Statistics figures show that between 2001 and 2010 22,526 registered deaths by suicide occurred in Australia affecting multitudes of families and health professionals. North Coast resident Krista Fuller has a psychology background and combines her warm and powerful storytelling and her years in therapy to create a book that parents, teens and teachers are using to learn about and explore the difficult topic of suicide and self-harm, childhood trauma, sexual identity, love and relationships and people can create a meaningful sense of value, fulfilment and social connectedness in their lives. Krista spent eight years
researching The Outsider’s Inn while dealing with her treatment for early childhood trauma and raising two small children. She is a passionate suicide prevention advocate and is committed to the idea that transformation is possible and the cycle of selfloathing can be overcome. This suicide prevention resource has a fresh, Australian context and helps readers recognise the signs of mental and emotional distress and harness the power people have to help themselves and others. “An amazing book - everyone should read this, especially teens.” Student (Newcastle, Age 14) To order copies of The Outsider’s Inn, go to: www.runeink.net
Paediatric Neuropsychology practice open in Northern Rivers
Keelin Turner is looking forward to receiving referrals at her new practice
Keelin Turner’s decision to change direction and follow her passion to work with kids has led her to open a private paediatric neuropsychology practice in Lismore. It’s the only child-focussed neuropsychology practice on the North Coast. Previously, Keelin , who has an Honours degree in Psychology and a Masters in Neuropsychology, worked in the public health system - in rehab, mainly working with dementia and stroke patients. She told HealthSpeak
HealthSpeak
spring 2013
that she was keen to work with school kids and make a difference to their learning capabilities at a young age, rather than try to help people at the end of their lives. “Early intervention is crucial, you need to act before attitudes and behaviours become cemented. Children’s brains are incredibly ‘plastic’, it’s the time in their lives when most neural changes are made,” Keelin said. Her practice caters for kids aged six to 16 and her work involves making assessments of
clients’ brains and writing up recommendations to help them in the school setting. “I look at the different areas of the brain and depending on the referral question, I assess things like executive functioning, speed of processing, attention skills, language, spatial skills and reasoning. “The referrals range from ‘My child is having attention problems and I’m not sure whether it’s ADHA or mild attention problems’ to assessing a child who’s had a brain tumour and it’s been removed. The parent might want to see how the child is going to go at school and what support they will need,” she said. Referrals to Keelin come through a GP or a paediatrician. The only drawback with Keelin’s new line of work is that for clients it’s not very affordable. “The government only covers psychology if you are doing counselling or therapy. Even if you get a Medicare rebate, it is still going to be $900.” To contact Keelin, phone her on 0403 012 774. Her practice is at 5/67 Molesworth Street, Lismore.
Shared medical appointments expert to visit Group consultations are gaining in popularity overseas and the US pioneer of these appointments is visiting the North Coast to talk on the topic. The presentation for GPs, practice nurses, practice managers and allied health professionals is by Dr Ed Noffsinger, who will talk about group consultations as a new way to manage chronic disease. Dr Noffsinger believes shared medical appointments (SMAs) can increase patient and provider satisfaction; improve efficiencies, encourage patient peer support and enhance self-management. The lecture is sponsored by the Australian Lifestyle Medicine Association and Southern Cross University and is RACGP accredited. Dr Noffsinger will speak at Lismore Gateway Motel & Restaurant on 24 September, and the C.ex Club Coffs Harbour on 26 September. The cost is $20. To register, email: ea@ lifestylemedicine.com.au or call 0431 321 848. Find out more about SMAs at: www.groupvisits.com
Bookmark HealthSpeak and read it online HealthSpeak is now on line and proving popular with more than 14,000 readers last issue. Bookmark it now at: www.issuu.com /healthspeak
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Dementia experts deliver local workshop North Coast health professionals were treated to expert teachings on dementia at a day-long workshop organised by North Coast Medicare Local in Ballina in June. A total of 27 participants took part including GPs, practice nurses and residential aged care facilities’ staff from townships including Urbenville, Iluka, Tweed and Nimbin. NCML’s Viv Walkington who organised the workshop said attendees were grateful to have such a high standard of professional development education delivered locally. One of the case studies examined at the workshop was a fascinating one centred on a 49year old barrister with early onset dementia. Viv said this case study showed all too clearly that no one is immune from dementia.
The University of NSW has produced an E-learning Active Learning Module (ALM) for Timely Diagnosis and Management of Dementia in general practice. If you are a GP and are interested in doing it, you will need to register at: www.thinkgp.com.au This module is an accredited ALM with a different activity number than the workshop and participants can log in as many times as they like to complete the ALM. There is also a useful and informative website designed for GPs to help them recognise the signs of dementia and help doctors make a real difference to the lives of those with dementia. It can be found at: www.detectearly.org.au Additionally, anyone wishing to find out further informa-
From left: Dr Allan Shell, Dementia Collaborative Research Centre UNSW; Dr Carol Stevenson, GP; Sharon Reutens, Lecturer, School of Psychiatry, UNSW; Christine Vannucci, Alzheimers Australia.
tion or what support is available around dementia, can phone the
National Dementia Helpline on 1800 100 500.
Bringing the Art of Communication and Self Care into Health Care By Chris James Developing and renewing skills in expression, communication, listening and self-care is a simple, essential and vital way of continuing and improving successful relationships with clients, patients and colleagues. It is now recognised that the way medical practitioners, and health care staff communicate is crucial as complaints and litigation against health practitioners rise. The curriculum for Australian general practice outlines five domains of general practice, and ‘communication skills and the patient-doctor relationship’ features prominently. As expressed by Dr Ronald McCoy, Senior Medical Educator at the Royal Australian College of General Practitioners, “There’s no mistake as to why it’s first on the list. It’s the foundation of everything we do. It can make or break a consultation.” Recent surveys in the UK and USA addressing communication 28
and tone of voice have elevated this skill to a must-have status. The Good Medical Practice Framework in the UK has brought in new measures that must be adhered to by practitioners in their revalidation appraisal, showing that they must have addressed communication, relationships and teamwork. The way that GPs and health professionals listen has been identified as being of great importance to patient outcome as misinterpretation of information takes on its own story and can result in serious consequences. Understanding tone of voice and way we speak and communicate is an essential part of this equation. A health care practitioner can be saying one thing but depending on the quality, tone, manner, and delivery, what is being said can be easily misinterpreted. The fact is that most complainants are not after financial gain or litigation – they just want to be heard. Active listening and presence of mind in the consultation room, any clinic or hospital
are essential. Presence of mind, awareness and focus are life skills that come from the ability to stay centered. Ultimately this brings self-care into the equation, balancing our lifestyle and professional lives. There is evidence that the reduced health and wellbeing of the doctor also notably reduces quality of patient care. As the AMA 2011 paper stated, the wellbeing of health care practitioners must now be brought into focus and presented as a number one priority. ‘The AMA encourages doctors and medical students to practise good lifestyle behaviours and to seek formal health care when necessary. It is valuable for doctors to find that which energises, restores and nourishes them as a person, whether this is creatively, physically or spiritually, and to make time for this in their lives.’ At the core of re-developing true communication and expression is also the fundamental understanding that how we live is what we impart. ‘The art of true communication is fundamental to excellent healthcare
Chris James
and is crucial to establishing a fruitful and nurturing doctor-patient relationship. Lack of communication is often one of the main reasons for complaints by patients and their relatives. It is beholden upon us as healthcare and medical professionals to continue to develop and expand our communication skills. Perhaps we are not as good at truly listening in a non-judgmental and compassionate way, as we like to think we are. As we highlight the importance of reflective self-care, and the positive impact that can have on our communication skills, a renewed and healthy appreciation of one’s self is also fostered.’ – Eunice Minford MBChB,MA,FRCS Ed. Consultant General Surgeon, UK. Chris James teaches internationally about the healing power of sound and song, voice and expression. Contact him on 6628 3308. HealthSpeak
spring 2013
A model for sustainability: NCML’s Hastings Macleay Palliative Care Local Advisory Panel By Paula Hicks Chair of NCML’s Palliative Care Local Advisory Panel, Hastings Macleay
Background North Coast Medicare Local’s Palliative Care Local Advisory Panel is a great example of successfully steering sustainable project outcomes from the Hastings Macleay General Practice Network to North Coast Medicare Local. From 2008 to 2011 the Hastings Macleay GP Network (which became North Coast Medicare Local in April 2012) was fortunate to be part of the Rural Palliative Care Project funded by the Department of Health and Ageing. The project resulted in two major achievements Increasing awareness of palliative care within Residential Aged Care Facilities And increasing General Practice education and support with visiting Palliative Care Specialists from Calvary Hospice in Sydney In order to carry these achievements forward, a sustainability plan was put together based on four components 1 Establishing building blocks with the setting up of a Local Advisory Panel (LAP) to provide governance 2 Identifying four focus areas including Partnerships for change; Education alliances and Resources and Planning and policy frameworks 3 A staged implementation 4 Identification of barriers and enablers From a sustainability point of view, the LAP was able to successfully maintain contacts HealthSpeak
spring 2013
through links formed between participants in the following ways Establishment of GP support contacts to the Medical Specialist Outreach Program (MSOP) palliative care service from Calvary Hospice. Links between the local palliative care services and the Residential Aged Care Facilities (RACF) LAP members Engagement of an LAP GP to assist in the community road show for Aboriginal and Torres Strait Islander people Education opportunities shared between LAP participants and their organisations. Sharing of knowledge and resources within and between partners The LAP continues to meet in both in Kempsey and Port Macquarie every three months or as required. The panel has provided support for Palliative Care grant applications, lobbied for palliative care staff within Mid North Coast Health District (MNCLHD), advocated for better GP access to residential aged care facilities, and assisted resource distribution and access to Palliative care education for member organisations.
General Practitioner Director of care from an Aged Care Facility. Close the Gap representative Chaplaincy representative The photograph below was taken at a special meeting of the
Hastings Branch of the North Coast Medicare Local Palliative Care Local Advisory Panel. The meeting was arranged when Dr Yvonne McMaster, a retired Palliative Care Specialist, now an advocate for Palliative Care, visited the district. An LAP meeting was also held in the Macleay area.
(Back L-R) Dr Anica Nieuwoudt GP Aged Care; Pauline Smith. CNC Palliative Care (MNCHD) ; Dr Brenton Schuetz, Palliative Care GP, VMO Wauchope District Memorial Hospital; Linda Kay, Nursing Unit Manager MNCHD; Sue McCann, Catholic Care of the Aged; Paula Hicks (Chair PC LAP) North Coast Medicare Local; Dr Kevin McDonnel,l GP Aged Care; Mrs Gae Green, Hastings Home Hospice. Seated (L-R) Dr Warwick Wilson; Dr Sam Bouwer, GP Aged Care; Dr. Yvonne McMaster, Retired Palliative Care Specialist and Palliative Care Advocate.
The Panel membership includes the following people NCML practice support staff Clinical Nurse Consultant or Palliative Care Nurse Practitioner Palliative Care Nurse Manager from (MNCHD) Community Pharmacist Hastings Home Hospice member (community representative) Hospital: Aged Care Nurse Practitioner
This photo was taken at a breakfast education meeting with Dr Frank Brennan from Calvary Hospice Sydney. Front L to R: Ms Debbie White, PC Nurse Practitioner MNCHD; Dr Brenton Schuetz, Palliative Care GP, VMO Wauchope District Memorial Hospital; Dr Anica Nieuwoudt GP Aged Care; Pauline Smith CNC Palliative Care (MNCHD); Dr Brenton Schuetz Palliative Care GP VMO Wauchope District Memorial Hospital; MS Donna Khun PC RN’ 2nd row Dr Frank Brennan Palliative Care Specialist Calvary Hospice; Ms Pauline Smith CNC Palliative Care ,Dr Anica Nieuwodt GP Aged Care; Dr Carol Booth Durri AMS Paula Hicks NMCL; Back L to R Dr Sam Bouwer GP Aged Care.
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Clinic at Bellingen Youth Hub
Dr Gull Herzberg, PsychologistJane Mosco and youth worker Amy Riddle with young people at the Bellingen Youth Hub Clinic.
Getting health advice and support on health matters has become a lot easier for the young people of Bellingen with a new Youth Health Clinic operating there two afternoons a month. At the Youth Health Clinic, twelve to 24-year olds can see doctors, psychologists and youth workers without having to make an appointment at the drop-in clinic. The consultations are bulk-billed and consultations are set down for half an hour, so that the time spent with health professionals is not rushed. The Youth Health Clinic was a collaborative project involving a number of community groups and services. North Coast Medicare Local’s Rowan Lunney
has a role at the as a community liaison and youth health project officer, assisting the clinic to access the health services they need. The Youth Health Clinic is open the first and third Thursdays of each month from 2pm to 5.30 pm, but it’s hoped it can progress to be open every Thursday. Youth Hub Coordinator Dean Besley told HealthSpeak that the clinic had been welcomed by Bellingen youth and was well utilised with health professionals being kept busy during clinic hours. For more information, contact Dean on 0412 361 562 or view their website at: www.belloyouthhub.net/
Bulk billed telehealth for cancer genetics Sydney Cancer Genetics provides a specialised telehealth service to support individuals and families concerned about cancer. They offer assessments of inherited risks, genetic counselling and testing and risk management. Dr Hilda High is part of this team and is a medical oncologist specialising in inherited cancer syndromes. She told HealthSpeak that with the spotlight put on cancer genetic testing following Angelina Jolie’s admission about her BRCA1 mutation status and double mastectomy, the Cancer Institute had set up referral guidelines for inherited cancer syndromes (www.eviQ. org.au) Dr High said the bulk-billed telehealth service was established to complement existing public services which often had long waiting lists, and to support local GPs, patients and specialists. Telehealth consultations are run on Wednesdays and Fridays. Who should be referred to a Hereditary Cancer Service? GPs are advised to refer patients who fit the following criteria: Cancer incidence 3:2:1 = 3 blood relatives, 2 generations, 1
Dr Hilda High
<50yrs Patient experiences cancer at a young age Multiple cancers in patient or family Syndromal features or cancer clustering Ethnicity re founder mutations, eg Ashkenazi Jewish heritage Tumour characteristics pathology includes loss of staining for MMR protein on IHC, triple negative breast cancer <40 years, rare tumour types, bilaterial or multifocal tumours How to refer? The Cancer Institute’s CanRefer website (www.CanRefer. org.au) lists details of both public and private Familial
Continued page 36
About Private Practice Dietitians What is a dietitian? A health professional who offers one on one or group nutrition advice based on scientific evidence. Advice is tailored to the individual and client-centred. Who are APDs? Accredited Practising Dietitians are nutrition and diet experts, recognised by the Australian Government to deliver nutritional and dietary advice with Medicare rebates available if referred through a GP Management Plan for
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chronic conditions; and private health insurance rebates for other appointments. APDs are also registered Department of Veteran's Affairs (DVA) providers. Who can benefit from seeing an APD? A wide range of patients can benefit from a consultation with an APD including adults, children and infants; underweight (malnourished) people through to people struggling to lose weight; people with chronic diseases (e.g. diabe-
tes, high cholesterol, cancer); allergies/intolerances; gastrointestinal conditions (e.g. IBS, coeliac disease); those with eating disorders, athletes and more. Private dietitians work across North Coast NSW. It’s possible to find APDs at: http://daa.asn.au/for-thepublic/find-an-apd and the Yellow Pages. Clients do not need a GP referral to see a private dietitian, although referrals, including medical history can be useful. The benefits of seeing a
private dietitian include a short waiting list, detailed individual assessment, counselling and follow-up. They also offer specialties not available in public health such as sports nutrition, a wide variety of clinic locations and the ability to conduct home visits. Information supplied by Northern Rivers Private Practice Dietitians – a group of Accredited Practising Dietitians (APD), Accredited Nutritionists (AN), an Accredited Sports Dietitian and all members of Dietitians Association of Autralia.
HealthSpeak
spring 2013
The long term future is upon us now The really scary thing about the 2013 Federal election campaign was the almost complete lack of focus on the long term by both the major political parties. The economic debate in particular seemed to be all about bringing the Federal Government budget back into surplus sometime in the next four years. If you could promise this, then apparently you were economically responsible. This of course is absurd. In the current economic climate where Australia’s economic fortune is determined largely by offshore events over which we have no control, such promises are deceptive and have a 100 per cent certainty of being wrong. The best economists in the country can’t predict four months ahead with any degree of accuracy, let alone four years or more. Most of this uncertainty is caused by swings in the economic cycle across the globe and, with fragility everywhere, predictions with any chance of being accurate, are impossible. We could surprise on the upside, we could muddle through or there could be another financial disaster. No one knows. The answer here of course is to promise to be flexible and to adjust to what is thrown up at us. But the story is more serious than this. Underneath all this volatility in the economic cycle lies a structural problem in the Australian economy that is shared by most of the western world. The federal budget on both the revenue and expenditure side is deeply flawed. Unless drastic and hugely unpopular decisions are made almost immediately we will run increasingly large budget deficits and accumulate huge amounts of government debt. That is really dangerous. Just ask the Greeks. We all know about the demographics of an ageing population in Australia (and most of the developed world) but nothing much is being done. Decisions HealthSpeak
spring 2013
are still being made with a short run, popular focus that ignores the huge structural problems that are now rolling towards us at an ever-increasing rate and are about to hit. The oldest of the baby-boomers are now retired and they will be joined by more and more of them over the next few years. The number of people leaving the workforce will be greater than those moving in. Economic growth will fall.
By 2050 the burden of supporting seniors will double Economic growth is the sum of two things; the number of people in the workforce and the rise in productivity per person employed. Over the past few decades we have had some productivity rise but we have also had a strong rise in the number of people in the workforce as the baby boomers started work. Now they are leaving and because they were not a particularly fertile bunch, they will not be replaced by their own offspring. As some observers have put it, over the past few decades we have benefited in terms of economic growth by a tailwind associated with a rising workforce. This is now changing to a headwind. It’s going to be tough. These demographic changes
will not only slow economic growth but will have staggering effects on the Federal budget. The boomers are not just retiring, they are living longer. Over the last 100 years, life expectancy at birth for men has risen by nearly 24 years and for women by almost 25 years. It is not inconceivable that in the future many people will spend more years in retirement than they did in the workforce. It means that by 2050 there will be only 2.7 people in the workforce, producing and paying taxes for every person over the age of 65 compared with double that at present. In other words, the burden of supporting our seniors will double. We have known about this problem for a long time now. The difference is that it is now upon us and we have done virtually nothing about it. We had a chance 12 years ago when the mining boom arrived. Hundreds of billions of extra dollars flowed into the federal coffers but were “squandered” on tax cuts, middle class welfare and initiating federal liabilities that were always going to have effects that lasted much longer than just another mining boom. We could have established a sovereign wealth fund where the mining proceeds would have been collected and invested off shore. Not only would we have put money aside to meet future liabilities but also we would have reduced the upward pressure on the Australian dollar. Australian
Economy David Tomlinson
industry would have been more competitive. But thanks to the actions and inactions of various governments we now have the situation where most retirees over the age of 60 will pay no tax at all, even if they are extremely wealthy. Their homes are also exempt from the capital gains tax. In addition the family home is exempt from the asset test for the age pension. It means that those owning a home worth many millions of dollars can still claim the age pension and all that health and other concessions that go with it. There are also generous tax concessions associated with negative gearing and of course there is huge waste in Government where the services provided by other levels of government are duplicated. As the population ages, the biggest drain on government coffers will not be age pensions but health costs that are rising rapidly. Health care and the PBS will gobble huge chunks of tax revenue in future year. So what do we do? There is no quick fix and any measures will take time to work and be unpopular. however the tax base needs to be broadened. Retirees will have to pay more tax either via their income or their expenditure (eg a higher GST). Government expenditure will have to be reviewed and more targeted so it is based on need. Measures will have to be introduced to increase the productivity of those left in the workforce. They are the ones producing the goods and services that we all consume or exchange for imports. This should mark the end of the age of entitlements. The longer these adjustments are put off, the more painful they will have to be. Just ask the Greeks. 31
Hundreds attend mental health event By Jesse Taylor Manager, Partners in Recovery, Mission Australia
You may not have heard about the 220 teachers and principals who gathered in July at Toormina High School for a pupil-free Professional Development Day with the Bongil Bongil group of schools represented by the Youth Mental Health and Wellbeing Network (YMHWN). This event was organised by North Coast Medicare Local's own superstar and community engagement officer Rowan Lunney and you deserve to hear about it. Professor Patrick McGorry spoke on the need to destigmatise mental ill health, how to encourage mental health help-seeking behaviours, the need to address the real issues of the young people who present, practical ways for teachers to
Prof Patrick McGorry speaks at the Toormina High School event.
respond to at-risk young people, and much more. Those present heard presentations from Janelle Storrie and Llywela Smith of the MNC Local Health District’s Child and Adolescent Mental Health Service (CAMHS), Jo Magill from On Track Community
Programs and Beth Holroyd, also from CAMHS. Participants strategised over case studies and brought the really difficult questions to the local panel comprising Annie Harmon (school counsellor), Dr Nicola Holmes (headspace Coffs Harbour GP), Wendy
Dowel of CAMHS, Jo Magill of On Track Community Programs and Dr Ian Nisbit, forensic psychologist with the Department of Juvenile Justice. One thing that was made clear through the event was that we work smarter by working together. Thanks to everyone who made this event possible, especially Principal Liz Donnan and her left hand woman, Lorraine from Toormina High School, all the school principals who helped in organisation and MC Rowan Lunney who picked up the proverbial ball and inspired us all. I encourage you to get involved, inspire others and organise and attend mental health networks like the Youth Mental Health and Wellbeing Network. Working together we will continue to change the way people think and respond to mental illness in all our communities.
GP campaigns to reduce alcohol fuelled violence in Byron Dr Graham Truswell is a GP working at a practice in Bangalow, not far from Byron Bay, known to many as a holiday destination, and more recently as Australia’s most popular ‘party town’ for young people. Byron Bay also has the third highest alcohol related violence in NSW, and as a Visiting Medical Officer at Byron Bay Hospital, Graham has seen far too many alcohol-related injuries to stand by and do nothing. Graham is one of the founders of Last Drinks at 12 – a community group whose main agenda is for all liquor outlets in Byron Shire to cease the sale of alcohol at midnight. The group believes that the mild, voluntary measures adopted by some local liquor outlets to address the issue are not working. The sobering statistics speak for themselves. Byron Bay CBD now has the third high-
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Our own youth do not feel secure on our streets after midnight.
Dr Graham Truswell
est alcohol related incidents of violence in NSW after Kings Cross. Eighty-one per cent of all assaults in Byron are alcohol related, compared to the state average of 41%. Drink driving rates are three times the state average and sexual assault is twice the state average. Since the town was, in Graham’s words, ‘trashed’ last New Year’s Eve, this committed group of local people has researched the issue of alco-
hol- fuelled violence in other communities and discovered that there are concrete measures that can be put in place to restore the equilibrium within Byron Bay. Graham believes that the violence resulting from heavy drinking into the wee hours in the town itself is primarily preventable. Apart from the senseless violence that affects so many, Graham said Last Drinks at 12 have identified other problems that have arisen because of this drinking culture by visiting young people.
“Jobs are being lost because people are not investing in this region. Families are not visiting because they feel threatened and unsafe and, as for our own youth, they also do not feel secure on our streets after midnight,” he said. Graham said that while Last Drinks at 12 commend the liquor outlets who have recognised the town has serious problems, the group believes that only a raft of compulsory measures can and will allow Byron Bay to lose its reputation as one of the most violent in the state. He told HealthSpeak that the town’s nurses, doctors, police and ambulance officers and all involved in dealing with alcohol fuelled violence have had enough. “It is now time for us all to act,” he said. To find out more about Last Drinks at 12 go to: http:// lastdrinks.org.au/category/news/ page/12/
HealthSpeak
spring 2013
Imagine … a long walk in the woods
Australian visitors to the English countryside often remark on the network of public footpaths that criss-cross the whole land. Why should this be so remarkable? We have lots more space here, but no such infrastructure. These are ancient paths going back a thousand years or so and even more noteworthy, much of this infrastructure is not mixed with road traffic. When land was distributed here 200 years ago, the traditional Aboriginal paths, ‘the Songlines’ were not recognised and obliterated with fences. Properties were allocated cheek by jowl without liberal public access in-between and bang went 50,000 years of common access. We have many beautiful beaches and national parks to be sure, but mostly need a car to get there. Anyone with a dog is even more restricted in this great wide land. Our cycle ways and footpaths are mostly along roads, even without separation from the traffic. These tracks can be scary and polluted and walking next to highways is not encouraged. Opportunity for a long walk in a natural setting can be a dilemma. But wait! A cubic centimetre of opportunity has suddenly presented to provide a wonderful countryside non-motorised track, all because the NSW state government recently announced that the train service between Casino and Murwillumbah will not be re-opened and this track is fallow. It is a very long paddock and straddles four shires. A casual observer can spot the old line at bridges and level crossings. It’s easy to miss because it is very HealthSpeak
spring 2013
Light Airs David Miller
Suppose a decsion to make a modern songline was made overgrown through long disuse. Most of this now defunct railway track goes through splendid countryside. I remember it, in the afternoon light, because I used to catch the sleeper overnight to Sydney from Mullumbimby station. It was such a good service in 1975 that passengers could carry their cars in a special carriage at the rear of the train. But that was in the ‘good ol’ days’. The original rail construction is a tribute to the skill of early 20th century Aussie engineers. The drains, the grading and contours are all intact. Trains do not go well on hills, so it is mostly flat, which would be good for a long ramble, even for elders or wheelchair. There are some tunnels and bridges. Unfortunately the steel rails, splintery sleepers and the rough gravel surface create conditions impassable to bike and foot. This land is owned by the SRA and could be a juicy piece of real estate. It is wider than just a train. Service roads run alongside the whole length, camouflaged in bush. How wide? I don’t know. I’m not an expert, but probably wide enough for a string of townhouses. Hopefully, no sections have been sold off and the whole length remains intact. Perhaps the NSW government has become more constrained and transparent in its dealings. Just supposing that a statesmanlike decision was made to create a modern Songline, what about the logistics? To take up
the rails and the sleepers would be expensive, but then again, these are valuable commodities. Quid pro quo maybe. If imagination runs riot it is not impossible to imagine kiosks in old stations, hotels and lodgings serving an area with a massive tourist population. Many residents wonder how to entertain the great numbers of guests to our area, where to go and what to do, especially without having to drive there. Send them for a good long walk in our amazing country. There is plenty of precedent. For example, here in Queensland and Victoria and in Britain and Canada, the conversion of disused railway tracks into walking and riding trails has been achieved with great success. The good news is that a steering committee exists, but there is not much in the papers to engender political will. This opportunity towards health for our children’s children could do with voice from doctors. You may think I’m a dreamer, But I’m not the only one Today you can join us, So the Northern Rivers can be as one. Find out more about a potential North Coast rail trail here: www.railtrails.org.au/trail-descriptions/nsw-and-act/country-nsw-andact?view=trail&id=221 For more information, contact Marie Lawton: mariethebay@gmail. com or phone 0434 552 283. 33
People living alone with dementia set to increase A discussion paper has found that the number of people living alone with dementia is expected to increase as singleperson households continue to rise. In 1961, 11 per cent of households were single persons. By 2011, that had increased to 25 per cent, approximately two million people. The discussion paper, released by Alzheimer’s Australia NSW, states that more than 30 per cent of Australians aged over 75 live alone, according to the Australian Bureau of Statistics. It is estimated there may be up to 65,000 Australians with dementia who live alone. The, Living Alone With Dementia paper looks at the implications this brings for social policy and the delivery of services. Alzheimer’s Australia NSW’s CEO John Watkins said it was known that most people living with dementia prefer to stay at
“People living alone with dementia tend to slip through the cracks.”
home for as long as possible. “They have the right to live at home, if they choose to, for as long as it is safe to do so. But, research shows that people living alone with dementia have a higher risk of economic insecurity and abuse, loneliness and depression, poorer health outcomes due to self-neglect
and increased vulnerability to malnutrition, falls, accidents and hygiene problems,” he said. Mr Watkins said there was often an assumption in dementia care that there was a spouse, relative or friend living with and caring for the person and this was reflected in service delivery. “People living alone with de-
Complacency over diabetes risk Remarkably, new research shows that nearly 80 per cent of Australians don’t think they are at risk of developing diabetes despite evidence that more than two million Australians have pre-diabetes and are at high risk, and many more are at medium risk of developing type 2 diabetes. Diabetes Australia’s CEO Professor Greg Johnson said the disconnect between public perception of risk and reality was a major concern. “Two hundred and eighty Australians develop diabetes every day – nearly 100,000 Australians developed diabetes in the past year. The continuing rose of this epidemic and the high impact on everyday Australians cannot be ignored,” he said. Diabetes Australia has launched a new campaign to raise awareness of all types of diabetes. Its theme is The Face of Diabetes and Diabetes Australia is wanting the federal govern34
The disconnect between public perception of risk and reality was a major concern ment to urgently develop and implement a new National Diabetes Strategy. “There is no such things as ‘mild diabetes’. All types of diabetes are serous and can lead to serious complications. For example, heart attacks and strokes kill people with diabetes early and are four times more likely in people with diabetes,” said Prof Johnson. He said on current trends diabetes would become the number one burden of disease in Australia over the next five years. Professor Paul Zimmet, a member of the expert commit-
tee which helped prepare the National Diabetes Strategy for Diabetes Australia set out the five key goals, all of which focus on prevention: Prevent complications through optimal management and earlier diagnosis Prevent more people from developing type 2 diabetes Reduce the impact of diabetes in pregnancy for women and children Reduce the impact of diabetes on Aboriginal and Torres Strait Islander people Strengthen prevention through knowledge and science. “Diabetes Australia is calling for national targets for the health system to focus on prevention of diabetes and its complications,” Prof Zimmet added.
mentia tend to slip through the cracks. This can not only lead to people not receiving appropriate care, it can also lead to a raft of problems.” He said with the right support it was possible for people with dementia to live independently, sometimes until the end of their lives. “We need to start planning for a future where more and more people with dementia will live alone in their own homes, and that is where they will require support.” There are a number of recommendations in the discussion paper, including that the Federal Government ensures community services are targeted and funded to respond to the individual support requirements of people living alone with dementia.
Funeral Attendance Survey Researchers from the University of Adelaide are undertaking a project about the funeral attendance practices of health professionals (in particular medicine, psychology, nursing, and social work). The study is a national, cross-discipline exploration of health professionals’ experiences, preferences and practices related to attendance at patients' and clients' funerals. If you would like to take part, you can find the short survey here: www. surveymonkey.com/s/funeralattendance An understanding of health professionals’ perceptions, practices and experiences of attending funerals, could be used to assist in training and professional development. For more info, contact: Sofia Zambrano on (08) 8222 5636 or email: sofia. zambranoramos@adelaide. edu.au
HealthSpeak
spring 2013
Books with Robin Robin Osborne
Madness: A Memoir Kate Richards Viking $29.95 The title of this self-revelatory work leaves little doubt about the content, as does the cover, filled with crazy scribbling. “Madness is a real world for the many thousands of people who are right now living within it and dying within it,” writes Kate Richards, who qualified with Honours in Medicine from Monash University and works in the field of medical research. In a memoir that seems as painful to read as it was for her to live through, she chronicles a life spent as much on the patient’s side of the desk as the doctor’s, not to mention time in hospital care and consultations with psychologists and psychiatrists. The tone is set with a detailed description of a self-harming episode: “A third of the way down from my shoulder to elbow the scalpel slides over and into my white skin, dimly freckled and smooth as mango. “Skin is surprisingly recalcitrant. The part of my mind that is consciousness has folded itself away. I am blank. The scalpel finds the deepest skin, the dermis, the little yellow pillows of fat like peals. Bluish-red bloodlines seep down my right arm, over my right breast. “It is true that blood is thicker than water.” The sang froid with which Richards describes such episodes - and there are many, with varying scenarios – is more attributable to her mental state than her medical detachment, but it is the latter that makes the book so disturbing, doubly transgressing the profession’s injunction of first doing no harm. A practitioner’s inadvertent injuring of a patient is one thing, deliberately self-harming is a dif-
HealthSpeak
spring 2013
ferent matter. Living for years with deep depression, the author recounts with lucidity a virtual merrygo-round – minus the merriment - of delusion, paranoia, self loathing, suicide attempts, and last-minute rescues by family members, friends and the health services. Sitting in her living room, wearing “appropriate clothing… no need for shoes,” bowls of water and food left out for her cats, she recounts that, “The people in my head are quiet, we are all in agreement: it is the right time to die. I sit on the grey carpet, cross-legged, with my back to the couch. “I start with a half bottle of white, coffin-shaped tablets. I take them carefully, two at a time. Then I take the blue ones, the white ones, the yellow ones, the orange ones, the other white ones… the phone is off the hook,
She wakes not in heaven, but in the familiar hell of a hospital bed the lights are out, all the windows are open to let in the fresh air – a room gets very cloying with a dead body in it. I close my eyes and fold my hands over my abdomen.” She wakes not in heaven but in the familiar hell of a hospital bed, intubated, informed by her parents and friends that she had nearly died. This is a grueling yet well informed read, drawing on the personal experiences of a mental health sufferer with professional knowledge of the field. Citing Hippocrates’s definition of melancholia as a state of “despondency, sleeplessness, irritability, and restlessness,” Richards explains that a depressive episode can last longer than a year without effective treatment, and even with it, sufferers can continue
to experience “sub-syndromal’ symptoms in between episodes of acute illness. When the reader, like the author, then aged 28 years, finally feels they can take no more, we find her seeking the help of a psychologist, finding a nearby one in the Yellow Pages but taking several days to work up the courage for an appointment. “In the meantime I take benzos and supplement with alcohol to drown the internal cacophony.” The first consultations with psychologist Jane were encouraging, but then Richards became disillusioned. Things got worse when psychiatrist Aaron wrote to say that she had poor insight, symptoms of psychosis and was not compliant with his recommended treatment. “I’ve been dumped by my psychiatrist. This is not something I’d considered – Duty of care and the Hippocratic Oath and all that… He wished me well for the future.” Meaningful help came in the form of psychologist Winsome Thomas who stuck with Richards - and vice versa - through the challenging times, going on to pen a heartfelt afterword to the book: “Kate Richards is one of the most courageous and intelligent clients I have ever had the opportunity to work with…One day in a session I said to Kate something like, ‘You know Kate, you have a mental illness. Once you admit that and acknowledge that you cannot live without your medication then your life will change.’ “She finally acknowledged the truth of my statement. That was the turning point… Her capacity to endure, to reflect, to trust and to survive is remarkable.” Kate adds, “No-one ever wakes up one morning and thinks, today I’d like to go mad…anymore than they think, today I’d like to get cancer.” In short, mental illness is what it says, an illness, not a choice. However, having a decent life despite it can be. Robin Osborne is a media and communications adviser, formerly with NT Health and NSW North Coast Health.
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Chiropractic crackdown
The Chiropractic Board of Australia is cracking down on chiropractors who step outside their primary role as healthcare practitioners and provide treatment that puts the public at risk. To protect public safety, the Board has: ordered practitioners to remove all anti-vaccination material from their websites and clinics removed several courses from the list of approved CPD programs, and introduced random audits of practitioner compliance with the Board’s registration standards. Board Chair, Dr Phillip Donato OAM, said the Board took its core role of protecting the public extremely seriously. ‘We know the vast majority of Australia’s 4,600 chiropractors work effectively to provide high quality care in the best interests of their
From page 30 Cancer Clinics, such as Sydney Cancer Genetics. What can Sydney Cancer Genetics offer? They provide specialist consults via video conferencing (Telehealth consults) to regional, rural and remote areas. Telehealth consults are bulk billed and booked via our head office on (02) 9473 8833. For patients who prefer, face to face appointments are
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patients,’ Dr Donato said. ‘However, the Board takes a very strong view of any practitioner who makes unsubstantiated claims about treatment which are not supported within an evidencebased context,’ he said. ‘We will not tolerate registered chiropractors giving misleading or unbalanced advice to patients, or providing advice or care that is not in the patient's best interests.’ The Board also cautioned chiropractors about marketing and promotional activities that breached the advertising requirements in the National Law. Section 133.1.e of the National Law specifically rules out directly or indirectly encouraging the ‘indiscriminate or unnecessary use of regulated health services’. The Board reminds chiropractors that they need to comply with the Law and the standards set by the Board. We take a very dim view of any practitioner who does not put the best interests of their patients first,’ Dr Donato said.
run from the head office in Wahroonga, Sydney. Some patients choose to self-fund their genetic testing. Patients who meet strict eligibility criteria for publicly funded genetic testing are referred to a public clinic, having already received information regarding their and their family’s potential risk as well as strategies to minimise this risk. More information, including patient information sheets, our family history questionnaire, referral information and
From page 19 swelling and the beginning of systemic symptoms. At this stage blood markers such as ESR, CRP and WCC may show elevation. SEVERE SYMPTOMS include significant facial / neck swelling, severe trismus, tongue and floor of mouth swelling, pharyngeal oedema and difficulty swallowing. This can result in airway threat and obstruction. Progression across these stages may be very rapid despite appropriate oral or even IV antibiotics.
Diagnosis
Impacted teeth, decayed teeth and severe periodontal problems share a number of possible signs and symptoms. The important point is appropriate diagnosis. Most of these problems will need a surgical solution either in the general setting or more often in the hospital setting. The diagnosis is reached through the usual history, examination and appropriate investigations. An OPG radiograph (OrthoPanTomogram) is the gold standard in establishing the aetiology such as impacted teeth, jaw cyst or tumours or even straightforward dental decay. In addition, advanced cases may also need a spiral CT of the head and neck ( axial and coronal planes) to visualise the extent of the collection, airway deviation and other vital anatomical structures such as maxillary sinuses etc Note: CT does not replace the OPG as the investigation most likely to reveal the diagnosis .
educational videos for Doctors and Patients, is available via the Sydney Cancer Genetics website: www.SydneyCancerGenetics.com.au About BRCA1 testing Regarding BRCA1 and BRCA2 genetic testing, women who meet the following criteria should be referred and are eligible for BRCA testing, even if there is no family history: Breast cancer <30yr; triple negative breast
Remember, always an OPG and only sometimes CT Proposed treatment sequence for and oral, facial or dental presentations: 1 The usual history and examination and provisional diagnosis. 2 Urgent OPG 3 Start antibiotics if appropriate early ensuring good coverage of the usual bacteria ie the Streptococci and Anaerobic Species. Amoxyl and Flagyl or Keflex and Flagyl or Augumentin Duo Forte.Clindamycin is a good alternative 4 Consider CT, Bloods only once an OPG is obtained or concurrent if warranted 5 Arrange A&E, Dental or Oral & MaxilloFacial Surgery review
Summary
Remember to follow the standard medical procedure of proper history, examination and investigations. Utilise the OPG radiograph early. Aim for more specific diagnosis rather than the common ‘dental infection’. Most presentations will require a surgical solution for cure. In the next issue: becoming familiar with the OPG as an aid to oral and facial diagnosis. Drs Arthur and Wojciech Bilski are medically and dentally qualified Specialist Oral and Maxillo-Facial Surgeons based in Lismore and cover the North Coast of NSW.
cancer <40yrs, Ovarian cancer (high grade serous, endometrioid or clear cell) <70yrs. Males with breast cancer < 60 would usually be eligible for testing while older men require additional family history. More about reasons to refer can be found here: http://www.sydneycancergenetics. com.au/for-drs/
HealthSpeak
spring 2013
Wine and good health The alchemy of acids and wine Have you ever been to a fancy restaurant and had a palate cleanser between entree and main, dear reader? You know, the sorbet or similar which gently lifts the remains of the appetiser off the tastebuds, leaving a blank slate for the main course to scintillate. The chef would have used lemon, lime or apple to achieve this I bet, and it’s no surprise the agents at work would have been the very acids giving life to the wine sitting at your right hand! Yes, citric and malic (from malus, meaning apple) acids are there in the glass, but the most important acid, and one found almost exclusively in grapes, is there in abundance as well; tartaric acid. All these acids not only help shape the flavour of wine, they also help in fermentation and (particularly tartaric acid) protect it from bacteria. As the yeast on the skin of the grape does its job on the sugars in the juice, these acids act as a counterpoint to balance the remaining sugars and alcohol and produce the miracle of wine. In almost all wine, and particularly so in red wine, the winemaker encourages a secondary fermentation to turn the malic acid into the much softer and milkier lactic acid. All champagnes (except Lanson) use this fermentation to soften the wine, as if butter has been added to it. Maybe this explains the old adage when tasting wine; “buy on apple and sell on cheese”, as the malic acid in the apple unmasks wine faults, while cheeses tend to mask these
Chris Ingall
same faults by marrying up with the softer lactic acid. A good one to remember when the rellies drop by...serve up your cheap plonk with some Castello Blue – they won’t know what they are drinking. So in your glass you have the perfect palate cleanser at
hand to enjoy between each mouthful. This means you effectively taste the meal as if each bite is the first. Of course, if you make your sips too generous you won’t know what you are eating, and conversation could become messy, so moderation is the key. While semillon has more lemon, rieslings have lime and sav
blancs other citrus like grapefruit. Chardonnay has a little more malic acid, and certain red grapes (like pinot noir and merlot) have low levels of tannins and are recognised by their acid profile. Other reds (think shiraz and cabernet) have more obvious tannins and these are drying, quite a different sensation to the tart, sharp acids. Just on that, the tannins are from the skin of the grape and bind with proteins in the meat or cheese on your plate, maximising the enjoyment of both the food and the wine. A marriage made in heaven! Maybe this is why we
mainly drink red wines with our meaty dishes, as white wines are basically fermented grape juice, and have very low levels of tannins. So when you think about it, wine not only shares with many of our fruits and vegetables the common acids found in nature, it also augments our enjoyment
Wine Tip
Cellar Tip
Like tannins, acids can be too sharp in a wine. I find this with Lanson Champagne. No amount of time will soften either, so there is no point cellaring wines which are too tart (aric) or too tannic. Just put them aside for Christmas drinks with the family, and add a little port if necessary to sweeten it up. Oh, and serve them with cheese.
In a very young white wine, the colour may not yet have formed, or still be close to straw, and it is difficult to be sure how it will develop. Over a year or three a green colour will become evident, and it is at that point in the wine’s evolution you can get an idea of the acidic makeup of the wine. Good cellaring wines have lovely refreshing acidity,
HealthSpeak
spring 2013
When your rellies drop by... serve up your cheap plonk with some Castello Blue. of meat and dairy dishes. When you add the digestive qualities of alcohol into the mix, and the near perfect balance of all these elements when natural yeasts are used in the ferments, it is little wonder wine is the favoured beverage of the ancients, and the preferred tipple of most Biblical figures. You won’t find Jesus turning water into bourbon at Cana, or the disciples drinking a beer during the Last Supper. No, wine has the nod, and it is little wonder considering grains need quite a bit done to them to produce a desirable ferment, while wine is basically produced by nature left to its own devices. So can these acids harm us? Only our teeth, as the pH of wine is less than 4, and this softens the dentine. I drink water between sips of wine, and will often have a dairy sweet to neutralise the acids, instead of brushing. It’s lucky I have a tooth left in my head really, given the amount of wine I drink. Seriously, if you want to minimise this potential harm, always have a jug of water handy through any meal, and while this may lead to frequent toilet stops, it will leave you in good shape for the morning after. Then you really will have the best of all possible worlds, dear reader.
which lasts on the tongue for some time after the wine is swallowed. These are the wines which can be safely cellared for many years, though it pays to check them every year or two to make sure the colour progression through to yellow is pedestrian. Thank God for Stelvin closures, which all but ensure this will be the case.
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Diary
Trivia
September
October
September 14 Brainwaves - a multidisciplinary education event for mental health professionals, those who work in RACFs, pharmacists, GPs and practice nurses. To be held at Ballina RSL Club from 8.30am to 5pm Presenters: Dr Tim Scholz & Physio Dean Phelps: LBH Multidisciplinary Pain Management Clinic; Dr Steven Conroy: Clinical Psychologist; Dr Patrick Dwyer: Director of Training in Radiation Oncology at the North Coast Cancer Institute; Veterans and Veterans Families Counselling Service: PTSD; Michael Johnston: Pulsestart Training Solutions– Asthma, Anaphylaxis; Shelley Fletcher, NCML: PIP eHealth and eHealth record; Colleen Cartwright: Advance Care Directive; Lesley Macey: Telehealth; NCML: Health Pathways; Mal Huxter: Clinical Psychologist For registration form and details: www.ncml.org.au
October 1 OSSANZ 2013: 24th Annual Scientific Conference of the Obesity Surgery Society of Australia and NZ To be held on the Gold Coast Contact: ossanz@thinkbusinessevents.com.au
Charlie Watts is the drummer for which rock band?
3
Rachel McAdams and Ryan Gosling starred in which 2004 weepy m ovie?
4
Where is William Shakespeare buried?
5
In what year did the Australian National Gallery open?
6
Who developed the ten stages of corporate life cycle, starting with Courtship and Infancy and ending in Bureaucracy and Death?
7
What is psychometrics?
8
What organization won the 2012 Nobel Peace Prize?
9
Name the best-selling educational author of the ‘Seven Habits of Highly Effective People’.
10
11
In 2012 fossils of 1.9m yearsold Homo rudolfensis were discovered in: Kenya; Australia; USA; or Iceland?
12
Who became the oldest actor to win an Oscar in 2012?
13
The Chao Praya River is in which Asian country?
14
Which English actor said that he was drunk when he bought an Elizabeth Taylor painting by Andy Warhol that later made him an 11 million pound profit?
15
What is the metal tip of an umbrella called?
16
Tracey Thorn was the lead singer in which English pop duo?
17
What is the name of the island that lies in the middle of Niagara Falls?
18
‘Lofsongur’ is the national anthem of which country?
19
A sculpin is what sort of creature?
20
Melanophobia is the irrational fear of which colour?
21
An ‘array’ is the term for a group of which animals?
In which nation’s London embassy is Wikileaks founder
October 27 to 30 15th World Conference on Lung Cancer To be held in Sydney Contact: wclc2013@icsevents. com
20
Melanophobia is the irrational fear of which colour?
November
Answers:
November 13-16 National Primary Health Care Conference 2013 To be held at the Gold Coast Convention and Exhibition Centre Sponsorship opportunities: please contact Trisha Wong, Manager Marketing and Health Promotion by phoning: 02 6228 0835 or email: twong@amlalliance.com.au Exhibition opportunities: please contact Nicole Shepherd, Senior Events Coordinator by phoning: 02 6228 0846 or email: nshepherd@amlalliance.com.au
12. Christopher Plummer 13. Thailand 14. Hugh Grant 15. Ferrule 16. Everything But the Girl 17. Goat Island 18. Iceland 19. A fish 20. Black 21. Hedgehogs
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2
Julian Assange living?
6. Dr Ichak Adizes 7. The science of measuring (or testing) human personality type (or mental abilities) 8. The European Union 9. Stephen Covey 10. Kenya 11. Ecuador
September 24 and 25 Standard Mental Health First Aid To be held at SCU, Lismore Campus This workshops teaches adults how to assist other adults experiencing a mental health crisis or developing a mental health problem. The presenter is Dr Jan Barling, an accredited mental health nurse with over 30 years experience in mental health nursing. Contact Carla Robinson on (07) 5589 3231 or Email Carla.robinson@scu.edu.au
October 18 through October & November Cultivating Emotional Balance (CEB) To be held at Lennox Head Public School. CEB uses mindfulness meditation and emotion regulation training to improve and enhance well-being and emotional resilience. The program will be run by Malcolm Huxter, Clinical Psychologist and runs between Oct-Nov 2013. Bookings essential. Cost $550 (early bird and concessions available). Enquiries and registrations: Mal Huxter 0431 768 299 or malhuxter@gmail.com
How many countries are larger than Australia?
1. Five (Australia is the sixth largest country: Russia, Canada, China, USA, Brazil) 2. The Rolling Stones 3. The Notebook 4. Church of the Holy Trinity, Stratfordon-Avon 5. 1982
September 19 and 20 Standard Mental Health First Aid To be held at SCU, Gold Coast Campus This workshops teaches adults how to assist other adults experiencing a mental health crisis or developing a mental health problem. The presenter is Dr Jan Barling, an accredited mental health nurse with over 30 years experience in mental health nursing. Contact Carla Robinson on (07) 5589 3231 or Email Carla. robinson@scu.edu.au
October 17-19 GP13: The Conference for General Practice of the Royal Australian College of General Practice To be held at the Darwin Convention Centre The Academic Session, including the RACGP Fellowship and Awards Ceremony, will be held on Wednesday 16 October 2013. Contact: racgp@racgp.org.au
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HealthSpeak spring 2013
PATHOLOGICAL WASTE DISPOSAL
more services · quality facilities
Container Collection/Exchange
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OPEN extended hours MON, TUE, WED & FRI - 8.30am to 7pm Thursday - 8.30am to 9pm SATURDAY - 8.30am to 5pm SUN - 9am-1pm
Goonellabah Pharmacy
Goonellabah Village, Oliver Ave, Phone 6624 2449
Goonellabah Physiotherapy Centre Gabrielle Boyce and Associates 581 Ballina Road, Goonellabah Phone (02) 6625 2888 Open Extended Hours
Continence and Pelvic Floor Physiotherapy For women, men and children Bladder, bowel, prolapse, pelvic & sexual pain, pre/post natal, pre/post surgery
•Sports & Orthopaedic Conditions •Treat Spinal Pain with mob/ manipulation and Sarah Key Method •Acupuncture for myofascial pain/ muscle spasm •Gym & Pool rehabilitation •Biomechanical analysis for runners and dancers •Orthotics using Gaitscan Technology •Waterproof casts / braces / splints •Vertigo & Balance Disorders Tony Morley & Emile du Plessis and Associates Physiotherapists MAPA
Lismore & Ballina Free Call 1800 662 125
VACANCY FOR ACCREDITED EXERCISE PHYSIOLOGIST
APA titled Continence and Womens’ health physiotherapist
Accredited Exercise Physiologist (part-time) required for expanding clinic. Must be experienced. Vacancy at Clinical Exercise, Northern Rivers in Alstonville.
3/10 Station St Bangalow 02 6687 2337 28 Brisbane St Murwillumbah 02 6672 3818
Contact Rebecca: 0499 499 992
Janelle Angel
Practising neurology and neurophysiology in Lismore. Dr Boyce has a full-time neurophysiology technician available to do electroencephalograms with little waiting time. Also nerve conduction studies and electromyography. The practice is Medical Objects friendly and welcomes referrals this way. Phone the practice on 6621 8245 or email: nrneurol.com.au For more information and links to other sub-specialty groups, view the website at: www.nrneurol.com.au
www.pelvicfloormatters.com.au
YOUR CLASSIFIED AD GOES HERE
A/Prof Geoffrey Boyce Neurologist
New Exercise Physiology Clinic in Alstonville. Specialising in: Chronic Disease Management Lifestyle Modification Falls Prevention. Groups and Individual services. Rebecca Trim (AEP, MAESSA) Ph 6628 8888
HealthSpeak is the perfect place to let the north coast health community know about your practice, company, rooms for rent or anything at all! With a readership of around 4,000 and a footprint from the Queensland border to just south of Port Macquarie, your message will get out to GPs, allied health practitioners, pharmacists and those working in the health care community. Display advertising is attractively priced. Simply email the editor to get a copy of our rates at: media@ncml.org.au We look forward to hearing from you.
HealthSpeak
spring 2013
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