HealthSpeak Summer 2012 by North Coast Primary Health Network

ISSUE 2 summer 2012

HealthSpeak A publication of North Coast NSW Medicare Local

, e g d e l w o n k s n o i local t u l o s l loca CIS – page 6

Connections Workshop – page 9

Generation Launch of the PITCH – page 4

of knowledge

Diffusion of knowledge

Application of knowledge

Expansion of PAL teams – page 11

Samurai Blue – page 10

The value of collaboration 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 7 Nullum Street Murwillumbah 2484 Ph: 6672 5158 General Manager: Gary Southey 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 2012 North Coast NSW Medicare Local Ltd Magazine designed by Graphiti Design Studio Printed by Quality Plus Printers of Ballina

One of the reasons I moved to the North Coast in 2008 was the excellent health care offered in the region. Due to strong advocacy from our politicians and

health professionals, many of our North Coast services rival those in metropolitan centres. This is certainly the case with the North Coast Cancer Institute. Under the able directorship of Professor Tom Shakespeare it boasts a wealth of talented, dedicated clinicians, nurses and staff with an enviable suite of state of the art equipment in three locations to diagnose and treat a range of cancers. Our feature in this edition of HealthSpeak introduces some of the Institute’s

staff who work alongside many in the community to provide advice and support to cancer patients and their families. In other news, NCML’s Chair Dr Tony Lembke has won the national GP of the Year award, a much deserved accolade for Tony’s skills as a GP in Alstonville and for his many wider roles in health organisations working to improve primary health care for all. We are pleased and proud to work alongside Tony – congratulations!

Working together to make a difference Vahid Saberi Chief Executive Officer

IT HAS BEEN A BUSY YEAR and we have all earned a few weeks break – Christmas could not come any quicker! The year has been both hectic and interesting. On April 2, the North Coast NSW Medicare Local was formally established. So we are now eight months old. And it has been in some ways an exhausting eight months for all staff. I am grateful for the commitment and patience staff have shown. Only those who have been involved in establishing a new organisation can understand how cumbersome and involved such work can be. Most encouraging has been the widespread receptivity to the reform message, and the goodwill Medicare Local has received as the facilitator of change. A key early task was to establish a new Board of Directors. We had about 50 responses to the invitation to apply. I am really pleased at the calibre, talent and experience of the NCNSWML Board. The Chair of the Board is Dr Tony Lembke. Tony not only brings in a vast range of experience, acute

intellect, national leadership past and present (currently the chair of the National General Practice Council) but was also the receptient of the National GP of the year award in 2012 - a testimony to his clinical credentials and ability. As I often say, for us to address the challenges in health we have to find local solutions - creative solutions to address local realities. We put out a call for clinicians to give us their ideas on how to address local changes. We called it Practical Ideas to Change Healthcare (PITCH). We got 27 ideas, five were short listed and I am pleased to say we are making progress in implementing them. The next round of The PITCH will be in April. Also, in order to share the many innovations that are taking place and bring everyone together to talk about health we have established the Copernicus Inversion Series Breakfasts. We have held two so far - in Lismore and Coffs Harbour. The next one will be held at Port Macquarie in February, followed by Tweed in March 2013. In October Federal Health Minister Tanya Plibersek officially opened our Head Office in Ballina. It was gratifying to hear the Minister say that North Coast Medicare Local was the embodiment of what the Federal Government wanted to achieve in primary health care reform in

Australia. Please have a look at the opening video: http://youtu. be/v_8u-F-0rlU The Minister was especially impressed with our innovation work and our efforts to generate, diffuse and apply local knowledge to meet local health care challenges. One of our first priorities has been to build upon our past success in general practice by extending the support to general practices and other primary health care providers. We have set ourselves the goal of supporting pharmacy, psychologists and aged care facilities as well as general practice. Reducing health inequities is a priority action area. An initiative that all NCML Branches are pursuing is to improve access to medical and nursing services for the homeless. We will be attempting to establish nursing and medical services in soup kitchens and other venues for the homeless at Lismore, Coffs, Port Macquarie and Tweed. We are also working with Corrections Health at Balund-a, near Tabulam, to deliver medical and nursing services to the Balund-a residents. You can read more about many of these activities and initiatives in this edition of HealthSpeak. I would like to take this opportunity to wish you and your family a happy Festive Season and look forward to talking to you in the New Year.

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Health professionals’ workforce shortages in rural Australia

While there are no rainbows on the horizon when it comes to attracting more rural GPs, a number of suggested measures need to be implemented

Andrew Binns Opinion

At a recent Senate Committee in the Australian Parliament (June 2012) there was consideration given to the long term workforce shortage problems facing our national medical, nursing and allied health professionals in the regions. The AMA has also recently put out a position statement on this topic (1). Not only is there a nation-wide workforce shortage of doctors the overall distribution of doctors is heavily skewed towards the major cities. The same applies to nurses and allied health professionals. Barriers relate to factors including professional development, income, accommodation and opportunities for spouses and children. The committee noted a growing trend towards specialisation among doctors. GPs are also tending to sub-specialise. With the increasing demands of managing people who have chronic diseases often with multi-organ involvement there is a growing need for generalists of all types. A good example is the need for a general physicians in rural areas particularly to back up GPs HealthSpeak

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The overall distribution of doctors is heavily skewed towards the major cities in the management of the more difficult and complex cases and also in rural hospital emergency departments. The presentations to emergency departments are often complex and not appropriate for a sub-specialist. The same applies to the big city hospitals where demarcation into care silos with artificially fragmented care of separate organ systems can lose the much needed more holistic approach. A general physician Karen Hitchcock recently wrote about this problem in The Monthly magazine (2) and said ‘fortunately it is dawning on authorities that the public needs hospitals and doctors to serve an ageing population among whom chronic diseases are on the rise; that hospitals need large general medical units with the staff, facilities and funding to scoop the chaotically unwell and the crumbling patients out of ED, to assess and treat them promptly and to go on caring for them till they are well.’

The AMA position statement suggested some measures to arrest the decline in generalism and attract and retain generalists in the medical workforce: Elevate the status of generalism Facilitate greater exposure to generalist practice during undergraduate medical training Increase state and federal funding for generalist positions Increase state and federal funding for rural specialist infrastructure Improve the level of remuneration for generalists to encourage generalist practice, including the removal of anomalies in the Medicare Benefit Scheme that reward sub-specialisation over generalism. Just as important as increasing the number of both specialist and generalist doctors in the regions is the need for more nurses and allied health professionals. The Senate Committee strongly supported the introduction of a HECS Reimbursement Scheme for nurses and allied health professionals similar to that for doctors to provide incentive to relocate to rural and remote areas. Other vital players in the role of attracting doctors to rural practice

are the universities and medical schools. It has been shown that students from a rural background are far more likely to return to these areas for their professional careers. The number of domestic medical students at Australian universities has risen to 12,946 in 2010 from 8768 in 2006. There has been a gradual increase in the number of clinical schools across the country funded through the Rural Clinical Schools program. There is also a scheme under the Rural Undergraduate Support and Coordination Program that specifies a target of 25% of medical students who must be from a rural background. Some universities are not achieving those targets and this needs addressing. With the dramatic increase in number of medical graduates coming through the system and with all the incentives to attract them to rural and remote regions the tide should be turning for the workforce shortage problem. However the challenge now is how to provide an adequate number of training positions in rural areas. The same issues applies to nurses and allied health professionals. (1) Regional/Rural Workforce Initiatives – 2012 (2) www.themonthly.com.au/howrebirth-general-medicine-will-savelives-last-resort-karen-hitchcock-5619 3

Launch of the PITCH On the evening of October 17, after the Minister’s morning visit, a second event was held to celebrate the opening of the head office and to showcase the five short-listed PITCHes (Practical Ideas to Change Healthcare). Out of an impressive field of 27 PITCH expressions of interest, the five two-minute PITCHes presented on the night were all thought provoking, creative and aimed at better connecting care in different health arenas. The PITCHes came from: Jerome Mellor, GP at Moon St Medical Centre, Ballina. His PITCH was about training GPs to connect with families of severe dementia and vegetative states in nursing homes to help families with informed consent or ‘substitute decision making’ to avoid patients having unwarranted treatments to prolong their lives that they would never have agreed to before they became ill. Chiron Weber and Thomas Rolley, Manager and GP at Mullumbimby Medical Centre/Mullimbimby Skin Clinic. PITCH: Regular Webinar presentations for patient information/

NCML’s Michael Carter and Sharyn White introduce The PITCH.

The PITCHERS, with most innovative PITCH of the evening awarded to Dr Tom Rolley of Mullumbimby Medical Centre (on the right).

education with rotating topics hosted by GPs and specialists in the NCML, footprint or further afield and webinars for health professionals. John Hurley, Associate Professor at Southern Cross University. PITCH: Idea to establish a collaborative care platform called the Coffs Harbour Mental Health Network. Gary Phillips, Tammy Jarrett, and Shane Mckeever, Partners at CSI Kempsey. PITCH: After listening to the Indigenous community, a partnership was formed and CSI Kempsey – a

Community Service Information Hub, supported by various aged and disability services opened in late August. The community now has a one-stop shop (2 days per week) where they can come to receive information, referral, advice and support without the difficulty of navigating the complex “service landscape”. CSI Kempsey invites health care, mental health and allied services to join CSI and the vision is for CSI to also provide education, training and employment opportunities. Linda Wirf and Trish Evans,

Transport Development Workers, Northern Rivers Transport Development Council, PITCH: Transport is the link that connects people to health services, make sure you inquire about a patient’s transport arrangements before making a specialist appointment A panel of four judges gave Chiron Weber and Dr Tom Rolley first placing due to their level of innovation and the many ways their proposed website portal could better connect healthcare, clinicians and community organisations in our footprint While there could only be one ‘winner’ on the night, it’s anticipated that all five short-listed PITCHes will all be supported to become reality in some way by NCML.

Introducing the NCML Board

From left: Vahid Saberi, Tim Francis, Di Blanckensee, David Gregory, Lesley Barclay, Tony Lembke, Phillip Silver (front), Scott Monaghan, Malcolm Marshall and Sheila Keane.

Recently, a new NCML Board was elected to take over from the Transitional Board. The new Board comprises Dr Tony Lembke, Chair; Professor Lesley Barclay; Dr Di Blanckensee; Ms Sheila Keane; Mr Malcolm Marshall; Dr David Gregory; Mr Philip Silver; Dr Tim Francis. For further information about Board members, go to: www.ncml.org.au. Click on the Programs & Services button on the main toolbar, click on Members and then Board.

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Federal Minister opens Head Office The official opening of North Coast Medicare Local’s Ballina head office became a red letter event with the news that the Federal Health Minister, Tanya Plibersek, would be present to unveil the plaque and attend an open meeting to find out more about NCML’s Innovation Arm. Thanks to the encouragement of the Federal Member for Page, Janelle Saffin, the Minister gave us more than an hour out of a busy whistle stop tour of the Northern Rivers, and expressed admiration for what North Coast Medicare Local had achieved in its first six months. NCML’s CEO Vahid Saberi told those attending the morning event – The Minister, politicians, health care providers, staff and Board members – about the organisation’s commitment to excellence, innovation and inclusion. “North Coast Medicare Local is not just about harnessing local knowledge. It’s the generation, diffusion and application of local knowledge that is central to bringing about change and the work of Medicare Locals,” he said. Vahid also introduced The He-

Federal Health Minister Tanya Plibersek cuts the cake at the Head Office opening surrounded by NCML Board members. On her left is the Federal MP for Page Janelle Saffin.

lix, the Medicare Local’s Innnovation Generator, which will strive to encourage innovative thinking, a culture of creativity and generating innovation to bring about real change to the delivery of primary health care on the North Coast. “We are using ways of working that are inclusive and create opportunities for all to participate in the generation of local solutions to local problems. When it comes to knowledge, what is shared is as important as what we keep and

what we hold in common is more important than what we own,” said Mr Saberi. The Health Minister praised NCML for its dynamism and energy in its first six months. “We have heard this morning that this particular Medicare Local really hit the ground running and I agree with the Federal Member for Page, Janelle Saffin, who told me that this Medicare Local is the embodiment of federal government primary health care reforms

in Australia. “Hearing today about what North Coast Medicare Local has planned for community and health care partnerships and working together to find local solutions to health care challenges, I agree with Janelle,” said Ms Plibersek. Unveiling the official North Coast Medicare Local plaque, Ms Plibersek said the reason the federal government had established 61 Medicare Locals around Australia was because local people know their communities best. “They know the strengths of their community, where the health care gaps are and how best to fill them. So, we’ve taken a whole lot of funding out of Canberra and put it into local communities, trusting the local people – the doctors, nurses, allied workers – to commit to their community, identifying gaps and filling them with the innovation we’ve heard about today. “Congratulations to North Coast Medicare Local, I’m sure I’ll come back and see some great results from the excellent work you are all doing,” Ms Plibersek concluded.

NCML staff sent a pictorial message of thanks to the Health Minister for officiating at NCML’s Head Office Opening.

Briefs

Free path test app Patients can get up to date information about pathology testing on their smartphones through a new app and find out what their doctor has asked to be

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tested and why. The Lab Tests Online-AU app information has been funded under the Quality Use of Pathology program of DoHa. Research shows that understanding the biology of their disease or condition can be very reassuring to people. For more information, go to: www.labtestson-

line.org.au

Good policy, poor delivery The national Mental Health Commission’s first report card into mental health and suicide prevention shows Australia has good mental health

policy but fails in its delivery of services. Commission Chair, Prof Allan Fels, said the statistics relating to physical illness and early death among people with a mental health difficulty were appalling. “People with a severe mental illness have their life expectancy reduced by 25 years on average

due to the increased likelihood of heart related conditions, diabetes and obesity. There are many contributing factors and there are no simple answers, but this demands immediate action.” A full copy of the report is at: www.mentalhealthcommission. gov.au.

Full house for first CIS presentation Improving Palliative Care and the benefits of peer support workers were the thought-provoking topics presented at North Coast Medicare Local’s inaugural Copernican Inversion Series (CIS) breakfast event, held on October 18. Part of NCML’s Innovation Arm, The Helix, CIS aims to turn knowledge on its head, providing an opportunity for health and community workers to talk to their peers about their ideas for improving healthcare. It is about fostering innovation and creative thinking. Hosted by NCML’s Chair Dr Tony Lembke, and held at the University Centre for Rural Health in Lismore, this CIS featured Dr Ken Marr, Acting Director of the Northern Rivers Palliative Care Service and Leisa Hoffman, from the Northern Rivers Social Development Council, a peer support worker, part of the Lived Experience Project.

Around 60 people attended the inaugural CIS presentation at UCRH.

It was a full house with about 60 people attending the breakfast presentation. Leisa Hoffman talked about her experience as a peer support worker with the Lived Experience Project. Because of her history of mental illness, she has been able to effectively and meaningfully help other people suffering from the same disorders. Leisa told the moving story of a severely depressed woman whose last hope was ECT treatment. Before her first treatment she

was screaming and yelling saying she didn’t want to do this. Leisa was working that day and having had 60 ECT treatments herself, Leisa was able to talk to her and calm her, explain what she was going to face and stayed with her during the treatment. In a wide-ranging talk, Dr Ken Marr told the audience that the demand for palliative care services means many patients are not being cared for as they’d like. He spoke of the need to extend palliative care outside of cancer patients.

“Other disease processes would benefit from staged care and properly resourced age staged care. The number of deaths in this area health service runs at about 3000 a year and only 25 % of those deaths are related to cancer, the rest are related cardiac disease, respiratory diabetes, dementia,” he said. He also spoke of the high staff turnover due to the demanding work and the large numbers of patients needing palliative care. “At the moment our services are not coping with 630 admissions, the harsh truth is that palliative care services in Australia are facing the need for double or triple their resources.” He said the way ahead was to change delivery of services out of hospices and into the community with a team of workers including community nurses, with the GP at the centre of care. The five short-listed PITCHes (Practical Ideas To Change Health Care) first presented at the official opening of the NCML Ballina head office the evening before, were also presented to the CIS audience.

After hours primary care From 1 July 2013, Medicare Locals across Australia will be responsible for administering funding to provide incentives for after hours primary health services. North Coast NSW Medicare Local will be developing a suite of new incentives and arrangements to support local practitioners to deliver after hours services appropriate to our region. General practice is at the core of after hours care and this will continue when NCML takes on this funding. Our immediate focus is to ensure that where appropriate after hours care is being delivered that we support this to continue. We are also working with practitioners across the region to find ways to support better access to after hours care. So far our research and consultation with practitioners and other stakeholders has identified many challenges for after 6

hours care in communities across North Coast NSW. We are working with practitioners to look for ways to make it more sustainable. Some key issues After hours incentives and arrangements need to support the relationship between patients and their regular GP. New after hours arrangements will not be replacing or taking resources away from regular hours primary health care, or taking on additional responsibilities for acute emergency care from hospitals. It will continue to focus on urgent care and advice for people whose health condition cannot wait until regular hours. Promoting the national after hours GP help-

line will be particularly important in our rural towns with limited after hours GP services. In non-life threatening cases this service can give free medical advice before a person decides to go the emergency department. Pharmacy services are not available after hours in some communities in our region. Residents in aged care in many communities have limited access to after

hours GP services. Many communities in North Coast NSW rely on a small number of GPs and have an aging GP workforce. Several rely on small hospital emergency departments for some or all after hours care. GPs working on Visiting Medical Officer rosters in hospitals may have limited capacity to provide out of hospital care after hours. Lack of transport presents a barrier to accessing care, particularly when people do not have private transport or are too unwell to drive. For more information contact Ian O’Reilly on 02 6618 5400, email afterhours@ncml.org.au or visit the NCML website. HealthSpeak

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Lismore headspace North Coast Medicare Local is leading a consortium of local agencies who have recently submitted an Expression of Interest to operate the soon to be established Lismore headspace centre. Drawing on the combined knowledge and experience of a number of local organisations such as On Track, Interelate, Youth Connections North Coast and the Ngunya Jarjum Aboriginal Child and Family Network has been one of the key factors in the success of the partnership so far. Headspace centres, which are already established in other parts of Australia, are specifically designed to improve the mental health of young people by offering a range of 'youth friendly' mental health, drug and alcohol and social and vocational sup-

port services. The centre will achieve this by co-locating a range of professionals from existing services around the region under one roof. The Federal MP for Page Janelle Saffin has been a strong advocate for a local headspace centre. “I have long been lobbying to have (a headspace centre) in our area, given that 92 per cent of young people have reported improvements in their mental health after using a headspace service,” Ms Saffin said. The Lismore headspace centre, which is set to open in 2014, will benefit the large youth population of over 25,000 young people living in the Richmond Valley area. More information about the headspace model can be found at www.headspace.org. au

Partners in Recovery North Coast Medicare Local is leading a collaborative reference group of agencies in a submission to establish and implement the Partners in Recovery (PIR) initiative throughout the NSW North Coast region. PIR is a national, coordinated support and flexible funding initiative for people with severe and persistent mental illness with complex needs. It will provide resources to better support people with severe mental illness and other complex conditions and their families by getting multiple sectors, services and supports to work together for the benefit of the client. NCML has demonstrated strong leadership as the lead agency for the PIR initiative. It has already staged two extensive consultations, giving an opportunity for 35 stakeholders from 25 participating agencies to provide input into the design of the PIR

service delivery model. A third consultation event, open to all stakeholders in the region, is planned for early December in Coffs Harbour. Contact jmills@ncml.org.au for details. NCML’s PIR proposal would see four teams of six to eight support facilitators in the Tweed Valley, Lismore, Coffs Harbour and Port Macquarie areas working to assist clients in navigating the health care system and join up the services within the region from which the individual person might need assistant. These Support Facilitators would be responsible for building and maintaining partnerships, establishing collaborative ways of working and implementing the PIR initiative at a local level. NCML hopes to report positive news on the outcome of the PIR submission in the next HealthSpeak magazine.

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02 6681 9900 7

First Connections workshop in Coffs Harbour NCML held its first consultative workshop with health professionals from throughout the North Coast in early October at Coffs Harbour. Thirty-one participants attended from general practice, allied health, Indigenous and family health, NCML staff and others involved in public health. NCML Chair Dr Tony Lembke opened the workshop explaining that the vision was for all present to be involved in the process of redesigning the health system to focus on primary health care. “The Connections Workshop seeks to listen and hear the voices of the community and its clinicians,” he said. NCML’s Chief Executive Officer Vahid Saberi told participants that the workshop was not an event that would provide all the answers NCML was seeking, but the beginning of a process to collectively generate knowledge. “The objective of the workshop is to develop principles, approaches and structures for meaningful consultation and advice for NCML,” he said.

A common sense of purpose brought everyone together Towards the end of the workshop Dr Lembke acknowledged the work of those participating and that the process of exploration had been driven by all in attendance, the local champions of health care. “A common sense of purpose brought everyone together here, being an interest and a desire to turn around the health system. The task now is to galvanise the energies of the communities engaged in this process and create a tribe with this common sense of purpose.” The day finished with participants writing down suggestions for the next actions NCML should take, as well as feedback on the workshop itself. Dr Lembke ended by saying that NCML would continue to collaborate and consult with its local health champions to shape its redesign of the primary health care system.

The objective of the workshop was to develop structures for meaningful consultation with health professionals and the community.

Participants wrote down suggestions for the next actions following the Connections Workshop.

Preventing vision loss in modern ophthalmology By Dr Roy van Eijden

“Old age is the most unexpected of all things to happen to a man.”- Leon Trotsky. It is my belief that every good editorial should start with a quote from a famous person that may or may not have anything to do with the subject matter. Over the past decade the world of ophthalmology has changed dramatically. We have seen the advent of therapies that in the past where only referred to in science fiction novels. The times of idly standing by and watching patients with Age Related Macular Degeneration (AMD) become blind are far behind us now. The use of anti-Vascular Endothelial Derived Growth Factor (anti-VEGF) allows us to prevent 8

visual loss in not only Wet Macular Degeneration, but also many vascular diseases of the eye, like Diabetic Retinopathy and Retinal Vein Occlusions. What is this miracle medication? It is a fragment of a monoclonal antibody that binds the VEGF, which is released in the eye by damaged or neo-vascular endothelium. This means that we can prevent new vessel growth in the eye and cause regression of existing neovascularisation. Now we can prevent deterioration of sight in patients with vascular damage and achieve a very real and measurable improvement in vision. These are the results we had always hoped for so many years ago. However, the dream is not quite as perfect as it sounds. For best results, the anti-VEGF

Dr Roy van Eijden

needs to be administered directly into the vitreous, where it has a limited time of action. The initial treatment for macular degeneration is three injections a month apart and follow-up injections may range from monthly to every three months for an as yet unknown duration. At least the treatment is quite easily administered by any general ophthal-

mologist under sterile conditions and is for most patients not uncomfortable. Advances are being made in developing medications with longer half-lives and hopefully longer time of action. We are excited that we are able to be part of this revolution that has seen ophthalmologists becoming active and aggressive managers of medical retinal pathology. Dr. van Eijden is working at the Ballina and Robina Eye Centre as a general ophthalmologist with special interest in anterior segment and paediatric ophthalmology. He completed medical training at the University of Pretoria and specialised in Ophthalmology at the Academic Hospital in Maastricht, The Netherlands. In 2009 he moved to Australia where he first worked at the Royal Eye and Ear Hospital in Melbourne. HealthSpeak

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Local Knowledge, Local Solutions care and clinicians revolve around them. We really like this interpretation. We at NCML encourage a culture of unfettered and altruistic sharing of knowledge and information for the benefit of all. It brings together local clinicians, service providers and the university sector together to discuss innovative ideas. CIS breakfasts will be held at Tweed Heads, Lismore, Coffs Harbour and Port Macquarie each year.

By Vahid Saberi NCML Chief Executive

The most significant word in North Coast Medicare Local is ‘local’. This has many dimensions. A key dimension of ‘local’ is generating local knowledge to find local solutions. To generate local knowledge, and bring about change, it would seem necessary to create an environment where local clinicians and community members can freely exchange ideas and converse. An environment where ideas breed, grow and multiply. Effective generation of knowledge would involve finding inclusive and creative ways and methods for all to participate with genuine respect and appreciation for each other’s views. In this way we can gain the all-important local knowledge and creatively use this to find innovative solutions to local challenges and inequities. We at North Coast Medicare Local have been thinking deeply about this. Through our consultation we have developed a framework for generation, diffusion and application of local knowledge - a framework that involves our local clinicians and local community. We have formed the view that to be successful in finding local solutions we have to ensure that there is action in all three segments of the pie. If we generate much knowledge, but don’t disseminate and distribute it, and subsequently it is not applied, little good will come of it. We hope that most of

Briefs

Why go to pot? Nearly half the people growing small quantities of cannabis in Australia use it for medicinal purposes, a new study has found. In the first study of its size in Australia, the National Drug Research Institute is conducting an anonymous online survey to find out more

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the knowledge we (that is all of us on the North Coast) generate will eventually be applied to improve healthcare and result in better health outcomes. To make sure we are working in all three segments we use the framework as a checklist. We populate each segment to ensure that our initiatives cover from generation to application of knowledge. Some example of the work done so far in each segment of the pie includes

Segment 1: Generation of Knowledge In order to help generate local knowledge, NCML established The PITCH (Practical Ideas to Connect HealthCare) where local clinicians and community members are invited to pitch their

about people who grow small amounts of cannabis in their backyards, cupboards and sheds. So far about 250 people have taken part and it’s hoped responses will double in coming months before the information is collated and compared with similar studies in the US, Canada, UK and across Europe. Almost half the survey respondents said they grew cannabis for medicinal purposes.

idea in a two-minute presentation either in person or virtually. In October the first PITCH evening was held with five presenters explaining their connecting healthcare proposal. The most innovative proposal – a web portal for education events and dissemination of information to the North Coast health community – is being supported to become reality through NCML. PITCHes, in addition to other forms of community consultation, such as focus groups, conversation spaces and local research, contribute in large part to this first piece of the pie. You can see a video on The PITCH at http://youtu.be/ TpNNNOFpyDs

Segment 2: Diffusion of Knowledge Another Helix initiative, the Copernican Inversion Series (CIS), was launched in October with a breakfast conversation at the University Centre for Rural Health in Lismore. Copernicus was a 16th century Polish astronomer who proposed the theory that the Sun, not the Earth, was the centre of the solar system. This resulted in Copernican Inversion. CIS aims to turn knowledge on its head and uncover new approaches, creative thinking and provide networking opportunities. The Federal Minister for Health, Tanya Plibersek, on her visit to North Coast NSW provided another interpretation of the Copernican Inversion, that of putting the patient in the centre of

Change and Improvement require imagination and innovation Segment 3: Application of Knowledge Generating and spreading knowledge are useful, but solutions cannot be achieved without the third piece of the pie, the application of this knowledge. This is about much of the work clinicians and service providers do. Finding local solutions requires creativity, imagination and innovation. To ensure we are creatively progressing the generation of knowledge NCML has established an innovation arm called The Helix.

The Helix was set up to encourage innovative thinking, harness a culture of creativity and generate innovation to bring about change. We look forward to working with all of you to generate local knowledge and find local solution to bring better health to the North Coast communities. 9

Samurai Blue meet Medicare Local: By Vahid Saberi and Tony Lembke

The 20,000 lights of Suncorp Stadium hold back the dark winter night. The roar of 44,000 fans spills out over an otherwise quiet night in Brisbane. At stake is a place in the World Cup finals. Will the Socceroos or their Japanese opponents - the ‘Samurai Blue’ - win a place to compete in Brazil in 2014? A photo of the stadium taken from a helicopter would show a vast sea of green and gold except for one patch of blue, where about 4,000 Samurai Blue supporters are clustered up high behind the goal-post at the Northern end of the ground. It is not just the colours that make this group stand apart. From the first whistle they generate a wall of sound that sweeps across the pitch. “Boom, boom, boom...” - their drummers provide a steady heartbeat, giving synchronicity to their distinct chant - Nippon Daihyo. The Samurai Blue are visibly lifted. Japan scores first. The Socceroos fans are also vocal and passionate. Many, many thousands scream support at the top of their lungs. But how is it then that 4,000 Japanese supporters generate so much more noise and enthusiasm than the green and gold fans that outnumber them ten to one? Every year, on average, each

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Australian has 22 health care interactions. Fewer than two of these occur in a hospital. The other 90%, are outside hospitals, in the primary health care domain. The primary health care sector is by far the larger provider of health care across the developed world. Like the green and gold fans, it occupies most of the seats in the stadium. Outside-hospital care has the larger number of patient contacts and the greater number of practitioners. Yet it

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is drowned out by the focus on hospital-based care – akin to the noise of the Samurai Blue fans. What can the primary healthcare sector learn from the Japanese soccer fans in order to gain the recognition it deserves and to take its rightful place? At halftime we risk the security of our seats and make our way through the crowd to sit beside the Nippon Daihyo supporters. Up close, the range of the fans at the ground is surprising. There are grandparents and children and fathers and mothers and lots of young people. This is similar to the heterogeneous make up of the primacy health care sector – GPs, pharmacists, psychologists, dentists, physiotherapists, speech pathologists, optometrists, specialists and others. Despite the mix, it does not take long for us to observe that the Samurai Blue fans embody the “As One” behaviour. Unity in diversity. Distinct, independent, united individual action - collective power. Baghai, m. Quigley, J. (2010) sums up the ‘As One’ concept eloquently. “As One. It is a short phrase. Only five letters. But those five letters are filled with meaning,

with inspiration. They make all the difference between a group of individuals and a unified team. Those five letters symbolise the culmination of individual action into collective power. They describe how individuals can collaborate to achieve extraordinary results – together.” For the primary healthcare sector to release the collective power it has it needs to act ‘As One’. Currently, there are too many silos and walls that separate the sector. Acting as one does not mean uniformity nor being stripped of volition or independence. It does not mean loss of autonomy or identity. It means liberation, interdependence and collective power. It is what the bees, the ants and the entire ecosystems have perfected over millions of years. To act as one, like the Samurai Blue fans, we, the primary health care clinicians and administrators have to behave differently, and be willing to be transformed and to transform. But what must we do to behave ‘As One’? What brought the Samurai Blue supporters together was a united vision and a common sense of purpose - the awareness HealthSpeak

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Lessons learned from Japanese soccer fans of belonging to something bigger and united them. It made them overlook their personal preferences and differences that can cause disruption and distraction in achieving the vision. It injected good-will, passion and commitment. A good place for primary health care to start would be to embrace the fact that we all belong to the primary healthcare team, just as the Nippon Daihyo fans embrace the Samurai Blue. We need to appreciate the distinct and important role each team member plays, and develop a common language and mindset. This is the first giant step in achieving what we have talked about for years - integration, streamlining, cohesion, a multidisciplinary team approach. Presently, primary health care lacks a shared vision that unites its component parts. The primary health care vision has to be articulated in a way that resonates with all. Three of the Samurai Blue supporters lead the chants, and direct the movements. Throughout the game, the leadership remains single-minded and committed to the cause. It is relentless in its enthusiasm, persistence, creativity and flexibility - all mixed with a good dose of humour! We are beginning to see new leadership structures for primary health care emerge. This is new and exciting!

Presently, primary health care lacks a shared vision that unites its component parts While it is early days, this leadership is notable at the national level with the work that the Australian Medicare Local Alliance is beginning to do. At the local level the Medicare Locals can contribute in the leadership front, working with primary healthcare providers, the Local Health Networks (Districts) and community. The obvious gap is with the State primary health care structure. Given the size of Australia and the health care system, the absence of a State structure, to link in with the State Health System and support Medicare Locals to bring about change is conspicuous. From the other side of the stadium, the workings of the Japanese supporters appear smooth and flawless. From up close it is different. It is clear that they are learning as they go. Sometimes the leaders start a chant that fails to resonate and dies off prematurely. At times when the action on the pitch is most fierce the leaders learn

to pull back and let the natural instincts of their companions run loose. They are adaptable, flexible, keen to try new things, and learn quickly. Embodying the concept of ‘Kaizen’ - of falling forward, of continuous improvement, of not being satisfied with the status quo, of making small steps forward. This posture of learning is crucial for the primary health care sector, especially Medicare Locals, to learn to make a difference: where to invest, how to hear the local voices and engage with local clinicians. Like the incessant sound of the drums, sustained change requires persistent action. Action that is uninterrupted - not intermittent, but continuous. Boom. The boom of the drums gives the Samurai Blue supporters a heartbeat, a pulse, a tempo. The beat demands consistent action. They persist when the team is doing well and when the chips are down. Their persistence embodied the Japanese concept

of ‘gambaru’ - the idea of sticking with a task with tenacity until it is completed - to ‘fall down seven times and get up eight’. The change process that primary health care is involved in is a tournament, not a single game. Just as there is no magic bullet in medicine, there is no magic restructure that will address the systematic challenges that health care faces. Medicare Locals are not about revolution but about accumulative small wins that over time will bring big change. Some sit to judge the Medicare Locals by the big things they will do and the dramatic victories. Yet the success of Medicare Locals will be defined by their small, persistent wins - wins that will not necessarily make it to the local paper but make a difference to a patient’s health - the success of a patient receiving the right care at the right time, or the local clinicians and community coming together to connect and design local solutions. The soccer rematch will take place in Japan on 4th June, 2013. Can the Socceroos fans work ‘as one’, with purpose and leadership, to match the effort of the Nippon Daihyo and be heard above the crowd in Tokyo? The fans have 12 months to organise themselves, probably the same time Medicare Locals will have to establish themselves, find their voice, and begin to make a difference.

New: Wrapped Around Practice Support Program Over the past couple of months, North Coast Medicare Locals’ enlarged Practice Assistance and Liaison (PAL) team has been busy making face to face calls to general practices, psychologists, pharmacies and aged care facilities in the region. The PAL team is now offering a Wrapped Around Practice Support Program so that primary health care professionals can learn in a collaborative

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way that supports individualised person-centred care. They will be the face of NCML and the first point of contact for health practices. The Wrapped Around Practice Support Program model centres on the role of the PAL team who will act as enablers, using a case management style model, linking health professionals to support and education as required. The PAL staff will actively engage with heath providers, promoting innovation and best practice. In partnership with

providers the team will work to improve integration and coordination of primary health care, ensuring practitioners have all the information needed to effectively treat their patients. This will be done through use of the Collaboratives Program methods, such as Kaizen meetings and Quality Improvement processes, and through the dissemination of best practice information through mailing lists, HealthSpeak, e-newsletters and face-to-face visits. Through collaboration with health professionals, North

Coast Medicare Local will create an annual education and meeting plan to meet the needs of the practices. Data collected by the PAL team will form the basis of individualised case management plans for all providers and to formulate the meeting and education plan. Contact our branch offices for a face to face visit with our PAL team. Phone Tweed Valley on 6672 5158, Northern Rivers on 6622 4453, Mid North Coast on 6651 5774 and Hastings Macleay on 6583 3600.

In a short time, a lot has been achieved This is an edited version of an article NCML Board member Professor Lesley Barclay wrote for the Croakey. com blog. Whilst I share the frustration of many that health reform is taking too long, I’ll give you an example that is hopeful, creative, and involves the community. I would like to describe ‘our’ Medicare Local. In a little over six months, the Medicare Local is starting to make a difference – albeit this is still small and vulnerable. The road it is taking, however, looks positive. This Medicare Local covers 35, 570 square kilometres of the North Coast of NSW with a population of over half a million. Despite pockets of affluence on the beaches, we are lower than the state average in almost all socio-economic measures and have nearly twice the NSW average of residents identifying themselves as Aboriginal. Our Medicare Local was formed in April by joining four Divisions of General Practice that covered two recently established Local Health Districts. An early and urgent priority was to address the sense of loss felt by the four Divisions of their own practical infrastructure and support and to meet their needs. A priority was to get them involved and benefiting from the Medicare Local. A solution has been to strengthen and consolidate the four Practice Assistance and Liaison (PAL) Teams who are now better resourced and working as a consolidated team. The Medicare Local now has eight full-time PAL staff who will regularly engage with each general practice to help with practice accreditation, continuous education, quality, auditing, training new staff in medical software, e-Health, Aboriginal Health, immunisation and ensuring practitioners have the latest information on Medicare. They are also available on the phone for support at any time. However, the ‘brief ’ for these workers has also expanded. They now are working to improve integration and coordination of primary health care by not only delivering support to GPs but 12

Professor Lesley Barclay

Meetings where health professionals share knowledge and work on quality improvement also other care providers such as psychologists, pharmacists and Residential Aged Care Facilities. They have set up practice improvement meetings (‘Collaboratives’) for these health professionals to learn from each other, share knowledge and work on quality improvement. These groups will also discuss how to make complex initiatives work – such as setting up electronic prescribing in aged care facilities. This requires the cooperation of general practice, aged care facilities and pharmacists. The Medicare Local has provided the vehicle for this to occur. Reconceptualising general practice has occurred through focused work from GP leadership around the medical home. This provides a vision but also the basis for the integration and activity linking disciplines and agencies. This work has established the centrality of the patient and family in wellness and managing illness for the Medicare Local. Board members and the CEO and local University researchers have already applied for competitive research funds to research the application of the medical home across the Medicare Local. The Medicare Local has identified that for real change “local knowledge and local solutions

are essential”. To achieve this, the Medicare Local has established an innovation arm. One initiative is the PITCH (Practical Ideas To Change Healthcare).The Medicare Local will then breathe life into the most innovative idea and fund its implementation to improve health services. Each PITCH series has a different theme. The first invitation to ‘PITCH’ ideas resulted in 27 entries. The final activity described here, but by no means is the least, is combined work occurring in one of the previous Divisions between the Local Health District, the Medicare Local, Aboriginal Controlled Medical Services, our ‘GP Training’ organisation and local university entities. This is planned to combine

services and teaching of students and registrars so gaps for underserved populations can be filled. Together we are all working out the best way to maximise skills, and a range of input from agencies to provide services where these do not exist. The capacity to work with students enables us to extend these services beyond those that are Medicare rebatable. No one should underestimate the difficulty of bringing about real reform given the entrenched divisions in funding and organisational structures in the Australian health care system. The expectation that Medicare Locals will make immediate change in short period of time is unrealistic. It is early days but we are hopeful and determined to succeed.

North Coast shuttle A wheelchair accessible shuttle service for patients needing to attend medical appointments at Brisbane hospitals has now been running for six months. The pilot program, North Coast Shuttle, is a 17-seater bus which departs from Ballina and stops in Byron Shire and also at the Tweed before heading on to Brisbane. It costs $50 for the return service and accompanying carers travel free of charge. Transport to and from the client’s home to the nearest shuttle stop can be provided at no additional charge. It drops patients at PA, Mater and Royal Brisbane hospitals and other nearby specialists’ destinations will be considered. While the service was set up

for the frail aged or someone with a permanent disability, other people can use the service if seats are available. The service currently runs on Mondays, Wednesdays and Fridays between 10 am and 1pm. Medical appointments should be made in Brisbane between this timeframe. Clients should ring the following numbers: Clarence Valley shire residents – 6645 3200 Lismore shire residents – 6628 6000 Tweed, Byron and Ballina shire residents – 1300 875 895 For further information about this service, phone Amanda Lucantonio on 0400 313 758.

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Working on the frontline By Janet Grist

Several friends have undergone treatment at the North Coast Cancer Institute this year and they have all been patients of staff specialist radiation oncologist, Dr Patrick Dwyer. Without exception they speak of his empathy, care and impressive technical skills in determining the exact nature of their radiotherapy treatment. When I met Pat at the Lismore Base Hospital Cancer and Haematology Unit, I was struck by his youthful good looks. Becoming a radiation oncologist takes many years of study and training. He completed his specialist training last year, training in Brisbane at Princess Alexandra Hospital, the Mater and Royal Brisbane – five years in radiation oncology. And it turns out that the NSW North Coast is very lucky to have secured his skills, as he was destined to undertake a Canadian Fellowship in 2012, until a happy event changed his plans. “My wife and I were lucky enough to have triplets. They are now 20 months. It was a huge surprise, getting a family all over and done with in one hit! “It would have been difficult going overseas, so I finished my time in Brisbane, looked for a local job and found one here,” said Pat. As it happens, Pat was familiar with the North Coast Cancer Institute as he’d undertaken regular locum work in Coffs Harbour, knew the staff and Director Professor Tom Shakespeare, and loved the region. “So we made a tree change. We took a bit of a gamble coming away from family and friends in Brisbane, especially needing support with the kids, but it’s all working out. “We have two boys and a girl – Georgie, Ralph and Finn. And I just love the work here, it’s so general.” Pat’s work involves seeing new patients and counselling them about the benefits of radiotherapy for their particular condition. “We also have multidisciplinary clinics with haematologists, medical oncologists and surgeons, so we have here the breast clinic, the upper GI and colo-rectal multi HealthSpeak

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Because of our exceptional technology, we are well placed to treat a variety of cancers

Pat at home with triplets Ralph, Georgie and Finn.

disciplinary team meeting, and my colleagues and I have just set up a general oncology meeting called the Oncology Case Conference, held every second Thursday where we discuss patient management,” Pat explained. With a special interest in other cancers such as head and neck, lung cancer, skin cancers and upper GI cancers, Pat still links in with colleagues in Brisbane for multi-disciplinary meetings. “I head up the Gold Coast head and neck meeting because prior to me coming here they didn’t have any experience treating head and neck cancer. It all got treated out of the region but now we have the dietitian/speech pathologist here and the high end techniques to treat head and neck cancer. So far we’ve treated about eight head or neck cancer patients.” Understandably these patients really appreciate being treated locally. Pat explained that in times past clinicians in metropolitan centres believed it was better

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to have such cancers treated at specialist centres, but with his extensive training in such specialist centres, Pat’s able to offer these services on the North Coast. The because of the exceptional technology available at the NCCI, they are well placed to treat a variety of cancers. “It’s as good as any of the centres I’ve worked at in Brisbane. We have high end radiotherapy techniques called intensity modulator radiotherapy or IMRT and that allows us to treat tumours to higher doses and avoid normal tissues better so we can improve the chances of cure and reduce the risk of side effects. We use that for all head and neck patients and so far it’s going well.” The North Coast Cancer Institute is also about to get a PET scanner at Lismore to scan lung cancer, head and neck cancer patients and those with GI cancers. “Those patients won’t have to travel to Brisbane. In fact they can have all of their diagnoses, tests and treatment here,” said Pat. Working alongside the NCCI’s Director of Research, radiation oncologist Professor Michael Mc-

Kay, the unit is able to offer radiotherapy treatment to a large range of cancer patients. So, what attracted Dr Patrick Dwyer to radiation oncology? “I really like the technology side of things and also diagnostic imaging and anatomy but I didn’t want to give up the patient contact, so it’s really a good combination of dealing with patients every day, having a technical side in terms of planning the radiotherapy treatment and giving them the best highest quality radiotherapy treatment,” he told HealthSpeak. Pat also enjoys working with technology to reduce side effects from treatment and target tucontinued next page

North Coast Cancer Care feature mours more accurately. “About half of our cancer patients undergo radiotherapy. Unfortunately, it’s still under-utilised, and particularly in regional and rural areas due to lack of access. It is a course of treatment usually over several weeks, so when patients have to live way from home it may be easier for patients not to have it, and patients may choose to have a mastectomy rather than a lumpectomy and radiation treatment. “But now we have an excellent service set up on the North Coast we can give local patients access and stop them having to travel, resulting in a greater uptake of radiotherapy.” As if his job is not big enough, Pat is also Director of Training at the NCCI. He is involved in teaching registrars at Lismore, Coffs Harbour and Port Macquarie as well as trainees rotating from Sydney and Newcastle to the North Coast. “It’s a really good place for them to train and it’s not super busy like a metro centre so they have a lot more time to do reading and research and become involved in the technical aspects rather than doing full clinical mode. And we have very good tele- conferencing facilities so they can link up with their other education in other areas of the network.” In terms of research, Pat is continuing with some projects carried over from his time in Bris-

bane and has also had an article published on using preoperative radiotherapy for melanoma in patients with unresectable disease (a tumour that cannot be completely removed through surgery) in the nodal areas. He’s also looking at a new technology called TomoTherapy and the impact of Tomo Therapy on head and neck patients, side effects and quality of life. The NCCI also has working groups that are implementing new technology, including a fourdimensional CT scanner where technicians can track the image of a lung tumour throughout all stages of the breathing cycle. Previously it was more of an empirical ‘guesstimate’ about where the lung tumour was in the breathing cycle. Now it’s possible to quantify the location of the lung tumour and provide more accurate treatment. Upfront about his delight in new technology ‘toys’, Pat also talked about a new treatment technique NCCI is looking to implement called ‘active breathing control’ for lung tumours. “This is where we actually get the patient to hold their breath during the radiotherapy and treat them while the tumour is stationary, whereas previously the tumour would be moving up and down during treatment. By reducing the motion of the tumour we can increase the potential dose and reduce the side effects. These are high end technologies only

This patient had a tumour in the base of tongue. Shown is the radiation dose wash around the tumour and sparing the parotid glands using a technique called IMRT.

It’s a really good place for registrars to train as it’s not super busy like a metro centre just being implemented in bigger metropolitan centres as well,” Pat explained. This enthusiastic clinician said he was lucky to work in a department where all the radiation therapists are dynamic and enthusiastic about implementing new technology,

“We do it in a controlled way. We look at the literature and see how it’s been used in the past and how it might be implemented in our patients and do rigorous quality assurance and physics checks to make sure it’s all done safely. We also have an excellent electronic medical record, so you can interrogate it and potentially do research projects or look at outcomes, and we run a lot of audits as to how things are going.” Pat is excited about the many possibilities of improving health outcomes for cancer patients with the various new technologies becoming available. “We are really pushing the limits with the cancers now in terms of continued page 21

Cancer directory: current, credible and complete Receiving a diagnosis of cancer is hard enough to face without the difficulties of sourcing reliable information and advice. Now there’s a one stop shop for all cancer resources – Cancer Directory. You can find it at: www.cancerdirectory.com.au The Cancer Directory Website provides consumers and health professionals with a useful, comprehensive online directory of trusted Australian cancer care resources that have been published since 2000 in print, audiovisual (AV) or electronic formats. This website has been developed to enable users to:

Search for the printed, audiovisual and electronic resources that best fit needs Submit a resource that your organisation has published Suggest a resource another organisation has produced that you have found useful Sign up to receive an electronic newsletter that provides updates on new resources and developments Give feedback on the listed resources and website.

This site offers access to credible cancer care resources from around Australia, specifically those published by the Commonwealth, State and Territory Government departments, Cancer Councils, major health services and major not for profit organisations. Resources cover a range of cancer-related subject areas and target audiences: All common cancer types Prevention, screening, early detection, screening, treatment, advanced cancer, palliative care Coping with cancer,

including psychosocial needs such as emotional and practical support, grief and loss, communication For women, men, children, adolescents, Aboriginal and Torres Strait islander peoples, people from other culturally and linguistically diverse communities, people with disabilities and health professionals. This website is managed and maintained by NSW Cancer Council. The Cancer Directory has received funding from Cancer Council NSW and Cancer Institute NSW.

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Our House is open! When HealthSpeak spoke to Rebekka Battista, the Fundraising Coordinator and powerhouse behind the 8-year long project, bookings had opened for Lismore’s Our House units and Rebekka was preparing for the block’s official opening on December 4. Our House comprises 20 purpose built motel-style units for cancer patients and their families receiving treatment at the Cancer Unit in Lismore. It also provides accommodation for parents with children or babies in Lismore Base Hospital. In mid-November Rebekka was busy furnishing the 20 units and was excited to report that the community had once again pitched in to help provide beds, microwaves and other items through donation or at cost price.

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Our House is a magnificent example of community cooperation, excellent leadership, persistence and vision.

“People have been just wonderful, I’ll certainly be personally celebrating the success of this

long project after December 4,” she laughed. The project began with the es-

tablishment of a charity specially formed for the project. It really got moving two years ago when the $5.5m required to fund the project came together. Rebekka explained that $3.6m came from the federal government, half a million dollars came from the Cancer Council of NSW and was matched by the state government with the community raising the remaining $1m. Our House is a tremendous example of vision, cooperation and persistence resulting in a wonderful result for patients who wish to be close by the Lismore Cancer Unit when undergoing care. Our House bookings can be made on 6629 4350. Twin rooms cost $60 per night which matches available government subsidies.

Lifestyle medicine for survivors of cancer By Assoc Prof Ram Seshadri

North Coast Cancer Institute Cancer survivors in the United States are defined by the Centres for Disease Control and Prevention (CDC) as anyone who has been diagnosed with cancer, from the time of diagnosis through the rest of their life. Since the declaration of “war against cancer” in the early ‘70s with advances in early detection and molecular understanding of biology of cancer and treatment there has been a steadily growing number of cancer survivors. With improvements in diagnosis and treatment, the number of patients surviving beyond five years has increased dramatically to the point that as many as 68% of newly diagnosed cancer patients are now survivors.(1) It has been estimated that approximately one in every 25 Americans alive today is now a cancer survivor. In Australia the five-year survival from all cancers increased from 47% in the period 1982-1987 to 66% in 2006-2010. The cancers that had the largest survival gains were prostate and HealthSpeak

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kidney cancer and non-Hodgkin lymphoma. (2) Recent studies have shown that the cancer survivor profile is different to those with other types of chronic disease. Cancer survivors have significantly greater number of co-morbidities and decreased Active Daily Living (ADL) scores compared with age-matched control individuals. For many cancer survivors the need for informed lifestyle choices becomes particularly important, aimed at preventing recurrence, second primary cancers and other chronic diseases. In 2006 the American Cancer Society (ACS) reported (with updated information in April 2012) guidelines for the lifestyle management of cancer survivors. Although research in this area is continuing in centres across the world, published evidence suggests that lifestyle management can reduce the recurrence of primary cancers, improve quality of life and prolong the duration of survival. For example in breast cancer, a 30-40% reduction in recurrence rate was observed in women who follow weight management and exercise regularly.

(3) In order to provide information about the advantages of lifestyle management for cancer survivors, a number of “cancer survivorship” clinics have been set up in a number of countries including Australia. These clinics operate within established cancer centres. It is our view that cancer survivor care would be best provided by primary care providers such as in our own NCML, in close collaboration with cancer centres and life style managers. The formation of NCML provides an opportuni-

ty to co-ordinate the care of cancer survivors in this region. Such an approach would help to initiate lifestyle intervention to improve the quality of life psychological wellbeing and overall survival of cancer survivors. We plan to develop a cancer survivor care plan template for GP practice software programs. This could be developed with the collaboration of cancer care providers at the time of completion of treatment of primary cancer and link with appropriate primary care allied health providers. The project would also involve training primary care providers to recognise the needs of cancer survivors and provide appropriate lifestyle interventions. (1)Siegel R, Naishadham D. Jemal A. Cancer statistics, 2012, CA Cancer J Clin 2012;62:10-29 (2)Cancer Survival and prevalence in Australia – period estimates 19822010. AIHW 2012 (3) Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med. Oncol. 2011; 28: 753-765

North Coast Cancer Care feature continues page 20 15

The Koori Grapevine New Aboriginal Health Practitioner Congratulations to Rebecca Palmer who works at Bugalwena General Practice in South Tweed Heads. She has recently been granted the title of Aboriginal Health Practitioner after chalking up 500 hours of clinical work. She was previously an Aboriginal Health Worker. Rebecca is part of a select group – there are only 500 Aboriginal

Health Practitioners in Australia. A Bundjalung woman, Rebecca also has some Torres Strait Islander heritage and ‘a little bit of the South Seas’. Rebecca works as a Chronic Disease Coordinator at Bugalwena and enjoys the contact with her patients. “I love my job and my patients and can often relate to their health

Hastings Macleay’s team flies the NCML banner at festival

Ro-Anne Stirling, Indigenous Program Officer NCML with Clay Frost, Community Development Worker from the Benevolent Society, presenting Ro with a Certificate of Appreciation for NCML’s involvement in the Play Your Part Festival event.

In September the NCML’s Closing the Gap Team from our Hastings Macleay Branch ran a stall at the Macleay Valley Play Your Part Festival – part of Child Protection Week at Services Club Park in Kempsey. North Coast Medicare Local’s CTG stall sparked a great deal of community interest. NCML Indigenous Program Officer Ro-Anne Stirling explains: “Our team members were busy all day networking, flying the Medicare Local banner and responding to general enquiries from the public. The Mayor had a lengthy conversation with me and invited us to make an appointment to see her.

“It was a very productive event in terms of promoting the Medicare Local to our community and providing quality information around Closing the Gap,” said Ro-Anne. The stall also provided an opportunity for two new Outreach Workers, Stacey Donovan and Stephanie to hit the ground running and meet the public. Around 15 information stalls from a variety of health and welfare organisations with a child and family health focus took part. Those who attended included carers, parents, young families, teachers and students from local pre-schools and infants schools as well as Family Day Care carers and children.

Koori Grapevine

journeys,” she told HealthSpeak. Rebecca has had an interesting career which started with her time as an Aboriginal Education Assistant at Wee Waa Public School. “I just loved working with the kids from Kindy through to Year 6, often getting down on the floor and playing with them. I also worked as an Aboriginal Behavioural Mentor in north coast schools, basically spending the whole day with kids with behavioural problems keeping them out of trouble.” It was a back injury that caused Rebecca to change career direction, studying for a Cert IV in Aboriginal Health with her sister. She was thrilled when she was offered the job at Bugalwena three years ago. Rebecca’s work at Bugalwena sees her working with people with chronic disease. She was also employed with the lifestyle management program Health for Life and along with Bugalwena’s dietitian Jess McCormack set up the Deadly Living group. “It took North Coast Area Health three years to set up such

Rebecca Palmer

a program and Jess and I managed it in six weeks. It was a lot of hard work. Now the group meets every Wednesday from 10 to 12.” Deadly Living started out as a healthy lifestyle program for Indigenous people with chronic conditions but has broadened to become a prevention program to help Indigenous people improve their fitness and wellbeing. When she’s not at work, Rebecca enjoys catching up with her family. She has three children and three grandchildren and the youngest, 11-month old Ezekiel, is taking up much of her time and attention. “He’s just magnificent,” she said, “he’s such a lovely age.”

Targeting otitis media Four medical practices in the Northern Rivers are taking part in a pilot otitis media campaign funded through the Closing the Gap program. NCML’s Northern Rivers Closing the Gap Program Manager, Jess Fernance said these are Bullina Aboriginal Medical Service in Ballina, Goonellabah Medical Centre, McKid Medical Centre in Kyogle and Meridian Medical Centre at Goonellabah. Two staff members from each practice are designing their own methods of how to best implement the recommendations for clinical care guidelines on the management of otitis media developed by the Department of Health and Ageing. Sadly Aboriginal children are at

greatly increased risk of severe otitis media (OM) and hearing loss. Some of the messages that health care providers will be giving to their Aboriginal and Torres Strait Islander patients include: OM improves with, breastfeeding, a smoke free environment and pneumococcal vaccination. Attend a health clinic as soon as possible whenever a child has a painful ear or discharge Frequent ear examinations are recommended even when a child is well Children with severe hearing loss can benefit through improved communications strategies and hearing aids.

Indigenous Services Providers Forum There was an exceptional response to the Indigenous Service Providers Forum held at Maclean in October with 72 people attending from 37 organisations. A joint venture between the Indigenous Health Program Officers from North Coast NSW Medicare Local’s Mid North Coast & Northern Rivers branch offices, the forum was held at the Maclean Services Club and participants came from the Tweed Valley down to Macksville. It aimed to identify opportunities for improved service delivery through coordination and collaboration across local organisations providing services and programs to local Aboriginal and Torres Strait Islander communities.

The club room was abuzz with conversations and people networking and increasing their knowledge of referral pathways. Around a dozen representatives from various organisations gave a presentation on the services they provided and how to access them. The local Heart Foundations Heartmoves exercise facilitator got everyone moving with a demonstration about how people with chronic health issues can ease back into exercise and become more active. Heartmoves is specifically designed for older people and those with health risk factors or stable chronic illnesses such as heart disease, diabetes and bone or joint disorders.

A Welcome to Country from Aunty Moo.

Deadly Tucker A healthy recipe from the FOODcents Program for Aboriginal and Torres Strait Islander People in WA Program.

Kangaroo Stew

Ingredients: 600g kangaroo meat, diced 3 potatoes diced 11/2 large onions diced ½ pumpkin diced 3 carrots diced

A Healthmoves facilitator helped get Forum participants moving again after a morning sitting and listening.

2 garlic cloves 3 tablespoons oyster sauce 3 tablespoons tomato sauce 3 beef stock cubes 31/2 cups water Cornflour to thicken

Cooking things: Large pot, chopping board,large knife, garlic crusher, tablespoon, cup measure. Method: Put beef stock cubes in water and mix well. Put the roo pieces in a pot with the lid on, cook in own juices on moderate heat until the meat is soft (about 45 minutes). Add potatoes, carrots, onions and pumpkin. Add tomato sauce, oyster sauce and beef stock. Mix together and add enough water to cover the meat. Simmer for 10 to 15 minutes. Mix a little cornflour with water to a paste and add to pot. Cook for a further 10 to 15 minutes. Continue cooking until meat and vegies are tender. Serve with rice, pasta or bread. Enjoy!

Jen Cook, Helen Lambert and Terry Donovan, from NCML’s Closing the Gap Team in Coffs Harbour at the Indigenous Services Forum.

Got a story? HealthSpeak is for the entire community and we are always happy to receive story ideas and submissions. Please direct your ideas and articles to the editor at jgrist@ncml.org.au

Koori Grapevine

Arts Health and Wellbeing Expression through dance without barriers HealthSpeak’s visit to Alstonville Dance Studio during a fun pilot project was filled with smiles and excitement. Sprung, a pilot project funded by Accessible Arts NSW, and held in late September, was the first integrated dance workshop held in the Northern Rivers. Using masks, hula hoops and backed by a didgeridoo and a percussion section, the participants revelled in the opportunity to create a unique experience for their audience. Proposed by paediatrician Dr Robyn Brady and dance instructor, Sue Whiteman, Sprung came to life as a week-long dance workshop where young people with or without disabilities workshopped a dance concert for the Friday night. Robyn’s 17-year old daughter Tara Coughlan has Down Syndrome and dancing has been her passion since she was four. “She’s got a great sense of rhythm and good technique and muscle strength and Ms Sue [Whiteman] has taken her on as a private student, doing solos and preparing her for a career in dance as an assistant and dance teacher within an integrated dance setting,” she said. Robyn sees many benefits in creative dance for people living with a disability. “I believe that we have lost touch with our primal voice and because of the focus on the academic we’ve learned to speak with large words and formal phrases and lost touch with our body’s expression which can often speak more truthfully in music and dance. Doing music and dance together enables us to connect again on a very deep level, and get the blood and the chi flowing,” 18

she explained. Talking to Tara, who is in Grade 11 at Xavier’s Catholic College in Skennars Head, she is a little shy but lights up when talking about her dancing. “I do my best. You can keep going and progress, always learning. I do hip hop, modern and contemporary,” she told HealthSpeak. Tara performed her first solo contemporary dance work at the Arts Activated 2012 Conference in Sydney in October, directed by Sue Whiteman. Sue, who enjoyed a career as a dancer before becoming a teacher in Alstonville, explained the benefits she sees for young people in creative dance. “There are the physical, spiritual and emotional benefits of dance. And it’s also about life lessons getting them to be organised, to network, meeting deadlines and having little projects. “With these kids in particular, number one it’s about them having fun because sometimes they struggle and their parents struggle with different activities,” she said. Sue said when the participants come together it’s a magical thing. “They can’t take off their disability ‘cloak’ but when they are all together there’s a sense of freedom and having the live music has been fantastic for them to understand that music does not just come from a machine.” A dance teacher for 25 years, Sue has taught lots of people and moved many on into dance careers. She also has a few deaf students and other students with disabilities who’ve gone on into the Arts. Sue believes that Tara could be a dance facilitator in the future. And even for those without disabilities, she said kids and adults

From left, Robyn Brady, Tara Coughlan, Max McAuley, Cassie Warman, Sue Whiteman, Zac Mifsud, Adam Rijks.

Zac and Adam provided a percussive backing for the dancers.

can learn to dance and come to dance classes for social and physical reasons. “Dancing can be a lifelong hobby,” said Sue with a big smile. Sue hopes that further similar workshops can be run on the North Coast. “We might be able to do some dance sessions during the week if there is enough interest. A lot of these people are in programs such as Multitask and Red Inc and they finish these programs at three,” she said. Another important project member was Adam Rijks, who works as a disability support

worker but has a background in music and creative arts and is interested in any opportunities to combine community work with creative arts. “Music is my passion and with the arts work, I get to work with the community and creatively. I chose percussion to back the Sprung project because percussion provides a universal back up that anyone can pick up and join in with,” he said. Adam also enjoys the challenges in extending his communication skills in this workshop environment and hopes this workshop will lead to other opportunities. HealthSpeak

summer 2012

Making sense of life through art

Mic Eales holds one of his porcelain cast lotus pods.

Mic’s installation ‘Too many Ladders’

By Sharlene King

These days two-time suicide survivor Mic Eales can embrace life, thanks to the healing and solace found in creating installation art. Now the Southern Cross University doctoral candidate hopes his latest exhibition Inspired Lives: Discovering Life in Imagination, on show at Melbourne’s Dax Centre until January 11 will encourage conversations and greater understanding about the darkness that leads people to take their own lives. It comes as the 59-year-old from Mallanganee, west of Casino in Northern New South Wales, was recently appointed to Suicide Prevention Australia’s Lived Experience Policy Advisory Committee. The Dax Centre’s Inspired Lives: Discovering Life in Imagination shares the original voice of artists who have attempted suicide. The exhibition explores the psychological and spiritual crisis of suicide and its damaging after-effects, revealing the deeply personal experiences of the artists as they work through their HealthSpeak

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struggles, find inspiration and take steps towards healing. Some of Mic’s pieces in Inspired Lives are drawn from his PhD thesis, ‘Different Voice, Different Perspective: a visual arts enquiry into understanding suicide through original voice narratives’. As an artist, Mic said he sees himself primarily as a storyteller. “Each of the installations

“There is a childlike quality, a playfulness, a quirkiness to the pieces,” Mic said. “At the core of my work is the question, ‘what is the opposite of suicide?’, and for me the answer is childhood innocence. The only time in my life when I felt free of emotional and psychological pain was as a very small child.” One of the Inspired Lives col-

At the core of my work is the question: ‘What is the opposite of suicide?’ began with a conversation about suicide. I connected with people who have attempted to take their own lives and reinterpreted their stories as artworks. I then worked with them to find materials, metaphors, symbols to accurately depict their story.” His installations are a departure from the typical darkness and forebodings expected of suicide art, and instead include children’s tales reproduced on lead; cube-shaped jigsaw pieces; and porcelain casts of lotus pods.

laborations is with Associate Professor Baden Offord, a senior cultural studies lecturer at Southern Cross University, who has a family history of suicide. “The story of suicide has been with me all my life. My father on the eve of my 19th birthday in 1977 and brother in 2008 both took their lives, while my sister, my mother and I have all attempted suicide,” said Professor Offord. “Working with Mic has been an incredible and life-affirming

experience as it has helped me recognise how much we can learn about this usually unregarded human story. As strange as it sounds, what I have learned through collaborating with Mic is how important it is for the deepest of human sufferings to be unveiled, expressed and given light, articulation and form. His work is an art of compassion and insight.” Mic twice-attempted suicide as a teenager but it was after his brother Bryan took his own life in 2002 that he began creating artworks about the family and community ramifications of suicide. He said art could be a form of therapy for all those touched by suicide, as well as the general community. “I want to reduce the stigma and taboos associated with suicide. We need to help and encourage people through their trauma and darkness to embrace life.” Mic said he was looking forward to being able to drive improvements in policy, service delivery and outcomes for suicide prevention through the Lived Experience Policy Advisory Committee. “I’ve finally got to the point in my life where instead of focusing on my own suicidal tendencies I want to start giving something back. To take what I’ve learnt and start making a wider contribution to the community.” Mic Eales’ website: www.toofewladders.com 19

North Coast Cancer Care feature

Surgical Fellow placement benefits north coast In 2003, Port Macquarie Hospital’s then general surgeon asked specialist Dr Guy Hingston to set up an oncoplastic breast reconstruction service for women at Port Macquarie Hospital. This service is free of charge and allows women who have undergone a mastectomy or double mastectomy due to breast cancer to become anatomically ‘normal’ again. In early 2005, with that practice up and running, Guy then expanded, starting a fly-in service in early 2005 to Lismore Base Hospital, performing breast reconstructions for women further north. With the support of surgeon Dr Robert Simon, this Lismore service operated well and Guy has since consolidated his service in Port Macquarie while moving from Coffs Harbour to Lismore to see women and perform surgery. In the past nine years, Guy has performed oncoplastic breast reconstruction surgery on around 200 patients. “In this time I’ve built up a lot of experience, helping women who don’t have to travel to have this important restorative surgery performed,” he said. With his breast reconstruction practice performing strongly and a successful private practice specialising in breast reduction, it seems the time was right for Guy to take on a General Surgical Fellow for one year’s specialist training. Dr Michael Yunaev, the first

Left: Dr Michael Yunaev and Dr Guy Hingston perform a breast reconstruction. Right: Port Macquarie Base Hospital where they are based.

Oncoplastic Fellow employed at Port Macquarie was the perfect candidate with an interest in Guy’s field. Since he took up the position early this year he’s gained regional experience in General Surgery, along with significant oncoplastic breast surgical experience. Michael trained at Sydney’s Westmead Hospital and at the end of last year completed his Fellowship in General Surgery and started looking at sub specialties in breast surgery. “It can be tricky to get the appropriate training and Guy’s employing new developments in oncoplastic breast surgery and is offering a full spectrum of options for the patient,” Michael told HealthSpeak. Since starting work with Guy,

Michael has obtained the training he wanted to benefit the patient both through plastic surgery and oncologically, mainly TRAM flap and breast implant reconstruction surgery. The TRAM flap (transverse rectus abdominus myocutaneous) is a tissue flap procedure that uses muscle, fat and skin from the abdomen to create a new breast mound after a mastectomy. Additional surgery is needed to create a nipple and areola. “I’ve learned a lot from him not just technically but also in decision making which is very important in cancer surgery. We’ve been working not just as a student and mentor but as a colleague and partner. He’s relied on me just as I’ve relied on him during surgery,” said Michael.

He’s grateful that Guy had the necessary experience and confidence to allow him to gain the necessary surgical involvement. “In surgical training it’s rare to find a surgeon who will support you from the start and get you involved hands on. Such people are difficult to find,” said Michael. He also believes having a Fellow improves the status of the regional hospital and may attract further trainees and surgeons who might wish to settle in Port Macquarie. Michael and his wife are expecting a baby soon and they will be experiencing the skills of the hospital staff first-hand. Certainly both surgeons find their work fulfilling. “A large number of women each year still lose their breast to cancer. Pretty universally the women are very grateful as it restores them anatomically and they can lead a lot more normal life – socially and with exercise – being able to wear a swimsuit or a low-neck dress,” said Guy. Guy says he’s found having Michael as a Fellow very rewarding. “I have had two junior registrars and some who’d finished their training, but having someone specialising in my sub-specialty was a breath of fresh air. “I enjoyed honing my skills and it was professionally satisfying having an ‘apprentice’. It was refreshing to work with someone in the first stages of their career.”

Plain packaged cigarettes will help save legs People at risk of debilitating lower leg ulcers will benefit from the Federal Government’s tobacco plain packaging laws that came info effect on December 1, according to the Australian Wound Management Association (AWMA), the peak body for 3,000 nurses, doctors and allied health professionals in this field. Welcoming the decision to remove some of the glamour from cigarette smoking, AWMA’s Medical Representative, Dr Stephen Yelland, said tobacco use is the single most preventable cause 20

of death and serious illness in Australia and closely linked with circulatory problems that contribute to lower leg problems. “Establishing a patient’s smoking history is a crucial part of treatment of lower leg ulcers. Patients experiencing this painful and intransigent condition tend to be elderly with a range of health issues, some related to being former smokers. In addition, there is a connection with smoking among many younger sufferers. Tobacco smoke, which includes a range of toxic chemicals, impedes

blood circulation and makes it very hard for wounds such as venous leg ulcers to heal naturally.” According to Dr Yelland, a Gold Coast GP with expertise in leg wound management, “At any time around 300,000 Australians suffer leg wounds requiring medical and nursing care. Wound care is one of the most frequently performed GP procedures and accounts for up to 80 per cent of community nursing treatments. “Yet the impact of smoking is entirely avoidable and the these efforts to reduce tobacco con-

sumption are welcomed. “It is gratifying to see that smoking rates have generally been dropping, but they remain dangerously high in certain segments of the population. “The more you smoke, the harder it becomes to quit and the greater the long-term risk to your health. Believe me, there is nothing glamorous about having weeping leg ulcers, whatever your age, so anything that could help reduce the desirability and acceptability of smoking deserves to be encouraged.” HealthSpeak

summer 2012

North Coast Cancer Care feature

The many benefits of a cancer retreat When HealthSpeak spoke to the facilitators of a retreat for people affected by cancer held north of Kempsey in October, they had just completed the three-day event and the uplifting experience was clear in their voices. Sue Baughman, a psychologist employed by North Coast Medicare Local. and her Sydney psychologist colleague Mudita Maclurcan had 25 people attend the retreat held at the Yarrahapinni Adventist Youth Centre, set on acres of rainforest adjacent to the beach at Grassy Head – the biggest number yet. Both women have broad experience with a host of healing modalities. Mudita combines her psychological skills with relaxation, mediation and restorative yoga and has worked in this mode for more than 12 years. Mudita has worked with cancer within retreat, community and hospital settings for 15 years and has completed research looking at the effects of such programs for women with breast cancer. For the past 10 years Sue has been employed through ATAPS (Access to Allied Psychological Services) funding, providing psychological counselling services and Emotional Health & Wellness Group Programs in the Macleay Valley. Like Mudita, Sue is an accredited teacher with Satyananda Yoga. Those who come to these retreats have different types of cancer and are at different stages. The only prerequisite to attend is

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cure rates. The cure rates have increased so much over the last 10 to 15 years that now every extra bit of treatment we give is only adding a small amount to cure, but potentially increasing toxicity. The idea now is to try to keep the cure rate as it is and reduce the toxicity by more accurately targeting the tumours or personalising therapy so that you know that a patient with a particular type of

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A colourful retreat artwork.

that you have to be medically fit. “Some are recently diagnosed and in shock and trauma,” Mudita explained. “They need short, sharp techniques to bring their anxiety levels down quickly. Survivors have different requirements. Some have recurring cancer and some know they are going to die.” People are placed into different groups with common themes and this group work is integral to the retreat process and success. The first day a lot of time is spent using techniques to bring the group together and identity the issues and concerns of each person. Mudita explained that the retreat works because the participants are with other people with cancer. “So there is a level of common understanding and there is always a bond.” As well as a range of psychosocial tools. the pair uses body energy and mindful techniques, bringing together body movements and breathing to facilitate healing. And a talk is given on Nutrition for Cancer. Sue told HealthSpeak that the

tumour is going to respond in a particularly type of way - the treatments are becoming more appropriate.” Pat also recently set up private consulting rooms at Lismore’s St Vincents Hospital. In their family life, the Dwyers are enjoying renting a country cottage on some acreage and are looking to buy before too long. “We’re really enjoying the North Coast,” he said.

To take part, participants simply need to be medically fit.

Gentle movement helps shift emotional challenges to do with cancer.

retreat aimed to provide participants with gentle practices to help them meet the physical and emotional challenges associated with their illness. Creative arts practices are also used to help people get in touch with feelings such as choosing a postcard from a large pile to express where they are at. “We purposefully provide different sorts of tool to cater to different stages of illness and different needs and different personalities,” said Mudita. The retreat work is clearly very healing for those taking part and rewarding for the facilitators, with some moving evaluations written at the end. These include: “I don’t feel alone anymore, I felt safe, like being in a big loving family.” “I feel stronger and able to face my chemo more easily.” “I no longer have a fear of the cancer returning.” Sue told the story of one participant, a woman who lived in Kempsey but travelled to Coffs Harbour for her chemotherapy as she wanted to have some ano-

nymity and stay private. “The decision to come to the retreat was big for her. She was able to find a safe place within a larger group and the validation she wanted. She really bloomed and a bonus was that she made good friends with another woman living in Kempsey with breast cancer,” said Sue. Mudita and Sue feel humbled to be able to offer the retreat as they see the positive influence on the participants’ lives and general coping abilities. Sue is not aware of other such retreats available through ATAPS funding and sees this retreat format as innovative and creative, really ‘hitting the mark’ in providing accessibility through Commonwealth funding to a special group. The two women will run another retreat next year. Sue is also keen to begin an ongoing group to keep participants connected and allow them to do more practice every four to six weeks. To find out more phone Sue Baughman on 6562 1866 or 0414 943 691 or email sbaughman@ ncml.org.au

Go4Fun

A book born out of experience and sharing Reclaiming Joy: Living Well with Chronic Illness Edited by Ruth Winton-Brown and Laura Jan Shore

Jonny (in black/pink flowered top at rear) with son Liam doing the V sign in the front and other Go4Fun participants.

By Franklin John-Leader Regional Program Coordinator, NSW Go4Fun® Program, NNSW LHD

Go4Fun® is a FREE, targeted healthy living and treatment program for children aged 7-13 years who are overweight or obese, and their family members to become fitter, healthier and happier. Go4Fun® is funded by NSW Health and has been delivered locally through the Lismore and District Women’s Health Centre. The program runs for 10 weeks during the school term and is delivered twice a week for two hours after school. Go4Fun® is not a diet and does not encourage rapid weight loss in children; rather it is about empowerment – putting the child at the centre of a range of ways to make healthy lifestyle changes through physical activity, food, self-confidence, body image and personal development. By following the Go4Fun® principles, participants can lose weight naturally and build a foundation for healthy living – for life. “Go4Fun® program is also showing significant medium to long term health benefits for many participants who attended local programs over the past 18 months. We have seen high rates of success, with ongoing positive results for families well after the program has ended, aid Franklin John-Leader, Regional Program Coordinator, NSW LHD. 22

In 2010, Liam took part in a 10-week Go4Fun® program in Goonellabah. Almost two years later, 14-year-old Liam has managed to keep fit and his mum Jonny Iuso said his confidence was still high. “During a pre-assessment, one of the questions that stuck out for us was, ‘How do you rate yourself against your peers?’ and Liam’s rating was quite low. Over the 10-week program, it really showed his confidence had increased and by the end all kids were standing tall and presenting in front of their peers,” she said. “Although this program had a lot of practical and fun ways to discuss nutrition and physical activity, it built a lot more for participants to practice how to get fitter and happier with small, incremental changes in their everyday life”, Ms Iuso added. As part of the 2013 program, a number of places worth up to $1200 per child are being offered to local families in Goonellabah, Casino, Ballina and Tweed Heads, with new venues starting in Evans Head, Lismore, Kyogle and Byron Bay. Go4Fun® encourages a family approach and a parent or a carer must attend all sessions with the child. Limited child care and transport assistance may be available to eligible families. For more details or to enroll in a program near you call 66219 800 or Free call 1800 780 900 or email: go4fun@lismorewomen.org.au

This inspiring and practical book was written by a group of North Coast residents who embraced the challenge to take responsibility for their own health and wellbeing. They were all part of a ‘Living Well Group’ which met regularly and found a sense of connection, belonging and validation of who they were regardless of their illness. Writing teacher Laura Jan Shore helped the group find its voice to produce this valuable guide to living well in spite of terrible adversity and debilitating conditions. Half of all Australians over 65 live with a chronic illness. This unique book contains intimate stories about each group member living with a chronic condition – fibromyalgia, chronic fatigue, depression, rheumatoid arthritis, paralysis, to name a few. It offers a host of insights about healing and practical exercises and remedies to enhance wellbeing. As editor Ruth WintonBrown says in her introduction: “The journey to recovery has revealed many common lessons. These are the tools you will find in this book: tools of patience, perseverance, trust, endurance, forgiveness, self-forgiveness and self-knowledge. We offer our collection of

tools, tips and personal stories in the hope they will inspire your own healing and celebration of life.” Chapter titles include: Power tools; Self care; Facing our Demons; The importance of Relationships and Living well, Dying well. In the Foreword Dr Ian Gawler states that ‘Truth is a rare and wonderful commodity... Reclaiming Joy is a wonderful book filled with eloquent truth offering insight, good humour and real positivity. This is a book of positive thinking – where you hope for the best and do a lot about it! It is my wish that this book is read widely.’ Anyone living with a chronic illness or caring for someone who does, will be thankful for the sharing, practical advice and acknowledgement of the many ups and downs faced on the journey, written by those who have lived these experiences. And the book’s reason for being: that joy can be reclaimed in spite of the challenges of chronic illness. To purchase a copy of Reclaiming Joy, email Ruth at: rwintonbrown@yahoo.com. au

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The Single Point of Access Project One of the most exciting developments discussed at the recent Northern NSW Local Health District (NNSWLHD) Chronic Disease Management Program Workshop held at South Tweed, was the Single Point of Access initiative to Community Health Services. Twenty-two General Practice staff and 10 Local Health District Allied Health workers met in November at South Tweed for the Connecting Care in the Community workshop - a joint event organised by the NNSWLHD and North Coast Medicare Local (NCML), which gave clinicians a chance to meet each other and put faces to names and services. Facilitated by Tweed GP and NCML Local Board Member, Dr Di Blanckensee and Tweed Valley GP Network Board Member and Practice Nurse, Chris Ash, the day long workshop was a valuable opportunity to discuss the management of chronic disease in various settings. Presentations were also given on how to improve prevention, diagnosis and management within the medical home model where the GP is the gateway to connecting the patient with other health care professionals in a team-based approach to chronic disease. At the workshop Kerrie Keyte, the Single Point of Access Project Manager from Murwillumbah Community Health, talked about this initiative that will start early next year. “We will introduce a single 1300 number for all Community Health Services which will provide easier access for general practice and all other callers, and will direct them to their local community health centre and the service that they require. There’s also work happening to implement a single contact number for the Aged Care Assessment Team intake across the Local Health District,” she told attendees. With a plethora of different services and referral needs, General Practice has been hard pressed to easily connect patients to the most appropriate and nearest Community Health

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Service. To help with this issue, a Community Health Services Information document has been produced and is accessible via a desktop ICON to all staff in the Tweed/Byron Network and work will soon be underway to commence a directory for Richmond/ Clarence Community Health Services. “Discussions are also underway with NCML to provide GPs with access to this regularly updated document which will sit on their desktop and assist them in the referral process,” she advised. Kerrie said a six-week GP Referral Form Pilot Project was currently being run in the Tweed/ Byron Bay area in conjunction with NCML. A single standardised referral form in ‘Medical

Director’ - to simplify referral pathways between GPs and Community Health - was developed for the trial. Further discussions about the formal commencement of this initiative across the Northern NSW Local Health District will take place soon. The ‘go live’ for the new 1300 number is scheduled for January 2013 and GPs will be advised by a mail out including a poster and business cards promoting the new service.

From early next year, a single 1300 number for all Community Health Services will provide easier access for general practice and all other callers.

ACON’s STIs’ youth campaign ‘Gonorrhoea is rocketing’ is the catchy name of a new campaign being promoted by ACON Northern Rivers to raise awareness among the Gay, Lesbian, Bisexual and Transgender (GLBT) community and especially young, sexually diverse people about the need to get into a routine of testing and treating sexually transmitted infections. Tobin Saunders, ACON Northern Rivers’ Community Health Promotion Officer, told HealthSpeak the campaign was prompted by a spike in notifications about the incidence of gonorrhoea on the North Coast last year. He said anecdotal evidence suggested a cluster of gonorrhoea occurred locally in 2011 and ACON was keen to encourage regular sexual health checks. “This campaign is not necessarily directed only at young people but a local youth group Fresh Fruits is helping to spread the word,” said Tobin. The Fresh Fruits group came out of an eight week ACON workshop for young gender

ACON’s Tobin Saunders at a recent community event at Ballina to raise awarenss about ACON campaigns.

diverse and sexuality questioning young people. They now meet fortnightly in Lismore and include youth from Casino, the Tweed and all along the coast. Fresh Fruits is not managed by ACON, but supported by its workers to assist young people to manage their health and wellbeing. The group also invites speakers from organisations such

as SHAIDS, Lismore’s Sexual Health Service, to talk to them about the fact that the sexual health staff welcome young people wanting a sexual health check and the service is free, confidential and you don’t need to present a Medicare card. ACON has also facilitated a workshop highlighting the need for regular sexual health checks and treatment. “It was fantastic,” said Tobin. “We had a pass the parcel game where we asked pertinent questions and the atmosphere generated by the group helped spread important messages in a fun way.” ACON Northern Rivers has extensive resources, such as posters for waiting rooms and other health promotion materials. Tobin would also be happy to run a workshop to assist health professionals with culturally appropriate language and tools to successfully engage with young GLBT people about their sexual health and the need to have regular checks. Phone Tobin on 6622 1555 or email: tsaunders@acon.org. au

Sachet-style Dose Admin Aid wins award APHS has won a Medicine Wise award for the comprehensive labelling of its sachet-style Dose Administration Aid system. APHS delivers pharmacy services to private hospitals, cancer care centres and aged care facilities. Joan France from the APHS Pharmacy in Lismore, said that the easy to use system is available for any community pharmacy to supply to its patients and nursing homes. The cost to the pharmacy for a patient’s sachets is $4 a week. The sachets come ready to use from the APHS packaging site in Perth. Packaging is fully automated with a checking system for tracking if required. Each sachet is numbered and checked by a

pharmacist and a machine picks up if there’s a broken tablet so it can be replaced. “You have all the details you need on every individual sachet – the drug name, the generic name and a description – so you are going to know that the oval mustard tablet is the multivitamin. And there are up to eight different time slots per day,” Joan said. While the Webster system has an error rate of four in 100 due to human error, the APHS sachet system has an error rate of 1 in 200,000. The sachets can be put into a dispensing box or used on their own. “If the patient is going out to lunch they just rip it off the roll and stick it in their pocket, not

like a Webster pack where you have to take the whole system with you,” Joan explained. For residential care facilities, APHS offers an entire system including med charts, signing sheets, and trolleys which the sachets fit into. APHS also provides chart audits, makes daily deliveries and takes orders. To get a private patient set up

with the sachets, a carer needs to call APHS and provide a signed medication chart from the patient’s GP. From there APHS deals with current scripts, sets up a profile and talks to the patient about their medications. A pharmacist oversees the regimen to avoid drug interactions. APHS pharmacies are in Lismore and Port Macquarie. They will organise for sachets to be made up and deliver them weekly for free to a patient’s home. “It’s so easy to use that everybody who has changed onto the system says ‘Why did we take so long, why weren’t we using these years ago?’, Joan said. For more information, contact Joan on 6624 0600.

Bullying: The missing link is parents

Dr Michael Carr-Gregg

With bullying on the rise in Australia, the Youth Mental Health and Wellbeing Network (of which North Coast Medicare Local is a member organisation) staged a one-day conference at Toormina High School, on the mid north coast recently to help tackle this disturbing trend. A total of 110 community leaders attended the conference which was led by keynote speaker Dr Michael Carr-Gregg, a psychologist and founding member of the National Centre Against Bullying. Entitled Tackling the Tough

Stuff: Grabbing Bullying by the Horns, the day-long conversation focused on how to transform this ugly bullying culture in various social arenas. Figures show that while one in six young people have experienced bullying personally, one in three say they are the victim of bullying in any one week. “There are hundreds of thousands of kids in Australia who simply do not feel safe at school.” said Dr Michael Carr-Gregg. Dr Carr-Gregg told the audience that the answer was not to create laws against bullying but about grassroots education.

There are hundreds of thousands of kids who simply do not feel safe at school “And the missing link is parents, because parents are so quick to outsource responsibility to schools. Parents need to know what bullying is… and what to do if their child is bullied or if their child is bullying.” said Dr Carr-Gregg. He pointed out that 85% of the time, bullying took place in front of bystanders. He called on bystanders of bullying to find ways to intervene like speaking up at the time of the incident or sending an SMS message to

school leadership about what they’d witnessed. “Community education sessions on bullying intervention help bring us one step closer to nipping bullying in the bud.” NCML’s Stakeholder Engagement Officer and YMHWN Steering Committee member, Rowan Lunney said after attending the conference. Another steering committee member Liz Donnan said: “I am pleased to sit here today alongside so many of my fellow school principals. This network of public and private professionals is changing the culture of how we collectively respond to bullying on the Mid North Coast.” North Coast Medicare Local Project Officer and YMHWN Steering Committee member, Rowan Lunney on attending Saturday’s conference said, “Community education sessions on bullying intervention help bring us one step closer to nipping bullying in the bud.” Resource links to help tackle bullying can be found on the YMHWN’s website: www.YouthMentalHealth.org.au For more information on how to get involved with the Youth Mental Health and Wellbeing Network, contact Jesse Taylor at j.taylor@hmnc.com.au

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Credentialed mental health nurse in Lismore In May, Dr. Thomas Wilmot, psychiatrist and psychoanalyst and Denis Casey, credentialed mental health nurse, combined to provide a new service for the Northern Rivers community at a practice in Lismore. Dr Wilmot has been in private practice on the north coast for 16 years and is well known for his work. Denis, who has worked for 24 years in the public mental health sector in Lismore, has for the past 12 years been clinically supervised by Dr Wilmot, with a specific focus on analytic theory and technique. They welcome referrals. A referred person is expected to require continuous treatment and management of their mental condition over the next two years with emotionally supportive therapy being the key element of the clinical relationship. To refer a person to this practice the person will need to be seen at least once by Dr Wilmot who will continue to take medi-

cal responsibility for the patients that Denis works with. A GP or psychiatrist can refer by requesting a 291 consultation with Dr Wilmot. (Consultant Psychiatrist and referred patient assessment and management). The referral must include a brief reason for the referral of the patient and an understanding that the person will be seen in an ongoing and regular capacity by Denis Casey for case management and therapy. The initial assessment will usually be conducted jointly by Dr. Wilmot and Denis Casey. A written report including a management plan will be provided to the referring doctor and the person referred and will include the recommended length of time and the frequency of sessions. To discuss a referral please call Denis on 6621 2241 and fax 6622 4335 or 0413 162 218 or phone Dr Wilmot on 02 9417 5625.

GP nursing is building

The rising number of nurses in general practice confirms their value.

A survey commissioned by the Australian Medicare Local Alliance (AMLA) demonstrates an increasing trend across general practices to employ nurses. AMLA Chair Dr Arn Sprogis said that the annual Australian Primary Health Care Research Institute report remained the only comprehensive survey of its type and confirmed the valuable place that the nursing profession has in general practice. “Since the first survey in 2003, not only have the numbers of nurses working in general practice increased from 2,400 to more than 10,500, the percentage of practices employing a nurse has increased from just over 40% to 63%,” Dr Sprogis said. HealthSpeak

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“Almost 90% of sampled practices report being registered for the Practice Nurse Incentive Payment (PNIP) with 16% of these indicating they were employing or intended to employ more nurses, “Dr Sprogis said. Among the key findings: 35% of nurses surveyed reported additional qualifications as an immunisation nurse compared to: 31% in 2009 27% in 2007 9% in 2003. In 2009, 9% of nurses reported having post graduate qualifications as a women’s health nurse, and this has risen to 15% in 2012.

Denis and Tom outside The Laurels in Lismore where their practice is located.

Evidence-based Immunisation Booklet available

NCML’s Immunisation Project Officers have welcomed the publication of The Science of Immunisation: Questions and Answers, a booklet produced by the Australian Academy of Science. Nationally, figures show that one in 12 children are not being vaccinated. Sadly, in the North Coast Medicare Local footprint this figure is much higher. Launching the booklet, the President of the AMA, Dr Steve Hambleton said it was a significant collation of the body of scientific evidence in support of immunisation to be made available to GPs to hand out to patients. “It has been prepared by the country’s leading scientists in the field of immunology and reviewed by some of Australia’s most prominent and esteemed science and medical figures,” he said. “The booklet will be an im-

portant reference for GPs and their patients, and it will be a valuable informative resource for the general public, public health services, schools and the media. North Coast Medicare Local’s Immunisation Project Officer for the Mid North Coast, Leigh Eastwood, said this authoritative booklet would be a great help in dispelling the many myths about vaccination swirling around the community. “Importantly, it will help counter the dangerous misinformation that is circulated by certain groups in the community who are opposed to immunisation,” she said. The Science of Immunisation: Questions and Answers is available for download or can be ordered on the Australian Academy of Science website at www.science.org.au/immunisation.html

Far North Coast – Family Referral Service

The Far North Coast Family Referral Service (FNCFRS) is a free service available for both service providers and families. The service consists of a telephone hotline and a face-toface referral service that will connect vulnerable families with the appropriate local services available to help them. The FRS is part of the NSW State Governments Keep Them Safe action plan and shares the same primary objective: better protection for children at risk. This includes: Improved access to universal services, early intervention and community based services in order to prevent problems from arising and preventing the need for children to enter the child protection system. Robust referral systems to connect children and families to the right services Providing support and referral information to Aboriginal families, connecting them to local services, with the aim of reducing the number of children coming into contact with the child protection system. Strengthened partnerships across the community services sector. FNCFRS is jointly operated by Northern Rivers Social Development Council and Interrelate Family Centres. How does the FNCFRS work? The telephone hotline is staffed by Family Intake Officers. The number for all referrals is 1300 338 774 and the Intake team operates Monday to Friday from 8am to 6pm. The area is from Tweed Heads to Grafton. The Intake Officers provide clients with advice and referrals to local community service. If a 26

FRS Team (Back left to right): Nikki Lee Family Outreach Worker - Tweed Hds, Anja Draper Family Intake Worker - Lismore, Fiona Casagrande Family Intake Worker – Lismore, Cath Hillard Aboriginal Community Development Worker – Lismore, Niki Gill Family Outreach Worker – Lismore, Anita Mansfield Program Manager, (missing Trudi Fehrenbach Team Leader, Melinda Plesman Family Outreach Worker – Grafton)

family needs more ongoing and supported assistance,the Intake Officers are able to refer the family to Family Outreach Workers. Family Outreach Workers are located in Tweed Heads, Lismore and Grafton. They can act in a case coordination role for up to six weeks. This can include meeting with families, facilitating referrals,

facilitating case conferences and brokerage to refer to a longer term lead agency. Often patients talk to their GPs or Practice Nurses about issues not specifically health related, for example a patient may mention that they have concerns regarding domestic violence, financial stress, homelessness or parenting issues.

GPs don’t always have the time and capacity to be aware of all the support services in their area. GPs and Practice Nurses can phone the Intake line for further information to help the family in concern. They can also make a referral with the family’s permission or provide the family with the hotline number. The FNCFRS is a resource for all members of the community, including community services organisations. By calling the Intake line people can find out about available employment, health, training, counselling, parenting education and support services and gain on the spot information about other family support resources. If you would like a member of the Family Referral Service to come and speak to your practice staff contact us on 1300 338 774 to arrange a time. Contact Details: Far North Coast Family Referral Service Telephone: 1300 338 774 For Tweed Heads residents you may need to call 02 66232780 Email: support@familiesnorth.org.au Mailing address: 5 Market Street, Lismore, 2480 NSW.

Become an antibiotic resistance fighter Last month NPS MedicineWise urged all Australians to join the global fight against antibiotic resistance and help reduce the spread of untreatable superbugs. With around 19 million prescriptions written every year, Australia has one of the highest rates of antibiotic use in the world. The good news is that if 35,000 Australians change the way they use antibiotics, we can bring our national antibiotic usage down in line with the average of other OECD countries. During Antibiotic Awareness Week (Nov 12 to 18) Australians were asked to pledge to become antibiotic resistance fighters by doing three things: Understand that antibiotics are only effective to

treat bacteria and not to treat viruses, like colds and flu. When needed, take antibiotics exactly as prescribed –the right amount, at the right times and completing the full course. Spread knowledge, not infections. This means practising good hygiene,

talking to your health professional about antibiotic resistance, and encouraging those around you to become resistance fighters too. More information about the NPS MedicineWise Resistance Fighter campaign is at www. nps.org.au/bemedicinewise/ antibiotic_resistance

HealthSpeak

summer 2012

It’s all very strange…

A strange lull has descended on financial markets and it’s not because the world’s problems have gone away. Latest forecasts see the world economy continuing to slow, Europe likely to move into deeper recession or even depression, and government debt levels mounting. The game changer has been the unprecedented entry of the major central banks into the economy. The “whatever it takes strategy” adopted by the European Central Bank and the US Federal Reserve has stymied the speculators. No-one wants to take on the Central Banks – with unlimited access to cash through the printing press. But it’s led to some pretty weird situations. To stave off disaster, Central Banks and governments are entering into financial transactions that are unprecedented. Situation 1 – The US The US Government is running a budget deficit of over $US1 trillion a year. As the US economy is in recession and investors extremely wary, how is the Government funding the deficit? The US Federal Reserve of course. The Fed is buying 80 per cent of the bonds issued by the Government. It is printing the money, ie creating it out of thin air, and using it to buy the bonds that provide the Government with the money it needs to cover the deficit. Simple really. Why do all that unpopular stuff of raising taxes? The Fed is also buying unlimited amounts of mortgages from the banks – taking bad assets off

HealthSpeak

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the banks’ balance sheets and giving them lots of freshly printed bank notes. The Fed says it will keep doing this forever if necessary. Isn’t this what started the mess in the first place? Situation 2 – Great Britain Like many other central banks the Bank of England (BOE) has been printing money to stop the UK economy from collapsing. Like the Fed, it has used the money to buy UK Government bonds, a nice thing to do because the UK Government is running a huge budget deficit. In fact the BOE has been buying so many Government bonds that their price has increased, the normal supply and demand effect. Now here comes the wacky bit. Because the bonds have gone up, the BOE has made a paper profit on the bonds it bought earlier – about £300 billion. Pressure is now mounting on the Government to use these ‘profits’ to cut taxes. If it was this simple maybe the BOE should run the presses day and night, buy so many bonds that the UK could eliminate taxes altogether. Situation 3 – Europe We all know that Greece is bankrupt and on life support through bailout funds. In August Greece was due to repay a multibillion loan to the EU. Lots of commentators thought this the beginning of the end game – the removal of Greece from the Euro and perhaps the end of the Euro itself. But no. Greece borrowed the money at reasonable interest rates and was able to repay the

Economy

David Tomlinson

loan. How come? Who would lend money to a government broke in every way except name? The answer is that domestic Greek banks bought most of the bonds. The money came from the Greek Central Bank that in turn obtained it from the European Central Bank, which printed the money. The Greek banks can then use these bonds as collateral to borrow even more money from the Greek Central Bank and the ECB. The Greek banks need the money to cover the withdrawal of funds by depositors who are placing their money abroad. Without the printing presses of the ECB, Greek (and Spanish) banks would have collapsed. Round and round we go. Situation 4 – Japan The Japanese Government has been trying to stimulate the economy since 1990. It now has the highest level of debt of any major economy. Frugal Japanese citizens and large pension funds that prefer Government bonds to the volatile stock market have financed almost all this debt in the past. So far so good. But times are changing. The largest pension fund in Japan with trillions under management has been a major buyer of Japanese bonds. But the workforce is aging and people are retiring. The pension fund recently announced it had stopped buying bonds and was now selling - to raise money to pay pensions. At the same time the Japanese saving ratio has dropped from 25 per cent in 1989 to around zero today. The Japanese Government debt is so large that at current bond interest rates of one per cent, half of all tax revenue goes in debt servicing costs. If the Government needs to attract foreign lenders then it may have to increase interest rates. But even a one percentage point increase would absorb ALL tax revenues. Commentators have said that Japan is a bug looking for a windscreen. Conclusion Clearly none of these situations is sustainable. Something will have

Ten years from now we are likely to be in one of the strongest bull markets we have seen to give. Printing money eases the immediate crisis but doesn’t solve the underlying problem of debt and poorly performing economies. So what are the dangers? When an economy is fully employed, money printing will lead to inflation or hyperinflation. While this doesn’t look like happening in the near term, longer term inflation looks to be the only viable solution to the mounting levels of debt. Anything else, such as big cuts to entitlements or leaps in consumption taxes, is too costly politically. But even here, the biggest sufferers from a hefty bout of inflation will be savers – predominantly retirees who will see their nest-eggs decline precipitously. Will we see retired babyboomers reverting to their youth – demonstrating, marching and trying to overthrow the establishment? 27

Profile

Brigitte Rousenel

The last chance: working as a rehab physiotherapist Going to the Paralympics and working with the amputees of the Australian team sounds like a wonderful opportunity, but in 1980 when Ballina physiotherapist Brigitte Rousenel took on this role, limited resources meant her role was akin to a ‘dogsbody’. The Olympics for the Disabled were the sixth Paralympic Games, held in Holland in June. Competitors were divided into four categories: amputee, cerebral palsy, visually impaired and wheelchair. Brigitte was invited to accompany the amputees in the Australian team because of her extensive experience in working with young people with spinal injuries and amputations at the Commonwealth Rehab Services Centre in Sydney. “At the time I was working with mostly young men, who’d done silly things – dived into shallow pools, fallen off motorbikes - and sustained serious injuries, and if a person’s goal was to get back into sports and participate, then part of my job was to support them doing that. And that’s what these people wanted to do, compete,” she told HealthSpeak. Team or individual Olympic sponsorship was pretty much non-existent in 1980, at least for Paralympians, so before setting off, Brigitte was also involved in fund-raising to meet expenses. But at last, the team were ready to fly to Holland, with Brigitte and one doctor. Emphasising she is not a ‘sports-focused’ person, Brigitte said she didn’t have many sports therapist skills, but relied on what she knew from her rehab work. The scope of the job was very broad. “No carers came with the team members, so you were doing everything for the athletes, getting up at 5am, getting them out of bed, carrying equipment, helping them get around and be on call all day and night until the last event was finished. “It was a very different challenge working with people who were at such a high athletic level compared to ordinary amputees and even in those days they were getting close to able-bodied times. But I think what comes out of those Games and the success of Paralympians probably flows onto people who are not so competitive,” Brigitte said. With a French father and Australian mother, Brigitte studied in Australia, but went backwards and forwards to France before deciding at 16 to live in Australia. Her decision to make a career in physiotherapy was based on having the autonomy to make decisions rather than being told what to do in a hierarchical structure such as nursing. And Brigitte considered being a doctor as ‘too 28

From left: Brigitte at the rehab gym at Ballina Hopsital, and at right, Brigitte at the Paralympics in 1980.

much hard work’. “In physio you can be dealing with feet, hands, kids, geriatrics, hydro, plasters and sports injury. It’s like medicine, there’s a whole breadth of work that you can generalise or specialise in,” explained Brigitte. Her love of rehabilitation work is based on the fact that no two patients are the same. “You can have two patients with problem knees – one a knee replacement and the other a septic knee. And two strokes are never the same.” And her enjoyment of her work comes from being able to help people. “People generally like what you do for them. It’s very rare that someone doesn’t get it and that makes you want to do more for them,” said Brigitte. Four years of study saw Brigitte complete her physiotherapy course and after 15 years working for the Commonwealth Rehabilitation Service in Sydney, Brigitte and her husband and son moved up to Ballina. Brigitte then became the supervising physio at St Vincents Hospital’s Rehabilitation unit (the Carroll Centre) in Lismore, working with Dr Hugh Fairfull-Smith. It was quite an adjustment for her going from working with mainly young people to working with older people on the North Coast. For the past four years, Brigitte has been the head physio at Ballina Hospital, working with the 31 patients in the hospital’s rehabilitation ward. The unit is now headed by Dr Ulla Gerich-McGregor.

The gym used for rehab work at the hospital is an inviting open space, however, it’s anything but hi-tech. “This area of rehab could be more hightech and have video games and handsets, robotics, but we are not at that level. We are happy to have a treadmill and other equipment. You can get use splints to walk and get electro-stimulation to the legs but that’s a $3000 item. The finances are not there to support that so we are very happy to have equipment that goes up and down and makes our life a lot easier” she smiled. The work is clearly satisfying as improving mobility and coordination is crucial to people returning home. Brigitte also enjoys setting a goal with a patient, working towards it and seeing measurable results. With more serious injuries, the rehab is broken down into smaller steps. Work-time challenges include supervising physio students and ploughing through the paper work required for each patient and the inevitable budget cuts that health services face from time to time. After more than 30 years as a physiotherapist Brigitte would gladly do it all over again. “Most people are very grateful for what you can do for them and really trust that what you can do for them will be the best. I think there’s a personality type that goes with being a nurse, a social worker, a physio – that you like to help people. “I love my work and do my best because these people we see don’t get another go – this is their last chance.” HealthSpeak

summer 2012

The Sandakan Death March

Light Airs

David Miller

Mr Sevee Charuruks AM, MBE

A memorial artwork depicting the Sandakan marches.

To the modern tourist, Sabah’s Mt. Kinabalu is a majestic mountain with a most unusual summit. Its features are even more striking when viewed through the frame of Doric columns which form the portico at the Kundasang war memorial at Ranau. In colonial times Sabah was known as British North Borneo The memorial is at the end of a very sad journey from 67 years ago and at a distance of 240 miles from Sandakan, a place where a series of infamous forced marches was enacted in 1945 by British and Australian war prisoners in the custody of the Japanese army. As the tide of war turned against Japan, the 1787 Australians and 641 British prisoners were marched through jungles swamps and mountains, plagued by leeches and malarial mosquitos. Mt Kinabulu’s peak is a wide tower, topped by several huge stone fingers and knuckles reaching through like the crenulations of an ancient ruined fortress. A HealthSpeak

summer 2012

swirling cloud mass around the colossus endlessly shrouds and reveals the features. The mountain grows taller by 5 mm every year, so I was told by the guardian of the war memorial at Ranau, Mr Sevee Charuruks AM, MBE. This delightful Thai gentleman played a part in breaking the silence about this rather forgotten episode of World War Two. Photos pinned up over the old ice-cream chest were yellowed and curled at the edges. One was an image of the Governor of Australia, Marie Bashir honouring Mr Charuruks at this site for his dedication to the memory of the Australian victims. The story goes that Sevee and an Australian friend chanced upon the neglected memorial some years ago. He decided to devote his retirement years to the restoration of the memorial originally founded by a Kiwi, Major G. Carter. To the Australian and British POWs 67 years ago, mount Kinabalu was a brooding and menacing presence and a symbol of Mheir suffering and oppres-

sion, towering above them ‘like a gigantic tombstone.’ Local legend says ‘this is the mountain from which the spirits of dead depart to the life hereafter’. Out of around two thousand men, a mere six survived the socalled death march of Sandakan. These few had escaped their captors and were cared for by local Borneo tribes, at great risk. The suffering of our soldiers at Kokoda in New Guinea and on the Burma Railway in Thailand is written in Anzac legend, so why not Sandakan? In 1942, the unthinkable. Western forces were overcome by an Asian army. First, the Americans at Pearl Harbour and soon after, it was the British turn to experience the disciplined Japanese army and air force in the fall of Singapore. There, tens of thousands of English and allied troops stationed in Singapore and Malaya were captured and became Japanese POWs. In a forced diaspora, these men were sent as slaves to work on various Japanese projects, most famously the Burma railway, immortalised in the ‘Bridge on the River Kwai.’ Today the pain has gone but the memory remains. Like the Kokoda track, the Sandakan walk offers an option for people who want to walk in the footsteps of our suffering soldier ancestors. After Sandakan there were not many left to tell the tale, but something more, a reluctance to face a sorry truth. The fate of the thousand men who might have survived was not unknown to the allied high command and there was even a rescue mission

One local woman who turned up with a moth flapping in her ear wrote to The Echo glowing with praise for the service

planned. But ‘Operation Kingfisher’ was not enacted due to faulty intelligence and more urgent distractions in other spheres of fighting. The suffering men were carelessly abandoned when many could have been saved. The men must have known that they had no hope of survival because six of them gave their wedding rings to a village lady for safekeeping. Sevee has an old photo of ‘The Ring Lady’. One of these rings has survived. Further Reading: ‘Only Three Returned’ and ‘The Land Below the Wind,’ biographies by Australian Agnes Newton Keith, who lived in British North Borneo and became a prisoner of the Japanese during the war. Photos from memorial by permission of Mr Charuruks. 29

Goodwill and health benefits on two wheels Bikes helped school teachers, health workers and midwives get to remote villages

By Terra Sword

Jennifer Clarke and Mark Pate’s lives revolve around bicycles. Walking up to the couple’s home in Byron Bay, Mark sits in the sunny front yard fixing a puncture in a tyre tube next to a brightly painted sign welcoming people to their home-grown charity, Goodwill Bicycles. Inside, half the lounge is a dedicated as a bike repair shop with all manner of wrenches, washers, glues, tubes and other handy gadgets. The backyard, which meanders fenceless into coastal bushland beyond the neat green grass, is brimming with veggie patches and hundreds upon hundreds of half-constructed bicycles. Jennifer tells me they have another 1500 in a storage shed up the road. Jennifer and Mark have been running Australian Goodwill Bicycles Abroad for 13 years and in that time they have collected, repaired and shipped more than 10,000 bicycles to developing nations including Ghana, the Solomon Islands, Nauru and Tonga. And it all started from a twoline ad in the local paper. It was 1999 and the couple was living in Darwin. The independence referendum had just been won in East Timor and the Indonesians had withdrawn. Darwin was seeing a lot of refugees arrive on its shores and Jennifer and Mark heard many stories of how limited transport was in the new nation. So they placed a classified in the NT News asking for people to donate old or broken bikes so they could fix them and send them to Timor. The ABC News heard about it and the story went national. “We had calls from Adelaide, Tasmania, everywhere. I think the phone rang 400 times that day,” Mark said. “We were living on the dole and we had no funding and no money. It just happened. We sent 8000 bikes to Timor and places like the Lions Club helped out.” The couple went to live in Timor for two years where they saw the amazing benefit some30

Jennifer Clark and Mark Pate rarely get a day off.

Half the lounge room is dedicated to a bike repair shop.

thing as simple as a bicycle could provide to people with virtually nothing. “East Timor was in pretty bad shape at the time and the people were pretty traumatised,” Jennifer recalls. “Transport was very important for people. It meant they could get their goods to market; kids could get to school easier and people could go to work over long distances. It also helped a lot of school teachers and health workers and midwives get to vil-

lages in remote areas. “Instead of a three-hour walk they’d have a one-hour ride.” In the past Mark and Jennifer have received help from AusAID. The couple has also worked with charities on projects in indigenous communities in Australia where kids are taught to repair and maintain BMX bikes which they then get to keep. Often the couple are reluctant for media coverage because their workload balloons and they

have no one to share the load with. But it’s hard to stop when Australians throw out two million bikes each year. “The bikes will just go to the dump. What a waste,” said Jennifer. “We’re the biggest bike recyclers in Australia as far as we know.” In July, Australian Goodwill Bicycles Abroad Inc achieved OADGS status, which means people can now make tax deductible donations. The couple is in the midst of writing proposals to philanthropists and corporations while putting together a shipment of bikes bound for Cambodia. First, they will need sponsorship from an NGO in Phnom Penh, which will help them ship and distribute the bikes to those most in need. “What we really need is people. If one person in every state took it up and became a collection point for us we could be sending thousands more overseas,” Mark said. The couple also provides cheap repairs and bicycles to Byron Bay locals. “Lots of people here rely on bikes as their only form of transport,” said Jennifer. “They are environmentally friendly, have a low carbon footprint, they provide cheap transport and it means there’s less traffic on the road. There are so many reasons why bikes are better.” Mark and Jennifer rarely get a day off from Goodwill Bicycles but the pair seems content with the life they’ve not necessarily chosen, but certainly adopted. “I had a great teacher who said, ‘If you can do something good, do it,’” Mark tells me. “That’s the basis for my whole existence.” For more information: www. goodwillbicycles.com HealthSpeak

summer 2012

Books with Robin Robin Osborne

The Office Gideon Haigh Miegunyah Press - $45.00 A short review can do little justice to this hefty (609 pages), deeply researched, superbly penned and splendidly designed history of how the work unit we take for granted came into being. Whatever images ‘the office’ may conjure, the subject is anything but dull, although as the author notes, “An office too exciting, of course, might conceivably be failing in its mission – offices are geared, after all, to transfiguring the events of an unequal, uncontrollable and unpredictable outside world into paper and process, and minimising distraction from the task at hand.” A middle path, then, which is certainly the dress style for the executives in the opening photos of this volume: the suited figures of Gary Cooper, in the film of Ayn Rand’s The Fountainhead, and the Don Draper character from Mad Men. Yet the real story of office work begins in the time of the Pharaohs, some 4000 years ago, when ‘model scribes’ were toiling away in an environment not greatly different to many an office today, minus the technology. Fast forward to mediaeval Europe where the word ‘office’ implied more a position than a place, but was ripe for development. By the 17th century the office was on a roll: “The church had pioneered it, the state had developed it; the office was about to encounter a third formative influence.” This was the world of commerce, and soon enough, banking, which gave rise to images familiar in the works of Dickens – frock-coated clerks bent over ledgers, squinting in the poor

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light, knowing they had decades of such toil before retirement. Offices, and the work conducted in them, would never look back, only becoming obsessed with the need for greater efficiency. There came the need to make copies of documents, at first by hand, including shorthand - the extraordinary Isaac Pitman is just one of a myriad historical characters - and later through the development of increasingly clever machines. Space became important – time for the work cubicle in an open-plan office, the typewriter, filing cabinet, drawered desk, the paper-clip and stapler... Office work went global thanks to the telegraph, telephone, now computers, and the buildings designed to accommodate the workers went upwards. Great city skylines, notably New York’s, is a major focus of the story. But apart from superstars like the Rockefellers, Donald Trump, Bill Gates and Steve Jobs, the individuals who staff offices, increasingly women, have remained surprisingly anonymous. As one source said back in the 1950s, “We know more about the...primitive people of New

Guinea or elsewhere than we do of the denizens of the executive suites of Unilever House.” While this has changed, thanks to endless movies, TV shows and novels - a great many of which Haigh lists - the whole picture has rarely, if ever, been assembled. So we should thank this Australian author and journalist, perhaps best known as a cricket writer, for showing how and why offices, in both the private and public sectors, came into being and have been organised, and how those spending their working lives there have undertaken their tasks. As for the big question about what’s coming next, he says, “The state of the office today reflects the global state of flux, from American overreach, Asian prosperity, technological advance, cultural abrasion; from the impacts of a period of accelerated and accelerating change, the office will not be spared.” As I’m writing this from home, I can hardly disagree. Robin Osborne is a North Coastbased media and communications adviser in the health field.

Links between chronic disease and oral health An Australian Health and Welfare Report, Chronic conditions and oral health, shows that people with chronic conditions and diseases were more likely than those without to have poor dental health. The report found that people with chronic conditions such as asthma, cancer, heart disease, diabetes, arthritis, stroke, kidney disease, high blood pressure and depression were more likely to: Experience toothache Be uncomfortable with their oral ap-

pearance Avoid certain foods due to oral health problems Have difficulties chewing food and Experience orofacial pain Among people with a chronic condition, those who had experienced a stroke had easily the highest average number of missing teeth, and were by far most likely to have inadequate dentition and to avoid some foods due to oral problems, said spokeswoman Professor Kaye Roberts-Thomson.

Australia’s rural women – achieving a healthy balance By Penny Hanley Media Manager, the National Rural Health Alliance

The National Rural Health Alliance is a dynamic collection of organisations that aim to apply their skills and expertise to help governments, health professionals and rural communities to improve the health of people in rural and remote Australia. The Alliance believes that all Australians should have equitable access to the health services they need, regardless of where they live. Women’s health has been a priority for the Alliance for some time, including at the biennial National Rural Health Conferences that it manages. The next conference is in April and details can be found at www.ruralhealth. org.au Leaders of the Australian Longitudinal Study on Women’s Health based at the Universities of Queensland and Newcastle, regularly report their findings about women’s health at these

Lesley Barclay out on the water practising work/life balance.

conferences. Their last report, on ruralurban differences, confirms that rural women have poorer health and worse access to health services than those in cities. They have higher levels of risk factors such as obesity, and the healthcare they receive is not measuring up. Despite this, women in rural areas are resilient and respond well to health promotion messages. Breast screening rates were higher in remote than in city areas, and Pap test rates were highest in regional areas. These issues are of particu-

lar interest to the Chair of the National Rural Health Alliance, Lesley Barclay, from Lismore who is also a Board member of North Coast Medicare Local. Lesley is an internationally recognised maternal health researcher who uses innovative methods to investigate complex problems. She is a Distinguished Fellow of the Australian College of Midwives and one of the few women designated a Samoan Chief in recognition of her outstanding work in Samoa. In her ‘day job’ Lesley is Professor and Director of the Northern Rivers University Department of Rural Health for

Sydney University. She enjoys her work but still maintains a sensible work/life balance, making time for her family, friends and relaxation. Fact Sheet 25 on Rural maternity services, Fact Sheet 31 on Women’s health in rural Australia and Fact Sheet 29 on Medicare Locals in rural Australia are available on the Alliance’s website above, along with the Alliance journal Partyline and a large range of other information on contemporary rural and remote issues. Subscription details for the Alliance’s peer reviewed journal, The Australian Journal of Rural Health are on the website.

Receptionist Training

Community interest in NCML It was a full house at the NCML training held for health practice receptionists recently in Lismore. Phone Viv on 6622 4453 to express interest in future training days.

Dementia care training online New online, interactive courses are available free of charge to NSW health professionals working in the demanding and growing area of dementia care. The Dementiacare Resource and Training eLearning program has two courses

NCML’s Tarmons House Mental Health Service was among exhibitors at a recent Community Day held at Lismore Library. Tarmons’ manager Vickie Williams said the After Hours GP helpline fridge magnets she handed out created much interest and that other exhibitors called by to chat and share information about local community and health services. The After Hours GP helpline number is 1800 022 222.

A 12-week course for acute care workers – RNs, ENs, and allied health professionals A 4-week course for community workers – Assistants in Nursing and Personal Care Assistants The content was developed by the University of Newcastle

and the program is delivered in weekly lessons with real time online chats, discussion forums, quizzes and case studies. Upon completion of a course, graduates can subscribe to the Alumni giving ongoing access to resources, research, peer collaboration and key stakeholders, academia and organisations working with dementia. The Northern NSW Local Health District (NNSWLHD) Dementiacare team is responsible for the development and deployment of this program to clinicians across NSW and it’s funded by the NSW Ministry of Health. For more information go to: http:/dementiacare.health.nsw. gov.au HealthSpeak

summer 2012

Wine and good health Chris Ingall

Refreshing wines for Summer It’s on again! Yes, you can feel summer in the air can’t you dear reader. And what better time to drink wine, something which refreshes and renews us like the season. If you are rushing into a bottlo on the way to a classy lunch, pick up a young riesling, pinot or one of those “Classic “ white wines from WA such as the Evans and Tate. Or, if you must, a sauvignon blanc. All will scintillate your tastebuds and help the gourmet BBQ food slip down (and who doesn’t do gourmet now, with Master Chef judges sitting at every table). How can you tell if a wine will last for you? Here knowledge is important, as knowing which grapes tend to last, their pedigree, will run true. Shiraz, cabernet and riesling are grapes which usually develop nicely in a bottle, while pinot noir, sauvignon blanc and chardonnay, particularly at a sub $20 price point, may well disappoint after a few years. You can also look at how the grape is handled, (think Beaujolais Nouveau compared to the later gamay version, a proper wine) and the vintage. So be a bit careful with the 2011 vintage in general, and the 2012 vintage in the Hunter, as the cold, wet db conditions made it

HealthSpeak

summer 2012

hard for grapes to ripen, and encouraged rot on the vine. Wines made from poor vintages may have a little sugar and/or tannins added to flesh them out, or have some grape juice from elsewhere mixed into the ferment. In the Trade, it is well known that Tyrrell’s “Long Flat “stretches all the way to the Barossa. Such manipulation does not a long life make, and in general wines made in the vineyard last longer than wines confected behind the cellar door. So if it is part knowledge, what is the other part? Why your senses of course. This obviously entails opening the bottle, or (if you are lucky) tasting it at the BBQ mentioned above. Sight, smell, taste and back palate perception are all you need to know when that wine will be at its peak. It goes like this; if you look at the (now empty) bottle and it has a crust on the inside, the wine will be concentrated and powerful, and usually a stayer. The now full glass gives you a clue as well. Purple hues in a red wine and green notes in a white tell you it has a few years left in it, while yellows and browns scream drink me now! (or yesterday). Once safely under the nose, the lack of smell (a closed wine) is an indicator the wine is still asleep, and should be left in the glass to waken over an hour or two. (This is in contradistinction to adolescent children, who can be quite ‘on the nose’ when poured out of bed in the morning, but should be similarly left for an hour or two to allow awakening). If the glass is full of heady aromas, much like a rose in bloom, then get stuck in and finish the bottle, and any others you can find in the cellar. It won’t get any better. By now it has made its way into the mouth, you are tasting more than smelling, and the sweetness of the wine will be your main sensation. A balance here between green (stalky, sappy) elements and the red and black fruits will make the wine delicious, but if the amines in the glass have developed to a point where all you can taste is plum (merlot), strawberry (pinot noir) or ripe berries (shiraz) then make hay while the sun still shines in

lack of smell is an indicator the wine is still asleep the bottle, and drink it all. If the fruit has left the wine, and it does not satisfy, serve it extra cold to the rellos at the next Christening. You are just about ready to swallow it, and now you will feel a sensation in the top of the mouth, something like oversteeped tea, and these tannins come from both the grape skins (in a red) and the wooden barrel. They should be long and soft ideally, and the longer they last the longer the wine will cellar for. Similarly in a white, it is the beautifully fine acid which is experienced on the tongue and palate which indicates its longevity. Like us, wine cannot stand up without a spine, and when it leaves the mix the wine falls over.

Wine Tip This spring throw all your wine into the fridge before serving. The whites can then find an ice bucket on the table, while the reds can warm up in your glass. As the wine warms, you will get to know the temperature you like to drink it. Reds will change from closed to open in your hand, and the alcohol will not fall out of the glass if it is cool enough.

Cellar Tip If you are out to lunch, and taste a bottle which you can now confidently say has some life ahead of it, photograph the label (I can never remember the vintage) and find it locally or on-line. Buy six bottles (or if you are under forty, maybe twelve) and bring one out every year or so. You’ll get to know the pedigree, and how it develops, much better that way. Only you can decide if you like it.

Diary

7-10 7th Australian Women’s Health Conference Sydney Themes: Gender as a social determinant of health and wellbeing; Advancing women’s health using science and technology; Creating health communities and systems for wellbeing; Information government policy to improve the health of Australian women; Innovative practice within a social health perspective. www.womenshealth2013.org.au 17-19 General Practitioner Conference and Exhibition (GPCE) Olympic Park, Sydney The Sydney General Practitioner Conference & Exhibition offers a superior learning experience that features 40 seminars, 68 hands-on workshops delivered by Expert speakers. It also provides access to leading healthcare products and services all in the one location. Contact: gpce@infosalons.com.au 26-29 Paediatrics and Child Health Annual Meeting Perth Convention Centre Contact: racpcongress@wsm. com.au

September 13 to 15 General Practitioner Conference and Exhibition (GPCE) 34

1 OSSANZ 2013: 24th Annual Scientific Conference of the Obesity Surgery Society of Australia and NZ Gold Coast Contact: ossanz@thinkbusinessevents.com.au

What is the largest country in Africa?

What is the national capital city of Canada?

What was the name of the first female singer to have 30 Top Ten hits?

How many ribs are in a human body?

In Roald Dahl’s famous book, what do the letters BFG stand for?

Australia has more beaches than any other country – does it have around 5,000, 7,000 or 8,000?

What is the minimum amount of games required to play to win a set in tennis?

From what animal fur are Akubra hats made from?

Which breed of dog is believed to be the fastest?

What is the capital of Jordan?

Which dinosaur ate plants and had spiky plates along its back?

What is the name of the largest river in France?

How many points is the green ball worth in snooker?

What was John F Kennedy’s middle name?

What was the Luftwaffe?

Which planet has the most moons?

How many lines does a limerick have?

In what year did Madonna release her song entitled ‘Like a Virgin’?

From which Disney film does the song ‘When you Wish upon a Star’ come?

17-19 GP13: The Conference for General Practice of the Royal Australian College of General Practice 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 27-30 15th World Conference on Lung Cancer Sydney Contact: wclc2013@icsevents. com

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

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Answers:

May

October

What is Tiger Wood’s real first name?

19/20 Asthma Australia 2013 National Asthma Conference Rydges Lakeside, Canberra Theme: Tackling asthma in Australia – the next 5 years. Contact: conference@asthmaaustralia.org.au

2. 3. 4.

7/8 6th International Endoscopy Symposium Hilton Hotel, Sydney More info: info@e-Kiddna.com

Which two parts of the body continue to grow throughout our lives?

14. 24 15. Big Friendly Giant 16. 7,000 17. Rabbits 18. The Greyhound 19. The Loire 20. Three 21. Fitzgerald

March

5. Jupiter 6. Five lines 7. Six 8. Amman 9. Stegosaurus 10. 1984 11. Pinocchio 12. Eldrick 13. Ottawa

January 27 to February 1 Diabetes – New Insights into Mechanism of Disease and its Treatment Keystone, USA Contact: info@keystonesymposia. org

Brisbane Convention Centre The launch of the Brisbane GPCE follows on from the success of the established GPCE events in Sydney and Melbourne. The Brisbane GPCE scientific program will be accredited by the RACGP and will focus on key primary healthcare topics with a specific bias towards Queensland-specific issues and themes. Seminars run for 1 hour, are didactic presentations and can hold from 60 to 200 delegates. Workshops are for smaller groups of up to 25 and are interactive, including the use of case studies, role plays or practical hands-on sessions. The Brisbane GPCE will be co-located with the Brisbane PNCE conference. Contact: vanessa.hilliard@reedmedicaleducation.com.au

The nose and the ears Algeria Mariah Carey The German air force during World War II

January

Trivia

summer 2012

Anne Criner Clinical Nutritionist

more services · quality facilities

Specialising in dietary advice for: Gastrointestinal Disorders Food Allergy and Chemical Sensitivities Appts available Alstonville/Lismore Some Health Fund Rebates Apply P :6628 5464 M: 0429 844 835

PATHOLOGICAL WASTE DISPOSAL Container Collection/Exchange

RICHMOND WASTE SERVICES Phone 6621 7431 – 6687 2559 Lismore • Ballina • Casino • Byron

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

•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

GOLD COAST VASECTOMY CLINIC Providing Vasectomies since 1993 Dr Greg Anderson Phone: (07) 5530 2822 Suite 5, Bell Place, Cnr Bell Place and Link Way Mudgeeraba Qld www.goldcoastvasectomy.com.au

GP VACANCY BALLINA Family Medical Centre www.ballinamedical.com.au

TINTENBAR MEDICAL CENTRE GP WANTED F/T, P/T GP wanted to join innovative, award winning, friendly small group Practice with full Nurse Support. Pathology is on site, in a beautiful rural setting. Phone Dr Lynne Davies on 0266878299 or email admin@tintmed.com.au

Seeking a full-time GP, 8-10sessions, M/F &/ or husband /wife team. Assistant with view to Associateship. Five doctor practice, currently 4 male,1 female. Happy workplace, long term loyal staff, supportive environment .Mixed billing. Modern purpose-built surgery, 5 consulting rooms, 2 bed treatment area and minor theatre. Opportunity to practice all aspects of Family Medicine in relaxed North Coast Lifestyle VMO position at Ballina Hospital optional. Well run, efficient practice. Enquiries pm@ballinamedical.com.au or phone 02 6686 3299

GOONELLABAH MEDICAL CENTRE www.gmc.net.au

GP VACANCY GP full or partime wanted. Large accredited and teaching practice 11 consulting rooms, 2 theatres, 7 bed nursing treatment area. Full nursing support, diabetes educator, psychologists Contact practice manager on 02 6625 0000

APHS Pharmacy Lismore Located in The KG Lawrence Centre, 20 Dalley Street, Lismore Specialising in: t Aged care medication service t Innovative medication sachets - Winner, 2012 National MedicineWise Award t Hospital, inpatient and outpatient oncology services, including patient liaison t Cytotoxic and sterile admixtures t Prescription and over-the-counter medication. APHS Pharmacy can provide hospital staff with the necessary education to minimise risk and ensure best practice in the area of medication administration.

www.aphs.com.au

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

summer 2012

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