HealthSpeak Summer 2014 by North Coast Primary Health Network

ISSUE 6 summer 2014

HealthSpeak

A publication of North Coast NSW Medicare Local

Closing the Gap

page 5

Connecting people with the health care they need 6

Telehealth made easy

Working on Christmas Island

The Topic of Sex

Talking about Weight Loss

Living in the land of plenty Janet Grist Head Office Suite 6 85 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncml.org.au Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 General Manager: Paul Ward Email: hm@ncml.org.au

Editor

I’ve just returned from southern India, a country I love, and always a stark reminder of our good fortune here in

Australia. Over there people die on the streets every day because there is no healthcare safety net, and it wasn’t that long ago that there wasn’t a word in Hindi for ‘cancer’. This was because cancer was something that most people couldn’t afford to treat, so there was no point in speaking about it. We often forget how truly lucky we are to live in a country where universal health care is

a given. At Christmas, it’s important to remember that some people in our communities are struggling, so why not dig into your pocket to help look after these families? Donate some money or goods to welfare organisations organising hampers and Christmas cheer. At least once a year it’s good to celebrate our good fortune and prosperity by extending a hand to help others.

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

Much achieved and more to be done Sharyn White Acting Chief Executive Officer

Tweed Valley Unit 4, 8 Corporation Circuit Tweed Heads South 2486 Ph: (07) 5523 5501 Acting General Manager: Wendy Pannach Email: tv@ncml.org.au

Contacts Editor: Janet Grist Ph: 6622 4453 Email: media@ncml.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Display and classified advertising at attractive rates HealthSpeak is published four times a year by North Coast NSW Medicare Local Ltd. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCML. The NCML accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. ©Copyright 2014 North Coast NSW Medicare Local Ltd Magazine designed by Graphiti Design Studio Printed by Quality Plus Printers of Ballina

Welcome to the final HealthSpeak for 2013. Our CEO Vahid Saberi is on a well-deserved vacation and my respect for the job that he does has certainly grown, the more time I spend attempting to fill his shoes. Christmas is fast approaching and the end of year mad rush is upon us. We have recently prepared and published our first full year annual report, which documents our progress since June 2012. I really enjoyed taking time to reflect upon the achievements of that first year, and they were many. Anyone can view the annual report at: http://www.ncml.org. au/index.php/about-us/keydocuments. If you pay that site a visit, you might also like to view the inaugural North Coast Medicare Local Needs Assessment which includes lots of information about the health of our region, the things that impact upon it, and how you can

provide feedback or additional information. Mental Health is a key area of need in our region and a particular focus for us. I am pleased to report that North Coast Medicare Local is expanding the services on offer to North Coast residents experiencing mental health problems. The headspace clinic in Lismore is due to open in late January and there is lots of excitement around this project. The building renovations are well underway and the site in Carrington Street is a hive of activity. The headspace Operations Manager is busy recruiting a team and working enthusiastically with the consortium to ensure the service will be a great one. We have been successful in being selected as one of only three demonstration sites for NewAccess, a beyondblue program. NewAccess is an innovative service delivering low intensity Cognitive Behavioural Therapy for people with mild to moderate depression. We know that many, in fact most people experiencing this level of anxiety and depression never get help, for a range of reasons, including feelings of stigma, difficulty accessing a GP referral

or problems with transport. Men in particular are reluctant to access help from traditional sources. The great thing about the NewAccess program is that it is free, and does not require a GP referral or attendance at a Mental Health Service. This program will allow us to employ eight coaches to deliver the services across our whole region. The service will open in January, so watch out for the advertising information and pass it on through your networks. While these two projects are very exciting, there is certainly much more to be done. At a meeting I attended today of agencies providing services to homeless people, or those at risk of becoming homeless, it was clear that mental health issues have a major impact on this extremely vulnerable group. As we all prepare for the Christmas break it’s sobering to pause and wonder what we would be celebrating, if many years ago a particular homeless family (with a pressing health need) had not been given access to shelter because one of them had a mental health problem? I would like to thank you for supporting Healthspeak this year and wish you a safe and Happy New Year.

Cover image ‘Closing the Gap’ by Alison Williams.

HealthSpeak is kindly delivered by HealthSpeak

summer 2014

The fat and the lean of it

Opinion Andrew Binns

– sarcopenia’s (increasing) relevance in the ageing society Amidst the nation’s rapidly growing ‘diabesity’ epidemic it is hardly surprising to see clinicians placing significant focus on the metabolically dangerous visceral fat that so easily concentrates around the waistline. But should we also be focusing more on the implications of the decline in lean muscle mass that we know begins after the age of 50? The term sarcopenia entered our medical vocabulary in 1989 when Irwin Rosenberg (Rosenberg I, Am J Clin Nutr 1989: 1231-3) stated that, ‘there is probably no decline in structure and function more dramatic than the decline of lean body mass or muscle mass over the decades of life.’ Rosenberg coined the Greek term ‘sarcopenia’ (derived from ‘sarx’ for flesh and ‘penia’ for loss) to describe the loss of muscle mass amongst older people, and before long the term had entered the medical mainstream. In 2010 the European Working Group on Sarcopenia in Older People developed a clinical definition for age-related sarcopenia, along with three consensus diagnostic criteria based on: 1) low muscle mass, 2) low muscle strength, and 3) low physical performance. The diagnosis requires the documentation of criterion 1 plus documentation of either/both of criteria 2 and 3. (Cruz-Jentoft AF et al Age Ageing 2010: 39 (4) 412-423). Sarcopenia can be caused by ageing alone or by sedentary lifestyle, bed rest, and certain diseases that involve organ failure, inflammatory disease, malignancy or endocrine disease. Additionally, nutrition can have an impact, with sarcopenia resulting from inadequate dietary intake of energy and/or protein as happens with malabsorption, gastrointestinal disorders or use of medications that cause anorexia. In other conditions such as malignancy, rheumatoid arthritis and ageing, lean body mass is lost while fat mass may be preserved or even increased. HealthSpeak

summer 2014

Above: An example of inexpensive and easy to store ‘body tube’. Below: Sarcopenic obesity with ageing

Thigh at age 25

As we age strength and power decrease This apparently paradoxical state is known as sarcopenic obesity. Muscle composition change is important when ‘marbling’ or fat infiltrates into muscle, alongside a decrease in fast twitch type 2 muscle fibres, lowers muscle quality work performance. So, as we age there is a decrease in strength and power, fast strong movements, fine dexterity, endurance of sustained power, acceleration/deceleration of movements and coordination. Muscle mass and type 2 muscle fibres diminish, central and visceral fat increases, and bone becomes demineralised, leading to osteopenia and osteoporosis. Chronic disease and falls risk increase. There is an associated decrease in motor and sensory

Thigh at age 63

neurons and reduced functional capacity and V02 max (the maximum capacity of an individual’s body to transport and use oxygen during incremental exercise).

Taking its measure

Sarcopenia can be measured in different ways. Muscle mass can be measured with CT, MRI, DXA, or more practically in a GP surgery with inexpensive BIA scales (not highly accurate but good for comparison after an intervention). Strength can be measured easily with a grip strength dynamometer and physical performance by gait speed and the so called ‘get up and go’ test. And don’t forget waist measurement for assessing visceral fat. Progressive resistance training is the best intervention to slow or reverse sarcopenia. Quality of life and function (through strength, endurance and balance training) may be increased at any age as long as the exercise intensity, duration and frequency are sufficient to overload the system

without straining them. Changing the load may be necessary for progressive resistance training and working against a heavier load. All this surely adds up to more than poly pharmacy could possibly achieve and at much less cost for both the individual and the overall health budget. A simple piece of equipment to recommend to a patient for resistance training is a professionally designed yet inexpensive body tube (rubber resistance tubing with handles). An important message for patients is that as they tone up and gain muscle they may lose fat but not necessarily weight. However losing visceral fat, as well as the fat that can infiltrate muscle, will lead to better metabolic health. In addition there will be major improvements in day to day functioning and quality of life.

The benefits of progressive resistance training: Increase in lean muscle mass and hypertrophy Fat replaced by lean mass Reduction in total and intra-abdominal fat Aerobic capacity and V02 max improvement (improved physical fitness) Improved joint mobility and flexibility for those with osteoarthritis Improved bone density Improved gait and gait speed Decrease in heart rate and diastolic blood pressure Improved insulin resistance Less risk of falls

Lismore headspace opens next month

Tony Lembke wins AMLA Award

The new home for Lismore headspace in the heart of the CBD.

Renovations are well underway at the new headspace offices at 2A Carrington Street, Lismore in preparation for the opening of the city’s new headspace. Lismore headspace, a part of a national headspace program, will provide an evidence-based, multi-disciplinary youth mental health service with an emphasis on early detection and intervention. Operations Manager Katrina Alexander told HealthSpeak that the threestorey building would house

headspace and other services looking after the same client group – 12 to 25 year-olds. “Member organisations of the Lismore headspace consortium will provide a range of staff to work with headspace clients, which will make headspace a one-stop shop for the mental health needs of 12 to 25 year olds,” she said. Lismore headspace is scheduled to open its doors in late January. A fun official opening is planned in March with a street party and local bands.

New Bereavement Search Filter makes finding evidence easy CareSearch, the Palliative Care Knowledge Network from Flinders University, has developed and validated a Bereavement Search Filter for use in PubMed, the free online version of Medline. The death of a loved person is a significant loss and people respond differently, with some experiencing intense and persistent grief. Bereavement is therefore an important part of care and care planning. The search filter is an experimentally derived, tested and validated tool that makes finding existing and emerging evidence easy. The Bereavement Search Filter has been combined with 21 topic searches dealing with important aspects of bereavement 4

care such as therapies or assessment, and bereavement in specific population groups. The Bereavement Search Filter and the PubMed searches are available in the Clinical Evidence section of the CareSearch website. http://www.caresearch.com. au/caresearch/tabid/2784/Default.aspx It adds to the resources that are available to support health professionals in specialist palliative care services, in hospitals, in residential aged care and in the community. The development of the Bereavement Search Filter was guided by an Expert Advisory Group of clinicians, counsellors and psychologists.

Tony Lembke receives his award at the ceremony on the Gold Coast.

NCML’s Chair Dr Tony Lembke has been recognised for his work in championing the Medicare Local model with the Individual Distinction Award at the National Primary Health Care Conference on the Gold Coast recently. Tony is a full time GP in Alstonville, and works as a VMO at the Lismore Base Hospital. No stranger to awards, Tony won National GP of the year in 2012 for his ongoing commitment to general practice and the 2007 John Aloizos Medal for outstanding contribution to the Divisions of General Practice. Tony said he was proud to receive the AMLA award and commended the other Medicare Local award winners for their outstanding work. Admired for his leadership and pioneering style, some of Tony’s achievements include

quality improvement models adopted by North Coast NSW Medicare Local, and the visionary implementation of a localised patient controlled electronic health record (a precursor to the PCEHR). He has also been a member of numerous national and state committees working to improve health. NCML CEO Vahid Saberi said the Medicare Local was fortunate to have Tony as its Chair. “He brings vast experience, acute intellect and a commonsense approach to the Board’s operations. “Tony’s work as a collaborative leader has been crucial in underlining the importance of general practice as a ‘medical home’. He has also been instrumental in bringing together health disciplines and service managers to focus on the idea of patientcentre care,” Vahid added.

Allied Health Hub for palliative care A new Allied Health Hub has been set up by CareSearch, the reliable palliative care website that hosts the Nurses Hub, GP Hub and the Residential Aged Care Hub. The Allied Health Hub will allow allied health professionals to have access to high quality online palliative care information to better

support clients who are approaching the end of life. It is specifically designed to meet the information needs of allied health professionals who work with palliative clients and is available at www. caresearch.com.au If you would like to request hard-copy resources or more information, email caresearch@ flinders.edu.au.

HealthSpeak

summer 2014

Terry Donovan wins prestigious Community Award NCML staff were thrilled to learn that popular Coffs Harbour Closing the Gap Outreach Worker Terry Donovan was recognised for his commitment to improving health in the Aboriginal community, recently winning the Grace Roberts Memorial Award for Community Worker of the Year. The awards were held at the Pacific Bay Novotel on November 8. Terry’s Closing the Gap colleagues nominated him and colleague Helen Lambert told HealthSpeak that it was an exciting night sharing a table with Titans player Preston Campbell and his manager Matthew Francis. Terry’s wife Leanne accompanied him to the awards. Terry told HealthSpeak that he was so certain he wouldn’t win

About the cover image

Titans player, Preston Campbell, Helen Lambert and Terry Donovan at the awards night in Coffs Harbour

the award he almost didn’t go to the ceremony, and when his name was announced he was in total shock. “But I’m very happy to have received this award and really proud of what we’re achieving

at NCML in Closing the Gap. We’re really starting to make a difference and over the past 12 months I’ve held cultural awareness training for more than 250 people in different parts of our region,” he said.

This issue’s cover image ‘Closing the Gap’ is by Aboriginal artist Alison Williams, a descendant of the Gumbaynggirr tribe who live in the Clarence Valley. Alison painted this artwork after being briefed on the Closing the Gap program. She is recognised as one of the leading contemporary Indigenous artists on the North Coast. Terry said he loves working at North Coast Medicare Local and wants to continue working with the Aboriginal community for the rest of his working life. Congratulations, Terry, we are proud to have you as our colleague.

Soup kitchen clinic hits a milestone The GP clinic that NCML established at the former Winsome Hotel in Lismore (now housing Lismore’s Soup Kitchen and accommodation for men who are homeless) has seen more than 100 patients since it opened late last year. Dr Charlie Hew and community nurse Bronwyn Browne run the clinic for ‘Winsome folk,’ and other marginalised people needing care, each week for one and a half hours, seeing up to six patients each session. Bronwyn said she was

delighted to have joined the team in August as the work that is done at the clinic is ‘so worthwhile’. The clinic has also provided nursing students from Southern Cross University with an opportunity to carry out health assessments on patients waiting to see the doctor. “It’s important for the students to get some real life hands-on experience in a community setting,” she said. Charlie said he was pleased to be able to volunteer his time to look after the Winsome patients and said patients present-

ed with all the usual conditions seen at a mainstream general practice. The Lismore Soup Kitchen Inc is staffed by volunteers and receives no government funding.. To help ensure a steady flow of funds, Winsome management set up The Winsome 500 Club. They are looking for 500 people to donate $10 per month. Donations are tax deductible. If you want to join, simply request your payroll officer to directly deduct the $10 payments each month. The account name is Lismore Soup Kitchen Inc. The BSB is 012-

Charlie Hew and Bronwyn Browne

528 and the Account number is 2011 09715.

IT’S BETTER SEEDLESS

Easy, Safe, Male Contraception Dr Greg Anderson | MB BS(Qld),Dip RACOG,FRACGP.

Providing vasectomies since 1993

HealthSpeak

summer 2014

Call 07 5530 2822

Suite 5 Bell Place Cnr Bell PL and Link Way, Mudgeeraba www.goldcoastvasectomy.com.au

Telehealth made easy The success that Holdsworth House Medical Practice in Byron Bay has had in linking its patients with specialists via Telehealth consultations is something its practice manager Teresa White wants other practices to know about. She’s an enthusiastic advocate for Telehealth, which she says is simple to set up and has proven to be a ‘win, win, win’ for the patient, GP and specialist. At Holdsworth House a Telehealth consultation takes place in one of the GP’s rooms with the GP and patient present, linked up via Skype and webcam to the specialist. After the Telehealth consult the GP will debrief with the patient before winding up the session. The feedback from patients has been overwhelmingly positive

and Teresa says even patients who were not tech savvy found they quickly became accustomed to the Telehealth setting and found they were very comfortable during the consultation. HealthSpeak visited Holdsworth House and spoke to Teresa to make use of the experience her GPs have gleaned, so that other medical practices, aged care facilities and clinics can easily follow in their footsteps. Here’s how to do it… 1) First, check eligibility and requirements at http://www.medicareaustralia.gov.au/ provider/incentives/ telehealth/ For instance, a range of health professionals can participate in Telehealth

Move, eat, live well outdoors

connection will work perfectly just before the link, it may well drop out when the specialist comes online, so allow five minutes to reconnect just in case. And make sure you have the phone number of someone in the specialist’s rooms to communicate with if Skype does drop out. Teresa White

including specialists, consultant physicians and psychiatrists, medical practitioners, nurse practitioners, midwives, practice nurses and Aboriginal health workers.You can also check if your location is eligible and find out any other policy and paperwork requirements on this web page. For instance, in rural/regional areas there’s a requirement that there be at least 15km distance by road between the specialist and the patient. 2) What equipment do I need? All you need is a laptop or an iPad with a webcam ( sound and vision) and a Skype account. If you don’t know how to set up Skype, simply Google ‘How to use Skype’ and a range of websites will pop up to guide you through this process.

From left: Maya Spannari, Healthy Communities Coordinator, Move, Eat, Live Well; Denis Juelicher, Project Officer, Community Garden and Aboriginal Move, Eat, Live Well; Trish David, Health Promotion Officer, North Coast Health Promotion; Christine Cox, Program Manager, North Coast Medicare Local; Peter Besseling, Mayor; and Libby Mackintosh-Sallaway, Clinical and Practice Support, North Coast Medicare Local.

In September, NCML staff from our Hastings Macleay office attended the official opening of the Town Beach Outdoor Gym in Port Macquarie. They also took part in a Heart Foundation Walk before the opening. Port Macquarie Hastings Mayor Peter Besseling cut

the ribbon and demonstrated how to use built in videos explaining how to use the gym equipment safely. This was followed by a healthy morning tea. The Outdoor Gym has proved popular and is a great asset to the Move, Eat, Live Well program run by Port Macquarie Hastings Council.

3) Schedule your Telehealth consult at the beginning of the day or first thing after lunch to ensure that neither party is running late for the appointment. 4) Remember the potential time difference if you are linking up to Queensland. 5) Allow around 45 minutes for the Telehealth consultation. 6) Murphy’s Law says that while your Skype

7) Make sure the GP sends a patient summary with a referral to the specialist a couple of days in advance so they are as up to speed as possible. And it may be necessary for the patient to see the GP shortly before the scheduled Telehealth session to make sure the specialist has the most up to date information about the case. 8) Check out the national databases for specialists using Telehealth to find out who is available for a Telehealth consultation. Here’s the link to the non-commercial directory set up by the Australian College of Rural and Remote Medicine. http://nrha. org.au/12nrhc/wp-content/uploads/2012/05/ ACRRM-Provider-Directory-Brochure.pdf 9) Enjoy the benefits that telehealth brings to you, your patient and improved health outcomes!

Telehealth benefits For the patient: the convenience of not having to travel to Sydney or Brisbane (at some expense) to see a specialist and not needing to take time off work to do so. For the GP: Teresa says her GPs have said that it’s really useful for them to sit in on the consultation with the patient and specialist to observe the thought processes of the specialist as they consult with the patient, particularly with psychiatry.

HealthSpeak

summer 2014

Young talent abounds in our schools Students from St Joseph’s Primary School at Tweed Heads took out first place in North Coast Medicare Local’s latest PITCH (Practical Ideas to Improve Health Care). In the latest edition of the PITCH (Practical Ideas to Improve Health Care), North Coast Medicare Local partnered with Healthy North Coast. We asked students from the Queensland border to Port Macquarie to submit proposals for videos on ideas to improve the health of residents of the North Coast. There was a strong response, and six finalists competed for first place at a viewing of the videos in October at the University Centre for Rural Health in Lismore. The video submitted by students from St Joseph’s, called Healthy Brains from Healthy Gardens inspired the judges with its clear depiction of the benefits students had gained from starting their own kitchen garden in the school grounds. They planted, tended and ate the produce, learning much about gardening, nutrition and how to prepare fruit and vegetables. North Coast Medicare Local’s Northern Rivers Manager Chris Clark said the video took out first place because the kitchen garden was a project that could be emulated at other schools and was something was the students

Kempsey High School students with their awards

There was a strong response, and six finalists competed for first place found both educational and fun. “This idea could be rolled out at other schools and teaches kids about the nutritional value of veges and fruits, how to grow them, and the need to eat fresh to stay healthy,” he said. Kempsey High School students took out second and

third place in the PITCH with videos on the prevalence of otitis media (middle ear infection) in the Aboriginal population and a light-hearted video titled The Evil Tooth Fairy about the importance of eating well to look after young teeth. Another finalist, Lismore student Natalie Gray created a video called Growing Strong on the importance of breast feeding in the Aboriginal population and Kempsey High School also submitted videos on Healthy Choices about choosing the right foods to eat and a boisterous romp called Fast Food Race demonstrating the perils of eating junk food.

Briefs

Consistent midwife a money saver WOMEN who see the same midwife throughout pregnancy are more likely to experience an unassisted vaginal birth and cost the health system less than women in standard shared antenatal care, a study has found. The research led by Prof Sally Tracy at the University of Sydney, randomly allocated 1748 pregnant women of varying risk into two groups to receive either caseload

North Coast Medicare Local’s Chair, Dr Tony Lembke, who was present at the PITCH viewing, was so impressed with the enthusiasm and creativity shown by Kempsey High School students that they also took out the Inaugural Chairman of the Board Award for their efforts. Thank to all the students, teachers and helpers who took part in making these videos. And it was terrific to see around 20 Kempsey High School students and teachers make the trip to Lismore for the evening. In the New Year, North Coast Medicare Local will hold a video making workshop to help the student finalists with their story development. We look forward to seeing what they create after the workshop. View the finalist’s videos at: http://healthynorthcoast.org.au/ the-pitch/pitch-short-film-competition-finalists/

care from a named midwife, or standard public hospital maternity care with rostered midwives and shared care with medical practitioners. While there was no significant difference in the overall rate of caesarean section between the two groups, women in the caseload group were more likely to have an unassisted birth without pharmacological analgesia and less likely to have an elective caesarean (8%) than the standard care group (11%). The overall median cost of birth per woman was $566.74 less for caseload midwifery than standard care.

St Joseph’s students with teacher Michael Martin and Chris Clark HealthSpeak

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eHealth: Connecting Australian health care The national eHealth record system will help deliver better patient care and make the health system more efficient. The Australian Government is rolling out the eHealth record system in stages. Over time, the eHealth record system will give health professionals better access to patient information – medications, test results and allergies or treatments – meaning improved, more efficient care for patients. Once a healthcare organisation is registered, authorised users can start using the eHealth record system either: via a conformant clinical information system, with a secure individual login; or via the eHealth record system provider portal, which is read only, using a PCEHR compliant digital credential. Why participate? eHealth gives: Better access to accurate patient information; their medical history and treatment More time treating patients Faster access to relevant information, helping to make better clinical decisions and save time Access to potentially life-saving patient information in an emergency Helps patients better manage their health The more healthcare organisations that participate, the better connected Australia's health system will become How does the eHealth system work? The eHealth record system provides access to information drawn from patients’ health records. With the patient’s’ consent, this information can be quickly accessed and shared with other authorised healthcare professionals involved in that patient’s care. An eHealth record will grow 8

NCML staff registering consumers for eHealth in Ballina.

over time to contain key healthcare events and activities, including medical history, allergies and current medications. The system is designed to be integrated into local clinical information systems. Who can enter information? Only identified healthcare professionals can enter information in the clinical section of an eHealth record, ensuring it is clinically relevant and as accurate as possible. Patients have their own section in the eHealth record, separate from the clinical section, where they can enter basic health information and keep notes – allowing consumers to be more actively involved in monitoring and managing their health. Does it replace existing records? eHealth records do not replace existing medical records. Healthcare professionals will continue to take and review clinical notes. More detailed patient information will be available on local information systems as happens now. The eHealth record system provides an active online record that follows patients as they move through Australia’s health system, capturing important clinical and treatment information.

The structure of a patient’s shared health summary is underpinned by the RACGP template for a GP health summary. As more individuals and healthcare organisations register, the eHealth record system will become more valuable. Get the most out of Australia’s health system and make it work better for you. How’s the roll out going? GP enthusiasm is evident with the rapid uptake by general practices in the North Coast NSW Medicare Local footprint with about 80% of general practices now engaged in eHealth. Some practices are actively promoting eHealth to their patients. For example, one practice has implemented ehealth through their chronic disease clinic, offering assisted registration to patients and uploading a shared health summary for those who register. In other areas, practices have used Medicare Local eHealth promoters to educate patients about eHealth and offer assisted registration. Many pharmacists believe that eHealth will essentially raise them out of the information void they have been in for so long and nearly 20% of pharmacies have registered already. In allied health, around 20% of HCP organisations such as RACFs, specialists and allied health professionals have

engaged in eHealth. RACFs are excited about the access to improved discharge summaries as to date this information has been difficult to access. Improved communication between the GP and specialist has also been a welcome result of eHealth. North Coast Medicare Local has worked hard to incorporate eHealth into the many programs and services it provides, with Tarmons House Mental Health Service, Nimbin Medical Practice, and Gurgun and Bugalwena Aboriginal Medical Services, all registering to provide eHealth services. The Closing the Gap teams are also working to raise awareness within Aboriginal communities and helping clients to register for their own eHealth record. What’s next? NSW Health has announced that they are committed to rolling out eHealth capabilities in rural and regional LHDs within the next 12 months with the integration of Healthenet to facilities within these LHDs. Improvements to eDischarge summaries will be a major focus. NCML is committed to supporting health care organisations to register and prepare to participate in eHealth with eHealth project officers in each branch working to deliver support to all providers. If you are a health care organisation or provider interested in registering to participate in eHealth or want to know more, contact your NCML eHealth project officer or email ehealth@ ncml.org.au. You can also go to www.ehealth. gov.au to find out more. HealthSpeak

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Awards winners impress with their dedication

Some of the NCML staff who attended the ball

HealthSpeak

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Around 300 people attended the 2013 Northern Rivers Community Sector Awards held in Lismore on November 9 as part of a colourful Masquerade Ball. More than 70 nominations were received for the awards. North Coast Medicare Local was an event sponsor and took a table at the awards night, joining in celebrating the achievements of some exceptional community sector workers. The Most Inspirational Award went to Adam Reading, a Disability Employment Consultant with On-Q Human Resources who underwent a heart transplant in 2009. Andy Hamilton from Foundations Care won the In the Line of Fire Award. He works as a mentor to troubled teens. The Above and Beyond the Call of Duty Award went to Julie Hornibrook, Chair of the Lismore and District Women’s Health Centre. The Community Group or Team Award went to Northern

Rivers Social Development Council’s Development and Innovation Team for its unique ‘Lived Experience’ program which has changed the approach of agencies to mental health issues. The Lightbulb Moment Award was given to two winners - Cringe the Binge and Family Law Pathways and the Aboriginal Reference Group. The Centre of the Universe Award went to two winners, Cathy Allan of Lismore and District Women’s health Centre Inc and Vivienne Watt of the Northern Rivers Social Development Council. Best dressed Team went to Far North Coast Family Referral Service and Sam Henderson, husband of North Coast Medicare Local’s Rajee Henderson, won Best Dressed Individual. Congratulations to all the winners and all those nominated for the awards for working hard to make a difference in our community.

Local health referral pathways under development

From left: Fiona Ryan, Project Officer, HealthPathways; Clinical Lead Dr David Gregory; Ian Anderson Streamliners NZ, Dr Dan Ewald, Clinical Advisor, NCML; Juanita Gibson, Streamliners NZ; Graham McGeoch, Streamliners NZ; Bronwyn Chalker; Director Allied Health (MNCLHD).

clinical tool and a health system reform process. In Canterbury this project has seen over 500 pathways developed, and has improved the efficiency of ambulatory / outpatient clinics, as well as having

Image: Lake by Lisa Wilson (May 2014)

A strong and enthusiastic team set up by North Coast Medicare Local (NCML) and Mid North Coast Local Health District is working towards setting up local referral pathways for GPs in the Hastings Macleay region for an initial six health conditions using the Health Pathways model. Health Pathways originated in Canterbury New Zealand in 2007. This project involved the development of a web-based information system for referral pathways, service description and contact information, as well as clinical resources and guidelines. The project brought GPs, specialists and other relevant staff together to discuss clinical conditions, and their best management at a local level. These clinician work groups developed bottomup health system reforms as they sorted out local problems with the health system. NCML’s Clinical Advisor, Dr Dan Ewald, describes Health Pathways as both a day to day

improved the communication and quality of clinical care across health sectors. Health Pathways is a key component of their whole of system reform that has significantly reduced their growth in hospital admissions, while improving care. The Health Pathways website is aimed at general practitioners but can also be used by hospital specialists, practice nurses/managers and community and allied health providers. The Mid North Coast Health Pathways team comprises Program Manager, Tracy Baker; Program Officer Fiona Ryan (funded by Mid North Coast LHD); Clinical Lead, Dr David Gregory, Executive Champion Bronwyn Chalker, with keen support from the MNCLHD CEO Stewart Dowrick. The initial six topics (along

Briefs

Genetic leukaemia link likely A team of researchers from the University of Washington have found an indicator of the gene which causes childhood leukaemia, according to a report in the journal Nature Genetics.

with 30 to 40 others to be developed) will be posted on the Health Pathways website, which will go live in the first half of next year. They are: Chronic Pain; Hospital in the Home (DVT and cellulitis); two topics developed by the project’s Musculo-skeletal Working Group and two developed by the project’s Paediatric Working Group. As well as these local referral pathways, there will be 500 Health Pathways topics developed in other regions of Australia and New Zealand available on the website. These will be progressively replaced with local versions as the program matures. Dr Ewald said although these many referral pathways wouldn’t include local contacts, they would inform GPs about the best way to manage many conditions. “In the event, say, of a person presenting with their first seizure, the GP can follow a straight forward protocol and be confident they are following best practice and using quality patient resource materials,” he said. Further local health referral pathways will be developed and added to the Health Pathways website over time. Dr Ewald said the Health Pathways project would improve the quality and consistency of the care given by a GP before the referral process. “Additionally, specialists should be able to discharge patients back to the primary care team earlier. This will mean, for example, that oncologists won’t need to follow up patients forever, this responsibility can go back to their GP,” he said.

“We’re in unchartered territory,” said study author Dr Kenneth Offit, Chief of Clinical Genetics at Washington’s Memorial Sloan-Kettering. “At the very least this discovery gives us a new window into inherited causes of childhood leukaemia. More immediately, testing for this mutation may allow affected families to prevent leukaemia in future generations.”

HealthSpeak

summer 2014

Trial: co-locating community health services into general practice The target population for this project is patients with chronic disease. North Coast Medicare Local (NCML) commissioned a study into strengthening the implementation of the patient-centred medical home in our region. Not surprisingly, it found scope for improvement in the integration and efficiency of care for patients receiving allied health care through Community Health Services and General Practice based care. The study recommends LHD employed Community and Allied Health Staff could be integrated into General Practice. Both Local Health Districts on the North Coast are supportive of the implementation and NCML is forming steering committees with each LHD to guide this trial.

Many people on the North Coast have chronic health problems requiring access to multiple health care providers such as GPs, allied health, community nursing and so forth over a long period of time. These services are located at different sites, with unconnected intake systems, unconnected record systems and often fragmented from one another. The objective of this project is to trial a system that begins to behave ‘as one’. It would have a single intake appointment system, be able to divert appointments from LHD sites to LHD staff working in an integrated way with general practice, and ideally be collocated. While not a completely new idea, this project will analyse the impact on workloads, the busi-

How ‘Needy’ is the North Coast? Do you ever wonder how ‘needy’ you are? Did you know that North Coast Medicare Local has been asking that question? Have you heard of the Whole of Region Needs Assessment? If not, then you don’t know what you are missing. A full 83 pages of valuable information about the North Coast Medicare Local Region gives you a snapshot of what our major challenges are and how we can address them. There are lots of facts and figures and references if you need to delve deeper for more information. Did you Know?... The people of the NCML region are above the State average for ageing population; Aboriginal people; levels of disadvantage; unemployment; expected growth; people with

HealthSpeak

summer 2014

disabilities; income support and alcohol consumption (to name a few). The people living in the NCML region are below the State average for educational attainment; immunisation of children and the ratio of GPs to the population. (This doesn’t paint a pretty picture) Have a look at the Needs Assessment as we would like to get your feedback. As well containing a lot of interesting information, this document will inform NCML’s strategic direction, so your input is really important. Go to the NCML website: www.ncml.org.au and click on ‘about’ and ‘key documents’ for a soft copy. For further information call Robyn Fitzroy on 6618 5 400 or email: rfitzroy@ncml. org.au

ness case, the extent of integration and skills transfer achieved. Many changes are required to the current health system to enable this type of integrated service delivery to be more widespread. Successful aspects of this reform process will be captured for wider adoption. NCML is seeking expressions of interest from general practices that would like to consider being part of this trial. It may be most applicable to practices currently making many referrals to public sector allied health, or those who struggle to get access to allied health for their patients. The actual allied health professionals who will be involved are not yet known, but could include: cardiac or respiratory rehab specialist nurse, wound care specialist nurse, dietician, etc. Practices would benefit from potential up-skilling their staff, eg wound care, providing a better informed service for their patients (working from their full GP records), and a more familiar setting for patients. The financial cost/ benefit would be monitored with a view to the practice not losing out. For more information, contact NCML Clinical Advisor Dr Dan Ewald: dewald@ncml.org. au or Health Reform Program Manager Tracy Baker: tbaker@ ncml.org.au

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Co-location of community services with general practice will benefit both patients and clinicians.

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Focus on Super Clinics With three GP Super Clinics operating in our region, and clinics soon to open in Coffs Harbour and Port Macquarie, HealthSpeak approached the existing three to find out what they are offering. Unfortunately, after phoning staff at the Lismore GP Super Clinic at Goonellabah and emailing head office in Brisbane, there was no response to our request for an article. The Tweed Health for Everyone SuperClinic invited HealthSpeak to visit and Mary-Anne Cole from Grafton’s Ochre Super Clinic kindly provided information about the practice.

Much care has gone into décor and design and the clinic has a homely feel

Tweed Health for Everyone SuperClinic

This purpose built clinic opened earlier this year and is run by three local GPs, Dr Jennifer Soden, Dr Austin Sterne and Dr Di Blanckensee. Practice Manager Rick McKee showed me around, and just entering the building one has a sense of space and light. There is even an onsite café as you enter the building. A main reception desk looks after GP patients, and an adjacent receptionist deals with allied health patients. There are separate wait-

ing areas (with names such as Sunset and matching décor) for particular practitioners, which creates a relaxed atmosphere. Much care has gone into décor and design and the clinic has a homely feel despite its size and many services. Each waiting area has a television screen and free wifi. Rick is justifiably proud of the clinic and said his staff are selected on their interpersonal skills as well as their work skills, providing excellent patient

service and communicating effectively with both practitioners and patients. Ten general practitioners and nine practice nurses provide health care for all age groups along with skin cancer medicine, immunisations, travel medicine, chronic disease management, wound management and more. Allied Health Services include psychology, dietetics, physiotherapy, exercise physiology, speech pathology, midwife, podiatry and diabetes education. Healthscope pathology and Tweed Holistic Dental are on site. Optometrist rooms are opening soon and a pharmacy is being built within the building. The clinic also has visiting specialists - a vascular surgeon, hearing services, a psychiatrist and geriatrician. Rick said patients really appreciated having a ‘medical home’ in the Tweed community with such a range of health services in one location. The SuperClinic also serves as a teaching facility for university students and general practitioner registrars. Find out more at: www.thesc.com.au

health care and chronic disease management. “We believe this is successful predominantly due to being well supported by on-site registered nurses and allied health practitioners including a mental health nurse, exercise physiologist, physiotherapist, podiatrist, occupational therapist, speech pathologist and counsellor. “In addition, our patients have access to on-site pharmacy and pathology collection services,” said Mary-Anne. Visiting specialties include diabetes educators, audiometry/ hearing specialists and sleep study practitioners. Mary-Anne told HealthSpeak that the Super Clinic has a strong multi-disciplinary culture

and a strong emphasis on lifestyle medicine. “This is reflected in our routine health screening, diabetes clinics, Aboriginal health, mental health and skin cancer treatments. We also offer Pilates, healthy cooking lessons, hydrotherapy and group visits which are proving very popular with patients, Mary-Anne said. Ochre Health’s Grafton GP Super Clinic also made the finals of the RACGP Practice of the Year. “This was largely based on our health outcomes and positive feedback from patients and we are looking forward to developing our progressive culture further in 2014,” Mary-Anne added.

Grafton GP Super Clinic

The Grafton GP Super Clinic was Ochre Health’s first Super Clinic to open in October 2011. It has grown rapidly and now houses eight GPs and is ac12

credited for clinical training. Nursing manager Mary-Anne Cole said the practice takes pride in delivering its community proactive primary /preventative

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summer 2014

Quit for new life The Quit for New Life (Q4NL) program aims to contribute to a reduction in smoking rates among pregnant Aboriginal women, women who identify as having an Aboriginal baby1 and other members of their households. The program is an initiative of the Centre for Population Health and the NSW Ministry of Health in partnership with NSW Kids and Families. The NNSW Local Health District (NNSWLHD) has received funding for the next three years to implement Q4NL locally. Q4NL has been informed by the evidence for what is likely to be most successful in supporting pregnant Aboriginal women and members of their household to quit smoking during the prenatal and post-natal periods and to remain smoke-free. The program is delivered as part of routine clinical practice as women attend their ante-natal care and other family support services during the post-natal period. The program is intended to be delivered primarily in AMIHS sites (ante-natal) and Child and Family Health sites

(post-natal). However, in the NNSWLHD many Aboriginal women undertake shared care with general practitioners. Locally, the Q4NL program will include all service providers from the first contact with the mother to approximately 10 to 12 weeks post-natal.

Cessation Support Officers will follow up pregnant Aboriginal women who are referred to the Q4NL program. The women will be provided with free Nicotine Replacement Therapy (NRT) either directly or through a voucher system. Household members will also be able to receive free NRT after assessment from the Cessation Support staff. The Quit for new life program comprises two key components - provision of cessation support strategies to women and household members; and provision of practice change strategies for service providers. It is intended that the delivery of the Quit for new life program in each LHD will build on existing local infrastructure and investment. Training in the Q4NL program will be provided by Tracey Greenberg, NSW Tobacco Cessation Trainer for all GPs, practice staff, pharmacists and pharmacy Staff. For any further information about the training or Q4NL resources, please contact Christine Sullivan on 6674 9517 or 0417 474 417.

Brainwaves seminar proves a hit

Front: Dr Tim Scholz and physiotherapist Dean Phelps from the Lismore Base Hospital multidisciplinary Pain Unit with seminar participants at the back.

The pleasing attendance and positive feedback from North Coast Medicare Local’s first multi-disciplinary education event, demonstrated a real appeHealthSpeak

summer 2014

tite for a variety of health professionals to come together under one roof to learn and network. Held on a Saturday in midSeptember at Ballina RSL Club,

45 health professionals took part including GPs, enrolled and registered nurses, physiotherapists, RACF staff, a prenatal counsellor, a GP office manager, a pharmacist, mental health professionals and a remedial/oncology therapist. Practice Nurse Glenda Mason from Casino Aboriginal Medical Service was the winner of the Lucky Door Prize, kindly donated by Southside Pharmacy, South Lismore. Coordinator Viv Walkington said participants enjoyed the variety of presentations and the opportunity to mix with a range of health professionals. The seminar was described as ‘interesting, very informative, with an excellent blend of topics and presentations that helped broaden learning. Another multidisciplinary seminar is planned for next year.

UCRH research grant to help reduce tobacco harm

Dr Megan Passey

Dr Megan Passey from the University Centre for Rural Health in Lismore has been awarded a handsome grant of $334,596 to help to reduce tobacco consumption among vulnerable groups. The grant is part of the prestigious Research Fellowships program of the National Health and Medical Research Council. Dr Passey’s project will add to the body of evidence in an existing program aimed at helping pregnant Indigenous women to quit smoking. She said the program had national relevance because smoking rates among pregnant women in certain population groups, including Indigenous people, continued to cause significant concern. Smoking during pregnancy, and exposing newborns to tobacco smoke pose serious health risks to vulnerable young children. It also tends to normalise smoking within the home, making it more likely that children will take up smoking in their teens. The grant work includes developing tools and evidence to better support smoking cessation guidelines in public antenatal services, Dr Passey said.

Dealing with astigmatised child death

The view from the Clunes retreat, available to those dealing with grief or trauma.

Specialising in loss and grief and relationship challenges, counsellor Dawn Macintyre (Spinks) has just completed her PhD on the impact of child drowning deaths. HealthSpeak had a cuppa with Dawn at her new home at Clunes – she’s moved down from Brisbane after practising counselling there for 20 years where she and her husband have purpose built their home so they can also offer free respite stays for those dealing with grief or trauma. “Child bereavement goes on forever, and hospitals and GPs are often not well equipped to offer support. While GPs are often the first port of call after a death, they are not usually trained in the area of bereavement and particularly in astigmatised, disenfranchised death such as driveway run overs or child drowning,” she said. Dawn is particularly concerned that there are no clear referral pathways for such child deaths. “My passion is to coordinate a pathway and trajectories and create the health pathway links for parents trying to cope with the loss of a child. It doesn’t have to be as hard as it is at the moment to find the right support,” she said. Speaking before National Drowning Day (October 4), Dawn also recommended in her PhD that trained coronial officers be available to support parents going through the legal process 14

that follows the death of a child by drowning or death through a parent running their child over. “Parents of children who die an unintentional death always go through a coronial inquest under law, but often they don’t know what’s going on, they don’t understand the process, and it can take up to two years to get your death certificate and the family can be in limbo all that time. “One of my clients said she was so relieved two and a half years after the death of her child when the family received the death certificate and she was finally able to say ‘it wasn’t my fault’,” said Dawn. As well as developing referral pathways, Dawn would like to see policy in place to deal with

school students affected by sibling deaths. “Children and parents often have difficulty when going back to school because of inappropriate, unintentional behaviour by staff and kids. Staff don’t appear to understand the need for flexibility in their approach and are not alerted to the likelihood of mood changes in the grieving child,” said Dawn. “One child was forced to get into a pool for swimming lessons because the teacher hadn’t been told that he had pulled his sister out of the pool dead a few months before. There needs to be policies and procedures in place in workplaces and schools. Once we start putting systems in place we can really have an

impact.” Dawn understands that many people are wary of undergoing counselling and has copies of her book Nothing Changes if Nothing Changes available free to anyone who’d like a copy. In it she explains the benefits of counselling and how to find the right counsellor for you. Dawn started the respite accommodation – a separate wing in her delightful home - to support families with kids who’d drowned and any family experiencing financial difficulties as a result of ill health in the family, being a long-term carer or struggling with grief. “Often these families have to leave work for some time and have other costs after the death and are financially stretched. I’d welcome referrals from any organisation that supports people through health challenges, church groups, carer or bereavement groups or GPs to give families some quiet time in a beautiful setting,” Dawn told HealthSpeak. “It’s also a lovely writer’s retreat and place for a few days away to recharge the batteries. Those that can afford to pay (paying guests don’t need to be experiencing hardship, will be creating their own wonderful holiday memories while being part of this ‘giving’ community. Funds from paying guests help us support those unable to contribute,” Dawn explained. Contact Dawn on 0417 633 977 or find out more at: www.nothingchangesifnothingchanges.com.au

GPs go online The Northern Rivers General Practice Network (NRGPN) has re-launched GPSpeak – the forerunner of HealthSpeak – as an active website, a weekly e-newsletter emailed to members and other subscribers, and a bi-monthly online journal published in PDF form. “GPSpeak has a range of current stories by and about local GPs, as well as relevant information on local, regional and national health issues,” NRGPN chair Dr David Guest

said. “As a founding member organisation of the Medicare Local North Coast NSW we remain fully committed to the overall planning and delivery of primary care in the larger regional footprint,” Dr Guest said. “We are also keen for GPs to have their own local forum for sharing matters of interest, and the opportunity to read about

things of specific interest to them,” he added. GPSpeak accepts sponsorship and advertising, and it is an ideal way for any company or organisation offering services or products to local GPs to make contact directly with the key clinicians and their practices. GPSpeak is now online at www.nrgpn.org.au

HealthSpeak

summer 2014

Partnering to improve outcomes capacity building has been conducted across the LHD, and some 8 to 10 clinical projects using multiple inquiry approaches are under CPU support. Unlike the ‘classic’ or ‘clinical chair’ approach to academy/ health service collaboration in nursing and midwifery, the CPU is framed as a three-arm service:

By Prof Iain Graham Dean, School of Health and Human Sciences Southern Cross University

“To do the patient no harm, aiming at quality and safe patient care.” These were the words of Florence Nightingale in the mid-19th century. Therefore, it is with some alarm that a recent paper published in the BMJ, Quality and safety edition, (2013), speaks of the growing global burden of unsafe clinical care. The paper supports the sentiment that sick patients should not be further harmed by unsafe care and that this should be a major policy emphasis for all nations. Within this policy lies the argument that the workings of both the academy and the health service providers should be better aligned. To that end, colleagues from the School of Health and Human Sciences at Southern Cross University and our health care provider colleagues, both public and private, have been working closely together over the last five years. The aim of these relationships is to improve the preparation of health practitioners so that they promote safe and quality based healthcare. Clinically focused research, continued education provision, more systematic clinical learning for undergraduates, curriculum design, staff appointments and post graduate education are being undertaken to ensure not only safe and improving quality patient care but improved clinical outcomes. This relationship is recognised via agreements and articulations, committee membership, and in the past, joint appointments between the university and the professions. With each of the School’ s partner organisations, be it the Local Health Districts, the Medicare Locals or the Aged Care sector, funding has been drawing us closer together in order to align our activities and agendas. One such initiative is the Collaborative Practice Unit (CPU) set up between the School and the North Coast LoHealthSpeak

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1. Workplace-based Research & Knowledge Transfer cal Health District, Nursing and Midwifery Directorate. The CPU mission is to develop seamless lines of communication and support between the North Coast LHD and the nursing and midwifery disciplines within the School, at all levels from novice nurse/ midwife just out of university, to senior nurses and midwives. The work of the collaborative can be understood in the following way - curricula innovation and development through leadership and the provision of programs of coaching and clinical supervision which support the adoption of evidence-based practice so to ensure safe patient care. Mechanisms to support the translation of research into clinical care are thereby promoting safe care and underscoring statesponsored nursing and midwifery strategies so that quality as well as safe patient care is realised. The work of the CPU is innovative and exciting. It is helping nurses and midwives find their voice so that they are better prepared to care and treat. The work is led by the Professor of Nursing, Andrew Cashin, in partnership with the Deputy Nurse/Midwife executive for the North Coast Ms Rae Conway. They are assisted by a postdoctoral research fellow Dr Greg Fairbrother. The whole project is led by the Executive Director of Nursing and Midwifery Adjunct Professor Annette Symes and myself. A CPU was established on the Lismore Hospital campus with outreach to nurses and midwives across the LHD in late 2012. Since its inception, formal research and evidence appraisal

Expertise in the application of research methodology and analytical support and training/mentorship supports the wedding of methodological and analytical skills with all clinical knowledge bases which require support and development

2. Professional role development and leadership coaching

Seeks to offer support to the nursing and midwifery corpus as a whole, as well as explore

and develop the professional roles within it. The role of nurse educators and clinical nurse consultants are being investigated and exploratory work has commenced around the role of clinical supervision in midwifery and the coaching among nursing leaders.

3. Conduit for faculty practice and research in LHD

The CPU is the point for academics to register collaborative practice and research in the LHD. The CPU is in the process of building a system to register activity and facilitate interaction with the LHD. The marrying of the School and the local health services, through a number of initiatives and activities is creating great opportunities for everyone. Particularly as we grapple with the economic, ethical, demographic and epidemiological challenges of the future.

Palliative admissions up The number of palliative care-related hospital admissions rose by 49% between 2001-02 and 201011, according to an Australian Institute of Health and Welfare (AIHW) report. The report, Palliative care services in Australia 2013, shows that there were around 54,500 palliative care-related admissions to public and private hospitals in Australia in 2010-11. AIHW spokeswoman Dr Pamela Kinnear said that patients aged 75 and over accounted for nerlay half of palliative care hospital admissions during this period. “About 16,500 patients, representing more than two-thirds of palliative care patients, died with cancer as a principal diagnosis,” Dr Kinnear said. The report also shows

that during 2011-12, nearly 12,300 permanent residential aged care residents were assessed as needing palliative care. In the same year, around 9,600 patients received a palliative medicine specialist service subsidised through the Medicare Benefits Schedule, for which about $3.5 million was paid in benefits. Over the five years to 2011-12, benefits paid for these services more than doubled. “Also, more than 19,000 patients had a palliative-care related prescription subsidised through the Pharmaceutical Benefits Schedule (PBS) during 2011-12,” Dr Kinnear said. Laxatives were the most frequently prescribed palliative-care related medications, followed by analgesics and anti-epileptics.

A conversation

with Dr David Chessor It’s impossible to understand all cultural backgrounds well.

By Amanda Shoebridge NCGPT

Doctor, Registrar, Lecturer, Medical Educator, Board Member, Chairperson… how does this doctor knit it all together? North Coast GP Training (NCGPT) registrar, Dr David Chessor, has hit some remarkable milestones in for a doctor still in training. David is both a Registrar Liaison Officer and a Registrar Medical Educator for North Coast GP Training where he teaches and advocates on behalf of fellow registrars, offering support, encouragement and advice to others on the journey toward becoming a GP. He is a clinician at Durri Aboriginal Medical Service in Kempsey and an Adjunct Lecturer at the University of NSW Rural Clinical School. He is the Chair of the GP Registrar Medical Educator and Supervisor Network and the new Chair of the General Practice Registrars Association. David was recently awarded the 2013 RACGP National Rural Faculty Rural Registrar of the Year Award as well as the GPET 2013 Registrar of the Year Award. He is a keen blogger and an award winning knitter. Where does he find the time? You must have very good time management skills David! How do you fit all of this in? No, in fact I’m a terrible procrastinator! It sounds like a lot but it’s really a lot of parttime roles that need differing amounts of energy and input at different times of the year. It helps to love what you’re doing. (And I won’t lie, there are a lot of late nights!) What was it that drew you toward medicine? And in particular, becoming a GP? I can’t remember ever not wanting to do medicine – it was a childhood fantasy that persisted into my adult years. The longer answer is a combination of communicating with people, the science and knowledge of human health and disease, and a fundamental desire to do something altruistic with my life. And GP, well, I didn’t truly realise I wanted to be a GP until after I became one! I sought out GP because the sacrifices I was going to have to make in hospital-based medicine didn’t seem worth it. I now consider it quite serendipitous that I undeservingly landed myself in the perfect area of medicine for me. Why Knitting? Why not? It’s constructive and soothing to the soul! I actually learnt when I was very young from my Mum, didn't do it for years, and then picked it back up during med school when my girlfriend (now wife) was 16

about Aboriginal health into your journey as a registrar. Check out www.gpra.org.au/ closethegap for tips. What advice would you give to registrars thinking about a placement in an AMS? Take the plunge! It’s hard to explain just how much you’ll learn about both medicine and life.

David receiving his award, with ex-NCGPT registrar, Dr Emily Farrell, GP registrar representative on the RACGP Council. Photo: RACGP National Rural Faculty

doing some. During breaks at work David can sometimes be found heading out to the waiting room to have a yarn with patients and knit a few squares. His proudest knitting triumph? A jumper made for his wife Suzanne, which won him first prize at Camden Haven Show. What have been the greatest challenges for you working in Aboriginal health? Learning more about Aboriginal culture and how to practice in a culturally safe way I would consider more of an opportunity, although it’s certainly been a challenge as well. Perhaps the hardest thing has been slowly getting to know the community, and witnessing how high levels of ill-health consistently impact individuals, families and the whole community.

What are some of the most important things to keep in mind when working with people from other cultures? Listen carefully and ask what is most important to them. It’s impossible to understand all cultural backgrounds well – acknowledging your ignorance of the way other people view the world, and adapting the way you behave to make it easier for them to tell you, is key. You have a keen interest in medical education – what attracts you to this area and why is it important to you? Both my parents are teachers – I always swore I’d never be one myself and then have somehow ended up there anyway! I love teaching, I learn heaps myself every time I teach. It provides variety in my job, students’ inquisitiveness and enthusiasm is infectious, and I get to feel like I’m contributing to the future of better health for my community. How did you feel when you were presented with the 2013 RACGP Rural Registrar of the Year and the GPET 2013 Registrar of the Year Award? Very proud and slightly embarrassed!

What do you see as being the greatest issues impacting Aboriginal health today? The social determinants of health – education, housing, good nutrition, etc.

What inspires you to keep doing what you’re doing? I’m lucky that the things I do every day inspire me – it’s self perpetuating in this sense and probably where I get my energy from. There is no doubt that we will be seeing a lot more of David in the future – especially as he is now the new face of the Australian General Practice Training Program. If you would like to keep up with what David is doing, tune into www.notjustagp.com where you can read his blogs on a variety of topics.

How can GPs/GP registrars help to close the gap on health inequality in Australia? Make an effort to learn more about Aboriginal history and culture, and think of some simple ways to incorporate more learning

North Coast GP Training is the Commonwealth funded Regional Training Provider delivering the Australian General Practice Training and Prevocational General Practice Placements programs on the north coast of NSW.

What have you found most rewarding about working in Aboriginal Health? Learning lots every day – from my cultural mentor, from my patients, from myself.

HealthSpeak

summer 2014

Sixteen months on

Christmas Island

fter his partner Mary went to study in Brisbane, North Coast clinical psychologist Mal Huxter decided he needed a change, but continue to provide psychological care to those in need. Janet Grist spoke to Mal about his experiences working on Christmas Island with asylum seekers from February 2012 to July 2013.

The island Christmas Island, where the main industry continues to be phosphate mining , is a dot in the Indian Ocean, 2600 km north-west of Perth. Just 22 kilometres across, it is home to 2100 residents and contains a detention centre with five facilities. Employed as a psychologist by International Health and Medical Services (IHMS), Mal would work on two month rotations spaced by two week breaks where he would be flown back to Brisbane to visit his partner and three adult sons. IHMS is contracted to provide physical and mental health care and screening for asylum seekers. IHMS staff - administrators, general and mental health nurses, doctors, psychiatrists, dentists and psychologists screen for health issues as well as mental health issues, and provide health services based on need. Single adult men (SAM), unaccompanied minors and families (including women and children) were detained separately. The SAMs in highsecurity compounds and, when possible, families were detained in APODS (Alternative Places of Detention) which Mal described as more like a caravan park atmosphere. The facilities are spread across the island. The APOD is closer to the settlement and the Christmas Island Public Hospital as well as the Island recreation centre. HealthSpeak

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When I asked Mal what his impressions of Christmas Island were he said that it was like a different world. “It’s really interesting, and so different from the way we work here and in terms of the people, the presentations, the team, and the systems you had to work with.” The ethnic groups detained on Christmas Island included Iranians, Afghans, Iraqis, Syrians, Sudanese, Tamils, Rohingyans (from Burma), Indonesian and Vietnamese. Apart from IHMS, Mal had to work with the security system and personnel employed by SERCO, Department of Immigration and Citizenship (DIAC) staff, interpreters, police and local health workers. Work operations were often complicated by the number of stakeholders and each of their systems. Just following up on a missed appointment to see a client, as an example, was difficult. “Sometimes there were competing appointments and DIAC appointments got priority. Something as simple as a man not showing for an appointment would involve a series of phone calls to find out that they may have been taken somewhere else and talking to compound security officers and working through the various procedures of each stakeholder – it was very complicated,” he said. The centre wasn’t designed as a therapeutic environment and had no purpose built consulting rooms, so Mal would often consult where he could - a small room without windows, a passage way or dining room.

Mental health presentations Within 24 hours of arriving on Christmas Island, detainees had their mental health status screen-

ing, looking at their emotions and their mental state. Even though there were significant numbers of people who seemed to be ‘economic refugees’, most people had a high degree of trauma. According to Mal, trauma and grief were the most common presentations. Just travelling on the boats was traumatic but also the places people were fleeing from were usually very stressful. The nature of the traumas depended on the political situation of the place of origin. Those from Syria, for example, had been exposed to the horrors of war. Those from Iran would often present traumatised by being imprisoned and tortured by their own countrymen. The Shia Hazaras from Afghanistan often presented with the after effects of terrible persecution and the experience of having loved ones murdered. Unfortunately, many Tamils from Sri Lanka presented with the traumas of war, persecution, imprisonment and torture. “Despite the claims from the governments that things were safe in Sri Lanka, I would hear reports from asylum seekers of a lot of discrimination and persecution. Many Tamil asylum seekers had bullet wounds, shrapnel, endured torture and women had been raped. Grief was common because the asylum seekers had left everything and many had lost family at home or on the boats on the way to Australia. “At the initial interview, you’d mark down whether they’d had torture or trauma in their history. You’d have to be careful how you asked that, because you didn’t want to trigger an untoward reaction. “Of those who identified with trauma or had experienced torture, I’d ask if they wanted to seek special services and if they agreed they’d go to the torture and trauma service based at the local hospital,” Mal told Health-

Christmas Island feature

Psychologist Mal Huxter

Many Tamil asylum seekers had bullet wounds and shrapnel

Christmas Island feature

Source: smh.com.au

Speak. Sometimes children who had been in war zones were completely traumatised. Going to appointments to the Torture and Trauma (T &T) services at the hospital was something Mal called ‘a lovely thing to do’ because the clients were seen in an environment conducive to healing. The rooms at the local T &T service had comfortable lounges, were away from the detention settings, there would be a view of trees and it was generally healing. The counsellors at T &T were skilled social workers and a nurse; also equipped to deal with children with whom they’d often do sand play work and art therapy. Adjustment disorder was also common. Many clients were generally stressed having to deal with living in cramped conditions with multiple cultures, strange noises and strange food.

Disillusionment It was common for Mal to see detainees who were disappointed, disenchanted and disillusioned. “People had been fed unrealistic stories from the people smugglers about the nature of the detainment and the range of services that they would receive. Many had high expectations about what was going to happen and they’d get frustrated or angry about their situation when they didn’t get what they had been told that they would get,” 18

The situation was very complex and the theme was uncertainty. he said. “Sometimes people would arrive and say ‘Can you get me a set of [dental] crowns? Or can I have an MRI?’ I’d say ‘we don’t have those kinds of medical services here’. And they’d say ‘But I was told Australia was a developed country, we were told to come and expect this.’” Mal also had to deal with a lot of his own anger that came up around the activities of the people smugglers and the fact that they were profiteering from human hardship. “They’d feed people misinformation and stuff them into tiny boats, many of which sunk, and the boats are so cramped, it’s just so horrific. And they would charge many thousands of dollars for this trip. Some people defend the people smugglers saying that they are helping people but many times they would be sending people to their death,” he said with a faraway look.

Dealing with frustration There was a maze of frustration in the system. If Mal wanted to run a group session and managed to book the room, he also needed to book an interpreter on the very slow computer system, and then the interpreter might

be taken by DIAC if a boat had come in. “Sometimes I nicknamed it Frustration Island. You’d work so hard to organise something and the pin would be pulled and you couldn’t do what you wanted to do,” he explained. Mal said the situation on Christmas Island was ‘very complex’ and the whole theme of the place was uncertainty with regular immigration policy changes and changes within the detention centre system. “It was like building houses on sand dunes. You’d be uncertain about whether a client could be at the next session, uncertain about policy shifts, about whether or not you’d get an interpreter. The uncertainty for us was just a fraction of what the clients would experience as everything had a pervasive sense of generalised uncertainty,” he said.

Detention syndrome When Mal first arrived there was a cohort of adult male asylum seekers that had been in detention for over 12 months. He told HealthSpeak that most of these men were experiencing ‘detention syndrome’. “It’s like a depression, a bitterness and an anger and a frus-

tration combined with a sense of hopelessness. If one walked into a compound with the long termers it was like walking into a learned helplessness experiment. “The men would hardly lift their eyes to look at you. There was a horrible feeling of despair amid the uncertainty about what’s happening, alongside frustration,” said Mal. “That cohort was difficult to work with in the sense that one would start to feel the hopelessness. We’d try to lift their mood and ask ‘How would you like me to help you?’ They’d say ‘The only way you can help me is to get me a visa, write a letter to Julia’ [Gillard] and point their fingers at me. While most people in the centre were grateful, sometimes you’d feel frustrated because so many people were complaining. “People would ask ‘When am I going to get shifted on? What’s going to happen?’ and I’d be constantly saying ‘I don’t know. “ These men would tell Mal that they’d rather be in prison, because at least they would know their sentence.

Satisfaction in helping In the face of so much uncertainty and frustration, how did he stay for 16 months? Despite the difficult therapeutic situations there was a sense of enormous satisfaction because one could feel as if we were making a difference in the cliHealthSpeak

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Christmas Island feature ent’s difficult experience. There were groups of people coming through, new arrivals, who were only there temporarily and that cohort was easier to work with because they had not yet developed the hindering sense of overwhelming despair,” Mal explained. While he went into sessions not knowing whether he’d see this client again, Mal would do what he could on a one-off basis and leave as if he would never see that client again. He also designed group work for people in detention which he said ‘hit the mark’. These groups were held on weekends in rooms used during the week to teach English. Mal said the group work was satisfying because he was able to teach mindfulness, offer meditation and movement and effective visualisation exercises. “We managed to do groups in Farsi, Tamil, Rohingyan, Arabic, Indonesian, Pashtu and Dari languages. With the help of some very kind interpreters outside of the detention centres I was able to record meditations in Farsi (Persian) Tamil and Arabic which became valuable resources for the clients. These recordings are now on my website (www. malhuxter.com). “The groups were very popular and everyone loved the meditation, discussions and movements...sometime we even danced. Sometimes there were up to 70 people in a room. We got into a system where I’d do two different groups in different languages in the morning on

Saturdays and Sundays. “ People would get points for coming to groups that they could exchange for things at the shop, such as sweets and toiletries. “The feedback I’d get from the groups was ‘Oh, that was wonderful, that’s the first time I’ve been able to relax, breathe or find some sense of peace since I have been here’,” said Mal. Another technique Mal used with despondent clients was to talk about inspiring people like Nelson Mandela who’d been in jail. He also talked about wisdom and compassion being the saviours of people in difficult times, and ask clients if they’d ever known anyone who was very wise who hadn’t gone through a difficult time.

Violence and conflict Inevitably living in such cramped conditions, conflicts would arise. Clients would often be concerned about what others were saying about them and squabbles and violence would occur. “Sometimes there was domestic violence perpetrated on women by men as there is in any culture. We had to work with the state police and we’d often

separate the two parties, like an Apprehended Violence Order (AVO).” Mal said the perpetrators were often shocked to discover that in Australia it’s against the law to use power and control over another person, including your wife. He worked with both the perpetrators and the wives and kids on these issues.

Ethical issues Of all the ethnic groups, Mal found the Tamil detainees particularly stoic and chilled out despite their situation. “It was ironic because that population were often sent back. Sometimes they’d arrive and then be flown back to Sri Lanka within weeks. This happened because they’d be given a screening and asked what had motivated them to come to Australia. In response they would say ‘to have a better life’ so the interviewing officer would tick the box saying ‘economic advantage’ and they’d be sent home. A lot of these people were too frightened to tell the truth, that they’d been persecuted and sometimes tortured. “Mind you, a lot of people were seeking economic advantage, but many were not.”

It was my Buddhist background that got me through, helped me to survive. During crab season Christmas Island roads become impassable

Many seemed to be genuine asylum seekers escaping persecution. Mal said some of these Tamils would say that they didn’t care where they were sent – to Manus Island or Naura – they just wanted to be safe. He expressed sadness that the Tamils who needed protection the most were the ones being sent home. However, Mal’s employer IHMS proved to be supportive and helpful to workers dealing with difficult ethical issues. “As psychologists we were able to have good supervision and a weekly teleconference with our peers across Australia as well as good contact with our mental health director. This, as well as having supportive colleagues with which to thrash out difficult ethical issues and professional challenges was an essential part of professional survival.”

Coping mechanisms On days off Mal bicycled around the island, snorkelled and learnt to scuba dive among the spectacular creatures of the coral reef. But he said it’s his Buddhist background that got him through, it was the development of equanimity and compassion that helped him to survive. The island had a mosque, a Catholic Church and Buddhist and Taoist temples scattered around it. Continued page 38

Source: smh.com.au

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The Koori Grapevine Dropping in on Casino Healthy Cooking/Living program There are some terrific lifestyle modification programs being run on the North Coast and one of these has come about through a productive partnership with the NNSWLHD and Casino Aboriginal Medical Service. HealthSpeak dropped into the Casino Uniting Church hall last month to meet the presenters and participants of this new program – Casino Healthy Cooking/ Living. The course began as a pilot project in May and those taking part meet each week in the comfortable surrounds of the hall to work on improving their health and fitness. The program facilitators are Anthony Franks, NNSWLHD Chronic Care Officer; Sue Rowell, Clinical Nurse Consultant, Aboriginal Health, Casino Community Health; Nutritionist Anne Criner who also works at Casino Aboriginal Medical Service. And the woman behind the scenes organising participants and everything else is Kylie Wyndham, Chronic Care Clinical Nurse Consultant at Casino AMS. Additionally, North Coast Medicare Local donated some funds to help buy food and resources for the new program. The program is open to Aboriginal people with chronic disease or at risk of chronic disease, and they must have a certificate from their GP to say they are fit to take part. At 11am participants’ blood pressure and blood glucose levels are taken as well as their weight and waist measurements. These will be measured again at the end of the six-week program. Then it’s time for some goal setting and reflection before a 40-minute exercise session with physiotherapist Andrew Neill. Obs are taken once again after the exercise and then there’s a round table chat about renal 20

If the community sees me as a participator, they see I’m going through the same journey as they are From left: Back: Deb Caldwell, Anne Criner, Sue Rowell, Anthony Franks. Front: Chris Troutman, Bruce Troutman and Archie Fernando.

Nutritionist Anne Criner preparing lunch with the help of Chris Troutman and Archie Fernando.

disease (the chronic disease topic of the week) and how to make manageable changes through diet and exercise to improve health. Meanwhile, Anne Criner and Debbie Caldwell, Chronic Care Aboriginal Health Worker, are cooking up some great smelling lunch. Deb’s cooking an old family recipe - fried scones - and Anne’s making kangaroo rissoles with passata sauce, accompanied by coleslaw with lemon juice and apple. Anne hands out the recipe for everyone to take home.

Koori Grapevine

Anthony Franks told HealthSpeak that he’s passionate about seeing Aboriginal communities improve their health. “I’m not a clinician but working with nutritionists such as Anne and people like Sue and Kylie, you bring your various skills to the table and share our knowledge and experiences with our clients.” Anthony, who’s lost 10 kilos in the past year, said it’s up to him to act as a role model. “One of the things I learnt is

that when I come to groups such as this I come first as a participator. Because if the community sees me as a participator, they see I’m going through the same journey as they are. You can then set an example and show the way.” Sue Rowell said she finds the program ‘inspiring’. “It’s a fabulous course. It’s great to get clients out of a clinical environment and into a more comfortable space where they feel at ease asking questions.” She said the practical nature of the course was the key to its success. “People get sick of health professionals telling them what they should be doing. With this course we show people what to do and we do the work together,” she added. After the pilot program, Sue said the most positive feedback was about how enjoyable the exercise was and clients also said it was good to try different foods. “They said ‘we see stuff in supermarkets, but we don’t know what to do with it’. Here we help cook and learn about the more healthy ways to prepare food,” said Sue. A similar program is being run in the Tweed and in Ballina and it’s hoped to get a program started in Yamba as well.

Getting together to improve Aboriginal health

Northern Rivers and Mid North Coast NCML Closing the Gap staff combined to host the Indigenous Forum. From left: Tara-Lee Morgan, Tristan Charles, Jess Fernance, Jen Cook, Helen Lambert, Jamie Wimbus, Terry Donovan and Anthony Kapeen.

NCML staff from the Northern Rivers and Mid North Coast worked together to organise an Indigenous Services Forum at Maclean last month to identify opportunities for improved service delivery through coordination and collaboration across local organisations. A total of 60 people from various organisa-

tions took part and there were presentations made from 21 different services. Participants were pleased to have the opportunity to network and learn about what community sector colleagues are doing for the Indigenous community and how to refer people to relevant services.

Leading Aboriginal psychologist recognised at Deadlys The Australian Psychological Society (APS) congratulates leading Aboriginal psychologist Professor Patricia Dudgeon FAPS on receiving the Deadly Award for Health at the National Aboriginal & Torres Strait Islander Music, Sport, and Entertainment and Community Awards. “Professor Dudgeon, a Fellow of the APS, has made an outstanding contribution to the discipline of psychology, particularly by developing and implementing initiatives aimed at improving the social and emotional wellbeing of Aboriginal people and highlighting the need for cultural understanding and awareness to achieve effective programs” said APS Executive Director Prof Lyn Littlefield. She added: “Her work in addressing Aboriginal mental health and suicide prevention has been significant, and she is

Professor Patricia Dudgeon

to be congratulated on receiving the Deadly Award for Health.” Prof Dudgeon was convenor of the first APS Aboriginal and Torres Straight Islander Peoples and Psychology Interest Group and is Co-Chairperson of the APS Reconciliation Action Plan (RAP) Executive Management

Group. “Prof Dudgeon was instrumental in ensuring Indigenous issues were part of the APS national agenda, and she has been a leader and advocate both in ensuring psychology meets the needs of Aboriginal and Torres Strait Islander peoples and that the interests of Aboriginal people are represented on the wider mental health agenda,” said Prof Littlefield. Prof Dudgeon became the inaugural Chair of the Indigenous Australian Psychologists Association (AIPA), formed in 2008 under the auspices of the APS, to address the social and emotional wellbeing and mental health of Aboriginal people. She is a National Mental Health Commissioner, and was the first Aboriginal psychologist to be awarded the grade of Fellow in the Australian Psychological Society.

Helping Aboriginal women through breast cancer A new, illustrated booklet designed to inform and support Aboriginal and Torres Strait Islander women through the breast cancer journey is now available. Launching the booklet, Health Minister Peter Dutton said the booklet had been developed in conjunction with Indigenous women and health experts and would be widely distributed throughout Australia to help women and their families better cope with breast cancer. “The booklet is entitled My Breast Cancer Journey: a guide for Aboriginal and Torres Strait Islander women covers diagnosis, types of treatment, how treatment can make you feel, going away for treatment and follow-up care,” said Mr Dutton. “All women with breast cancer face the significant challenge of treatment but Aboriginal and Torres Strait Islander women have the added burden of often struggling to navigate these complex breast cancer pathways, and as a result, are less likely to receive and complete treatment. “That is why this booklet is a really valuable resource for Indigenous women.” Mr Dutton said breast cancer is the most commonly diagnosed cancer in Aboriginal and Torres Strait Islander women and survival is significantly lower in Indigenous women than their non-Indigenous counterparts. “Between 2006-2010, Aboriginal and Torres Strait Islander women had lower five year crude survival for breast cancer than non-Indigenous women (69% and 83% respectively),” he added. An online PDF version of the booklet is available at: www.canceraustralia.gov.au. Hard copies are available by phoning 02 9357 9400.

Koori Grapevine

Arts Health and Wellbeing A journey through writing and music By Jan Gracie Mulcahy My experience as a teacher of adults spans a 25-year music career as a professional bass player with the Australian Opera and Ballet Orchestra and the Sydney Symphony Orchestra. My next career as a yoga teacher and natural therapist emerged after going through a midlife health crisis of stress, divorce and personal neglect. It is a fairly common story, the big wake up call to embark on serious self-examination. I changed my diet and lifestyle and embarked on a path of self discovery and discipline. My career teaching yoga spanned 30 years and I loved the interaction of classwork and stimulating discussions. In my fifties, I graduated from university with a Social Science and Communication degree. Now, at the age of 77, I practice yoga to maintain good health and practice meditation for spiritual growth. I retired to the Northern Rivers in 1999 with my musician husband, Larry Mulcahy and the change to country living gave me the time and opportunity to research and write my family history. I self-published the book, Other Than English and it was launched at the Byron Bay Writers Festival in 2006. During the writing and editing period, I embarked on an inner journey of making peace with my past. I had been widowed

Book launch: My Story of Change Healthy Communities in the Macleay Valley has collected a series of stories from participants in healthy lifestyle programs that have made lasting changes to their health and their lives in general. The book entitled My Story of Change is the result and will be launched at Kempsey Library on February 11 at 2pm. Author Leonie Henschke runs workshops for writers through Coffs Harbour Writers Group and education sessions for children at the regional art gallery. To find out more about Healthy Communities, contact Coordinator Julie Woodrow on 6566 3334.

Jan at home with her dogs.

in tragic circumstances at the age of 23 and divorced at 43 and never really grieved those losses. I had also experienced a very troubled childhood with an adored mother, a singer, who suffered mental illness and a father who loved her and his two sons, but was emotionally distant towards me. To assist this gruelling process, in 2001, I began writing poetry and became a founding member of the local group, Dangerously Poetic Press. My association with these wonderful poets meant attending ongoing workshops where I learned to dig deep to retrieve old memories and bypass the inner critic, to let the words flow onto the page. These poetic free writing exercises, I hasten to add, are more intense than those in the U3A classes. I have contributed to all six Dangerously Poetic anthologies and am now one of three editors for their 2014 anthology, Ordinary Miracles. My current writing project, Flyaway Girl, is a memoir of my unusual childhood and musical career. It will be published next year. In February 2013, I wanted to help older people learn to appreciate what I call the inner music and to take them into a more informed world of lesser known classics. So I asked U3A to take enrolments for a fortnightly Classical Music Appreciation class and over 20 people turned up. I set out with my portable CD player, CDs of Bach and Beethoven and notes on the structure of music. Without intending to, I began sharing anecdotes from my memoir and the group responded by saying, â&#x20AC;&#x2DC;Your stories are nearly

Performing in the Nimbin Performance Poetry World Cup in 2008

To assist with this gruelling process, I began writing poetry as good as the music.â&#x20AC;&#x2122; Now at the end of this first year, we enjoy performances of Sibelius, Prokofiev and Puccini projected onto the big screen from DVDs or YouTube. The advantage of seeing the symphony orchestra on the screen is better than a performance because the camera can zoom in and show the oboist or French horn soloist close enough to touch. Some documentaries of operas and ballets give incredible insights as to what goes on backstage. I hope to keep a balance between my little talks before the performance, not to get too bogged down with the technicalities but to keep the level of enjoyment in tandem with what to listen for, a change of key, the accompaniment, the inner fabric to the voices, the build up of drama, the joy and the pathos. Being informed does not lessen the theatrical magic and it encourages the audience to get a taste of the interior of the magnificent opera houses and concert halls in London, New York, Amsterdam and Paris. Engaging with the artists as a small audience and experiencing the benefits of those star studded performances, is a privilege and unique. We laugh together, we weep and we always feel incredibly uplifted. HealthSpeak summer 2014

Following the call to a colourful life By Janis Balodis “I simply ask, can any woman, in truth, serve two masters and be faithful to both?” This quote from the 1998 movie Elizabeth starring Cate Blanchett is a rhetorical paraphrase of Matthew 6:24 in the New Testament. Blanchett’s Queen Elizabeth I asked it of men, but for Dr Angela Bettess it articulated a life and careerchanging dilemma. After dedicating more than 25 years to working as a GP, Angela gave up doctoring to become a visual artist. Why and how does someone decide to do that? Surrender a healthy income and good standing in the community for the uncertainties of creative endeavour and the odd raised eyebrow? The simple answer is contained in the name Angela Bettess chose for her November exhibition in Brisbane – Fascinated by Colour. And, like overnight success stories, lifechanging decisions do not just appear, they take a lifetime. Angela’s mother was a tailoress and as a child Angela loved the vivid colours of threads and patterns. Her mother fed this passion with visits to fabric stores and encouraged sewing and needlework. Angela did little art at high school where she proved to have a greater affinity for sciences than humanities. The combination of her interests in people and the sciences led her to train in medicine. And as one of the few professions wherein women were considered equal to men, medicine was increasingly becoming a good career choice for women. It wasn’t until her daughter did art at high school that Angela’s horizons widened. She began taking drawing classes and workshops at TAFE and with local artists on weekends. Like someone with an unknown and unquenched thirst, having sipped at the stream, Angela found herself being drawn further and further into the depths. To complete a Certificate II in Art, Angela attended TAFE for HealthSpeak summer 2014

Angela in her studio

two days a week; the Certificate III was three days a week and four days for the Diploma. The course work was increasingly challenging and she really enjoyed it but had to cut down working as a GP. The need to show and sell her work online meant a further Diploma in Web Design. Some of Angela’s work found its way amongst the artworks on the walls of Goonellabah Medical Centre (GMC) where she practiced. Her colleagues encouraged her and Dr Andrew Binns was ‘an amazing mentor’. One of the enjoyable things about GMC is that sitting in the waiting areas you can look at the art and be distracted, uplifted by its beauty or stimulated to do your own.

Angela art, and this exhibition in particular, which includes multi-media works, is all about colour. She loves animals, and birds, and cats, dogs and flowers feature prominently. She wants her paintings to be positive and uplifting and uses colour for a sense of fun, to be intriguing. In one painting an old lady wearing a hat seems to be hiding in a bid of flowers, inspired by a neighbour from years ago. Creativity is a demanding mistress, medicine a stern master. Both require attention to detail and follow up. Both take you over completely. Angela continued to serve both until three years ago when some health problems gave her pause. Though she misses the collegiality of medicine and the

interaction with patients, she decided to take some time off to follow her interests in the visual arts. Angela continues to involve herself in the administrative side of medicine, organising meetings and with Northern Rivers Arts Health and Wellbeing Inc, as well as the Northern Rivers General Practice Network, doing web and design work. But art took over. ‘Life is a struggle in making choices. You never know what opportunities lie ahead. Something in the art and therapy line perhaps,” said Angela. A final thought about art and wellbeing from Hippocrates, he of the physician’s oath: Life is short, art long, opportunity fleeting, experience treacherous, judgment difficult.”

Some of Angela’s work 23

By Alison Rahn Sex Therapist

Do you routinely ask patients about their sexual function? Research suggests most patients won’t tell you about their sexual problems unless you ask. GPs are often the first point of contact when a patient has a sexual concern. However many people do not feel comfortable talking about their sexual function unless their GP is comfortable discussing sexual matters and invites them to speak openly. In Australia, research indicates: 56% of people are dissatisfied with their sex life 22% of men over 40 in monogamous relationships report no sexual activity in the past year 30% of men experience erectile dysfunction (impotence) 25% of men report lack of sexual desire (libido) 24% of men report ejaculating too quickly 16% of men & 17% of women report performance anxiety 55% of women report lack of sexual desire (versus 30% in USA) 30% of women report difficulty reaching orgasm (versus 7% in Denmark) 27% of women report little or no sexual pleasure What this means is that many Australians are struggling with sex. Much of this is due to poor sex education, poor understanding of their bodies, and people’s unrealistic expectations of their partners. And we are an ageing society, where: 70% of women over 60 and 92.7% of men over 60 are sexually active The majority of people with concerns about their sexual function are not seeking treatment. And when they do, they are often not referred to a sexual 24

The Topic of

Sex

Research shows 56% of people are dissatisfied with their sex life health physician or sex therapist. In a US study of 1,682 people conducted in 2004, 15% of respondents reported they sought treatment for problems related to sexual functioning from their personal physician, while only 7% sought treatment from a psychologist or sex therapist. Across all age brackets, men are more likely than women to report having sought treatment from their personal physician or a specialist physician for their sexual functioning-related problems. In my own practice, I am often hearing anecdotal stories about the range of responses given by GPs to patients’ sexual concerns. Some examples: The inexperienced 18-year-old man who was so keen to make his girlfriend’s first experience perfect that he consulted his male GP about his inability to achieve an erection ‘on demand’. He was prescribed Cialis, but was not educated about

how it works and when to take it. The result was a high level of distress when his penis didn’t perform. The medical practice waiting room with prominently displayed signs saying ‘this practice does not prescribe contraception or give referrals for terminations’. The 24-year-old man who ceased having erections, even during his sleep, and was told ‘it’s all in your head, go talk to someone’ but was not given a referral. The 50-year-old man who tentatively raised the subject of his low libido with his young female GP and was hurriedly prescribed Viagra without any further discussion or a medical history being taken. And on a more positive note: The young female GP who openly enquires about her patients’ sex lives while performing routine pap smears, giving them permission to speak freely.

One obvious reason why GPs don’t invite discussion of a patient’s sexual function is the time limitation of a standard consultation. Many GPs feel they’ll be opening ‘a can of worms’ that will lead to a time blowout they can’t afford in an already busy day. Many GPs also report inadequate training when it comes to sexual functioning, since most medical degrees devote very little time to sexual function. GPs cannot afford to ignore or dismiss sexual concerns. Evidence shows that sexual dysfunction is often an early indicator of many serious health conditions, cardiovascular disease being the most common. If you have patients with any of these conditions, they probably also have sexual issues they need help with: Anxiety / depression Diabetes Cardiovascular disease Chronic pain Spinal injuries Prostate or gynaecological problems Recent childbirth Menopause Likewise, patients taking a variety of medications suffer sexual side effects. The most common of these are SSRI anti-depressants, anti-anxiety and anti-psychotic medications. New research also indicates that sudden cessation of SSRI medications can permanently remove sexual desire and the ability to orgasm. To find a sex therapist to refer to in your area, go to The Society of Australian Sexologists (http://assertnational.org. au/) for more information. Sex therapists have extensive sexual health training and come from a variety of fields, including doctors, nurses, psychologists and counsellors. Alison Rahn is a sex therapist based in Mullumbimby and Southport. She has a Master of Health Science (Sexual Health) and is a member of SAS (Society of Australian Sexologists). Alison is the only sex therapist practising between Coffs Harbour and the Gold Coast. For more information, contact Alison on 0432 599 812 or go to www. alisonrahn.com.au References available on request. HealthSpeak

summer 2014

Helping weight loss by not focussing on it from modern weapons technology used in warfare at the one extreme, and ‘screen dermatitis’ and eyesight problems from using computers too much at the other? Overuse of technology (eg using cars instead of walking) can also be associated with weight gain.

By Prof Garry Egger Among the ongoing rabble that is the translation of health science to the general public, is an argument about the importance (or not) of obesity as a cause of disease. Looked at dispassionately, this is set to become a paper tiger: Does obesity CAUSE diabetes? Is it sugar that’s CAUSING the obesity epidemic? Is the rise in BMI really reflective of a CAUSE of health problems etc. In simple terms, a summary view could be that: 1 Obesity is not the direct cause of disease but a signal, or ‘a canary in the coalmine’, warning of bigger problems in society as a whole; 2 It’s the determinants of obesity (nutrition, inactivity etc.) rather than obesity per se that lead to diseases like heart disease, cancers, Type 2 diabetes etc. 3 There are a number of these determinants that can be defined under the acronym NASTIE ODOURS. Please explain?

Modern diseases and causality Historically, infectious diseases have been the most common cause of illness and death amongst humans. In the 19th century however, we realised that these were due to microbial organisms (‘germs’) and hence we were able to focus our concentration on drugs, hygiene and immunisation to help overcome these. More recently, this type of disease has been replaced with more non-infectious non-biological, chronic diseases (heart disease, cancers, diabetes etc) that are related to our modern environment and the way we live. Obesity may be a side product of this, but not a direct cause of disease. The question is then, how do we categorise those aspects of the HealthSpeak

summer 2014

environment and lifestyle that lead to obesity AND chronic disease? One answer is an acronym – NASTIE ODOURS. Here it is for the benefit of the reader: Nutrition – of the inadequate, or over-use variety is connected with many different types of disease. Too much food in general, and processed food in particular, is the problem. But we also eat too much (saturated and trans) fats, sugars and salt and too little food variety, fibre, fruit, vegetables and whole grains. Not only can all this make you fat, it can make you sick. Activity – or more correctly inactivity, is one of the biggest causes of health problems, being associated with over 35 modern diseases. Both aerobic and muscular fitness are at a low level, and sitting for too long is now regarded as an independent risk factor for disease. Again, the path to ill-health may be through obesity, but can also be without any weight gain. Stress anxiety and depression – have always been around, but it’s only in the modern age that flight or fight is a less viable option for dealing with it (you can’t beat the boss or run-away from work) leading to a chronic build up of the stress related chemicals (eg cortisol) that can lead to disease – either with or without obesity. Techno – Pathology - Among all the benefits of technology, there are also some downsides. What about death and destruction

Inadequate sleep – is a major cause of chronic disease problems like Type 2 diabetes and heart disease. This is because it’s also related to over-eating and use of entertainment devices that involve inactivity (eg video games, computers). Too little sleep can also be related to weight gain – as can be too much sleep. Environment –not just the physical environment, which includes the tones of endocrine disrupting chemicals (EDCs) that have been pumped into the air, water and soil, but the sociocultural, political and economic environments, right up to, and including the modern system of economic growth which not just encourages, but almost demands increased consumption that leads to overweight and ill-health. Occupation – is often neglected as a cause of health problems which can occur as a result of physical factors, such as hours worked, shift work, exposure to chemicals etc. Additionally, psychological factors such as bullying, powerlessness, and feelings of lack of control in the work environment lead to overeating and drinking, and hence overweight. ‘Is it your job that is making you fat?’ is a question that needs to be asked as much as ‘do you over-eat?. Drugs, smoking and excessive alcohol – are all no- brainers when it comes to overuse. In the case of cigarettes, any use is unhealthy (although not fattening). Alcohol is a little more ambiguous because there are some health advantages in moderate usage, but major problems with over-use. Even prescription drugs have side effects (such as weight gain with anti-depressants and anti-psychotics) that can lead

to health problems other than those which they are designed to treat. Over and Under exposure – is usually associated with sunlight, leading to skin cancers (in the case of the former) or vitamin D deficiencies (in the case of the latter). These aren’t directly associated with weight gain, but seasonal affective disorder (SAD) which results from too little light in winter (mainly at very high latitudes). This is an under-appreciated determinants of weight gain. Vitamin D deficiency is also associated with depression, which in turn is associated with a range of illnesses and disabilities. Relationships – like how you get on with your spouse, the level of social support you can call on when things go wrong, and your feelings of isolation, can all have an effect on your health and weight. Social disadvantage – may not seem to be a health issue, but recent research tends to support a link. Large-scale studies have now shown that living in a country with big differences between the rich and the poor is more fattening and unhealthy than either living in a country where everyone is rich or everyone is poor. Why this happens seems to be unclear, but it could be related to a lack of trust, leading to fear of walking crime-ridden streets, or to the economic insecurity that comes from trying to ‘keep up with the Jones’.

Summing up Taken together, your patients’ NASTIE ODOURS profile is likely to be a better indication of their overall health than their level of overweight or obesity. To maintain a healthy body weight and good health, anybody would be well advised to look at all 12 components of the acronym and not just one or two (eg diet or exercise.) The take home message? If you don’t smell, it doesn’t really matter how big you are! Get your house in order and your body will follow. 25

Responding to suicide bereavement One of Australia’s most successful ready response services to suicide loss has been launched on the North Coast by Northern Rivers Social Development Council and United Synergies’ National StandBy Response Service . United Synergies is a notfor-profit organisation based on Queensland’s Sunshine Coast. Families and communities in Australia are often ill-prepared for the emotional and social impact that occurs following the suicide death of a friend, loved one or colleague. Suicide has a significant and dramatic effect often causing distress and concern across the whole community. The North Coast StandBy program offers a 24-hour coordinated crisis response to

assist people bereaved by suicide, regardless of when or where the suicide occurred, by using existing emergency and community support mechanisms. Funded by the Australian Government, the local service region goes from Tweed Heads to Port Macquarie. Local StandBy Coordinator Rose Hogan said: “This is a significant social issue that we can address together to provide support and improve the wellbeing of people we know who are bereaved by suicide. We

Expert baby care talk proves popular Earlier this year, Healthy North Coast ticked off another milestone with the inaugural live broadcast of ‘Healthy North Coast Presents...’ The talk, which featured Dr Howard Chilton, a neonatologist at Sydney’s Prince of Wales Private Hospital and the Royal Hospital for Women, gave North Coast residents the opportunity to engage with a leading health expert. Nearly one thousand people have viewed Dr Chilton’s talk which featured advice on co-sleeping with a baby, the use of dummies and his coined term ‘reassurology’. Healthy North Coast Coordinator Alex Lewers said hosting events like this was part of the Healthy North Coast ethos and that the success of the first video would pave the way for more. “Healthy North Coast is committed to making high quality, reliable and up-todate health information accessible to the entire North Coast community. Through

Howard Chilton

using online video streaming we can bring a health expert into everyone’s living room, allow our audience to ask real-time questions, and hopefully make a difference in their lives,” he said. Those who missed the live discussion can view a recording at www.healthynorthcoast.org.au/category/videos . Dr Chilton is now available for face-to-face consultations on Fridays fortnightly via GP referral for babies up to 18 months of age. Visit www.babydoc.com.au for more information. If you are a clinician wanting to give a live talk, contact Alex Lewers at alewers@ ncml.org.au or on 6618 5419.

look forward to the opportunity to deliver this program on the North Coast and to how we as a community respond to tragedy of suicide and its impact.” Health providers, community groups and agencies are invited to contact the North Coast StandBy Service and learn about the StandBy approach, how to refer to the StandBy Service and the role of local health and community services can play in supporting those bereaved by suicide. National StandBy Response

Coordinator Jill Fisher said: ”Providing an integrated and comprehensive locally based response using existing emergency and community support results in bereaved people accessing the support they need at the time of their greatest need from their own local community. We are pleased that other Australian communities are joining this internationally recognised program and making a difference in the lives of those bereaved by suicide.” For further information about the North Coast StandBy Response Service , please contact the Standby Coordinator, Rose Hogan on 66201 800 or standby@nrsdc.org.au To seek support after suicide call the Suicide Call Back Service 1300 659 467 or Lifeline on 13 11 14

Accessing public dental services Who is eligible? Free dental care is available at NSW public dental clinics for Children under 18 Adults who hold a Pensioner Concession card, a Commonwealth Seniors Health card or a Health Care card Anyone listed on the cards is eligible for free dental care All patients must be eligible for Medicare and have a valid Medicare card. How to make an appointment If you live on the North or Mid North Coast of NSW, then phone 1300 651 625. The call centre staff will ask for your concession and Medicare card numbers and ask about your teeth so they can prioritise you on a waiting list. If you need an interpreter or Aboriginal Liaison officer then ask the call centre staff to arrange one at your appointment. You can also use the National Interpreter Service on 13 14 50. What else do I need to know? Bring your current concession and Medicare cards with you to

your treatment. Your first visit may involve a check and you should not expect your teeth to be fully fixed on this visit. If you require further care you will be given an appointment or placed on a waiting list or given a voucher to see a private dentist, depending on your needs. Generally, public dental services are unable to provide crowns, implants or root canal therapy on back teeth. What if I cannot make my appointment? You must ring 1300 651 625 and cancel your appointment. If you fail to attend your appointment or do not call to change it, your treatment might be cancelled. What about a dental emergency? If you have Bleeding in the mouth that will not stop Swelling of the face from a tooth infection Recent injury to your teeth, then After hours, you should go to your local hospital’s emergency department. During work hours, you should call 1300 651 625. HealthSpeak

summer 2014

Heart Failure Management: Getting It Right!

Heart failure clinical nurse specialist Francesca Leaton presenting her talk at the conference in Byron Bay.

This one day conference, held in Byron Bay in September was co-hosted by UCRH and NNSWLHD Cardiac Services and attracted a total of 98 participants and feedback was extremely positive. The emphasis for the day was on a multidisciplinary approach to heart failure management so it was great to see registrations reflecting that objective with a good mix of nurses, pharmacists, GPs, exercise physiologists, physiotherapists, dieticians, aged care workers and other allied health professionals. The principal messages from the day were around clinical collaboration, medication management, lifestyle management and

patient self-empowerment. Dr Ajay Gandhi, a cardiologist from Tweed Heads, kicked off the day with an overview of current best practice and new developments in HF management. Dr Di Blanckensee from The Tweed Health for Everyone SuperClinic then talked about the benefits of having a range of health clinicians under the one roof when implementing a care plan for a heart failure patient. Presentations followed from consultant pharmacist, Debbie Rigby, mental health specialist, Jem Mills, exercise physiologists Peter Hood and Tiphanie Johnson, heart failure clinical nurse specialist, Francesca Leaton and dietician, Richard Grzegrzulka.

New hep c service for mid north coast North Coast residents with chronic Hepatitis C infection (HCV) can now access a new Telehealth-based assessment and treatment program. The LORA Program (Liver OutReach Australia) aims to increase capacity for assessment and treatment of HCV in regions where there is a high unmet need. Sawtell-based S100 Hepatitis C Prescriber, Dr Trish Collie successfully collaborated with the North Coast HIV and Related Programs (HARP) and received funding for a nurse-led HCV treatment program based in her general practice. “It is very exciting for all of us in the community to receive this new comprehensive

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nurse-led assessment program for HCV in consultation with a general practitioner (GP) and specialist. “Coffs Harbour and surrounds will benefit from the addition of a Fibroscan to assist with treatment decision making, whilst providing an additional site for treatment,” Dr Collie said. “It is wonderful to know that my patients now have access to more options for assessment and treatment.” “Fibroscan is a noninvasive, ultrasound based technology for assessing liver scarring or fibrosis. At the moment, clients referred for a Fibroscan have to travel to Sydney, Newcastle or Brisbane,” Dr Collie explained.

Take home messages: Medication: Less than a fifth of heart failure patients (research presented at CSANZ 2012) are having heart failure medications up-titrated to recommended target doses to achieve desired improvements in survival rates, cardiac function and quality of life. The message was ‘start low and go slow but try to achieve target maintenance dose’; refer all heart failure patients for a Home Medicines Review; Exercise: clinicians can begin with the ‘any exercise is better than no exercise’ message; increase incrementally to low to moderate intensity aerobic exercise on most days and individually prescribed low to moderate intensity resistance training at least twice a week; reduce sedentary time or risk accelerated muscle fatigue and reduced efficiency of the body’s regulatory processes; Diet: refer all HF patients to a dietitian. Advise patients that cooking meals from fresh ingredients is the most effective strategy to ensure a reduction in salt intake, at the same time increasing nutrition and fibre intake. Acknowledge cultural and family history around food and diet and their emotive associations and work with the patient to modify their diet within achievable parameters; Mental health: a high percentage of patients with heart failure also have mental health problems so screen all HF patients; best outcomes are achieved when there is a high level of treatment adherence and selfmanagement by pa-

tients. Adherence and self-management result when patients’ fears, resistance and competing goals are acknowledged and validated by skilled and empathetic clinicians; provide information and feedback, not ‘you must’ or ‘you should’. Aboriginal Health Worker, Ellis Bradshaw’s presentation of the National Heart Foundation’s “Living Every Day with My Heart Failure” booklet provided practical advice for culturally-appropriate assistance for Aboriginal heart failure patients. The case study discussion panel included two consumers. Their ‘tell-it-how-it-really-is’ comments provided practitioners with strategies to motivate and empower patients to self-manage their heart failure. In their conference evaluations, many participants acknowledged they had insufficient knowledge around appropriate diet and exercise advice for heart failure patients and, in future, would spend more time working with patients to help them manage lifestyle issues. The importance of mental health strategies and appropriate counselling for patients was also noted following a lively and informative presentation by Jem Mills. Thanks to North Coast Medicare Local, Southern Cross University, Byron Bay Community Centre, Pfizer and the Sorin group for their support for the event. Lindy Swain Pharmacy Academic UCRH Sue Nelson Pharmacy Project Officer UCRH Kerry Wilcox Cardiac Services Coordinator NNSWLHD 27

Understanding health professionals The difference between physiotherapists, exercise physiologists and personal trainers. By Alex Lawrence Exercise Physiologist and Sport Scientist

ment. Exercise Physiologists have a broad knowledge in all health related aspects of working with injury and chronic disease. Working in public and private health sectors, EPs will also address lifestyle and behaviour modification. Like physiotherapists, exercise physiologists often specialise in specific areas according to their strengths, so when seeking out the services of an EP it is preferable to find one that specialises in your target area to assure optimum treatment results. Both EPs and physiotherapists are required to complete continued education to stay accredited.

Personal training

I am often asked to explain the difference between physiotherapists and exercise physiologists, so I thought I’d try to clarify the differences in this article. I also thought it would be good to talk about personal

Trainers as I feel they have an important role to play. Distinguishing between the two professions isn’t easy, as they are not mutually exclusive. Both physiotherapists and exercise physiologists can work within a

broad scope of practice, providing that they are appropriately trained. As a result, there is an overlap, so it is understandable that confusion exists within the community.

Physiotherapy

A physiotherapist is a university trained professional (four years) that is also part of the “Allied Health” group. Generally, physiotherapists are specialists in the area of musculoskeletal disorders; prevention, treatment and management. The reason I say generally, is because they can also be specialists in an area such as cardiovascular, pulmonary and neurological rehabilitation. Physiotherapists are known to use a variety of methods such as acupuncture, therapeutic exercise, massage, joint mobilisation and manipulation. While physiotherapists are well trained in all musculoskeletal injuries, some will specialise in specific areas, such as paediatric or sport physiotherapy.

Exercise Physiology

Compared to physiotherapy, exercise physiology is a relatively new profession in. Also University trained (four years) and part of the Allied Health group, Exercise Physiologists, sometimes referred to as EPs, use exercise for injury and chronic disease prevention and manage28

In order to become a personal trainer it is usual to complete a TAFE or RTO course. These courses are designed to give the trainer the skills to train the general population in a safe and effective manner. A good trainer will continue to improve their skill set by completing established accredited courses or going on to further tertiary education (Certificate III, IV and Diplomas in Personal Training are often used as a stepping stone into University). Unfortunately, the fitness industry is loosely regulated and there are a lot of bogus and fad courses. If you don’t suffer from any medical conditions, do not let that turn you off seeking advice from a personal trainer - there are a lot of highly qualified trainers that are doing their industry justice. However, I would advise that you check the qualifications of your personal trainer before proceeding with them in order to protect your own health and safety. Alex Lawrence is the owner and founder of Alex Lawrence Rehabilitation in Nambucca Heads.

Free

advertising! Do you run a community health activity on the North Coast? You can promote it free on the Healthy North Coast website. Visit http://bit.ly/1gOYNWb to create an account and register your activity.

HealthSpeak

summer 2014

Animal adventures in Chiang Mai

Travel

By Janet Grist arket

m Chiang Mai has all the ai night Chiang m allure of Thailand’s much bigger capital, Bangkok, but it’s easy to get around and offers a smorgasbord of sightseeing activities and adventures. Located 700 km north of Bangkok, it is nestled among the highest mountains in the country. Not far from the Thai/Burma border, Chiang Mai is also among Trip Advisor’s 25 Best Destinations in the World. t is culturally significant with more than 300 Buddhist temples, a City Arts and Cultural Centre, the Chiang Mai was ordered. It was as if four of the naughtiest kids National Museum, the Tribal Museum showcasing at school had been given a snake farm to run and the history of local mountain tribes, and an old coin were making a go of it. museum. At the front was a faded photo of a middle-aged Shopping opportunities are everywhere, from arts Thai man with Sylvestor Stallone in Rambo IV. He and crafts, to knock off watches and clothes. The was later spied in a hammock taking a nap, and now night markets are equivalent to an entire suburb looked to be around 80. and when it all gets too much, the air conditioned The young men managing Airport Plaza has speciality stores, the snake farm were fun and Robinsons department store and engaging and very mischievous. a Cineplex. They obviously loved performAnd like Bangkok, Chiang Mai ing and would accompany you is a foodie’s paradise with choices around to the various cages, galore. From hole in the wall local making jokes and draping Burcafes to well-appointed restaumese pythons and other crearants, the city offers a huge range tures around our shoulders. The tigers of cuisines. Strolling through of Tiger And then came the snake its night markets, the smell of Kingdom show itself with staged seating barbecued pork fills the air and surrounding a ring with a small diners are hard pressed to make guard rail. Here the ‘naughty a decision with such a variety of boys’ proved to be expert snake mouth-watering dishes prepared before their eyes. handlers, delighting the audience with their antics I spent six days in Chiang Mai, staying with and moves as they ‘played’ with king cobras and friends at the very comfortable Opium Apartments other venomous snakes. The finale was when in a quieter part of the city. We were able to walk to a young man ‘kissed’ the cobra, a mesmeristhe city centre but were away from the backpackers’ ing sight as it took him some minutes eyehaunts, so it was quiet and restful at night. balling the snake and goading him, before Apart from the arduous work of eating and sightslowly placing his forefinger on the snake’s seeing, we also ventured out of the city itself to the ‘adventure enclave’ of Chiang Mai, a strip full of fun head and leaning in for the embrace. Other family attractions in this area and excitement for all ages. include the Patara Elephant Farm (also a The highlight of my trip was a visit to Tiger conservation project) where visitors interact Kingdom, a conservation project to protect the Indo Asian tiger. Born in captivity and reared by hand, the with elephants helping to wash them, feed them, ride them and learn about this fascitigers are ‘trained’ not ‘tamed’. nating animal. There is also the Zoo Night For $AU28 we were able to spend 15 minutes Safari where tourists travel around in train cars. each with small and big tigers in a compound with and the Flight of the Gibbon where you zip a softly spoken Thai keeper. Tiger Kingdom is well through the jungle canopy on zip wires and run with clear instructions on how to behave with platforms. the animals and a calm atmosphere. I can recommend Chiang Mai as a It’s very humbling to look into the eyes of these wonderful family holiday destination. magnificent creatures at such close quarters and to You could easily spend 10 fun-filled days pat and cuddle their bodies - you are not permitted here. to touch the tiger’s head. It was hard to tear ourselves away from Tiger Kingdom, but the Snake Farm nearby beckoned. Air Asia now flies direct to Chiang Mai The snake farm was as chaotic as Tiger Kingdom from the Gold Coast airport.

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summer 2014

Here the ‘naughty boys’ proved to be expert snake handlers

King Cobra from the Snake Farm

GP Registrars encouraged to join AMSes North Coast GP Training (NCGPT) has produced a 10minute video highlighting the benefits, rewards and challenges of working in an Aboriginal Medical Service (AMS). It also dispels some myths and misconceptions about working in Aboriginal health, and shines a light on the critical role that GPs and GP registrars can play. GP Supervisor Dr Peter Fletcher from Durri Aboriginal Corporation Medical Service said working in an AMS gives registrars the best bang for their medical buck along with the opportunity to help Close the Gap. Filming took place at a number of NCGPT Aboriginal Health Training Services including Durri in Kempsey, Casino Aboriginal Medical Service and Galambila Aboriginal Health Service in Coffs Harbour.

CEO of Casino AMS, Steve Blunden, wanted to use the opportunity to bring awareness to the situation of Aboriginal health in communities, and the important role doctors play. “The reason why the AMS is involved with North Coast GP Training is that we really

Are you on the National Health Services Directory? The National Health Services Directory (NHSD) is a free, comprehensive national directory of health services enabling consumers and health providers to access reliable and consistent health information. The NHSD can be found on websites including those of Medicare Locals , state and territory websites, the RACGP and the Pharmaceutical Society of Australia. Consumers can find out a variety of information such as clinic address details, opening hours and information on wheelchair access – it can all be placed onto the NHSD. To find out whether your organisation is listed on the NHSD, go to these sites and search for your service - www.nhsd.com.au or www. healthdirect.org.au

care about doctors understanding the problems experienced by Aboriginal people, and want them to experience the different health problems that our community has”, said Steve. The video makes apparent the broad range of health issues patients present with at AMSes. The Aboriginal health services model is quite different to the norm in General Practice with a strong focus on collabo-

ration and teamwork between the doctors, allied health professionals and Aboriginal health workers to create a holistic approach to medicine. NCGPT is offering free use of the video to other Regional Training Providers or government departments. NCGPT offers registrar placements within six accredited Aboriginal Medical Services throughout Mid North and North Coast NSW. To find out more about becoming a registrar and working in Aboriginal health, contact NCGPT on 6681 5711 or go to: www.ncgpt. org.au You can view The Aboriginal Medical Service Experience at www.ncgpt.org.au/aboriginalhealth-training North Coast GP Training is the Commonwealth funded Regional Training Provider delivering the Australian General Practice Training and Prevocational General Practice Placements programs on the north coast of NSW.

Partnership to enhance the role of PNs

If it’s not listed, register by going to: http://manage.nhsd. com.au/register If your details are incomplete, complete the feedback form at: http://manage.nhsd.com.au/ feedback.aspx In the near future, you will be able to keep your own details up to date on the NHSD. For more information, email: nhsd@healthdirect. org.au

The Australian Medicare Local Alliance (AML Alliance) and the Australian Primary Health Care Nurses Association (APNA) have signed an unprecedented agreement to jointly deliver the Nursing in General Practice program into 2015. The program is funded by the Commonwealth Government, through the Department of Health. “Our joint work on this program will help achieve our vision for primary health care nurses to be integral members of multidisciplinary teams, working collaboratively with general practitioners, consumers, healthcare providers and the community to achieve quality primary health care,” said AML Alliance Chair, Dr Arn Sprogis. The program’s key activities will include: leadership development for primary health care nurses; practical research and

policy work to develop the role of the profession; projects to further develop nurse clinics in general practice settings; nurse education workshops and resources; and work to promote optimal value of the nursing workforce. APNA President Ms Julianne Badenoch agrees that as a result of the partnership there is a genuine opportunity to support and build the capacity of the nursing workforce. “This program aligns with and will help to achieve APNA's strategic vision of a healthy Australia through best practice primary health care nursing,” said Ms Badenoch. “By expanding opportunities for nurses in primary health care, the outcome will be better health care for the Australian community,” she added. HealthSpeak

summer 2014

Brave new world We are about to enter the next scary phase of the post GFC recovery. To survive as investors we are going to need a stout heart and a titchy finger hovering over the sell button on our computers. We are once again about to enter unchartered waters with only hope and a smattering of untried economic theory to guide us. In January, 67-year-old Janet Yellen takes over from Ben Benanke as chair of the US Federal Reserve. As we know, this is the most important and most powerful economic job in the world. She will have the job of steering the US economy into recovery without causing major traumas along the way. The fortune of the entire world economy rests on her shoulders. What policies will she adopt? What are the risks? Ben Benanke, a student of the great depression, decided at the beginning of the GFC that he would protect the banking system at any cost. He blames the 1930s banking crisis as the trigger for the depression. Some of his followers go further. They blame the policies of the Fed for the collapse of the banking system, the great depression and the rise of Hitler and WWII. The problem back in the 1930s was that the US Federal Reserve stuck obstinately to the gold standard believing that protecting the value of the currency was the correct policy response. Unfortunately it led to a severe liquidity crisis for the banks and of course

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many collapsed. We are no longer on the gold standard but during the GFC the liquidity problem remerged with a vengeance. Benanke’s response was to push interest rates to zero and start printing money. Trillions were used to buy treasury bills at first, a traditional central bank function, but later the net was widened when this proved insufficient. The Fed started buying all sorts of bank assets ranging from long-term government bonds to housing loans and even car and student loans. This was unprecedented but it worked.

It’s like trying to push a rock with a piece of string The US banks survived and are now in a healthy financial position. The Fed has now assumed the role of kick starting the US economy using monetary policy alone. When confidence is low, easy money and zero interest rates won’t necessarily result in more economic activity. As Keynes observed, it is like trying to push a rock with a piece of string. The biggest effect of all this money printing has been to cash up the banks (they are now holding trillions in cash and deposits with the Fed which they are reluctant to lend out) and to push up asset prices and devalue

Economy David Tomlinson the US dollar. The Fed hoped that this would make people feel better, lead to higher consumer spending and lead eventually to a sustained economic recovery. It’s a bit like the trickle down effect. The rich get richer and hopefully start spending where it will create jobs. There are signs this is working to a limited extent but it is darn slow. So what happens next? At some point, probably fairly soon, the Fed will “taper” its money printing program and eventually stop altogether. This is crunch time. If it is handled badly then shock waves will reverberate through the share, bond and property markets. Interest rates will rise, confidence will slump and the world economy could once again be looking into a black hole. To counter this the Fed is now proposing that it will promise to keep interest rates near zero for several more years – possibly to 2017. This is again unprecedented and the risk is that the markets might just not believe them. One problem is that all this money printing has left trillions of dollars sloshing around with nothing to do. It is a latent inflation risk. If this money starts to find its way back into the real economy, consumer prices could start moving up very quickly. Would the Fed still want to sit on zero interest rates? And what effect would it have on investors?

If you know you can borrow at say three per cent a year for four years and get a return of six per cent on say a share portfolio, then it would make sense to borrow to the hilt to magnify the return three or four fold. The hedge funds and the speculators would go wild. Bubbles could well inflate everywhere, once again risking the economic recovery. Meanwhile back in Australia it would probably mean that the Australian dollar would remain high, industry would still struggle and our own Reserve Bank would be in a serious policy bind. All the distortions in the world markets caused by money printing have left the Aussie dollar overvalued. If the Reserve cut interest rates to make it less attractive it could start a series of asset bubbles in the share and property markets at home. This is all scary stuff and it could go horribly wrong. It all depends on how astute the policy makers are in the Fed. Unfortunately, as the GFC has shown, the track record is not good.

Tension pneumothorax can cause dogged drama By Andrew Binns Walking one’s dog is a true pleasure, the exercise being as good for the health of the owner as for the dog itself. However, our suburbs harbour hazards, not least the dogs of others, particularly when unleashed and of an aggressive breed or disposition. On a recent morning walk my little dog Scruffy, a timid and harmless chap, was attacked by a large dog. He was picked up around the chest wall and shaken in what seemed to be a split second. While I was able to separate them without, mercifully, sustaining injury to myself, Scruffy received a serious chest injury. As it was clear he was only using one lung to breathe and was in obvious pain, I carried him home and rushed him to the local vet, X-ray showing collapsed lung Richard Creed at Lismore Veterinary Clinic. Richard’s assessment of the situation included an x-ray which showed two fractured before takeoff asking if there was a doctor on ribs and a right collapsed lung. board, and he and another doctor attended a There was no break on the skin, so clearly lady who’d had a minor motorcycle accident the lung had been punctured by a broken on the way to the airport. Initially it was rib and there was some mediastinal shift to thought that the injury was a minor fracture the left and right chest wall subcutaneous of her upper arm with bruising, and a splint emphysema (air in the tissues of the chest was made. wall). Scruffy was cyanotic and very unwell. However, 90 minutes later, as the plane This all added up to a tension pneumothowas flying at 30,000 feet above India, the rax. lady bent over to remove her shoes and imHe was given nasal oxygen, a drip and a mediately developed severe left-sided chest dose of methadone for pain and breathlessness. the pain, followed by the Dr Wallace was again lifesaving task of releasing called, this time noting the air under pressure in that the windpipe felt in the lung cavity. This was the neck had moved to done with the insertion one side, indicating she of a needle and catheter had a potentially lethal through the chest wall pneumothorax. connected to a sy“I knew I needed to ringe with three way tap, put in a proper chest and the air under pressure drain—the correct in the pleural cavity let treatment for a tension out. pneumothorax—but there The breathing and his was only basic equipment overall condition seemed in the aircraft’s medical to instantly improve and kit, including a scalpel he was bound up with and a 14-gauge urinary Professor Angus Wallace tape around the chest catheter,” he recalled. wall. Scruffy picked up “I created a chest drain well after a few days and came home on anby using a coat hanger, as suggested by one tibiotics and a fentanyl patch. He has made of the cabin crew, which I made into a trocar an excellent recovery. for the catheter. I also used a bottle of Evian While tension pneumothorax is not comwater, with two holes punched in the cap for mon in animals or humans following trauan underwater seal drain, oxygen tubing to ma, the life threatening and dramatic course attach the catheter to the drain, and Sellotape of this injury is certainly worth reflecting – to seal the catheter to the drain. and when necessary, acting - upon. “Xylocard (100 mg of lignocaine in 10 In 1995 an orthopaedic surgeon, Profesml) was the local anaesthetic provided in the sor Angus Wallace, with whom I worked in emergency kit, and to disinfect my equipthe UK in the late ‘70s, was on a flight from ment I used a bottle of 5-star brandy offered Hong Kong to London. A call went out by the crew, who then set up an operating 32

Tension pneumothorax survivor Scruffy

Not surprisingly, Dr Wallace said he needed some of the leftover brandy after the operation theatre on the back row of the plane, out of the way of passengers. “I inserted the chest drain, a procedure obviously painful for the patient, although she seemed better within about five minutes and went on to make a good recovery.” (1). Not surprisingly, Dr Wallace said he needed some of the leftover brandy after the operation. Later, he became world famous for this case, as well as for many other reasons. (Professor Wallace is from the Division of Orthopaedic & Accident Surgery, University of Nottingham, Nottingham University Hospitals. He is a highly respected surgeon, educator and inventor of successful orthopaedic procedures and devices.) The more that doctors travel, the greater the likelihood of coming across somebody needing urgent medical care. Fortunately the medical defence organisations now provide indemnity insurance cover for this community service and apart from being careful to stay within the boundaries of one’s clinical skills and competence there is no reason not to intervene. Good Samaritan intervention can save lives, as in this case, and in any event will no doubt always be appreciated by people in need. (1) BMJ Careers, Good Samaritan experiences, 21st Dec 2012

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King Island locum: more than just the cheese ‘I always wanted to go to King Island.’ Many people respond like this when I tell of my recent locum experience as a grey nomad doctor. Even though it was for just a few days, it was great to mix with the welcoming community of 1700 locals. ‘If you live here you have to face your demons,’ the director of the King Island cultural centre told me. Certainly there are no nightclubs and few teenagers. High school goes up to year 10 and then it’s boarding school in the outside world. King Island is a land splinter west in Bass Strait. At 64km long and 27km wide, it’s mostly flat and green, dotted with black and white cows. A lack of foxes means that feral flocks of ex-domestic turkeys, handsome pheasants and peacocks roam freely around paddocks. Before folk arrived, there lived a huge colony of elephant seals. Extinction took place within 2 years and by 1805 all were gone. The sailors involved had lived under violence of the lash and could see only the prize money of oil and skins. Elephant Seal Bay wistfully survives only in name. A tragic legacy of shipwreck followed discovery by Dr George Bass in 1798 that Tassie is a separate land mass. Ships exhausted by the long passage from Europe took advantage of the Bass Strait short cut, while risking a perilous passage called the ‘Eye of the Needle’. With GPS navigation this is history, but in the 1800s sail-

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My travelling companion complained my souvenir cheese bag had the aroma of an axilla ing ships relied on the newly invented chronometer, basically a windup clock to determine longitude position. If it went haywire or someone forgot to wind it up, then the ship and those in her risked death. ** The most poignant shipwreck was the Neva, with a cargo of Irish convict women bound for Botany Bay. It was wrecked on the northern tip of Cape Wickham such that wailing laments of the doomed women and children, still shackled below deck, could be heard from onshore. The

captain saved himself by lifeboat and received no criticism at the subsequent inquiry; such was the status of his cargo. During a recent reparation ceremony, Irish linen washed in the sea at this forlorn place was taken to Cork Prison where today’s female inmates lovingly fashioned memorial bonnets, one for each of the 224 women. Another shipwreck was the Cataraquai. It remains Australia’s greatest peacetime maritime disaster. The root cause analysis sheets the cause home to an abrasive relationship between the ship’s doctor and the captain, who was goaded into carrying full sail, because it was to be the last night at sea. Passengers were already dressed in their finery for the Melbourne landfall when the Cataraquai was impaled on the foam-gnashed fangs of King Island with a loss of 400 souls and nine survivors. Lack of jobs is today’s problem on King Island and closure

Light Airs David Miller

of the abattoir has turned the pretty seaside town of Grassy into a virtual ghost town. What of the practice and the hospital? It was busy enough and everybody was bulk billed. The patients have the much-loved Dr Ruth who needs a regular associate rather than FIFOs such as myself. Multiple casualties are not unknown, such as a group of Chinese golfers driving on the wrong side of the road. The Flying Doctor is the only backup. Golf is the dream. I’m not a golfer, but I find it hard to understand how anybody can accurately hit a ball through the Roaring Forties. There is cheese; lots of it, and a grateful patient even gave me some. In the confines of the tiny Saab commuter aeroplane, my travelling companion complained my souvenir cheese bag had the aroma of an axilla. If you ever visit King Island, you have to fly because there is no passenger ferry. The locals won’t let you forget to take home the cheese. King Island cheese is the best and very cheap to buy on the island. Even the French love it, because it’s a Chernobyl-free product. ** From Longitude by Dava Sobel – ‘the story of a lone genius who solved the greatest scientific problem of his time.’

Helping families in difficulty The Mid-North Coast Family Referral Service (FRS) is a free service providing assistance for families experiencing difficulties, with the aim of preventing a crisis and the family needing FaCS intervention. The service commenced in August last year and covers 7 LGAs from Coffs Harbour to the Great Lakes. The service system can be quite difficult to navigate and the FRS can help families in accessing appropriate services to address their needs. This can be anything from knowing what childcare is available, to what to do if their child has a diagnosis, to more complex matters such as domestic violence and mental health. Being a parent is not easy and there are times in all our lives where we could use some assistance and the FRS is here for such times. The Family Referral Service is funded by NSW Health as part

FRS staff Mykol Paulson and Susan Livermore

of the Keep Them Safe reforms and is operated in partnership between The Benevolent Society and Burrun Dalai. The Benevolent Society is Australia’s oldest charity and Burrun Dalai is a government funded, not for profit, Aboriginal community controlled organisation providing out of home care and family support services.

How does it work? Families can be referred by anyone including themselves. The FRS not only directly assists families, it also helps organisations find the right information for their clients. Hours of operation are Monday to Friday from 8am to 6pm except public holidays. People

Physio aides win award for ‘inspiring care’ Congratulations to two hard-working physiotherapy aides at Caroona Kalina aged care facility at Goonellabah. Sue McKay and Dite Pinter have won a NSW Uniting Care Aging Inspired Care Award, against five other contenders, for their fabulous programs and care. Accepting the award, Sue McKay paid tribute to the support provided by the rest of the staff to the physio team. “Our manager Susan Clark lets us run with ideas and we appreciate her support. Our ideas don’t all work, but the spa program was one of these ideas and it’s been of real benefit to residents,” said Sue. The Spa Room is a beautifully appointed, dimly lit space with a large spa bath and a beautiful mural overhead. Residents can relax in the spa and enjoy aromatherapy and a choice of soothing sounds including ‘waves breaking on

can call on 1300-006-480, email on familyreferral@benevolent. org.au, or drop into our offices located in Kempsey and Taree. The Family Referral Service also provides outreach to families that are unable to attend one of our offices and require a face-toface interview. Patients often divulge information to GPs and Practice Nurses that may impact but are not directly related to their Health such as parenting issues, domestic violence, and financial stress among other things. The FRS can assist with providing information to GPs and Practice Nurses about appropriate agencies that may be able to assist or if the GP or Practice Nurse has consent, the FRS is able to then contact the family directly. If you would like more information, we are able to come out and see you and explain our service in more detail or to send you our brochures, magnets, and posters. Contact: 3/37 Forth Street, Kempsey and Suite 10, 219 Victoria Street, Taree. Phone: 1300-006-480.

Briefs

Telehealth delivers on cost

Physiotherapy aides Sue McKay (left) and Dite Pinter pictured in Kalina’s Therapy Room. The colourful mural at the end of the walking bars helps give residents an alluring destination to walk towards.

the beach’ and ‘tropical storm’. Sue said having time in the spa room gave residents a welcome break from their regular routine and allowed them to ‘drift away’. At the award ceremony, Uniting Care Aging’s Resi-

dential Operations Manager for North Coast NSW, Valmae Dunlea thanked Dite and Sue, saying the award was well-deserved and that the programs Sue and Dite had developed had proven benefits for Kalina residents.

Telehealth is finally delivering on one of its greatest promises: huge cost savings for the healthcare system, according to Australian research. After a big initial outlay, Townsville Cancer Centre has saved more than $320,000 by using video consults for some of the state’s most remote cancer patients, a study has found. The study, published in the Medical Journal of Australia, is the first detailed cost analysis of Townsville’s tele-oncology project, which has been running since 2007.

HealthSpeak

summer 2014

Books with Robin Robin Osborne

Cheryl felt she had ‘walked up to the door of death’ with her husband.

HealthSpeak

summer 2014

The End Bianca Nogrady Vintage – $34.95 There continues to be a plethora of books and articles on better living, one recent one of worth being 50 Foods that will change your life – A Woman’s guide to health and vitality (Emma Sutherland & Michelle Thrift, Viking $35.00). Less common is published advice about better dying, a sombre subject perhaps, but one of relevance to us all, both individually and as members of families and communities. Science writer Bianca Nogrady has done exhaustive research, scoping the medical literature, eliciting the views of a range of clinicians, ethicists (notably, the well-known Professor Tonti-Filippini), relatives of the deceased, and people who appear to have come back from near-death experiences. Also, no mention of the nowlate Kerry Packer’s brusque summation of visiting ‘the other side’: after being revived by fibrillation he reported, “Believe me son, there’s nothing bloody there.” The author delivers a valuable ‘profile’ of dying and death from both the personal, including religious and clinical perspectives, clearly written yet technically precise, and brimming with compassion. Yet no punches are pulled, as for example the view of palliative care physician Dr Christopher Gault who says “A good death is a bit of a myth of western medicine. Dying just isn’t fun, no matter what you do… After twenty years, I have not the

vaguest concept of what a good death is…there doesn’t seem to be a way that you can make death pleasant.” A colleague, Dr Bernard Spender, likens the death experience to “an overwhelming sense of malaise”, comparing death to a combination of malaria, bad hangovers and bad doses of influenza, all three of which he has experienced. Two North Coast sources figure prominently in this endof-life exploration, Byron Baybased Zenith Virago, termed a ‘death walker’, and Prof. Colleen Cartwright, director of the aged services unit at Southern Cross University. Although living in the Blue Mountains, not locally, the author gives considerable space to both, quoting Virago as regarding death as “a bit like giving birth – a rush of endorphins that can sometimes enable you to actually embrace the pain and transform it into something else.” Virago challenges the common belief that nobody should die alone: “I would totally ask people to really think about that because I will be very happy to die alone because I will be concentrating on what’s happening on the inside,” she says. While Virago, a death walker or shaman, is portrayed as “more of a spiritual companion,” Texas-based Deanna Cochran, an RN with hospice experience, is a “death doula”, an end-of-life counterpart to the doulas who provide antenatal and labour support. “Because she is hired by the families themselves and operates outside the medical system, Deanna is able to do thing that would be well out of the scope of a hospice and its staff.” Prof. Cartwright, a wellknown researcher and policy adviser in the field of end-of-life issues, believes “one of the reasons why end-of-life care is not done as well as it ought to be is the confusion about what is and isn’t euthanasia.” This leads to inadequate pain management, and the inappropriate use of invasive technology that does no more than prolong

dying. In her view, the intention is the key factor – was the aim to relieve pain, or to end a life? Prof. Cartwright takes issue with those who say switching off life support is ‘passive euthanasia’, arguing, “Passive euthanasia is not the right term, because if the machine is doing no more that prolonging the person’s dying, then switching it off is no form of euthanasia – it’s simply good medical practice.” At this point, the philosophy and role of the Swiss organisation DIGNITAS is also discussed at some length. The book progresses to such matters after a journey through the many highway and byways of the death experience, with chapters headed, ‘Why We Die’, ‘Defining Death’ – a challenging examination of just when should someone be pronounced ‘dead’ ‘Experiencing Death’, ‘A Place to Die’, ‘A Time to Die’, ‘From the Outside’, and ‘Death and Belief. Not surprisingly, the experiences of surviving family members produce the most touching stories. Cheryl, the wife of a long-time immigrant to the USA, reports telling her dying husband that she closed her eyes and saw a group of disparate people in varied historical clothing, one holding a sign saying, “Welcome back, Stephen Eckl”. When she told her husband, he said it was like the Ellis Island immigration centre, to which she added: “Yeah, except here they know how to spell your name for once.” Soon afterwards, Stephen settled down, went into a coma and passed away. Cheryl felt she had “walked up to the door of death” with her husband. This book confirms that death is a mansion of many doors, with many pathways leading to them. By increasing our understanding it helps demystify and glorify the process. HealthSpeak contributor Robin Osborne is a media and communications adviser, formerly with NT Health and NSW North Coast Health. He is the editor of GPSpeak online (www. nrgpn.org.au)

Water Births now available at Murwillumbah District Hospital The Murwillumbah District Hospital, through the Tweed Valley Birthing Service, has been providing pregnancy, birth and postnatal care to women in the Tweed region for four years. This year the service was accredited to incorporate water birthing. In early August Lauren Solca became the first woman to have a water birth in the hospital’s Women’s Care Ward. “Lauren and partner Dave Warne are the proud parents of baby Grace, their second child. Grace’s birth will not only be memorable for her parents but also for the midwives,” said Cheryl Colley, Midwifery Unit Manager. The Midwifery-led Model of Care offers women with a normal pregnancy an alternative to traditional maternity care. Using this model, women are able to have continuity of care with the same midwife throughout their pregnancy, birth and early post

natal experience. “Building a relationship with a midwife has proven successful for women in the region. In addition, research indicates that women receiving care from a known midwife experience lower rates of unnecessary intervention, excellent outcomes

NCGPT wins two national awards At the GP Education and Training Awards (GPET) presented in September in Perth, North Coast GP Training registrar Dr David Chessor was named GP Registrar of the Year. He was recognised for his commitment to promoting the GP profession, Aboriginal Health, the AGPT Program and rural general practice. (see interview with David on page 16) Ms Liz Degotardi, Aboriginal Health Training Strategy Project Manager at North Coast GP Training, was also recognised with an award for Staff Excellence. She works to support NCGPT’s commitment to help close the gap on Indigenous disadvantage.

Liz Degotardi with her award

and higher rates of satisfaction,” said Cheryl. To find out more about the Tweed Valley Birthing Service, call the midwives on (02) 6672 0108.

Cricket commentator Henry Blofeld to speak on North Coast Veteran English cricket commentator Henry Blofeld, or ‘Blowers’ as he’s affectionately known, will be speaking in Lismore on January 8 as a fundraiser for the Lords Taverners charity. Lords Taverners, whose tagline is ‘Giving the young and disadvantaged a sporting chance’ supports local youngsters with ability to achieve their sporting dreams, financing them to attend special sports camps and compete in events they otherwise couldn’t afford. It’s sure to be a cricket diehard’s dream and even those not so enamoured of the game will find Henry an engaging speaker. The event is at the Lismore Workers Club from 6pm on January 8 from 6pm.Tickets are $25 for adults and $50 for a family. To book, email: events@ lordstaverners-northernsw.com.au

NCML delivers on promise for Yamba As pledged at a community mental health forum earlier this year, North Coast Medicare Local has established a free, government-funded ATAPS psychological service in Yamba to meet the needs of the community. Psychologist Elizabeth Hagl is employed as an outreach worker through Tarmons House Mental Health Service in Lismore. Residents of Yamba, Iluka and Maclean now have access to mental health services such as Suicide Prevention and Child Mental Health Services, along with adult and adolescent mental health services. Elizabeth is based at Treelands Drive Community Centre, in Treelands Drive at Yamba and works two days per week. For a GP to refer a patient, a Mental Health Treatment plan is required, along with a referral letter. Please fax referrals to Tarmons House on 6621 7082. For more information on the service or the referral process, please call 6621 7319.

Bookmark HealthSpeak and read it online HealthSpeak is now online and proving popular with a growing number of readers. Bookmark it now at: www.issuu.com/ healthspeak

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Wine and good health The festive season calls for bubbles… Why is it we have a fascination with Champagne, dear reader? We bring it out to wet our babies’ heads, to celebrate our successes and mollify our failures. We reserve it for the important moments, as if it itself is important. Yes, the bottles, constructed to safely contain liquid under pressure, are themselves impressive, but it is the wine which is magical. Like the clever Dom those centuries ago, we feel we are ‘drinking stars’ as the bubbles dance in our mouths, but even when fizzless the base wine is delicious. Chardonnay, pinot noir and pinot muenier are the three main grapes allowed to be grown in the Champagne district. The latter two red grapes produce the depth of flavour, while the Chardonnay brings lively acid and brioche creaminess. Add early picking and specially selected yeast to do the work and you have a unique creation, with the methode champenoise adding the icing to an already lovely cake. (I like the tongue in cheek from Jansz in describing the process as methode tasmanoise). Other parts of France, such as the Loire Valley and Burgundy, use the methode champagnoise like Champagne, but can source other (lesser) grapes and so call their wines a cremant. These are delicious wines, and only a fraction of the price of their Champagne cousins. Other forms of fermentation, such as that used to create Asti Spumante and the like, cannot achieve the same degree of control of the final taste spectrum, with fermentation in the bottle the key. The colours of champagne also intrigue me, as the combination of red and white grapes should produce a pink drink, non? Actually the grape juice from the crush is allowed to run free, with minimal contact with the skins, so it stays clear. Sometimes a blush of colour is allowed by letting the skins stay HealthSpeak

summer 2014

Chris Ingall

in the mix for a short while, and the Rose style is actually created by blending back in a little red wine. As with any good idea, the next thing to do is export it, and the Champagnoise have managed to do this at the same time as they battled on in the courts to protect their name. What to do when you only have so much land? Why, share-farm with intelligent people you can trust…like us Aussies. Moët invested in the Yarra Valley in 1986 producing the lovely Chandon brand. Deutz has gone across the ditch and Jansz is now an entirely Australian family owned company, after Louis Roederer set up its operation in Tassie, also in 1986. I must admit I find it hard to fault the Frogs when it comes to making wine, and each of their expeditions into the New World has impressed me. So what can we expect from fizzy grog in the future? In the short term, good champagne under $40 will include Moët, Mumm and the present group, while even better houses such as Veuve and Bollinger will be less than $50 for Christmas this year. Snap it up, as we won’t see these prices again once the US stops printing money. In the medium term, the trend to screw caps in still wine will extend to fizz, with the traditional wire muselet (from the French ‘to muzzle’) replaced by a crown seal. Not quite as much ceremony, but there will be e few folk who keep an eyeTip as a Cellar result. And in the long term, the pinot noir and chardonnay vines planted in Tasmania and Victoria will send their roots down further into the subsoil, making for more interesting Aussie fizz. It will only get better! And a merry Christmas to you all, dear readers, with a wish for the 2014 vintage to be the best yet.

Wine Tip

Cellar Tip

What are the best fizz cocktails? A bucks fizz (or Mimosa) is popular, but not my style unless you are using up cheap plonk on the rellos, while a Barbotage, adding Cognac and Grand Marnier, sounds more interesting. And of course a good champagne punch is hard to beat, but remember the size of the hangover is inversely proportional to the quality of the ingredients.

Good fizz is picked early, and will last quite a while in your cellar. As with other wine, the more you pay, generally the better the cellaring potential. Drink up the non-vintage French and Aussie under $40 while it is still fresh, as an aperitif, while more sophisticated vintage plonk can be cellared for many years, the time on lees adding a lovely dimension which improves the wine over time. Particularly good recently is the 2002 vintage, with Lanson presently going for a song from Dan Murphy’s for $50

Mindfulness-Based Stress Reduction program coming to Lismore & Casino

Christmas Island feature From page 19 One little shrine room close to a larger temple was very tidy with a particularly nice garden, and this became one refuge for this embattled psychologist. “Inside there were mostly statues of female deities and I’d bow, pay my respects and slip into the Tara mantra. I would feel a palpable energy of compassion – it would feel like angels were in the room just giving me compassion. It felt like they were giving me compassion and that I’d be taking that back into the detention centres.”

Coming home From left: Social worker Jenny Cobden with ACE Manager Anne Stapleton

Lismore’s ACE Community College will provide a world-renowned health program, Mindfulness-Based Stress Reduction (MBSR) next year. Anne Stapleton, Manager of ACE Community Colleges said ACE was proud to present a course with such wide-ranging benefits. “As a Community College we are committed to providing educational programs that are of value to the people on the North Coast and we are delighted to host this course”. The MBSR program will be taught by Jenny Cobden, a social worker with years of experience working in Community Health – providing counselling support and group programs to people adversely affected by their health. MBSR was founded by Dr Jon Kabat-Zinn in 1979. It’s an eight-week program where participants are trained in mindfulness meditation skills and how to apply these skills to the

challenges of everyday life – whether dealing with an illness or not. Anyone can learn mindfulness skills and they can be practiced for a lifetime. More information about MBSR can be found at: www.umassmed.edu/cfm The course has benefited people in various ways – reducing stress, helping to deal with chronic medical conditions and pain, helping to deal with anxiety, fatigue and mild to moderate depression and teaching people how to improve their wellbeing. This course is not suitable for those severe depression, people feeling suicidal or those with alcohol or substance abuse issues. Research confirms that most people who complete the MBSR course report benefits to their well-being and self-esteem, gaining the ability to relax with reduction in physical and psychological symptoms and pain levels. The 2014 dates for the MBSR program at Lismore and Casino can be found at www.acecolleges.edu.au

At the end of his contract Mal came back to the Northern Rivers and developed a nasty lung infection, losing his voice. He also went on a retreat and during the retreat realised he couldn’t bring Christmas Island to mind. “I realised I was experiencing sadness throughout my body. It was the enormity of grief I’d seen over 16 months and the only way I could process it was in my body.” On the other side of the coin, the positives of life on the island were developing

relationships with co-workers and clients. “For the most part the clients were simply lovely. I felt honoured to be able to develop warm and friendly relationships with these people from so many different cultures. It was also wonderful to meet and become friends with the residents of Christmas Island as well as workers within IMHS and other services, including interpreters, DIAC, Serco and others on short and long term contracts. He is also grateful that he was able to learn to work with intense trauma using mindfulness and compassion focussed approaches, as well as other strategies. “In groups, I’d ask people what they wanted and they’d say ‘We want to forget the past’. “And I’d say ‘Okay, we can’t really forget, but you can learn to change the way the past affects you,” he said. While Mal found his time on Christmas Island ‘fascinating’, he has no inclination to go back. “I think I’d had it by about one year in. I found the uncertainty hard to deal with, everything shifting all the time. But it certainly was a powerful experience.”

I realised I was experiencing sadness throughout my body, it was the intense grief I’d seen

HealthSpeak

summer 2014

PATHOLOGICAL WASTE DISPOSAL

more services · quality facilities

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

Continence and Pelvic Floor Physiotherapy For women, men and children Bladder, bowel, prolapse, pelvic & sexual pain, pre/post natal, pre/post surgery Janelle Angel APA titled Continence and Womens’ health physiotherapist 3/10 Station St Bangalow 02 6687 2337 28 Brisbane St Murwillumbah 02 6672 3818 www.pelvicfloormatters.com.au

Picturesque Ballina Female GP Wanted Ft/PT for a busy accredited practice Excellent Remuneration No weekends, but shared on call Dedicated staff and two practice nurses Please call Shannon on 6681 1333 We are not DWS or area of need

•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

Murwillumbah B & B Windermere Bed And Breakfast is ideally situated right in Murwillumbah. Walk to restaurants, a short drive to famous Tweed River Art Gallery, Mt Warning and Tweed Coast beaches. Well appointed, air conditioned rooms and only 150 metres to Murwillumbah Hospital. Contact owner on special rates for longer stays. Phone Doug or Pat on 6672 2031.

CONSULTING ROOMS Modern, clean, quiet, attractive, well presented, professional, light, bright, modern/fully furnished, air conditioned consulting rooms available for full or half days for medical practitioners or allied health professionals. Close to Lismore Base Hospital. Car parking. 44 Hunter Street, Lismore NSW 2478 Contact: Dr Sabrina Pit E: Sabrina@workwiser.com.au P: 02 66 216 397

Lismore & Ballina Free Call 1800 662 125

General Practitioner Full/Part Time Tweed Health for Everyone is currently looking for General Practitioners to join our young vibrant team of 7 GPs. Our practice can offer you: • Patient centred care • State of the art facilities within a purpose built building • Flexibility and work-life balance • In house pathology collection, pharmacy, optometrist, dentist, physiotherapist, dietician, psychologist, diabetes educator, speech pathologist and podiatrist • Full time registered nurse assistance with 8 RNs • In house CPD training & much more.

A/Prof Geoffrey Boyce Neurologist Practising neurology and neurophysiology in Lismore. Dr Boyce has a full-time neurophysiology technician available to do electroencephalograms with little waiting time. Also nerve conduction studies and electromyography. The practice is Medical Objects friendly and welcomes referrals this way. Phone the practice on 6621 8245 or email: nrneurol.com.au For more information and links to other sub-specialty groups, view the website at: www.nrneurol.com.au

We are committed to the provision of high quality, integrated health care that meets the changing needs of our community. This is not a DWS position Please forward all enquiries to the Practice Manager Rick McKee E Rick.mckee@thesc.com.au T 0438 752 884

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

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summer 2014

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